Health Insurance–A Tale Of Two States (And A District)

Several days ago, I wrote about the ordeal I have been going through trying to move my health insurance from Kentucky to Maryland.  Because I had a health insurance policy with Anthem Blue Cross in Kentucky, the local Blue Cross was obligated to offer me what is called a guarantee issue conversion policy that does not require underwriting (a good thing since I have several pre-existing conditions that would otherwise make it difficult for me to obtain health insurance).

As I reported earlier, the Maryland conversion policy was almost no insurance at all so one of the options I wanted to explore was what kind of policy CareFirst (the Blue Cross company that serves the Washington, DC metro area, including the Virginia and Maryland suburbs) would offer me if I lived in the District instead of in Maryland. I asked CareFirst to send me the information and when it arrived it was a stunner.  We are talking about maybe a 15 mile difference in location and the same company.  But the policies were radically different, which CareFirst attributes to insurance laws which vary by location.

If you live in Maryland, there is a $250 deductible and  for most things, you pay 25%, the plan pays 75% up to a very unrealistic lifetime maximum of $250,000 (most plans have a $1,000,000 maximum or no limit).  There is no cap on out-of-pocket expenses.  Premium for a 55 year old woman? $443.22, less than my Kentucky policy but for a lot less coverage and substantial risk.

But hop on the Metro and move into the District and wowswers–the guaranteed conversion plan there has a $750 deductible, pays 80% instead of 75% and there is a $3500 cap on out of pocket expenses for an individual.  There was nothing that I saw about a lifetime maximum.  Sounds good so far, but there is a catch and it is a big one–the premium.  Are you sitting down? $1448.  Per month.  Aside from CEO’s of health insurance companies, not too many people can afford that.

For comparison’s sake, it is worth comparing these plans to the Federal Pre-existing Condition Pool, which incomprehensibly also varies from state to state.  In Maryland, the premium is as high as $354/month with a $1500 deductible and an out of pocket limit of $1500.

In the District of Columbia, the Federal Pre-existing Condition Pool is a bit more complicated with premiums as high as $436 and,

In addition to your monthly premium, you will pay other costs. In 2011, you will pay a $1,000 to $3,000 deductible, which varies by your plan option, for covered medical benefits (except for preventive services) before the plan starts to pay. A plan option may have a separate drug deductible. After you pay the deductible, you will pay a $25 copayment for doctor visits, $4 to $40 for most prescription drugs, and 20% of the costs of any other covered benefits you get. Your out-of-pocket costs cannot be more than $5,950 per year. These costs may be higher, if you go outside the plan’s network.

The kicker with the federal plans however is that in order to qualify,

  • You must be a citizen or national of the United States or lawfully present in the United States.
  • You must have been uninsured for at least the last six months before you apply.
  • You must have a pre-existing condition or have been denied coverage because of your health condition.

The first and third points seem reasonable, but requiring that you be without insurance for six months is absurd and causes unnecessary financial hardship and risk to public health.  When you have met the other two conditions, you should be immediately eligible.  There is no other country on earth that would require you to go without health insurance before you could qualify for it and that we, the richest country in the world should do so is beyond belief.

Fortunately for me, there is also a Maryland State pool where six months of state residency is required, but there is no requirement that you be uninsured before qualifying.

I am still trying to determine the best option for myself and will write more about that later. But as I was sorting through the possible scenarios, I wanted to point to the total absurdity that insurance plans should vary so drastically in one metropolitan area.  It is well past time for a federal single payer plan that makes health care expenses equitable, regardless of where you live or work or how healthy you are.

And finally, while Blue Cross guarantees you coverage if you move, that does not mean it will be adequate or affordable or even remotely like the coverage you had before you moved.  The result is that for people like me with pre-existing conditions, Blue Cross is effectively making it so you may have to go without coverage for 6 months because you can’t afford $1448 premiums (or if you live in a state like Maryland, have very minimal and inadequate insurance until you have lived here for six months)and then force you into one of the high risk pools.  Just because you moved.  But somehow I don’t think insurance CEO’s or the elected officials they’ve financed are losing sleep about this.

*********

Addenda:  Health insurance for all of us is under siege, whether you have an individual policy, obtain coverage through your company or have Medicare or are uninsured, etc.  Here is an important piece about what is happening to workers at Kaiser Permanente, which ironically is a health insurance provider.  The author compares what is happening there with what is happening at Verizon. She makes the point that we need to stand together, a point that should be true regardless of how you get coverage.  A lot less attention has been paid to those of us in the individual market than those who get coverage via employment or Medicare.  We need solidarity regardless of how we obtain health care coverage.

(Cross-posted from my personal blog, Reclaiming Medusa)

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  1. Lucinda, thanks for writing this blog. The entire health reform issue has gotten lost in concerns about jobs and the economy. There has been pitiful little thought leadership about why real health reform–universal coverage, single payer–would benefit both the jobs situation and the economy overall. Aside from the personal stress and strife you have described–and they are surely significant–people need to understand that making sure all Americans have access to decent health care all the time is not a net cost but a net gain for all.

    • Gloria, thank you for your kind comment and I completely agree, it is a much bigger problem than just me.

    • b
    • August 23rd, 2011

    As absolutely unnecessary, unhealthy and down right dangerous the 6 month wait is, this is an improvement over what was in place before. My daughter, a Type 1 diabetic who was to ill to enroll in college, was 18, uninsured and uninsurable for almost 6 years until the PECP came into being. Uninsured for 6 years ?? We didn’t keep the rejection letters from the insurance companies. And even though it had been 6 years, she had to go through the rigamarol of being rejected yet again. However, she is now covered under that program. Her dad and I kept her alive during those 6 years. To the tune of, on average, $23,000 a year. And because she was an adult, we couldn’t take a tax deduction. So, in effect, it was a $23,000 income reduction for us. Each. Year. Because without medication, supplies, medical supervision by specially trained medical personnel, a Type 1 diabetic dies … not in a far off and distant future.. but in a matter of weeks. And she wouldn’t have died in a galaxy far, far away… but in a room across the hall from where we sleep. But what parent loves their 23 year old, less than their 3 year old?? Our system remains broken. Even with this program, the system is broken… I doubt that the full measure of Washington’s bogus reform due to be in place by 2014, will do much to alleviate anything. The system is broken. Like a car that has too many parts not working, the system is a clunker. Time for a new system. Completely. New.

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