Until I found myself without a group plan, I never really thought about healthcare. I was blissfully oblivious to the trainwreck they call US healthcare. You either get it through work, or you're on Medicaid, right?
I didn't realize people (especially ME!) could fall through the huge, gaping cracks.
I have a family member born with a heart problem that randomly requires surgery. She's been on Medicaid her entire life. That's right, welfare and Medicaid. She never worked, or worked shady situations for cash so she could stay on the dole. I always thought she was lazy, and a leech. But I get it now.
If you aren't lucky enough to have a good group plan, your pre-existing condition will make you bankrupt, unless you are on Medicaid where it is so very free. She knew she couldn't afford to risk her health by working. We, however, decided to try to accomplish something and do something and build a business. Now, she has magical, free healthcare, I am uninsurable, and everything we've built is at risk.
Wow, did I ever get some great comments on my grave health that prevented me from getting a reasonable health insurance plan. Really, check them out here.
The one that really got me was an anonymous commenter who said when you gamble with your health insurance, you're always "all-in." That's exactly it. With our health insurance, we risk our entire net worth, plus our business. It's all-in. So, yea, maybe the risk is low, maybe really low. But it's all in! It's more risky than buying a house we can't afford or buying a maid or anything else. It could break us.
For now, we're splitting the difference (as suggested by chacha). I am staying on COBRA for $650/month. Senor Dog's new HDHP is 50$/month with a 5K deductible. Can you even believe that? His exact same plan for a woman two years younger than him is $180/month. They approved him in 1 day, didn't even exclude his eczema.
The Texas Risk Pool (never thought I'd be there) is $300/month for me, but, get this, it excludes pre-existing conditions!!! What good is the high risk pool when it excludes all of it anyway???
We'll re-evaluate in six months. Maybe I'll have a corporate job by then. Maybe healthcare will be totally different. Maybe we'll use a group of some sort. We'll figure it out then. Something should change in six months, either in politics, or hopefully in the Doghouse.
Thursday, July 30, 2009
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8 comments:
In my state, preexisting conditions cannot be excluded from coverage if you had insurance for the last twelve months. Does this apply to the TX Risk Pool?
I found this on the site. http://www.txhealthpool.com/eligibil.html
The Preexisting Condition limitation does not apply if an individual was continuously covered for an aggregate period of at least 12 months under Creditable Coverage that was in effect up to a date not more than 63 days before the individual's effective date of coverage through the Health Pool (excluding any waiting period under the prior health coverage) provided that the individual's application for coverage through the Health Pool was made no later than 63 days following termination of the prior health coverage.
Please don't snap off my head BUT are you sure about that pre-exisiting clause? Here in NY if you have had continual insurance for at least the past year, and your medical insurance has not lapsed for 63 days, you can get a new health care medical insurance plan with the pre-exisiting clause waived.
Just saying.
I find it odd that you don't have the same thing in Texas. Also, do they have a waiting period for the pre-exisiting clause? Sometimes, like a year or so?
You have to understand (and I am not defending insurance companies) that they have to protect themselves from people who contract a life threatening disease, sign up for health care, get the treatment, then once cured, drop out and cancel. That's a gross loss margin. Questions, such as this, have been raised for the govt plan. What's to stop people from doing the same thing to the govt, thus bankrupting them? That's why medical insurance will be mandatory. The govt is betting on all the young, healthy people subsidizing the sicker people.
Anyway, I'd double check on that pre-exisiting clause and let the insurance co know you have already had insurance for the past few years and your coverage has not lapsed. Worth a try.
I think that you made the right decision. Its definitely not worth gambling on your health.
From reading the Tx health pool quickly it looks as if you wouldn't be eligible just because you are eligible for COBRA. Once COBRA expired then you would be eligible. Did I read that correctly?
@ Anon -- Yes, I think you're right. Good thing I can afford COBRA, I guess.
Wait, I wrote that Anon post but I didn't mean to make it Anonymous. Sorry!
Once we got insurance through the husband's work, and it wasn't even self-insurance but it was cheap-ass insurance, which is almost the same.
They caught wind of the fact that I had been to a cardiologist in the prior year due to heartbeat irregularities (which turned out to be a benign thing that everyone has - I was under stress and basically flipped out over palpitations, but was given a clean bill of health with a strong, perfect heart.)
I had to agree to a clause that excluded any heart problems. I remember a lot of "investigations" about what could possibly be wrong with my heart when there was and is NOTHING wrong with it.
I understand your frustration, Dog.
@ Morrison. I have no idea. I think it would be easier to read ancient Greek than healthcare regulations.
My understanding is that Texas doesn't allow EXCLUSIONS but that waivers are not exclusions. Nice, huh?
Sounds like a reasonable approach ...pretty much ... as you know from my original post on your earlier thread, I'm a big fan of group coverage for the legal rights it confers; is Sr. Dog's HDHP group? Or individual? But either way, you've avoided the exclusion, which I think is important, so congratulations on that!
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