Benefit Limits–another way insurers remove the sick patient

Health insurance with financial limits appears to be the norm in the U.S. What better way to protect insurers’ profits.

“Those who need organ transplants or who have hemophilia, Gaucher disease or other costly chronic illnesses can easily rack up medical bills that blow through the lifetime benefits cap of $1 million or more that is a standard part of many insurance policies”.

A million dollars in health care over a lifetime sounds like a lot. Right?

Yet in this day of drugs costing over $50,000/year, all too frequently people with chronic illness, some not so chronic, find themselves over the limit. Then what?

If you are fortunate enough (medicynical irony) to suffer from end stage renal disease or are over age 65 there are provisions for you to qualify for unlimited lifetime coverage from Medicare at reasonable cost. Those who exceed their insurance’s limit and are too young or who do not have the “correct” problem find themselves trying to qualify for disability with its associated Medicare coverage or to prove indigency and qualify for Medicaid. The recurrent theme here is to shift the cost from the private insurer to a public program. This in a country that has problems with “socialized medicine.”

In the U.S.’s so-called health care system it is an accident of fate, having the right disease or being old enough that assures health coverage rather than policy or rationality. Quite a system.

One response to “Benefit Limits–another way insurers remove the sick patient

  1. We should require all officials in charge of negotiating a new health plan, I.E. President and staff, Senators and staff, Congress and staff will have the SAME health coverage as the citizens they are trying to cover.

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