Health Insurance in Texas

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Kattysmith
Kattysmith Member Posts: 738
edited November 2016 in Employment, Insurance, and Other Financial Issues

Howdy,

I got laid off last October the same week that I got my diagnosis of Stage 4 Breast Cancer (they weren't related events). My COBRA coverage lasts until next March, and I will be eligible for Medicare in August 2017 when I turn 65. Under COBRA, I am covered by Blue Cross/Blue Shield and am being treated at MD Anderson. I took early retirement and got approved for disability. I won't be going back to work.

I am scared to death about what insurance will be available after COBRA ends that will allow me to continue at MD Anderson. Texas is a nightmare as far as ACA; many companies don't participate and cancer patients have found themselves without access to MD Anderson. This is where I need to stay because I'm Stage 4. My COBRA insurance is expensive (what isn't?), but it's been good so far. Everything has been approved. I wish I could stay on the same plan.

I want to start researching now. Is anyone else here from Texas who is no longer working? What insurance do you have?

Any advice?

Thank you!!!

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  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited October 2016

    Katty, you are probably going to have to wait to research until November when open enrollment starts. Right now we don't know what plans will be available. A lot of this year's plans won't be available next year. Scott & White is pulling out (I got my letter more than a month ago that my plan won't be available.). I'm pretty sure BCBS is not planning on offering any PPOs. Sadly, based on what is available in Dallas, I would be very surprised if M.D. Anderson is covered on any of the exchange plans. UT Southwestern is not here.

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  • keepthefaith
    keepthefaith Member Posts: 2,156
    edited October 2016

    My current plan will not be available either...I have had to change insurance every yr since my DX. I hope I can get something affordable that has my providers in network next yr. It is something we should not have to worry about, esp during treatment. I'm sure you have already checked, but maybe someone at MDA can give you some information. I have a friend, whose husband has Multiple Myeloma. He has been on disability and Cobra for quite some time. Seems like maybe they got it extended...? I'm not sure. If I think about it, I will ask her and let you know if I find something that might be helpful. Best wishes.

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  • goldie0827
    goldie0827 Member Posts: 6,595
    edited October 2016

    We are having trouble here in AZ too. We had Humana, they are pulling out of AZ. We are being told that we can only go to doctors in our county. I live in a very rural county, hardly any doctors here, let alone specialist. And by the time we pay our premium and deductible, it will have cost us over $50,000.00 for 2017. And that's not with a PPO. A lot of people don't even make that much a year!

    Yes, I said $50 K.

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  • Kattysmith
    Kattysmith Member Posts: 738
    edited October 2016

    It is ironic - and by ironic I mean effing crazy! - that I live in Houston, a city that has a world-renowned cancer center, but it is getting harder and harder to access it, because the major insurance companies have pulled out. Grrrr!

    $50,000 is nuts! It should not be that way under any system, ever.

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  • Kattysmith
    Kattysmith Member Posts: 738
    edited October 2016

    Thank you!

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited October 2016

    I believe that if you are found to be disabled, which at stage IV and eligible for compassionate allowance from SSA you can be, you can then extend your COBRA by 11 months, for a total of 29 months. You would need to contact SSA and expedite approval if you have not already done so. That would tide you over to the point where Medicare coverage can take effect due to age, and you can elect a Medi-gap plan to cover what Medicare does not. Here is a link with info, see Question 13:

    https://www.dol.gov/ebsa/faqs/faq-consumer-cobra.html?links=false

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  • MinusTwo
    MinusTwo Member Posts: 16,634
    edited October 2016

    Katty - hope you are able to get the extension coverage Special is talking about until Medicare kicks in.

    Once you turn 65 you should be OK. I am in Houston and on standard medicare with a medigap policy through AARP. I have never had any trouble getting in to see any docs or hospitals that I chose - with no referrals - and Medicare had paid for everything. Literally not one thing that was billed correctly was denied. Five surgeries, rads, chemo, numerous scans... just one round of my infusions was $75-90K and I had 9 in one year, plus Herceptin. I am so thankful for this coverage.

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  • Kattysmith
    Kattysmith Member Posts: 738
    edited October 2016

    Thanks, Special K &Minus Two -very reassuring!

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  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited October 2016

    Kathy, you might also check w/ MD Anderson to see if they have a social worker who assists patients with financial/insurance issues. Many medical centers do, and they can be quite helpful. Good luck getting this sorted out.

    (My sister lives in TX and I'm always taken aback by the limitations she encounters compared to our situation up north...)

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  • pajim
    pajim Member Posts: 2,785
    edited October 2016

    Hopeful82014, I was going to suggest something along the lines of SpecialK's suggestion. It sounds like you need insurance for five months until Medicare kicks in.

    What about contacting your old HR department and explain? Play the cancer card and ask if you can extend your COBRA for five more months.

    It's not costing them any cash out of pocket -- you're paying that -- so they may be willing to do it.


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  • etnasgrl
    etnasgrl Member Posts: 650
    edited November 2016

    Katty....talk with your nurse navigator! I live in the Houston area and went to MD Anderson. I didn't have an issue with insurance, but my nurse navigator told me that if I ever did, she would be the one to talk to.
    Your nurse navigator can absolutely point you in the right direction!

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