health insurance

[chesspain]

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Well I currently live in md, soon to move to LV. I have no prior conditions but i sprained my leg. I'm gonna get a settlement and everything should be fine. I imagine showin a current leg sprain would be horrific. Any other suggestions?

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Disclosing that you've had a leg sprain recently only means that the insurance won't cover bills related to this injury. However, if you're relocating to NV, it may be best to just wait until you get there, after which you can contact a local health insurance agent about getting rate quotes.

FWIW, I doubt that you will be able to get the "traditional" $15 copay HMO for under $250/month. Unless you want to pay exorbitant rates, your best bet will be a high deductible policy.

[mosdef]

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Disclosing that you've had a leg sprain recently only means that the insurance won't cover bills related to this injury.

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This isn't necessarily true. Depending on how bad your leg is messed up, they may exclude all future leg injuries from the coverage, as well as all "related" issues, meaning (for example) that if you develop a bad back because of your leg problem then that's not covered either.

[Rick Nebiolo]

Beware of the "Death Spiral". Years ago I remember a Newsweek column writen by Jane Bryant Quinn on this topic. I couldn't find tha article but did find this link. From the link:

"How the Death Spiral Works

In insurance lingo, a death spiral occurs when a health plan starts attracting sicker patients, which causes the price of premiums to go up, which causes more healthy people (who have other options) to leave the plan, which causes the remaining pool to be proportionately sicker, which causes the price of premiums to increase even more, eventually resulting in the company going bankruptÑin other words, dying.

The image of a death spiral is a useful metaphor for thinking about the role of access to health care within the larger context of American social and economic life. Because employment and health insurance are tightly linked, job disruptions such as layoffs or firings, starting one's own business, or taking time off to care for small children or elderly parents can lead to the loss of health coverage. That loss can easily lead to health concerns going untreated, a situation that can exacerbate employment problems by making the individual less able to work. Alternatively, the downward spiral can begin with health problems that lead to employment problems, making it less likely that one will have health insurance and thus reducing the chances of solving the original health issues.

Whatever the starting point, once a person enters the death spiral, it is difficult to escape. Because employment adversity is so thoroughly intertwined with medical adversity, those caught in the spiral cannot amass either the bodily or the financial resources needed to break out. Descent through the death spiral, for millions of Americans, leaves irrevocable marks of illness on their bodies and souls.

As an aside, I haven't read the whole linked article yet, but plan to within the next few days.

Comments appreciated.

~ Rick

[fishyak]

As soon as group stops admitting new, healthy participants, the remaining participants will enter a premium death spiral. With each premium increase healthy members leave and sicker members increase morbidity. (I teach this stuff.)

Get insured with a pool that is accepting new, healthy, participants.

[fishyak]

Lying on your application is worse. It makes your policy contestable for at least two years. An investigation that reviews your initial application at the point of a big claim can result in your policy being cancelled. The technical term is recession.

Disclose your health problems to a local agent with health insurance experience and let them guide you through the options in your state.

[Rick Nebiolo]

[ QUOTE ]
As soon as group stops admitting new, healthy participants, the remaining participants will enter a premium death spiral. With each premium increase healthy members leave and sicker members increase morbidity. (I teach this stuff.)

Get insured with a pool that is accepting new, healthy, participants.

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My understanding is that even big health plans divide their well advertised plans into relatively small pools (especially for the self employed). So let's say you are currently healthy and get half decent coverage with for example Blue Cross or Healhnet. Over time the premiums for your coverage become much higher than similar coverage for new customers because of the "death spiral". This is fine if you are healthy (you can get new coverage in a new pool) but puts you in deep sh_t if you acquire an ongoing medical problem.

Is this essentially true?

~ Rick

[goodgrief]

Yeah, in my case it was. Different states have different laws but even though I was perfectly healthy after age 45 there was no plan that I could afford available to me. Also, I was being carried month to month anyway, so it seemed apparent that if I ever had a serious illness like cancer, I would be dropped after the first month.

Catastrophic coverage wasn't much cheaper than PPOs or HMOs, yet, in essence, it covered nothing until you'd racked up a huge deductible -- at which point, I suppose, the month would be over and they'd drop you from the plan. One agent I spoke with said that he considered the catastrophic coverage offered in my parish to be a scam.

In my state, Louisiana, you have two options. Marry someone with a secure job who can get spousal/family health insurance through the job, or you must yourself get such a job. Not a very attractive choice but after a certain age it's fairly unavoidable. I don't advise anyone to rely on the coverage that is offered to self-employed people if they can help it. I'm sorry to sound so cynical but I hope you see why.

[Rick Nebiolo]

[ QUOTE ]
Yeah, in my case it was. Different states have different laws but even though I was perfectly healthy after age 45 there was no plan that I could afford available to me. Also, I was being carried month to month anyway, so it seemed apparent that if I ever had a serious illness like cancer, I would be dropped after the first month.

Catastrophic coverage wasn't much cheaper than PPOs or HMOs, yet, in essence, it covered nothing until you'd racked up a huge deductible -- at which point, I suppose, the month would be over and they'd drop you from the plan. One agent I spoke with said that he considered the catastrophic coverage offered in my parish to be a scam.

In my state, Louisiana, you have two options. Marry someone with a secure job who can get spousal/family health insurance through the job, or you must yourself get such a job. Not a very attractive choice but after a certain age it's fairly unavoidable. I don't advise anyone to rely on the coverage that is offered to self-employed people if they can help it. I'm sorry to sound so cynical but I hope you see why.

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Thanks for the reply.

The realities of "health insurance" for the self-employed, marginally employed, and so on is so important I believe the topic merits a major thread (although I'm not sure what forum it belongs on).

This is especially true with so many people on this forum are considering becoming poker players full-time. You aren't always going to be young and without a medical history.

~ Rick

[fishyak]

In CA, Rick this is dead wrong. All insurance products are labeled and are filed with the Dept. of Insurance. Carriers cannot create sub-pools of experience within a single product.

Self-employed individuals are sold individual health insurance plans. With a total of 2 or more employees, even if the owner is "self-employed" (i.e. not incorporated) group insurance w/o evidence of insurability is available. You do have to be able to document a valid employer-employee relationship to be eligible for group insurance.

The Blues have lots of old plans around, but keep in mind they have been writing coverage for 50+ years. In CA, death spirals occured when you bought "cheap" insurance with relatively unknown carriers or with trusts. But the cost spiral of reliable companies is bad enough. When you cross an age break, every 5 or 10 years, your rates jump again without the annual cost increases.

Also, individual plans in CA by law CANNOT rider pre-existing conditions if you had prior coverage. They can only accept, rate up, or decline. This makes it hard to get approved if you have any kind of significant history.

In fairness, medical CPI is higher than even education CPI and when you add the normal morbidity increase as you age people need to plan for and expect their annual contribution to health costs including their insurance to do nothing but go up under current conditions.

Remember medical care represents overe 14% of our nation's Gross Domestic Product. That expense represents someone's premium. Who is ready to stop going to the doctor?

[fishyak]

Individual plans with reliable big carriers will not be cheap, but can be relied on to provide good coverage. One of my clients, self employed, with an individual policy issued by Blue Cross of CA had a heart transplant and paid only his deductible and co-insurance.

So be careful who you buy from, but going without health insurance is the fastest road to bankruptcy if you have a health problem.