Health marketplace sticker shock spreading


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Last-minute shoppers to the health insurance marketplace plans might do well to heed the advice of Butler County physician Mark Musmanno:

Know what you’re signing up for.

Since the Affordable Care Act health exchanges went live Jan. 1, Dr. Musmanno says his office has seen patients who were unhappily surprised by higher-than-expected deductibles and copayments.

Now, with Monday’s enrollment deadline looming, he worries that those still making up their minds will simply opt for the cheapest plan without considering the out-of-pocket strings attached.

One example: Dr. Musmanno said a patient at his Butler urology practice signed up for a health insurance exchange plan late last year in anticipation of losing insurance Dec. 31.

When the patient came to see him in January, though, he learned that his copayment to see a specialist, which previously carried no charged, was now $70 and his deductible — the amount a patient pays before insurance kicked in — went from $300 to $3,000.

“When we told him that, he was angry at us. And, because of that, he didn't want to make another appointment to see me,” said Dr. Musmanno. “This is changing the doctor-patient relationship. Patients are seeing doctors as money grubbers, and we have nothing to do with that.”

It’s little surprise that people are confused, as well as frustrated. Shopping for the best health plan requires understanding unfamiliar terms and eligibility rules, as well as a host of other variables. Without that knowledge, an apparent bargain can turn out to be a health insurance money pit.

“I think you’re going to be hearing more about this, and the reason you’re going to be hearing more is that people are signing up for low-premium plans,” said Martin Giglio, communications practice leader at Buck Consultants, Downtown.

“What they don’t realize is that the cost-sharing component — the cosharing and copays and so forth — may have increased. So when you are looking for a plan on the exchange, you have to look at a lot of factors, not just the premium you’re paying.”

The jump in medical out-of-pocket costs “is not only happening to people on the exchange,” added Mr. Giglio.

“This past year, a lot of employer-based plans have increased their cost sharing — deductibles and coinsurance — so employers and employees are seeing the same kind of sticker shock.”

Bill England, state director for Enroll America, the nonprofit encouraging the uninsured to find a health plan on the exchange, said the navigators who assist people signing up do explain all the costs.

However, with only six navigators covering Allegheny, Beaver and Butler counties, there are likely not enough navigators to help everyone who needs it by the Monday enrollment deadline.

“I’m not sure we had enough to start with,” said Mr. England. “Countless people have never had insurance so, in talking to the assisters, they’re spending significant time explaining the plans.”

Mike Fraser, CEO of the Pennsylvania Medical Society physicians association, said he’s hearing at least one sticker shock anecdote “pretty much from every county medical society” and he’s expecting more will follow.

In one case, a physician told him, a patient decided to postpone surgery because of the copayment and other out-of-pocket costs.

“That’s certainly not going to make anyone any better,” he said.


Steve Twedt: stwedt@post-gazette.com or 412-263-1963.

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