Medical insurance questions...

[Mackey Mouse]

Our Cobra is running out...here's the question I have as I just read something Paige wrote on her autoimmune thread about picking up a cancer addendum. I was under the impression once you have a pre-existing condition as my DH has that no other insurance company will take you on. I am thinking we have to stay with the one we have and if I told you what we have to pay monthly, you will all faint.

Should I be looking somewhere else? Any ideas would be gratefully received...

 

[Goofyluver]

I know that with my insurance company, I can purchase a cancer addendum...however, not in the middle of my yearly insurance term, and I don't believe I can buy it after the condition already exists.

 

[Shugardrawers]

Marsha, you do have him on medicare for disability right?

 

[Mackey Mouse]

We just got the information that he was eligible.... and we applied.. but medicare will not cover everything, right??

I have been at the lab and watched little old ladies being turned away because medicare would not cover their blood work.. I am not playing that game with the State or whomever is in charge of that.. I would rather pay and make sure he is covered.. even with paying, they still hit us up with what ins will not cover... every day I get another bill to pay.. I am so fed up with hospitals, insurance and doctors.

 

[Shugardrawers]

No they don't pay everything but it's a darn good start on a lot of things and could save you a HUGE chunk of money if not in premiums then at least on the bills themselves. You've both worked all your lives. You've earned this. Use it. There are medicare supplements available although I wouldn't have the vaguest idea what the cost would be or how it would compare to what you are paying now.

If you get him on medicare they become primary and your insurance becomes secondary, reducing your out of pocket costs by a staggering amount so even if you were to lose your COBRA, there's some semblance of a safety net there. Get your hiney down there and apply!! And be prepared, I think it's in the handbook that all applications are stamped denied just for fun the first time or two It's also possible, if he's not already receiving it, that he can get disability pay retroactive to the day he had to stop working. GO! NOW!

 

[Mackey Mouse]

Shug......you are so good to me..

How are you doing?? I think of you often.....please do let us know how things are going with you.. Hugs.

 

[j's m]

Marsha, I can understand what you are dealing with in getting private insurance. We own a small company, prices keep going up and we looked into getting coverage on our own. It was somewhere in the $ 25,000 range for crappy coverage.

My mom has a BCBS plan secondary to Medicare, and it covers everything that Medicare doesn't, and a separate Medicare prescription plan. But she doesn't have major bills and has had this since forever.

Good luck with getting reasonable insurance, I can't imagine going out on the open market with major pre-existing conditions. to both of you.

 

[luveeyore1]

I just wanted to tell you that if you can get a medicare supplement it will help when he gets medicare. I work for a med onc in illinois. Most "cancer policies" pay the pt directly and not providers just so you know. Also at least in Illinois most medicare supplements can not deny a pt unless the have been diagnosed with certain renal diseases. 80% coverage may sound like a lot but chemo is very expensive and Medicare only pays 80%. Good luck.

 

[JandJ]

My Godmother retired, got old enough for Medicare, but didn't have a supplemental. Then she got colon cancer and a year later breast cancer. During treatment for the breast cancer, I believe, she went to AAA and they have supemental policies through private insurers. If you are a AAA member it might be a good thing to check out - or see about becoming a member to get it. I know she's been very happy with her coverage (sorry I don't know the name of the company but they vary by state). She's since had surgery for 3 blocked arteries and they picked up a good portion that Medicare did not.

Good Luck!!

 

[Mackey Mouse]

I do have AAA, thanks for the information and I will check it out..

 

[barkley]

when you get approved medicare you will get sent a medicare handbook that explains all the coverage (and amazingly for a gov. issued book it's written pretty straightforward and understandable). you can go online before you get approved and start researching what your state offers in the way of medicare supplemental insurance (every state has different contracted offerings).

if you have private insurance along with medicare, medicare becomes your primary and gets billed first. as an example-i have an hmo, so when i get medical treatment it would get billed to medicare first then go to my hmo. since i've yet to encounter a non medicare provider whose in my hmo's group i end up not having to pay my co pays for services (medicares share covers it). when i switch to a ppo, medicare will get the bill first-then it goes to the ppo who looks at the balance left on the bill and uses that to calculate what their percentage covers and what my remaining balance to pay is.

as for a medicare application. i reviewed thousands of these when i worked for social services (in our state people can apply for state only coverage while a medicare application is pending), and by and large the ones for medicare that got approved on the first go round (mine included) are those where the patient (or a spouse or advocate) coordinated sharing of information with all the doctors involved with the applicant to ensure that they all reported all the pertinant information. so if your dh has a primary physician and one or more specialists, it helps incredibly if you can write up a note for them to refer to about each doctor's diagnosis and the medical events re. the disability. that way all of them can make sure to at least mention it in their report. my primary care physician was nice enough to do a draft of the report he was going to send which i provided to each of my specialists, they made notes on it which i in turn copied for all of them to use in making my final reports. that way they all made sure they were ALL including the same info (one of the reasons medicare seems to bounce applications is because one doctor will address one issue but another doctor doesnt, so medicare seems to take this as one doctor not concurring or supporting that diagnosis).

another resource for medicare apps. that can realy help get them through faster is to see if your local social services agency has any advocates on staff that work on social security disability or medicare. agencies that have these workers have a wealth of information on what the usual reasons apps. for certain diagnosis are denied or returned for more info. if you know everything the medicare worker processing the application will need you can provide it from day one and lessen the flow of paperwork requesting it (in my situation i knew that certain neurological tests would be a key factor, so i reminded my pcp that the neurologist had done them and what the results were-so the pcp in his report could make mention that those tests had been done, same with some more standard tests the pcp had done-made sure the neuro. remembered it and mentioned it in his report. in fact my med reports from all the doctors pretty much read the same, included the same information-everyone documented and supported each other's diagnosis-i think thats the main factor on why mine got approved on the first try).

good luck-i know it's a horrendous hassle, but honestly the coverage medicare provides is allot better than having none at all.

 

[LKHomemail]

have you tried aflac ? as a secondary ?

have YOU tried to get part time employment if you are able ? might be worth it to work outside home part time just for the insurance benefits ? if you have kids you could always use the money you make to fund part time day care instead paying insurance ?? Most employers health care insurance plans do not have preexisting clauses in them and they can become effective on the day you start work. sometimes there are waiting periods. generally, they have to cover all emplyees /families , can't be as picky as small insurance companies are.

also, have you talked to an attorney ? facing serious medical expenses it might be wise to move your assets around to protect yourself ? you could end up with a medical lein on your house and be forced out / have your retirement money spent on medical stuff ? you are better off being "broke" and judgement proof. PLEASE don't be scared by all this , you have enough to deal with. Just wanted to bring to your attention , cause you may not have considered all this while you are overwhelmed with news/treatment etc.
Prayers to you and family !

 

[CarolAnnC]

I thought you had to be affiliated with an employer who offers AFLAC in order to participate?

I've been job searching and cannot find any part time jobs that offer health insurance benefits. Do you have some ideas on which employers may offer this kind of benefit? I have done a far and wide search of small and large companies and even health related field jobs. Nothing that I can see.

Just hoping to find a job somewhere that would actually offer the health insurance benefits for myself.

 

[LKHomemail]

the aflac insurance offers secondary coverage to supplement your primary. we met an older couple at the Mayo Clinic in Rochester who told us about this. The coverage as we were told also helps with travel expenses when necessary for medical care.

my first job was a retail clerk for jcpenney co. there were a lot of women that worked part time reduced schedule just for the insurance. jcpenney.com see careers site. there might be a call center / field office near where you live , which might be easier work.

i am also told that Starbucks coffee shop offers part time insurance.

http://www.starbucksunion.org/node/494

Also told but not verified that Container Solutions store has benefits for part time employees.

I am sure there are many others, maybe search the listings for the vault.com or part time jobs with health insurance benefits. Best to you and your family.

 

[CarolAnnC]

AFLAC was an offering brought in at my previous employer. I did not take the coverage, but inquired about picking it up later. The Rep told me you must be affiliated with a participating employer..in order to join.

Thanks for the tips on the part time jobs that offer health insurance. Can't afford anything in the lower spectrum of paychecks, however.

Very hard to find a professional position with part time health insurance.

 

[LKHomemail]

Here is a link with some info re: AFLAC ... i believe that they must sell insurance as primary and secondary ?? i understand it may also be purchased for specifically to cover things such as cancer. opposite of what i'd expect from an insurance company ??

http://www.hoovers.com/aflac/--ID__13111--/free-co-factsheet.xhtml

the couple we met at Mayo were on medicare or medicaid (sorry can't recall) ?? as their primary insurance and the AFLAC was the secondary coverage that paid out what the primary didn't pay. my parents have supplmental insurance through AARP to help with copays, deductibles, etc.

Not sure what kind of work that you do , but is there a chance of a job share ? anyone you know who would be interested in that flexible work option ? i currently work in a technology company and have seen this work between two engineers and also between two project managers. the partners are on half salary and are entitled to full benefits. i do not have any feedback to know from the employee or management perspective how the arrangement is working out. Our company is a bit slower / conservative but is working on the concept of future seamless mobility workers.

 

[Deesknee]

I know this was first posted in March, I just came across it. Marsha, I hope now with the new insurance laws in MA that insurance has become more affordable. Like others have stated alot of time with medicare as primary, a secondary, ( even the ones that seem to be minumal) you end up with little or no subscriber balance. Thinking of you and Tom lately, hope all is well and you are both enjoying your grandson!

Dee

 

[CarolAnnC]

the aflac insurance offers secondary coverage to supplement your primary. we met an older couple at the Mayo Clinic in Rochester who told us about this. The coverage as we were told also helps with travel expenses when necessary for medical care.

my first job was a retail clerk for jcpenney co. there were a lot of women that worked part time reduced schedule just for the insurance. jcpenney.com see careers site. there might be a call center / field office near where you live , which might be easier work.

i am also told that Starbucks coffee shop offers part time insurance.

http://www.starbucksunion.org/node/494

Also told but not verified that Container Solutions store has benefits for part time employees.

I am sure there are many others, maybe search the listings for the vault.com or part time jobs with health insurance benefits. Best to you and your family.

Well, received my official response from JC Penney today regarding health insurance for part time employees. You must work a minimum of 35 hours per week in order to be elgibile for health insurance. This is too bad as I was ready to take a position there. Oh well, the search continues.