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Insurance questions...

alexinlv's picture
alexinlv
Posts: 194
Joined: Jul 2010

Good morning everyone! I have been researching insurance info and this morning I had an ephinany, "I can ask my friends on the cancer board! Someone is bound to know much more than I do." The insurance laws and info on the web are very hard to figure out.

So here goes... we are insured through my work, teachers, in Las Vegas. We're both natives! yes, how sad, right? because now Vegas is in the toilet! (My husband, Tony, dx stage iv- from stage iii 2 years ago.) Our dream has always been to live at the beach. We always said that when the kids are out of the house that's what we would do. With our son getting ready to go away to college next year, two girls 15 and 11 at home, along with already having a small condo we could live in in SD, maybe now is the time! The girls could get CA residency, because we reallllly want them to be able to get out of Vegas and we really want to get out of Vegas! (And to be honest, we both agree that if something happens to him, we don't want the girls and I to be in this city!)

When it comes to insurance, I have heard that you can not be denied for a preexisting condition as long as there is no more than 30 days lapse in your coverage. I am unclear about laws regarding moving over state lines. Tony is self employed and I am thinking we could possibly go for self insurance. He would be able to telecommute for his job. I do know how expensive self insured is as we did it before I went back to work 7 years ago. I'm sure it is astronomical now that he has cancer though. Or if I get a job in CA would he be covered under my insurance?

Thank you for any info you may have!
Alex

mukamom's picture
mukamom
Posts: 402
Joined: Oct 2010

about self insuring..I have found that there is a 365 day waiting period on pre-exisiting conditions. I don't know if all self insured plans are like that, and I was surprised because I thought Obamacare nixed that, or maybe it's not in effect yet. I would guess your best bet would be COBRA, which your employer has to offer to you when you leave a job, You can use it for 18 months. The premiums can be hefty as you are paying 100% plus 2% administrative fees. This is the route we took when Robert applied for disability and subsequently was let go from work. You have the same coverage, and then when you get settled and pick up ins from your employer, you have creditable coverage. Is your husband on your insurance now? If so, he would be covered under COBRA and new group ins from future employers.

I hope this helps!

Angela

I am jealous...my dream is to retire on the beach. I am a beach bum at heart!

Kenny H.'s picture
Kenny H.
Posts: 503
Joined: Aug 2010

Good Q. on prexisting conditions. Only reason Im staying at my current job is I need thier insurance. Lots of pressure, but if I go somewhere else I may not be able to get new insurance being DX back in 5/10.
Ive heard Obama talk about it, just its not a law yet. (or will it be)

Buckwirth's picture
Buckwirth
Posts: 1271
Joined: Jun 2010

than it cannot take pre-existing conditions into account.

The problem is going to be the definition of "new". It probably applies to the date when the insurance company first offered the plan. These are grandfathered to allow the prohibition of pre-existing conditions.

All of this ends on 1-1-14, when the healthcare law (please do not refer to it as "Obamacare" as that is strictly a political term and has no place on this board) goes fully into effect.

Parts of the law have been challenged, and could be changed if those challenges hold up in court, but the challenges are limited, applying to things like the individual mandate. Even if those are deemed unconstitutional and are removed, the rest of the law still goes into effect.

mukamom's picture
mukamom
Posts: 402
Joined: Oct 2010

"(please do not refer to it as "Obamacare" as that is strictly a political term and has no place on this board)"

I wondered if I should have used that term. lol

Buckwirth's picture
Buckwirth
Posts: 1271
Joined: Jun 2010

carry COBRA for 18 months, keeping the same benefits you currently have, and the COBRA payments would be tax deductible.

If you were able to get a teaching position in San Diego during that time, you could add him onto the policy.

CA has some good benefit plans for teachers, but you may have difficulty finding a full time position due to the current state of the budget. Certainly worth a try though, and San Diego should be a good market. We have had a wave of teacher retirements, but there are also a lot of recent graduates seeking teaching positions.

laurettas
Posts: 372
Joined: May 2011

After two years on SSDI, Tony would be eligible for Medicare as well.

Buckwirth's picture
Buckwirth
Posts: 1271
Joined: Jun 2010

being self employed, it may be better to stay of SSDI as long as possible.

California has a program that is part of Medi-Cal for those continuing to work. If Tony ever needed to go to SSDI, then he might be able to qualify for this one. You might even be able to swing it just by getting residency in the state.

Medi-Cal for the Working Disabled

What is interesting is how the program counts income. All disability related payments do not count as income, so SSDI and any LTD would not be counted, and only half of earned income is counted. So, even though you might have an LTD that puts Medi-Cal out of reach, if you were to work a few hours every month (or have a small earned income) you could qualify under this program.

abrub's picture
abrub
Posts: 2146
Joined: Mar 2010

as I am a broker of Health Insurance for self-employed, and California is one of my states.

The 30 days (actually 63 days in most states) "grace period" for pre-existing conditions applies only to Group Insurance, not individual insurance.

Self insurance in California with a history of Cancer will be near impossible - they reject you if you sneezed in the 4th grade.

However, we (my company) has available Health Insurance in CA that is not medically underwritten (essentially Group Insurance), and could be available to you. The rates are the same, regardless of medical history. That being said, the rates are astronomical, and will be going up by 15% as of January 1. Family rates are currently well over $5,000/month in our cheapest plan. Frankly, you won't have many options if you go on your own - we may be the best you can do. (We send healthy applicants elsewhere to try to find better rates.) Private Message me if you want my business contact info/website. I won't post here - I'm not advertising. However, I have arranged coverage for a number of cancer patients/survivors, when all else has failed. We cheer each other on with our respective good reports!

Let me know if I can help,

Alice

Buckwirth's picture
Buckwirth
Posts: 1271
Joined: Jun 2010

And we complain about our COBRA costs!

Family Cobra is going to run me about $1,000 a month, about 20% of what you offer.

Out of curiosity, what is the deductible, co-pay and annual max out of pocket for your $5k plan?

Annabelle41415's picture
Annabelle41415
Posts: 6652
Joined: Feb 2009

We don't even take in $5,000 a month let alone be able to afford that kind of insurance. That is very expensive.

Kim

abrub's picture
abrub
Posts: 2146
Joined: Mar 2010

I dread having to discuss options with our California clients. I hate telling them that there isn't a typo on our site, those are the monthly rates, not the annual rates (the question comes up all the time.) At least we have a product to sell, tho not many people can afford it. I do have a few cancer buddies who need that insurance, as well as HIV patients who can't get anything else.

I just want you to know what you are up against, and California is ugly. The Dept of Insurance puts no limits on what the insurers charge.

No deductibles - the $5000+ plan (going up 15% on Jan.1) is an in-network only HMO plan w/$15 copays; max copay of $750/hospital stay; max out of pocket $1500/individual, $3000/family. PM me for the links to the plan specifics.

By the way, $1000/month for family coverage is excellent by any standards (assuming the coverage is decent.) Even in our lowest priced state (NY metro area) the rates range from $1600 - $3300/month for family coverage.

laurettas
Posts: 372
Joined: May 2011

Those rates are absolutely ridiculous--can't imagine a company having the gall to ask such prices.

abrub's picture
abrub
Posts: 2146
Joined: Mar 2010

But this is the current state of health insurance in the US. Some states, rates are better regulated than others. The state governments and their respective Departments of Insurance need to be made accountable.

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