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New Temporary Health Insurance
Old 08-26-2010, 03:55 PM   #1
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New Temporary Health Insurance

Just curious is anyone in their respective states, have seen their new Temporary Health Insurance plans that are coming out now as part of the
Health reform?

We live in Oklahoma and they are offering this insurance until 2014 when the insurance exchanges take effect (Assuming they do)

Can only apply for a limited time until funds run out.

Anyway, it does have a lifetime limit of 1MM, $2000 deductable, up to $4400 out of pocket and costs a 60 yo about $550 per month.

How is this comparing to your states?

Also suprised at the life time limit, thought new insurance plans could not do that under the reform law?

Not to make this political, I am sure many will be surprised, that have never priced insurance on the market, at the high monthly fees. They thought it would be affordable.
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Old 08-26-2010, 04:22 PM   #2
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My thought would be that the rating on those policies is 'communnity rated', they can't exclude people with pre-existing conditions.
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Old 08-26-2010, 10:27 PM   #3
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The states that aren't having the program run by the federal government can impose their own rules. Here in VA the program is run by the feds and costs $616/month for over age 55. Policies can only be on one person, no family rates. $2500 deductible before any benefits except preventative care and a very strange Rx benefit structure. I've referred 4 people who wouldn't qualify for individual insurance to the PCIP - all of them called me back saying it was too expensive and wanted to know if I had something cheaper.

I also got an e-mail from Humana today stating that only 2400 people have signed up in all 22 states that the program is being run. That's about 40 people per day through the entire country.
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Old 08-27-2010, 08:20 AM   #4
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Goldenz, don't you have to be uninsured for six months before you can get on the fed plan? Or am I remembering incorrectly?
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Old 08-27-2010, 08:26 AM   #5
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You need to be without insurance for 6 months to qualify.

Quote:
Here in VA the program is run by the feds and costs $616/month for over age 55. Policies can only be on one person, no family rates. $2500 deductible before any benefits except preventative care and a very strange Rx benefit structure.
This is a better rate than I currently have - I'd change in a second. But the 6 month wait is a killer.

This offering - high risk and currently uninsured - is intended to be high profile but low enrollment.
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Old 08-27-2010, 08:33 AM   #6
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Goldenz, don't you have to be uninsured for six months before you can get on the fed plan? Or am I remembering incorrectly?
Correct. Of course, there has been no definition of what "uninsured" means....does a short term policy count? What about one of the garbage limited-benefit plans from Cinergy or Mega Life & Health? Who knows....and how could they possibly expect you to prove that you were uninsured? You can't prove a negative action...
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Credible coverage
Old 08-27-2010, 08:59 AM   #7
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Credible coverage

It is difficult to prove one has had no coverage. Still, some things can be done. Ask for the most recent coverage certificate (shows end date), ask for prior year tax return (look at medical deductions), ask for proof of denial of coverage from insurance company. Generally speaking, though, preexisting conditions practically guarantee that there is no current credible coverage, and the absence of preexisting conditions would make this option unnecessary.
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Old 08-27-2010, 09:10 AM   #8
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It is difficult to prove one has had no coverage. Still, some things can be done. Ask for the most recent coverage certificate (shows end date), ask for prior year tax return (look at medical deductions), ask for proof of denial of coverage from insurance company. Generally speaking, though, preexisting conditions practically guarantee that there is no current credible coverage, and the absence of preexisting conditions would make this option unnecessary.
"I don't have a coverage certificate" is an easy answer for someone gaming the system. Remember, you're proving a negative, not a positive. The prior year tax return would only show health insurance premiums deducted if they are self-employed, otherwise it would have to be itemized and over 7.5% of AGI. Getting a denial of coverage is easy because even approved coverage with a medical exclusion qualifies.
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Old 08-27-2010, 09:34 AM   #9
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Originally Posted by dgoldenz View Post
"I don't have a coverage certificate" is an easy answer for someone gaming the system. Remember, you're proving a negative, not a positive. The prior year tax return would only show health insurance premiums deducted if they are self-employed, otherwise it would have to be itemized and over 7.5% of AGI. Getting a denial of coverage is easy because even approved coverage with a medical exclusion qualifies.
What are we talking about here? People are going to commit fraud to gain eligibility to a high-risk insurance pool?

The real point (IMHO) is still that this program is all bark and no bite.
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Old 08-27-2010, 10:38 AM   #10
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What are we talking about here? People are going to commit fraud to gain eligibility to a high-risk insurance pool?

The real point (IMHO) is still that this program is all bark and no bite.
If someone's back is against the wall they certainly could....I agree though, and having only 2400 people signed up in 2 months shows that. Just wait until 2014 and see how many people will pay these kind of rates when everyone has to have guaranteed coverage. Don't forget about the 3 years of rate increases between now and then too.
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Old 08-27-2010, 11:07 AM   #11
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Originally Posted by dgoldenz View Post
If someone's back is against the wall they certainly could....I agree though, and having only 2400 people signed up in 2 months shows that. Just wait until 2014 and see how many people will pay these kind of rates when everyone has to have guaranteed coverage. Don't forget about the 3 years of rate increases between now and then too.
It is a risk pool so not surprisingly the rates are high.

I know that a number of state risk pools have lower rates for lower income people and the money for some of these subsidies are coming from the feds. I don't know about the fed pool.
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Old 08-27-2010, 11:10 AM   #12
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It is a risk pool so not surprisingly the rates are high.

I know that a number of state risk pools have lower rates for lower income people and the money for some of these subsidies are coming from the feds. I don't know about the fed pool.
As far as I know there are no lower-cost options for low-income individuals on the new federal risk pools. From what I understand, if you buy the PCIP coverage and are traveling to a state where the risk pool is run by the state instead of the feds, you're also considered out of network. The in-state networks also stink because the providers are only reimbursed based on Medicaid rates. It is what it is though.
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Old 08-30-2010, 08:24 AM   #13
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From what I understand, if you buy the PCIP coverage and are traveling to a state where the risk pool is run by the state instead of the feds, you're also considered out of network. The in-state networks also stink because the providers are only reimbursed based on Medicaid rates. It is what it is though.
Ouch. One thing that bugs me about health insurance is the state differences and how difficult it makes travel and moving from state to state. Today mobility rules but our insurance laws impair that mobility.
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Old 08-30-2010, 09:32 AM   #14
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<sigh> it makes my current $16k per year out-of-pocket premium (family, good coverage) look less insane than before. Until it rises 10% a year for a few more years, that is.

Still, aren't these first roll-outs mainly the equivalent of block grants to the states for the uninsured or underinsured? It may play out differently once general risk pooling is folded in.
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Old 08-30-2010, 09:55 AM   #15
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<sigh> it makes my current $16k per year out-of-pocket premium (family, good coverage) look less insane than before. Until it rises 10% a year for a few more years, that is.

Still, aren't these first roll-outs mainly the equivalent of block grants to the states for the uninsured or underinsured? It may play out differently once general risk pooling is folded in.
Is your family healthy enough to qualify for an HSA plan? That would limit your max out of pocket to a much lower number.


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Ouch. One thing that bugs me about health insurance is the state differences and how difficult it makes travel and moving from state to state. Today mobility rules but our insurance laws impair that mobility.
I sell a lot of Anthem and CareFirst BCBS plans because people know the network as a national name and the Anthem rates are hard to beat. Those people would be totally screwed if they became uninsurable and moved to another state because they can't port their coverage. CareFirst is only in MD/DC/VA and Anthem does not allow porting from other states - both Humana and United allow coverage to be portable and I believe sells in every state except NY and NJ. It's a big consideration for people approaching retirement because many of them will move to a new location and have no clue that they can't take their coverage with them.
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Old 08-30-2010, 10:11 AM   #16
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The fed risk pool is a state by state thing. These are the options a state has:
  • Operate a new high risk pool alongside a current state high risk pool;
  • Establish a new high risk pool (in a state that does not currently have a high risk pool);
  • Build upon other existing coverage programs designed to cover high risk individuals;
  • Contract with a current HIPAA carrier of last resort or other carrier, to provide subsidized coverage for the eligible population; or
  • Do nothing, in which case HHS would carry out a coverage program in the state Fact Sheet.

Here is what the fact sheet says about premiums:

Premiums in the high risk pool will be affordable for participants to ensure that those who have been locked out of the insurance market have access to high-quality insurance. Premiums must be set so that they:
  • Equal a standard rate for a standard population (that is, not exceed 100 percent of the standard non-group rate); and
  • Do not vary by age by more than 4 to 1.
If you are on a state's risk pool (35 states have pools) you are not eligible for the fed pool, even if the fed pool is much cheaper. This is because of the "six months without insurance" rule.


The whole concept is different from the 2014 reforms and is a temporary patch. I am aware that a number of states are offering subsidies on their own risk pools and the money in part comes from the feds. I reviewed subsidy application materials from Minnesota but I did not qualify. The income requirements are pretty low. We don't know the total effect of this patch without knowing if enrollment has increased under plans states already have in place. There is unfairness in this plan as people who scrambled to pay for expensive pools or inadequate insurance are stuck there and can't get the cheaper federal insurance.
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Old 08-30-2010, 10:16 AM   #17
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If you are on a state's risk pool (35 states have pools) you are not eligible for the fed pool, even if the fed pool is much cheaper. This is because of the "six months without insurance" rule.
Yep. DW is in our risk pool and those eligible for the fed pool will pay roughly 50% less in premiums than she pays. And to think I once believed going naked on health insurance coverage was a bad idea...
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Old 08-30-2010, 10:16 AM   #18
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Here is what the fact sheet says about premiums:

Premiums in the high risk pool will be affordable for participants to ensure that those who have been locked out of the insurance market have access to high-quality insurance. Premiums must be set so that they:
  • Equal a standard rate for a standard population (that is, not exceed 100 percent of the standard non-group rate); and
  • Do not vary by age by more than 4 to 1.
If you are on a state's risk pool (35 states have pools) you are not eligible for the fed pool, even if the fed pool is much cheaper. This is because of the "six months without insurance" rule.
Hah, that's certainly up for debate....I've yet to come across someone eligible for the risk pool that could afford the premiums. The premium for age 55+ in Virginia is $616 per month. A $2500 deductible HSA plan with 100% after deductible is about half that price on the individual market, so I don't know where they got the "equal a standard rate for a standard population" bit. The PICP benefits also require co-payments after deductible, they are not paid 100% and there is an out of pocket maximum of $5,950.
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Old 08-30-2010, 10:29 AM   #19
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Hah, that's certainly up for debate....I've yet to come across someone eligible for the risk pool that could afford the premiums. The premium for age 55+ in Virginia is $616 per month. A $2500 deductible HSA plan with 100% after deductible is about half that price on the individual market, so I don't know where they got the "equal a standard rate for a standard population" bit. The PICP benefits also require co-payments after deductible, they are not paid 100% and there is an out of pocket maximum of $5,950.
What's the premium for a 55+ HSA plan for someone with a disqualifying or pre-existing condition? There is none.

This thing is just getting started. They are trying to get a structure in place that will allow additional measures to be developed. I think states that thumb their noses at this now are missing an opportunity - or at least their residents are.
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Old 08-30-2010, 10:32 AM   #20
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What's the premium for a 55+ HSA plan for someone with a disqualifying or pre-existing condition? There is none.

This thing is just getting started. They are trying to get a structure in place that will allow additional measures to be developed. I think states that thumb their noses at this now are missing an opportunity - or at least their residents are.
I understand that if you can't qualify that something is better than nothing. To say that the premiums are "affordable" and equal to standard rates for a healthy person is misleading. One of the biggest problems I have with this risk pool is that they will not allow HIPAA-eligible individuals to get into the risk pool. HIPAA rates for a similar policy can be 2-4x that price.
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