Health Insurance Gotchas - For people over 55...

[mykidslovedogs]

A Few Gotchas to think about if you are over 55 and trying to get private, individual health insurance....

1.) Have you had a physical in the past 2 years? If not, you might want to consider getting one. Many carriers will not even consider you for coverage if you haven't had a physical in the past 2 years (especially the ones that offer preferred rating). On the other hand, there are a few carriers that will not disqualify for lack of having had a physical. If you are worried about what the outcome might be, you might want to limit your plan selection to a carrier that is not going to require that you've had a recent physical. Ask a local broker for input.

2.) Common pre-existing conditions that might present a problem with obtaining coverage. (Based on my past experience)

a.) Elevated Cholesterol diagnosed within the past six months. Insurance carriers like to see stability on either a diet & exercise regimen or medication, with controlled results after at least six months of treatment.

b.) High Blood Pressure diagnosed within the past six months. Insurance carriers like to see stability on two or less medications, with controlled results after at least six months of treatment.

c.) Height and Weight. Not a problem in itself, as long as you do not fall into the grossly obese category, but in combination with elevated cholesterol and HBP, a declination of coverage could result due to the combination of risk factors. BMI above 30 will result in a premium rating.

d.) Degenerative disc disease - This is usually going to be excluded from coverage
e.) Osteopenia/Osteoporosis- This is usually going to be excluded from coverage
f.) Basal Cell skin cancers - can result in premium ratings or exclusion riders or a even a decline if treatment was recent (within the past 3-6 months. ). Other skin cancers - usually a decline.
g.) Actinic Keratosis - usually an exclusion or possible premium rating.
h.) Depression/Anxiety - must be out of counseling for at least 1 year, and medications must not have changed over the past 1 year. Likely outcome...exclusion of coverage or premium rating.
i.) History of drug or alcohol abuse or excessive alcohol or DUI within the past 10 years - decline. (Golden Rule is the only one that only goes back 5 years on this, and there are a few exceptions going back only 5 yrs on DUI.)
j.) Any past history of cancer, even if it is cured - almost always a decline.
K.) Hypothyroidism. Never a problem as long as it is being treated with medication.
L.) Arthritis - Osteo - exclusion or decline depending on severity
M.) Arthritis - Rheumatoid - decline
N.) Any combination of four or more conditions that would have resulted in an exclusion, will usually cause a decline. Insurance carriers typically do not like to exclude more than three conditions at a time. If that happens, they will usually just decline.

[astroboy]

Aren't these conditions just as dangerous for folks under 55 trying to get insurance? What about thrombocytopenia? Thanks.

[Hydroman]

What about family history? My mom died from Breast Cancer at age 52 and my dad had a heart attack followed by quadruple by-pass surgery at age 58 (cholesterol, BP and weight were in normal range).

[magellan_nh]

I just finished applications for BCBS and Assurant and neither of these asked about family history at all.

Not sure what other carriers might do...

Jim

[mykidslovedogs]

Except for the mandatory physical exam , all of the same underwriting guidelines apply to people under the age of 55. Thrombocytopenia....

Definition:
Thrombocytopenia-absent radius (TAR) syndrome is a rare genetic disorder that is apparent at birth (congenital). The disorder is characterized by low levels of platelets in the blood (thrombocytopenia), resulting in potentially severe bleeding episodes (hemorrhaging) primarily during infancy. Other characteristic findings include absence (aplasia) of the bone on the thumb side of the forearms (radii) and underdevelopment (hypoplasia) or absence of the bone on the "pinky" side of the forearms (ulnae). Other abnormalities may also be present, such as structural malformations of the heart (congenital heart defects), kidney (renal) defects, and/or mental retardation that may be secondary to bleeding episodes in the skull (intracranial hemorrhages) during infancy. TAR syndrome is inherited as an autosomal recessive trait.

If I were an underwriter,I would probably decline unless I were to get a letter from a Doctor stating that the disease presents very little risk of any sort of future complications. I can't find any specific guidelines in the written documentation on this disease, as my underwriting guidelines usually only discuss likely outcome of more common disorders.


Insurance carriers don't underwrite based on family history. They can only actually look at your personal, CURRENT health status and other conditions that you have had throughout your lifetime. Most carriers don't look back more than 10 years.

[tomz]

Thank you for posting this, mykidslovedogs.

(I still disagree with you on National Healthcare).

[Nords]

Originally Posted by tomz

(I still disagree with you on National Healthcare).

MKLD, your statements in that debate also make me question your credibility in this thread. It's difficult to separate fact from opinion.

I'm skeptical that all the different companies in the industry, especially the ones greedy for market share, are going to insure in the same manner described above. I'm not talking about minor differences... I would suspect that each would try to differentiate their coverage and be willing to make frequent exceptions to every guideline discussed above.

Where are the other insurance experts and their opinions? We can't swing a dead cat on this board without hitting a couple of annuity salesmen. So where are the other insurance brokers/agents/underwriters/actuaries to comment on this thread?

[mykidslovedogs]

Originally Posted by Nords

MKLD, your statements in that debate also make me question your credibility in this thread. It's difficult to separate fact from opinion.

I'm skeptical that all the different companies in the industry, especially the ones greedy for market share, are going to insure in the same manner described above. I'm not talking about minor differences... I would suspect that each would try to differentiate their coverage and be willing to make frequent exceptions to every guideline discussed above.

Where are the other insurance experts and their opinions? We can't swing a dead cat on this board without hitting a couple of annuity salesmen. So where are the other insurance brokers/agents/underwriters/actuaries to comment on this thread?

I have posted many articles and facts to back up my opinions, but my opinions are just that...opinions. Like them or not. I don't agree with the left's arguments oftentimes either, but I do take everyone's comments into consideration in forming my opinions.

You are right. Each carrier has their own underwriting guidelines. I posted the most common gotchas that I can think of at the beginning of this post, and the most likely underwriting outcomes that I have seen. There can always be exceptions, especially with some of the lower quality insurers like "World Insurance", "Mega Life and Health", "Midwest National Life of Tenesse", (this is my opinion as I have had A LOT of complaints about these companies), etc....My posts are based on my experience with most of the largest and more reputable carriers in the market...BCBS, Humana, Golden Rule, Kaiser Permanente, United Healthcare, Assurant Health, Celtic Insurance.

[Martha]

Mykids, can you give us a rough idea as to how much of your business is sale of non-group health insurance? Also, if you know, how much of that business was for people over 50?

[brewer12345]

Originally Posted by Martha

Mykids, can you give us a rough idea as to how much of your business is sale of non-group health insurance? Also, if you know, how much of that business was for people over 50?

And which states you place business in. Many of the companies you reference don't even sell individual policies in my home state.

[mykidslovedogs]

Originally Posted by Martha

Mykids, can you give us a rough idea as to how much of your business is sale of non-group health insurance? Also, if you know, how much of that business was for people over 50?

We have been sellling individual insurance for about 11 years, and it makes up maybe...1/4 of our income? Taking a guess right now. I don't have exact numbers as to how many are over 50. Underwriting guidelines are pretty much the same from one age category to the next, except for the fact that once you are over 55 insurance carriers really like to see that you have had a physical within the past year or two.

[Oldbabe]

All those "gotchas" coincide with my experience applying for health insurance in Colorado. I ended up with World Insurance, which has a more "lenient" underwriting than most others, according to my agent.

And I am very much a proponent for National Health Insurance, now more than ever.

But, MKLD, I am sorry for the little conflict we had. I was still "raw" from my ordeal with health insurance and took it out on you. My bad.