Sunday, July 13, 2008

Coming Up Short

[Welcome Kaiser Network readers!]

A million bucks doesn't go as far as it used to.

Neither does $2,000,000.

But according to CNBC and the Kaiser Foundation, 22% of employer group plans had capped benefits at $2,000,000 lifetime.

Mary Wusterbarth thought her toddler was struggling with an ear infection when she seemed sluggish. Instead, a virus had attacked the little girl's heart, damaging it beyond repair. Brea needed a transplant.

Within three weeks of a 2007 doctor visit, the 20-month-old had exhausted the $1 million lifetime maximum on her health insurance. Her parents have scrambled ever since for ways to cover thousands of dollars in monthly medical costs.

My experience is, it is mostly public plans that have low caps. Private industry usually chooses much higher caps.

Employees who participate in the state of Georgia plan have a $1,500,000 cap.

Setting a low cap is not a cost saving measure. To increase a cap from $2,000,000 to $5,000,000 adds about 5% to the premium.

Kelly and Tom Treinen had an option. They could have chosen a plan with a $5M cap through Tom's business. Instead, they opted for the plan with a $1M cap through Kelly's job as school principal.

Then their son became ill with leukemia.

His treatment called for 10 doses of a chemotherapy drug that cost $10,000 per dose. A 56-day stay in an intensive care unit cost about $400,000.

Michael reached his $1 million lifetime maximum in less than a year. The Noblesville, Ind., family had to issue a public plea for help after a hospital told them it needed either $600,000 in certified insurance or a $500,000 deposit to continue preparing for a critical bone marrow transplant.

$1,000,000 seems like a lot of money. It is, until you need every penny and then some to restore your health.

Mary Wusterbarth, a stay-at-home mother with two other children, thinks legislation on minimum lifetime caps is an excellent idea.

This is not a legislative issue.

Rather, it is a matter of educating the public about health care and its' costs.

It is a matter of Functional Illiteracy.
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