Why does health insurance vary state to state

[mykidslovedogs]

True, Medigap (supplemental private insurance) does work fairly well, but you sacrifice selection in that process. There are only something like 6 different Medigap plans, and the only plans that are worth anything are Plans F and J. Our culture demands freedom of choice. Would you like it if your choices for private insurance were limited to two or three Federally mandated plan designs? I'll bet most people would answer NO to that question.

A lot of people still don't buy Medigap because they feel like it is too expensive, and the lower cost options aren't worth the price.

[kramer]

You can't sell gasoline blended in any other non-California state within California, etc.

I am currently going through health insurance acquisition. My agent didn't really even know much about portability -- it is something that most people are just not aware of. For me, it is the #1 issue.

I live in California -- if it changes to a mandatory issue state then my rates could soar. I want insurance on my insurance and the ability to move.

This is one reason I am leaning toward Assurant Health, largely based on MKLD's recommendation.

My insurance agent also turned me on to Nationwide. You can only buy it in California or Ohio (and you must be a resident), but later if you move you can bring it with you to almost any state without underwriting (they just can't sell residents of states other than OH or CA new policies). And they have a nationwide network, presumably due to all their group plans. I was on the phone with them this morning confirming all of this. But I am still leaning toward Assurant.

Policy issues aside (we must deal within status quo at this time regardless of changes one would like to see), my advice is buyer beware when you are shopping. Many policies are not portable because most buyers are simply not aware of this restriction. If it became an issue, I bet that various state Blue Cross' would start contracting with one another for portability, etc.

I am going to call Aetna next and ask about their portability across states for individuals. I will report everything that I find back to the forum.

Kramer

[FIRE'd@51]

Originally Posted by mykidslovedogs

True, Medigap (supplemental private insurance) does work fairly well, but you sacrifice selection in that process. There are only something like 6 different Medigap plans, and the only plans that are worth anything are Plans F and J. Our culture demands freedom of choice. Would you like it if your choices for private insurance were limited to two or three Federally mandated plan designs? I'll bet most people would answer NO to that question.

A lot of people still don't buy Medigap because they feel like it is too expensive, and the lower cost options aren't worth the price.

Gee, a choice of 6 plans with 2 good ones is more than a lot of people have now in the individual market, especially if they have a pre-existing condition which they didn't have when they first took out their insurance and now want to move. And, of course it's going to be expensive - you are talking about people who are over 65 and, as I understand it, the policies are guaranteed-issue. My insurance agent told me that when a person turns 65 and goes onto Medicare/Medigap(even plans F or J) his insurance cost will drop significantly relative to when he was 64 on a good individual policy, and he will have better coverage in terms of lower deductibles and copays.

[mykidslovedogs]

Kramer,

I think portability, with regards to private individual plans is just now starting to become an issue, with employer-sponsored plans becoming less and less affordable, and with so many, particularly small employers, dropping their benefits because of cost.

If we don't go universal soon, I can guarantee you that there will be some kind of legislation coming down the pipeline with regards to state to state portability of individual insurance.

[mykidslovedogs]

Originally Posted by FIRE'd@51

Gee, a choice of 6 plans with 2 good ones is more than a lot of people have now in the individual market, especially if they have a pre-existing condition which they didn't have when they first took out their insurance and now want to move. And, of course it's going to be expensive - you are talking about people who are over 65 and, as I understand it, the policies are guaranteed-issue. My insurance agent told me that when a person turns 65 and goes onto Medicare/Medigap(even plans F or J) his insurance cost will drop significantly relative to when he was 64 on a good individual policy, and he will have better coverage in terms of lower deductibles and copays.

Only a very, very small percent of the population is uninsurable. Of these people, a fraction is ineligible for Medicaid. Do we restrict choice for the great majority of the population just so this small fraction of people can have portability from one state to the next? Or...do we try to come up with other creative solutions for the working poor such as affordable solutions for small employers like Anthem Blue Cross and Blue Shields "BeneFits" employer sponsored health plans?

Medigap is only guaranteed issue if you buy it within 6 months of obtaining Medicare Part B. If you choose not to buy it because it wasn't affordable at the time you became eligible for guaranteed issue, you can be declined for pre-existing conditions later on.

[FIRE'd@51]

Originally Posted by mykidslovedogs

Medigap is only guaranteed issue if you buy it within 6 months of obtaining Medicare Part B. If you choose not to buy it because it wasn't affordable at the time you became eligible for guaranteed issue, you can be declined for pre-existing conditions later on.

I bet everyone on this board would savor the opportunity to move to a new state and have a 6-month window to buy a guaranteed-issue policy as good as the best Medigap policies. My point is once one has a Medigap policy it can't be taken away and it is portable. If someone chooses not to buy it, that's their problem. At least they had the chance to buy it.

[brewer12345]

Originally Posted by FIRE'd@51

I bet everyone on this board would savor the opportunity to move to a new state and have a 6-month window to buy a guaranteed-issue policy as good as the best Medigap policies. My point is once one has a Medigap policy it can't be taken away and it is portable. If someone chooses not to buy it, that's their problem. At least they had the chance to buy it.

Don't worry: MKLD will find a way to twist everything you say into praise of how wonderful the current system is.

[mykidslovedogs]

Originally Posted by FIRE'd@51

I bet everyone on this board would savor the opportunity to move to a new state and have a 6-month window to buy a guaranteed-issue policy as good as the best Medigap policies. My point is once one has a Medigap policy it can't be taken away and it is portable. If someone chooses not to buy it, that's their problem. At least they had the chance to buy it.

Yes, I too would love to be able to move to any state I want to without being re-underwritten, and there are CURRENTLY plenty of private healthcare plans out there that give people that choice, if they are willing to pay a little extra for that benefit. I guess my point is, we already have products out there that give you exactly what you are asking for (state to state portability), so I don't understand what you are complaining about? (again, Assurant Health, UHC, Humana, Celtic, etc...) Why should we all be confined to two or three choices of healthplans just because a small percent of the population didn't have the sense to think ahead and buy the right kind of policy when they first signed up?

[FIRE'd@51]

MKLD,

This is a forum of people who are trying to figure out how to avoid financial ruin (from health care costs) if they retire before Medicare age. I agree with a lot of what you say, and find your comments helpful. I view you as a person who could be a conduit for our concerns. I think it is an egregious outrage that someone can pay for health insurance (either directly or through an employer) from the time he/she leaves college (i.e plays the game the way it should be played) and then when he is 50-65 years old, he is told he can't cross state lines because he has developed a "pre-existing condition". I would think you, as a representative of the insurance industry would want to find a way to fix this problem.

IMO, the only way the health care system can work is if everyone is in it. The young must subsidize the old initially, but they will be old someday. The healthy must subsidize the sick, but they too will become sick someday. That's the way insurance works. What we have now is a system where the young and healthy subsidize the old and sick, but then when they get old and sick, quirks in the system throw them out altogether or, at best, make the cost unreasonably expensive.

[kramer]

Yes, I too would love to be able to move to any state I want to without being re-underwritten, and there are CURRENTLY plenty of private healthcare plans out there that give people that choice, if they are willing to pay a little extra for that benefit.

This is exactly what I plan to do. And, so far, I have several plans from which to choose.

Kramer

[FIRE'd@51]

Originally Posted by mykidslovedogs

Yes, I too would love to be able to move to any state I want to without being re-underwritten, and there are CURRENTLY plenty of private healthcare plans out there that give people that choice, if they are willing to pay a little extra for that benefit. I guess my point is, we already have products out there that give you exactly what you are asking for (state to state portability), so I don't understand what you are complaining about? (again, Assurant Health, UHC, Humana, Celtic, etc...) Why should we all be confined to two or three choices of healthplans just because a small percent of the population didn't have the sense to think ahead and buy the right kind of policy when they first signed up?

In a previous post (look back) you said the portability was just between selective states and certain carriers, not universal.

I also think your last sentence shows complete insensitivity to the person who did think ahead and buy the right policy, then lost it through a quirk (e.g. his carrier left the individual insurance market and canceled his policy).

[mykidslovedogs]

Originally Posted by FIRE'd@51

MKLD,

This is a forum of people who are trying to figure out how to avoid financial ruin (from health care costs) if they retire before Medicare age. I agree with a lot of what you say, and find your comments helpful. I view you as a person who could be a conduit for our concerns. I think it is an egregious outrage that someone can pay for health insurance (either directly or through an employer) from the time he/she leaves college (i.e plays the game the way it should be played) and then when he is 50-65 years old, he is told he can't cross state lines because he has developed a "pre-existing condition". I would think you, as a representative of the insurance industry would want to find a way to fix this problem.

IMO, the only way the health care system can work is if everyone is in it. The young must subsidize the old initially, but they will be old someday. The healthy must subsidize the sick, but they too will become sick someday. That's the way insurance works. What we have now is a system where the young and healthy subsidize the old and sick, but then when they get old and sick, quirks in the system throw them out altogether or, at best, make the cost unreasonably expensive.

If legislation were initiated to provide for better portability of coverage for individual policies WITHOUT taking away freedom of choice and WITHOUT resulting in higher premiums for everyone, I would support it. Mandates of that sort typically result in higher premiums for everyone. For now, I would rather be here to educate people about what their CURRENT choices are for health insurance, and help them pick a plan that will fit with their lifestyle. Obviously, I will try to recommend only policies from reputable carriers that I have confidence in from a business and financial standpoint. I have no control over state or federal regulation, which is typically the cause of reputable carriers, like Mutual of Omaha, being driven out of the individual health insurance market.

50 years ago, people depended on employer sponsored coverage for their health insurance. Times are changing. It will be difficult to go back and fix the problems that began 50 years ago without completely destroying the American free market system. I'm not saying it's perfect, but I really feel it's better than the alternative (universalized). Did you read through those links I posted earlier (or just ignore them because you thought they were biased?) Believe it or not, health insurance carriers are very concerned about the population of uninsured, and higher ups are spinning their wheels trying to invent newer and better products that will suit the lifestlyes of today and resolve the problems of the uninsured! Yes, they do care, because their jobs depend on it!

I am in the trenches, I go to the meetings, I read the communications and listen to the ideas.. There are so many up and coming products that most people aren't even aware of that insurance carriers are feverishly trying to get out to the marketplace. They are currently working on innovative solutions to bring down the numbers of the "working poor' without health insurance.

I'm not sure that higher premiums (created by mandated portability) would be popular in this day and age. The main way for insurance carriers to control costs is to network with physicians within certain geographical areas. I think you have to have some give and take in order to provide the kind of freedom of choice and level of service that the majority of Americans demand. This may mean that a small percentage of Americans will be grounded in their state due to pre-existing conditions. However, as time goes on, newer and better solutions combined with better legislation will become available to people and these problems will resolve. I am confident in that.

America is at a turning point and bursting at the seams trying to figure out what is the best solution to todays problems. I am not convinced that a Universal system is the fix-all....particularly 20 or 30 years down the road when my children will not have access to the best possible care because of rationing. Look at Canada...it took just over 30 years for their system to break! People in Canada are now begging to be able to purchase private health insurance legally.....either that, or they are crossing the border to get faster care in the USA. I don't want that to happen to my children.

[Martha]

Originally Posted by mykidslovedogs

Only a very, very small percent of the population is insurable. Of these people, a fraction is ineligible for Medicaid. Do we restrict choice for the great majority of the population just so this small fraction of people can have portability from one state to the next? Or...do we try to come up with other creative solutions for the working poor such as affordable solutions for small employers like Anthem Blue Cross and Blue Shields "Benefits" employer sponsored health plans?

I haven't seen good "real" numbers on the extent our population is uninsurable. I have seen a number of 2.5 million, or 1% of the population kicked around as the number of unisurable people with preexisting conditions. I think this number is way too low. The reason is that a good number of the uninsurable is covered in the group market through their employers. I know that the group plan I am currently part of has a very large percentage of participants that would be uninsurable if they entered the individual market. The individual market is still a very small portion of the total insurance market. Only a small number of people trying to get into that market are declined, but many never apply because they know they are uninsurable. I have read that only about 20% who apply to the individual market are declined or have exclusions on their coverage. The problem with this statistic is that the truly uninsurable often never apply to the individual market and instead go on a risk plan, go without, or stay on the job.

[Martha]

Proposals that I have seen to promote portability when moving from state to state have had too many unintended consequences to be workable. Mostly, it magnifies adverse selection problems.

[mykidslovedogs]

Originally Posted by Martha

I haven't seen good "real" numbers on the extent our population is uninsurable. I have seen a number of 2.5 million, or 1% of the population kicked around as the number of unisurable people with preexisting conditions. I think this number is way too low. The reason is that a good number of the uninsurable is covered in the group market through their employers. I know that the group plan I am currently part of has a very large percentage of participants that would be uninsurable if they entered the individual market. The individual market is still a very small portion of the total insurance market. Only a small number of people trying to get into that market are declined, but many never apply because they know they are uninsurable.

Martha,

We don't really have to worry about state to state portability of employer-sponsored coverage, though, because HIPAA provides for that.

[Martha]

Originally Posted by mykidslovedogs

Why should we all be confined to two or three choices of healthplans just because a small percent of the population didn't have the sense to think ahead and buy the right kind of policy when they first signed up?

This is insulting and not accurate. Only about 4% of the population in the United States is covered in the individual insurance market.

[Martha]

Originally Posted by mykidslovedogs

Martha,

We don't really have to worry about state to state portability of employer-sponsored coverage, though, because HIPAA provides for that.

Sort of true. So long as your new employer has group health insurance coverage it is easy to go from one group plan to another with no preexisting condition waiting periods.

[mykidslovedogs]

Originally Posted by Martha

This is insulting and not accurate. Only about 4% of the population in the United States is covered in