Retirement and Health Insurance

[bookman51]

Folks, I am in the process of retiring (early 60s). Since I am leaving my employer, my wife and I applied for health insurance via Blue Cross and Blue Shield in Nebraska. She was rejected for a diagnosis of sleep apnea, spastic dystonia, and rheumantic heart disease. We have been assured by our physician that none of the conditions in her situation are all that serious. Yes, they exist and could become serious if not monitored. My first question, has anyone had any positive experience with trying to appeal a Blue Cross and Blue Shield rejection?

The rejection puts her in the CHIP program of Nebraska, which requires a six month legal residence in the state. We have maintained our legal residence in Nebraska, although we have lived for about a year and a half in another state while I took a temporary job. That is, we kept our house, drivers license, mailing address, etc. in Nebraska. My second questions, are we in trouble in trying to claim we are legal residence of Nebraska?

My current employer (a university) has COPRA, of course, via me but its coverage is more expensive (about $1,250) per month for us together as a family (we cannot go on it separate in this state) than my wife to have CHIP in Nebraska (with $7,500 deductible) and me to go on the regular insurance with Blue Cross-Blue Shield. Will I have to (or should I) go with the COPRA...particularly until I have six months living back in Nebraska?

Any advice or recommendations as to where I can get valid advise greatly appreciated. Thanks in advance. Bookman

 

[Martha]

Have you been paying income taxes in Nebraska? If so, I would not be as concerned about the residency issue. If not, I am concerned despite the fact that you kept the home, address and license. Some states have a residency "test" or checklist, you might look for that.

I have no idea on whether the appeal would be successful. If not and it looks like she has to go on CHIP/risk pool, there are two option. The option you are looking at is getting on because she has been denied insurance. This option is the one that requires a 6 month residency. Another downside with this option is that there may be a pre-existing condition exclusion period.

The other option, if there is a residency problem or a pre-existing condition waiting period problem, is to go on CHIP using her HIPAA rights. Under HIPAA, she can go on CHIP without a 6 month prior residency and without a preexisting condition exclusion. However, she will have to use up her COBRA benefits first. This is the big downside because of the COBRA expense.

More info here: Nebraska’s Comprehensive Health Insurance Pool (CHIP) - Nebraska Health Insurance Help

 

[bookman51]

Martha, Thanks, I will see if there is a residency test for Nebraska. Yes, I see the downside of using the COPRA if we have to do so. We are in Minnesota (too), and Cobra is about $1,250 per month or about $15,000 for the year.

 

[bookman51]

Martha, Oh yes, we have paid income tax in Nebraska...in addition to Minnesota. Thanks, Bookman

 

[Purron]

Martha, Oh yes, we have paid income tax in Nebraska...in addition to Minnesota. Thanks, Bookman

By paying taxes in both Nebraska and Minnesota, did you claim to have resided in each of these states for a period of time? If so, it could impact the residency requirement. As previously suggested, I would find out how residency is determined and see if there is a test or checklist.

 

[Martha]

Doing a quick google, which is about as far from legal advice as you can get, I did not find any convenient checklest or test for Nebraska residency. I did find this old attorney general opinion which is interesting: Attorney General - Opinion Archives

 

[bookman51]

Folks, Thanks, Yes, we did claim on our federal and state income tax forms Nebraska as our primary residence. We still have Nebraska driver's licenses, and we still have our house (primary residence) in Nebraska (versus an apartment) in Minnesota. I talked with a Blue Cross and Blue Shield Nebraska rep today. I think we are good to go. I am guessing it looks about $900 a month for insurance, including a big deductive in the high risk pool for my wife. Better monthly cost than the $1296 for the COBRA for Minnesota, but then the coverage is not as good. It is all a gamble Health insurance will be by far our largest single monthly expense. Thanks Bookman