Massachusetts Individual Health Insurance

[inquisitive]

Am wondering if anyone here has an individual health insurance plan in Massachusetts?

Am reading The New Health Insurance Solution which I think is really good and advocates for individual health insurance plans over group plans as they are generally cheaper and one isn't at risk of losing their insurance when they lose a job. Also discusses the benefits of health savings accounts.

By reading the book, I did find out that MA is 1 of 5 states in the country that has what are called community-based plans which makes health insurance here much more expensive than elsewhere and I'm not sure that any individual plans qualify for a HSA, which is strange because I think there is now legislation that anyone in the country can get a HSA which wasn't the case before. I will look into individual plans to see if anything is available.

 

[dgoldenz]

Am wondering if anyone here has an individual health insurance plan in Massachusetts?

Am reading The New Health Insurance Solution which I think is really good and advocates for individual health insurance plans over group plans as they are generally cheaper and one isn't at risk of losing their insurance when they lose a job. Also discusses the benefits of health savings accounts.

By reading the book, I did find out that MA is 1 of 5 states in the country that has what are called community-based plans which makes health insurance here much more expensive than elsewhere and I'm not sure that any individual plans qualify for a HSA, which is strange because I think there is now legislation that anyone in the country can get a HSA which wasn't the case before. I will look into individual plans to see if anything is available.

MA's individual health insurance market is expensive because there is no underwriting and no waiting period for pre-existing conditions....so it's basically group health insurance on an individual level. Rates for a family plan in MA are 2-4x what they cost where I am. This is what the individual health insurance market will look like nationwide if no changes are made to PPACA when 2014 rolls around.

Politicians are bad at math and most fail to understand how HSA's work because they know nothing about health insurance other than they want a $10 co-pay when they go to the doctor. That drives up the cost for everyone and HSA plans will not meet the guidelines for "platinum/gold/silver" plans under the bill's requirements. So anyone who wants an HSA plan won't get any subsidy from the government because they would have to buy it outside the healthcare exchange.

 

[Mulligan]

MA's individual health insurance market is expensive because there is no underwriting and no waiting period for pre-existing conditions....so it's basically group health insurance on an individual level. Rates for a family plan in MA are 2-4x what they cost where I am. This is what the individual health insurance market will look like nationwide if no changes are made to PPACA when 2014 rolls around.

Politicians are bad at math and most fail to understand how HSA's work because they know nothing about health insurance other than they want a $10 co-pay when they go to the doctor. That drives up the cost for everyone and HSA plans will not meet the guidelines for "platinum/gold/silver" plans under the bill's requirements. So anyone who wants an HSA plan won't get any subsidy from the government because they would have to buy it outside the healthcare exchange.

Dgoldenz, so do think if you are unable to qualify for a subsidy, the HSA may still be a way to avoid some of the increased premiums when the full impact of the program hits in 2014?

 

[dgoldenz]

Dgoldenz, so do think if you are unable to qualify for a subsidy, the HSA may still be a way to avoid some of the increased premiums when the full impact of the program hits in 2014?

It remains to be seen how coverage outside the exchanges works, but generally, yes I do think that. What you'll have is a bunch of upper middle class people buying HSA plans because they are half the price and require underwriting, then a bunch of people making less than 400% of FPL buying the best plans available because they are subsidized at a high cost to taxpayers. Example:

John makes $80k with a family of 4 and qualifies for subsidized coverage that can cost a maximum of 9.5% of his income. So no matter what plan he chooses, he will pay a max of $7,600 per year or $633 per month. Let's make up some approximate insurance pricing for the year 2014:

Platinum plan - $1,800/month
Gold plan - $1,500/month
Bronze plan - $1,200/month
HSA plan (let's say...$5k deductible) - $700/month

Since John pays no more than $633/month in any of these scenarios with the rest subsidized by taxpayers, which plan does he buy?

If John made $95k and did not get any subsidy and had to pay 100% of the cost, which plan does he buy?

 

[nun]

MA's individual health insurance market is expensive because there is no underwriting and no waiting period for pre-existing conditions....so it's basically group health insurance on an individual level. Rates for a family plan in MA are 2-4x what they cost where I am. This is what the individual health insurance market will look like nationwide if no changes are made to PPACA when 2014 rolls around.

I think no under writing should be a fundamental characteristic of any medical plan....my issue with Obamacare is that the insurance companies are still in the system. The issue I have with HSAs are they are great if you are healthy, but don't work for the ill....which is quite a failure when it comes to a healthcare product. The championing of HSAs also reminds me of the 401k debate 40 years ago....and look where that got us.

Just interested to see what a family plan costs where you are and what you get for that ie deductibles etc. In MA its $950 a month for two 40 year old parents with a family and you gate a $4k/$10k annual deductible and out of pocket max. That's not too good in my book. I like that MA mandates healthcare, but I wish MA provided the healthcare with a socialized single payer model.

 

[dgoldenz]

I think no under writing should be a fundamental characteristic of any medical plan....my issue with Obamacare is that the insurance companies are still in the system. The issue I have with HSAs are they are great if you are healthy, but don't work for the ill....which is quite a failure when it comes to a healthcare product. The championing of HSAs also reminds me of the 401k debate 40 years ago....and look where that got us.

Just interested to see what a family plan costs where you are and what you get for that ie deductibles etc. In MA its $950 a month for two 40 year old parents with a family and you gate a $4k/$10k annual deductible and out of pocket max. That's not too good in my book. I like that MA mandates healthcare, but I wish MA provided the healthcare with a socialized single payer model.

Family of 4, two 40-year-old parents and two 15-year-old kids:

$6k deductible HSA plan - $346/month
$2500 deductible co-pay plan, max benefits, 100% after deductible, max 2 deductibles/family - $495/month
$750 deductible co-pay plan, 3 office visits/year, $4250 max OOP/person, max 2 deductibles/family - $393/month

No underwriting = higher prices. Great for people in bad health, horrible for people in good health. Problem is when people in good health are forced to pay $1k/month, they are more likely to buy nothing and distort the overall risk, pushing prices up higher since all you have is unhealthy older people in the pool. Guaranteed-issue sounds great until you have to pay for it. Most of my clients with a family pay $300-600/month. If they had to pay $1000/month, they would likely have no health insurance at all.

 

[Whisper9999]

Family of 4, two 40-year-old parents and two 15-year-old kids:

$6k deductible HSA plan - $346/month
$2500 deductible co-pay plan, max benefits, 100% after deductible, max 2 deductibles/family - $495/month
$750 deductible co-pay plan, 3 office visits/year, $4250 max OOP/person, max 2 deductibles/family - $393/month

No underwriting = higher prices. Great for people in bad health, horrible for people in good health. Problem is when people in good health are forced to pay $1k/month, they are more likely to buy nothing and distort the overall risk, pushing prices up higher since all you have is unhealthy older people in the pool. Guaranteed-issue sounds great until you have to pay for it. Most of my clients with a family pay $300-600/month. If they had to pay $1000/month, they would likely have no health insurance at all.

Question for you guys: are HSA's very uniform from state to state? And where can I get a good easy-to-read summary of what they are and how they work?

 

[Mulligan]

I think no under writing should be a fundamental characteristic of any medical plan....my issue with Obamacare is that the insurance companies are still in the system. The issue I have with HSAs are they are great if you are healthy, but don't work for the ill....which is quite a failure when it comes to a healthcare product. The championing of HSAs also reminds me of the 401k debate 40 years ago....and look where that got us.

Just interested to see what a family plan costs where you are and what you get for that ie deductibles etc. In MA its $950 a month for two 40 year old parents with a family and you gate a $4k/$10k annual deductible and out of pocket max. That's not too good in my book. I like that MA mandates healthcare, but I wish MA provided the healthcare with a socialized single payer model.

If it was affordable, Nun, I would be in agreement with you. But in the present state, I have to agree with Dgoldenz. I might be an exception, but it is cheaper for me to have the HSA big deductible and pay for the whole deductible out of pocket, than it would have been to stay on the group plan that I retired from. Since I am healthy that has not occurred yet, and I am saving thousands, while having to admit I am benefitting from the underwriting process. That is not denying that unhealthy people are in a tough predicament, or that healthcare premiums are exorbitant for a lot of people.

 

[inquisitive]

So I did a lot of research and called a lot of places, and if it will help anyone, there ARE now HSA plans available in MA which originated after the book I mentioned in the original post was written, but they are ridiculously expensive and not worth it. For individual insurance with no/low income, there is MassHealth and Commonwealth Care, for someone who has income there is Commonwealth Choice, but in general insurance is expensive and it is much better to go with an employer if it is possible.

 

[palomalou]

I think no under writing should be a fundamental characteristic of any medical plan....my issue with Obamacare is that the insurance companies are still in the system. The issue I have with HSAs are they are great if you are healthy, but don't work for the ill....which is quite a failure when it comes to a healthcare product. The championing of HSAs also reminds me of the 401k debate 40 years ago....and look where that got us.

Amen, nun.