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Re: HIPAA costs ?
Old 12-13-2006, 12:59 PM   #21
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Re: HIPAA costs ?

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Originally Posted by macnjus
I did find out the HIPAA insurance cost through BCBS, and their rate was 2250/month for my wife and myself.
Really?! That's the highest premium I've ever heard of for a standard, nonrated policy. Where are you located, if I may ask?
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Re: HIPAA costs ?
Old 12-13-2006, 02:07 PM   #22
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Re: HIPAA costs ?

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Re: HIPAA costs ?
Old 12-13-2006, 02:20 PM   #23
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Re: HIPAA costs ?

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Originally Posted by Rich_in_Tampa
Really?! That's the highest premium I've ever heard of for a standard, nonrated policy. Where are you located, if I may ask?
Rich - this was in North Carolina. This rate is about 5 times what it would be for a standard good health policy. Pretty bad eh ?
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Re: HIPAA costs ?
Old 12-13-2006, 02:30 PM   #24
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Re: HIPAA costs ?

Quote:
Originally Posted by macnjus
Rich - this was in North Carolina. This rate is about 5 times what it would be for a standard good health policy. Pretty bad eh ?
Just curious - what is the deductible for that policy?
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Old 12-13-2006, 02:34 PM   #25
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Re: HIPAA costs ?

macnjus,

Was that $2200/month for a guaranteed issue HIPAA policy? In other words, anyone would be able to get that policy? I'm in NC and it would be good to know if that is the "worst case" price.
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Re: HIPAA costs ?
Old 12-13-2006, 02:45 PM   #26
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Re: HIPAA costs ?

I think the deductible was around 2500 per person, but not positive.

This was for a HIPAA eligible person, meaning one who is coming out of a COBRA or a group plan. I am not quite sure what all of the requirements are for being HIPAA eligible, it is a bit complicated.

In the case of NC, BC/BS will offer a policy to anyone, but they have 7 grades of pricing (aside from HIPAA) based on how they rate your health. The worst rate is considerably higher than the HIPAA rate. I asked what factors would put somebody into the highest category and I was told "High Blood pressure, high cholesterol, morbid obesity, smoker", if combined , would put you in that category. I asked what about blood pressure controlled to normal with medication and was told this might bump you one level higher then "preferred".

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Re: HIPAA costs ?
Old 12-13-2006, 02:58 PM   #27
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Re: HIPAA costs ?

Quote:
Originally Posted by macnjus


This was for a HIPAA eligible person, meaning one who is coming out of a COBRA or a group plan. I am not quite sure what all of the requirements are for being HIPAA eligible, it is a bit complicated.



To be HIPAA-eligible, you must meet all of the following criteria:

You must have had 18 months of continuous creditable coverage, at least the last day of which was under a group health plan (including those offered by public employers and churches).

You also must have used up any COBRA or state continuation coverage for which you were eligible.

You must not be eligible for Medicare, Medicaid or a group health plan.

You must not have health insurance. (Note, however, if you know your group coverage is about to end, you can apply for coverage for which you will be federally eligible.)

You must apply for health insurance for which you are federally eligible within 63 days of losing your prior coverage.



The big advantage of being HIPAA eligible is that federal law requires states to have a mechanism in place for you to purchase individual health insurance even if you are in poor health and not generally insurable in the individual market. Unfortunately, the federal government didn't see fit to regulate rates so your state's option may not be affordable. Different states do different things to meet HIPAA requirements. For example, they may have:

--designated insurers who must offer a HIPAA policy to the uninsurable;
--requirements on all insurers to offer a HIPAA policy;
--a risk pool;
--conversion insurance requirements through the same company you had insurance through before;
--or they (as in a few eastern states) may require all insurers insure everyone at a regulated price.

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Re: HIPAA costs ?
Old 12-13-2006, 02:59 PM   #28
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Re: HIPAA costs ?

Quote:
Originally Posted by justin
macnjus,

Was that $2200/month for a guaranteed issue HIPAA policy? In other words, anyone would be able to get that policy? I'm in NC and it would be good to know if that is the "worst case" price.
People thinking about retiring to NC should keep this in mind. In many ways, NC is a very backward state. Also lacking, even here in Raleigh, are part-time jobs that offer meaningful healthcare benefits.
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Re: HIPAA costs ?
Old 12-13-2006, 03:06 PM   #29
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Re: HIPAA costs ?

Another point to mention when looking at these policies is look at:

--what is the deductible
--what are the copays apart from the deductible
--what is the maximum out of pocket
--what is your network and what will it pay if you are out of network, if anything
--what is excluded (some states allow certain things to be excluded from policies)
--what are your lifetime limits
--are there any yearly limits
--are there any limits for a specific condition

I have seen states where their HIPAA qualified policies have $50,000 yearly caps, and $250,000 lifetime limits. I haven't checked recently to see if that is still the case and I also can't remember right off which are the worst states.
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Re: HIPAA costs ?
Old 12-13-2006, 09:09 PM   #30
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Re: HIPAA costs ?

Quote:
Originally Posted by macnjus
It seems to me like there could be a good market out there for some insurance company to allow uninsured individuals to pay something to have the right to pay the negotiated prices as opposed to the "list prices". Does anybody know of any company that does this ?
There's a guy who does financial cut-ins on the morning radio show I listen to. His name is Jordan Goodman and he has mentioned something called "Medical Re-pricing". He says it's a way to get reduced prices, but I've never looked into it.
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Old 12-13-2006, 11:06 PM   #31
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Re: HIPAA costs ?

A good book to read about this topic is "The New Health Insurance Solution". Go to http://www.tnhis.com/statebystateguide.htm to look at the HIPAA plans available in every state and the approximate cost for these plans in each state. The rates and rules for eligibility vary from state to state. The author has compiled a great reference tool for anyone needing "guaranteed issue" coverage. I read the whole book and found it very helpful.

Also, there IS such a thing as a discount health insurance plan. They are all over the place, and they allow you to get negotiated discounts without actually having to qualify for coverage. You usually see signs for these kinds of "affordable health plans" on street corners. If you can't afford a State Guaranteed HIPAA plan and if you can't qualify for actual health insurance, then a discount health plan or a discount prescription drug card is at least one way to save on health care costs. If you want to find one of these plans, just go on the internet and search for affordable healthcare. You will find all kinds of "agents" selling these discount "health plans" and drug cards. Just remember, it's not insurance, even if it sounds like it is. I would also be careful to ask about the network and make sure there are plenty of participating providers. You can probably tell I'm pretty sceptical about the discount "affordable health plans". In my opinion, a State Guaranteed HIPAA plan is going to provide a lot more protection if it is affordable (and in some states, it IS actually affordable - Just check the website I mentioned above. The reference tool is excellent.)
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Re: HIPAA costs ?
Old 12-14-2006, 06:44 AM   #32
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Re: HIPAA costs ?

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Originally Posted by mykidslovedogs
A good book to read about this topic is "The New Health Insurance Solution". Go to http://www.tnhis.com/statebystateguide.htm to look at the HIPAA plans available in every state and the approximate cost for these plans in each state. The rates and rules for eligibility vary from state to state. The author has compiled a great reference tool for anyone needing "guaranteed issue" coverage. I read the whole book and found it very helpful.
Martha posted a very thorough review of "The New Health Insurance Solution" last May. You can find it here:

http://early-retirement.org/forums/i...p?topic=7585.0

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Old 12-14-2006, 07:26 AM   #33
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Re: HIPAA costs ?

mykids - thanks for the reference. The state by state guide is great and it really makes me think twice (3 times) about moving to NC. Not only is NC's guaranteed issue policy absurdly expensive, it has a lifetime cap of $500K, which I find particularly pathetic. This actually makes my current home of NJ look relatively good by comparison.

If I could determine that I would qualify for a good rate in NC, I still might move there, I will try to apply from here and see what I get, but at this point I will not commit to the move until I know.
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Old 12-14-2006, 09:25 AM   #34
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Re: HIPAA costs ?

Careful on relying too much on the state by state guide. It is very misleading in that the rates are based on what would be charged a 35 year old male. There are not a whole lot of them here on this forum looking for guaranteed issue insurance. The rates are almost always a LOT higher the older you are. Plus, there is a lot a variability on rates depending on deductibles available.
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Old 12-14-2006, 09:38 AM   #35
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While the rates will certainly be higher for older people than what appears in this guide, I would think that the relative price differences would be similar. However, of greater interest to me is the lifetime max payments allowed. From an asset preservation point of view, it makes a huge difference whether you will be subject to a $500K lifetime max, as many states allow, or whether you will have an unlimited cap, which is what I would very much prefer. Note - NC is the worst in both categories, no other state costs nearly as much for the coverage, yet it also provides the lowest lifetime cap, 0 for 2, you pay the most and get the least.
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Old 12-14-2006, 09:50 AM   #36
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I agree that NC is among the worst. But it is hard to draw too many conclusions on the comparison because states do differ on how much they increase premiums for age. And some states charge more for women. And some states offer family coverage and others only individual. Also, some plans also have yearly caps and caps for particular conditions, which makes them particularly bad. Some cover drugs and some don't. But it is very helpful that he reported the lifetime cap information and the maximum out of pocket.

But the online guide is a good starting point as this information is not readily available elsewhere in a comparative format.
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Old 12-14-2006, 09:52 AM   #37
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Re: HIPAA costs ?

Quote:
Originally Posted by macnjus
While the rates will certainly be higher for older people than what appears in this guide, I would think that the relative price differences would be similar. However, of greater interest to me is the lifetime max payments allowed.
This book was published in 2005 using information that dates back to 2004 in some cases. Rates, coverages and maximums can change very quickly, so be sure to check out current information before relying on what's in the book.

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Old 12-14-2006, 09:58 AM   #38
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Re: HIPAA costs ?

Fred Brock has published Healthcare on Less than you Think. Anyone read it yet? I have heard him talk about the healthcare system and he seems to know what he his talking about. I have resisted buying the book yet.

http://www.amazon.com/gp/product/080...721990-2856664
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Old 12-14-2006, 10:00 AM   #39
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Re: HIPAA costs ?

REWahoo,

Martha gave a very detailed review, however, I think she missed the most basic point that Pilzer was trying to make in his book. I think what Pilzer is trying to do with his book is really just help people to understand the many different options that they have to reduce insurance costs. I don't think he minimized the issues that many who are "uninsurable" are facing. However, he is very blunt in his opinions regarding the fact MANY (not all) people who are "uninsurable" have gotten into that situation because they did not obtain their own coverage while they were still healthy. Pilzer recognizes the fact that our "entitlement" culture has facilitated this problem. If we didn't depend on our employers to provide expensive benefits to us throughout our lives, often times with low deductibles and copays that encourage us to overutilize our policies, then we wouldn't be left hanging in the early-retirement years between age 55 and 65 before Medicare becomes available to us.

With the complexity of insurance and various State regulations it would be impossible to depict every single scenario in the book. I think the use of a healthy 35 year old male was really the only way he could make an "apples to apples" comparison among the various State HIPAA plans in a way that could make sense to the average audience. I think Pilzer did an excellent job researching all of the different State Guaranteed plans, and he put it all together in an excellent, not to mention, FREE, reference tool on his website. Kudos to him for his work on that!

I would like to make a few points on areas where I agree/disagree with Martha/Pilzer:

1.) Generally, Individual and Family coverage IS much less expensive than group insurance. Martha makes it seem like it is unfair for individual and family health insurance carriers to rate/exclude pre-existing conditions, or charge higher premiums as we age. However, I completely disagree with her on that point. Like any other business in the free market, insurance carriers exist to be profitable. I don't see anything wrong with that. Of COURSE the healthy gravitate to these individual policies while the unhealthy gravitate to risk pools! That is the WHOLE idea of individual coverage. Individual and Family insurance carriers are not in the business to provide coverage to people who are already sick. They are in the business to provide financial protection to you in the unlikely, unforseen, event that you come down with a costly, financially devastating, illness. If insurance carriers did not have the flexibility to underwrite, like in the State of NY, NO ONE would be able to afford coverage, because no one would ever buy insurance until they needed it, and the rates would go through the roof, and all of the competition would drop out of the marketplace.

One of the biggest problems we face in our country is the entitlement mentality. People wait until they get sick and unemployed before they decide to buy their own coverage, and then they get angry at insurance companies for denying them affordable coverage due to their pre-existing conditions. Do you think a property/casualty insurance company would sell you home-owner's insurance if your house was burning down? Pilzer maintains that if we purchase our own coverage while we are healthy instead of relying on our employers for benefits, then we wouldn't have a problem obtaining and keeping that coverage in later years, nor would we be tied to employment because we need insurance.
If someone asked you to guarantee them $2,000,000 in case they were to come down with a financially devastating illness, wouldn't you want to assess the risk in doing so first, and wouldn't you want to make sure that they were being completely honest with you about their current health status? People forget that the basic idea behind health insurance is to protect you against financial devastation. It really was never meant to protect you from the cost of routine office visits and occasional prescriptons. The $5 copay plans are what gave us that mentality, and now, we are paying dearly, because overutilization has, in part, led to increased health care costs, which in turn, has led to very high health insurance premiums. These high premiums will force us begin looking at higher deductible major medical plans like the ones that existed before the $5 copay HMO plans came about in the '60's and '70's.

2.) The only time pre-existing condition waiting periods will apply on any type of new health insurance policy (including riskpools) will be if the person obtaining coverage has ALLOWED THEMSELVES to have a gap in coverage of a certain, defined, length of time. This is only fair as it protects the insurance carriers from "adverse selection" or only buying the plan AFTER getting sick. If people are aware that they are going to have a pre-existing condition waiting period, then they will be more likely to seek out the policy upon losing their other coverage instead of waiting until they get sick before they replace their old coverage or purchase new coverage.

3. I agree with Martha in that the topic of the affordability of health insurance and Medicaid for the working poor is probably much more complicated than the amount of time that Pilzer gave to the subject. However, in Pilzer's defense, that subject is a whole 'nother book! There is no way he could address all of the social problems with health insurance and Medicaid in the book he wrote, so I don't think it is fair to criticize him for that. He was merely trying to point out that if you absolutely cannot afford your own policy, then you should probably check into Medicaid or a discount plan as that could likely be an option for you.

4.) Lastly, I agree with Martha and I do not agree with Pilzer on the idea of having employers drop their group benefit plans and setup HRA's to allow employees to go out and buy their own insurance on a tax-deductible basis. There is too much room for "discrimination" in setting up such a system, and to keep my point simple, I think that it could set up employers up for legal action against them in the case that one of their employees could not qualify for an individual plan. I just think it puts employers at risk of being sued for discrimination. I have more opinions on this subject, but I won't go into them here.
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Re: HIPAA costs ?
Old 12-14-2006, 10:48 AM   #40
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Re: HIPAA costs ?

Quote:
Originally Posted by mykidslovedogs
REWahoo,

Martha gave a very detailed review, however, I think she missed the most basic point that Pilzer was trying to make in his book. I think what Pilzer is trying to do with his book is really just help people to understand the many different options that they have to reduce insurance costs. I don't think he minimized the issues that many who are "uninsurable" are facing. However, he is very blunt in his opinions regarding the fact MANY (not all) people who are "uninsurable" have gotten into that situation because they did not obtain their own coverage while they were still healthy. Pilzer recognizes the fact that our "entitlement" culture has facilitated this problem. If we didn't depend on our employers to provide expensive benefits to us throughout our lives, often times with low deductibles and copays that encourage us to overutilize our policies, then we wouldn't be left hanging in the early-retirement years between age 55 and 65 before Medicare becomes available to us.
When I reviewed the book I simply said I disagreed with his political positions. I think it is troubling to say that people got themselves into a position of being unisurable. The way our insurance system works is that nearly everyone gets insurance through work. Not on their own. To blame people for that doesn't make sense.

The individual market is self selected as healthy because insurance companies exclude the unhealthy. People often stay with individual policies for short periods of time and then move to a group. Given these facts it is not surprising that policies cost less on the individual, non-risk market. Also, as I said in my review:

Pilzer repeatedly claims that individual health insurance is cheaper than employer provided insurance. It probably is cheaper if you are 35 and healthy. Probably not if you are 60. This is because employers charge the same rate to everyone, whether you are 20 or 60. Also, only 4% of people in the US have insurance on the individual market. So it is a small part of the overall market. Pilzer doesn’t break down what that market looks like as to age and health of its participants.


I have posted plenty of times that the free market does not work for health insurance. Of course, insurance companies want to insure for future risk only. That is the nature of insurance. So goverment interference is necessary for people to get coverage for past conditions. Government requires guaranteed renewability of individual health insurance plans. If it didn't, insurance companies would cut you off after you had too many claims. Much like an auto insurer does. But they can raise the rates. Or terminate the plan.

Quote:
With the complexity of insurance and various State regulations it would be impossible to depict every single scenario in the book. I think the use of a healthy 35 year old male was really the only way he could make an "apples to apples" comparison among the various State HIPAA plans in a way that could make sense to the average audience. I think Pilzer did an excellent job researching all of the different State Guaranteed plans, and he put it all together in an excellent, not to mention, FREE, reference tool on his website. Kudos to him for his work on that!
Very few 35 year olds buy guaranteed issue insurance. He should have used a range in cost. But, as I said, at least he did the work to provide some information which is a good starting point.

Quote:
I would like to make a few points on areas where I agree/disagree with Martha/Pilzer:

1.) Generally, Individual and Family coverage IS much less expensive than group insurance. Martha makes it seem like it is unfair for individual and family health insurance carriers to rate/exclude pre-existing conditions, or charge higher premiums as we age. However, I completely disagree with her on that point. Like any other business in the free market, insurance carriers exist to be profitable. I don't see anything wrong with that. Of COURSE the healthy gravitate to these individual policies while the unhealthy gravitate to risk pools! That is the WHOLE idea of individual coverage. Individual and Family insurance carriers are not in the business to provide coverage to people who are already sick. They are in the business to provide financial protection to you in the unlikely, unforseen, event that you come down with a costly, financially devastating, illness. If insurance carriers did not have the flexibility to underwrite, like in the State of NY, NO ONE would be able to afford coverage, because no one would ever buy insurance until they needed it, and the rates would go through the roof, and all of the competition would drop out of the marketplace.
This is why I support national health care.

Quote:
One of the biggest problems we face in our country is the entitlement mentality. People wait until they get sick and unemployed before they decide to buy their own coverage, and then they get angry at insurance companies for denying them affordable coverage due to their pre-existing conditions. Do you think a property/casualty insurance company would sell you home-owner's insurance if your house was burning down? Pilzer maintains that if we purchase our own coverage while we are healthy instead of relying on our employers for benefits, then we wouldn't have a problem obtaining and keeping that coverage in later years, nor would we be tied to employment because we need insurance.
Did you buy individual health insurance when you were 20? Or did you get health insurance from an employer? What if you had asthma since you were 3 years old? How about childhood cancer? What often happens is that people are trapped into a particular job. What happens if their employer drops health insurance? A lot of the 46 million unisured in the US work for employers that don't offer health insurance or dropped insurance. We are a rich country, we can figure out how to make healthcare an entitlement. I don't find anything wrong with that. It won't sap the entrepreunerial energy of the county.

Quote:
If someone asked you to guarantee them $2,000,000 in case they were to come down with a financially devastating illness, wouldn't you want to assess the risk in doing so first, and wouldn't you want to make sure that they were being completely honest with you about their current health status? People forget that the basic idea behind health insurance is to protect you against financial devastation. It really was never meant to protect you from the cost of routine office visits and occasional prescriptons. The $5 copay plans are what gave us that mentality, and now, we are paying dearly, because overutilization has, in part, led to increased health care costs, which in turn, has led to very high health insurance premiums. These high premiums will force us begin looking at higher deductible major medical plans like the ones that existed before the $5 copay HMO plans came about in the '60's and '70's.
I have seen no good evidence that we over-ulilize the heathcare system. In fact, there is some evidence that increasing copays have caused a number of people to go without necessary drugs.


Quote:
2.) The only time pre-existing condition waiting periods will apply on any type of new health insurance policy (including riskpools) will be if the person obtaining coverage has ALLOWED THEMSELVES to have a gap in coverage of a certain, defined, length of time. This is only fair as it protects the insurance carriers from "adverse selection" or only buying the plan AFTER getting sick. If people are aware that they are going to have a pre-existing condition waiting period, then they will be more likely to seek out the policy upon losing their other coverage instead of waiting until they get sick before they replace their old coverage or purchase new coverage.
This is true if you do not comply with deadlines when you are HIPAA eligible. Not true in other circumstances. Say you live in one state and have an individual insurance plan. You move to another state. You could become ineligible for your individual plan because you left the service area. You are not HIPAA eligible. You will have a pre-existing condition waiting period most everywhere you go.

I can give other examples. What if you rates go up too high to afford because of your health? If you switch policies, you will have a waiting period, maybe a waiting list, and maybe no options at all.

What if you bought individual insurance when you were healthy. The insurance company finds those in the plan are too costly. They terminate the plan and offer new plans only to those who meet their underwriting standards. You are SOL if you aren't healthy.

Quote:
3. I agree with Martha in that the topic of the affordability of health insurance and Medicaid for the working poor is probably much more complicated than the amount of time that Pilzer gave to the subject. However, in Pilzer's defense, that subject is a whole 'nother book! There is no way he could address all of the social problems with health insurance and Medicaid in the book he wrote, so I don't think it is fair to criticize him for that. He was merely trying to point out that if you absolutely cannot afford your own policy, then you should probably check into Medicaid or a discount plan as that could likely be an option for you.
I understand the subject is too complex for one book. But he did not have his facts right concerning Medicaid.

My thoughts on his book were summarized at the beginning of my review:

He is easy to read with a breezy style. The book has pretty good explanations of HIPAA and COBRA and a number of good tips. However, health insurance in the United States is complicated. The price he pays for simplicity is accuracy and thoroughness. It is a pretty good book if you are 35, perfectly healthy, and thinking about buying insurance. But what is good for when you are 35 is not necessarily good 5, 10 or 20 years later. (Should I pay for drug coverage?. . . pregnancy coverage?) I would never rely on this book for making policy decisions or for forming opinions on healthcare in the United States. I strongly disagree with many of his policy recommendations.


By the way, welcome to the forum!

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No more lawyer stuff, no more political stuff, so no more CYA

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