Are State Sponsored Insurance Plans as Good as Employer Coverage?

Yes, in fact it might be better……

By Kerstin Nemec and Tim Norwood

State Sponsored Insurance Plans provide quality health coverage to 1 in 5 Americans. It has long been the cornerstone of coverage for those who may need it most: children, the disabled, and the elderly.

While these plans still provide coverage to this vulnerable population, the enactment of the Affordable Care Act became a game changer for our nation’s state sponsored health insurance program. By increasing the income limits for eligibility, the ACA paved the way for states to expand their coverage to previously excluded working adults and their children. Great news, right?

Not so fast. Are the plans cut-rate programs with limited benefits, no participating doctors and hospitals in limited neighborhoods?

No, its’s not.

Thanks to Medicaid expansion in 2013, an additional 11 million working adults and their families are now receiving comprehensive affordable, quality health care. The program’s mission of providing health services to Americans has evolved in several key areas:

  • Access to Care: The vast majority of expanded states contract their plans to Managed Care Organization (MCO’s), like Kaiser, Anthem, Blue Cross, and many others. While these plans may be financed publicly, care is provided in the private marketplace. Over 75 percent of all beneficiaries are enrolled in managed care served by private insurers. MCO choices are usually available in each state, and employees can compare quality rankings from the National Committee on Quality Assurance (NCQA). Many of the rankings are on par with private commercial coverage and in some states even higher.
  • Expanding Who Can Be Covered: Many employees who previously could not be covered are now eligible in expanded states. A typical household of four, with total income less than $35,000 could eligible in expanded states. This equates to over 40 Million households in the United States.
  • Coverage for Hard Working Americans: The majority of state plan enrollees in expanded states work full time, generally in Industries such as restaurant and food services, construction, schools, hospitals, grocery stores, home health care services, and department stores.
  • Cost Efficiency: Coverage is generally FREE (a few states charge a small premium).
  • Out of Pocket Expenses: Most state plans have NO deductibles, and very low copays. This is especially important as employer plan deductibles rise each year. On average, the Kaiser Family Foundation reports employees pay an average of $2,295 per year before insurance kicks in. That’s a heavy financial burden.
  • Covered Services: Benefits are comprehensive and similar to employer provided benefits. In all states, services include:

Inpatient Hospital Services

Outpatient Hospital Services

Physician Services

Lab and X-Ray

Pediatric and Family Nurse Services

Home Health Services

Early and Periodic Screening, Diagnostic, and Treatment

Birth Center Services

Additional services generally include vision, dental, and prescription drug.

The new administration has called on lawmakers to reform the health care system to “expand choice, increase access, lower costs, and at the same time, provide better health care.” Medicaid expansion in the states shown below has done just that. If your business operates in one of these states, wouldn’t it make sense to give your employees the opportunity to learn about and enroll in this valuable, quality coverage?

So, What’s Next?

The entire country is watching Washington D.C. to see what will happen next with healthcare legislation. We do know at this time that any proposed changes will not go into effect until 2020 and that there is also discussion about Americans that are utilizing state health insurance plans such as expanded Medicaid be allowed to stay on those programs after 2020. So, for the next 2.5 years, it is imperative for those employees that are potentially eligible to be educated on these programs and give them the option to take advantage of these cost savings opportunities that make a significant difference to them and their families.

Tim Norwood Executive Vice President Med-Enroll, Inc.

Tim Norwood
Executive Vice President
Med-Enroll, Inc.

Kerstin Nemac President Med-Enroll

Kerstin Nemac