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Addressing medical debt during open enrollment – Daily Montanan [1]

['More From Author', 'November', 'Donna M. Christensen']

Date: 2022-11-29  

We are in the midst of a medical debt crisis in America, which is affecting the lives of more than 100 million Americans, including many Montanans. This crisis is worsening racial disparities in health and wealth and forcing Montanans to change the way they live due to financial constraints.

That’s why with Open Enrollment running through Jan. 15, 2023, Consumers for Quality Care is sharing information that Montanans can use to help keep their out-of-pocket health care costs low and avoid medical debt. The keys are to avoid tricky health insurance plans and policies, to ask good questions about charity care options, and to know your consumer rights if you ever get stuck with a surprise medical bill.

The health insurance choices made now can determine financial stability down the line. With selecting a plan, it’s important to watch out for Short-Term Limited Duration Insurance plans. These plans are exempt from many of the consumer protections found in the Affordable Care Act, and though they offer lower premiums, they include pre-existing condition exclusions, dollar caps on covered services, and a lack of preventative care coverage. STLDI plans often spend less than 10 cents on the dollar on your health care – and out-of-pocket expenses can pile up quickly under these plans.

But it’s not just junk plans that lead to high out-of-pocket costs and medical debt. An increase in plans with high deductibles, high copays, and high coinsurance means that insured Montanans seeking care are often left with large bills they are unable to pay.

Some plans also include copay accumulators that shift prescription medicine costs from the insurance companies to patients by blocking any financial assistance you receive – like a voucher or a coupon – from counting toward your deductible. It’s insurance company double-dipping, and it has left many mired in debt or unable to afford their lifesaving medication.

Although 14 states have banned copay accumulators, legislators in Montana have yet to act, highlighting the need for a national ban on this harmful practice that is leaving many patients in our state and across the country with medical bills they can’t afford to pay.

Insurance plans are only part of the problem. Consumers need to be vigilant when visiting nonprofit hospitals. While IRS rules require nonprofit hospitals to provide financial assistance to patients who qualify – in exchange for tax breaks – fewer than half of these hospitals informed qualifying patients and 45% of nonprofit hospitals regularly send bills to patients who qualify for charity care.

Always ask about your options if you are treated at a nonprofit hospital, and if you feel that charity care has been wrongly denied, file a complaint with the Montana Department of Health and Human Services.

Finally, it’s important to know your rights when it comes to surprise bills. Though the federal No Surprises Act took effect this year to help cut down on surprise billing, about 1-in-5 Americans have reported receiving a surprise medical bill since the law took effect. If you’ve received a surprise medical bill this year that you think violates the No Surprises Act, visit the Centers for Medicare and Medicaid Services website to learn more and file a complaint. Your community’s legal aid organizations may also be able to assist.

It’s no secret we need major reforms in our health care system to stop hospitals and insurance companies from viewing patients and their families as sources of profit and nothing more. Until then, CQC will work hard to make sure Montanans are in the know by sharing the information they need to make sound health decisions.

The Honorable Donna M. Christensen is a member of the Consumers for Quality Care board. She retired in 2015 from the U.S. House of Representatives, where she served nine terms. She is the first female physician to serve as a member in the history of the U.S. Congress.

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[1] Url: https://dailymontanan.com/2022/11/29/addressing-medical-debt-during-open-enrollment/

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