Are We Uninsurable?

[EarthMother]

I may have healthcare for the next few years until my husband turns 65 in which case he will no longer be able to qualify to participate in his former employer's group coverage. But since he's 11 years my senior, that leaves me without benefits for sometime.

Our current medical group is having contract disputes with the insurance company and it could be that I will loose my Doctor (who has overseen my care for 10 years!) So I made some calls yesterday to see if we could purchase a family plan as individuals under something like BlueShield. The agent asked me a few questions and then gave me a quote for how much it would be to cover my husband, and each of my three kids ... I asked her what my quote would be and she said "You will never get health care insurance with your pre-existing conditions."

I guess I knew this in the back of my mind but hearing the words brought tears to my eyes.

As I said, we have coverage for a few years still, and perhaps President Obama will be successful in healthcare reform and more options will open up down the line.

But I was wondering, what do other people face who try to get health insurance (especially after losing their job because of POTS)? If you qualify for Social Security, does that make you eligible for Medicare?

Then of course if Social Security declines your disability status ... but insurance companies insist your medical needs make you uninsurable ... seems like a catch22 that many people with chronic illness must face.

[firewatcher]

EM,

You are NOT uninsurable. But you need to go to an independent agent, you will need something more a la carte. It is a great deal like buying health insurance for the self employed. It will be expensive anyway. Fifteen years ago, when I bought my health insurance outright it was $365 a month, just for me and that was an HMO with no prescription coverage. You need to determine what kind of coverage you need: everything covered, major hospitalizations only, disaster coverage... You may have to get a high deductible and jump through many, many hoops, but you can get coverage. As long as your ANS condition will not affect your morbitity (cause you to die,) it should be insurable (heart disease patients and diabetics can get coverage!) THere is always the COBRA option from your husband; you get the same coverage as your husband has now, you just pay for it outright (I forget how long that lasts.) Don't let it bring you to tears yet, there are options.

BTW I used to have a health/life insurance license, but it has been 10 years.

Edited January 14, 2009 by flop
Quotation removed, please use the "add reply" button at the bottom of the page

[janiedelite]

My mom has metastatic cancer and her Cobra just ran out. Her old health plan said she could not be insured under an individual policy. She has been on social security for several years, and is eligible for Medicare. She has opted to stay on her husband's employers insurance, but her other option is to get Medicare (she has the medicare that pays for inpatient hospitalization, but not the other plans). If she chose to be covered by Medicare, she is then eligible to purchase a Medicare supplement policy for a few hundred bucks a month from any other private insurer. They do NOT usually check for pre-existing conditions for these policies. At least my mom's old insurer said she could purchase the supplement plan without a problem.

When she was approved for SSDI, she initially declined the more comprehensive medicare coverage because she wanted to keep her Cobra coverage. It's now several years later, and if she wants to add medicare coverage they have open enrollment only a certain time of the year (I think November to December). Just something to investigate and plan for if you are going to add medicare.

When she was initially denied coverage by her old insurer they said she could apply for coverage under Oregon's high risk insurance pool. But I hear that you aren't guaranteed coverage that way either.

[firewatcher]

Q: What happens after 18 months, when my COBRA or state continuation coverage runs out?

A: Then your options start to get a little tricky. You become what we call "HIPAA-eligible." The law states that if you?re chronically ill, no matter where you live, there has to exist a non-group insurance option that can?t turn you down. It varies state by state, but for instance, about 30 states mandate a "high-risk pool" plan to sell insurance to people who cannot pass medical underwriting for a normal policy. HIPAA coverage also will not impose a preexisting condition exclusion, which is an important protection. However, HIPAA coverage can be very expensive, because federal law doesn?t limit the cost of this type of coverage.

Bottom line: Try convincing a prospective insurer that you are an acceptable risk. Some insurers will automatically deny coverage when they learn you have diabetes, for instance, but you may be able to successfully argue that your diabetes is under control.

Q: What if I did not elect COBRA or any continued coverage?

A: You?re left with buying a policy on your own in the individual market. A few states require at least one insurer to sell health insurance to any resident without regard to the person?s health. We call this a "guaranteed issue" policy. New York, New Jersey, Vermont, Massachusetts, and Maine are five states that require all insurers in the individual market to sell to any resident without regard to the person?s health. So if your situation is particularly dire, you could move to the Northeast. Without premium subsidies, though, policies can be very expensive. In most other states, you can be turned down by health insurers in the individual market if you have even a mild health condition. If you live in a state that offers a high-risk pool, you might try that as an alternate source of coverage. Unless you are HIPAA-eligible, however, the high-risk pool will probably exclude from coverage (for 6 to 12 months) the very preexisting condition that made you eligible for the pool in the first place. As a result, high-risk pool programs tend to be very difficult to enroll in.

Bottom line: For more information about coverage options in your state, check out the National Association of Health Underwriter guide for medically uninsurable individuals.

[MomtoGiuliana]

It also depends what state you are in what options are available to you. I know in MD, the state will provide health insurance if you are denied it by insurance companies (at a cost which I understand is reasonable).

I was also denied AFFORDABLE health insurance during the time I worked part-time and could not get health insurance through my employer (and my husband is/was self-employed). The only coverage I could fine cost close to $400/month for three years (it was great coverage). This is the main reason I went back to work full-time. During that time period I had virtually no significant medical bills either.

Our health care system is ridiculous. I know too many people who have been sick and gone through very difficult, demeaning, frustrating, excessively expensive experiences due to the way insurance works in this, until recently perhaps, very wealthy country.

I hope you can find a good solution.

[Sunfish]

i'll try to get back later with a more thorough answer, but for now wanted to chime in with the quick answer to your medicare/ SSDI question. in short, the way it works (at least for now) is that you qualify to receive medicare 2 yrs after your SSDI benefits begin, which - at the very soonest - is 6 months after your determined disability onset date. so....essentially your medicare will/ can start 2 & a half years after the date determined by the social security folks to be the start/ onset of your disability.

in the midst of a complicated situation (don't let anyone try to convince you otherwise ) hope this helps clarify at least one little detail,

melissa

[janiedelite]

i'll try to get back later with a more thorough answer, but for now wanted to chime in with the quick answer to your medicare/ SSDI question. in short, the way it works (at least for now) is that you qualify to receive medicare 2 yrs after your SSDI benefits begin, which - at the very soonest - is 6 months after your determined disability onset date. so....essentially your medicare will/ can start 2 & a half years after the date determined by the social security folks to be the start/ onset of your disability.

in the midst of a complicated situation (don't let anyone try to convince you otherwise ) hope this helps clarify at least one little detail,

melissa

Oops! Thank you, Melissa, for clarifying when you qualify for Medicare. And I remember that when my mom looked into Oregon's high-risk insurance pool the rates were astronomical. What's been so frustrating for my mom and I is that the sicker you are, the more charges or bills you incur, the more stuff you have to figure out with doctors and insurance companies, which in turn makes you sicker!

Hope you can get something worked out. I'm so thankful for my hubby's health insurance, but we have purchased long-term disability insurance for him and a lot of life insurance in case something happens to him. My long-term disability insurer has been trying to get me on SSDI, but I've been denied twice. I am on a waiting list for a hearing (Oregon has the least amount of disability cases approved of any state), and I hope that data from Mayo will be convincing.

Dealing with insurance companies is about as fun as hitting your head against a brick wall!