Monday, November 4, 2013

And then there was that issue of pre-existing conditions...

I should've known better than to have believe that I'd finally gotten to the end when I wrote my last Critical Information about Health Plans post.

Friday, just in the nick of time I sat down with the insurance broker and hastily filled out the application (again.  I'd already done it online but repeated the process again so that she'd get the credit) to get it submitted in time to get coverage effective 11/1.  Everything went swimmingly until we got to the final section where you had to list "other doctors" in which case I brought up the doctor my wife has seen for a pre-existing condition...  That condition was not called out at all in any of the prior questions except possibly as one of the "any other conditions" general catch-alls.  When I mentioned it the broker's face dropped and she said... "I need to be honest.  She will be declined, or HIPPA rated meaning she will get the highest rate."

Needless to say I was caught off-guard.  When the broker ran the quote for my wife ALONE at the highest rate the premium was double the rate that I had previously seen for my ENTIRE family.  Furthermore, while I don't have the final underwriting details yet it would appear that the new premium (for the entire family) will be a. nearly as expensive as COBRA (which I'm currently on) and b. as expensive as unsubsidized silver-level plans under the ACA.

It would seem that the ACA-compatible health exchange policies are:

  1. Necessary - because we now have a pre-existing condition that, remarkably and unbelievably, puts us in the same category as something really serious like having cancer
  2. More affordable premium - even if we don't get subsidies and definitely if we do (which would apply up until about $100k salary)
  3. More affordable deductibles and out of pocket limits.
  4. Subjectively more trustable - had I not discovered the significance of reporting the condition above I might have switched to the policy at the cheaper quoted rate only to discover that the policy (at least for my wife) was voided because I failed to report a pre-existing condition.  That won't happen with ACA-compatible plans.
Apparently this story is still not over yet as I haven't finalized a new policy so stay tuned.