Yamileth Medina

A Group Health Insurance Plan May Become More Expensive For Some



Posted: Tuesday, April 13, 2010

by Yamileth Medina
VitalOne Health

According to the recently passed healthcare reform law, the cost of health insurance should go down, especially for individuals and small businesses. There are relatively few measures included to control costs, but they exist nonetheless.

One of the main mechanisms for reducing health care expenses is the promotion of wellness incentives. Employees are given money to take health assessments, and save more if they reach certain goals. Most of the programs relate to the promotion of healthy habits: quitting smoking, losing weight, lowering cholesterol or blood pressure. The law increases the maximum premium discount to 30 percent by 2014. In the future, it could reach 50 percent. Their deductibles or co-payments could also be waived. In contrast, the current limit for discounts is 20 percent of the cost of health benefits.

Those who already are or become healthy will pay less in premiums as a result. However, many people with chronic conditions will have more costs shifted towards them. Some illnesses, such as asthma, may limit or prevent a person's involvement in exercise and other wellness programs. In effect, people with pre-existing conditions will end up paying more for insurance--a practice that the Obama administration's health insurance reform legislation claimed to stop. Granted, the law calls for those in that predicament to be offered the chance to meet an "alternative medical standard".

Some believe that there is nothing wrong with such a strategy; it is simply the reverse of what happens in many companies, where employees in good health partially subsidize the health insurance plans of unhealthier employees, the latter of whom are more likely to file claims. Understandably, many people don't want to pay for what they see as other people's bad choices.

However, some warn of negative impact. They believe that instead of keeping rates steady and discounting them for those who meet the standards, group health insurance companies will instead increase rates for the entire company while applying the discount to bring some employees' premiums back to their original level. A provision in the law states that corporate wellness incentives cannot be used as a sneaky method of health status discrimination, and that the programs must have a "reasonable chance" of success. Still, how can that be proven? Many smokers take multiple attempts to succeed in quitting. Some studies have shown that up to 95% of those who have lost weight regain it, yet does that erase the success millions have had at maintaining their weight loss--or diminish the need for trying?

(Image: Pink Sherbet Photography under CC 3.0)

Yamileth Medina is an up and coming expert on Group Health Insurance and Healthcare Reform. She aims to help people realize that they can find a quality health insurance plan right now. Yamileth lives in Miami, FL.
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