Question about applying for health insurance?

Health insurance question? Looking for insurance agents to answer please.?

• Assume all these facts are true; give honest answers please, no jokes! or lectures..... Stan, in his twenties, is unemployed. His insurance ended when he lost his job. Because Stan is obese, the only health insurance his parents found that would accept him is charging alot of money extra (this is real health insurance, not a "discount plan for people with pre-existing conditions" plan. Stan doesn't have any health problems yet because of his weight such as diabetes, etc. However, the deductible is very high, it is either 2,500 or 5,000 dollars per year, I forgot what the parents said. They bought the insurance in case he gets hurt, is hospitalized and racks up several thousand dollars in debt. The problem is, when he first got the insurance he had quit smoking cigarettes for a couple of months and is insured as a non-smoker, however, he started smoking again, somewhere in the range of under a pack a day. But worse, he smokes marijuana daily, since he was 15. My question is, if he goes to the doctor for anything, the first $5000 isn't covered at all, he doesn't have a co-payment, correct? And, if he did rack up a huge bill at the hospital, would the insurance company have tests run on him to find out if he has cigarettes and marijuana in his system to get out of paying the bill after the deductible? That's what I think they'll do, anyway, So, is it a complete waste of money to even buy insurance for him? If he gets diabetes, the insurance company won't pay for any of the supplies until it reaches $5000 anyway, right? (Yes, I know his parents should tell him to lose weight, quit smoking, etc. but how do you force someone to do that?) His friends buy him cigarettes and marijuana, the tradeout is he fixes their cars, in case you're wondering. Please advise. BTW, throwing him out is not an option. He is their only child and he is spoiled.

• Answer:

  Keeping in mind all the details you mentioned, I’m going to address your questions one at a time. First, you asked, “If he goes to the doctor for anything, the first $5000 isn't covered at all, he doesn't have a co-payment, correct?” The answer: Not necessarily. If you’re talking about major medical services like hospitalization or surgery or something of that order, then you’re probably right. But if he’s going in for a checkup or for some other form of preventive care, he may only have to pay a copayment. Rules will vary from one plan to another, but not all medical services are subject to a deductible. As a result of health care reform, certain preventive care screenings are now covered on new plans without any out-of-pocket cost for the insured person, even if the deductible is not met. Your second question was, “Would the insurance company have tests run on him to find out if he has cigarettes and marijuana in his system to get out of paying the bill after the deductible?” This is unlikely. Insurance companies don’t typically order tests of the sort you’re suggesting. Now, if he was seen for a condition potentially caused by cigarette smoking and it came out that he was a recent smoker at the time he applied for coverage, that could be a problem. Most health insurance applications will ask if a person has been a smoker in the past 12 months. If he only quit for a couple months, then he lied on the application. That could cost him in the end. On the other hand, if he had been a non-smoker for 12 months or more and then started smoking again, well, purchasing health insurance does not involve making a pledge never to become a smoker. Lastly, you asked, “So, is it a complete waste of money to even buy insurance for him?” No, it’s not. First of all, like I said, there may be preventive care services available to him even before his deductible is met. Secondly, any number of possible things that could happen. He could get seriously ill, for instance. He could have an accident and need hospitalization or surgery. Any of those events could result in bills well in excess of $5000. Being covered could still make the difference between having a financial future and not having a financial future.