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It's health-plan enrollment time: Costs increase as benefits shrink
Stick out your tongue and say "AIYEE!"
This is going to hurt, no doubt about it. This year, your health-insurance premiums very likely are going to skyrocket. At the same time, the benefits you received last year will probably shrink. That doctor you've had for so long may well have abandoned your insurance ship. And the particular prescription drug you've counted on just may not be fully covered.
Get ready to see major changes in many health plans.
"We're faced with a double whammy right now — an economic downturn happening at the same time that we're seeing a substantial increase in medical costs," said Scott Forslund, spokesman for Premera Blue Cross, one of the state's largest health insurers.
For many employees, now in "open enrollment" periods in which they'll choose a health plan for next year, these changes mean they need to down a double latte and pay attention.
The same goes for laid-off employees, who may be taking their first look at individual plans.
"Don't assume that things are going to continue as they've been," cautions Beth Berendt, a deputy commissioner with the state's Office of the Insurance Commissioner. Here are some things to expect:
You'll pay more for premiums. Rates for large groups are increasing an average of more than 16 percent. These rate increases are based not only on the steeply rising costs of medical care, but on what the companies' medical costs were the previous year. So some groups may see increases as high as 50 percent. This year, many companies will pass a larger share of the increase to employees.
For small groups, which saw large increases last year, rate increases vary, with the average under 11 percent.
Your out-of-pocket costs will increase. Many plans will be incorporating measures designed to make health insurance more affordable for businesses, such as limiting which drugs are fully covered, said Berendt. As employers try to cut costs, Berendt said, they may also require employees to shoulder higher copayments or deductibles.
Doctors are saying "bye." And just to make the life of a patient even more challenging, an unprecedented number of doctors and other providers are just saying "no" to reimbursement rates they say put them in financial jeopardy. Without some legwork, you may not be aware that your doctor or clinic is about to call it quits with your insurer.
For example, Skagit Health Associates, representing 60 doctors in Skagit County, recently announced that it will no longer accept Group Health Cooperative's reimbursement rates.
A large group's defection can mean severe limitations on your doctor and hospital choices. Swedish Medical Center's hospitals and doctors have given notice that they will not renew contracts with Aetna; they'd provided 20 percent of Aetna's physicians and hospital beds.
(In both cases, the insurers say it's not a done deal.)
For the consumer, this rapidly changing health-insurance scene means more risk. And more reason to do your homework.
You'll probably have to make hard choices, and that means thinking about your coverage priorities: Is it crucial that medications your doctor prescribes are fully covered? Could you live with a large deductible? Do you insist on seeing the specialists of your choice? "The bottom line is, people need to ask questions," says Berendt. Don't wait until you've gone to the doctor to pick up that benefits booklet, she says.
"It's part of taking responsibility for your health."
Resources for comparing plans:
• First stop should be the state's Office of the Insurance Commissioner: 360-753-3613 or, in Washington only, 800-562-6900. Consumer-health advisers: 800-397-4422. Web site: www.insurance.wa.gov. You'll find consumer tips and phone numbers for insurers.
• Consumer Reports magazine's October issue rated HMOs throughout the country (including a few from the Northwest), based on survey data from 83,000 subscribers. Copies: www.consumerreports.org (go to the index and look for HMOs and PPOs) or call 800-766-9988 and request reprint No. 9876.
• The National Committee on Quality Assurance, a private, not-for-profit organization, assesses and reports on the quality of some managed-care plans. Web sites: hprc.ncqa.org or www.healthchoices.org.