The Plague of the Pre-existing Condition

Posted by MoneyThinker in budget | 2 comments

I’m not a fan of our health system. But, I don’t know the answer to it either. Health insurance is one of the most expensive things that Americans have to pay for. So, I want to tell you about Molly, someone I know who struggles with ever getting affordable health insurance outside of employment benefits because of something that companies call “pre-existing conditions.”

Molly is a huge health insurance risk. She’s had several knee injuries, she’s technically morbidly obese, and she has a myriad of emotional disorders. Now, with the new health reform, Molly can no longer be denied health insurance, but because of the risk she is, she either has to pay a load of money for monthly coverage, or she has to take insurance that doesn’t cover the pre-existing conditions.

Because her pre-existing conditions are under control, Molly says that it’s a lot cheaper for her to just pay per visit as opposed to paying a monthly fee. I asked her about some of her costs, and she gladly shared them so I could compare them to what she’d pay in health insurance.

First, Molly has a condition called Gastro-esophageal reflux disease, or GERD. She takes two pills a day for this condition, which together cost her about $50 every three months. She then suffers from severe ADHD, which requires a $30 prescription monthly. Finally, she also struggles with depression and anxiety, which costs her about $20 a month.

She goes back to the doctor for an actual appointment 3 times a year at $75 each appointment. With other health things, Molly goes to the dentist twice a year (about $100 each visit) and gets new glasses every few years (she’s quite thankful that her prescription has finally remained consistent; she used to have to get new glasses yearly).

So, Molly’s total cost between her medications and her appointments? I won’t include glasses (that’s like $300 every 3-5 years), but if you look at it, it costs her about $1225 a year. Now, a lot of people would say “You’d pay less with insurance!” But when Molly was debating with herself about whether or not she should get insurance, I helped her out and this is what we came up with.

Because of Molly’s pre-existing conditions (some of them work under the same treatment or medication, but if you count them individually she has 6), health insurance would cost her a minimum of $250 a month. That alone would be $3000. Then, if you throw in co-pays and such, Molly would end up paying $3500 a year for what she’s paying $1225 for.

What if she didn’t include treatments for her pre-existing conditions in there? She could get it for as low as $90 a month, but if she was going to do that and still pay the $1000 a year for the pre-existing stuff (that takes out the cost of the dentist appointments), it would still end up being $2500. Molly has been seeking for government assistance for health insurance, but their rates still aren’t making the purchase of health insurance worthwhile.

Now, Molly admits, where it would become worthwhile is if she ended up needing surgery for any of her problems, or if her knee finally quit on her permanently and she needed to get physical therapy or other treatment. She currently has something called accident insurance, which gives her coverage in case she ends up in the emergency room for an injury or has to get treatment because of some sort of injury, but because this is a reimbursement-based program (they pay her back after she pays for it herself), it will not count when the legislation goes through that fines must be placed on people who don’t have health insurance.

So, after talking to Molly, I really think that our new health care reform needs some more fine-tuning. The idea is great; the execution is not-so-great. Hopefully people like Molly can figure out a way to not go broke because of these reforms before they go into full effect in 2016.