Why does health insurance vary state to state

[FIRE'd@51]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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

Martha,

I am talking about individual to individual coverage here....not group to individual....And if you are coming off of a group plan and moving to individual...HIPAA provides that you are at least eligible for a state high risk pool or guaranteed issue plan once Cobra runs out.

Others on this thread are proposing that individuals should have something like a Medigap plan ( 2 or 3 state mandated plan designs) that we could purchase and have it be portable from one state to the next. Proposals are to eliminate choice so we won't have to worry about portability of coverage from one state to the next in the individual market. I feel that proposal really alienates a great majority of people just to provide portability for a few who might not qualify if they moved.

 

[Martha]

Martha,

I am talking about individual to individual coverage here....not group to individual....And if you are coming off of a group plan and moving to individual...HIPAA provides that you are at least eligible for a state high risk pool or guaranteed issue plan once Cobra runs out.

Others on this thread are proposing that individuals should have something like a Medigap plan ( 2 or 3 state mandated plan designs) that we could purchase and have it be portable from one state to the next. Proposals are to eliminate choice so we won't have to worry about portability of coverage from one state to the next in the individual market. I feel that proposal really alienates a great majority of people just to provide portability for a few who might not qualify if they moved.

I think that the number who would qualify for portability when they move from one state to another is pretty low. Only certain states and only certain plans.

Mykids, you are in the business. If you are "just" a consumer, it is mighty tough to know what to look for when you shop and all the future might bring. This is why I suggest people work with a good broker, but a broker isn't going to know the future.

 

[FIRE'd@51]

HIPAA provides that you are at least eligible for a state high risk pool or guaranteed issue plan once Cobra runs out.

HIPAA is better than nothing, but it is of no help on the cost side. We recently had a thread about a 50-yr old woman in NC who developed breast cancer while on COBRA. HIPAA would guarantee her access to insurance, at over $2000 per month.

 

[Martha]

HIPAA is better than nothing, but it is of no help on the cost side. We recently had a thread about a 50-yr old woman in NC who developed breast cancer while on COBRA. HIPAA would guarantee her access to insurance, at over $2000 per month.

Yes, HIPAA does not regulate cost at all. Also, the lifetime limits or limit per illness or per year can be low. Look at Mississippi. Or South Carolina.

 

[FIRE'd@51]

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.

This is exactly my point. And you have no way of knowing for sure that all the people to whom you are recommending Assurant (or any other carrier) won't end up exiting the individual insurance market for exactly the same reason.

Will you then say they "didn't have the sense to buy the right kind of policy"?

 

[mykidslovedogs]

Martha,

You are right....I can't predict the future, but there are a lot of plans out there that are portable to a large majority of the States without the requirement of re-underwriting. This is something that the average person should think about when purchasing a policy. Some states will not be included, such as NY, because the carriers have chosen not to do business in a state that is unprofitable due to State mandates like community rating and guaranteed issue.

These carriers that have great portability from one state to the next include Assurant Health, UHC- Golden Rule, Humana, and Celtic Insurance. I am sure that there are more in other states that I am not aware of.

What causes reputable individual insurance carriers like Mutual of Omaha to drop out of the market are usually poorly thought out Federal and/or State regulations that cause immediate and irreversible damage to company profitabililty (such as guaranteed issue and community rating mandates) I obviously have no control over these kinds of legislation. Most reputable insurance carriers do not drop out of the market just to purposely hurt hundreds of people.

However, just because we can't predict the future does not mean that we have to force everyone to have the same coverage. IMO that does more harm than good in the LONGRUN!

 

[Martha]

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.

You are right about our culture demanding freedom of choice. Read the book, the Paradox of Choice. It illustrates how this surfeit of choices are often meaningless and debilitating. A little less choice, with more quality in the choices, might be better for everyone. One theory of the author is that the more we are allowed to be the masters of our fates, the more we expect ourselves to be masters of our own fate. We believe we should be able to find work that is exciting, socially valuable, and pays well. Everything we buy is supposed to be the best. Along with this rise in expectations of ourselves is the fact that American culture is even more individualistic than it used to be; we are not so bound by needs of family, friends, and community. The author states that our individualism means that not only do we expect perfection in all things, but we expect to produce this perfection ourselves. When we fail, the culture of individualism biases us toward causal explanations that focus on personal rather than external factors. Our culture encourages the individual to blame himself for failure. This doesn't breed less failure, instead it leads to people giving up, to unhappiness and depression.

I feel like you are feeding into this mentality when you talk about people making the right decisions when they purchase insurance. So many places to trip up and if you trip up, you are a failure.

 

[mykidslovedogs]

This is exactly my point. And you have no way of knowing for sure that all the people to whom you are recommending Assurant (or any other carrier) won't end up exiting the individual insurance market for exactly the same reason.

Will you then say they "didn't have the sense to buy the right kind of policy"?

So we screw up health care for everyone, just because a tiny percent of people will be adversly affected by irresponsible legislation (community rating and guaranteed issue) that they, themselves, have voted for? Assurant Health has been in business for over 50 years in the individual market. The likliehood of them dropping out is slim to none, and it probably will only happen if more and more states continue to move to community rating and guaranteed issue. The legislation that people with pre-existing conditions vote FOR is what leads to their own demise.

 

[bright eyed]

You are right about our culture demanding freedom of choice. Read the book, the Paradox of Choice. It illustrates how this surfeit of choices are often meaningless and debilitating. A little less choice, with more quality in the choices, might be better for everyone. One theory of the author is that the more we are allowed to be the masters of our fates, the more we expect ourselves to be masters of our own fate. We believe we should be able to find work that is exciting, socially valuable, and pays well. Everything we buy is supposed to be the best. Along with this rise in expectations of ourselves is the fact that American culture is even more individualistic than it used to be; we are not so bound by needs of family, friends, and community. The author states that our individualism means that not only do we expect perfection in all things, but we expect to produce this perfection ourselves. When we fail, the culture of individualism biases us toward causal explanations that focus on personal rather than external factors. Our culture encourages the individual to blame himself for failure. This doesn't breed less failure, instead it leads to people giving up, to unhappiness and depression.

I feel like you are feeding into this mentality when you talk about people making the right decisions when they purchase insurance. So many places to trip up and if you trip up, you are a failure.

well said!

 

[FIRE'd@51]

So we screw up health care for everyone, just because a tiny percent of people will be adversly affected by irresponsible legislation (community rating and guaranteed issue) that they, themselves, have voted for? Assurant Health has been in business for over 50 years in the individual market. The likliehood of them dropping out is slim to none, and it probably will only happen if more and more states continue to move to community rating and guaranteed issue. The legislation that people with pre-existing conditions vote FOR is what leads to their own demise.

Many of the people with current pre-existing conditions didn't have them when they first took out their insurance. They didn't vote for anything. They just were unlucky. They carried insurance for many years and then lost it due to a quirk in the system.

My wife has a policy with Assurant. She was originally with Mutual Of Omaha. When MOH exited the individual market, Fortis (now Assurant) looked over the risk pool she was in and cherry-picked the healthy people. They offered her a policy (not-guaranteed issue) at an attractive premium. Now I see exactly the same thing going on with Assurant that happened with MOH prior to them leaving the market. The 15-20% premium increases every 9 months. I don't know how you can be sure they won't exit the individual market. Oh BTW, I also had a $5000 deductible policy with MOH - had it for 10 years - never collected a dime (and I'm thankful for that). However, I was declared uninsurable and ended up with a guaranteed-issue policy from BCBS, at nearly double what I was paying MOH for approximately the same coverage. Thanks to HIPAA no waiting periods. But htese things just shouldn't happen, One buys insurance for a sense of security.

 

[mykidslovedogs]

You are right about our culture demanding freedom of choice. Read the book, the Paradox of Choice. It illustrates how this surfeit of choices are often meaningless and debilitating. A little less choice, with more quality in the choices, might be better for everyone. One theory of the author is that the more we are allowed to be the masters of our fates, the more we expect ourselves to be masters of our own fate. We believe we should be able to find work that is exciting, socially valuable, and pays well. Everything we buy is supposed to be the best. Along with this rise in expectations of ourselves is the fact that American culture is even more individualistic than it used to be; we are not so bound by needs of family, friends, and community. The author states that our individualism means that not only do we expect perfection in all things, but we expect to produce this perfection ourselves. When we fail, the culture of individualism biases us toward causal explanations that focus on personal rather than external factors. Our culture encourages the individual to blame himself for failure. This doesn't breed less failure, instead it leads to people giving up, to unhappiness and depression.

I feel like you are feeding into this mentality when you talk about people making the right decisions when they purchase insurance. So many places to trip up and if you trip up, you are a failure.

Martha,
I agree with you that many people in the USA have sacrificed happiness AND HEALTH for greed, MONEY AND HIGH STRESS JOBS. I'll bet 80% of my applicants take anti-depressants, and at least half are overweight or obese, but those are lifestyle CHOICES. There are a lot of things our culture could do to facilitate better choices, but instead, we have let our moral values deteriorate to the point where are children are taught (particularly by the entertainment industry) to value money and possessions over happiness.

All of that has nothing to do with my point here. Universalizing healthcare is a BAD idea. When you take away choice (in the healthcare industry), you can't possibly ADD quality in the choices. IMO, Most people will be alienated or forced into something that they didn't really want (especially when we reap the unintended longterm consequence - lack of true access to care - because certain kinds of care will not be readily available AT ALL). A few will have something better than they had before. "Quality" is subjective and dependent upon perception. For me, quality (from a healthcare perspective) is a 5000 deductible health insurance plan combined with 100% coverage for any major medical care I might need in the future as well as accessibility to any kind of care I will need. Actually, accessibility is more important to me than the risk of a high deductible, which I can take a loan out to pay for if I have to. For you, "quality" is something different (perhaps a low deductible plan for all with plenty of "front end" benefits such as copays and a drug card, and you seem to be willing to sacrifice of quality of care as a means to the end - coverage for all). IMO, we should all be "Free" to choose what we want. I believe in freedom of choice. I also have a lot of confidence that the marketplace will eventually resolve the problems for the great majority of people.

Why do you assume that your definition of quality, when it comes to healthcare should be imposed upon me or anyone else?

People in America want the best possible care. Most Americans percieve "quality" as being able to have a mammogram on the latest equipment when we want to and not having to wait on THE LIST for several weeks for surgery while worrying about dying while we wait. Take a look at what socializing the system did to Canada....people there are NOT happy with the system, and they are BEGGING legislators to legalize private health insurance. I posted a couple of links earlier in the thread. I simply prefer choice over lack of access to care. With that may come the sacrifice of a small percentage of people having less access than other people. To me, it makes more sense that only a few people are disadvantaged, than having EVERYONE be disadvantaged in the name of equality.

 

[Rich_by_the_Bay]

I agree thata the current system makes no sense. However, for those of us who may have to contemplate buying our own insurance at some point, having regulatory schemes taht have different rules in different places is of some use. If I am in good health when I RE, I can move where I please, especially to a low cost state with cheap insurance (maybe CO, for example). If I have some sort of health issue, I can stay in a guaranteed issue state (may not be cheap, but at least it will be available).

True enough, but many of us (esp with families) reach points where your choice of home towns is driven by other factors: care of elderly parents, desire to be near kids, personal interests and friends, or even the need for assisted living and so on. At that stage, one doesn't necessarily have the luxury of making a savvy choice from an insurance perspective. Life intervenes.

 

[Rich_by_the_Bay]

I guess if all doctors decided one day to stop contracting with insurance carriers, then you all wouldn't have to worry about which state you move to.

Actually, to reply to the absurd example, there are laws against doctors colluding in such a manner as I understand it. But more importantly, the main reason is that carriers have a virtual stranglehold on many markets. The competing carriers dominate the system (and are employer-based), ratchet down prices and each demands the use of their own "preferred" labs, imaging centers, and other services; these can change often with upheaval in the paperwork and so on. Failure to "participate" by doctors is possible in selected circumstances but ruinous to new practitioners who have no established practice. They kite payments by delaying on technicalities and the paperwork requires added personnel in the office who do nothing but fight denied claims, many of which are hung up on trivial issues. It's a nightmare.

There are examples of doctors fighting particularly foul carriers (Aetna comes to mind years back), but as a sustained, organized global boycott it is no longer realistic. The market is too heavily under the chokehold of the carriers.

It would be like an autobody dent shop not accepting anything related to car insurance.