What is a “qualified plan?

As everyone knows by now, come January 2014 pursuant to Obamacare, everyone in this country must have health insurance, or pay a penalty.  But, not just any health insurance will do.  You must have a “qualified” plan as defined by the Secretary of Health and Human Services.

Of course, certain things, by law, must be in that plan such as emergency services, rehab services, mental health and substance abuse services, and prescription drugs.  But, what about those things not listed in the law itself?  Most feared that lobbyists for everything imaginable would camp out on the Secretary’s doorstep pleading their case for inclusion of all sorts of medical treatments.  But, logic dictates that the more that is included, the higher the premiums.

Last Friday, however, the Secretary of Health and Human Services announced the final decision…the states will be able to decide what plans sold in their states must include.  However, this is not a blanket permission.

The new proposal would let states pick a benefits package from several federally approved options. Those range from benefits offered to federal and state employees to the most popular small business plans in the state and to a large health maintenance organization, or HMO.

This, of course would be the starting point, as states could heap more benefits on the package.  So the lobbyists will now be forced to circle their wagons around each state capital.

But, this may not be the best approach either.

Neil Trautwein, employee-benefits manager at the National Retail Federation, said he was concerned the cost of a federal-employee plan could be beyond the reach of an individual purchaser or small employer.

It most certainly will be, as will the cost of most state government plans. 

Then, there are those who are concerned that,

[t]he implementation plans also raise questions of possible disparity, with people in some states having better plans than others.  And, depending how substantive the coverage differences are among states, it could lead some people to move in an attempt to get better coverage elsewhere.

How true.  If your coverage happens to be “free”, as it will be for many, “relo” will be the word of the day.  Ironically, the states most likely to pick “the most popular federal employee plan” (and thus the most expensive plan) as their standard are the very states who are least capable of dealing with the influx of folks receiving free insurance who move there because of the mandated insurance benefits.

Of course, the converse is also true.  If you actually have to pay for your insurance, your instinct will be to move from a state that mandates the most (i.e. high premiums) to a state that mandates the least.  You may not need all of the whistles and bells of the fancy “federal and state” like plans.  Besides, unless absolutely necessary, you will think twice about using one of those missing whistles if you actually  have to pay for it yourself. 

What is interesting is that those on the far left seem to be horrified by this approach.  Their plan was that everyone  would be stuck with the same theoretical insurance  benefits.  I say theoretical because that is what Obamacare is.  Everyone has insurance, but only the rich will actually be able to see a doctor.


8 replies
  1. JBS
    JBS says:

    Egads, car insurance is bad enough! Lord, let this ?bamaCare thing be struck down in the courts. (Is there an Appeal Court to the SCOTUS?)
    Instinct says to go with the least costly plan, upgrade in the next year if necessary. As all of this is hypothetical, it would be good to know, hypothetically, of course, just what these plans are going to cost, what they will and will not cover, deductibles, etc. Without an apples to apples comparison, it is an exercise in imagination to try to predict. Actually, a nightmare if it comes true!
    If this is what is to come, airy “oh, let the states decide”, there is going to be chaos when this



  2. Mommahan
    Mommahan says:

    All I know is that I am paying more than ever right now and with the high deductible I have, I cannot afford to go to the Doc. I can barely afford my scripts. (I am in good health but need an occasional migraine pill) I fear it will only get worse once Obamacare kicks in. I am lucky in that I know a lot about?vitamins and nutrition but the goverment is trying to get its paws in on that too. I only hope that they don’t succeed. Of course the irony is that if I didn’t HAVE to have insurance, I could use that money that I pay out to go in for a visit. The whole thing is a mess. My insurance had to pay for 2 preganancy tests that I didn’t ask for when I brought my two young daughters for their physical.? They told my girls to “eat their veggies” and charged 30 bucks each for that wealth of info. It is a debacle?and this plan isn’t fixing anything.

  3. winnie
    winnie says:

    SOS, you’re correct — only the rich will be able to see a doctor.? MDs are already refusing new/transfer medicare patients.? How long for them to make it s.o.p. to not accept those forced to carry o’care?? I’m glad I like my doctor…I wouldn’t want to be looking for a new one right now.

    • winnie
      winnie says:

      As bad as this “plan” is now, I’d hate to see their fix when we get to the point of crying uncle.? It’ll be 1000x worse–they’ll make sure of it.

  4. Lynn
    Lynn says:

    We need to make Congress have the same plan as we do. If we can’t get rid of Obamacare any other way. No waivers either.

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