Archive for August 29, 2011

My New Health Insurance Blog

I’ve made several posts on Reclaiming Medusa regarding my experience of trying to move my health insurance from Kentucky to Maryland.  In order to make it easier to follow those posts, I started a new blog devoted to that issue only so that those posts don’t get lost between other subject matter on this blog.  The original posts on this blog have been cross-posted there and new posts have been added as well. The new blog is called Pre-Existing Pundit.  Please spread the word!

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Health Insurance–A Tale Of Two States (And A District)

Several days ago, I wrote about the ordeal I have been going through trying to move my health insurance from Kentucky to Maryland.  Because I had a health insurance policy with Anthem Blue Cross in Kentucky, the local Blue Cross was obligated to offer me what is called a guarantee issue conversion policy that does not require underwriting (a good thing since I have several pre-existing conditions that would otherwise make it difficult for me to obtain health insurance).

As I reported earlier, the Maryland conversion policy was almost no insurance at all so one of the options I wanted to explore was what kind of policy CareFirst (the Blue Cross company that serves the Washington, DC metro area, including the Virginia and Maryland suburbs) would offer me if I lived in the District instead of in Maryland. I asked CareFirst to send me the information and when it arrived it was a stunner.  We are talking about maybe a 15 mile difference in location and the same company.  But the policies were radically different, which CareFirst attributes to insurance laws which vary by location.

If you live in Maryland, there is a $250 deductible and  for most things, you pay 25%, the plan pays 75% up to a very unrealistic lifetime maximum of $250,000 (most plans have a $1,000,000 maximum or no limit).  There is no cap on out-of-pocket expenses.  Premium for a 55 year old woman? $443.22, less than my Kentucky policy but for a lot less coverage and substantial risk.

But hop on the Metro and move into the District and wowswers–the guaranteed conversion plan there has a $750 deductible, pays 80% instead of 75% and there is a $3500 cap on out of pocket expenses for an individual.  There was nothing that I saw about a lifetime maximum.  Sounds good so far, but there is a catch and it is a big one–the premium.  Are you sitting down? $1448.  Per month.  Aside from CEO’s of health insurance companies, not too many people can afford that.

For comparison’s sake, it is worth comparing these plans to the Federal Pre-existing Condition Pool, which incomprehensibly also varies from state to state.  In Maryland, the premium is as high as $354/month with a $1500 deductible and an out of pocket limit of $1500.

In the District of Columbia, the Federal Pre-existing Condition Pool is a bit more complicated with premiums as high as $436 and,

In addition to your monthly premium, you will pay other costs. In 2011, you will pay a $1,000 to $3,000 deductible, which varies by your plan option, for covered medical benefits (except for preventive services) before the plan starts to pay. A plan option may have a separate drug deductible. After you pay the deductible, you will pay a $25 copayment for doctor visits, $4 to $40 for most prescription drugs, and 20% of the costs of any other covered benefits you get. Your out-of-pocket costs cannot be more than $5,950 per year. These costs may be higher, if you go outside the plan’s network.

The kicker with the federal plans however is that in order to qualify,

  • You must be a citizen or national of the United States or lawfully present in the United States.
  • You must have been uninsured for at least the last six months before you apply.
  • You must have a pre-existing condition or have been denied coverage because of your health condition.

The first and third points seem reasonable, but requiring that you be without insurance for six months is absurd and causes unnecessary financial hardship and risk to public health.  When you have met the other two conditions, you should be immediately eligible.  There is no other country on earth that would require you to go without health insurance before you could qualify for it and that we, the richest country in the world should do so is beyond belief.

Fortunately for me, there is also a Maryland State pool where six months of state residency is required, but there is no requirement that you be uninsured before qualifying.

I am still trying to determine the best option for myself and will write more about that later. But as I was sorting through the possible scenarios, I wanted to point to the total absurdity that insurance plans should vary so drastically in one metropolitan area.  It is well past time for a federal single payer plan that makes health care expenses equitable, regardless of where you live or work or how healthy you are.

And finally, while Blue Cross guarantees you coverage if you move, that does not mean it will be adequate or affordable or even remotely like the coverage you had before you moved.  The result is that for people like me with pre-existing conditions, Blue Cross is effectively making it so you may have to go without coverage for 6 months because you can’t afford $1448 premiums (or if you live in a state like Maryland, have very minimal and inadequate insurance until you have lived here for six months)and then force you into one of the high risk pools.  Just because you moved.  But somehow I don’t think insurance CEO’s or the elected officials they’ve financed are losing sleep about this.

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Addenda:  Health insurance for all of us is under siege, whether you have an individual policy, obtain coverage through your company or have Medicare or are uninsured, etc.  Here is an important piece about what is happening to workers at Kaiser Permanente, which ironically is a health insurance provider.  The author compares what is happening there with what is happening at Verizon. She makes the point that we need to stand together, a point that should be true regardless of how you get coverage.  A lot less attention has been paid to those of us in the individual market than those who get coverage via employment or Medicare.  We need solidarity regardless of how we obtain health care coverage.

And addenda last–this story has gotten so absurd that I made it a whole new blog of its very own.  You can follow the continuing saga at Pre-Existing Pundit.

 

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Have An Individual Health Insurance Policy And Pre-Existing Conditions And You Want To Move? Good Luck With That.

I recently moved from Louisville, KY to the Washington, DC area.  When you move, a certain amount of hassle is to be expected with such things as phone and cable service, getting new license plates, etc.  In the end those tasks all got done.  Moving my health insurance however, not so much.

The following is the letter I am sending to the appropriate elected officials in Kentucky and Maryland as well as both states’ insurance regulatory agencies and Blue Cross Blue Shield as well as health insurance reform advocates.  It documents the infuriating, scary, time-consuming and unconscionable experience I have had trying to move from one state to another without losing adequate health insurance.  When I receive responses, I will post them as well.

Dear _________,

I recently moved from Louisville, Kentucky to the Washington, DC area to better facilitate my work as a political activist and writer.  For a long time, I was afraid to make this move because of the risk of losing my health insurance, an individual policy through Anthem Blue Cross Blue Shield. Due to several health problems, I was afraid I would not be able to obtain insurance elsewhere.  Yes, there are now high risk pools but the Federal pools require that you be uninsured for six months before you qualify and obviously that would be a substantial risk if you have a major illness or accident during that period.

Then I found out that Blue Cross has an arrangement called an intra-association transfer group conversion which means that the Blue Cross company wherever you live has to offer you an insurance plan that does not require going through underwriting although it may have less benefits and cost more.  Armed with that information, I wanted to find out what coverage might be available to me depending on if I lived in the District or in a suburb in Maryland or Virginia.  Even though I’m a writer with more than passable research skills, I could not get anyone at CareFirst, the Blue Cross company for the DC metro area to give me that information.  The Sales Department wouldn’t talk to me because they only handle policies that go through underwriting and Customer Service said they couldn’t give it to me until I actually transferred my policy.

After multiple conversations and a lot of hold time, I finally called my agent in Louisville, who had always been quite good about answering my questions.  She sent me information about an HMO plan that CareFirst offered in DC that had open enrollment, no underwriting and better benefits and lower cost than the policy I had in Kentucky. I was ecstatic and relieved that I could move without jeopardizing my healthcare or financial well-being. At no point did she tell me that this was only available in DC and not in the surrounding suburbs in Maryland and Virginia or that the plan was not always open to new members.

After finding a house to rent in Rockville, MD, I was finally able to move.  When I transferred my insurance however, I got a major shock.  The policy my Anthem agent had told me about was only available in the District.  In Maryland, the policy offered me cost much more for a lot less coverage.  The terrifying part of the policy is that it has a $250,000 maximum benefit.  If you have a major disease or accident, that would be grossly inadequate. 

While this policy is completely different than my old policy and written by a different company, apparently it does not have to comply with the new healthcare rules on lifetime limits.  Getting a more comprehensive policy from CareFirst  will require underwriting and when I discussed this with a customer service representative at CareFirst, I was told that because of my health, I would be denied.  What I find incredible is that I’ve been repeatedly told that because each Blue Cross is a different company, they don’t have to offer the same coverage as my old Blue Cross company did but they still can get away with offering me a ridiculously low minimum because the policy is considered to be grandfathered, not a new policy.  It is outrageous that they can get away with this.

As I understand it, once I have lived in Maryland for six months, I will qualify for the Maryland state high risk pool as long as I apply for an underwritten policy and am denied or if the policy I’m offered is more expensive than what Maryland offers in the pool which would certainly be the case with the policy that CareFirst has given me. If however I were to have a catastrophic health event before that, once the CareFirst policy was used up, my medical care could bankrupt me.

What I find the most disturbing is that the misleading information that I was given by my Anthem agent has, at least in the short run, substantially raised my health care costs.  Had I known that while CareFirst administers Blue Cross plans in the entire DC area, the plans vary substantially, I would have made sure to take that into account before choosing exactly where to live.

It is appalling that, for people who buy their own insurance on the individual market at great expense (and this impacts women the most since they are less likely to work for companies that offer health insurance), insurance companies can decide whether you can move without jeopardizing your healthcare and financial well-being.  Given my health history, it would not surprise me at all if Anthem deliberately misled me about what would be available to me to get me off their policy.

After finding out that the group conversion policy offered by CareFirst in Maryland was seriously deficient, I spent a great deal of time on the phone trying to find out what my best course of action was.  Even though they would be involve huge cost, the options as I understand it include:

 

  1. Break the lease on the house I am renting and move into the District.  The fly in that ointment is that sometimes the Open Enrollment HMO that CareFirst offers there closes to new enrollment.  CareFirst is sending me information about the group conversion plan they offer in DC so I can compare that to the Maryland policy (information I was not able to get before I moved).  If it is better, I may consider doing this, although the expense would be huge.
  2. Apply for an underwritten policy and if rejected, which I’ve been told will likely happen, apply to the pool after I’ve lived here six months. It is however abhorrent that the simple act of moving effectively forces people into the high risk pool.  There is a lot of talk about the individual mandate that would require people to buy insurance.  Given the way insurance companies are treating people now should make it quite obvious that this is not going to be a good idea.
  3.  Maintain a residence in Kentucky with a second home in Maryland.  Had I know that I would not be given adequate insurance here, this would have been the best option even though it wasn’t really what I wanted to do and would be expensive.  Revisiting that route however would be a substantial hassle and expense at this point and given the double digit increases and continual decrease in coverage that I’ve gotten from Anthem over the years, there is no guarantee that this would be a good idea.
  4. Marry someone with great family health insurance benefits.
  5. Find a job with health care benefits even though I’ve been self-employed for almost 30 years.
  6. Move to another country.

I have not yet determined the best course of action; fully understanding the options takes a lot of time.  In a bizarre side note, when I called the Maryland high risk pool helpline, the woman I spoke to said that she saw that I had just spoken to someone else in her office a little while ago.  When I said that no, I had spoken to someone at CareFirst, she told me the office they worked for answered questions for both.  After asking her a few questions about the Maryland program I asked her something about the CareFirst policy.  She told me she couldn’t answer that while on the Maryland phone but if I called her at her CareFirst extension, then she could answer the question.  Given that CareFirst has de facto made it quite clear that they have no plans to sell me an adequate insurance policy, it would seem to me that there is a major conflict of interest here.

On a personal basis, I am angry and scared.  Because I work for myself and foot my own insurance bill, and because I have health problems should not be an excuse for being totally screwed because I want to move.  This would not happen if we had a single payer health plan.  It is immoral and unconscionable. When Congress was having their epic debate about health care reform, I wrote several times about the lack of attention to the problems faced by those on the individual market.  Despite all of my efforts, I am now mired in the impact of the neglect to address this issue.

I would appreciate any help you can give me in obtaining adequate, affordable insurance.

Sincerely,

Lucinda Marshall

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Former health care executive and Gov. Rick Scott (FL)

 

“The advocacy group Physicians for a National Health Program estimates that “private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.”” http://www.stltoday.com/news/opinion/editorial/article_97afa329-42f8-5f12-adb0-97fa305c3e4b.html

(Former health care executive) “Gov. Rick Scott, a critic of the federal health care overhaul, is paying less than $400 a year for health insurance for himself and his wife.”
http://www.dailykos.com/story/2011/08/11/1005803/-Rick-Scott-Getting-Govt-Provided-Health-Insurance-For-Less-Than-$400-Per-Year

 

 

 

 

 

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