Planning to apply for Health Insurance

[Lakewood90712]

I'm planning to leave my full time employer (Municipal Gov.  in so cal) , and work part time for   private employers.   

  Late 40's ,Have 2 pre-exist conditions,
2 bad disks in lower back, no surgery done or recomemmded , and a urinary tract problem that required outpatient surg. in 1987 and last year.

I can get BC PPO under COBRA for 36 mo at about $520/mo.  After that ,under HIPPA, how high can the rates go ?  My pref. is a high deductable plan with lower rates.

? Am I better trying to get my own coverage before I leave , and use COBRA, only if denied coverage ? and does anyone know if the above conditions would  be unacceptable to the insurance carrier? The insurance brokers seem evasive on that topic.

Second Ques.  Any good ideas for 20 /hr week employment with group health, even if employee has to pay most of the cost?   Do part time teachers have access to health insurance ?

Thank's in advance.

John.

 

[Rich_by_the_Bay]

2 bad disks in lower back, no surgery done or recomemmded , and a urinary tract problem that required outpatient surg. in 1987 and last year.

I can get BC PPO under COBRA for 36 mo at about $520/mo. After that ,under HIPPA, how high can the rates go ? My pref. is a high deductable plan with lower rates.

? Am I better trying to get my own coverage before I leave , and use COBRA, only if denied coverage ? and does anyone know if the above conditions would be unacceptable to the insurance carrier? The insurance brokers seem evasive on that topic.

John,

Generally COBRA applies only to continuation of prior coverage under your last employer, and is only for 18 months, not 36. Your situation may be different, but best check it out. Also, HIPPA does not provide or require health insurance; it is just the larger program under which COBRA is mandated. COBRA rates are the same as your past premiums plus a 2% administrative surcharge.

Your preexisting conditions -- esp the back -- probably will cause you difficulty, either in finding coverage or in the premiums you pay. Brace yourself.

May as well use COBRA for the full 18 months allowed, and start looking around for alternatives at about 15 months out. Then pray that the rules have changed, or consider a part-time job which provides group health.

Alas, this is a dilemma faced by millions of Americans. Maybe under future administrations things will change; hard to know.

 

[REWahoo]

...COBRA rates are the same as your past premiums plus a 2% administrative surcharge.

Actually you will pay both your premium and the employer's portion, so your cost for COBRA could be significanly higher than your past premium. In my case, it doubled.

 

[Rich_by_the_Bay]

Actually you will pay both your premium and the employer's portion, so your cost for COBRA could be significanly higher than your past premium. In my case, it doubled.

Exactly.

And, if your employer's group insurance changes you are subject to the same rates a current employee would pay, I believe.

It's better than a sharp stick in the eye, I guess. Lots of folks just can't get coverage without working half-time or more. Period. Sucks.

RWWahoo, may I ask what kind of coverage you have, and how much it's setting you back? I have BC/BS with all the frills for me and DW, would cost me about 12K per year if I were on my own.

 

[free4now]

I'm in a similar situation... I left work a few months ago, and I'm using CORBA.  I applied for an individual policy but was denied... as reasons for the denial they listed almost every medical event I wrote down on my app, but listed my ear issue (hearing loss on one side for which I had an operation) as being the main reason for denial.

I'm thinking I'll continue to use CORBA for 18 months ($470/mo is quite high for a 36 year old like myself, but it's excellent coverage).  Then I can go into the California high risk pool, for which coverage costs in the same ballpark for much worse coverage.  http://www.mrmib.ca.gov/MRMIB/MRMIP.html

That is good for up to 36 months, but 2 years from now I might go with the group insurance offered to IEEE (an engineering society) members.  It costs $400something per month for mediocre coverage and looks like they won't reject based on preexisting conditions.   You have to be an IEEE member for 2 years to qualify, which is why I just joined recently.

In the meantime I'll keep applying to other individual plans in case one accepts me.  My understanding is that California doesn't allow individual plans to exclude preexisting conditions (if you have HIPAA continuous coverage), so in CA it seems that the individual plans will just reject you flat out if you have a condition they don't want to deal with.

 

[REWahoo]

RWWahoo, may I ask what kind of coverage you have, and how much it's setting you back? I have BC/BS with all the frills for me and DW, would cost me about 12K per year if I were on my own.

Rich, I'm paying ~$750/mo for a low deductible United Healthcare policy with "all the frills" as you say. Covers DW and I and includes dental and vision. Don't know what a similar individual policy would cost, but guess the premium for medical coveage only would be well north of $1000 per month.

DW has pre-existing conditions that will result in exclusions when COBRA runs out in November (we applied for individual policies before I retired and she had three exclusions, thus our decision to go with COBRA). As a result, she will get coverage through the TX high risk pool (currently $450/mo for $2,500 deductible, 80/20) and I plan on a high deductible HSA policy. Today the combined premiums for the two would run somewhere in the neighborhood of the $750/mo we currently pay, but with no dental or vision coverage. By November, who knows.

 

[Martha]

I

I can get BC PPO under COBRA for 36 mo at about $520/mo. After that ,under HIPPA, how high can the rates go ? My pref. is a high deductable plan with lower rates.

? Am I better trying to get my own coverage before I leave , and use COBRA, only if denied coverage ? and does anyone know if the above conditions would be unacceptable to the insurance carrier? The insurance brokers seem evasive on that topic.


John.

The pre-existing conditions likely are going to be problematic in buying a policy on the individual market. But you do have some rights under HIPAA. HIPAA doesn't regulate rates, but does give you the right to buy an insurance policy with no pre-existing condition exclusions. States are not uniform in what they do to comply with HIPAA. California requires mandatory acceptance by all individual insurance carriers without exclusions for preexisting conditions. However, insurance companies set the rates so it may not be affordable. If that is the case there is a risk pool for California residents who have used up their COBRA. I don't know the applicable rates; they differ depending on your age. You can stay in the risk pool for three years and then you have rights to go into the individual market.

See, www.healthinsuranceinfo.net for general information on California and http://www.healthinsurance.org/california/riskpoolinfo.lasso for info on the risk pool.

 

[Lakewood90712]

So after looking at the ca state insurance dept. website , looks like after COBRA is exhausted,  under the ca HIPAA rules ,and I apply no more than 63 days later, a carrier must offer coverage on  at least 2 plans , with no exclusions, but they can set ANY rate they want.

If the rate is double or tripple the published individual rate , I CAN live with that.
(most of the individual rates are 150-250 mo. in my age bracket).


If the insurance carriers usually refuse to offer coverage to individuals with a medical history of anything more serious than an ingrown toenail , why do we see so many ad's for individual coverage ?      is cherry picking that profitable in insurance ?

 

[cute fuzzy bunny]

You are BIG time going to have issues with the insurers in CA applying separately. I got initially refused by BC-BS over a screwed up test from 5 years earlier that on retest turned up negative. About as minute and minor as you can get.

If you cant stick through the cobra/hippa path, you CAN get insurance through the state risk pool, but thats big bucks.

Theres other funny business with the hipaa thing...they're supposed to offer a SIMILAR package to what you had under cobra, although as you note they can get a little nutty (but not too nutty) on the rates...but they're allowed to cancel/close out an entire product and you with it, as long as they dont single you out. So watch out for 'oddball' offerings that seem too good to be true or that seem would appeal to people with a lot of medical issues.

 

[cute fuzzy bunny]

If the insurance carriers usually refuse to offer coverage to individuals with a medical history of anything more serious than an ingrown toenail , why do we see so many ad's for individual coverage ? is cherry picking that profitable in insurance ?

Oh yeah...they love getting those 18-35 year old non-smokers. Chances are they're going to make money.

The 45-60 year olds with 'issues'? No thanks...

 

[Rich_by_the_Bay]

is cherry picking that profitable in insurance ?

Uhh... yes; one reason I favor national health care, at least for catastrophic coverage.

Health insurance companies are not idealistic.

 

[free4now]

California requires mandatory acceptance by all individual insurance carriers without exclusions for preexisting conditions. However, insurance companies set the rates so it may not be affordable.

Interesting. I applied for a BC individual policy and they flat out denied me... the letter says "Applicants with the above health history are ineligible for enrollment in any of our medically underwritten health insurance plans".

Then it has a section entitled "What are my options", and it lists only: 1. Reconsideration, 2. CA Major Risk Program.

But after reading Martha's post above, I reread the letter and towards the end it has a section on HIPAA where it says "If you wish, and if you qualify, we will offer you coverage under your choice of our available HIPAA plans", then it says to call them to find out more. It seems like they buried that info because they don't want to deal with HIPAA policies.

 

[free4now]

Found a good page on California HIPAA plans, including links to rates and plan information for some HIPAA plans:

http://www.davefluker.com/hipaa.html

 

[doushioukanaa]

When I retired my COBRA was much more expensive than the local BC/BS plan via Care First in the DC area. I switched immediately. I was only 35 then, a nonsmoker, with few medical issues, so perhaps I was cherry picked. My suggestion is to get a quote from your local BC/BS for underwritten coverage and compare it to COBRA.

 

[Rich_by_the_Bay]

When I retired my COBRA was much more expensive than the local BC/BS plan via Care First in the DC area. I switched immediately. I was only 35 then, a nonsmoker, with few medical issues, so perhaps I was cherry picked. My suggestion is to get a quote from your local BC/BS for underwritten coverage and compare it to COBRA.

Another problem, not to make things even tougher, is that if you have been cherry-picked at age 35 and get a new problem at age 40 they will cover it, but you may not be renewed if you are on an individual policy (or you will be rated).

In some cases (mine included) my employer will allow me to remain on their group policy after FIRE. I have to pay my own premiums which are very high (12k/y/family) but at least I am guaranteed coverage on the same terms as the entire group which is very large. Probably worth the cost to assure coverage, rather than saving a couple thousand a year at the risk of getting dropped for future medical issues.

 

[Martha]

Another problem, not to make things even tougher, is that if you have been cherry-picked at age 35 and get a new problem at age 40 they will cover it, but you may not be renewed if you are on an individual policy (or you will be rated).

One other thing HIPAA did was provide guaranteed renewability. So once you have the individual plan, the insurer has to renew it. UNLESS they drop the plan for everyone.

However, this may not help in states which don't limit the ability of insurers to increase rates based on claims, though most states do not allow that practice. Insurance companies can be quite clever though in getting around these sorts of limitations. For example, an insurer may provide in a particular plan that rates increases are limited for maybe 3 or 5 years and then rates for everyone increase dramatically. At that point, the company allows you to apply for a cheaper rate plan, but the cheaper plan is a new plan and requires underwriting. Therefore, it is only available for the healthy.

Shop carefully.

IIRC, I think the California risk pool has low lifetime limits and low yearly limits, so stay away if possible.

 

[Rich_by_the_Bay]

One other thing HIPAA did was provide guaranteed renewability. So once you have the individual plan, the insurer has to renew it. UNLESS they drop the plan for everyone.

Martha, does that apply to de novo individual policies (unrelated to COBRA or prior group policies)?

 

[saluki9]

John,

Generally COBRA applies only to continuation of prior coverage under your last employer, and is only for 18 months, not 36. Your situation may be different, but best check it out. Also, HIPPA does not provide or require health insurance; it is just the larger program under which COBRA is mandated. COBRA rates are the same as your past premiums plus a 2% administrative surcharge.


COBRA benefits actually range anywhere between 18 and 36 months according to the law. Most employers choose to limit it to 18 months because they can. I have however seen some (mostly state and local govt jobs) that do give the full 36 months.

 

[Martha]

Yes Rich.  Here is the language straight from the statute:

``(a) In General.--Except as provided in this section, a health
insurance issuer that provides individual health insurance coverage to
an individual shall renew or continue in force such coverage at the
option of the individual.

``(b) General Exceptions.--A health insurance issuer may nonrenew or
discontinue health insurance coverage of an individual in the individual
market based only on one or more of the following:

``(1) Nonpayment of premiums.--The individual has failed to
pay premiums or contributions in accordance with the terms of
the health insurance coverage or the issuer has not received
timely premium payments.

``(2) Fraud.--The individual has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage.

  ``(3) Termination of plan.--The issuer is ceasing to offer
coverage in the individual market in accordance with subsection
(c) and applicable State law.

``(4) Movement outside service area.--In the case of a
health insurance issuer that offers health insurance coverage in
the market through a network plan, the individual no longer
resides, lives, or works in the service area (or in an area for
which the issuer is authorized to do business) but only if such
coverage is terminated under this paragraph uniformly without
regard to any health status-related factor of covered
individuals.

``(5) Association membership ceases.--In the case of health
insurance coverage that is made available in the individual market only through one or more bona fide associations, the membership of the individual in the association (on the basis of which the coverage is provided) ceases but only if such coverage is terminated under this paragraph uniformly without regard to  any health status-related factor of covered individuals.

 

[Rich_by_the_Bay]

Yes Rich. Here is the language straight from the statute:

Thanks - didn't realize that. It does provide some comfort, though dropping entire plans within an insurer's offerings is not unheard of round here.

 

[Lakewood90712]

Did some more research into COBRA at w*rk this week.  18 mo. is the limit in my case (this employer will go up to 36 in cases of disability) But, all of our health plans have a conversion to individual coverage clause   Don't know at what cost.

I still have lot's of time to plan and ponder,  tenative date to pull the ejection seat ring is early june 2007. Don't want to stay that long , but I must for vesting purposes.

Maybe if the big ressesion does hit , and the city budget get's hit hard , some sort of "Bronze Handshake" will be available to get people to leave.They may not offer it to me ,as they sort of like my w*rk .

Thank's everyone for your input.

 

[Lakewood90712]

I've still got 27 mo. to go, 11 of work an 18 of COBRA.  Looking at the Kaiser HMO website, they apply a flat rate of 170% of the standard rate for HIPAA plans, with total rate of $312 to $429 /mo for 40-49 age.depending on the plan.It jumps about 50 % for 50-59 age bracket.

This is way under the cost for any other HMO or PPO. 40-50 % in some cases.

My Doctor thinks Kaiser is the worst healthcare under the sun. Others are very happy. I'd only be concerned if I had some really bad illness and got rationed care.

Is Kaiser really bad or are those reports from a few unhappy members.

 

[Nords]

My Doctor thinks Kaiser is the worst healthcare under the sun. Others are very happy. I'd only be concerned if I had some really bad illness and got rationed care.

One of my neighbors does operations analysis number-crunching for Kaiser, another one recruits doctors for the network.

They both think that doctors treat HMO staff as though they're the worst things under the sun...

 

[brewer12345]

I've still got 27 mo. to go, 11 of work an 18 of COBRA.  Looking at the Kaiser HMO website, they apply a flat rate of 170% of the standard rate for HIPAA plans, with total rate of $312 to $429 /mo for 40-49 age.depending on the plan.It jumps about 50 % for 50-59 age bracket.

This is way under the cost for any other HMO or PPO. 40-50 % in some cases.

My Doctor thinks Kaiser is the worst healthcare under the sun. Others are very happy. I'd only be concerned if I had some really bad illness and got rationed care.

Is Kaiser really bad or are those reports from a few unhappy members.

29 months by my count (11 + 18), but close.

My MIL has retiree healthcare from Kaiser in CO and she has been very happy with them.

 

[cute fuzzy bunny]

Kaiser kaiser kaiser....

I'm a former customer and my dad uses their medicare hmo currently. I know a fair number of people who use them.

The good: minimal paperwork, minimal horsepuckey, I always got an appointment quickly and when I wanted one (within a day or two...none of this "we can see you next week" stuff), the doctor popped into the room within a couple of minutes of the scheduled appointment, it was usually an actual doctor and not a PA or NP, and I had my prescriptions filled in the same building within a couple of minutes of them being written, without any problems. Costs were reasonable for the coverage received compared to PPOs available. Services rendered seemed to be better than adequate, I never had to twist anyones arms to do something that I thought should be done, no trying to keep it cheap. Consumer reports rated them #1 in health care insurance providers last time I checked, over both all other HMO's and PPO's. I liked them fine and would use them again.

The bad: appointments are short, usually limited to 12 minutes. Doctors rotate through so fast your eyes will spin, so you probably wont see the same doctor twice unless you go frequently. My wifes friends husband developed stomach cancer and died, and her opinion was that they didnt do as much as they could have although he ignored his symptoms for over a year and he was pretty much a goner when he walked through the door. May be tough to get truly specialized attention depending on where you live and what resources are available to you. Some nickle and diming on the co-pays, ie you see the doctor and he nicks you for a copay, he sends you to get a blood draw and an x-ray and they each take a copay again.

Short answer: great for the average to moderate user of medical care. Maybe not so great if you anticipate (by whatever means) needing a lot of medical care.