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Health Care Help!
Old 02-27-2012, 06:54 AM   #1
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Health Care Help!

I FIREd in August and just turned 47. Based on recommendations from folks here, I avoided COBRA and found a HDHC plan with a $2500 deductible. $191/mo. Dental for $23/mo.

Had one "incident" in October with an ER visit. Heart scare, but turns out nothing was wrong, just a virus, but set me back $1200. UGH

Former employer agreed to pay for my health care if I help him out a bit.

I can:
a) Stay on my plan and get reimbursed $191 + 23 + $175 (HSA contribution) or
b) go on his corporate health plan which cost him $370 until I'm 50, then it goes to $503.

Here is where I need the help. We could quibble over which one will cost less, that is important, but I can run those numbers. I'm more concerned about getting and keeping health care that provides protection from the catastrophic downside (i.e. $30-100,000 surgeries, organ stuff).

If I go on his plan, will it be harder to get my own plan in a couple years (especially if I'm over 50) when I no longer "help him out a bit?"

What happens if I go on his health care plan and have an event, like a heart attack, then decide not to help anymore...will it be hard? near impossible? to get health care at that point? Would it be better for me to just keep the plan that I have? (since I have it)

I don't understand the laws, and I love managing my finances, but I dislike HC. Since I have HC, can they take my current coverage away from me? or just charge me through the nose for the policy if I do have some sort of event?

If you can give me your thoughts broken down by "if obamacare goes through" and "if obamacare doesn't go through."

Thanks for the help, need to decide in the next week.
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Old 02-27-2012, 07:06 AM   #2
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I cannot see Obamacare being repealed and killed. To many people of all political beliefs have already benefited from it. Changed? You bet it will be changed.

As I understand it, under Obamacare, insurance companies will not be able to single you out for a rate increase because of an illness. You will be in some type of group and the rate for the group can be raised but not your individual rate. Please correct me if I am wrong about this.
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Old 02-27-2012, 07:16 AM   #3
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REattempt, a group plan is safer than an individual plan even though it may cost more. This is because HIPAA regulations - which have been implemented differently in each state - require insurance companies to issue health care plans for companies but not individuals. In other words, your individual plan can be cancelled much more easily than your employers group plan. If your primary concern is guaranteed availability the employers group plan is the better choice.

This may change when the Patient Protection and Affordable Care Act is fully implemented in 2014. When that happens you can reassess your options.
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Old 02-28-2012, 10:45 AM   #4
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IMHO, I would stick with the HSA regardless if you decide to help out the former employer or not. A great benefit of the HSA is the portabillity. That it belongs to you even if you switch j*bs or FIRE or get the ax.

From another point of view, what if you chose to go on the former employers plan but between now and when you decide FIRE again you develop an uninsureable condition? Then what?

If Obamacare goes through, a big part is that you can't be refused if you have a pre-existing conditon. But I think it's too much of a crapshoot as no one really knows now what will happen.

Again, if it was me, I'd stay FIRE'd (I enjoy it just too much!). If the medical expenses is too much a setback on the budget, there's nothing wrong with reimbursing yourself for the qualifying expenses from your HSA, which is another option not yet mentioned (I've decided to use my HSA for this route instead of looking at it as an investment).
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Old 02-28-2012, 10:51 AM   #5
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Quote:
Originally Posted by Chuckanut View Post
As I understand it, under Obamacare, insurance companies will not be able to single you out for a rate increase because of an illness. You will be in some type of group and the rate for the group can be raised but not your individual rate. Please correct me if I am wrong about this.
This was true even before the new health care laws, I'm pretty sure. They can put you into a higher risk group when you obtain the policy, but they can't re-rate you into a higher risk group or raise your rates individually because of an illness. They can reprice the premiums for an entire group, but they can't move you to another group or single you out for an increase.
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Old 02-28-2012, 11:28 AM   #6
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Quote:
Originally Posted by ziggy29
This was true even before the new health care laws, I'm pretty sure. They can put you into a higher risk group when you obtain the policy, but they can't re-rate you into a higher risk group or raise your rates individually because of an illness. They can reprice the premiums for an entire group, but they can't move you to another group or single you out for an increase.
This is the way I understand it, through studying it and dgoldenz has also explained it a few times here in the past. Chuckanut has a common misperception, that I also previously thought ( and many still probably do) that companies can individually raise your rate. As Micheal said there are a some safety nets involved in staying with a group. That being said, the tremendous cost savings for me, proved too alluring, and I dropped my group plan that I could have stayed on and bought an individual plan.
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Old 02-28-2012, 12:00 PM   #7
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Ok, now I'm really confused. Seems like there are two different definitions of "Group." A "Group Plan" such as an employer plan vs. an individual plan. Then there is my "Rating Group" which is the group that I was rated at as in individual when I got the individual plan. Do I have that so far?

Ok,

MichaelB is saying they can cancel me as an individual, but not if I'm on the corporate ("group plan") plan. Got that.

Easy Surfer is saying that if I go on the corporate plan, then have an event and eventually fire, I may not be able to get coverage.

Ziggy is saying that they cannot individually raise my rate, NOR can they move me to a higher risk "rating group" if something happens.

So, if I add it all up, the choice is between A) keeping the individual plan and the risk of the them cancelling it vs. B) going on the corporate plan and the risk of having an event on the corporate plan and not being able to get insurance later. Did I get this right?

I can't predict the likelihood of an event happening. I would assume, if one does happen, that I may not be able to get insurance coming off the corporate plan. Any sense out there of the actual risk associated with having my individual policy cancelled?

I would think then, given what I know, that staying on my current plan, particularly because of my rating group would be the best option (2500 deductible, $191 a month) and taking on the risk of them cancelling the coverage.....
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Old 02-28-2012, 12:23 PM   #8
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Originally Posted by REattempt View Post
Ok, now I'm really confused. Seems like there are two different definitions of "Group." A "Group Plan" such as an employer plan vs. an individual plan. Then there is my "Rating Group" which is the group that I was rated at as in individual when I got the individual plan. Do I have that so far?

Ok,

MichaelB is saying they can cancel me as an individual, but not if I'm on the corporate ("group plan") plan. Got that.

Easy Surfer is saying that if I go on the corporate plan, then have an event and eventually fire, I may not be able to get coverage.

Ziggy is saying that they cannot individually raise my rate, NOR can they move me to a higher risk "rating group" if something happens.
I would put it this way: If you can get rated into a preferred risk group of an "individual" health plan and the employer wouldn't be subsidizing the group plan, you'll *probably* be better off in the individual plan. If you can lock in a preferred rating, you would remain in that group as long as the policy remains in force and does not lapse.

If you stay on the corporate plan, it does not prevent you from getting coverage later as long as you follow the rules under HIPAA (take and exhaust COBRA and don't have a break in coverage of 63 days or more).
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Old 02-28-2012, 12:34 PM   #9
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Once went to a presentation by financial advisors, who suggested that people planning to retire may want to go on an individual plan BEFORE they retire, so that they would be grandfathered in and couldn't be refused coverage.

Of course, insurers aren't shy about recissions and finding ways to deny coverage if they think you had some preexisting condition that you failed to disclose.

I think the financial advisors were partly saying you needed to budget for buying your own coverage as another argument for their services, i.e. you need the returns they will provide to help fund all these unforeseen budget items.
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Old 02-28-2012, 12:38 PM   #10
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Quote:
Originally Posted by REattempt
Ok, now I'm really confused. Seems like there are two different definitions of "Group." A "Group Plan" such as an employer plan vs. an individual plan. Then there is my "Rating Group" which is the group that I was rated at as in individual when I got the individual plan. Do I have that so far?

Ok,

MichaelB is saying they can cancel me as an individual, but not if I'm on the corporate ("group plan") plan. Got that.

Easy Surfer is saying that if I go on the corporate plan, then have an event and eventually fire, I may not be able to get coverage.

Ziggy is saying that they cannot individually raise my rate, NOR can they move me to a higher risk "rating group" if something happens.

So, if I add it all up, the choice is between A) keeping the individual plan and the risk of the them cancelling it vs. B) going on the corporate plan and the risk of having an event on the corporate plan and not being able to get insurance later. Did I get this right?

I can't predict the likelihood of an event happening. I would assume, if one does happen, that I may not be able to get insurance coming off the corporate plan. Any sense out there of the actual risk associated with having my individual policy cancelled?

I would think then, given what I know, that staying on my current plan, particularly because of my rating group would be the best option (2500 deductible, $191 a month) and taking on the risk of them cancelling the coverage.....
I hate to speak for Micheal, but the "cancelling " you are referring to is different than Micheals, I believe. Insurance companies cant just cancel you as an individual because they want to or you cost too much for them. One example of cancelling may be the insurance company decides to vacate your state and not deal with HI in your state anymore. Another could be they proved fraud on your part when applying, such as saying you arent a smoker when you are. Although you are in an individual policy, you are for all intents and purposes in a rated group. If one goes up all do in that group. Keep in mind you will be subjected to rate increases crossing "age bands". I am about the same age as you. I have not hit one of those yet. In fact my premium is still $2 a month less than what is was when I started over a year and a half ago. My question would be if you cant stay on that plan when/if you quit again, what is the benefit of joining it, only to risk having to reenter individual health market again?
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Old 02-28-2012, 01:41 PM   #11
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I've had an individual plan for almost 9 years. REattempt, check with your insurer regarding cancellation. Anthem, here in Virginia can not cancel you as long as you pay your premiums. This is who I use.
Things I have learned about individual plans:
1. You can stay in your plan but as the insurer develops other products/plans AND as other others in your group move to the new plans, you may be left in the old plan. Insurers up the premiums on those old products, hoping to force people to apply to their new products. So consider plan reviews every year.
2. Insurers have an out. In order to move to a new individual plan, one still has to medically qualify and go thru underwriting again. I was denied this once because a doctor put thru the wrong diagnosis code for a blood test. Took me a long time to get that straight. Once straight, I was allowed to change plans.
3. Watch your diagnosis codes. Going back to my example in #2, my doctor put thru an adrenal gland test and coded it as adrenal gland failure. Well the test was normal. It took a specialist to run another test and letters from both doctors stating the first doctor was wrong.
4. Group/corporate plans can actually be more expensive when just one person has something wrong. And like others here, I wonder what happens when in the future you retire again.
ObamaCare will change a lot of things. But somehow I think at the individual level, insurers will develop new and cheaper products, the people that can medically qualify for them will move out of the group, leaving those that cannot medically qualify in the older more expensive products. They may not be able to cancel you but they sure can make it so expensive you wished they would.
If you stay with the individual policy, just be aware that you may want to review your choices each year, particularly if your health status has not changed. If it has not, there should be no reason you should not medically qualify for the newer cheaper plan...etc. Reviewing Health Insurance options is one of those things that we all should review each year to see what new products the insurer is offering...etc. Time consuming...yes.
At this time and at this age (56) if I was able to go back to a group policy, I don't think I would. I have more control over what happens to my health care with the individual policy. For example: I don't need maternity or well baby visits...all of which may be in your policy in a group setting...etc.
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