I would agree, if even possible this seems extremely risky. Most insurance policies are written specifically to prevent this very behavior with pre-existing conditions.
I would be very surprised if they let you get away with this- they would most likely just deny you coverage. Could also land you in court after the fact.
What is not recognized here is that Massachusetts is a guaranteed-issue state. That is, an insurance company operating in Massachusetts must accept all applicants regardless of pre-existing conditions. This is one reason why insurance is so expensive in Massachusetts!
Now, the only restriction of which I know is that, if you are not already insured, with qualified insurance, there is a waiting period for pre-existing conditions: these treatment of these conditions will not be covered (or, I'd guess, more accurately, will be subject to 100% copay) during the waiting period. The length of the waiting period depends on how long you were without insurance.
What Frank does not realize is that the pre-existing condition exclusion is, by law in Massachusetts, limited in application to people who have been uninsured for more than a certain period. If you are insured, you can switch plans.
from http://www.healthinsuranceinfo.net/ma01.html
� All health plans in Massachusetts must limit exclusion of pre-existing conditions. There are rules about what counts as a pre-existing condition and how long you must wait before a new health plan will begin to pay for care for that condition. Generally, if you join a new plan your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage.
� You cannot be turned down for an individual health plan because of your health status, age, or any other factor that might predict your use of health services. This is called guaranteed issue.
In other words, *if you have health insurance*, you can join a new health plan with no pre-existing condition exclusion period.
However, the picture is not quite as favorable as I had thought. I *was* misled by the salesman for the insurance we got. Specifically, I was told that if one of us developed a condition requiring expensive medication, that we could and should change to an HMO that covers prescriptions. This part I did not check (I *did* check about guaranteed issue). While it would not have changed my decision, I should have checked. From the same web site as above:
� Even if your coverage is continuous, there may be a pre-existing condition exclusion period for some benefits if you join a health plan that covers benefits your old plan did not. For example, say you move from a group plan that does not cover prescription drugs to one that does. You may have to wait up to one year before your new health plan will pay for drugs prescribed to treat a pre-existing condition.
Now, what this means in effect is that we'd be looking at paying for a year's worth of drugs, while at the same time paying the increased amount for drug coverage. This may not be as bad as it sounds. First of all, that drug coverage *would* apply to any new conditions. Secondly, this *is* a limit. After the year, drugs would be covered.
But, as far as anything covered under the older inexpensive policy -- even if covered with substantial copays or deductibles, they would be fully covered under the new policy.
There is one more fly in the ointment. If we were to move out of Massachusetts, today, we would not be eligible under the federal guaranteed-issue rules, so we might not have new insurance rights in the state to which we move. However, it appears that if we were to return to a group plan (to which we did belong before dropping it) *for as little as a day, being the last day of coverage*, we would be federally eligible for guaranteed issue -- at least as far as I can see -- in other states.
At this point it gets much more complicated, but it does seem that *with group plans* there is the possibility of running a similar insurance strategy. I have *not* researched this, and there is another plan which we'd be following if we didn't live in Massachusetts:
We'd get high-deductible insurance (probably about $5,000 deductible) which would qualify for Medical Savings Account federal-tax-deductibility. Then we would contribute the deductible, per year, to the Medical Savings Account. This strategy, overall, is really the same as no-deductible insurance, yet it typically costs less. And it will typically build savings.
The Massachusetts situation is a result of the peculiarities of Massachusetts law; essentially, we are taking advantage of what might be seen as a loophole in the law.
I looked at the same web page's information about California, and found the following:
� If you are a small employer buying a fully insured small group health plan, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in your group. All fully insured health plans for small employers must be sold on a guaranteed issue basis.
� If you are a small employer buying a fully insured group health plan, the health status of your employees cannot be taken into account when your premiums are set. Other factors such as the age of your employees can be taken into account. This is called modified community rating.
So the situation is basically the same in California *for group plans*. What is different about Mass is that this applies to individual plans as well.
Essentially, my recommendation to any self-employed individual is to look ahead. When you get sick is not the time to be considering buying health insurance, the system is heavily weighted against you. There are often relatively cheap insurance options that most people don't consider because the benefits seem *lousy*. However, an efficient insurance would, in fact, pay or reimburse nothing in a normal year.
However, when we were in California we were members of the Kaiser Permanente health plan. This was very good and also quite cheap, perhaps half the price of equivalent insurance in Mass. It's a true HMO, as distinct from HMOs which are really insurance companies. It's owned by the doctors who work for it, I think. Kaiser used to be in Massachusetts, but abandoned the state....
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * To post a message: mailto:[EMAIL PROTECTED] * * To leave this list visit: * http://www.techservinc.com/protelusers/leave.html * * Contact the list manager: * mailto:[EMAIL PROTECTED] * * Forum Guidelines Rules: * http://www.techservinc.com/protelusers/forumrules.html * * Browse or Search previous postings: * http://www.mail-archive.com/[EMAIL PROTECTED] * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
