Health Insurance for the Healthy(ish)
October 8, 2010 11:38 AM Subscribe
Should I apply to the Illinois high-risk insurance pool or try to get an individual policy?
I am self-employed and have not been covered by health insurance for three years (almost 7 years since my last comprehensive, preventative plan) but I feel its time to finally get a policy again.
Four years ago I applied for an individual policy to a number of companies through a broker. I was denied by one company (for a minor skin condition) but simultaneously approved by another. That policy lasted one year before I moved abroad and was required to cancel it (because it did not cover me more than 3 months outside the U.S.). I knew this was going to cause a pre-existing and previosuly-denied issue when I applied again but I had no other choice. I have not been insured since.
I am a healthy woman in her early 30s but any minor doctor visit seems to pop up as a red flag when applying to insurance these days. Aside from the skin condition (which a specialist was shocked I'd been denied for) and being slightly overweight I am in great health. The last time I applied for a policy the phone interviewer refused to believe I exercised 3 times a week or believe my dress size. Although I am not normally flustered it was a horrible experience and the idea of applying again stresses me out. I have been putting off getting insurance for years because I'm afraid that I will be denied again and don't believe that they won't just drop me if I ever get sick. I really would like to take care of myself but am afraid to pay out of pocket for a doctor and get diagnosed with anything and get shouldered with another pre-existing condition that would make it even more difficult to get insurance. I do pay for yearly gynecologist visits ad birth control (IUD) even without insurance. I've gotten full checkups while traveling (Thailand) and would do that again if I was in the area but I'll be in the U.S. for the foreseeable future.
The state of Illinois has a preexisting condition insurance plan that just went into effect in September. Although I would never consider myself high risk, apparently at least one major insurance company does. The premiums for under-35, non-smoking Chicago/Cook Co. residents are $150/month, which are cheaper than I would get on the individual market for a similar plan. There aren't a lot of details available on the plan but at 80/20, $2k deductible it seems like a great deal.
1. Will being covered by the high risk pool until the new insurance guidelines go into effect in 2014 black flag me for an typical individual policy in the future?
2. Is there anything I'm not thinking of (either drawbacks or alternate solutions)? Short of changing my career to get a job just for insurance or marrying someone for insurance I don't see a lot of options.
3. Should I try again for a typical individual policy before I try for the Illinois program? It will cost more money and my rates are almost guaranteed to rise each year. I intend to get a $2000-5000 deductible but a doctor's co-pay would be nice. I typically go to the gyno and internist once a year for checkups unless I have a problem, which doesn't happen often. I don't go to the doctor for colds, sprains, etc. but once you get blood tests done, pay for lab fees and so on the costs really add up and paying the discounted insurance rate helps. I always shop around and try to negotiate fees paying cash but surprisingly few doctors will offer discounts.
I am self-employed and have not been covered by health insurance for three years (almost 7 years since my last comprehensive, preventative plan) but I feel its time to finally get a policy again.
Four years ago I applied for an individual policy to a number of companies through a broker. I was denied by one company (for a minor skin condition) but simultaneously approved by another. That policy lasted one year before I moved abroad and was required to cancel it (because it did not cover me more than 3 months outside the U.S.). I knew this was going to cause a pre-existing and previosuly-denied issue when I applied again but I had no other choice. I have not been insured since.
I am a healthy woman in her early 30s but any minor doctor visit seems to pop up as a red flag when applying to insurance these days. Aside from the skin condition (which a specialist was shocked I'd been denied for) and being slightly overweight I am in great health. The last time I applied for a policy the phone interviewer refused to believe I exercised 3 times a week or believe my dress size. Although I am not normally flustered it was a horrible experience and the idea of applying again stresses me out. I have been putting off getting insurance for years because I'm afraid that I will be denied again and don't believe that they won't just drop me if I ever get sick. I really would like to take care of myself but am afraid to pay out of pocket for a doctor and get diagnosed with anything and get shouldered with another pre-existing condition that would make it even more difficult to get insurance. I do pay for yearly gynecologist visits ad birth control (IUD) even without insurance. I've gotten full checkups while traveling (Thailand) and would do that again if I was in the area but I'll be in the U.S. for the foreseeable future.
The state of Illinois has a preexisting condition insurance plan that just went into effect in September. Although I would never consider myself high risk, apparently at least one major insurance company does. The premiums for under-35, non-smoking Chicago/Cook Co. residents are $150/month, which are cheaper than I would get on the individual market for a similar plan. There aren't a lot of details available on the plan but at 80/20, $2k deductible it seems like a great deal.
1. Will being covered by the high risk pool until the new insurance guidelines go into effect in 2014 black flag me for an typical individual policy in the future?
2. Is there anything I'm not thinking of (either drawbacks or alternate solutions)? Short of changing my career to get a job just for insurance or marrying someone for insurance I don't see a lot of options.
3. Should I try again for a typical individual policy before I try for the Illinois program? It will cost more money and my rates are almost guaranteed to rise each year. I intend to get a $2000-5000 deductible but a doctor's co-pay would be nice. I typically go to the gyno and internist once a year for checkups unless I have a problem, which doesn't happen often. I don't go to the doctor for colds, sprains, etc. but once you get blood tests done, pay for lab fees and so on the costs really add up and paying the discounted insurance rate helps. I always shop around and try to negotiate fees paying cash but surprisingly few doctors will offer discounts.
I don't really need to read this to be able to answer your question.
Try to get a policy now. If you can, it's going to be cheaper than any equivalent plan in the high risk pool, almost by definition, until the subsidies start kicking in in 2014.
High risk pools of any sort--health, personal auto, property--exist specifically to serve people who cannot find affordable coverage on the private market. Homeowners along the Gulf and Atlantic coasts are generally eligible for participation in their state's wind pools, and most states have some sort of residual market for people whose driving records are so bad that private carriers won't take them. They're expensive, and the coverage they provide isn't awesome, but it's better than nothing. Which is the only reason you should go there.
posted by valkyryn at 1:21 PM on October 8, 2010
Try to get a policy now. If you can, it's going to be cheaper than any equivalent plan in the high risk pool, almost by definition, until the subsidies start kicking in in 2014.
High risk pools of any sort--health, personal auto, property--exist specifically to serve people who cannot find affordable coverage on the private market. Homeowners along the Gulf and Atlantic coasts are generally eligible for participation in their state's wind pools, and most states have some sort of residual market for people whose driving records are so bad that private carriers won't take them. They're expensive, and the coverage they provide isn't awesome, but it's better than nothing. Which is the only reason you should go there.
posted by valkyryn at 1:21 PM on October 8, 2010
Well, you shouldn't worry about being blacklisted after 2014 for having a pre-existing condition; after January 1, 2014 there will no longer be any such thing as a pre-existing condition. Companies won't be allowed to take your health status into account at all when offering you coverage (which they will be forced to do, even if you're currently hooked up to a ventilator hanging on by a thread or in any less-dire health straits) nor when calculating the cost of that coverage.
However, I'd be a bit surprised if you're able to qualify for the preexisting condition plan without applying for individual coverage again and being turned down. In the FAQ, it reads:
What is a "pre-existing condition" for purposes of the IPXP?
You can establish that you have a pre-existing condition in any one of four ways:
*Provide information showing that you have one of several "presumptive conditions;"
*Provide documentation from a health insurance company stating that you are ineligible for comprehensive coverage due to a medical condition;
*Provide documentation from a health insurance company offering you health coverage with a rider that excludes coverage for your medical condition; or
*Provide a written statement from a physician stating that you have an existing medical condition that may result in denial of comprehensive coverage by a health insurance company.
If you look at the physician form (pdf), the condition that would have to be certified is things like AIDS, Parkinsons, quadrapelgia, hemophilia, and so on. Given that list, I'd be surprised if you were approved for the high-risk pool because of a skin condition--unless you got a recent letter from the insurance company denying you coverage because of it.
As I read it, it looks like you're going to have to apply for individual coverage anyway (and be turned down) before you'd be allowed into the high-risk pool, so that might be the best course of action to start with.
posted by iminurmefi at 1:26 PM on October 8, 2010
However, I'd be a bit surprised if you're able to qualify for the preexisting condition plan without applying for individual coverage again and being turned down. In the FAQ, it reads:
What is a "pre-existing condition" for purposes of the IPXP?
You can establish that you have a pre-existing condition in any one of four ways:
*Provide information showing that you have one of several "presumptive conditions;"
*Provide documentation from a health insurance company stating that you are ineligible for comprehensive coverage due to a medical condition;
*Provide documentation from a health insurance company offering you health coverage with a rider that excludes coverage for your medical condition; or
*Provide a written statement from a physician stating that you have an existing medical condition that may result in denial of comprehensive coverage by a health insurance company.
If you look at the physician form (pdf), the condition that would have to be certified is things like AIDS, Parkinsons, quadrapelgia, hemophilia, and so on. Given that list, I'd be surprised if you were approved for the high-risk pool because of a skin condition--unless you got a recent letter from the insurance company denying you coverage because of it.
As I read it, it looks like you're going to have to apply for individual coverage anyway (and be turned down) before you'd be allowed into the high-risk pool, so that might be the best course of action to start with.
posted by iminurmefi at 1:26 PM on October 8, 2010
Also, while I totally understand this:
I have been putting off getting insurance for years because I'm afraid that I will be denied again and don't believe that they won't just drop me if I ever get sick.
given your experience of being humiliated last time you applied, I want to strongly encourage you to apply again. It's kind of like having a terrible experience at the dentist; if you let that put you off ever going to any dentist again, you're really (in effect) punishing yourself for something that someone else did to you. It's no good.
If it makes you feel better, one of the immediate effects of the health care legislation was to ban recission, which was the (now illegal) policy of yanking someone's insurance when they got sick by going over their application with a fine-tooth comb and finding the most minor omission or error. Going forward, an insurance company can only cancel your policy if they can prove that you were knowingly fraudulent or omitted something materially relevant to your condition--for example, if you failed to disclose that you had been tested for HIV and knew that you were positive, but didn't disclose it and later were seeking treatment for AIDS.
You've gained significant consumer protections in the past year in the individual market, and state insurance commissioners are under a lot of pressure to really police the carriers in their market, so if there's any way you can screw up your courage to apply for a policy, you should do it. If someone makes you feel bad or unhealthy or accuses you of lying, just remind yourself that their rejection is only going to qualify you for this new insurance you might prefer anyway, SO YOU WIN EITHER WAY. (Plus, there's only 4,000 - 6,000 slots in the Illinois high-risk insurance plan that you're looking at, and I'm sure they'll fill quickly, so applying for individual insurance sooner rather than later is important.)
posted by iminurmefi at 1:41 PM on October 8, 2010
I have been putting off getting insurance for years because I'm afraid that I will be denied again and don't believe that they won't just drop me if I ever get sick.
given your experience of being humiliated last time you applied, I want to strongly encourage you to apply again. It's kind of like having a terrible experience at the dentist; if you let that put you off ever going to any dentist again, you're really (in effect) punishing yourself for something that someone else did to you. It's no good.
If it makes you feel better, one of the immediate effects of the health care legislation was to ban recission, which was the (now illegal) policy of yanking someone's insurance when they got sick by going over their application with a fine-tooth comb and finding the most minor omission or error. Going forward, an insurance company can only cancel your policy if they can prove that you were knowingly fraudulent or omitted something materially relevant to your condition--for example, if you failed to disclose that you had been tested for HIV and knew that you were positive, but didn't disclose it and later were seeking treatment for AIDS.
You've gained significant consumer protections in the past year in the individual market, and state insurance commissioners are under a lot of pressure to really police the carriers in their market, so if there's any way you can screw up your courage to apply for a policy, you should do it. If someone makes you feel bad or unhealthy or accuses you of lying, just remind yourself that their rejection is only going to qualify you for this new insurance you might prefer anyway, SO YOU WIN EITHER WAY. (Plus, there's only 4,000 - 6,000 slots in the Illinois high-risk insurance plan that you're looking at, and I'm sure they'll fill quickly, so applying for individual insurance sooner rather than later is important.)
posted by iminurmefi at 1:41 PM on October 8, 2010
Recent article at Get Rich Slowly about this. It's from the standpoint of someone buying for a family, but it should give you a few things to chew on.
posted by rhizome at 7:33 PM on October 8, 2010
posted by rhizome at 7:33 PM on October 8, 2010
I just discovered that there are people out there whose job it is to help you make these decisions. In Cook County, I think it's these guys. Their services should be free, and they should sit down with you and help you figure out the pros and cons. They will also advocate for you if you are unfairly turned down.
posted by emilyd22222 at 7:38 PM on October 8, 2010
posted by emilyd22222 at 7:38 PM on October 8, 2010
This thread is closed to new comments.
posted by jrockway at 1:14 PM on October 8, 2010