Searching for choice where there is none

I have been grossly remiss in posting an update about my family’s unemployment saga, so please bear with me as I bring you up-to-speed since this post .

Mark was hired as an IT analyst for a consulting company in mid-August 2010. Although the consulting company (surprisingly) had excellent benefits (reasonably priced, quality health care and paid time off, among other perks), we were living quarter-to-quarter (and sometimes month-to-month) wondering whether his position would continue to be funded by the on-site client.

In December, Mark was recruited by another consulting company to return to his passion – web analytics. The salary was higher, but the cost of health care benefits negated that (more on this in a moment). However, this new position was funded through the end of 2011 -- finally ensuring some semblance (albeit limited) of job security – so Mark accepted. Such is life in a job market where contract jobs are the norm, instead of the exception. (No, the recession is not over!)

But, back to the health care issue.

Throughout our life together, Mark and I have weighed more than a few job offers and, all things being equal, the decision always hinges on the health care plan – its quality (co-pays, deductibles, physicians’ network, etc.) and its cost.

With this new position, when we calculated family coverage for medical, dental and vision, the annual bill totaled about $22,000.

After I picked my jaw up from the floor, I embarked on a quest (a futile one, I suspected) to find an alternative health insurance choice that would offer quality and affordability for our family.

Right out of the gate, we knew Mark’s health issues would render him uninsurable outside of an employer-sponsored plan. This was confirmed by several insurance brokers I met during my search. In addition, J and I both have pre-existing conditions (if you are a Maria Talks Back reader, you are familiar with mine), so that was an additional factor to consider.

I was advised to apply for Blue Cross and Blue Shield’s well-advertised Blue Advantage plan, despite knowing that Mark would be denied outright. Those in-the-know said we could insure Mark through his employer and then compare the cost of Blue Advantage versus the employer’s plan for the kids and me. These same knowledgeable folks also said that BCBS was the most likely insurer to accept us since it is “more lenient” with pre-existing conditions.

When the much-awaited decision from BCBS arrived, only R qualified for BCBS’s “preferred” rate of $165/month. My monthly premium came in at $980 and J’s was $545 – and this was just for medical coverage.

Plan B: Since Mark was denied outright and J and I were “up-rated,” we were eligible to apply for Inclusive Health, a program in North Carolina that provides health care coverage to people “…who do not have access to an employer health plan and face higher premiums due to a pre-existing medical condition.” Inclusive Health’s rates were a bit lower ($694/mo for me; $353 for J). However, none of our doctors were in-network and there was a cap on how much the plan would pay out.

In the end, our choice was no choice at all. We are going to pay $22,000/year for health care coverage.

That decision made, a new wrinkle emerged.

The effective date of coverage for the new insurance is the first of the month, following 60 calendar days of employment. However, due to unforeseen circumstances, Mark’s start date changed from Jan. 31 (which would have initiated medical coverage on April 1), to Feb. 2 (which will start coverage on May 1). Therefore, by the space of two days, we will exceed the magical, mystical 63-day window that all health insurance companies use before subjecting you to their dreaded pre-existing conditions restrictions. In laymen’s terms, if we are uninsured for more than 63 days, the new insurer will refuse to pay for any claims that relate to health issues for which we have already received treatment during the first year of coverage. This basically means that we would pay for health insurance, but could not use it.

So, now we’re electing COBRA -- at $1,440/mo (just for medical) – to avoid the pre-existing conditions trap. Will we get our money’s worth for that coverage? Not likely. But, again, we have no choice.

Are you seeing a pattern here?

Walter Cronkite once said, “America's health care system is neither healthy, caring, nor a system.”

True ‘dat!

And yet, Americans accept the rules that health insurers set, jumping through their flaming hoops without question. I liken it to an abusive relationship where the abused doesn’t know that a better life is possible, and continues to suffer.

Health care reform may not be the perfect solution, but it’s a start. The alternative is to keep things as they are – and that choice is unacceptable.