Individual health insurance in ER question

[obgyn65]

Please let us know which health insurance product you decide to buy. Did you have a look at United Healthcare Plan 80 or Plan 100 ? If ER'd now, I would consider the Plan 100.

Do you buy private health insurance in ER? If so, has the cost of your insurance coverage gone up every year? By what percentage? And does the increase in insurance cost correlate with your health statistics? i.e., if your blood pressure, or cholesterol is high, your premium seems to go up significantly the following year?

 

[Retire2013]

Please let us know which health insurance product you decide to buy. Did you have a look at United Healthcare Plan 80 or Plan 100 ? If ER'd now, I would consider the Plan 100.

Thank you, obgyn, I have not ER'd yet. I will look into Plan 100 as per your advice.

 

[Retire2013]

Retire2014,

You probably already know, but just in case, you have to be already covered under a High Deductible Health Care plan before you can open a HSA account. For example, you can't just walk into a bank that manages HSAs and say I want to open an account without the insurance.

Many of us here (myself included) have the HSA with HSA Administrators.
Here's a link to their site to their tab "HSA Education"

Health Savings Account - HSA Administrators

The idea is a little tricky about what you can/cannot do, I think, but once when in place I love my HSA.

Thank you, Easysurfer, no I did not know about any of this before you and Mulligan told me about HSA. I am sure when the time comes, I will have more questions for you. Thank you for the link. I will study the info at that resource. Have a great day!

 

[Mulligan]

Thank you, Easysurfer, no I did not know about any of this before you and Mulligan told me about HSA. I am sure when the time comes, I will have more questions for you. Thank you for the link. I will study the info at that resource. Have a great day!

Make sure your plan, Retire, is HSA compatible. A lot of times insurance companies give you "preferred HSA choices". This usually means higher fees and lower interest rates. Many banks and credit unions offer HSA's. You have control over who you decide to have your HSA with, not the insurance company. Early on, the initial tax deduction and low fee structure are the most important components. Make sure you choose one that doesn't nickel and dime you to death.

 

[easysurfer]

Thank you, Easysurfer, no I did not know about any of this before you and Mulligan told me about HSA. I am sure when the time comes, I will have more questions for you. Thank you for the link. I will study the info at that resource. Have a great day!

You're welcome. When more questions come up, feel free to ask away.
Have a nice day too.

 

[Live And Learn]

Thanks to the folks who posted info on premiums / deductibles / max OOP for those with pre existing conditions. Scary numbers but it validates what I have budgeted for health insurance

 

[nvestysly]

Thanks to the folks who posted info on premiums / deductibles / max OOP for those with pre existing conditions. Scary numbers but it validates what I have budgeted for health insurance

While there are similarities from area to area you really have to obtain quotes for your zip code. Ultimately, the best way to do this is contact a local, independent agent. But a good starting point is www.ehealthinsurance.com

For instance, I recently spoke to a friend in another state and the premiums he told me about seemed ridiculous. I subsequently found he was right - for his zip code and the surrounding area the premiums are nearly double the premiums in my area. In addition, I had dozens of plans to choose from - he had less than ten.

 

[teejayevans]

Would love to hear what people who do have pre-existing conditions are paying.

I cannot get individual HI because of a pre-existing condition, so that would be 0.
TJ

 

[Live And Learn]

I cannot get individual HI because of a pre-existing condition, so that would be 0.
TJ

and thats just downright wrong ! I hate to hear that people cannot get health insurance.

I'm going to show my stuipidity right now ... if my position gets eliminated that qualifies me for unsubsidized HI. Does that mean I get the same rate as someone who does not have pre-existing conditions ? I'm sure the costs will be awful but at least I'd be covered.

 

[Mulligan]

and thats just downright wrong ! I hate to hear that people cannot get health insurance.

I'm going to show my stuipidity right now ... if my position gets eliminated that qualifies me for unsubsidized HI. Does that mean I get the same rate as someone who does not have pre-existing conditions ? I'm sure the costs will be awful but at least I'd be covered.

If I understand you correctly, you will be able to stay on your company plan, but have to pay the premium? You would pay the premium that the company has been paying for you as an employment benefit. Some companies also can charge you premium rate plus 2% administrative costs. You would pay the same whether you are in good or poor health. But, that being said, I had the option to stay on my group plan until 65 and decided to take individual insurance instead. My group plan was $500 a month, with $1000 deductible, but also had co-pays and tiered prescription. Me being healthy and on no meds, I just gambled and went out on my own. I have only been retired about 2.5 years, but going on my own has saved me $15,000 already. I say this only to look at all angles and be informed before you make your final decision.

 

[Live And Learn]

If I understand you correctly, you will be able to stay on your company plan, but have to pay the premium? You would pay the premium that the company has been paying for you as an employment benefit. Some companies also can charge you premium rate plus 2% administrative costs. You would pay the same whether you are in good or poor health. But, that being said, I had the option to stay on my group plan until 65 and decided to take individual insurance instead. My group plan was $500 a month, with $1000 deductible, but also had co-pays and tiered prescription. Me being healthy and on no meds, I just gambled and went out on my own. I have only been retired about 2.5 years, but going on my own has saved me $15,000 already. I say this only to look at all angles and be informed before you make your final decision.

both DH and I have pre-existing conditions, so I'm sure our costs would be horrible IF we could even get covered. The option to stay on the employer plan (paying 100% of the premium) only exists if I get laid off. Otherwise I have to stay another 5 years. Like so many HI is the big "who knows" in my ER planning.

 

[Mulligan]

both DH and I have pre-existing conditions, so I'm sure our costs would be horrible IF we could even get covered. The option to stay on the employer plan (paying 100% of the premium) only exists if I get laid off. Otherwise I have to stay another 5 years. Like so many HI is the big "who knows" in my ER planning.

It still never hurts to know all options. I remember reading previous threads how some people would be denied from one carrier and accepted from another. From what I have read, companies price various pre-existing conditions differently. That being said, if I had a pre-existing condition, that was of any significance I would think twice about leaving the group you are in at your present company. This is a small consolation, but remember any medical expenses including premiums are tax deductible above 10% of AGI starting next year ( that are not claimed in your HSA) so that may bring some of your costs down.

 

[marko]

it would kill me to essentially write a monthly donation to a company without the charitable tax write off benefit.

but HI premiums are tax deductible aren't they? so, the 'charity' is yourself in a way, right?

 

[pb4uski]

both DH and I have pre-existing conditions, so I'm sure our costs would be horrible IF we could even get covered. The option to stay on the employer plan (paying 100% of the premium) only exists if I get laid off. Otherwise I have to stay another 5 years. Like so many HI is the big "who knows" in my ER planning.

If you are otherwise ready to go perhaps you could request to be laid off rather than resign.

 

[MichaelB]

Preexisting conditions usually lead insurance companies to deny coverage. In some cases they offer riders or exclude coverage for certain conditions. If you have group or employer policy HIPAA regulations implemented in most states enable you to keep that policy for 18 months if you leave the group.

The only way to know how much a policy costs or even if you can get one is to talk with an insurance agent.

 

[teejayevans]

Preexisting conditions usually lead insurance companies to deny coverage. In some cases they offer riders or exclude coverage for certain conditions. If you have group or employer policy HIPAA regulations implemented in most states enable you to keep that policy for 18 months if you leave the group.

I believe it's COBRA for 18 months, then only if you haven't let the coverage lapse, HIPAA kicks in. Your other option is to try to convert your COBRA policy to an individual policy (not sure if you would talk to HR or the insurance company), again this only works if you don't let the coverage lapse. Once you have gone 1 day without insurance, your options become limited. HIPPA will run about ~200% of the COBRA rate, so you can guessestimate your costs that way. For those with preexisting conditions, it's still the best deal.
The world is your oyster if you are perfectly healthy.
TJ

 

[Retire2013]

Dear ALL, thank you so much, for all the information, and advice. I am so fortunate to have found this Forum in 2009. I have learned and continue to learn so much from you ALL! With much gratitude! Retire 2014!

 

[Retire2013]

I believe it's COBRA for 18 months, then only if you haven't let the coverage lapse, HIPAA kicks in. Your other option is to try to convert your COBRA policy to an individual policy (not sure if you would talk to HR or the insurance company), again this only works if you don't let the coverage lapse. Once you have gone 1 day without insurance, your options become limited. HIPPA will run about ~200% of the COBRA rate, so you can guessestimate your costs that way. For those with preexisting conditions, it's still the best deal.
The world is your oyster if you are perfectly healthy.
TJ

I've always thought of HIPAA as an Act to protect medical privacy etc. Does HIPAA have anything to do w/ offering health insurance? I've researched online on HIPAA and its website seems to indicate that it is about medical data privacy protection, etc. Found nothing on rates or coverage for those with pre-existing condition, etc. Please clarify. Thank you so much.

 

[rbmrtn]

HIPAA guarantees the right to purchase individual health insurance, if the rules are followed.
All states have some type of HIPAA plan, it may be the state high risk pool or a private company.

The details are here...

http://www.cms.gov/Regulations-and-...sume/downloads/HIPAA_Eligibility_Criteria.pdf

 

[MichaelB]

HIPAA is primarily regulations of health care insurance for employers and insurance providers. COBRA is a different set of regulations that give employees with current health care coverage certain rights. They are different health care regulations that overlap. One reason health care and insurance is so difficult to understand.

 

[John Galt III]

and thats just downright wrong ! I hate to hear that people cannot get health insurance.

I'm going to show my stuipidity right now ... if my position gets eliminated that qualifies me for unsubsidized HI. Does that mean I get the same rate as someone who does not have pre-existing conditions ? I'm sure the costs will be awful but at least I'd be covered.

Live and Learn,

In my state, you can quit voluntarily and still get COBRA for 18 months. You do not have to be laid off to get COBRA. And the COBRA rate would be the same rate they are paying for you now, which would be the same rate as people in your company with no pre existing conditions ( 99 percent sure, someone correct me if necessary).

In my state, the only way you would not be eligible for COBRA would be if you were fired for "gross misconduct".

It seems to me you could just plain quit and get COBRA at the group premium rate.

I called my HR person, and she said yes, I could quit and get COBRA for 18 months, at the low group rate premium I now have. I would be paying $385 a month for decent HI, since $385 a month is what they are paying in premiums for me now.

I don't think your pre existing conditions would affect your COBRA premium.


Best Wishes,
JG3

 

[teejayevans]

HIPAA is primarily regulations of health care insurance for employers and insurance providers. COBRA is a different set of regulations that give employees with current health care coverage certain rights. They are different health care regulations that overlap. One reason health care and insurance is so difficult to understand.

Not to mention that every state implements the COBRA & HIPAA differently, you need to check the guidelines for your state.
TJ

 

[nun]

The OPs question is difficult to answer because so much of healthcare insurance is dictated by where you live. ACA might bring in some uniformity, but with the possibility of opt outs and the resistance coming from many states there will still be enormous geographical differences.

So if you ER you cam get insurance through COBRA and after 18 months you will have to buy it on the private market. In both cases you will have to cover the entire cost and as health insurance and care is expensive in the US you will have to carefully consider your budget. In many states a preexisting condition will make your search for insurance difficult, while in some there are laws that protect you from being denied coverage.

If you want to investigate the system in Massachusetts that Mitt Romney did a lot to develop and was the model for ACA there is a state website where you can to compare policies and buy insurance. The ACA wants every state to provide a similar website for people to buy insurance.......but how or if that gets implemented is still pretty unsure, but the link below will show you how it works in MA.

https://www.mahealthconnector.org/portal/site/connector

 

[Katsmeow]

It seems to me you could just plain quit and get COBRA at the group premium rate.

Well you need to check. I remember when DH retired he went from the rate employees pay for family coverage to the subsidized retiree rate which was a lot less than the COBRA rate. For an individual and spouse for example the rates were something like this for individual coverage monthly:

Employee rate - $95
Subsidized retiree - $359
COBRA or unsubsidized retiree - $893

So, COBRA coverage was a lot, lot, lot more expensive than the employee rate or the subsidized retiree rate.

 

[Live And Learn]

<snip> . For an individual and spouse for example the rates were something like this for individual coverage monthly:

Employee rate - $95
Subsidized retiree - $359
COBRA or unsubsidized retiree - $893

So, COBRA coverage was a lot, lot, lot more expensive than the employee rate or the subsidized retiree rate.

I have 20k per year budgeted for medical costs (HI, copays, other out of pocket) for DH and I combined. As crazy as it sounds, I'd take the $893 per month in a heartbeat and be extremely happy !