A sick freelancer’s guide to American health insurance

Caduceus

Updated on 5/26/14: As of January 1, 2014 most of the information in this post became outdated due to the start of the Affordable Care Act. Insurance companies can no longer deny me insurance because of my pre-existing conditions. They can not charge me more than a man of the same age because I’m a woman. (Yes, they used to do this.) When I applied for health insurance under this new act the application was only 4 pages long. When I’d applied before the act the application was 22 pages long. It was shocking how easy it had become now that they no longer could quiz me on all the medications I’d taken in the past 2 years or ask me if I currently had any chronic diseases.

I’m going to keep this post up as a reminder of how awful it was before the ACA. If anyone feels the need to complain about any imperfections in the ACA they can see how much worse it was for people like me before it.


When I started freelancing full-time in July 2009, the most challenging problem I faced wasn’t how to get clients, how to figure out taxes, or how to track my invoices. The most challenging problem was figuring out how to get health insurance for a chronically ill, self-employed person. I live in the US and at this time health insurance is typically employer based. You get a job and get to be part of that employer’s group plan. Outside of that, some people qualify for Medicare or Medicaid. I don’t know much about those programs other than I don’t qualify for them, but if you’re old or poor you might.

I faced more difficulty than normal getting health insurance because I have a chronic headache and I’m overweight according to the BMI charts. Typically, the more you need health insurance, the less likely you are to be approved for it. Health insurance companies aim to make a profit or at least break even, so they don’t like to acquire customers who will take more than they give. I thought I’d write about my experiences trying to get health insurance in the hopes that it will help any other sick or fat freelancers out there.

PLEASE NOTE: I do not work for an insurance company and I am not a medical professional. This information comes from my personal experiences with health insurance companies and medical professionals over approximately the past 10 years. It’s possible that some of this information could be incorrect or outdated. Please double-check everything with your own providers. This information is based on my experiences as a single female in her 20’s applying for plans without any dependents. Your options may differ depending on your circumstances.

First stop, COBRA (No, not the snake)

I worked full-time at a corporation before I left to freelance. Because of this I qualified for COBRA (Consolidated Omnibus Budget Reconciliation Act). COBRA gives you the right to stay on your employer’s health plan for 18 months after leaving their employment, but you have to pay the full price of the insurance. Typically when you’re employed by someone else they pay for part of the insurance and the other part is automatically deducted from your paycheck. When you go on COBRA the price you pay for insurance goes up to cover the part your employer was paying. In my case COBRA cost about $400 a month and included dental. This is kind of expensive, but it was still less than I would have spent on my medications and doctor appointments without the insurance, so I was happy to pay it and be covered.

This was great for 18 months, but then I faced another problem: What the hell would I do when COBRA expired?

Individual insurance plans (Flying solo)

Let’s start by clarifying the difference between individual plans and group plans. When you are part of a group, like all the people who work for a big corporation, that group is able to go to the insurance company and say, “Hey, we can bring you a lot of business, but you have to insure everyone in our company. You can’t pick and choose who to cover in the pool.” So, even though some of the people who work for the company are sick, a lot of them aren’t. Covering those sickos who take more than they give is worth it to get the business of everyone else who gives more than they take. The insurance company determines a rate based on their magic formula and everyone in the company gets insurance.

Alone

If you don’t work for a corporation or if the one you do work for doesn’t offer insurance, you can apply to a health insurance company for an individual plan. In this case you answer lots of questions about your medical history. They ask your weight, age and height. They ask what prescriptions you’ve taken in the past two years and what surgeries you’ve had. There is a long checklist asking if you’ve had any problems in certain areas, like heart health, liver disease, diabetes, etc. They make you confirm that you’re not pregnant and that you don’t have HIV. You give them permission to access your medical records. They make you disclose if you’ve recently been diagnosed with a disease. (They don’t want sick people applying for insurance right after they get sick. They’d lose money that way. In their defense, it is like applying for fire insurance when your house is on fire. If they let you do that, why would anyone pay for insurance until they were in trouble?)

Someone reviews your application and double-checks all your information, looking through your medical history and pharmacy records to be sure you’ve been honest. Sometimes they’ll call you or send a letter asking for more information about something. Then they decide whether you’re a small enough risk to insure. They look at their actuary tables and give you a rate determined by your age, gender and weight. If you’re fat you have to pay extra. If you’re way too fat, you’ll be denied. If you’re a woman in your 20’s, you’ll be paying about twice as much as a man in his 20’s. I believe this is because 1) Women are more likely to go to a doctor, whereas men try to tough it out and 2) You are a potential baby factory and your uterus could cost them thousands of dollars in pregnancy-related fees if you get knocked up. So, even if you’re not getting screwed, you’re getting screwed.

Because you are an individual, you do not have the negotiation power of a group. The health insurance company had to take all the sickos in the group plan if they wanted the business as a whole, but they have no incentive to insure a sicko when you are a lone sicko applying by yourself. So, if you have a chronic headache condition like me, you’re totally screwed. There’s no way they’ll insure you because you are a money pit. However, there is a nice ditch behind the hospital that you can go die in.

You can find and compare insurance plans in your state by visiting eHealthInsurance.com. It can be confusing figuring out what each plan covers, but most of the differences lie in the deductible, co-pays and out-of-pocket limits for the year. Oh, yeah, you’d better start learning all the technical health-insurance lingo because you’ll need to understand it.

Short-term insurance (A temporary stopgap)

Health insurance companies also offer something called a short-term plan which is different than an individual plan. A short-term plan runs for 6 months maximum, but you can request a term shorter than that if you like. Short-term plans are meant to cover someone when they experience a short lapse in insurance, like when they’re in between jobs. Because the term is so short, the risk that you’ll get sick in that time drops which makes you more appealing to the insurance company. They won’t be stuck paying for years of your prescriptions and doctor’s visits, so you’re more likely to qualify for a short-term plan, though you might still get denied. And even if you do get covered, you’ve only fixed the problem for six months. I never applied for short-term insurance when I was sick, so I don’t know how likely they are to deny sickos, but I’d guess the chances aren’t good.

Most insurance companies will let you apply for a second short-term plan of six months after your first plan. But after that you usually have to wait another year before you can apply with them again. You can play a game where you flip-flop between two insurance companies every year. I did this right after college when I worked at a small company without a group plan. I wouldn’t recommend it unless you have to do it. It’s mostly meant to protect you from a huge bill if something catastrophic happens, like a car accident.

The other point of most short term plans is to prevent you from having the dreaded pre-existing condition. If you’ve experienced a gap in coverage longer than three months (I think, though it might vary), any medical problem you were diagnosed with before that time becomes a pre-existing condition. And trust me, YOU DO NOT WANT A PRE-EXISTING CONDITION. Please note that pregnancy counts as a pre-existing condition, so you really want to be insured before you get pregnant.

If you do experience a lapse in coverage, your next insurance company either won’t cover anything related to that condition or will enforce a waiting period before they will. Usually that term is 12 months, which means you’ll be paying the full cost of those bills for a year. Also, you won’t be privy to the discounts the health insurance company has with providers.

Oh, yeah, did I mention that medical fees are cheaper when you have insurance? In the same way that a company seeking a group plan can bully an insurance company to give them a good rate and cover their sickos, an insurance company can bully doctors and hospitals to give them discounts because they provide them with lots of business. If a doctor or hospital isn’t covered by your health insurance plan, you’re a lot less likely to go there, so it’s important for them to keep the health insurance companies happy.

This means that when you have no insurance, or if you’re waiting for a pre-existing term limit to expire, you’ll be paying full price for all your bills. No discounts for you! If you’re savvy, you might be able to talk to the billing department beforehand, play your sad violin and finagle a discount out of them. The hospital prefers to get paid something instead of getting paid nothing if you declare bankruptcy. Medical bills are the number one reason people declare bankruptcy in America. Sometimes the hospital can write off costs you don’t pay as some sort of tax advantage which I don’t know much about, but a friend of mine who had cancer and no insurance was able to do this.

The problem with short-term plans is that if you develop a chronic condition that takes longer than six months to treat while you’re on one, it’ll be much harder to get another policy when yours expires.

Find another group plan (Share with someone else)

If you’ve been denied individual insurance and short-term insurance doesn’t sound like it’s for you, you can try finding a group plan not connected to your employer. Usually this means going on your spouse’s health plan. People who are at a disadvantage in this aspect are homosexual couples who live in states without gay marriage rights or who have plans that don’t support life partners. Also, single people. (Why did you bother working hard to start your own business when you could have been looking for a sugar daddy or sugar mommy to pay your medical bills?) If you’re under 26, you can get on one of your parents’ plans.

Share

I am not married nor am I under 26, so the options I looked at included things like the Freelancer’s Union or the Author’s Guild. These are organizations that offer group plans…if you live in certain states. To qualify for the Freelancer’s Union group plan you must live in certain counties in New York state. For the Author’s Guild, you must live in certain New York counties too, but there are also Massachusetts plans. They offer plans in a few other states, but their site says they have become too expensive for most members. Let me emphasize, those are the states where you can get a group plan, not an individual plan. As I mentioned above, a group plan has more bargaining power because the healthy people in the plan balance out the sickos.

There are likely plans offered by other professional groups, so you can try searching for one in your chosen field. The web sites for these groups also usually include links for you to apply for insurance even if you live outside the area that qualifies for the group plan. However, applying that way is no different than applying for an individual plan. So, if you got denied for that kind of plan before, you’re probably going to get denied again if you apply through those links.

High-risk pools run by your state

If you’ve struck out with all of the above, you can look into options your state might offer. Many states operate high-risk insurance pools that are made of sickos like us who can’t get health insurance anywhere else. The qualifications for the plans vary from state to state. Typically they require that you not qualify for any other coverage, regardless of how expensive such coverage is. I had to wait for my COBRA term to expire before I qualified. I think some states require that you’ve been without insurance for several months before you qualify, which really sucks because of the pre-existing condition implications. You can find out more about the options in your state by using the finder at HealthCare.gov. Be sure to select that you are an “Individual with a Medical condition” to get info on high-risk pools.

I was fortunate that the state I live in, North Carolina, has a high-risk plan you can apply for after living there for a month. To qualify I had to have been denied for individual health insurance within the past 6 months. That meant I had to go through a farce of applying for coverage when I knew I’d be denied. Because of that, I decided to save time by only filling in enough information that I thought would surely get me denied, leaving out many of the dozens of meds I’d taken in the past two years because I didn’t want to spend all that time digging through my medical records. Big mistake. The insurance company checked my pharmacy records and made me reapply. It took at least an hour or two to fully fill out the application and then I spent another hour on the phone with a representative who wanted to go over all the medications I’d taken. All this just to get denied.

I qualified for the North Carolina Inclusive Health State Option and got to choose between several plans with different deductibles. The plan was pretty comparable to my COBRA plan, but it costs over $100 less. Be sure to triple-check the checklist if you apply for coverage like this. I thought I had sent all my paperwork, but I’d missed the fact that I needed to send in a Certificate of Credible Coverage, the lack of which temporarily instituted the 12-month hold on treatments related to my pre-existing condition, a chronic headache. The Certificate of Credible Coverage is a note from your old insurance company saying how long you’d been covered by them. In the case of my plan, North Carolina needed me to have been covered for at least 18 months to remove any pre-existing condition holds. What was funny was they had my proof of COBRA termination letter on file which clearly stated I’d been on it for 18 months. But, whatever. If any of this made sense I wouldn’t have to write this post.

It was not fun getting a letter from the mail-in pharmacy a week before my meds ran out saying they couldn’t fill the prescription, even though I’d sent it in a month beforehand to leave plenty of buffer time. I had to pay full price for my meds at a local pharmacy, which cost over $500. I quickly filed the Certificate of Credible coverage, and I was reimbursed three months after I sent in a claim, but the whole thing was a huge pain in the ass and almost a pain in my head if I hadn’t been able to get the meds. So, let this be a lesson to you. Triple-check the checklist! Call someone to be sure all your paperwork has been submitted!

Changes in 2014 (if you trust the government)

There are supposedly changes coming to the US health insurance system in 2014. Everyone should be able to buy health insurance under either state or federal plans, or they can just keep their employer’s insurance if they’re on that. I certainly hope all this comes to pass, but I’ll believe it when I see it. I wouldn’t be surprised if the whole thing gets delayed several years or they find some way to change the bill or totally nix it. The US was supposed to switch to the metric system back in the 90’s or 80’s, but that never happened.

Wow, you’re still reading this? You really must be sick

So, there you go! There is my summation of what I’ve learned about the health insurance system as it relates to sick, self-employed people. I hope it helps you out. If you don’t qualify for anything I mentioned, you might want to consider moving to a country that provides better coverage for its citizens. I know someone with a chronic condition that actually did this.

If anyone caught any factual errors in my post, let me know and I’ll make corrections. I think this topic is too complicated for one person to know everything. Feel free to add your own advice or experiences in the comments. You can ask questions too, but as I said I’m not an expert, so anything I say should be double-checked with a professional.

Good luck! You’re going to need it.

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[…] you’re a new freelancer, Jennette Fulda has pulled together some information and resources from her research as she’s tried to find post-COBRA coverage with a chronic health condition. It’s a good […]

Katy Widrick • May 25, 2011 at 8:29 am

Bookmarked for further review…

This is great stuff — I have health insurance through work but have considered getting it on my own (various reasons, including the concerns I have with working for a small business).

My main problem is that as a 31-year-old woman who WOULD like to get pregnant in the next couple of years, I have to pay so much more, in many cases I have to wait because pregnancy is considered a pre-existing condition and I’d have to be on the plan for 6-12 months AND maternity is not covered very well.

Ugh.

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Debbi • May 25, 2011 at 8:43 am

I was quoted a very high rate for individual health insurance due to my obesity. I checked with my state’s Insurance Commissioner, who began an investigation and eventually got me a reduction in my rate and a refund of several hundred dollars. In WV, at least, they’re not allowed to charge more if you’re overweight. Don’t know if this applies to your current premium or not, and don’t know if this might result in a premium reduction or not. I’m with you on the 2014 changes – will they or won’t they 1) happen or 2) help?

You did a great job of explaining all of this. It shouldn’t be so hard. My personal philosophy is that health care is a human right, and we should have a Medicare-type plan from the cradle to the grave. It looks like Vermont will be implementing an almost-like-that plan soon. I hope the rest of the country, state by state, also adopts single-payer. It can’t happen too soon!

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Fern • May 25, 2011 at 8:49 am

…this is why I’m glad I live in England, where the NHS means that this just isn’t a problem. I will never understand the American resistance to national healthcare.

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fd • May 25, 2011 at 9:07 am

@Debbi –
the UN and its many member states agree with you. healthcare is a right. how its implemented is a whole other ballgame.

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fd • May 25, 2011 at 9:25 am

Jennette, well done for explaining all that. It must be a nightmare. I can’t really imagine getting past the part where you hurl stuff at walls and stamp your feet in frustration at how damn stupid and difficult it is. Clearly you have.

Any idea why the government changes are only coming into effect in 2014? Surely this is a longer cycle than most policy changes? You might have a whole other President by then.

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maggie • May 25, 2011 at 9:41 am

I work part-time, and therefore, don’t qualify for the company-subsidized insurance. I can pay the full rate the insurer charges the company, but that’s over half my income. I cry every open-enrollment. Your article helped me make sense of my options, of which I still have a few. Of course, the easiest way would be to leave my dream job and work at Starbucks, because THEY offer health insurance at 20 hours/week. It’s kind of sad that being too poor to move out of my parent’s house is still too successful to qualify for medicaid. Forget this country, I’m moving to Sweden!

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vivi • May 25, 2011 at 9:51 am

I really hope US citizens get the what we in Europe consider “normal” insurance from cradle to grave. It’s a right. The same as retirement money or unemployment money. Your employer and you pay while you are working and that’s it. If you don’t work anymore, you are covered by the ones who are and don’t get sick. That’s it. In your whole lifetime, a little a month, you’ll be paying far more than you’ll be needing in the end, so there is always money for those who need it. You won’t be paying more if you get sick (or fat), and you’ll never be denied whatever medical attention you need. And of course, if you prefer, you can always choose a private insurance company, which means you get the same doctors that work in the state-run system, but you get a single room with your own tv at the private wing of the hospital.

I will never understand why USA has so many problems with the system we use in Europe (or at least, in all the European countries that I know).

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Tanya • May 25, 2011 at 10:07 am

Another option to consider is the “hospital only” (includes out-patient after care too) type plan. A pain, but it’s usually around $200/ mth and it’s better than nothing.

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JenFul • May 25, 2011 at 10:22 am

@fd – I’m not sure, but I think it’s to give them time to set up the organization to run all this stuff. They’ll also need to hire and train people to work there, and provide some sort of education to office workers who have to code and submit claims. That’s just my guess.

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Paula • May 25, 2011 at 10:23 am

@Fern – Just thinking the same thing, I will never complain about the NHS again!

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Danielle • May 25, 2011 at 10:42 am

I’ll second the opinion of the Europeans – I’m in Canada, and we pay for our healthcare through our taxes – everybody is covered, no exceptions. My mom had an operation recently, and the only had to pay for parking when we went to visit her and pick her up.

I don’t know why Americans resist this sort of “socialist” plan – it’s a lot better than losing your house or declaring bankruptcy due to an illness. Not to mention fighting with an insurance company when you’re sick and scared, hoping they cover you.

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Drew • May 25, 2011 at 11:26 am

I went through the individual health insurance maze (I’m now luckily insured through my employer), and I would highly recommend working with an insurance broker. They’re paid by the insurance companies, so it’s free to you, and you can find someone who works with many different plans so they’re not trying to sell you on one thing. I tried ehealthinsurance at first and it was a complete mess. With a broker, you can call them up and they can give you advice based on your situation. They can even help you submit a “pre-application” (at least in CA) where you turn in a short form and the insurance company tells you whether they’re likely to cover you if you formally apply.

I’d also like to point out that having an insured spouse is not a free ticket on the health insurance train. My husband was insured through his employer at the time I was applying for individual coverage; his company doesn’t offer dependent coverage. I could have gone on his plan and paid the full price (like COBRA), but the individual plan was less expensive (though it didn’t cover maternity).

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jennifer rose • May 25, 2011 at 12:37 pm

Move to Mexico, where health care is affordable — and good. There is a wide range of services from world-class to ordinary.

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Shelly • May 25, 2011 at 12:44 pm

In California, once you’ve exhausted COBRA, you cannot be denied for a pre-existing condition. They can charge you whatever they want but nobody can deny you. If you let anything lapse though, you’re screwed. I’m self employed and pay over $5K a year in premiums and co-pays before my insurance kicks in a penny. I often think about going back to the corporate world just for healthcare benefits.

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Susan • May 25, 2011 at 12:57 pm

You really can negotiate with your doctor or dentist for rates that they pay to insurance companies if you are uninsured. Especially if you are a long term patient, they often will work with you to pay much less than full price. After all, it never hurts to ask. (Says the person who was put into labor by a huge argument with her insurance company once-upon-a-time.)

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Samantha • May 25, 2011 at 1:03 pm

Ive had chronic migraines since I was 11. This led to not getting a degree and since then Ive always had temporary/seasonal jobs. Yes, Im poor enough to be getting medical assistance through Medicaid. Although July 1st Im not sure whats going to happen. I wont qualify anymore because Im not pregnant or have a child. (Ive been exploring my options) How screwed up is that?

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Elissa • May 25, 2011 at 2:37 pm

Navigating the health care system is a nightmare. I’m still on COBRA and dreading the day it expires. Thanks for this; it’ll definitely be helpful when the time comes.

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Shadow of My Former Self • May 25, 2011 at 3:05 pm

Thanks for the breakdown of the issue. I am also skeptical of the 2014 miracle that we’ve been promised. I work at a job I loathe only because I need their insurance. I wish I could move to Europe. I think the hoops to jump through to make that happen might make my head explode.

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sherijung • May 25, 2011 at 3:17 pm

Excellent article! My only suggestion is that you make a little more clear that the laws and programs vary widely by state. And that if you innocently leave off ANY sort of medical diagnosis and get terribly ill, your insurance company can retroactively cancel your coverage. Like, get cancer and forgot to mention you had acne as a teen? Too bad, your coverage was obtained ‘fraudulently’ and you’ve been cancelled! True story.

Folks, if you reside in a Republican district and/or state, and want to see health care reform actually put into place in 2014, make sure your rep hears from you, and often.

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Dee • May 25, 2011 at 5:00 pm

@vivi – The problem our country has is with restraints on profit margins for the insurance companies that would come with a fair system like most European countries. My brother lives in Japan, and has better coverage as a non-citizen (with a work visa) than he ever had when living in the US). Maybe one day the US will become a fairer place to live.

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Debbi Does Dinner Healthy • May 25, 2011 at 5:51 pm

What a pain in the butt! I’m self employed but my hubs is able to cover me and the kids. I guess I should be grateful!

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Tami Stackelhouse • May 25, 2011 at 7:54 pm

I have a good friend who is going through a lot of what you’re describing. Fortunately, when I went self-employed, my husband’s insurance covered me. We do joke, though, every time they raise his rates. We say it’s all my fault. =)

Excellent job on the article. I’ll definitely be sharing this around!

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Emily • May 25, 2011 at 10:39 pm

not sick, just really interested. i just became a licensed life and health intermediary (no, i don’t want to sell anyone any insurance). it’s just relevant to my recent education.

also, as someone who has been in the insurance industry for many, many years, i find insurance minutia to be really interesting. sad, i know.

i am glad you were able to get in a risk sharing pool with your state. the system is really freaking broken. i don’t know how to fix it, but man, i wish i could.

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Emily • May 25, 2011 at 10:42 pm

@Tanya – at least that would protect an insured in the event of a catastrophic event.

it’s just such nonsense to me that it’s any kind of discussion. healthcare shouldn’t belong to the wealthy, nor the healthy. it’s a basic human right.

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Sarah Hackley • May 25, 2011 at 11:05 pm

The U.S. should see some good changes come 2014. Until then, active freelance writers should take advantage of the group plan offered in all 50 states by the National Writers Union. (I was going to get on this myself until I got married recently.) It’s still pretty expensive, but it is better than some of what’s out there. And, it sure beats the pants off nothing. (Plus, an NWU membership has a bunch of other great benefits.)

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Miss E • May 26, 2011 at 2:25 am

I just went through that whole post – not because I’m going to live in the US any time soon… but becuase I’ll be in that position next month when I leave my job.
However, we do have almost-free public health service for all; only thing is that there aren’t enough facilities for all those who need it. So if you can afford to get health insurance and access private care things are so much better for you. I just hope to be in another job soon enough to not have to go through a waiting period with my next insurance.

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kicking_k • May 26, 2011 at 5:14 am

This is the clearest explanation I’ve come across of how American healthcare works.

I’m reading mostly from antropological interest, since I’m in the UK, but I have great sympathy for all the people who have to go through this. My husband has had serious depression since he was 12, and we had a tricky enough time arranging life and critical illness insurance – but it was nothing like this. All that happened in the end was that he is specifically NOT covered for any mental illness that prevents him from working.

As for healthcare – we may have waiting lists to contend with but nobody can refuse to treat him.

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Nancy • May 26, 2011 at 4:46 pm

These good changes will only come to pass in 2014 if the Republicans don’t repeal or figure out a way to nullify the health care act passed last year. Fingers crossed that it will come,and we can get better individual options (and our daughter off the high risk pool).

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Cindy • May 26, 2011 at 5:45 pm

In Massachusetts you can apply to be under the state health plan if you make under a certain amount of money or are unemployed. It does take a few months to get all the information processed, so waiting until your previous coverage has ended to start the process is a bad idea. You also do not have to fill out any questionnaire and you will not be denied if you have a previous medical condition, like I do. It cost me about $75/ month (not including doctor visits and prescriptions) for the coverage, (which was pretty good; I was able to get my breast reduction covered by them!) but it was set to go up to over $100 before I moved to Scotland (where everything is covered 100% so far as a grad student- I don’t even pay for prescriptions, so if you have a medical condition go back to school and move to Scotland to do it!) (Just kidding.)

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Leigh • May 26, 2011 at 7:19 pm

The American health care system is obscene. But until everyone aggresively insists on better health care, we’re stuck with it. So, everyone..write your congress critter, write your governor and make your voice heard.

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Moosecat • May 27, 2011 at 6:22 am

“I will never understand the American resistance to national healthcare.” I’m with Fern, living in Australia, we have Medicare, which isn’t perfect by any means but it is funded by the Government and paying for private medical insurance is a choice, not a necessity.

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AF • May 28, 2011 at 1:30 am

This is a great summary, Jennette. It will be interesting to see what happens in 2014, especially if my employer (assuming I have one) doesn’t offer health insurance, I still can’t get on a private plan, and I’m still stuck in my current state which, according to the information I received from them a few years ago, charges $500/month for coverage in their high-risk pool. Which is kind of odd, because a)how many high risk people can afford that, even if they’re not poor enough to qualify for Medicaid? and b)our states neighbor each other and have a lot in common (does NC get a discount for not being quite as insane as most of the rest of the South?).

Healthcare in this country isn’t a profession or a set of professions, it truly is an industry that exists to make money, and an insidiously corrupt one at that.

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AF • May 28, 2011 at 1:51 am

Also, health insurance is the main reason I’m seriously considering trying to move to Canada as soon as that’s a realistic possibility. The state-run healthcare systems in Canada and elsewhere do have very real problems, but if my choice is between possibly mediocre care sparingly parceled out, or too little or no care (or care followed by crushing debt) for whatever serious condition, injury, or illness may befall me for having the audacity to be alive and live life like a normal person instead of an actuarial calculator, I’d be stupid not to choose the state-run system. People in my field are in demand, and I’d almost certainly benefit whatever community I lived in more than I would cost the Canadian government in health costs.

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Alison • May 28, 2011 at 9:31 pm

Thanks for this post. I am one of those sickos who kept reading. I’m moving to a different state soon, likely without a job and am dreading all of the upcoming healthcare madness. I know I will consult this again as I try to figure things out.

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Kathy W. • May 29, 2011 at 5:42 pm

great post!

one tiny addendum: You don’t have to be “old” to get on Medicare. If you’re any age–20s and up– and qualify for social security disability, you also qualify for Medicare two years after you’re approved for SSDI.

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NewMe • May 30, 2011 at 11:53 am

As a Canadian, your description makes my head explode.

The US has many strengths and weaknesses, but when it comes to health care, the only way to describe your system is “barbaric”.

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marcelle • May 30, 2011 at 3:36 pm

I am so frustrated by the medical coverage situation in this country I could scream! I was always the model of good health, exercised regularly, perfect blood pressure, cholesterol, weight, no illness of any kind. My health or ability to get health insurance was not a factor in any decision in my life so part of my 5 year plan was to leave my job and become a consultant. Then in 2008-09 I started having a lot of trouble breathing and eventually was diagnosed with severe mitral regurgitation that they believe is due to not getting antibiotics in time at some point as a child (scarlet fever or strep). They had to replace my mitral valve with a pig valve which has a life span of about 15 years. Thankfully I was still on my employers excellent coverage and all of the $300,000 (yes, that much) was covered as are the twice yearly check ups I now get. I have recovered well and in every way except this ‘heart thing’ I have the same health as before – ran two half-marathons, perfect numbers, but I’m uninsurable and becoming a freelancer is no longer part of my plan and very carefully manage my corporate career to ‘stay above the yellow line’ as my company likes to do yearly layoffs.

I don’t have ANY faith that the changes in 2014 will help my situation ..sure they can’t deny me, but I can only imagine how much they will charge someone who needs another $300K surgery.

I ran into someone at a party recently who was against medical reform because he was convinced it would ‘enable people to not take care of themselves’…it was all I could do not to WISH some catastrophic out of the blue/not your fault illness on him.

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Acadian Librarian • May 31, 2011 at 12:42 pm

I’m just echoing the other Canadians, Europeans and Aussies. I know I am truly fortunate to not have to deal with that crap around health care. I still can’t get over comments from Americans who think a privatized system is the way to go – clearly they have never had to deal with a serious long-term illness.

My MIL has battled breast cancer, undergone reconstruction and been diagnosed with a chronic auto-immune disease. She will now have to routinely go for blood work and tests and see specialists. Luckily except for some of her drugs (covered by health insurance), the rest of it was covered our national medicare. The Canadian system isn’t perfect – ask anyone who has waited 4+ hours for an x-ray for a broken arm and yes we pay more taxes but at least when she was literally fighting for her life, she and our family didn’t have to worry about how we would cover the cost of the surgeries, hospitals and rehabilitation.

Hopefully reforms will come for you (and that the darn H-word finally goes away!)

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Lauren • June 2, 2011 at 3:20 pm

I read the whole post and it was very informative. I hope never to have to buy health insurance alone when I already have a pre-existing condition, but sometimes it happens.

And I really hate to get into the whole socialist health care debate, but I will say that it’s a terrible idea. Health care is NOT a “right” just like retirement is not a “right”. Nothing gives you the “right” to live off other people’s hard work no matter what your condition. The constitution is built on the principle that everyone is their own person and you should not be beholden to anyone, be it government or another individual. But you can see how screwed up that has already become.

If you wonder why the USA has so many problems in health care I can tell you a few:

A) The government. The fact that our country has already moved to semi-socialist is what is causing difficulties for everyone else who’s trying to do it the honest way and not mooch off of other people. Just look at how much health care costs rose after Obama passed his socialist garbage.

B) The fact that the US does SO MUCH of the world’s R&D that the costs of that R&D are reflected here. When a company spends millions of $$ to create a new drug that cures some disease, they have to make up that cost in order to profit – which means higher prices. But when the patent wears off, countries like Canada, etc., can simply copy the recipe and create the drug – without ever having to spend a penny on the development of that drug. Hence, prices in other countries are cheaper. The difference is, people in US are generally more wealthy and can afford the latest and greatest medications.

C) Not having good individual insurance. As Jennette has so aptly pointed out, it’s a pain trying to find individual coverage. If the US could move away from employer-based insurance it would be much more affordable for everyone. This could be accomplished in a multitude of ways, one way being to allow policies to be sold across states.

D) Tort reform. Legal costs are also huge in the medical industry. People sue for all sorts of reasons and it mostly profits the lawyers. If the tort system was reformed we could remove a lot of the incentive, which would mean lower insurance costs for doctors, which means lower costs for the hospital, which means lower costs for the patients.

And that’s just scratching the surface. I’m sorry to rant. I understand that everyone has their opinions about this and most people who like socialist health care like it because their emotions tell them that it’s what’s “right” so they get angry if you confront them about it. But I don’t see anything “right” about you stealing from my pocket to pay for your medical bills.

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Anna • June 6, 2011 at 9:27 am

@Lauren – wow. It never fails to amaze me to hear the ‘screw the sick and elderly’ speech.

A person born with a severe disability or that has a severe illness may have the strong desire to work and contribute fully to society but be unable to. That does not mean we ‘punish’ them by denying them access to full healthcare.

Yes there are moochers in any socialist styled system, as there are in any system, but for the majority of the population it is a safety net. It means that we can live our lives in peace knowing that we need not fear having a severe illness, giving birth to a child with health issues or having a single catastrophic event destroy our family’s wealth and future.

I am more than happy to pay my taxes knowing that I may not fully utilise the system and that someone who has paid less taxes than me may do so.

One final point to consider. You consider socialist health care to be “stealing from your pocket to pay your medical bills”. I consider paying a private company for insurance to be set up in a very similar manner. In fact the main difference being that the insurance company also builds in a profit margin for themselves (as well as passing on advertising costs and all the other costs associated with being a private company). I would rather a sick person be “stealing from my pocket” to get vital health care than a huge corporation profiteering from my need for basic health care services any day.

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vivi • June 6, 2011 at 11:28 am

@Lauren – You are aware that through taxes you pay for motorways that perhaps you’ll never use, aren’t you? Or perhaps for firefighters and you may never need them. Well, the same is for medical care. If everyone pays for a tiny bit of the motorway, regardless of the fact that they may or may not use it, but they could if they wanted it, when someone suddenly needs it, it is already built and payed for.

You think it is unfair that you pay for people who get sick because you think you’ll never get sick. Well, let me tell you something. You’ll get sick. Surprise! According to the current world, you’ll most likely develop cancer. And you’ll die after spending lots of money trying to extend your life as much as possible. Don’t you think you can start paying little by little now and then use it in the end? or do you prefer to sell the house you’re living at and move to your children’s, when you’re 80 in order to pay for medical attention?

Ok, if you are part of the unlucky ones who, say, die at an early age in a terrible accident and therefore never use the money they paid in advance, don’t you think it’s good that other people take advantage of it? The same as the motorway.

It is a right. You live in a society, not as an isolated individual. It is a gift from the society to you and from you to the society. If you don’t like such a system, go live in the woods.

But first, think how you want to die. Then, think again about what you want your healthcare to be.

Ah, and regarding patents and drugs: don’t think you guys in the US get the best medical attention while the rest of the world has to live on whatever patents have worn off. You’re so wrong. Start by reading the history of aspirin. And don’t think US people are the wealthiest and therefore get the better health care. Sure you are, compared to… I don’t know, Nigerians perhaps. But there are other countries in the world. And the US has the lowest life expectancy among the developed countries. And that’s due to the healthcare system alone. Now think again how you want to die.

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JenFul • June 6, 2011 at 12:45 pm

Hello, everyone! While you all have a right to your opinions about how health insurance *should* be in this country, this post is about how it *is* and how to navigate it as it stands right now. I’d appreciate it if the comments didn’t turn into a debate about what should be. Thanks!

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Chocolate & Vicodin: My Quest for Relief from the Headache that Wouldn't Go Away Half-Assed: A Weight-Loss Memoir

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