There are still lifetime caps on insurance!

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carmstr835
carmstr835 Member Posts: 388

Mine is $1,000,000. I have rarely been sick all my life. I paid extra all my working years to have good healthcare in my retirement years. I retired in July 2014. I just received a letter from my insurance company telling me I am approaching my lifetime cap. I have spent almost 1 Million dollars of insurance on this Bilateral Her+ breast cancer diagnosis and treatment. I have no other medical issues or problems and there were no extenuating issues with my surgeries chemo or radiation. All expected normal cancer costs and it is almost 1 million; I won't have any more outpatient coverage. How can this be acceptable? 1 out of 8 woman will get breast cancer in their lifetime and that will max out their insurance for life? Obama care was supposed to do away with lifetime caps, but not for Michigan teachers or religious organization insurances. Some powerful organizations were able to be exempted from this 1M cap. Teachers are mostly women and retire about the time they will most likely get breast cancer. So all this insurance, we worked our full lives for, can be wiped out in 1 diagnosis of cancer. I calculated the months of premiums it would take to cover 1M and that is just 52 years of premiums for each Million in payments. Teachers teach about 30-40 years each, then retire and if 1/8 gets cancer, it only takes 2 to cover that million in payments. I have a feeling this keeps the insurances companies with lots of profits and our expense. I guess that is a way the insurance company can wipe their hands of any recurrences because there is no way I have the insurance coverage left for chemo again or even very many scans. If the cancer comes back and I don't get my scans to find it early, most likely it will not be anything I can beat. It will then probably be a death sentence. In 3 years , I am now 63 years old and will soon have no health care for outpatient coverage. My Her+ chemo and scans for year took most of my coverage. I never should have done this reconstruction surgery because this is all outpatient and falls under my 1M dollar cap. I need another surgery early next year but I will probably not have it done. I will just be lopsided and deformed. Had I known that, I would have not had my bilateral DIEP and would have stayed flat.There should be help for us. I called the American Cancer Society (AMC), they just referred me to the Breast Cancer Foundation (BCF) that requires a $50 application fee to see if they will help. Nobody answers their phone, their voicemail is full, and they say they are out of the office for the next several weeks. It is very easy to donate money to them, but to get help from them, it is a maze and lots of ways to get lost. I found nothing that will help me either at ACS or the BCF. Also, they say on their website they will not help anyone that has a household income of over $29,000. It is only for those that are in poverty. Poverty people have medicaid what do people do that worked all their lives, paid taxes, and paid into their retirement health care and pensions? Now will not have the life saving medical coverage that is necessary for any of us with a cancer diagnosis. It's all about the money.

Comments

  • DeeDeeT
    DeeDeeT Member Posts: 76
    edited October 2018

    This is truly unacceptable. I'm so very sorry. Am I correct that you have only been receiving treatments since last year? This is just wrong.

  • carmstr835
    carmstr835 Member Posts: 388
    edited October 2018

    Yes, diagnosed March 13, 2017. No other health issues at all just bilateral Her2+ IDC breast cancer. No medications or anything.

  • DeeDeeT
    DeeDeeT Member Posts: 76
    edited October 2018

    Oh that's awful. I wish I had a solution to this. Honestly, it terrifies me too, because I think we have the same insurance cap. I'm 44. I had severe migraines and physical therapy for frozen shoulder before getting breast cancer. I never worried about a cap before, because 1,000,000 sounds like so much. Maybe not so much over the course of a lifetime. Yikes!!

  • carmstr835
    carmstr835 Member Posts: 388
    edited October 2018

    Well chemo for a year; herceptin and Perjeta, Her2+ breast cancer treatment is $65,000 every 3 weeks for 1 year that is over 1 million if they paid the full price, but they didn't, they actually paid only 23,000 so it was 400K, but half of my lifetime out patient medical coverage.


  • hapa
    hapa Member Posts: 920
    edited October 2018

    Will you not qualify for medicare in 2 years?

  • buttonsmachine
    buttonsmachine Member Posts: 930
    edited October 2018

    I'm sorry you're going through this. You're right that it's unacceptable!

    There is a new study on this I've been trying to call attention to. According to the study, nearly half of us will totally deplete our assets paying for cancer treatment within two years, and average losses were around $92,000. Importantly, the study notes that "large financial burdens have been found to adversely affect access to care and outcomes among cancer patients."

    What you are describing is exactly part of this problem. My hope is that there will be reforms and this will get better one day. Best wishes to you, and thanks for calling attention to this problem.

    The thread I started on this is here: https://community.breastcancer.org/forum/113/topics/867808?page=1#idx_4

    The original study is here: https://www.amjmed.com/article/S0002-9343(18)30509-6/fulltext#/article/S0002-9343(18)30509-6/fulltext


  • carmstr835
    carmstr835 Member Posts: 388
    edited October 2018

    Thankyou Buttonsmachine. We have work to do!

  • Lumpie
    Lumpie Member Posts: 1,650
    edited December 2018

    Carmstr835: Let me, too, say that I am sorry you are going through this.

    ACA (Affordable Care Act) policies should not have lifetime limits.

    The cost of care can be astronomical. Depending on what drugs you are getting, infusions every 3 weeks can be $15,000 to 25,000 or more. Yes. Every three weeks. Add on top of that diagnostics, scans/imaging, surgery, labs, office visits, hospital stays and other pharmaceuticals and this can add up to $500K per year. Truly extraordinary. Even if you have never had an illness or surgery in the past, this type of catastrophic illness can be.... well.... catastrophic. Very few people could absorb even a fraction of this cost out of pocket.

    Buttonsmachine: I am going to check out your thread. Thx.

  • NotBrokenJustBent
    NotBrokenJustBent Member Posts: 394
    edited December 2018

    A Federal judge has struck down Obamacare and called it "unconstitutional". Many of us will be facing this issue of maxing out of our insurance if on appeal the Judge's ruling stands. Yep, a million dollar max does not go far these days.

  • Lumpie
    Lumpie Member Posts: 1,650
    edited December 2018

    I am posting these links on a couple of threads:

    If there are coverage junkies out there watching the various proposals, there is a good summary of the various Democratic proposals here:https://www.vox.com/2018/12/13/18103087/democrats-...

    and an interesting libertarian-leaning proposal here: https://niskanencenter.org/blog/ahca-catastrophic-... ((aspects seem promising but it achieves cost savings primarily through lifetime caps so that's a no-go.)

    Watching this thread re the ACA, too: https://community.breastcancer.org/forum/113/topic...


  • jessie123
    jessie123 Member Posts: 532
    edited December 2018

    I thought the judge is challenging the legality of taxing people who don't have insurance.

    Had not though about maxing out insurance. Does anyone know if Medicare has a lifetime limit?

  • Meow13
    Meow13 Member Posts: 4,859
    edited December 2018

    I don't think medicare has a limit. My blue cross blue shirld doesn't seem to have one either. I haven't had alot of expense treating my cancer. I am not actively receiving any treatment. My DIEP surgery and hospital stay was under $100,000. That was the most expensive part of this journey.

  • Meow13
    Meow13 Member Posts: 4,859
    edited December 2018

    Herceptin and perjeta are sooo expensive, you have to ask why? Doesn't seem fair.

  • Beatmon
    Beatmon Member Posts: 1,562
    edited December 2018

    Good question, are they counting billed 1 million...they certainly didn’t pay 1 million out as you noted. I’m so very sorry that you have to worry with this and try to stay alive at the same time. I’m well over a million lifetime charges

  • Lula73
    Lula73 Member Posts: 1,824
    edited December 2018

    carmstr- here’s what I found about limits in grandfathered plans. If MI teacher insurance enrolled new employees in the same benefit plan you’re on after March 23, 2010 and the rate for plan holders has gone up substantially (which I’m sure it likely has), you may have a case to get them ungrandfathered which would mean no more max coverage limit among other things.

    image

  • Meow13
    Meow13 Member Posts: 4,859
    edited December 2018

    Well, I am worried, I am afraid all of us having breast cancer if it comes back they will say pre-existing condition sorry. Could be very expensive for us.

  • carmstr835
    carmstr835 Member Posts: 388
    edited December 2018

    Thanks, Lulu!

    I believe the state of Mi has complied with the law so they can continue the million dollar cap. I believe the new hirees are no longer a part of our retirement health care. Our union would have checked, but I will pass this info to them to be sure. Meow13, yes I still will have a cap when I am old enough for medicare, but the million dollar cap starts over, so I think as long as I don't have a recurrence, I should be fine. I just need to get to 65 before I hit the cap. I am about $850,000 now with at least one more revision surgery and scans every 6 months.

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