Massachusetts Healthcare Exchange for… Businesses??

by | Aug 10, 2012 | Uncategorized

So you may have heard that Massachusetts is ahead of the curve when it comes to healthcare. Implementing a system that offers individuals affordable health insurance with the click of a mouse on your computer is a fantastic initiative because it’s quick and easy.  Just a quick story regarding the health connector: When I first got out of college a few years ago—I was entering the worst job market in history.  So, at 21 I hit the streets looking for a job with my shiny new college degree—and came up empty for quite some time.  (In reality it only took three weeks to find my first job, but that felt like an eternity to a 21 year-old)  So, I was forced to purchase health insurance, and didn’t know a thing about it. I asked around and found that the Mass Health Connector was the easiest route to go down.  I purchased health insurance online in about 20 minutes, on a month-by-month basis with a premium of 422.60 a month…for a 21 year old who never goes to the doctor aside from the annual physical, I was shocked!  But, it was over—and I only needed it for a month anyway until my employer-sponsored plan kicked in.  As a person, this felt great—I was done in only 20 minutes, had health insurance and wasn’t going to be penalized tax-wise, and that’s all I cared about.  

Let’s re-cap the events that I had at the health connector:

 1. Went online.

 2. Plugged in my personal information on the computer. 

 3. Clicked my health insurance option. 

4. And that was that. 

Nowhere in that series of events was I advised of the benefits I had purchase, all I knew was that I had Fallon Community Health Plan.  I didn’t speak to an actual person, so I had no idea when my premium was due, and there was no communication from the health connector’s part.  (Aside from an email confirmation) While the healthcare exchange is a fantastic idea for individuals to obtain coverage, it’s no way for a business to make a decision that will cost them hundreds of thousands of dollars.  I’ve been a health insurance broker for awhile now—I’ve come to the realization that communication and attention to detail are among the most important factors in this industry. With my experience, as brief as it was…I received a health plan without a single spoken word from a human being!  Received no explanation as to how my health plan works and didn’t have any enrollment discussion with a representative over the phone.  So, I pulled out my old confirmation email and saw the health plan information: FCHP direct care 1000 (limited network).  

Let me offer an example as to why this could’ve cost me much more than the monthly premium that I had agreed to pay.  Had I gotten into a car accident, I clearly would’ve reached my thousand dollar deductible with a hospital stay and subsequent day-surgery.  In addition to that, I would’ve incurred a coinsurance expense.  This means I would’ve been on the hook for 20% of the expenses up to 10,000 dollars above my $1,000 deductible.  To summarize, my hospital stay cost $50,000 after I reached my deductible—I would’ve been on the hook for $10,000 in medical expenses.  Situations such as this are evidence as to why businesses should be wary when dealing with healthcare exchanges.  In this industry, the quick and easy route is almost never the best choice, and simple communication, product knowledge and attention to detail could save employers and employees thousands of dollars in the grand scheme of things.     

So, my tale is a cautionary one.  Healthcare exchanges are fantastic for individuals looking to obtain coverage due to a number of reasons, but where they fall short is communication and service.  I urge businesses to consider talking to a licensed health insurance broker before they try and look at the exchange.  Group health insurance rates are set by the state’s Division of Insurance, meaning you can go to five different brokers and get the same information than that of the exchange.  But, what matters most is execution, and communication of that plan to its subscribers.  Having a broker review all of your options, talk with you about what your employees want in a health plan, and guide you down the path of understanding can make all of the difference in the world—as opposed to clicking a few times with the mouse on your computer.  Before you do it the quick and easy way, reach out to someone who does this for a living and have a discussion.  You could save yourself and your employees a lot of money in co-pays and coinsurance, but more importantly with a health insurance broker—you’ll have the expertise and understanding that is necessary when making such a large decision for your business. 


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