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He Bought Health Insurance for Emergencies. Then He Fell Into a $33,601 Trap Created by the Trump Administration.

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Jenny Deam reports in ProPublica:

In the spring of 2019, Cory Dowd suddenly found himself without health insurance for the first time. A self-employed event planner, he had just finished a Peace Corps stint that provided health benefits, but he was still more than a year away from starting a graduate program that would provide coverage through his university.

So, like countless others in an online world, he went insurance shopping on the internet.

But the individual insurance market he was about to enter was one dramatically changed under President Donald Trump’s push to dismantle Obamacare, offering more choices at cheaper prices.

Dowd is well-educated and knew more than most about how traditional health insurance works. But even he did not understand the extent to which insurers could offer plans that looked like a great deal but were stuffed with fine print that allowed companies to deny payment for routine medical events.

Not bound by the strict coverage rules of the Affordable Care Act, the short-term plans that Dowd signed up for have been dubbed “junk insurance” by consumer advocates and health policy experts. The plans can deny coverage for people with preexisting conditions, exclude payments for common treatments and impose limits on how much is paid for care.

Dowd, like millions of other Americans who have flocked to such plans in the past three years, only saw what looked like a great deal: six-month coverage offered through an agency called Pivot Health, whose website touts the company as a “fast-growing team obsessed with helping you find the right insurance for your needs.”

Monthly premiums for the two short-term plans he bought were surprisingly cheap at around $100 a month each, with reasonable co-pays for routine doctor visits and treatments. Best of all, the first plan he bought promised to cover up to $1 million in claims, the second up to $750,000. That should more than do it, he thought. Dowd was 31 and healthy but wanted protection in case of a medical emergency. He signed up and began paying his premiums without closely reading the details.

Then he was hit with the very kind of emergency he had feared. And he wasn’t protected after all.

Short-term plans have been around for decades, and are meant to temporarily bridge coverage gaps. Under the Affordable Care Act they were limited to three months. But when the Trump administration allowed them to be extended to nearly a year, they became a fast-growing and lucrative slice of the insurance industry.

Because these plans are not legally bound by the strict rules of the ACA, not only do they come with hefty restrictions and coverage limitations, but insurers can search through patients’ past medical histories to find preexisting conditions.

All companies selling short-term plans have to do is acknowledge that they are not ACA-compliant and may not cover everything — a disclosure the insurers insist they do.

Still, the Biden administration faces a challenge on what to do about the proliferation of such plans.

Once in office, President Joe Biden quickly moved to make enrolling in comprehensive ACA coverage easier and make plans more affordable. On Thursday, the Department of Health and Human Services announced 940,000 people had signed up for ACA plans this spring after enrollment was reopened in February. In many states, enrollment will run through the summer.

Yet, while health policy experts say ACA expansion is important, it does not specifically address those who remain in plans outside the health care law and could be at risk for financial ruin.

“The Biden administration is going to have to find a way to put the genie back in the bottle,” said Stacey Pogue, a health policy analyst for Every Texan, an Austin-based advocacy group.

True numbers of how many people have noncompliant plans remain elusive, as such plans often fly under regulatory radar and industry tracking. Still, an investigation last year by the U.S. House Committee on Energy and Commerce concluded that at least 3 million consumers had short-term limited duration plans in 2019, the last year for which information was available. That was a 27% jump from the previous year, when deregulation began in earnest, the investigation found.

“I would not be surprised if  . . .

Continue reading.

Written by Leisureguy

8 May 2021 at 10:24 am

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