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Author Topic: Govt. Pre-Existing Condition Healthcare Plans  (Read 1455 times)

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Offline Dennis

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Govt. Pre-Existing Condition Healthcare Plans
« on: July 01, 2010, 08:16:26 PM »
The government healthcare website went live today for those with pre-existing condition. Anyone who applies before the 15th should have coverage beginning August 1st. You can't apply online until August. However, there is an application which can be downloaded and mailed in.  From the articles I have read thus far, premiums man not be cheap.


Offline J.R.E.

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Re: Govt. Pre-Existing Condition Healthcare Plans
« Reply #1 on: July 01, 2010, 08:29:35 PM »

Also read this on The ST. Pete times page today :


Floridians who opt into the new federal high-risk health insurance pool will pay pricey premiums

By Richard Martin, Times Staff Writer
In Print: Friday, July 2, 2010

Help is on the way for people who are uninsured because of a pre-existing condition such as heart disease, diabetes, cancer or AIDS if they can afford it.

Floridians can now apply for health coverage through a new federal pre-existing condition insurance plan, also known as a high-risk pool. It is one of the first programs to take effect under the new health reform law.

The plan is a temporary fix that's supposed to cover this high-risk group until Jan. 1, 2014, when more permanent components of the health reform law take effect. In 2014, insurers will no longer be able to exclude people with pre-existing conditions, and a new health insurance exchange is expected to offer more affordable premiums for them.

But even as the new program launches this week, many questions remain. It's unclear at this point whether the program will be able to accept everyone who applies, since no one knows how long the $5 billion set aside for the program will last. And there's concern that many will not be able to afford the premiums, which in Florida can be more than $900 a month, depending on your age and health condition.

Here are the basics:

What is a pre-existing condition?

It's a health condition, disability or physical or mental illness that you have before you enrolled in a health insurance plan.

Who can apply for coverage?

You must be a U.S. citizen or legal U.S. resident and have been previously denied insurance coverage because of a pre-existing condition. And you must be uninsured for at least six months before applying. State health officials estimate that as many as 760,000 Floridians meet the criteria.

How do you apply?

You can download and print out an application in English or Spanish at a newly created website, www.healthcare.gov. Applicants must include a copy of a letter from an insurance company denying coverage or excluding coverage for a medical condition. U.S. noncitizen nationals must include a copy of a document that confirms their status, such as a U.S. passport, and a copy of their immigration documents. You must mail in your completed application. But starting on Aug. 1, applications can be filled out online at the same website. If you don't have access to a computer, call (866) 717-5826.

Once your application is accepted, you will be notified by mail with information about your premium, and you'll also receive your first monthly bill.

How much will premiums be?

Premiums must be the same as the standard individual health insurance rates in each state. In Florida, that ranges from about $140 to $984 a month, depending on the type of plan and the applicant's age. Federal health officials estimate the premium for a 50-year-old in Florida will be between $552 and $675 a month for a plan that includes deductibles of $2,500 for in-network and $3,000 for out-of-network care. Once you meet the deductible, you are responsible for a $25 co-pay and 20 percent of in-network and 40 percent of out-of-network costs.

The plan will cover primary and specialty care, hospital care and prescription drugs.

How soon will coverage begin?

If you apply and are approved for enrollment by July 15, your coverage will begin Aug. 1. Generally, applications received on or before the 15th of the month will take effect on the first day of the next month. Those received after the 15th of the month will go into effect on the first day of the following month.

Will there be limits to the number of people who can enroll?

There are no plans to limit enrollment. But the law does give the secretary of Health and Human Services the ability to impose limits if necessary. Federal health officials expect the program to cover 200,000 people nationally at any given point.

How far can $5 billion go?

One of the biggest criticisms of the plan is that $5 billion will not be enough to cover everyone who is eligible and can afford the coverage until 2014. "The consensus of opinion is that it's underfunded," said Mary Beth Senkewicz, deputy commissioner for life and health with the Florida Department of Health.

Cost was a major reason Florida opted not to run its own high-risk pool plan, choosing instead to have the federal government run it. Twenty-one states have gone this route.

But Richard Popper, deputy director of a new insurance office at the federal Health and Human Services department, said $5 billion can be sufficient if managed properly. The federal government can work with states to adjust benefits and co-pays to their plans. And even though each state is allotted a share of the $5 billion (Florida's is expected to be about $351 million), money can be shifted from states where there isn't high participation, Popper said.
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 25 mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg






Diagnosed positive in 1985,.. In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started on  HAART on October 24th, 2003.

 As of 9/16/16,  t-cells are at 501,   Viral load remains <40

Current % is at 12%

 65 years young.

Offline Hellraiser

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Re: Govt. Pre-Existing Condition Healthcare Plans
« Reply #2 on: July 01, 2010, 08:32:03 PM »
Why is it an application?  What would be grounds to turn you down if you can afford to pay the premium?

Offline Dennis

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Re: Govt. Pre-Existing Condition Healthcare Plans
« Reply #3 on: July 01, 2010, 08:40:13 PM »
What's also troubling is you have to include a letter from an insurance company showing that you have been denied coverage more than 6 months ago. Now, I've applied for private insurance years ago to numerous companies, and gave up after I realized I was fighting a losing battle. Do you think I saved those denial letters? I don't even think I received on from most of them. Once again, persons with pre-existing conditions will continue to be denied coverage because they fail to have this letter dated more than 6 months ago.

Offline Dennis

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Re: Govt. Pre-Existing Condition Healthcare Plans
« Reply #4 on: July 01, 2010, 08:41:16 PM »
Why is it an application?  What would be grounds to turn you down if you can afford to pay the premium?

If you can't afford the premium they refer to apply for medicaid.

Offline RAB

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Re: Govt. Pre-Existing Condition Healthcare Plans
« Reply #5 on: July 01, 2010, 10:17:43 PM »
I'm actually in one of these high risk pools.

I had to demonstrate denial from the carriers in my state.

It really wasn't all that difficult. 

Applied for individual coverage, received a rejection (duh), and forwarded it to my state's high risk pool.

That was it, easy, schmeezy.

My cost is no where near some of the figures I've been hearing about.

My experience with being in a high risk pool has been pretty positive.

And to someone who referred to it as "Govt. Wellfare" (I think it was a different thread), in my state not one dollar of tax payer money goes toward the high risk pool.

The cost comes from two sources.

1.  Premiums.

2.  Assessment to insurance companies doing business in my state based upon their % of market coverage.  It adds approximately .25 cents per month per members premium

compare this to the cost of individuals who have no health insurance.  They present to the emergency room (the most expensive place to receive health care), many of whom could be adequately treated in a less expensive setting, and who pay nothing.  Those costs are passed onto those who have health insurance. 

This health insurance reform leaves much to be desired, there will continue to be broadly worded proclamations about what it does and doesn"t do.  But with whatever shortcomings it has, it is a start.

I think we need to focus on that.


Offline PeteNYNJ

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Re: Govt. Pre-Existing Condition Healthcare Plans
« Reply #6 on: July 02, 2010, 12:34:11 AM »
Why do you have to be without healthcare for 6 months?   Are those 6 months a cross your fingers and hope situation?  Seems a bit silly.


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