Best States for Health Insurance

[mykidslovedogs]

Quote:

Originally Posted by EddieG When we go to apply for private health insurance, any suggestions on whether we should do one app at a time, or just do them all at once to avoid having to answer "yes" if asked if we have been turned down or rated in the past ___ years/months? I did go to the Health Insurance Consumer Guides page. - thanks. I just ordered the Pilzer book from our public library and I'm picking it up today. - Thanks. I checked out the Nahu page and ehealthinsurance.com - once again, thanks. Lots of good advice. I'm following through on all of it. I've been training hard for two upcoming tennis tournaments, and doing this research. Today, we get to have some fun! We're going to a big RV exhibition and looking at what's out there. Just for fun now, but perhaps one day we'll go for it. (Prudently of course!) Thanks again everyone. Eddie

You can turn in multiple applications at the same time if you want to, however, if you are accepted, some carriers will just automatically take your first premium payment (which you must submit with your application), and then if you decide to cancel during the "Free Look" period, you will have to wait for your refund.

Being declined with one carrier doesn't necessarily mean being declined with another. You aren't blackballed once you are declined. Although underwriting guidelines are similar from one carrier to the next, it is possible to be accepted with one carrier even after being declined with another.

[FinanceGeek]

Quote:

Originally Posted by Milton Here you go, Eddie: Immigrating to Canada.

Sigh. Why does it seem that every thread on health insurance degenerates into a discussion of the pro's and con's of socialized medicine?

That aside, did you notice that in order to immigrate to Canada you have to pass a medical exam that includes an assurance that you have no condition which "would cause excessive demand on health or social services in Canada".

Hmmm. Methinks that quite a few people who cannot get private health insurance in the US due to things like past cancer history, heart disease, etc. wouldn't be welcomed into Canada's system either. Funny how that is.

[teejayevans]

Quote:

Originally Posted by FinanceGeek Sigh. Why does it seem that every thread on health insurance degenerates into a discussion of the pro's and con's of socialized medicine? That aside, did you notice that in order to immigrate to Canada you have to pass a medical exam that includes an assurance that you have no condition which "would cause excessive demand on health or social services in Canada". Hmmm. Methinks that quite a few people who cannot get private health insurance in the US due to things like past cancer history, heart disease, etc. wouldn't be welcomed into Canada's system either. Funny how that is.

"and away we go..." (who use to say that, Jackie Gleason?)

[FinanceGeek]

Quote:

Originally Posted by teejayevans "and away we go..." (who use to say that, Jackie Gleason?)

Yeppers it really shows that there indeed limits even in so-called compassionate political systems when it comes to providing universal "free" healthcare...guess those annoying laws of physics (and finance) hold true in the great white north just the same as they do here...

[Martha]

Nice coverage of the topic. I'll add a couple of small points.

First, the Pilzer book has a political agenda, so keep that in mind when you read it. The most valuable portions of the book are the state by state comparisons. These are also available online at TNHIS State-by-State Guide

The data is getting a bit old, with cost numbers from 2004. The biggest problem with the cost numbers is that they are based on men age 35. Cost for people who are older can go up significantly.

As usual, the devil is in the details. If you end up with risk pool coverage, make sure you can be covered on at least an emergency basis when you are out of state. IIRC there are some limitations on out of state coverage with the Wisconsin risk pool.

Also watch for low lifetime maximums. Wisconsin and Minnesota are pretty good. Some states are lousy, like Mississippi and North Carolina. Watch also for yearly caps on what will be paid and for caps on what will be paid for a single illness. Again, Wisconsin is pretty good.

Check out carefully how prescriptions are covered.

Some states are in considerable flux right now, like California, so it is hard to see what the future is going to bring.

If you are not insurable on the non-group market, you have the most rights when you are HIPAA eligible, so get your ducks in a row while you are HIPAA eligible. EVERY state has to offer you some type of insurance product if you are HIPAA eligible, whether it is a risk pool product or private insurance. However, HIPAA doesn't regulate cost so what is offered to you might not be affordable and might not be very good coverage. States can choose or not choose to regulate the rates. Minnesota is known for having one of the least expensive risk pools with some of the best coverage. Wisconsin is good too, but is more expensive.

Read the link REWahoo posted carefully.

[mykidslovedogs]

I read the whole book by Pilzer and I didn't see a political agenda. From my point of view, he gave a very detailed over view about how the current health insurance system works, and what are the best ways to maneuver around our existing system. For the most part, his information seemed very accurate, but Martha, you are right as far as pricing getting outdated. Prices really aren't any good for more than a year.

[Milton]

Quote:

Originally Posted by FinanceGeek Sigh. Why does it seem that every thread on health insurance degenerates into a discussion of the pro's and con's of socialized medicine?

I'm not interested in a debate. Emmigrating to Canada or other countries with public healthcare is a genuine option for someone who wants to ensure adequate health insurance in retirement. That doesn't mean it is invariably the 'best' option ... but it is worthy of consideration.

Quote:

Originally Posted by FinanceGeek In order to immigrate to Canada you have to pass a medical exam that includes an assurance that you have no condition which "would cause excessive demand on health or social services in Canada". Hmmm. Methinks that quite a few people who cannot get private health insurance in the US due to things like past cancer history, heart disease, etc. wouldn't be welcomed into Canada's system either. Funny how that is.

I know of no cases in which otherwise qualified immigrants to Canada have been rejected on health grounds. Can you provide references, or is your post mere idle speculation?

[FinanceGeek]

Quote:

Originally Posted by Milton I'm not interested in a debate. Emmigrating to Canada or other countries with public healthcare is a genuine option for someone who wants to ensure adequate health insurance in retirement. That doesn't mean it is invariably the 'best' option ... but it is worthy of consideration. I know of no cases in which otherwise qualified immigrants to Canada have been rejected on health grounds. Can you provide references, or is your post mere idle speculation?

Nope, I have not seen any statistics on that, and I doubt that the Canadian govt publishes any. But the quote I referenced, e.g. that you have to pass a medical test to make sure you don't have a condition which "would cause excessive demand on health or social services in Canada" is pretty scary to me, it seems to provide broad discretion to turn away a potentially large number of applicants - quite a few of which probably cannot get health insurance in the US under a medically underwritten system either.

What would trigger this provision in practice? Diabetes? Cancer? AIDS? Allergies? MS? Schizophrenia? Retardation? Is it perhaps never utilized?. I can tell you that the US does not exclude immigrants unless they have a communicable disease (see Google Answers: US Immigration and medical exam), e.g. the possibility of "excessive demand on health or social services" is not a part of the US immigration system.

My point is that even healthcare systems which claim to provide universal care to all comers (for "free"), seem to have had to establish some limits on who they can take on.

My suggest to you and any others who may be thinking of immigrating to Canada or elsewhere would be to contact an attorney who has handled actual cases in this area and ask what typical practice (versus one phrase pulled off their website) is.

[Milton]

Quote:

Originally Posted by FinanceGeek What would trigger this provision in practice? Diabetes? Cancer? AIDS? Allergies? MS? Schizophrenia? Retardation? Is it perhaps never utilized?

I am confident that the "excessive demand" component is rarely applied. Among other facts to consider, health care in Canada is a provincial matter, not federal.

Quote:

Originally Posted by FinanceGeek I can tell you that the US does not exclude immigrants unless they have a communicable disease, e.g. the possibility of "excessive demand on health or social services" is not a part of the US immigration system.

Actually, there are several other medical grounds for excluding immigrants to the US. See What are ‘Medical Grounds of Inadmissibility’ for Immigration Medical Exams?

Quote:

Originally Posted by FinanceGeek My suggest to you and any others who may be thinking of immigrating to Canada or elsewhere would be to contact an attorney who has handled actual cases in this area and ask what typical practice (versus one phrase pulled off their website) is.

Fair enough.

[FinanceGeek]

Quote:

Originally Posted by Milton Actually, there are several other medical grounds for excluding immigrants to the US. See What are ‘Medical Grounds of Inadmissibility’ for Immigration Medical Exams?

Here are the grounds for exclusion from the US, to me this list doesn't read of a "cost avoidance" mentality, e.g. cancer / MS etc are not there, but perhaps AIDS would be. Its more of a public safety mentality.

The Canadian page reads like they are targeting high cost illnesses, I don't know how this is applied in practice.

• Communicable disease of public health significance • Lack of required vaccinations (for immigrant visa applicants only); • Physical or mental disorders with harmful behavior • Drug abuse or drug addiction

[Milton]

Quote:

Originally Posted by FinanceGeek The Canadian page reads like they are targeting high cost illnesses, I don't know how this is applied in practice.

Exactly.

[mykidslovedogs]

Quote:

Originally Posted by FinanceGeek The Canadian page reads like they are targeting high cost illnesses, I don't know how this is applied in practice.

FinanceGeek, you might find this article interesting. It's about someone who was turned down for immigration due to having a child with a mental illness that "might reasonably expected to cause excessive demands on health or social services".

Canada Immigration is right to bar the disabled

[mykidslovedogs]

Here's another quote taken from a Canadian site:

"Is HIV/AIDS a grounds for inadmissibility to Canada?
Maybe. If you have a Canadian spouse or partner, you should be able to immigrate to Canada even if you are HIV-positive. Because of the costs associated with HIV treatment, however, you probably will not be able to immigrate under the “point system” because the Canadian government fears that the cost of your illness could become an “excessive burden” on Canadian health or social services."

[FinanceGeek]

OK then - MKLD has found two references to the notion that Canada does apply this rule to exclude some people - at least in some cases.

It often bugs me how people who are unhappy with the US health care system point to Canada as a perfect example of what they'd like to see instead. Often they are frustrated by their lack of ability to maintain insurance coverage here, and they feel that immigrating abroad is some sort of quick fix to their dilemma. When examples like this surface it makes it reminds me that the laws of economics are universal, and there really is no such thing as a free lunch. Or free health care. Its all about cost transferral. At the end of the day, countries like Canada with their points-based systems and "excessive burden" exclusionary doctrine, are performing an implicit cost-benefits analysis on each potential immigrant. Economists would say its very wise for them to do that, but the US system seems far less mercantile to me.

I'm also somewhat surprised that folks retiring from the US would consider immigrating to Canada to get free health care, since the US system - warts and all - actually seems to do an OK job for seniors by providing Medicare (and guaranteed issue Medigap policies). Its the plight of the younger folks who choose not to (or cannot) purchase insurance that's really the major drawback of the system here.

It seems like if free health care was one's primary motivation to move to Canada, you'd be best off migrating there when you're young and healthy, and return when you're older and actually more likely to need the leading edge procedures that may not be available in Canada, or available only with substantial waiting periods. Just make sure you're paying into the US system for at least 10 years to guarantee SS & Medicare eligibility.

[vino]

Hai,

I am vino. I am Newbie to here.

First I wish to say Hi....... to all.

What is COBRA continuation health coverage?
Congress passed the landmark Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions in 1986. The law amends the Employee Retirement Income Security Act, the Internal Revenue Code and the Public Health Service Act to provide continuation of group health coverage that otherwise might be terminated.

What does COBRA do?
COBRA provides certain former employees, retirees, spouses, former spouses, and dependent children the right to temporary continuation of health coverage at group rates. This coverage, however, is only available when coverage is lost due to certain specific events. Group health coverage for COBRA participants is usually more expensive than health coverage for active employees, since usually the employer pays a part of the premium for active employees while COBRA participants generally pay the entire premium themselves. It is ordinarily less expensive, though, than individual health coverage.

Who is entitled to benefits under COBRA?
There are three elements to qualifying for COBRA benefits. COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying events:

Plan Coverage - Group health plans for employers with 20 or more employees on more than 50 percent of its typical business days in the previous calendar year are subject to COBRA. Both full and part-time employees are counted to determine whether a plan is subject to COBRA. Each part-time employee counts as a fraction of an employee, with the fraction equal to the number of hours that the part-time employee worked divided by the hours an employee must work to be considered full time.

Qualified Beneficiaries - A qualified beneficiary generally is an individual covered by a group health plan on the day before a qualifying event who is either an employee, the employee's spouse, or an employee's dependent child. In certain cases, a retired employee, the retired employee's spouse, and the retired employee's dependent children may be qualified beneficiaries. In addition, any child born to or placed for adoption with a covered employee during the period of COBRA coverage is considered a qualified beneficiary. Agents, independent contractors, and directors who participate in the group health plan may also be qualified beneficiaries.

Qualifying Events - Qualifying events are certain events that would cause an individual to lose health coverage. The type of qualifying event will determine who the qualified beneficiaries are and the amount of time that a plan must offer the health coverage to them under COBRA. A plan, at its discretion, may provide longer periods of continuation coverage.

Qualifying Events for Employees:
* Voluntary or involuntary termination of employment for reasons other than gross misconduct
* Reduction in the number of hours of employment

Qualifying Events for Spouses:
* Voluntary or involuntary termination of the covered employee's employment for any reason other than gross misconduct
* Reduction in the hours worked by the covered employee
* Covered employee's becoming entitled to Medicare
* Divorce or legal separation of the covered employee
* Death of the covered employee

Qualifying Events for Dependent Children:
* Loss of dependent child status under the plan rules
* Voluntary or involuntary termination of the covered employee's employment for any reason other than gross misconduct
* Reduction in the hours worked by the covered employee
* Covered employee's becoming entitled to Medicare
* Divorce or legal separation of the covered employee
* Death of the covered employee

[pfpelican]

vino..........
I'm curious about your signature. Are you advertising insurance?

[EddieG]

Well, I thought we might be rated up, but we filled out apps and our NALU agent phoned his contacts at 3 separate insurers before apps were formally submitted. I'm going to be flat out rejected, and the wife would have a couple riders, which we need to find out more info about.

So it looks like I will be on COBRA for 18 months, which will be 320/month for myself, and then I can go onto the WI HIRSP program. We're still determining the best route for the DW.

The good news is that I found specific info on rates and coverage for the HIRSP program, and it's not too bad. My quarterly premium would be 772, so 242/month. And that would be with a $1000 deductible.

I still have to find out if I should take the 2500 deductible and if I'm able to use an HSA with it. Does anyone know if the insurance premiums themselves are considered to be allowable HSA expenses, or just actual medical expenses?
mykidslovedogs , or anyone else, any opinion whether I should actually submit the apps now for rejection (WI requires 2 or more rejections), or is there some reason why I should wait until closer to the time when I would be switching to HIRSP?

Take care,

Eddie

[Martha]

If you are coming off of a group plan and are HIPAA eligible, you do not need to be turned down by insurance companies before getting a HIRSP plan. Here are the requirement in those circumstances:

• You are a resident of Wisconsin.
• You did not voluntarily cancel your coverage.
• You are not eligible for employer-sponsored group health insurance, Wisconsin Medicaid, or Medicare.
• You exhausted your continuation coverage under your employer-sponsored group health insurance, including state continuation coverage or COBRA coverage.
• Including this employer-sponsored group health insurance, you have had continuous insurance coverage for at least 18 months with no gap in coverage greater than 63 days.
• Your most recent period of health insurance coverage was under employer-sponsored group health insurance. As documentation, you are required to provide HIRSP with a certificate of creditable coverage from past insurers or employers.
• You applied to HIRSP within 63 days of losing your employer-sponsored group health insurance.

See, Health Insurance Risk Sharing Plan (HIRSP) of Wisconsin

IIRC, none of the Wisconsin risk pool plans are HSA qualified, but that might have changed.

[EddieG]

Quote:

Originally Posted by Martha If you are coming off of a group plan and are HIPAA eligible, you do not need to be turned down by insurance companies before getting a HIRSP plan. Here are the requirement in those circumstances: You are a resident of Wisconsin. You did not voluntarily cancel your coverage. You are not eligible for employer-sponsored group health insurance, Wisconsin Medicaid, or Medicare. You exhausted your continuation coverage under your employer-sponsored group health insurance, including state continuation coverage or COBRA coverage. Including this employer-sponsored group health insurance, you have had continuous insurance coverage for at least 18 months with no gap in coverage greater than 63 days. Your most recent period of health insurance coverage was under employer-sponsored group health insurance. As documentation, you are required to provide HIRSP with a certificate of creditable coverage from past insurers or employers. You applied to HIRSP within 63 days of losing your employer-sponsored group health insurance. See, Health Insurance Risk Sharing Plan (HIRSP) of Wisconsin IIRC, none of the Wisconsin risk pool plans are HSA qualified, but that might have changed.

Hi Martha,
You may already know this from reading the posts, but the reason we applied was to see if we could get a good private rate right away, rather than using up cobra first. I know I will qualify for hirsp by being turned down by 2 or more carriers, but there would be a 6 month pre-existing period. I am unsure if I would qualify under the rules you mentioned. Specifically, would quitting my job, therefore losing my health insurance go against

• You did not voluntarily cancel your coverage.

I will be on cobra through my wife's employer, not mine, since she is quitting after me. Would this count against these rules, since it was not my employer? :

• Your most recent period of health insurance coverage was under employer-sponsored group health insurance. As documentation, you are required to provide HIRSP with a certificate of creditable coverage from past insurers or employers.
• You applied to HIRSP within 63 days of losing your employer-sponsored group health insurance.

I might sound paranoid picking these rules apart, but do they split hairs in determining eligibility? I talked with my nalu agent, and he seemed to think i would qualify without being rejected by 2 carriers. Would you agree?

Thanks,

Eddie

[eridanus]

Quote:

Originally Posted by EddieG Does anyone know if the insurance premiums themselves are considered to be allowable HSA expenses, or just actual medical expenses? Eddie

Yes, COBRA premiums are allowable HSA expenses.

IRS Publication 969:
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Special rules for insurance premiums. Generally,
you cannot treat insurance premiums as qualified medical
expenses for HSAs. You can, however, treat premiums for
long-term care coverage, health care coverage while you
receive unemployment benefits, or health care continuation coverage required under any federal law as qualified medical expenses for HSAs.
----------