Health Care Premiums Rising: Some Just Cannot Afford To Have Insurance - And That Is Alarming

September 22, 2022

This year when the talk about health insurance came up, everyone was warned that premiums could go up as much as 50%. Guess what? The reality has hit home - and as many are renewing for next year - they are being hit in the face - in ways financially that all of us have never seen before. Alice and Greg Wilson are being affected in a way where both Hallandale Beach residents are in fear of losing their home. That is how bad things have gotten. Alice, 62, is a part time employee - and her husband, 63, works full-time, making just over the amount that is allowed - where neither are eligible for a subsidy.

The panic has already set in for Greg, who now pays $1,245.00 a month and his wife, who found a less expensive $950.00 a month policy that is a bare minimum - with higher co-pays and a deductible that is laughable. “I am ready to scream,” Alice said. “I have cried myself to sleep many a night, thinking how are we going to make it - when we are not making any money and living paycheck to paycheck. We are being penalized for working our tails off for over 40 years and now having to wait three years to get any assistance. We will be out on the street.”

Alice has contacted the Government and marketplace a number of times - and while they are sympathetic about what is going on - they are not helping at all. “We live in South Florida - which is one of the most expensive areas to be,” Alice pointed out. “When awarding subsidies that could make life easier for people in their 60’s, they are doing the opposite. There are so many people I talked to - in our age group - that are not taking insurance, opting to pay the much cheaper penalty.”

The Wilson’s are certainly not alone. This is a problem that will end up affecting everyone - over time. The reality of all this, is premiums are up, deductibles and out-of-pocket caps are higher and provider networks are smaller for the most affordable plans. Consumers who have been affected the most include working-age individuals who expect to make more this year and don’t qualify for employer based insurance. In that group are small business owners, early retirees with lucrative investment incomes, real estate sales reps, accountants, insurance brokers, some doctors and nurses, accountants and bookkeepers and other independent contractors.

Employers Hold The Key
The days of your employers paying for the entire insurance premium are over. The rising cost has forced these companies to make adjustments and over time, everyone is not thrilled. The employer portion of health insurance that you pay varies depending on your business’s size and the type of coverage. Though there is no single answer to how much employers do pay for health insurance, there are average amounts. Most insurance companies require employers to cover at least half of the employee’s premium. This makes insurance more affordable for employees.

The Affordable Care Act (ACA) sets the rules for employer-sponsored health insurance. Whether you have to provide coverage depends on your business size. An employer’s size is determined by the number of its full-time employees, including full-time equivalents. Some of the provisions of the Affordable Care Act, or health care law, apply only to small employers, generally those with fewer than 50 full-time employees, including full-time equivalent employees. If your employer has fewer than 50 employees, but is a member of a group with a certain level of common or related ownership with 50 or more full-time employees, including full-time equivalent employees, the business is subject to the rules for large employers. The ACA represents a tremendous step forward on the path toward meaningful health system reform. Under the Affordable Care Act, patients who may have been uninsured due to preexisting conditions or limited finances can secure affordable health plans through the health insurance marketplace in their state.

In a recent effort to improve access to health care for millions of Americans, the Biden-Harris Administration proposed a new rule to overhaul the enrollment processes for Medicaid, the Children’s Health Insurance Program (CHIP), and Basic Health Programs (BHPs), and eliminate arbitrary coverage caps for children in CHIP. In a Notice of Proposed Rule Making (NPRM), the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is working to reduce red tape and simplify application and verification processes to make it easier for children, older adults and people with lower incomes with Medicaid and CHIP coverage to enroll in and retain vital health insurance. This proposed rule follows President Biden’s executive orders in April 2022 and January 2021 directing federal agencies to take action to expand affordable, quality health coverage, including by strengthening Medicaid and the Affordable Care Act.

A recent study estimated that only about half of eligible low-income individuals enrolled in Medicare were also enrolled in Medicare Savings Programs. This proposed rule would automatically consider older adults for Medicare Savings Programs enrollment when they apply for low-income subsidies to help pay for Part D Medicare coverage, reducing the burdens of both time and expense by eliminating the need to complete multiple applications.