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The premiums are gonna kill me !
Old 10-08-2011, 08:08 PM   #1
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The premiums are gonna kill me !

My COBRA insurance runs out at the end of next month and what lies ahead "ain't pretty."

I have a pre-existing condition which is likely (no, make that CERTAIN) to preclude me from getting a "regular" individual policy in Florida where I live. Since I'll be HIPAA eligible, each individual insurer is required to offer a couple of policies...but the rates are through the roof. So far, my research suggests that the premiums for a $2000 deductible will cost almost $1000 a month, a $3000 deductible goes for about $825 a month, a $5000 deductible is just over $600 monthly.

Is there anything that I'm missing? Are there better options in Florida that provide comprehensive coverage (including prescriptions?)

Thanks.
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Old 10-08-2011, 08:32 PM   #2
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What is your age , and does the policy have RX coverage. Those two things affect the rate a lot.

PS for comparison , At 51 in California , all of the HIPAA ppo plans I see have a much higher deductables (like 5 ,000)and a higher rate, and that is without RX coverage . HMO plans are not much less, and even more with some carriers. I am lucky , as my employer has a conversion clause in our plans for people who want coverage when cobra runs out. I can keep the so called "cadalac plan" with 1,500 ded. and RX with $20 co pay after cobra runs out.
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Old 10-08-2011, 08:36 PM   #3
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My impression is that nobody even looks at deductibles less than $5000 nowadays, so you always pay that $5000 out of pocket in addition to premiums. Although I suppose you put that $5000 in a HealthSavingsAccount.

The other thing to look at is the Co-pay. Even after you have met the deductible some plans still make you pay 20% up to another $10,000, or $20,000 or so. So for anything major, your annual bill is hefty. If you don't get sick, you might come out ahead.

Anyways, somebody has to pay for your health costs; it might as well be you.
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Old 10-08-2011, 08:38 PM   #4
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Originally Posted by ARB57 View Post
... Since I'll be HIPAA eligible, each individual insurer is required to offer a couple of policies...but the rates are through the roof. So far, my research suggests that the premiums for a $2000 deductible will cost almost $1000 a month, a $3000 deductible goes for about $825 a month, a $5000 deductible is just over $600 monthly.

Is there anything that I'm missing? Are there better options in Florida that provide comprehensive coverage (including prescriptions?)

Thanks.
Just for reference, my megacorp (family coverage) retiree ins cost about that per month (lower deductible though), but pre-existing conditions are not a factor. And that is after megacorp pays a (small) portion of the total.

So from that perspective, it does not sound so bad. Well, OK, it does sound bad, but not so much worse as what others pay. Hopefully you can do better, but that just might be it.

-ERD50
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Old 10-08-2011, 09:23 PM   #5
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If you don't get sick, you might come out ahead.
How would that work?
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Old 10-08-2011, 09:55 PM   #6
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Are you working with a broker? If you aren't, you should be. They don't cost you a dime and they will do the legwork for you. A good one will understand the lay of the land and can advise you on which companies are possibilities with your pre-existing condition and which ones you shouldn't waste your time with. Time is short. Find a broker!

I have used them in the past and they are a great resource in the complicated world of health insurance.

DH and I pay $339 per month for both of us in the Tampa Bay area with Humana but our family deductible is $11000 (100% after that) and we have no pre-existing conditions.
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Old 10-08-2011, 11:41 PM   #7
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There is hope. I got a individual policy with a recent cancer on my medical records. The lower premium on the HSA plan makes up for the high deductible, 5k for me.My premium is lower in Virginia,under $400 And it 'feels right' I'm paying a premium if something bad happens(hospitalization) and paying as I go for my meds and treatments.
If they never spend a dime on me in the next 5years I will be as pleased as they will be.

Just saw you are ending COBRA in a month, pick something NOW the underwriting and review can take a while and you lose some federal protections if you're without coverage for 90(60?) days.
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Old 10-09-2011, 01:24 AM   #8
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Thanks all for the great feedback. By the way, I'm 56...so I'll be in the individual insurance game for a while. I'm going to look into a broker...I'm all in favor of getting help with the legwork. Bottom line: I've got to get going on this NOW.
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Old 10-09-2011, 05:46 AM   #9
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What are your monthly medical outlays? Total them up and compare them against the saved premiums for a particular deductible. A $5k deductible may sound expensive but not when you look at the saved premiums.

Even if you max out your deductible, it looks like you are saving $1800 by going to the $5000 deductible. If I am reading your post correctly, you will pay $4800 less in premiums ($600 per month versus $1000 per month) by paying $3000 more in deductible (going from a $2000 deductible to a $5000 deductible, given everything else is equal).

The savings is potentially more if you don't max out your deductible.
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Old 10-11-2011, 01:42 PM   #10
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No complaints here. Just got my annual renewal and it went down a whopping $4/mo. Last year it went up $4.
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Old 10-11-2011, 10:39 PM   #11
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United Health One will probably be your best bet in FL. They charge 2.2 times the standard premium for HIPAA guaranteed-issue policies. I don't think they offer an HSA plan in FL for HIPAA policies and not sure that anyone else does either.

You can also take your chances by having no coverage for 6 months and then getting into PCIP. The network sucks compared to a major health insurance company and it's a big gamble going 6 months with no coverage, but rates for a $2k deductible would be $376/month.
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Old 10-15-2011, 11:07 AM   #12
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Just for reference: My retiree insurance plan premiums cost (HDHP/HSA) for me, spouse, two kids for 2012 will be $337/month. Plan has $3k deductible and $7k coinsurance. On top of that will have $161+/month Medicare part B for wife's disability insurance. Total is ~$6k/year just for premiums. I budget for the $10k/yr ( we ALWAYS spend that amount) out of pocket and of course the premiums each year so probable max medical is $16k/year. This does not cover vision and dental.
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Old 10-19-2011, 12:28 AM   #13
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ARB57 - How is your search going?
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Old 10-19-2011, 01:26 AM   #14
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United Health One will probably be your best bet in FL. They charge 2.2 times the standard premium for HIPAA guaranteed-issue policies. I don't think they offer an HSA plan in FL for HIPAA policies and not sure that anyone else does either.

You can also take your chances by having no coverage for 6 months and then getting into PCIP. The network sucks compared to a major health insurance company and it's a big gamble going 6 months with no coverage, but rates for a $2k deductible would be $376/month.

dgoldenz - what is PCIP?

If this is local to VA, is there anything similar in California? I am currently looking at plans, and I have High BP, as well as high Cholesterol.

Thanks for any advice you can provide, although I have no health problems right now, I need to resolve the issue of coverage soon.
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Old 10-19-2011, 06:50 AM   #15
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dgoldenz - what is PCIP?

If this is local to VA, is there anything similar in California? I am currently looking at plans, and I have High BP, as well as high Cholesterol.

Thanks for any advice you can provide, although I have no health problems right now, I need to resolve the issue of coverage soon.
Pre-esixting condition insurance plan. Here is the California offering.Welcome to the California Pre-Existing Condition Insurance Plan (PCIP)
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Old 10-19-2011, 10:26 AM   #16
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Pre-esixting condition insurance plan. Here is the California offering.Welcome to the California Pre-Existing Condition Insurance Plan (PCIP)
I believe the PCIP program is a part of the healthcare reform (ACA). It's a temporary program which will expire in 2014 when the reform takes over. With the current political climate and all the talks about repealing I'm not sure if it will survive.

The OP situation is not unique. Many older americans with pre-existing condition and without a decent job that provide medical insurance may have to go without insurance since the high risk pools (if available) and hippa premiums are high to be able to afford. I hope someone will ask those who talk about repealing the ACA to come up with a solution for this problem.
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Old 10-19-2011, 11:43 AM   #17
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dgoldenz - what is PCIP?

If this is local to VA, is there anything similar in California? I am currently looking at plans, and I have High BP, as well as high Cholesterol.

Thanks for any advice you can provide, although I have no health problems right now, I need to resolve the issue of coverage soon.
Someone already answered the question about PCIP, but high BP/cholesterol don't necessarily make you ineligible for individual coverage. I write people in their 40's/50's/60's with that combination all the time. If you have those combined with smoking and/or overweight could change things (the "three strikes" rule).

I'd suggest talking to a California independent health insurance agent that knows the underwriting of several companies and can help you get a fully underwritten policy, which is your best bet if you can qualify.
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