Questions for ERs with individual health insurance

[audreyh1]

Another reason to get individual health insurance quickly and avoid COBRA is because COBRA coverage is usually expensive since it is a low (or no) deductible plan with very comprehensive coverage.

But really, getting individual coverage before a nasty pre-existing condition shows up is very, very wise.

Audrey

[Rich_in_Tampa]

Originally Posted by audreyh1

Another reason to get individual health insurance quickly and avoid COBRA is because COBRA coverage is usually expensive since it is a low (or no) deductible plan with very comprehensive coverage.

Really? I thought it was 18 months continuation of your policy from employment plus a few extra percent premium for administrative reasons. So what you get is basically what you had, on your nickel.

Was I misinformed?

[perinova]

I was offered COBRA before (I declined: too expensive).

It is basically the same plan as during employment, same deductible etc.
The cost (premium) is the same as during employment (give or take a small admin. cost? I am not sure of that). The whole employer paid portion being now passed on the former employee.

audreyh1 may have meant that her employer plan is/was an HMO kind of plan with no deductible?

[Papi]

Originally Posted by audreyh1

Another reason to get individual health insurance quickly and avoid COBRA is because COBRA coverage is usually expensive since it is a low (or no) deductible plan with very comprehensive coverage.

But really, getting individual coverage before a nasty pre-existing condition shows up is very, very wise.

Audrey

Hi Audrey,

When you say "before", how long "before" do you mean?* I plan on ERing in 5 years.* Do I get individual coverage today, in 2 years, 4.5 years, 5 years, etc?* How do you figure out when you should get individual coverage?

Thanks!

[Martha]

Papi, the answer to your question is a big "it depends."

Things to look at:

*How much does an individual policy cost which provides the coverage you want?
*How much does your policy at work cost? Are you going to drop that policy?
*Does your state allow insurance companies to raise your premiums in the future based on your health/claims? Based on age?
*How does your state deal with HIPAA rights? Does it allow you to move from your group policy to an individual policy with no underwriting? Does it have a risk pool? Or does your state allow insurance companies to price the individual policy at whatever amount they chose?

As I stated above:

Federal law (HIPAA)requires guaranteed renewability of individual health plans (though the insurer can cancel the plan for everyone). However, HIPAA is silent on premium increases. A number of states allow insurers in the individual market to increase rates based on claims or the age of covered individuals. Other states require community rating of health insurance premiums. In those states no policyholder can be charged more than any other based on health status, health history, or other risk factors. Other states require modified community rating with adjustments permitted for age, but not health status. Yet other states impose rating bands that limit how much premiums can vary based on health status, age, and other factors.


So if you are healthy, in a place where individual insurance isn't too pricey, and your state prohibits raising rates based on your health or claims, it might make sense to buy an individual policy sooner rather than later.

[Martha]

Originally Posted by Rich_in_Tampa

Really? I thought it was 18 months continuation of your policy from employment plus a few extra percent premium for administrative reasons. So what you get is basically what you had, on your nickel.

Was I misinformed?

No.

[perinova]

Originally Posted by Martha

So if you are healthy, in a place where individual insurance isn't too pricey, and your state prohibits raising rates based on your health or claims, it might make sense to buy an individual policy sooner rather than later.

martha
I see that raising rate due to claims might be a real issue. Do you where I could find information about which states prohibit this practice?

I am thinking that if my future home state (TBD) prohibits the practive I would get a personal insurance early. If not I am not sure it would be worth paying premiums ahead of time. I would get a catastrophic insurance instead. Or none at all.

[REWahoo]

Originally Posted by perinova

Do you where I could find information about which states prohibit this practice?

www.healthinsuranceinfo.net/ has this information, but you will have to look at the summary (chaper 1) for each individual state. I'm not aware of a chart that might provide a side by side comparison of each state.

[mark500]

This subject is clearly complicated. No wonder some people end up unable to obtain health insurance.

I called one person at my insurance company and they were of little help.

Does anyone know anything about conversion contract clauses in your group health care insurance policy? Does your policy contract state you can convert to an individual policy without the need for "evidence of insurability?" What good is that?

[MJ]

For me, my NY Cobra group insurance is pretty high, but it is still much lower than other comparable individual insurance. One of the reasons I am leaving for AZ is to get much lower high ded insurance.
I never thought about Cobra and the possibility of getting a health condition that could jeopardize changing insurance companies. Since I am a worry wart, i'll probably add this to my long list of worries until I get my new insurance in about 1 1/2 months.

[audreyh1]

Originally Posted by Rich_in_Tampa

Really? I thought it was 18 months continuation of your policy from employment plus a few extra percent premium for administrative reasons. So what you get is basically what you had, on your nickel.

Was I misinformed?

Yes, you get basically what you had, on your nickel. But the company may be paying for a much more expensive policy than you would carry for yourself as an individual. For example - paying for pregnancy, dental, prescription, low co-pay, no deductible, etc. At the time my company provided a much more comprehensive plan than we needed. I guess things like this are changing now.

Audrey

[Martha]

Originally Posted by mark500

This subject is clearly complicated. No wonder some people end up unable to obtain health insurance.

I called one person at my insurance company and they were of little help.

Does anyone know anything about conversion contract clauses in your group health care insurance policy? Does your policy contract state you can convert to an individual policy without the need for "evidence of insurability?" What good is that?

Some states require group health insurers to offer a conversion policy. Often conversion policies will not provide the same coverage as your group plan. In addition, conversion policies are usually much more expensive. However, in a few states there are rules establishing minimum benefits that conversion policies must cover and maximum rates that can be charged. Otherwise, if you are not in a state with these limitations, conversion policies tend to have somewhat limited benefits and are very expensive. The upside is you get coverage even if you are otherwise uninsurable.

[farmerEd]

Listening to all these in's and out's, caveats, what-ifs, and exclusions, pre-existing condition concerns, etc...its amazing to me that anyone could think that a free-market solution to the health-care crisis would ever work(yes, its a crisis with 40+ million people w/out insurance and costs going up 10+% every year).

Its quite clear, that any "free-market" solution will be to cover healthy young people, and then either drop or gouge elderly/sickly people as they start to need more care...Why would an insurance company aiming to make a profit voluntarily cover someone with a pre-existing and expensive condition unless their premiums covered their care? and if the premiums need to cover the care, are you really getting "insurance".

[KB]

Originally Posted by youbet

KB..... Didn't you mean that the difference between the negotiated rate/fee and the billed amount must be written off by the provider.......not by BC/BS?

Yes, that's what I meant. And the BC/BS plan will enforce it if needed (if the provider balance bills).
Thanks for clarifying my statement.

[perinova]

FYI
I just read that generally it is not allowed by insurance companies to increase personal rates due to claims. If true, it remains a good idea always to get your insurance while healthy.

[perinova]

Originally Posted by Shepherd

Its quite clear, that any "free-market" solution will be to cover healthy young people, and then either drop or gouge elderly/sickly people as they start to need more care...Why would an insurance company aiming to make a profit voluntarily cover someone with a pre-existing and expensive condition unless their premiums covered their care? and if the premiums need to cover the care, are you really getting "insurance".

By insuring the many young and healthy (most of us), the high cost of a few very elderly or sick is not a point of matter, it makes sense as a social point of view and insurance companies do not have to make profits on ALL policies.
IMHO Mandatory insurance (disconnected from employment) or Single payer system are the clear answer.
Of course one can say that with more elderly boomers the cost will increase but well... that's a fact of life: most of us will be old. Someone will need to pay for our health care.: US, helped by our children. The problem is not much different from social social security. The young Gen-X, Baby-bust will pay high cost of health care, social security and also work more because the boomer will be old and retired. (They will also be paid more and have a easy time finding jobs)

[Martha]

Originally Posted by perinova

FYI
I just read that generally it is not allowed by insurance companies to increase personal rates due to claims. If true, it remains a good idea always to get your insurance while healthy.

Depends on which state you live in.

[perinova]

Originally Posted by Martha

Depends on which state you live in.

That's is what I thought too. But Paul Zane Pilzer in is recent book seems to think that it is not allowed. Maybe he generalized. I am going to have to check www.healthinsuranceinfo.net/ mentioned by ReWahoo! to see what I can find out.

[Martha]

Let me point you to a dandy chart. On the www.healthinsuranceinfo.net site, click on the link on the right side of the page called Summary of Key Consumer Protections in Individual Health Insurance. It has a chart which describes in brief each state and what is required.

Raising premiums due to age or health is not governed by federal law, so a state at any time can change what it requires of insurance companies regarding premiums.

(The term "community rating" means the same premium for all, no matter what your health status.)