1) COBRA coverage: If you or your spouse has recently lost their job, COBRA may be an option. COBRA is simply an extension of the health insurance you had before, but with a 2% surcharge tacked on. Many people are shocked at the cost of COBRA, but remember, the plan costs the same as it always has, it’s just that now you will be paying the entire monthly premium and your former employer will not be contributing anything toward the monthly bill. There are no medical questions to elect this coverage and you can generally keep it for up to 18 months if you choose.
2) The Texas High Risk Pool at www.txhealthpool.org. Again, this can be an expensive option especially if you are over the age of 50, but you cannot be turned down due to medical reasons. There are a few eligibility requirements to meet in order to qualify, so make sure to check their website.
3) Our most popular option: We call this the PCI flip. When healthcare reform was passed in 2010, this lead to the creation of the Pre-Existing Condition Health Plan (www.pciplan.com). The PCI Plan is a federal program and is generally much less expensive than the Texas Risk Pool or COBRA, but there is a catch. There are two eligibility requirements in order to gain entry. A health insurance carrier must have declined you AND you must be uninsured for at least 6 months.
How do you protect yourself if you need to be uninsured for 6 months? At http://www.selectedbenefits.com Selected Benefits, we offer a benefit plan that will not jeopardize your eligibility for the PCI plan and will give you protection against unforeseen medical issues. This program has excellent benefits for doctor visits, well care, lab/x-ray, prescriptions, surgeries and accidents.
How does it work? Let’s say you have your gallbladder taken out and the charges total $30,000. If you have this “benefit plan”, here’s how the charges will pan out. You’ll be a member of a PPO, so that will generally knock about 1/3 off the cost. Now we’re down to $20,000. The plan will also pay 100% of whatever the Medicare surgical pays on that surgery. As an example, let’s say that’s another $8,000. Now we’re down to $12,000. The plan pays another 25% of the surgical amount toward anesthesiology, so that’s another $2,000, which brings us down to an even $10,000. The final component is the Karis Patient Advocacy program that comes with the plan for no extra charge. They will take the remaining charges and negotiate with the physician/hospital on your behalf for a lower price. This program can save as much as 80-90% of the original charges. The final result is just a small fraction of the original $30,000.
We recommend staying on this benefit plan for at least 6 months after which time you can hop into the PCI plan with no restrictions. If you would like to take advantage of this strategy or know of someone who could, please feel free to contact us at 866.270.6209.