I started this blog out of frustration. Health insurance was an expense I saw out of my paycheck every two weeks without any real value. The issue with health insurance is that it becomes more and more expensive each year, but people are not becoming healthier. The return on investment is simply not there for individuals and businesses.
Think about it: if you buy the world’s most expensive, comprehensive health insurance plan, does it make you or your employees healthier? When the price goes up 10% each year, do you or your employees become 10% healthier? The answer is no.
All of this came to a head for me after the delivery of our first child. I thought I knew everything about health insurance and would be well prepared. In fact, I had a Masters degree in health policy and management from Johns Hopkins University (and so did my wife). I worked in corporate finance for the hospital where we delivered our child. I had my health insurance broker’s license, in which I had to learn everything about health insurance to qualify. On paper, I could not have been better prepared for the health expenses that came with having a baby.
Then came the bills. They just kept coming and coming and we didn’t even know what they were for. Each time we thought we had finally paid for everything related to my wife’s pregnancy, we would receive another bill. The number of places that we received bills from was astounding: imaging bills, third-party labs, the hospital, the OB/GYN, the anesthesiologist, the primary care doctor and more. We tried to get help from my wife’s company and their HR team but were constantly pointed back to the health insurance company. The HR department didn’t have a clue and if they did, they didn’t have the time to help us figure it out.
We kept trying to call my wife’s health insurance plan to get clarity around things. How close were we to reaching our deductible? Do our copays count toward our deductible? Can we see how close we are to reaching our out-of-pocket max? What happens to my wife’s plan when we have a baby? Does the deductible start over? What happens to the payments we made if the deductible changes?
We couldn’t get any answers. We ended up just taking it on the chin and paying a lot of money to something we didn’t understand. We didn’t have another choice. How do you plan for something when you don’t know how much it costs?
Needless to say, we both became super frustrated. In my current role, I interface with a lot of seniors who have questions about Medicare and Medicare Advantage. The same questions I had when we delivered our child are the ones they face with Medicare Advantage. Not many seniors understand Medicare and even less truly understand Medicare Advantage. Most seniors I have interacted with that have Medicare Advantage don’t understand the benefits, why they picked their plan, and how they can save money on their health expenses.
Like I did, they take it on the chin and pay up when health expenses come their way. As more and more people become eligible for Medicare Advantage, I want them to feel empowered to pick a plan that makes sense to them. After all, Medicare Advantage is one of the most free-market health plans you can have. Meaning your employer isn’t giving you two options, but truly the marketplace is your oyster.
The same goes for individuals trying to pick between a PPO or HMO or POS or HDHP at work. I want them to be able to pick the plan that makes the most sense to them and their families. They aren’t able to do that if they don’t have guidance or clarity. I think people either pick the cheapest plan because of the price or the one with the most coverage because they are scared of the risk. This false dichotomy means that some people are underinsured and others are paying way too much for something they don’t use. Neither of those situations have to happen.
I also want small to midsize employers to know they have options. Group health plans aren’t always the best and rarely are ever the most affordable health coverage for your employees. There are new offerings that can allow you to control your budget and offer great coverage to your employees.
It is a weird passion, but I love bringing clarity to health insurance. It is a near-universal cost to everyone in our country, but so few understand it enough to take control. My hope is that I can provide some clarity to those who want to figure this out.