Best states to avoid medical billing shenanigans?

January 22, 2020 8:33 AM

My brain hurts from Googling "best states for aca 2019" and I'm trying to figure out what criteria is important, and what I might be missing.

We're getting older (isn't everyone?) and thinking about where we want to settle down. Since healthcare is at least as expensive as rent, and medical bankruptcy seems as likely a hazard as fire, flood, or Giuliani, I am thinking I want protections at the state level, as well as low premiums and good healthcare (yes I want it all!)

I recently was reading up on state protections for balance billing and state efforts to control spending. These aren't mentioned in the various listicles that come up in search results, so I am wondering what other state and local initiatives I'm missing, and how highly I should be weighing them. For example, Massachusetts has the #1 spot in many surveys, but hasn't implemented full protections for balance billing.

We're currently self-employed, and would like to keep doing what we're doing without having one of us beholden to an employer for insurance, as so many of our friends are forced to do. But I understand that self-funded plans may have fewer protections.

I'm also vague on the potential effects of the red-state ACA lawsuit and what states could best weather the shock were it struck down, for example could they successfully retain protection for pre-existing conditions?

Maybe I'm overthinking this, and I want the best overall healthcare performance, whatever that is. (Or maybe it'd be a better use of time to research countries, not states ... ?)

posted by RobotVoodooPower to Health & Fitness (6 answers total)

Every state has an attorney general, who heads their consumer protection agency, which will be strong or weak. Every state has an insurance regulatory agency, Maine's is pretty good ( biased, friend works there, but even so, they earned a B) and it translates into a bit more muscle for resolving entrenched problems. Harder to sift through rankings of health insurance providers. In Maine, it changed a lot and for the better with our Dem governor.*

AARP might be a resource, but they provide health insurance, so grain of salt.

*I'm at an event, Give. Mills just showed up before it started, got a standing ovation for being pretty darn terrific.
posted by theora55 at 9:13 AM on January 22, 2020

Colorado just passed a law outlawing balance billing.

My significant other and I are immigrating to Canada this year for the same reasons you asked this question described in that first paragraph. I'm self-employed and he's an apprentice so his goal is to one day be self-employed as well and to have other people work for him/train under him.
posted by zdravo at 11:41 AM on January 22, 2020 [1 favorite]

I don’t have an answer for your main question, but “self-funded plans” are a certain type of employer plan, not individual plans for self-employed people, so I don’t think you need to worry about the specific regulations for those.
posted by songs about trains at 2:17 PM on January 22, 2020

This is less of a legal aspect than a practical one, but if I were you, I would strongly consider moving to somewhere that had a large, well established Kaiser Permanente system. In the last ten years I've had them, you occasionally have to be a good self-advocate to get more care, but I've never had a billing issue. You know upfront exactly what it will cost, and the answer is usually $20 or $40.

That being said, you have to go to their doctors, their physical therapists, and their mental health staff. That can be a pain, but for me it was worth it. (And for what it's worth, I've had generally pretty great doctors.)
posted by mercredi at 2:19 PM on January 22, 2020 [1 favorite]

Not a lot of advice, probably because it really is that dire.

As to Kaiser Permanente, YMMV. Local charges are on the order of $120 copay to see a doctor, and $800 copay for imaging. Additional invoices arrive months after the service. Agreed on competent doctors and staff.

Overall, the current U.S. setup is optimized to extract as much cash as possible, whenever they can, out of whoever can pay.
posted by dum spiro spero at 4:55 PM on January 22, 2020 [1 favorite]

I don't know the answers for the specifics or comparisons you're asking about, but I like your overall idea of figuring healthcare costs into where you look to live. On that note, I'll mention one great thing about Massachusetts for before you're Medicare age: making less than 300% of the Federal Poverty Level (so about 50K for a family of two), qualifies you for ConnectorCare, which is good, cheap insurance. E.g. at most maybe ~$150/month for a respected name-brand HMO with a good network, $0 deductible, very low co-pays, and $1500+$750 prescription out-of-pocket maximums. If you make well under the ~$50K cap, the costs are even lower. That's thousands less per year than plans on the MA healthcare marketplace as a whole that have much higher deductibles, co-pays, and OOP's. There's no asset test; it's solely income-based. I don't know whether other states have comparable plans in place, or whether MA is a leader in this regard.
posted by daisyace at 10:51 AM on January 23, 2020