Monday, August 02, 2010

Jump in the Pool, Make $50

Medical Mutual of Ohio is the official carrier for Ohio's new ObamaPool©, and starting today, the pool is open for business:

"Medical Mutual will begin accepting applications for the Ohio High Risk Pool program, with coverage to be effective for the first enrollees on September 1, 2010."

What's interesting is that they're offering a finder's fee for agents to steer folks into the pool. As an agent, I'm pleased that any efforts I make to encourage folks to take advantage of the program will be rewarded in some way (unlike, say, Cigna). On the other hand, there are a lot of hoops through which to jump, which make the $50 "reward" somewhat questionable; for example, I'll have to confirm an individual's eligibility and help them complete and submit the paperwork (including some onerous documentation). I'll also need to collect and submit my new client's check, as well as my own "Broker Verification" form.

Those seeking to purchase coverage through the ObamaPool© have some hoops of their own, which include (among others):

" ■ Be a citizen or national of the United States or lawfully present in the United States;
■ Be uninsured for six months prior to the date the person applies for coverage;
■ Have a qualifying pre-existing condition as evidenced by a denial of coverage by two insurers, or by documentation from a healthcare provider

My biggest issue is with the second: why six months? Why not 2 months? Or a year? This is arbitrariness for its own sake. In fact, it seems to me that the shorter the better for those who are uninsured. And isn't that one of the stated goals of ObamaCare©: to insure the uninsured?

Or am I missing something obvious?

I'm also having trouble with one of the alternate qualification requirements:

"Written certification by a licensed physician or nurse practitioner, issued within the past six months, certifying that the individual has a history of or suffers from a qualifying medical or health condition."

On the one hand, the site lists almost 100 different qualifying conditions, from Addison's Disease to Wolff-Parkinson-White Syndrome (no word on Zuska's Disease). And you'll need to bring that list with you to the doc. Which of course begs the question: who pays for that doc visit if you're uninsured?

I think we already know the answer to that.

So you have a very serious illness and need insurance. You've been uninsured for at least half a year, and now you can purchase insurance that can take effect in as little as two weeks' time. But what can you buy, and how much will it cost?

There are two plans available, one with a $1500 annual deductible, the other at $2500. Once that deductible's been met, there's an additional $3000 or $4950 in co-insurance, depending on which deductible you choose. The plans themselves appear to be based on the company's "Elite" plan configuration.

Both options include a $30 co-pay benefit for office visits ($50 for specialists), and a $40 urgent care co-pay. Nice. There's also first-dollar preventive benefits for things like mammograms and immunizations. Hospitalized? No problem, the plan takes care of 80% of your covered expenses after the deductible's met; unless it's an ER visit, for which you'll be dinged a reasonable $200 (which they'll forego if you end up admitted to the hospital).

There's even a prescription drug card benefit, including a break if you choose mail-order (home delivery). Heck it even covers "The Pill." All in all, a very nice plan (although I'll remind readers that, around here, we call that "Phantom Insurance").

And since this is part of ObamaCare©'s effort to reduce the number of uninsured, I'm sure it's a bargain.

Fortunately, the site includes handy rate charts, as well. Let's see how the numbers stack up:

Let's take a typical Columbus area resident, say a 27 year old non-smoker (interestingly, the rates are unisex). Should you opt for the $1500 plan, the monthly premium would be $150 (there's a 25% surcharge for smokers). The $2500 plan would save you $14 a month (or $168/year). Frankly, that's not even close to enough of a rate differential to encourage folks to opt for the higher deductible plan.

But let's compare that rate to those for a "healthy" 27 year old, using MMO's own plan design and rates. In that case, Joe would pay just $96 and Jane $133. But that's not the most interesting part: a 37 year old healthy Joe pays just $130 for the $1500 version, versus over $200 for his very sick twin brother. But a healthy 37 year old Jane pays about $190 a month, while her sickly twin pays just $16 more.

Which is actually a much bigger problem than one might think: according to the benefits recap, "Maternity Services" are covered. "Healthy" Jane would pay an additional $456 per month for this (optional) coverage, and have to wait 9 months for it to become effective. Not so for "sick and pregnant" Jane, whose coverage could be in effect in as little as a fortnight. In fact, "pregnancy (current)" is one of the automatic qualifiers for coverage.

And then it gets interesting:

The website offers a helpful FAQ section, under which we find the following: "What happens to my first payment if I am placed on the waiting list?" Ironically, this section is the first, last and only one to even mention the term "Waiting List." So I called up the helpful folks at MMO, where I confirmed what I'd already inferred: remember that the budget for the whole Ohio version of ObamaPool© is $150 million? You guessed it: when that initial funding is gone, then whoever's left behind has to wait for the next round (if and/or when). How many childbirths are going to chip away at that $150 mil before it's gone?

Your guess is as good as mine.

[Hat Tip: FoIB Beth D]
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