monthly private health insurance $

[syd03]

I know this topic has been covered extensively. I was hoping to get an update that is current (2009/2010).

I am trying to figure out what an average health insurance policy might cost in Pennsylvania for a family of 3. Me-43, wife 41 and daughter 9. No health issues for myself or my daughter. Wife has mild Crohn's.

We are planning to retire in the next 2 years and neither one of us has any type of coverage to carry into retirement from our employers.

We are interested in a policy that offers decent coverage and are aware that a high deductable/catastrophic type plan is probably the only way to keep this reasonable. But maybe we are wrong.

Could anyone share some $ numbers and just a very brief overview of their coverage? We are trying to get some idea what to expect. We have done some online searches and the quotes were literally all over the map. We just don't have any idea what to really expect.

thanks in advance!!

 

[dgoldenz]

I know this topic has been covered extensively. I was hoping to get an update that is current (2009/2010).

I am trying to figure out what an average health insurance policy might cost in Pennsylvania for a family of 3. Me-43, wife 41 and daughter 9. No health issues for myself or my daughter. Wife has mild Crohn's.

We are planning to retire in the next 2 years and neither one of us has any type of coverage to carry into retirement from our employers.

We are interested in a policy that offers decent coverage and are aware that a high deductable/catastrophic type plan is probably the only way to keep this reasonable. But maybe we are wrong.

Could anyone share some $ numbers and just a very brief overview of their coverage? We are trying to get some idea what to expect. We have done some online searches and the quotes were literally all over the map. We just don't have any idea what to really expect.

thanks in advance!!

I sell health insurance for a living and as of right now, I don't know of any private companies that will offer coverage to someone with diagnosed Crohn's disease, even if it is mild. Crohn's is always on the "auto-decline" list for every company. Some of the prescriptions used to treat Crohn's are incredibly expensive (ex: Humira can be $2,500/month) and insurance companies are not willing to take that risk.....unless the health reform bill passes at least.

Is there no COBRA coverage available to you and her after you leave your job(s)? If she can get on COBRA and fully exhaust the 18 months of it, she will be eligible for a guaranteed-issue policy under the HIPAA laws. Those policies can be pretty expensive, but it is better to pay that than have nothing, especially if you have enough assets to be retiring at that early of an age.

You could always get yourself and your daughter on private insurance now to lock in your insurability, but you may or may not be willing to pay the difference at this point. It would depend what the employer is paying, what you are paying, and what the plan benefits are. Is maternity of concern for you? Private plans do not cover maternity (except complications of pregnancy) unless the company has it as an optional rider, and even then it is very expensive since the people who opt for it almost always plan to use it.

The quotes you found were probably all over the map because you have 5-6 different companies with 5-6 different plans with 5-6 different deductible levels to choose from, and the benefits on each policy can be completely different in the fine print. Some cheaper plans have limitations on prescription drug coverage (ALWAYS make sure you have unlimited Rx coverage for both brand name and generic), limits on outpatient procedures, etc. Just some things to consider.

What's your zip code? I'll try to show you what might be a good plan to work with if you're going the HSA route.

 

[Trek]

You could always get yourself and your daughter on private insurance now to lock in your insurability, but you may or may not be willing to pay the difference at this point.

I've wondered, what's to stop an insurance company from dropping your coverage if you become expensively ill at some point? Is it possible to "lock in insurability" really? Is there a law stopping them from it?

 

[dgoldenz]

I've wondered, what's to stop an insurance company from dropping your coverage if you become expensively ill at some point? Is it possible to "lock in insurability" really? Is there a law stopping them from it?

Health insurance is guaranteed renewable as long as you keep paying the premiums. They can't drop you because of your claims, contrary to popular belief. Private insurance is like group insurance - you are part of a massive group of policyholders. They can't raise your rates without raising everyone else's rates, and they can't single you out because of claims history. The only time you can be dropped is if the insurance company stops selling insurance in that state altogether, which has happened before....that is why I try to tell people to only buy insurance from the biggest nationwide companies (BCBS, United Healthcare, Humana, Aetna, Assurant). As an example, American Community in Ohio just stopped selling new policies and I am sure at some point they will pull out of the state altogether if they can't get their act together.

 

[Trek]

Health insurance is guaranteed renewable as long as you keep paying the premiums. They can't drop you because of your claims, contrary to popular belief.

That's good to know, I wasn't aware of that. Can you point me to the law or regulation that makes it such so I can research it more. Thanks!

 

[dgoldenz]

That's good to know, I wasn't aware of that. Can you point me to the law or regulation that makes it such so I can research it more. Thanks!

It will be in the policy contract - hope that helps.

 

[Trek]

It will be in the policy contract - hope that helps.

So it's something promised by each insurance company but can be changed then at a later date? In that I mean there is no law requiring it and they could write policies without that in the contract?

 

[dgoldenz]

So it's something promised by each insurance company but can be changed then at a later date? In that I mean there is no law requiring it and they could write policies without that in the contract?

Correct. It can't be changed once it's in the policy since it's a contract, but they would be stupid not to include it because they wouldn't sell any policies if people knew they could just revoke it like car insurance. Who would pay $10k/year for health insurance if they knew it could be taken away when it's needed most?

 

[ziggy29]

Keep in mind, though, that while no *individual* who keeps paying their health insurance premiums can be *singled out* for premium increases or be dropped due to developing an expensive condition, there are a couple of potential gotchas:

1 -- Many policies will have a "lifetime maximum" benefit. If you have a prohibitively expensive (and probably chronic) condition, you can trigger this maximum at which point your benefits are exhausted. Typical maximums range from $1-5 million, and some of them (including mine, fortunately) have no limit.

2 -- Individuals can not be targeted for "punishment" if they remain current on their premiums, but they *are* placed into a "group" of insureds who can collectively have their rates jacked up if the insurer's loss history for that group is too high or if too many in the group develop the expensive conditions.

 

[dgoldenz]

Keep in mind, though, that while no *individual* who keeps paying their health insurance premiums can be *singled out* for premium increases or be dropped due to developing an expensive condition, there are a couple of potential gotchas:

1 -- Many policies will have a "lifetime maximum" benefit. If you have a prohibitively expensive (and probably chronic) condition, you can trigger this maximum at which point your benefits are exhausted. Typical maximums range from $1-5 million, and some of them (including mine, fortunately) have no limit.

2 -- Individuals can not be targeted for "punishment" if they remain current on their premiums, but they *are* placed into a "group" of insureds who can collectively have their rates jacked up if the insurer's loss history for that group is too high or if too many in the group develop the expensive conditions.

#1. You are correct, all policies can have lifetime limits. Almost every good policy has a $5 million or higher lifetime limit. It would be very, very difficult to get past $5 million in treatment. Even someone with constant cancer treatments (among the most expensive treatment) would more than likely die before ever reaching that. I always tell people to stay away from policies with a $1 mil or $2 mil lifetime maximum

2. Again, you are correct. This is what is known as "blocking". Companies introduce new products at lower prices to attract healthy people. The healthy people leave the old block of business and the sick people stay because they can't be underwritten again, so they are stuck. This leads to higher claims for that block of business, driving up the premiums. However, as stated, the policy is still guaranteed renewable if you keep paying those premiums. Group insurance works the same way though - if your group has high claim levels, there is nothing stopping the insurance company from jacking up the rates for the group. This is a major problem with small businesses who may only have 10 employees and then one of them has a claim for a million dollars. Spread that over 10 employees and you've got an average claim for the group that year in excess of $100k. Where do the rates go with that kind of claim history?

 

[Gone4Good]

Health insurance is guaranteed renewable as long as you keep paying the premiums. They can't drop you because of your claims, contrary to popular belief.

While that is technically true they can "rescind" policies for other reasons. So any mistake or omission, regardless how innocent, can be used as grounds to cancel a policy once someone starts filing large claims. They can also sometimes cancel a policy on the grounds that someone "should have known" they were sick, even if they were never diagnosed with a pre-existing condition.

There was a whole congressional hearing on this . . .

Blue Cross praised employees who dropped sick policyholders, lawmaker says - Los Angeles Times

Certainly those rules are in place to protect the insurance company from fraud. And there is no good data to say what percentage of rescissions are actually legitimate (could be most of them, but I'm skeptical). But what is clear is that as long as rescissions are allowed, an individual policyholder can not be sure his private insurance will actually be there for him if he gets really sick. People who belong to group insurance or in no underwriting states like NJ don't have that problem, although they pay more for the privilege.

The executives -- Richard A. Collins, chief executive of UnitedHealth's Golden Rule Insurance Co.; Don Hamm, chief executive of Assurant Health and Brian Sassi, president of consumer business for WellPoint Inc., parent of Blue Cross of California -- were courteous and matter-of-fact in their testimony.
But they would not commit to limiting rescissions to only policyholders who intentionally lie or commit fraud to obtain coverage, a refusal that met with dismay from legislators on both sides of the political aisle.

 

[dgoldenz]

While that is technically true they can "rescind" policies for other reasons. So any mistake or omission, regardless how innocent, can be used as grounds to cancel a policy once someone starts filing large claims. They can also sometimes cancel a policy on the grounds that someone "should have known" they were sick, even if they were never diagnosed with a pre-existing condition.

There was a whole congressional hearing on this . . .

Blue Cross praised employees who dropped sick policyholders, lawmaker says - Los Angeles Times

Certainly those rules are in place to protect the insurance company from fraud. And there is no good data to say what percentage of rescissions are actually legitimate (could be most of them, but I'm skeptical). But what is clear is that as long as rescissions are allowed, an individual policyholder can not be sure his private insurance will actually be there for him if he gets really sick. People who belong to group insurance or in no underwriting states like NJ don't have that problem, although they pay more for the privilege.

I very much agree that something needs to be done about the ability to rescind a policy. I don't care whether you are Republican, Democrat, for health reform or against it, it's pretty much universally agreed upon that hte practice of rescission needs to be eliminated, or at least limited to obviously intentional fraud (like a smoker claiming they are a non-smoker and then getting lung cancer). Unfortunately, arguing about the technicalities is what lawyers are for.

 

[Martha]

Health insurance is guaranteed renewable as long as you keep paying the premiums. They can't drop you because of your claims, contrary to popular belief. Private insurance is like group insurance - you are part of a massive group of policyholders. They can't raise your rates without raising everyone else's rates, and they can't single you out because of claims history. The only time you can be dropped is if the insurance company stops selling insurance in that state altogether, which has happened before....that is why I try to tell people to only buy insurance from the biggest nationwide companies (BCBS, United Healthcare, Humana, Aetna, Assurant). As an example, American Community in Ohio just stopped selling new policies and I am sure at some point they will pull out of the state altogether if they can't get their act together.

They also can raise rates for everyone on a particular plan, driving out the healthy who can get underwritten so they buy a cheaper plan and leaving the unhealthy behind with a very expensive plan.

They can offer a new deal to those who can get underwritten, leaving behind the unhealthy and then raising their rates because of the bad group experience.

HIPAA doesn't bar rate increases. Some states do not bar raising rates because of claims by an insured.

 

[Martha]

I know this topic has been covered extensively. I was hoping to get an update that is current (2009/2010).

I am trying to figure out what an average health insurance policy might cost in Pennsylvania for a family of 3. Me-43, wife 41 and daughter 9. No health issues for myself or my daughter. Wife has mild Crohn's.

We are planning to retire in the next 2 years and neither one of us has any type of coverage to carry into retirement from our employers.

We are interested in a policy that offers decent coverage and are aware that a high deductable/catastrophic type plan is probably the only way to keep this reasonable. But maybe we are wrong.

Could anyone share some $ numbers and just a very brief overview of their coverage? We are trying to get some idea what to expect. We have done some online searches and the quotes were literally all over the map. We just don't have any idea what to really expect.

thanks in advance!!

For your wife, check out the Georgetown university guide on health insurance, it will talk about HIPAA options if she is uninsurable. Health Insurance and Coverage Help for Consumers Everywhere

You might also check for the rest of you Health Insurance - Affordable Health Insurance Quotes, Individual Health Insurance for initial quotes. The final price may be higher after you are underwritten.

 

[dgoldenz]

They also can raise rates for everyone on a particular plan, driving out the healthy who can get underwritten so they buy a cheaper plan and leaving the unhealthy behind with a very expensive plan.

They can offer a new deal to those who can get underwritten, leaving behind the unhealthy and then raising their rates because of the bad group experience.

HIPAA doesn't bar rate increases. Some states do not bar raising rates because of claims by an insured.

That's what I wrote above about the practice of "blocking". Scummy, but that's what they do and you have to play the game the way the rules are set as of now.

Can you link me to a state's laws that don't bar raising the rates because of claims by an individual insured? I know every state has different rules and regulations for health insurance, but that's one I haven't heard of.

 

[Martha]

I'll try to dig it up. I had a list in a folder somewhere and in the move I can't find my folder. It may have come from the Kaiser Family Foundation.

 

[Martha]

Can you link me to a state's laws that don't bar raising the rates because of claims by an individual insured? I know every state has different rules and regulations for health insurance, but that's one I haven't heard of.

There is some info in a post of mine from a while ago: http://www.early-retirement.org/for...urance-in-new-jersey-nj-27149.html#post509480

It is hard to pin down how many insurers use changes in medical status, claims history, or other factors in re-underwriting at renewal. The factors used by insurers in the underwriting process are reported to be closely guarded trade secrets. Some experts contend that that practice of medical re-underwriting is limited to only a few small, for-profit insurers and that recent media reports have brought undue attention to the issue. Other recent events suggest this might not be the case. At the annual meeting of the National Conference of State Legislatures in July 2002, a workshop on re-underwriting at renewal briefed state legislators on the "resurrection of re-underwriting." The Health Insurance Association of America has said it opposes high annual rate increases but not modest rate increases based on medical condition or claims history. The Wisconsin Physicain Services Insurance Corporation, a not-for-profit insurer with more that 220,000 custormers in the state, has publicly stated that it has begun to charge some policyholders more at renewal based on their claims in the prior 12 months. These examples suggest that medical re-underwriting at renewal is a growing trend. Protecting Consumers from Unfair Rate Hikes: The Need for Regulation of Health Insurance Renewal Premium Increases. Published in 2003 by FamiliesUSA.



I only have more specific information in paper form and my paperwork is 500 miles away.

 

[dgoldenz]

There is some info in a post of mine from a while ago: http://www.early-retirement.org/for...urance-in-new-jersey-nj-27149.html#post509480

It is hard to pin down how many insurers use changes in medical status, claims history, or other factors in re-underwriting at renewal. The factors used by insurers in the underwriting process are reported to be closely guarded trade secrets. Some experts contend that that practice of medical re-underwriting is limited to only a few small, for-profit insurers and that recent media reports have brought undue attention to the issue. Other recent events suggest this might not be the case. At the annual meeting of the National Conference of State Legislatures in July 2002, a workshop on re-underwriting at renewal briefed state legislators on the "resurrection of re-underwriting." The Health Insurance Association of America has said it opposes high annual rate increases but not modest rate increases based on medical condition or claims history. The Wisconsin Physicain Services Insurance Corporation, a not-for-profit insurer with more that 220,000 custormers in the state, has publicly stated that it has begun to charge some policyholders more at renewal based on their claims in the prior 12 months. These examples suggest that medical re-underwriting at renewal is a growing trend. Protecting Consumers from Unfair Rate Hikes: The Need for Regulation of Health Insurance Renewal Premium Increases. Published in 2003 by FamiliesUSA.

I only have more specific information in paper form and my paperwork is 500 miles away.

I found the article you pulled the quote from. Here's the link: http://www.familiesusa.org/assets/pdfs/Rate_Hikes_Revised_Feb_2003ca7a.pdf

Families USA [MODERATOR EDIT] ....I wouldn't trust them as far as I could throw them. I don't know what that insurance company is doing, but I also found no mention of them "publicly admitting" to increasing the premiums for current policyholders when I searched google. That is also a small regional insurance company, which is again why I said I would never sell for one of those type of companies.

 

[Martha]

I found the article you pulled the quote from. Here's the link: http://www.familiesusa.org/assets/pdfs/Rate_Hikes_Revised_Feb_2003ca7a.pdf

Families USA [MODERATOR EDIT] ....I wouldn't trust them as far as I could throw them. I don't know what that insurance company is doing, but I also found no mention of them "publicly admitting" to increasing the premiums for current policyholders when I searched google. That is also a small regional insurance company, which is again why I said I would never sell for one of those type of companies.

I can't address the issue to any significant extent as I don't have my source material which lists the states which specifically bar re-underwriting. However, I am aware that there are a number of states that do not bar the practice. IIRC, some states that do not bar the practice by law nevertheless have insurance commissioners or AGs that take the position that insurers nevertheless should not be able to re-underwrite. The question, and where there may be room for debate and room for exaggeration on both sides, is the extent re-underwriting occurs.

EDIT: Here is discussion of one company that stopped the practice and moved to a blocking practice, after a WSJ article about the issue: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=12773

 

[oliverdickens]

This may seem a very dumb question, but we currently both are in a guaranteed, no underwriting required, group retiree health plan from my previous employer that has life time benefit at only $1mm. Cost for both of us is $650/mo and goes up about 10% every year.

Are there any companies out there that offer a reasonable secondary supplemental policy that would cover us if, heaven forbid, we passed the $1mm life time benefit?

We are 57/60 and are healthy.

Have never seen this and doubt it exists, but thought I would ask the experts

Thanks

 

[dgoldenz]

This may seem a very dumb question, but we currently both are in a guaranteed, no underwriting required, group retiree health plan from my previous employer that has life time benefit at only $1mm. Cost for both of us is $650/mo and goes up about 10% every year.

Are there any companies out there that offer a reasonable secondary supplemental policy that would cover us if, heaven forbid, we passed the $1mm life time benefit?

We are 57/60 and are healthy.

Have never seen this and doubt it exists, but thought I would ask the experts

Thanks

Not for full major medical. Are you both not in good health? What state are you in?

 

[oliverdickens]

We are in oklahoma.

Guess it depends on the definition of good health, ours or the insurance underwriters.

I take cholesteral medicine, am normal weight, but have been told I would not be covered because I tend to have high blood pressue readings at doctors, don't know why as it is in the 130/85 range normally. I currently need choloscopy every 3 years due to one find of benine polyop. Spend about $3/month for the meds, that is it

Wife always is on edge with weight/height ratio and takes cholesteral and HP medicines, thus gets hit with three strike rule. Also takes thyroid so been told she is uninsurable. Again, cost of meds are less than $10/month and have no other expenses.

So we feel heathly, have little issues, but have been told underwriters will get us for items mentioned above, so don't bother.


So in a nutshell, take the guaranteed coverage and live with it as it is no hassle getting, etc.

Thanks

 

[walkinwood]

Moderators: This is a great thread, but it belongs in the health forum so people looking for this information can find it easilly.

You could always move to NJ. It is a community rating state and you cannot be denied insurance. If you have continuous coverage, you can't be denied coverage for pre-existing conditions either. On the other hand, NJ has higher income and property taxes.

 

[ziggy29]

Moderators: This is a great thread, but it belongs in the health forum so people looking for this information can find it easilly.

Agreed, and moved.

 

[dgoldenz]

We are in oklahoma.

Guess it depends on the definition of good health, ours or the insurance underwriters.

I take cholesteral medicine, am normal weight, but have been told I would not be covered because I tend to have high blood pressue readings at doctors, don't know why as it is in the 130/85 range normally. I currently need choloscopy every 3 years due to one find of benine polyop. Spend about $3/month for the meds, that is it

Wife always is on edge with weight/height ratio and takes cholesteral and HP medicines, thus gets hit with three strike rule. Also takes thyroid so been told she is uninsurable. Again, cost of meds are less than $10/month and have no other expenses.

So we feel heathly, have little issues, but have been told underwriters will get us for items mentioned above, so don't bother.


So in a nutshell, take the guaranteed coverage and live with it as it is no hassle getting, etc.

Thanks

Depending on your wife's height/weight and your actual BP reading averages over the past year, you might be able to qualify individually. By the time you get done paying the rate increases that would be assigned, the information you got is probably right.....I don't know what rates are like in Oklahoma, but you might be better off just keeping what you have even though the lifetime maximum is low. Depends how much you are comfortable spending and what kind of benefits your current policy has. Have you talked to an independent broker who represents multiple major companies, or just talked to people that directly work for each insurance company?