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When "Shopping" During Open Enrollment: A Doctor's Advice on Utilizing Care

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During an NCAPIP web presentation on open enrollment,
Dr. L. Eric Leung of the Chinese Community Health Plan offered the following tips to patients on how best to take advantage of their insurance:

  • Go Silver and Avoid Choosing the Lowest Tiered, Cheapest Plan Available
It’s attractive to go after the cheapest plan available, but copays, coinsurance, and deductibles are always higher at the Bronze tier, while Silver tier and above plans offer better services at lower costs.

“Bronze plans carry the lowest monthly premium cost, I would strongly advise consumers to choose at minimum a silver-tiered plan. This is because lower tiered plans have higher deductibles and higher co-pays: many plans on the bronze tier charge between $50-$80 per visit to a primary care provider, which is actually higher than your average HMO or PPO plan...and deductibles for these plans can be quite high; you would need to pay $2500 to $5000 before coverage actually kicks in. On the other hand, many silver plans offer several PCP visits at reasonable co-pays which incentivize patients to come in and get checked out before symptoms worsen.” For those subscribers who qualify for premium subsidy the out of pocket premium between Bronze and Silver may often be minor compared with the higher co-pays and deductibles.

  • Once Insured, Take Advantage of Free Preventive Services
The first step is to schedule an appointment with a doctor for a health assessment, aka routine check-up, and take advantage of free preventive services. This will allow you and your doctor to get to know your current health status; your doctor will also be able to work with you to take full advantage of the covered services available to you.

“We’ve seen a significant increase (14,000 in San Francisco and San Mateo Counties) in patients during the first open enrollment period, but as of September, only 40% of those new patients have actually scheduled a visit. Reasons for this include the simple fact that with anything new, there is a learning curve in navigating to access care. But patients can also be deterred by copays and high deductibles.

Fortunately, under the ACA, the government mandates that a variety of screening processes and other preventive care benefits are completely free of charge. However, a lower tier plan might offer only one free wellness visit, and then after that a patient would be responsible for full charge for additional visits until the deductible is met. These charges would become more expensive if the patient needed to be referred to a specialist like an ENT, orthopaedic surgeon, etc.

At CCHP, we sent letters to our newly insured patients who hadn’t yet come in, giving them a list of preventive services including laboratory and diagnostic tests that would come at no out-of-pocket cost to them, we also encourage them to complete the free laboratory and diagnostic tests and arrange for an appointment to see their primary care doctor for a free preventive care visit. It’s up to health plans to educate their subscribers on what is available to them now that they are insured through Covered California or elsewhere.”

  • Good Health is Smart and Economical for Young Invincibles
A large portion of the newly insured are younger, and ostensibly, healthier. However, Dr. Leung advises these “young invincibles” that accessing care early - particularly free preventives services - is key to preventing more serious conditions and illnesses from developing and costing them later in terms of health but also dollars.

“Younger patients are healthier, immersed in their career. We don’t see them much - They are more likely to wait out a cold or the flu. So this creates a potential problem in the future: one day they may discover a medical problem that is more serious than if they had done regular checkups.

While the government did mandate that all plans cover Essential Health Benefits, including many preventive services, different plans at different levels differ in terms of how detailed coverage is, and differ in cost as well. Again, it makes economic sense in the mid to long term to choose a plan that covers these costs more effectively in exchange for a slightly higher premium.”
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Open Enrollment Underway: Keys

“Thanks to the Affordable Care Act, nearly 6.6 million Americans have access to quality, affordable health coverage for 2015 through the Federally Facilitated Health Insurance Marketplace. As we turn to the New Year, our focus is on helping every individual who is interested in quality, affordable health insurance to understand their options and to get covered. For coverage starting on February 1, it is important for people to sign-up now ahead of the January 15 deadline.”
Secretary of State Burwell
Enroll by January 15th to have your new coverage begin on February 1st.

Learn about the Health Insurance Marketplace & your new coverage options.
If you are uninsured or want to shop for a different plan,make sure to enroll before the end of Open Enrollment: February 15th.
If you own or operate a small business, you can start offering coverage to your employees at any time.
Your patients can now call 1-800-318-2596 to speak with a trained customer service representative 24 hours a day, seven days a week. Representatives will be available in English and Spanish, and there will be a language line to assist callers in over 150 additional languages including Asian and Pacific languages.
Ho Luong Tran, M.D., M.P.H., President & CEO, NCAPIP

Health Insurance Marketplace: 10 Things to Tell Your Patients

Are you prepared for the new Health Insurance Marketplaces?
Open enrollment begins October 2013.
A health insurance marketplace is designed to help people shop for and enroll in health insurance coverage. Individuals, families and small businesses will be able to use the health insurance marketplace to help them compare commercial insurance options, calculate costs and select coverage online, in-person, over the phone or by mail. The health insurance marketplace will also help people to check their eligibility for health care programs like Medicaid and sign up for these programs if they are eligible. The health insurance marketplace will also be able to tell what type of financial assistance is available to applicants to help them afford health insurance purchased through the marketplace. Insurance coverage can be purchased through the health insurance marketplace beginning in October 2013 and will be effective January 1, 2014.

Under the Patient Protection and Affordable Care Act, a health insurance marketplace will be operating in every state starting in 2014. States have the option to either set up a health insurance marketplace themselves or to allow the federal government to set up a marketplace in their state.
who we are
NCAPIP is an organization created by Asian American and Pacific Islander physicians to advocate for the optimal health of our patients and communities.

Join our network and become a part of a growing and powerful voice of physician advocates.
Washington, DC
1322 18th Street NW, Suite 200
Washington, DC 20036
(703) 261-4220 | advocate@ncapip.org
San Francisco, CA
National Council of Asian Pacific Islander Physicians
445 Grant Avenue, 202
San Francisco, CA 94108

Telephone: (415) 399-6565
Email: advocate@ncapip.org