Thursday, July 12, 2007


You probably know that if you lose or leave your job, separate from a spouse, etc... Federal law provides for COBRA, which mandates your insurance company to continue offering you the insurance you had while employed for up to 18 months.

You may or may not know (I didn't), that in California, you can get an additional 18 month extension of your COBRA (called CalCOBRA) for a total of 36 months.

But what happens after those 36 months expire? Well, you can buy insurance on the open market. Which, if you have no pre-existing conditions is, as I've found, fairly straightforward, and not exceptionally expensive. But what if you do have a pre-existing condition? Not necessarily a debilitating one, or one that requires constant medical attention, just one that increases your risk. As in my case, having had stage I breast cancer 3.5 years ago.

Well, it turns out that most of the insurance companies will sell you, under some conditions, more expensive policies to compensate for risk. So for example, if you are somewhat overweight, you can get a policy for 25% above the normal fee. If you're a little more overweight (i.e., 192-228lbs for a 5'.5" woman), you can get it for over 50% over the normal fee. But if you had stage I breast cancer, like I had, you need to wait 7(!) years before you're eligible for insurance, even at double the price. Meaning that today I'm completely ineligible to buy insurance, no matter the price.

But this story (surprisingly) has a happy ending. Because in 1996 congress passed something called HIPAA (the Health Insurance Portability and Accountability Act). Which says, among other things, that if you've exhausted your COBRA possibilities, insurance companies are obliged to offer you at least a couple of their standard insurance plans, at a somewhat (but not terribly) increased rate. For me my choice will be a Blue Cross Share 1500 plan, which is a PPO with a $30 office visit co-pay, a $1500 yearly deductible (not applied to office visits), maximum yearly out of pocket payment of $5,000, and maximum lifetime benefit of $5,000,000,000. Not too shabby.

And how much will it cost? $535 a month, vs. $383 for the same policy if I had no pre-existing conditions and could have purchased it on the open market. Meaning it will cost me 40% more than my no-risk counterpart. Not ideal, but not bad. This (along with COBRA) is an example of Congress doing something right. Consider that without HIPAA I would have had NO option of buying health insurance (with the possible exception of insurance through California's high risk pool, with its yearly, or lifetime, maximum payout of $75,000...).

Here's my question though - have you ever heard of HIPAA? Did you know you could get post-COBRA insurance through HIPAA? Isn't it the best kept secret ever?

Well, I'd hadn't heard of it until I found a health insurance broker and consulted her. Here's her name, click for her web site: Maryann Zukin. If you ever need to buy health insurance on your own, I highly recommend her.


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