The adage “you get what you pay for” has come back to haunt Richard Sankovich. He’s paying big time, and his experience is a cautionary tale for those shopping for health insurance in the federal marketplace. Low-premium plans can come with big price tags later on and provide precious little peace of mind.
Mr. Sankovich, a Virginia resident, went to the emergency room at West Penn Hospital with stomach pain while visiting family here in March. He was diagnosed with a pulled muscle, then got a medical bill big enough to induce nausea. As reported by the Post-Gazette’s Steve Twedt last week, he has to shell out more than $6,000 for his 2½ hours of hospital care because his plan includes a $6,500 deductible.
Under the Affordable Care Act, which requires Americans to have health insurance, those who do not receive coverage through their employers can purchase plans through a federal marketplace. There, sundry insurers offer plans at various price and benefit levels. As 63-year-old Mr. Sankovich found out, lower-premium plans — his Aetna coverage costs $478 a month — come with higher deductibles and co-insurance. His plan, moreover, does not cover emergency room care at all.
His predicament is ironic, though far from unique. There is evidence that others share his plight. The law was designed to increase access to health care for the uninsured and underinsured. Yet nothing about Mr. Sankovich’s case is affordable, and he certainly seems to have been underinsured. Paying down his medical bills will diminish his quality of life for months to come. Next time, he’ll think twice about seeing a doctor for an ache or pain. That would undermine Obamacare’s goal.
Navigating the marketplace can be a challenging exercise for less-sophisticated consumers, and those of modest means or those seeking deals will gravitate to lower-costing plans. Obamacare may provide a safety net for catastrophic care and major illnesses, but consumers must understand their possible exposure to big bills for simpler care. Obamacare is no cure-all. Let the buyer beware.
First Published: July 27, 2016, 4:00 a.m.
