So waiting 90 days to qualify would leave you screwed.
Well, if you are referring to a gap in coverage of 90 days then your pre-existing conditions would not meet the requirements for exemption, as outlined by the Feds. However, you would be eligible for coverage upon enrollment for any non-related issue
And if you have a systemic illness, like diabetes or high blood pressure, for instance, or multiple sclerosis, your pre-existing condition can be said to affect just about any illness you have (and maybe even injury, if you have something like MS) and your new insurer can use it as a reason not to cover anything for the gap period.
And in this economy, where people are searching fruitlessly for work long enough to fall off of the already twice-extended unemployment rolls, not having a gap longer than the HIPAA statute limit is a true rarity.
One of the most fundamental concepts in insurance is “selection”, aka “anti-selection”. This refers to the fact that people voluntarily purchase insurance, and people tend to do things that favor them, and therefore a disproportionate percentage of the purchasers of insurance are likely to be people who think - usually with good basis - that they are likely to receive more in benefits than they pay. That is not a workable situation for the insurance companies, and they need to avoid this. Many of the clauses and conditions of insurance relate to this, and few discussions of insurance make any sense if this is ignored.
Employer-based coverage is one example. The main reason it’s so much cheaper than individual coverage (in addition to administration costs) is because it’s subsidized by the company. Because of this, it’s a “good deal” for a lot of people who still expect to get less in benefits than the cost of the premiums. For example, suppose a random guy thinks he will likely incur 5,000 in medical bills. He is less likely to purchase an 8,000 policy than a guy who expects 10,000 in medical bills. But suppose the employer pays 5,000 of the 8,000 cost. Then a guy expecting 5,000 in claims will still be inclined to purchase it, because he lays out 3,000 and gets 5,000 in return. (This point was also made earlier in the thread by Manda JO.) In general, underwriters will give more favorable rates for plans that are more heavily subsidized, for this reason. (There’s also a rule in group coverage that the group cannot exist for the primary purpose of obtaining insurance, also for the same reason.)
Pre-existing conditions are another example, even more egregious. If people are allowed to wait until they have a medical condition before obtaining coverage, healthy people will have little incentive to purchase coverage, and most coverage will be purchased by sicker or injured people. That’s why the insurance industry is willing to forgo the pre-existing condition clause in exchange for a mandatory coverage requirement - if you force everyone to have coverage, then the primary reason for have the pre-existing coverage clause goes away. But it doesn’t necessarily do that. It depends on how stiff the penalties for non-coverage are. I read recently that in Massachusetts, which recently eliminated pre-ex clauses and instituted mandatory coverage, there’s been an upsurge in people signing up for temporary coverage as needed and paying the penalty otherwise - the penalty is not high enough.
(The same also applies to COBRA coverage. People remark on the inadequacy of COBRA from the perspective of a laid-off employee, but it’s also a big money loser for employers. Employers are allowed to charge the full cost of the plan plus a 2% admin fee, but this doesn’t account for selection. Mostly sicker ex-employees tend to elect COBRA. It’s thought that the true cost of COBRA to an employer is about 170% of the actual cost, versus the 102% that they charge.)
Re the history of benefits, I believe they really got started when wages were frozen during WW2, and employers needed alternative methods of attracting employees. (Similarly, at one point bank rates were frozen so backs began attracting accounts by offering toasters. Toasters didn’t survive deregulation, but medical benefits did.)
No, just break a leg and try and get it paid for. I quit one job and the next day received a letter explaining that from the moment I quit, I was not covered. I was always healthy enough to take risks, but if you quit a job, you are taking a huge risk.
The gap refers to the time on the job that you have to put in to qualify for benefits.Generally it is 90 days.
I think I mentioned above that that’s how my insurance got started. Kaiser (the shipbuilder) actually established a hospital for the employees at the shipyards, making pretty good care available to employees (and their families, I think) and saving the company tons of money. But they did, I assume, have their noses in employee’s records.
In other words, you dont’ have a counter-argument, or ignore some of the less pleasant history of the United States, and dont’ want to admit it. The era of Big Progressivism is a complex one, and tends to be lightly taught. I will say it reached its height and in WW1, but declined thereafter. It heavily influenced the New Deal, but did not control it entirely.
The idea of making the U.S. of A. into a highly centralized corporatist state not something I made up. Mussolini was highly admired by all the “right” people because he did precisely that at least on the surface. Early on, there was a lot of admiration for Stalin and Hitler on similar grounds. And these same individuals (the admirers, not the dictators) tended to have a huge amount of influence in creating much of the regulatory nets we’re entangledf in today. The leaders of the Progressive cause wanted a centralized corporatist-unionist state, headed by them.
Varies from one employer to the next. The past three firms I have worked for I was able to enrol and their coverage went into effect on the first day of the following month. During that time I was still covered by my prior employer’s plan.
I’ve been uninsured half my working life. As a professional working on aerospace subcontracts, sometimes it was impossible to get “permanent” work, so I would contribute to a project as a “contractor” for years at a time. I’d get the same pay as the guy next to me but zero benefits, zero unemployment protection at the end. And the insurance costs for a single person are triple what the company paid, so I had to cross my fingers and live without it. Now I’ve got it again, and while still not sick I at least have peace of mind.
So it occurs to me, as all single party insurance buyers, why I have to pay so much. What’s so magic about having the employer buy the plan instead of me. Why isn’t there a pool for all of us? We constitute a pool like any other, so why does nobody go after our business?
Tying things to employers just skews the system, prevents true price to benefit ratios.
See post #64 above.
I take it you were an independent contractor working on a 1099. If so, you weren’t making the same wage as the perm employees, you were making much less after you factor in the missing benefits, FICA, unemployment insurance, workman’s comp, etc. Was it not possible to work via an agency as a contractor instead?
The system wasn’t “tied” to employers. Employers sought out benefit programs in order to attract the best workers. The advent of HMO plans turned all the plans into much the same offering, just different groups of medical providers participating in the plan.
Do very highly paid employees, CEOs and down a few levels, get paid health insurance? If yes, is it anything like what we get? I’ve never seen a CEO at Kaiser. At least I don’t think so. Same hospital, different areas, I suspect.
Where do they go when the get an owie?
Peace,
mangeorge