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  1. #1
    🏆🏆🏆🏆🏆 ElNono's Avatar
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    I'm hoping somebody familiar with the insurance industry (101A?) could answer this one for me.

    Basically, we reside in NJ, but the specialists my wife sees are in PA (45 min ride from here). She is likely to lose her job soon due to a (hopefully temporary) disability, and under the FMLA, her insurance coverage ends at the end of October. We both used to be insured under her job's group plan.

    Now, under NJ insurance laws, premiums are all the same regardless of age or health condition, which puts insurance for the two of us at about $1,700/mo, and that's without including the fairly high deductibles. Crazy, and we just can't afford that.

    On the other hand, PA insurance doesn't have the same premium limitations as in NJ, and thus it's much more affordable (about $450/mo for the two of us). We're both in our late 30's, no smoking.

    Could we buy insurance in PA even though we reside in NJ? I wouldn't mind having to drive to see PA doctors. Or you have to reside on the state?

  2. #2
    🏆🏆🏆🏆🏆 ElNono's Avatar
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    Actually, after looking up some more, I guess the answer is no. Still, if somebody has more info, please chip in.

  3. #3
    Displaced 101A's Avatar
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    EN,

    Well, you found it, you cannot buy insurance across state lines, and in trying to do a good thing to help out the tough to insure; NJ has made the prices for everybody very high, indeed. (I believe they also have a very "rich" mandated benefit package; driving the price up even higher).

    You should ask your wife to find out how much COBRA premiums will be for both her individually, and you as a couple - or if she is retaining her job, if she can continue on the group benefit plan, if you pay the full premium. Of course, chances are, that is not going to be significantly more attractive. Unfortunately for you, PPACA will, to a large degree help mitigate the costs for you - but not until '14.

    Situation sucks. Employer funded health insurance has inherent problems.

  4. #4
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    Ummm the GOP have been proposing allowing this for as long as I can remember. Your side thinks it's a crazy idea.

    My wife and I are about 10 years older than you, I smoke, and we pay $335 a month for health insurance here in Texas.

  5. #5
    Displaced 101A's Avatar
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    Ummm the GOP have been proposing allowing this for as long as I can remember. Your side thinks it's a crazy idea.

    My wife and I are about 10 years older than you, I smoke, and we pay $335 a month for health insurance here in Texas.
    I have no idea what you are talking about, and if you are a 53 year old smoker, you aren't paying $335 for insurance anywhere - in fact, you're damn near uninsurable. You're not a risk, you're a claim.

  6. #6
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    I have no idea what you are talking about,
    Seriously you have never heard republicans talk about this? It's on the GOP website.

    Purchase Health Insurance across State Lines
    Americans residing in a state with expensive health insurance plans are locked into those plans and do not currently have an opportunity to choose a lower cost option that best meets their needs. We will allow individuals to buy health care coverage outside of the state in which they live.
    http://www.gop.gov/pledge/healthcare
    and if you are a 53 year old smoker, you aren't paying $335 for insurance anywhere
    Where did you get 53? I'm 45, he said he's late 30's and I said about 10 years older. And we pay $335 a month with Blue Cross/Blue Shield...it's true whether you want to believe it or not.

  7. #7
    Displaced 101A's Avatar
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    Seriously you have never heard republicans talk about this? It's on the GOP website.





    Where did you get 53? I'm 45, he said he's late 30's and I said about 10 years older. And we pay $335 a month with Blue Cross/Blue Shield...it's true whether you want to believe it or not.
    Sure I know its a point - and it's been addressed, however, Nono wasn't making a political point; just asking for advise; you decided to tribe up on the topic; should of been more clear about why I was perplexed by your post. Thought you were responding to me, and somehow remembered my age from a previous discussion.

    Stop smoking. HUGE difference between 45 and 53, btw. 15 years from now? You're practically on borrowed time. Seriously stupid, bro. Stop.

  8. #8
    🏆🏆🏆🏆🏆 ElNono's Avatar
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    EN,

    Well, you found it, you cannot buy insurance across state lines, and in trying to do a good thing to help out the tough to insure; NJ has made the prices for everybody very high, indeed. (I believe they also have a very "rich" mandated benefit package; driving the price up even higher).

    You should ask your wife to find out how much COBRA premiums will be for both her individually, and you as a couple - or if she is retaining her job, if she can continue on the group benefit plan, if you pay the full premium. Of course, chances are, that is not going to be significantly more attractive. Unfortunately for you, PPACA will, to a large degree help mitigate the costs for you - but not until '14.

    Situation sucks. Employer funded health insurance has inherent problems.
    Thanks for heads up. I'll ask her to find out about COBRA. The type of insurance used in her job was self-insured, so I hope there's no problem with that and COBRA.

  9. #9
    🏆🏆🏆🏆🏆 ElNono's Avatar
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    Basically, I'm more concerned with her situation at this point than the insurance, and even if her surgery goes ok next week, she'll lose her job and insurance anyways (DSEK surgery on her only good eye, 2-3 months recovery time). COBRA sounds like the ticket going forward. I believe she used to get $70 taken off her paycheck for insurance, so the premium would be $140, right?

  10. #10
    Displaced 101A's Avatar
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    Thanks for heads up. I'll ask her to find out about COBRA. The type of insurance used in her job was self-insured, so I hope there's no problem with that and COBRA.
    Self insured (ERISA) plans are absolutely subject to COBRA - however there is a difference in how COBRA premiums are calculated. This can work for, or against you. In a fully insured plan, COBRA premiums are set 2% above premium cost; in a self-funded plan, they are set actuarially based on the actual cost to the plan of a given unit (employee or spouse in this case).

    Note: MANY companies skimp on this step, and don't actually pay an actuary to determine their rates; if the rates are excessive, ASK to see the actuarial calculations, or report, that determined them. If they cannot produce this, call the DOL (regulates ERISA plans) - or at least threaten to, the fines are beyond severe for screwing around with this.

  11. #11
    🏆🏆🏆🏆🏆 ElNono's Avatar
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    Ummm the GOP have been proposing allowing this for as long as I can remember. Your side thinks it's a crazy idea.
    My side does? Not me.

    I personally would rather have single payor from a price-control perspective, but since that's off the table, I would take cross-state insurance any time of the day.

  12. #12
    🏆🏆🏆🏆🏆 ElNono's Avatar
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    Self insured (ERISA) plans are absolutely subject to COBRA - however there is a difference in how COBRA premiums are calculated. This can work for, or against you. In a fully insured plan, COBRA premiums are set 2% above premium cost; in a self-funded plan, they are set actuarially based on the actual cost to the plan of a given unit (employee or spouse in this case).

    Note: MANY companies skimp on this step, and don't actually pay an actuary to determine their rates; if the rates are excessive, ASK to see the actuarial calculations, or report, that determined them. If they cannot produce this, call the DOL (regulates ERISA plans) - or at least threaten to, the fines are beyond severe for screwing around with this.
    Good info. Many thanks!

  13. #13
    Displaced 101A's Avatar
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    Basically, I'm more concerned with her situation at this point than the insurance, and even if her surgery goes ok next week, she'll lose her job and insurance anyways (DSEK surgery on her only good eye, 2-3 months recovery time). COBRA sounds like the ticket going forward. I believe she used to get $70 taken off her paycheck for insurance, so the premium would be $140, right?

    Im afraid not. Were talking actual cost not just what is charged to emplyees. There are other nuances to consider - got to crash. Ill PM you tomorrow to discuss further.

  14. #14
    🏆🏆🏆🏆🏆 ElNono's Avatar
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    Im afraid not. Were talking actual cost not just what is charged to emplyees. There are other nuances to consider - got to crash. Ill PM you tomorrow to discuss further.
    I see. No problem. I'll have her call her job and ask. They'll probably be able to find out what the rates are. Thanks for the good info

  15. #15
    🏆🏆🏆🏆🏆 ElNono's Avatar
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    Looks like after 6 months without insurance she would qualify for PCIP (NJ Protect here in Jersey). I'll see if I can find out more too.

  16. #16
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    "Employer funded health insurance has inherent problems."

    ... to the benefit of the employers and insurance companies.

    COBRA sucks because you have to pay 100% of the premiums yourself, without being able to deduct any of it from taxable income, like a Corporate-American can. I know one medical-condition lady who tried to do COBRA (she couldn't afford it) but reduce her premiums by converting it to high deductible. "Fnck you, lady. No premium reductions"

    Same for self-employed. Pay 100%, nothing deductible from taxes.

    The tax code certainly discourages entrepreneurial self-employment and the Human-American. It's all rigged to screw them and prefer the Corporate-Americans. Why don't the tea baggers take up that issue?

  17. #17
    Esse quam videri ploto's Avatar
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    I'm 45, he said he's late 30's and I said about 10 years older. And we pay $335 a month with Blue Cross/Blue Shield...it's true whether you want to believe it or not.

    And what is your deductible. I pay over $200/month for a $5000 deductible policy through BC/BS and I am a female non-smoker, and it is only for me. This policy has never paid out a penny but it is there for an emergency.

  18. #18
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    "it is there for an emergency."

    The industry term is "catastrophe insurance", usually with $3K or $5K deductible.

  19. #19
    e^(i*pi) + 1 = 0 MannyIsGod's Avatar
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    Cobra is going to be incredibly expensive but its probably your best option at this point because your wife is going to have a preexisting condition so getting new insurance is going to be pretty much impossible. I'm not sure where you got your quote from, but I doubt they would even insure you depending on your wife's condition. If they will insure you, it will likely be for everything BUT what you're getting covered for.

    Where did you get that quote if you don't mind me asking? My license lapsed nearly a decade ago so I have no real current info but 101 is providing you with solid advice. Otherwise, your best bet will be to talk to several insurance agents to see what they can do for you. Definitely find out about Cobra or about getting insurance through your employer if possible.

  20. #20
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    There are a few websites, google "pre-existing condition health insurance".

  21. #21
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    And what is your deductible. I pay over $200/month for a $5000 deductible policy through BC/BS and I am a female non-smoker, and it is only for me. This policy has never paid out a penny but it is there for an emergency.
    Hmmm, Is this one of their healthcare savings plans? We've had this plan a long time and I honestly don't remember all the details off hand. I think we have the Select Saver plan with a $2500 deductible. It pays most of the routine care costs, plus rx benefits, etc. Details here...
    http://www.bcbstx.com/coverage/indiv...s4compare.html

    Stop smoking. HUGE difference between 45 and 53, btw. 15 years from now? You're practically on borrowed time. Seriously stupid, bro. Stop.
    No need to lecture, I know it's stupid. I quit smoking regulary on my 40th birthday. I now allow myself to enjoy some smokes one day every other weekend plus when when we're on vacation. I stick to that strictly so I don't get hooked again. I promised my wife I would quit completely on my 46th birthday...I'll miss it though.

  22. #22
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    Where's the outrage against Corporate-Americans and sick-care providers who've limited access to insurance AND raised costs so high to be out reach, to be impoverishing for middle Americans and self-employed.

    Americans are bunch of indoctrinated sheeple, indoctrinated with the idea that Corporate-Americans are beyond reproach, are the highest form of human activity, never guilty of anything, and are anyway beyond any chance of stopping their predations.

  23. #23
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    Where's the outrage against Corporate-Americans and sick-care providers who've limited access to insurance AND raised costs so high to be out reach, to be impoverishing for middle Americans and self-employed.
    I think you've monopolized it all.

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  25. #25
    Displaced 101A's Avatar
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    Americans are bunch of indoctrinated sheeple, indoctrinated with the idea that Corporate-Americans are beyond reproach, are the highest form of human activity, never guilty of anything, and are anyway beyond any chance of stopping their predations.
    Where do you get this? "CEO" is just below "Crack ", and just above Congressman in the most reviled professions list.

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