Because nobody would pay the rates that it would cost if they had a single large group. How many healthy, not-currently-pregnant 25 year olds would sign up for health insurance at $400-500/month? If they won't sign up now for $100/month, I'll guess that the answer would be not many...
Interesting NYT Article on Obtaining Health Insurance
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Because nobody would pay the rates that it would cost if they had a single large group. How many healthy, not-currently-pregnant 25 year olds would sign up for health insurance at $400-500/month? If they won't sign up now for $100/month, I'll guess that the answer would be not many...
The rules now are basically the same as before. Health insurance is guaranteed renewable in every state I've seen (Martha has posted that one or two states may have an exception, but never seen it in action). The "new" rules still allow insurance companies to rescind policies for intentional misrepresentations, they just make it harder for the insurance company to jump through the hoops to do it...
For those reference the article about the COBRA payment being two cents off - insurance companies have nothing to do with COBRA administration. They are handled by third parties and the systems are automated so if the full payment is not received, they will automatically terminate. Seen the same thing happen before....the problem is if you give one exception, where does the line stop? When they are two cents short, two dollars, twenty dollars, two hundred dollars? Just playing devil's advocate here.
Corporate ORphan
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"For those reference the article about the COBRA payment being two cents off - insurance companies have nothing to do with COBRA administration. They are handled by third parties and the systems are automated so if the full payment is not received, they will automatically terminate. Seen the same thing happen before....the problem is if you give one exception, where does the line stop? When they are two cents short, two dollars, twenty dollars, two hundred dollars? Just playing devil's advocate here."
dgoldenz,
I see your point. I agree that some people will do it on purpose, like not signing the check, etc.
On the other side, when we were a few cents off, the third party administering the account (which just happens to be the same one that administers the COBRA) worked with us to fix it. It just seems downright mean to cut people off when they have made an honest mistake instead of telling them they made a mistake.
WHen they sent the COBRA coupons, they made a few cent error in the amount (it was a little higher) and kept telling us we had overpaid. We called them and asked for new coupons because we knew the rules on underpaying COBRA. THey sent out us new coupons very quickly ... with the same wrong amounts. WE just keep overpaying the few cents.
dgoldenz,
I see your point. I agree that some people will do it on purpose, like not signing the check, etc.
On the other side, when we were a few cents off, the third party administering the account (which just happens to be the same one that administers the COBRA) worked with us to fix it. It just seems downright mean to cut people off when they have made an honest mistake instead of telling them they made a mistake.
WHen they sent the COBRA coupons, they made a few cent error in the amount (it was a little higher) and kept telling us we had overpaid. We called them and asked for new coupons because we knew the rules on underpaying COBRA. THey sent out us new coupons very quickly ... with the same wrong amounts. WE just keep overpaying the few cents.
I agree that it's harsh. As you mentioned, the "oops I forgot to sign the check" is another one people try to play games with. Have had the same thing happen on life insurance policies a few times. Interesting how when that happens it's the people who are having money trouble 90% of the time. Some COBRA administrators are more helpful than others though, that's for sure.
ItDontMeanAThing
Full time employment: Posting here.
Don't know about your state, but in Cali we elect a state insurance commissioner. Health care insurance for individuals is regulated Individual Health Rate Fillings
I used to work for UnitedHealth Group, America's largest health care company. Providers and suppliers accept UHG covered patients after they come to an agreement with UHG about compensation. How is that taking?
UHG's 94 billion in revenue last year seems staggering, but the net was only 4.9% of that. Whoever they're taking from, they're not very good at it.
toofrugalformycat
Full time employment: Posting here.
I'm not a lawyer, nor an insurance salesman, so I'm not an industry expert, I just know what it's like to try to buy individual health insurance.
I have had private health insurance yanked away (Mutual of Omaha sent me a letter saying, sorry charley, we're pulling out of your state entirely). So I had one month's notice to find another carrier who will take a middle-aged woman? After several denials, I found the State high-risk insurance pool with a premium I couldn't really afford, for a $15,000 deductible policy. If I wasn't one of the fortunate State employees who could eventually get retiree health insurance, I could never have ERed, or retired, period. The premium for the insurance I get for free, that State employees who started work later than me have to pay for, is approaching TWICE my pension check.
So when someone says they should let the free market take care of the health insurance problem, I just shake my head. Walk a mile in my shoes, buddies.
I'm not a lawyer, nor an insurance salesman, so I'm not an industry expert, I just know what it's like to try to buy individual health insurance.
I have had private health insurance yanked away (Mutual of Omaha sent me a letter saying, sorry charley, we're pulling out of your state entirely). So I had one month's notice to find another carrier who will take a middle-aged woman? After several denials, I found the State high-risk insurance pool with a premium I couldn't really afford, for a $15,000 deductible policy. If I wasn't one of the fortunate State employees who could eventually get retiree health insurance, I could never have ERed, or retired, period. The premium for the insurance I get for free, that State employees who started work later than me have to pay for, is approaching TWICE my pension check.
So when someone says they should let the free market take care of the health insurance problem, I just shake my head. Walk a mile in my shoes, buddies.
Guaranteed renewable only applies if the insurance company is still doing business in your state. If they pull out of the state altogether, they do not have to renew the policies. Same thing just happened here in VA with Unicare. Assuming you have no other coverage available and you meet other HIPAA qualifications, you would have been HIPAA eligible....unless your state does not allow companies to offer HIPAA plans and forces you into the risk pool. That would be an issue to take up with your state legislature.
Just to be clear, policies are guaranteed renewable under federal law. The issue is whether the premiums can change based on experience, which is a matter of state law. The "guaranteed renewable" concept has other holes. For example, insurers pulling out of a state, like what happened to Too Frugal, or an insurer phasing out a particular plan so the new healthy customers apply for new plans, leaving the people in the plan seeing higher costs as the healthy abandon the plan.
Right. IIRC it is a broad federal mandate with state implementation. My own experience (NY) the guaranteed renewal is specific to policy type/group. In this way the insurer can have multiple offerings for the same customer base that are similar in coverage and retain the ability to drop one if it becomes problematic in any way - with no obligation to pick up the newly uninsured in any other group unless mandated to do so.
Unless NY's wacky regulations say otherwise, insurance companies can't just drop one subset of policyholders and keep all others. That only works if they drop all policyholders and stop selling insurance in the state. In any case, NY is guaranteed issue anyway, so what's the difference? I've never met someone who actually bought individual health insurance in NY....sure have talked to a lot of people that couldn't afford to though.
Well, Independent Health dropped my individual policy and all those that pertained to whatever group it pertained. We're talking somewhere around '00 or so. It continued to offer other individual and group policies. Many insurance policies in the US are segmented into groups that give the issuer an escape clause if they need to avoid renewal.Unless NY's wacky regulations say otherwise, insurance companies can't just drop one subset of policyholders and keep all others. That only works if they drop all policyholders and stop selling insurance in the state. In any case, NY is guaranteed issue anyway, so what's the difference? I've never met someone who actually bought individual health insurance in NY....sure have talked to a lot of people that couldn't afford to though.
As for NY State guaranteed issue, the terms are better than nothing, but not by much. Limited coverage, high price, low limits. The price wasn't the problem for me, but the lousy coverage was.
RetirementColdHardTruth
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Yes, this was one of my main reasons for leaving contracting. I had a lucrative career being paid high$$$ per hour for my services. Once my costs were clicking close to the 17k mark for premiums, and $5000 in deductibles per person X 3, I decided it was time to go back with a company and get group benefits. It was ridiculous. In 5+- years I never had them pay 1 cent towards care as I never hit the deductible per person. Yet every year I was getting 20-25% increases in premium. When I was in California, I did switch to Kaiser. They have a great HMO plan and I was paying 528 a month for the three of us. Unfortunately when I came back to Georgia, I had no choice but to go back with my previous insurer, for more rip off premiums.
Oh, well this year my costs are about $660 a month for 80/20 coverage. Much cheaper, although so am I in terms of income costs.
Oh, well this year my costs are about $660 a month for 80/20 coverage. Much cheaper, although so am I in terms of income costs.
It's possible they may be allowed in NY since other coverage is already guaranteed-issue. I don't know anything about NY health insurance other than it's GI and ridiculously expensive.
There's a reason the coverage in NY is lousy and the price is sky high. You can probably guess what that is...
Inadequate regulation and unbridled profit?
NY has inadequate regulation? There's a laugh...NY has no competition and sky high prices because they have regulated the market to the point where nobody will buy anything. Health insurance in NY is guaranteed issue and a healthy person in their 20's pays the same rate as a 64 year old smoker with diabetes and heart problems. What kind of healthy young person would pay over $1000/month for health insurance? My brother is 26 and for him to buy an individual policy with limited coverage from an HMO (no PPO plans available) was $1100/month. Fat chance.
mews
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I had indiv ins in NYC, for a short time some years ago, after COBRA ran out. (I had returned to grad school).
It cost as much each month as my apartment.
Today, I think, it would cost more!
ta,
mew
It cost as much each month as my apartment.
Today, I think, it would cost more!
ta,
mew
I know a lot of people who say they never get sick and they can't afford health insurance... I'm not one of them. But recently I had a freak accident and lost a finger (I am not kidding, my right ring finger). My ring caught on something and is gone. So for anyone (not especially here) who says they don't get sick... that's not the only reason to have health ins.
I'm just glad there's a high risk (and high cost) pool for me to go into for the 16 months after I am off COBRA and before Medicare starts. I budgeted heavily for it, figuring I'd better consider the worst case scenario. I expect this finger thing - while not ongoing in a year - will toss me into high risk. I'll find out in 7 months - I have 10 months of COBRA left after March.
By the way, counting on your fingers (April, May, June...) is really hard when you have only 9! I am making light of a terrible experience... sigh. But I have to live with it.
Just call it: Nine Fingered Frodo and the Ring of Doom. I do (substituting my name...)
I'm just glad there's a high risk (and high cost) pool for me to go into for the 16 months after I am off COBRA and before Medicare starts. I budgeted heavily for it, figuring I'd better consider the worst case scenario. I expect this finger thing - while not ongoing in a year - will toss me into high risk. I'll find out in 7 months - I have 10 months of COBRA left after March.
By the way, counting on your fingers (April, May, June...) is really hard when you have only 9! I am making light of a terrible experience... sigh. But I have to live with it.
Just call it: Nine Fingered Frodo and the Ring of Doom. I do (substituting my name...)
The hoops are apparently necessary given the bonuses linked to insurance employees for targeting customers with expensive illnesses.
Rescission Health Insurance - Blue Cross praised employees who dropped sick policyholders, lawmaker says - Los Angeles Times
There are two sides to every story:
WellPoint's Reuters Response -- INDIANAPOLIS, April 22 /PRNewswire-FirstCall/ --
fisherman
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Interesting but after reading both the two links do not appear to be directly related. The first is about a house subcommittee investigation and the second is a rebuttal to a Reuters article that is not linked as best I can tell.
Goggle Assurant rescissions and you will find where the lost a few lawsuits over the practice cited in the first link. I am also sure the second link has some validity in that undoubtedly some applicants intrntionally lie on their apps. Its the fear of not remembering a doctors visit that is mst problematic to the process.
Why can they not pull our records and rate us on them without expecting us to fill out an application and remember every little detail? They could even site our records for a rate up or drop so that we could challenge the accuracy of the record if needed.
Goggle Assurant rescissions and you will find where the lost a few lawsuits over the practice cited in the first link. I am also sure the second link has some validity in that undoubtedly some applicants intrntionally lie on their apps. Its the fear of not remembering a doctors visit that is mst problematic to the process.
Why can they not pull our records and rate us on them without expecting us to fill out an application and remember every little detail? They could even site our records for a rate up or drop so that we could challenge the accuracy of the record if needed.
OrcasIslandBound
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Well...
I see plenty of heated discussions here about the whole Obama care. More then what I would have expected from an ER forum...
We waited ~60 years for some kind of health care reform. It's far from perfect, but, I can think of no group that would benefit more from the successful implementation of this bill then the members of this forum. Myself included.
Pre-existing exclusions are eliminated. Companies still compete with one another. 85% of premiums have to be paid out to doctors instead of insurance administration. Not that bad. I believe that this plan, if not repealed, will allow the DW and I to retire at the age of 56 in 3 years. It is my intent to found my own business, and, if successful, will allow some payback into the economy in terms of jobs, exports, etc. The business will be in UAVs.
So, I really hope it doesn't get repealed!!!!
- Stephen
I see plenty of heated discussions here about the whole Obama care. More then what I would have expected from an ER forum...
We waited ~60 years for some kind of health care reform. It's far from perfect, but, I can think of no group that would benefit more from the successful implementation of this bill then the members of this forum. Myself included.
Pre-existing exclusions are eliminated. Companies still compete with one another. 85% of premiums have to be paid out to doctors instead of insurance administration. Not that bad. I believe that this plan, if not repealed, will allow the DW and I to retire at the age of 56 in 3 years. It is my intent to found my own business, and, if successful, will allow some payback into the economy in terms of jobs, exports, etc. The business will be in UAVs.
So, I really hope it doesn't get repealed!!!!
- Stephen
Wellpoint's response was all part of the same "story" that was referenced earlier in this thread. I know Assurant got in hot water and shelled out a ton of money on one case, but you are still talking about a very, very few people out of millions of insureds. I'm not trying to defend the actions of companies where they are clearly in the wrong like Assurant was, just pointing out that you shouldn't believe everything you read or hear without checking the facts first.
Out of all of the health insurance policies I've written and that my dad wrote before I got into the business, not one of them has ever been rescinded.
nun
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man I'm glad I live in MA under "Romneycare". Everyone must have health insurance is by law, no pre-existing conditions and as a 50 year old man I can get a $5000 deductible plan for $300/month and a no deductible everything covered one for $600/mth. Also the state is implementing ways to reduce costs.
And if you were a 35-year-old with a healthy family of four, you would be paying $1000-2000 per month for the same coverage you can get in other states for half the price. For every winner, there is a loser in that type of system. Costs go down for older people, costs go up for younger people. Younger people can't afford premiums or decide to pay penalty, only older, sicker population left in the pool, then premiums go up again. Can't have it both ways...
Also, a healthy 50 year old man can get a $3k deductible HSA policy here for $143/month with no pre-existing clause assuming they have prior coverage. Half the price for half the deductible compared to what you're paying...of course, if you have medical conditions, the rate would be higher.
nun
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Yes MA is expensive for healthcare. However, the general opinion here is that its a good system. FYI I got something wrong in my post. My $300/month premium buys me a plan with a $2000 annual deductible and $5000 annual out of pocket max. For a family of 4 with 35 year old parents a $4000 deductilbe/$10000 out of pocket max costs $900/month, but you only pay that if your income is over $67k a year, below that the children are covered by MassHealth and the parents can get MA subsidized health insurance for a max of $150 a month.
