The Health Insurance You’re-Too-Healthy Penalty

Topics: Aging and Costs of Aging, Wellness and Health

I got my annual increase in health insurance premium last month with no increase in coverage. “Starting with your January invoice…(we will bill you) an increase of $38 or a 14 percent increase from your previous monthly rate.”

Ouch. So I started shopping for alternatives.  I have no health problems except a chronic battle to avoid overweight, work at being fit, and try to practice the lifestyle I preach.  Luckily, I haven’t had to use my health insurance in 20 years.

I found another, similar plan from the same large national health insurance company. The new plan provides comprehensive coverage and is nearly identical, for $68 less than the new rate.

I thought: $800+ saved annually is certainly worth the hassle of a re-application and documentation of any and all health concerns encounters I could remember. I assumed the health insurance company wouldn’t or couldn’t transfer my data from one of its plans to another of its plans (though it would lower healthcare spending).

So I re-applied online, and got a call from MaryAnn RN.  She informed me that I could continue with the application if and only if I had a physical examination, lipid and diabetes tests, height, weight, blood pressure and a documented past medical history.

Why? Not because I was sick.  But because I was not sick.  “It’s because nobody has eyeballed you in the past two years”, MaryAnn explained.  I actually had seen an optometrist…but “they don’t count”,  she said. “Besides, even healthy people can get sick.”

Indeed they can: acute illness does often arise unannounced, though chronic diseases often suggest themselves well before you get one.

Interestingly, the U.S. Preventive Services Task Force recommendations suggest a lipid test every five years and a diabetes test every three years, not every two years, as now required by the insurer.

Hmmm. An insurer leveraging its offer of insurance outside of professional guidelines for clinical testing? Unheard of.

Yet there it is: the insurance company penalty for being healthy. Healthcare spending wastefulness 101.

My triumph of being healthy enough to avoid having to see a clinician for 24 months is not rewarded by the disease treatment system that is most health care today.

Our disease treatment system values medical and surgical intervention.  It doesn’t value eating well, exercising, avoiding tobacco, sensible drinking, managing stress and getting enough sleep: behaviors that aim to prevent disease and actually do.

MaryAnn suggested walking-in to a walk-in clinic.  I’ve long supported these clinics: I like the idea of democratizing care for those who cannot afford it. Nurse practitioners do a great job of staffing these centers, which could also teach nutrition and give out my ChefMD recipes: many Walgreen’s still do, after I co-hosted Health Corner TV.

I haven’t decided whether to walk-in yet: a visit to a clinic will cost $100 and half a day (the nearest one is over an hour away). If my exam and lab work are acceptable and if the insurer doesn’t raise rates mid-year, not accounting for the time off work, I could still save money. So, I’m thinking about it.

But what really ticks me off is the stupidity.

*I could have been seen for a blemish within the past two years by a physician assistant, been told that it was a blemish, and qualified for the cheaper, nearly identical health care plan, without any of these crazy new requirements.*

The insurer’s algorithms of  “insured person eyeballed” apparently don’t care who does the eyeballing or what they eyeball.  Any clinician (except an optometrist, I guess) will do.

I know I’m lucky.  I haven’t fallen off a ladder or driven a nail through my hand at my urban mini-orchard, or ballooned 75# up despite being embraced by treats, great cooks and frequent travel, or developed a bump, rash, bleed or bruise that wouldn’t go away.  And I work at staying healthy.

Too much, according to the health insurer. Never mind that helping people take control of their own health with what they eat and how they live is what matters most!

The insurance system in America penalizes the healthy if they want to have even catastrophic insurance…just like it penalizes those with chronic disease and pre-existing conditions, who want to have any insurance.

If you want to stay healthy, and see the doctor only when you choose, you might just have to choose a DIY health care plan, or be subjected to tests that you might not really want or might be  unnecessary.  In my opinion, that’s no way to care for people.

Now I’d like to hear from you.

Have you tried to stay healthy enough to avoid having to see the doctor?

Has your health insurance company worked with you, or against you?

What strategies have you tried to get the health insurance you want to have?

  • Mitzi

    Sometimes insurance companies (good ones) worked with me, but recently I have had one dead set against. I have a hereditary connective tissue disorder with mild respiratory, digestive, and circulatory effects. Nothing life threatening if I avoid the asthma triggers, exercise regularly, and eat a healthy diet. The most expensive risk is from the joint problems associated with the condition. My mother, grandmother, and aunt were crippled in their 40s and 50s by early-onset, severe osteoarthritis.
    I have spent decades studying the condition in the medical literature (Thank God for Pubmed) and implementing my findings. I weigh less than half what my mother did at my age. I religiously exercise and do my physical therapy. I am 40, and my hip and ankle X-rays were normal this year. With the normal result, the insurance company retroactively (back to March from July) cut off all coverage for my joint exacerbations, stating I didn’t need treatment if nothing showed up on X-ray. For a connective tissue disorder.
    I got other opinions. I switched from chiropractic to a faculty physical therapist at a local medical school. Didn’t matter. Mom’s surgeries and trips to an expensive orthopedic group are always covered. Two of her surgeries alone added up to almost $70k, and still left her completely disabled. Physical therapy and lifestyle modification have me still using the stairs on a daily basis at work, at an age when Mom was already spending much of her time sitting on the couch or in a recliner. You are right- the system does penalize people who try to stay healthy.

  • Good for you for persevering, Mitzi. You are clearly captain of your own health ship, and will be healthier (and I hope happier) for it.