Short Takes On News & Events

Solo Coverage For $430 A Month? For This Enrollee, It’s A Deal

By Randy Dotinga

January 22nd, 2014, 5:00 AM

This post is Randy Dotinga’s latest update on his efforts to secure health insurance as a single, freelance writer with pre-existing conditions. You can also read his earlier installments, Taking A Risk To Secure Health Insurance and My Other Pre-Existing Condition: Unstable Insurance.

After 13 years of being an insurer’s worst nightmare, I just heard some wonderful words: The insurance company will see you now.

Randy Dotinga

They even gave me coverage. Darned good coverage, in fact, for $430 a month for my single, middle-aged and pre-existing-conditioned self.

Cheap? No. Priceless? Yes — especially after the steady stream of state and federal bureaucratic hassles that have plagued me for the last several months; and, before that, years of individual market coverage from insurers that abandoned me, turned out to be fraudulent or raised my rates into the stratosphere.

My experiences show that the health coverage can be a difficult proposition for a self-employed guy who is fairly healthy but has a heart that beats funny and no spouse. Until recently, my only feasible option to remain insured was to cough up $748 a month for shoddy coverage via California’s high-risk plan.

Then the Affordable Care Act provided new options for folks like me, but only if I went six months without any coverage first. I crossed my fingers, and got through the hiatus without a scratch. That was in 2012.

This coverage, through the California Pre-Existing Condition Insurance Plan at $265 a month, took me through June 2013. Then it expired, and I had to switch to yet another temporary program, the federally run Pre-Existing Condition Plan, at $287 a month.

And finally, it was Jan. 2014, and I could find a health plan through Covered California, the state’s online insurance marketplace.

After signing up for a Blue Shield of California plan, I received a letter the other day telling me that I could have extended the federally run Pre-Existing Condition Plan through January “to prevent a lapse in coverage.” Too late: I was already covered and therefore ineligible for an extension.

I could have saved $143 by sticking with the federal plan for another month instead of joining Blue Shield. But I might as well get used to it. Yes, I’m now paying $430 a month instead of the $265 or $287 I paid in 2012 and 2013, but it still beats the days of paltry coverage for a premium with a price tag in the $700s.

The transition has not been entirely smooth, though. For instance, after I used the California exchange to enroll in my new plan, I worried over the non-arrival of a bill from Blue Shield that would acknowledge my coverage and provide my policy number. It finally came at nearly the last minute, urging me to pay pronto and mentioning a previous bill that had never arrived.

I’m definitely insured now, though. My payment, which I made online, went through, and my insurance ID card showed up in my mailbox. It was two weeks late, since my coverage began on Jan. 1. But it’s here, I’m covered, and I’m glad.

16 Responses to “Solo Coverage For $430 A Month? For This Enrollee, It’s A Deal”

  1. Patty says:

    Obamacare turned on the lights and the cockroaches are scattering! No more insurance company scams, Obamacare is here to stay! This article echos all across America. Americans have been getting screwed by insurance companies that have always had one single motive in mind…profit! Obamacare is not perfect, but it’s a giagantic step on the long road to single-payer nationalized healthcare. The healthcare game has been a rigged game for far too long. Rigged in favor of providers and insurers. The healthcare consumer has been at the bottom of the food chain for decades. Obamacare begins to change that. So far millions have enrolled in Obamacare. We will see millions more getting enrolled before the enrollment period ends in just over two months. If HHS is smart, they will extend the enrollment period another month since the rollout was so confused. The subject of this article now has peace of mind. Before Obamacare, he was just a pawn in the healthcare scam. Millions more Americans will be enjoying peace of mind as more and more people enroll. I will count health reform a success only when the last healthcare insurance company goes out of business. Health insurers have ruined America’s healthcare system. They have driven up costs to unaffordable levels. Only when health insurers are finally extinct will America’s healthcare system finally begin to heal.

  2. killroy71 says:

    yup, Patty, and when your dream is realized, you are in for a nasty reality. health care is still expensive. health insurers already pay out more than 80 cents of every dollar to doctors, hospitals and meds for guys like this; on group plans through employers, it’s more like 90-95 cents. somebody will still have to do all the claims processing and IT work. doctors don’t work for the government, they don’t HAVE to take single-payer money; there are people with actual money who will pay them more. And even when doctors do work for the government – like the VA – those costs are still going nowhere but up.

    Hopefully we don’t wait for your dream to materialize before we start dealing with the actual costs being charged by doctors (mainly specialists, since only 12 percent of docs are general practice), hospitals, drugs and devices.

  3. Pat says:

    Patty, I disagree with your ‘cockroaches are scattering’ analogy. I do agree with your statement that it’s a giagantic step to single-payer nationalized healthcare. Obamacare enables adverse selection to florish. Why buy insurance now if I am healthy. I’ll wait until next year’s open enrollment to consider buying it. What if I find out I have cancer in June? I can marry someone, which is a qualifying event to buy prior to open enrollment, or ‘move’ to another coverage area, which is also a qualifying event. For those who buy on the Exchange and obtain a subsidy, here’s a 25% premium savings tip. Do not pay your Oct, Nov and Dec premiums, unless you have a big claim. Your late payment period runs 90 days. Coverage will be provided if premium is sent. Re-sign up during the next Open Enrollment for coverage effective again January 1st. Repeat again the following year and pay 9 months of premium with no tax/fine for the missing 3 months.
    As for Insurance companies driving up the costs – how? Who creates the charges for the medical services? The Insurance company? No, the bill arrives from the Hospitals, clinics and physicians. Will they charge you $17,500 for an appendectomy or $67,500? They don’t know and neither can you. Now that’s a scam. Are you ok with that?

    Obamacare limits insurance companies to a minimum loss ratio (MLR) of 80%. Any loss ratio below 80% and the carrier must refund the difference to the policyholders. Any loss ratio above 80% and the Ins carrier has to live with the shortage. Let me ask you a question. Would a waitress prefer to collect a 20% tip on a $50 food bill or a 20% tip on a $200 food bill? Obamacare creates this conundrum for Insurance carriers. Why hold back the medical providers’ charges for their insured members if it means 20% can be kept of a higher amount? The higher the claims, the higher the rates they can charge to people who are now, by law, obligated to buy insurance. 20% can be kept of the new, higher rates. Who created this scam? Obamacare.

  4. Walter says:

    Hey Kilroy,

    Besides putting themselves squarely in the middle to disrupt the doctor/patient relationship, besides offering no real value except to collect premiums and process claims, remind me again, why do we need health insurance companies?

  5. Michael Bertaut says:

    While I am certainly happy that the subject of your story got a better deal, it begs the question how many younger, healthier folks had to have their rates increased so this gentleman could get his “deal”.

    Ah, but young folks get tax credits you say to defer their higher costs? At whose expense? The money for the advanced tax credits, and the Medicaid expansion, is supposed to come from three major sources:
    1. SAVINGS to Medicare (that means CUTS, if you don’t have a background in DC-speak)
    2. TAXES and FEES on insurance companies. Which I’m sure they won’t pass along in higher taxes right?
    3. FEES on medical providers, like the people who make artificial hips and knees. Again, I’m sure they will simply absorb the increased costs, so no problem.

    Reality is, healthcare financing is a zero sum game. There is always an equal and opposite force somewhere for every dollar dispensed through exchanges.

    IN other words, just like your Dad told you, there really is no free lunch.

    mrb

  6. K says:

    Walter, I hope you’re kidding. If you don’t think we need health insurance companies, by all means have fun paying out of pocket for your next x-ray. MRI. Surgery.
    Or was your suggestion going to be that we can all just sign on to government-funded health programs? An entire nation of medicaid recipients: what could possibly go wrong?

  7. Dave says:

    Growing up in the 1950′s nobody had health insurance. If health insurance is so mandatory, how did we survive back then? We had a family doctor. He did everything from delivering babies to removing warts. He got paid in cash. Most times he’d give us credit. As far as how insurance works, even a moron knows insurance works best when you have large risk pools. Like auto insurance for instance, good drivers have always subsidized bad drivers. Seems to me Obamacare works the same way. Healthy people subsidize sick people. How hard is that to understand? I guess if you are a moron, you’ll never understand risk pools, right? Risks pools…get it? Duh!

  8. camaron says:

    Hey Dave,

    My sympathies. Stop casting pearls before swine. Stop wasting your time. If they had ears, they still wouldn’t hear you.

  9. K says:

    “Like auto insurance for instance, good drivers have always subsidized bad drivers.”
    So first of all, by this logic, what incentive do any of us have to be good drivers?
    “Seems to me Obamacare works the same way. Healthy people subsidize sick people.”
    Nope. Not how it works. Wealthy and middle-class people are sibsidizing the non-working poor, regardless of how healthy or unhealthy anybody is.
    But most of all, you all are evading my questions, and I’m genuinely curious: what is your brilliant plan for paying for healthcare (again, MRI’s, surgeies, not cheap) when private health insurers have been totally demolished. Is the plan REALLY to have an entire nation of government-funded healthcare recipients? REALLY?

  10. Iden Campbell says:

    I am insured in DC by the city’s plan that allowed individuals and families to be insured by BCBS/CareFirst without being denied. I have been since 2008 and enjoyed a low rate of $273 that included dental and vision and a low co-pay of $10 for my primary care and $20 for a specialist. Last September I received a letter in the mail due to this new health care reform saying my insurance would be raised to $347.00 a month and I would have to switch to a new policy by the end of 2014 to ensure continuos coverage. I looked at the policies including the platinum coverage they all cost more averaging $100 a month extra and I am losing the perks of a low co-pay, dental and vision. So to heck with this new reform, I was fine without it now I am being priced out by rising expenses.

  11. killroy71 says:

    Walter – health insurers are a mechanism to pool the money and spread the risk. You don’t want to face the bills from a cancer “episode” all by yourself. It takes a lot of healthy people paying premium to help you pay for that.

    To Dave’s point, there’s a LOT more to medicine than there was in the 50s. Organ and joint transplants, multiple chronic disease to manage for decades, more types of cancer to deal with; auto-immune disorders, new diagnostic tools and tests. This all costs more.

    If as a nation we decide we want the govt to pool the money and spread the risk, fine. But the essential work still has to be done – claims processed and paid, computer systems developed, upgraded, maintained; customer service calls, PLUS a whole lot of stuff we need to do better: care coordination, medical homes, electronic records, research of treatments to see what works vs what just costs money, streamlining waste and duplication.

    And taking insurers out of the picture will give you a one-time reduction of about 5 cents on the dollar, tops (that’s net profit, and on the high end, and only for insurers, not all the profit-making services they pay for). Then what? we still have a lot to pay.

  12. lawrence says:

    “But most of all, you all are evading my questions, and I’m genuinely curious: what is your brilliant plan for paying for healthcare (again, MRI’s, surgeies, not cheap) when private health insurers have been totally demolished. Is the plan REALLY to have an entire nation of government-funded healthcare recipients? REALLY?”

    Huh?

    Healthcare systems in Europe and Canada have been running for decades without health insurance. They are blessed to have eliminated the insurance middleman and have opted to go with a socialized single-payer government run healthcare system. Healthcare systems in Europe and Canada cover 100 percent of their populations. As a percentage of GDP, healthcare systems in Europe and Canada are costing half as much as America’s healthcare system. The major flaw that some Americans try to claim about those “socialized” healthcare systems is wait times for elective appointments. In America, having a wart removed is a 911 event. In Canada and Europe, consumers have long ago realized the insanity of how Americans view urgent care. Fact is, nobody in those countries waits for urgent care. Anyone who has lived in Canada for any length of time laugh when they hear Americans say that Canadians wait to be treated for an aggressive cancer or for a heart attack. That is simply a lie that can easily be proven false. So, with Americans paying twice as much for the same or worse healthcare and with over 50 million Americans not paying for anything because the can get uncompensated healthcare at the hospital emergency room, tell me again what insurance companies have done to make America’s healthcare system so great?

  13. stan says:

    Only in America has the healthcare industry hype been used to inflate costs. Only in America, when the word “cancer” is mentioned, do Americans shell out outrageous amounts of money to make that word go away. The healthcare industry knows this. The healthcare industry isn’t dumb. While other nations take healthcare for its citizens in stride, the healthcare industry in America has marketed fear for decades. No other nation on earth uses fear and dread to bilk trillions of dollars out of unsuspecting and innocent healthcare consumers. Only in America has the healthcare industry capitalized on fear and dread to the point where Americans pay at least twice as much as any other nation on earth for their healthcare. Shame of America’s healthcare industry! The only way to stop the insanity is to stop the marketing of fear and go to a single-payer system that resembles those of the rest of the world. End the healthcare industry hype and you’ll end the insane skyrocketing costs.

  14. stan says:

    In American? Hey Doc, I’ve got this pain in my toe. Hmmmmmmmm…you you need a new “johnsonrod”. What’s a “johnsonrod”? Who knows? What does a “johnsonrod” do? Not exactly sure. What does a “johnsonrod” cost? We won’t know until we get under the hood. Will insurance cove it? Maybe…we’re not sure. Maybe not.

    In Canada? Hey Doc, I’ve got this pain in my toe. Hmmmmm…does not look too serious. Don’t sweat it! You’ll be fine. Just take two aspirin and call me in the morning.

  15. stan says:

    In America? Hey doc! I just saw the ad on TV about a new prescription drug that will make my eyelashes look fuller? Can I have some? You bet! It costs $1500 per month and the best part is, doctors get a 10 percent kickback for every script they write. Hey doc! That’s a lot of money! I can’t afford it. Don’t worry, both Medicaid and Medicare will pay for it.

    In Canada? Hey doc! I just saw the ad on TV about a new prescription drug that will make my eyelashes look fuller? Can I have some? Hmmmmmmmmmm….no!

  16. stan says:

    The difference between socialized healthcare and America’s healthcare is how they view the patient. In Canada and Europe, providers are salaried. So, providers do what they can with the salary that they get. The only way to increase wealth is to be more efficient. Being more efficient usually means keeping patients well and seeing less people in their office. Well people cost less to treat so docs in countries with socialized medicine get to work less hours while receiving the same salary. In America, providers concentrate on ways to generate cash because they don’t have salaries. So, they need to bilk Medicare, Medicaid, private insurers and the consumer. With no salary, generating fee-for-service cash is all they think about. They make sure that they keep people coming and that they have a waiting room filled with sick people. More sick people means more profit. They have zero incentive to make people well because well people see the doctor less. Since they aren’t paid a salary, the need to rely on fee-for-service payments to increase their profits. In America, less patients in the waiting rooms means less profit in providers pockets. Providers in Canada and Europe don’t have that problem since, regardless of how many patients are in their waiting rooms, they continue to receive their set salary and can focus on the wellness of their patients that they see. In Canada and Europe, the governments have found a way to reduce greed in the system. How? They pay salaries to providers instead of fee-for-service payment. Simple as that!

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