state high risk plans

[lucija]

OK... I need some insight from all of you...

In my opinion, our biggest roadblock and wild card to our ER plans is healthcare (cost & availability). So, I have been trying to figure out how to adequately plan for it... As part of this research I looked what our options would be in a not-so-rosy scenario when we do not qualify for (cheaper) individual policies.

In short I took a look at MD's high risk pool options (this is where I live, no plans to move) as outlined here:
Maryland Health Insurance Plan (MHIP)

Surprisingly, the options appear to be not that bad. The coverage is through (probably) the biggest insurer in MD. A family high deductible plan is available to 64-year olds for under $10.5k/yr max total cost ($5.2k deductable + premiums). As a worst case scenario, it's not all that bad. I can live with that. As a mater of fact, if I needed this insurance now, the premiums + deductible are cheaper than what is available to me through COBRA.

Am I missing anything? Are there any drawbacks to state sponsored plans? The doc availability/coverage appears to be good.

[Sandy]

I did not look at MD's plan. There is much variability on state high risk plans. Florida found the plan too expensive and closed it to new enrollees for years ago, so enrollment is decreasing and when the last member goes so will the plan.

Google "state high risk pool" and you should find some literature that explains the pros and cons and some that may even compare them state to state.

[Martha]

You might want to read this FAQ Buying Private Health Insurance and look at Health Insurance and Coverage Help for Consumers Everywhere guide for Maryland.

Be sure to check and see what your maximum out of pocket is for each year, whether there are any dollar limits per illness, and the lifetime maximums. There is big variability in state risk pools as to the adequacy of coverage. At least as of 2004, the Maryland plan had a reasonable maximum out of pocket and reasonable lifetime limits of $2,000,000. TNHIS State-by-State Guide - Maryland

[REWahoo]

Probably not a surprise, but be ready for some unhealthy rate increases on state pool coverage (no pun intended).

After exhausting COBRA last December I went the state (TX) high risk pool route for DW and purchased an individual plan for me. Both are $5k deductible from BCBS and use the same network of doctors and hospitals. Hers provides a little better coverage (4 office visits per year with a $30 copay, limited drug coverage with a separate $200 deductible) but is roughly twice the cost of my plan...for now. My plan increased ~7% last year and hers went up ~16% (not including the $100/mo increase when she hit 60), plus her drug deductible went from $100 to $200.

Our first year premium cost was $8,300. If future increases maintain the same rate, our annual premiums will be ~$13k by the time I'm 65.

[toofrugalformycat]

I used the State of Alaska high risk pool after my private insurance company pulled out of the State, a few years ago. It was expensive, and rates went up each year more than inflation, but I think that'll likely be true of any private insurance you may buy. I had a $10,000 deductible so (luckily) I never had to try to get it to pay anybody.
I didn't read up on your State. As always, look carefully before you leap.

[AlmostDone]

We also live in MD and I looked at the high risk pool. I was surprised at the rates, because I thought they seemed pretty reasonable. I was also thinking that maybe I missed something. I am planning to leave full-time work on 3/31, so I'll be looking at it more closely, as that's the route we'll have to go after COBRA.

[Twinkle Toes]

Originally Posted by lucija

OK... I need some insight from all of you...

In my opinion, our biggest roadblock and wild card to our ER plans is healthcare (cost & availability).

We pulled the plug in '96 at 49. Health insurance was our biggest cost for years. We had a $5,000 deduct policy, no med, no vision, no dental and lots of exclusions. Never filed a claim. Premium started out at about $2,200 annual. Premiums went up annually, sometimes semi-annually. When it hit $9,600 we really started exploring other options.

We moved from TX to NM and applied for BCBS of NM (same $5,000 deduct but they didn't exclude anything). Our 2004 monthly premium dropped from $800 to $236 when we changed to BCBS NM (policy includes both of us). We both turned 60 this year and premiums went up to $265, which was our first increase under BCBS NM. That is the only bright spot of news I have for you.

I hope that both of you are healthy and stay that way! If you have any major health issues, you may want to google "health insurance death spiral". It spotlights the health insurance practice of simply raising premiums to the point where sick people can no longer afford to pay them. So, if you have serious pre-existing issues, think twice about working until you can take your health benefits with you.

I have been surprised at the number of people I've talked to who just go without health insurance. I've never been able to bring myself to do that. In hind sight, we have covered all of our medical expenses out of pocket (nothing exceeded $5,000), plus paying outrageous premiums for years...so maybe they were right after all.

[lucija]

Thanks guys for sharing your thoughts...

I am glad I did not miss anything too obvious. We still have ways to go (10-15 yrs) before taking a plunge, so lots can change in the mean time.

I guess, I was just surprised at the quality & (relative) affordability of our in-state high risk plan.