Getting health insurance with MS???

[jillmb]

I always hear about "pre-existing conditions" when it comes to insurance. How hard is it to obtain insurance on your own with MS? I am currently doing COBRA which is pretty expensive; but am thinking about looking into getting the insurance on our own to see if it's cheaper? Is it possible to even get it with MS? Is it a fortune and with limited coverage?
Help!

[Spydre]

I would imagine that you would have to go through your state's high risk pool, but as long as you've had continual insurance coverage, they can't refuse to cover your MS.

[onlyairfare]

It would be very rare for any other individual private insurer to accept you knowing that you have MS. The state high risk pool may accept you after you jump through the hoops, but typically you have to have no other alternative - that is, prove you have been turned down by other insurers.

Some of the states that have started high risk pools under the health care reform act may require you to be uninsured for 6 months before you are eligible for the high risk pool. If that is the case for the plan available to you, be sure and get all your testing and meds before you change, as the intervening 6 months will be out-of-pocket costs for you!

The best thing of course is to get back under an employer group plan, then there is no pre-existing exclusion condition.

[Redwings]

Is it possible to even get it with MS? Is it a fortune and with limited coverage? Help!

Almost all companies will reject an individual policy for MS. COBRA accepted you because they had to as a condition of providing continuing coverage. New polices don't have to. The section of the health care reform act that requires coverage of pre-existing conditions doesn't go into effect until 2014 and may be repealed before then.

Individual policies are not inexpensive for pre-existing conditions. If you can find a policy to accept you, it will cost a fortune with possibly limited coverage. My individual policy has good coverage, but the premium alone is about $700 per month, just for me, on the cheapest plan available.

If your state has a high-risk pool, they will accept you with MS. However, the coverage is still expensive (could be on-par with COBRA) and there will be enrollment requirements. While some pools require that a person be without coverage for some length of time, mine required proof that I did have coverage before enrolling, but that it was going to expire and I had been turned down for other private policies.

The high-risk pool should not be confused with Medicaid, which will accept you based only on financial need.

And another confounding factor about high-risk pools is that the waiting list may be long and you could be without insurance for months before there's room for you. Plus, your state may allow you to be a member of the pool for a limited time, requiring that you eventually find other insurance anyway. I had to wait about 3 months to get into my state's pool, and the "long-timers" were "graduated out" after a few years even though we hadn't been able to obtain other insurance. Fortunately, the state arranged with some insurance companies to accept the "graduates." But again, the coverage is expensive.

[Spydre]

Medicaid accepts based on two things - financial need if you have children, and disability. But even with disability, you have financial constraints you need to fit to, with some states its more liberal than others. As soon as I stopped working, I was put on Medicaid because I live in a state that has generous parental coverage. I didn't have to apply to get it disability based (usually a 90 + day process). Once my Medicare started up, I was switched over to SLMB coverage a month after my Medicare started - SLMB is the type of Medicaid coverage that pays for Medicare copays.

If you are on COBRA and not currently working, I would definitely suggest that you apply for your state's disability Medicaid, and supply them with your medical records yourself (they are not always good about getting medical records). The worst that can happen is they can say no, and you may be able to get that changed at a first level appeal (in front of a "hearing officer", not a judge). That's something I worked on for seven years - I've discovered I'm grateful that I live in Illinois, where they have liberal parental coverage, compared with Missouri, if you make over TANF levels (the cash grant that non working parents of children get) you don't qualify for parental coverage.

[NeuroNixed Craig]

As an important adjunct to this thread's subject, allow me to share this insurance "discovery."

I went on total disability June of 2003 and in 2010 while having my final financial documents prepared the attorney requested a complete declarations page for my three life insurance policies.

I contacted the company, referring back to the original selling agent whom I had no contact with since the purchase of my life insurance policies in 1986. I will cut to the chase and save you all the gory details of the discovery process but the bottom line is I had Disability Waiver of Premium and did not even know it.

Here we are 94 months after the fact and the selling agent asked me if I would like to make a claim. Well, no s**t! By contract the insurance company is only obligated to pay refund on any premiums paid after total disability is proven for one year back from date of notification.

Had I not checked the life policies, which have Disability Waiver of Premium issued almost as a standard rider, I would have missed out on receiving 94 months of past paid premiums as a tax free refund.

Please, if you are totally disabled or in the process, read through your life insurance policies for this rider receiving a possible refund if no longer having to pay the premiums for the duration or your total disability. You may be talking about thousands of dollars.

[wkikta]

Generally, if you have been continuously insured with no breaks many Insurance Companies will no pre-existing restrictions. You just have to call them, Blue Cross/Shield is pretty good on this.

The Disability Premium Waiver usually requires you have no 'Earned Income', even a little bit is too much. One of the reasons I am reducing my Earned Income to zero, save almost a $1000 on premiums, will offset some of the loss of income. Interest and Dividends are not Earned Income.

[onlyairfare]

It depends on the state, wkikta.

In Pennsylvania as I understand it, the Blues are the "insurer of last resort" so in exchange for a tax break, they will insure the otherwise uninsurable. Most insurance companies will not issue individual policies to people with an expensive pre-existing condition like MS.

Even then though, you're right, you have to have continuous insurance coverage with no breaks, for no longer than 62 days.

[1936siol]

Hwalth insurance

Many years ago.I tried to get health insurance. All the companies said they would insure me. They filled out the forms, sent them in and I always got a note back saying I was uninsurable. This happened many times.

I had teachers insurance when I retired on disability. Thank God I never gave it up. 45 years later I'm still on teachers insurance. I have to pay for it but I have it. They all turned me down because of MS.

Now they can't turn you down for preexisting conditions. I haven't tried to get it so I don't really know how it works. I just know Obama says they have to insure you.

Lois

[onlyairfare]

You can be turned down for private individual insurance due to pre-ex until 2014 when full health care reform takes place, assuming the law is not repealed.

So keep the teachers insurance for now, until health reform is fully implemented.