Sunday, September 25, 2022

Health reform law could bring surprises

Open enrollment, starting in October for most companies, allows employees to make changes to their benefits for the coming year.  It’s often the only time during the year that employees can make changes to their health insurance plans, and the passage of the recently enacted healthcare reform means that Americans could be facing more changes to their existing health insurance plans.

“Now that the options for healthcare have been extended to encompass the majority of Americans, including millions with pre-existing conditions – and families of children with disabilities and chronic illnesses – those who are already covered can expect an increase in premiums or more cost-cutting measures,” said Dennis Borel Executive Director with the Coalition of Texans with Disabilities. 

Borel advises that the cost-containment could mean reductions in health benefits and coverage of prescription drugs currently keeping employees healthy. To ensure they can continue adhering to their prescription regimen and maintain coverage which most positively impacts their healthcare, employees should pose key questions to their benefits or insurance manager:

                1. Is my doctor going to be covered?

                2. Does this plan cover my medication?

                3. At what cost are my meds covered?

                4. What should I be asking my doctor about my medication and what to expect?

                5. What wellness programs are offered as an insurance benefit?

“Even people with individual plans need to very carefully review the options offered by their insurance company, especially if they take daily medications,” said Borel.

Health insurance companies have already been increasing efforts to contain costs and increase profits by raising premiums and mandating pharmaceutical switching. In some cases, insurance companies have also started to determine how much of a medication they think patients should be taking. If a doctor decides to prescribe more than the insurance companies believe to be appropriate, they may not provide coverage for that medication at that dosage.

Certain groups that rely on very specific daily medications for their well-being, such as patients living with MS, epilepsy or mental health issues, can suffer dire side effects if they are given a medication that’s different – or in a different quantity – than that originally prescribed for them. 

 “Asking the right questions can help you to save money on your plan,” says Borel.  “But more importantly, it can prevent unpleasant surprises regarding vital daily medications or the cost of future doctor visits.”

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