Hope For Uninsured
New program to provide subsidized insurance for high-risk individuals
The Charleston Gazette, July 4, 2005
Have you been turned down for health insurance because of a pre-existing condition? A new state program might be able to help. AccessWV is a health plan run by the state Insurance Commission for people who have been turned down for insurance because of a health problem, or who have lost their insurance because they were laid off or their employer closed its doors.
The program started taking its first calls Friday. Individuals who are eligible are expected to start receiving coverage Aug. 1, said Lynette Maselli, spokeswoman for the Insurance Commission. Commission employees will answer applicants’ questions, help determine eligibility and send out application forms. A Web site is coming soon.
To qualify for Access WV, a person must:
Not be eligible for a group insurance plan through an employer or spouse’s employer
Not be eligible for Medicaid, Medicare or the Children’s Health Insurance Program
An individual also must have a chronic medical problem such as diabetes that prevents them from receiving private health insurance and has to have been rejected by an insurance carrier in the last six months.
The cost for participants is no more than 50 percent higher than the average insurance cost for people their age, Maselli said. That’s still not cheap, but it’s a lot better than the prices they pay in the private market, if they can receive insurance at all.
Also, the state’s health providers are subsidizing the program with a one-tenth of 1 percent surcharge, she said. Participants will be able to choose between different plans with different costs and benefits.
The annual deductibles for single people range from $400 to $2,000, depending on the cost of the plan. Family deductibles range from $800 to $4,000.
The annual out-of-pocket maximum for singles is $2,000 to $3,000, and for families is $4,000 to $6,000. The most money a person can receive in one year is $200,000, and the most in a lifetime is $1 million. The plan also covers prescription drugs, with co-pays of $5 to $15 for most drugs.
Costs are greater for using health providers who are not part of the Public Employees Insurance Agency network.
West Virginia is the 32nd state to offer insurance to high-risk individuals. Former Gov. Bob Wise proposed the program in 2004, and lawmakers passed the proposal later that year.
The state already sponsors a plan to help small businesses provide health insurance. About 60 businesses and 200 employees have signed up since January, Maselli said. It has taken about a year to get the high-risk program running with help from a $500,000 grant from the federal government.
Right now, private insurance plans are paying for the cost of treating uninsured patients.
Around 255,000 West Virginians are uninsured, and the number is expected to rise to 282,000, or 15 percent of the population, by 2010, according to a report released last month by health-care consumer group Families USA.
The unpaid medical expenses of uninsured West Virginians add an average $660 to employer-based, individual policies — about 15 percent of the annual $4,372 premium. For employer-based family policies unpaid medical expenses account for 15 percent — or about $1,800 — of the average $11,890 premium, the report found.
Nationally, the estimated 48 million uninsured Americans cost insured Americans an extra $920 for a family policy and $340 for an individual. Those dollar amounts are expected to rise to $1,502 and $532 respectively by 2010 when the nation’s number of uninsured reaches 53 million, Families USA projected.
The report’s figures were “conservative” and possibly much higher, the report’s author Kathleen Stoll told the Gazette last month. In writing the report it was assumed that the uninsured paid one-third of their medical bills and that they were charged insurance company rates and not hospital rates, which are typically much higher, she said.
The outlook wasn’t inevitable, she added: The situation could improve if action is taken.
The hope is that AccessWV will be such an action and reduce the ranks of the uninsured in West Virginia and help keep health insurance premiums down, Maselli said.
“This will help stabilize our insurance market, and lower everyone’s rates,” she said. “This is one of many steps Gov. Manchin is using to help as many West Virginians get health insurance as they can.”
For more information, call AccessWV at 558-8264 or (866) 445-849.