Ten years ago we all had to learn the term “Managed Care” as it took hold of the horizon of health insurance. The new phrase you are going to hear more and more of in the coming months is “cost sharing”.
What exactly is meant by cost sharing? It means the insured is going to share in more of the cost of medical care along with the employer (paying premiums) and the insurance company (paying claims). How this is accomplished may vary from employer to employer. Some of you may choose plans with higher deductibles in an effort to offset rising costs of premiums. Higher deductibles mean you will pay more out of your pocket before the insurance kicks in. Other ways you may see cost sharing come into play are higher co-pays at the doctor’s office, your employer requiring you to pay a percentage of the premium where they used to pay 100% of your coverage, or separate deductible for prescriptions .
Keep in mind , The Constitution of the United States of America offers you the rights of life, liberty, and the pursuit of happiness. It makes no mention of a fully funded PPO Plan for you and the kids. If you recognize that health insurance and medical care come at a cost – and a high one these days, and recognize that you are responsible for that cost in some fashion, you will have a much easier time facing the changes you will undoubtedly experience in the near future. The days of 100% coverage are gone. Policies that pay from the first dollar of expenses are also gone.
The good news is that the shift is turning away from strict managed care plans. At a recent meeting with Eight of the top insurance companies in NJ presenting a panel discussion, the comments were about reducing the gatekeeper scenarios and doing away with referral systems, and heading back to fee for services.
Irene Card & Betsy Chandler share the responsibilities of running Medical Insurance
Claims, Inc. a health insurance services company. If you have questions relative to this
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