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December 31, 2003

Wal-Mart and Health Insurance

The meme seems to be that Wal-Mart foists its worker's health coverage on the state, by offering little or none of its own. Daniel Weintraub reports this is not the case at all.

...Wal-Mart has structured its health benefits to emphasize catastrophic care. While the company has relatively high deductibles – up to $1,000 for a plan that costs an employee $13 every two weeks – it also pays 100 percent of medical charges above $1,750 a year in out-of-pocket expenses. ... Wal-Mart has no lifetime caps on its coverage...

The idea of health insurance, after all, is to prevent unexpected medical bills from bankrupting and devastating an individual. In this regard Wal-Mart’s coverage might be on the cutting edge. While it leaves individual workers responsible for routine expenses, Wal-Mart’s coverage steps in when things get serious and then covers everything, forever. Doesn’t sound so bad.
And that's not even the whole story. One thing that you never see quoted, and is always missing from those benefit tables, is the insurance company's negotiated discounts with its preferred medical partners.

Even if NONE of an expense is covered due to deductables, the patient often pays significantly less due to these standard discounts. I've seen one case where a hospital's charges were discounted from a $43,000 rack rate down to $1300, before the insurance/patient split was calculated. That's unusual of course, but routine discounts of over 50% are not uncommon.

Given these negotiated discounts, any insurance is better than no insurance.

Posted by Kevin Murphy at December 31, 2003 03:50 PM | TrackBack