Have you been refused health insurance coverage and can't afford state coverage?

[Mimosa]

Yesterday my partner and I -both over 55 and with pre-existing conditions, not major- were refused coverage by Aetna. It would have been $468 a month, $5000 deductible. We can no longer afford $895 a month for our BC/BS $10,000 deductible insurance. It looks like we will have to go without.

And it's a long time before Medicare. It's scary to contemplate not being insured.

I went to http://www.healthcare.gov/>healthcare.gov, the site the blue link people always tout. Here's what I could get after 6 months without health insurance IF we could afford it. But we can't. :(


Pre-Existing Condition Insurance Plan: Georgia

* Share
o Add this to...
o Send a link to Pre-Existing Condition Insurance Plan: Georgia to someone by E-mail
o Share Pre-Existing Condition Insurance Plan: Georgia on Facebook
o Tweet about Pre-Existing Condition Insurance Plan: Georgia on Twitter
o Bookmark Stop Pre-Existing Condition Insurance Plan: Georgia on Google
o Submit Pre-Existing Condition Insurance Plan: Georgia to Yahoo! Buzz
o Bookmark Pre-Existing Condition Insurance Plan: Georgia on Delicious
o Rank Pre-Existing Condition Insurance Plan: Georgia on Digg
o Close
* Email
* Print Icon

On July 1, eligible residents of Georgia will be able to apply for coverage through the state’s Pre-Existing Condition Insurance Plan program run by the U.S. Department of Health and Human Services.

To qualify for coverage:

* You must be a citizen or national of the United States or lawfully present in the United States.
* You must have been uninsured for at least the last six months before you apply.
* You must have had a problem getting insurance due to a pre-existing condition.

PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even if it’s to treat a preexisting condition.

Below are the monthly PCIP premium rates for Georgia by the age of an enrollee.

Ages 0 to 34: $323

Ages 35 to 44: $387

Ages 45 to 54: $495

Ages 55+: $688

In addition to your monthly premium, you will pay other costs. You will pay a $2,500 deductible for covered benefits (except for
preventive services
preventive services
Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.

) before the plan starts to pay. After you pay the deductible, you will pay a $25
copayment
copayment
A flat dollar amount you must pay for a covered service. For example, you may have to pay a copayment5 copayment for each covered visit to a primary care doctor.

for doctor visits, $4 to $30 for most prescription drugs, and 20% of the costs of any other covered benefits you get. Your out-of-pocket costs cannot be more than $5,950 per year. These costs may be higher, if you go outside the plan’s network.

Learn more about the Pre-Existing Condition Insurance Plan and apply.

[old mark]

1. I have similar state insurance in PA. It started at $235 a month, but last

March it went up to $600 a month with 30 days notice. It is now $639 a month.
there is a new State program, but that requires 6 months with no insurance, and I can't do that...I will be 65 in 2 years, and I will probably have to wait it out.

Private insurance - Blue Cross - was over $800 a month 2 1/2 years ago, just for me...my wife is on disability insurance.


mark

[still_one]

2. and what if you can't afford the premium, what is the remedy for that? /nt

[hobbit709]

3. You die.

[still_one]

9. So there is no difference before HCR and after HCR? /nt

[hobbit709]

10. Not if you don't have any money.

[still_one]

12. That is quite disappointing. I thought there were supposed to be subsidies if you could not afford

the premiums.

No wonder a poll out a few weeks ago indicated that the majority of people wanted the HCR to go much further than it did

It appears that after the midterms it will even be more impossible to obtain a real public option

[hobbit709]

15. And none of that will kick in until 2014.

If I didn't have coverage from the VA I'd be dead by then.
And I'm pretty sure that it didn't help my wife. Between her COBRA and copays, she was paying $1000/mo since she was dumped from her previous job before the stimulus COBRA deal took effect. So she didn't get some tests run because she thought she didn't have the money and it ended up killing her.

[still_one]

20. So sorry about what happened /nt

[Mimosa]

44. Hobbit, my heart goes out to you

That's exactly how we women think. We're scared to be a financial burden. And many of us will die because of inadequate health care 'reform.'

[Dragonfli]

11. There is a difference it is called a fine to be payed because you are too poor

I know very few people that could pay the deductibles we will be looking forward to, some may be able to pay the percentage of income they want us to pay for premiums to the protection racketeers, but they would have to live in there cars.

At least we will be fined so that we can be even poorer, that should make the rich feel better at least.

[hobbit709]

16. Well, if you're too poor to pay the fine

at least you'll get some healthcare when they lock you up.

[SammyWinstonJack]

24. Locked for not being able to pay a fine for health coverage you won't be getting because you can't

afford the premiums?

Pay for nothing or get locked up?

What a great deal! :sarcasm:

Makes me want to :puke:

Who thinks this is a good thing? :banghead:

[Dragonfli]

28. Blue link people and easy marks that think this is a game rather than life or death. /nt

[Recursion]

18. There is an expansion of medicaid and subsidies for premiums

If you call that "no difference"...

[Pab Sungenis]

45. There is a big difference.

Now it's against the law not to buy the unreasonably priced insurance.

[MedicalAdmin]

14. My wife and can't afford the insurance that is offered

So we haven't been officially denied. We both have preexisting conditions and we are both in our mid 40s.

For us there is no solution. None.

I'll tell you this, I'll eat a lead sandwich before I impoverish my family. No ambulance and no hospital. Ever.

[old mark]

4. There is no "remedy"...NO other private insurance but BCBS will take

anyone - like me - who has had bypass surgery, even though mine was very successful, almost 7 years ago, and is still good as new according to the lase test battery of tests I had...andmy cardiogram yesterday,

mark

[still_one]

8. I thought there would be subsidies if the premiums could not be afforded, obviously not /nt

[Recursion]

17. There are subsidies

Which apparently nobody seems to ask about.

[still_one]

23. That is what I am trying to find out about. There are some posts which indicate

that isn't the case for them

I guess if that is so, it depends on when the subsidies kick in, and the minimum income you have before you qualify for them

[Recursion]

25. Actually that is the subsidized price, it turns out

CoverFlorida is the name of the state-run program; it's a partnership between the state and six private companies, and the price quoted is the subsidized price, which is why the premium is cheaper than, for example, the premium for Medicare.

[Dragonfli]

26. I imagine then you think the deductible and co-pays shouldn't be counted?

The two things designed specifically to put ACTUAL HEALTH CARE out of reach.
This republican health care idea resurrected from the 90's and adopted by our party is as bad an idea now as it was then.

Unless you are one of the corporations that will profit heavily from it, it will suck money and deprive people without a few grand lying around to cover the deductable. There are many who can't even afford the "cheap" in your world premiums.

I was hoping you could tell me something that doesn't prove this sucks for blue collar people. We don't have the money you think we do and we do get sick, I myself have a disease that is killing me and this will not help me in the least, even if I live 'till 2014.

[Recursion]

29. You're assuming a lot about me with no basis

All I did was point out that this price is the subsidized price, which is why it's cheaper than the OP would be able to get insurance anywhere else, including if Medicare was open to everyone.

It's way too expensive, but that will be true whether we use this hybrid system or had single payer. We pay way too much for health care, and as hard as this is to admit, it's not insurance companies' fault.

[Dragonfli]

30. I apologize for the assumptions, but I disagree that it is not the insurance companies fault

Their entire reason for existing is to make as much money as possible, that mission conflicts with the mission to treat the sick and dying.
In countries that use insurance properly (heavy regulations) the costs are far less, about half our costs if I recall correctly, how is that explained?

[Recursion]

32. Because their procedures cost less

Medical providers charge less in Europe than in the US. Doctors make less. Nurses make less. Tests cost less. Drugs cost less. That's why countries like Switzerland can insure everyone through private insurance companies and still pay a lot less than we do.

[Dragonfli]

35. The costs are higher here but largely due to high administration costs

The labor costs you speak of are not as much higher as you have been led to believe.
Our nurses and med techs are not growing rich, some specialists are but not by the factors needed to account for so much of a difference.

You may not know it but you have convinced me now that a universal nationalized system would be the only way to bring the costs down to a level where people can afford health (I once thought single payer would be enough, it works well in Canada and we are so close in more ways than proximity).

If our people can not afford to see a doctor and they die because of it as will (by your account) continue, then our people have been failed to such a degree that it is a very real life or death issue, I realize that white collar people don't yet have to die because they can't afford to live, but working class people are just as important and this is simply unacceptable to us even if it does not threaten you personally (if you are white collar that is, I do not mean to assume but you talk as if the cost is a nuisance to you and not a death sentence).

I do not think you can convince me of your POV and I feel you will continue to believe that the vampires (ICs) are blameless no matter what I say so our conversation can only degrade from here and so I will end my responses with this post.

One last thought, factor in the deductibles and co-pays and it is not cheaper than medicare, something you avoided addressing, factor in also 30 to 40 percent savings in admin costs due to the huge staff needed to sort through so many insurance company claims and I believe we can reach parity with civilized countries that care about the health of the citizenry.

Dying for profit is simply unacceptable to me, sorry I can not learn to accept this as necessary, that is where we differ so strongly that I fear this degrading into a senseless argument.

[Recursion]

38. What's this "us" and "you"?

The labor costs you speak of are not as much higher as you have been led to believe.

The cost is a lot of things, but labor is a big part of them. Particularly for specialists, as you point out. But a lot more is for equipment use and drugs. We do a whole lot of very expensive tests that doctors in other countries don't do, and each of those tests costs more in the first place here than they do in other countries.

Insurance companies all together make about 15 billion dollars in profit a year. Take that entirely out -- remove profit completely, and that barely makes a dent in how much health care costs. And we're a less healthy country than any country in Western Europe to begin with, which becomes a vicious circle.

you talk as if the cost is a nuisance to you and not a death sentence

Ummm.. no idea how you got that from my post, but OK.

a universal nationalized system would be the only way to bring the costs down to a level where people can afford health

That probably would bring costs down, though our nationalized health system (the VA) is also having some severe cost problems in addition to quality of service problems. There's also absolutely no conceivable way you would get that to pass any Congress that would be elected in the next generation.

[Mimosa]

42. You don't get it

We are not dead broke, do not qualify for medicaid but cannot afford health insurance.

What you are calling subsidised -the exact correct plan for GA I posted- is unaffordable for MANY. You seriously don't get it.

[Recursion]

46. What do you think I don't get?

What you are calling subsidised -the exact correct plan for GA I posted- is unaffordable for MANY

Yes, the already-subsidized plan is unaffordable for many. Way too many. Insuring people who need medical care is ridiculously expensive. The problem is delivery costs.

[enlightenment]

37. They are not available yet - that part of the great 'reform'

doesn't kick in until 2014.

What people are talking about here is the current eligibility to apply for insurance coverage 'despite' pre-existing conditions - that is one of the elements of the 'reform' that has kicked in; unfortunately, it does not include any subsidy.

As such, many are finding that it doesn't matter that they can apply for coverage, because they cannot afford the coverage.

Your attitude is absurd - obviously you are so determined to support this 'reform' plan that you would prefer to think that people in desperate straits, who need access to medical care, would overlook - or simply fail to 'ask about' - any subsidy that might be available.

Perhaps you should try doing a little research yourself, before you accuse others of 'not asking about' something that does not currently exist.

Or perhaps you believe that people who need help now can just wait until 2014?

[Recursion]

41. The price quoted is the subsidized price

I was wrong about there being separate state subsidies; it turns out in Florida it's just part of the package.

[CurtEastPoint]

5. Same boat, Mimosa. This is totally insane, unacceptable, wrong... you name it.

Those who get rejected (us) have to pay MORE than someone who has a job. OK, I see... thank you sir...may I have more?
What's the solution? Not sure.

[Vinca]

6. My husband and I are in the same boat.

I've finally given up on it all. Either we live or die until Medicare kicks in - a year or so for my husband, 3 years for me. My biggest worry is that my poor hip will totally give out before then. But as long as fat cats get tax cuts, America is the greatest nation on earth.

[DCBob]

7. Yeah, I have been denied by both BCBS and United.. I am 55 with minor health problems..

I finally got a "decent" deal with Kaiser.. $250/month with 5000 deduct and co-pay. I am getting married soon and need to add wife.. rate will probably go way up.

[Lint Head]

13. Is it clear yet? The corporate fascists are killing us!

How long will this go on? Will generations pass before humanity is somehow saved from corporate fascist slavery or are we doomed to be subservient to greed?

[Recursion]

19. It's a state-run plan

What's corporate about it?

[JanMichael]

21. is it administered through a private company

through a contract?

[Recursion]

22. Six private companies, apparently

http://www.coverfloridahealthcare.com/

Which makes it revenue neutral to the state. The premium quoted in the OP is still cheaper than medicare.

[lins the liberal]

31. How in the world is that cheaper than medicare?

I thought medicare cost about $100 a month.

[Recursion]

33. The full unsubsidized Medicare premium for Parts A and B is $800 per month

The unsubsidized Part B premium is $350.
The unsubsidized Part A premium is $460.

viz: https://questions.medicare.gov/app/answers/detail/a_id/2260/~/medicare-premiums-and-coinsurance-rates-for-2010

Most people pay $100 for Part B and nothing for Part A. The remaining $700 is paid for by the trust fund, which you have hopefully paid into over your career (which is why you have to pay $800 per month if you haven't worked enough quarters with Medicare deducted). This is the trust fund that is scheduled to go broke in 2029 just at current cost levels (before HCR it was scheduled to go broke in 2017). This is how much it costs Medicare just to break even, and they pay providers less than any private insurance company does (which makes those of us with private insurance pay more, as providers make up their medicare and medicaid losses through us).

[lins the liberal]

39. I don't see where you got this info

from the link you provided. My understanding was that the government was paying medicare Advantage plans $800 a month and that this $800 a month was costing more than traditional medicare.

[Recursion]

40. Medicare advantage is a separate issue

The link I posted shows the Medicare part A premiums based on quarters worked with Medicare deductions:

https://questions.medicare.gov/app/answers/detail/a_id/2260/~/medicare-premiums-and-coinsurance-rates-for-2010

$461 / month is the full unsubsidized premium if you haven't had at least 30 quarters of Medicare-deducted employment.

Medicare Part B, in contrast to Part A, is subsidized based on income:

http://questions.medicare.gov/app/answers/detail/a_id/2261

As that page shows, the premium with no subsidy is $353 / month

So, the full premium for Medicare parts A and B is 461 + 353 = 814 dollars per person per month.

People who are paying less (which is most people) are having the rest paid out of the trust fund, which they paid into over their career. This trust fund is projected by its trustees to run out of money in 2029 (HCR pushed that day back 12 years).

That money is not some accounting fiction. It is actual money transferred from the trust fund to Medicare, and it has to come from somewhere. It is an article of faith on this board that adding more people to Medicare will make these costs go down. I see no particular reason to believe that.

[Mimosa]

43. Now you're arguing Medicare

That's not what the OP is about.

I have 7+ years to go before I'm old enough for medicare.

20014 is 4 years away. God only knows what will happen to me and people like me before then. If I fall? If I develop cancer?

[AngryAmish]

27. Years ago.

I have seizures every once in a while. I was denied coverage at my first job and then did not reapply until my thirties. I have coverage now. State coverage was outrageously expensive.

[Safetykitten]

34. Hi, I have health insurance and I don't care obligitory post.

I have health insurance, and I don't care. I mean I care that we won. We can say we did something that people may think was something, but in actuality does nothing but corral whole groups into death camps of non-affordable coverage as a tiny monority are showcased with coverage to prove that we did something.

But again, it does not affect me, so I will continue to push the HCR bill as the greatest thing of the 21st century. I do because I care about style over substance, policy over reality, and I have health insurance, so there are always things people without can do....so I am told.

[Dragonfli]

36. Your POV is prevalent around here, I applaud your courage in defending HCR!

It is after all about politics and not health, I am so sick of people bringing the sick into this!!