Health insurance provides peace of mind as well as coverage on services from preventative care to hospital stays. Everyone should be afforded basic healthcare coverage, and state funded health insurance is the answer for some. Like any other type of coverage, it has cons that seem very unfair. I am continually finding out in very costly ways.
I was denied healthcare coverage through private insurance on more than one occasion because of preexisting medical conditions. I would not have been able to afford the insurance even if I had qualified. Eventually I became eligible for state funded coverage, but it is not without hitches, exclusions, aggravations and drawbacks. It is far better than nothing, but it is not free – at least not for me, and the cons are frustrating to say the least.
Policies and Cons Vary
Keep in mind that inclusions, exclusions and coverage varies from one state to the next. When trying to find out the cons of Medicaid before signing on, consider the following possible issues and problems, and consult your insurance provider for policy details. Also, many more cons may exist than what I have listed. These are the cons that I have experienced thus far with state funded health insurance that I personally pay for each and every month.
One of the cons of state funded health insurance is a major lack of choice. You can only see one general care physician. If that doctor is not available when you need care, you will not have the luxury of making an appointment elsewhere. If you do, it will not be covered. The doctor must accept Medicaid patients, and those patients must sign on through their insurance plan before making an appointment. If the doctor does not work out for whatever reason, you can go elsewhere, but there are still cons. The insurance company must be notified of your desire to change providers, and they must approve that change before moving on.
Out of State Prescriptions are Not Covered
Another one of the cons of state funded health insurance is a lack of freedom of another kind. If you leave the state for work or pleasure and require a prescription refill while out of town, it will not be covered. I found out the hard way while on vacation in Arkansas. The article entitled Out of State Prescriptions on the Healthy Indiana Plan explains what happened in my particular situation. Check your state funded health insurance policy for details. You might run into the same problem if you should require a prescription refill.
Prior Authorization Problems
State funded health insurance policies are far more limited than private plans or company funded plans. Even though it is considered Medicaid, I pay for my health insurance, and the cons are quite costly at times. A prior authorization requirement is another one of the many cons. I require daily medications, and I am only allowed a two day grace period to pick up one of the prescriptions before it runs out. Because I only have two days in which to pick it up before running out altogether, I must plan my activities around those two days, each and every month.
To add insult to injury, it is not on the covered list. It requires a prior authorization even though my doctor prescribes the medicine. She would not prescribe it if I did not need it, but the state funded insurance company demands that I jump through their hoops before they will pay. It is just another one of the many cons and inconveniences of state funded insurance, and it is ridiculous and unfair. On more than one occasion I had to pay full price for the medication because of a technicality regarding the date.
I would be more than willing to pay more for health insurance that is not partially funded by the state, but the cost is far too high. If health insurance companies will be allowed to continue to discriminate against those with health problems, I will not qualify anyway. If at all possible, opt for private or company health insurance instead of the state funded variety. The savings is not always worth the many cons, expectations and unreasonable limitations.
Source: Personal Experience with the Cons and Pitfalls of State Funded Heath Insurance
