How is cancer covered under ACA Obamacare, Medi Cal, Denti Cal,  Medicare, Dental Plans???

ACA Coverage – Misc.

“Medical Questions – Underwriting – If not in Guaranteed Issue Period?”

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• Question I have Plan F Medi Gap and applied for Plan G to save premium. So what if the Part B Deductible is higher. It wasn’t my birthday. What RIGHT does the Insurance Company have to deny the transfer because I had an alleged pre-existing condition a nothing squamous cell skin cancer. It’s hard to find someone who has not had a skin cancer

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• Answer 1st off, when I ask my higher ups at any of the Medi Gap Insurance Carriers about health underwriting, I get a blank stare, as most everyone gets a Medi Gap policy or change at a Guaranteed Issue date – period.
  • Thus, I can’t get underwriting guidelines from anyone. Here’s an excerpt from a well known carrier, prior to ACA/Obamacare when asking health questions and pre X clauses where outlawed for under 65. Conversely, there is a mandate and only certain times one can enroll.
  • There are exclusions for tons of stuff. Insurance Companies need to collect $1 to pay claims of 80 cents. It’s called MRL Medical Loss Ratio and is written into ACA/Obamcare. It was pretty much the way it was before.
  • Insurance underwriters evaluate the risk and exposures of potential clients. They decide how much coverage the client should receive, how much they should pay for it, or whether even to accept the risk and insure them. Underwriting involves measuring risk exposure and determining the premium that needs to be charged to insure that risk. The function of the underwriter is to protect the company’s book of business from risks that they feel will make a loss and issue insurance policies at a premium that is commensurate with the exposure presented by a risk.
  • Each insurance company has its own set of underwriting guidelines to help the underwriter determine whether or not the company should accept the risk. The information used to evaluate the risk of an applicant for insurance will depend on the type of coverage involved. For example, in underwriting automobile coverage, an individual’s driving record is critical. However, the type of automobile is actually far more critical. As part of the underwriting process for life or health insurance, medical underwriting may be used to examine the applicant’s health status (other factors may be considered as well, such as age & occupation). The factors that insurers use to classify risks are generally objective, clearly related to the likely cost of providing coverage, practical to administer, consistent with applicable law, and designed to protect the long-term viability of the insurance program.[3]
  • The underwriters may decline the risk or may provide a quotation in which the premiums have been loaded (including the amount needed to generate a profit, in addition to covering expenses[4]) or in which various exclusions have been stipulated, which restrict the circumstances under which a claim would be paid. Depending on the type of insurance product (line of business), insurance companies use automated underwriting systems to encode these rules, and reduce the amount of manual work in processing quotations and policy issuance. This is especially the case for certain simpler life or personal lines (auto, homeowners) insurance. Some insurance companies, however, rely on agents to underwrite for them. This arrangement allows an insurer to operate in a market closer to its clients without having to establish a physical presence.
  • Two major categories of exclusion in insurance underwriting are moral hazard and correlated losses.[5] With a moral hazard, the consequences of the customer’s actions are insured, making the customer more likely to take costly actions. For example, bedbugs are typically excluded from homeowners’ insurance to avoid paying for the consequence of recklessly bringing in a used mattress.[5] Insured events are generally those outside the control of the customer, for example (typical in life insurance) death by automobile accident, contrasted with death by suicide. Correlated losses are those that can affect a large number of customers at the same time, thus potentially bankrupting the insurance company. This is why typical homeowner’s policies cover damage from fire or falling trees (usually affecting an individual house), but not floods or earthquakes (which affect many houses at the same time).[5]wikipedia.orgInsurance_underwriting
  • Here’s our webpage on the rate review process. That is, the CA Department of Insurance reviews the rates and underwriting guidelines to make sure they are actuarially sound.
  • COST OF TREATMENT FOR SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK IN THE UNITED STATES
    • Average per patient cost of care for SCCHN in the US was estimated to be $20,876.
    • Higher costs resulted for patients that present with advanced cancers.
    • The estimated cost of treating a patient with Stage IV lip SCC ($19,274) was four times that of Stage 0 lip SCC ($5,062).
    • The site with the lowest cost of treatment was lip ($7,261) while the highest cost was associated with hypopharyngeal SCC ($28,584).
    • The cost per patient for palliative care ranged from $2,052 for lip SCC (28% of total cost of care) to $7,172 for sinonasal SCC (30% of total cost of care).
    • The lifetime cost of managing annual incident SCCHN cases was estimated to approximate $976 million.
      • CONCLUSION: This study found that tumor stage and location are useful predictors of increased treatment costs. The results suggest that prevention and early detection are critical in reducing the treatment costs of SCCHN. wiley.com/

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• Question I’m living outside the USA, if I apply for a Medigap plan and am subject to underwriting, how much extra would coverage cost and what are the underwriting requirements?
  • The requirements or at least the questions are in the respective insurance company applications.
  • The price – premium is the same for those who enroll during a SEP or Guaranteed Enrollment Period. You can get those rates on our webpages for each company by using the site map, menu above or the link above to Blue Cross and Blue Shield affiliate sites.
  • I find it very odd that there are some situations where you can be offered an underwriting-free MediGap choice upon return to the US.
  • Is this only if you have or once had a policy?
• What if the provider cancels the policy when you are out of state/country (as it can do)?
  • Those situations are limited to getting a Medicare Advantage Plan and then using the Trial Period to get a Medi-Gap plan or did I forget an SEP into Medi Gap?
  • MAPD enrollment when returning to USA doesn’t matter on if you had a MAPD or Medi Gap policy before.
  • I’m not aware that a Medi Gap carrier can cancel coverage when you move out of state or country. Residency is only required when you purchase coverage.

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• Answer I don’t ever want to deal with underwriting because even though I’m a healthy person, the insurance companies may look at the info in the MIB and think I am not.  So it sounds like I should get a regular Plan F at the get go when starting Medicare in June.  Is that what you would recommend?
  • How healthy are you, related to the questions on the applications above?
  • Have your reviewed your MIB Medical Information Bureau File? mib.com/request_your_record
  • MIB shouldn’t have anything that isn’t being asked in the applications. There’s a law somewhere that says Insurance Companies cannot deny you based only on the MIB file. They can only use it to indicate things that need to be investigated further.
  • If you want the Medi Gap plan with the highest benefits Plan F and don’t want to worry about underwriting, yes.  Note Plan F is no longer available if you turned 65 after January 1st 2020.
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