what do I do when Cobra runs out?

CherriBlossom
CherriBlossom Member Posts: 44 Member
edited March 2012 in Head and Neck Cancer #1
hello survivors and caregivers,
I have survived the cancer but the healthcare system is killing me! I was too sick to work during treatment, and I was discharged from my job after the FMLA ran out. I am on SSD (social security disability) payroll since January of this year. It barely enough to cover my COBRA premium and yet I have insurance co-pays and deductibles, rent, student loan, and utility bills to pay. I was denied of SSI (supplemental security income) because my SSD payment amounts have exceeded the eligible income level by $75 per month. It disqualifies me either SSI and state medicaid. I was like you kidding me right? Just $75 over!! I told them give me $100 less but they rejected the offer. Ok so fine I will be on SSD for 2 years and supposedly the medicare will kick in by then? The problem is my COBRA ends next March, which is one year from now. I was denied the 11 month COBRA extension but that's another story I do not want to get into right now. So there is a one year gap without insurance coverage between my COBRA expiration date and medicare start date. No insurance coverage for a year! How the heck I supposed to get my follow ups and all kind of scans to ensure the cancer does not come back?? My health is getting better now and I hope I will find a job that has group insurance but with the bad job market and my medical issues, it will be much more challenging to find work. Worst case, if I could not find a job by then, should I drop my SSD and re-apply for SSI which will put me on medcaid? If this option doesnt work then I may have to continue borrowing money to pay for individual health insurance plan after my COBRA has exhaused but not sure if any insurance companies would accept me with pre-existing condition. That brings another question, HIPAA. I know it helps me get into group plan without worrying about any pre-existing conditions but does it also apply to individual health insurance plan? Thanks for reading and any help would be greatly appreciated!

Diagnosed with Nasopharyngeal Carcinoma Stage IV in July 2011. Completed 7 weeks of radiation treatment with Cisplatin every 3rd week and 3 additional sessions of Cisplatin with 5FU.

Comments

  • Pam M
    Pam M Member Posts: 2,196
    #2
    Depends
    When my Cobra ran out, I started with a state-approved coverage for folks like us. It's coverage the state forces an insurance company to accept us for. I pay $600 a month for it. I recently got a job with a big company, and thought I could get in on a group plan, but the coverage is lousy, so I'll keep the Access coverage for now. (The same insurance company that dropped me like a rock is the one that is covering me now). You can probably call your COBRA provider and ask them for guidance - they'll know if your state has a coverage plan for high risk/uninsurable individuals. Hopefully, you won't need a back up plan, but if you do, make sure you have your ducks in a row before your COBRA is exhausted. In my state, you have like 30 or 60 days from end of COBRA to process the application.
  • longtermsurvivor
    longtermsurvivor Member Posts: 1,842 Member
    #3
    there are all manner of private grants
    that you may qualify for. Its complicated, but my situation was similar to yours. The besgt thing that happened to me is that my med onc's office had a social worker who was a master at manipulating the various aid organizations. She got me qualified for a number of these programs. Funny you broughtg this up today, because just today I worked out the bottom line with the med onc office, calculating the grant moneys that are due to come in, and paid my final chemo bill. There is a direction for you to investigate starting right away. Some of these bills you may be able, given your economic circumstances, to petition the hospital to write off as well. We learned about this from the same social worker.

    Don't panic. The system sucks, but you've got plenty of time ot figure this out.

    Pat
  • jtl
    jtl Member Posts: 456
    #4
    When my COBRA ran out I was
    When my COBRA ran out I was offered Continuation Insurance which was essentially the same coverage but if was age rated so it went up every year. It started out at about $600 and by the time I qualified for Medicare it was $1500 per month. This was an individual policy so my wife's policy premium was on top of that.
  • Redbanker
    Redbanker Member Posts: 36
    #5
    HIPAA
    Too many darn laws. HIPAA enforces privacy controls on your medical records and doesn't affect a health insurance company's underwriting policies. It's the much maligned Health Care Reform Act (Obamacare) that tackled the pre-existing condition problem. This legislation is being implemented over several years and it won't be until 2014 that insurers must not consider an adult's pre-existing conditions. When the provision comes into effect it applies to both group and individual policies. You can get group insurance not because of either of these laws, but because the insurers build the additional risk into their rates to make up for the fact that they can't underwrite on an individual basis. Sidenote: A child's pre-existing condition were excluded from insurer consideration six months after the bill's passage.

    This is such a frustrating story. You've been through so much already and won the real battle. I have never had to work the system, but there have to be some secret levers that you might be able to push. I know others have recently faced similar and I'm sure you'll hear them chiming in. Could you call out your state so that perhaps some participant with special knowledge might be able to give you specific tips.

    Nancy
  • CherriBlossom
    CherriBlossom Member Posts: 44 Member
    #6
    Redbanker said:

    HIPAA
    Too many darn laws. HIPAA enforces privacy controls on your medical records and doesn't affect a health insurance company's underwriting policies. It's the much maligned Health Care Reform Act (Obamacare) that tackled the pre-existing condition problem. This legislation is being implemented over several years and it won't be until 2014 that insurers must not consider an adult's pre-existing conditions. When the provision comes into effect it applies to both group and individual policies. You can get group insurance not because of either of these laws, but because the insurers build the additional risk into their rates to make up for the fact that they can't underwrite on an individual basis. Sidenote: A child's pre-existing condition were excluded from insurer consideration six months after the bill's passage.

    This is such a frustrating story. You've been through so much already and won the real battle. I have never had to work the system, but there have to be some secret levers that you might be able to push. I know others have recently faced similar and I'm sure you'll hear them chiming in. Could you call out your state so that perhaps some participant with special knowledge might be able to give you specific tips.

    Nancy

    Good idea Nancy, I live in
    Good idea Nancy, I live in NYC and has worked in this city since graduating from college.

    I don't understand these laws, I know folks on Medicaid with no medical issues; they are just not employed. Why can't I? I am young so I don't have any savings. I became unemployed due to my illness. Just because I worked and paid taxes therefore my SSD payment is slightly higher which disqualifies me for medicaid. The gov is helping people who don't want to work but abandoning the sick folks that really need help. Thanks uncle sam!
  • nwasen
    nwasen Member Posts: 235 Member
    #7
    CherriBlossom said:

    Good idea Nancy, I live in
    Good idea Nancy, I live in NYC and has worked in this city since graduating from college.

    I don't understand these laws, I know folks on Medicaid with no medical issues; they are just not employed. Why can't I? I am young so I don't have any savings. I became unemployed due to my illness. Just because I worked and paid taxes therefore my SSD payment is slightly higher which disqualifies me for medicaid. The gov is helping people who don't want to work but abandoning the sick folks that really need help. Thanks uncle sam!

    Nancy is right and you might even try calling your congressman. Our ex congressman was helpful to those in need. The guy we have now could care less about anyone other than his rich cronies...BUT it is worth asking. Have you asked your health providers? Where I went for treatment (The James, in Columbus OH) had signs everywhere about treatment even if you were without funds.
    I know this has to be tough, but I do believe if you can find the right people, they can help you through this.
    Wish we would have had a president who would have pushed for reform in health care and insurance long before these times.
    Nancy
  • Redbanker
    Redbanker Member Posts: 36
    #8
    CherriBlossom said:

    Good idea Nancy, I live in
    Good idea Nancy, I live in NYC and has worked in this city since graduating from college.

    I don't understand these laws, I know folks on Medicaid with no medical issues; they are just not employed. Why can't I? I am young so I don't have any savings. I became unemployed due to my illness. Just because I worked and paid taxes therefore my SSD payment is slightly higher which disqualifies me for medicaid. The gov is helping people who don't want to work but abandoning the sick folks that really need help. Thanks uncle sam!

    NYC Resources
    I'm just a suburban Jersey girl, but I've been reading the Times' Neediest Cases feature for years. I've been combing through the stories they've published as part of this year's fundraising drive and haven't yet found something that exactly matches your case, but I think it would be worthwhile to reach out to one of organizations that benefit from the Times's contributions. These are high-power organizations that know the ropes. While you might call one that is not an exact match for you, I suspect that whoever you talk with can give you the referral you need to the right organization. Just let them know your are looking for help to find help. Here are the groups...

    Brooklyn Community Services; Catholic Charities of the Archdiocese of New York; Catholic Charities, Diocese of Brooklyn and Queens; the Children’s Aid Society; the Community Service Society of New York; the Federation of Protestant Welfare Agencies; and UJA-Federation of New York.

    Re the cost of scans: My boyfriend has a very high deductible policy--$5,000. When he was scheduled for his first PET he was immediately offered a 3-year payment plan since the center didn't expect him to be able to cough up the money. (Not the case.) He suspects that he could have negotiated even better terms, so I wouldn't miss an important test without seeing what terms you can get.

    Nancy
  • Buckwirth
    Buckwirth Member Posts: 1,258 Member
    #9
    you may qualify for this
    http://www.health.ny.gov/health_care/medicaid/program/buy_in/

    It is Medicaid for the working disabled, are there are numerous ways to make this program work.

    in your case, see if someone you know will give you "consulting" work at $20 an hour, and "work" one hour a month. We have a similar program in California and I hope to use it as a backup should COBRA ever become unaffordable.

    Btw, SSI and SSDI are complementary programs. You will not be able to drop one to claim the other. Those who recommend contacting a Congressman or a Senator are giving good advice. Not sure what hospital you are working with, but they should have social workers who can steer you in the right direction as well.
  • Buckwirth
    Buckwirth Member Posts: 1,258 Member
    #10
    Buckwirth said:

    you may qualify for this
    http://www.health.ny.gov/health_care/medicaid/program/buy_in/

    It is Medicaid for the working disabled, are there are numerous ways to make this program work.

    in your case, see if someone you know will give you "consulting" work at $20 an hour, and "work" one hour a month. We have a similar program in California and I hope to use it as a backup should COBRA ever become unaffordable.

    Btw, SSI and SSDI are complementary programs. You will not be able to drop one to claim the other. Those who recommend contacting a Congressman or a Senator are giving good advice. Not sure what hospital you are working with, but they should have social workers who can steer you in the right direction as well.

    Check the Superthread
    Almost forgot, but Sweetblood maintains an awesome resource for this forum, and there may be some links that are pertinent to you.
  • CherriBlossom
    CherriBlossom Member Posts: 44 Member
    #11
    Just some updates about me -
    Just some updates about me - my energy level is back to normal, i can eat almost everything, and i am ready to work again but unfortunately I couldn't find a job and I am still trying. I did not get the state HMO managed care medicaid but I did manage to get the federal "straight" Medicaid but non of my current doctors accept this, does anyone have this type of Medicaid and did you have difficult time finding docs that would accept you?
  • longtermsurvivor
    longtermsurvivor Member Posts: 1,842 Member
    #12
    CherriBlossom said:

    Just some updates about me -
    Just some updates about me - my energy level is back to normal, i can eat almost everything, and i am ready to work again but unfortunately I couldn't find a job and I am still trying. I did not get the state HMO managed care medicaid but I did manage to get the federal "straight" Medicaid but non of my current doctors accept this, does anyone have this type of Medicaid and did you have difficult time finding docs that would accept you?

    welome back
    any coverage that offers substantially reduced pay has, as a side-effect, the added feature of making it difficult to find a physician who will accept us as patients. Where I live, that means I almost couldnt find a doctor who would take my medicare. Do you live where there is a residency program in internal medicine or family practice? Odds are they will take you. The quality of care is typically pretty good, nd the same staff doctor who wouldnt take you in his private practice is usually the one who will be staffing your cinic.

    Pat
  • Pam M
    Pam M Member Posts: 2,196
    #13
    CherriBlossom said:

    Just some updates about me -
    Just some updates about me - my energy level is back to normal, i can eat almost everything, and i am ready to work again but unfortunately I couldn't find a job and I am still trying. I did not get the state HMO managed care medicaid but I did manage to get the federal "straight" Medicaid but non of my current doctors accept this, does anyone have this type of Medicaid and did you have difficult time finding docs that would accept you?

    Good
    Great to hear you're doing so well.

    Sorry about the job search. I had a horrible time finding a job, too. I couldn't get an interview at all, and ended up going with something out of my comfort zone, and for a LOT less money than I used to make. Hoping you don't need to lower your standards, and get a job you like soon.
  • Tim6003
    Tim6003 Member Posts: 1,514 Member
    #14
    Pam M said:

    Good
    Great to hear you're doing so well.

    Sorry about the job search. I had a horrible time finding a job, too. I couldn't get an interview at all, and ended up going with something out of my comfort zone, and for a LOT less money than I used to make. Hoping you don't need to lower your standards, and get a job you like soon.

    Welcome back...
    Please check out this website (I swear I can't do a link, where is John Skiffin or Balck Swamp Boy when you need them) :)

    https://www.pcip.gov/

    Check with your local provider / care clinic about this pcip ...it does cost a monhthly premium but you can qualify if you have no ability to get any other coverage. It's calle Prexisting Coverage Insurance Plan.

    Sounds like you are doing well (if you are trying to work) ...don't forget to check with local charity org. that help people get back to work ....they can get you employed via tax credits and then that may lead to getting hired perm by an employer who likes your work ethic...

    Best,

    Tim
  • caregiver99
    caregiver99 Member Posts: 27
    #15
    Tim6003 said:

    Welcome back...
    Please check out this website (I swear I can't do a link, where is John Skiffin or Balck Swamp Boy when you need them) :)

    https://www.pcip.gov/

    Check with your local provider / care clinic about this pcip ...it does cost a monhthly premium but you can qualify if you have no ability to get any other coverage. It's calle Prexisting Coverage Insurance Plan.

    Sounds like you are doing well (if you are trying to work) ...don't forget to check with local charity org. that help people get back to work ....they can get you employed via tax credits and then that may lead to getting hired perm by an employer who likes your work ethic...

    Best,

    Tim

    Thanks to all for the
    Thanks to all for the helpful info you have provided. Wish things were easier for people who went through so much physically and mentally.

    using my fiancé account

    Cherri

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