Will Better Health Care Consumers Ring in the New Year?

by Cathy Miller on January 1, 2013

in Health and Wellness, Health Insurance

bigstock-Happy-New-Year-Hat-2278293The new year may bring health care consumers kicking and screaming into reality.

  • The elections in the U.S. ensured some form of health care reform
  • Reform’s individual mandate, a cornerstone of the law, may force that reality
  • The trend towards outcomes-based wellness incentives adds to the push for accountability

Are individuals prepared to become better health care consumers?

So far, the signs have not been promising.

Consumer Learning Curve

There are many reasons Americans are lousy health care consumers. The reasons vary for each individual, but the following have had an impact on the consumer learning curve.

Employer-Sponsored Benefits Concealed True Cost

For years, employers took care of health care costs without communicating costs to employees.

Employees basked in ignorant bliss.

  • Copayments or employee-paid expenses were a small fraction of the total cost
  • Health maintenance organizations (HMOs) did not issue payment explanations
  • That left many consumers making assumptions like prescriptions cost just $10

In paternalistic style, many employers of the past did not share the high cost of their contribution to employee benefits.

Despite recent increases in cost-sharing between employers and employees, the fact remains that employer-sponsored health plans pick up the majority of health care premiums.

The graph below from the Kaiser Family Foundation’s Employer Health Benefits 2012 Annual Survey shows the average percentage covered workers pay for premiums. The averages are broken down by the type of employer – Private, Public, and Non-Profit.

The left side of the chart shows the average percentage for single coverage and the right side depicts family coverage.


Avg Percentage

Note the average for all employer types.

  • Single coverage – 18 percent paid by covered worker (82 percent by employer)
  • Family coverage – 28 percent paid by covered worker (72 percent by employer)

Even though there is a significant difference in the percentage for family coverage at private employers, the employer still covers the majority of the premium cost.

Faced with paying the entire premium cost after losing coverage, more than one individual elected to do without health insurance.

Ignorant bliss turned into sticker shock.

Individuals Lack Understanding

Think about your health benefits description you received from your employer or insurance company.

  • Do you understand the benefits and coverage?
  • Have you even read the description?

If you’re like many consumers, the first time you study your benefits is when one of the following occurs.

  • You need health care
  • You had something denied
  • You received a bill for a large amount

While healthcare reform’s Patient Protection and Affordability Act (PPACA) calls for easier-to-understand Summary of Benefits and Coverage, the real test to understanding comes soon.

The first major wave of changes from PPACA begin in 2014.  One of the most significant changes is the introduction of health insurance exchanges. Benefits and coverage descriptions will play a major role in decision-making as consumers compare health plans.

Consumers will begin reviewing their options in 2013. Let’s hope they understand them.

Disengaged in Health Care

The reasons we are disengaged in our health care is as individual as we are.

  • Some view health insurance as the employers’ problem
  • Or its sick insurance – you get sick, insurance pays – why worry if you’re not sick?
  • And for others, it’s an expense they feel they cannot afford

Engagement is the buzzword of health care.

  • It is not enough to build it because most will not come
  • Engagement is when individuals want to participate
  • And therein lies the challenge

Are individuals prepared to become better health care consumers?

Time will tell, but the first step is communication – from employer sponsors, insurers, and the healthcare industry.

And most importantly – from the consumers themselves.

  • Are we ready for accountability?
  • Our good health depends on it

The Future of Simply Stated Health Care

The goal of this site is keeping health care simple & informative.

The plans for 2013 include providing resources and documents for better understanding. Please let me know if there are specific areas of interests you’d like to see.

I wish you and your loved ones a happy and healthy 2013!


Helping you Keep it simple, clear & uniquely yours – contact me for help with your business writing needs. Visit my business blog, Simply stated business.


BigStock Photo Credit


Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician for health care issues.




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