HIPAA costs ?

[macnjus]

I think the deductible was around 2500 per person, but not positive.

This was for a HIPAA eligible person, meaning one who is coming out of a COBRA or a group plan. I am not quite sure what all of the requirements are for being HIPAA eligible, it is a bit complicated.

In the case of NC, BC/BS will offer a policy to anyone, but they have 7 grades of pricing (aside from HIPAA) based on how they rate your health. The worst rate is considerably higher than the HIPAA rate. I asked what factors would put somebody into the highest category and I was told "High Blood pressure, high cholesterol, morbid obesity, smoker", if combined , would put you in that category. I asked what about blood pressure controlled to normal with medication and was told this might bump you one level higher then "preferred".

This is nasty stuff, perhaps I will un-FIRE

 

[Martha]

This was for a HIPAA eligible person, meaning one who is coming out of a COBRA or a group plan. I am not quite sure what all of the requirements are for being HIPAA eligible, it is a bit complicated.

To be HIPAA-eligible, you must meet all of the following criteria:

You must have had 18 months of continuous creditable coverage, at least the last day of which was under a group health plan (including those offered by public employers and churches).

You also must have used up any COBRA or state continuation coverage for which you were eligible.

You must not be eligible for Medicare, Medicaid or a group health plan.

You must not have health insurance. (Note, however, if you know your group coverage is about to end, you can apply for coverage for which you will be federally eligible.)

You must apply for health insurance for which you are federally eligible within 63 days of losing your prior coverage.


The big advantage of being HIPAA eligible is that federal law requires states to have a mechanism in place for you to purchase individual health insurance even if you are in poor health and not generally insurable in the individual market. Unfortunately, the federal government didn't see fit to regulate rates so your state's option may not be affordable. Different states do different things to meet HIPAA requirements. For example, they may have:

--designated insurers who must offer a HIPAA policy to the uninsurable;
--requirements on all insurers to offer a HIPAA policy;
--a risk pool;
--conversion insurance requirements through the same company you had insurance through before;
--or they (as in a few eastern states) may require all insurers insure everyone at a regulated price.

 

[jeff2006]

macnjus,

Was that $2200/month for a guaranteed issue HIPAA policy? In other words, anyone would be able to get that policy? I'm in NC and it would be good to know if that is the "worst case" price.

People thinking about retiring to NC should keep this in mind. In many ways, NC is a very backward state. Also lacking, even here in Raleigh, are part-time jobs that offer meaningful healthcare benefits.

 

[Martha]

Another point to mention when looking at these policies is look at:

--what is the deductible
--what are the copays apart from the deductible
--what is the maximum out of pocket
--what is your network and what will it pay if you are out of network, if anything
--what is excluded (some states allow certain things to be excluded from policies)
--what are your lifetime limits
--are there any yearly limits
--are there any limits for a specific condition

I have seen states where their HIPAA qualified policies have $50,000 yearly caps, and $250,000 lifetime limits. I haven't checked recently to see if that is still the case and I also can't remember right off which are the worst states.

 

[gindie]

It seems to me like there could be a good market out there for some insurance company to allow uninsured individuals to pay something to have the right to pay the negotiated prices as opposed to the "list prices". Does anybody know of any company that does this ?

There's a guy who does financial cut-ins on the morning radio show I listen to. His name is Jordan Goodman and he has mentioned something called "Medical Re-pricing". He says it's a way to get reduced prices, but I've never looked into it.

 

[mykidslovedogs]

A good book to read about this topic is "The New Health Insurance Solution". Go to http://www.tnhis.com/statebystateguide.htm to look at the HIPAA plans available in every state and the approximate cost for these plans in each state. The rates and rules for eligibility vary from state to state. The author has compiled a great reference tool for anyone needing "guaranteed issue" coverage. I read the whole book and found it very helpful.

Also, there IS such a thing as a discount health insurance plan. They are all over the place, and they allow you to get negotiated discounts without actually having to qualify for coverage. You usually see signs for these kinds of "affordable health plans" on street corners. If you can't afford a State Guaranteed HIPAA plan and if you can't qualify for actual health insurance, then a discount health plan or a discount prescription drug card is at least one way to save on health care costs. If you want to find one of these plans, just go on the internet and search for affordable healthcare. You will find all kinds of "agents" selling these discount "health plans" and drug cards. Just remember, it's not insurance, even if it sounds like it is. I would also be careful to ask about the network and make sure there are plenty of participating providers. You can probably tell I'm pretty sceptical about the discount "affordable health plans". In my opinion, a State Guaranteed HIPAA plan is going to provide a lot more protection if it is affordable (and in some states, it IS actually affordable - Just check the website I mentioned above. The reference tool is excellent.)

 

[REWahoo]

A good book to read about this topic is "The New Health Insurance Solution". Go to http://www.tnhis.com/statebystateguide.htm to look at the HIPAA plans available in every state and the approximate cost for these plans in each state. The rates and rules for eligibility vary from state to state. The author has compiled a great reference tool for anyone needing "guaranteed issue" coverage. I read the whole book and found it very helpful.

Martha posted a very thorough review of "The New Health Insurance Solution" last May. You can find it here:

http://early-retirement.org/forums/index.php?topic=7585.0

 

[macnjus]

mykids - thanks for the reference. The state by state guide is great and it really makes me think twice (3 times) about moving to NC. Not only is NC's guaranteed issue policy absurdly expensive, it has a lifetime cap of $500K, which I find particularly pathetic. This actually makes my current home of NJ look relatively good by comparison.

If I could determine that I would qualify for a good rate in NC, I still might move there, I will try to apply from here and see what I get, but at this point I will not commit to the move until I know.

 

[Martha]

Careful on relying too much on the state by state guide. It is very misleading in that the rates are based on what would be charged a 35 year old male. There are not a whole lot of them here on this forum looking for guaranteed issue insurance. The rates are almost always a LOT higher the older you are. Plus, there is a lot a variability on rates depending on deductibles available.

 

[macnjus]

While the rates will certainly be higher for older people than what appears in this guide, I would think that the relative price differences would be similar. However, of greater interest to me is the lifetime max payments allowed. From an asset preservation point of view, it makes a huge difference whether you will be subject to a $500K lifetime max, as many states allow, or whether you will have an unlimited cap, which is what I would very much prefer. Note - NC is the worst in both categories, no other state costs nearly as much for the coverage, yet it also provides the lowest lifetime cap, 0 for 2, you pay the most and get the least.

 

[Martha]

I agree that NC is among the worst. But it is hard to draw too many conclusions on the comparison because states do differ on how much they increase premiums for age. And some states charge more for women. And some states offer family coverage and others only individual. Also, some plans also have yearly caps and caps for particular conditions, which makes them particularly bad. Some cover drugs and some don't. But it is very helpful that he reported the lifetime cap information and the maximum out of pocket.

But the online guide is a good starting point as this information is not readily available elsewhere in a comparative format.

 

[REWahoo]

While the rates will certainly be higher for older people than what appears in this guide, I would think that the relative price differences would be similar. However, of greater interest to me is the lifetime max payments allowed.

This book was published in 2005 using information that dates back to 2004 in some cases. Rates, coverages and maximums can change very quickly, so be sure to check out current information before relying on what's in the book.

 

[Martha]

Fred Brock has published Healthcare on Less than you Think. Anyone read it yet? I have heard him talk about the healthcare system and he seems to know what he his talking about. I have resisted buying the book yet.

http://www.amazon.com/gp/product/0805079807/ref=pd_cp_b_title/103-8721990-2856664

 

[mykidslovedogs]

REWahoo,

Martha gave a very detailed review, however, I think she missed the most basic point that Pilzer was trying to make in his book. I think what Pilzer is trying to do with his book is really just help people to understand the many different options that they have to reduce insurance costs. I don't think he minimized the issues that many who are "uninsurable" are facing. However, he is very blunt in his opinions regarding the fact MANY (not all) people who are "uninsurable" have gotten into that situation because they did not obtain their own coverage while they were still healthy. Pilzer recognizes the fact that our "entitlement" culture has facilitated this problem. If we didn't depend on our employers to provide expensive benefits to us throughout our lives, often times with low deductibles and copays that encourage us to overutilize our policies, then we wouldn't be left hanging in the early-retirement years between age 55 and 65 before Medicare becomes available to us.

With the complexity of insurance and various State regulations it would be impossible to depict every single scenario in the book. I think the use of a healthy 35 year old male was really the only way he could make an "apples to apples" comparison among the various State HIPAA plans in a way that could make sense to the average audience. I think Pilzer did an excellent job researching all of the different State Guaranteed plans, and he put it all together in an excellent, not to mention, FREE, reference tool on his website. Kudos to him for his work on that!

I would like to make a few points on areas where I agree/disagree with Martha/Pilzer:

1.) Generally, Individual and Family coverage IS much less expensive than group insurance. Martha makes it seem like it is unfair for individual and family health insurance carriers to rate/exclude pre-existing conditions, or charge higher premiums as we age. However, I completely disagree with her on that point. Like any other business in the free market, insurance carriers exist to be profitable. I don't see anything wrong with that. Of COURSE the healthy gravitate to these individual policies while the unhealthy gravitate to risk pools! That is the WHOLE idea of individual coverage. Individual and Family insurance carriers are not in the business to provide coverage to people who are already sick. They are in the business to provide financial protection to you in the unlikely, unforseen, event that you come down with a costly, financially devastating, illness. If insurance carriers did not have the flexibility to underwrite, like in the State of NY, NO ONE would be able to afford coverage, because no one would ever buy insurance until they needed it, and the rates would go through the roof, and all of the competition would drop out of the marketplace.

One of the biggest problems we face in our country is the entitlement mentality. People wait until they get sick and unemployed before they decide to buy their own coverage, and then they get angry at insurance companies for denying them affordable coverage due to their pre-existing conditions. Do you think a property/casualty insurance company would sell you home-owner's insurance if your house was burning down? Pilzer maintains that if we purchase our own coverage while we are healthy instead of relying on our employers for benefits, then we wouldn't have a problem obtaining and keeping that coverage in later years, nor would we be tied to employment because we need insurance.
If someone asked you to guarantee them $2,000,000 in case they were to come down with a financially devastating illness, wouldn't you want to assess the risk in doing so first, and wouldn't you want to make sure that they were being completely honest with you about their current health status? People forget that the basic idea behind health insurance is to protect you against financial devastation. It really was never meant to protect you from the cost of routine office visits and occasional prescriptons. The $5 copay plans are what gave us that mentality, and now, we are paying dearly, because overutilization has, in part, led to increased health care costs, which in turn, has led to very high health insurance premiums. These high premiums will force us begin looking at higher deductible major medical plans like the ones that existed before the $5 copay HMO plans came about in the '60's and '70's.

2.) The only time pre-existing condition waiting periods will apply on any type of new health insurance policy (including riskpools) will be if the person obtaining coverage has ALLOWED THEMSELVES to have a gap in coverage of a certain, defined, length of time. This is only fair as it protects the insurance carriers from "adverse selection" or only buying the plan AFTER getting sick. If people are aware that they are going to have a pre-existing condition waiting period, then they will be more likely to seek out the policy upon losing their other coverage instead of waiting until they get sick before they replace their old coverage or purchase new coverage.

3. I agree with Martha in that the topic of the affordability of health insurance and Medicaid for the working poor is probably much more complicated than the amount of time that Pilzer gave to the subject. However, in Pilzer's defense, that subject is a whole 'nother book! There is no way he could address all of the social problems with health insurance and Medicaid in the book he wrote, so I don't think it is fair to criticize him for that. He was merely trying to point out that if you absolutely cannot afford your own policy, then you should probably check into Medicaid or a discount plan as that could likely be an option for you.

4.) Lastly, I agree with Martha and I do not agree with Pilzer on the idea of having employers drop their group benefit plans and setup HRA's to allow employees to go out and buy their own insurance on a tax-deductible basis. There is too much room for "discrimination" in setting up such a system, and to keep my point simple, I think that it could set up employers up for legal action against them in the case that one of their employees could not qualify for an individual plan. I just think it puts employers at risk of being sued for discrimination. I have more opinions on this subject, but I won't go into them here.

 

[Martha]

REWahoo,

Martha gave a very detailed review, however, I think she missed the most basic point that Pilzer was trying to make in his book. I think what Pilzer is trying to do with his book is really just help people to understand the many different options that they have to reduce insurance costs. I don't think he minimized the issues that many who are "uninsurable" are facing. However, he is very blunt in his opinions regarding the fact MANY (not all) people who are "uninsurable" have gotten into that situation because they did not obtain their own coverage while they were still healthy. Pilzer recognizes the fact that our "entitlement" culture has facilitated this problem. If we didn't depend on our employers to provide expensive benefits to us throughout our lives, often times with low deductibles and copays that encourage us to overutilize our policies, then we wouldn't be left hanging in the early-retirement years between age 55 and 65 before Medicare becomes available to us.

When I reviewed the book I simply said I disagreed with his political positions. I think it is troubling to say that people got themselves into a position of being unisurable. The way our insurance system works is that nearly everyone gets insurance through work. Not on their own. To blame people for that doesn't make sense.

The individual market is self selected as healthy because insurance companies exclude the unhealthy. People often stay with individual policies for short periods of time and then move to a group. Given these facts it is not surprising that policies cost less on the individual, non-risk market. Also, as I said in my review:

Pilzer repeatedly claims that individual health insurance is cheaper than employer provided insurance. It probably is cheaper if you are 35 and healthy. Probably not if you are 60. This is because employers charge the same rate to everyone, whether you are 20 or 60. Also, only 4% of people in the US have insurance on the individual market. So it is a small part of the overall market. Pilzer doesn’t break down what that market looks like as to age and health of its participants.


I have posted plenty of times that the free market does not work for health insurance. Of course, insurance companies want to insure for future risk only. That is the nature of insurance. So goverment interference is necessary for people to get coverage for past conditions. Government requires guaranteed renewability of individual health insurance plans. If it didn't, insurance companies would cut you off after you had too many claims. Much like an auto insurer does. But they can raise the rates. Or terminate the plan.

With the complexity of insurance and various State regulations it would be impossible to depict every single scenario in the book. I think the use of a healthy 35 year old male was really the only way he could make an "apples to apples" comparison among the various State HIPAA plans in a way that could make sense to the average audience. I think Pilzer did an excellent job researching all of the different State Guaranteed plans, and he put it all together in an excellent, not to mention, FREE, reference tool on his website. Kudos to him for his work on that!

Very few 35 year olds buy guaranteed issue insurance. He should have used a range in cost. But, as I said, at least he did the work to provide some information which is a good starting point.

I would like to make a few points on areas where I agree/disagree with Martha/Pilzer:

1.) Generally, Individual and Family coverage IS much less expensive than group insurance. Martha makes it seem like it is unfair for individual and family health insurance carriers to rate/exclude pre-existing conditions, or charge higher premiums as we age. However, I completely disagree with her on that point. Like any other business in the free market, insurance carriers exist to be profitable. I don't see anything wrong with that. Of COURSE the healthy gravitate to these individual policies while the unhealthy gravitate to risk pools! That is the WHOLE idea of individual coverage. Individual and Family insurance carriers are not in the business to provide coverage to people who are already sick. They are in the business to provide financial protection to you in the unlikely, unforseen, event that you come down with a costly, financially devastating, illness. If insurance carriers did not have the flexibility to underwrite, like in the State of NY, NO ONE would be able to afford coverage, because no one would ever buy insurance until they needed it, and the rates would go through the roof, and all of the competition would drop out of the marketplace.

This is why I support national health care.

One of the biggest problems we face in our country is the entitlement mentality. People wait until they get sick and unemployed before they decide to buy their own coverage, and then they get angry at insurance companies for denying them affordable coverage due to their pre-existing conditions. Do you think a property/casualty insurance company would sell you home-owner's insurance if your house was burning down? Pilzer maintains that if we purchase our own coverage while we are healthy instead of relying on our employers for benefits, then we wouldn't have a problem obtaining and keeping that coverage in later years, nor would we be tied to employment because we need insurance.

Did you buy individual health insurance when you were 20? Or did you get health insurance from an employer? What if you had asthma since you were 3 years old? How about childhood cancer? What often happens is that people are trapped into a particular job. What happens if their employer drops health insurance? A lot of the 46 million unisured in the US work for employers that don't offer health insurance or dropped insurance. We are a rich country, we can figure out how to make healthcare an entitlement. I don't find anything wrong with that. It won't sap the entrepreunerial energy of the county.

If someone asked you to guarantee them $2,000,000 in case they were to come down with a financially devastating illness, wouldn't you want to assess the risk in doing so first, and wouldn't you want to make sure that they were being completely honest with you about their current health status? People forget that the basic idea behind health insurance is to protect you against financial devastation. It really was never meant to protect you from the cost of routine office visits and occasional prescriptons. The $5 copay plans are what gave us that mentality, and now, we are paying dearly, because overutilization has, in part, led to increased health care costs, which in turn, has led to very high health insurance premiums. These high premiums will force us begin looking at higher deductible major medical plans like the ones that existed before the $5 copay HMO plans came about in the '60's and '70's.

I have seen no good evidence that we over-ulilize the heathcare system. In fact, there is some evidence that increasing copays have caused a number of people to go without necessary drugs.

2.) The only time pre-existing condition waiting periods will apply on any type of new health insurance policy (including riskpools) will be if the person obtaining coverage has ALLOWED THEMSELVES to have a gap in coverage of a certain, defined, length of time. This is only fair as it protects the insurance carriers from "adverse selection" or only buying the plan AFTER getting sick. If people are aware that they are going to have a pre-existing condition waiting period, then they will be more likely to seek out the policy upon losing their other coverage instead of waiting until they get sick before they replace their old coverage or purchase new coverage.

This is true if you do not comply with deadlines when you are HIPAA eligible. Not true in other circumstances. Say you live in one state and have an individual insurance plan. You move to another state. You could become ineligible for your individual plan because you left the service area. You are not HIPAA eligible. You will have a pre-existing condition waiting period most everywhere you go.

I can give other examples. What if you rates go up too high to afford because of your health? If you switch policies, you will have a waiting period, maybe a waiting list, and maybe no options at all.

What if you bought individual insurance when you were healthy. The insurance company finds those in the plan are too costly. They terminate the plan and offer new plans only to those who meet their underwriting standards. You are SOL if you aren't healthy.

3. I agree with Martha in that the topic of the affordability of health insurance and Medicaid for the working poor is probably much more complicated than the amount of time that Pilzer gave to the subject. However, in Pilzer's defense, that subject is a whole 'nother book! There is no way he could address all of the social problems with health insurance and Medicaid in the book he wrote, so I don't think it is fair to criticize him for that. He was merely trying to point out that if you absolutely cannot afford your own policy, then you should probably check into Medicaid or a discount plan as that could likely be an option for you.

I understand the subject is too complex for one book. But he did not have his facts right concerning Medicaid.

My thoughts on his book were summarized at the beginning of my review:

He is easy to read with a breezy style. The book has pretty good explanations of HIPAA and COBRA and a number of good tips. However, health insurance in the United States is complicated. The price he pays for simplicity is accuracy and thoroughness. It is a pretty good book if you are 35, perfectly healthy, and thinking about buying insurance. But what is good for when you are 35 is not necessarily good 5, 10 or 20 years later. (Should I pay for drug coverage?. . . pregnancy coverage?) I would never rely on this book for making policy decisions or for forming opinions on healthcare in the United States. I strongly disagree with many of his policy recommendations.


By the way, welcome to the forum!

 

[mykidslovedogs]

Hi Martha,

Good conversation! I can tell we do not share the same philosophy, but that's what makes these forums so much fun!

One thing you're forgetting is that employer-sponsored health insurance premiums are only composite rated (averaged) with groups larger than 10 employees. Small employers (2-10 employees) make up a huge percentage of those offering employee benefits, and their benefits are usually age-banded. Thus, those over the age of 50 get killed pricewise in the group market. oftentimes, and individual or family plan is 2-3 times less expensive for someone in that age category. For an employee over the age of 50 who is not receiving benefits for spousal coverage, an individual plan for the spouse can save thousands of dollars (if the spouse can qualify for coverage).

I understand your point about those born with congenital illnesses, but if their parents had had their own individual policy at the time of birth or adoption, that child would have been granted guaranteed issue onto their parent's plan and the parents would not then have to worry about qualifying for coverage for a sick baby later on. Yes, different States have different regulations and not all carriers do business in every State, but if it came down to moving or facing financial devastation, then wouldn't you just choose not to move? It's not like people don't have choices. Why would you move if you knew you were going to face financial devastation because of health insurance problems? Also, in general, insurance carriers do not rate based on PERSONAL claims experience. Rates are increased based on industry trends and utilization of large groups of members within geographical areas. Therefore, the cost of that child's coverage is not going to inflate any higher than any other person within the insurance carrier's membership. Lastly, if that carrier happens to go out of business or stop doing busines in your state, then the child would be granted creditable coverage towards pre-existing condition exclusions on the state-guaranteed plan if they do not have a gap in coverage. Buyer beware. When purchasing health insurance, be sure to choose a carrier that has had stability in your state for many many years.

As a matter of fact, I do have my own individual insurance policy. I do not want my health insurance to be tied to my employment. That is my CHOICE. I know you are going to ask me about the people who can't afford it, but here is what I have to say about that....There is always going to be a MINORITY of people who cannot afford health insurance. It is a fact that in a capitalistic society, some will be better off than others. I don't know the actual statistics, but I am confident that more people CAN afford it than CANT, and a very large percentage of the uninsured actually CAN afford it but choose not to buy it. Life is not fair. For those who cannot afford their own coverage, there are many many government sponsored programs for discounted and even free services. Here are a few of them:

Bureau of Primary Health Care - This government run web site will help you find a clinic that will give you medical care, even if you have no medical insurance or money.

Centers for Disease Control National Breast and Cervical Cancer Early Detection Program - Guide for women looking for low-cost mammograms and pap smears.

Centers for Medicare and Medicaid - A government run website for people with or needing medicare or medicaid

Insure Kids Now - Now, you may have one less thing to worry about. Your state, and every state in the nation, has a health insurance program for infants, children and teens.

Medicare - Compare Medicare Prescription Drug Plans; Formulary Finder.

Partnership for Prescription Assistance - The Partnership for Prescription Assistance brings together America's pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that's right for them.

My last point...You say that we are a rich country, yet you point out that national health insurance is important because there are so many poor. Are you willing to give up 50% or more of your hard- earned income to pay for everyone else's healthcare needs? What is wrong with each of us doing the best we can to take care of our own financial needs? Yes, it is unfortunate that some will not be as well off as others, but if we move to a national healthcare system, we are going to compromise the very thing that makes the United States the leader in health care technology and innovation - competition! If we nationalize healthcare (and I mean a purely socialized form of healthcare and not one where people are given a basic level of care with the option to supplement with their own insurance because we already have that...) then we are going to lose good doctors, and compromise the quality of care in our country. After all, why would anyone want to become a Doctor if they knew their income potential would be limited?...If the government were to nationalize care, I can guarantee that Doctors would be paid pennies on the dollar compared to what they make now. Do you really believe that most Doctors would stay in the business just for humanitarian reasons? Some will, but our young people will not choose health care careers if they are forced by the goverment to care for everyone at the same government-mandated rates.

Well, that's how I see it, but I would love to hear your point of view! And...thanks for welcoming me to the forum!

 

[Rich_by_the_Bay]

...Yes, different States have different regulations and not all carriers do business in every State, but if it came down to moving or facing financial devastation, then wouldn't you just choose not to move? It's not like people don't have choices. Why would you move if you knew you were going to face financial devastation because of health insurance problems?

Hope none of us has or will face devastating illness, but I work with this all the time.

I can tell you that a system which forces an already-besieged patient and family to move out of state mid-crisis just to get better coverage is not a good system. Uproot family, home, and friends when you need them most? No thanks!

Mykidslovedogs, not implying you personally meant it in this way, but to describe that as a "choice" borders on the cynical. Surely Americans deserve better than that.

 

[mykidslovedogs]

Actually, what I was saying is that if you were sick, and you already had good coverage in your state, then why would you move, thus creating a problem for yourself to get coverage in the new state? Martha had stated that it can be hard to obtain coverage in a new state if you move when you have a pre-existing condition, which is true. So my point was, "then why would you move?" People have the choice to stay right where they are.

 

[Rich_by_the_Bay]

Actually, what I was saying is that if you were sick, and you already had good coverage in your state, then why would you move, thus creating a problem for yourself to get coverage in the new state? Martha had stated that it can be hard to obtain coverage in a new state if you move when you have a pre-existing condition, which is true. So my point was, "then why would you move?" People have the choice to stay right where they are.

OK, gotcha. Too much text in one message for me to digest .

 

[Martha]

Hi Martha,

Good conversation! I can tell we do not share the same philosophy, but that's what makes these forums so much fun!

Yup. We disagree on a lot.

One thing you're forgetting is that employer-sponsored health insurance premiums are only composite rated (averaged) with groups larger than 10 employees. Small employers (2-10 employees) make up a huge percentage of those offering employee benefits, and their benefits are usually age-banded. Thus, those over the age of 50 get killed pricewise in the group market. oftentimes, and individual or family plan is 2-3 times less expensive for someone in that age category. For an employee over the age of 50 who is not receiving benefits for spousal coverage, an individual plan for the spouse can save thousands of dollars (if the spouse can qualify for coverage).

True about the rating of small employers. It is a big problem. The employer can't afford the insurance. The employees often can't either, or end up with exclusions in their coverage. If the employee is perfectly healthy they do ok, but plenty of people in their 50s are close to uninsurable.

I understand your point about those born with congenital illnesses, but if their parents had had their own individual policy at the time of birth or adoption, that child would have been granted guaranteed issue onto their parent's plan and the parents would not then have to worry about qualifying for coverage for a sick baby later on.

Fine until the kid is an adult and can't buy insurance.

Also, in general, insurance carriers do not rate based on PERSONAL claims experience. Rates are increased based on industry trends and utilization of large groups of members within geographical areas. Therefore, the cost of that child's coverage is not going to inflate any higher than any other person within the insurance carrier's membership.

But, there is individual underwriting which may result in them not selling you a policy or selling at a very high cost. Plus, there is a dispute as to how much "reunderwriting" occurs resulting in increasing premiums based on individual experience.

Lastly, if that carrier happens to go out of business or stop doing busines in your state, then the child would be granted creditable coverage towards pre-existing condition exclusions on the state-guaranteed plan if they do not have a gap in coverage.

But, if they are not HIPAA qualified, there may be a waiting list or a preexisting condition waiting period. There is no federal law which would bar a preexisting condition waiting period if coming off of an individual plan. And the insurance might not be affordable.

Are you willing to give up 50% or more of your hard- earned income to pay for everyone else's healthcare needs? What is wrong with each of us doing the best we can to take care of our own financial needs? Yes, it is unfortunate that some will not be as well off as others, but if we move to a national healthcare system, we are going to compromise the very thing that makes the United States the leader in health care technology and innovation - competition!

Fifty percent of my income? Where do you get such a number? We pay more already in the United States for healthcare than many countries with universal care, and those countries often have better outcomes.

If we nationalize healthcare (and I mean a purely socialized form of healthcare and not one where people are given a basic level of care with the option to supplement with their own insurance because we already have that...) then we are going to lose good doctors, and compromise the quality of care in our country.

I don't buy this. Plus, we do not guaranty people a basic level of care. There are resources as you mention, but many get turned away. I just read an article about the "free clinic" in my neighboring Wisconsin. They can't come close to treating everyone who seeks care. And the resources are often only for the very poor. A middle class person without insurance can easily be financially destroyed by a medical problem. Do we really need to have people lose their retirement funds and home to pay for necessary care?

 

[Martha]

Want to add one more thing. Lack of insurance increases the likelihood you will die.

We compared mortality of a nationally representative cohort of insured and uninsured near-elderly people with stratification by race; income; and the presence of diabetes, hypertension, or heart disease, using propensity-score methods to adjust for numerous characteristics. Lacking health insurance was associated with substantially higher adjusted mortality among adults who were white; had low incomes; or had diabetes, hypertension, or heart disease. Expanding coverage to the near-elderly uninsured may greatly improve health outcomes for these groups.


http://content.healthaffairs.org/cgi/content/abstract/23/4/223

More than 40 million Americans are subject to greater health risk because they lack health insurance. Research studies consistently show that working-age Americans who do not have health insurance have poorer health and die prematurely (now we are up to 46 million uninsured.)

http://www.rwjf.org/research/researchdetail.jsp?id=1041&ia=132

 

[mykidslovedogs]

Yup. We disagree on a lot.
"True about the rating of small employers. It is a big problem. The employer can't afford the insurance. The employees often can't either, or end up with exclusions in their coverage. If the employee is perfectly healthy they do ok, but plenty of people in their 50s are close to uninsurable."


I'm not sure I understand how to post your quotes in my response but here goes....In my state, all group coverage is guaranteed-issue. You cannot be denied coverage or have policy exclusions on an employer-sponsored health plan. If you are self-employed, you can also qualify for guaranteed issue coverage with no exclusions or pre-existing condition waiting periods.


"Fine until the kid is an adult and can't buy insurance."

In my state, if you are a child on a parent's INDIVIDUAL health plan, you can keep that policy throughout the rest of your life. Once you turn 19, you simply come off of the parent's plan, and you roll over to coverage under your own social security number with no re-underwriting.


"But, there is individual underwriting which may result in them not selling you a policy or selling at a very high cost. Plus, there is a dispute as to how much "reunderwriting" occurs resulting in increasing premiums based on individual experience."

That's why you want to buy the policy while you are still healthy because the rate you are given at policy inception will define all future increases. Your rates will never be increased after that based on PERSONAL claims history, but only on industry trends and utilization among the entire carrier's membership.


"But, if they are not HIPAA qualified, there may be a waiting list or a preexisting condition waiting period. There is no federal law which would bar a preexisting condition waiting period if coming off of an individual plan. And the insurance might not be affordable."

In my state, there would be no need to come off of an individual plan onto a HIPAA plan. Once you have individual coverage, it it guaranteed renewable. If the plan ceases to exist, then you become HIPAA eligible (I don't know about other state laws on that issue).


"Fifty percent of my income? Where do you get such a number? We pay more already in the United States for healthcare than many countries with universal care, and those countries often have better outcomes."

The reason we pay more for healthcare than other countries with universal care is because our technology and innovation is so much better. (I have a feeling that you believe the insurance carriers are simply ripping us off, but I do not believe that is true.) We pay more for better services and timelier service. In the U.S, we don't have to wait for heart surgery when we need it. I'm sorry for the misstatement. What I believe is that if we go to a national healthcare system, our tax rates, in general, will increase to more than 50% (The tax bracket I am in right now is already 50%, so I believe a national healthcare system will make it even worse.) I don't know about you, but I put in about 60 hours or more per week at my job, and I do mind being forced to give half of my income away for the welfare of other people. I don't mind giving my share, but half is an awful lot!

"I don't buy this. Plus, we do not guaranty people a basic level of care. There are resources as you mention, but many get turned away. I just read an article about the "free clinic" in my neighboring Wisconsin. They can't come close to treating everyone who seeks care. And the resources are often only for the very poor. A middle class person without insurance can easily be financially destroyed by a medical problem. Do we really need to have people lose their retirement funds and home to pay for necessary care?"

Why doesn't the middle class person buy their own health insurance while they are healthy? At $300 or less a month for an individual policy, it is certainly affordable for the middle class. That's less than a trip to Disney Land.

 

[macnjus]

Amen Martha -

"A middle class person without insurance can easily be financially destroyed by a medical problem. Do we really need to have people lose their retirement funds and home to pay for necessary care?"

I would add that this could also happen to a person with a several million dollar net worth, decidedly above "middle class".

They shouldn't call the prices paid by insurance companies as "discount prices", rather, they should refer to list prices as "uninsured person surcharge". In many cases, the reason some people with low net worth choose not to insure is that it does them no good, as when they incur a large charge, they simply can't pay it anyway, they become yet another sad medical bankruptcy case. Thus, it is the relatively well-off, who desire insurance but can't get it for some reason, that are the only ones who actually pay the "uninsured person surcharge".

In my opinion, medical service providers who take insurance and medicare payments should not be allowed to charge more than around 20% more for that service to an uninsured person.

 

[Martha]

Mykidslovedogs, the quote thing is a bit of a pain. You can cut and paste quotes from a prior post by bracketing the quotes like this: [quote ] insert what you want to quote here [/quote ], leaving the space out between "e" and "]"

You are in one of those expensive guaranty issue states where HIPAA is not so important. Only a few states are that way. Most other states give few rights once you are in the individual market. Federal law only protects the HIPAA eligible, those coming off from group plans or moving from one group plan to another. The only rules HIPAA has that effect the individual market are (1) individual policies are guaranteed renewable (with some exceptions, including termination of the plan itself) and (2) states have to have a mechanism in place where HIPAA eligible people are offered some sort of insurance policy. There is no cost regulation and if you lose your individual policy there is no federal law which will guaranty coverage elsewhere.

So, if you are not in a guaranteed issue state, and you are not HIPAA eligible, you may not be able to buy insurance at any cost. (Unless you move to NJ or some other guaranteed issue state.) If you lose your individual health insurance, even if you are insurable you will have a pre-existing condition waiting period when you buy into a new individual plan.

I am fortunate to live in Minnesota. It has the greatest percentage of insureds in the United States. It does this without breaking the bank. There is a risk pool that covers more people than any other risk pool in the US. The rates are limited to between 101% and 125% of average individual plan rates. For those that can't afford the risk pool and are not eligible for medicaid, there is a sliding fee plan, Minnesota Care.

 

[Martha]

Mykids, I don't think that insurance companies are ripping us off in any way that isn't just in the nature of insurance (though some of the executive compensation is a disgrace). Instead, I think that the insurance model is not a good way to pay for health care. An insurance company's interest is to make money. They want to insure healthy people and drop them when they get expensive. This is the nature of insurance. Because of that problem, we need government interference of one kind or another.

I refuse to believe that it is irresponsible for people not to buy health insurance on the individual market when they are healthy. They buy through their jobs because that is the way it has been for years. It is almost always cheaper for the employee to go that way. Man, people have enough problems in life without thinking about all the bad things that can happen if they didn't buy the right kind of insurance at the right time. You can't just turn that history around by saying what should have happened. The American religion of personal responsibility wants us all responsible for our own portfolio, our own retirement plan, our own children's education, and now healthcare. This is overwhelming in an increasingly complicated world. When people are overwhelmed, they often check out and do nothing.

We also have no idea how the individual market would have worked. If employers hadn't got into the group coverage business, it could be that only healthy people would have been able to get health insurance and the government may have had to step in sooner to regulate the individual market.
I always thought it was a bad idea to tie insurance to employment.