Individual Insurance

[tomz]

Whenever you hear some “free-marketeer” complaining that people with incomes over $50K don’t buy health insurance and so uninsurance is voluntary, think about this woman, featured in the NY Times, who would love to buy health insurance but has cancer and so cannot—unless she comes up with $27,000 a year out of her $60K income.

Here's the article in today's NY Times. Here's the commentary.

Health Care Blog

 

[mykidslovedogs]

First of all, I would ask, Why didn't she purchase permanent (as opposed to temporary) insurance while she was healthy? After all, it is insurance. We aren't allowed to buy home owner's insurance while our house is burning down, either. It's never a good idea to stay on temporary insurance (including COBRA) for very long, especially if you are healthy when you buy it. It should be used only as a vehicle to get by while in underwriting for more permanent coverage or to use while in a waiting period at a new job. Had she bought permanent insurance before she got sick, it may have been affordable in her income category. I'm sure that most people who are going to incur hundreds of thousands in medical expenses would LOVE to buy insurance rob insurance companies for a fraction of the cost of their risk on a guaranteed basis after they get sick, but honestly, if we allowed everyone that opportunity, then there would be no such thing as insurance.

This is a very sad situation and a testament to the fact that employer-sponsored health inusurance is no longer a good idea. It worked in the early days, when employers were forced by the government to limit salaries and their only means to attract good employees were through employee health benefit programs, but today, we need to get away from employer sponsored coverage.

It's too bad she doesn't live in the State of Colorado where she could get guaranteed issue on a "group of one" or "self-employed" policy with a $3000 deductible plan at a very competitive price. (Approx $300/mo). The problem is that in some states, too much government regulation has all but driven most insurance carriers out of the small group market preventing carriers from being profitable with "group of one" insurance in those states. ...and some states don't even allow "group of one" insurance. Maybe she should move to Colorado. For now, we have fewer mandates in Colorado resulting in a better health insurance market than many other states.

 

[Carl Spackler]

Thanks for posting the link to the Health Care Blog. I've been looking for information on HSA's, and that blog has a lot of good info/links.

Does anyone have an HSA? I just can't figure out if they're worth the trouble. I'm not happy with my current plan, but maybe it's not so bad:

I'm 50 and pay $275 a month for an individual, high deductible plan ($1500 for office visits, etc., and $10G for surgery). My out-of-pocket last year was about $2G (hence my interest in an HSA).

Is this a good deal, or can I do better?

 

[Empty Pockets]

Spackler,

Short answer to the HSA question. Yes, they are worth the trouble.

It's not that much trouble at all, any competent Health Insurance Agent should be able to help. If you talk to one that can't, go on to the next.

 

[FIRE'd@51]

It's too bad she doesn't live in the State of Colorado where she could get guaranteed issue on a "group of one" or "self-employed" policy with a $3000 deductible plan at a very competitive price. (Approx $300/mo). The problem is that in some states, too much government regulation has all but driven most insurance carriers out of the small group market preventing carriers from being profitable with "group of one" insurance in those states. ...and some states don't even allow "group of one" insurance. Maybe she should move to Colorado. For now, we have fewer mandates in Colorado resulting in a better health insurance market than many other states.

I am amazed at the cost of health insurance in North Carolina. I believe we have had other posts about the extremely high rates there. I think of NC as a fairly "free market" state with many insurers, so I can't believe these rates are caused by over-regulation. These rates are much higher than in highly regulated states like NY and NJ.

In my state (not a highly-regulated state), a "guaranteed-issue" policy with a $5000 deductible for a 50 year-old would be about $360 per month with a separate $200 deductible for drugs. It would, however, have a 12-month waiting period for pre-existing conditions unless she were HIPAA eligible. I'm sure the ones you are talking about in CO have waiting periods, too - otherwise people would just wait until they got sick to buy the insurance.

 

[REWahoo]

Does anyone have an HSA? I just can't figure out if they're worth the trouble. I'm not happy with my current plan, but maybe it's not so bad:

Spackler, several of us posting here have HSA's. Personally, I think it is worth the trouble but everyone's situation is different.

There have been many discussions of the pros & cons of HSA's. I suggest you use the search button to look for threads on "HSA" and you'll find lots of information.

 

[Carl Spackler]

Thanks E.P. and REWahoo! ... there is lots of info.

 

[mykidslovedogs]

I am amazed at the cost of health insurance in North Carolina. I believe we have had other posts about the extremely high rates there. I think of NC as a fairly "free market" state with many insurers, so I can't believe these rates are caused by over-regulation. These rates are much higher than in highly regulated states like NY and NJ.

In my state (not a highly-regulated state), a "guaranteed-issue" policy with a $5000 deductible for a 50 year-old would be about $360 per month with a separate $200 deductible for drugs. It would, however, have a 12-month waiting period for pre-existing conditions unless she were HIPAA eligible. I'm sure the ones you are talking about in CO have waiting periods, too - otherwise people would just wait until they got sick to buy the insurance.

In CO, it's UPTO a 6 month waiting period (equal to the number of days in lapse of coverage) going forward on "business groups of one or self-employed coverage" IF you have had a lapse in coverage of 90 days or more. Otherwise, if you have had continuous coverage, you cannot have any pre-existing condition exclusions. Anthem Blue Cross and Blue Shield Standard and Basic HMO products and Kaiser Permanente Standard and Basic HMO products have no waiting period (those plans are thus, more expensive). Also, in order to enroll on a "group of one", you have to have been self-employed and work at least 24 hours/wk for at least one year, and the qualifying events for enrollment are a.) an involuntary loss of other coverage, b.)enrolling within 30 days of your birthday, or c.) an exhaustion of Cobra. These restrictions to help prevent some adverse selection.


You are right, as far as NC not being highly regulated. Actually, $360/mo, ($12/day), for a 50-yr old doesn't really seem that outrageous for guaranteed issue health insurance, but I guess that's just my opinion. Others may feel differently. Heck, many people spend more than that eating out at restaurants these days. Granted, the deductible is high, but at least it's guaranteed issue. I'd rather pay a $5000 deductible than $150,000 in medical bills for a heart-attack or cancer treatment.