Group health coverage for ER's?

[Cb]

...I just saw the following news blurb and found it interesting:

"Minneapolis (January 27, 2005) – UnitedHealth Group (NYSE: UNH) announced today its support for the National Health Access initiative launched by the HR Policy Association at the behest of a coalition of Fortune 500 companies.

UnitedHealth Group worked closely with the HR Policy Association to design the program, and the coalition selected Uniprise, a business unit of UnitedHealth Group, as the primary provider of the group health plans.

“It is unacceptable that 44 million Americans do not have health insurance. UnitedHealth Group has long held that business, government, health care providers, health insurers and consumers themselves all have a role to play in fixing the problem. We see innovative programs like National Health Access as part of a mosaic of solutions needed to address this problem,” said UnitedHealth Group Chairman and CEO William W. McGuire, M.D. “Therefore, we are pleased to participate in National Health Access and to serve the member companies of the HR Policy Association and their employees.”

National Health Access is designed to help working Americans who previously did not have access to employment-based coverage for themselves and their dependents. Worker groups eligible to voluntarily participate include part-time workers, temporary and seasonal employees, contract workers, workers at franchises with more than 50 employers, and pre-Medicare retirees without employer-sponsored coverage. The HR Policy Association estimates that at least 3 million currently uninsured Americans could benefit from National Health Access."

http://www.unitedhealthgroup.com/news/rel2005/0127NHAI.htm

It'll be interesting to see the details this September.

Cb

 

[jrwooden]

Greetings CB:

Do you know how this turned out?

A method for securing health insurance for my family is the late remaining roadblock for my ER plans

Thanks,
Jim

 

[Martha]

Jim, I don't know where this initiative is at; haven't heard anything since UnitedHealth's press release.

Have you looked at www.ehealthinsurance.com for quotes? Are you familiar with rights that you might have in your state? If not, look at the Georgetown University guide at www.healthinsuranceinfo.net.

If you want to tell us what state you live in, people here might have some ideas for you.

 

[Cb]

Jim, I've Googled for updates periodically (including a few minutes ago) and can't find any updates on that initiative. No great surprise, I guess.

Right now I'm still working part-time with employer health coverage. When I wrap it up in a few months I'll go onto my wife's mega-corp employee plan. She just might stay on long enough to get an early-out package including retiree health coverage, but in our ER planning I'm budgeting for private HSA-eligible health insurance.

Here are our (current) plans for health coverage if my wife retires without retiree health coverage taken from The Thing I Wrote For My Wife:

"I think we ought to go with a straight $5000 deductible plan, in which we’d pay 100% for all costs (including prescriptions) until we hit the $5000 point, and $0 thereafter. The better plans cost around $250-$300 per month, or ~$3,600 per year.

I expect that in most years our total health care costs would be the around $4000 - $4500.
$3600 premium plus $500 - $1000 out of pocket for our expenses under the $5000 limit

In the worst case they’d hit a maximum of $7850, the $3600 premium + ($5000 x 85%)
on the $5000 out-of-pocket you subtract the 15% HSA tax benefit

So in all probability we’d bear 100% of our health care costs, never hitting the insurance unless something catastrophic happens. Because we had that coverage we’d still get the substantial discounts negotiated by our provider on our out-of-pocket expenses, however.

I’ve budgeted $9000 each year for health care costs anyway, partly to be conservative, but mostly because health insurance premiums are rising more quickly than inflation. In truth though, if one of us became sick enough that we were hitting our maximum deductible every year, our expenditures on travel and a number of other activities would probably fall. It’s also conceivable that the sick guy wouldn’t make 102 years of age."

 

[jrwooden]

Hi Martha!

thanks for the speedy reply.

I live in North Carolina, and from reading past appends saw reference to the www.healthinsuranceinfo.net site.

I have just printed out the document there that applies to NC for some "light weekend reading"

Thanks in advance for any other suggestions from the group!

Jim

 

[jrwooden]

"Jim, I've Googled for updates periodically (including a few minutes ago) and can't find any updates on that initiative. No great surprise, I guess. "

>>> I am not surprised ... when it was announced I kinda figured it was a PR move

"I think we ought to go with a straight $5000 deductible plan, in which we’d pay 100% for all costs (including prescriptions) until we hit the $5000 point, and $0 thereafter. The better plans cost around $250-$300 per month, or ~$3,600 per year. "

>>> Something like that would work for me & mine. I still have 2 kids @ home 12 & 16, so cost would be higher, but if as a family we had a $5K deductable and premiums of <say> another $5K/yr. that would be within reach.

I then would only worry about having the rug pulled out from under me.
By either having the policy cancelled or having the premiums raised so much that it became unaffordable. I guess the regulations on those items vary from state-to-state (I'm in NC).

I would hope that it is non-cancelleable (so long as I continue to pay premiums in timely manner) and that any rate increases would have to be applied to entire insured population?

My ER plan includes a small business that should make $10K per year (I hope) I need to talk to my acct. but I might (?) be able to deduct the premiums for the policy from the gross revenue of the business - by having the business "officially" make health care a benefit for employees and their family. If this is legal then the premiums would be paid with "pre-tax" dollars and the $5K deductable would be as well....

THANKS!!!!
Jim

 

[BUM]

Compared to New York for example, North Carolina is a breeze to acquire individual healthcare coverage. I've looked at both Aetna and BCBS and will likely choose Aetna when I establish NC residency.

After you've waded thru all that weekend reading call your doctor's office or go there and ask the "nice lady" in the billing department for an opinion. I did and I got some helpful info regarding the plans they accept and the plans they prefer.

Its a pain but once you get this out of the way other ER obstacles will be a cinch.

 

[jrwooden]

Thanks BUM!

When I leave my "real" job I'll have COBRA so I will have some quiet time to think thru the details and not have to jump into anything, I just want to make sure that I do "look BEFORE I leap" ;-)

Jim

 

[rogersteciak]

A method for securing health insurance for my family is the late remaining roadblock for my ER plans 

Because I'm healthy, I was able to get a High Deductible Health Plan (i.e., it's catastrophic insurance -- I pay for the small stuff and the health plan pays for the big stuff).

Once you get a High Deductible Health Plan, you are then eligible to open a Health Savings Account.  If you happen to be healthy, the financial benefits of these plans are excellent.

To research this, go to www.treas.gov (click on “Health Savings Accounts HSA”).  But you might also want to talk to an insurance agent for the details for your particular situation.  There is a lot of "small print" in terms of eligibility and what you can and cannot do with these plans.

 

[MJ]

I am single and active and healthy (so far at 58). I am shortly moving out of NYC, one of the reasons is to lower the cost of insurance. I am planning to get a high deductable policy. I was wondering for those of you who either have it or plan to get it, what do you consider to be a high ded amount, $2.5k, $5k or $10k.

 

[jrwooden]

Thanks Roger!

"fine print" ... yeah I may have to go ahead and pull the trigger on ER so I'll have time to READ all the fine print

Found one article here from consumers report that is "less than complimentary" on some aspects of HSAs....

http://www.consumerreports.org/cro/...alsepromisesconsumerdrivenhealthplans0605.htm


Vagabond:
Just a comment ... insurance in theory at least is to help you protect against a risk that you can not personally protect against and still sleep well. Again, in theory, since you have no health issues now, I get the prices on all 3 deductables. I'll bet you find it worthwhile to move "up the ladder on the ded. amount to at least $5K. Insurance companies don't want to process paperwork anymore than you do, so from my limited experience seem to "reward" higher ded. with lower premiums due to reduced risk on the company's part and also reduced hassle as they are less likely to have to do any work other than cash your checks...

Jim

 

[MJ]

I guess I am trying to determine what is the best value, for example AZ BCBS has
$5000 ded for $128 versus
$10000 ded for $95

It seems you are risking a lot to save a mere $396. It would take about 10 years to recoupe one bad medical year if you wound up staying in the hospital for 1 week.

 

[jrwooden]

Geezz.. I'd take the $5K deductable at those prices...

That's only one less dinner out a month cover the difference, or one good sale on eBay to pay the difference

what's the delta between $2.5K and $5K?

Jim

 

[MJ]

Geezz.. I'd take the $5K deductable at those prices...

That's only one less dinner out a month cover the difference, or one good sale on eBay to pay the difference

what's the delta between $2.5K and $5K?

Jim

They weren't offering $2.5k.

 

[free4now]

I favor lower deductibles as well. You have to consider the possibility that you get sick for many years and end up paying the full deductible every year. Plus if you're that sick you're probably paying for additional non-covered health expenses, which you might not be able to afford if you are paying big deductibles.

 

[jrwooden]

I agree!
But sometimes there are some "annomalies" (sp?)

e.g. I got a quote from BCBS for regular (not-HSA) coverage a while back and to difference in annual premiums between the same policy with $500 ded. and $2500 ded. was about $2200/yr. so clearly worth going with the higher deductable.

Jim

 

[perinova]

From this data in AZ it seems that increasing the deductible amount does not worth the premium difference.
For most of us when doing the computation the best is to include current average expenses and only once every 10 years a very big expense (Per person?)? If a long term illness sets in there is time to change the insurance policy at that time and any increase in cost can be well compensated by previous savings.

Am I right about the once every 10 years? What is the consensus about probability of a serious illness/accident? DOes anyone has any stats about this to share?

Did anyone read the book from Paul Zane Pilzer "the new health insurance solution"
It actually says that Cobra and Employer based health insurance are NOT good deals and that it is cheaper to have individual health insurance while you are healthy and keep it thereafter.

perinova

 

[free4now]

If a long term illness sets in there is time to change the insurance policy at that time and any increase in cost can be well compensated by previous savings.

There is time but there might not be availability. Once you have a serious long term illness you may not be able to find any other affordable insurance. This is why our system is broken.

 

[haha]

There is time but there might not be availability.  Once you have a serious long term illness you may not be able to find any other affordable insurance.  This is why our system is broken.

IMO, our system is broken but not for this reason. To allow what you suggest is to destroy insurance, because of adverse selection.

You should always be able to continue insurance at whatever level you chose when you were underwritten, but not to carry a cheap high deductible policy and then exchange it for an all-coverage policy when you get seriously ill. The people who paid for a full policy all along would pay for this system gaming.

Ha

 

[razztazz]

You should always be able to continue insurance at whatever level you chose when you were underwritten, but not to carry a cheap high deductible policy and then exchange it for an all-coverage policy when you get seriously ill. The people who paid for a full policy all along would pay for this system gaming. Ha

Yes but what if one, at age 18, cannot afford the kind of policy he will need at 40 or 50 or 60 or 19 after a life altering totally disabling illness sets in, or accident is incurred? See, then people will say "He SHOULD HAVE planned ahead". Now, if he says he can't afford it they will be told... "You're young/healthy get a cheap assed policy because you don't NEED anything else. Why spend the big money? "

See either way a person chooses as certain class of people will sh!t on him and blame him as if we can all see the exact future in all our lives.

Another broken part of insurance is lifetimes caps. Don't get sick more than 1 or 2 million bucks. Or maybe we can all simply by a 50 billion dollar policy at age 17 or 18 (When they're cheap, ya know) and grow old, and sick, and get run over by motorcycles or SUVs and not have to worry about it?

And another broke part of the system is, even if you are too sick or hurt to work and keep those big bucks comming in you still have to pay for the policy. That's a great way to find equalibrium. Guy buys a big time policy. Gets sick or hurt , maybe from an adverse reaction to an nnecessary drug that his doctor gave him. He gets several thousand, maybe several thundred thousand dollars worth of good care. Then it's renewal time. He is bankrupt due to not being able to work. Gets dropped from his expensive 10 million dollar lifetime cap policy. Well he should have known better and bought a cheaper policy he could afford!

 

[perinova]

IMO, our system is broken but not for this reason. To allow what you suggest is to destroy insurance, because of adverse selection.

You should always be able to continue insurance at whatever level you chose when you were underwritten, but not to carry a cheap high deductible policy and then exchange it for an all-coverage policy when you get seriously ill. The people who paid for a full policy all along would pay for this system gaming.

Ha

I agree - since the purpose of insurance is to average the risk on all. That's is why it should be mandatory to all (or available to all), just as auto insurance is.
Several levels of deductibles and coverage "riders" doesn't destroys the insurance system (not completely anyway). Just as auto insurance you can choose deductible, collision ... ou might chande your coverage when the car value is below a certain amount.
What seem important is minimum mandatory coverage for very expensive stuff such as hospital. Not the runny-nose visist to a familly doctor.

 

[jrwooden]

I'm not looking to start a fight Let me observe that I think there are two very different situations here ...

Situation #1) Good example is a motorcycle accident - A friend of mine at work just went throught that and the bills will be in excess of $700,000. This is a "one time" event and is exactly what health insurance is supposed to insure against (and in his case did insure against) by spreading a HUGE one-time risk over the population of insured ... the company (and the insured) both hoping that only a VERY SMALL percentage of the population incurr a $700,000 bill in a given calendar year. Will this person have another motorcycle accident NEXT year? I think not... thus this year his premiums did not come CLOSE to covering what the company paid out, but in the big picture / long haul everything is ok.

Situation #2) Lets say I have a on-going condition that will require treatment every year for a long long time .... maybe forever (forever being defined as - the period for which I pay permiums). I'm a diabetic, I take anti-depressants, or ... whatever. To be fair to the other customers I should be paying something in excess of the average cost of my care. The company has to make a reasonable profit, and they have to have reserves to cover situaiton #1. So if my expected cost of coverage is $10,000/year, year in and year out how much should the company really charge me? Well ... absent "social engineering" I would say they HAVE to charge say $11,000 or so....

If they do not they are in effect consistantly "robbing Peter to pay Paul". That is to say charging people that are on-average healthy more than they should pay (to cover the cost of a 1 in 1,000,000 motorcycle accident plus normal expenses) to help cover the "expected cost" of other clients.

It would be kind of like charging the person at the bottom of an active volcano the same rate for fire insureance as a home owner that lives on a small island in the middle of a big lake. The guy in the middle of the lake is only going to get "burned" by the typical grease fire / electrical wiring issue while the guy at the bottom of the volcano is gonna get burned by lots more.....................


Just my thoughts and again... not trying to cause a fight ... and in this case I'm not sure if I would be "Peter" or "Paul"

Jim

 

[Martha]

This discussion and examples show why I think that it is difficult to use an insurance model to pay for healthcare.

So you get type 1 diabetes when you are 7 years old. You could be priced out of the market forever. Or, like my grandneice who requires an intestine and now liver transplant. No insurance company will ever want to insure her and she already has reached lifetime limits that many policies have in place. And she isn't a year old.

Most people are never underwritten for insurance. They get it through work. But tying insurance to employment has numerous problems--family coverage may not be available, employers unable to purchase affordable coverage, what happens if you lose your job, portability issues, divorce, death, ER. . .

 

[jrwooden]

Martha:

"Yeah, what you said!"

Individual policies being what they are currently - offered by for-profit private companies that have to try and on average make a bit of a profit from each customer simply can not write policies that fit the needs (and pocketbooks) of many individuals. Its a mess.

The only reason I have any hope that it will get even partly addressed in the next few years is that things can not continue along their current course for much longer before we have a total implosion - salaries going up on average of 3%/yr, health costs rising @ 10%+ per year and group/employers passing thru more and more of the cost increases to employees....

It will be totally broken soon and our elected officials will no longer be able to ignore the problem.

Jim

 

[ladelfina]

It would be kind of like charging the person at the bottom of an active volcano the same rate for fire insureance as a home owner that lives on a small island in the middle of a big lake.

This is a terrible analogy. The vast majority of health issues are not the result of choices, so the "free" market of insurance is currently woefully inappropriate and inadequate in its rationing of health care. You can choose whether to live next to a volcano, on the coastline, etc. and either pay for higher insurance or assume the risk. You can choose whether to ride a motorcycle or drive a Volvo. No one chooses diabetes or cancer. We collectively end up paying as a society for the emergency-room visits, the reduced productivity, the bankruptcies, etc. caused by the current system.

The question should not be "can we afford to do it?" but "can we afford NOT to..?" Even with 40+ million uninsured we pay double per capita what other developed countries pay, yet they have overall better results.. If we were to recoup savings on overhead and spread that number out over all Americans, we'd still be way ahead of the game, yet covering everyone.