Managed Care - July 2008 - (Page 48) Young invincibles don’t get proper care s might be expected, being uninsured or sporadically insured during the course of a year impedes access to the health care system. “If young adults lose their coverage at age 19 or upon graduation from college, their ties with primary care physicians may be severed at precisely the time they should be forming stronger links to the health care system and taking responsibility for their own care,” says “Rite of Passage: Why Young Adults Become Uninsured and How New Polices Can Help, 2008 Update,” a study by the Commonwealth Fund. Only 41 percent of uninsured adults 19 to 29 had a regular doctor, compared with 79 percent of those who were insured all year. The cost of care prevented two-thirds of young adults from seeking needed services if those young adults had been without insurance coverage. A Cost makes many young adults defer care Total Insured all year Uninsured during the year 54% 49% 41% 30% 21% 19% 9% 32% 27% 16% 18% 40% 35% 34% 66% Did not fill a prescription Did not see a specialist when needed Skipped medical test, treatment, or follow-up Had medical problem, did not see doctor or clinic Any of the four access problems Source: The Commonwealth Fund Biennial Health Insurance Survey (2007) them’s medical and pharmacy directors were very involved in structuring the benefits in the coverage options offered. “Medical directors play a critical role in translating medical policy into member benefits,” says Ward. Anthem’s market research pinpointed three main reasons young adults go without insurance. They view it as being too expensive, too complicated, and too difficult to apply for. Tonik addresses those concerns, says Ward. Three options Except for the generics-only drug benefit, Tonik has more extensive benefits than what can usually be found in the individual market, unless someone buys optional coverage, Ward says. Tonik offers three plans, the Risk Taker with a $1,500 annual deductible, Dare Devil with a $3,000 deductible, and the Thrill Seeker with a $5,000 deductible. The premiums in California range from $90 to $167 a month. The exact amounts are based on several factors, including state insurance regulations, age, health, geographic region, and the member’s desired deductible and co-insurance levels. The Tonik plans also include limited dental and vision coverage. “You have preventive dental coverage, you have limited-dollar vision coverage,” says Ward. “The medical plan includes dental benefits for preventive, diagnostic, and minor restorative services.” The actuarial benefit of dealing with a young population enables the health insurer to offer Tonik at reasonable premium rates, says Ward. “An individual plan is rated differently than employer-based plans,” she says. “In the individual market and with Tonik, you find that premiums are more appropriate for what younger and healthier persons might experience [in terms of needed services].” What generates the publicity Tonik receives is 48 MANAGED CARE / JULY 2008
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