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What is a Health Insurance Mandate and How Does it Affect You?
A health insurance mandate is something that a health insurance provider is required to cover, usually through State regulations. They can be imposed on all health insurance plans within the state or only on certain types of plans, such as group plans. Mandates usually fall under one of three categories:
1. Provider type: Massage therapists, psychiatrists, etc.
2. Benefits: Childhood immunizations, cancer screenings, etc.
3. Beneficiaries: Disabled dependents, Unmarried adult children, etc.
Each state has its own mandates and some have relatively few mandates, while others have many. Mandates provide a way for as many people as possible to get the health care coverage that they need, without paying out-of-pocket in addition to their health insurance policy. While this may sound great, there is a downside to these mandates – the more your state has, the more expensive health insurance policies will be in your area. If state A has 20 mandates and state B has 40 mandates, health insurance premiums in state B are likely to cost three times as much as a policy in state A. This is because the provider has to assume that you will take advantage of most of these coverage options, which can include podiatrist visits and acupuncture treatments, even though you may not.
However, the number of mandates isn’t the only thing that can drive up the cost of healthcare coverage in a state, as some mandates are much more expensive than others or may be more popular than others. For example, a mandate that many people will end up using, such as a certain number of ultrasounds during pregnancy, will cost much more than an alternative medicine treatment for foot odor. Likewise, a mandate on IVF and other expensive fertility treatments would make insurance costs skyrocket as well. Read more
A Test for Small Businesses: How Age & Pre-Existing Conditions Affect Coverage Options
With the high cost of health insurance coverage these days, it is only reasonable that many people look to their employers first and foremost in order to try and get the health coverage they need. But for those employed by a small business, this solution can be hard to come by. Although some small business owners just cannot afford to offer their employees healthcare coverage, others are willing to help pay for their employees health insurance policies, but are unable to secure a plan due to circumstances within their business.
There are two main factors that help keep a small business from acquiring health insurance for their employees: age and pre-existing conditions. For larger businesses with hundreds or thousands of employees, these factors have less of an impact because there are plenty of young, healthy people to help spread the risk around. The plans may be a little higher, but the employer can still secure health insurance for their employees. However, a small business may be completely shut out and denied by an insurance company if even just one or two of their employees are older or have a pre-existing condition, simply due to the fact that there are not enough young, healthy employees to help spread the risk around enough for it to be beneficial to the health insurance provider.
For these businesses, they have no choice but to ask their employees to purchase their own private health insurance or remain uninsured. Their options are severely limited and even if they could secure a policy, it would likely be sky-high. So how can a small business overcome this obstacle? There may be one good option. One that many self-employed persons use to help secure a group plan for themselves that is more affordable than a private, individual plan: join a group of other very small businesses and apply for a policy as one. One small business with 10 employees may not be able to get reasonable health insurance coverage for their employees, but 100 small businesses with 10 employees – totaling 1,000 employees covered under the plan – may be able to, since there is a larger pool of people to spread the risk around to. These plans may not be as cheap as those from employers who have thousands of employees, but it will be a cost effective solution to the alternative of no insurance or costly individual coverage for some of your employees.
Remember, running a small business has many challenges and obstacles that you must learn to overcome and adapt to … finding health care coverage for you and your employees is no different. It is just another aspect of running a small business that you must learn to find a positive, cost-effective solution to, just as you would any other business operation. If you can afford the coverage and can secure it for your employees, you will be able to retain the outstanding employees that you already have and pick up some of the best and loyal employees on the market.
