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I recently quit teaching. I taught for three years in Nashville Public Schools--long story short, I didn't love it--and now I'm back to my previous job as a self-employed business writer. The scariest thing about quitting teaching is losing great health coverage and having to buy my own insurance again. Anyone who's had to buy their own insurance knows the confusion and stress of the process. If you don't, you can experience it vicariously through me. Join me, won't you?

I'm looking forward (with some trepidation) to October, when I'll be able to buy health insurance through an exchange. In the mean time, I have to figure out how to get my family covered from September through December of this year. I've just begun my journey.

Here are the options available currently:

1. COBRA. I can continue my current insurance with Cigna through COBRA. However, the coverage is so good that it will cost more than $1,500 per month (PER MONTH!) to keep the coverage. I am guaranteed coverage through COBRA as long as I pay for it. However, I cannot sign up for it until I receive an offer from my employer. They told me that they have 45 days to get the offer to me (which would be October 15!), meaning I'm in limbo until then. If I choose COBRA coverage, it will be retroactive to September 1 as long as I pay the full premium due from that date. I could just plan on getting coverage through COBRA for the rest of the year, but that would eat up our emergency savings, which I'm counting on as I restart my business.

2. Individual health coverage with underwriting. Underwriting is the dirty word of health insurance coverage. You can look through any site and see their "estimates" for monthly premiums, but nothing is set in stone until the underwriters take a look. And by "take a look," I mean examine your entire life's worth of health records for anything that looks like it will cost the insurance company money. Once they find something, they will either set the rates higher than the published pricing or they will give you a rider, which means you will never be covered for a particular illness. Had a mole removed in 1979? No coverage for melanoma. Had a colonoscopy before you were 50? No coverage for colon cancer. An astounding real-life example from our own experience was when my husband had a sonogram to check his thyroid. He ended up having a rider for goiter from our next insurance carrier. Goiter? Really? Anyway, published prices for individual coverage for our family run from $300 per month ($22,000 family deductible!) to more than $1,200 per month ($3,000 family deductible)...if we qualify! At our ages (61 and 52, with a 13-year-old daughter), we will most likely have to get insurance physicals and blood tests as part of the application process. And, with all of these policies, the no pre-existing condition rule is in place for the first year because most of these plans are grandfathered. They are not subject to the ACA's rule on no pre-existing conditions.

3. Short-term insurance. This coverage is high-deductible with no pre-existing conditions for a limited number of months. This is a viable alternative because it would probably cost no more than $1,500 for the entire four months. However, that means no doctor's visits for any current illnesses unless we want to pay the full published charge or visit a clinic. This coverage is primarily for accidents and medical emergencies. However, it's unclear to me how the pre-existing conditions clause would work for emergencies. My husband is on cholesterol medication. If he had a heart attack while under a short-term plan (knock on wood, he's never had any heart problems), would his high cholesterol be considered a pre-existing condition leading to a heart attack? What kind of financial nightmares would be possible with this type of coverage. The unknowns scare me the most.

4. Go without insurance. This is actually not a bad option. With COBRA, I have 60 days after receiving the letter from my past employer to decide whether to continue coverage retroactive to September 1. And I can elect coverage for the entire family or just the person who needs it (reducing the premium to $666). I could wait it out until the last few days (the earliest being October 30 and the latest being December 15 depending on when I receive the notice), and if we haven't had to use it, just don't get it. Then I could do the short-term plan for the last month or so before the ACA plans kick in. This is a little scary, but it may be the best option. If you can think of others, please speak up in the comments.

I don't have to decide until the end of August, but we're leaning toward some combination of COBRA and short-term insurance to get us through to January 1. Of course, who knows how smooth the move to Obamacare will be. The early predictions are not good, but I'm hopeful. I live in Tennessee, so I'll be looking at the national exchanges. I'll keep you posted.

Originally posted to Libertina on Wed Aug 14, 2013 at 11:19 AM PDT.

Also republished by Three Star Kossacks and Community Spotlight.

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Comment Preferences

  •  Work the COBRA waiting period (9+ / 0-)

    I think that's your best option.

    "let's talk about that"

    by VClib on Wed Aug 14, 2013 at 11:55:03 AM PDT

    •  Second VcLib (3+ / 0-)
      Recommended by:
      VClib, Senor Unoball, FloridaSNMOM

      Work the Cobra and pay the first $1500 and then look for a $20,000 - $30,000 deductible plan.  This is somewhat of a self insurance plan except you get to use the reimbursement rates of the insurance company which are as low as 10% of the retail price. It's the difference between paying $5,000 for an emergency room visit and $500.

      I saw $30,000 deductibles for $140.00 from United Health at age 55.  All I really wanted was the discount card (insurance card). It used to be you could get in the front door in all places with the insurance card regardless of deductible, but you'll have to choose your providers carefully as some have forced people to come up with the deductible before getting service unless it's an emergency. But I read somewhere that some facilities are discontinuing their emergency services or just providing the bare minimum. Not sure where I read it so take with a grain of salt.

      Keep in mind they have to give you the free diagnostic services  with any plan so it may cost more even with a high deductible plan.

      “ Success has a great tendency to conceal and throw a veil over the evil of men. ” — Demosthenes

      by Dburn on Wed Aug 14, 2013 at 07:23:09 PM PDT

      [ Parent ]

      •  What about pre-existing conditions? (7+ / 0-)

        I totally agree about the discounts. It's best to be on some type of plan. However, if I get a plan now, I'll be subject to the pre-existing conditions clause whereas if I wait until the exchange comes out, I can get similar insurance without the waiting period.

        Never interrupt your enemy when he is making a mistake.

        by Libertina on Wed Aug 14, 2013 at 07:34:15 PM PDT

        [ Parent ]

        •  Depends on potential cost of pre-existings (1+ / 0-)
          Recommended by:
          FloridaSNMOM

          I thought you could get insurance now with PE but, apparently I'm wrong. If you are getting a huge deductible  and the pre-existings  don't cost much $$ then it may get accepted as it will fall under the deductible.

          I don't know how  cholesterol is treated now by insurance companies . I had high triglycerides and I had quit smoking  in 2001. I managed to get Insurance then with a mere $2000 deductible & no riders. But then again I was only 45 then.  It seems like once you get out of the 45-54 group, insurance goes up like a big balloon which never comes down or blows up.

          They used to have the first year rate suck-in then drove it up 25-40% in year two. I was switching insurance companies thinking I had that scam figured out until I read a clause in Indiana law for single policies (freelancer) that stated: No Insurance company is obligated to pay out more than has been paid in." Cute huh? I didn't know it was a savings plan. A whole bunch of insurance companies are based here. I wonder why?

          Must be because It's Indiana. Cost of living is cheap. That means the legislators  sell out cheap. The insurance companies own this state.

          I think insurance companies will find a way to screw us on Obama-care like the delay in no cap in it's first year of subsidized insurance. That means people can now afford to buy the junk, but they still can go bankrupt. It's absolutely amazing that clause made it in  or maybe not-

          It makes me wonder how many clauses are in there that knock the guts out of everything but the mandate and the penalty for individuals, not companies. That out of pocket cap undermines virtually half of Obamacare.  Based on elections in 2014, if The D's lose the senate how long will a bill come up to make that permanent.

          That means I have to hold off being sick until 2016. Geez, I hope my body will cooperate. Anyone who doesn't have 5 Million in liquidity or more can easily go broke with a major chronic disease.

          “ Success has a great tendency to conceal and throw a veil over the evil of men. ” — Demosthenes

          by Dburn on Thu Aug 15, 2013 at 10:10:11 AM PDT

          [ Parent ]

          •  If you want to... (0+ / 0-)

            know about what's in Obamacare, try reading it. I'm sure you could find a copy of it online somewhere if you looked. Are you over 65? The doughnut hole applies only to Medicare, I think. I read the whole bill when it was online before the votes on it, but it was so long ago my memory is fuzzy.

  •  You could try to find out what would happen (5+ / 0-)

    with the short-term insurance and your husband's health situation; try to get something in writing.  Then you could make a better-informed decision.

    I'd probably do as VClib suggests, then if necessary get the short-term coverage for a month if there's no health reason you need to have had the COBRA coverage.

  •  Excellent diary Libertina (10+ / 0-)

    I too am self-employed and trying to figure out what I should do. Right now I have a crappy high deductible individual plan, and the company is raising the premium at the end of this month.

    Healthcare.gov is supposed to be the place where you can get concrete specific info, but some of the language seems quite vague to me. I tried using the online chat and the person who tried to help me seemed to know less than I did when it came to the specifics.

    For example, because I am a one-person LLC and do not have employees, it was my understanding that I could enroll in Obamacare as an individual. But this person kept insisting that I was an "employer" and need to follow that path. She was wrong as it clearly states on the site.

    My main concern is the verbiage indicating that my crappy policy may need to expire before I can enroll in the exchange.

    Replacing individual insurance

    You may use the Marketplace to replace individual insurance you currently have. In the Marketplace, you can find out whether you can get lower costs on monthly premiums and reduce your out-of pocket-costs. You can compare plans based on price, benefits, and other features important to you.

    Check with your insurance company before cancelling your policy. You may have to wait until the end of your policy year before you can cancel.

    So my main issue is I'm not sure what to do for the last 4 months of this year. My current plan ends on Aug 31--do I just let it expire and then sign up for Obamacare for coverage starting on Jan 1? That makes me nervous because I have had some health issues and I'm not sure trying to skate by for four months is a good idea. But I really don't want to renew it if it means I must wait another year until my renewed policy expires.

    I am in Wisconsin where Walker refused to set up an Exchange, so I'll be looking at the default Fed Exchange. (Not all bad--it can't be worse than what Walker would come up with.)

    Good luck figuring it all out!

  •  your Cobra and short term insurance plan sounds (6+ / 0-)

    good.

    I had been all excited about the exchanges until I learned recently that as an unemployed person in PA (no medicaid expansion) I qualify for $0 subsidy with an annual premium near $10,000.

    Someone suggested yesterday that all I need to do is provide an estimated salary for 2014 that is above the medicaid limit and I will get the subsidy.  This sounds reasonable, because if I can't find a job that I can make at least $17000 at, I'll have more pressing concerns than my health care!

    Good luck.

    "Don't Bet Against Us" - President Barack Obama

    by MRA NY on Wed Aug 14, 2013 at 12:23:54 PM PDT

  •  Self-insured is not such a bad option (5+ / 0-)

    I've been "uninsured" (or, as I like to think of it, "self-insured") for a couple of years, and will likely stay so at least until Jan. 1. The coverage I have access to would take 1/3 of my income, and I'm just not willing to go there.

    My experience, for what it's worth, is that many hospitals & doctors are quite willing to negotiate, depending on your income level (you may have to provide tax returns, and fill out forms). So do not just pay the "rack rate" without asking, and don't let anyone prescribe routine tests without telling them you're self-paying and is this really essential. Some also offer a discount (10% is reasonable) if you put it on a credit card or write a check instead of making them send bills. And if any of you are on ongoing medications, definitely shop around to the chain pharmacies, Target, and Costco. For 4 months, you can probably put off routine physicals and all that stuff.

    With all due respect to the President, the idea that absolutely everyone must have insurance coverage in place every moment of their lives -- regardless of cost -- is just ludicrous.

    So in your situation, I would definitely play the COBRA waiting game instead of signing up for coverage right away, and if you don't need it by the deadline, risk a short gap between when you have to make the decision and Jan. 1.

    •  Just don't... (13+ / 0-)

      Get in an auto accident
            or
      Trip going down the stairs
            or
      Find a lump somewhere
            or...
      You get it.

      Until we get single-payer, I don't see what you can do but mandate.

      "Nothing happens unless first a dream. " ~ Carl Sandburg

      by davewill on Wed Aug 14, 2013 at 04:03:07 PM PDT

      [ Parent ]

    •  RE: (7+ / 0-)
      the idea that absolutely everyone must have insurance coverage in place every moment of their lives -- regardless of cost -- is just ludicrous.
      You said, "regardless of cost." I don't think that the President or anybody else would argue that people should purchase health insurance regardless of cost. To the contrary, many don't have that option.

      However, if at all possible, absolutely everyone should have insurance coverage in place every moment of their lives. "I've been uninsured, and everything is fine" is not an argument for being uninsured.

      Here's a rule of risk management that we should all follow, if not for our own benefit, then for the benefit of the people who care about us: Don't risk more than you can afford to lose.

    •  Mostly uninsured here (1+ / 0-)
      Recommended by:
      cjo30080

      I have Florida's 'medically needy' program. Essentially I have to spend about $1000 before medicaid kicks in. That can be done in the ER without actually spending anything and they will cover it, or I could actually go to a doctor and pay half of our monthly income every month before I qualify. I was in the ER last Saturday, I still don't have my temporary card for the rest of the month so I can schedule a follow up appointment and get the scripts I still have on hold. I'm hoping to find something I can afford in October, since my stupid state hasn't expanded medicaid like they are supposed to. There's no point until then, with my pre-existings there will be no coverage until they don't have a choice, no matter the price.

      "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

      by FloridaSNMOM on Thu Aug 15, 2013 at 12:07:07 PM PDT

      [ Parent ]

      •  "2012 Florida Statutes" (0+ / 0-)
        409.9101 Recovery for payments made on behalf of Medicaid-eligible persons.—
        ....
        recovery shall be accomplished by the agency filing a statement of claim against the estate of a deceased Medicaid recipient
        ....
        The acceptance of public medical assistance, as defined by Title XIX (Medicaid) of the Social Security Act, including mandatory and optional supplemental payments under the Social Security Act, shall create a debt to the agency in the total amount paid to or for the benefit of the recipient for medical assistance after the recipient reached 55 years of age
        ....
        6) The debt created under this section shall not be enforced if the recipient is survived by:
        (a) A spouse;

        (b) A child or children under 21 years of age; or

        (c) A child or children who are blind or permanently and totally disabled pursuant to the eligibility requirements of Title XIX of the Social Security Act.

        (7) No debt under this section shall be enforced against any property that is determined to be exempt from the claims of creditors under the constitution or laws of this state.

        (8) The agency shall not recover from an estate if doing so would cause undue hardship for the qualified heirs
        ....

        http://www.flsenate.gov/...
  •  Your excellent diary (13+ / 0-)

    and the resulting comments show how crazy our entire "health care" system is.

    You are obviously an intelligent person with good reading comprehension and other skills.....and look how confusing it is!  Imagine if you didn't possess the skills that you do.

    This country NEEDS a single payer system.  Health insurance is not health care, yet Americans continue to conflate the two.

    Stand Up! Keep Fighting! Paul Wellstone

    by RuralLiberal on Wed Aug 14, 2013 at 03:26:41 PM PDT

  •  At minimum.. (3+ / 0-)

    I've run into this too.. you'll want to make sure you carry some minimum level of coverage, because it will make it easier to get better coverage later.   For the most part, coverage with high deductibles isn't disasterous.. it's cheap and it won't prevent the basic costs - but it can save you from any major incident..

    Just make sure you don't end up with what the insurance company calls "bad bet" insurance, these policies will never, never pay out.

    We carry United Health Care, with a 1500/2500 deductible on a fam of 3 for about $480.

    But shop around (we used I think ehealthinsurance, but there are plenty out there).. policies with a 5k deductible are cheaper - and not terrible, they at least prevent you from going into a situation where a medical situation could bankrupt you.

    Gandhi's Seven Sins: Wealth without work; Pleasure without conscience; Knowledge without character; Commerce without morality; Science without humanity; Worship without sacrifice; Politics without principle

    by Chris Reeves on Wed Aug 14, 2013 at 03:51:14 PM PDT

  •  A detail about one of the options you mentioned (3+ / 0-)
    Recommended by:
    cjo30080, Senor Unoball, Oh Mary Oh

    You described NEW individual insurance as a policy that is grandfathered.  I think that's not correct, because you would be a new subscriber to that particular policy.

    At least that's the way it works in my state (NY).

    A year ago my husband became old enough to enroll in Medicare so that the individual policy (meaning freestanding, outside of any employer-provided insurance) that we had was ended at the option of the insurance company.  Since we were both covered under the family policy, I continued with the same insurance but for only a single person because I am few years younger.

    Before the Medicare split our insurance had been "grandfathered" because it was the same policy from year to year so we didn't get any of the early goodies from the ACA.  But, to my surprise, when I got a new policy (same as the old one, but just for me alone) it was a "new policy" so I did get the new things from the ACA law. It was the same insurance plan code, deductible, rates, coverage details , etc., it's just that I was deemed a new subscriber, so the grandfathering business ended.

    You should make sure that you have the correct info about the individual policies in your state.  I think it's only the marriage of a plan and a previous, unbroken subscribership to it that creates grandfathering. It's not the plan itself which is grandfathered.

    Make sense?

    Because everybody hates their insurance company, I'm also bound to report that surprisingly, even after the split (which happened in March) my new coverage was allowed to count the deductible expenses ($4,500) we had already incurred for the year w/o having to start anew on my own. That surprised me, but I was very grateful since it saved me a couple of grand. My insurance company is one of the few remaining non-profit Blues (Excellus of Rochester). So kudos where they are due.

    (I was very pleased to see that they were used as a benchmark company in designing NY state's Exchange products - and doubly pleased to see that they are offering all levels of insurance under the ACA in my area. Other companies will have to offer something much, much better to get me to switch from them.)

    Araguato

    •  About "grandfathered" plans (4+ / 0-)

      Hi Araguato. I understand the confusion, because I was in a plan that was grandfathered by my last insurance company (Tennessee Rural Health) right after the ACA passed. That plan allowed me to keep that insurance even though all the new plans they developed after that date had higher costs and fewer benefits. But the ACA speaks specifically about grandfathered "plans":

      A group health plan that was created—or an individual health insurance policy that was purchased—on or before March 23, 2010. Grandfathered plans are exempted from many changes required under the Affordable Care Act.
      So the way I understand this, if a plan was created before that date, they don't have to adhere to the ban on pre-existing conditions. I contacted both Blue Cross/Blue Shield of TN and Tennessee Rural Health and was told that if I got one of the plans that they offer today, then I'm subject to the 12-month pre-existing conditions clause. It's only the new plans that they will offer for the exchange that will cover everything immediately. So, there is absolutely no reason to sign up for a currently offered plan when I can do short-term and have full coverage through an exchange plan on January 1. (In addition, I'll most likely qualify for subsidized coverage, so there's no reason not to wait.)

      BTW, Tennessee Rural Health informed me that they have chosen not to offer plans on the exchange. BCBST most certainly will, but nobody's publishing any details until October 1.

      Never interrupt your enemy when he is making a mistake.

      by Libertina on Wed Aug 14, 2013 at 04:59:47 PM PDT

      [ Parent ]

      •  Just do a short-term or Cobra until exchanges open (2+ / 0-)
        Recommended by:
        Senor Unoball, Oh Mary Oh

        then. Probably short-term, I wouldn't take Cobra for $1500.

      •  I'd check with Farm Bureau (TRH) again. (1+ / 0-)
        Recommended by:
        Oh Mary Oh

        I hate those people but that is what my husband has had for years. It's a long story but when we originally applied, they would not insure me but would insure my husband so he has  had it for years.

        About a year ago we changed banks so he had to go there to set up the automatic withdrawal. They said "we wondered when you would come in, we have new plans." Turns out they were charging him for a family policy even though they would not cover the family (me). So he got a different policy with a lower premium and a higher deductible. They keep sending him letters now about how lucky he is that he is grandfathered so he doesn't get the preventive care or any benefits under the ACA. Now it was last year that he switched so maybe that is the reason he is grandfathered, but it is worth checking again. There was a better plan he could have applied for but he would have had to go through underwriting. So see if there is a plan you can switch to that would not require underwriting. Otherwise, I'd bite the bullet and go with COBRA.

        Husband is also looking forward to Oct. when he can apply for the federal exchange.

        You can't scare me, I'm sticking to the Union - Woody Guthrie

        by sewaneepat on Thu Aug 15, 2013 at 06:03:45 AM PDT

        [ Parent ]

        •  TRH (1+ / 0-)
          Recommended by:
          sewaneepat

          I checked and all their plans require underwriting. When we used to be with them over three years ago, we were in a plan that was grandfathered. They only had one plan at the time and we had it for years. When the ACA was approved, they closed that plan (but we, and probably your husband, were grandfathered) and opened up a bunch of different, more expensive plans. I imagine when your husband called they talked him into one of the new plans to get him off the cheaper, older plan.

          I talked to someone yesterday and she said that underwriting is used on all their plans, they all require a 12 months preexisting conditions clause, we would be treated as new subscribers if we wanted to go back to them, and they would not be participating in the exchanges (they were going to "wait and see what happens"). Based on my previous   communications with the CEO (see my earlier post from 2010), I believe he's hoping the ACA will be repealed. He had published some anti ACA propaganda when it first passed with lots of doom and gloom predictions.

          I imagine they will lose some subscribers when the exchanges open since many of their subscribers will qualify for subsidies. It will be interesting to see how TRH responds.

          Never interrupt your enemy when he is making a mistake.

          by Libertina on Thu Aug 15, 2013 at 08:28:17 AM PDT

          [ Parent ]

          •  I misread. I thought you still had TRH. (2+ / 0-)
            Recommended by:
            Libertina, SingleVoter

            I can't read the editorials in their magazine any more. It raises my blood pressure.  They are an ultra conservative bunch of follks and we will be glad to get rid of them come January.

            My husband's new policy was cheaper than the old because they had been charging him for a family plan instead of an individual plan for 15 years. Asses.

            Good luck.

            You can't scare me, I'm sticking to the Union - Woody Guthrie

            by sewaneepat on Thu Aug 15, 2013 at 09:52:32 AM PDT

            [ Parent ]

  •  AARP (4+ / 0-)

    I was in a similar situation a few years ago. I had COBRA insurance after getting laid off, and that transitioned to a HealthNet guaranteed-coverage policy after my 18 months of COBRA ran out.

    That policy was excellent but they kept raising rates until it became unaffordable. At the end, my rates went up from about $700 to $900 when I turned 50. A couple of months later I got a notice from HealthNet that, hey, it was the anniversary of my insurance policy start date, so they were raising it yet again, up to more than $1,100.

    For just me.

    I had preconditions, including two bouts of cancer. Even though those were 6 and 8 years previously, every insurance company I called just laughed at me when I called up to find out about coverage.

    I heard about this AARP coverage, however, and applied. It's NOT a Medicare supplement, but a regular group health plan issued through Aetna.

    See here.

    Yes, I declared my previous cancer, and noted that I was no longer under treatment. I was accepted for the coverage. Not at the lowest rate but, at $500 per month, it was less than half of what HealthNet was wanting.

    Check it out.

    •  Also (3+ / 0-)

      Are you a member of any organizations? College alumni group?

      They might offer insurance for members.

      Years ago I completed a certificate in my field, taking night courses through a local university. I did not have a degree from the school, but that was enough to allow me to join the alumni association.

      And that association offered group insurance to its members. Not the best insurance, but it was sufficient to cover me until a better policy came along.

  •  ya, go with short term to take effect just before (2+ / 0-)
    Recommended by:
    Libertina, Senor Unoball

    you have to commit to COBRA. If horribleness happens you can pay the back premium for cobra, if all is good short term is cheap and in Jan you are covered by Obamacare.

    I've been self insured for a decade and a half. It's not good.

    “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

    by ban nock on Wed Aug 14, 2013 at 04:37:01 PM PDT

  •  The short term plans are not so wonderful (2+ / 0-)
    Recommended by:
    Senor Unoball, Oh Mary Oh

    You might be okay now because it would get you to 2014, but for example having a serious accident or illness in the last week would leave you in a situation where you can't renew the policy and you'll have preexisting conditions for the next policy. Tread with extreme caution.

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Wed Aug 14, 2013 at 05:35:57 PM PDT

  •  Looking too (3+ / 0-)
    Recommended by:
    Libertina, Senor Unoball, Oh Mary Oh

    Great post.  I too have been seeking alternatives in Tennessee.  Your info was/is helpful to investigate the process and see how others are faring.  Recently my family (my wife and two sons -- all healthy) and I punted on the standard coverage we had for years, and went for the way high deductible -- $10,000.  We never met our previous deductible anyway ($3500 ea), so I figured why not?  Our seldom visits were not that expensive -- usually a $45 co pay and the price of an anti biotic...whatever.  I did have a kidney stone like three years ago, and the retail cost on my lithotripsy was an obscene $20,000 or so.  That was honestly one of the only times in the past 10 years we've "needed" insurance.  I am still unclear whether my high deductible now would consider that procedure an "elective" or not (probably would).  As I write this I recognize how insurance companies like to keep the information vague...

    Anyway the way high deductible took our payments from over a thousand dollars a month to less than $500 (dental too).  That's a lot of savings.  I plan to create a health savings account, and if I can be disciplined enough to pack away a couple of hundreds bucks into that per month, I figure in a year or two I would have a good enough cushion for our typical doctor visits and still be saving.

    I went on an exchange site today, and learned that my wife and my combined income (2014 estimate) does not qualify for any tax subsidy, and the recommended coverage puts us right back to where we were...like $1200 per month. SHEESH.  All this time I was thinking we were the poster child family for Obama care.  Not rich, but rich enough to pay an obscene amount of money for health care coverage that we don't really need.  (Like about 20% of our net pay going to "insurance" that every time we go to the doctor -- rarely - is adjusted so that we owe pretty much the same as the cash price)

    Still seeking a reason to be psyched about Obamacare, but bummed at the first look at the exchange.  

    •  The exchange isn't available yet (1+ / 0-)
      Recommended by:
      Senor Unoball

      Where did you see exchange prices? Everything I've been told says the exchange won't be published until October 1 and the insurance companies in Tennessee aren't sharing their rates until then. I'd love to know what the prices will be like. We will most likely qualify for subsidies this year, but hopefully my business will take off. Then, of course, we'll have to pay more.

      Never interrupt your enemy when he is making a mistake.

      by Libertina on Wed Aug 14, 2013 at 07:20:44 PM PDT

      [ Parent ]

      •  The exchange isn't available yet (1+ / 0-)
        Recommended by:
        Oh Mary Oh

        Hey there Libertina:

        You are correct.  I mis spoke about the "exchange" being available.  I cant remember the site I went to to find out if I qualified for subsidy ( I didn't).  But I found this site pretty useful for side by side comparison:

        http://www.healthcare.com

        Good luck

        •  I just went to the site above and (2+ / 0-)
          Recommended by:
          Oh Mary Oh, Libertina

          I don't see anything about the exchanges. I did not want to fill out the contact info so maybe that is why I did not get that far.

          However, I have been to the Kaiser Foundation link and while it is not specific to TN, it does have a page to plug in info and tell you what a Silver plan under the exchange would cost. I have no idea where they get their estimate and how accurate it is since different states would have different premiums but am hoping it is based on the federal exchange.

          You can't scare me, I'm sticking to the Union - Woody Guthrie

          by sewaneepat on Thu Aug 15, 2013 at 06:17:29 AM PDT

          [ Parent ]

          •  Watch out for commercial sites! (2+ / 0-)
            Recommended by:
            sewaneepat, Calamity Jean

            The site healthcare.com is a commercial site masking itself as related to the ACA. The real site is healthcare.gov. I really like the Kaiser site as well since it gives some solid facts about the coming coverage (such as you can use the subsidy toward any level of plan). The costs are national costs...hopefully Tennessee will be a little lower, but we'll see...

            Again, no details about actual Tennessee pricing are expected to be released until October 1.

            Never interrupt your enemy when he is making a mistake.

            by Libertina on Thu Aug 15, 2013 at 08:38:38 AM PDT

            [ Parent ]

  •  For $1500 a month (2+ / 0-)
    Recommended by:
    Libertina, GRLionsFan

    you could move to the south of France and have all your expenses paid.

  •  I believe you've missed something critical (0+ / 0-)

    I went through what you're doing about 12 years ago and it was even harder to get good information then than it has been in recent years.

    It's difficult to imagine any desirable scenario where you'll spend less on your own than what you're offered through COBRA.  They can only charge you 2-3% over their own cost for the coverage.

    My wife and I have separate individuals HSA's that were not subject to underwriting (more on that in a moment) and together we pay $1500 monthly with dual $2600 annual deductibles and $5000 out-of-pocket maximums.  This is with BCBS.  There's nothing explicitly punitive about this rate.  It is based entirely on age, gender, and ZIP code.  It has inflated to about 3 times what we paid back around 2001, but not in any way based on claim history.  We might have done better with a joint plan but there were other reasons we didn't do that.

    COBRA isn't forever.  Fortunately you'll be able to get into an exchange come January and I'd think you'll see major improvement there, especially as it sounds like money is an issue and so you'll be under 400% of the poverty level.  That will make you eligible for a subsidy.   Without the advent of the exchange, you could have kept COBRA for 18 months IIRC .  Then your state would have offered you much more expensive pool coverage.  

    But the critical point you're missing is the one-time right to transfer creditable coverage from group to individual coverage.  To exercise this right, you must first exhaust your COBRA coverage.  And you must enroll within 63(?) days of its termination.   During that window you can enroll in an individual plan with no underwriting and no exclusion of pre-existing conditions.  

    It's a one-time right.  You can't go from individual to individual that way.  You can't go from individual back to group (unless the group plan has open enrollment for new hires).  You can't even change your deductible within an individual plan without going through the qualification process.

    When I started writing this, I had forgotten you have to exhaust the COBRA before you can transfer your creditable coverage.  Maybe ACA has already brought liberalization of transfer rights and you can already do so now without first exhausting COBRA.  I'd say investigate that question first.  Also double check the number of days in the window.  But one way or another, you CAN buy insurance without medical qualification -- either by COBRA or by this transfer right.   That will carry you to January.

    Much as I regret to say it, I think you're going to be forced to go the non-qualifying route.  I don't see how you're going to find any "real" qualified insurance that doesn't cost a lot more than what you can get when you don't have to qualify.  That doesn't mean you shouldn't seek the information, but I surely would be suspicious and extremely cautious about any apparent miracles.

    ------
    Ideology is when you have the answers before you know the questions.
    It is what grows into empty spaces where intelligence has died.

    by Alden on Thu Aug 15, 2013 at 09:51:40 AM PDT

    •  transfer to individual coverage from COBRA (2+ / 0-)
      Recommended by:
      Libertina, Alden

      isn't necessary once ACA is in effect next year. Under ACA you can't be denied coverage, or have your rate raised, for pre-existing conditions, even if you were not previously on group coverage such as COBRA. That is a big change, and good news, because the special class of individual plans that former COBRA participants qualify for (HIPAA plans) are very expensive.

      •  Exactly Wobbly! (1+ / 0-)
        Recommended by:
        Alden

        My monthly COBRA rate will be $1500+ if I choose to take it (which I most likely won't). By comparison, the rate we were paying four years ago with Tennessee Rural Health was less than $500 per month (but rising quickly). The coverage was not as good, but not bad ($1000 indiv. deductible). However, as I understood it, they had the right to cancel at any time, so it was very scary. If we had a major health event, would they have paid it? Not so sure.

        With the exchange, I'll most likely be paying less than $500 per month due to subsidies, have all preexisting conditions covered on day on, not have to go through underwriting, etc. I'm not considering other options after January 1...I'm just trying to figure out what to do until then.

        Never interrupt your enemy when he is making a mistake.

        by Libertina on Thu Aug 15, 2013 at 11:39:34 AM PDT

        [ Parent ]

        •  Apples to oranges (1+ / 0-)
          Recommended by:
          Libertina

          I don't know TRH but it sounds like the kind of "fake" insurance I was warning about.

          Anything in the pre-ACA world that significantly underbids mainstream prices is likely to be the kind that evaporates the moment you need it most.  There's so shockingly much of that fake insurance around, especially in Appalachia and the more anti-regulation red states elsewhere.

          Even the prices you quoted are total rip-offs if they're only (in reality) going to pay for routine office visits.

          ------
          Ideology is when you have the answers before you know the questions.
          It is what grows into empty spaces where intelligence has died.

          by Alden on Thu Aug 15, 2013 at 12:53:27 PM PDT

          [ Parent ]

          •  At least they have a long record (0+ / 0-)

            TRH could be one of the good guys or at least the better guys.  At least it appears they were established that way in 1947. They're at pains to note that they were established then as a non-profit (whatever that means in today's word) but they don't actually state that they remain so.  They're an outgrowth of the Farm Bureau movement which at least has a good heritage but seems to have also evolved into a representative of the profit-making non-profit species.

            They state that they administer their plans through BCBS of Tennessee.

            Whatever the heritage, if it's true as you (Libertina) say  that a TRH plan can be cancelled just because you had legitimate claims, that fact does speak for itself.  At best such a plan could be called "red state insurance."

            ------
            Ideology is when you have the answers before you know the questions.
            It is what grows into empty spaces where intelligence has died.

            by Alden on Fri Aug 16, 2013 at 01:40:26 PM PDT

            [ Parent ]

      •  Right, I get that (0+ / 0-)

        I'm wondering if ACA may have expanded the application of creditable coverage for the interim until Jan 1. Plus even the old setup can be useful news for someone who may be exhausting COBRA before then.

        ------
        Ideology is when you have the answers before you know the questions.
        It is what grows into empty spaces where intelligence has died.

        by Alden on Thu Aug 15, 2013 at 12:40:50 PM PDT

        [ Parent ]

  •  Be very careful that you fully understand (0+ / 0-)

    the conditions for your COBRA coverage.  For one thing, the following would be very unusual:

    I am guaranteed coverage through COBRA as long as I pay for it.
    Normally, COBRA benefits last only for 18 months.

    You should look into "healthcare navigation" organizations.  I can't tell you the names of any reliable organizations in the Nashville area, or what a consultation might cost (the company I went to 3+ years ago has more than doubled its fee since then, from $300 to $750 for a 90-minute consultation).

    Even if the fee seems high (and $750 is a lot to shell out for a 90-minute consultation), it can potentially save you from making a mistake that can end up costing you thousands.

    We must drive the special interests out of politics.… There can be no effective control of corporations while their political activity remains. To put an end to it will neither be a short not an easy task, but it can be done. -- Teddy Roosevelt

    by NoMoJoe on Thu Aug 15, 2013 at 11:36:57 AM PDT

    •  Your statement shows how messed up (5+ / 0-)
      Recommended by:
      cjo30080, NoMoJoe, Libertina, gmats, llywrch

      our system is.

      You should look into "healthcare navigation" organizations.  I can't tell you the names of any reliable organizations in the Nashville area, or what a consultation might cost (the company I went to 3+ years ago has more than doubled its fee since then, from $300 to $750 for a 90-minute consultation).
      While I think this is good advice, the fact that someone must hire a consultant to understand their healthcare options shows how utterly insane our system is.  My Canadian friends tell me that they just go to their medical provider and present their Medicare card.  There are no phone calls about coverage, no large billing staff to determine whose insurance covers what etc.  It's just so simple.  It boggles my mind why people don't think that would be preferable to the quagmire we call health care in this country.

      “It is the job of the artist to think outside the boundaries of permissible thought and dare say things that no one else will say."—Howard Zinn

      by musiclady on Thu Aug 15, 2013 at 12:17:43 PM PDT

      [ Parent ]

      •  No argument from me. (0+ / 0-)

        There's a FP diary up on the subject of healthcare navigators:
        LINK

        We must drive the special interests out of politics.… There can be no effective control of corporations while their political activity remains. To put an end to it will neither be a short not an easy task, but it can be done. -- Teddy Roosevelt

        by NoMoJoe on Thu Aug 15, 2013 at 02:38:02 PM PDT

        [ Parent ]

    •  "as long as I pay for it" (1+ / 0-)
      Recommended by:
      cjo30080

      meaning "on the condition that I pay for it." You're right that it can only be had for 18 months in most situations, but the plan is actually too good, in that it would cost me $1500 per month. I can't afford that. Also, would never pay a consultant to tell me how to buy insurance...I am pretty good at research myself. And to charge more than an attorney? Sounds fishy to me.

      Never interrupt your enemy when he is making a mistake.

      by Libertina on Thu Aug 15, 2013 at 02:45:07 PM PDT

      [ Parent ]

  •  tax deduction (0+ / 0-)

    Since you are self-employed, your health insurance premiums will be tax deductible, but your out of pocket health costs will not be unless you have a HSA.

  •  Libertina, I did not see mentioned in the diary (2+ / 0-)
    Recommended by:
    Libertina, llywrch

    whether enrolling in your spouse's workplace insurance is an option?  My apologizes if I have overlooked this being mentioned.

    Just thought I'd mentioned it in case it is a viable option.

    This past spring, my spouse made a career change-AKA quit his "job" to help establish/work with a start up.  Contractor status. The only way he could make this transition was to request that his wages reflect both COBRA premiums & estimated taxes.  This was a necessity as we had unexpected medical events in the prior year that continue.  

    The insurance he had in the job he left was excellent-covered  the vast majority of major medical, ongoing medical bills & RX.  Because the medical event involved things like transplant teams, hospitalization & ongoing followups with pain clinics/therapy/labs/MRIs, we took the COBRA route to be on the safe side financially...

    There was not a lapse of coverage, same insurance plan at a little over 1K a month for both of us (ages 57/61 & I am unemployed).  Coverage includes dental & vision, typical co-pays & apparently does not have a very high deductible since the only out of pocket was for A TENS pain unit at the first of the year.  

    We would have never considered doing this prior to the unexpected medical event.  We're the type that just do not go to doctor unless we feel close to death, lol.  Being involved in back to back start ups or under employed has typically meant no health insurance or garbage insurance for the past 16 years.

    But, as we learned the hard way, accidents happen.  In our case a common outpatient surgery gone wrong with no guarantees as to the long term outcome.  
     What we have paid in premiums thus far does not even come close to covering the most recent MRI (horrifically expensive), so I am relieved that we chose this route.
    That being said, we'll also be looking at the national exchange when it becomes available-hopefully before COBRA ends.  Otherwise we are seriously screwed if Pre-X is still on the table under the guise of "grandfathered".

    All the best in your endeavors!

    •  No changes (1+ / 0-)
      Recommended by:
      worldlotus

      The exchanges cannot have grandfathered plans, and all exchange plans will cover pre-existing conditions. I don't see any indication that that could possibly change.

      My husband has always been self-employed. We only went on employer-sponsored insurance when I became a teacher three years ago, and I left that job to re-start my own business.

      Never interrupt your enemy when he is making a mistake.

      by Libertina on Thu Aug 15, 2013 at 05:57:24 PM PDT

      [ Parent ]

  •  COBRA. (0+ / 0-)

    They accept you as you are. I don't get the waiting period though. I had zero lapse in coverage between my departure from employment and the start of my COBRA coverage. Not even a minute.

    If you hate government, don't run for office in that government.

    by Bensdad on Thu Aug 15, 2013 at 08:00:11 PM PDT

    •  It's not really a waiting period... (2+ / 0-)
      Recommended by:
      cjo30080, Bensdad

      It's just that the employer does not start the paperwork until after the last day of employment and/or health insurance. Mine ends Aug 31. Then they send me the forms. As long as I write the check within the window (60-75 days depending on when I get the letter) my coverage will be retroactive to Sept 1, so there is no loss in coverage. My options would be to sign up right away or to wait until near the end of the window and, if I haven't needed the coverage, just don't pay for it. It's about the only way I've heard of where you can pay for insurance after you see whether you needed it or not.

      Never interrupt your enemy when he is making a mistake.

      by Libertina on Fri Aug 16, 2013 at 06:04:53 AM PDT

      [ Parent ]

  •  thank you for writing this diary (1+ / 0-)
    Recommended by:
    Libertina

    and thanks to all who have shared their thoughts and comments.  I too will be entering the fray due to upcoming loss of employment (plant "consolidation") and we are looking at our options.  The discussion here has been helpful.

    In walked the village idiot and his face was all aglow...he's been up all night listening to Mohammed's Radio (Warren Zevon)

    by Wonton Tom on Fri Aug 16, 2013 at 03:39:46 PM PDT

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