by isabelfern » Mon Apr 02, 2012 06:27 pm
I am a small business owner and I have an individual health insurance, with a very high premium. I have the option of joining my husband's excellent insurance policy at the company where he works, with a group rate, which is much lower.
However, my husband will eventually stop working for somebody else and have his own company too, in a few years. At that point I will be forced to get individual health insurance again.
I just called my insurer and they said that in the future, if when I tried to get a new individual policy, I had been sick, such as a broken ankle or cancer, they may exclude payment for those treatments, or just not take me as a member at all. I asked about HIPAA laws and they said they only apply to people under 19. They said if I keep making payments on my individual policy they would not be able to decline coverage.
Is there a way I can join my husband's group policy with a much lower rate and still have peace of mind that in the future I will be able to get coverage under an individual policy regardless of health status, or should I just continue with my individual policy? Maybe under the current government new health law?
Thanks in advance for your input.
Isabel
However, my husband will eventually stop working for somebody else and have his own company too, in a few years. At that point I will be forced to get individual health insurance again.
I just called my insurer and they said that in the future, if when I tried to get a new individual policy, I had been sick, such as a broken ankle or cancer, they may exclude payment for those treatments, or just not take me as a member at all. I asked about HIPAA laws and they said they only apply to people under 19. They said if I keep making payments on my individual policy they would not be able to decline coverage.
Is there a way I can join my husband's group policy with a much lower rate and still have peace of mind that in the future I will be able to get coverage under an individual policy regardless of health status, or should I just continue with my individual policy? Maybe under the current government new health law?
Thanks in advance for your input.
Isabel
Posted: Tue Apr 03, 2012 11:49 pm Post Subject:
Hi Isabel,
Great questions, and unfortunately, they cannot be answered fully until the U.S. Supreme Court has their way with ObamaCare and the individual mandate. There's the possibility that the whole, darn thing may unravel in the near future.
Under current legislation, as of 2014 no health insurance plan will be able to exclude a person based on their pre-existing conditions. They will be required to accept all applicants, regardless of medical problems or conditions and cannot exclude coverage based on medical history or preexisting conditions of the insured.
In the meanwhile, you have a couple of choices. Being eligible for your husband's group insurance could be a very good thing: group contracts almost always have better coverage and lesser premiums per person. If you join your husband's group plan and your husband later leaves his workplace, there's the possibility that you may be able to continue coverage under COBRA or your state's continuation and conversion rules. All states have laws and rules that address this kind of thing.
If the PPACA (Obamacare) stays in place, you'll have no problem getting coverage when, and if, the group coverage ends. On the other hand???
Finally, the reference to HIPAA and age 19 is kind of, well, off-based. I think whoever gave you HIPAA information kind of confused a couple of things. Children under the age of 19 have pretty much always been under a different set of rules in just about every state. I think that what that person was referring to was the PPACA requirements that insurers accept all applicants for individual insurance coverage under the age of19 without imposing preexisting conditions restrictions or refusing to issue a policy.
InsTeacher 8)
Posted: Wed Apr 04, 2012 04:54 am Post Subject:
As InsTeacher hinted at, if you are a member of a group, when your group eligibility ends (before or after COBRA continuation) you have a state-mandated right to convert to an individual policy with the same insurance company without proof of insurability. Just have to pay whatever the individual premium is, and there will be no preexisting condition exclusions,
If Obamacare is trashed by the Supreme Court in June, it will likely take Congress years to replace it with something workable. However, I think the insurance companies will steal some of their thunder by figuring out how to provide coverage to persons with preexisting conditions at more affordable rates.
Unlike Obamacare, they will have to pay substandard premiums, but they will not be declined for coverage. Insurance companies with a broad base of healthy younger folks (like our demographics here in Southern California) have already discovered they can mostly make that work in their Senior HMO programs (Medicare Advantage) when the government kicks in about $500 per month. So if other non-seniors are willing to pay about that much, it should work for them, too.
PPACA is an abomination. It was totally misrepresented to the American public. Not that it doesn't have some good points, but as a whole, it is unworkable and is destined to put insurance companies out of business -- all in the name of "COMMERCE" at the Solicitor General argued last week.
Without the insurance companies, there can be no commerce. Without the insurance companies, you have Medicare. With Medicare, you have impending disaster -- to the tune of nearly a $120 trillion unfunded liability today and into the future. There is not enough money in America to pay that bill today.
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