A new Reuters/Ipsos poll shows that nearly 60 percent of likely voters across the nation want the Affordable Care Act to remain in place.
Chad Bertanzetti is young, active and healthy at 44. But he bought health insurance three years ago in case he was injured while enjoying outdoor hobbies such as rock climbing, snowboarding and mountain biking.
So when a high-speed snowboarding accident shattered and dislocated the Colorado Springs man’s shoulder in 2016, he thought his hospital stay would be covered by his short-term plan.
But repeated payment claims for a shoulder-repair operation, doctors’ visits and a follow-up surgery were rejected by his health insurer.
Bertanzetti has filed a federal lawsuit challenging the refusal of HCC Life Insurance and HCC Medical Insurance to pay his claims. He has amassed tens of thousands of dollars in unpaid medical bills.
“I’m still able to pay all my (non-medical) bills and take care of my family,” Bertanzetti said. “But they just killed my credit.”
Bertanzetti and other consumers will have more choices when shopping for insurance when the six-week open enrollment period for health plans under the Affordable Care Act begins Thursday.
Millions of consumers buy coverage through the Obamacare marketplace. New rules created by the Trump administration allow more options, including less-expensive, bare-bones plans that lack the consumer protections found in Obamacare insurance.
More than 8 in 10 consumers who sign up for Affordable Care Act plans receive federal subsidies that offset the monthly costs of their insurance. But those who earn too much to qualify for the subsidies are left to pay the full monthly premiums. For many Americans, those plans are too costly.
In August, the Trump administration finalized a rule that allows insurers to sell short-term plans that last up to 364 days. The Obama administration limited those plans’ terms to 90 days.
The plans are usually less expensive, but they often don’t cover the minimum set of benefits such as prescription drugs, mental health or maternity care that Obamacare plans must cover. And unlike Obamacare plans, they can also exclude or limit coverage based on pre-existing medical conditions.
When unveiling the plans, Health and Human Services Secretary Alex Azar said they might appeal to temporary contractors and gig-economy workers who don’t get health insurance through a job.
Another factor that could steer more healthy consumers to these plans: The elimination of the individual mandate.
Under legislation approved by Congress and signed by President Donald Trump, consumers in 2019 who don’t get health insurance won’t have to pay a penalty.
Most Americans get coverage through an employer or a government insurer such as Medicare or Medicaid.
Some consumers who bought less-expensive, short-term plans paid penalties under the Affordable Care Act because these plans were not considered “qualified health plans.”
California, Massachusetts, New York and New Jersey have effectively banned these plans. Another 17 states have imposed stricter limits than the federal government.
Still, the Congressional Budget Office estimates 2 million people will buy them.
‘There’s a reason why they are cheaper’
Christina Marsh Dalton is an assistant professor of economics at Wake Forest University.
Dalton predicts some healthy consumers who buy their own coverage but don’t qualify for ACA subsidies may choose to buy short-term plans.
“They no longer have to choose between a fine and a plan they don’t need or feel they can’t afford,” Dalton said.
Dalton says it’s the consumer’s responsibility to know what they are buying.
“They are cheaper,” Dalton said, “And there’s a reason why they are cheaper.”
An April survey of 24 short-term plans by the nonpartisan Kaiser Family Foundation found that 71 percent didn’t cover prescription drugs and 62 percent didn’t cover substance-abuse treatment.
In an analysis released this week, Kaiser found that short-term plans charged an average of 54 percent less than Affordable Care Act plans by excluding coverage of preexisting conditions and limiting benefits.
Consumers often don’t realize what they’re buying.
The Commonwealth Fund analyzed brochures from five companies marketing short-term plans. These plans required customers to fill out a health questionnaire to screen applicants.
The plans may limit coverage, the fund reported, offering $250 for an ambulance trip that might cost thousands, or $1,000 for a one-day hospital stay that likely would cost far more.
Short-term plans are sold year-round. But experts predict consumers will be bombarded with ads during the six-week Obamacare enrollment period.
“Consumers are going to get a lot of ads for these plans,” said Sara Collins, the Commonwealth Fund’s vice president of health coverage and access. “People really need to read the fine print.”
“They might be cheaper than other plans. That price will reflect the lack of guaranteed protections.”
Companies that sell short-term plans say consumers should be aware of what they are buying.
Sean Malia is senior director of carrier relations for eHealth, an online marketplace that facilitates the sale of short-term plans and other types of insurance.
Malia says short-term plans were never intended as a replacement for Affordable Care Act plans. He says some consumers buy short-term plans so they aren’t uninsured.
“People who are buying these plans are people who have already determined they can’t afford an Affordable Care Act plan,” Malia said. “Therefore, these plans really serve as an alternative to going uninsured as opposed to an alternative to ACA.”
He says not all short-term policies are cheap, bare-bones plans. Some provide more robust coverage; they tend to cost more.
A $35,000 kidney stone
Bertanzetti, 44, said he chose his policy after contacting and chatting with a HCC Medical sales representative.
He says the sales representative asked him a series of questions, and then assured him he had chosen the company’s best policy.
Bertanzetti bought his first plan in late 2015. It was set to expire three days after his snowboarding accident in February 2016.
In his federal lawsuit filed in Denver, Bertanzetti’s attorneys said the insurance company told him that the first claim was denied because he was not eligible for coverage the date of his hospital stay even though his policy had not expired.
The insurer also said it did not receive information requested from the medical provider, according to the lawyers.
The insurer also denied coverage for a followup operation to remove plates and screws and clear up a severe infection in his shoulder, claiming it was a pre-existing condition, according to the lawyers.
HCC does not comment on pending litigation, said Doug Busker, the company’s vice president of financial planning and analysis and public relations.
In court papers, the insurer said it acted in good faith, and all claims that were denied or excluded reflected the terms of the plan.
HCC LIfe Insurance agreed this year to pay $5 million to settle with insurance commissioners in 42 states. The settlement followed a multi-state investigation of the company’s marketing and sale of short-term health insurance plans and claims handling.
The company admitted no wrongdoing. The company said it discontinued selling short-term medical insurance in the 42 states, according to the settlement agreement.
Busker said that the settlement did not identify deficiencies in the company’s sales, marketing or claims practices.
“HCC Life and MIS (Medical Insurance Services) agreed to the settlement in order to resolve disputed matters associated with this former line of business and agreed to pay $5 million to the settling states for the examination, administrative costs and compliance,” Busker wrote in an email.
Attorneys representing Bertanzetti advised consumers to request a policy and review details before signing up for a short-term plan. Attorney Jeffrey Hill said Bertanzetti’s policy listed 59 separate exclusions.
“What they have essentially done, they have built in a very broad set of reasons after the fact to justify not paying the medical bill,” Hill said. “That is what the average person does not understand.”
Some consumers remain optimistic that cheaper, short-term plans will work for them.
Chris Barber has bought short-term policies to cover his family in recent years. His current family plan, purchased through eHealth, costs $220 per month and covers himself, his wife and their three children.
Because the plan has a $2,500 deductible, the family negotiates directly with their pediatrician for routine visits for their kids. The short-term plan would provide protection in the event of a catastrophic event.
The Fort Worth, Texas, man said the arrangement worked well until August, when a kidney stone landed him in a hospital emergency room. A week later, he had surgery to remove the kidney stone.
Now he has $35,000 in medical bills and he’s uncertain whether his insurer, Lifeshield National Insurance, will pay for anything.
Lifeshield did not respond to an initial request for comment. A woman who answered a second phone call to Lifeshield told USA TODAY that the insurer would not comment on Barber’s case. She declined to identify herself or forward the inquiry to another person.
Barber says the insurer rejected his initial claim, and made him fill out a questionnaire about his medical history. The company also asked him to retrieve detailed medical records and doctors’ notes from his providers.
“They are taking a long time to pay out,” Barber said. “We are to the point where they may not honor what they said they would … We’re hoping they do the right thing.”
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