Whose Ox is Being Gored?

Your perspective on the availability and pricing of health insurance depends mostly on whose ox is being gored. If you are in good health, you pretty much have your pick of plans, carriers and pricing. If you are not your choices become much more limited.

I can empathize with those who are having difficulty finding health insurance due to existing health conditions. But I do find it interesting that some are almost militant in their demand for ready access to health insurance without restriction.

Let’s say you are using anti-depressants, are on a low, maintenance dosage, and have had good success in your treatment. You have not been hospitalized, taken time off from work, have not attempted suicide or other bodily harm. In general, you function within “normal” limits but the meds help to stabilize your moods.

No problem, right?

Not necessarily.

If you are looking for individual coverage the best you can hope for among PPO plans is standard issue but no coverage for meds or provider sessions associated with depression for the first 12 months your policy is in force. Or you may find a carrier that will exclude coverage for depression for 3 years . . . or for as long as you have the policy.

Not fair you say?

You should be entitled to the same health care benefits as others, right?

OK, how about a diabetic? That’s a common affliction, particularly type II diabetes and most people have few problems.

But some people DO have problems. A friend has lived with diabetes (type I) for almost 40 years. Although he is not old (at least not by my standards) he has been on disability for more than 2 years. Over the last 10 years or so he has had numerous surgeries on his eyes, feet, shoulders and probably a few other parts. He is covered as a dependent under his wife’s health insurance. My guess is the carrier has paid out over $200,000 for surgery, therapy, medication, etc.

Is it any wonder why a carrier would not want to insure a diabetic . . . especially on an individual health plan?

Let’s shift gears just a minute. Forget about health insurance. Let’s talk about borrowing money. After all, health insurance is really just a blank check for a loan you never have to repay.

Let’s say you pay your bills on time, are not overextended on credit and are generally a good credit risk. You probably expect (and get) the best rates available on loans.

The people who have a poor credit history, never pay on time, maybe even have a bankruptcy should get the same rate on loans that you get, right?

Of course it doesn’t work that way. Folks with good credit get the 0% financing on cars and 5% or so on home loans. Folks with bad credit get their cars at the buy-here-pay-here place and if they can even qualify for a home loan end up paying 12% or even higher.

Same principle applies to health insurance.

Good risks get the good rates, poor risks pay a higher rate. Those are the rules.

If YOUR ox is the one being gored, and you are having difficulty finding the coverage you want, it may be because you are not looking in the right place. Or more appropriately, you are not talking to the right agent. Very few people are truly uninsurable.

Bob Vineyard, CLU
(The Professor is still in the desert southwest looking for El Dorado . . . the lost mine, not the Cadillac. He should return in a few days and will have fun fixing the mess I have made of his site. For now, enjoy!)