Insurance Options for Health Care Access in Rural Areas

HealthCare Writer

Updated on January 31st, 2021

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It probably comes as no surprise that studies show rural areas of the United States have fewer health care providers. For the 20 percent of Americans living in these locations, this often means that they must travel substantial distances to access health care services, as well as often have long wait times when trying to schedule appointments. These factors can result in many residents choosing to forgo preventive and screening services, and even delay treatment for illnesses and injuries. Ultimately, many rural residents make the decision to seek medical treatment only in emergency situations.

But alternative health coverage options, such as short term medical insurance, offer you different choices, including the flexibility to visit any health care provider that you want to see. Here’s why that’s important:

If you live in a rural area and have been thinking about purchasing a health insurance plan through the marketplace exchange, consider this: the issue of health care access in rural areas has recently become even more complicated. An analysis by the Centers for Medicare and Medicaid Services shows that more than 1300 counties in the U.S. – many of them rural – might be limited to having only one marketplace exchange insurer option in 2018. And with most exchange insurers limiting benefits coverage to narrow provider networks, if you live in a rural area, purchasing an exchange plan may mean you having fewer health care provider choices than ever before.

Short Term Medical – Flexible Coverage to Meet Your Needs

Compared to traditional major medical plans, short term medical insurance offers many similar benefits, such as:

  • Hospitalization, surgery and medical services coverage
  • Physical therapy
  • Mental health services
  • Home health care and extended care facility
  • Up to $1,000,000 in benefits per coverage period

When you purchase short term medical insurance through Pivot Health, you even receive added non-insurance benefits, including:

  • Valuable discounts on vision care services and products
  • A prescription drug savings card for use at thousands of pharmacies throughout the country
  • 24/7 telemedicine consultations, enabling you to skip traveling to the doctor’s office, and instead connect with a doctor whenever it is convenient for you.

Short term health insurance also provides you incredible flexibility for several key features, so you can have your desired coverage and see the providers you want, all at an affordable price.

Plan Features

When you purchase short term health insurance from Pivot Health, you choose the coverage options that meet your benefit needs and budget. For example, you have the freedom to select from various amounts for your:

  • Deductible – options range from $1,000 to $10,000
  • Coinsurance – either 20 percent or 30 percent
  • Out-of-pocket maximum – choices range between $3,000 and $10,000
  • Copayment – decide whether to select a plan that offers copays for primary and specialty physicians, and for urgent care services

You may even choose plans that have separate deductibles for prescription drugs, and copay options for generic and brand prescription medications.

Coverage Choices

Short term health insurance provides you medical coverage for a designated period until you find a more permanent health insurance solution. Federal regulations state that short term medical plans may provide a minimum of 30-day and up to 364-days of coverage per certificate of insurance. In addition, Pivot Health offers the opportunity to apply for four consecutive short term health coverage certificates at one time (depending on your state’s regulations). By purchasing four 90-day policies, you receive a lower rate than 364-days of coverage, but you are required to download a new ID card eery 90-days. Deductible, coinsurance and out-of-pocket maximums also restart every 90-days. Purchasing back-to-back certificates during your initial application means that you won’t need to re-qualify at any point during the duration of your coverage. (Most states also allow you to purchase an additional two years of coverage after your first year of coverage expires.) No mater which coverage durations you select, Pivot Health offers you the flexibility to select the duration of coverage that best meets your needs, whether it’s a few months or up to nearly a full year.

You also have great flexibility when selecting your coverage start date with Pivot Health – you may begin coverage anywhere from 24 hours up to 60 days after applying. There’s no penalty for canceling your coverage at any time. Through Pivot Health, you even receive a 10-day “free look” period. If you purchase a plan and cancel within the first 10 days, and haven’t filed any claims, you’ll receive a full refund of your premium.

No Provider Restrictions

Unlike most exchange plans, which typically have limited provider networks, short term medical coverage offers you the flexibility to visit any health care providers you want. This is particularly valuable in rural areas which already have fewer provider choices, as well as for individuals who require specialized care, or prefer to visit certain providers.

The freedom to visit the providers you want and obtain coverage that meets your needs at a budget-friendly price makes short term health insurance a reasonable alternative to exchange plan coverage.

Challenges for Marketplace Exchange Plans in 2018

Despite talk since the 2016 election that Republicans would replace and repeal the Affordable Care Act, all Congressional efforts to act have failed thus far. And unless Congress acts quickly after returning in September from their end-of-summer recess, it is unlikely that any significant reforms will go into effect for the federal health care legislation by 2018.

The Centers for Medicare and Medicaid Services issued new regulations earlier this year to help stabilize the exchange markets. These regulations included reducing the annual enrollment period to align more closely with employer-sponsored insurance enrollment periods, requiring insureds to pay back premiums from previous year’s coverage before automatically enrolling in coverage for a new plan year, and requiring more documentation to verify the validity of special enrollment requests. These changes were intended to reduce the number of people who enroll in coverage only after they need health care services, or who stop paying for coverage after receiving costly medical treatment.

However, industry experts have stated that Washington needs to take more substantive actions. First, experts have urged the federal government to enforce the individual tax mandate, which was designed to compel healthy individuals to enroll in exchange plans and thus dilute the insurance risk pool by providing premium payments to help offset claim costs for less healthy enrollees.

Second, insurers have asked for a firm commitment from the government to continue funding cost-sharing reduction subsidy payments, which are reimbursements that the government pays to exchange insurers for offering discounted rates to low-income exchange enrollees. For 2017, the federal government is scheduled to reimburse exchange insurers approximately $7 billion. However, the Trump administration is considering whether to continue those payments, or instead, simply let the Affordable Care Act exchanges implode. A federal court has already determined that the government is not obligated to fund the reimbursements.

Third, although Congress suspended the Affordable Care Act’s tax on health insurers for 2017 (costing the government almost $14 billion in revenue, which would have helped fund parts of the federal health care legislation), that tax is scheduled to be imposed on insurers again in 2018. Should that tax resume in 2018, insurers have stated they will need to increase premiums by an additional 3 percent to compensate for that tax, and therefore they are currently lobbying Congress for an outright repeal of that tax provision.

For months, insurers have warned that without the government taking these three steps, chaos could ensue. Now, with the September 27 deadline looming for insurers to sign contracts with the government outlining the marketplace plans and rates they will offer in 2018, it’s clear that many exchange insurers are filing significant premium rate increases for 2018, or withdrawing entirely from the exchange.

Staggering Premium Increases

Although many states have not yet received filings from exchange insurers with 2018 plan and rate requests, of the approximately 20 states that have received filings, the trend is clear – throughout the country, exchange insurers are proposing substantial premium rate hikes for 2018. For a mid-range “silver plan”, insurers have filed increases such as 29 percent in Seattle, 34 percent in Albuquerque, 23 percent in Philadelphia and 49 percent in Wilmington, Delaware, and are now awaiting approval or changes from those states’ regulators.

In Maryland, however, state insurance regulators have already approved staggering average rate increases between 23 and almost 50 percent. While these rate increases were approved, they were lower than the requests filed by the state’s only two exchange insurers, which stated that they have lost more than $447 million combined since they began selling exchange plans in 2014. Even these significant premium increases won’t be enough to cover those losses.

The financial impact of these premium increases on individuals who do not receive government subsidies to help pay for their coverage is devastating. According to a recent study by the Kaiser Family Foundation, about 1.6 million exchange enrollees earn too much to qualify for subsidies. Further, another 5.1 million individuals buy coverage off the exchange, often because they don’t qualify for subsidies, or perhaps are unable to find a plan which allows them to see their providers of choice. It’s clear that at a certain point, these premium increases will become unsustainable for many consumers.

Limited Exchange Insurer Choices

With many insurers completely withdrawing from the marketplace exchanges, there are now approximately 2.5 million individuals – about 23 percent of exchange enrollees – living in counties where only one insurer will offer coverage in 2018. This is a less-than-ideal situation for enrollees. First, when there are fewer (or no) choices in the exchange markets, insurers may not price premium rates competitively for consumers. Second, a lack of choice means that individuals will probably have few choices for doctor and hospital networks covered by the insurer. With many of these counties being rural or sparsely populated, residents already have limited access to primary and specialty care providers.

Although some communities are starting to increase access to health care providers through innovative rural health care models, such as Frontier Extended Stay Clinics and Frontier Community Health Integration Programs, as well as creating team-based care models such as Patient-Centered Medical Homes, there is no guarantee that exchange plans will pay benefits for services provided by these programs if they are not part of the plan’s provider network.

Short Term Medical – A Sound Coverage Alternative

If you live in an area with only one insurer option available to you, consider short term medical coverage as an alternative option. The flexibility to visit any health care provider and select a plan that meets your benefit and budget needs can be compelling. Plus, the telemedicine benefits you receive with Pivot Health’s short term health insurance plans can be a smart and convenient solution for you to connect with a health care provider for many medical situations.

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