4 Reasons Why #CoverageMatters

Before the Affordable Care Act became law, millions of people throughout the United States worked hard, managed families and lived their lives without the benefit of health insurance. People with pre-existing conditions, like Crohn’s disease or high blood pressure, were charged substantially higher rates for coverage and some couldn’t find coverage at all. On top of that, entrepreneurs who wanted to live the American dream by branching out on their own had to wait until they were financially secure enough to start their own businesses. Health insurance typically offered through work prior to the ACA, kept millions of people under an employer’s thumb for years.

Health care coverage matters. Affordability and access to quality health insurance allow people to go for their dream jobs, take care of those they love and lead longer healthier lives. There are hundreds of reasons why coverage matters. Here are a few of them.

Negotiated Rates

Because insurance companies are a significant customer for healthcare providers, they have a long history of negotiating special discounted rates for services and products that customers need. Often, these rates are half or even a fraction of the full rate that the average person would be charged walking in off the street. While the full rate for a two-day hospital stay may be over $10,000, the insurance negotiated rate may be as low as $2,000, with the covered person’s out of pocket cost being only 10 to 20 percent of that. That means you’d be paying about $200 to $400 for a hospital stay that originally cost $10,000. When you’re weighing the real cost of coverage, consider how much you’d have to pay out of pocket if you needed serious medical care.

If you have a pre-existing condition, getting these negotiated rates on medications and routine exams to monitor the disease trajectory can be a lifesaver. For conditions like multiple sclerosis, the monthly medication cost may be over $2,000 a month. The insurance company negotiates that rate down with the pharmaceutical company, and your monthly copay could be as low as $50 for that same medication. Coverage matters because it brings down your out-of-pocket costs in worst-case scenarios.

Early Detection

Getting routine medical checkups can help identify major health concerns early. For instance, certain types of cancer can be managed, treated and even cured if they’re caught early enough. But cancer isn’t like other medical conditions, such as the flu or a stomach virus. People go for years without experiencing any symptoms. This is why annual wellness visits are critical. You could live for 30 years with prostate cancer under a managed care plan, or you might face a terminal diagnosis when you’re 65 because you waited to get some suspicious pains checked out. Prostate cancer, the most common form of cancer in men other than skin cancer, can strike men as young as 40. The sooner you establish a routine yearly checkup with your doctor, the better chance you have of treating any problems before they develop into something much worse.

Early detection is also critical in mitigating the effects of and preventing heart disease. High blood pressure, high glucose levels and high cholesterol levels are all contributing factors to heart disease, but these symptoms aren’t often felt or seen until you have bloodwork done. Getting an annual physical with lab work can alert your doctor to any significant changes in your body, which in turn might save your life.

Under Obamacare, insurance plans are required to cover preventive care at no co-pays, which means your monthly premium covers routine wellness checks and certain screening tests without any added out-of-pocket cost to you. Coverage matters because, without it, you might develop a chronic problem that could spiral out of control – and cost thousands of dollars in the long run.

Emergency Room Visits

In 2011, over 136 million Americans visited an emergency room, but only about 12 percent of those visits resulted in hospital admission. Many emergency room visits could have been avoided through primary care or even urgent care. With so many Americans using the emergency room for their primary care needs, the system is overloaded. What’s more, hospital care is the most expensive form of care on the healthcare continuum. Checking into a hospital’s emergency room can cost hundreds of dollars, if not thousands, especially if you don’t have health insurance. There are alternatives to an emergency room in a non-life-threatening situation, but most people opt for the ER when they don’t know where else to turn.

In an emergency room, the patient gets billed for a number of expensive items, including lab work, physician visits, tests and other procedures. Having insurance ensures that not only are you getting the negotiated rate for these services, which usually are about half of the full retail rate, but you also have almost all of these costs contained in a single copay amount that is a fraction of the true cost. You might pay $200 for a visit that would cost upwards of $1,000.

For younger people who may feel invincible, there are several serious conditions that may send you to the emergency room. One condition that strikes usually before the age of 30 is appendicitis. A ruptured appendix is life-threatening, but treating it when it happens usually has a positive outcome. Coverage matters because it can mitigate the fear of the high cost associated with a potential hospital visit, so you don’t ignore a condition so long that it costs your life.

Immunizations for Children

If you have children, insurance coverage more than pays for itself with all of the preventive and emergency healthcare your little ones will need. In the U.S., nearly every state requires that children receive a full range of preventive immunizations before being admitted into public schools. Vaccines are costly, but they save lives. If you don’t have insurance, then you could pay hundreds of dollars a year out of pocket to protect your kids. The CDC offers a complete breakdown of these costs. Without health insurance, it’ll cost you about $620 for the first year of vaccines per child.

While many non-profit organizations offer free or low-cost immunizations, these organizations may or may not file those immunizations with the state immunization tracking service. When you’re registering your child for upper elementary grade levels, securing the records for all of their immunizations back to birth can be daunting if you have pieced together different providers to obtain those records.

Because all new insurance plans under Obamacare include annual preventive visits that include immunizations, using the same pediatrician for all of your child’s preventive care can save a lot of time, effort, and money when it’s time to send your kiddo off to school. Having the same set of trained healthcare eyes on your child also can help identify early warning signs of other conditions, including diabetes or mental health conditions. Your child’s pediatrician also has a network of specialists that he knows, trusts and recommends if you need them. Coverage matters because setting the stage for a healthy life means having access to treatment when you need it most.