How hard will it be getting insurance when we move out of state?

Char2010

Cycle-path - I did have continuous coverage - was moving of a Cobra plan. So it was probably to determine the up-rate?

cycle-path

"So it was probably to determine the up-rate?"

Right. If you had a hangnail once, they'd charge you 10% more than the "normal" rate.  If you broke your finger, they'd charge you 20% more than the "normal" rate. If you'd broken your ankle and had a bloody nose, you'd pay 30% more. And so on. 

(I use the word "normal" very loosely because I don't think anyone gets it). 

Char2010

So it sounds like even if they "have" to offer you coverage, most people with a pre-existing condition cannot afford it.

mccrimmon324

My husband is most worried about the cost of the insurance, I'm worried about not being able to get it. You ladies have eased my mind so much.  At least I no when the time comes I will be able to get the insurance. 

Fearless_One

HIPPA Guaranteed Coverage is only available when certain conditions have been met:

 What is HIPAA (sometimes incorrectly referred to as HIPPA)? How can the HIPAA laws help me in obtaining health insurance coverage? Why should I even care about HIPAA? You may find the HIPAA laws as a very integral part to helping you to find comprehensive and low cost individual health insurance coverage.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was designed to help those people who have kept continuous health insurance coverage and for reasons beyond their control are unable to continue or obtain health insurance coverage.

One of the main things that HIPAA was designed to combat is the idea of "Job Lock". Job lock is a situation where an individual wants to leave their job but they still stay at their job because they are on the employer's group health plan. The employee does not want to leave the job and its benefits behind because the employee is concerned that they will be unable to obtain any other coverage due to a major health problem.

HIPAA plans are individual health insurance plans that are most of the time exactly like a regular individual health insurance plan from top companies like United Healthcare, Blue Cross Blue Shield, Aetna, Humana, Celtic, etc. The only difference is that the HIPAA individual health insurance plan is underwritten on a guaranteed issue basis. That means that an individual with a health issue such as cancer or diabetes that would most likely cause them to get turned down for a fully underwritten regular individual health insurance plan will be approved if they meet the criteria for a HIPAA eligible plan.

There are 6 criteria that must be met in order to qualify for a HIPAA eligible individual health insurance plan.

1. You must not have any other health insurance coverage (or it will be involuntarily terminated soon - for example: the end of your 18 months or 36 months under COBRA coverage is approaching soon). If you are offered benefits at a new employer then the moment that you become eligible for those benefits you cease to be eligible for a HIPAA plan.

2. You have been insured by creditable coverage (creditable coverage being defined as having a full comprehensive major medical policy and not just a plan that is supplemental in nature or insures only against accident, disability, or liability) for the last 18 months or more with no lapse of coverage of more than 63 days.

3. Your most recent coverage was under a group health plan, a governmental plan, or a church plan; or under an individual plan that terminated due to: the insurer's insolvency, the insurer's discontinuance of all its individual coverage in your particular area; or the fact that you no longer live in the service area of your prior insurance company.

4. Your most recent coverage was not terminated due to nonpayment of premiums, fraud, or intentional misrepresentations.

5. You are not eligible under a conversion plan, a group health plan, Medicare, or Medicaid.

6. You accepted and exhausted any group continuation of coverage (including COBRA) that was offered to you.

Like I said in my first post, coming off of a group plan is an entirely different animal.   Mccrimmon324, I strongly urge you to keep whatever insurance you currently have.

mccrimmon324

I'm sorry to sound like a complete idiot.  But here is our situation.  We live in Florida and our insurance is currently thru my husbands job. 

We are both very unhappy in Florida, all of our family and friends are in Pennsylvania, we have absolutely no one here.  It made going thru treatment extremely hard for both of us, now we just want to go home. 

If I understand, once my husband leaves his job we can get cobra and then switch to the new group plan offered by either of our new employers when we get new jobs and I should be fine.  There would be no lapse in coverage.   

Fearless_One

Mccrimmon, you are NOT an idiot!  This stuff gets really complicated.   Anyways, from what you just said, you should be just fine.   If you are going from one group plan to another (i.e. his old job in Fla to a new one in PA), with no gap of more than 63 days - you will have no problem.   You have so much more protection under group plans.

I initially thought you were going from a group plan to an individual one with some time in between the two.

No worries - you will be fine!   Keep in mind, he may have to wait 90 days from the start of his new job for insurance to kick in, so you will need to keep Cobra until that happens.   It just depends on his company.   I usually have had a 90 day wait with most jobs.

You can carry COBRA for at least a year, even more if you file an extension.  

cycle-path

Good info above from Fearless_One. I agree with her 100% -- if you're going from a group plan to another group plan (or even from a group plan to an individual one) you should be fine. (I also agree that you're not stupid and that this stuff is mighty complicated! Sometimes I'm amazed that I understand it at all.)

Char: "So it sounds like even if they 'have' to offer you coverage, most people with a pre-existing condition cannot afford it." 

It's definitely more expensive if you have a pre-existing condition AND are going from a group to an individual plan. "Cannot afford," of course, depends on how much more expensive it is in your particular case and what your financial situation is. I wouldn't give up hope without trying. 

mccrimmon324

Thank you, I think this post of yours alone will ease his mind.  He's very worried, I'm trying to be his rock when it comes to this stuff.  Now all we have to do is find jobs and a place to live.  We certainly have our work cut out for us but we got down here I'm sure we can get home.

mccrimmon324

Spoke to my oncologist yesterday, he still seems to think will have problems getting insurance.  He says that I should call an insurance company and get a formal quote just to see what type of coverage and an estimate of the cost.  Not really sure where to start on that one.  We'd like to move back to PA, so BCBS of PA? 

riverhorse

I think that HIPPA already covered portabiity of insurance including pre-existing conditions.  Here is the link

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html 

Char2010

Mcc - start with BCBS, also google high risk insurance pools and see if Pennsylvania has one

mccrimmon324

Thank you.  PA does not have a high risk insurance pool but I did google BCBS, tried to get a quote, ended up with another company.  I swear this is the one area, I just don't understand, the more I try to learn the more confused I get.  I feel an imbecile. 

ICanDoThis

What we finally did was call our insurance agent who had provided coverage on our house and cars for years and ask to talk about medical. They had one full-time person who did nothing but know about medical insurance.

His recommendations were free - only got charged when we finally talked with several recommmeded companies, and made a selection. He got a small referral fee. I guess it was more of a service they provide.

I am very tired of trying to become an expert on everything. So, I've finally decided that I will become an expert of finding people who know what they're doing, and pay them to do it. I don't need the stress.

I would hit the yellow pages, and look for an insurance agency you would be willing to trust your home and car insurance to -- you are going to have to do it anyway.

lauri

Maybe the key is for one of you to find a job with benefits in PA before you make the move -- in the current economic situation, there are people who exhaust their COBRA before finding a permanent job.  (Or one of you should find a part-time job with benefits and take it just for the benefits -- I've heard of good things about Starbucks and Java Juice.)

cycle-path

mccrimmon: "Spoke to my oncologist yesterday, he still seems to think will have problems getting insurance."

I just fail to understand why your oncologist's opinion on this carries any weight. He pretty obviously doesn't know anything! You have a group plan now. Therefore a new insurer is REQUIRED BY LAW to cover you. PERIOD!!! Tell your oncologist to go back to practicing medicine and leave the insurance to people who know about insurance. Sheesh. 

As far as insurance quotations go, you can get a worst case scenario by contacting an insurance agent and asking them the cost for a HIPAA policy.  

mccrimmon324

Thank you Cycle path, honestly I have no idea why we seem to think our onc knows about insurance.  I guess becuase we think he's a fantastic doctor??  I'm really glad I started this thread, it's definitely eased my worries about insurance when we move. 

cycle-path

I'm sure he's a great doctor! But he just doesn't seem to know about insurance. 

That reminds me of a funny story. One day when my kids were very young I had some sort of ongoing medical problem with one of them. At a Friday appointment with the pediatrician I said something about how I didn't know how I'd handle the situation over the weekend. He wrote a phone number on a piece of paper and gave it to me.

"Oh!" I said. "Are you giving me your home phone number?"  

"Yes," he replied, and then he hesitated for a moment. "You don't work for an insurance company, do you?"

More than 20 years later that still makes me chuckle. But more to the point, it made me realize that relationships between doctors and insurance companies are entirely adversarial. We patients may dislike our medical insurance companies, but I've come to realize that doctors dislike them much, much more.

And that's probably why your terrific MO is so leery of anything that has to do with an insurance company.  

Liz08

Hi lades,

I've skimmed your posts, now I have an insurance question about HIPPA coverage.  I understand how the HIPPA act is supposed to protect us.

I've been continuously covered by an individual plan (not group plan) which I got approved for prior to my cancer diagnosis, I'm transitioning to a state which is ouside of the service area that my individual insurance policy covers, do I quality for HIPPA? How does that exactly work?  

And who do I contact about HIPPA coverage?

 I've checked into the state high risk pool & the rates are almost $1,000 a month with no meds covered & all care, including preventative, is subject to a high deductible.   Both my husband & I are self employed but with the horrible economy, our income is a joke.  Both of us are & have been doing resumes like crazy trying to secure employment with benefits.  

I have no clue where to begin.  Any information would be appreciated.  Thank you.   

flash

Every state has an insurance comissioner or office of insurance that regulates that state.  It is the best place to get accurate information regarding which companies and what things are available in that particular state.

cycle-path

Lizzy, if you look up this thread to a post by Fearless One (it's all in bold) you'll see information that will answer your questions. To get HIPAA coverage, just contact an insurance agent in your new state.

However, be warned that HIPAA is usually pretty expensive! It may not be less than the state's high risk pool. 

Liz08

Thank you for your responses! 

I think I may have to bite the bullet, hope & pray for the best & go with out insurance for 6 months to get into the federal high risk pool.  We just can't afford an extra $1,000 a month bill with already being short in covering our present bills, thanks to the horrible economy.  With being aggressive & not picky, hopefully, either my husband or I will secure a job with benefits with in the 63 days that are allowed in the lapse of coverage.

flash

check your state's high risk pool also.  depending on the state, it could be a better answer

AmyIsStrong

Check the prices on your state's high risk pool.  I am in the one for my state (MD)  - it is just under $800/mo for the highest deductible policy. It is $5000/year deductible, so needless to say, since my active treatment is over, it has not paid anything yet. But I am not complaining, I am very glad to have it in case something big and bad does occur. But I am mentioning this to you specifically, Lizzy - so that you do not drop your insurance and think that the state high risk pool will be a whole lot cheaper. It isn't, in our case.

Mcrimmon - my advice would be NOT to relocate until one of you definitely has a job IN HAND that provides a health insurance group policy. It is VERY possible if you relocate, that you could both find jobs, but neither of them offers health ins. And THEN you would be in the situation your onc warned you about.  MANY companfer do not offer health insurance, or you could get jobs as contractors (rather than employees - many companies are going that route now) and not have a group plan available to you. And then you would have to buy an individual policy on the open market and run into trouble.  So I think that the onc's concerns do have some validity. Of course I don't know the type of work that you and your husband do - maybe it is something that is easy to find work with a big company and get benefits. I don't know - but please be careful. This IS a tricky area and you do NOT want to be left scrambling.

Amy 

mccrimmon324

I have another question about insurance.  My onc and I want to do the BRAC test however he says that some people don't want the test for fear of the insurance plans not covering them if its positive.  Is this something they can do?

poolas

Just some info for you. BCBS in PA is Highmark BCBS so you might give them a call!

cycle-path

Heather, since you've already had BC, you already have a pre-existing BC condition. A new insurer can refuse to cover BC-related treatments for up to 18 months. I don't think being BRCA positive would change this -- as I say, they're already going to think you have a pre-existing condition. Even if you came back BRCA negative it wouldn't change this for you. 

Liz08

Heather-

utimately it's your choice to have the genetic testing. There's pros & cons to any test. Research both & then make your decision.  Would you do anything different (double mast & ovaries removed?) if you tested positive or would it just cause more anxiety?  I've read alot of insurance literature lately & I've read that genetic testing will not be considered in absense of symptoms BUT you've already had BC.  So if your BRAC comes back postitive & you've had BC, then would BC  & the BRAC test results ALWAYS affect you being able to get insurance & the rates for the rest of your life?  I was also told that with insurances, once you're atleast 5 & for some insurances 7-8 years out from diagnosis it becomes easier to get insurance. Most insurance companies go back up to 10 years anyway.  BUT if you test postive for the BRAC test, then it may ALWAYS work against you. If you tested postivie for the BRAC but never had BC then it wouldn't be counted against you. For now, group insurances will accept you without exclusions if you didn't have a break in coverage for 63 days or more. Also, U.S. healthcare is in serious state of uncertainty.  I've spoken to many insurance agents/companies & ALL tell me that they don't know what will happen in 2014.  I already know that the state high risk pools are not affordable & to get into the federal high risk pool (which is more affordable), you have to risk your life since you have to be uninsured for 6 months before you can even apply & then it takes the gov't another month to process your application, so actually you have to go 7 months without any healthcare coverage. Very scary...

mccrimmon324

Ok, I realize I sound like an idiot, I just can't comprehend insurance.  As long as either me or my husband find a job with a group insurance plan, and I'm on cobra, which lasts for 18 months, with no lapse in coverage, I should be fine with both my Pre-existing BC and if I were to test positive for the BRCA gene? 

Now, we don't need to disclose our health to future employers either right?  That would be considered discrimination? 

Thank you so much for all the info.  I know it seems crazy that we would move and risk the insurance, I really don't like to play games like this and the insurance is extremely important.  I'm an office worker so I don't think getting in a group plan would be difficult at all provided I find a job.  We are going to relocate closer to the city so hopefully that will be in our favor. 

We are just miserable here, we have no friends or family close.  Going thru treatment without anyone here made us realize there are some things more important, I don't want to waste another day being unhappy. 

Make sense?

cycle-path

Nope, you don't sound like an idiot at all. 

"As long as either me or my husband find a job with a group insurance plan, and I'm on cobra, which lasts for 18 months, with no lapse in coverage, I should be fine with both my Pre-existing BC and if I were to test positive for the BRCA gene?"

Let's just assume you get tested for BRCA and are positive, since that's the worst case scenario here. 

I hadn't noticed this before but Lizzy mentioned it. The pre-existing BC and BRCA+ are two separate issues and there are two separate rules about them. Regarding BRCA:

"HIPAA prohibits plans from applying a preexisting condition exclusion to pregnancy, genetic information, and certain children." In other words, under HIPAA, your BRCA status can't be considered by an insurer.

Regarding pre-existing BC:

"Under HIPAA, a plan is allowed to look back only 6 months for a condition that was present before the start of coverage in a group health plan. Specifically, the law says that a preexisting condition exclusion can be imposed on a condition only if medical advice, diagnosis, care, or treatment was recommended or received during the 6 months prior to your enrollment date in the plan. As an example, you may have had arthritis for many years before you came to your current job. If you did not have medical advice, diagnosis, care, or treatment - recommended or received - in the 6 months before you enrolled in the plan, then the prior condition cannot be subject to a preexisting condition exclusion. If you did receive medical advice, diagnosis, care, or treatment within the past 6 months, then the plan may impose a preexisting condition exclusion for that condition (arthritis). In addition, HIPAA prohibits plans from applying a preexisting condition exclusion to pregnancy, genetic information, and certain children.

"If you have a preexisting condition that can be excluded from your plan coverage, then there is a limit to the preexisting condition exclusion period that can be applied. HIPAA limits the preexisting condition exclusion period for most people to 12 months (18 months if you enroll late), although some plans may have a shorter time period or none at all. In addition, some people with a history of prior health coverage will be able to reduce the exclusion period even further using 'creditable coverage.' Remember, a preexisting condition exclusion relates only to benefits for your (and your family's) preexisting conditions. If you enroll, you will receive coverage for the plan's other benefits during that time." 

In other words, a new group plan can refuse to cover any treatment for a BC-related condition for either 12 or 18 months.  

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

"Now, we don't need to disclose our health to future employers either right?"

Right, and personally I would not. I've heard too many horror stories.

I know you're very concerned about all this and I think you have every right to be. Here's what I would do if I were you. Go shopping for new coverage right now, not to buy it but to find out what's available. Call an agent and disclose your pre-existing condition, saying that you're now covered under a group plan but you think you'll be leaving your jobs and will need to purchase individual policies. Find out what would be excluded and for how long. Confirm whether BRCA+ can be held against you.

I think doing that will give you some peace of mind. And good luck!