Saturday, July 16, 2011

Insurance Crisis

We recently suffered an insurance crisis. This won't be relevant to our non-U.S.-based readers, but I hope some of you can learn from my experience!

I was insured by Anthem (Blue Cross Blue Shield) for three years while we lived in St. Louis, through my employer. It was good coverage, high deductible, but I wasn't paying any premiums, so it worked out OK. Last spring I quit work as we prepared to move and I was on COBRA for several months. My husband began a PhD program and we signed both of ourselves up for one-years' worth of coverage on the student health plan, running from August to August. I also applied for Medicaid to cover our son and my pregnancy costs. I had United Healthcare Student Resources as my primary insurance and Medicaid as my secondary (being covered by two policies was actually a big headache to me, the insurance companies, and my doctors, but that's another blog post). When Medicaid ran out for me, both boys were still covered by it and I was covered by UHC StudentResources.

We received a letter from the school my husband attends during the first week of July that indicated dependent coverage on the student plan would be discontinued. This news = disaster for us. When I left my job in St. Louis, I knew that I wouldn't be eligible for most individual plans, and the availability of group coverage was a BIG part of the reason that we felt comfortable taking the plunge back into school. Even without 14K in healthcare costs, we are living off savings and shacked up with my parents.

So I started investigating my options (and my husband started thinking about what sort of full-time work he might like to begin immediately and do for the next 30 years). Turns out there aren't many, and they are all EXPENSIVE. If I am HIPAA-eligible, a proposition that's truth is yet to be confirmed or denied by an underwriter, the options are expanded, but the cost problem remains. I crunched some numbers, both to figure out exactly how much money we'd be out next year and to figure out exactly how much it would cost us for me to go without insurance (a possibility that neither my husband nor I relished, but really had to at least explore as an option).

If I paid for all my routine diabetes-related expenses (pump supplies, prescriptions, doctors' visits, and lab work) out-of-pocket, it would cost us $7,500. I would encourage every Type I diabetic to do this. It made me not so terrified of the costs associated with diabetes, and I'm really grateful that I now know. Turns out that actual care from doctors PALES in comparison to test strips. $3,000 for a years' worth of One-Touch Ultra test strips (I check my blood glucose 8 times a day)! Crazy! Anyway, that grounds me in the reality of what it costs for my medical care in one year. And that's only anticipated expenses - it doesn't include other illnesses or accidents. Being a very healthy Type I diabetic, I don't think I should have to pay more than $9,000 total to account for the risk of something crazy happening to me.

Last year, including insurance premium, deductible, co-pays, and coinsurance, we paid $3,600 for me (no wonder we're in the healthcare mess we are now...whose paying the extra $4,000 per year?! I guess now I will be paying for it!). When I began looking at HIPAA guaranteed-issue plans from Anthem and Aetna, it was going to cost a minimum of --- drum roll, please --- $13,600! That's right. A full $10,000 more each year, at a minimum. Yikes. What surprised me most was that there literally were not any options between my group coverage ($3,600) and a guaranteed-issue individual plan for someone with a pre-existing condition ($13,600). That news hurt!

...But it gets better (or worse, depending on how you look at it). I'm not even sure that I'm eligible for HIPAA guaranteed-issue plans. An Anthem representative and an employee of our state's department of insurance told me that I would not be, but United Healthcare seemed to think I would be. The reason for the discrepancy is that I've been covered on a student plan, rather than an employer plan. HIPAA language states that everyone HIPAA-eligible must have been on a "group plan", and the examples that the law gives include employer plans but not student plans. We will have to see what the underwriter thinks.

Failing a HIPAA guaranteed-issue plan, here are my only options:

BlueCross BlueShield Open Enrollment. BXBS has an "open enrollment" plan and the premium is literally just based on your age. There's no underwriting, they don't turn down anyone, and they don't cover pre-existing conditions for the first 10 months. Almost $500 per month premium, but decent coverage. However, because diabetes isn't covered, I would end up paying over $13,000 in the first year. Thereafter, I would pay about $8,000.

PCIP. In other words, the federal government insurance program recently-instituted by the PPACA. Yuck. The suckiest thing about this plan is that, despite President Obama's executive order to the contrary, it sounds as though abortions may end up being covered by these insurance plans (I read an article in the most recent issue of First Things describing a clever way of getting around his executive order, which carries little legal weight in contrast with the statutory language of the law itself. And pro-choice lawyers are clever...see Roe v. Wade). The second suckiest thing about this plan is that you have to be without coverage for 6 months before you are eligible. I just don't really want to go there.

And, by the way, none of these plans cover maternity. Neither the HIPAA guaranteed-issue plans, and not the open enrollment plan. I wasn't able to get good enough info on the PCIP, but I'd be willing to bet it doesn't cover pregnancy/childbirth costs. Apparently insurance companies and the government think they know better than women themselves how to define "too sick" and "too poor" to have a baby. If I weren't eligible for Medicaid, I would be begging on the doorstep of every homebirth midwife I know, pleading my case for a chance at an out-of-pocket homebirth. As it is, if I turn up pregnant this year, I will probably be seen by a maternal-fetal specialist on the baby-factory assembly line.

We'll see how it shakes out. I'll keep you posted (in case any of you are actually interested in this saga...based on the number of comments we get I'm thinking that no one actually finishes reading my posts :).

6 comments:

  1. Please keep updating! We're in a similar situation as my husband will be finishing his active duty army contract next March, and we don't have a clue what we'll do for insurance! He'd like to go to school, but the school doesn't offer insurance.

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  2. I will keep you updated! My suggestion is that if your current insurance offers COBRA, take it. It will be an expensive premium, but good coverage is just going to cost you a lot these days. After COBRA runs out (18 months), you will be eligible for HIPAA guaranteed-issue individual plans and they will have to cover your diabetes.

    When in doubt, call the Department of Insurance for your state. Ours was very helpful, and they will be able to guide your decision-making.

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  3. From what you have said regarding abortion & the government health plan, I understand that you are passionate that any pregnant woman should carry the baby to term. That is fine, I respect your right to feel that way, although I feel a woman has the right to her own reproductive decisions.

    This includes the right to have choices in pregnancy/birth health care, choices in contraceptives, and the choice to end a pregnancy.

    I'm diabetic. I'm infertile. My health insurance, which is a personal pay plan from Blue Cross Blue Shield, will only pay some costs related to pregnancy & birth. It will not cover fertility treatments. It will not cover contraception costs. It will not pay abortion costs. It will also not pay costs associated with diabetic complications in pregnancy/birth.

    My point, is that shouldn't reproduction costs be covered? Just plain covered? Then those who say that diabetics should have children would be lumped in with those who believe there should be a limit to the number of children a woman is allowed to have and with the people who believe that my cousin who was raped at 14 should have been forced to carry her child to term.

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  4. Wendy - perhaps I've gotten in over my head here and maybe I should leave the debate about health care to other bloggers. But my main point is that I don't want to be a part of a health plan that pays for certain reproductive choices (abortion, among others).

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  5. Wanted to chime in on a couple notes.

    First, I agree about joining in on plans that cover procedures I don't want to contribute to. After seeing the debate on the federal financing, I looked into our group plans. Insurance also pays for these with communal funds. It's a hard one to deal with. It reminds me of Emerson's protests about the Mexican American War and Dorothy Day's not wanting to fund war efforts she disagreed with -- the only way to really deal with it is to be so poor you simply don't pay federal taxes, but then the systems are so entangled that it's hard to keep clean hands no matter what you do. I wish we could return to the times when insurance was for catastrophic costs, and most costs were out of pocket. If you could get the costs down by taking out the middle man, I think even Type 1 diabetics would come out ahead under that system. But it's not an option any more.

    Wanted to mention that we use a state sponsored high risk pool for our daughter. These will stop existing soon most likely, after the federal laws kick in. But for now we can get coverage for her for about $260 a month. Pretty high copays, but much is covered and she's protected against a huge hospitalization bill.

    Also, our family has a high deductible plan (the rest of us). To balance the risk, we have an accident only plan for $50 a month. Since it's only for injury, not illness, pre-existing conditions don't matter. So if one of my other kids gets a diagnosis of diabetes, we pay $10,000 in costs and after that all is covered for the year. But if I get into a car accident, our regular insurance still wants me to pay up to the $10,000 deductible but our accident insurance will then reimburse that.

    Hope you find good answers.

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  6. Thanks for your thoughts, Lisa. The way money moves around is very complicated and I should probably hold my tongue when I don't know enough to speak about it competently. Fortunately (and unfortunately), most of the plans I'm currently looking at don't cover any reproductive costs (contraception, abortion, fertility or pregnancy/childbirth).

    Do you know whether most states have a high-risk pool like the one your daughter is a part of?

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