Private Health Insurance Possible?

[skeptik73]

Does HIV disqualify you outright from getting private health insurance?

I'm just trying to get an understanding of how the system works.

Say I'm on ATRIPLA and doing really well, have insurance through my employer.

What if the company I work for suddenly dissolved, and I had to go out and purchase health insurance?  I would hope that at least it would be worthwhile for me to do so -- e.g. that --

(1) something would be available
(2) that if drugs aren't covered for some reason, I could get Atripla for $1100/month that the pharmacy chick thinks it costs instead of the $1700 that I see plastered everywhere now.

Or even better that I could actually get insurance that really truly does cover everything for $1200 or something like that?

Is there any good source for information like this?  Everything I find is about Medicare or just talks in generalities like "too expensive".  No one has any figures anywhere.  And even when its being debated (Obama vs. Hillary) its still in generalities.  Just when is a person "gaming the system".  The talk was all as if we have a responsibility to get insurance.  But just how much are we expected to pay?  No one talks about that.  I probably worry too much, like with everything else.... but really, where's the information at?  For all I know, "the system" is going want me to pay $2000/month for HIV-related care and then another $500/month for everything else.  I guess that's a pretty good absolute ceiling that I've constructed on my own, just from my own understanding.  Even if I had to pay "RETAIL" for everything, and got no discounts from anyone for anything, I'm not "LIKELY" to cost myself anything more than $2500/month healthwise.  So I shouldn't have to pay anything more than that, including co-pays.

But should is not is.  The odd thing about insurance, is the people who its not a good deal for (who pay more than they get) are much less likely to go for it, so the average trends higher than it should.

Anyone know where I can get some real numbers?

[pozniceguy]

I think l that the confusion is deliberate....lots of Political talk but little action...I was in a situation where the company was sold and most of employees were "surplussed" the company insurance was good for 90 days then, if your company has it, there is COBRA ,which is private insurance, which would have cost me $1500/month....a lot of money if you don't have a job...I was approved as a "disability" for SSDI.....so that took care of most meds /medical through various programs...
you should check with the local ASO to find out exactly what is available in your particular area...it varies from place to place all over the country
A good idea to find out before you need it..

Nick

[allopathicholistic]

With the following website http://www.ehealthinsurance.com/ehi/individual-health-insurance.ds  I ran a dummy search in my zip code and the premiums were wild, as in, all over the place. Some were more than double others.

This other site seems to address coverage for individuals in all 50 states: http://www.healthinsuranceinfo.net/guides_map.htm

[skeptik73]

I know about COBRA.  I'm a little freaked out to hear that COBRA could cost anyone $1500/month though.  Is that possible?  Is there any group plan where an insurer really gets away with charging that much?  Maybe if its a plan for seniors?

I actually was still paying for COBRA from my previous job until like two months ago.  It was like $360/month.  Not bad.  I'm covered now by my current employer.

My company would have to offer COBRA.... unless I do something really heinous I suppose, or, much more conceivably, they don't exist anymore.  That's the scenario I'm thinking about. 

Do you have any idea of why/how COBRA could cost $1500/month?  Or was this maybe a different kind of COBRA -- as in, covered under COBRA law, but the company/organization was for some reason exempted from offering true COBRA?  My understanding is that COBRA is NOT an individual/private plan, but rather your continuation in the group plan, at your own expense, for up to 18 months.

I really wouldn't be surprised to be individually quoted $1500/month for an individual plan that was the equivalent of the insurance my employer gives.  Actually, I'd probably be relieved and grateful and amazed that "the system" is so fair.  That I don't have to be completely destitute to benefit from socialist policies.  :-P

The healthinsuranceinfo.net site did answer one question for me -- yes, there will be an option.  But so far as I can tell from what they write -- it would be completely legal for that option to be that I have to shell out thousands per month with a million dollar per year deductible before they pay anything.  But at least I'd be "covered".  Sheesh.

I know its going to vary state to state, but is there anyone out there who is HIV+ and is actually paying for an individual policy?

Oh, and as for "ehealthinisurance.com", I don't see any way to get them to weigh in HIV.  Those premiums that are all over the place are all way too low, at least the ones I see.  I'd be downright shocked to see anything less than $800 as a real figure.  I would guess $1500.  I fear it would be much much higher than that, and I want someone to calm me down.  Heheh.

[Robert]

Here is my take on what Nice (pozniceguy) meant when he said his COBRA costs $1500.  You're right.  On COBRA you pay the going rate that your previous employer was paying for your coverage.  When that period is up and you're on your own, the same coverage transfers from the group rate you had with your previous business to your own individual.  Same coverage.  Different rate.  So when Nick's 'COBRA' expired, the coverage of his individual policy jumped up to $1,500/month.

The same was true for me.  I  had COBRA and when it expired I went on SSDI.  There was no way I could have continued my previous group coverage at an individual rate.   

Along with ADAP, my SSDI covers my current HIV/AIDS expenses. 

So,  yes you can get individual insurance following your COBRA coverage but the price would be exorbitant.

robert

[skeptik73]

Oh I see.  So after the 18 months, he was able to convert the COBRA policy to an individual one costing $1500/month?

That seems fair.

Thanks guys... you've all been helpful.

[skeptik73]

Looking at what Nice wrote again, he's clearly not talking about a period of 18 months.... if the $1500/month is right, either something unusual is at play, or his employer was in some way an exception to CORBA laws.

[pozniceguy]

Hey guys ...sorry for the confusion, The COBRA  was about $400/ mo  the follow on was $1500...with an annual "review"...which means  if you have any claims they screw you even more.
Having the determination of "disabled" and getting on SSDI was a godsend....thenl I was switched to Medicare...( two years on disability and they switch you to Medicare)

Nick

[madbrain]

Oh I see.  So after the 18 months, he was able to convert the COBRA policy to an individual one costing $1500/month?

That seems fair.

Thanks guys... you've all been helpful.

Conversion to an individual policy is not the best option. Once your COBRA coverage is exhausted - either because you have been on it for 18 months, or because your employer no longer exists and thus can't offer it, you can apply for an HIPAA policy, as long as you didn't have a 60 day break in your coverage. HIPAA policies are policies with preset rates and benefits. Every insurer has to offer it. Just call them and ask for their HIPAA rates. HIPAA policies don't consider your individual health condition. Only age is a factor in the cost of the policy. And they have to keep offering them to you forever as long as you don't have a coverage break. This is a much, much better deal than applying for an individual policy and going through a medical review. And they cannot raise your premium every year based on your condition either. You get to pay the same preset HIPAA rate that everyone else pays when their COBRA expires (that may go up a little each year, but not triple).

In California my COBRA last year was about $360 for a few months. The HIPAA rates for my Kaiser HMO are not much higher (for age 32), definitely under $500. That's a policy without an annual deductible and with reasonably low copays, pretty close to what I get through my employer.

[skeptik73]

Thanks MadBrain!  That's the answer I've been searching for.

I wonder how they get away with specifically screwing the 50-64 crowd though.  HIPAA can consider age but not anything else?

Oh, and that's not your real hair color is it?

[madbrain]

Hi,

Thanks MadBrain!  That's the answer I've been searching for.

I wonder how they get away with specifically screwing the 50-64 crowd though.  HIPAA can consider age but not anything else?

Oh, and that's not your real hair color is it?

You are welcome. I don't know why they can consider age. That's something you should ask the lawmakers.
I know they aren't allowed to consider your individual health condition for coverage (no pre-existing condition exclusion) or for setting the rates.
And no, it's not my natural hair color .

[redhotmuslbear]

I don't know why they can consider age. That's something you should ask the lawmakers.
I know they aren't allowed to consider your individual health condition for coverage (no pre-existing condition exclusion) or for setting the rates.

The age consideration was a "gimme" for the insurance industry to go along begrudgingly with HIPAA.  Age factors into other types of insurance, e.g.  automobile, life;  so, they argue that people carrying differing levels of healthcare financial risk based on their age.