By Sam Habernathy
On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA), colloquially known as “Obamacare,” and despite some hiccups along the way, many claim that the ACA has already transformed insurance coverage.
Cosmetic surgery coverage, however, has essentially remained the same. The procedure definitions and ‘medical necessity’ criteria are virtually unchanged [i]. It remains difficult to get elective cosmetic surgery covered by health insurance.
What has changed since the ACA, however, is cosmetic surgery delivery and price.
The ACA switched Medicare and Medicaid reimbursement from volume-driven reimbursement to a value-driven model. Private insurance companies are following suit. This requires the adoption of electronic medical records (EMRs). The additional labor to administer EMRs and reduced reimbursements are forcing cosmetic surgeons to abandon private practices and opt into hospital networks [ii]. Today’s cosmetic surgery patients can expect to work with surgeons who are part of insurance-accepting hospital networks, as opposed to private practices.
The ACA includes a 2.3% excise tax on medical devices [iii], and these costs eventually make their way down to patients. Medical device manufacturers charge more for their devices to cover increased cost of production. Surgeons, facing increased cost of business, pass on the additional cost on to the consumer by increasing the price of their procedures.
The ACA is a sweeping piece of legislation. It is reducing the uninsured rate in the United States [iv], meaning more people are potentially eligible for cosmetic surgery. However, patients in today’s health market may pay more for these procedures, and they may undergo these procedures in a group practice as opposed to the posh private offices of yore.
Sam Habernathy is a contributor to Rhinoplasty Surgeons. He has been involved in health insurance for more than 10 years. He is ACA and Consumer Directed Health Care certified by the National Association of Health Underwriters. He can be reached via [email protected].
[i] WebMD [Internet]. Available from: http://www.webmd.com/health-insurance/affordable-care-act-is-this-covered
[ii] BuildMyBod—Plastic Surgery in the Age of the Affordable Care Act [Internet]. Available from: https://www.buildmybod.com/blog/plastic-surgery-in-the-age-of-the-affordable-care-act/
[iii] IRS.gov—Medical Device Excise Tax: Frequently Asked Questions [Internet]. Available from: http://www.irs.gov/uac/Medical-Device-Excise-Tax:-Frequently-Asked-Questions
[iv] Time.com—Studies Show Obamacare is Reducing the Ranks of the Uninsured [Internet]. Available from: http://time.com/2976166/obamacare-health-care-reform-affordable-care-act-uninsured/