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States' high-risk insurance pools aside, some caregivers may still be out of luck

by Isabel Fawcett, SPHR

With the passage into law of the Patient Protection and Affordable Care Act (PPACA) on March 23, 2010, state governments are scrambling to comply with the temporarily federally-funded and legislatively mandated "high-risk" insurance coverage pools for eligible uninsured individuals across the country. Under PPACA, eligibility is the key that unlocks the door to universal healthcare.

Attention Unpaid Family Caregivers: Healthcare Reform Train Left the Station

In the aftermath of PPACA's passage there are healthcare winners. By default, there are also losers. I know a high-risk health insurance pool winner. She finally has health insurance coverage.

The individual's high-risk designation under the new federal law happened at a perfect moment in time. For years, she has been gainfully employed as a contract worker. In spite of being gainfully employed she was unable to afford health insurance coverage. Last month she was diagnosed with an aggressive form of cancer.

Under federal law guidelines, having been uninsured for at least 6 months prior to the date she applied for high-risk health insurance coverage meant that she was eligible under the new law. Her newly diagnosed pre-existing condition is not subject to exclusion. Hers is a success story in the brave new world of healthcare reform and almost-universal coverage.

Almost-Universal Coverage and Slim Pickings

When I left a paying job to provide full-time assistive care to my mother, I elected to remain fully ensured as allowed under the Consolidated Omnibus Budget Reconciliation Act, more commonly known as COBRA.

What is COBRA?

Generally, COBRA allows workers who become unemployed through voluntary or involuntary termination of their employment to elect temporary health insurance by extending their health insurance coverage of the worker's most recent employer. If elected, COBRA generally covers usual, reasonable and customary medical costs as determined by insurance providers, including physician services, hospitalization, outpatient treatment, and in some instances, prescriptions. Dental insurance coverage may or may not be offered under COBRA. Life insurance is not offered under COBRA. With a few notable exceptions, COBRA extension health insurance coverage ranges from 18 months to 36 months. Comprehensive legal information on COBRA is available on the U.S. Department of Labor's website. My COBRA sharing is not a leal representaton of COBRA, nor should it be construed as such.

COBRA is Temporary

Coverage under COBRA is of limited duration. In theory, COBRA assists workers in life transitions of limited duration, including between jobs, death of a spouse, divorce and other life events as defined under federal law. Under COBRA, it seems, unpaid family caregiving in one's home, or a parent's, is just not limited enough. Choosing to become a caregiver may be a COBRA non-life event.

When my COBRA benefit ended, so did my former health insurance coverage. After 18 months of paying monthly premiums of nearly $500 for my health and dental insurance extended coverage under COBRA, I joined the ranks of those who are under-insured.

Under-Insured Caregiver

In transition from COBRA to other health insurance, at age 50-plus, I automatically fell into the ranks of those designated "high-risk" by insurers and the federal and state governments. Insurance company underwriters confidently write away my pre-existing conditions as if they never existed.

To keep my monthly health insurance premiums affordable my deductible is ridiculously high. There's no winning for losing! I now pay an insurance company a little over $200 for my monthly premium. In turn, as I see it, the insurer covers my annual flu shot, if I am lucky. Just about everything else has been written off as a "pre-existing" medical condition. One of the application screening questions I was asked by the insurance company representative is whether I plan on seeing a doctor anytime in the next 6 months. How comforting to know that underwriters care - not!

I was proud for not allowing myself to be uninsured between my COBRA ending and the effective date of my new health under-insurance. I'm more than a little bit baffled that I'm high risk for health insurers because of my age and pre-existing medical issues, yet not high-risk enough to be eligible under this state's high-risk insurance pool mandate. Live and learn all about creative writing by insurance underwriters!

2014 is Right Around the Corner?

Under PPACA, effective 2014, insurance companies will no longer be allowed to exclude pre-existing medical conditions. On June 8, 2010, in an unrelated healthcare reform pitch to seniors who are Medicare members, President Obama reminded his audience that "2014 is just around the corner."

If you are in need of health insurance, you should become informed about your state's high-risk insurance pool and whether it is more inclusive than the 6-month uninsured federal eligibility clause. Texas has opted to go with the 6-month federal eligibility under the new law. A list of "State Insurance Risk Pools and Where to Contact Them" is available online. (Be sure to scroll down the page to view state-by-state contact information and URL.)

I am reminded of foreign cultures where I have asked for directions after I became lost. "…It's right around the corner…." is the answer I received while vacationing in Jamaica, the beautiful Island in the Sun.

"No problem, [mon.]"