Did You Have Health Insurance Prior to Signing Up With an Exchange?

[nvestysly]

Several recent radio and television stories seem to indicate people signing up for insurance on the ACA exchange were all (mostly?) without insurance prior to signing up on healthcare.gov. I wonder what the statistics are for E-R forum members.

I wanted to keep the poll simple (yes, there could have been other answers). Please reply to the poll if you've signed up for health insurance on the healthcare.gov web site or are otherwise buying an "exchange" policy - including state exchanges. I think there may be other avenues to purchasing exchange plans so if you've purchased any type of exchange plan please reply.

It's a YES / NO poll:

YES if you had insurance prior to signing up on the exchange - regardless of where you purchased it: employer, individual policy, parents, etc.

NO if you did not have insurance in the recent past - lost your job, didn't take time to buy a policy, thought you were not eligible, etc.

Full disclosure: I have a non-exchange (ACA compliant) policy that I purchased several years ago. For now I'm staying with that plan. So I am not voting in the poll because I did not purchase an exchange policy.

 

[audreyh1]

I had insurance, BUT my insurance was expiring Jan 1, 2014 because I now can buy insurance directly. I am no longer limited to buying only state risk pool coverage.

Oops - I did not buy my insurance through any exchange, but want directly to my insurer of choice, so I probably shouldn't have answered your poll.

You don't have to by new 2014 insurance through an exchange unless you want to get the subsidy.

 

[jowi]

This drives me INSANE! Even on the site it implies that people didn't have insurance. Yes, I had insurance. Paid for individual insurance my entire adult life, as has DH. And even with 'pre-existing conditions' - DH had insurance when he got his 'condition' and then when we changed insurance, he moved into HIRSP. So even the whole, "Nobody would insure me" thing isn't exactly so, at least not in my state. HIRSP took everyone - all you needed was to be denied by 2 insurance companies and you were in.

 

[audreyh1]

This drives me INSANE! Even on the site it implies that people didn't have insurance. Yes, I had insurance. Paid for individual insurance my entire adult life, as has DH. And even with 'pre-existing conditions' - DH had insurance when he got his 'condition' and then when we changed insurance, he moved into HIRSP. So even the whole, "Nobody would insure me" thing isn't exactly so, at least not in my state. HIRSP took everyone - all you needed was to be denied by 2 insurance companies and you were in.

Well, enough companies wouldn't insure your DH so he had to move to a state high risk pool and pay a much higher rate if he wanted insurance. There is a distinction there. And not all the states were the same on this.

This might seem perfectly reasonable assuming everyone had serious, expensive conditions. But denied because someone was once treated for back pain long ago, or a migraine once, or umpteen other one time incidents that didn't turn out to be chronic issues? A lot of people with low or no medical expenses got "stuck" in expensive risk pools due to the cherry picking underwriting system.

Don't downplay that denial part and the inability to buy "normal" individual insurance.

 

[jowi]

Well, enough companies wouldn't insure your DH so he had to move to a state high risk pool and pay a much higher rate if he wanted insurance. There is a distinction there. And not all the states were the same on this.

This might seem perfectly reasonable assuming everyone had serious, expensive conditions. But denied because someone was once treated for back pain long ago, or a migraine once, or umpteen other one time incidents that didn't turn out to be chronic issues? A lot of people with low or no medical expenses got "stuck" in expensive risk pools due to the cherry picking underwriting system.

Don't downplay that denial part and the inability to buy "normal" individual insurance.

Thing is, though - HIRSP was *cheaper* than the ACA Bronze plans with lower deductible, so ....

 

[audreyh1]

Thing is, though - HIRSP was *cheaper* than the ACA Bronze plans with lower deductible, so ....

Not at all in my case. ACA Bronze plan is much cheaper with lower deductible and lower max OOP.

 

[MichaelB]

Neither DW not I were able to buy individual health insurance until now.

 

[Dawg52]

The poll doesn't apply to me since I have not signed up for a plan through the ACA exchange. I had health insurance before ACA came along and still have the same policy. Of course next year(1/2015) I will be forced to sign up with something different.

 

[frank]

had private individual plan for myself and wife since 1995 before that nothing. but from what info I can get my private plan is cheaper than the aca plan.

 

[RitaR551]

We have insurance we pay for ourselves. Our policy is one that will be cancelled because it doesn't comply with ACA . Unless we are very, very careful, and keep our income low, our ACA policy will not qualify for subsidy which means we will not be able to afford coverage. [mod edit]

 

[pb4uski]

I have had health insurance my entire adult life. Mostly employer sponsored other than the last two years, which was individual insurance once I ER'd.

My existing 2013 policy was extended until 3/31/2014, but then I will have insurance from our state exchange.

 

[nvestysly]

Interesting results so far. As of this morning 19 people have voted. There are 18 YES and 1 NO.

I realize this is not a scientific poll and there are lots of other (and meaningful) ways this question could have been asked. I thought E-R members would have a relatively high YES response but the 18:1 ratio is higher than I expected.

Has anyone come across more detailed information on the subject? I recall hearing the number of uninsured persons in the U.S. and hearing how many people were expected to sign up via the exchange. My memory (faulty at times) says the two numbers were very similar leading most people to think that nearly everyone who was uninsured would become insured. However, if this E-R poll is a small indication of what's going on in the broader picture it appears many people are transitioning from an old plan to an exchange plan.

 

[MichaelB]

Has anyone come across more detailed information on the subject? I recall hearing the number of uninsured persons in the U.S. and hearing how many people were expected to sign up via the exchange. My memory (faulty at times) says the two numbers were very similar leading most people to think that nearly everyone who was uninsured would become insured. However, if this E-R poll is a small indication of what's going on in the broader picture it appears many people are transitioning from an old plan to an exchange plan.

Here is a recent brief from KFF on the uninsured.Key Facts about the Uninsured Population | The Henry J. Kaiser Family Foundation

Key Facts about the Uninsured Population Sep 26, 2013
Over 47 million nonelderly Americans were uninsured in 2012. Decreasing the number of uninsured is a key goal of the Affordable Care Act (ACA), which will provide Medicaid or subsidized coverage to qualifying individuals with incomes up to 400% of poverty beginning in 2014. This brief answers some basic questions about the uninsured, including why people are uninsured, trends in the uninsured, who the uninsured are, access and financial implications of not having coverage, and the likely impact of the ACA on Medicaid and the uninsured.

Here's a short piece on underinsured, estimated at another 29 million people. . http://www.healthwellfoundation.org/sites/default/files/About.the_.Underinsured.Final__0.pdf

For many Americans, having health insurance does not necessarily mean they can afford critical medical treatments. When insurance coverage is inadequate, significant costs fall on people’s shoulders for premiums, deductibles, prescription copays and other expenses insurance doesn’t cover.

 

[jowi]

Not at all in my case. ACA Bronze plan is much cheaper with lower deductible and lower max OOP.

DH (52) was paying $350/mo on HIRSP for a 3K deductible with IIRC a $4700 OOPmax. On our new plan, his portion is about $400 or so and our deductible is $11K and OOPmax almost $13K.

I thought it was pretty strange when the news started coming out about the rates for ACA and that his rates would be GOING UP. I thought, How can that be? He was in the 'high risk' pool with supposedly sickly people and now, with a mixture of everyone, the rates are more. Just kind of negates the argument that this is 'affordable' for those with pre-existing conditions when compared to HIRSP. I guess the only way it's 'affordable' is if the person is in the category of getting a subsidy and/or cost-sharing.

But at least it's EASY to apply now and to shop around. I'm thankful for that! Those old insurance applications were about as fun as walking through glass.

** I know I compared indiv deductibles to family above - but even for an individ plan for him, his rates would go up. And at the VERY least (since HIRSP may have gone up next year, too) they stay the same (are no more affordable) for like coverage.

 

[scrabbler1]

I have had a variey of plans in the last 6+ years since I became ineligible to remain in my former employer's group health plan after I reduced my weekly hours worked from 20 to 12.

I was on COBRA, then in an individual plan whose premiums jumped 50% in 2 years, then I switched to a hospital-only plan (not ACA-compliant). I had no plan to remain in that plan going into 2014 so I just signed up through my state's exchange for a more comprehensive plan.

 

[audreyh1]

DH (52) was paying $350/mo on HIRSP for a 3K deductible with IIRC a $4700 OOPmax. On our new plan, his portion is about $400 or so and our deductible is $11K and OOPmax almost $13K.

I thought it was pretty strange when the news started coming out about the rates for ACA and that his rates would be GOING UP. I thought, How can that be? He was in the 'high risk' pool with supposedly sickly people and now, with a mixture of everyone, the rates are more. Just kind of negates the argument that this is 'affordable' for those with pre-existing conditions when compared to HIRSP. I guess the only way it's 'affordable' is if the person is in the category of getting a subsidy and/or cost-sharing.

But at least it's EASY to apply now and to shop around. I'm thankful for that! Those old insurance applications were about as fun as walking through glass.

** I know I compared indiv deductibles to family above - but even for an individ plan for him, his rates would go up. And at the VERY least (since HIRSP may have gone up next year, too) they stay the same (are no more affordable) for like coverage.

Perhaps in your state the high risk pool had a good deal on rates. In my state, by law, risk pool members had to pay 2x the "going rate" for equivalent insurance so it was definitely less affordable. I was paying $540 a month. It had been $570 but was reduced recently to comply with some ACA profitability limits. I will now be paying $294 a month for a lower max OOP Bronze plan which is HSA eligible so I'll also be saving some taxes in addition to the much lower premium.

 

[Mr. Paul]

Results of your poll are not surprising as your sample population is folks that have either retired early or are considering it. This is not the group where you would expect to find people without health insurance.

 

[nvestysly]

Results of your poll are not surprising as your sample population is folks that have either retired early or are considering it. This is not the group where you would expect to find people without health insurance.

Yes, I see your point. Although I think I've seen several threads and posts on E-R that indicated some of the members were without insurance for various reasons.

DW said the results were not surprising because most people on this forum are more savvy than the Average Joe.

Giving this further consideration, the results make me wonder why so many people that already had insurance have switched to an exchange policy. Lots of reasons I guess... subsidy, easier to purchase (assuming the exchange web sites work well), better coverage for some.

Hmmmm... maybe this leads to another poll if it's not already been done - why did you switch from your existing insurance to exchange insurance?

 

[MooreBonds]

Giving this further consideration, the results make me wonder why so many people that already had insurance have switched to an exchange policy. Lots of reasons I guess... subsidy, easier to purchase (assuming the exchange web sites work well), better coverage for some.

Hmmmm... maybe this leads to another poll if it's not already been done - why did you switch from your existing insurance to exchange insurance?

For many people, if their policy expires in Jan/Feb/March 2014, they might assume they "have to" go to the exchange now for 2014. They don't realize that they could enroll in a new 2013 policy in December 2013 and put off going to the Exchange until December 2014.

Also, I assume that I personally would have to go to the Exchange to buy an individual policy after January 1, 2014, so next year this time, EVERYONE for individual policies will be buying on the exchange. Unless you go for off-exchange policies - which I personally don't know much about, and which many average Americans don't either, since it seemed that previous talk was always about everyone going through the exchange for individual policies, and the average person (including myself) may not know much at all about what an off-exchange policy can be, legality of it (avoid the penalty), etc..

With something like Healthcare insurance, many people will simply avoid being a trailblazer with things like off-exchange policies unless they spend a lot of time researching it, given the potential for unknown gotchas that may come up, considering how many little-known provisions there are for fees/taxes/penalties/permissions tucked away in ACA that are gradually being phased in, and will likely just opt in for an exchange policy to avoid disaster, and letting someone else be the guinea pig.

In 3 years, enough kinks will be worked out, and enough success/horror stories will abound and enough market equilibrium price adjustments will occur to be able to make an educated and well informed decision about what Exchange/non-exchange policy is the best for each person.

 

[M Paquette]

Readers should bear in mind that the E-R.org crowd is a self-selected audience of people prone to doing longer term planning and preparation for future events than the population at large. Unless the population at large has suddenly become dominated by the INTJ folks... ;-)

Before retiring, I had planned out a full decision tree to chart a course that would make sure my family had health insurance coverage. This led me to switch our coverage BEFORE retirement to the one group plan our employer provided that was run by an in-state HMO, which would then guarantee us 36 months of COBRA and Cal-COBRA coverage. The other plans led to 18 months of COBRA maximum. The decision tree also guided when and what types of individual coverage we would apply for, as well as points where we could risk having physical and eye exams that might lead to extended treatments which would make us ineligible for most individual coverage without exclusions, or force us into very expensive (about 35-45% of our income) high risk pools.

So, yes, I had coverage before signing up for coverage through the health insurance exchange, and I worked pretty darn hard to get and keep it. If the ACA had been around when I retired, I could have avoided much stress and anxiety. But that's just me...

 

[youbet]

Neither DW not I were able to buy individual health insurance until now.

A bit of a confusing answer in regard to the poll. Having read zillions of your posts Michael, I'd have a hard time believing you went uninsured prior to the ACA. So, while you couldn't buy individual health insurance, you did have health insurance, right? Or did I misinterpret some of your long ago posts?

 

[MichaelB]

A bit of a confusing answer in regard to the poll. Having read zillions of your posts Michael, I'd have a hard time believing you went uninsured prior to the ACA. So, while you couldn't buy individual health insurance, you did have health insurance, right? Or did I misinterpret some of your long ago posts?

Let's see. Our retirement began with a fairly long period of inadequate coverage, occasionally interrupted by periods of no insurance or insurance that didn't cover anything. We were eventually able to get decent coverage, which we currently have, but our application, even under the new rules, is still subject to recission. You can appreciate my reluctance to discuss.

My previous post was correct. We have applied for individual coverage 6 times since moving to Florida, with all the major carriers, and all have declined coverage. Three declined to accept our application once we answered affirmatively " have you previously applied for HI and been denied ?"

Since my retirement this has cost me more sleepless nights than either of the two recessions.

 

[AllDone]

For many people, if their policy expires in Jan/Feb/March 2014, they might assume they "have to" go to the exchange now for 2014. They don't realize that they could enroll in a new 2013 policy in December 2013 and put off going to the Exchange until December 2014.

Also, I assume that I personally would have to go to the Exchange to buy an individual policy after January 1, 2014, so next year this time, EVERYONE for individual policies will be buying on the exchange. Unless you go for off-exchange policies - which I personally don't know much about, and which many average Americans don't either, since it seemed that previous talk was always about everyone going through the exchange for individual policies, and the average person (including myself) may not know much at all about what an off-exchange policy can be, legality of it (avoid the penalty).

If you are not going to qualify for a subsidy, there is no reason not to buy a policy of the exchange ... as long as an insurance company is willing to sell you one. There are no penalties for doing so. The insurance companies still have to meet medical loss ratios, etc. The exchanges are meant to be an easy way to shop for plans and calculate subsidies at the same time. However, if you prefer, you can call an insurance broker and shop the old-fashioned way.

 

[jowi]

Yes, I see your point. Although I think I've seen several threads and posts on E-R that indicated some of the members were without insurance for various reasons.

DW said the results were not surprising because most people on this forum are more savvy than the Average Joe.

Giving this further consideration, the results make me wonder why so many people that already had insurance have switched to an exchange policy. Lots of reasons I guess... subsidy, easier to purchase (assuming the exchange web sites work well), better coverage for some.

Hmmmm... maybe this leads to another poll if it's not already been done - why did you switch from your existing insurance to exchange insurance?

I switched because I know my rates would have gone up anyway and both my kids and DH lost their insurance (DH was in HIRSP and my kids both in the state plan, which *used* to allow ANYONE, regardless of income, buy into it (not subsidized but we paid the entire premium, but it was a good rate - about $95 per child - which they decided to not allow anymore). And for a few years, until my oldest is 18, we will qualify for a small subsidy, since we're right at the cutoff. So while we all have a much higher deductible, our monthly family rate (about $600) is the lowest we've paid in insurance for as long as I can remember! Pre-subsidy it was just about the same as before, but much higher deductible, still.

As for just renewing in Dec 2013 like someone else suggested - no THANKS. I've had enough of underwritten insurance applications in my life that I'm glad to be DONE with that! I probably would have been denied by my OWN insurance company for some dumb reason.

 

[youbet]

We were eventually able to get decent coverage, which we currently have

I'm glad to hear that.

As a matter of fact, DW and I never had individual policies either. We both switched directly from being covered on our parents' employer-based policies to being covered by our own employer-based insurance. But we were always covered.

It appears that the vast majority of poll responders here did have coverage prior to the ACA, but as others have said, I doubt this group would be a typical sample of the population as a whole.