Best States for Health Insurance

[EddieG]

Hi all,

The wife and I are checking into health insurance for post ER. Before we even start getting quotes, I just wanted to tap the vast knowledge on this forum and perhaps save myself a lot of time and headaches and money.

We are residents of Wisconsin, but we are open to establishing residency in another state if that could help cut costs. We've been looking at southern states for the winters. Arizona, Florida, etc. But we would want to maintain at least a condo or apartment in WI for a good portion of the year. I'm 42, and I have some pre-existing conditions that may effect insurance rates. Family history of heart disease, current hbp, weight, etc. I have a couple expensive prescriptions per month. The wife is 50 something and has no health issues except [SIZE=-1]pre-osteoporosis for which she takes one med.[/SIZE]
[SIZE=-1]
We are probably taking her cobra starting a few weeks from now, which will be $707/month for the two of us together. I know we can keep that for 18 months, and then we would be on our own to find private insurance. Here's my questions:

1) Should we take the cobra for sure, or is it possible to do better in the private sector right away?
2) If we do take the cobra, what would we expect to pay on the private market once cobra expires? Any specific rates for people like us which any of you are paying would be appreciated. I'm hearing from some people the way to go is with a large deductible like $5,000. Does this sound correct or not?
3) Are there any states which are better than others when determining premiums? If so, any general rule as to what we would need to do to be considered residents of the chosen state? Is it just a majority of the year, like 51%, or is it more, like 75%?, or are they all different.
4) I've checked into the HIRSP wisconsin hipaa program, so I know that is an option if I maintain primary residency in WI, but does anyone know if there are states which have superior hipaa type programs?
5) Any thoughts on applying as a married couple, or is it better to do individually? Is it even possible to do as a couple?
6) Are there health insurance purchasing "agents" or something like that who can guide people in their search for health insurance? I don't mean insurance agents. I mean someone who works for the client seeking health insurance.

Any links or advice would be appreciated. I've done some checking on my own, but I thought you all might be able to save me some research time because you probably get these types of questions occasionally.

Have a good one,

Eddie
[/SIZE]

 

[REWahoo]

...[SIZE=-1]you probably get these types of questions occasionally.
[/SIZE]

Yep, health insurance is a very popular topic around here.

I won't attempt to answer your questions, but here is an excellent non-commercial source for detailed state-by-state information on health insurance: Health Insurance Consumer Guides

Click on the "Summary of Key Consumer Protections In Individual Health Insurance" on the right of the home page to get an overview of each state.

 

[teejayevans]

Hi all,
[SIZE=-1]1) Should we take the cobra for sure, or is it possible to do better in the private sector right away?
[/SIZE]

If your in good health, I would get private insurance immediately, because
cobra only lasts for 18 months, if you get ill between now and then you
can imagine how difficult and expensive it might be to switch later.
TJ

 

[teejayevans]

Hi all,
[SIZE=-1]3) Are there any states which are better than others when determining premiums? If so, any general rule as to what we would need to do to be considered residents of the chosen state? Is it just a majority of the year, like 51%, or is it more, like 75%?, or are they all different.
[/SIZE]

For the state you choose to reside:
Make sure you have permanent residence there(not just a PO Box)
Use that address to get your driver's license and register to vote
as well.
TJ

 

[stargazer08]

DH and I (47 and 44) retired 1 month ago. We are Illinois residents. I did not utilize the COBRA from my job (I carry the family health insurance) because it was more expensive ($1000/month) than the private insurance we were interested in. We planned ahead and obtained health insurance prior to my last day of employment. I applied through ehealthinsurance.com with two carriers. I will say that the underwriting process is very thorough. It took 6-8 weeks and several phone interviews with the underwriters to obtain policies with both companies. We accepted the policy with the best coverage. We did go for health spending account polity with a 10G/year deduct. which costs $200/month. I would suggest you check out the application for at least two different carriers. I think they are more forgiving of certain minor pre-existing conditions when you go with the higher deductibles. If you want the low deductible, low co-pay type of insurance, you need to be extremely healthy and will still pay through the nose! Our youngest daughter will graduate college in November and we obtained a 6 month temporary policy that cost us $150 (no maternity) for the 6 month period. She will have a job with benefits after graduation so we only needed to get her through November of this year. IMO, COBRA is usually not the best route to take if you are able to obtain private health insurance coverage.
I just re-read your post. Family history does not come into play when applying for private health insurance. They only ask about your health status. With your pre-existing conditions you might have a difficult time getting coverage or coverage that won't exclude your conditions. You and your wife can apply for coverage separately. I know in Illinois, you have to exhaust your COBRA and be turned down for private insurance before your become HIPPA eligible. You can find Illinois requirements by searching the governmental website. I don't have that address handy at the moment. I'm sure other states have the same info on their web sites.

 

[Rich_by_the_Bay]

EddieG - don't assume that you can even get health insurance just cause you are willing and able to pay high premiums. Sometimes you just can't get it if your underwriting is not optimal.

So, as a former Wisconsinite, I suggest that you don't give up that Wi resident status too soon - you have a high risk insurance pool which, while expensive, can be your fallback if nothing else pans out.

You have a lot of homework to do with all the discussions on this topic here on the board. Good luck.

 

[maddythebeagle]

I have looked at WI's high risk pool and I dont think it is that expensive and make sure that you read the premiums correctly since they are by quarter and not month...WI apparently "taxes" health insurance carriers (cherry picking) in the state to help pay for the program....

 

[mykidslovedogs]

1) Should we take the cobra for sure, or is it possible to do better in the private sector right away?

--- I would use your 60-day Cobra grace period to take the time and apply for individual coverage. If you can't qualify, you can always go back and elect the COBRA on the 60th day. I would start applying for individual coverage right away, as it can sometimes take a while to get through underwriting...especially if the insurance carrier wants to order your medical records to review prior to making an offer. If your current conditions are elevated BP and weight, you are going to be limited on your options. First question I would have as a broker is wether or not the BP is under control with medication yet. If so, how many meds, and what is the current cost of your meds? These are questions that the underwriters take into consideration before making an offer. HBP in combination with "obesity" can lead to a declination of coverage. HOWEVER...three carriers that are more lenient on height and weight are Celtic Insurance (they will rate up subtantially, but are less likely to decline), Assurant Health and Aetna. Aetna is probably the most lenient. I don't think your wife would have too much trouble qualifying, but some individual carriers are going to exclude osteopenia AND osteoporosis from coverage in the individual market, if you choose a state that allows insurance carriers to incorporate exclusionary riders into their coverage offering.


2) If we do take the cobra, what would we expect to pay on the private market once cobra expires? Any specific rates for people like us which any of you are paying would be appreciated. I'm hearing from some people the way to go is with a large deductible like $5,000. Does this sound correct or not?

Premiums are going to be very hard to predict. It all depends on which state you pick. You can get free quotes on Health Insurance, Medical Insurance, Individual Health Insurance Quotes, but the rates quoted will be "preferred rates", and they aren't likely to be at all what you will be offered considering extra risk created by the HBP and weight. (you should expect an "uprating" of, at minimum, 25-100% more than the preferred rates for the additional risk.


3) Are there any states which are better than others when determining premiums? If so, any general rule as to what we would need to do to be considered residents of the chosen state? Is it just a majority of the year, like 51%, or is it more, like 75%?, or are they all different.

I would suggest reading the book, "The New Health Insurance Solution", by Paul Zane Pilzer for some guidance on that question.


4) I've checked into the HIRSP wisconsin hipaa program, so I know that is an option if I maintain primary residency in WI, but does anyone know if there are states which have superior hipaa type programs?

Again, read the book I mentioned above for a good state by state guide to high risk pools.


5) Any thoughts on applying as a married couple, or is it better to do individually? Is it even possible to do as a couple?

You usually get a little discount, in the individual market, for applying as a family, but you might consider applying separately if you decide to do an HSA, because then, each of you will have your own deductible, which is 1/2 the "family" deductible.


6) Are there health insurance purchasing "agents" or something like that who can guide people in their search for health insurance? I don't mean insurance agents. I mean someone who works for the client seeking health insurance.

I am an insurance "broker". I "shop" the market for my clients and do not represent any single carrier. My goal is to find the right product, best rates and underwriting for each client based on their specific health status and financial situation. The various carriers all have varying underwriting guidelines, so based on your health status, one carrrier might be more likely to accept you for coverage than another, or one carrier might be less likely to rate as high as another. As a broker, we learn over time, the various underwriting guidelines and outcomes of the various carriers, so we are better able to make good recommendations to our clients. We also do "prescreening", so we can get an idea of underwriting outcome prior to placing an application. There are many, many "brokers" ut there. One way to get a list by zipcode is to follow this link:

NAHU - Consumer Information - Find an Agent

 

[EddieG]

Using Cobra repeatedly?

First of all thanks for the responses. Keep em coming if anyone else has other ideas.

Just a thought that popped into my head. Would a couple be able to do something like this?

Take cobra for 18 months. Towards the last few months, one of them find a job with decent health insurance, work a few months or however long it took to get onto the health insurance plan (some companies insure from day 1. Some have 90 day probations, etc). Take the family or 1 + 1 plan, then quit and start another 18 months of cobra under the new plan?

Or do employers or insurance companies have some ways to prevent this from happening?

 

[MileKing]

Family history does not come into play when applying for private health insurance. They only ask about your health status. With your pre-existing conditions you might have a difficult time getting coverage or coverage that won't exclude your conditions.

Stargazer, since you recently went through the underwriting process for private health insurance, perhaps you can shed some light on a few things. This may sound like a silly question, but what exactly qualifies as a "pre-existing condition"? I understand if, for example, one has high blood pressure or high cholestorol and takes medication, that is an obvious pre-existing condition. Ditto if one had a heart attack. Did you have any situations in your background where you went to the ER for something you thought at the time was a problem (chest pains, bad adominal pain, etc.) and they found nothing wrong? How do the underwriters handle these? Thanks.

 

[tryan]

If your in good health, I would get private insurance immediately, because
cobra only lasts for 18 months, if you get ill between now and then you
can imagine how difficult and expensive it might be to switch later.

This is exactly why we skipped COBRA. If any of the 4 of us gained a pre-existing condition ... I'ld be back at w*ork. Then we found BC/BS family policy was a little more than 1/2 the mega corp COBRA costs. So skipping COBRA was a no brainer.

 

[FinanceGeek]

Nice reference to the Paul Zane Pilzer book, it looks quite good.

I didn't have the sense to purchase individual health insurance years ago when I and family would have qualified without exclusions/uprating, and I agree with Pilzer that this, rather than employer coverage, is much cheaper.

But, I think there are a couple of significant downsides to going with individual policies -

1. negotiating power. You have little to no leverage in any "gray area" disputes over coverage, billing issues etc. versus someone who's a member of a large group (and who could complain to those who choose the group carrier and influence future purchasing decision). Face it if you get a chronic condition, your individual health insurance carrier has no incentive to please you, and lots of incentive not to and hope you take your business elsewhere.

2. state portability. HIPAA etc only applies to people leaving group coverage not those leaving individual policies. I don't believe one has any HIPAA rights to get individual coverage in another state once you're on an individual policy, or for that matter with another carrier in your home state, if for example you are not satisfied with their "network" or service. Worse yet if you're not HIPAA eligible I don't think you're even guaranteed to be eligible for state-level high risk pool insurance in most states. By the way, many so-called "guaranteed" state high risk pools in fact have waiting periods or are closed to new applicants, so that safety net isn't always there.

3. true cost savings. Most companies subsidize (heavily) the health benefits they offer employees. I doubt many will pay you the full savings of not covering you if you bought individual policy on your own, which is what Pilzer assumes.

I have researched avenues of coverage for my family, and honestly it looks like forming / buying into a business to obtain small-group coverage is the best method in many states. Guaranteed issue, decent premiums, community underwriting.

 

[EddieG]

Problem with cobra?

If your in good health, I would get private insurance immediately, because
cobra only lasts for 18 months, if you get ill between now and then you
can imagine how difficult and expensive it might be to switch later.
TJ

I do have a lot to learn. I figured we would just go with cobra and then just start looking for private insurance about a year into cobra. So would taking cobra negatively affect us if we shopped for private insurance while on cobra? Or are you saying to switch now because cobra would probably be more expensive during the 18 months?

Also, if we did have a big change in health while on cobra, wouldn't we be able to get on the state hipaa plan because of being turned down or rated by private insurance?

Are you saying that if we get on private insurance asap, and then something goes wrong, we would be covered by them indefinitely? They couldn't cancel us or raise our rates by more than what they would be raised for everyone else covered by that insurer?

I guess going with the cobra is partly because she has had this bcbs plan for a couple years, and we are finally fairly comfortable with the rules, participating providers, etc.. It seems anytime you switch insurance, there is a big learning curve, which we are trying to avoid, at least for a while. But we will have to go private at some point.

EddieG

 

[stargazer08]

I was extremely nervous when I started to read the questions on the apps for health insurance. BCBS basically wanted to know EVERY instance you saw a doctor, went to the emergency room or immediate care center or were diagnosed with any condition above and beyond what they inquired about in the stock questions of "have you been treated/diagnosed within the past 10 years with...". Both carriers wanted to know about acne, HBP, depression, migraines, liver problems, hemorrhoids, chiropractor visits etc. Naturally, we had a few yes questions on our apps. I have migraines, pimples, go to the chiropractor, had treatment for vericose veins and have a mild liver condition for which there is no treatment and does not cause any problems now or in the future. Hubby had chiro visits. Neither of us have HPB, diabetes, heart disease etc. You also list all you meds and dosages. We were accepted by both carriers but BCBS put a permanent exclusion on me for any type of headache and for vascular type issues. Decided to go with United Healthcare which did not have any exclusions. You can go to ehealthinsurance.com and download some apps to see what the questions are like. You have to register with each carrier but it's free and really is no big deal to do that. If you PM me your e-mail, I can see if I still have the electronic version of the BCBS and Humana apps and send them to you.
I just checked and I only have a completed app and I'm not comfortable sending that out. Sorry. I sent you a PM with summary of quesitons.

 

[mykidslovedogs]

Eddie -

COBRA is usually quite a bit more expensive than individual coverage...again, it depends on the state, and it also depends on your prior employer's healthplan. If you worked for a large company, rates were likely "composited" or "averaged" based on the average age of the group. This can be very advantageous to older people, because the younger people in the group subsidize the extra risk of the older people. In a case like that, it IS possible that COBRA can work out to be a better deal, price/quality than an individual plan.

ON THE OTHER HAND...if you develop a health condition while you were on COBRA that would cause you to get declined in the individual market, then you will be stuck with a risk pool plan, IF your state has risk pool inusrance (some states don't), and I can guarantee you the rates will be expensive.

You had a question about using employment to get access to COBRA coverage. I know a lot of people who do that....but, it doesn't feel very good when you are on the receiving end of having an employee use you for health insurance. As an employer, I had that happen to me once....only, the employee got us to pay in advance for a whole quarter of family coverage, which were going to deduct the cost of her dependents out of her paycheck. Guess what? She left the job only a few weeks in, didn't pay us back for the health insurance she used us for, and we also wasted a lot of money training her. All in all, we were probably out about $3,000 when it was all said and done. Ethically, it's not a very nice thing to do to an employer, but people do it anyways.

One last thing. Private insurance carriers have to renew your rates at the same percentage level as everyone else in your "group"..those who applied around the same time as you did. They can't just single you out as individual for a rate increase. If you are worried about rate increases, I would stay away from Assurant health. They take rate increases every 9 months, and their renewal rates are not at all in line with new business rates for the same level of coverage. On the other hand, Humana and Blue Cross seem to be very good at keeping renewal rates in line with new business, but they are going to be "tighter" on underwriting for HBP and weignt guidelines. Celtic Insurance is terrible with their rate increases, and when you renew, they won't even let you move around to different products with higher deductibles without being re-underwritten. For that reason, I do not sell a lot of Celtic Insurance. Aetna is too new to know how good or bad they are going to be with renewals.

I wish you luck in your efforts.

 

[Florida]

Definetly try and get private insurance before the 60 day grace period for Cobra expires. With pre existing conditions you may be declined.

Take Cobra, it's a good deal if you have medical issues.

When Cobra expires you are entitled to a plan in any state you declare residency under the Hippa law. Residency is a physical address, drivers license, voters registration, file state income tax. Not the PO Box route. Under Hippa at least one insurance company has to offer 2 types of plans but I do not believe an HSA or high deductible plan is offered. And premiums will run about 200% the rate of a standard plan so figure about $800 per person.

If you get another job that offers medical benefits you should be able to start the Cobra process again.

Some states are better than others. If you live in NY, NJ, Mass. and some others (guarantee issue states) they take everbody and cover pre existing as long as you do not have a lapse of insurance for more than 63 days.
Premiums are very high for the guarantee issue plans but a HMO may be available for a reasonable rate. But do you really want to live there?

Then there are state risk pools which will take you if you are Hippa eligible or uninsurable. New Mexico, Minnesota maybe Colorado have very reasonable rates. Others can cost alot.

Decide where you want to live. You have to get a plan in every single state if you are comming off Cobra. Then compare premiums in your choice states.

 

[teejayevans]

I do have a lot to learn. I figured we would just go with cobra and then just start looking for private insurance about a year into cobra. So would taking cobra negatively affect us if we shopped for private insurance while on cobra? Or are you saying to switch now because cobra would probably be more expensive during the 18 months?

Also, if we did have a big change in health while on cobra, wouldn't we be able to get on the state hipaa plan because of being turned down or rated by private insurance?

Are you saying that if we get on private insurance asap, and then something goes wrong, we would be covered by them indefinitely? They couldn't cancel us or raise our rates by more than what they would be raised for everyone else covered by that insurer?
EddieG

They can't cancel you because you get sick, they can't raise your rates
because you get sick (they can cancel you not paying, lying on your
application, etc and they can raise the rates as you get older).
But when you apply if you have a pre-existing condition, they will either
jack up your rates because you are a sure bet that they will be paying
out or they'll eliminate that condition and anything resulting from that
condition from insurance coverage.
So if you are in good health, you are in the best position to get
insurance and get the lowest rates. Later, you might not be, and
even if they have to insure you (hippa), doesn't mean that have
to give you a reasonable rate.
Put yourself in the insurance shoes, if you been spending 20K/yr on
meds for some condition, do you really think that your insurance
would be anything less than 20K/yr? They are a business, not a
charity. If you are in good health, walk through the open door
before it closes. In my case, the individual insurance is half of
what cobra insurance, so ASAP I will be applying for individual
insurance, 60-90 days before I need it
TJ

 

[EddieG]

update

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

 

[FinanceGeek]

Just found another link that's got a lot of really good info comparing the issuance standards of each state for individual coverage and the description of the high risk pool operated in that state.

This looks like a really informative site!

Individual Market Guaranteed Issue - Kaiser State Health Facts
High Risk Pool Programs - Kaiser State Health Facts

 

[Milton]

The wife and I are checking into health insurance for post ER. [SIZE=-1]Any links or advice would be appreciated.[/SIZE]

Here you go, Eddie: Immigrating to Canada.

 

[mykidslovedogs]

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]

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]

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]

"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.