Individual health insurance for 2021 is about the same as 2020 except for rate increases and plan design changes.
The biggest change is that most Americans cannot afford a $400 medical expense much less the high deductible plans we all seem to buy. How did we get to this is uncertain but the annual increases in cost since the affordable care act are causing major financial issues for most Americans? Costs have increased annually since the beginning of the affordable care act that most people now refer to it as the unaffordable care act.
Remember, go to any doctor, any hospital and your out-of-pocket costs will be less than they are today. Boy, did that expression backfire on former President Obama and Congress. Yet, no one is stepping up to change things so Americans can afford health care.
The real problem is that all plans must include what is called essential benefits and all plans must include maternity, prenatal and children’s benefits even if you have no more children or even have children.
The way to fix this is to allow insurance companies to design plans based on demographics. People without children or those not planning on having children certainly do not need those benefits. It simply adds to the cost while providing no benefit. Single people without children and not planning on having any do not need maternity benefits. Those who are gay certainly do not need those benefits, but they are required to be included in the health insurance plans.
We should be able to pick the plan that meets our needs and not have to pay for things we do not need. Those over say 55 certainly do not need maternity benefits yet they must have them in the health insurance plans. Many only want catastrophic coverage and while those plans exist, some still are too costly to buy. The average cost for individual health insurance in 2020 was $456 per month and family coverage cost $1152 per month. Naturally, the family coverage was only considering a family of 4. That continues to increase each year with no end in sight. Congress needs to address this immediately.
The real issue is Congress is not on the affordable health insurance as they have their own coverage that has more benefits and costs less than the affordable care act. The same could be said for social security and Medicare. Those costs keep rising and Congress is not doing anything to fix it. They are not on those plans, so they really do not care about the costs. If they were on the same plans as the rest of America is on the problems would be fixed immediately because it affects them. Since they have their own plans, they do not care what we are on. There is not enough outrage by the American public to force Congress to fix it. If there were, this would be a non-issue as it would have already been addressed.
Those Americans on Medicare have their own issues. All Medicare recipients must purchase a drug plan even if they do not take any medications. They are fined for life if they do not have a creditable drug plan. Most MAPD plans include drug coverage and those on Medicare Supplements must purchase a standalone drug plan as the plans do not include it. The other issue with drug plans is you can only change your plan from 11/15 until 12/7 annually. The issue is many plans change formularies annually and sometimes your drug which was on the plan last year may not be on your current plan. This simply means you must buy that drug outside the plan and wait until the next annual election period to change your plan. These timeframes were enacted to supposedly save the government and the insurance companies time but condensing everything into a short 48-day period. This is not helpful for most Americans. Many of my clients call me after the AEP to complain about this issue. The only solution is to pay cash for your new medication if it is not on your formulary. What is suggest is to look to one of these sources such as goodrx.com, NevadaDrugCard.com, or singlecare.com. Costco and Walmart are also good alternatives. Then wait until the next AEP to change your drug plan.
One of the items that could change the playing field is to allow those on Medicare to change their drug plan during the Open Enrollment Period for MAPD plan which is January through March. That would give Medicare recipients another 3 months to change their drug plans. It would eliminate many problems seniors face with their medications.
Len Barend, broker
The Barend Agency Inc.