Health insurance premium questions

[Mulligan]

Being new to individual health insurance premiums I had a couple of questions I was hoping some forum members would take a shot at: 1)I pay for 2 individual plans a $1000 deductible with co-pay plan for my teenage daughter (18 years old) and a 5K deductible HSA plan for myself (46 years old). They both come from Blue Cross Anthem. Hers went up $16 this month to $167 (first increase in 12 months), and mine went down $12 to $61 (I just started my plan in Sept, after ER). Why would one go up and the other down? 2) Also I ve read on the forum about crossing the 60 year old barrier results in higher premiums. Are their any "age bands" besides this one I need to be aware of to plan for "premium shocK"? Thanks for any input!

 

[REWahoo]

As I understand it the age bands are at 5 year intervals 50, 55, 60... But with the newly passed legislation, all that may be changing. I started my individual health policy at age 59 and the increase I got hit with when I recently turned 64 was 3x the size of the 'band' increase when I turned 60.

 

[dgoldenz]

Age bands vary by company. Hers probably went up because there is a lot more utilization with low deductible co-pay plans than their is with $5k deductible HSA plans. Yours may have gone down to satisfy the new 80% loss ratio requirement, or possibly just because they are lowering their rates in general. Contrary to what you hear on the news, Anthem is one of the best companies when it comes to annual renewal rate increases.

 

[walkinwood]

Do the plans have their rates online? You could check there to see if they have age bands and the impact. Otherwise, try eHealthInsurance.com and input various ages.

 

[dgoldenz]

Do the plans have their rates online? You could check there to see if they have age bands and the impact. Otherwise, try eHealthInsurance.com and input various ages.

That won't work because the age bands and ratings for in-force policies can be different than new policies.

 

[Mulligan]

Thanks for the feedback everyone. Dgoldenz, I bet you are right on the 80% ratio for the premium, because the only thing the customer agent could tell me was the premiums were "reformulated based on new health care laws". I just assumed that meant they should jump up! REWahoo, I wonder if the insurance company will let me go from 63 to 65 and just skip 64 Of course who knows what the health care landscape will be like then, though.

 

[dgoldenz]

Good news for you, and apparently I misspelled "there" in my post above....grinds my gears when people do that, but I can't edit the post. Damn.

 

[golfnut]

Being new to individual health insurance premiums I had a couple of questions I was hoping some forum members would take a shot at: 1)I pay for 2 individual plans a $1000 deductible with co-pay plan for my teenage daughter (18 years old) and a 5K deductible HSA plan for myself (46 years old). They both come from Blue Cross Anthem. Hers went up $16 this month to $167 (first increase in 12 months), and mine went down $12 to $61 (I just started my plan in Sept, after ER). Why would one go up and the other down? 2) Also I ve read on the forum about crossing the 60 year old barrier results in higher premiums. Are their any "age bands" besides this one I need to be aware of to plan for "premium shocK"? Thanks for any input!

$61 per month seems awfully low. Curious on this. We (family of 3 - one teenager) are paying $900 month with a $4,000 deductible/$8,000 max of pocket and this is premium is net of my former employer's subsidy.

 

[homestead]

We just got new Insurance since our Cobra ran out.
I got Blue Cross Anthem HSA $3500 deductible for $205/mo (age 57)
My spouse got in the state high risk pool deductible $1500 for $546/mo (age 62)

 

[Htown Harry]

Do the plans have their rates online? You could check there to see if they have age bands and the impact. Otherwise, try eHealthInsurance.com and input various ages.

That won't work because the age bands and ratings for in-force policies can be different than new policies.

dgoldenz, could you elaborate on this?

Does this mean one (or any) of the following?

• All customers who signed up for the 2010 MegaInsure Be Healthy MegaPremium age 20-40 plan are in an in-force "group", whose ratings and premiums are annually evaluated as a group for purposes of calculating increases or decreases in premium
• Like with car insurance, health insurance companies give discounts to continuing customers with favorable claim histories
• Insurance companies use [-]bait and switch[/-] loss-leader sales strategies in selling first-year premiums without any representations regarding future-year premiums
• A current customer with a low claims rate is a known entity, deserving of a lower rate than a pool of seemingly identical new applicants - some of whom will provide less than full disclosure of their ailments

Just trying to understand...

 

[Mulligan]

$61 per month seems awfully low. Curious on this. We (family of 3 - one teenager) are paying $900 month with a $4,000 deductible/$8,000 max of pocket and this is premium is net of my former employer's subsidy.

I'm definitely not complaining! I didnt do anything special other than get the policy that seemed to fit me best (went through ehealthinsurance). They originally quoted me like $79 but said there would be a possible adjustment after approval (I assumed up, but it wasnt) and the first bill came in at $73, now its down to $61. I had 3 other fellow teachers retire with me (they were early 50's and healthy) I know one is paying around $125 for a 3000 deductible at age 54. We all had the choice of staying on our school group plan until 65 but it was $500 a month with $1k deductible, we werent impressed with it, but we do have a year by law to get back on it if we want to. My daughter has been on an individual since 1997, and it started out at $85, so it has really only doubled in 13 years. As a prior poster said, Anthem BC BS has not been bad with premium hikes. My plan is Anthem BC/BS Lumenous $5500 deduct. We all live in rural town an hour south of St. Louis. Maybe that helps with lower premiums. I know we are all healthy and take no medicine. I'm sure that keeps it lower, also. I have been on group plan paid for by school my whole adulthood, so Im still nervous but maybe it wont be that bad.

 

[dgoldenz]

dgoldenz, could you elaborate on this?

Does this mean one (or any) of the following?

• All customers who signed up for the 2010 MegaInsure Be Healthy MegaPremium age 20-40 plan are in an in-force "group", whose ratings and premiums are annually evaluated as a group for purposes of calculating increases or decreases in premium
• Like with car insurance, health insurance companies give discounts to continuing customers with favorable claim histories
• Insurance companies use [-]bait and switch[/-] loss-leader sales strategies in selling first-year premiums without any representations regarding future-year premiums
• A current customer with a low claims rate is a known entity, deserving of a lower rate than a pool of seemingly identical new applicants - some of whom will provide less than full disclosure of their ailments

Just trying to understand...

The answer depends on the state laws and how the insurance company rates their policies. In some cases, the in-force premium can be different than the new policy premium. I'm not sure how else you want me to explain it.

Also, health insurance companies don't give discounts to continuing customers with favorable claims histories. Whether you have used $500k in services or $0 in services, you would pay the same rate as anyone else the same age and risk class and rate adjustments in your group/demographic. They can't give one person a lower rate increase than someone else just because they had less claims.

 

[golfnut]

I'm definitely not complaining! I didnt do anything special other than get the policy that seemed to fit me best (went through ehealthinsurance). They originally quoted me like $79 but said there would be a possible adjustment after approval (I assumed up, but it wasnt) and the first bill came in at $73, now its down to $61. I had 3 other fellow teachers retire with me (they were early 50's and healthy) I know one is paying around $125 for a 3000 deductible at age 54. We all had the choice of staying on our school group plan until 65 but it was $500 a month with $1k deductible, we werent impressed with it, but we do have a year by law to get back on it if we want to. My daughter has been on an individual since 1997, and it started out at $85, so it has really only doubled in 13 years. As a prior poster said, Anthem BC BS has not been bad with premium hikes. My plan is Anthem BC/BS Lumenous $5500 deduct. We all live in rural town an hour south of St. Louis. Maybe that helps with lower premiums. I know we are all healthy and take no medicine. I'm sure that keeps it lower, also. I have been on group plan paid for by school my whole adulthood, so Im still nervous but maybe it wont be that bad.

Thanks for the response. We live outside of Chicago. I went to the Anthem site and apparently they do not biz here as I was redirected to BCBS of Illinois. For grins, I got some preliminary quotes ranging from $600 to $700 per month including dental. Dental is approx. $90 per month.

Based on your numbers, I wish Anthem was here in Illinois.

Again, appreciate your response.

 

[Corporate ORphan]

I think I finally am understanding why people say to get your insurance before COBRA expires but I want to make sure I understand. Here are my questions. Can anyone confirm/answer them?

1. If we start now while we are relatively healthy and get sick while on the new insurance, it will not effect our rates in the future if we keep the same insurance. Rates are determined when you are underwritten and are based on age and sex (in MO). So the several hundred dollars we might save staying on COBRA could be eaten up very quickly in the 10 years we have before medicare kicks in.

2. If I apply for insurance 90 days before we need it, the insurance co will honor the rate quoted even if we get sick or are in an accident before the insurance kicks in. If not, how many days ahead will they honor it? 45? 30?

Other questions:
1. I went online and "applied" so I could see how far back they went and the type of questions they asked. United Health Care asked for 10 years and details like prescriptions including doses. I have no idea what medication I received when I had an operation 2 years ago or needed an antibiotic for a mild ailment. Will they try to rescind me in the future for not answering completely or incorrectly? Do I need to get my medical records? I know we legally can get them but they charge copy fees. It could get rather expensive to go back 10 years plus I have a couple of doctors who no longer practice. I have no idea how to contact them.

2. The couple of places I looked wanted SS# and credit cards so they can bill me if I'm accepted. Can I apply without doing that? That would be mean I should only apply for one policy at a time. How can you really comparison shop then if you don't know the cost? Plus, what if the cost is higher than what we were quoted and want to continue to look around??

I probably have more but this is all I can think of now. Thanks!

 

[Rich_by_the_Bay]

Good news for you, and apparently I misspelled "there" in my post above....grinds my gears when people do that, but I can't edit the post. Damn.

Their, their, it's OK

 

[dgoldenz]

I think I finally am understanding why people say to get your insurance before COBRA expires but I want to make sure I understand. Here are my questions. Can anyone confirm/answer them?

1. If we start now while we are relatively healthy and get sick while on the new insurance, it will not effect our rates in the future if we keep the same insurance. Rates are determined when you are underwritten and are based on age and sex (in MO). So the several hundred dollars we might save staying on COBRA could be eaten up very quickly in the 10 years we have before medicare kicks in.

2. If I apply for insurance 90 days before we need it, the insurance co will honor the rate quoted even if we get sick or are in an accident before the insurance kicks in. If not, how many days ahead will they honor it? 45? 30?

Other questions:
1. I went online and "applied" so I could see how far back they went and the type of questions they asked. United Health Care asked for 10 years and details like prescriptions including doses. I have no idea what medication I received when I had an operation 2 years ago or needed an antibiotic for a mild ailment. Will they try to rescind me in the future for not answering completely or incorrectly? Do I need to get my medical records? I know we legally can get them but they charge copy fees. It could get rather expensive to go back 10 years plus I have a couple of doctors who no longer practice. I have no idea how to contact them.

2. The couple of places I looked wanted SS# and credit cards so they can bill me if I'm accepted. Can I apply without doing that? That would be mean I should only apply for one policy at a time. How can you really comparison shop then if you don't know the cost? Plus, what if the cost is higher than what we were quoted and want to continue to look around??

I probably have more but this is all I can think of now. Thanks!

You need the help of an agent who can answer these questions for you, but the answers are....

1. Correct

2. If you have a change in health before your effective date, you are required to notify the insurance company and they can then re-underwrite you. So until your effective date, any change in health could cause you to be declined, even after you have already been approved. Always apply for the earliest effective date possible. The length of time you can apply in advance depends on the company. Some have a max of 60 days in advance, some are 75, etc. The "change in health" rule will apply with all companies.

1. Answer the questions to the best of your ability. If you don't know what prescriptions you were given, state on the application that you took medication but don't remember the name. If it was antibiotics and you don't remember the name, tell them that. You don't need to get medical records. If a company asks for medical records, they will usually request them from the doctor directly and pay for the records.

2. Most companies will require a credit card to bill the first month's premium. Some, like United, will bill you immediately whether you are accepted or not. Other won't bill you until the policy is approved. One of the BCBS companies here doesn't ask for any payment on the app and sends a bill in the mail upon approval. You always have a 10-day "free look" period to accept or reject the policy once you receive it in the mail. If you reject it, they refund your money and that's the end of it. Be careful of this if you aren't 100% sure you want to reject it because some companies won't let you re-apply for a certain amount of time if you do reject it. For example, United requires a six-month wait to re-apply if you reject an offer.

 

[MichaelB]

Their, their, it's OK

 

[Corporate ORphan]

1. Answer the questions to the best of your ability. If you don't know what prescriptions you were given, state on the application that you took medication but don't remember the name. If it was antibiotics and you don't remember the name, tell them that. You don't need to get medical records. If a company asks for medical records, they will usually request them from the doctor directly and pay for the records.

dgoldenz,
Thank you so much! If I remember right you were or are in the business?

A couple of follow-up questions, if you don't mind answering some more.

Based on above someone is "covered" as long as he/she mentions they had the infection, surgery, etc. but don't remember the particulars? What happens if you forget to put something down?

Again, thanks for your feedback! For the last couple of nights I wake up wondering if I forget something on the form, it won't be covered. (And we haven't had that much treatment. I can't imagine how someone who has had a lot done with a bunch kids handles it!)

 

[dgoldenz]

dgoldenz,
Thank you so much! If I remember right you were or are in the business?

A couple of follow-up questions, if you don't mind answering some more.

Based on above someone is "covered" as long as he/she mentions they had the infection, surgery, etc. but don't remember the particulars? What happens if you forget to put something down?

Again, thanks for your feedback! For the last couple of nights I wake up wondering if I forget something on the form, it won't be covered. (And we haven't had that much treatment. I can't imagine how someone who has had a lot done with a bunch kids handles it!)

Yes, I sell health insurance. Whether someone is covered or not depends on the company. Every company has different underwriting and some may exclude specific medical conditions from coverage (United does this) instead of applying a rate adjustment. Some may do one or the other, or both, just depending on the conditions. As far as I know every BCBS company will not place exclusion riders, they will only rate up or decline.

If you forget to put something down, your policy can only be rescinded for intentional misrepresentation/fraud (like having a heart attack or being a smoker and telling them you're a perfectly healthy non-smoker). Unfortunately, a lot of people conveniently "forget" to put things down and it makes the agent's job harder. Just be up front about your medical history with your agent, their job is to help you.

 

[oldtrig]

I plan on retiring in the near future for reasons I cannot discuss here. I will not buy insurance. The heck with it. When I was self employed years ago I had insurance. I used it one time and they would not pay. I done the math and for those twenty years I paid in around $60,000. There was some fine print I did not read and was tricked into thinking I was covered. I will roll the dice and put $1200 a month in my safe when I make the move later this year. I will also cash my CD's in and spend it.

 

[FIRE'd@51]

I plan on retiring in the near future for reasons I cannot discuss here. I will not buy insurance. The heck with it. When I was self employed years ago I had insurance. I used it one time and they would not pay. I done the math and for those twenty years I paid in around $60,000. There was some fine print I did not read and was tricked into thinking I was covered. I will roll the dice and put $1200 a month in my safe when I make the move later this year. I will also cash my CD's in and spend it.

While I don't disagree with the concept of self-insuring, you may want to consider purchasing a very high deductible policy (e.g., 10K or 20K deductible) just to give you some protection against a catastrophic illness that could wipe you out financially.

 

[REWahoo]

I plan on retiring in the near future for reasons I cannot discuss here. I will not buy insurance. The heck with it.

Based on this...

I have decided that I will continue to work as long as I can get out of the bed in the morning.

...it doesn't look like you could get anyone to insure you even if you did try to buy it.

Sorry to hear you can no longer stand on your own two feet and hope you get better soon.

 

[frank]

I too was self-employed and paid throught the nose for the past 30 years, enormous amounts of money to the insurance companies, but to drop it now, would be to let the ins. company win. they have all your money and have never to pay a claim. what will you do for insurance and health coverage? welfare, medicaid? just curious

 

[dgoldenz]

I too was self-employed and paid throught the nose for the past 30 years, enormous amounts of money to the insurance companies, but to drop it now, would be to let the ins. company win. they have all your money and have never to pay a claim. what will you do for insurance and health coverage? welfare, medicaid? just curious

I have a client + spouse who are both 60 years old, perfect health, etc. They had been paying a lot of $$ for health insurance for a lower deductible co-pay plan and never used because of their good health. They finally decided to go the HSA-plan route and chose a $10k deductible. Of course, the first year they had it, they incurred $10k in claims. Just because you've been healthy for 20 years doesn't mean disaster can't strike now.

I'd suck it up and keep paying for the insurance. Like someone else said, even a $10k deductible HSA policy won't be that expensive and will at least cover you in the event that something disastrous happens or you develop a chronic condition. This is an ER forum and I would venture to guess a major event or chronic illness could easily ruin those plans.

 

[Martha]

I think I finally am understanding why people say to get your insurance before COBRA expires but I want to make sure I understand. Here are my questions. Can anyone confirm/answer them?

1. If we start now while we are relatively healthy and get sick while on the new insurance, it will not effect our rates in the future if we keep the same insurance. Rates are determined when you are underwritten and are based on age and sex (in MO). So the several hundred dollars we might save staying on COBRA could be eaten up very quickly in the 10 years we have before medicare kicks in.

This is where I always put a few caveats to dgoldenz answer. Technically this is a matter of state law and if your state law does not bar re-underwriting, the insurance companies can raise rates based on claims. Many states do bar this practice. I don't know about Missouri. It is very unclear how common this practice is in states that do not bar it but it certainly has happened. It may be the case that it occurs less or not at all with "name brand" insurers.

What is more common is that the rates for the entire group may go up, especially if the people in the group are aging or have a lot of claims. The healthy ones leave the group for better rates and the rates go higher and higher for the ones who are left and can't get underwritten insurance.

Or, the plan is terminated and the healthy people are able to get on a new plan and the unhealthy are not.

So, just because you get a plan and are healthy now is no guaranty that things will not change in the future. I wonder how many people on individual plans end up on the same plan for decades. Not many I would guess.