Insurance "choices"

[psoriaspouse]

Hello all! It has been awhile since I have been on here. DH's P has been doing so much better since he got a light box at home. As is true with many people, when the P improves, the visits to the forums declines.

I thought you all may be able to help with this question. DH is quitting his job with a large contractor and starting to work on his own doing small-scale contracting, remodels, and carpentry. He will lose his company insurance at the end of the month.

We are considering the pre-existing conditions scenarios and which type of plan will be best for DH to buy to keep himself covered. There is no COBRA option with the company policy, only a 3 month continuation option that costs $250.00 per month. This would be good to have only if he requires treatment for his P since it will not be considered a pre-existing condition.

We can also start with an individual policy that may not cover his P - ever - but will be his own insurance for his company. This is iffy just because if he ever had a crisis with his P, he would be denied coverage (which is a bunch of !*@#).

Basically, he has plaque on his head and guttate on his body. He manages it without derm visits and without meds. The light box, baths, lotions, diet, meditation, and stress reduction (quitting his job), are the best treatments he has found so far.

In your opinion, do you think he would be at risk for a full e-dermic flare with (currently) minimal coverage of plaque and guttate? I believe that an e-dermic flare would be the only reason he would need formal medical care that we would want to have insurance coverage for. What do you all think? Does anyone have experience with insurance transitions? What choice have you made? Any input would be greatly appreciated! Thanks so much!

[LadyHawke9973]

I've always been picked up on my new insurance AS LONG AS I didn't let the previous insurance lapse (in other words, had the new insurance in place before the old insurance coverage ended).

I had a good experience with an Individual plan as long as my meds were low key...when I went after something like Enbrel it took some fast talking by my doctor to get them to consider it. The price was still pretty high on my end, but better than paying full price!

Best luck!

[SCCatman]

First, do not go without insurance.
CORBA is a federal law, so I am not sure what company policy has to do with it. Maybe the company is self insured, and just has a company like aetna administer it?
Anyway, do the three month continuation.
It works differently in different states, but if you have insurance, you are guanteed to get insurance that covers all pre-existing conditions. Call you state insurance commissinor about it. And ask about the no COBRA polacy also.
In Ga, you apply to the insurance commissinor, who selects an insurance company which must take you at the state rate with the state minimum services. My CORBA was 220 a month, my state forced insurace (with Kiaser Permante) is 480. They pay for 1,400 for embrel every month.

If I had not taken the COBRA, dropped the CORBA, or waited more than 60 days after CORBA ended to appy, I would not have been eligabel.

Also I think they is a law that after two years, all preexisting conditons become covered.

Call you insurance commissinor
Dennis

[PJ Leary]

Hi,

Gald you came to ask that question. I agree that you should not go without insurance, keep that $250 plan for the three months, and get started immediately on determining your options. As Dennis said, COBRA is a federally manadated program, so call your insurance commissioner.

The other place you can call for help is the Foundation. They have a department especially for assisting patients and their families with all types of insurance issues. If you have a copy of your policy, please send one to them.

I am confused about why you think that psoriasis would be considered a pre-existing condition. As long as constant coverage is maintained without any lapse, there is no pre-existing condition.

As to your question concerning an e-dermic flare, if he has never had one before and is maintaining as you say , there should be no serious risk. Stay on top of infections, of course. There has been a bit of discussion about e-dermic flares lately, and I would hate for folks to get the idea that they are common at all, in fact they are very rare.

There is another reason beyond potential life threatening illness to maintain the best coverage you can, and that is in case there is a change to his disease that is less dramatic but none the less makes it much more challenging. If there is one thing most of us wth this disease understand is that it can change at any time. You may want to keep a level of coverage that would keep treatment options like biologics open possibilities for later on, just in case.

Good luck, let us know if you have any other questions, and get on the phone with both the Commisssioner's office and the Foundation!

Regards,

[SuzanneT]

Don't let your coverage lapse!

"HIPPA of 1996
Title I of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 was the result of many discussions and state legislation enacted in the early 1990s. It guarantees that no person can be denied group health insurance through an employer because of a preexisting condition, nor can anyone be required to pay a higher premium than anyone else in the same employment category. HIPAA certainly goes a long way to address the problem of pre-existing conditions and health insurance granted through an employer, although it does not pertain to those who are self-employed or who need to purchase insurance through a private company for any number of reasons. HIPAA does extend its eligibility to individuals who change employers, as long as they do not let their coverage lapse for more than 63 days between jobs."

See link here http://www.healthinsurance.info/health-insurance-and-you/Pre-Existing-Condition-Coverage.HTM

[psoriaspouse]

Well, our options are truly limited. I have also contacted the foundation and got some great information if we are ever truly backed into a corner with this.

We have a great insurance agent with whom we have worked in the past, and he is still great. We found out that DH's group plan has no COBRA option since the group was comprised of less than 20 members. He can buy a three month continuation policy, but we still have the same options waiting for us after those three months are over.

I guess the kicker is that he is going from group coverage to an individual policy. As our agent put it, the underwriters of individual policies are the evil ones of the earth who eat their own, and they do everything they can not to pay. With a group policy, the risk of the policy is based on the collective risk of the group. DH is all alone now, as he is the only employee of his business, and his risks are being considered alone.

If we get him on an individual policy, it is VERY unlikely that he will have coverage for P, medications for P, or complications that arise from P - at least for the first 12 to 24 months of the policy. Personally, I don't see how this can be legal, but it is. This is even with seamless coverage - no lapse between the transition from his company's group policy to his individual policy. It is all a bunch of BS in the end.

So we have decided on a temporary major medical (catastrophic) policy since nobody will cover his P anyway. Thankfully it is well managed right now, and he doesn't take any meds. It will save us tons of money as well as buy us 6 months of insurance and 6 months of time to start the cash flow and buy an individual policy that he can carry long term.

Thanks again for all of your input. Until this country gets unconditional, universal health care, situations like this will continue to happen. Like I said, there are options that the foundation hooked me up with if things became grim, but there are waiting lists and large premiums down that road. I just hope we never have to take it. At least we can ski and snowboard without worry this winter - we always like to have good insurance before the season starts!