High rates for high-risk patients

Arizona residents who want to buy health insurance but are locked out due to pre-existing conditions can buy into a state plan but should be prepared to pay high rates, particularly patients over age 44.

Under the plan, which became available in July, those with pre-existing conditions who have been denied coverage and been uninsured for at least six months face fairly high monthly premiums:

• $323 up to age 34
• $387 ages 35-44
• $495 ages 45-54
• $688 ages 54 and up

Income is not an eligibility factor to participate although some will find they remain priced out of the plan. In addition, the plan does not charge more for women, a practice engaged by most private-pay plans.

Persons who enroll in this program will also face a $2500 deductible and $25 copay for physician office visits. Prescription copays range from $4 to $30 for most drugs.

The good news is that out-of-pocket costs may not go above $5950 for patients who remain inside the network the state has created. In addition, this plan covers basic preventive services at no additional charges.

As of Thursday, insurance companies are prohibited from denying coverage to children under age 18 who have pre-existing conditions. However, the health care reform law does not limit how much insurers can charge. They can continue to deny coverage to adults until 2014.

Patients can begin to collect Medicare at age 62; however, if they were born after 1937, they will not receive full benefits at that age. Depending on the year a person was born, benefits may not be paid in full unless they work up to a certain age. For example, persons born after 1960 must work to age 67 to qualify for full benefits.

The Social Security Administration publishes a breakdown on birth and retirement years.