Posted on in General

The state medical insurance exchanges in the US have been launched. This will bring affordable health care insurance to the many millions who were previously uninsured. It will also improve how insurance will work by eliminating pre-existing conditions in the insurance contracts.

The exchanges will offer 4 levels of plans: bronze, silver, gold and platinum. The low end plans will be relatively cheap but will still require out-of-pocket payments or co-payments by the insureds. These co-pays could add up to $6,000 per year.

Silver plans do not kick in until the patient has spent $2,000. Patients might pay up to 20% of hospital costs and some drugs. Cost sharing is capped at $6,350 per person and $12,700 per family. It is much less for low income insureds.

The medical insurance will vary by plan and by location. The low end silver plan for a 40 year old will be $300 per month in many places but up to $700 per month in New York.

Drug deductible in New York is zero but up to $250 in California. With specialty drug coverage, the percentage owed by the patient for specialty drugs is 20% in California and 50% in Vermont.

The medical insurance sold through the exchanges is not cheap but it will prevent many bankruptcies from excessive medical bills.

In Canada, healthcare is free. No medical bankruptcies because of the medical bills. However, there can be excessive costs to the individual and to the employer associated with the long wait for the healthcare services.

For example, if it takes 1 to 2 years for spinal surgery in Canada, then the employee is on a reduced income from the short term disability insurer. If the employee does not have short term disability insurance, then they will be on unemployment insurance payments.

If their wait for the surgery extends beyond say 26 weeks, then they  might or might not get a pay cheque from their long term disability insurer.  If they don’t have long term disability insurance, then they have NO income.

A medical bankruptcy is a possibility in Canada.  The problem exists not because of high medical bills but because of the costs attributable to the wait.

The implication is clear- Canada needs an affordable care act to protect patients and employers from the excessive costs of waiting in the queue.