Health insurance anxiety

progrocker

I hope I am not inundating the board too much, but one of the things keeping me up at night is health insurance. My husband is mostly retired and our insurance is through my employer. Should I lose my job due to this illness,  I would probably be eligible for COBRA for 18 months, but I worry what would happen after that. Does anyone have any advice? Thank you!

steveja

I was self-employed for many

I was self-employed for many years, had COBRA after I left my last employer then bought a UHC plan with high deductible.   I had he UHC plan when I got CRC in 2016 - so I paid the high deductible, and they did their part - no complaints.  In late 2017 I qualified for Medicare (65yo).   I will note the UHC plan cost less than COBRA, so  I could have saved some money searching out plans instead of COBRA..

I *believe* the ACA plans cannot exclude for most pre-existing conditins, including cancer.

https://www.cancer.net/navigating-cancer-care/financial-considerations/cancer-and-affordable-care-act

https://www.healthcare.gov/get-coverage/

ACA insurances also subsidized if your income is low (~$46k couple) which might apply.

Many states operate subsidized high-risk insurance pools for those who can't qualify for other insurance.

It's very difficult to itemize on taxes and deduct the medical expenses (those beyond the 7.5% or 10% of AGI), b/c the new tax plan has a $24k std deduction for couples, and only a $10k max allowance for tate&local&property taxes.    There is probably still a way to pay your share (premiums. co-pays etc) with pre-tax dollars, but you should contact a tax expert.

progrocker

steveja said:

I was self-employed for many

I was self-employed for many years, had COBRA after I left my last employer then bought a UHC plan with high deductible.   I had he UHC plan when I got CRC in 2016 - so I paid the high deductible, and they did their part - no complaints.  In late 2017 I qualified for Medicare (65yo).   I will note the UHC plan cost less than COBRA, so  I could have saved some money searching out plans instead of COBRA..

I *believe* the ACA plans cannot exclude for most pre-existing conditins, including cancer.

https://www.cancer.net/navigating-cancer-care/financial-considerations/cancer-and-affordable-care-act

https://www.healthcare.gov/get-coverage/

ACA insurances also subsidized if your income is low (~$46k couple) which might apply.

Many states operate subsidized high-risk insurance pools for those who can't qualify for other insurance.

It's very difficult to itemize on taxes and deduct the medical expenses (those beyond the 7.5% or 10% of AGI), b/c the new tax plan has a $24k std deduction for couples, and only a $10k max allowance for tate&local&property taxes.    There is probably still a way to pay your share (premiums. co-pays etc) with pre-tax dollars, but you should contact a tax expert.

This is really helpful..

This is really helpful.. thank you!

abrub

progrocker said:

This is really helpful..

This is really helpful.. thank you!

I believe Cobra is now 36 months

Pre-existing conditions do not affect rates & coverage in the Individual Market.

Twinzma

FMLA

My husband is also concerned about loosing his job because of time off needed for treatment, and our insurance is through his employer. If your employer is large enough you are proteced....

The Family and Medical Leave Act (FMLA)...

The Family Medical Leave Act of 1993 gives you the right to take time off due to illness or caring for an ill dependent without losing your job. This law:

• guarantees that eligible employees can take up to 12 weeks of unpaid leave, which can be used all at once or in increments as short as a few hours at a time.
• guarantees that eligible employees maintain their health insurance benefits while out on leave.
• guarantees that an employee who returns to work will be given his or her previous position or an equivalent job with the same salary, benefits and other conditions of employment.

To qualify for FMLA, an employee must have worked for his or her employer for at least 12 months, including at least 1,250 hours during the most recent 12 months. The law applies to workers at all government agencies and schools nationwide, as well as private companies with 50 or more employees within 75 miles.

 

JanJan63

I live in Canada. We never

I live in Canada. We never have to worry about this. I'm so sorry that you guys do. It's definitely not needed with everything else going on. I can't imagine cutting my treatments short because of cost. For the record, whever I see someone extolling Canadian health care, they seem to always include prescriptions and dental coverage. Our prescriptions and dental coverage are only covered under private plans. Chemo is covered, though, it comes directly through the cancer centre, so no cost for that.

Jan

progrocker

abrub said:

I believe Cobra is now 36 months

Pre-existing conditions do not affect rates & coverage in the Individual Market.

Oh that is great to know!

Oh that is great to know! Thank you!

progrocker

JanJan63 said:

I live in Canada. We never

I live in Canada. We never have to worry about this. I'm so sorry that you guys do. It's definitely not needed with everything else going on. I can't imagine cutting my treatments short because of cost. For the record, whever I see someone extolling Canadian health care, they seem to always include prescriptions and dental coverage. Our prescriptions and dental coverage are only covered under private plans. Chemo is covered, though, it comes directly through the cancer centre, so no cost for that.

Jan

That is interesting, Jan. I

That is interesting, Jan. I was never sure how that system worked. It sounds as stress-free as possible 

JanJan63

progrocker said:

That is interesting, Jan. I

That is interesting, Jan. I was never sure how that system worked. It sounds as stress-free as possible 

We do lack some cancer

We do lack some cancer treatment options but I think that's more because we have a longer waiting period for drugs and procedures to be approved by the government. We also have way higher taxes and less tax write offs so we kind of pay for it. Some provinces have a monthly healthcare payment but Alberta doesn't. We used to. It was a hundred bucks a month and usually the employer paid half.

Jan

Trubrit

Twinzma said:

FMLA

My husband is also concerned about loosing his job because of time off needed for treatment, and our insurance is through his employer. If your employer is large enough you are proteced....

The Family and Medical Leave Act (FMLA)...

The Family Medical Leave Act of 1993 gives you the right to take time off due to illness or caring for an ill dependent without losing your job. This law:

• guarantees that eligible employees can take up to 12 weeks of unpaid leave, which can be used all at once or in increments as short as a few hours at a time.
• guarantees that eligible employees maintain their health insurance benefits while out on leave.
• guarantees that an employee who returns to work will be given his or her previous position or an equivalent job with the same salary, benefits and other conditions of employment.

To qualify for FMLA, an employee must have worked for his or her employer for at least 12 months, including at least 1,250 hours during the most recent 12 months. The law applies to workers at all government agencies and schools nationwide, as well as private companies with 50 or more employees within 75 miles.

 

Great information

Thank you, Twinzma

Tru

progrocker

Twinzma said:

FMLA

My husband is also concerned about loosing his job because of time off needed for treatment, and our insurance is through his employer. If your employer is large enough you are proteced....

The Family and Medical Leave Act (FMLA)...

The Family Medical Leave Act of 1993 gives you the right to take time off due to illness or caring for an ill dependent without losing your job. This law:

• guarantees that eligible employees can take up to 12 weeks of unpaid leave, which can be used all at once or in increments as short as a few hours at a time.
• guarantees that eligible employees maintain their health insurance benefits while out on leave.
• guarantees that an employee who returns to work will be given his or her previous position or an equivalent job with the same salary, benefits and other conditions of employment.

To qualify for FMLA, an employee must have worked for his or her employer for at least 12 months, including at least 1,250 hours during the most recent 12 months. The law applies to workers at all government agencies and schools nationwide, as well as private companies with 50 or more employees within 75 miles.

 

Thank you for this.. super

Thank you for this.. super helpful

Twinzma

JanJan63 said:

We do lack some cancer

We do lack some cancer treatment options but I think that's more because we have a longer waiting period for drugs and procedures to be approved by the government. We also have way higher taxes and less tax write offs so we kind of pay for it. Some provinces have a monthly healthcare payment but Alberta doesn't. We used to. It was a hundred bucks a month and usually the employer paid half.

Jan

I can not phantom on paying

I can not phantom on paying $100 a month for healthcare! Ours costs $16,000 per year for our family and that is at a discount through his employeer and my husbands premium is covered. The 16K is for me and our 2 boys. I had to make the choice between the roof over our head and our insurance! I chose to move thank God, so I would not have a mortgage payment anymore. Even at that we have another $7,000 out of pocket we have to pay before our bills are covered 100% in network. Now if I go out of our select group of doctors I have to pay even more. Since not all his treatment is covered by insurance I actually had to accept charity from the hospital for some of the bills. It's ridiculous! Everyone talks reform here in the states. Maybe they should regulate costs instead. My Epi-pen went from $100 to $600 and I go through several a month! The chain of hospitals here if you are not insured discounts self pay by 75%. That's absurd, one test should cost the same no matter the insurance period, it shouldn't be a varibale rate. Okay I am stepping down from my high horse now...It's make my rear look big! lol 

 

JanJan63

Twinzma said:

I can not phantom on paying

I can not phantom on paying $100 a month for healthcare! Ours costs $16,000 per year for our family and that is at a discount through his employeer and my husbands premium is covered. The 16K is for me and our 2 boys. I had to make the choice between the roof over our head and our insurance! I chose to move thank God, so I would not have a mortgage payment anymore. Even at that we have another $7,000 out of pocket we have to pay before our bills are covered 100% in network. Now if I go out of our select group of doctors I have to pay even more. Since not all his treatment is covered by insurance I actually had to accept charity from the hospital for some of the bills. It's ridiculous! Everyone talks reform here in the states. Maybe they should regulate costs instead. My Epi-pen went from $100 to $600 and I go through several a month! The chain of hospitals here if you are not insured discounts self pay by 75%. That's absurd, one test should cost the same no matter the insurance period, it shouldn't be a varibale rate. Okay I am stepping down from my high horse now...It's make my rear look big! lol 

 

We do pay $365 a month for

We do pay $365 a month for dental and prescription coverage. When my husband was working it was less and his employer paid half. Now that he's retired we had to get private coverage. With the costs of some of our drugs it's worth it. I have prescriptions and he had a heart attack last year and a triple bypass and he takes several meds a day, too. Our coverage is 80% for that.

The states really needs to step up that way. It's horrible that anyone would have to choose their treatments based on their coverage or lack of. Or not go to the doctor because they can't afford it.

Jan 

progrocker

JanJan63 said:

We do pay $365 a month for

We do pay $365 a month for dental and prescription coverage. When my husband was working it was less and his employer paid half. Now that he's retired we had to get private coverage. With the costs of some of our drugs it's worth it. I have prescriptions and he had a heart attack last year and a triple bypass and he takes several meds a day, too. Our coverage is 80% for that.

The states really needs to step up that way. It's horrible that anyone would have to choose their treatments based on their coverage or lack of. Or not go to the doctor because they can't afford it.

Jan 

Totally agreed

Totally agreed

kyolcu

Medicare Adva

I wonder has anyone using Medicare Advantage plan. I am under 65 years old and has Aetna through my wife’s employer and I have secondary Medicare. My wife is going leave job soon and I will have Medicare only and will be responsible 20 % of everything which is going to cost a lot with chemo every 2 weeks. Insurance  companies will not sell secondary insurance, Medigap because I am under 65. one of the insurance agent asked me to buy Medicare Advantage plan. I called MD Anderson they told me they have no contract with Medicare Advantage but with Advantage Humana plan they can work with. Has anyone have same type of problem and Medicare Advantage is working or not? I am not sure about it. Thanks for input.

abrub

kyolcu said:

Medicare Adva

I wonder has anyone using Medicare Advantage plan. I am under 65 years old and has Aetna through my wife’s employer and I have secondary Medicare. My wife is going leave job soon and I will have Medicare only and will be responsible 20 % of everything which is going to cost a lot with chemo every 2 weeks. Insurance  companies will not sell secondary insurance, Medigap because I am under 65. one of the insurance agent asked me to buy Medicare Advantage plan. I called MD Anderson they told me they have no contract with Medicare Advantage but with Advantage Humana plan they can work with. Has anyone have same type of problem and Medicare Advantage is working or not? I am not sure about it. Thanks for input.

can your wife keep her employer's coverage through Cobra?

That might be a good option for you.

Annabelle41415

Twinzma said:

I can not phantom on paying

I can not phantom on paying $100 a month for healthcare! Ours costs $16,000 per year for our family and that is at a discount through his employeer and my husbands premium is covered. The 16K is for me and our 2 boys. I had to make the choice between the roof over our head and our insurance! I chose to move thank God, so I would not have a mortgage payment anymore. Even at that we have another $7,000 out of pocket we have to pay before our bills are covered 100% in network. Now if I go out of our select group of doctors I have to pay even more. Since not all his treatment is covered by insurance I actually had to accept charity from the hospital for some of the bills. It's ridiculous! Everyone talks reform here in the states. Maybe they should regulate costs instead. My Epi-pen went from $100 to $600 and I go through several a month! The chain of hospitals here if you are not insured discounts self pay by 75%. That's absurd, one test should cost the same no matter the insurance period, it shouldn't be a varibale rate. Okay I am stepping down from my high horse now...It's make my rear look big! lol 

 

Insurance

We had great health insurance and then the ACA kicked in and instead of paying $1,500 deductible it went to $10,000 during my diagnosis and that was just for my husband and myself and then our monthly payment went from $50 to $300.  We were paying everything up to about $15,000 a year after ACA and it took so much away from us financially.  Payments have gone down in the last two years, but nothing like it was before 2010.  It's sad how government gets involved and it seems insurance payments go up and treatment isn't the same.  It's hard to get sick.  Things seem to be a little better now though.  Hopefully it will improve.

Kim

kyolcu

abrub said:

can your wife keep her employer's coverage through Cobra?

That might be a good option for you.

Cobra

Conra will be offeref for certain amount of time and might cost more than Medicare Advantage plan.

Thanks

p14175

No Insurance

My colorectal surgeon estimated the cost of treatment without insurance to be about $40k US.  I don't have insurance and don't qualify for the state run medical assistance program, but I do for the hospital financial assistance program (gives me Medicare rates for most things). For tests and services outside the hospital I have to be my own advocate and push for discounts. It isn't fun, but it's a very educational experience.     

I am waiting to sign up for obamacare in November. I should get 100% subsidy for 2019.  Hopefully that will reduce costs a bit.