Depressed--Trying to get Individual Policy

[astroboy]

Seems to me that to avoid some of this problem in the first place is try to get a quote or screening for ind. ins. before you actually retire. I know that sounds good, but in reality, does that really work? If so, you'd have an idea of whether you'd be accepted (if not, then could look at other options), and if so at what cost, which would factor into your budget and see if that cost would work to retire when you want.

Like others, this is a major unknown for me coming off employer insurance. While I'll get 10 yrs paid after retirement and can delay this benefit for five years, during those five years, seems like you would have to compare costs of ind. insurance, cobra (then ind. ins. 18 mos later), conversion, and potentially state high risk pools. The costs of cobra and risk pool can be found but individual and conversion take some work to determine.

If you're moving from one state to another, would an agent in your new city really be willing to go through the application/screening process for you even though you haven't moved yet and may never based on what they find out for you? And what kind of assurances can you get from them that the info. they quote you will really pan out if you do make the move and then need to get the insurance? Thanks for your help.

 

[mykidslovedogs]

If you're moving from one state to another, would an agent in your new city really be willing to go through the application/screening process for you even though you haven't moved yet and may never based on what they find out for you? And what kind of assurances can you get from them that the info. they quote you will really pan out if you do make the move and then need to get the insurance? Thanks for your help.

If you are planning on moving, the best place to find an agent is:

http://www.nahu.org/consumer/findagent.cfm

I have done lots of prescreens for people that are moving into town. I can only prescreen based on current underwriting guidelines. Since guidelines can change from time to time, you might want to get a new prescreen if there is a long delay before you move.

MKLD

 

[AlmostDone]

Does anyone know how depression as a pre-existing condition is viewed by insurance companies?

 

[mykidslovedogs]

Does anyone know how depression as a pre-existing condition is viewed by insurance companies?

I am a broker is the state of Colorado. In my state, most carriers like to see that you have been out of counseling for at least 1 year. If you are currently in counseling, an individual policy would likely be declined. Once you are out of counseling, you will typically be accepted with an exclusion of coverage for any medication that you are currently taking. However, on Humana One's high deductible health plans, they will typically write you as standard once out of counseling for at least a year with NO exclusion of coverage for your precriptions. Humana One considers a high deductible plan (in my state) as "any of their available plans with deductibles of 2500 or more." I don't know if the same rules apply for other states.

Oh yeah, and they also like to see that any current medications you are on have been stable and unchanged for at least 6 mo to a year. (a year in most cases)

MKLD

 

[Beststash]

I am a broker is the state of Colorado. In my state, most carriers like to see that you have been out of counseling for at least 1 year. If you are currently in counseling, an individual policy would likely be declined. Once you are out of counseling, you will typically be accepted with an exclusion of coverage for any medication that you are currently taking. However, on Humana One's high deductible health plans, they will typically write you as standard once out of counseling for at least a year with NO exclusion of coverage for your precriptions. Humana One considers a high deductible plan (in my state) as "any of their available plans with deductibles of 2500 or more." I don't know if the same rules apply for other states.

Oh yeah, and they also like to see that any current medications you are on have been stable and unchanged for at least 6 mo to a year. (a year in most cases)

MKLD

My current coverage for my wife and self (Aetna) is $862 per month. My previous employer (retired) has cut dependent coverage for my wife and raised my premium to $249 mo.
This is for POS 90/10 with 1000 max deductable per person. Our prescription co-pays are now 10/25/45/60 for 30 day. This means that I am paying $10344 before we ever walk into the office. I was thinking that I would be better off with a HSA plan with a high deductable?? The problem is my wife has been being treated for Iritis (inflammation and high IOP) in her right eye. She has been having to go to the opthalomologist about every 6 weeks for the last 1.5 years. The total cost at $25 (co-pay) per office visit is not that much and about an equal amount for meds.

We live in Texas - It is my understanding that in Texas, if you get a individual policy then they might/could exclude any pre-existing condition forever

It is also possible that next year the corp might drop our subsidy and provide access only - not sure what that means.

Any opinion on this?? Does this premium seem excessive, or is it typical??

Thanks!

 

[REWahoo]

My current coverage for my wife and self (Aetna) is $862 per month. My previous employer (retired) has cut dependent coverage for my wife and raised my premium to $249 mo.
This is for POS 90/10 with 1000 max deductable per person. Our prescription co-pays are now 10/25/45/60 for 30 day. This means that I am paying $10344 before we ever walk into the office. I was thinking that I would be better off with a HSA plan with a high deductable?? The problem is my wife has been being treated for Iritis (inflammation and high IOP) in her right eye. She has been having to go to the opthalomologist about every 6 weeks for the last 1.5 years. The total cost at $25 (co-pay) per office visit is not that much and about an equal amount for meds.

We live in Texas - It is my understanding that in Texas, if you get a individual policy then they might/could exclude any pre-existing condition forever

It is also possible that next year the corp might drop our subsidy and provide access only - not sure what that means.

Any opinion on this?? Does this premium seem excessive, or is it typical??

Thanks!

Beststash, your costs do seem high, but what your employer has to pay for health insurance can vary quite a bit based on the number of employees in the company. Your cost might be typical of a small company, I’m not sure. They are definitely high for a large company.

As to getting your own individual policy in Texas for you and your spouse, you are correct that pre-existing conditions can be excluded. However, with what you are currently paying, you might still come out ahead by getting your own individual HSA policy and going to the high risk pool for a high-deductible policy for your wife (the pool policy isn't HSA eligible).

I’d advise you to do some research by looking at the Texas health insurance information at http://www.healthinsuranceinfo.net/tx00.html and the Texas Risk Pool at http://www.txhealthpool.org/index.html You will need to do your homework but it may be worth your while, especially if your employer drops the subsidy which might increase your costs north of $1,000 per month.

 

[mykidslovedogs]

Beststash,

Everything Wahoo said is correct.

In the group market, the rates that your employer pays can be very high for those age 40+, especially in a small group. This is in part because group coverage is guaranteed issue (meaning you can't be declined or have pre-exisisting condition exclusions), and group coverage also typically mandates maternity coverage which is built into your rates whether you need it or not. As the healthy dependents drop out of the group for reasons you stated above, a self-perpetuating phenomenon called adverse selection occurs leaving a higher pool of unhealthy people in the group market which, in the longrun, can also have a negative impact on group rates. We are starting to see more and more of this over the past few years, with costs becoming too high for employers to pay for dependent coverage.

One thing you might want to do is just a quick search on maybe www.ehealthinsurance.com just to get an idea of what some of the costs of the different HSAs are in your State. I would also recommend looking for a good broker who can shop the market for you and do some pre-screening on your wife's condition. (there is no additional cost for you to use a broker.) you can find one in your State on http://www.nahu.org/consumer/findagent.cfm.

If the premiums are significantly lower, than it might be worth it to move your wife over to her own policy (or even both of you) if it is significantly less expensive than what you would be paying your employer for your portion of your coverage.

But you should keep this in mind... Currently, the premiums that you pay on your work policy are probably paid on a pre-tax basis, so before you switch yourself over to an individual plan, you might want to make sure the cost isn't more than what yours is through work when you take into consideration the pre-tax deduction.

Lastly, it is likely that your wife's eye condition will be excluded from coverage in the individual market, so you would want to make sure that you are willing to take on that risk. Remember that if her condition is excluded from coverage, then what you pay for services will be the full, network discounted rate for both office visits and prescriptions (not just $25 per visit and prescription), so you will want to do a cost analysis to find out how much the condition would cost you if you had no coverage for it.

If you are not willing to take on the risk of paying for her eye condition out of pocket, then you might want to look at risk pool coverage for her. Information about individual risk pool plans can be found here for each and every State:

http://www.tnhis.com/statebystateguide.htm

Since risk pool plans are guaranteed issue, they can sometimes be just as expensive as group coverage...It really depends on the State in which you live.

 

[REWahoo]

Information about individual risk pool plans can be found here for each and every State:

http://www.tnhis.com/statebystateguide.htm

The above links to information that is two to three years old. I'd recommend going to the Georgetown University site at www.healthinsuranceinfo.net for more up to date information and links to individual state pool websites. Rules and premiums change frequently and I wouldn't trust any information from a second hand source (including me ).

 

[Rich_by_the_Bay]

I agree with the good information provided by MKLD and REWahoo.

One final caution on accepting exclusion of her eye situation: you may be able to pick up the office visit and medication fees related to this but if there is even a small chance that a surgical or laser intervention might be recommended, you will suddenly be facing thousands -- possibly tens of thousands -- in bills, esp. if hospital or outpatient surgery expenses are excluded.

None of your choices are good in the current system, but the high risk pool may provide the greatest peace of mind. Good luck.

 

[mykidslovedogs]

The above links to information that is two to three years old. I'd recommend going to the Georgetown University site at www.healthinsuranceinfo.net for more up to date information and links to individual state pool websites. Rules and premiums change frequently and I wouldn't trust any information from a second hand source (including me ).

An excellent link! The one thing I like about the http://www.tnhis.com/statebystateguide.htm link is that the website links for getting quotes on the risk pool coverage is listed in a place that's easy to find, so you can start doing research right away without having to dig through too much information.

 

[mykidslovedogs]

I agree with the good information provided by MKLD and REWahoo.

One final caution on accepting exclusion of her eye situation: you may be able to pick up the office visit and medication fees related to this but if there is even a small chance that a surgical or laser intervention might be recommended, you will suddenly be facing thousands -- possibly tens of thousands -- in bills, esp. if hospital or outpatient surgery expenses are excluded.

None of your choices are good in the current system, but the high risk pool may provide the greatest piece of mind. Good luck.

I'm not totally sure about this but the cost of a lazer surgery might still be less expensive than 1/2 a year's worth of premiums in the group or risk pool market. Probably the best thing to do is talk to the Dr. about the risks of going without coverage for the disease and what the costs would be in the worst case scenario.

 

[Beststash]

Thanks for the excellent information!! I will begin my pursuit for alternatives. I don't expect it to be much better but I just don't it to be a whole lot worse. I always said that I wouldn't be returning to work unless I run out of money but I never expected healthcare to become such a large issue.

Again, Thanks everyone for the information - I feel like I have a good starting point now and will see what happens!!

Happy New Year!!!!