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ER Healthcare in N.C. w/ pre-existing cond.
Old 12-06-2007, 11:06 AM   #1
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ER Healthcare in N.C. w/ pre-existing cond.

Hi all,
I'm very fortunate that at the age of 47, I've nearly got enough saved to live off 4% and exit the high-tech, high-stress, commute to work every day life style.
But as for many, the big glitch is heath insurance.
Though I recently lost 45 lbs, I'm still nearly 100 lbs over-weight, and have had to take one med for hypertension and one med for blood sugar for over a year now. I was able to cut the doses of both after my recent weight loss, and there's a very good chance I can get off both if I can shed another 50lbs or so. I also take a generic adderall for ADHD which will likely continue.
If I can get to the point of no meds for hypertension or blood sugar, is it certain that I don't have to specify those as pre-existing conditions after 12 months?
My current plan is to stay at my job until I can get off the meds (difficult, but quite motivating!), buy old plan via cobra for 12-13 months, then hopefully apply for a single or group policy w/o thos pre-existing conditions.
Am I correct about that?
Also, if anyone has specific experiences to relate about group policies via AAA, or IEEE, or other membership orgs or professional orgs, I'd love to know!
Thanks,
-- ymidt
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Old 12-06-2007, 12:20 PM   #2
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I suggest reading this FAQ http://www.early-retirement.org/foru...nce-30756.html

When you apply for individual health insurance you likely will have to disclose your prior treatment for HBP and high blood sugar, and other medical conditions from the past. But this does not mean that you will get turned down for insurance if you are currently healthy. Though you might. Different insurance companies have different requirements on how far back you have to disclose treatment for prior conditions. I think 10 years is fairly typical. Some are unlimited in how far back they look. You might want to read some of the links about the insurance underwriting and application process in the FAQ.

I echo your question on IEEE group policies. Are they still available? Anyone know? I believe AAA is not a group policy.

Otherwise, if you are uninsurable you might end up with a HIPAA guaranteed policy or risk pool plan. IIRC, NC does not have the best choices.
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Old 12-06-2007, 01:38 PM   #3
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I echo your question on IEEE group policies. Are they still available? Anyone know?
The IEEE group policy was closed to new applications on 1/1/2007. Also, rates have gone up and services decreased. The insurer showed IEEE that the previous levels of rates and services were not sustainable.

That does not bode well for non-company-based insurance...
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Old 12-06-2007, 02:08 PM   #4
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Max look-back period

I think this site Individual Market Portability Rules - Kaiser State Health Facts is telling me that NC has a max look-back period of 12 months for individual plans (6 for group plans).
It also says NC uses "objective standard" which according to them means "someone actually received medical advice, diagnosis, care or treatment prior to enrollment to be counted as pre-existing".

I was hoping this meant I would be in the clear if I was off meds and tests for 12 months....
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Old 12-06-2007, 03:03 PM   #5
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The look back for pre-existing conditions has to do with the time period where pre-existing conditions are not covered on your new insurance policy.

Whether a company will insure you is a different question and has to do with underwriting. Typically insurance companies look back 10 years or more at your health history for underwriting purposes. If they don't like what they see, they can refuse to insure you. (Unless you are in a guaranteed issue state, which you are not). However, say that they decide to insure you but you have HBP. If there is a preexisting condition waiting period, that HBP won't be covered during that period. So, two different issues.

In some states, the insurance company may permanently exclude conditions from coverage. In other states this is not allowed.

If you can't get insurance on the private market, your options are as I described in my FAQ.
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Old 12-06-2007, 03:23 PM   #6
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Thanks for clearing up that very important issue Martha.
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Old 12-06-2007, 05:43 PM   #7
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I have looked into this for North Carolina in the past. My understanding is that BCBS will issue you a policy (insurer of last resort). However, they may rate you very poorly and charge you up to 7 times the "quote" for the most healthy applicants. This was what the BCBS insurance agent told me, anyway. I have a similar issue of being overweight, but the insurance company won't reveal the "magic weight" they want to see to not severely jack up premiums due to obesity.
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sad dose of reality
Old 12-08-2007, 01:14 PM   #8
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sad dose of reality

well, this realization is quite sad for me. i thought i had found a way out of the daily commute lifestyle that i can no longer stand. but it seems now like if i pull the cord, one serious medical problem could drain the coffers and leave me stuggleing to make ends meet.
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Old 12-08-2007, 01:34 PM   #9
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Quote:
Originally Posted by ymidt View Post
well, this realization is quite sad for me. i thought i had found a way out of the daily commute lifestyle that i can no longer stand. but it seems now like if i pull the cord, one serious medical problem could drain the coffers and leave me stuggleing to make ends meet.
It is a bitter pill to swallow, but don't despair. Better to know this now than to find yourself out on a limb a few years down the road.

It is pretty likely that some kind of health care reform will occur in the next 5 years or sooner. Vote carefully next November. And remember, your hard-earned savings should liberate you to find a part time or lower paying position that is closer, has less stress and which you could use for group health insurance while this is sorting out. It's not a black and white scenario.
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As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
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Old 12-09-2007, 08:53 AM   #10
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Quote:
Originally Posted by ymidt View Post
well, this realization is quite sad for me. i thought i had found a way out of the daily commute lifestyle that i can no longer stand. but it seems now like if i pull the cord, one serious medical problem could drain the coffers and leave me stuggleing to make ends meet.
We are somewhat in the same boat. I went through the same issues for months.

We do have a high-risk state run insurance pool but it does have a "go bare for 6 months" clause before one is able to join. Like yourself, I've met FI and await on when to go to full FIRE. I looked at your state to see if moving there would help: it was best for me to stay put.

There are some good books out there that may help give you some ideas. My plan has multiple solutions to use once I make the full FIRE decision. Don't just focus on using one option but multiple options within each solution. The total solution generation will not happen overnight, it took me several weeks to generate multiple solutions.

Good luck, Hillbilly

PS I have changed the way I looked at my job until I FIRE. It is much more a "hobby" job that I use to "roll up the score". I CAN leave at any one moment regardless. The harder they push, the slower I get . I'm one phone call away from an UHaul truck.......
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Old 12-09-2007, 11:12 AM   #11
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We do have a high-risk state run insurance pool but it does have a "go bare for 6 months" clause before one is able to join.
Likely the "go bare for six months" clause does not apply if you are HIPAA eligible. (Look at the private health insurance FAQ for HIPAA eligibility rules)
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Old 12-09-2007, 12:12 PM   #12
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Likely the "go bare for six months" clause does not apply if you are HIPAA eligible. (Look at the private health insurance FAQ for HIPAA eligibility rules)
Martha:

I will buy you a very nice Christmas gift if, after reading the link information below, you say I'm wrong in thinking that a person must "go bare for 6 months" . We are talking non-Tenncare persons.

AccessTN
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Old 12-09-2007, 06:42 PM   #13
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Originally Posted by Hillbilly View Post
Martha:

I will buy you a very nice Christmas gift if, after reading the link information below, you say I'm wrong in thinking that a person must "go bare for 6 months" . We are talking non-Tenncare persons.

AccessTN
Well, I can't earn a Christmas present, but there are options if you are HIPAA eligible in Tennessee that will insure you right away with no waiting periods and no elimination riders, but it isn't Access Tennessee. Individual Health Plans - Tennessee Health Insurance Help
  • If you are HIPAA eligible, however, individual insurers cannot turn you down. All insurers that sell individual insurance must offer you coverage. Insurers can offer you all of their individual health plans, their two most popular individual health policies, or two policies specially designed for HIPAA eligible individuals - a “high” and a “low” option policy, whose benefits must be similar to those sold to everyone else. Companies that do not designate two policies must offer you a choice of all their individual insurance policies. Policies sold to HIPAA eligible individuals cannot impose pre-existing condition exclusion periods.
To be HIPAA eligible, you must meet certain criteria
If you are HIPAA eligible in Tennessee you are guaranteed the right to buy an individual health plan and are exempted from pre-existing condition exclusion periods. To be HIPAA eligible, you must meet all of the following:
  • You must have had 18 months of continuous creditable coverage, at least the last day of which was under a group health plan.
  • You also must have used up any COBRA or state continuation coverage for which you were eligible.
  • You must not be eligible for Medicare, Medicaid or a group health plan.
  • You must not have health insurance. (Note, however, if you know your group coverage is about to end, you can apply for coverage for which you will be HIPAA eligible.)
  • You must apply for health insurance for which you are HIPAA eligible within 63 days of losing your prior coverage.
The downside is that I do not believe price is regulated for the HIPAA eligible plans, so they may be very pricey. Access Tennessee in contrast does limit premiums, but as you say, requires you to "go bare" for 6 months. You may want to talk to an agent about HIPAA eligible plan offerings in Tennessee.
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Old 12-09-2007, 07:18 PM   #14
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Thank you Martha. It looks like high cost HIPPA or a move via the UHaul to a better state plan. Got that UHaul telephone number in my wallet just in case...

ymidt may look to do the same. Tough call.

Thank you, Hillbilly
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