Health Insurance in FIRE

[Free_at_49]

BlueCross/BlueShield Plan A, about $300.month, it covers everything except when it doesn't

As for the question above: I had employer-sponsored BCBS in NE, did COBRA for a while, and after moving South to another state I was under HIPPA, and my current policy is individually underwritten. Dunno if that answers your question, in any case healthcare is a big scam in this country.

 

[GTM]

What is the best state to live in order to get affordable health insurance with a prexisting condition.

If a pre existing condition is serious then one needs a guarantee issue state.

New Jersey is one that has to take everybody but will charge more if health conditions call for it.
New York, Mass and others also have the same laws.

New Jersey seems to offer a number of plans where New York has a limited # of companies. (I guess they don't want that business).

 

[Martha]

If not a guaranteed issue state, the other option is a state with a risk pool. Minnesota is considered one of the leading states for coverage of those who have preexisting conditions that make it difficult or impossible to find coverage elsewhere. The coverage is good and the cost is about 125% of the estimated cost for an individual policy outside of the pool. Wisconsin is pretty good too, but the cost is higher.

 

[maddythebeagle]

martha: does that mean that "pre-existing conditions” are included for the "high risk pool states". Does this also mean that anyone that wants a policy can get one?

 

[REWahoo]

While you wait for Martha's response, here is an example of the eligibility rules for the state of Texas. In this case (and probably all others), the answer to both your questions is yes.

Eligibility

An individual is eligible (for Health Pool coverage) IF under age 65 and has been for at least 30 days and remains a legal resident of Texas and a United States citizen, or a permanent resident of the United States for at least 3 continuous years, and IF the individual provides the Health Pool's administrator evidence of one of the following:

1. Notice of rejection or refusal by an insurance company to issue substantially similar individual health insurance due to health reasons;

2. A certification from an agent or salaried representative of an Insurance Company, on the Pool's Application form, that states the agent or representative is unable to obtain substantially similar individual Health insurance for You with any state-licensed Insurance Company, which the agent or representative represents, because You will be declined for coverage, as a result of Your medical condition, under the underwriting guidelines of the Insurance Company.

3. Either an offer (by an insurer or HMO) to issue or an in-force substantially similar individual health insurance policy that excludes a medical condition or conditions;

4. Either an offer (by an insurer or HMO) to issue or an in-force substantially similar individual health insurance policy at a premium rate greater than the current Health Pool rate;

5. The individual has been diagnosed with one of the Qualifying Medical/Health Conditions.

An individual is also eligible (for Health Pool coverage) IF under age 65, remains a legal resident of Texas, and IF the individual has maintained health insurance coverage for the 18 months preceding application for coverage to the Health Pool, with no gap in coverage of greater than 63 days, provided the last health insurance was through an employer sponsored plan, church plan, government plan, or another state's high risk pool. (United States citizenship or permanent residency is not required for this eligibility category only.)

Dependents are also eligible for Health Pool coverage. If the eligible individual is a child, family members of the child who have been for at least 30 days and remain legal residents of Texas and United States citizens and who reside with the child are also eligible for Health Pool coverage.

REW

 

[Martha]

REWahoo's example of Texas is pretty typical as to types of people covered (eg, those rejected by an insurance company in the individual market, or someone with a specific health problem such as cancer). Speaking in generalities, most often states that have risk pools have a state residency requirement (often 6 months). If you are HIPAA protected (basically going from a group health plan and have exhausted COBRA) then usually can get into the risk pool with no pre-existing conditions waiting period and often with no need to prove you are uninsurable. If not HIPAA protected, for example you were previously uninsured, then often there is a pre-existing condition waiting period, generally six months to a year.

Risk pool costs vary tremendously. Some states are very expensive.

Some states limit the number of people that can come on to the pool. Florida closed their pool a number of years ago.

 

[MJ]

I have been thinking of moving out of NY within the next year or so. 10 months ago, I began tracking selected health insurance rates for a single through ehealthinsurance. I am relying on their accuracy.

In NM, BCBS 20% co-ins 20% after deductable just went up 3.75% while 20% co-ins $20 co-pay went up 14%
In OR, BCBS went up over 8.25%
In AZ, Golden Rule went up over 11%

On the flip side, my company group insurance rate which I will begin receiving through cobra, will remain the same for another year except for the $5 increase to the co-pay. It is still about 2 times the cost of the comparable one in NM.

 

[Patrick]

In NM, BCBS 20% co-ins 20% after deductable just went up 3.75% while 20% co-ins $20 co-pay went up 14%
In OR, BCBS went up over 8.25%
In AZ, Golden Rule went up over 11%

Any idea what the actual premiums are?  Even though a rate may have gone up 11% it could still be lower than one that only went up 8.25%, if the starting amount were lower.

 

[JonnyM]

While I wind down in the work-a-day world, my Health Coverage is paid for via a Cafe Plan, that covers both DW and myself, we chose Kaiser, plus separate Vision, and Dental.

Upon retirement I receive a Health Insurance Stipend of $18.50 per year of service up to a max of $370 per month. This will cover 3 years of Cobra for just me, plus the other coverages. After the Cobra runs out, the plan is essentially the same except the copayments for Dr. Visits and drug copays rise from $5 to $10 per visit/perscription. DW has been just depositing her Health Insurance Stipend while I cover her, so I guess the bottom line is our costs double 3 years after my ER, but is canceled out by the Stipend which in the meantime for DW is gravy spendible cash. Yah Baby!

Another example of a not so well known perk of Public Service vs the private sector. We don't make as much in Salary compared to the same level of knowledge and responsibility in the Coporate world, but IHMO the benefits can more than make up for that in the long haul.

 

[REWahoo]

This will cover 3 years of Cobra for just me, plus the other coverages.

Thought Cobra was only for 18 months?

REW

 

[JonnyM]

Re: Cobra is usually just 18 months...

Me 2. However in my little corner of the world, the locals will spot you 3 full years. I was suprised and delighted to find this out when DW ER'd. It's the law here. COOL!

 

[maddythebeagle]

Yes, in state service, they do help you out often on the health insurance front until medicare kicks in.

Curious, you are in california, how long can you go and pay for the insruance then?

 

[Bayfield40]

After we left our employment, we went ahead and picked up cobra coverage while applying for individual coverage. Boy am I glad we did!! We applied for a BC/BS plan in Florida that was for Hospitalization only with high deductible, thinking it would be a breeze. Well, 5 months later we finally get a decision and are turned down due to some really stupid stuff! We are both healthy and have had very few Dr. visits so I really thought it would be a non-issue. Hmmmm... I guess their underwriters thought otherwise. Needless to say I'm going to work for a while so I can get cobra less expensively through a large employer and we'll be good to go for another 18 months. But really! Do you have to run out of cobra coverage before they will pick you up for individual coverage? And then I suppose its much higher than the quotes you see online...

 

[MJ]

Any idea what the actual premiums are? Even though a rate may have gone up 11% it could still be lower than one that only went up 8.25%, if the starting amount were lower.

I was only showing the increase pattern but here they are. These rates are for a single male age 58.

State Deductable Co-Ins Visits Jul-05 Apr-05
NM BCBS 2000 20% 20% after deductable $149.11 3.76% $143.51
NM BCBS 2000 20% $20 $206.03 13.94% $177.31
OR BCBS 5000 20% 20% after deductable $216.00
OR BCBS 2500 20% 20% after deductable $265.44 6.57% $248.00
OR BCBS 1000 20% $20 $362.00 8.29% $332.00
AZ Golden Rule 2000 20% $35 $207.32 11.19% $184.12

 

[TargaDave]

If a pre existing condition is serious then one needs a guarantee issue state.

If you are a (mild form of) cancer survivor with a 5+ year clean bill of health does that usually count as serious?

 

[REWahoo]

If you are a (mild form of) cancer survivor with a 5+ year clean bill of health does that usually count as serious?

Probably so, but each insurer does their own review of individual situations. FYI, in our case (TX) you have to have evidence of rejection of coverage or exclusion of a specific condition by an insurer to qualify for the state pool.

REW

 

[Martha]

A But really! Do you have to run out of cobra coverage before they will pick you up for individual coverage?

Be sure to work on getting your individual coverage before running out of COBRA. Being on a group plan and then COBRA gets you a number of rights under HIPAA, including the right to force the sale to you of an individual policy. Unfortunately, HIPAA doesn't limit the cost. For the skinny on your HIPAA rights go to http://www.cms.hhs.gov/hipaa/hipaa1/content/cons.asp

 

[JonnyM]

Curious, you are in california, how long can you go and pay for the insruance then?

Once I convert to the "retiree" group health plan, I'm good to go indefinitely, the only catch is I don't have a lot of choices. I'm currently insured by Kasier, that works well where I live, might change plans if we move to the Pacific Northwest someday.

The answer would be forever. I expect that the cost will increase over time, but hopefully, they will increase the stipend as well, if not I'll grudgeingly make up the difference.

 

[ShokWaveRider]

I am going through this right now. Trying to find reasonably priced health care in North East Florida. I am starting to look around. Blue Cross is my first stop. I am trying to undestand all the ins and outs, Copays and Percentages. It all gets so complicated and convoluted. Anyone would think it was run by the government.

Currently I am covered by the Canadian system, but that changes when we spend more than 6 months away.

Anyone have a good source of healthcare in Florida I can look into?

SWR

 

[Bayfield40]

Good luck! As you can see in my previous post, it took a number of months for a decision and I couldn't technically apply until I was "eligible" (ie unemployed and a florida "resident"). Just make sure you have interim coverage and don't be surprised with the results... I went back to work temporarily just for the benefits not horrible, but not what I had in mind initially. I guess it could be worse if we were in ill health and really needed treatment. Sure makes me wonder if it's worth it at this point. Our existing cobra is 520.28 per month, sure would rather have the cash... We may rethink this before too long.

 

[Martha]

Bayfield, did you look at the Georgetown University guide for your state so you know your rights inside out? See www.healthinsuranceinfo.net. This will help you when you work with insurance companies to know what they can and can't do.

Also, try www.ehealthinsurance.com for help in finding a plan.

 

[windsurf]

This was a big wad to swallow;  I spent most of my "good years" defending docs sued for malpractice and often won.  I am very type A and have a hard time sitting in a crowded waititng room;  I am cynical about the approach of corporate med;  I resent the poorly paid passive aggressive help populating the desk with rude behavior; I have heard some of the best docs I know say that we need socialized medicine to protect them and us.  All I know is that this is the highest premium I am paying on any product I am buying save connectivity which should be as free as the air we breathe.

 

[BUM]

Windsurf,

I too spent years in the medical field. Its an ugly place with all too few ocurrances of brilliance and beauty. I too couldn't sit in a waiting room, or stand in line...until ER. Now I bring a book and watch the world go by. Don't think we'll see SocMed anytime soon but then the passive aggressive "Oh thats all I need is you and your rash." types at the desk will flourish. Either way its a mess!

I'm trying to spend more time to be healthy because I have no time to be sick.