Who will insure the middle-aged?

November 21, 2006 6:51 AM

Health insurance for the self-employed and middle-aged?

My partner, a Perl programmer, lost his telecommuting job a few months ago. He's doing a regular 8:30-5:30 on-site job now and hates it, and is looking for another telecommuting job. Most telecommuting jobs seem to be contract work; his last telecommuting job was.

I want him to be happy (he was so happy working in our basement) but I have a lot of anxiety about contract work. We'll set aside the way I cling to an outdated employment model (my dad worked for General Motors for 35 years! Isn't that the way it's supposed to be?) and focus on one specific issue: health insurance.

He's 40. I'm 41. He has been treated for high cholesterol, he has asthma, he's got thyroid problems. I'm in excellent health but fat. Oh, and for extra spicy goodness, he's a transsexual (way post-transition).

Obviously, one good option for us is to use the insurance from his current employment under COBRA for 18 months. But what then? When he was in his old job, I researched private health insurance, and most of the information I found was aimed at the young and healthy. According to my research, it is very important not to be denied insurance--having been denied once can make it much more difficult to get insurance in the future.

I'm home full-time with two little kids. We obviously have way too much income to qualify for any publicly-supported insurance.

What are our options at the point our COBRA insurance runs out? What steps should I take at that time to get insurance for us? What is and is not possible? Anyone have experience with this? Advice? Things absolutely not to do?

posted by not that girl to health & fitness (11 comments total)

A clarification: I mentioned specific health stuff to generally make the point that we are not in the "easy-to-insure" category, not to ask for advice re: specific maladies or insuring the transgendered.

Also, we live in Michigan.
posted by not that girl at 6:55 AM on November 21, 2006

Self-employed? So you're a freelancer? The Freelancers Union has cheaper-than-COBRA insurance and other benefits. Check it out.
posted by Xoder at 6:56 AM on November 21, 2006

If you want to make sure you get good trans-specific information, I know that's one of their specialties at the Callen-Lorde Center -- and they also have a general dedication to advising people about their insurance options.
posted by allterrainbrain at 7:05 AM on November 21, 2006

Go through an insurance broker. Their job is to wade through all the options for you, and they're paid by the insurance companies, not by you. As for getting denied coverage, at least in VA it's not that big of a deal. I was denied by BCBS but got coverage through Aetna with no problem.
posted by Nathanial Hörnblowér at 7:27 AM on November 21, 2006

Well, I WAS going to suggest the NASE, which I used when I couldn't afford anything else, but then I found all these links that say they're pretty bad.

It's worth looking into, but be sure to read carefully.
posted by Sprout the Vulgarian at 7:38 AM on November 21, 2006

Using an insurance broker does not change the price of the premium - you might as well use one so you can understand all your options. Apparently, it is important not to get formally denied from a health insurance application, so don't start applying for health insurance without knowing if you'll be accepted or not (paradoxical I know - this is what the broker can help with).
I'm not recommending the book, "The New Healthcare Solution" (It's basically a shill for the Bush health savings plan, but you might want to get a copy from the library and browse through it), but it does have state-by-state (Michigan) information as well as a contact for the Michigan state insurance office.
posted by j at 8:18 AM on November 21, 2006

Many states have a state-sponsored health insurance plan of "last resort". When I moved from CA to TX, my former individual plan (Pacificare, in this case) made me reapply in my new state, then refused to cover me due to prior conditions. I used that rejection as a basis to qualify for coverage for the state "high-risk pool".

Just googling through Michigan, I see that Blue Cross has options. This page includes the following:

Can I be denied coverage because of a medical condition?

Blue Cross and Blue Shield of Michigan individual health care plans are not medically underwritten. This means you will not be excluded from coverage because of medical history or current health status.

Is there a pre-existing waiting period?

Our nongroup IC Blue coverage requires a 180-day pre-existing exclusion period. This means if you had a medical condition for which medical advice, care or treatment was recommended or received 180 days before your enrollment date, any services you receive to treat that condition within the first 180 days after your enrollment date will not be paid by your nongroup coverage.

It's expensive, but worth it especially since you have kids.

Good luck!
posted by Robert Angelo at 9:27 AM on November 21, 2006

Self-employed? So you're a freelancer? The Freelancers Union has cheaper-than-COBRA insurance and other benefits. Check it out.

This appears to be specifically for persons in New York.
posted by Robert Angelo at 9:29 AM on November 21, 2006

Costco has some great insurance plans and rates. I was pleasantly surprised at how low it was when I was getting insurance for my small business.
posted by Invoke at 9:47 AM on November 21, 2006

NASE, which I used when I couldn't afford anything else, but then I found all these links that say they're pretty bad...It's worth looking into, but be sure to read carefully.

My experience with NASE as a healthy 26 year old who never went to the doctor even once in the time I had coverage with them was that they doubled my premiums in a year. Citing increasing health care and investment management costs. In 1997/1998 when a brain-damaged monkey could get insane returns on investments. For insurance with terrible first-dollar coverage and lots of fine-print limitations once the real expenses kick in.

I looked at them again when I was 30, but not only could I not shake the previous experience, I became more uncomfortable when I realized while researching NASE and another plan I was looking at from a similar association (the Alliance for Affordable Services) that both of their plans were ultimately from an insurance company called UICI. And it doesn't look like these associations are really independent from UICI -- in fact, it looks like they're essentially marketing vehicles. They recently settled a lawsuit related to this issue. Apparently there was also some WSJ Coverage.

Ultimately, I have no experience with using their coverage, but I'd have to be in a hard spot before I'd try it again.

I'm going to be on COBRA shortly; I'm currently looking into professional and other associations that I'm reasonably certain are legit. The ACM might have a place for a Perl Programmer. I haven't checked out their health plans yet, but it appears they do offer some health coverage.
posted by weston at 11:16 AM on November 21, 2006

The Michigan Business and Professional Organization has some pretty reasonable health insurance options. I'm not sure what it takes to qualify, but I don't think it's much.
posted by EllenC at 4:54 PM on November 21, 2006