Health Care Insurance for ER?

[Seattle]

Looking to ER at 50 and my thought process was around just getting a very high deductible catastrophic health insurance policy for my wife and I (we are healthy and fit except for my high blood pressure which is under control - I think it is job stress related - another reason for ER)

I have found $10K deductible policies for around $500 a month which I am fine with. I *believe* I can put away $6K a year in an HSA and reap the tax benefits.

This is the route I was thinking about going in ER but I have heard some horror stories about insurance companies just cancelling the policies once something more costly is diagnosed. Anybody else have any experience with this?

My worst fear is to have something like breast cancer hit my wife and the insurance company cancel the policy and it wipes out my entire savings to care for her. I have also heard that these policies have $1M lifetime benefit limits so something pretty hard core could still wipe us out.

How do the rest of you in ER and not eligible for medicaid or medicare yet handle medical insurance coverage?

I think my last big hurdle before executing my ER is health care...it has me very concerned (I have fantastic medical benefits in my current job)

Any and all advice would be greatly appreciated

Seattle

 

[MichaelB]

Seattle, there's not much one can do. The PPACA in being implemented and the remaining provisions take effect by Jan '14. That will effective resolve your concers.

 

[Seattle]

Interesting

I never considered how Obamacare would affect my plans...thanks for pointing that out. Guess I have to do some research on this and what it means and how I fit into it (or dont).

Thanks Michael B for pointing this out. Really great info...

 

[MichaelB]

Seattle, let me suggest Kaiser Family Foundation for information on health care (The Henry J. Kaiser Family Foundation - Health Policy, Media Resources, Public Health Education & South Africa - Kaiser Family Foundation) , insurance and reform. Kaiser Health Reform Gateway: Health Care Reform and Health Insurance Reform Analysis, Data and Information

The PPACA affects us all in many ways, but two specific to your post are guaranteed access to coverage and no lifetime limits. Others will point out that high costs are still an issue and the Supreme Court has yet to rule. This is true, but neither of the two specifics mentioned above are subject to the recent Supreme Court case.

 

[2B]

I am sure we can expect significant health care changes over the next couple of years no matter what the Supreme Court says later this summer. There are gaps/opportunities for improvement in the PPACA that will have to be addressed even if the complete law is upheld. We can expect lots of froth on this over the next few years. If I go on, MichaelB will stomp the crap out of me.

Age 50 and high blood pressure ever being diagnosed would probably exclude you from getting any individual heath plan here in Texas except in the High Risk Pool. It costs more than the typical heath plan but at least it's available. Washington State has their version and you can easily do a search to see the cost and deductible.

If you can get a personal plan, insurance companies can't cancel you for getting sick but you have to be sure that when you got the policy there weren't exclusions. I know someone in Texas that was offerred a plan; but because of his high blood pressure, it excluded heart disease and stroke. Why would anyone buy that plan?

The other insurance company trick is to raise the rates significantly for everyone in your plan. Everyone in that plan then has the opportunity to reapply for a lower rate plan but they can rescreen people that may have developed health issues. The insurance company then effectively transfers these to the High Risk Pool.

Bottom line, your worst case scenario is that you get 18 months of COBRA and then you get forced on to a high risk pool. I would suggest you price that into your planning and see if you can get a lower cost personal plan when the time comes.

 

[fisherman]

Seattle, let me suggest Kaiser Family Foundation for information on health care (The Henry J. Kaiser Family Foundation - Health Policy, Media Resources, Public Health Education & South Africa - Kaiser Family Foundation) , insurance and reform. Kaiser Health Reform Gateway: Health Care Reform and Health Insurance Reform Analysis, Data and Information

The PPACA affects us all in many ways, but two specific to your post are guaranteed access to coverage and no lifetime limits. Others will point out that high costs are still an issue and the Supreme Court has yet to rule. This is true, but neither of the two specifics mentioned above are subject to the recent Supreme Court case.

I hope you are right but I thought, after just half a cup of coffee, that if the SC throws out the entire law we lose those two items also.

 

[MichaelB]

I hope you are right but I thought, after just half a cup of coffee, that if the SC throws out the entire law we lose those two items also.

The Supreme Court is not reviewing the entire law. From a media summary last year

The justices combined petitions filed by the 26 states, NFIB and the Justice Department. They will hear two hours of argument on whether the law’s requirement to buy insurance is constitutional.

They’ll spend another 90 minutes arguing which pieces of the law should be struck if the mandate falls. The states and NFIB want the whole law knocked down, but the federal government argues that only two insurance reforms would have to go.

And they’ll devote an hour to the Anti-Injunction Act * which could put off the whole issue until after the individual mandate goes into effect. The law says consumers cannot challenge a tax law until they have to pay it. If the court says the mandate's penalty is a tax, the court could throw all the pending lawsuits out until consumers pay the penalty on their 2015 tax returns.

The court will also review for an hour the law’s Medicaid expansion, which the states claim is an unlawful coercion by the federal government since they must expand the program or drop out completely.

 

[2B]

The Supreme Court is not reviewing the entire law. From a media summary last year

Lest I delve into what could be considered political - My understanding of their options include tossing out the entire law. When I read your post with the media summary quote, it also seemed to say that.

 

[MichaelB]

Lest I delve into what could be considered political - My understanding of their options include tossing out the entire law. When I read your post with the media summary quote, it also seemed to say that.

The Supreme Court is not reviewing the entire law. It is reviewing the individual mandate and a Medicare expansion. It is also considering the argument that the absence of these should invalidate the remaining provisions.

They’ll spend another 90 minutes arguing which pieces of the law should be struck if the mandate falls. The states and NFIB want the whole law knocked down, but the federal government argues that only two insurance reforms would have to go.

There is no challenge to the remaining provisions, many of which are already implemented. One of those expressed in the OP, rescission of policies by insurance companies when people become ill, has already been agreed to by the Health Insurance Business Association.

 

[Sue J]

Look carefully when considering your state's High Risk Pool. Here in Ohio you don't qualify unless you have been uninsured for 6 months before you apply.

Who makes up this stuff? What are they thinking?

https://www.ohiohighriskpool.com/eligibility.aspx

 

[dgoldenz]

High blood pressure is not going to get you declined if it's under control. Companies cannot rescind a policy or terminate your coverage except in the case of an intentional fraud or misrepresentation on the application (ex: you had a heart attack last week, didn't disclose it, and somehow still got approved). There are no lifetime maximums on health insurance.

 

[Gumby]

If I go on, MichaelB will stomp the crap out of me.

Just a quick diversion on this topic, because it might be helpful for everyone to know this -- the moderators discuss flagged posts as a group and reach consensus as to any action taken. In moderating, any one of us speaks for all of us. Thus, while MichaelB ultimately may have been the one to do the actual moderating, any of the rest of us would have done the same.

Sermon over. Please carry on.

P.S. -- if you really do think you have a problem with a particular moderator, you can send any of us a PM.

 

[Mulligan]

Seattle, I have found Dgoldenz to be very knowledgable and helpful in this area. I don't believe the comments have mentioned this, but if you are going the individual route, I would get on it ASAP and avoid the COBRA, as if you developed a health problem while on COBRA you may find the individual market very unwelcoming. States are all over the map in terms of pricing if you aren't married to your present location. I personally wouldn't want to move just for health insurance reasons but my premium in my state is a fraction of yours. I pay $72 a month for a $5500 deductible HSA plan. I have no health problems ( at least what I am aware of) and 48 years old. The premium has basically been unchanged in the almost 2 years I have had it.

 

[haha]

Seattle, I have found Dgoldenz to be very knowledgable and helpful in this area.

I second this. Dgoldenz speaks from a deep knowledge base

 

[Midpack]

Looking to ER at 50 and my thought process was around just getting a very high deductible catastrophic health insurance policy for my wife and I (we are healthy and fit except for my high blood pressure which is under control - I think it is job stress related - another reason for ER)

I have found $10K deductible policies for around $500 a month which I am fine with. I *believe* I can put away $6K a year in an HSA and reap the tax benefits.

That matches what we've found too...

If I go on, MichaelB will stomp the crap out of me.

The Supreme Court is not reviewing the entire law. It is reviewing the individual mandate and a Medicare expansion. It is also considering the argument that the absence of these should invalidate the remaining provisions.

That's my understanding as well.

 

[pb4uski]

My main interests were 1) gaining access to negotiated rates for medical services through local docs and hospitals and 2) protecting myself from a catastrophic financial loss in the event of an expensive major illness.

I ended up forming an LLC for some consulting that I might do and the LLC purchased a small group health insurance policy (for a group of 1 - me and DW) through the state chamber of commerce. This route was about 20% lower premium that buying an individual policy for DW and I with similar coverage.

 

[MichaelB]

Seattle, I have found Dgoldenz to be very knowledgable and helpful in this area. I don't believe the comments have mentioned this, but if you are going the individual route, I would get on it ASAP and avoid the COBRA, as if you developed a health problem while on COBRA you may find the individual market very unwelcoming. States are all over the map in terms of pricing if you aren't married to your present location. I personally wouldn't want to move just for health insurance reasons but my premium in my state is a fraction of yours. I pay $72 a month for a $5500 deductible HSA plan. I have no health problems ( at least what I am aware of) and 48 years old. The premium has basically been unchanged in the almost 2 years I have had it.

Group policies are subject to greater regulation than individual policies and insurance companies are much more limited in what actions they can take. Going from from group to individual coverage is a risky step which should be carefully thought out.

 

[dgoldenz]

Group policies are subject to greater regulation than individual policies and insurance companies are much more limited in what actions they can take. Going from from group to individual coverage is a risky step which should be carefully thought out.

I would disagree with this statement. Individual major medical policies are heavily regulated both on a federal and state level. Group policies are subject to the same rate increase/decrease actions as individual policies.

If the OP is leaving the employer anyway, going on COBRA instead of buying an individual policy does nothing but kick the can down the road 18 months, at which point OP could face significantly higher rates if their health at that time makes them uninsurable. Buying an individual policy not only may be less expensive than COBRA, but it also locks in the insurability too.

 

[ejman]

My main interests were 1) gaining access to negotiated rates for medical services through local docs and hospitals and 2) protecting myself from a catastrophic financial loss in the event of an expensive major illness.

I ended up forming an LLC for some consulting that I might do and the LLC purchased a small group health insurance policy (for a group of 1 - me and DW) through the state chamber of commerce. This route was about 20% lower premium that buying an individual policy for DW and I with similar coverage.

We had to do something similar when we retired back in 2002. I could not find an individual policy at all. I though we were in great shape for a 52/54 year olds ( high blood pressure under full control with medications and my wife has mild carpal tunnel) but I could not find anybody that would insure us for any amount of money. We ended up purchasing a high cost high deductible group policy (for 2) under our farm for my wife and myself (from COSTCO of all places). This is the one area where what I thought was my extensive planning before ER was totally inadequate. I don't really know if Obamacare will fix this or not but the current system sucks.

 

[MichaelB]

I would disagree with this statement. Individual major medical policies are heavily regulated both on a federal and state level. Group policies are subject to the same rate increase/decrease actions as individual policies.

If the OP is leaving the employer anyway, going on COBRA instead of buying an individual policy does nothing but kick the can down the road 18 months, at which point OP could face significantly higher rates if their health at that time makes them uninsurable. Buying an individual policy not only may be less expensive than COBRA, but it also locks in the insurability too.

Fair enough. We probably agree on most things and are looking at different aspects of current regulation. Individual policies are less expensive, but because underwriting and pre-existing conditions exclude so many that need insurance coverage. Individual policies can be cancelled as long as its the policy and not the individual. This has happened to me (we discussed this previously) so it is a reality.

The key (IMHO) is that group coverage is mandated in all states while individual coverage is not. As long as you are a member of the group you cannot be denied coverage, while individuals are routinely denied coverage. Once you have group coverage COBRA regulations assure you can convert that into individual coverage, bu each state defines how,

The OP expressed concerns about accessibility, recession and coverage limits. My take would be that group coverage could be more expensive than individual but would address those concerns more effectively.

 

[Mulligan]

Fair enough. We probably agree on most things and are looking at different aspects of current regulation. Individual policies are less expensive, but because underwriting and pre-existing conditions exclude so many that need insurance coverage. Individual policies can be cancelled as long as its the policy and not the individual. This has happened to me (we discussed this previously) so it is a reality.

The key (IMHO) is that group coverage is mandated in all states while individual coverage is not. As long as you are a member of the group you cannot be denied coverage, while individuals are routinely denied coverage. Once you have group coverage COBRA regulations assure you can convert that into individual coverage, bu each state defines how,

The OP expressed concerns about accessibility, recession and coverage limits. My take would be that group coverage could be more expensive than individual but would address those concerns more effectively.

I certainly agree that I would have preferred to stay on my group plan. However the cost difference was too much to ignore for me (500 a month 1000 deduct. vs. 72 a month and 5500 deduct. plus HSA tax break). If the group plan had been closer to 300 a month, I would stayed on the plan and ate the $ difference.

 

[Seattle]

Seattle, I have found Dgoldenz to be very knowledgable and helpful in this area. I don't believe the comments have mentioned this, but if you are going the individual route, I would get on it ASAP and avoid the COBRA, as if you developed a health problem while on COBRA you may find the individual market very unwelcoming. States are all over the map in terms of pricing if you aren't married to your present location. I personally wouldn't want to move just for health insurance reasons but my premium in my state is a fraction of yours. I pay $72 a month for a $5500 deductible HSA plan. I have no health problems ( at least what I am aware of) and 48 years old. The premium has basically been unchanged in the almost 2 years I have had it.

Wow! $72 a month for a $5500 deductible HSA? That is amazing. I was planning to use COBRA for 18 months and then slip into an HSA and I was budgeting for $600+ per month for my wife and I. She has zero health problems and I think my BP will go away with the job. But $72 a month is amazing.

Thanks for the tip.


Seattle

 

[obgyn65]

This is correct. And I am afraid we already know what the SC will decide, don't we ?

The Supreme Court is not reviewing the entire law. It is reviewing the individual mandate and a Medicare expansion. It is also considering the argument that the absence of these should invalidate the remaining provisions.

 

[obgyn65]

Did you check here ? Health Insurance - Find Affordable Health Insurance Plans and Buy Medical Coverage Online

Any and all advice would be greatly appreciated

Seattle

 

[Midpack]

This is correct. And I am afraid we already know what the SC will decide, don't we ?

We do? I wouldn't put much stock in the media reports, they're prone to hype suspense...but you may well know more than I do (happens all the time).