ElderWeb

I often discuss Medicare coverage, but another important issue is access to health care coverage for the "pre-retirement" or "early-retirement" group aged 50-64. This is a group that may have had employer group health coverage in the past, but is no longer eligible because they retired, quit their jobs, or were fired or laid off before the age of 65. They are not eligible for Medicare, and may not be able to join another group plan for one reason or another.

Older adults may have more difficulty than younger people in getting any new job, whether or not the prospective employer has a good group health care plan. They may find smaller employers more willing to hire them, but smaller employers are less likely to have a group health care plan. Many in this age group who leave their old job end up self-employed, with no employer group health plan, either because they decide to use the experience they have acquired in their own business, or because no other options are available. Those who retire (either voluntarily or through early retirement options offered by companies who are down-sizing) may have worked for an employer that does not offer health care coverage to retirees, and will need to take care of their own health insurance until they become eligible for Medicare.

People in this age group may be able to get coverage under COBRA for 18 months after they leave their previous job, but once that runs out they will need to buy an individual health policy. Individual health insurance can be very expensive, or unavailable at any price, for those age 50 or older and/or those with pre-existing health conditions.

What options are available for health insurance for this group? I did some research and came up with two wonderful resources:

The Genetics and Insurance Committee (GAIC) of the British Department of Health announced that genetic tests for Huntington's Disease can be used by insurance companies when assessing applications for life insurance. The Association of British Insurers is trying to have the policy extended to include testing for Alzheimer?s and breast and ovarian cancer. Patients will not be required to have testing performed, but they will have to disclose results if tested in the past. If a patient refuses to disclose results, insurers can either deny or charge much higher fees for coverage. Critics in the UK view the policy as discriminatory and have expressed concern over the government?s plan to expand the practice.

Professor John Durant, Chairman of GAIC said, "Genetic test results are already used in certain circumstances by insurers and the Committee was asked to look at the reliability and accuracy of the genetic test for Huntingdon's Disease...This decision will mean that those with a negative test result will not be asked to pay more for life insurance because of their family history of Huntington's disease...Many who have a family history of a genetic disorder such as Huntington's Disease have difficulty in obtaining insurance because of their family history. The approval of the two tests for Huntington's Disease will allow insurance to be provided at normal rates to those who have a normal test result."

President Clinton announced that the Department of Health and Human Services (HHS) is releasing new national standards for electronic claims for health care transactions. All health care providers will be able to use the electronic format to bill for their services, and all health plans will be required to accept these standard electronic claims, referral authorizations and other transactions. Currently different insurers require different electronic and paper forms from health care providers filing claims. Under the new regulation all electronic claims transactions must follow the single standardized format. Providers will still be allowed to use paper forms, but the simplified process is expected to encourage more electronic filing.

The new standards, described in a regulation to be published in the Federal Register, establish standard data content and formats for submitting electronic claims and other administrative health transactions. By promoting the greater use of electronic transactions and the elimination of inefficient paper forms, the administrative simplification regulations are expected to provide a net savings to the health care industry of $29.9 billion over 10 years.

The proposed regulation was required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). In developing the proposal, HHS consulted extensively with private sector organizations and individuals and published a preliminary rule in 1998. More than 17,000 public comments on the proposal were received.

The new standards will be required to be implemented consistent with the privacy regulation that will be finalized later this year.

SelectQuote.com offers an online process to apply for life insurance, but the process didn't work very well this week. Applicants who tried to input personal information into an online form found that the information input by a previous applicant was still showing on what should have been a blank input form. The company said the problem emerged when they tried to fix another problem, and emphasized that only about 20 users were affected. They also said the problem has now been corrected. Even so, this was bad publicity for SelectQuote, since users are understandably worried about protecting the privacy of information they provide online.