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    No insurance if SSDI approved

    Having been without health insurance for 15 years, the only way I was able to get my diagnosis was by signing up for Medicaid last spring. However, Welfare has verified that if I get the amount of SSDI that the SS caseworker told me, I'll lose the Medicaid.

    I checked into private coverage through my current insurance company, and it looks like the Obamacare subsidies would cover my premiums in full. However, the deductible is nearly $6000, which is slightly more than 1/3 of my projected income. Even though my house is paid off and my lifestyle simple, there's no way I can afford to pay that much. My winter heating bill will take more than 50% of what's left.

    I know that Ocrevus has a patient-assistance program, but their website doesn't spell out the particulars. I am assuming that I would still be responsible for paying the facility that administers it, as well as the staff, and I have no idea how much my neuro charges.

    Then there are the yearly visits to my GP (for prescription renewal, among other things) and the mammograms that are required for Ocrevus. The daily prescriptions themselves don't bother me, because they're quite affordable through Sam's Club.

    I know that there are a lot of people out there without insurance who have been stuck in the 2-year waiting period, but how did you handle it? Any suggestions of what I should do?

    i don't know whether to get the private insurance and limit myself to whatever treatment co-pays I can cover, or just skip everything until Medicare kicks in. The Ocrevus alone would max out my deductible, and I already know I can't pay it. If that's already out of the question, would I be better off just paying cash for my necessary PCP visits and skipping everything else for 2 years?

    #2
    Originally posted by NoraS View Post
    Having been without health insurance for 15 years, the only way I was able to get my diagnosis was by signing up for Medicaid last spring. However, Welfare has verified that if I get the amount of SSDI that the SS caseworker told me, I'll lose the Medicaid.
    Oh wow; I'm so sorry!

    Let me recap to be sure that I understand.
    - Last year, you signed up for Medicaid. Your income was low enough that you qualified.
    - You have recently applied for SSDI. If approved, this will increase your income so you will no longer be eligible for Medicaid.
    - SSDI has a two year waiting period before you'll be eligible for Medicare. During this two year gap, you'll be eligible for affordable insurance through the ACA, but your deductible is high.
    - The expenses of Ocrevus and other medical costs will likely be beyond your ability to afford them, with the $6000 deductible.

    My only suggestion is to look into the possibility of purchasing a lower deductible plan. Even though the premiums would likely no longer be covered, the premiums might be more affordable than the deductible.

    My guess, though, is that if this were possible, you'd have already thought of it. The option to choose your deductible might not be available?

    I hope someone else will have a workable suggestion. In the meantime, have you talked with the nurse at your doctor's office about it? Maybe she (or he) will have an idea.
    ~ Faith
    MSWorld Volunteer -- Moderator since JUN2012
    (now a Mimibug)

    Symptoms began in JAN02
    - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
    - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
    .

    - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
    - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

    Comment


      #3
      Question:. Will you be eligible for any SSDI back pay?
      ~ Faith
      MSWorld Volunteer -- Moderator since JUN2012
      (now a Mimibug)

      Symptoms began in JAN02
      - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
      - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
      .

      - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
      - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

      Comment


        #4
        Yes, I'd cut my hours so much and was missing so many additional days that I qualified for Medicaid in February. Because of my work history, any Disability I get will just bump me over the income limit.

        I'll look over them again, but I'm pretty sure that the deductibles didn't go much lower.

        I meet with the neuro on Friday to discuss whether to continue the Ocrevus after my reactions to it, so I'm going to lay it all on the line for him and see what he can suggest.

        On a good note, I've followed a pretty set pattern of only having major attacks every 3-4 years, so I could just gamble on having Medicare before something else happens. Of course, it would be really nice if the Ocrevus could prevent that from happening!

        Comment


          #5
          As far as back pay, I don't think so. The caseworker did mention the possibility of going back to August, because that's when I started an online application, but she didn't seem very positive about it. I'd hoped that it could go back to when I stopped working full time, but I think that's too much to wish for.

          And adding to my other out-of-pocket costs, the insurance won't finish paying off my CPAP for something like another 14 months, so that'll be an additional $150-$200 a month once I'm dropped by Medicaid. I can handle that one, as long as I'm not paying insurance premiums.

          Comment


            #6
            The Ocrevus program is QUITE generous and worth pursuing. If you stay on Ocrevus, when you get Medicare it will be billed under part B which is much cheaper than part D.

            Comment


              #7
              Saw the neuro this morning, and he wasn't the least bit disturbed by the possible loss of insurance. He verified that Ocrevus covers 100% of the infusions for several of his patients, and he's pretty sure I'd qualify if I can't afford private insurance.

              I'm still checking into various insurance policies, but this is a major load off my mind!

              Comment


                #8
                Originally posted by Temagami View Post
                If you stay on Ocrevus, when you get Medicare it will be billed under part B which is much cheaper than part D.
                Nora, this is good news. If it's billed under Part B (medical) instead of Part D (rx drugs), it's possible that it will be affordable.

                I encourage you to call:
                (844) OCREVUS (844-627-3887) . They will likely be able to answer many of your questions and perhaps put your mind at ease.
                ~ Faith
                MSWorld Volunteer -- Moderator since JUN2012
                (now a Mimibug)

                Symptoms began in JAN02
                - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
                - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
                .

                - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
                - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

                Comment

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