Young Adults Vulnerable To High Medical Bills Under Massachusetts Health Insurance Plans, Report Says

Health insurance plans offered by Massachusetts to residents ages 19 to 26 under the state's health insurance law leave young adults vulnerable to high medical bills because of annual limits and caps on outpatient care and surgeons' fees, according to a report released Tuesday by the Access Project, the Boston Globe reports. The plans are modeled after coverage many college students have had to purchase since 1989.

Most of the young adult plans cap annual coverage at $50,000 to $100,000. Most student plans have annual caps of $25,000 or $50,000, but minimum caps will be increased to $50,000 in the fall. State officials say the caps on the student and young adult plans allow insurers to "balance affordability and coverage for what is typically a healthy population," according to the Globe. The Commonwealth Health Insurance Connector has authorized the caps for young adults to lower premiums while banning caps for other age groups with a higher risk for serious illnesses.

The report recommends that the state overhaul the student plans and eliminate caps in all plans. The report also suggests the state allow students with low incomes to enroll in statewide subsidized insurance programs (Dembner, Boston Globe, 5/29).


The report is available online. Note: You must have Adobe Acrobat Reader to view the report.

House Hearing
Patients, physicians, health care advocates and businesspeople at a Massachusetts House hearing on Tuesday suggested changes to proposed minimum health coverage requirements under the state's health insurance law, the Boston Globe reports. The law requires all state residents to obtain health insurance by July 1 or face tax penalties.

The Commonwealth Health Insurance Connector in March gave preliminary approval to minimum standards for coverage that would limit out-of-pocket spending to $5,000 for an individual and $100,000 for a family. Under the proposed standards, copayments of $100 or less, prescription drug costs and payments for services received outside of an insurer's network would not count toward the out-of-pocket spending limits. The Connector board is scheduled to vote on the requirements on Tuesday. Diane Pickles -- who spoke as part of the Affordable Care Today Coalition, which worked to pass the health insurance law -- said, "Out-of-pocket limits should include all out-of-pocket costs," adding, "Those are the kinds of costs you can't budget for."

Meanwhile, physicians at the hearing presented a petition calling for government-sponsored health coverage for all state residents. The petition, presented by internist Andrew Wilper, said health plans with copays and deductibles of up to $2,000 make "skimpy policies" that would provide inadequate coverage. Wilper asked the Connector to minimize copays and deductibles, adding that he has seen low-income residents delay needed care because of costs.

Representatives of small businesses at the hearing urged the Connector to allow significant copays and deductibles to keep employer premiums low. Several speakers at the hearing discussed their concerns about a low-cost prescription drug requirement for health plans that the Connector will develop later this year (Dembner, Boston Globe, 5/30).

Comparison Shopping
In related news, the health insurance connector board has launched a Web site that allows state residents to comparison shop for health insurance plans available under the insurance law, the AP/Boston Herald reports. The site, MAhealthconnector, allows residents to compare different plans based on premiums, copayments, deductibles and maximum out-of-pocket expenses. Plans can be viewed individually or alongside other plans.

The site also allows visitors to sign up for coverage immediately after making a decision from six participating insurers: Blue Cross and Blue Shield of Massachusetts, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England, Neighborhood Health Plan and Tufts Health Plan. The Web site also offers information for employers and brokers (AP/Boston Herald, 5/28).

Broadcast Coverage

In related news, NBC's "Nightly News" on Tuesday reported on the Massachusetts health insurance law. The segment includes comments from Connector Executive Director Jon Kingsdale; Sally Pipes, president and CEO of the Pacific Research Institute; and Massachusetts residents (Ellis, "Nightly News," NBC, 5/29). Video of the segment is available online.

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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