Changes to high risk gov't health plan

[MichaelB]

As has been noted here previously, the plans for people denied insurance elsewhere have seen very low enrollment rates. Changes are being announced today, with premiums falling by up to 40% and only a note from a Doctor needed for proof of eligibility. Now this looks more like a viable option.

Quote:

Government to lower prices, ease rules on health plans for people with preexisting conditions WASHINGTON — The Obama administration, expanding a program created by the new healthcare law, moved Tuesday to make health insurance more affordableand accessible for Americans who have been denied coverage because they are sick. ./. Now, federal officials estimate, premiums in some states could come down as much as 40%, thanks to a more refined analysis of what the plans should charge. The administration is directly slashing premiums in most of the 23 states and the District of Columbia which have elected to have the federal government run their health plans. The remaining 27 states, which each runs its own plan, will be able to reduce premiums, as well. At the same time, the administration will no longer require applicants for these plans to furnish a letter from an insurance company showing they had been denied coverage. Instead, applicants will need only a letter from a doctor, nurse or physician's assistant stating they have a medical condition. Applicants will still have to show they had been without coverage for at least six months. Preexisting condition plans: New rules on government health plans for preexisting conditions - latimes.com

[67walkon]

You still have to be uninsured for 6 months.

From what I have read, the cost for someone over 55 in Florida will be $376 monthly, although USA today comes in with a lower number. For that, you get free preventative care and the insurance pays 80% of everything else until you reach your out of pocket max of around $5,500. It is the same plan government employees have.

Health insurance is a big reason I'm still working. I'm 61 and extraordinarily healthy. Except I had a congenitally deformed aortic valve replaced 4 years ago; they expect it to last about 15 years. And I got hurt pretty bad in December, 2009 in an accident and will eventually need hip replacement, but it could be 1 year, 5 years or 15 years.

My company pays for insurance right now. BCBS was the best we could find last year and I think the premium for a family is around $1,200 a month and around $750 for an individual. For that we get an HSA plan with something like $5,500 per person deductible. The government plan has better coverage and is much cheaper, but you have to have a pre-existing condition and be uninsured for at least 6 months.

Which leads to the question, do you feel lucky, punk, well do you? I meet the pre-existing condition, but I wouldn't want to go 6 months with no health insurance for me, my wife and our college age youngest child.

[dgoldenz]

Biggest problem is the 6-month uninsured rule. Notice how they are also now paying brokers $100 to enroll people starting in October. Wonder why that is....

[JohnnyQuest]

I see this as a very important & positive development for people with pre-existing conditions. My Group coverage runs out in 15 days and I am in the process of applying for an individual policy with UHC. I have hypertention and an ectatic aortic root that seems pretty stable right now(doctor sees no immediate cause for concern). If these are considered "pre-existing conditions", then I am seriously considering letting my insurance expire on June 15th and then going uncovered for six months so I can then qualify for the high risk pool in Texas or Florida. I am assuming this will run somewhere between $300-400/month.

I know there is a certain degree of risk associated with this, but I have been to my family practicioner, cardiologist, and dermatologist already this year and they see no specific issues other than the ones I have already mentioned. Seems that a sensible path is to run without insurance till Dec 15 and then apply for the high risk coverage under the new rules. Thoughts? BTW, I am 52 years old.

[dgoldenz]

Quote:

Originally Posted by JohnnyQuest I see this as a very important & positive development for people with pre-existing conditions. My Group coverage runs out in 15 days and I am in the process of applying for an individual policy with UHC. I have hypertention and an ectatic aortic root that seems pretty stable right now(doctor sees no immediate cause for concern). If these are considered "pre-existing conditions", then I am seriously considering letting my insurance expire on June 15th and then going uncovered for six months so I can then qualify for the high risk pool in Texas or Florida. I am assuming this will run somewhere between $300-400/month. I know there is a certain degree of risk associated with this, but I have been to my family practicioner, cardiologist, and dermatologist already this year and they see no specific issues other than the ones I have already mentioned. Seems that a sensible path is to run without insurance till Dec 15 and then apply for the high risk coverage under the new rules. Thoughts? BTW, I am 52 years old.

Does your group not offer COBRA?

[JohnnyQuest]

Quote:

Originally Posted by dgoldenz Does your group not offer COBRA?

Cobra runs out on June 15. Sorry, I posted a thread on my situation earlier in the year and just updated that to try and give the complete picture. As the resident expert here, I would be interested in your views. Thanks.

[dgoldenz]

Quote:

Originally Posted by JohnnyQuest Cobra runs out on June 15. Sorry, I posted a thread on my situation earlier in the year and just updated that to try and give the complete picture. As the resident expert here, I would be interested in your views. Thanks.

If your COBRA is expiring, you would likely qualify for a guaranteed-issue HIPAA policy. UHC charges 2.2 times the standard premium for HIPAA coverage, or at least that's what they do here in VA. Some states limit the plan choices available or force you into the risk pool, but I don't know the Texas rules.

That is a much safer bet than going uninsured for 6 months. The UHC coverage is also portable to most states in case you move and their network is far superior to the PCIP one, which reimburses physicians at Medicaid rates and you might have a tough time finding a doctor that will accept it.

Edit - looks like UHC doesn't offer HIPAA policies in Texas. Risk pool might be your only option.

[ziggy29]

Quote:

Originally Posted by dgoldenz If your COBRA is expiring, you would likely qualify for a guaranteed-issue HIPAA policy. UHC charges 2.2 times the standard premium for HIPAA coverage, or at least that's what they do here in VA. Some states limit the plan choices available or force you into the risk pool, but I don't know the Texas rules.

The Texas High Risk pool premiums are capped by law at 2x the "standard risk rate":

http://www.txhealthpool.org/rates.html

Quote:

Originally Posted by dgoldenz Edit - looks like UHC doesn't offer HIPAA policies in Texas. Risk pool might be your only option.

Makes sense given that the risk pool's 2x premium cap is lower than UHC's 2.2x. There wouldn't be a market for it.

[Moemg]

Quote:

Originally Posted by JohnnyQuest I see this as a very important & positive development for people with pre-existing conditions. My Group coverage runs out in 15 days and I am in the process of applying for an individual policy with UHC. I have hypertention and an ectatic aortic root that seems pretty stable right now(doctor sees no immediate cause for concern). If these are considered "pre-existing conditions", then I am seriously considering letting my insurance expire on June 15th and then going uncovered for six months so I can then qualify for the high risk pool in Texas or Florida. I am assuming this will run somewhere between $300-400/month. I know there is a certain degree of risk associated with this, but I have been to my family practicioner, cardiologist, and dermatologist already this year and they see no specific issues other than the ones I have already mentioned. Seems that a sensible path is to run without insurance till Dec 15 and then apply for the high risk coverage under the new rules. Thoughts? BTW, I am 52 years old.

I would not go without some sort of health insurance with your pre-existing conditions . Look into a catastrophic plan with a high deductible . You mentioned you have Marfan syndrome which can result in an aortic dissection and the cost from that would wipe you out . You also have hypertension which comes with it's own set of risks . Just because your Physician's gave you a recent okay does not mean that it can not change in a minute .

[audreyh1]

Quote:

Originally Posted by dgoldenz If your COBRA is expiring, you would likely qualify for a guaranteed-issue HIPAA policy. UHC charges 2.2 times the standard premium for HIPAA coverage, or at least that's what they do here in VA. Some states limit the plan choices available or force you into the risk pool, but I don't know the Texas rules. That is a much safer bet than going uninsured for 6 months. The UHC coverage is also portable to most states in case you move and their network is far superior to the PCIP one, which reimburses physicians at Medicaid rates and you might have a tough time finding a doctor that will accept it. Edit - looks like UHC doesn't offer HIPAA policies in Texas. Risk pool might be your only option.

If you are in TX, any health insurance company (including BCBS) will outright deny you for even the most minor of "pre-existing condition" issues - there is NO guaranteed issue HIPAA policy. Your only option will be to get insurance with a rider excluding any condition or apply to the Texas Health Risk Pool if you want to stay covered without interruption. You really have to have a very clean medical history to get an individual health insurance policy with no exclusions.

I don't know if things have changed, but with the TX Risk Pool you had to enroll right at the end of your COBRA coverage if you wanted pre-existing conditions to remain covered. Any gap meant that pre-existing conditions wouldn't be covered for 12 months after you enrolled - something like that. To enroll you need to show that you have been denied coverage without a rider and that you have no access to a group health plan through your employer or spouse.

Audrey

[Buckeye]

Quote:

Originally Posted by JohnnyQuest I see this as a very important & positive development for people with pre-existing conditions. My Group coverage runs out in 15 days and I am in the process of applying for an individual policy with UHC. I have hypertention and an ectatic aortic root that seems pretty stable right now(doctor sees no immediate cause for concern). If these are considered "pre-existing conditions", then I am seriously considering letting my insurance expire on June 15th and then going uncovered for six months so I can then qualify for the high risk pool in Texas or Florida. I am assuming this will run somewhere between $300-400/month. I know there is a certain degree of risk associated with this, but I have been to my family practicioner, cardiologist, and dermatologist already this year and they see no specific issues other than the ones I have already mentioned. Seems that a sensible path is to run without insurance till Dec 15 and then apply for the high risk coverage under the new rules. Thoughts? BTW, I am 52 years old.

Due to unemployment, my sister (50 yo), her two kids and her husband (60 yo) have had no health insurance for nearly 3 years. So far, so good but there is really no other option at this point. I would make sure you have your medical coverage kicked up on your auto insurance.

[Katsmeow]

Quote:

Originally Posted by JohnnyQuest If these are considered "pre-existing conditions", then I am seriously considering letting my insurance expire on June 15th and then going uncovered for six months so I can then qualify for the high risk pool in Texas or Florida. I am assuming this will run somewhere between $300-400/month.

Are you absolutely sure that you have to be uninsured for 6 months to get coverage in Texas?

See this web page for eligibility requirements:

Eligibilty Requirements for Obtaining Coverage from the Texas Health Insurance Pool.

[dgoldenz]

Quote:

Originally Posted by Katsmeow Are you absolutely sure that you have to be uninsured for 6 months to get coverage in Texas? See this web page for eligibility requirements: Eligibilty Requirements for Obtaining Coverage from the Texas Health Insurance Pool.

Risk pool is different than PCIP

[Glo]

I have had no insurance for 2 years as I can't get coverage because of preexisting conditions. On February 1st I'll be elligible for medicare. Hope I can make it until then!

[dgoldenz]

Quote:

Originally Posted by Glo I have had no insurance for 2 years as I can't get coverage because of preexisting conditions. On February 1st I'll be elligible for medicare. Hope I can make it until then!

Why not sign up for PCIP now? Sounds like you're exactly the type of person that this program is made for.