What would yo advise them to do?

[Hillbilly]

Interesting health insurance discussion with a family member last week. I'll try to cover the basics:

1. Couple (male/female) in early 40's living in TN
2. Are FI today, net worth ~ $1M -1.5M (my guess), both want to RE at same time
3. Both still work with male carrying female on his work group insurance plan
4. Female was turned down (rejected) in 2001 for individual insurance policy by BCBS, non-reoccuring skin (basal) cancer & fibromyalgia (still has)were thought to be the issues
5. Male's COBRA insurance will extend for 3 months after quitting work
6. A few of TN's uninsurable insurance program (AccessTN) requirements are that one must be turned down twice (rejected) to secure individual policy and be without insurance for the past 6 months when applying. Also, no access to group coverage is available when applying.
7. HIPPA policy costs 3X-4X normal policy, TN uninsured program costs 2X-3X normal policy, either can be afforded but HIPPA would be a stretch on the budget long term
8. AccessTN will allow 6,000 max. in program (ie program may close at anytime)


Assumptions: Assume the female would be qualify for either TN uninsured program (AccessTN) or be HIPPA eligible, assume the male would be able to secure his own policy with riders

Question(s): For the female, would you recommend that she try to qualify for HIPPA eligible individual health insurance after COBRA OR should she go without health insurance for 6 months after hubby's COBRA expires to qualify for the State's AccessTN program for uninsurables?

If you feel that she should go without insurance to qualify for AccessTN, what would you propose to be the effective and feasible risk mitigation measures to use during the 6 months without insurance, if any?


Thanks, Hillbilly

[Hillbilly]

Sorry, blew the title. Should have read "What would you advise them to do?"

Hillbilly

[kcowan]

One possibility is to see if she can buy temporary travel insurance and then spend 6 months in Mexico while waiting for the period to expire.

[ladelfina]

kcowan.. I started laughing.. but you know, you have a point!

I was tempted to post on this board about how easy (and cheap) it was to get "specialty risk" health insurance for those periods when I travel to the US. $1million cap policy for something like $60/2weeks.

Just fill out a form online with DOB, etc., pay w/credit card, and print out a policy/coverage card. Took about 5 minutes...

It should be so easy for US residents!

I'm sure there's a catch somewhere but at least I got the sense that maybe 1/2 my ass would be covered in the event of a car accident or some such major thing.

[haha]

Originally Posted by ladelfina

kcowan.. I started laughing.. but you know, you have a point!

Just fill out a form online with DOB, etc., pay w/credit card, and print out a policy/coverage card. Took about 5 minutes...

What is DOB?

Ha

[REWahoo]

Originally Posted by HaHa

What is DOB?

It's not polite to ask a lady that question.

[haha]

Originally Posted by REWahoo!

It's not polite to ask a lady that question.

Oh God, forgive me for my grievous transgression and utter lack of sensitivity!

Ha

[FIRE'd@51]

Under no circumstances would I advise her to go without insurance for 6 months with the hope of getting into AccessTN. In addition to the obvious financial risk she would face should something bad happen, by going without insurance for more than 60 days, she would lose her HIPAA eligibility. Then, if AccessTN closed or was full, she might find herself never able to get insurance.

Are you sure about that "going without insurance for 6 months" to get into AccessTN? Many (if not most) states which have a guaranteed-issue insurance may have waiting periods for pre-existing conditions (which can often be waived if HIPAA eligible), but the idea of encouraging someone to go without insurance to get access amazes me.

[Hillbilly]

Here is the short version of the AccessTN eligibility:

1. No income determination, no asset test
2. US Citizen or qualified legal alien
3. TN resident (6 months)
4. Age 19 or over
5. Uninsurable by medical or insurance determination
6. Been without health coverage: 6 months
7. No access to insurance at time of application
8. Exhausted COBRA or any other continuation coverage

FIRE'd@51: It is #6 above that is driving me crazy. Sounds like one must "go bare" for 6 months OR go the HIPPA route with other insurance. I'm thinking the HIPPA route is the best (like you say) and not risk everything, however, self insuring for 6 months with a large cash reserve crosses my mind. Also not noted above, the State of Tennessee is reserving 75% of the first 6,000 openings to those let go of TennCare last year (TennCare replaced Medicaid few years back). So, there may be very few openings, but the AccessTN pricing may keep many from not applying.

kcowan: thanks for your reply. I've thought along your ideas too. Got to study up some on the approach. Canada sounds better since there are in-laws in New Hampshire, however, I don't know if it is feasible yet.

Any more ideas are welcomed.

Hillbilly