Surgery is the type of major medical event that one typically envisions health insurance covering. People don’t generally buy insurance just to cover the small stuff.
But according to a report from Kaiser Health News, many plans offered through Healthcare.gov don’t cover outpatient surgeries, which account for two-thirds of all surgeries performed in the U.S.
And yet, the current situation represents an improvement for the Patient Protection and Affordable Care Act. After the law was implemented two years ago, many employers that had previously not offered insurance to their workers began providing employees with insurance policies that did not provide any coverage of hospital services, including inpatient surgeries. The Obama administration told employers that such plans did not offer the minimum level of coverage required under the law, and that they would be subject to fines if they did not offer more comprehensive coverage.
As a result, employers and insurers seeking to offer the lowest level of coverage possible without running afoul of the law now offer to cover inpatient surgeries but not outpatient ones. But some suggest that the administration won’t stand for this cost-cutting technique either.
“I really wonder whether they can do that,” Timothy Jost, a law professor and expert on health law at Washington and Lee University, told Kaiser. “Refusing to cover any outpatient physician surgical services is arguably a violation.”Large low-wage employers that have traditionally not offered their workers benefits are the target market for these types of “skinny plans.”Cathy Reichelderfer, the CFO of JFC Staffing, a temp agency based in Camp Hill, Penn., voiced conflicting feelings about providing skinny benefits to more than 700 of the company’s employees.
On one hand, she explained, the company wants to comply with the law to avoid paying fines. However, if it simply didn’t provide coverage, its employees might be able to acquire more comprehensive coverage through the individual marketplace. Employees who are provided coverage through their employer typically aren’t eligible for subsidies to buy individual plans through the PPACA marketplace.
On its website, JFC Staffing touts the health insurance it offers new associates: “Low co-pay health insurance and prescription plans are provided to associates and their families right away!”