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Practically Speaking

Kyle and her husband moved to Brookfield in 1986. She became active in local politics and started blogging in 2004. Her focus is primarily on local issues but often includes state and national topics, too. Kyle looks at things from the taxpayers' perspective in a creative, yet down to earth way, addressing them from a practical point of view.

Health Care: ....About those pre-existing conditions

Health care, President Obama, Government / Bureaucracy

Today's post is part 2 of yesterday's Pre-existing conditions: Could any insurance company stay solvent this way?

Early on in the health care debate, President Obama promised that his health care reform would not exclude anyone because of a pre-existing health condition. (The House and Senate versions of the bill all prohibit private insurance companies from excluding pre-existing conditions.)

If you didn't know better, you might assume that no one with a pre-existing medical condition could ever get health insurance, thus making Obama's healthcare reform a necessity.

Since most people, by the time they are 40 years old, have some sort of pre-existing health issue, does that mean they are unable to get health insurance?

Well, yes and no. It was my understanding that if a person (or their spouse) had an employer who offered group health insurance, the answer was NO, they were not banned from obtaining group health insurance.

Just to be sure of my position, I called my insurance carrier, Humana. Here is what I found out:

  1. If you (or your family if you have a family plan) were previously insured with another company, you are covered under the new insurance carrier, regardless of treatment in the past--your pre-existing conditions.
  2. You are still considered previously insured even if there was a lapse of up to 60 days* of insurance coverage. This would be important if you moved or changed jobs.
  3. If you were unemployed, thus uninsured, for longer than 60 days, purchasing a COBRA insurance policy would guarantee future coverage. Wisconsin's BadgerCare and Medicaid also count as maintaining health insurance coverage.
  4. IF you let all health insurance coverage lapse during your unemployment (or never had health insurance), and then get a job from a company offering group insurance, you may still enroll in their group policy plan. All dependent children will be fully covered immediately on family plans. You will be covered immediately for everything EXCEPT the conditions you were previously treated for. Coverage for those pre-existing medical conditions will not be covered until a 6 to 12 month waiting period has passed.

They also confirmed that pre-existing conditions were medical conditions you were treated for by a doctor in the past, such as high blood pressure.

We see that group health insurance plans then can be very helpful to people with pre-existing conditions. The offering of group health insurance by an employer becomes an important asset in evaluating future employment opportunities.

If unemployed, keeping COBRA coverage is imperative, however, the monthly premium can be prohibitive. This is one area some reform would be helpful in. Say, if unemployed, a major medical only COBRA plan could be offered? Major medical being just for major needs, thus less expensive than the more comprehensive group plan. Or, possibly some interim group plan offered for the unemployed?

The Humana reps I spoke with were from the group insurance division and did not have the facts on private policies and pre-existing conditions. But I have seen Humana ads that tout basic individual coverage for under $70/month. That rate would be for a healthy young adult. (I had a plan like that after I graduated from college and got my first job. Although I was under 25 and still living at home, my parents did not have a family health insurance plan that covered me.)

As an individual ages and experiences health issues, private insurance policy premiums rise. The very nature of insurance is shared risk.** Those that don't need the insurance help build reserves in the insurance company so that they can pay out for those in need. If those younger, healthier individuals choose to enroll in employer offered group policies, their premiums help offset the group members with greater needs.

But should Obamacare pass, those same healthy young adults, who choose to carry no health insurance, will be required to pay for Obamacare health insurance at the same percentage rate of income that the unhealthy, older adults pay.

Do we need some sort of health insurance reform? Yes, but not the House and Senate versions. As I mentioned above, providing some sort of interim plans during times of unemployment would be good. Possibly group plans for those individuals in high risk would be helpful too? These would come from the private sector. At least for the present, the pre-existing condition isn't as excluding as the president would lead us to believe it is.


*I had called 2 times. One agent told me 60 days, the other 90 days.

**With private life insurance or long term care policies, age and medical conditions enter into the equation for calculating premium rates. The higher the risk, the higher the premium. For example, my long term care policy charged me slightly more for my age group because I have low thyroid function.

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Brookfield7, Fairly Conservative, BetterBrookfield, Vicki McKenna, Jay Weber, The Right View Wisconsin, Randy Melchert, Mark Levin, The Heritage Foundation, CNS News, Breitbart BigGovernment

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