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 :).