Consumer-oriented coverage can help people through that process. And since the rollout of the insurance exchanges, a couple of the leading local news outlets in Carol’s area—the Philadelphia Inquirer (going through a tumultuous period) and Philly.com—have offered some of that sort of coverage. On Oct. 21, Inquirer reporter Harold Brubaker delivered a strong story about a local man, Lee Koff, who’d been dumbfounded to receive a bill for more than $6,000 after a new defibrillator implant; in 2010, a similar procedure had left him with out-of-pocket costs of $81. The difference? A coinsurance provision applied when Koff’s plan was his changed by his insurer.
Koff is an 87-year-old with Medicare Advantage plan, so he’s not shopping on the new insurance exchanges. But his experience, as described by Brubaker, is relevant to consumers throughout the insurance marketplace (that’s an important point for reporters: the lessons about digging into the fine print are often the same, no matter what sort of plan you’re shopping for). From the article:
“The thing I looked for when I got the notification is, how much more is the premium. It went from $146 a month to $175.80,” Koff said.
Coinsurance is the piece that caused Koff’s $6,100 bill, but that change escaped him. “I think I’m pretty alert, but I didn’t read every word” of the plan description, he said.
Just this week, Philly.com republished a good piece by ProPublica’s Charles Ornstein about the coming “second rate shock”: many consumers’ discovery that what look like affordable premiums on the new exchanges will come with higher deductibles, copays, and coinsurance than they’re accustomed to. Larry Levitt of the Kaiser Family Foundation said this to Ornstein:
“I think it remains to be seen whether people see these plans as offering them good protection against catastrophic health expenses — which they do — or are disappointed that they won’t generally provide much coverage for occasional visits to the doctor or prescriptions.”
Philly.com also has a group health policy blog in partnership with Kaiser and an FAQ page where readers can ask questions of a local professor, both of which are worthwhile even if I found them a bit underwhelming. And last Sunday, the Inquirer profiled a local woman with serious medical needs who’s been working with a “certified marketplace enrollment specialist,” though the article was a little light on detail to serve as resources to other readers.
But a few good articles aren’t enough. There are lots of pieces to this story at the moment, especially with the president now scrambling to try to deal with anger over policy cancellations in introducing some new complications in the process. But there are millions of people shopping for policies in a confusing marketplace right now, and they need all the help they can get. National news outlets and niche blogs have a role to play, but major local news organizations have an important responsibility: with plan offerings and regulations differing state by state (or even county by county), they’re the outlets that can drill down and provide targeted guidance to local consumers.
By Tuesday Carol had had enough of this website shopping business. HealthCare.gov allowed her past the security questions, but it kept telling her the user name did not work. “I feel like I’m getting nowhere,” she told me. “I can’t get on the goddamn website no matter what I do. It’s ridiculous.”
On Thursday, she thought she had finally hit the jackpot. The website allowed her to create an account—and then it froze once more, and she could go no further. (She was able to reach the website’s livechat service, and was told there are still glitches and to try later. “I feel at least there has been some improvement though,” she said.)
Carol is now thinking of keeping her Aetna policy after all; it’s grandfathered, so she can keep it as long as she pays the higher premiums. The question still is, what’s the best option for her? Oh yes—whatever plan she chooses, Pennsylvania law says she has 10 days to change her mind and cancel the policy. None of the materials and no website information she examined told her that.
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