Health Insurance Summary

[REWahoo]

The Kiplinger Retirement Report has an excellent article on health insurance for early retirees. This is a concise summary of information for those asking "What about health coverage?".


"The price you pay depends on where you live, your health and the insurer’s rules. In Arizona and Florida, insurers can set any premium they want or reject you if you have a medical condition. In New Jersey and New York, insurers can’t turn you down based on illness and premiums for those with medical conditions are relatively affordable. (Visit www.healthinsuranceinfo.net to check coverage in your state.)"

"You can save time, and maybe money, by hiring a local insurance broker. You can find a broker through the National Association of Health Underwriters (www.nahu.org; 703-276-0220). You can also compare policies on www.eHealthInsurance.com (800-977-8860)."

"You’re most likely to get affordable coverage if you’re healthy….Each insurer has its own coverage rules, so it pays to check out many companies... If an insurer rejects you, ask for a written explanation. An insurer could change its mind if your physician provides details on how you’ve been managing a condition."

"As you search the market, you should continue coverage with your former employer under the federal COBRA law. You’ll pay the full premium yourself, but it may be worth it if you have a medical condition. In most cases, COBRA coverage is available for 18 months."

"If you’re rejected by commercial insurers, you might be able to turn to a state-run, high-risk pool. About 30 states extend coverage to individuals who are otherwise uninsurable, although rates are usually higher than in the private market."

"Before you buy, check with your state insurance commissioner for any complaints. (Visit the National Association of Insurance Commissioners at www.naic.org and link to your state.)"

 

[lazygood4nothinbum]

The Kiplinger Retirement Report has an excellent article on health insurance for early retirees.
"As you search the market, you should continue coverage with your former employer under the federal COBRA law. You’ll pay the full premium yourself, but it may be worth it if you have a medical condition. In most cases, COBRA coverage is available for 18 months."

oldbabe warns of cobra in another post but i think that warning deserves amplification here:

cobra is a dangerous snake and as such should be handled with care. cobra should never be used for anything more than a quick stopgap giving you time to shop for private insurance, particularly in states such as florida.

while 1 and 1/2 years of extended previous coverage might sound like a blessing, it can easily curse you should a medical condition develop during those 18 months which might then be considered a pre-existing condition to private insurance you later find.

the quicker you remove that venom, the better.

 

[Martha]

Yes, if you are healthy and get get covered on an individual plan, do it sooner rather than later. Besides, COBRA is usually expensive. However, if you are unisurable on the individual market, most if not all of the time risk pools and other insurance you get because you are HIPAA eligible will require you to use up your COBRA benefits first.

 

[FIRE'd@51]

From the article REWahoo cited:

"One way to reduce premiums is to raise your deductible. For instance, Blue Shield of California offers a PPO policy with a $500 deductible that costs $1,064 a month for a healthy 56-year-old male, but the premium drops to $405 for a similar policy with a $2,000 deductible."

I know raising the deductible will lower your premium, but this example is ridiculous. By raising the deductible from $500 to $2000, you save $659 per month, or $7908 annually in premiums. Why would anybody buy the $500 deductible? Does anyone think the numbers in this example are correct?

 

[mykidslovedogs]

I know raising the deductible will lower your premium, but this example is ridiculous. By raising the deductible from $500 to $2000, you save $659 per month, or $7908 annually in premiums. Why would anybody buy the $500 deductible? Does anyone think the numbers in this example are correct?

Those sound more like group rates than individual rates to me....

 

[REWahoo]

From the article REWahoo cited:

"One way to reduce premiums is to raise your deductible. For instance, Blue Shield of California offers a PPO policy with a $500 deductible that costs $1,064 a month for a healthy 56-year-old male, but the premium drops to $405 for a similar policy with a $2,000 deductible."

I know raising the deductible will lower your premium, but this example is ridiculous. By raising the deductible from $500 to $2000, you save $659 per month, or $7908 annually in premiums. Why would anybody buy the $500 deductible? Does anyone think the numbers in this example are correct?

It does sound unreasonable, so I just checked it out.

According to ehealthinsurance.com, a quote on a Blue Shield policy using a 56 year old male residing in San Diego yields the following:

$500 deductible PPO - $1,070 per month
$2,000 deductible PPO - $414 per month

I assume the slight difference is the result of a premium increase since the article was posted July.

Wow. You do pay dearly for a lower deductible.

 

[Helena]

With a PPO, there is an additional benefit
that begins paying immediately even if
the deductible has not been met.

With most plans, contracting doctors/hospitals
must accept the PPO's allowable amount [usually
a discount] so the total cost to the insurer... and
the patient... is reduced.

For example:

Doctor contracts with Blue Cross Blue Shield of Texas PPO.
Doctor charges $2000 for surgery. Member's PPO deductible
is also $2000. If Blue Cross' allowable for this surgery is
$1500. Then $1500 applies to patient's deductible and
doctor will only bill patient $1500. So, in this example,
the patient gets a $500 discount even if his deductible is
not met.

 

[wallygator69]

Hi,

Don't want to hijack the thread but does anyone have an idea of what specific tests or guidelines Insurance companies require for Individual policies.

I assume they do Height, weight, bloodpressure. But do they take blood and Test for Cholesterol, PSA (Prostrate), Liver etc....

Anyone have any links...

Thx

W

 

[REWahoo]

wally,

I don't think any tests are required. I just applied for and got an individual BC/BS policy and BC/BS apparently relied almost entirely on the information I provided them in the application. I took no tests of any sort and I don't think they contacted any of the physicians I listed on the form.

As pointed out in some of the other recent threads on this subject, once you do have a claim of any real magnitude, then they will research your medical history to see if you had any past diagnosis or treatment that would indicate it was a known preexisting condition. If they discovered something, they would likely deny payment for that condition and/or cancel your policy entirely.

 

[Martha]

It does sound unreasonable, so I just checked it out.

According to ehealthinsurance.com, a quote on a Blue Shield policy using a 56 year old male residing in San Diego yields the following:

$500 deductible PPO - $1,070 per month
$2,000 deductible PPO - $414 per month

I assume the slight difference is the result of a premium increase since the article was posted July.

Wow. You do pay dearly for a lower deductible.

Yes, this doesn't make any sense at all. Assuming you met the deductible, the cost of premiums plus deductible is $13340 for the $500 deductible plan and $6968 for the $2000 deductible plan.

 

[REWahoo]

Yes, this doesn't make any sense at all. Assuming you met the deductible, the cost of premiums plus deductible is $13340 for the $500 deductible plan and $6968 for the $2000 deductible plan.

I went back to ehealthinsurance.com a second time to do a little more in-depth comparison. Looks like the author of the piece didn't do enough homework to know the only difference in the two policies ("Shield Spectrum PPO Plan 2000" and "Shield Spectrum PPO Plan 500") wasn't a difference in deductibles. The coverage isn't the same:

Plan 2000: 30% coinsurance, $45 copay, $7,000 out-of-pocket limit, $500 prescription deductible
Plan 500: 25% coinsurance, $30 copay, $4,000 out-of-pocket limit, $250 prescription deductible

This would certainly account for some of the increase in premium cost, but the difference still seems unreasonable.

And it also reaffirms my low opinion of financial journalists.

 

[FinanceDude]

Hi,

Don't want to hijack the thread but does anyone have an idea of what specific tests or guidelines Insurance companies require for Individual policies.

I assume they do Height, weight, bloodpressure. But do they take blood and Test for Cholesterol, PSA (Prostrate), Liver etc....

Anyone have any links...

Thx

W

Different companies test differently. However, you should never "lie" on an app for two reasons:

1)The company can drop coverage or not bind you if they find your info fraudelent.

2)When you sign off on the app, they will pull your MIB profile (medical information bureau), and can see your medical history going back.

I think it's better going with an insurance broker that can shop 30-40 companies, and do the work for you. BC/BS IS better in some states and worse in others.

 

[mykidslovedogs]

I went back to ehealthinsurance.com a second time to do a little more in-depth comparison. Looks like the author of the piece didn't do enough homework to know the only difference in the two policies ("Shield Spectrum PPO Plan 2000" and "Shield Spectrum PPO Plan 500") wasn't a difference in deductibles. The coverage isn't the same:

Plan 2000: 30% coinsurance, $45 copay, $7,000 out-of-pocket limit, $500 prescription deductible
Plan 500: 25% coinsurance, $30 copay, $4,000 out-of-pocket limit, $250 prescription deductible

This would certainly account for some of the increase in premium cost, but the difference still seems unreasonable.

And it also reaffirms my low opinion of financial journalists.

Wow! In Colorado, the OOP limit typically does not include the deductible or copays. (The OOP limit is the cost of your portion of coinsurance after deductible), so to get the TRUE maximum exposure you have to add the OOP limit to the deductible. In the example above, the 2000 deductible plan would have twice as much maximim exposure than the 500 deductible plan. (9000 total exposure vs. 4500 total exposure). So, to buy the 500 deductible plan, your paying 6372 extra to buy yourself 4500 less exposure, plus 250 less exposure for prescriptions. That's a total of 4750. Also, since copays are unlimited and do not count towards exposure, the insurance carrier is probably taking into account some risk for the lower copays on the $500 deductible plan too.

Obviously, the insurance carrier does not want to sell the $500 deductible plan. The pricing doesn't make any sense, so my guess is they're planning on phasing out that plan for new applicants sometime in the near future.

I'm a little bit surprised at how expensive individual coverage is in California, but I think part of the reason is because, and I'm pretty sure about this, but not 100%, State law out there prevents insurance carriers from being able to exclude even minor conditions from coverage, so the insurance carriers have no choice but to either decline or rate-up in a lot of cases, even when a person just has a minor pre-existing condition. This lowers the number of people in the risk pool which probably leads to an increase in pricing overall for everyone who is eligible for coverage.

 

[REWahoo]

Wow! In Colorado, the OOP limit typically does not include the deductible or copays.

Apparently that's not the case in California:

"Plan 500 out of pocket limit- Individual: $4,000. Includes deductible"

Nor is it the case in Texas with my $5,000 deductible BC/BS policy:

"Out-of-pocket maximum: $5,000 (includes Deductible, outpatient prescription drug Copayment Amounts and Coinsurance)"

 

[REWahoo]

I'm a little bit surprised at how expensive individual coverage is in California, but I think part of the reason is because, and I'm pretty sure about this, but not 100%, State law out there prevents insurance carriers from being able to exclude even minor conditions from coverage, so the insurance carriers have no choice but to either decline or rate-up in a lot of cases, even when a person just has a minor pre-existing condition. This lowers the number of people in the risk pool which probably leads to an increase in pricing overall for everyone who is eligible for coverage.

A a great source of information on the coverage requirements for each individual state can be found at Georgetown University's website: http://www.healthinsuranceinfo.net/

 

[mykidslovedogs]

Apparently that's not the case in California:

"Plan 500 out of pocket limit- Individual: $4,000. Includes deductible"

Nor is it the case in Texas with my $5,000 deductible BC/BS policy:

"Out-of-pocket maximum: $5,000 (includes Deductible, outpatient prescription drug Copayment Amounts and Coinsurance)"

That's good to know, because we get a client every now and then who moves to CA, so it's good to be able to tell them what to expect. I had a client that moved to CA. She had minor sleep apnea, and she got declined out there. In CO, they might have just excluded the condition from coverage, and she would have been able to get coverage, but in CA, she was declined, so she had to look into risk pool coverage there.

 

[mykidslovedogs]

A a great source of information on the coverage requirements for each individual state can be found at Georgetown University's website: http://www.healthinsuranceinfo.net/

Thanks, I have bookmarked the site!

 

[wallygator69]

Different companies test differently. However, you should never "lie" on an app for two reasons:

1)The company can drop coverage or not bind you if they find your info fraudelent.

2)When you sign off on the app, they will pull your MIB profile (medical information bureau), and can see your medical history going back.

I think it's better going with an insurance broker that can shop 30-40 companies, and do the work for you. BC/BS IS better in some states and worse in others.

Thanks Wahoo and FDude,

I suffer from White Coat syndrome on the blood pressure. Much higher in the doc's office. Usually 130 over 85 at home. 150 over 90 to 100 in Doc office. Was put on 24 hour monitor when they were pushing me to go on Meds and on follow up said Never Mind but watch it...

Cholesterol is also a bit high but am convinced the cure (Statins) are worse than the disease.

I have never been treated for either. Doc mentioned maybe Cholesterol meds were warranted but he never pushed. Is saying no lying? If I had a heart attack could they een say it was definitively Cholesterol? Waters appear muddy.

Thanks again,

W

 

[mykidslovedogs]

Thanks Wahoo and FDude,

I suffer from White Coat syndrome on the blood pressure. Much higher in the doc's office. Usually 130 over 85 at home. 150 over 90 to 100 in Doc office. Was put on 24 hour monitor when they were pushing me to go on Meds and on follow up said Never Mind but watch it...

Cholesterol is also a bit high but am convinced the cure (Statins) are worse than the disease.

I have never been treated for either. Doc mentioned maybe Cholesterol meds were warranted but he never pushed. Is saying no lying? If I had a heart attack could they een say it was definitively Cholesterol? Waters appear muddy.

Thanks again,

W

Hey W,

Those are really good questions. When insurance carriers underwrite cholesterol and blood pressure readings, they usually like to see they they are under control with medication or diet and exercise for about 6 months before they will approve you for coverage. They also look at the quanitity of meds required to get it under control, because if the cost of meds exceed the premium, they are not going to approve you for coverage.

Insurance companies will not typically exclude elevated cholesterol or HBP from coverage or any disease related to them. They are either going to take the risk to accept you or they are going to decline you based on how well it is controlled.