We Got Trouble?

Credit: Sira Anamwong at FreeDigitalPhotos.net

In the Broadway musical The Music Man, one of the most famous songs is called “Ya Got Trouble?” During the song, a smooth-talking con man named Harold Hill tries to convince River City, Iowa locals that they need to give him money for band uniforms and instruments so that he can put together a marching band for the young people and protect them from the debauchery of a pool hall. I’m no con man, and I’m not asking for money for a marching band, but I’m sad to say my words today sound a little like Professor Harold Hill’s in the sense that I think we might be about to be in for some trouble, right here in the good ‘ole US of A.

You see, for many employees and retirees, open enrollment is about to begin, and for people insured through the Health Insurance Marketplace, open enrollment starts November 1st. And the word on the street is not good. I have read numerous pieces from typically liberal-leaning and typically conservative-leaning outlets and I've listened to multiple industry experts talk about 2017 health insurance coverage, and they all seem to be saying the same basic thing: brace yourself. The number of insurance carriers is going down, the number of plans available is going down, and the quality of coverage seems to be going down while the cost of coverage is going up, considerably. Last week some of this projected trouble came to fruition as the White House announced marketplace plan premiums will go up by an average of 25% in 2017.

If you read my blog, you know I’m not often one to sound the alarm. I’m not sounding the alarm today either, but I am trying to get your attention. When your open enrollment packet comes, you need to treat it like you are a member of the bomb squad. Carefully analyze every detail of your situation and proceed only with extreme caution.

We’ll have to see what happens to your premium. We’ll have to see what happens to mine. For now, here are a few general thoughts:

• If you get a scary letter that your plan doesn’t exist anymore, don’t panic. You’re just going to have to pick another one.
• If your plan is discontinued, don’t assume you will roll into a similar plan. Likewise, if your plan is still available, don’t assume you will automatically be reenrolled. In some cases, insurance companies feel they are now better off if they don’t have you as a customer at all, so the days of them trying to keep you with some sort of automatic election or renewal may be over. Be careful. You need coverage.
• A lot of deductible amounts are supposedly going to be higher. If you are looking at a lower deductible plan option, look closely. It may not be as favorable as it once was.
• A lot of co-insurance percentages are supposedly going to be less, so read carefully.
• If you are considering going to a lower coverage plan to try and minimize increased premiums or to actually try to reduce your premium, consider your financial situation if you have a major medical event. You could be setting yourself up to win the financial battle if you’re healthy, but lose the financial war if you get sick.
• The length of covered physical therapy treatments is supposedly going to be reduced. Read the fine print, particularly if you are planning or expecting a surgery that will require extended physical therapy.
• Some procedures now require other procedures in order to be covered. For example, you might need a CT scan, but it might only be covered if you first have an X-ray. I can personally attest to that little quirk, so read the fine print now, and if the time to use your coverage comes, ask a lot of questions, work with your doctor, and be proactive with your health insurance provider to make sure you play the game as best as you can to reduce your out-of-pocket expenses.
• If you are considering changing health insurance providers or plans, make sure your doctors you really like are still going to be willing to see you. A trusted, experienced physician might be worth a little higher premium if you can still see them.
• If you are a retiree and your old employer has always paid your health insurance premiums, you might want to look into how much longer that is going to be the case. With the premium increases of recent years, the expected premium increases in 2017, and the projected premium increases going forward, many companies are beginning to pass some of the health insurance coverage burden to their retirees.
• If your deductible or maximum out of pocket figure is greater than your cash on hand and rainy day fund, it may be time to boost those up so you can remain financially solvent even if you get hit with a real medical issue.

I’m truly sorry I can’t offer you something more concrete. I just want to warn you about the common tremors I am hearing from media sources that rarely agree. I hope I’m wrong, I hope there’s no trouble in River City, and I hope I can just go play pool!

-Tom