Health Cards and Health Insurance Are Very Different

Recently there has been a proliferation of advertisements for health cards. These cards claim to offer access to high quality and affordable medical care, dental care, prescription drugs, vision and other health care services. The rates vary but may be as little as $20 a month to as high of $125 a month for a family. The two big selling points of these plans are that they are affordable and that you cannot be turned down.

Exactly what are you buying? Health cards can also be called discount medical programs or plans. This industry has grown so large that they even have their own trade association, the Consumer Health Alliance. Here is the definition of a health card given by the Consumer Health Alliance. “Our member companies make health care products and services, including prescription drugs, dental, chiropractic, eye care, physician, hospital and laboratory services, available to millions of Americans by providing opportunities for consumers to directly purchase health care services and products at discounted rates.” According to the Consumer Health Alliance more then 28 million consumers have purchased these plans for various companies.

The problem lies not in the concept of the programs but in the sale and execution. The most important fact you must know about these health cards is that they are NOT health insurance. Many consumers have failed to understand what they are buying and as a result have been saddled with hundreds and even thousands of dollars in medical bills they assumed would be covered by their health card.

These plans advertise that they are affiliated with networks of medical providers. That is generally true. Their affiliation may even be with some of the national networks that insurance companies use themselves. The plan representative tells you that if you use the services of a network provider, you will get a discount on the service similar to the discounts that insurance companies negotiate when providers join their networks.

One company, for instance, gives you an example. If you see a network provider, that doctor’s normal charge for an office visit may be $120. But with your discount health card, you will only be charged $90 thus saving you $30 each time you visit the doctor, On the surface that may sound good, but remember, the consumer and only the consumer, has to pay the provider $90 every time he visits that doctor.

What happens if we discuss a hospitalization rather than a doctor’s visit. You find you need a hip replacement. According the the American Academy of Orthopedic Surgeons, the average cost of a hip replacement in 2006 was $42,000. You see a doctor who is in the network used by your $29.95 a month health card. You expect to get a significant discount for the procedure because you used a network provider. Remember your doctor visit. You got a $25% discount and only had to pay the doctor $90 of the $120 bill.

But now you have a bill from the hospital for your hip replacement for $42,000. It is also discounted at 25%. That means you owe the hospital $31,500. And you have to pay it. It’s better than owing $42,000 of course, but $31,500 is still a pretty significant amount of money that the consumer has to pay out. Unfortunately, the companies that sell these cards focus your attention on the small services. But, if consumers are smart, they will focus on the big items, which is the real risk of not having health insurance.

For some people who don’t qualify for medical insurance, discount cards may be the only option. Individual health insurance generally is medically underwritten which means if a person has a medical condition that the insurance company does not want to insure, they will be unable to get health insurance. Most states have what are called pool plans, which will insure persons with medical conditions, but as you can imagine, these plans are extremely expensive.

The real danger of these cards is the aggressive methods used to sell them. Many of these plans are actually sold as Multi Level Marketing plans. The sales representatives do not have to be licensed insurance agents, because the plans are not insurance. There interest is in adding people to their downline as that is how they make money. Learning the programs and carefully advising consumers as to what they are buying may not be the most important thing to these sales representatives.

If you are considering buying a health plan, be careful and ask questions. Understand first and foremost, that you are NOT buying insurance. Be wary of extravagant promises of discounts up to 60%. In our hip replacement example, for instance, a 60% discount would mean the service would only cost you $16,800. It is unlikely that a provider hospital would give you that kind of discount. Ask for specifics about hospitals, doctors and procedures. Ask if all the providers honor the advertised discounts. Sometimes doctors and other providers are not even aware they are listed as participants in these plans.

Ask about hidden fees. Often there are administrative fees hidden in the fine print. Be especially careful if there are fees charged for each use of your card. These fees may eat up almost all of your discount.

Discount health cards are never a substitute for health insurance. Before you consider buying one, think about how you will use it. If your need is for less expensive services, such as routine doctor’s visits, dental or vision discounts, they may be worth it. Remember, if you need an expensive procedure such as a hospitalization or surgery, you will be paying most of the bill yourself. No matter what the representative tells you or the advertisements imply, your card will never pay one single cent to any provider. The consumer will always be responsible for the amount of the charge less any discount that might be applied.

Consider your needs and the needs of your family. If you can afford it, buy health insurance. Even a plan with a high deductible such as an HSA will be a better option because at some point after the deductible is met, the insurance will pay the balance of the bill. If you can’t afford insurance or you cannot qualify because of medical problems, a health card may be useful. But before your buy, understand what it is and what it can really do for you.

This entry was posted in Uncategorized. Bookmark the permalink.