The Effect Of Healthcare Insurance Challenges On Care And Patient Well-Being
The American Psychological Association reports that approximately 66% of Americans experience stress a result of health insurance costs. Stress related due to costs of health insurance tends to affect people of numerous income levels. As a result, healthcare insurance challenges can have momentous effects on a person’s general health and welfare.
This article explores common challenges in relation to health insurance, the effect on individuals and their families, as well as ways to best navigate these particular dynamics.
Types of healthcare insurance challenges patients experience
One of the primary concerns that affects individuals and families relates to out-of-pocket expenses required by health insurance companies. These expectations can have substantial effects on both individuals and their families.
Financial concerns related to insurance coverage
Concerns in relation to finances can stem from numerous factors relating to specific health insurance plans. For instance, many people experience anxiety surrounding the intricacies of their health plans deductible.
Deductibles
For many health insurers, their plans require individuals to meet a certain deductible. A deductible is the cost that an individual must pay before an insurer begins to provide payment for care. For instance, if someone has insurance coverage with a deductible of $3000 and needs a procedure that costs $5000, they typically need to pay the first $3000 for that particular procedure. This can be cumbersome if someone is experiencing other financial tolls at the time of their health-related procedure.
Health insurance premiums
There are many individuals who experience challenges when considering appropriate insurance plans. For instance, some individuals may be tempted to take on a plan with a low deductible to avoid major expenses in the long-term. The tradeoff, however, is worry about paying higher monthly health insurance premiums. A high premium typically means less take-home income for essential expenses related to aspects of food and housing. The stress in relation to these major decisions can often lead people to question whether they’ve made a reasonable decision for themselves and their families.
Co-pays
There are numerous insurance providers that require a co-pay for each health-related procedure. While some opt out of using their insurance, people who have recurrent medical conditions may have to make co-payments frequently given their involvement with health visits. This can lead to financial inequities and stress. Some people experiencing financial hardship may forgo seeking medical care, thus resulting in the potential of more severe medical repercussions.
Health insurance challenges related to employment
Employment decisions can often be swayed due to the need for health insurance. For instance, this may lead a person to choose a job that doesn’t pay wages commensurate with their experience. Some may be timid to leave a job to start a business due to their loss of medical insurance given that pursuit. This can become especially cumbersome for individuals with dependents, resulting in fear that their families will be unable to receive adequate care. This stress can often impact work performance and fulfillment, thus impacting their mental or physical health.
Health insurance during unemployment
One of the most common stressful situations relating to health insurance is finding appropriate coverage during a period of unemployment. Some individuals may not be eligible to receive coverage through programs such as Continuation of Health Coverage (COBRA). COBRA is an option that allows people to stay on their former employer’s insurance plan for an elongated period. Some individuals may consider applying for health insurance coverage under the Affordable Care Act (ACA). This type of coverage may be out of reach for some people depending on their unemployment benefits.
People without the financial means to pay for COBRA or ACA may opt out of coverage until they gain employment with a job that offers insurance. This can lead to deterrents in pursuing healthcare services, thus increasing the likelihood of medical adversity.
Challenges related to mental health care
Those navigating mental health concerns may notice additional disparities due to stress associated with health-insurance related decisions. For instance, persons taking medication for mental illness may have anxiety about the possibility of health coverage lapsing. Others may need mental health medication access regularly to reduce mental health adversities such as psychosis or dissociation. If someone living with a mental illness experiences financial hardship or loses insurance coverage, they may experience temptation to cease their medication temporarily. This can have adverse repercussions for their mental health and overall functioning.
Those not experiencing mental health conditions may also experience hardship in relation to insurance challenges. The financial burdens relating to deductibles and copays can lead to significant stress.
Online mental health assistance
While there may be stress associated with individuals experiencing health insurance complications, many mental health providers now offer services at a more affordable rate. Online therapy platforms like BetterHelp tend to be more affordable than traditional in-person therapy without insurance. Furthermore, BetterHelp is recognized by most Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA). Online therapy allows individuals to also connect with a therapist at a time that fits with their schedule. This can be useful for individuals attempting to balance work-related themes in efforts to achieve equitable health insurance options.
What does the research say about online mental health care?
There are numerous peer-reviewed studies that have demonstrated online therapy to be effective. One meta-analysis from 2017 found online cognitive behavioral therapy (CBT) to be effective for depression, social anxiety, bipolar disorder, phobias, and adjustment disorder. Adjustment disorder, which is a condition resulting from stress-related factors influenced by major life transitions, can occur after a transition such as job loss or change in relationship status.
Takeaway
Below are some common questions related to health insurance challenges.
What types of challenges do patients face with health insurance companies?
Some people face challenges when it comes to remaining with the same health care providers if their insurance plan changes or if their providers change networks. Some people may also experience difficulty getting insurance claims approved for reimbursement.
What are Medicare Advantage Plans, and what type of insurance coverage do they provide?
Medicare Advantage Plans are special plans provided by independent companies approved by Medicare. Medicare Advantage plans typically cover pre-existing conditions regardless of current health status, and some offer coverage for transportation, health and wellness services, and over-the-counter medications not covered by Medicare Part D.
What are the problems with health insurance?
Two of the biggest challenges with health insurance are cost and access. Surveys reveal that about half of United States adults find it challenging to afford health services and worry about being able to pay unexpected medical bills. Many report that they’ve skipped taking prescription drugs and put off going to health care facilities due to the cost.
What is the biggest challenge faced by payers in healthcare?
One of the most notable challenges faced by healthcare payers is the rising cost of health care services. Complying with changing regulations is also a notable difficulty within health systems.
What is the biggest challenge facing healthcare?
The rising cost of medical services, paired with a shortage of professionals in the healthcare industry, is perhaps the biggest challenge currently facing healthcare as a whole. The need for improved mental health services and increased healthcare access is also significant.
What are four common barriers to adequate health insurance?
Common barriers to adequate health insurance include staffing shortages, insufficient health care coverage by insurance, bias and stigma within the medical community, language barriers, transportation barriers, and work-related barriers.
What are some disadvantages of insurance?
While it’s generally viewed as a positive thing to have insurance, whether it’s public or independent insurance (about a third of US adults have public insurance, and two-thirds are independent), there can also be downsides. For instance, insurance tends to come with a long list of complicated terms and conditions, it can be more expensive for those who are older or in fair or poor health, and typical health insurance doesn’t necessarily cover vision and dental care.
What is a disadvantage of having health insurance?
One disadvantage of having health insurance is that not all local providers may be considered “in-network,” which can limit the care available to insurance holders. Even if a person’s primary care doctor recommends seeing a certain specialist, for example, that specialist won’t necessarily be covered by the individual’s insurance provider.
What factors affect health insurance?
Many factors affect health insurance. Premiums for those who purchase insurance through the federal government are impacted by age (with younger adults paying less than older adults), tobacco use, location, plan category, and whether the chosen plan covers dependents.
Why is affordable healthcare a problem?
The current lack of affordable healthcare can present problems like a lack of access, leading to poor health outcomes. Budgeting for medical expenses may mean struggling to pay for other living expenses. Uninsured adults may try to avoid seeking medical care altogether due to cost. Many people receive health benefits from their employers (just over half of US adults, as of 2023), and there are also Medicare beneficiaries, Medicaid enrollees, and those who pay for public insurance. These individuals may have some coverage, but it may not always be enough, and this common struggle to afford healthcare may necessitate modern solutions.
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