The Second Half: Are you at risk?

February 17, 2010

By Kathleen D. Tresemer
Columnist

Insurance is a funny thing in the Second Half of life, especially when you don’t have any.

Well, maybe “funny” isn’t the right word… unfortunate, sad, unfair, disgraceful, ridiculous, embarrassing, detrimental and socially irresponsible come to mind, but that’s only if you don’t have insurance or are under-insured. If you have insurance—good insurance—you might be thinking, “So? Go get some and quit whining!”

A 50-something gal, Kay, explained her dilemma: “I am overweight. A few years ago, a doctor put me on high blood pressure medication, even though my pressure was fine. She had assumed I needed it because I was overweight. After a couple of weeks, I questioned this decision, and she discontinued the meds.”

Kay shook her head, “Now, insurance companies won’t cover me—I’m overweight and I was on blood pressure medicine, a double whammy in terms of pre-existing conditions.”

Kay had to get a denial of coverage from one insurance company to qualify for a state-subsidized plan…a plan that charges her double what the original coverage would have been because of her pre-existing condition, in the ballpark of $600 per month. Kay works part time and wonders how to make the payments.

What’s high-risk insurance? The National Association of Health Underwriters Web site offered this information:

“States are not required to have an alternative option for medically uninsurable individuals to access coverage, but most do… high-risk pools serve as the guaranteed-issue purchasing option for individuals who wish to exercise federal group-to-individual insurance portability rights.”

I was pleased to note that Illinois does have this option. I scrolled down the page and found a section about cost:

“Risk pool health insurance is more expensive than traditional individual insurance. This is fair because pool members, by definition, are those who are considered to be medically uninsurable. State laws generally cap risk pool rates between 125-150 percent of the base individual market rate (bolding is mine). … Pool rates are fairly affordable nationwide because they are directly tied to the rates in each state’s existing individual market.”

“Fairly affordable” is debatable…I started calculating: “If my insurance is $300 a month, multiply by 150 percent, bringing my high-risk rate to…$750 per month!”

A couple of weeks ago, I spoke to a Second-Half gal with a pre-existing condition who never gave coverage a second thought—until life intervened: “I am a diabetic, but I was always covered on my husband’s insurance. When we divorced, he paid the COBRA cost for a period of time, but then it was up to me to find my own insurance. I couldn’t come close to affording high-risk rates!”

I asked her what she did for medical care: “I won’t be 65 for a couple of years, so, until then, I go to Crusader’s Clinic.”

Some of her friends may be shocked that she has had to “resort to” non-profit discounted health care, but she doesn’t feel that way: “It’s a long drive, but I only pay $20 a visit, and my insulin is very affordable. The facility is really nice and modern, they are wonderful to me, and—aside from the lack of choice—I’m happy to have this option.”

Shades of 1969! I recall any number of community health centers that were available during my high school and college years, mostly used by the kids I knew for birth control. Some of the “radical” ideas about serving patients were first seen in those lovely places, such as treating patients like customers instead of medical idiots, and respecting customers’ wishes and ideas regarding their own health care plan. Far out, man!

Recently, I had to find a new insurance carrier—as a free-lancer, I have to buy my own. Under my previous policy, I hurt my shoulder and required a few sessions of physical therapy. When I made a claim, they decided my preventive maintenance with a chiropractor put me in the pre-existing category (shoulder attaches to spine, thus the connection—go figure!). They also wanted a HUGE premium increase, retroactive from the day I got the policy! Not likely…I have a new insurance carrier now, but any injury or illness related to the spine is not covered.

By now you know what “side” I’m on—I can’t understand how the best country in the world can allow some folks to pay huge insurance premiums for the same coverage others get for much less, while still others go without medical care for lack of coverage. If we can send folks to the moon, for heaven’s sake, we can make quality medical care available for our citizens. Elizabeth Cohen, CNN Senior Medical Correspondent, wrote:

“The industry’s trade association, America’s Health Insurance Plans, has a proposal to help people with pre-existing conditions as part of a comprehensive health-care reform plan. But there’s a catch: The association says insurance companies could guarantee coverage for people with pre-existing conditions only if all Americans are required to purchase coverage. If that happens, the group says, not only would people with pre-existing conditions be covered, their premiums would not be higher.” (CNNHealth.com; May 14, 2009)

I know it sounds like work, but, just in case, check out the links in the box following this column—you can read the AHIP proposal, investigate high-risk insurance for someone you love, or learn about community health care options.

Just in case.

And remember my motto for long life: “Watch out for that bus!”

Insurance and medical coverage

If you want to learn more about getting insurance coverage or affordable medical care in today’s consumer climate, begin here:

The National Association of Health Underwriters Web site offers a good FAQ page regarding high-risk insurance: http://nahu.org/consumer/HRPGuide.cfm

The Healthy Access Database offers information about high-risk providers in various states: http://nahu.org/consumer/healthcare/index.cfm

AHIP’s proposal called “Now is the Time for Health Care Reform: A Proposal to Achieve Universal Coverage, Affordability, Quality Improvement and Market Reform” can be found at: http://www.americanhealthsolution.org/assets/Uploads/ahipreformpolicyproposal.pdf

Crusader Community Health offers discounts based on federally-established guidelines.  You may be eligible for a discount if you are not covered by an insurance plan.  Discounts are based upon family size and income.  Proof of income is required to be considered for a discount.  Crusader Community Health provides assistance in completing entitlement applications.

Learn more at the Crusader Community Health Web site: www.crusaderclinic.org

The National Association of Community Health Centers shares their vision for the future on this site: http://www.nachc.org

The Illinois Primary Health Care Association serves the medically underserved in Illinois—see how: http://www.iphca.org 

In her second half of life, Kathleen D. Tresemer is both a journalist and an award-winning fiction writer. She lives with her husband on a small ranch in rural Shirland, Ill. Kathleen can be contacted by e-mail at kdt-insights@hotmail.com.

From the Feb. 17-23, 2010 issue

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