Tag Archives: pre-existing conditions

Many state run high risk pools to close

Time To Get Out Of The High-Risk Health Insurance Pool? : Shots – Health News : NPR.

The problem…

The online health insurance marketplaces can’t open soon enough for Chris and Kristi Petersen. Enrolled in the Iowa high-risk insurance pool because insurers on the private market won’t cover them, the couple pays more than $1,300 each month for a plan with a $2,500 annual deductible and a 20 percent copay for medical services. It’s more than they can afford.

“At the end of this year, these exchanges are either going to have to offer some relief, or I’m just going to quit working and let the welfare take care of us,” says Chris. “I’m fed up with it. I’m fed up with insurance.”

The potential solution

Starting next year, insurers will no longer be able to deny coverage to people because they’re sick, and high-risk pools will no longer be necessary for those patients.

Although shuttering high-risk pools will likely cause anxiety for those who rely on them, people may well find better, more affordable coverage on the state-based marketplaces (also called exchanges), which will open in October to offer plans that start in 2014.

“It’s likely that the premiums will be lower on the exchanges, the deductibles will be lower, and there will be no annual or lifetime [benefit] maximums,” says Jean Hall, director of the Institute for Health and Disability Policy Studies at the University of Kansas.

In addition, people who have incomes up to 400 percent of the federal poverty level ($45,960 for an individual in 2013) may be eligible for subsidies on the exchanges to make coverage more affordable.

The risk pools will have to close in self defense. Most people will leave voluntarily and at that point they will not be able to function from a financial perspective.

It sure would be nice to understand why the Petersen’s are uninsurable. Sometimes it’s a matter of working with the right insurance company, sometimes not.

Assuming a legitimate medical issue such as diabetes, heart attack, cancer, etc, to me, this is the problem health care reform is, or should be, trying to address.

This statement from Chris Peterson I also find troubling…

“At the end of this year, these exchanges are either going to have to offer some relief, or I’m just going to quit working and let the welfare take care of us,” says Chris. “I’m fed up with it. I’m fed up with insurance.”

I’m not debating the “fed up with insurance statement”. I’m concerned about “let the welfare take care of us”. If Chris is willing to quit his job yet keep his family income slightly above 133% of the Federal Poverty Level (FPL), he can maximize his subsidy and also receive additional Silver Plan benefits available only to insured’s whose income is < 250% of the FPL. (yes, he would have to sign up for a Silver plan.)

The incentive to “game the system” is laid out on a Silver platter to Chris and those like him.

Also, if I were Chris, I’d be out recruiting the young invincibles to sign up.


Obama needs the young to be stupid?

Stupid error by omission: ObamaCare’s Success Depends On Young People Acting Stupidly – Investors.com.

Here’s the error….

What’s more, ObamaCare guarantees insurance coverage when one of these “young invincibles” does get sick, and at subsidized rates, since the law bans insurers from charging more based on health status.

How long will it take for the young to figure this out, and tell all their Twitter pals how to game the Obama-Care system?

What Investors Business Daily (IBD) says is true, however it’s the error of omission that’s the problem. Everyone repeat after me:


Outside of specific qualifying events, of which getting seriously ill or being injured in an accident are not included, you can only sign up for major medical plans during open enrollment.

When is open enrollment? Glad you asked….

  • The first open enrollment period is extended. It starts October 1st, 2013 and ends March 31st, 2014
  • Subsequent open enrollment periods will be from October 1st through Decmeber 7th

Even if the young invincibles, and everyone else for that matter, can schedule their critical illness diagnosis or major accidents during the open enrollment period there are still issues. Repeat after me…


If you don’t have coverage, the soonest coverage can start is the 1st of the month after you apply. Your application must be in by the 15th of the prior month. So, the soonest coverage can start is 15 days and the longest could be 45 days and that’s if you are in the open enrollment period. No calling from the ambulance and signing up!

What if you are outside of the open enrollment period and need coverage. Repeat after me…


There is no major medical plan available to you period. Other medical insurance plans that are not major medical would not cover pre-existing conditions for at least 1 year and can still decline to offer coverage.

The only options I can see outside of open enrollment is that you manufacture a qualifying event OR perhaps you can become eligible for medicaid.

Note to young invincibles, I’m not saying you’re not getting the “screw job”, you most definitely are. I’m just saying be careful out there and make your decisions with the knowledge above. Arm yourself with some type of coverage, even if it isn’t an Obamacare Qualified Health Plan.


States: ‘Blindsided’ by plan to shift costs of ‘uninsurables’ to them under ObamaCare

States: ‘Blindsided’ by plan to shift costs of ‘uninsurables’ to them under ObamaCare | Fox News.

In a letter this week to Health and Human Services Secretary Kathleen Sebelius, state officials said they were “blindsided” and “very disappointed” by a federal proposal they contend would shift the risk for cost overruns to states in the waning days of the program. About 100,000 people are currently covered.

Craziness. Best I can tell, this is an issue for the 27 states that elected to run their own high risk pools with money Continue reading States: ‘Blindsided’ by plan to shift costs of ‘uninsurables’ to them under ObamaCare


Obamacare: Subsidizing smokers in California

Why Calif. Doesn’t Want Smokers To Pay More For Health Insurance : Shots – Health News : NPR.

Smoking has its risks, but in California higher prices for health insurance probably won’t be among them.

The article doesn’t hint  that at the margin non-smoking rates will go up to subsidize the increased cost of covering smokers. Aren’t non-smokers hurt “at the margin” too?


$5 bil Pre-existing Conditions Fund Set Up By ObamaCare Already In Red

$5 bil Pre-existing Conditions Fund Set Up By ObamaCare Already In Red – Investors.com.

We’re talking about the Obamacare PCIP (Pre-existing Condition Insurance Plan) that was set up to provide people with pre-existing health conditions insurance coverage until Obamacare plans started January 2014. Key points of this type of plan are (were):

  • Applicants have to have a significant pre-existing condition
  • Coverage could start the 1st of the month if a complete application was received by the 15th of the previous month
  • Applicant could not have had recent major medical coverage
  • There was not waiting period for pre-existing conditions

In other words, for those who knew how to “work the system”, if you qualify for coverage, there’s no need to actually apply for coverage until expenses are on the immediate horizon.

Continue reading $5 bil Pre-existing Conditions Fund Set Up By ObamaCare Already In Red


Is smoking a pre-exising condition under Obamacare?

Smoking Is a ‘Preexisting Condition’ – Kevin D. Williamson – National Review Online.

It depends!

The District of Columbia’s Obamacare czars — the board that sets rules for the phony insurance marketplace, or “exchange,” that the law creates — have decided that henceforth insurers shall be forbidden by law to charge smokers higher rates than non-smokers. Smoking, as it turns out, “is a preexisting medical condition,” according to Dr. Mohammad Akhter, the chairman of the D.C. Health Exchange Board. Two liberal states, California and Connecticut, have decided likewise, while Colorado and Alaska have rejected the idea. (emphasis added-Ed)

Thank you Colorado for a rare display of common sense.