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Health Insurance for the Sick Holly Whelan, MPA Health Action 2006 Conference Washington, D.C. January 27, 2006.

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Presentation on theme: "Health Insurance for the Sick Holly Whelan, MPA Health Action 2006 Conference Washington, D.C. January 27, 2006."— Presentation transcript:

1 Health Insurance for the Sick Holly Whelan, MPA Health Action 2006 Conference Washington, D.C. January 27, 2006

2 1/27/20062 Health Insurance For The Sick Health insurance options available when losing job-based coverage Basics of each program What actions states have taken to help consumers obtain and keep health insurance when job-based coverage ends

3 1/27/20063 Health Insurance For The Sick For a person with a serious illness like diabetes, HIV/AIDS, cancer, multiple sclerosis, etc., obtaining health insurance coverage after losing job-based insurance is not easy Why?

4 1/27/20064 The Three As Access – is it available? Medical underwriting excludes those who need it most. Affordability – can people with serious illnesses afford it? Adequacy – does it cover the needs of those with serious health care concerns?

5 1/27/20065 What Happens When You Lose Health Insurance Coverage? If losing job-based coverage: COBRA State Continuation Coverage HIPAA Conversion Coverage State high-risk pool Individual policy Other job-based coverage

6 1/27/20066 COBRA Available to employees of businesses with more than 20 workers Certain groups are exempt (churches, church-affiliated orgs, etc) Costs can be prohibitive – full cost plus 2% administration fee Health benefits are exactly the same as they were as an employee

7 1/27/20067 COBRA – What States Have Done Massachusetts Will pay for 60% of the cost of COBRA if you are eligible for unemployment benefits

8 1/27/20068 State Continuation Coverage Available in 41 states Applies to employees of businesses with less than 20 workers Workers must have been covered under the employer group health plan for a set period of time to become eligible (varies per state) Cost prohibitive - full cost plus an administration fee Benefits may be the same as when employed, but can vary

9 1/27/20069 State Continuation Coverage – What States Have Done States that do not offer continuation coverage: AK, AL, AZ, DE, ID, IN, MI, NJ, PA, VA, WA Some states offer continuation coverage for an extended period of time (18-36 months) CA, CO, CT, FL, IL (if divorced or widowed), KY, MD, MA, MN, NV, NH, NY, NC, ND (for annulment or divorce), RI (except for disability), SD, TX (except termination of coverage), WV, WI

10 1/27/ HIPAA Must have had 18 months of prior group coverage and used up any COBRA or state continuation coverage Options vary greatly among states (individual policies, high-risk pool, etc) Cost-prohibitive based on state limitations Benefits available can vary based on type of coverage and state limits

11 1/27/ HIPAA – What States Have Done States that do not require HIPAA-eligible individuals into state-high risk pool: AZ, CA, DC, DE, FL, GA, HI, ID, ME, MA, MI, MN (some), MO (some), NV, NJ, NM, NY, NC, OH, OR (some), PA, RI, TN, VT, VA, WA, WV States requiring greater benefits than HIPAA standard policies FL (some), GA (some), ID, ME, MA, MI, MN, MT, NV, NJ, NM (some), NY, OH (some), OR, PA, VT, VA

12 1/27/ Conversion Coverage When leaving a fully-insured group health plan, some states allow employees to convert their coverage to an individual policy. Approximately 38 states offer conversion coverage, though variation occurs in what must be offered, etc. Cost-prohibitive Benefits vary greatly – though in some states coverage is similar to what was available as an employee

13 1/27/ Conversion Coverage – What States Have Done States that do not offer conversion coverage: AL, AR, DE, HI, LA, ME, MA, MS, NE, OR, SD, TX States that allow more than 30 days to elect conversion coverage: CA, FL, NY, SC, UT States without a minimum prior length of coverage requirement: AZ, AR, CT, ID, MN, NJ, NM, NC, ND, OK, SC, VT, VA, WA

14 1/27/ State High Risk-Pool Coverage Over 30 states have established high-risk pools, though they are underutilized Pre-existing condition waiting periods vary (3 months -12 months) Cost prohibitive – most common reason why high-risk pool coverage not purchased by people with diabetes (ADA and Georgetown, 2004). Benefits vary, but coverage can be limited

15 1/27/ State High-Risk Pools – What States Have Done Maryland Eliminated pre-existing condition waiting period Reduced monthly premium to make coverage more affordable Montana Instituted high-risk pool subsidy for those who meet income guidelines (currently closed) Alabama and South Dakota Only accept individuals into high-risk pool who are HIPAA-eligible

16 1/27/ Individual Health Insurance Policies Most states allow insurers to turn people down for individual coverage based on the status of their health Individuals with chronic illnesses are negatively affected Policies can be expensive if available Coverage may not include all of the health care needs of an individual, though mandated benefits must be covered

17 1/27/ Individual Health Insurance Policies – What States Have Done States without medical underwriting NY, NJ, MA, VT, ME MI, PA, VA, NC, DC for Blue Cross policies No rating limits in VA, NC, DC

18 1/27/ Additional Resources American Diabetes Association Georgetown University Health Policy Institute


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