Skip the COBRA and go individual insurance right away?

[Buckeye]

I am completing an application for an HSA for DH and myself with American Community. I am working with a local insurance broker (owners' adult son) who recommended AC because, among other things, the plan has a network in FL. We will be able to maintain our current coverage when we move to FL. Agent and his family use AC for their health insurance which is a pretty good recommendation. We have no health issues and don't take any medications. We were quoted $398 per month.

Me 50.5
DH 59.9

- $5,000 deductible and then 100% in the SuperMedPlus network.
- Imbedded family deductible which means benefits are paid after the first $5,000 deductible is attained. I haven't seen an explanation in writing yet but that's the box I checked and what I was quoted. Seems strange.
- Covers accidental injury at 100% for the first 30 days regardless of status of deductible.
- $5 million maximum.
- In network covered after deductible at 100%.
- Out of network covered after deductible at 75%.
- Out of network deductible is 2X in network deductible.
- Drug discount card until deductible met.

Because I'm being laid off, my COBRA premium would be reduced by 65% for 9 months. That would bring the monthly cost down to $390 for 90/10 coverage with $500 deductible. 75%/25% out of network.

Do you agree it makes sense to transition immediately to AC so we don't have to face the possibility of becoming uninsurable while on COBRA? COBRA will not be affordable after the 9 month subsidy period so we would have to purchase individual insurance at that time if I wasn't working at a job with benefits. Coverage at current job will end July 31st.

 

[W2R]

I wonder if the premium would go up drastically when your DH reaches 60 later this summer?

I don't know which I would do. My main worry would be that the policy might go up considerably after you have had it a while. But that fear is mostly from some of the horror stories I have read about here on the board. At least with COBRA, I would think that your cost is more likely to remain reasonably steady for the nine months. But then, you have the deal in hand right now with the other policy. Hmmm.

 

[Martha]

I'd get the private insurance now.

 

[Achiever51]

I second Martha.

 

[FIRE'd@51]

I agree with "locking in" individual insurance now if you can pass underwriting. In case you haven't done so already, I'd check what AC's premium would be if you moved to FL today. I assume the $398 is for your current zip code and would guess that health insurance premiums are higher in FL than in OH.

 

[Buckeye]

W2R - The individual policy premium is guaranteed for 12 months. The COBRA rate is probably good until February 1 when my employer's plan year begins.

COBRA will increase to 100% of employer premium, $800, in April 2010 when 9 month subsidy disappears. Employer plan is too much coverage with such a low deductible ($500/$1,000) when we don't spent $1,000 in an entire year between the two of us. The HSA will be a better fit.

 

[Buckeye]

FIRE'd@51 - Agent priced other policies in FL (yes, higher) but he didn't mention an increase in the AC premium when we moved. We only talked about what network we would have to use. I'll double-check exactly what will happen to the premium when our address changes.

 

[dex]

Have you compared the HSA with BCBS of FL?
BCBSF

 

[Buckeye]

dex - We don't know when the house will sell so we will have to start with OH insurance. I went to the BCBS of FL website and looked at the available plans. The posted (I assume "preferred") rates look pretty good. I started an online application. Very, very comprehensive set of questions. I will have to have our medical records in front of me to answer all the questions. They want a date and description for every visit and every test for the previous 5 years, wellness visits and otherwise. Yikes!

Thanks for digging that up. It's good to be able to compare.

 

[dex]

Buckeye,
It must be different for all states - I didn't have to do any of that - then again I didn't go to the dr too often and I just gave them my regular dr. name.

 

[Buckeye]

Broker said the premium increase for Buckeyes moving to FL has been under 10%.

I had the broker quote the non-imbedded plan and it was significantly cheaper at $307. This means we have a $10,000 family deductible instead of $5,000 per person before benefits are paid. Given our current health status (very good), I don't think it's worth $91 per month to get the $5,000/$5,000 versus $10,000 deductible.

I'm assuming a 10%-15% premium increase every year so I want to start with the lowest premium. I submitted our application to the broker today. It's feels like turning in a final exam and waiting for my grade. I want an A, i.e. preferred rates!

 

[W2R]

I started an online application. Very, very comprehensive set of questions. I will have to have our medical records in front of me to answer all the questions. They want a date and description for every visit and every test for the previous 5 years, wellness visits and otherwise. Yikes!

Reminds me of a sad story I heard on TV recently. (60 Minutes, maybe?) Anyway, a woman had insurance but when she developed breast cancer, she was dropped. The insurance company said that she hadn't revealed the fact that she was treated for acne years ago. Because she hadn't been forthcoming with her entire medical history, they had the excuse they needed to drop her, even though her acne had nothing to do with her breast cancer. So, despite paying her premium regularly (with no complaints from the insurance company about getting payments while she was healthy), when she developed cancer she had no insurance and couldn't afford the treatments for her cancer that might prolong or save her life. What a nightmare!

 

[Dawg52]

Do you agree it makes sense to transition immediately to AC so we don't have to face the possibility of becoming uninsurable while on COBRA?

It makes a ton of sense. Get it while they will take you.

 

[ziggy29]

Yeah -- the cheap subsidized COBRA for nine months is very tempting -- probably better coverage for less money -- but I'd probably spend the entire nine months worrying about developing a condition that made me uninsurable on the open market when the subsidy was over. Which in turn would likely cause stress-related conditions to develop...

 

[Buckeye]

ziggy29 - The subsidized COBRA is more expensive (additional $100 per month) than the high-deductible policy we are applying for. Of course, it's not apples to apples since the COBRA has only a $500 deductible and the high-deductible has a $10,000 deductible. We have been low consumers of health care and we will work to keep it that way. We much prefer to spend our money on a fitness club membership, healthy food, and a few supplements rather than insurance premiums.

Yes, I too would worry about developing an uninsurable condition. I've actually been worrying about it for the 3 months I have known I was going to leave my employer and would need individual insurance. The broker said it should take about 2 weeks to get the new policy approved with a start date of 8/1/2009. It's a real feeling of freedom to not have my employment and our health insurance intertwined.

W2R - There are many horror stories out there. Obama has a healthcare website (or it's part of his website) where he has asked folks to contribute personal stories and comments. Many of the stories are incredibly heart-breaking. Something has to be done.

 

[MichaelB]

Before we moved to Florida (from NY) I contacted BCBS-Fl for info on individual coverage and quotes. They gave me some rough numbers, said a pre-existing condition I had would require a separate rider, and said they could not provide any further info until we were resident in Fl and actually applied. UHC response was similar.

Once in FL I applied and was immediately denied – due to the same condition I discussed by phone. DW was also denied – due to a reason our family Dr. says is bogus. He even intervened on her behalf – to no avail. Insurance regs in Fl are pretty loose – individuals and very small businesses are at the mercy of insurance co’s.

My only point: there is no guarantee of coverage is Fl except when federally mandated, such as cobra. If you do choose to pursue the AC option, I would at least attempt to "pre-qualify" with a Fl based AC agent, even with the clear understanding that their view wold not represent a commitment.

 

[huusom]

A little off topic here but I think Cobra is a joke. What happen to people who lost their jobs and can't find another job that offer medical insurance and they happen to have a pre-existing condition?

I know HIPPA is a choice but the cost is prohibited if you're unemployed.

 

[Buckeye]

MichaelB - The broker will remain our agent when we move to FL. There is no additional underwriting when we make the move. I double-checked because it sounds like it's all working out too well! The first real test of whether it's all coming together will be AC's response to our application. Does the actual premium resemble the quote?

 

[Buckeye]

huusom - I absolutely agree with you. Something has to be done to assist the folks you describe. There but for the grace of God go my husband and I.

Everyone comments his health is important. It's extremely true today with the messed up health insurance situation and the fact it is very easy to become uninsurable through no fault of your own.

 

[ziggy29]

A little off topic here but I think Cobra is a joke. What happen to people who lost their jobs and can't find another job that offer medical insurance and they happen to have a pre-existing condition?

The biggest problem is that employer health plans tend to be very expensive. Employees often have more than one health insurance option at open enrollment time, but most of them tend to be very expensive. Of course, the fact that it's group insurance also makes it more expensive (because it has no medical underwriting).

 

[dex]

I'm assuming a 10%-15% premium increase every year so I want to start with the lowest premium. I submitted our application to the broker today. It's feels like turning in a final exam and waiting for my grade. I want an A, i.e. preferred rates!

Are you going with BCBS?

Here is a way to same some money - every year, when you get the new premium notice ask for a review - the increase has been lower for me. Also, look at the other plans available at that time; switching to another plan with slightly different options might save you more money. It is all very easy to do; if you didn't have any health problems.
I had a plan $203/mo. with 6 dr. office visits -$40. co-pay - broke my collar bone and used them all. Next year I went to a plan with 3 dr. office visits - $150/mo. no problem.

 

[Buckeye]

dex - We are submitting an application to American Community because we have to start with coverage in OH until the house sells. There will be no underwriting involved in our transfer to FL (hopeffully soon). $307 covers 2 of us (50/60) which seems pretty reasonable. We will definitely shop around as required.

 

[Martha]

Reminds me of a sad story I heard on TV recently. (60 Minutes, maybe?) Anyway, a woman had insurance but when she developed breast cancer, she was dropped. The insurance company said that she hadn't revealed the fact that she was treated for acne years ago. Because she hadn't been forthcoming with her entire medical history, they had the excuse they needed to drop her, even though her acne had nothing to do with her breast cancer. So, despite paying her premium regularly (with no complaints from the insurance company about getting payments while she was healthy), when she developed cancer she had no insurance and couldn't afford the treatments for her cancer that might prolong or save her life. What a nightmare!

This "re-underwriting" when someone makes a large claim on health insurance seems to occur at least frequently enough that there is almost always a story like this out there. Most policies seem to at least require that the omission from the application be material, inotherwords, it at least would have been grounds to deny coverage in the first place. Hard to see materiality with acne.