<p>For various reasons, we are looking at buying healthcare insurance for our famly, and need advice on how to go about doing this. Can one only purchase insurance within the State of residence? Also, what are the traps and pitfalls of buying as an independent family? My biggest concerns are that my H has Type-2 diabetes, and also that he is a long-time smoker.</p>
<p>For various reasons, we are looking at buying healthcare insurance for our family, and need advice on how to go about doing this. Can one only purchase insurance within the State of residence?</p>
<p>Generally, yes. Health insurance is regulated by the states, and the agent/broker/company that you deal with must be licensed in your state of residence.</p>
<p>Also, what are the traps and pitfalls of buying as an independent family? My biggest concerns are that my H has Type-2 diabetes, and also that he is a long-time smoker.</p>
<p>You’ve got the right idea about individual health insurance - you will find it is more difficult to cover many health conditions. While most insurers will rate up but still accept a smoker, many will decline a Type 2 diabetic or eliminate that condition from coverage if they issue a policy.</p>
<p>Be very careful here - dropping group health insurance (I’m assuming you have it at present) in favor of an individual policy can have serious pitfalls, and the advice of a local agent or broker could help you avoid them.</p>
<p>Good luck!</p>
<p>Be very careful with this. When my husband started his company three years ago, we bought a policy with PHCS and were promised the sun, moon and the stars by the agent. The coverage was adequate except for meds. The agent neglected to tell us there was a cap on coverage for prescription expenditures…which we discovered the hard way. Thank goodness we now have enough employees to set up a group plan with a different carrier. But we are still waiting on certificates of prior coverage by PHCS so that we can waive waiting periods for major dental coverage. At this point they won’t even return our phone calls.</p>
<p>We are not voluntarily dropping Group, but actually preparing a contingency plan. I was reading up on rankings of different plans, and was surprised to see, for example, that Aetna in Pennsylvania is ranked far higher than Aetna in NJ, as far as claims, customer satisfaction, preventive care etc. So, can one directly buy insurance from Aetna in another State?
Has anyone had to buy individual insurance either due to loss of employment, or starting their own business?</p>
<p>Buying an “individual” policy, versus being able to participate in a group is usually quite expensive.</p>
<p>Often “individuals” will find they can be part of some group (professional association, small business association, Chamber of Commerce…), which can lead to better coverage/lower premiums. Worth investigating.</p>
<p>When you have a pre-existing condition (such as diabetes), it is possible it will NOT be excluded from coverage if you are covered under a policy (which also chooses not to exclude the condition) at the time you choose to change carriers. So it’s important to stay covered, if you currently are, while you shop for alternate policies. YMMV.</p>
<p>You can save substantially on your health insurance premium - if you <em>must</em> go with an individual policy, not a group policy - by increasing your deductible. High deductibles might be $1K/family member; $3K total family. They can go very high to an amount I consider huge (eg, $15K/family member; $30K/total family). If you are comfortable with the possibility of such a substantial deductible, you can save quite a bit on your monthly outlay. In effect, you are giving yourself “catastrophic” insurance.</p>
<p>Chocoholic:</p>
<p>Consumer Reports regularly ranks health plans. You may find one in your state that fits your needs and your purse.</p>
<p>When my S graduated from college and took a gap year, he had to go on individual coverage since he was no longer our dependent. It costs as much as our family coverage (which used to cover 4). In our state, if you lose your insurance because of unemployment, you can continue being covered by your plan under COBRA for 18 months, but the cost goes up signiificantly as per my S’s experience.</p>
<p>Chocoholic - ask the agent about pre-existing conditions… a lot of times, diabetes alone will not exclude you from a plan, but that mixed with something else will. It really depends on how they underwrite it. </p>
<p>If you are replacing/being kicked out of an employer plan or being kicked out of some other type of plan, ask the agent about Guaranteed Issue. They’ll know what you mean. That could waive any type of pre-existing conditions that you or your family may have as well as give you a guaranteed right to enroll in it - however the conditions may make the premium higher depending on how or if they underwrite it. Also, don’t cancel anything until you are certain you are covered by your new plan. You never know when something will get lost and you find yourself with no coverage. Also ask about life time max’s, deductibles, maximum out of pocket expenses, and cap’s on certain items (such as prescription drugs).</p>
<p>And as far as having coverage from out of state - I think it really depends. I have Delta Dental of New Jersey for my Dental Insurance yet I live in Pennsylvania… even though we have Delta Dental in Pennsylvania.</p>
<p>Hope I was able to help.</p>
<p>Get anything the agent promises IN WRITING, especially the pre-existing conditions regarding diabetes. It’s important not to have a lapse in your coverage to optimize your chances of getting a good premium rate & having the pre-existing conditions covered. Group policies are generally the least expensive option-as was said often thru professional organizations or anything else you or hubby may belong to, like small business association, etc.
It’s good that you’re researching your options now so you won’t be stuck. If the policy is going to lapse before you find the right one, you need to find out about HIPPA & COBRA, which requires that you be offered continuing coverage (tho often at a higher premium rate) for 18 months after your policy would otherwise end. This will give you more “breathing room” to get the right policy. Here’s a site with more info about your rights to continuing coverage.
<a href=“http://www.dol.gov/ebsa/programs/ori/techrel/cobra.htm[/url]”>http://www.dol.gov/ebsa/programs/ori/techrel/cobra.htm</a></p>
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As self-employed persons, we have had to arrange our own coverage for several years. We have changed a few times - have had “group” plans through various associations as well as individual. Have had HMO as well as indemnity coverage.</p>
<p>as far as my job goes, and my daily dealings with insurance companies, people in pennsylvania have blue cross from every state in the union, and vice versa, so yes, you can get insurance from any state. it just depends where the company gets the best deal. If you or husband are self employed, you can check with the small business association and sometimes you can get in a group plan with them that can be much better than going yourself to get insurance. I am not a fan of aetna at all because of my experiences with them, and it can be very hard to find a hospital or doctor that accepts their pathetic payments. Another potential option would be to get an extremely part time job at a place that offers health insurance that you could purchase, which is what I did a few years ago before going full time. The thing to watch for and ensure you know about is what exactly is covered, and what isn’t. I have seen insurance plans that only cover $2000 per hospitalization, and that is eaten up in the first few minutes in the ER! You have to be very careful because people sometimes think they have a lot more than they do, and they only find out when something catastrophic happens. and dont’ think that just because it’s a well known product that it’s going to be good, like blue cross, because they also have some extremely awful plans.</p>
<p>If you have group coverage through an employer now, I would recommend COBRA, even though it is ridiculously expensive. The coverage is SO much better. I was hell-bent NOT to do COBRA when I parted ways with The Company From Hell last April (they actually paid the COBRA through end of 2005), because it is $1600 for my family of 4. I shopped around- using various agents- for a private plan. Our financial advisor told me to suck it up and stick with the COBRA. It is much better for our family (Wild Child does physical therapy and some other stuff that the group plan covers). Otherwise, what I discovered was that Blue Cross generally had the best coverage for my needs, and it was STILL pretty expensive unless you wanted a very high deductible plan.</p>
<p>MOWC - Doesn’t COBRA have an expiration or maybe it’s just how long the company pays or you get a preferred rate? I guess I forget why we moved away from the COBRA plan so many years ago.</p>
<p>COBRA is good for 18 months. It is always high, but how high depends on the experience of the company (your employer). You are paying the whole deal- no help from the company- once you pick up COBRA.</p>
<p>I just looked up Blue Cross plans, all the way up to their premium levels, and none covers diabetes too well. There is a 50% co-insurance, at best, with a $2500 annual max!!! This is our national disease!</p>