Pondering Health Insurance options

[pedorrero]

Submitted as topic for discussion:

I am a (mostly) healthy, 46-yo man (retiree) who is a full time student at a state university in Florida.

My current health care is BCBSFL which is a guaranteed issue policy -- because I had some pre-existing conditions. I was fortunate, around 2003, to qualify under the HIPAA law (?) that a prior student health plan from another State was considered a "group" by BCBSFL. Because Florida is like many states, where if you've ever had a pimple on your behind, you have the dreaded "pre-existing condition" and individual health plans won't touch you.

I am assuming, but for discussion: as a student, I could enroll in the student plan at much lower rate, but roughly 1/10 the maximum coverage ($200K vs $2M.) (Also offered by BCBSFL, but I think this is incidental to the discssion).

Would this be worth doing? It seems to me the main considerations, given the slippery nature of health insurance, would be:

!. Will I be able to resume my "guranteed issue" (BCBSFL) insurance at a future date, such as when I am not a current student?

2. I currently have no serious health issues; is $200K vs. $2M of lifetime maximum a good gamble?

3. I am also eligible to reduce my 100% underwriting charge on my existing policy; so another option is to see if they'd cut my premium on my current (reasonably good) policy, if they will re-underwrite me or whatever the heck they call it.

[Rich_by_the_Bay]

I assume if you drop the BCBS policy you will not be allowed to re-enroll. Your student insurance will end. If you develop illness you may be bare. $200k of coverage will disappear fast with a major illness.

Can't tell you what to do, but sounds like there are risks here most people would not be able to tolerate. I'd stick with BCBS if you can afford it. Hope that after the election we will eventually have easier access to health insurance with fewer underwriting constraints.

It's a terrible situation which repeats itself all the time among well-meaning people who take good care of themselves, pay their taxes, but have the nerve to get sick.

[Dawg52]

I would stay put.

[Martha]

I also say stay put. You are now 46. The risks outweigh the benefits of the cheaper plan.

As far as whether you could go back to the HIPAA plan when you are no longer a student, it will depend on the law at the time you are going back. Under current law you probably will be HIPAA eligible when you leave the group plan, provided that you have no break in coverage. However, there are a lot of things that HIPAA doesn't regulate and if you leave your plan now, Florida might change what type of plan you are eligible for when you try to get back on in the future. For example, Florida could decide that people coming from plans that only have $200,000 lifetime maximums will only get $200,000 lifetime maximums. Florida has not done this, but with the expense of insurance I would not rule out new restrictions for people coming into their HIPAA plan.


So, stay where you are.

[Florida]

Stay ........................

Hippa is only for those who finish cobra.
If you go off it you cannot get back on it unless you start cobra over again, exhaust it then you have 63 days to apply for Hippa again.

And that translates to going back to work in order to get another cobra plan.

[Martha]

Florida, that isn't necessarily the case. HIPAA aplies to most people who have had 18 months of coverage, the last day of which was on a group plan. If you are eligible for COBRA, you have to exhaust it first to be HIPAA eligible. If you are not eligible for COBRA, which is true of college student plans, you are not excluded from HIPAA coverage.

For more information, you might want to read our FAQ on private health insurance. http://www.early-retirement.org/foru...nce-30756.html

[Alan]

I would stay with what you have. Last March our 26 yr old son graduated and moved back home while he looked for a job. Durig the last year at college he suffered with, and was treated for, clinical depression.Before he came home he applied for health insurance with my help but was refused. While considering next steps he got a job within 6 weeks of returning so that problem was solved fortunately. Within a couple of months he fell off his bicycle and broke both wrists, one requiring surgery with metal pins etc. Out of pocket was over $3K, total cost was over $25K. ( $200K lifetime benefits can be consumed really quickly )

[cute fuzzy bunny]

DONT mess with your health care. We got into all sorts of funny business last year when we migrated from one plan to another. The new plan accepted, then rejected, then accepted us. In the interim while we sorted out the mess and got back into another group plan, we had to cough up about $5k for Cobra to bridge the coverage and avoid preexisting condition complications.

Big time zero fun.

[Florida]

[quote=Martha;705110 If you are not eligible for COBRA, which is true of college student plans, you are not excluded from HIPAA coverage.
[/quote]

Thanks for that info Martha

[pedorrero]

Thanks for the ideas so far. I will approach the topic carefully, and here are two things that are options for me:

1. My "underwriting" period is up (ten years); I will apply for reduced cost coverage. they will either grant it or not. In either case, my current policy is still in force.

2. I will check on the option of a high deductible (HSA) policy. Last I checked (few years ago), this was not an option in FL. Insurance Co. seems really dumb: they wouldn't have had to pay much, if any in claims, in recent years if I'd had (say) a $10K deductible. They just don't seem to realize that if someone (me) is paying $300-400+/mo. for coverage, I'm going to use it!

3. The longest shot will be to carefully consider the ramifications (as others noted here); maybe even to get a paid legal opinion from whoever the expert(s) are. In any case, the "open enrollment" for the student plan is only a few weeks, so I might have to wait for the next semeseter or whatever.

In any case, an important decision like this should not be rushed.

[tangomonster]

I agree with staying with what you have---and agree that it is insane for you not to be able to obtain a high deductible policy that would just be used for major problems.

Just curious: who do you think a paid legal opinion would come from? My own attorney, when we were doing some estate planing, was clueless about health insurance matters. An insurance broker may have their own agenda. Almost seems like the only/best expert would be an actuary who could provide the stats about the odds, etc. Possibly there is a good financial planner who can do this (oops! Can't believe I said that on this board! And I'm not sure I really believe that such a creature exists....

[pedorrero]

I'm not sure I can find an informed opinion. Just that this is an example of a "look before you leap" transaction that might call for an expert opinion, in addition to the fine advice offered here, of course.

[mark500]

A $200,000 lifetime maximum is unacceptable. Nowadays, a $1 million lifetime maximum may be too low.

[Rich_by_the_Bay]

Quote:

Originally Posted by mark500 A $200,000 lifetime maximum is unacceptable. Nowadays, a $1 million lifetime maximum may be too low.

The $200k amount seems to be credible, but remember that this includes your health insurance premiums and out of pocket costs, and you are rescued by Medicare for many catastrophic complaints.

Someone without insurance would likely need much more in order to confidently avoid health-induced personal poverty. With insurance and Medicare it's spread more widely.

[Martha]

Quote:

Originally Posted by tangomonster I agree with staying with what you have---and agree that it is insane for you not to be able to obtain a high deductible policy that would just be used for major problems. Just curious: who do you think a paid legal opinion would come from? My own attorney, when we were doing some estate planing, was clueless about health insurance matters. An insurance broker may have their own agenda. Almost seems like the only/best expert would be an actuary who could provide the stats about the odds, etc. Possibly there is a good financial planner who can do this (oops! Can't believe I said that on this board! And I'm not sure I really believe that such a creature exists....

An independent insurance broker may be the best bet as they should at least know your market. When I first was looking into ER we talked to a financial planner. He knew absolutely nothing about health insurance. I found that no one knew much of anything. So I figured it out for myself. It was good to be at least familiar with HIPAA and COBRA laws, so being a lawyer helped.