The Widdershins

Archive for March 7th, 2012

Just a little background information:  I have been without health insurance for quite a long time; going back to after Hurricane Katrina.  Through a number of mix-ups, screw-ups and literally the mail not going through, I found myself without health insurance.  This is not a good thing when you take *maintenance* medications for things like hypertension, elevated cholesterol and some other issues.  So naturally, this was a scary prospect I was facing.

I was fortunate that I found one pharmacy that has a prescription savings plan which gives you a discount on certain medications.  You join the “club” for an annual fee and then you are eligible for the discounted price.  My hypertension medication, cholesterol med and several others were on their list.  Also, there were antibiotics, antifungals and a goodly number of other medications.  This helped quite  bit, however, when the doctor wrote a prescription that wasn’t on the list of medications, it could get expensive.

And speaking of which, there’s the physician issue.  There are a number of “doc in a box” offices around, but the problem with those is that you are never certain you will see the same physician each time.  You can call me old-fashioned or any other term you wish, but there is a certain “comfort factor” when you can see the same doctor each time you need to go to one.  I was fortunate in that the same internist who saw the momster decided he could also see me on a cash basis and not worry about not having insurance.  He was also willing to give me a discount for seeing him with no insurance coverage.

Now when you see a doctor there are going to be those times when they are going to want to do some diagnostic tests, labs or similar tests.  On labs, i.e. bloodwork, cholesterol tests, etc. there simply were no discounts to be had; you paid what the charges were.  On imaging tests like x-rays or an ultrasound, my physician was able to get the imaging group to give me the “Blue Cross” price.  What that means is that if I had a sinus x-ray, I paid what they expected to be the Blue Cross payment.  No, not what an insured with Blue Cross would pay as their share,  I paid the “Blue Cross” part.  It’s not cheap.  And Lord help me if I had needed an MRI, CAT or anything like that; I would have had to forget it.  The same goes for if I had needed to go to an emergency room for anything other than being in a car accident.  (I had increased my medical payments part of the car insurance so I could at least make a dent in an E.R. bill if I was in a wreck.)

I knew I needed to have some sort of  health insurance, if for no other reason than the fact that the momster had a history of cardiac/vascular issues and I had already had one of those issues myself.  However, when I started pricing individual plans, they were simply out of sight.  I checked through the Tulane Alumni Association.  They had an insurance broker where I looked for a quote and I simply stopped the process when it got to $1400/1500 a month and a $5000 deductible.  I had checked with another insurance company and their premiums were a bit lower but there was a pre-existing clause whereby they would not cover anything on those conditions for a year.  Lovely.

Some time back I had seen that there was a plan with the Feds called the Pre-existing Insurance Program, but one of the criteria was that you had to have a quote from an insurance company showing the denial of the pre-existing conditions, or you needed to show that the insurance quote was substantially higher than it would have been for someone without a pre-existing condition.  I had not checked that site for some time so I decided to go back and check it again.  I did and quelle suprise there *had* been a change in the requirements.  The only requirement I had to have was to have my doctor write a letter stating the pre-existing conditions I had, and to include his full name and state of licensure and the license number.  Hurray for me!

Here, I’d like to provide a description of the plan, what it covers and approximate costs.  (N.B.: I am describing the federal PCIP plan.  Some states have their own plans while others opted to just use the plan created by the Federal Government and administered by one of the companies that offers a Federal Employee Health Plan) The PCIP health plan is an 80/20 plan which basically means they pay 80% of costs and you pick up the other 20%.  There are deductibles, and you have a choice of three options in the federal pcip plan; a standard option, an extended option and a HSA option. If you enroll in the extended option, which I did, you pay a higher premium but you also have lower deductibles.  You can find some additional information on this, here but I’ll provide a general idea of what it is covered.

Each of the three PCIP plan options provides preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates a preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings. For other care, you will pay a deductible before PCIP pays for your health care and prescriptions. After you pay the deductible, you will pay 20% of medical costs in-network.

Let me add that for doctor’s visits and, I believe, a few other things you do not have to meet the yearly deductible; instead you have an office co-pay.  

Premiums are based on the state you live in and an age group.  You can find a list of the premiums, by state, here.

Again, here are the basic requirements to eligible for this plan:

To be eligible for the Pre-Existing Condition Insurance Plan:

    • You must be a citizen or national of the United States or lawfully present in the United States.
    • You must have been uninsured for at least the last six months.
    • You must have a pre-existing condition. To prove this, you will be asked as part of the application process to submit one of the following documents dated within the past 12 months:
      • A letter from a doctor, physician assistant or nurse practitioner stating that you have or had a medical condition, disability or illness. This letter must include your name and medical condition, disability or illness, and the name, license number, state of licensure and signature of the doctor, physician assistant or nurse practitioner.
      • A denial letter from an insurance company licensed in your state for individual insurance coverage. Or you may provide a letter from an insurance agent or broker licensed in your state that shows you aren’t eligible for individual insurance coverage from one or more insurance companies because of your medical condition.
      • An offer of individual insurance coverage that you did not accept from an insurance company licensed in your state for individual insurance coverage. This offer of coverage has a rider that says your medical condition won’t be covered if you accept the offer.

For children under age 19 or persons who live in Massachusetts or Vermont: You must have been quoted a premium of 200% or more of the Pre-Existing Condition Insurance Plan premium for the Standard Option in your state.

So what is the downside of the PCIP plan?  It ends January 2014 when “Obamacare” is supposed to have the insurance exchanges established.  😦   But, I’ll put it this way:  I’ll worry about that when it happens.

I’m not going to say this is an absolutely great plan but it is better than nothing.  That $1000 deductible isn’t cheap but it’s better than what I found on the open market.  That being said, I hope someone sees this and is able to make use of the program.

This is an open thread and also:



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