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Finding affordable health insurance

The Affordable Health Care Act is laden with provisions to help consumers with their insurance until 2014

By Tim Turner – contributor

Michael Story can’t tell you what impact healthcare reform will have on the future of the insurance industry in Mississippi. All he knows is that because of measures it already has in place, he is assured of having a future.

Story, a 63-year-old retiree from Meridian, was in a tough spot. He has severe heart issues that have plagued him since he was 39, the year he first had a pacemaker implanted in his chest. It lasted 10 years before Story needed another one. Seven years into living with the second device, Story retired. He was doing OK financially and was waiting to reach Social Security age. In the meantime, he thought he’d be able to contact one of those companies that guarantee health insurance for customers regardless of their health status. He thought wrong. Because of the pacemaker, Story was uninsurable — by anybody.

“It was amazing,” Story said. “No doctor, no insurance company would touch me. They all turned me down. Sure they will cover you if you are healthy and you don’t ever file a claim.”

So for three years Story went without insurance during his search. He found his answer online when he came across the Pre-Existing Condition Insurance Plan, a program run by the U.S. Department of Health and Human Services. It is one of the many provisions in the Affordable Care Act are already being implemented. Other changes will be implemented through 2014 and beyond.  Story found it with not much time to spare.

“I knew I needed another (pacemaker) and got online and found out I could get (insurance),” said Story. “This gives me great piece of mind and they won’t ever cancel you. I applied last August and was approved.

“Then I went to see my cardiologist who said you are due now. His exact words were, ‘The patient has exceeded battery life.’ That was on a Thursday. I had the surgery the next Tuesday. I had only been in the program a month. It has worked terrific for me.”

And that is what the government had in mind when it pushed for this legislation. The Affordable Care Act is laden with provisions to help consumers with their insurance until 2014 when a more competitive insurance marketplace will be in place. At least that is what the government is selling it as. That is three years away and who really knows what anything in the healthcare and insurance industries will look like.

“This will turn the insurance industry on its head,” said Aaron Sisk, senior assistant attorney with the Mississippi Insurance Department. “It changes it completely. It will be a complete overhaul. Then again this is completely speculative. With so much of it not taking place until 2014, this is all completely speculative. It’s going to be really hard to predict the landscape then. There is so much to be determined.

“It’s a tough time for agents. It seemed they were (initially) left out in the cold (when healthcare legislation was crafted). I think they have recently acknowledged just what an important role they play.”

And although some are benefitting from it now on the consumer side with the PCIP, the full effect on insurance producers is still being figured out.

“It is still wait and see,” said Mike Chaney, Mississippi Insurance Commissioner, said. “Our approach is we don’t regulate the health side, but we’ll end up being involved in it. We don’t have anything to do with businesses. Our sole responsibility is to regulate individual rates – not group rates or self-insured. We are all waiting to see what happens.”

Pre-Existing Condition Insurance Plan: Mississippi

Eligible residents of Mississippi can apply for coverage through the Pre-Existing Condition Insurance Plan program run by the U.S. Department of Health and Human Services.

To qualify for coverage:

>> You must be a citizen or national of the United States or lawfully present in the United States.

>> You must have been uninsured for at least the last six months before you apply.

>> You must have a pre-existing condition or have been denied coverage because of your health condition.

PCIP covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even if it’s to treat a preexisting condition.

In addition to your monthly premium, you will pay other costs. In 2011, you will pay a $1,000 to $3,000 deductible, which varies by your plan option, for covered medical benefits (except for preventive services) before the plan starts to pay. A plan option may have a separate drug deductible. After you pay the deductible, you will pay a $25 copayment for doctor visits, $4 to $40 for most prescription drugs and 20 percent of the costs of any other covered benefits you get. Your out-of-pocket costs cannot be more than $5,950 per year. These costs may be higher, if you go outside the plan’s network.

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