Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Risk Management News

Are Providers Updating Patients on ACA and Financial Risks?

- The Affordable Care Act (ACA) not only gives the opportunity for more individuals to find quality health insurance at the right price, it also requires patients to take more financial responsibility in their health. Deductibles and co-pays may have shifted drastically, which could be a huge surprise to many individuals.

If a recent study is any indication, the majority of Americans are severely uninformed about their healthcare responsibilities. When providers do not keep an open conversation with their patients, it is more likely for the impact and implications of the ACA to go unnoticed. This could cause financial issues to patients, providers and insurers farther down the road.

According to a study conducted on behalf of HealthMarkets, Inc., 59 percent of Americans do not believe the ACA has had an impact on their lives. Moreover, respondents who did think they had been impacted, 78 percent viewed the changes as negative and 55 percent claimed their health insurance is more expensive under the law. Just 20 percent of those who thought they had been impacted stated that they now have better coverage.

Another key factor in the study is the age groups of those who believe they were affected by the ACA. The only category where the majority of those surveyed said the law had impacted them were Americans between the ages of 45 and 54 (52 percent). Only 43 percent of 18 to 34-year-olds said they were impacted by the ACA, while 44 percent of respondents between the ages of 35 and 40 said the ACA affected them.

“The Affordable Care Act has changed the health insurance landscape tremendously and nearly everyone agrees that having more people insured is positive. However, current educational efforts have not produced the level of understanding required to ensure Americans are making informed decisions to protect both their physical and financial health,” Kenneth Fasola, President and Chief Executive Officer of HealthMarkets, Inc. said in a statement.

For example, just because individuals are covered by a qualified health plan with monthly premiums they can afford, does not mean that they have selected a plan they can afford to use, Fasola said. Additionally, Americans might not have selected a plan where they are adequately protected from financial hardship in the event of a serious medical problem. Because of that, it is “critical that the right resources are in place to create informed consumers.”

The survey found that the median affordable out of pocket costs for a family earning the current US median household income ($51,939) is $976 dollars. However, the same family of four could face out of pocket costs of up to $10,400 under a Silver plan.

It is also crucial for healthcare providers and insurance companies to be willing to work with patients as more organizations shift to upfront billing practices. Industry data shows that the overall number of citizens with high deductible plans – an annual deductible of $1,250 or more for individual coverage, $2,500 for a family – increased from 1 million in 2005 to 16.5 million in 2013.

Healthcare experts said that the move can minimize the after-service bill shock, and help patients get financial assistance or put into a more affordable program right at the start. Either way, it is important to get financial conversations started earlier so patients and providers can avoid confusion surrounding healthcare costs.

 

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