Health insurance for Jewelers

Jewelry Discussion
1

Orchid Friends - I would like to revisit / update on
health insurance providers that you use. I gathered in
the Archives for 2008 and 2007. There were references to Blue Cross
and Blue Shield with high deductibles. Also references to the HSA
accounts.

Basically I am long time self employed but was covered under my
husband’s policy. With this recession that status is about to
disappear. I am aware there is COBRA but I understand that is ONLY
if his employer remains viable.

I have been licensed in my city for years and will be looking into
possible insurance through Chamber of Commerce. My husband has been a
"silent" [unpaid] helper over my career until now.

The biggest issue is that he had a kidney transplant in 1990. By all
standards a success but it becomes a red flag on applications. We
still have 5 years before Medicare.

I always look to Orchid when I’m stumped with technical questions so
would appreciate any in this insurance maze. I am
particularly interested if someone has had a very good [or very bad]
experience.

Feel free to contact me off Orchid but I believe others may want the
as well.

Orchid Rules! Karla in sunny So. Calif.

2

Hi Karla,

I would check to see if the State of California has a program like
we have here in Colorado. It is called “Cover Colorado”. It is a
health insurance program for those of us living in Colorado that are
basically uninsurable.

I have Diabetes and have had numerous Angiograms and Angioplasties,
thus, making me uninsurable as an individual. I too have 6 years
until Medicare.

I lost my group coverage when I sold my automotive business. I
started looking for individual insurance and was turned down by
everyone. It was then suggested I check with “Cover Colorado”. I
filled out all of the paper work and etc. Since I am an insulin
dependant Diabetic it was very easy to qualify.

The insurance I get is with a west coast ocean care soon to be
brought together as one, if you know what I mean. My current premium
is 518 clam shells per month. It is well worth it considering the no
insurance at all program.

Good luck,

Ken Moore
www.kenworx.com

3

Hi Karla,

This is really a very sticky issue for people, and varies from state
to state. You are probably better off contacting a few insurance
agents in your area and your state insurance commissioners office to
get an idea of what your options are. I’m in Wisconsin and this is
how it appears to would work here. You could get continued coverage
through you husband’s former employer via the COBRA agreement for 18
months (or as long as they stay in business). During those 18 months
you could convert your group coverage to individual coverage and you
and your husband could not be turned down, but the premiums could be
very high because of preexisting conditions. Once you have that
policy in place they can not drop you, but they can raise your rates
until it’s unaffordable. If you would somehow be somehow lose
coverage because you are uninsurable, in Wisconsin, you become
eligible for the state run high risk health insurance plan. But that
has a 6 month waiting period for preexisting conditions if you jump
into it when you are without insurance (so you need to plan ahead to
be sure you always moving from one insurance policy to the next
without any lapse in coverage).

Bottom line is that this is a huge problem for thousands of people,
maybe millions of people. I am hopeful that the new administration
will address this issue early on. We all need to be able to get
insurance regardless of our health situation. It seems to me that
there is such a huge pool of people that the risk should be spread in
a way that insuring everyone should be both feasible and profitable.
What we need is a way that allows anyone who wants to leave the
safety of their group health insurance coverage and move to an
individual policy that is both reasonably affordable and without risk
of being canceled, even when the parties have preexisting conditions.
If that would happen, I believe that millions of people would leave
their jobs and start up new businesses, because insurance is all
that’s holding them back. Those small businesses are the engine that
drives our economy. It seems like a no brainer to me.

Mark

4 
I am aware there is COBRA but I understand that is ONLY if his
employer remains viable. The biggest issue is that he had a kidney
transplant in 1990.

Just a few thoughts and suggestions. I hope this is helpful. My day
job is in health care and I have been in your shoes before. We could
not find insurance for our healthy 2 year old son because he had
“tubes in his ears”. COBRA at the end of our very long, arduous
search, was our short-term option until I switched my job to one
with benefits.

COBRA, in CA, is legislated. Your ability too be covered under COBRA
should not be effected by your husband’s employer’s status (unless
if your husband’s employer is your health care provider, that is).
COBRA may be your best option in the first months until you find
something that will work for you. The cost of COBRA is determined by
your current coverage. Your coverage is unchangeable until “open
enrollment”. Most of the enrollments have passed by now, if yours is
open at this time, you might look at switching to a coverage that
that is more affordable for you, please be mindful of your and your
husbands needs (special medications, lab work, doctors etc).

With your husband’s pre-existing condition, it will be nigh on
impossible to find him coverage except via the “group plan”. Are you
associated with any groups? Can you join any groups that offer
access to health care? If you can find access for your husband under
a group plan, this will be your best bet for the long term and for
your wallet. If other Orchideans have experience with this, I hope
they chime in.

California, as a state, lags far behind many other states in
assistance with health care access,…unless, if one is
disabled, poor, a single mom with children, or illegal. Does your
husband qualify for disability? If he qualifies but has not filed,
this can take some time so once again COBRA is your best short-term
option. If one is poor…dirt-poor to qualify…, then there
is medicaid. Single Moms with dependent children, if I remember
correctly, can obtain basic coverage for dependent children, but, I
haven’t heard anything about this program recently. If illegal,
well, that is a whole discussion in itself.

There was considerable discussion about federal programs. If anyone
knows more about this maybe they can chime in. Maybe these programs
all fell through. Medicare will be your best option here once your
husband qualifies.

5 
because you are uninsurable, in Wisconsin, you become eligible for
the state run high risk health insurance plan. But that has a 6
month waiting period for preexisting conditions if you jump into it
when you are without insurance....

In my case, in Indiana, my daughter is a type 1 insulin dependent
diabetic (juvenile onset), and thru the state sponsored/subsidized
plan, we started out with a premium of 300/month and a 6 month
pre-exist clause. It stayed there till she turned 18, and the
premium jumped to 600/month. And a year later, when she turned 19,
the premium advanced to 900/month. This policy only covered her and
noone else! At this point we were forced to drop the policy, since we
wanted to do silly things with our money like food, mortgage,
etc…and then she was hired by Ameritech and was able to get a
decent company plan. When layoffs happened, she had lowest seniority
in entire state so was the very 1st to go, then was able to transfer
to COBRA for 18 months and has been without health insurance
since-about 4 yrs. Now we buy all her insulin and supplies (average
200/month) and pay her diabetic doctor visits-runs a couple thousand
/yr all totaled- much cheaper than insurance premiums. As long as
she has no major diabetic problems. Then we/she will figure out
something else, like bankruptcy.

Ed

6

Going without insurance is a very risky plan for person with type 1
diabetes. My sister’s diabetes was diagnosed when she was about 12,
and lasted until she got a pancreas transplant when she needed a
kidney transplant in her early 40s. The complications from diabetes
can come much earlier for some people than for others, and transplant
surgery is horrifically expensive. (Dialysis ain’t cheap, either.)
Then there are the anti-rejection drugs – wow, the price of those!
And the extra dental care necessary because of the effect of
anti-rejection drugs on the kind and amount of saliva you produce…

In some states, pre-existing condition clauses are waived as long as
there has been continuous coverage in effect for some period of time.
This is something to take into consideration if cancelling your
coverage seems like an option.

7

The best advice I can give is to shop for an independent insurance
agent. Don’t trust the company people to give you a straight story.
An independent has access to all kinds of info and coverage from many
different companies that a single company won’t tell you about. They
also know the state programs and laws inside out. A real pro will be
able to match you with the best company and policy for your
particular situation for far less than you will be able to find on
your own. You also never have to have direct contact with the
insurance company. Everything goes through the agent. Pretty sweet
deal all around.

My wife quit her job five years ago to help in my business, losing
our insurance in the process. I applied to Blue Cross Blue Shield of
NC and got a quote of just shy of $4000 a month. My wife is an
insulin-dependent diabetic on an insulin pump with other conditions,
and I am in the “over 50” group.

At first we checked with every insurance salesman that called on the
phone, and as soon as they heard “diabetic” they quickly said “Thanks
for your time, we’ll be in touch”. None ever called back. Two years
later, with no insurance and no effort to find any, a guy came in
looking for an engagement ring. Turns out he was an independent
insurance agent. We told him our story and he said he’d check it out.
He got us into Blue Advantage by BCBS for about $750 a month for me,
my wife and our 28 year old son that had just joined us. Plus he
bought a three stone diamond ring.

We now have four people on the policy and after the last annual
review our rates went DOWN to just over $900 a month, for four (we
pay all of it, so this includes what might be considered the
employee’s share). BCBS just paid for most of two new insulin pumps
(about a 20% co-pay) and for a complete physical for me (including a
stress test and colonoscopy - YIKES), an eye exam and flu and tetanus
shots ($35 per visit co-pay, four visits). It also pays for
prescriptions (including insulin and test strips with a $4 co-pay at
Wal-Mart). It does have a high deductible ($5,000 per calendar year I
think) for over-night or longer hospital stays, however.

We got this coverage after becoming an LLC, but I don’t know how
significant that might be.

I wouldn’t have believed it if I hadn’t seen it. Contact me off-list
and I’ll be glad to get you in touch with our agent if you would
like. He won’t be able to help you outside of NC but I think he can
probably hook you up with someone in your state that can.

Dave

8 
Orchid Friends - I would like to revisit / update on
health insurance providers that you use. I gathered in
the Archives for 2008 and 2007. There were references to Blue
Cross and Blue Shield with high deductibles. Also references to the
HSA accounts.

This lack of health insurance isn’t found just in Orchid. I also
belong to ABANA (Artist-Blacksmith’s Association of North America).
Hey - it’s all metal, right?

Recently ABANA has made arrangements through Transamerica and
Ameritas insurance companies for insurance plans for members. Not
being an insurance expert, I’m not going to attempt to describe these
plans, but details may be found on WWW dot ABANA dot ORG.

Perhaps someone might have the expertise to start something like
this for Orchid?

Or perhaps some of you might want to join a group of folks who
practice a related branch of metalworking. Hey, it’s all metal!

9 
Recently ABANA has made arrangements through Transamerica and
Ameritas insurance companies for insurance plans for members.
Perhaps someone might have the expertise to start something like
this for Orchid? Or perhaps some of you might want to join a group
of folks who practice a related branch of metalworking. Hey, it's
all metal!

The problem with getting health insurance with a group like the
local Chamber of Commerce or a Jewelers Association of some sort in
the US appears to be that although the rates are better because of
the “group”, it’s not actually treated like group health insurance.
Rather you get a better rate on what is essentially individual
insurance. The problem with that is that you can’t get the insurance
if you have a preexisting condition that the insurance company deems
uninsurable. If it were an actual group policy the insurer would have
to take all comers by law. If you and your family are healthy it’s
easy to get insurance in the US, you only have a problem getting
coverage if you or your loved ones are sick. When it comes to health
insurance, if it doesn’t make sense it must be true.

Mark