Hi, 48 yr. in divorce, need medical insurance

[shadowfax]

I am 48 years old. My husband had an affair early last year, he couldn't stop. We tried to reconcile for a year, but that didn't work. So, we are in the middle of a divorce proceeding to end our 20 years of marriage. It will end in two months.

I was part of his company group health plan for the past 10 years. The insurance company is Aetna. After the divorce, I won't have it anymore. I have been self employed since 1990. So, I don't belong to any group or company. I will need to find something. I will live in Washington and in Hawaii. I am in pretty good health, fit, never smoke, don't drink. .. Physical exam results are perfect.

4 years ago, I was diagnosed for Sleep Apnea. So, I use CPAP machine.

What are good insurance companies and brokers I should contact? What areas should I pay attention to? Could you please send me their web sites or phone numbers. Should I be on Cobra or not?

Thank you.

 

[REWahoo]

Hello shadowfax and welcome to the forum. Sorry about your situation.

Regarding health insurance, please take a look at our FAQ section, in particular the information compiled in the "Buying private health insurance" thread. A lot of good information there.

 

[Moemg]

Welcome to the forum and sorry about your divorce !

 

[FIRE'd@51]

Welcome shadowfax. I believe in the event of a divorce, you would be eligible for COBRA for 3 years. However, since you will still have 14 years until Medicare after you come off COBRA, you may not want to risk waiting 3 years to try to buy private insurance, especially if you are healthy now and can get a good policy at a reasonable rate.

 

[shadowfax]

Thank you much for the quick responses. I will check them out. This is very depressing.

 

[haha]

Since you will be living in Washington (my home), unless the law has recently changed you can go directly from Cobra to an individual policy without underwriting or even having to answer the usual questionnaire. I myself did this several years ago.

In that regard WA is a pretty good place to make this transition.

Ha

 

[Bikerdude]

Personally, if I was in your situation (48 and good health) I would look seriously into an HSA (Health Savings Account). This combines a high deductible (say 5k or 10k) health plan with a tax deductible and tax sheltered saving account that can be used for HC costs. These can be purchased for a resonable monthly amount. If you can afford $5,000 (on the chance a medical emergency did happen) this could be a very cost effective way to go. You could even end up making money. Good luck!

 

[MovingtotheCove]

Sorry to hear about your situation....

I would also agree that looking at private insurance (search websites such as eHealth Insurance) with a High Deductible and combined with an HSA account might be worth investigating. You pay 100% up to the deductible of whatever and then it pays 100% over that. Usually tough to get maternity coverage with such a plan but for other things quite good.

 

[FIRE'd@51]

Since you will be living in Washington (my home), unless the law has recently changed you can go directly from Cobra to an individual policy without underwriting or even having to answer the usual questionnaire.

Is that any individual policy offered by any insurance company in the state of WA? Or is it one particular guaranteed-issue policy that is more expensive than those for which you must go through underwriting?

The latter is the case here in VA.

 

[haha]

Is that any individual policy offered by any insurance company in the state of WA? Or is it one particular guaranteed-issue policy that is more expensive than those for which you must go through underwriting?

The latter is the case here in VA.

Although the state of WA does have a guaranteed issue pool, that is not what I am referring to. This is any policy you might want, that is comparable in coverage to the COBRA that you are leaving.

If you have let COBRA lapse, or never qualified for it, then you might be thrown onto the guaranteed issue pool if you have conditions that make you a non standard risk.

Ha

 

[Stevewc]

Just to add another possibility to the mix, keep in mind that the legislation that is about to be voted on includes cobra until age 65. I'm not sure what it will look like by the time its finished but could be something worth looking at.
Steve

 

[Martha]

There was a guide that isn't published anymore that discussed in detail your rights in each state regarding health insurance. Below is the section of the guide which addressed buying an individual health plan in Washington state, it talks about when you cannot be turned down for individual health insurance. This information is now a couple of years old so may not be entirely accurate:

Generally, insurers that sell individual coverage in Washington can turn you down if you have health problems or a history of health problems. In most cases, you will be required to complete a standard health questionnaire (a health screen) to determine your eligibility for an individual health insurance policy. Your health conditions will be assigned points depending on how costly they are. If you accumulate more than 288 points, you can be turned down. If you accumulate less than 288 points on the health screen, the insurer cannot turn you down.

· If you are not eligible for an individual health insurance policy because of your health, the insurer must give you a written notice telling you that you are eligible for health coverage provided by the Washington State Health Insurance Pool (WSHIP). The insurer must also provide you with an application for WSHIP. If the insurer does not provide or postmark the notice within 15 business days, then the insurer must sell to you an individual health insurance policy.

· There are some situations when you do not have to take a health questionnaire and must be offered an individual health insurance policy

You do not have to take a health questionnaire and be offered an individual policy if you are relocating from one area of the state to another or you are changing plans to stay with a family doctor who was removed from the network of your previous plan.

You do not have to take a health questionnaire and must be offered an individual policy if you are HIPAA eligible. If you are a HIPAA eligible individual, you qualify to buy an insurance policy from an insurance company selling individual health insurance. Insurers must offer you a choice of all the individual health insurance policies they sell, unless they elect to make a choice of only two policies available to HIPAA eligible individuals.

In addition, where you are HIPAA eligible, you can also buy individual coverage from WSHIP, if you prefer. (See page 23) To be HIPAA eligible, you must meet certain criteria.

To be HIPAA eligible, you must meet certain criteria:

If you are HIPAA eligible you are guaranteed the right to buy an individual health insurance policy and are exempted from pre-existing condition exclusion periods. In Washington, if your most recent coverage was under a fully insured employer group plan, you can buy a conversion policy. If, not you can buy individual coverage from any insurer in the state that offers individual policies.

To be HIPAA eligible, you must meet all of the following:

· You must have had 18 months of continuous creditable coverage, at least the last day of which was under a group health plan.

· You also must have used up any COBRA or state continuation coverage for which you were eligible.

· You must not be eligible for Medicare, Medicaid or a group health plan.

· You must not have health insurance. (Note, however, if you know your group coverage is about to end, you can apply for coverage for which you will be HIPAA eligible.)

· You must apply for health insurance for which you are HIPAA eligible within 63 days (90 days if applying for group insurance coverage) of losing your prior coverage.


I suggest that you meet with an independent insurance agent and discuss your options. You may very well simply qualify for an individual plan without worrying about whether you will have to buy a HIPAA plan.

 

[wheel9]

I read a recent article where someone signed up for classes at a local University in order to qualify for student insurance which was very reasonably priced and had no age limit at this particular university. Might be worth exploring.

 

[Koolau]

Shadowfax,

Didn't quite catch whether you planned to w*rk or not. If so, Hawaii requires employers to offer health ins. to "full time" employees, though much of the cost may be passed to the employee. Still, I think it covers just about anyone for anything, though I don't know that for a fact.

RIght now, a j*b in Hawaii is not so easy to come by, but you might check it out. If you have a certain skill set or specialized qualifications, it's possible you might get health ins. in this way.

I've heard good things about the state of Washington as far as a place to be, but I know how wonderful it is to actually live in Hawaii, so I'd be leaning in that direction if you could pull it off. Perhaps you could get the Ex to stake you to a move as part of the settlement. You both might like the distance this puts between you.

Sorry to hear of your situation and hope all turns out for you. Be sure to check back here with an update and/or further questions.

God speed!

 

[Bestwifeever]

Can the cost of insurance coverage for you be made part of a settlement?

 

[Olbidness]

Shadowfax,

Welcome. Sorry for your current situation. Speaking from experience. IT WILL GET BETTER.

I think Bikerdude was right on with the High deductable/ HSA route.

Also if you have an IRA or will get money from an IRA/401k as a settelment, you could roll some of that money into a HSA without taxes and just have a small monthly premium for your insurance.

( I hope these links work, I'm kinda computer challenged)

http://ustreas.gov/offices/publicaffairs/HSA
http://www.ehealthinsurance

 

[Gotadimple]

Shadowfax,
You say you are self-employed? Do you belong to any industry associations? Or your local chamber of commerce?

Many times an association or a chamber will sponsor a health plan. That would get you into a plan on a group basis. There may be certain minimum requirements to qualify (like paid membership for a minimum period of time before applying), but it is another alternative.

-- Rita

 

[Martha]

I read a recent article where someone signed up for classes at a local University in order to qualify for student insurance which was very reasonably priced and had no age limit at this particular university. Might be worth exploring.

Often these plans have very low maximum claim limits and limits on how much they will pay for an illness. Exclusions are often common, such as not covering transplants.

 

[Voyager]

Group Health

Hi,

I was in a similar situation five years ago and chose to enroll in Group Health Cooperative. I am a resident of Washington State, so my choice might be relevant to yours.

Group Health, as you may know, is a Health Maintenance Organization (HMO). You must first see a family doctor, internist, PA, or nurse practitioner, who acts as "gatekeeper" before you can access most specialists (dermatologist, etc.).

The downside (limited access to specialists) in my case was outweighed by the upside (premiums of about $160 per month at age 48, much cheaper than Blue Cross/Blue Shield and similar PPO plans).

Some significant preventative procedures, i.e. mammograms are 100% covered. Downside: almost nothing else is 100% covered. You will pay $95 for a typical office visit, and 100% of prescription drugs. (My biggest worry).

But, you are limited to $4000 per year out-of-pocket medical, and there is a $1 million lifetime coverage limit. Enough to keep me from disaster until I hit Medicare eligibility (I hope). Also, you can shelter about $3000 a year taxable income, in a Health Savings Account (for me, this means my co-pays, prescriptions, etc., if any, are 15% tax advantaged since this is my tax bracket; your savings may be greater).

Is this the health plan of my dreams? No. But paying around a couple of grand a year in premiums vs. six or seven thousand, is a big positive for me. I am (reasonably) confident that if I got cancer or some other life-threatening disease, I would receive very competent care. Most surgeries and interventions would occur in their own hospitals; but if you need something exotic but non-experimental, it's my understanding that they have to pay for it elsewhere, if they don't have the Group Health in-house expertise.

I'm sorry you have to scramble around for health insurance under the circumstances you're facing. As others have suggested maybe you can negotiate continuation of the coverage you were receiving pre-divorce in your settlement (seems only fair).

But if you want basic coverage without paying $400-$500 per month, and you live/work in Washington and are 48 and in good health, you should be able to get it at Group Health.

 

[Zoocat]

Hi there Shadowfax,
I echo the previous sentiments. It will get better, I promise.

As for the health insurance situation. You are probably better off taking the COBRA now. Get yourself settled into your new residence, get the divorce finalized. Then find an excellent independent health insurance broker. Do not use ehealthinsurance.com or any of those other online quote sites. They will only give you a ball park figure. You need a broker who will pre screen you with various companies and tell you exactly what you will quality for and for how much.

I'm semi-retired and self-employed PT. I ended up with World Insurance which is the Great West Network. It might be available in Washington State. I don't know. I have a $2700 deductible.

I do urge you to get on your own policy as soon as you feel able to deal with the process. It is a lengthy and somewhat stressful process because you have to collect all your medical records for the past ten years and all the doctors information as well.

The danger is that you might come up with some other medical situation between now and the time you apply for your policy that could limit your choices.

I wish you all the best.

 

[martyb]

Shadowfax, my contribution to this discussion is that you might look into the possibility of obtaining a federal civil service job, regardless of grade, in order to take advantage of the no-qualifying access to federal employees group health insurance. There is no pre-existing condition clause (I know you said you are in perfect health) and if you keep the coverage for 5 years, and then stay on until you qualify for the most minimum retirement status, you will be able to keep the insurance for life, paying only the employee portion of the premiums. The employer covers approx. 75% of the premiums, so it's a good deal. Just another angle to consider. Best of luck.

 

[TopDown]

SHIBA in Washington State

Shadowfax - The State of Washington has Statewide Health Insurance Benefits Advisors (SHIBA). The first link is to the State website. The second link is to the Whatcom County website. The second one has a friendlier feel to it but both have the same 800 number. Good luck and hope they can help you.


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