FIRE and health insurance w/pre-existing conditions

[ArizonaJay]

We are blessed with a paid off mortgage, no other debt, and sufficient finances to keep us going (unless we get really stupid). Our biggest, most worrisome problem is health insurance for me. I am ten years away from Medicare eligibility, and have pre-existing conditions that eliminate me from individual insurance programs.

I handled HR and benefits while I was employed, so I am very familiar with this topic. When I retired (at 53), I had COBRA for 18 months, then was able to obtain insurance through a group plan with the Arizona Small Business Association. I actually started several online businesses, primarily to obtain this health insurance coverage.

However, now we are considering relocating to another state (Florida, I suspect) and I will not be able to stay on the AZ SBA plan.

I am very familiar with the PCIP plan that is the first step on the Health Care Reform Act. However, it has (at least) two MAJOR flaws:

1. You have to take the financial risk of going without any insurance for 6 months before you become eligible to enroll in PCIP.
2. No one can say what will happen to those that are enrolled in PCIP if the HCRA gets repealed.

I'm currently paying almost $700/mo for coverage with a $5000 deductible - which is high, but at least I have the coverage, and we're blessed that we can afford it. As we have substantial assets in IRA's, going without coverage or looking at Medicaid isn't in the cards either. We have actually considered leaving the country because of this issue (isn't THAT a sad statement!).

So - what do other people do when you don't have a union or government or employer sponsored plan for your retirement?

 

[REWahoo]

We were fortunate to live in a state with a high risk pool for DW (pre-existing conditions - no 6 months naked requirement) and I was able to buy individual coverage on the open market.

 

[chinaco]

... We have actually considered leaving the country because of this issue (isn't THAT a sad statement!).

...

Yes! It is sad. A sad situation indeed.

 

[MichaelB]

I handled HR and benefits while I was employed, so I am very familiar with this topic. When I retired (at 53), I had COBRA for 18 months, then was able to obtain insurance through a group plan with the Arizona Small Business Association. I actually started several online businesses, primarily to obtain this health insurance coverage.

However, now we are considering relocating to another state (Florida, I suspect) and I will not be able to stay on the AZ SBA plan.

Health insurance for small businesses is mandatory (guaranteed issue) in Florida. The rules are slightly different for "businesses of 1" but that is mostly an enrollment period issue. The KFF website linked elsewhere will tell you by state what the availability is for small groups and business of 1.

 

[dgoldenz]

The rates for a one-person business in FL are pretty hefty...

 

[ArizonaJay]

The rates for a one-person business in FL are pretty hefty...

Yep - I looked at that already. In my age group (I will be 55 in November), in Lee Country (which seems to be pretty middle of the road premium wise), the cost for THIS year would be $1500+/month. The open enrollment period is August. There is also a question about how long a business must be established in FL before it is eligible for this on-person business coverage (aka one-life).

Not to alarm anyone - but the Dept of Insurance in Florida told me that they may be eliminating the program next year, in favor of the PCIP. The 6 month waiting period to join the PCIP seems to be one of the barriers to them doing it.

 

[ArizonaJay]

We were fortunate to live in a state with a high risk pool for DW (pre-existing conditions - no 6 months naked requirement) and I was able to buy individual coverage on the open market.

May I ask what state that is?

 

[REWahoo]

May I ask what state that is?

<<<<<<<< Look to your left.

 

[MichaelB]

Yep - I looked at that already. In my age group (I will be 55 in November), in Lee Country (which seems to be pretty middle of the road premium wise), the cost for THIS year would be $1500+/month. The open enrollment period is August. There is also a question about how long a business must be established in FL before it is eligible for this on-person business coverage (aka one-life).

Not to alarm anyone - but the Dept of Insurance in Florida told me that they may be eliminating the program next year, in favor of the PCIP. The 6 month waiting period to join the PCIP seems to be one of the barriers to them doing it.

Eliminate what program? It's a regulation. No involvement by the state. AFAIK a business does not need to be established in FL for coverage, it just needs to provide financial records showing it is a viable and ongoing business and the insured are Fl residents.

I have coverage with a small business policy and it is pricey but not much less so. Perhaps you should speak with an agent.

 

[ArizonaJay]

The Florida Dept of Financial Services was who I spoke to about the one-life insurance - meaning, a small business located in Florida, with only one employee who resides in Florida. Open enrollment and guaranteed acceptance is the month of August only.

They were the ones that told me that Florida MAY decide to discontinue this plan next year, referring new applicants to the PCIP coverage already available through the Health Care Reform Act. I did not inquire about what they might do with those that are already insured under these policies.

 

[MichaelB]

The Florida Dept of Financial Services was who I spoke to about the one-life insurance - meaning, a small business located in Florida, with only one employee who resides in Florida. Open enrollment and guaranteed acceptance is the month of August only.

They were the ones that told me that Florida MAY decide to discontinue this plan next year, referring new applicants to the PCIP coverage already available through the Health Care Reform Act. I did not inquire about what they might do with those that are already insured under these policies.

I understand. Perhaps the Fl rep is confused. PCIP coverage has nothing to with small business coverage. Florida law require insurers to offer small business health care policies. The State does not subsidize or get involved - so there is nothing to discontinue and no plan to drop.

PCIP is health care insurance for people with preexisting conditions that have been denied coverage elsewhere. Florida does not offer a PCIP program and has stated they have no plan or intention of offering one.

If you have health care coverage in one state you should be able to get a conversion plan without waiting until August. For that you should speak with an insurance agent.

 

[Leonidas]

For $1,500 a month would that still include a $5,000 deductible?

$23,000 before the insurance company pays a dime?

May I ask what state that is?

<<<<<<<< Look to your left.

A young Texan was going to travel Outside, and his father was giving him loving counsel: “Son, remember never to ask any man where he is from. If he’s from Texas you’ll soon know it. If he’s not, you’ll just embarrass him.”

 

[Mulligan]

For $1,500 a month would that still include a $5,000 deductible?

$23,000 before the insurance company pays a dime?

A young Texan was going to travel Outside, and his father was giving him loving counsel: “Son, remember never to ask any man where he is from. If he’s from Texas you’ll soon know it. If he’s not, you’ll just embarrass him.”

My deepest sympathy for anyone who would ever have to be forced to pay that amount for that insurance "policy". You could fly to India and have a double bypass in a world class facility every year and still be $10k ahead each year! Outrageous!

 

[ArizonaJay]

I understand. Perhaps the Fl rep is confused. PCIP coverage has nothing to with small business coverage. Florida law require insurers to offer small business health care policies. The State does not subsidize or get involved - so there is nothing to discontinue and no plan to drop.

PCIP is health care insurance for people with preexisting conditions that have been denied coverage elsewhere. Florida does not offer a PCIP program and has stated they have no plan or intention of offering one.

If you have health care coverage in one state you should be able to get a conversion plan without waiting until August. For that you should speak with an insurance agent.

Michael, I appreciate and understand what you are staying. But I'm not sure I am explaining myself properly.

The government of Florida is (evidently) considering amending the law that require insurers who do business in Florida to offer this small business coverage. The reason they are considering this is because the Health Care Reform Act will (supposedly) be a replacement.

You are correct - FL does not have a high risk pool for people with pre-existing conditions (at least, not since 1991). They have turned this over to the new Federal PCIP. (which requires you to have no insurance whatsoever for 6 months prior to enrollment. )

My health coverage now (in AZ) is with a group set up by the AZ Small Business Association. A conversion plan, if available, would be upwards of $1500/month. As I am the owner of the business (and it's only employee), if I leave AZ, the business goes with me, making the insurance invalid (though they do offer a couple of months to allow you to make other arrangements.)

For my specific situation, I need to look at states that DO have high risk pools.

 

[ArizonaJay]

For $1,500 a month would that still include a $5,000 deductible?

$23,000 before the insurance company pays a dime?

You betcha. Hell, I'm already paying $680/month with a $5000 deductible, and I'm a healthy, non-smoking, not overweight 54 year old female.

BUT I have pre-existing conditions on my record, and still take medication related to that condition. No insurance company will accept me without being forced (like through HIPPA, or other guarantee issue arrangements). And since they medically underwrite the policy, they are legally allowed to charge 150% to 300% of the standard rates (depending on the state).

Does anyone have familiarity with the plans in states that DO have a high risk pool? Like TN, AL, MS and TX?

 

[dgoldenz]

You betcha. Hell, I'm already paying $680/month with a $5000 deductible, and I'm a healthy, non-smoking, not overweight 54 year old female.

BUT I have pre-existing conditions on my record, and still take medication related to that condition. No insurance company will accept me without being forced (like through HIPPA, or other guarantee issue arrangements). And since they medically underwrite the policy, they are legally allowed to charge 150% to 300% of the standard rates (depending on the state).

Does anyone have familiarity with the plans in states that DO have a high risk pool? Like TN, AL, MS and TX?

Washington DC has a plan from Blue Cross/Blue Shield that is guaranteed-issue, no pre-ex exclusions or waiting periods, $0 deductible, $373/month for a 54 year old single person. It's actually cheaper than their fully underwritten policy with the same type of benefits. Only catch is that there is a cap of 2,500 entrants into the policy, but the company has never reached the cap of 2,500 from what I've been told. I've sold quite a few of them this year, some even to people with no pre-ex since the benefits are good and price is relatively low. It is not a risk pool, but is open enrollment.

 

[REWahoo]

Does anyone have familiarity with the plans in states that DO have a high risk pool? Like TN, AL, MS and TX?

Link to the Texas High Risk Pool: Texas Health Insurance Pool Home Page
Link to the premium rates: Premium Rate Tables for the Texas Health Insurance Pool

Rates vary based on deductible selected, age, gender, residence zip code, and history of tobacco use.

 

[FIREd]

And here is a link to Alabama's high risk pool:

https://www.alseib.org/healthinsurance/ahip/

 

[MichaelB]

Michael, I appreciate and understand what you are staying. But I'm not sure I am explaining myself properly.

The government of Florida is (evidently) considering amending the law that require insurers who do business in Florida to offer this small business coverage. The reason they are considering this is because the Health Care Reform Act will (supposedly) be a replacement.

You are correct - FL does not have a high risk pool for people with pre-existing conditions (at least, not since 1991). They have turned this over to the new Federal PCIP. (which requires you to have no insurance whatsoever for 6 months prior to enrollment. )

My health coverage now (in AZ) is with a group set up by the AZ Small Business Association. A conversion plan, if available, would be upwards of $1500/month. As I am the owner of the business (and it's only employee), if I leave AZ, the business goes with me, making the insurance invalid (though they do offer a couple of months to allow you to make other arrangements.)

For my specific situation, I need to look at states that DO have high risk pools.

ArizonaJay, you are quite clear and I understand.

FYI, the 2011 Fl legislative session is closed and there was no discussion of chancing the health care regulations. The 2012 session does not open until next january, and there is no agenda yet. No politician has made any statement showing an intention to change the existing regulatory environment. The only pronouncements so far regarding health care has been Gov Scott announcing that Fl will not make any effort to put in place PCIP. IMHO someone at the Fl DOFS is BS'ing you.

 

[nun]

So - what do other people do when you don't have a union or government or employer sponsored plan for your retirement?

Move to Massachusetts. No pre-existing conditions and a basic plan with a $2k deductible and $5k annual max fo a 50 year old male is $350/month.

 

[tapper]

Does anyone have familiarity with the plans in states that DO have a high risk pool? Like TN, AL, MS and TX?

Link to the Minnesota High Risk Pool: Minnesota Comprehensive Health Association
Link to the premium rates: Funding and Premiums

 

[ArizonaJay]

ArizonaJay, you are quite clear and I understand.

FYI, the 2011 Fl legislative session is closed and there was no discussion of chancing the health care regulations. The 2012 session does not open until next january, and there is no agenda yet. No politician has made any statement showing an intention to change the existing regulatory environment. The only pronouncements so far regarding health care has been Gov Scott announcing that Fl will not make any effort to put in place PCIP. IMHO someone at the Fl DOFS is BS'ing you.

Might very well be true.

Regardless, the one-life premium for me, at 55 years old, would be over $1500/month. For me, that's a deal killer (as I would imagine it would be for the vast majority of people, even those that are lucky enough to have retired so early.)

 

[teejayevans]

Some states have long waiting lists for their special HI programs.

What about HIPAA?? I thought that kicks in after COBRA ends, I think you need a denial letter from an insurance company to qualify, rates run about 2X you normal age group.
TJ