Topic: Experience finding individual ins coverage after COBRA ends?
sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
Does anyone have any advice or experience in finding individual medical coverage to switch to after my COBRA plan ends in June?
I have had no luck seeking government assistance. I am 28yrs old, single, and have no children. I have been unable to work for over a year due to illness. I've applied for SSDI but have been denied (due to age and education) and am currently on the 2yr wait list for a hearing.
I would appreciate any advice that you might have to share. thanks!
Posts: 5237 | From here | Registered: Nov 2007
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Dekrator48
Frequent Contributor (5K+ posts)
Member # 18239
posted
Hi sammy,
My experience is that there are 2 kinds of plans that cover major medical events.
Medically underwritten plans: means you have to be medically evaluated and approved for the plan and it costs less. Not likely to be approved at all with a lyme diagnosis.
Guaranteed issued plans: You cannot be turned down for medical reasons. The premiums are higher (considerably).
When I had a COBRA plan and it ran out, I stayed with it and paid the premimum. That way they could not deny me coverage.
It turns out that this is the only way I was going to have any coverage because I would never be accepted into a Medically Underwritten plan (and that was just with a fibromyalgia diagnosis years ago)
I recently looked into my options again. The only options for me, with a pre-existing condition, is either the Guaranteed Issue Plan that I already have, or a Guaranteed Issue Plan with a much higher premimum that includes prescriptions.
My present option (no coverage for Dr visits or prescriptions costs $380 per month. It was less, and was raised to over $480 per month in January. I filed a complaint with my state's Insurance Commission and the premium was reduced. The Insurance Commission is still investigating.)
The other Guaranteed Issue option was a high deductible health plan including prescription coverage and was about $640 per month,so I stayed with the plan I had.
In both of those catagories (Medically Underwritten and Guaranteed Issue) there are various kinds of plans....PPO, HMO, etc.
Besides that, you can check to see if your state has any subsidized plan according to income. For instance, PA had one called Adult Basic that just ended when the funding ran out.
I wish I could say that the options for people with preexisting conditions are better, but that hasn't been my experience.
Maybe someone else with more insurance experience will have more ideas.
I sure hope you find something that works for you.
Big Hugs!!
-------------------- The fibromyalgia I've had for 32 years was an undiagnosed Lyme symptom.
"For I know the plans I have for you", declares the Lord, "plans to prosper you and not to harm you, plans to give you hope and a future". -Jeremiah 29:11 Posts: 6076 | From Pennsylvania, USA | Registered: Nov 2008
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chiquita incognita
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posted
Have you talked with social workers locally? They may know of options for you, you never know.
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chiquita incognita
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Copying/pasting this from another thread I posted. Stick with me and keep reading, it gets better and there is news about where to apply for medical funding, lyme-specific. Best wishes, CI
Here is some new information I just came across in a book which I just got from the library. Toot toot, hooray for the librarians! They are on our side. Yippee!!
"Coping with Lyme Disease, A Practical Guide to Dealing with Diagnosis and Treatment" by Denise Lang, with Kenneth Liegner, MD An Owl Book, Heny Holt and Company
What do we do if we are (Criminally, if you ask me) turned down for insurance payment?
Bad news first, then good news thereafter.
on page 205: "Depite international and domestic research to the contrary, despite the CDC's emphatic statements that chronic Lyme disease is a serious condition and should be treated appropriately, and that CDC criteria for tracking lyme disease should not be used for any other purpose, most insurance companies have glommed onto CDC restrictive criteria as well asa set of medical practice guidelines concerning Lyme disease issued by the Infectious Diseases Society of America (IDSA).These guidelines assert that there is "no significant evidence that chronic lyme disease exists" and taht there is "no role for treatment with antibiotics beyond one or at most two months for any case of LYme disease".
Do we all fit into their box? Methinks not. Time to sue these unconscienable harm-doers? Methinks yes.
Here is a note of hope: on page 213 of the book above:
"Equitable treatment from insurance companies is also the province of Families USA, located in Washington, DC. Formerly the Villers FOundation, it was founded in 1981 by Philippe Villers and his wife, Kate, to reform the health care system in the United States so that it assures universal access to care. Villers, who fled to escape Nazi persecution, grew up to become the creator of Computervision, a successful computer company. The foundation is his contribution to his adopted country. It provides grants and advocacy to those seeking redress in the health care arena. Under its Health Assistance Partnership, Families USA assistance to consumers ranges from education and mediating solutions to investigating complaints and actually representing consumers in hearings".
Wisely, the book also suggests appealing to the media for help. Publicity can shame these wrongdoers down, forcing them to pay. If not, other people may step forward to help.
I knew someone who did that when one person needed an organ transplant and couldn't afford it. They had an article written up in the biggest local newspaper about organ transplants, the long waits in line, etc. followed by a one-sentence statement that "as far as the cost, we frankly don't know what we are going to do". They got about $5,000 in donations to help.
More resources listed in the book. MANY of them! HEre are a few:
Medscape AE recent research updated daily, posted on Pubmed, could be helpful as support in writing claims Medscape AE www.medscape.com
NeedyMeds.com has info about how to get coverage in absence of insurance. Don't call with problems, see website www.needymeds.com
The book also mentions appealing to your State for help.
You could contact a case worker in your State Representative or Senator's office and ask them to help you.
YOu can also call the State's Insurance COmmission to get instructions for appealing on the State level.
Lots more resources and info in this book! THanks to my local library, toot toot trumpets blast woo hoo! It's good to know that there are people who care. We are not fighting this alone. Perhaps the libraries have more resources than any mentioned above. And the book has more resources, check it out.
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sammy
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Member # 13952
posted
Thank you Dekrator. I didn't think about needing a guaranteed issue plan. I guess I should start calling around. I need to know what my options are but I'm scared to hear the price.
Does anyone know, when an employer buys group insurance does it cost them anything more than the premiums for each employee? Like additional fees per person?
I'm thinking about asking my former employer if they would allow me to stay on their group plan for a couple more months (offering to pay more than 100% plan cost). I doubt they'd even consider but it might be worth asking. What do you think? Am I crazy to ask?
Posts: 5237 | From here | Registered: Nov 2007
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chiquita incognita
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posted
Hi Sammy The way I was able to get health insurance for a reasonable rate, despite having the pre-existing lyme diagnosis, was because I am covered under the wing of my husband' s health insurance at work (group plan rate). We do have to pay the monthly premium but it's about half of what it would have been if I had ventured out of hte group plan covered by his employer.
I say, go for it! What does it hurt to ask? The worst they can say is no, and if they do, I might consider looking for a different job,if it was me myself...good luck with this!
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Dekrator48
Frequent Contributor (5K+ posts)
Member # 18239
posted
sammy,
You could ask...as CI said, the worst they can say is no.
I don't know if the employer pays more than the employee premimums.
It's been about 10 years since I had COBRA, but I was thinking that you should have the option of keeping that same plan, only it becomes an individual plan for you, and you self pay.
If I remember correctly, that is what I did.
Maybe that is not always an option, but you could check on it...that way you do not need to apply for a plan(with the chance of being turned down).
Over the years, Highmark changed the name of my plan several times, but it is still the same plan that I had when I left that job.
I applied for a Medically Underwritten Plan and was denied.
I pray this all works out for you.
-------------------- The fibromyalgia I've had for 32 years was an undiagnosed Lyme symptom.
"For I know the plans I have for you", declares the Lord, "plans to prosper you and not to harm you, plans to give you hope and a future". -Jeremiah 29:11 Posts: 6076 | From Pennsylvania, USA | Registered: Nov 2008
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posted
Sammy I am in the same position, my cobra finishes in June aswell........
do you have a State Plan?,...its for people with pre existing conditions that cant get insurance...its under the federal high risk pool for on pre exisitng conditions.or when cobra ends.....as i said .its under the federal high risk pool..........
It would be worth calling them but I am sure thats an option for us.....thats what I had planned on.........hope I am not wrong.....
just checked it and i am correct but check your state.....
-------------------- Oct 09 Positive CDC Western Blot Jan 10 Positive Babesia Duncani Jan 10 Cd57 28 Mar 10 EBV, IgM, IgG HHV-6 IgG Posts: 739 | From NC | Registered: Oct 2009
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I was just looking into getting individual health insurance coverage for myself. I`m not even sure if it is lyme that I have, but highly suspect it, so was planning on going to an LLMD soon. I was really disappointed to see that there were really no plans worth pursuing, as most plans will only pay up to 50% of your meds(your #1 cost), then you might have a deductible, co-pay`s and your monthly premium. Cost would turn out to be the same as paying out of pocket.
Chiquita Incognita: Thanks for the information.
Posts: 85 | From Northeast | Registered: Mar 2011
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posted
Hubby converted his COBRA plan to an individual plan with Anthem BCBS 9 or 10 years ago. He is rated as level 4. Premium for just him is currently $1388 per month. I do not have insurance -- had to drop mine after a year or two in order to afford his premiums.
His is the typical 80/20 coverage for major medical in network (70/30 for out of network) but his prescription coverage is limited to $5000 annually. We thought that was supposed to change under the new law but so far has not been confirmed by the insurance company.
Originally the plan was not too expensive but premiums have gone up about 12 - 15% per year except for last year -- they only went up $30 per month.
Depends on the state I think, but some states will not accept you in the high risk pool unless you let your insurance lapse for 6 months under the new laws.
If you are still covered under COBRA then any company licensed to sell insurance in your state must accept you but they can make you pay a level 4 (highest) premium.
Bea Seibert
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
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sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
Thank you all. You've told me so much that I did not know.
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