"I mean, people have access to health care in America. After all, you just go to an emergency room.".
-G.W.Bush, 7/10/07.

(Quote Source: Official Bush White House U.S. Government Archives, Paragraph 16, here).



HEALTH INSURANCE AND PRE-EXISTING CONDITION RULES IN YOUR U.S. STATE (THRU 2014 )

BY-STATE: PRE-EXISTING-CONDITION DANGERS AND INFORMATION-SOURCE TABLE

--WITH SPECIAL ATTENTION PAID TO INSURANCE SYSTEM FLAWS THAT CAN FINANCIALLY WIPE OUT PEOPLE WITH SAVINGS AND OTHER ASSETS TO LOSE (Serious financial wipe-out problems for people with assets in 23 states if they don't move between states, in 37 states if they do try and move)--


--Posted by Norm Spier


--(THE BY-STATE TABLE BELOW WAS COMPILED IN EARLY 2008, BEFORE THE OBAMA REFORM PASSED MARCH 2010, AND BEFORE THE MAIN PROVISIONS WENT INTO EFFECT IN JAN 2014.)







2019: Recovering the data referenced here, and finding new information, such as high-risk-pool rates. (Rates were mostly not reported in this old table on this page). Use a saved version of the Georgetown health insurance info site, from 2011, say. Georgetown www.healthinsuranceinfo.net 2011 capture. (Unfortunately, they stopped funding it a bit before the ACA main provisions went into effect, so you can't really get at the info for the latest pre-ACA year. (The "no longer updated" message starts in about 2012, and you find it on the cover page for the site.)

I've tried, and you can click on links on the page, and get subpages. So, for example, I found on a subpage that the IL high risk pool was sometimes closed, with a waiting list. (I actually caught that in the table, you will not, when I went through and made the table in 2008.)

The subpages tend to have some sketch of high-risk-pool rates in states that had high risk pools, but you may want to try the Wayback Machine itself on the high-risk-pool site for detailed high-risk-pool rates.

If you want to find say, for a certain state, particular detailed high-risk-pool information and detailed rates , you can try putting state high risk pool addresses into the Wayback Machine.

Hey look, the process works, although there may be some gaps. I got the 2010 Illinois High Risk Pool rates that way.

Neato, Wayback Machine!



Important Legal Disclaimer: I am trying to put useful, helpful information on this page. However, I can not be responsible for any errors above. Therefore, please check with the appropriate state insurance departments, and/or seek legal advice, as appropriate, before relying on the information above.

*NOTE about last column of table below:The "DANGER"s in my last column indicates where a responsible decent-earning person or family, saving hard and continuously maintaining health insurance whenever available, can fail badly and have no insurance coverage at all for pre-existing conditions (or only insurance at an unbounded premium), and therefore get financially devastated quickly from the hospitalization costs of an illness. By "bounded" insurance premium, I mean where there is at least a bound by the high-risk-pool or insurer of last resort (I have seen in 2008 as a highest value $25,000 a year per person as this bound in the near-65 age group, lower for lower ages and in certain high-risk-pool/insurer-of-last resort states.) The case where you have insurance, but the rate is "unbounded" is where the regulations have it that no rational insurer will charge you less then your individual (unpooled) expected medical cost plus a profit. So if you have just got cancer, and it looks like the next year's treatment will cost about $200,000., they have to charge you $200,000 + maybe a $50,000 extra allowance for profit, i.e. $250,000.)

Subsequent Note (7/09): In doing the "DANGER"s in the last column, I realize now that I did not factor in the additional risk of your insurer, only at the point when you file a big claim, will then review your medical records, and find a "pre-existing condition" that they say you didn't report on your intitial application, and not pay your bills, or cancel your policy. (This happens a good bit, and is in the video and text transcript here Insurance Industry Executives have sworn, in front of Congress, that they intend to continue this practice of post-claim policy rescission and bill denial even when a policyholder wasn't acting to deceive.) Now, the very tricky thing for the high saver with a lot of assets at risk, is that even if you decide you don't remember all of the hundreds of things that a doctor told you at some time that may turn out to be a pre-existing condition, and decide to pay extra and go with a high-risk pool (if your non-community-rated state has one -- many don't). However, you may find that to get the high-risk pool, in your state you need to have been turned down by one or two private insurers. The problem is, if you don't get turned down, you can't get the high risk pool. Thus, you have a risk of missing an obscure pre-existing condition in your application (and really having no coverage despite the policy you have). And you have no alternative to get the high risk pool, as you weren't turned down. (In this case, I think you ought to be able to get the high risk pool by just putting "I have other pre-existing conditions that I don't remember at the moment" on your private insurance application, so its really not a problem, as long as you are willing and have the money to pay the up to $25,000 a year per person that the high-risk-pool costs. This may sound like a strange strategy, but I actually did this myself back when I lived in CT, where they have no community rating and do have a high-risk pool, which at least at the time fortunately did NOT require prior rejection by private insurers. I had nothing that I believed was a pre-existing condition, but I couldn't be sure something a doctor had told me and I forgot, or that something a doctor wrote down but neglected to tell me the consequences of would void private insurance. And in CT, it had been publicized that Assurant Insurance had done precisely that denying of claim payments to people with policies based on pre-existing conditions supposedly not on the policyholder's application. So I just went with the CT high-risk pool. In my age bracket at the time, the stop-loss plus premium costs were only about $15,000 for the high risk pool, so it wasn't that bad.)

Do also note that there are certain financial dangers that seem to exist in each and every state that I have not specifically placed in that last column. They concern what happens to you if you are in the hospital, so sick (for a time interval) that you can not think through the general necessities of running your life, or in a coma. There are 2 issues: that you lapse on payment of your individual health insurance premium while in such state, or that you don't get any needed pre-approval on managed care. To the best of my knowledge, the law is not on your side in such situations in any state. However, you may be able to mitigate or eliminate these risks by substantially pre-paying your insurance premiums, and by appointing reliable family members, friends, or lawyers as your power of attorney, at least at the point that you see a sickness coming.

Date: The table below was filled in in early 2008, using direct state sources when available, which presumably were current, but using occasional backup information from the Georgetown and Kaiser sites, which is certain cases may have been 1 to 3 years old. For the most part, with the exception of the possible new high-risk-OK insurance, little has changed since then, but you should check with your state carefully (their website and phone the State Insurance Department) to be sure you know about all current options.


STATE-WISE HEALTH INFORMATION RULES, LINKS, AND DANGERS

(FOR PEOPLE UNDER MEDICARE AGE 65)

To: Key to This Table
Directly to State: AL AR AK AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA MA ME MD MI MN MS MO MT NE NV NH NJ NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Non-US





STATE

STATE INSURANCE DEPT
HIGH RISK POOL
GEORGETOWN BOOKLET /
KAISER CROSS-STATE INFO/ NEW FEDERAL INFO SOURCE
MEDICAID

Notes On FINANCIAL-WIPEOUT DANGERS Affecting Higher Savings Individuals Who Have Responsibly Maintained Continuous Prior Coverage*

My "DANGER--ALL: " symbol is for when it looks like people who've always lived in state have a serious potential problem (23 states have this symbol without question marks).

For people moving into the state with a pre-existing condition, many additional states have problems that look to be only for that group, for which I have used "Danger--Moving In:". (14 additional states have that symbol without question marks, meaning 23+14=37 may be problematic to move into with a pre-existing condition.)

Though my "DANGER" notes were compiled before the 2010-passed Reform, the pre-2014 parts of the Health Care Reform may possibly help any individual, but for the most part, all of the states that were dangerous for people with savings in certain situations remain dangerous in most of those same situations until 2014. (E.g., the new pre-existing-conditions-OK insurance that may become available in certain states in 2010 is said to require 6 months without insurance to get it, so that six months is a real wipeout danger to people with savings.)

In 2014, the full law goes into effect, and things should be much more secure for just about all citizens. (There are a few things in the 2014-and-after rules Congress and the administrators will have to keep an eye on, such as possible high rates on older people with just a little too much income to qualify for the subsidy; also ever-rising medical costs, but things should be much, much more secure 2014 and after.)


ALABAMA
Alabama Insurance Department. Alabama State Employees Insurance Board (Seems to apply to those with prior group coverage only) healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Alabama Medicaid Agency -

Pre-existing-condition-screened individual insurance

DANGER--ALL: The high-risk-pool is only for people with prior group coverage. Thus, if you start with individual insurance, you are in a pretty good pickle. And even if you get initial insurance initially, whose to say the cherry-picking dynamic, or an insurer cancelling a policy class, won't wipe you out? (I do not see any evidence of any alternative protection on individual policies, like an insurer of last resort.)

Also, I do not see a stop-loss at all on the high-risk pool policies, at least from the brochure. You should check this.

"Rescission? See this note.

[See column label and Key to understand these comments.]


ARKANSAS
Arkansas Insurance Department/Health Division Arkansas Comprehensive Health Insurance Pool healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Arkansas Medicaid

Pre-existing-condition-screened individual insurance

DANGER--ALL?: The rules for this high-risk pool are very complicated. It looks to me like you can have a problem if you ever have individual coverage. This is certainly true if you move into the state with prior individual coverage (due to 30 to 90 day residency eligibility, and the fact that out-of-state prior individual coverage is not recognized for eligibility unless it is high-risk-pool coverage).;

In-state only I see some problems unless you are already in the high risk pool. That is, if you have individual coverage, and it is terminated on you involuntarily, or costs you at least 50% more than the high-risk pool, you can get the high risk pool (with a 10% additional surcharge to have pre-existing conditions waived). However, notice that if cherry-picking forces your individual policy to be say 48% more than the high risk pool, you have to keep the individual policy! Thus, in the state, you have to plan your rates to be 148% of the high high-risk-pool rates. The high-risk pool rates are about $10,000 a year for an older non-smoking male, with a $2,000 stop loss, so you have to plan on $17,000 a year with stop-loss (in case you are stuck in that individual policy and can't switch to the high risk pool).

There is a logically subtle issue that if you join the high-risk-pool, then get completely well enough and clear of the pre-existing condition so that you can get individual insurance, and do so, within a few months you relapse the the individual insurer pulls out of the state, you are going to get stuck without any insurance, as you can't rejoin the high-risk-pool within 12 months of leaving it. To avoid this risk, you can never leave the high risk pool for individual insurance once you join.

"Rescission? See this note.

[See column label and Key to understand these comments.]


ALASKA
Alaska Insurance Department--Consumer Infor Alaska CHIA healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Alaska Department of Health and Social Services

Pre-existing-condition-screened individual insurance

The high-risk-pool requires 12 month prior residency, for people coming off of an individual policy. This is a problem if you move into the state with a substantial pre-existing condition.

DANGER--ALL:Continuous prior coverage is credited only for prior group coverage under HIPAA rules. This is a problem if you come off of an individual plan, which pulled out of the state. (You will be stranded.) It is also a problem if your current individual policy became very expensive (due to the cherry-picking dynamic). In this case, you will be able to get onto the high-risk pool, but you will need double coverage (your individual plus high-risk pool) until the high-risk pool pre-existing condition exclusion period ends.

"Rescission? See this note.

[See column label and Key to understand these comments.]


ARIZONA
Arizona Insurance Dept--Consumer Health None (Even though no form of community rating) healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
I can't find any Arizona Medicaid site on the internet.

Pre-existing-condition-screened individual insurance

DANGER--ALL: If the Georgetown booklet I checked (latest on site; dated 2004) is correct, there is no high risk pool, and nothing like an alternative community rating or modified community rating or an insurer of last resort.
You are in quite high risk in this state, whether your current insurance is individual or group. (If you lose your group or individual insurance and need individual, there is no bound on what you may be charged if you have a substantial pre-existing condition.)

"Rescission? See this note.

[See column label and Key to understand these comments.]


CALIFORNIA
California Insurance Department--Consumer Info California Major Risk Medical Insurance Program
(NOTE: sometimes a waiting list.)
healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Medi-Cal

Pre-existing-condition-screened individual insurance

DANGER--ALL:As I read it, all high risk policies have a $75,000 per year benefit maximum. This puts you in grave danger in the state, if you have money or assets to lose!

Watch out that high-risk pool is sometimes closed (when it runs out of state money). This also puts middle class people in grave financial danger.

Continuity-wise, there may be some trouble for people moving into the state, in that there has to be a rejection before applying.

I can't believe middle class people in such a big state are so ill-protected.

(NOTE: I've observed Governor Schwarzenegger on Charlie Rose indicated that there was a recent health care reform initiative, supported by him and passed by one house of the state legislature, while turned down by the other. I do not know the details of the plan, but, given the status quo, California looks unsafe for people with assets to lose, who may wish to avoid the state.)

"Rescission? See this note.

[See column label and Key to understand these comments.]


COLORADO
Colorado Insurance Department -- Consumer Page Cover Colorado healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Colorado Medicaid Eligibility

Pre-existing-condition-screened individual insurance

In terms of having a problem with a gap of time with no coverage, it looks to me like permanently in-state people who maintain continuous coverage don't have a problem if they need the high risk pool -- it looks well engineered with respect to that.

Danger--Moving In: Coming in with individual insurance from out of state is a different matter. If you move in with individual insurance, the 6 month residency requirement for the Cover Colorado high risk pool may leave you stuck. (You might be OK if you are coming from another state's high risk pool and that prior state's will keep covering you for 6 months.) At any rate, if you are stuck moving into the state with a serious pre-existing condition, you can't get the high risk pool for 6 months, and then, at that time, since you won't have had continuous prior coverage, the high risk pool will accept you but not cover pre-existing conditions for another 6 months. Total 12 months of no coverage possible if out of state coverage was individual.

High Risk Pool rates are not too bad. They seem to go up to about $10,000 a year for a non-smoker, with a small 2,000 hospitalization stop-loss. But you must add in that there is a $2500. prescription drug deductible, then a 10% copay on the rest. So you might want to allow $15,000 a year total expenses. If your income is under $50K a year, there are discounts, but not such immense discounts that you'll find it just doesn't pay to work. (Though it may pay to keep your income below those caps -- the fact that they have these hard bounds that make it pay to work is imperfect engineering. But at least the magnitude of the penalty for working is not that bad, if you compare what they've done with one of the plans over in Connecticut.)

"Rescission? See this note.

[See column label and Key to understand these comments.]


CONNECTICUT
Ins. Dept.--Health Division CT Health Reinsurance Association

Links to 2012 rates, archived 2012 on Wayback machine:

CT Health Reinsurance Association 2012 $7500 stop-loss plan:
$2077.18 a month for a male 60-64


CT Health Reinsurance Association 2012 $1000 stop-loss plan
$3908.02 a month for a male 60-64
healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Department of Social Services

Pre-existing-condition-screened individual insurance

Watch out for very high stop-losses on high-risk pool ($5000 per person on the HMO, $7500 per person on the PPO).

High-risk-pool rates can be steep, where I calculate up to about $23,500 a year per person when you add the stop-loss to the premium, whether you go HMO or PPO. (<--Prior was written about 2009. In 2012, $32,000 a year for a male 60-64. See archived links under links.)



"Rescission? See this note.

[See column label and Key to understand these comments.]


DELAWARE
Delaware Insurance Department--Health No High Risk Pool?
(Even though individual insurance can turn down for pre-existing conditions) con
healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Delaware Medicaid

Pre-existing-condition-screened individual insurance

DANGER--ALL:If I understand the information on the Georgetown and Kaiser sites, you can be in real trouble if you have either prior employer-based or prior individual insurance and you have a serious pre-existing condition, even if you have responsibly maintained it continuously prior.

If your prior insurance was group, you will be offered and individual policy by federal HIPAA law, but the rate is unbounded. With prior individual insurance, they don't even have to offer you a policy. Therefore, responsible people who save in this state seem to be at a risk of sudden bankruptcy.

I ain't moving here!

"Rescission? See this note.

[See column label and Key to understand these comments.]


DISTRICT OF COLUMBIA
District of Columbia Insurance Bureau

Pre-existing-condition-screened individual insurance

No high-risk pool. Seems there was an insurer of last resort, though with an exclusion for pre-existing conditions, but that was phased out 2/08. See Georgetown booklet, p. 13 (Jan 2007 version). You should double check with the insurance department that there is no replacement.

healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
D.C. Medicaid

Pre-existing-condition-screened individual insurance

DANGER--ALL:If the Georgetown booklet is correct, and the Guaranteed Issue policy from CareFirst Blue Cross has been phased out and not replaced with anything, then people with serious pre-existing conditions and prior employer or individual coverage can be in a pretty good pickle. If your prior coverage was employer, Kennedy-Kassebaum will let you get individual coverage, but your rate is unbounded. With prior individual coverage, you may not get any coverage.

Should you find out that there is some replacement insurer of last resort, then a high level of danger may or may not exist. The danger may be high if there are pre-existing condition exclusions even if you have continuous prior coverage, or if there are maximum annual medical bill payment caps (like the $35,000. a year in PA under certain conditions), or humongous rates or deductibles or stop-losses.

"Rescission? See this note.

[See column label and Key to understand these comments.]


FLORIDA
Florida Insurance Department High risk pool not open for new enrollees Phone (850) 309-1200 (From another site: closed to new enrollees since 1991?) healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Florida Department of Children and Families

Pre-existing-condition-screened individual insurance

DANGER--ALL:Based on the Florida State insurance site, the Georgetown Booklet, and Kaiser tables, it looks to me that high-savers are at high financial risk in this state. The high-risk-pool is no longer available. If your prior coverage is group, then Kennedy-Kassebaum will allow you to get coverage from any insurer, but if you have a serious pre-existing condition, it looks like the rate is unbounded. There are also cases such as if your insurance company leaves Florida, you have to be given a policy by any insurer. But again, with a serious pre-existing condition, it looks like there is no bound on what they can charge you. (I am in fact not absolutely sure, from the 3 sites, that rates are completely unbounded -- therefore, before you leave this state, or fail to move into it, double check with the state insurance department.)

NOTE: If you lose your group insurance from a non-self-insured small employer, it looks like they have to give you some coverage, with some state limitation on the rate they can charge you. This alone does not change the state from being financially dangerous to savers, in my view, but is something you should look in if the particular situation affects you.

"Rescission? See this note.

[See column label and Key to understand these comments.]


GEORGIA
Georgia Insurance and Fire Safety Dept No High Risk Pool or Insurer of Last Resort healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Georgia Medicaid

Pre-existing-condition-screened individual insurance

DANGER--ALL: There is definite trouble if your prior insurance is individual in continuity of reasonably priced coverage for people with serious and expensive medical conditions. And there is no high risk pool or insurer of last resort to insure you when individual insurance is unavailable or unboundedly expensive. This is enough for me, personally, to avoid ever moving to this state.

If you start with an in-state group policy and then lose your job at a time you have a serious pre-existing condition, it looks like in many cases (not all cases) you will get (either direct from the old group insurer, or through the state) a comparable "conversion" policy, which can be expensive, but it seems to be still controlled at about 150% of a group rate -- sort of like a high risk pool rate. However, I am still worried about the permanent controlled cost and availability of this. The Georgetown booklet says, at the bottom of p. 19, that rates may go up as you age goes up or health worsens on the conversion policy. The "health worsens" bit has me worried that the rate stops being controlled after it is initially issued. Or, Georgetown may have an oversight. You should call the Georgia Insurance Office to verify details if you are, or may be in the future, in this boat.

By the way, on the conversion policies, what if the company offering the conversion policy eventually pulls out of the state? Would you be stuck without coverage if you had a serious pre-existing condition at the time? Check with the Georgia Insurance Office.

"Rescission? See this note.

[See column label and Key to understand these comments.]


HAWAII
Hawaii Insurance Department None? healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Hawaii Department of Human Services

Pre-existing-condition-screened individual insurance

Hawaii has an unusual requirement that employers provide health insurance for people while they are working (and pay for half of it) in certain cases. I am not sure the extent that employers get around this by hiring people part time, etc., and I can see that this may help keep more people covered. Nonetheless individuals who have saved assets are at risk in this state. Thus,

DANGER--ALL: There are no regulations with individual insurance on what you may be charged with a pre-existing condition, and there is no high-risk-pool or insurer-of-last-resort to mitigate your financial peril if you lose your employer health insurance (and after the COBRA expires), or to keep you from getting cherry-picked to exorbitant rates in the individual insurance system.

Thus, me never aloha Hawaii, never even consider aloha Hawaii.

"Rescission? See this note.

[See column label and Key to understand these comments.]


IDAHO
Idaho Insurance Department Idaho High Risk Pool at Insur. Dept healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Idaho Department of Health and Welfare

Pre-existing-condition-screened individual insurance

The best high-risk-pool plans have a high $10,000 stop-loss, which brings the total that you may have to pay out to about $20,000 a year per person if you are in certain age groups.

Checking the Idaho high risk pool website, the high-risk-pool at least looks reasonably engineered (up to next paragraph) so that in-state residents who maintain continuous coverage should be safe from complete non-coverage of pre-existing conditions, or higher than high-risk-pool rates, whether prior health insurance is individual or group. (You may conceivably have a problem if an insurer pulls out of the state, but if they give notice, you have time to apply for other insurance, and you should be O.K.)

There is a logically subtle issue that if you join the high-risk-pool, then get completely well enough and clear of the pre-existing condition so that you can get individual insurance, and do so, within a few months you relapse the the individual insurer pulls out of the state, you are going to get stuck without any insurance, as you can't rejoin the high-risk-pool within 12 months of leaving it. To avoid this risk, you can never leave the high risk pool for individual insurance once you join. (I have not marked this Kafkaesque little problem with "DANGER-ALL" based on my criterion, because if you keep the high-risk-pool forever you have a bounded rate.)

Watch out that last I checked, I believe the Kaiser site indicated Idaho had no high risk pool, which is incorrect.

Incidentally, if you lose employer coverage in this state, the state seems to mandate they give you a conversion policy with limits on how much you can be charged. This may be an option to look into if you are in that situation.

Danger--Moving In: Moving in from out of state, I am not sure if there is a problem where you may have a short duration of non-coverage. I am referencing the rule that you have to have been rejected by an insurer to get the high risk pool. I am not sure whether the insurer rejecting you has to be for an in-state policy. Even if not, coming in from community-rated states, it will be impossible to find an insurer to reject you while out of state. You may be able to get around this by establishing a residence in Idaho (i.e. renting an apartment first before moving in), and then applying. Check with the insurance department. (Also, your prior policy in the state you move from might cover you for a little bit in the new state in certain cases -- check with them.)

"Rescission? See this note.

[See column label and Key to understand these comments.]


ILLINOIS
Illinois Insurance Dept. Illinois CHIP healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Illinois Department of HealthCare and Family Services

Pre-existing-condition-screened individual insurance

DANGER--ALL:The high risk pool sometimes is closed to new enrollment. (This is very dangerous--middle class folks in danger of huge financial loss.)

Coming from an individual policy, there is a 6 month residency requirement. Thus, you can not safely move into the state with a substantial pre-existing condition.

If your individual insurance becomes more expensive than the high risk pool plan, you can get the high risk pool plan. But it will exclude pre-existing conditions for 6 months. So for that time period, you need to maintain both plans.

High-risk pool is up to about $10K-$15K a year, with $5K stop-loss to be added in.

"Rescission? See this note.

[See column label and Key to understand these comments.]


INDIANA
Indiana Insurance Department--Health Indiana Comprehensive Health Insurance Association healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Indiana Medicaid

Pre-existing-condition-screened individual insurance

The rates in this state for the high risk pool are not too bad, hitting up to about $13,000 a year with a small stop-loss of under $2,000.

For in-state residents who maintain continuous coverage, non-coverage gaps seem pretty well engineered out (but see next paragraph), in the sense that continuous prior individual or group coverage is credited, and you can entolll if you currently have individual insurance whose rate has gone above the high-risk-pool rate due to cherry-picking by insurers. (There was an issue in the wording in the enrollment packet: pre-existing conditions are not excluded from the high risk pool plan if you "lose your coverage" -- to me this might mean if you voluntarily cancelled your overpriced individual plan, you might have a waiting period for pre-existing condition exclusion, and need to maintain double coverage for that period. I called the high risk pool, and they said you would be O.K. even if you cancelled the prior policy yourself. You should double check.)

There was an issue with if you quickly lose your current coverage, i.e. your current individual insurer pulls out of the state. If they do this quickly, since you have to have been rejected by an individual insurer, or charged more than the high-risk-pool rate by them, the process of applying and getting rejected might cause you to be uninsured for, say, a month. However, I am not sure this is really possible, as the insurer leaving the state may be required to give a few months of notice. You should check with the insurance department.

Also, residents of the states should be warned that the high risk pool requires a recent prior Medicaid application (even if you have way to much in assets), so they shouldn't miss this piece of paperwork.

Danger--Moving In: Moving into Indiana with a serious pre-existing condition is entirely another matter. There is a 12-month residency requirement on the high-risk-pool if your prior insurance is not group. Further, once you move in and have been there 12 months without health insurance, since you have had no insurance for a year, the high-risk-pool will exclude pre-existing conditions for 3 months. So you've got 15 months without coverage on that pre-existing condition.

"Rescission? See this note.

[See column label and Key to understand these comments.]


IOWA
Iowa Insurance Division Iowa Comprehensive Health Assoc. healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Iowa Medicaid

Pre-existing-condition-screened individual insurance

The rates for the high risk pool hit about $10,000. a year, with just a $2500. stop-loss. This is not bad. I am also impressed by the $3,000,000 lifetime cap. (Some states are as low a $500,000, and $1,000,000-2,000,000 is more standard.)

For in-state people, you look O.K. in terms of the possibility of having no coverage on a pre-existing condition if you maintain continuous prior coverage. HOWEVER, there is one tricky thing. If your individual insurance rate climbs to above the high-risk-pool rate, you can get the high risk pool, but it seems that in that case (voluntary termination of continuous prior coverage) it excludes pre-existing conditions for 6 months. So you have to maintain double coverage for 6 months. Given the relatively modest rates of the high risk pool, that's not too bad, but you have to watch out for it. (Do double check my assertion with the Insurance Department before you spend the money on double coverage. That is how it looks to me from both the high-risk-pool site and the Georgetown booklet.)

Danger--Moving In:Moving in is different. There is a 2 month residency requirement if your prior plan is not group. However, I think it's actually worse -- there will also be a 6 month exclusion on pre-existing conditions if your prior individual policy was not cancelled involuntarily. So it actually is 8 months without coverage or without coverage on the pre-existing condition (if you have a serious pre-existing condition and your other-state coverage is individual).

"Rescission? See this note.

[See column label and Key to understand these comments.]


KANSAS
Kansas Insurance Department--Health/Life Kansas Health Insurance Association healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Kansas Medicaid

Pre-existing-condition-screened individual insurance

High-risk pool rates plus stop-loss go up to about $17,000 a year. (Note $6500 stop-loss on the lowest-deductible plan.)

DANGER--ALL:$100,000 high-risk pool annual maximum payout -- you pay the rest of your medical bills.

Transportability looks OK if you live in the state all of your life. (With prior coverage individual or prior.)

However, if you move into the state with a serious pre-existing condition, and your prior coverage was individual, the 6 month residency requirement for the high risk pool can expose you to 6 month without coverage. And then, since when you finally can apply for the high-risk pool, you may not have had individual coverage (since you couldn't get it), you have a additional several months of pre-existing condition exclusion on the high-risk pool.

"Rescission? See this note.

[See column label and Key to understand these comments.]


KENTUCKY
Kentucky Office of Insurance Kentucky Access High Risk Pool healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Kentucky Cabinet for Health and Family Services

Pre-existing-condition-screened individual insurance

High-risk-pool rates are not that bad, hitting $10,000 a year, plus $5000. a year out-of-pocket maximum for older people (for the Preferred-Provider plan). Watch out that without the pharmacy rider, 20% pharmacy copays could be very high in certain cases -- you probably want the rider.

Avoidance of coverage gaps for in-state people maintaining continuous prior coverage looks pretty sound, in that the high-risk-pool credits prior coverage even if it is individual, and allows access if an individual insurer denies coverage, or charges more than the high risk pool. As in all states where application processing by an individual insurer is required for the high-risk-pool (unless prior coverage is group), you have to hope the insurer's processing time doesn't mess you up -- for example, if your current individual insurer goes bankrupt or pulls out of the state, and you suddenly lose coverage. If you are worried about this issue, check with the Insurance Department.

Danger--Moving In:Moving in is different. There is a 12 month residency requirement if your prior plan is not group. So if you move into the state with prior individual coverage and a serious pre-existing condition, you can have 12 months of no coverage at all. Then, you can get the high risk pool, but then your pre-existing condition will not be covered for another 12 months. So thats 24 months without coverage for the pre-existing condition.



"Rescission? See this note.

[See column label and Key to understand these comments.]


LOUISIANA
Louisiana Department of Insurance Louisiana Health Plan healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Louisiana Medicaid

Pre-existing-condition-screened individual insurance

High risk pool rates are kind of high, hitting about $16,000 a year for non-smokers, plus a $4,500 out of pocket maximum. Note that there are two versions of the plan -- one for people with prior group coverage that does not exclude pre-existing conditions, and one for people with prior individual coverage that does exclude pre-existing conditions for 6 months.

The enrollment and pre-existing conditons rules for people with prior individual coverage are complicated, and I can not figure out what the risk is, for a complete coverage gap. Except I can see: DANGER--ALL: the pool that covers prior-individual-insurance enrollees may be closed to new enrollees at times. I also see that the pool that covers prior-individual-insurance enrollees excludes pre-existing conditions for 6 months, and I do not see a waiver of this for people with continuous prior coverage. Conceivably, if you have your individual insurance, you may have your individual rates rise very high -- if they rise high enough, you are eligible for the high risk pool, but may need double coverage. There may also be a problem in that if your individual insurer stops writing policies in the state, the 6 month pre-existing condition limit on the high risk pool for individual-insurance-prior people would leave you stuck. However, I see that in certain cases when your individual insurer has stopped writing policies in the state, they will let you have the group-prior policy, which doesn't have a pre-existing condition exclusion. (You'd better check on this with the high-risk-pool if you are worried about this.)

Besides the potential enrollment cap on the individual insurance high risk pool, which in my opinion, makes the state unsafe for people with assets to lose, the other serious problem is that the high risk pool coverage is simply too weak -- whether the prior insurance is individual or group. There is a $100,000 annual cap on what they pay out for your medical bills, and a $500,000 lifetime cap. There is also a $15,000 a year maximum on prescription drugs. I am not enough of an expert to know if the $100,000 per lifetime cap on transplants is a worry, too.

"Rescission? See this note.

[See column label and Key to understand these comments.]


MASSACHUSETTS
MA Connector
None needed -- Modified Community Rated healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Massachusetts Medicaid

MASSACHUSETTS HAS HEALTH REFORM ALREADY (97.4% Insured Rate). Now that national health reform is apparently killed (ironically, by a senator from MA), if you are from out of state and have, or are worried about getting expensive pre-existing conditions, in many situations, it is your best bet to move here.

People from outside MA should consider moving QUICKLY into MASS before the legislature adds requirements that would impede people with pre-existing conditions moving from out of state from getting insurance immediately upon moving in. People interested in pursuing this strategy can use this link to the Massachusetts Insurance Exchange or search for "Mass Connector" on Google, for rate quotes, and any requirements details. (Rates do not depend on pre-existing conditions, and further, Massachusetts taxpayers will provide you with a decent subsidy on your premium to make it affordable if your income is up to some fairly high amount as here, provided you don't currently have insurance.) From a call I made to the Connector (1/26/10), at this time you don't even need prior coverage, and pre-existing conditions don't matter (of course, double and triple check yourself before moving to MA).

For you convenience, this is a map of MA with zipcodes. (Boston is in the east. The west is more rural. The west has some nice summer culture. There are some nice college towns around Amherst. More info on moving to MA in MA state moving-in guide, with MA regional descriptions and amenities Welcome to Mass. Guide. You can use Google Earth to size up areas to move with aerial and street views, as well as road and street maps. You can download Google Earth from here, if you don't already have it. Some other local information will be available from Craigslist MA hub. )

My understanding is that the new system is working adequately for people with relatively higher incomes and/or assets to lose, in that they can basically afford the modified community rated insurance in the first place, and the Connector does a little to reduce their costs by making insurance a little more efficient. (There is criticism that costs, due to 10%-15% a year medical cost increases, are still not controlled because restructuring of the Medical system is not adequate. There is also a problem with many of the lower income, but above-Medicaid-plus-some 300% of poverty being unable to afford their unsubsidized insurance--and thus being worse off than if they didn't work at all. This is analogous to, before the reform, many of these same people being penalized for working by not being eligible for Medicaid, and thus being part of the uninsured working poor. The only solution for this is for the country to actually fix the problem of this poverty trap, by paying more to cover the actual costs to give working poor uninsured coverage and/or to provide that additional coverage with the resource provided by the abundant opportunities for streamlining in our health care delivery system. See this American Prospect article by the former editor-in-chief of the New England Journal of Medicine.

[See column label and Key to understand these comments.]


MAINE
Maine Bureau of Insurance & any High-Risk-Pool None (Modified Community Rating healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Maine Medicaid

Modified Community-Rated which assures pre-existing conditions don't affect your rates, or get you denied coverage, if you get a pre-existing condition (as long as you have previously maintained continuous coverage).

DANGER--MOVING IN:Despite the Modified Community Rating, there is still a danger issue when one moves in regarding a coverage gap. (On a 2/1/10 call to the Insurance Department, you need "Residency", which is legally defined in a way that you actually have to have been living in the state for at least 2 months, and there may be additional criteria. The relevant law is sections C-C1-C2 on this page. Thus, even if you have continuous prior coverage in your current state, you would seem to have a gap in coverage coming if you can't get your current plan to cover you for your first few months of residence in ME. Further, if this makes you wind up with a gap of over 3 months, then your ME plan has a gap of 1 year on pre-existing conditions.

[As an alternative, you might be able to rent an apartment for a while in a 3rd state and grab a policy of some sort which will cover for you for 6 months in ME. If I recall correctly, you could actually get the CT high risk pool just about immediately if you have a residence in the state, and at one time at leat, you could hold that policy 6 months after moving into a new state.)

[See column label and Key to understand these comments.]

Rate rises note: Though your protection in a Community-Rated state is much better than elsewhere, at least if you have pretty good savings, you should still make contingency plans for steep rate rises beyond the medical inflation rate (through age 65 when Medicare will take over). For example, my Aetna community-rated New York rate for one person went from:
yr 1) $730 a month
yr 2) $844.a month
yr 3) $802 a month (yes, small decrease)
yr 4) $1057 a month (yup--up 32%)

[See column label and Key to understand these comments.]


MARYLAND
Maryland Insurance Administration Maryland Health Insurance Plan healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Maryland Medical Assistance Program

Pre-existing-condition-screened individual insurance

The high risk pool rates are impressively low, at $5,0000 to 6,000 a year for the 60-64 age group. (Lower for younger people.) The stop-loss is $3,500-4,000 a year, so that total costs for a 60-64 year old individual are about $10,000. a year -- much lower than, say, CT, where that group pays $23,000 a year. Many other states have similar rates to CT.

For in-state residents, coverage gaps look pretty well avoided, whether your prior insurance is individual or group when you need the high risk pool. You are eligible for the high-risk pool if your prior individual insurance goes up to beyond the high risk pool rate, or else completely denies coverage or excludes a pre-existing condition. The only problem I see might be if your current insurer leaves the state or goes bankrupt, where you may not have time to get a needed new individual insurance application and rejection quickly enough. (You should check with the insurance department to see if there is really a problem.)

Danger--Moving In??:I can conceive of a problem moving in with a pre-existing condition. If you were in another state's high risk pool, then they take you immediately in the high risk pool. Otherwise, there is a requirement that you be rejected by a health plan in the last 6 months. (It may be impossible to have been rejected coming from certain other states.) You may be able to get around this by renting an apartment in Maryland and getting yourself rejected before you move to Maryland (if your future potential insurer cooperates). Otherwise, Maryland is still pretty generous in only having a 2 month pre-existing condition exclusion on the high risk pool, which I think you may be able to buy your way out of by paying extra for 6 months. In that case, the real issue would be whatever short time without any coverage at all when you first move in.

Despite some continuity issues for people moving in, the state should be commended for doing well by its citizens.



"Rescission? See this note.

[See column label and Key to understand these comments.]


MICHIGAN
Michigan Department of Labor & Econ. Growth No high-risk pool. There is an insurer of last resort. healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Michigan Medicaid

Pre-existing-condition-screened individual insurance

DANGER--ALL: Transportability issues with insurer of last resort coming from an individual policy.

"Rescission? See this note.

[See column label and Key to understand these comments.]


MINNESOTA
Minnesota Dept. of Commerce Minnesota Comprehensive Health Association healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Minnesota Medicaid

Pre-existing-condition-screened individual insurance

I believe individuals in-state are safe from unbounded rates. Though you aren't eligible for the high-risk pool if your individual insurance rates go above the high risk pool rates, the Kaiser site indicates individual insurance rates have a state-regulated maximum, which I assume is around the high-risk-pool rates. You should double check with the Insurance Department, however, just in case the Kaiser site is wrong or outdated. (Note: if the rates on individual policies are not bounded not much more than the high risk pool rates, than "DANGER--ALL" would go here, based on everything else I know. Danger--Moving In: Watch out for 6 month residency requirement for high risk pool.

"Rescission? See this note.

[See column label and Key to understand these comments.]


MISSISSIPI
Mississippi Insurance Department Mississippi Comprehensive Health Insurance Risk Pool healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Mississippi Medicaid

Pre-existing-condition-screened individual insurance

Rates for the high-risk-pool hit $12,000 a year, with no out of pocket limit on 20% copay. There is a $500,000 lifetime maximum. DANGER--ALL: The copay would be $40,000 in a year in which you had $200,000 in medical expenses. The $500,000 lifetime maximum would seem inadequate.

For in-state residents, it looks to me like continuity of access if your prior plan is individual is O.K. up to care needed in 1 case. If your current insurance company leaves the state or cancels your policy class or goes bankrupt, you can enroll in the high risk pool and not worry about pre-existing conditions. However, if your current individual rates go to beyond those of the high risk pool, you can enroll in the high risk pool, but have a 1 year exclusion on pre-existing conditions. So you have to maintain double coverage for a year to avoid this trap and successfully transfer to the high risk pool.

Moving in from out of state looks problematic. You are eligible for the high risk pool if you were in a prior state's high risk pool. But in many cases, people maintaining continuous prior coverage who now have a pre-existing condition will not be in the other state's high risk pool. Further, it looks to me like the high-risk-pool will exclude pre-existing conditions for a year in all cases where you move in from out of state where prior coverage is anything other than group.

"Rescission? See this note.

[See column label and Key to understand these comments.]


MISSOURI
Missouri Insurance Department Missouri Health Insurance Pool healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Missouri Social Services

Pre-existing-condition-screened individual insurance

High-risk-pool plans fairly expensive, to about $18,000 a year per person, with a $2500. out-of-pocket maximum plus a separate $3000. prescription drug stop-loss. (Add all 3 to find your maximum.)

For in-state people, continuity of coverage seems sound. DANGER--ALL:Only 50% of out of state emergency care covered.

There is a logically subtle issue that if you join the high-risk-pool, then get completely well enough and clear of the pre-existing condition so that you can get individual insurance, and do so, within a few months you relapse the the individual insurer pulls out of the state, you are going to get stuck without any insurance, as you can't rejoin the high-risk-pool within 12 months of leaving it. To avoid this risk, you can never leave the high risk pool for individual insurance once you join.

If you are moving into the state with a pre-existing condition, there is a problem. If you prior out-of-state policy is individual, the high risk pool requires either involuntary termination of a prior policy, or a rate higher than the high-risk-pool, in order to not exclude pre-existing conditions for a year. There are many ways you could have continuous prior coverage in another state, with this not being satisfied.

"Rescission? See this note.

[See column label and Key to understand these comments.]


MONTANA
Montana State Government -- Insurance Division Montana Comprehensive Health Association healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov

Montana Medicaid

Pre-existing-condition-screened individual insurance

Rates appear to run up to about $13,000 a year plus allow another $5,000 a year for the out-of-pocket limit, plus allow $5,000?? or more for prescription drugs, which are not covered by the out-of-pocket limit.

DANGER??--ALL The problems I am seeing are only involving the "may" language, rather than definite language, regarding waiver of the 12 month pre-existing-condition exclusion. If your prior coverage is individual, and your rates rise to beyond roughly the high risk pool rate, the high risk pool will take you, but you have a 12 month exclusion on pre-existing conditions. So you need to maintain double coverage for a year. (That seem's definite -- that's not the problem.) What is the problem is that if your individual insurer pulls out of the state or goes bankrupt, there is language that the high-risk-pool "may" credit your prior coverage and not exclude pre-existing conditions for a year. The "may" worries me -- without a definite "will" on crediting your prior coverage, you could be stuck without coverage for a pre-existing conditon for a year, even if you responsibly have maintained health insurance continuously prior. You should call the high risk pool, or perhaps have them send you something in writing, if this issue makes you want to leave or not settle in Montana.

Danger--Moving In:The high-risk pool has a 1 month residency requirement if your prior insurance is individual, and further, will only credit prior coverage (at best) if it was involuntarily cancelled and has a gap of less than 30 days. As I calculate it, moving into Montana with a pre-existing condition and prior individual insurance would leave you for a full year without coverage of your pre-existing condition.

"Rescission? See this note.

[See column label and Key to understand these comments.]


NEBRASKA
Nebraska Department of Insurance Nebraska Comprehensive Health Insurance Pool healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Nebraska Department of Health and Human Services

Pre-existing-condition-screened individual insurance

Beware for in-state residents that if your individual insurance rates climb to beyond that of the high risk pool (i.e. voluntary termination), you can get the high risk pool, but pre-existing conditions are not covered for 6 months. Thus, you need to maintain double coverage for 6 months.

Otherwise, availability of coverage seems sound to me for in-state residents.

Danger--Moving In: High-risk pool has 6-month pre-existing condition coverage gap if you move into the state from an individual policy. Individual-insurance rejection-required criteria may cause this coverage gap to lengthen to longer than 6 months.;
Rates not cheap for older people (up to about $20K/yr), but at least stop-loss is not that high.

"Rescission? See this note.

[See column label and Key to understand these comments.]


NEVADA
Nevada Division of Insurance None (State seems to try to have something like a high risk pool by forcing guaranteed issue and some price caps if your previous private insurer cancelled policies, or for previous prior group (HIPAA rules) coverage.) healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Nevada Department of Health and Human Services

Pre-existing-condition-screened individual insurance

State Insurance Department site defers to the Georgetown site, which booklet leaves things unclear to me.

Rates for individual policies may be higher based on health condition and age, but there is some state regulatory control over how much higher a sick or old person would have to pay. I can not find any information on just how high the rates could be.

Danger--Moving In: There is clearly a problem getting coverage moving into this state from a prior individual policy with a serious pre-existing condition, as there is no guaranteed way to get coverage in that case.

"Rescission? See this note.

[See column label and Key to understand these comments.]


NEW HAMPSHIRE
New Hampshire Insurance Department New Hampshire Health Plan healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
New Hampshire Medicaid

Pre-existing-condition-screened individual insurance

Rates go to $10,000 a year per person plus $7000. out of pocket maximum (HMO plan A). DANGER--ALL:The plans pays at most $10,000 for pharmaceutical per year.

Continuity of coverage does not seem to be a problem for in-state residents. (Specifically, continuous prior individual coverage is useable to qualify one for the high-risk pool without exclusion of pre-existing conditions, and there is no 6-month residency requirement.)

Danger--Moving In?: I do see that there may be trouble for people moving into the state from an individual policy, because they have to be essentially rejected by an individual insurer. You may have to have bought a house in NH before beginning this application process.

Rates seem basically reasonable for non-smokers. On plan-A of the managed care, I calculate stop-loss plus premiums around $15,000 a year per person. Much worse for smokers--don't smoke!
However, I see a $10,000 per year pharmaceutical cap on the high-risk pool plans. This might conceivably wipe you out if you have the wrong disease.

"Rescission? See this note.

[See column label and Key to understand these comments.]


NEW JERSEY
New Jersey Department of Insurance and Banking:
Rules
Rates
None needed -- Community Rated healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
New Jersey Medicaid

Community-Rated, which assures pre-existing conditions don't affect your rates, or get you denied coverage, if you get a pre-existing condition (as long as you have previously maintained continuous coverage).

Some, especially young people, may find rates high, due to inefficiencies in the health delivery system and freeloading. This is impossible to fix without national government intervention mandating coverage, and creating efficiencies.

Rate rises note: Though your protection in a Community-Rated state is much better than elsewhere, at least if you have pretty good savings, you should still make contingency plans for steep rate rises beyond the medical inflation rate (through age 65 when Medicare will take over). For example, my Aetna community-rated New York rate for one person went from:
yr 1) $730 a month
yr 2) $844.a month
yr 3) $802 a month (yes, small decrease)
yr 4) $1057 a month (yup--up 32%)

[See column label and Key to understand these comments.]


[See column label and Key to understand these comments.]


NEW YORK
New York Insurance Department:
Rules
Rates
NOTE: HMO stop-loss is generally $1500.

NOTE: Though neither the insurance department website, nor the Georgetown booklet (link to right) make it clear, a State Insurance Department phone representative on 1/12/10 indicated you might be able to find higher deductible or higher copay or higher stoploss plan than the ones whose rates are quoted on the state web site. These would also be community rated. However, she indicated most insurers do not offer one for individuals, but I might possibly find a larger insurer that does. [In my county, Broome, I spent hours on the phone and internet, checking all 5 insurers, and I have only been able to find one insurer offering anything like a high-deductible or high stoploss policy, which is not a high deductible/copay policy, but a limited hospitalization only policy. For completeness, you should check your own county, and double check my assessment even if your county is Broome.]
None Needed -- Community Rated healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
New York Medicaid

Community-Rated, which assures pre-existing conditions don't affect your rates, or get you denied coverage, if you get a pre-existing condition (as long as you have previously maintained continuous coverage). Some, especially young people, may find rates high, due to inefficiencies in the health delivery system, freeloading (=people picking up insurance only after they get sick), and possibly even a "death spiral" (which is where both there is some freeloading, medical costs rise, and soon more freeloading, and eventually the process continues to where even people trying not to freeload freeload have to freeload, or just go without insurance all together). This may have started already in my own area in NY. This is impossible to fix reasonably without national government intervention mandating coverage, and creating efficiencies.



Rate rises note: Though your protection in a Community-Rated state is much better than elsewhere, at least if you have pretty good savings, you should still make contingency plans for steep rate rises beyond the medical inflation rate (through age 65 when Medicare will take over). For example, my Aetna community-rated New York rate for one person went from:
yr 1) $730 a month
yr 2) $844.a month
yr 3) $802 a month (yes, small decrease)
yr 4) $1057 a month (yup--up 32%)

in an area upstate which is actually quite poor.

Some other parts of the state (I am in Broome upstate) have companies with lower rates (down to about $750/month per person in many areas, particularly in areas with a non-profit.) There rates have also been rising pretty rapidly.

As I have indicated, a "death spiral" may have started on individual policies in New York. Since the NY State government finances are collapsing, the legislature is know to be malfuctional at the moment, and we have a legally blind governor, I don't expect any remedy in the state.

Obviously, since 16% a year rate rises means a doubling every 4 and 1/2 years, I have a move planned to either Mass. or Maine in the not too distant future. Or, if I choose not to move, obviously, it becomes economically smarter to do without the insurance (avoiding Aetna keeping what I estimate to be 25% to 30% of premiums that they don't pay in anyone's bills--they won't tell me the proportion they keep: one-sided knowledge of their "payout rate" gives them a market-malfunction-advantage over the rest of us) and just pay cash on rates I personally negotiate with providers. (I can always pick up the insurance just when my body feels like it's getting sick--I am morally opposed to this strategy, which of course is what causes the "death spiral", but without a mandate there may be no choice.) I

[See column label and Key to understand these comments.]


NORTH CAROLINA
North Carolina Department of Insurance No high risk pool. There is an insurer of last resort: Blue Cross of North Carolina, which apparently can charge much more for people with pre-existing conditions. healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
North Carolina Division of Medical Assistance

Pre-existing-condition-screened individual insurance

It looks like, for people with continuous prior coverage, the insurer of last resort, Blue Cross, has to take you and not exclude pre-existing conditions. However, I am not sure if there is any limit to what they can charge you. I am not able to find any limit on the Georgetown site, or the BCBS site, or the state insurance department site.

DANGER--ALL?:It would seem as though you have a problem with unbounded rates both if your prior coverage was group or individual.

(Therefore you absolutely should call BCBS or the insurance department to find out on any legal bounds before moving into this state.)

"Rescission? See this note.

[See column label and Key to understand these comments.]


NORTH DAKOTA
North Dakota Insurance Department Comprehensive Health Association of North Dakota healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
North Dakota Medicaid

Pre-existing-condition-screened individual insurance

Rates are not too bad for the high-risk pool (hitting about $9000 a year for older people), plus stop-loss is $3000 per year.

For in-state residents, getting stuck without coverage for people maintaining continuous prior coverage seems O.K., except that if your individual insurer pulls out of the state or goes bankrupt, the requirement of rejection by a new insurer may give you a little time without coverage.

There is a logically subtle issue that if you join the high-risk-pool, then get completely well enough and clear of the pre-existing condition so that you can get individual insurance, and do so, within a few months you relapse the the individual insurer pulls out of the state, you are going to get stuck without any insurance, as you can't rejoin the high-risk-pool within 12 months of leaving it. To avoid this risk, you can never leave the high risk pool for individual insurance once you join. (I have not marked this Kafkaesque little problem with "DANGER-ALL" based on my criterion, because if you keep the high-risk-pool forever you have a bounded rate.)

Danger--Moving In: Six-month non-coverage for pre-existing conditions if your prior coverage was individual. (Again, making moving into the state impossible, and further, in-state residents are stuck if their insurer cancels the policy class. In-state residents also may need to carry double coverage for the pre-existing condition period if the cherry picking dynamic has forced their individual premiums to go sky high and they want to get lower high-risk-pool rates.)



"Rescission? See this note.

[See column label and Key to understand these comments.]


NON-U.S. DEVELOPED COUNTRIES
(These include, France, Germany, Italy, Netherlands, Sweden, Denmark, Canada, Norway, Australia, New Zealand, Austria, Switzerland, etc.) Everyone gets health insurance whether they have a pre-existing condition or not;

Rates are not higher for people with pre-existing conditions (and in many countries the insurance is even free);

Pre-existing conditions are covered for all people

It has been this way for a long time in all of these countries. (The latest was Switzerland, where it has been the case since 1994.)

P.S. At the same time as the notoriously conservative country of Switzerland was changing from our system to something reasonable, U.S. health insurance companies were spending our premium dollars to run ads like this, to scare the people and successfully block the Bill Clinton Universal Coverage plan, and make us keep the system that we now still have. Sorry, pretty much they won't let just you move to these other countries without a cumbersome application process (and a good possibility of rejection), because everyone sick who is going broke in the U.S. might just move there and bankrupt their country!

Comparative performance. Pretty much everywhere, it costs the countries' economies less, and life expectancy is as good or better. (In some cases, low-bang-for-buck highly-intensive/late-end-of-life care is less, while preventive care is higher.) See these graphs. Also see the table at bottom here, and the table with dates enacted here, to verify the universal coverage in every other developed country but ours.

Why are, the U.S., so damned bad at this?

Well, we have a government structure that makes competent action difficult (why not read a comparative government book when you have some time?)

We have a very divided country due to lots of different groups, and with a lot of people comitted to a low-end approach to things.

Our politicians may be particularly bad, often with a law background rather than something more respectable like economics or history or math or science. (My opinion: they really should have advanced degrees, and political science degrees don't count--political science is just the study of the manipulation of the people.)


OHIO
Ohio Department of Insurance None. There seems to be an open-enrollment period trying to replace a high-risk pool, but with weaker protections than community- and modified- community rating. healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Ohio Medicaid

Pre-existing-condition-screened individual insurance

At the time I examined the state insurance department site, the state consumer guide to health insurance was being revised. Since the Georgetown booklet is leaving gaps, I can not give a complete report.

I do see that there is a problem for people moving into the state from individual policies, as they might not be able to get affordable or any health insurance if they have a substantial pre-existing condition, unless they moved in in synch with an open enrollment period. Further, it might be the case that no policies would be available for them during an open-enrollment period, because each company they called has hit its open-enrollment cap.;

DANGER--ALL??:I also see a problem even for people with a current individual policy in the state in that if your current individual insurance company pulled out of the state outside of an open enrollment period, you might be stranded without insurance until the next open enrollment period, if you could count on that. Further, your continuous coverage requirement might have lapsed by open-enrollment time, leaving you stuck for longer.
Only "basic" and "standard" plans are required to have "open enrollment". Since "open enrollment" is what you need if you have a pre-existing condition, the question arises as to how good the coverage is on the "basic" and "standard" plans. I am unable to determine this, so you should find this out.

"Rescission? See this note.

[See column label and Key to understand these comments.]


OKLAHOMA
Oklahoma Insurance Department -- Life and Health Division Oklahoma High Risk Pool healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Oklahoma Health Care Authority

Pre-existing-condition-screened individual insurance

Rates + stoploss can be pretty steep: up to $20,000 a year per person plus a $10,000 stop-loss, for a total of $30,000 a year per person. However, if you accept much larger deductibles, and 40% copays, you probably can get about $24,000 a year deductible+premium+copay.;

DANGER--ALL:Note total lifetime coverage is only $500,000 -- more common in other states is $1,000,000-2,000,000 or no limit for HMOs;

Continuity for continuous in-state residents looks OK, in that even from individual coverage, you are eligible, and your pre-existing conditions are not excluded.

Continuity if you move in from out of state is another matter. If your prior coverage is individual, the 12 month state residency requirement will get you. And, in fact, if you move in, can't get insurance, and then pick up the high risk pool, you will not have continuous prior coverage when you apply for the high risk pool. So you basically will be uncovered for the pre-existing condition for 24 months total. Yikes!

"Rescission? See this note.

[See column label and Key to understand these comments.]



OREGON
Oregon.gov Insurance Division Oregon Medical Insurance Pool healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Oregon Medicaid Health Plan

Pre-existing-condition-screened individual insurance

Basically, this state has a pretty good high-risk pool in that the rates are low (hitting only about $10,000. a year per-person with an additional cost of $1500. stop loss).

Further, if you come to the pool from either prior individual or group coverage, according to the person I spoke to at the pool (information not on the web-site--you should double check the information I got yourself), the coverage will keep you from having your pre-existing condition(s) excluded. That's good, and is not the case in some states.

The legislators have tried hard in this state to do well for their citizens, but I still found a few potential holes: (a) You need to be turned down for individual coverage, or given individual coverage with a significant exclusion (unless you have certain presumed-exclusion medical conditions). If you apply for one or more individual policies, and they all agree to insure you for a very high rate (say $40,000 a year), then you are stuck unless you have a presumed-exclusion condition. (I don't know if this is actually likely to happen -- but you shouldn't assume it is not unless you determine otherwise from a reliable source.)

Danger--Moving In?: The other hole (b) is if you move into the state. Since you need to be essentially turned down (unless certain other things apply, such as prior high-risk pool membership in your state, or presumptive condition, or prior coverage is group), you have to make sure you can arrange to be turned down somehow before you are in the state and need immediate coverage. This might actually be impossible if you currently live in a community-rated state. You might try and rent an apartment in Oregon, and apply for individual insurance from that address -- but the insurance company might not accept it.

"Rescission? See this note.

[See column label and Key to understand these comments.]


PENNSYLVANIA
Pennsylvania Insurance Department Instead of a high-risk-pool, this state has very weak guaranteed-issue plans, and only for people with prior group coverage. healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Pennsylvania Department of Public Welfare

Pre-existing-condition-screened individual insurance

This state seems very dangerous if you have any amount of assets to lose.

Firstly, the only plan you can get with substantial pre-existing conditions is the "guaranteed issue" plan, which is one of the ones offered by Blue Cross in each area. However, you have to have prior group coverage to get this plan, and are dead in the water if you have continuous prior individual coverage. (The information I got on the phone about this from Independence BCBS varied from what I found on the state insurance site in details but not in essence -- the BCBS representatives told me you had to have a full 18 months of group coverage to be eligible, whereas the web said 18 months of prior coverage with the last day being group. In either case, you are dead with prior individual coverage.)

DANGER--ALL:Most stunning is the weakness of the coverage of this guaranteed issue plan. The first year, it will pay no more than $35,000. in payments, the second year $40,000., $rising by 5,000 every year until they'll pay $60,000. This is so financially dangerous, that it is barely worth adding that the copays have no stop-loss. (Note these details are all for the Philadelphia area--a correspondent has indicated to me that you may do much better if you live in other parts of PA.) Though the plan is not that expensive (I got a test quote of around $10K a year for a person 62 years old), the possibility of going bankrupt from medical costs outweighs the relatively low cost.

A little while back, I personally made the decision to avoid settling in Pennsylvania precisely because the health insurance situation was so risky.

(Since the state uses Blue Cross guaranteed issue plans instead of a high-risk pool, I am relying on information in a recorded phone call to independence Blue Cross Blue Shield 3/13/08. You should call the relevant BCBS in your area to verify.)

"Rescission? See this note.

[See column label and Key to understand these comments.]


RHODE ISLAND
Rhode Island Health Insurance Commissioner's Office None -- Uses Insurer of Last Resort Blue Cross Blue Shield of Rhode Island. healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Rhode Island Department of Health and Human Services

Pre-existing-condition-screened individual insurance

The state has an insurer of last resort, Blue Cross Blue Shield of Rhode Island, rather than a high risk pool.

I was unable to get rate information from the web for these policies. You should call them, and make sure you check the rate for say a 63 year old male with lots of pre-existing conditions.

The policy did generally seem open to people with prior individual insurance, which is a major problem in many states. I also did not see low annual maximum payments of medical bills (like $35,000-$75,000, as in CA and PA), which is good.

There may be some transportability/timing issues necessitating you to have no health insurance coverage during certain periods: There is an open enrollment period (about a month each year), and you might have to start the policy at that time. (I was unable to tell from the web info if the "medical exception" alternate entrollment criterion would apply to you if you lost your individual coverage outside of the enrollment period.)

There may be some problem with no coverage for a short while if you leave one insurance policy while you wait to get the BCBS plan. I believe I read something somewhere about your initial coverage actually having to be gone before you apply for the BCBS plan in certain cases.

Danger--Moving In?: Transportability into the state from out of state may be a problem in certain cases, especially if your move does not coincide with open enrollment. You might have to have no health insurance until open enrollment starts. You should double check with BCBS.

"Rescission? See this note.

[See column label and Key to understand these comments.]


SOUTH CAROLINA
South Carolina Insurance Department South Carolina Health Insurance Pool

Some information, and further contact information, is on the Insurance Department Website
healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
South Carolina Department of Health and Human Services

Pre-existing-condition-screened individual insurance

High-risk pool rates can be steep, to $25,000 a year for an older pre-Medicare male, with a small stop-loss. You may be able to have a bit smaller premium plus stop-loss with a high-deductible/stop-loss option. If you enter the pool because your individual health insurance rate rose to beyond the pool's rate, there is an additional charge for 6 months, with rate going to $30,000 a year for those 6 months.

In terms of continuity-of-coverage problems, these seem relatively small. You are O.K. if your prior coverage is individual, though you need to be declined insurance or charged more than the high-risk-pool rate by some insurer (if your prior coverage is individual). This may conceivably cause a gap in coverage while the application is being processed.



Danger--Moving In: Since 30-day state residency is required (for people with prior individual coverage), there is an issue of no coverage for at least 30 days when you move into the state. Though 30 days is small, this could certainly wipe one out financially if that persons gets hospitalized at the wrong time.

"Rescission? See this note.

[See column label and Key to understand these comments.]


SOUTH DAKOTA
South Dakota Insurance Department South Dakota Risk Pool healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
South Dakota Department of Social Services

Pre-existing-condition-screened individual insurance

The lower-deductible risk pool has rates up to about $11,000 a year for a non-smoker. However, this plan also has a stop-loss for hospital and pharmacy separately, totalling about $7000, so you have to count $18,000 a year in the high age bracket (non-smoker).

Apparently, reimbursement amounts to providers are kind of low, but will usually be taken by medical providers in-state. DANGER--ALL:When you are out of state in an emergency, you have to try to negotiate with the provider and see if they will agree to take the South Dakota reimbursement, or else you may have to pay the difference yourself.

There may be a maximum-insurance-cost issue in state -I can not tell whether it is an issue or its magnitude based on the information I can find. This is the issue: If you have prior individual coverage, it has to have been terminated involuntarily on you. This leaves you stuck with potential extraordinary high rates of the high risk pool in the case when cherry-picking has raised your individual rates to higher than the high-risk pool. However, I can't tell whether this could raise your rates to something humongous (like $60,000 a year), because there is some sort of cap on individual rates in some sense. But I can't find out what that cap is based on the information I can find on the web. If you live in this state, you should definitely find out by calling the insurance department and asking questions until you get the answer.

There may also be an issue for a child born with a serious pre-existing condition, not covered by group insurance when they are born. As I see the high-risk-pool rules, it looks like the child may not ever be able get any individual or high-risk-pool coverage. (They may be declined individual, and can not get high risk pool without having prior insurance being terminated involuntarily.)

Moving into the state there is a possible problem for the high-risk pool: you need involuntary termination of your prior coverage if your prior coverage is individual. But, it seems to me that leaving your old state by choice might make your cancellation "voluntary": however, you should check with the SD high risk pool about this. Perhaps they classify the cancellation in that case as involuntary.)

"Rescission? See this note.

[See column label and Key to understand these comments.]


TENNESSEE
Tennessee Department of Commerce and Insurance AccessTn healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Tenn-Care Medicaid Managed Care

Pre-existing-condition-screened individual insurance

The high-risk-pool has annual rates plus stopless up to about $15,000 a year per person.

DANGER--ALL:As I read it, the high-risk-pool requires 3 months of medical un-insurance to enroll. This is unacceptable, and could bankrupt you.

As I read it, the high-risk-pool has a $100,000. yearly maximum payout. You pay the rest. This could easily bankrupt one.

The web-sites I see are unclear about pre-existing condition exclusion, even if you have continous prior coverage. The Georgetown information suggests that there may be an exclusion.

You should double check the information above. If it is correct, my advice would be that people with assets to lose should avoid this state.

NOTE: Though many states handle HIPAA=Kennedy-Kassebaum=Group-Coverage-loss coverage Federal mandates through offering such people the high-risk-pool, it appears to me that Tennessee doesn't do this and has the individual insurers offer policies. However, if I understand it correctly, this is where the vacuousness of Kennedy-Kassebaum kicks in. You must be offered a policy by each individual insurer if you have the correct type of prior coverage, but there is no limit to what they can charge you.

"Rescission? See this note.

[See column label and Key to understand these comments.]


TEXAS
Insurance Department Texas Health Insurance Risk Pool healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Texas Medicaid

Pre-existing-condition-screened individual insurance

High-Risk pool rates kind of expensive: up to $16,000 a year for a non-smoker (allow $4,000 extra for out-of-pocket maximum to total $20,000).

Danger--Moving In: 30-day residency requirement, plus standard individual policy rejection requirement will cause people to have a period of non-coverage if they move into the state, except with immediately prior group coverage.

The language of the pre-existing condition waiver is not absolutely clear. It looks like you are O.K. -- they will probably cover pre-existing conditions if prior coverage is individual. However, double check with them.

"Rescission? See this note.

[See column label and Key to understand these comments.]


UTAH
Utah Insurance Department HIPUtah healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Utah Medicaid

Pre-existing-condition-screened individual insurance

The rules in this state are complicated, and I have not been able to find certain key details using the Web and the Georgetown/Kaiser site. Therefore, if you live in, or are thinking of moving into the state, and have assets to lose, you should check carefully with the Insurance Department.

There seem to be certain mandates on individual insurers accepting individuals with continuous prior coverage, and non-exclusion of pre-existing conditions, as well as maximum rates that can be charged. (Unlike a form of "community rating", you are charged substantially more with a pre-existing conditon, but with some bound. I have been unable to find out what the bound is--you should call the insurance department and check.) HOWEVER, even if individual insurance within the rate bounds is acceptable, as far as I can tell, in the case of certain conditions, an insurer can still choose not to cover that condition at all. Further, there is some indication that there may be quotas for each insurer on very sick patients. Therefore, it seems that you can't count on being able to get an individual policy that covers all pre-existing conditions, even with continuous prior coverage. So you may have to use the high-risk pool, which the state does have.

On the high risk pool, basically ability to enroll and have non-exclusion of pre-existing conditions seems sound for continuous in-state residents who have maintained prior individual or group coverage. There may be an exception in that I've noted mention that the Utah high-risk- pool has the potential to be closed to new enrollment. There may be some contingency plan, where that if this happens, individual insurer partly make up by some special enrollment criterion. You should check this.

There may also be a tricky issue with the high-risk pool for in-state residents in that you have to have had involuntary termination of prior insurance if it is individual to get pre-existing conditions not-excluded for 10 months. If your current individual policy became much more expensive than the high-risk pool (but recall there are some bounds--perhaps this case can not happen), and you wanted to switch to the high-risk-pool for cheaper rates, then you might have to hold double coverage for 10 months.

Danger--Moving In: However, moving in from out-of-state, there seems to be a problem with the high-risk pool, in that there is a 12 month Utah residency requirement for people coming from non-group insurance, unless they have come from another state's high-risk-pool. However, there are certain cases where you can have responsibly maintained continuous prior coverage, have a pre-existing condition now, and your previous coverage was not in any state's high risk pool. (For one, many states don't have a high-risk pool.)

The rates on the high-risk pool are not that high, topping out at about $11,000 per person per year with stop-loss added in. There is a $300,000 annual maximum payout, which is much much higher than in problem places like PA and CA, but one could conceivably exceed it in a bad year.

All in all, I think this state is trying to do well by its citizens, but they may still have left some gaps.

"Rescission? See this note.

[See column label and Key to understand these comments.]


VERMONT
Rules
Rates
None needed--Modified Community Rated? healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Vermont Department Children and Families

Modified Community Rating? which assures pre-existing conditions don't affect your rates, or get you denied coverage, if you get a pre-existing condition (as long as you have previously maintained continuous coverage).

Rate rises note: Though your protection in a Community-Rated state is much better than elsewhere, at least if you have pretty good savings, you should still make contingency plans for steep rate rises beyond the medical inflation rate (through age 65 when Medicare will take over). For example, my Aetna community-rated New York rate for one person went from:
yr 1) $730 a month
yr 2) $844.a month
yr 3) $802 a month (yes, small decrease)
yr 4) $1057 a month (yup--up 32%)



[See column label and Key to understand these comments.]


VIRGINIA
Virginia Bureau of Insurance None --Insurer of Last Resort, Instead healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Virginia Department of Medical Assistance Services

Pre-existing-condition-screened individual insurance

As I read the Georgetown information, at best in this state, you have to be prepared to act strategically and hold double coverage if certain sets of events happens to you in this state. (I did not obtain information about insurer-of-last-resort coverage caps. If they are low, the situation would be even worse for a person with substantial assets to lose.)

If you lose your group coverage, Kennedy-Kassebaum (in VA without a state deferral to the high-risk-pool) forces companies to give you insurance without pre-existing conditions exclusions. DANGER--ALL:But in this state they can charge you whatever they have to to cover their risks based on your health, so there is no telling how expensive your policy will be. Based on the info I pulled from the Georgetown booklet and Kaiser site, there is no rate control at all.

If you had continuous prior individual coverage in VA or another state, but say cherry-picking forced your rate on the current policy very, very high, if you have a serious pre-existing condition, it looks like you are stuck. A new insurer doesn't have to insure you, or can exclude any conditions for a period of time, and can charge you whatever it wants.

There are insurers of last resort, Blue Cross / Blue Shields, which would give you a policy if your prior coverage is group or individual, but they have 10-12 month exclusions on pre-existing conditions, even if you have continuous prior coverage. (If in-state and cherry-picking has forced your rate to rise, you may be able to get out of this mess by holding double coverage for 10-12 months. Similarly for prior group, where, if you plan double coverage during your COBRA period you may be O.K.) However, if your prior coverage is individual and the company has stopped doing business in the state, you would seem to be stuck.

NOTE: Since I didn't see last-resort-policy coverage information on the VA Anthem BCBS site, I did not examine rates or coverage caps on the BCBS last-resort policy. If you live in the state, or are considering moving in, you should definitely call the relevant BCBS in your area, to see if there are other problems, such as humongous rates, or the amazingly small $35,000-$60,000. annual caps on medical bills paid by the last-resort insurer, that I found in parts of PA for the last-resort policy.



"Rescision? See this note.

[See column label and Key to understand these comments.]


WASHINGTON
Washington State Department of Insurance

An unusually informative state site, with rates for individual policies from each carrrier posted, and other useful information on the rules. (Kudos!)
Washington State Health Insurance Pool healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Washington State Department of Health and Social Services

Pre-existing-condition-screened individual insurance

The rules looks pretty well-thought out, with people with assets to lose pretty well protected. (Though there might still be a short period without coverage in certain cases -- I am not sure of this -- see below.)

Each individual policy is sort of modified community rated (rates for all on the web at the state site) and can not exclude pre-existing conditions, but, unlike MA, NY, NJ, VT, ME they are not guaranteed issue -- they can turn you down even if you have continuous prior coverage. This makes it a different system than those 5 other aforementioned states -- you may get stuck without an individual policy, but in this case the high-risk-pool seems to be thoughtfully constructed so that you won't likely get stuck.

The high-risk pool rates seem to run to about $14,000 a year (at high ages) with the stop-loss added in, if you choose preferred provider, which is better than many states. And the rules credit prior coverage. The only issue which I can see which may cause an interruption of coverage for a brief time is the requirement that an individual policy (using the state's standard health-status assessment form) turn you down to get in the high-risk-pool. If you lose your current coverage suddenly, or move in from another state, you might conceivably have a period of non-coverage while you apply for an individual policy, wait for rejection, and further wait for the beginning of the month for the high-risk-pool coverage to start. However, perhaps there are ways around this -- call the Insurance Department if this is an issue for you.

All in all, by my assessment, this state has tried hard to do well by its citizens in the area of keeping the pre-existing condition problem from wiping people's assets out. Up to those details of possible short (month-or-two?) coverage periods (particularly if you are moving into the state) that you might be able to get around, and which, if they really exist, could still wipe a person out, they've done an effective job.

"Rescission? See this note.

[See column label and Key to understand these comments.]


WEST VIRGINIA
West Virginia Insurance Commissioner's Office Access WV healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
West Virginia Medicaid

Pre-existing-condition-screened individual insurance

Rates for the high risk pool run to about $15,000. plus add the $1600. out-of-pocket maximum, plus possibly add something for the $25,000. annual prescription drug maximum payout. DANGER--ALL: The $200,000. annual maximum in your medical bills that the high risk pool will pay seems dangerous to me. Also the $25,000. prescription drug annual maximum. Also, you would seem to have trouble if your individual insurer pulls out of the state or goes out of business. After applying for other insurance and getting rejected, the high-risk-pool will accept you but exclude pre-existing conditions for 6 months.

There are some tricky issues for in-state residents with prior individual insurance that you should know about. If you have individual insurance, but insurer cherry-picking has forced the rate to more than the high-risk pool, you can get the high risk pool, but to deal with the 6-month pre-existing-condition exclusion (that does NOT credit prior coverage), you need to maintain double coverage for 6 months.

There is a logically subtle issue that if you join the high-risk-pool, then get completely well enough and clear of the pre-existing condition so that you can get individual insurance, and do so, within a few months you relapse the the individual insurer pulls out of the state, you are going to get stuck without any insurance, as you can't rejoin the high-risk-pool within 12 months of leaving it. To avoid this risk, you can never leave the high risk pool once you join.

Moving in from out of state: also add the 30 day residency requirement for people with prior individual insurance. Add the 6 month waiting period on pre-existing condition coverage even for people with continuous prior individual coverage, and you have a possible 7 months of no coverage for the pre-existing condition.

"Rescission? See this note.

[See column label and Key to understand these comments.]


WISCONSIN
Wisonsin Commissioner of Insurance Wisconsin Health Insurance Risk Sharing Plan healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Wisonsin Medicaid

Pre-existing-condition-screened individual insurance

High-risk-pool premiums run to about $14,000 a year, with an additional $2000. out of pocket maximum. That is better than many states.

DANGER--ALL: For in-state people with continuous prior individual coverage, if your insurer pulls out of the state or goes bankrupt and you can not get other individual insurance because of your pre-existing condition, the high risk pool will take you, but exclude pre-existing conditions for 6 months, despite continuous prior individual coverage.

Moving in to the state: yields more problems. There is a 3-month residency requirement, so if you move into the state with a substantial enough pre-existing conditon and need individual insurance, the high-risk-pool will exclude you for 3 months, and then give you an additional 6 months without coverage of your pre-existing condition.

"Rescission? See this note.

[See column label and Key to understand these comments.]


WYOMING
Wyoming Insurance Department Wyoming Health Insurance Pool (at State Insurance Dept.) healthinsuranceinfo.net
kaiser statehealthfacts.org

Federal www.healthcare.gov
Wyoming Medicaid

Pre-existing-condition-screened individual insurance

Rates can be pretty steep in the high-risk-pool, hitting $20,000 a year per person in the just-pre-Medicare age group, plus a $2,000. per person out-of-pocket maximum. (I am referencing the "Gold" plan, as the $500,000 lifetime maximum payout on the "Brown" plan seems too little.) The "Gold" plan itself has only a $750,000 maximum medical-bill payout, which I would normally flag with "Danger" (being under $1,000,000.), but I won't flag it on the guess that medical costs may be less in Wyoming.

For in-state residents, since the high-risk-pool will not exclude pre-existing conditions if you have sufficient prior coverage, even if individual, it looks like the problem of a complete lack of coverage for pre-existing conditions is OK (for people responsible maintaining continuous prior coverage). I am a little worried about the requirement that you have 2 insurance rejections if your current individual insurance company goes bankrupt or leaves the state -- it may take too long to get the rejections and you may have a short gap without coverage. You should check with the insurance department to see if this is a worry.

There is a logically subtle issue that if you join the high-risk-pool, then get completely well enough and clear of the pre-existing condition so that you can get individual insurance, and do so, within a few months you relapse the the individual insurer pulls out of the state, you are going to get stuck without any insurance, as you can't rejoin the high-risk-pool within 12 months of leaving it. To avoid this risk, you can never leave the high risk pool for individual insurance once you join. (I have not marked this Kafkaesque little problem with "DANGER-ALL" based on my criterion, because if you keep the high-risk-pool forever you have a bounded rate.)

Danger--Moving In??:I am worried about the requirement of 2 rejections if your prior insurance is individual and you come from out of state. You may not be able to be rejected out of state, so your rejection may have to thus be in Wyoming. This may conceibably cause a gap of coverage when you move in. Further, if it is too long, then the 12-month pre-existing-condition exclusion may not credit your prior coverage. You should check with the Insurance Department.

"Rescission? See this note.

[See column label and Key to understand these comments.]








Who am I? I am Norm Spier, a mathematical statistician who has spent most of his life in Metro NYC, Upstate New York, and Connecticut. Recently (3/2010), I moved from Vestal, in Upstate New York, to the Five Colleges area of Massachusetts.




Important Legal Disclaimer: I am trying to put useful, helpful information on this page. However, I can not be responsible for any errors above. Therefore, please check with the appropriate state insurance departments, and/or seek legal advice, as appropriate, before relying on the information above.

Also, please note the above information is copyright Norman A. Spier.