I am so glad for you, Landshark. I cannot believe you have had to go through this all, especially as such a healthy, imminently insurable person. I still don't understand why a healthy individual shouldn't get the same plan as a group rate. It seems like it should be so much easier and clearer than it is.
Merry Christmas!!! Maybe it is a Christmas miracle.
It certainly isn't a Christmas miracle or anything, but Tonik Health/Blue Cross of California insured me today. My premiums are going to be 50% higher, which is still less than HIPAA. They stated that if one of the conditions is improved in the next six months that I can reapply for other coverage.
I can't tell you how less stressed I am. It's been a nightmare for the past three months, countless phone calls, online applications, research and discussing my options with multiple agents.
Eligibility Under HIPAA Under HIPAA, you are guaranteed coverage at our basic rate without a medical review if: • You meet the eligibility guidelines listed in Step 1; and • You supply us with a certificate of creditable (acceptable) coverage that ended less than 63 days ago and states that you had coverage for 12 continuous months, or 18 months with no breaks of more than 63 days. Generally, coverage can be effective as of the date your previous coverage ended.
Open Enrollment HealthMate Coast-to-Coast Direct or HealthMate for HSA Direct: If you are not eligible for coverage under HIPAA or you did not pass our medical underwriting review, you can apply during our annual open enrollment period. At that time, you are guaranteed coverage at our basic rate. Open enrollment is held May 15 to June 15 each year. Coverage begins on July 1."
So for one month a year, this system allows those who are uninsured and can't get insurance to get a plan. That is better than nothing, but still will keep a lot of people uninsured!
Unfortunately, you may be without a plan for months waiting for this system to meet this stringent time rule before you can apply and before you are insured.
But it's better than what many experience, this is true.
The "Social Security" tax which is basically a payroll tax covers the health system, unemployment benefits and retirement and disability pensions. As a self-employed worker, my husband has chosen to pay the minimum allowed, about 260 euros a month, which means his unemployment and pension benefits will be small, but of course health care is covered for the whole family. Our daughters are covered by his contribution until the age of 25, at which time in theory, they would be paying their own payroll taxes. But the reality is, the national health care system will treat anybody in need even if they do not pay in. They expect those who can afford it to either sign up or pay for non-emergency care.
I am so grateful for the public health care system in the European country where I live. I still have private insurance, but it is pretty cheap I believe compared to what you pay in the U.S., precisely because it competes with the public system and for the many other reasons health care costs are lower here. D1, who I dropped from the private family plan when she went to college in the U.S., had to go to the ER last summer for an allergic reaction...a truly reassuring experience as she got plenty of timely attention and follow-up. I am fully aware that there may come a time that we are not willing or able to pay the extra cost of a private plan, with its small advantages, but I can sleep easy knowing that an emergency or serious illness could never bankrupt us.
I don't mean to sound condescending when I say this, but I truly feel sorry for Americans who don't understand what they are missing having a universal system. Sure people in Europe and Canada etc., complain about its many flaws and there is much room for improvement. But I don't know anyone who would give up the sense of security that guaranteed health care provides for something as chaotic and inefficient as the U.S. system.
With BC/BS in RI, anyone can get a self pay plan and the rates are the same for everyone. Those that are healthy can apply for the preferred rates. This seems fair to me.
are you sure?
"Open Enrollment HealthMate Coast-to-Coast Direct or HealthMate for HSA Direct: If you are not eligible for coverage under HIPAA or you did not pass our medical underwriting review, you can apply during our annual open enrollment period. At that time, you are guaranteed coverage at our basic rate. Open enrollment is held May 15 to June 15 each year. Coverage begins on July 1."
With BC/BS in RI, anyone can get a self pay plan and the rates are the same for everyone. Those that are healthy can apply for the preferred rates. This seems fair to me.
Public option would limit access to health care, don't know why anyone would want that system.
Because most people don't live in places like Rhode Island or Massachusetts where there is fairness. If everyone in this country could get a self pay plan with good benefits and reasonable rates that are the same for everyone, we wouldn't need a public option.
As long as the Democrats continue to believe that objections to health insurance reform are about health insurance reform the issue will continue to be injurious to them. The rest is noise.
If that is the case, that's great. What I have learned about individual insurance, I tend to doubt it.
I am applying to my fourth insurance carrier, Anthem Blue Cross of Cal. If I get accepted, I have already been told my rates will be substantially higher based on my self-reported medical conditions (none that require hospitalization.)
If I don't qualify, I will automatically be enrolling in HIPAA when the COBRA runs out.
With BC/BS in RI, anyone can get a self pay plan and the rates are the same for everyone. Those that are healthy can apply for the preferred rates. This seems fair to me.
are you sure?
if you have diabetes l, you will be accepted at standard rates?
About 35 million- so you think we should have State or Regional health care systems instead of one national system? California, NY, Texas and NY could each have their own, The New England states could have a regional system. Is your claim that economics of scale would not work. That the US population means it would be impossible to have a national system. Doesn't Canada utilize their each province in administering their system. The US could do something similar.
geeps why do you think the polling data indicates that Canadians are far more pleased with both the affordability and quality of their health care system than Americans are with our system?
With BC/BS in RI, anyone can get a self pay plan and the rates are the same for everyone. Those that are healthy can apply for the preferred rates. This seems fair to me.
Public option would limit access to health care, don't know why anyone would want that system.
I wish that all companies and individuals were at least allowed to join the government group plan in the State they employ people or reside. That would give everyone access to a large group plan. It would still be expensive but at least the coverage would be better.
SLS, I'm so sorry this is happening to you. I truly hope something comes along for you soon.
As far as the health reform act, the industry fought like crazy for certain provisions, and this is one they won on. Underwriting pre-existing conditions has always been what insurers did. The Health Reform law won't impact this provision until 201. The Republicans and Dem. Nelson supported the industry on this, saying that the insurers couldn't make enough money if they actually had to, you know, pay claims.
The situation you're experiencing now is one of the reasons people have been fighting for health reform for so long. People who didn't experience your problems, never saw them. It was always the other guy's problem.
If this problem occurs to someone in 2014, they would be able to get insurance because, due to Obamacare, pre-existing conditions will not be part of the underwriting process.
There's actually quite a bit of government-funded research that goes into the private sector via startups or large companies taking a proof-of-concept and then turning it into a product or an improvement for existing products.
Which can be a problem.
DS got a government-funded research grant with his prof as a sponsor. He left the startup after 5 months in a management dispute- and he was the only employee. The consultant won. The startup will probably fold at the end of the year.
There's actually quite a bit of government-funded research that goes into the private sector via startups or large companies taking a proof-of-concept and then turning it into a product or an improvement for existing products.
What has the private sector ever privatized from the government sector and a) gotten right and b) made better? I'm coming up empty on it. Please enlighten me...
The group medical insurance thing generally works out reasonably well if you work in a large company. I don't know of anyone where I work that has been turned down for a job due to medical issues.
It is a messed up system. FUBAR is right, poetsheart!
Most people don't truly get it, until they read about a kid who didn't get their transplant because they were rejected, or it's happened to them.
We previously bought health insurance on our own about 10 years ago. No problems getting insured and at that time, had more significant issues. Underwriting seems more complex and the bottom line is a huge concern. I believe they are getting ready to dump anyone from their books that might cost them more money in the long run.
While I can't blame them from a business perspective, I am in a tough spot. Millions of people are in a tough spot. I am not seeing improvement in access to health care.
Quote: "Insurance companies are happy to take your premiums when you are well and if you aren't, well, you are absolutely screwed. It's unreal.
Group coverage HAS to insure you, but they can rescind you when you really need it. This is a huge problem."/Quote
And yet somehow in recent months, people have allowed themselves to become convinced that "private health insurance" doesn't engage in "rationing" health care. Apparently, only a government run health care system places people in that jeopardy. It's as if we've all forgotten how FUBAR our privately-based health care system has become.
-- Edited by Poetsheart on Saturday 11th of December 2010 10:59:18 PM
-- Edited by Poetsheart on Saturday 11th of December 2010 11:00:01 PM
(Speaking as Samurai. Still working on figuring out the posting glitches.) Exactly right. My insurance agent believes we will move to a public option in the next few years. I think I believe him.
I don't think I fully grasped this. Insurance companies are happy to take your premiums when you are well and if you aren't, well, you are absolutely screwed. It's unreal.
Group coverage HAS to insure you, but they can rescind you when you really need it. This is a huge problem.
What did you end up doing, Jordicin?
-- Edited by MadHatter on Saturday 11th of December 2010 04:53:30 PM
-- Edited by MadHatter on Saturday 11th of December 2010 04:56:32 PM
Samurai, If the public option was passed, you would have been all set. Without the public option we are all still at the mercy of greedy, cold, calculating private health insurance companies.
My husband worked for a small company when I got cancer. When you get seriously ill is when you find out how bad your coverage is. They wouldn't cover half the prescriptions, some costing $1,000 per month. When the plan came up for renewal soon after I got sick, all of a sudden MRI's, CAT Scan's, and X-rays were no longer covered. Our deductible went way up including hospital stays. You can pay premiums for years without using it, but as soon as you need it the insurance company will figure out a way to keep you from using it.
People are terrified of "socialized medicine" but they have no fear of private health insurance companies? I will never understand that.
The "law of unintended consequences" exerts is malign influence to exponentially greater extents with increasing system complexity.True for laws, true for electronics, true for mechanical systems, true for social systems.
Occam's Razor (varient Ockham's Razor) for William of Ockham;The simplest explanation is more likely the correct one. I modestly suggest a corollary to this: The simplest system that can do a job is the most likely to work.
All engineers know to KISS (keep it simple stupid).
-- Edited by BigG on Saturday 11th of December 2010 01:30:21 PM
I have spoken of my odyssey to become insured on the private individual health insurance market, but wanted to update my cyber friends about the latest developments. My advice to you all: don't lose your group coverage, don't get laid off and if you start a business, make sure you have at least two full time employees.
Family's health plan went to COBRA mid-2009 after layoff. I don't have health insurance at my job. Even though I also have my own business, I am a sole proprietor. I cannot buy my own group coverage because I am the only one who works for my company. I can't take on any more employees yet, my business is not big enough for that. If it was, I probably could have gotten coverage.
Never been uninsured. Health issues have been nothing more major than minor illnesses that have never required hospitalization (except childbirth).
Plan A -PPO accepted me and my family in October. Plan was "uprated" which made it much less budget-friendly than quoted. I opted to keep shopping, knowing we had benefits till mid-January.
Plan B - PPO denied three of five family members for minor medical issues. Two were accepted. We didn't take plan for just those two members. This plan was actually our insurance company for the last 4 years.
Plan C - well known HMO approved 4 out of 5 members, not me for minor medical conditions and prescription drug use. I use one prescription a month which I can actually get over the counter. Never been hospitalized. We opted to take plan for husband and kids.
Reapplied for Plan A. They approved me before, so I figured nothing has changed. I had to put down on the application whether I was previously declined for insurance. I honestly answered this question.
Plan A, which previously approved now "can't take the risk" even though their underwriters were willing to 7 weeks ago.
I now have the option of guaranteed issue coverage through COBRA or a Pre-existing condition plan. Yes, they are very expensive.
