Minimum Insurance Under Mass. Health Reform Must Cap Patient Costs

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Santa Monica, CA — Minimum health coverage must protect patients against financial disaster when they purchase an insurance plan under Massachusetts’ health reform, said the nonprofit Foundation for Taxpayer and Consumer Rights (FTCR) in a letter sent today to the board implementing the law.

In order to provide basic coverage and protect patients from financial ruin, minimum policies under the state’s new health law must cap out of pocket expenses at $7,500 per individual, or $10,000 per family, ban limits on what insurers will pay per treatment or illness, and include affordable prescription drug coverage, said FTCR.

Dana Christensen of Playa del Rey, Calif. was left with $450,000 in unpaid medical bills when her husband died of cancer because her insurer, Mega Life and Health Insurance Co., limited its own payments but did not cap her out of pocket expenses. The Boston Globe has reported on Massachusetts patients who were left with thousands of dollars in unpaid bills under similar junk insurance plans, which cover at least 30,000 people in the state.

“Insurance is not insurance unless it provides basic coverage and protects patients from financial disaster,” wrote Carmen Balber of FTCR. The rules “‘will determine whether Bay State citizens will be offered quality health care policies, or be required to buy junk insurance under the state’s universal health care law.”

A policy committee of the board charged with implementing the Massachusetts health care mandate meets tomorrow to draft regulations defining insurance under the reform law. The full board will vote on Monday.

Affordability, however, is just as important as minimum standards for insurance if Massachusetts seeks to fulfill its promise of universal health coverage, concluded FTCR.

“Truly universal health coverage must also be affordable, a need that will only be met when health insurer waste and overhead is limited, premiums require prior approval and rate changes are justified,” said Balber.

Read the letter.

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Consumer Watchdog
Consumer Watchdog
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