Issue link: https://read.dmtmag.com/i/14162
Health reform payoff “As soon as they heard that, they basically hung up.” – Mandy Boyer, wife of former owner-operator Gary Boyer, about efforts to secure health coverage. deductibles, and the caps are low.” Last year’s GAO report noted the average policy among state HRPs carried an annual deductible of $1,593. That’s almost three times higher than the average employer-sponsored-plan deductible, though it’s lower than White’s $2,750 deductible, which she meets every year, she says. The vast majority of state HRPs, noted GAO, came with lifetime benefits limits averaging $1.6 mil- lion. While limitations such as these are characteristic of somewhat less-expansive plans in the employer- sponsored market, they might well be considered typical of plans for high-risk individuals with turbu- lent medical histories. “Crete’s plan is a PPO,” White says, meaning she chooses specialists and generalists from a preferred provider organization network. “It’s a really good policy.” White feels fortunate to have the ability to buy into her carrier’s plan as a leased owner-operator. Some carriers don’t allow that due to the increased govern- ment scrutiny of independent contractor relation- ships among businesses. At Boyer’s former carrier, for instance, buying into the company health plan wasn’t an option, he says, so he and his wife were forced to shop for individual policies. “I was an owner-operator for under a year – I just recently gave it up,” he said in June. “We had to do something. We went without insurance for us or the kids for a year.” Adding insult to injury, Mandy had to quit her part-time sales job with Sears to get the family income below the threshold to qualify for Indiana’s Medicaid program. Soon, the Boyers will have insurance for them- selves, when the three-month waiting period at Gary’s new carrier, Covenant Transport, is over. Boyer says Mandy “is pretty happy that I’m a com- pany driver again.” How to get high-risk coverage Have you been denied health cov- erage because of an existing or past medical condition? To get coverage, first see if you live in one of 31 states (plus the District of Columbia) that are administering the new national high-risk pool (HRP) under the Pre-Existing Condition Insurance Plan name. A full list, including contact information, of most rele- vant state departments is available at naschip.org. Click link under “Member States.” Otherwise, look up your state’s health services department for info or utilize the healthcare.gov site to steer you toward the right contact. IF YOU’RE IN ONE OF THE 31 STATES: 1. Call for application informa- tion. Some states have waiting lists for their state HRPs, but the new national HRP should be open to new applicants. 2. Be sure to request informa- tion on both national and state HRPs, such as they exist. The national pool may represent a more affordable option than your state’s original pool, as long you meet its requirements. IF YOU’RE NOT IN ONE OF THE 31 STATES: 1. Visit the U.S. Department of Health and Human Services website for the Pre-Existing Condition Insur- ance Plan, healthcare.gov, for infor- mation on joining the national pool. 2. Be prepared to provide proof of the following to obtain coverage in the national HRP: • That you have been without creditable health insurance cover- age for the last six months. • That you are a citizen or legal resident of the United States. • That you have been denied health insurance due to a pre- existing condition or something else in your medical history. ANNUAL SPENDING CAPS: For those enrolled in the national high-risk pool, out-of-pocket spending limits for 2010 are $5,950 for individu- als, $11,900 for families. Compare these figures to the average yearly premium costs alone ($5,820) for enrollees in existing state high-risk pools. If your state has its own HRP and you qualify for both it and the national pool, compare key features, such as monthly premium, level of coverage, deductibles and provider network. States administering the national HRP Application to the new national high-risk pool should be made through the U.S. Department of Health and Human Ser- vices (visit healthcare.gov) unless you live in the District of Columbia or one of these states: Alaska, Arkansas, Cali- fornia, Colorado, Connecticut, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachu- setts, Michigan, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Okla- homa, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Washington, West Virginia, Wisconsin. To access your state’s plan admin- istrators, visit healthcare.gov. n 42 OVERDRIVE AUGUST 2010