How to get insurance

Only some of Obamacare has been implemented so far, and the banning of preexisting condition exclusions was only enacted for children, to date. But it will fully implement in January 2014, so you don't have too much longer to wait. Insurance exchanges will open this October, so you will have access to what is available to you. If your state is participating in the exchange, that will be your first stop. If it isn't, then you go to the Federal Exchange. It still may be expensive, since insurance companies are not prohibited from charging more based on your health history. But, over time, rates should come down, as more healthy people have coverage. Here is a link to more information:

http://obamacarefacts.com/obam...surance-exchange.php

Jan

Here is my dilemma :

My COBRA runs out in January 2014. I hope/pray that Obamacare is not over-turned, but if not, then here are my options

1. California offers Cal-Cobra after your employer-sponsored 18 month plan has run out. Cal-Cobra will cost me $700-$1K per month for an HMO plan – YIKES! I am currently pay $580 per month for United Healthcare HMO and Dental (for an individual only plan that is not based on age)
2. California State Exchange calculates my health insurance to cost about $75 per month (based on part-time employment). But what the heck does the plan cover – catastrophic care only? Will the rate fluctuate based upon the number of young, healthy people who join the plan? Will Cal-Cobra disappear if we now have a State Exchange?

I am going to insist that my surgeon do my hernia operation in December before I run out of insurance and/or the "Unknown status" of my insurance in January.

quote:

It still may be expensive, since insurance companies are not prohibited from charging more based on your health history. But, over time, rates should come down, as more healthy people have coverage.

Everything I've read suggests that insurance purchased through the exchanges is not priced based on health history. There are different tiers of plans (trading lower price for higher copays), and there are income-based subsidies.

This was the whole point of the individual mandate - if you don't pool everyone together, only the sickest folks tend to buy the insurance, which further drives up the price in a destructive cycle.

Unfortunately, while they cannot refuse you because of preexisting conditions, it can still factor into your rate, along with other things. The exchanges will probably give you the best rates, because they are competing for your business.

From the link above:
"Please be aware costs can vary greatly depending on a number of factors including location, health status and age."

Plus, until most people are covered, there will not be the vast pool sharing the risk that was hoped for. The tax penalty for not getting health insurance is going to be phased in over several years. The good news though, is that people in lower incomes will pay less, on a sliding scale.

Jan

From healthcare.gov, regarding insurance purchased through an exchange:
"Starting in 2014, being sick won't keep you from getting health coverage. An insurance company can't turn you down or charge you more because of your condition.

Once you have insurance, it can't refuse to cover treatment for pre-existing conditions. Coverage for your pre-existing conditions begins immediately.

This is true even if you have been turned down or refused coverage due to a pre-existing condition in the past."

They can't turn you down, but they can charge you a whopping premium, isn't that true?

I deal with insurance cost issues often with my clients. I remember a client who owned a pit bull that kept biting people, and complained that their homeowners' liability insurance company kept raising their premiums. Eventually, after the 3rd dogbite incident, the insurance company pulled the plug on coverage completely.

Many of my clients think insurance companies exist to pay claims made against them and that there are no consequences for such claims, because that is what they purchased when they paid the premium. However, the premium reflects a risk calculus which changes with the claims history.

Any insurance premium that is charged for any kind of insurance is based on a calculus of risk determined by actuaries and underwriters. It's been explained to me in the context of homeowners and auto liability insurance, but health insurance premiums are determined on the same equation: RISK. Pre-existing conditions mean high risk and anyone who thinks that they will be covered cheaply is living in a fantasy land. I don't think this is like the mortgage industry 10 years ago that was giving away credit to people who were bad credit risks. The reason for that is that there were tons of middlemen - real estate brokers, mortgage brokers and attorneys - who were making money on every mortgage transaction involving a person who should not have been given a mortgage. It is not going to work that way with health insurance because there are no middle persons making any money on the transaction.

So as health insurance claims increase, so will your premiums. The claims history and payments made for your healthcare will be studied carefully in determining your premium payment.

quote:

They can't turn you down, but they can charge you a whopping premium, isn't that true?

No, it's not true. The law won't allow what's called "individual underwriting" for policies sold through the exchanges. They can't charge you more because of your condition. Pricing is based on the entire pool, including the sick, the as-yet healthy, and everyone in between. This would be crazy if not for the requirement that everyone actually be in the pool. That requirement isn't perfect (the penalties are small and the political sabotage has been remarkable, and people don't like requirements), but lots and lots of folks, healthy and sick, will be glad to finally be able to purchase health insurance without having to work for a biggish company.

It's very much like the reason you don't have to pay a higher premium if you get sick and are insured through a group at work. The exchanges operate similarly, like a giant group.

I am covered on a group plan through work but I saw an apportionment of the premium to each person that is covered under the policy and I am by far the highest (no surprise). I think the apportioned number on me was $521/month but that may have been for 2011. I am kind of lucky to have coverage given all the prescriptions I take.

The best news I had so far this year is that under my new plan which is Anthem Blue Cross-Blue Shield, I only had to pay a $30 co-pay for my annual pouchoscopy. Last year under ConnectiCare it was a $500 co-pay.

Scott, you are right that starting January 2014, insurance companies cannot individually underwrite based on pre-existing conditions, and they have to maintain a combined or separate pool for all individual and small business enrollees (having a "healthy" low cost pool is prohibited). But, they can adjust your rate based on your age, tobacco use, location, and family size.

So, at least we do not need to worry about specific high-cost diagnoses that have plagued us in the past. The hard part is getting everyone signed up. A poll in my state (California) indicated that about half the people who are eligible for discounted or free rates through the exchange/expanded Medicaid are not aware of it.
http://www.insidebayarea.com/n...ans-still-uninformed

I am really hoping this works out and does not eventually get repealed (hopefully just tweaked and improved), because one of our retirement worries is the time before Medicare and having to get coverage individually.

I know there will be some missteps along the way, just as there were with Medicare, and Social Security.

Jan

I lost my insruance 2 weeks ago so I pay cash at CC and everything else at the moment. Waiting for the Army to fix this mess up and we will re reinstated with Tricare.

I know my friend took out new insurance 6 months ago in California that was called HIPPA and they weren't allowed to even ask her history but it is pricey, about 500 a month.

I must be the only one that prefers to have insurance not related to obamacare. I am not a fan though. If this really happens, that they can't charge us an ass and a leg for premiums based on disease then that will be good. I rather keep the insurance we have though. It will be cheaper (200 a month) than obamacare. I believe the base is estimated to be 240 a month per individual.

HIPAA conversion coverage is not the same as Obamacare, but is what is currently available when your Cobra coverage runs out. Cobra is not cheap either.

I will be looking into the insurance exchanges in October when they open, for my son. He is unemployed, has UC, and may benefit from the new coverage. My husband and I have been paying for his insurance.

Vanessa, I don't think you are the only one who isn't interested in Obamacare, as there is a huge movement to try to get it repealed. But, I am confused why they don't want to give it a chance, unless it is purely politically motivated. Time will tell I guess. I don't want this thread to get sidetracked into a political debate, so let's stay on topic... I want this topic to stay informational for those who need it.

Jan

She didn't have Cobra actually she just applied for the HIPPA. She is pretty much almost disabled from getting a jpouch so hasn't worked in almost 2 years.