Disruptive Woman Stephanie Cohen recently spoke with DW’s Alex Masi to discuss an update on the state of health care reform (or ACA) and specifically, Young Adult’s participation in the insurance exchange marketplace. With more than two decades of experience in group and individual health insurance, disability programs and life insurance, Cohen is the co-founder of the Gaithersburg, MD, health care benefits firm Golden & Cohen. Her firm has grown into one of the largest among female-owned companies in the Washington metropolitan area.
DW: Do you have any anecdotes you can share about how you have helped Young Adults get insurance and the challenges they may have faced?
SC: We have helped Young Adults in a variety of ways since the opening of the exchange, and even prior. In most instances, we are assisting the parents of Young Adults looking for coverage for their families.
Most of the calls we have gotten from people over the age of 26 are people who had their insurance dropped, received a letter stating their insurance is ending or are looking to see if there is a better policy available the exchanges not fully understanding that the exchanges and what it can offer.
DW: Six months from now, what do think is going to be the biggest issue for the exchanges? Do you think there will be even greater challenges?
SC: I think the avalanche has not hit us yet. Until people begin using their new policies they will not understand the limitations of the plan they selected. When you actually use a plan you learn the details about what is covered, what is not and the out-of-pocket costs associated with the plan. Health care costs are not limited to the premium, the costs of the co-pays and deductibles can create significant unexpected costs. With insurance plans, especially out-of-pocket expenses. The devil is in the details. There is limited understanding of the limitations that exist in some of these new policies and each plan is very different than one another.
DW: What do you believe are the best and worst things about the exchanges?
SC: I think that it’s positive that there is guaranteed coverage for people with preexisting conditions across the country, it has to be noted though that there where many states that already covered these individuals offering guaranteed issue. I believe this is one of the few positives.
The rhetoric surrounding the exchanges has been the biggest negative. The idea that the plans offered would be less money and offer better benefits is not necessarily true. In addition, the new system it is not user friendly, difficult to navigate and is in a format that is not presentable for the consumer. The website is not the only issue, the Summary Benefit Comparisons (SBC) that were developed to explain each policy are very difficult to understand and do not fully explain the product you are purchasing. The new SBCs do not help people understand what their real out-of-pocket costs will be.
DW: Has the ACA gone far enough in providing coverage for consumers and consumers with chronic conditions, or is there more to do?
SC: For consumers with chronic conditions the ACA has created access to care. People with preexisting conditions are now able to call a broker or an insurance company and purchase insurance and the insurers cannot say “no” based on the individual’s health. The new issue may be the cost of coverage creating a barrier to care. This may be a bigger issue than we had before, frankly. I believe the better path would have been to expand Medicaid and offer coverage to individuals with preexisting conditions. For example, Maryland already offered coverage to individuals with preexisting conditions (and has been this way for 15 plus years) and the rates after the implementation of the ACA are higher than before.
DW: Anything else you would like to share?
SC: There are many misunderstandings about insurance brokers and what they do. The first questions we often receive are “How much are you going to charge me?”, “What’s in it for you?” and “Why would the insurance company do this?” There are no costs to the consumer for using an insurance broker. We work to help you make this importance decision with the right information. Brokers serve as advisors helping you understand the policy you may be purchasing. They can check to see if your current doctors are included in the plan’s network and if your prescriptions will be covered; helping you avoid unexpected out-of-pocket expenses. Also, if you have specific disease, you need to make sure that the plan you’ve selected covers your disease in a way that will be affordable. Without an advisor and advocate that understands the totality of the policy you will be at a disadvantage.
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