Uninsured Older Persons

I frequently receive calls from persons who are 60 - 64 with no health insurance.  Sometimes the person never did have coverage; sometimes the individual took Social Security Retirement Benefits early at age 62 with the misguided notion that he or she would also get Medicare; then again sometimes the person was on SSI and Medicaid, not eligible for Social Security Disability benefits when, at age 62, he or she was required to apply for Social Security Retirement benefits which was high enough to disqualify the person for further SSI.  Though disabled persons on Social Security Disability will qualify for Medicare after 24 months of eligibility for SSD, it is surprising how many people do not realize that Medicare is not a retirement benefit one can get until he or she turns 65 (or full retirement age which is higher for persons born in 1937 and later).  It is not unusual to run across a person who lost a job at age 59, qualified for COBRA coverage for 18 months and then finds himself without health insurance coverage at age 60.  This is a devastating problem for a person in that age category.  What to do? Alabama Health Insurance Plan may be a solution for some (AHIP).

HIPAA (Health Insurance Portability and Accountability Act) provides protections for persons who lose employer group health insurance coverage by requiring guarantee issue coverage with no pre-existing conditions.  To comply with HIPAA protections, Alabama guarantees these HIPAA protections through a state high-risk pool.

AHIP, while not guaranteeing coverage for  all high risk individuals who cannot get health insurance, is specifically for those who had coverage through their employer, and those benefits have run out.  AHIP offers two types of plans, a traditional indemnity plan through Blue Cross and Blue Shield of Alabama and a managed care plan through United HealthCare.  Both plans cover doctor visits, prescription drugs, hospital care and emergency care while away from home, but they differ in how services are provided and the premium cost.

To qualify for AHIP a person must have had previous coverage through a group health, government or church plan; with previous coverage not ending because of fraud or failure to pay premiums; with benefits exhausted without eligibility for any other coverage (to include spouse group plan coverage); with no break in coverage greater than 63 days.  

Costs are high for this coverage.  For instance, at the time this entry is written, a 60 year old, non-smoking female can obtain traditional individual coverage with a $1000 deductible for $739 per month (with a $2500 deductible, $493 per month).  A female smoker will pay $782 for traditional individual coverage with a $1000 deductible and $520 per month with a $2500 deductible.  The non-smoking female will pay $667 for managed care, and the smoking female will pay $704 for the managed care plan.         

Persons who find themselves in the eligibility category can call toll-free 1-877-619-2447 for more information about AHIP or to request an enrollment package.  It is important to be ready to make a decision once continued coverage ends, not only due to the risk of being uninsured, but due to the 63 day limit on break in coverage to qualify for AHIP coverage.