Best Health Insurance Book Hosts New Year’s Cav
Jonathan Pletzke of Consumer’s Health Insurance Blog did a thorough job of organizing the latest risk related articles in the blogosphere into an easily readable and organized format in the New Year’s edition of the Cavalcade of Risk. The Colorado Health Insurance Insider was noted because of Louise’s post about the latest AHIP (association of health insurance plans) proposal in Individual Health Insurance Not That Affordable or Accessible.
David Williams of Health Business Blog also commented on the AHIP proposal in an article titled Health Plan Association Promotes “Guarantee Access”.
Under the AHIP proposal, individuals who are denied insurance coverage –or offered substandard coverage– can apply for the Guarantee Access program. Those whose expected medical claims are <200% of the average will receive coverage from health plans at 150% or less of standard rates. Those whose claims are expected to be >200% of the average will be eligible for a Guarantee Access Plan, again at 150% or less of the standard rate. Of course, some sort of subsidy will be required to make that work. Improvements in predictive modeling enable the health plans to more accurately place people in a specific cost category.
In Colorado, the idea of “guarantee access” to people with health conditions that disqualify them for individual/underwritten coverage at a higher rate subsidized by tax money is already a reality because of CoverColorado. You’d think this would be an option already available in all states, wouldn’t you? But in most of the red southern states, if you can’t get coverage through an employer and you don’t qualify for individual/underwritten health insurance, you’re SOL.
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North Carolina guarantee issues health insurance, but the premiums can be up to 7 times the quoted premium, which could price many folks out of the market. The coverage is also limited to the tune of $500,000 lifetime maximum.
A high risk pool was authorized by the legislature and the details of how it will work are being hammered out. The pool will subsidize the costs of insurance for those that cannot afford the current rates and have a medical condition. Perhaps they will look to CoverColorado as an example.
One bright spot in North Carolina is that there are two small group (1-49 lives) plans that must be guaranteed issue to small businesses. While this isn’t an option for everyone, those with any sort of business have an affordable guaranteed issue option, even if they are a sole proprietor and the only employee.
Colorado also has two (four, if you consider that each option is available as an HMO or PPO) small group plans - Basic and Standard - that are guaranteed issue for any small group with 1 - 49 employees. So a self-employed person has the option of getting a Basic or Standard group of one policy. Groups of 2 - 49 employees are eligible anytime, guaranteed issue, although it’s a little trickier for a self-employed ‘group of one’. The self-employed person must be able to show tax records incidcating self-employment for at least one full year, and the policy is only guaranteed issue during open enrollment, which is defined as a qualifying event (eg, loss of COBRA or other coverage, marriage, divorce, etc.) or within 30 days of the self-employed person’s birthday.
But for people who do not have an option for health insurance through an employer, are not self-employed, do not qualify for Medicaid/Medicare, and cannot meet the medical underwriting standards of individual health insurance carriers, Cover Colorado is the best option.
I should have included it in the post, but here is a list of all states that have risk pools:
http://www.naschip.org/states_pools.htm