State officials launch expansion of state high-risk pool

People with pre-existing conditions to get insurance

September 01, 2010|By Andrea K. Walker, The Baltimore Sun

An additional 3,500 uninsured Marylanders will get health coverage as the state expands its high-risk program using $85 million in federal funding received under national health care reform.

The program will enable those who have been denied coverage because of a pre-existing condition to obtain health insurance. The first of them became eligible for coverage yesterday.

"This is an important day and shows we are moving in the right direction in improving our health care system," said Rep. John Sarbanes, a Maryland Democrat. He said denial of coverage because of pre-existing conditions became the "poster story for health care reform in this country."

Unlike most states, Maryland has run a program that provides insurance to people who could not get coverage because of an existing illness since 2002. The existing high-risk pool insures about 20,000 people.

The new federal plan is similar to the existing program, but state officials said it costs less.

Monthly premiums for a person under age 30 are $141 under the plan funded with federal dollars. Premiums for the state's existing plan range from $135 to $474 for a person under age 30, depending on whether the person chooses a PPO, HMO or high-deductible plan.

There is a waiting period under the existing state plan if patients want a pre-existing illness, such as diabetes, treated right away. To bypass that waiting period, patients can choose to pay higher premiums. Under the new federal plan, pre-existing conditions can be treated immediately.

The new federal plan, which is just for individuals, has only a high-deductible option, meaning patients have to pay $1,500 in out-of-pocket expenses before they can use the insurance. That cost is lower than the state's comparable plan, which has a deductible of $2,600. The other options under the current state plan either have lower deductibles or do not have one.

The state also has a high-risk plan specifically for low-income people. Deductibles on that plan are up to $500. Premiums are $155 or $184 for a person under age 30.

State officials presented insurance cards to two Maryland residents yesterday who had not been able to get insurance because of pre-existing conditions.

Charles Robinson of Baltimore had been without insurance since 2006 when he reached the cap on a state program that he was using for coverage. Born with hemophilia, Robinson has never been able to get coverage from an insurance company. He also has diabetes and is HIV-positive.

He's gone deeply into debt trying to keep up with his medical bills without insurance.

Robinson said the federally supplemented high-risk pool being offered isn't perfect. He's worried that he'll reach the $100,000 cap it places on prescription drugs. But he's glad to have insurance again.

"I won't have to worry about indebtedness because of hospitalization," he said. "It will certainly make it easier. There's no denying it's better to be insured than uninsured."

William Gilbert, who lives in Berlin, had been unable to get coverage because he has hepatitis C that caused him to drastically lose weight and muscle. Gilbert, who is unemployed, still worries about how he will pay premiums and deductibles but is grateful to have insurance.

"This will allow me to come to Johns Hopkins where I can be saved or at least have a fighting chance," he said.

The money Maryland received was part of $5 billion the federal government gave out nationwide as part of health care reform. Most facets of reform won't be implemented until 2014, and the additional money is meant to fill gaps in coverage until then.

State officials have said health care reform will save Marylanders $829 million over 10 years and cut the number of uninsured in half.

CareFirst BlueCross BlueShield administers the high-risk plan for the state.

andrea.walker@baltsun.com

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