U.S. Department of Health and Human Services Secretary Kathleen Sebelius has announced that the Affordable Care Act grant will provide $3,979,002 to Tennessee to combat unreasonable TN health coverage premium increases. Sebelius also released a report called "Rate Review Works" to show how previous rate review grants have helped to mitigate insurance premium hikes and increase transparency in the marketplace.
While Sebelius says, "States continue to have the primary responsibility for reviewing insurance rates and these grants give them more resources to hold insurance companies accountable, the grants are just the most recent federal action to increase access to health insurance for Tennessee. Almost $250 million in grant money have been distributed to different states to facilitate health insurance rate reviews.
Tennessee Health Insurance Changes Follow Health Care Reform
As of September 1, 2011, health care reform requires Tennessee health insurance companies that plan to increase individual and small group insurance premiums by more that 10 percent to submit a request. If the rate increase is deemed to be unreasonable, the insurance company will need to publicly justify it. Federal authorities hope that this will improve health insurance accountability and lead to significantly lower costs for individuals, families and small business owners who buy coverage through the individual marketplace.
This May, Governor Haslam signed a bill into a law that expands the TN Department of Insurance's scope of review and gave the Department an approval authority regarding proposed rate increases on individual and small group policies. Currently, the department is working on regulations regarding its new approval authority.
As of July 1, 2011, all individual and small group Tennessee insurance rates needed to be filed in advance for this approval from the commissioner. The department is exploring how to incorporate the Tennessee's All Payer Claims Database in order to enhance the rate review process.
Tennessee Health Insurance Has Not Yet Met All Of The Affordable Care Act Provisions
The state is one of four granted a temporary one-year waiver to slowly transition from policies available prior to health care reform to those that meet new national standards for increased coverage. The waiver was deemed necessary to prevent some Tennesseans from losing their existing coverage, even if it was below national standards.
Certain fast food restaurant chains implied they would end insuring workers completely if required to offer more substantial health coverage for Tennessee. These companies, along with Tennessee health insurance companies, are still required to meet federal standards after the waivers expire.
While marginal health coverage is better than none at all, some of the policies available in Tennessee have been criticized as leaving policyholders exposed to major medical costs that could ultimately force bankruptcy. One of the most critical elements of any insurance policy is the maximum out-of-pocket annual limit. That's a fancy way of saying the total amount of medical costs that you could be responsible for paying in a single year.
Since policies contain co-payments, co-insurance and sometimes multiply deductibles, confirm what you'd end up spending in a worst-case scenario. Why don't Tennessee insurers just say what they will pay and what you'll have to pay? Perhaps someday the pressure to increase transparency will make that possible. For now, there are online resources that can help you decipher what insurance terms mean in terms of how much you'll actually be paying for health care with a particular policy.
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