HIPAA costs ?

[macnjus]

I am going onto a COBRA, which can last for 18 months. We will likely be moving to NC, where if necessary, I can purchase HIPAA coverage after the COBRA time runs out. We are 50 years old, and would like to remain retired, but this health care thing can be a real mystery. My understanding on the HIPAA coverage is that this must be made available, and it will cover all potential problems, but the cost may be quite high.

Does anybody have any idea just how high the HIPAA coverage might possibly be ? I priced out a BC/BS high-deductible policy for my wife and myself, and that should be around 9K per year, but I can find no HIPAA quotes. Is it right to think that 20K or so would be a worst case ? It would be helpful tp have some idea what to expect as a worst case.

[Rich_by_the_Bay]

The cost is usually about 3% higher than premiums for other enrollees.

You seem to be assuming you can "renew" your HIPAA coverage after 18 months? That is not usually the way it works in most states. Just a heads up so you don't discover this too late - best to research it first.

[Martha]

It sounds like you are talking about rights you have under HIPAA to buy insurance in the individual market. I suggest that you check the Georgetown website for what rights you have under HIPAA in North Carolina. www.healthinsuranceinfo.net States differ on how they comply with HIPAA.

HIPAA is only important to you if you are unisurable in the individual market. Be sure not to miss any deadlines.

[macnjus]

Actually, how I understand it is that I will be entitled to coverage under HIPAA AFTER my COBRA time runs out, which is in 18 months. I am pretty sure this is how it works, at least that is what it says here:

http://www.healthinsuranceinfo.net/nc.pdf

page 15 describes the HIPAA option

While I would anticipate that my wife and I would be insurable, I have seen so many bad stories on this web site that I want to know what the worst case is. Is there any easy to know if we will be able to get good insuurance prior to the COBRA time running out ?

[Martha]

My particular computer isn't opening PDF files right now. But, I do know that HIPAA doesn't provide insurance, it just requires states to have a mechanism in place where you can buy inurance if you are HIPAA qualified (generally, because you are coming off of COBRA after being covered by a group plan.)

[macnjus]

Right, but what I don't know , and can't find info on, is what does the coverage under HIPAA requirements ususally cost ? I would anticipate it would be something more than the COBRA costs, but I have no idea how much more ? Twice as much ?

Does anybody have any experience with this ?

[FIRE'd@51]

Quote:

Originally Posted by Rich_in_Tampa The cost is usually about 3% higher than premiums for other enrollees. You seem to be assuming you can "renew" your HIPAA coverage after 18 months? That is not usually the way it works in most states. Just a heads up so you don't discover this too late - best to research it first.

I believe you are confusing HIPAA and COBRA. What HIPAA does, is guarantee that you will be able to get coverage (with no pre-existing conditions limitations or waiting periods) from any insurer in the state after you come off COBRA. However, they can charge you their highest rate, which may be more than twice what a person in good health would pay, depending upon the state.

[Martha]

Quote:

Originally Posted by macnjus Right, but what I don't know , and can't find info on, is what does the coverage under HIPAA requirements ususally cost ? I would anticipate it would be something more than the COBRA costs, but I have no idea how much more ? Twice as much ? Does anybody have any experience with this ?

Sorry we are taking a while to work through your question. I looked at NC and I see that Blue Cross Blue Shield is the only insurer in NC that has to offer you a policy if you are otherwise uninsurable and you are eligible under HIPAA. The state does not regulate what they can charge. The only real way to tell what your premium will be is by asking BCBS. Unfortunately, people's experience in other states will not be very helpful as rates differ tremendously in different states and even in regions of states. If someone here bought insurance through BCBS in NC who was otherwise unisurable, that experience may help.

I suggest you contact BCBS in NC for information on the cost of their HIPAA eligible policies. You may also try the NC insurance commissioner who may have information as well on cost.

EDIT: A BCBS insurance agent can help you too.

[macnjus]

Thanks Martha, that's probably a good approach to take.

[FIRE'd@51]

You might want to consider foregoing COBRA and buy an individual policy right away if you are in good health. That way you don't risk developing a "pre-exisiting" condition while under COBRA, which could force you to go the HIPAA route after COBRA runs out. Additionally, often an employee policy (which you would continue under COBRA) might have a low deductible and, thus, be fairly expensive. If you are in good health, it may well be possible for you to obtain a policy with a higher deductible for less money than continuing your employee policy under COBRA.

[AlmostDone]

Does "uninsurable" mean something serious or are you "uninsurable" if you have less serious things like high blood pressure or diabetes or depression.

[Rich_by_the_Bay]

Quote:

Originally Posted by AlmostDone Does "uninsurable" mean something serious or are you "uninsurable" if you have less serious things like high blood pressure or diabetes or depression.

There is no universal standard for the term "uninsurable." Carriers are free to determine whom they will accept as long as their standards are not based on race, etc. Their only incentive is that if they exclude all patients with a BP of > 150, for example, their potential market decreases.

To address your immediate question, yes, you can be turned down for even well-controlled high blood pressure, cholesterol, history of low back pain, kidney stone or almost anything else. Because of variation in what different carriers will cover, you should shop it aggressively. More commonly for minor or controlled risks, they will insure you but only at a higher premium, a pre-existing disease exclusion, or both.

Insurance carriers are not your friends. A national health care plan is your friend, though the devil(s) will be in the details.

[macnjus]

If a carrier places a restriction on paying for a "pre-existing condition", if you then need treatment for it, will you have to pay the usurious "list price", or will you at least get to pay the "negotiated price" for treatment of your ailment ?

[Rich_by_the_Bay]

Quote:

Originally Posted by macnjus If a carrier places a restriction on paying for a "pre-existing condition", if you then need treatment for it, will you have to pay the usurious "list price", or will you at least get to pay the "negotiated price" for treatment of your ailment ?

I would presume that legally you could be liable for the full price. Realistically, the provider will likely bill the carrier for the negotiated price and when the claim was denied, they would bill you for the same amount.

Bottom line: you don't want to be on the hook if you can help it. It's a profoundly dysfunctional system. The doctors hate it, the patients hate it, the hospitals hate it. The insurance carriers do not appear to hate it.

[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 ?

[Coach]

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 ?

I think such things exist -- try googling health savings card.

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

Coach

[Martha]

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 ?

Maybe a market but a bad idea. You will still need insurance for catastrophic events, like cancer treatment, bad accidents, etc.

Minnesota has a nice option for you. If you are uninsurable, buy through the risk pool and choose a big deductible. If you are between 50 and 54 years old, you could choose a 10,000 deductible and your monthly premium would be $149. You still submit claims before you reach the deductible so you get the insurance company negotiated rate. And you are covered for catastrophies. Lobby your state for something similar.

[FIRE'd@51]

Quote:

Originally Posted by Martha Minnesota has a nice option for you. If you are uninsurable, buy through the risk pool and choose a big deductible. If you are between 50 and 54 years old, you could choose a 10,000 deductible and your monthly premium would be $149. You still submit claims before you reach the deductible so you get the insurance company negotiated rate. And you are covered for catastrophies. Lobby your state for something similar.

Do they impose a 12-month waiting period on pre-existiing conditions if you are not HIPAA eligible?

[macnjus]

The MN plan sounds pretty good. I did some digging around NC, where I plan to go, and their high-risk pool seems much more expensive. I did find out the HIPAA insurance cost through BCBS, and their rate was 2250/month for my wife and myself. Pretty pricy, but I guess I would take that route if I had to. Hopefully nothing will make us uninsurable and force us onto that plan, but at least it's an option.

While you may think it's a bad idea just to have the negotiated rates without catastrophic coverage, I still would rather have the negotiated rates than not. A real catastrophe might cost $1mm at list prices versus $250k at negotiated rates. The lower number is bad but I can deal with it, the higher would hurt too much to consider leaving as a possibility.

[REWahoo]

Texas, far from the most progressive state when it comes to this sort of thing, has a program similar to the risk pool Martha speaks of in Minnesota. The premiums are 30+% higher than in MN (set at 200% of what a healthy person would pay on the open market), but we are glad we live in a state that offers this option. We went that route for DW with a high deductible. There are no waiting periods for pre-existing conditions if you are HIPPA eligible, a six-month period if you are not.