HIPAA costs ? - Page 2

**Rich_in_Tampa** · 12-13-2006, 12:59 PM

Quote:

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?

Nords · 12-13-2006, 02:07 PM

Quote:

Originally Posted by Coach

It's a hell of a note when "to google" is a verb....

Hey, if American English didn't evolve then we'd still be speaking British English... or even worse, Latin.

macnjus · 12-13-2006, 02:20 PM

Quote:

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 ?

FIRE'd@51 · 12-13-2006, 02:30 PM

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?

justin · 12-13-2006, 02:34 PM

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.

macnjus · 12-13-2006, 02:45 PM

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".

This is nasty stuff, perhaps I will un-FIRE

**Martha** · 12-13-2006, 02:58 PM

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.

jeff2006 · 12-13-2006, 02:59 PM

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.

**Martha** · 12-13-2006, 03:06 PM

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.

gindie · 12-13-2006, 09:09 PM

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.

mykidslovedogs · 12-13-2006, 11:06 PM

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.)

REWahoo · 12-14-2006, 06:44 AM

Quote:

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

macnjus · 12-14-2006, 07:26 AM

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.

**Martha** · 12-14-2006, 09:25 AM

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.

macnjus · 12-14-2006, 09:38 AM

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.

**Martha** · 12-14-2006, 09:50 AM

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.

REWahoo · 12-14-2006, 09:52 AM

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.

**Martha** · 12-14-2006, 09:58 AM

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

mykidslovedogs · 12-14-2006, 10:00 AM

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

12-13-2006, 02:34 PM	#25
justin Thinks s/he gets paid by the post Join Date: Jun 2005 Posts: 4,010	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.

12-13-2006, 02:45 PM	#26
macnjus Dryer sheet aficionado Join Date: Nov 2006 Posts: 39	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". This is nasty stuff, perhaps I will un-FIRE

12-13-2006, 03:06 PM	#29
Martha Moderator Join Date: Feb 2004 Location: minnesota Posts: 9,796	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. __________________ . Do not rely on the information provided--my posts are not to be taken as legal advice. Needless to say you must consult with your legal representative. I am not responsible for errors. If I offended you with cya I apologize. If I did not, I tried.

12-13-2006, 11:06 PM	#31
mykidslovedogs Full time employment: Posting here. Join Date: Dec 2006 Posts: 865	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.)

12-14-2006, 07:26 AM	#33
macnjus Dryer sheet aficionado Join Date: Nov 2006 Posts: 39	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.

12-14-2006, 09:25 AM	#34
Martha Moderator Join Date: Feb 2004 Location: minnesota Posts: 9,796	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. __________________ . Do not rely on the information provided--my posts are not to be taken as legal advice. Needless to say you must consult with your legal representative. I am not responsible for errors. If I offended you with cya I apologize. If I did not, I tried.

12-14-2006, 09:38 AM	#35
macnjus Dryer sheet aficionado Join Date: Nov 2006 Posts: 39	Re: HIPAA costs ? 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.

12-14-2006, 09:50 AM	#36
Martha Moderator Join Date: Feb 2004 Location: minnesota Posts: 9,796	Re: HIPAA costs ? 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. __________________ . Do not rely on the information provided--my posts are not to be taken as legal advice. Needless to say you must consult with your legal representative. I am not responsible for errors. If I offended you with cya I apologize. If I did not, I tried.

12-14-2006, 09:58 AM	#38
Martha Moderator Join Date: Feb 2004 Location: minnesota Posts: 9,796	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 __________________ . Do not rely on the information provided--my posts are not to be taken as legal advice. Needless to say you must consult with your legal representative. I am not responsible for errors. If I offended you with cya I apologize. If I did not, I tried.