Saturday, July 24, 2010

A Change for the Better

I'm looking into changing health plans from MinnesotaCare to MCHA.
Minnesota has essentially had nationalized healthcare for decades,
offering several plans at free or reduced rates. I know this costs
money to the state and the taxpayers: but what is a nation's wealth
for, anyhow, other than to enhance and prolong the lives of its
citizens, either directly or indirectly? But I digress.

MinnesotaCare, intended for people below the poverty line, has an
annual inpatient maximum of $10,000. I have used up all of mine with
my diverticulosis episode and the initial cancer biopsy, so I have
none left to cover the next big surgery an hospitalization (which will
likely be $40,000 or more). FYI, the chemo (since it is outpatient) is
still covered at 100%.

So, I have begun shopping for health insurance.

What you want in the health insurance world is to be continuously
covered, or to have a gap no longer than 62 days (why this fairly
random-sounding number, I have no idea). I *have* coverage currently,
through MinnesotaCare, so that's good. But almost any health plan has
the right to exclude me based on pre-existing conditions if they're
serious enough. Cancer qualifies.

So, again, Minnesota comes to the rescue. We offer something through
the Minnesota Comprehensive Health Association, or MCHA.

From the MCHA website:

- - - - -

MCHA was established in 1976 by the Minnesota Legislature to offer
policies of individual health insurance to Minnesota residents who
have been turned down for health insurance by the private market, due
to pre-existing health conditions. MCHA is sometimes referred to as
Minnesota's "high risk pool" for health insurance or health insurance
of last resort. Currently, about 30,000 Minnesota residents are
insured by MCHA throughout the State of Minnesota.
MCHA is a non-profit Minnesota corporation, organized under Chapter
317 of Minnesota law. MCHA is not a State agency. It is regulated by
the Minnesota Department of Commerce. An eleven-member board of
directors provides policy direction to MCHA. An executive staff
manages the administration of the risk pool. Since its first year of
operation in 1977, MCHA has contracted with an outside organization to
perform day-to-day operations of the plan.

Premiums charged to policyholders are generally higher than rates for
comparable policies in the marketplace By law, MCHA premiums must be
set between 101% - 125% of the weighted average for comparable policies.

Minnesotans who have been turned down for individual health insurance
in the private market due to pre-existing conditions.

Circumstances include:

• Individuals who exhaust COBRA benefits.
• Individuals working for employers who do not offer health insurance.
• Individuals who have exceeded lifetime maximum limits, or their
previous coverage.
• Former employees of bankrupt companies.

- - - - -

I haven't been turned down yet by other companies (such as Blue Cross,
Medica, Etc.) but I am assured by several sources including MCHA that
I *will* be.

The premiums are reasonable, in the self-insurance world. About $250 a
month. But there are many benefits. The first of which is that the
annual out of pocket maximum is $3,000. This is a bunch of money, but
doable, and I'm told by my doc that this cancer thing will cost $1
million by the time it is done. In the scheme of things, paying 3k per
year plus my monthly $250 (about 6k per year altogether) is peanuts
for 100% coverage. There is a $5 million lifetime cap on benefits, but
I think that is a very comfortable buffer.

The biggest news? MCHA is accepted at Mayo clinic. I have confirmed
this by phone with both Mayo and MCHA. This means that my surgery will
now be done by the #1 guy in the U.S. (and possibly also the best guy
on the planet) for my exact kind of cancer, at one of the world's
leading medical institutions. I feel very good about this.


emily said...

i feel very good about this too. :) and OMG SOCIALIZM!!1!

Kelly McCullough said...

Glad to hear it. BTW, the health care bill that passed this spring eliminates lifetime limits starting in 2014. If MCHA can bridge you through to then the lifetime limits go away. The preexisting conditions problem should go away then too. It isn't single payer but it's a hell of a first step in the right direction.

Cathy Crea said...

I can pretty much guarantee you'll be turned down for private individual plans--in fact, I wouldn't even bother to apply, unless you find something other than MCHA that guarantees acceptance despite pre-exisiting conditions. I was turned down by Blue Cross for having had cataract surgery in one eye at age 29. No other major health issues, and no evidence that cataracts at a young age are linked to any other specific health conditions. My eye doctor said they just see it as a red flag, albeit a red flag for nothing specific.

John Slade said...

I heartily endorse my tax dollars going to support you. Go go go! Ja ja socialismus!

llochen said...

Bill was on MCHA because of his "pre-diabetic" condition when we were both contractors. I could get BCBS but he was SOL. We has the exact same policy that covered each of us with a $3000 deductable - his cost slightly more than mine because he is older and higher risk. The nice thing is - it is mostly covered by the patient's fees. If he had been able to get the same policy as me through BCBS, he would have had about the same premium he paid to MCHA. The main difference is that where the insurance companies are risk-averse with pre-existings, the State of MN took the on risk. When Bill was on it, MCHA was a well run program (run by BCBS now run by Medica)that suited our needs. Well worth it. I agree with Cathy, right now don't even bother with the "insurance" companies...they won't cover you.


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