Insurance

[homer]

I'm considering quitting my job to start a small business. Problem is, I have a pre-exsting medical condition. I'm on medication and haven't had any issues in almost two years but there's always a chance of a re-occurance. I was wondering if I could even get insurance? I would be happy to pay for it out of my own pocket and realize I'll probably have to pay a bit more than most due to my health background. This is really the only thing holding me back from pursuing this. Anyone have experience with this?

 

And please, don't insert your political feelings on the matter - there's a big long discussion on the political board about health care.

[Teatoe993]

I made the mistake of switching jobs with a pre-existing condition. The condition is just some random fluke. It's not because I live an unhealthy lifestyle or have heredity problems. I was able to get health coverage but they would not cover anything remotely related to my pre-existing condition. Shortly after, I had complications from a previous surgery and the doctor had to go in again. That was over three years ago. Last week I finally made my last payment for that surgery.

My advice to you would be to just stay where you are at. I doubt congress will ever work together to create a public option. The very least they could do ban the denial of people with pre-existing conditions. Until that day happens, you'd be better off staying where you are at.

[chadomac]

Like Tito said, I would recommend staying at your work in order to keep your benefits. Is staying on part-time an option there?

 

I used to work for a major health insurance company in Milwaukee and you definitly will be able to get coverage... it's just a matter of finding a policy that will cover your pre-existing condition. The chances of finding one that is affordable to you is very slim.

 

You can definitely get short-term or personal insurance yourself, but the better coverage you get the more you're going to pay - obviously.

[colbyjack]

I may be facing a similar situation, and was wondering what constitutes a pre-existing condition, and how does that work if you are simply changing employers and not paying for your own insurance? Do things like a skin disorder or sleep apnea count as a pre-existing condition?

[And That]

Do things like a skin disorder or sleep apnea count as a pre-existing condition?

Anything that you've been diagnosed with could eventually be considered a pre-existing condition.

 

Without making this political, I'd wait a few months to see how the health care bill plays out before making long-term plans about insurance, if possible.

[homer]

The thing with my pre-existing condition is that the medication I'm on makes me susceptible to a bunch of other things.

 

So maybe I have a pre-existing condition to everything. That would suck.

[And That]

I don't think elevated susceptibility to something makes it pre-existing.

[chadomac]

on one of the short-term policies we offered I remembered the terminology of the contract being something like "signs, symptoms, threatment, or diagnosis" of a particular problem/ailment/illness.

 

 

So if you went to a doctor the day your coverage started - let's say on a Friday - and he asked you how long you've been feeling ill... if you answered "Thursday" - THAT would be a pre-existing condition just because you felt the signs or symptoms of it before your coverage started.

 

 

Be careful and always read your contract first.

[Invader3K]

homer, I'm not sure if you happen to be married? Can you get coverage through a spouse or someone else, possibly?

[homer]

homer, I'm not sure if you happen to be married? Can you get coverage through a spouse or someone else, possibly?

No, still single. Know anyone? Preferably female...

[Invader3K]

You're in Chicago? Nope, no female friends down there, sorry. http://forum.brewerfan.net/images/smilies/wink.gif

[pretendastronaut]

I've been self-employed for 2.5 years, and have had plenty of experience with insurance companies in that time. I would be amazed if you found an insurance company that would cover a pre-existing condition. Most of them will attach a rider for the simplest of things, the important thing is to understand their rules about the rider.

 

For instance;

 

My wife had some back issues after being pregnant, and when we tried to switch insurances over a year later, careful review of the riders really opened up a lot of holes, such as, some insurance companies wouldn't cover ANY back related issues for her ever then. So if she got in a car accident and messed up her back and needed surgery as a result of that, it wouldn't be covered. The one we eventually went with pretty much put a time limit on anything they considered a pre-existing condition, and if in that time frame there are no other issues with that condition, they will re-evaluate the rider. Also, they waive the deductible for accidents for 30 days, for issues related to the accident, which is really unique. That's about the best we could come up with.

 

You take a lot more risk on by striking out on your own, you have very little protection in the law if you're not on an group plan. However, I wouldn't be so bold as to say never leave your job so you can have insurance. Depending on your business goals, you may be getting your own group plan that way initially.

 

It's important to not have a gap in coverage. If you leave, pick up COBRA as a stop-gap just in case. That ended up saving our butts pretty good personally.

[dadofandrew]

Homer, worst case scenario, you can get on a state program, though it is expensive, about $600/month. If you are in IL, I'm not sure what they have, but odds are, they got something.

 

I would not wait for health care reform, as that won't take affect until '14...if ever. It's really not reform anyway, it's Medicaid expansion, and as a single guy with no kids, you'd have to be under $12-14K to qualify.

 

If you are wondering about a specific thing, shoot me a pm and I'll look into it. However, don't let it stand in the way of your dreams...as you as you do things properly, health bills can't be a reason to make a lien against your business, if you set it up properly.

 

I do know many policies only consider it active if you have had issues in the last 3 years...of course, one trip to the doc, that'll stop that.

[homer]

Thanks, Al. I'm actually in grad school so I could get insurance that way, but there's a clause that says any pre existing condition cannot have re-occurred in the last year. I need to get more details on what that entails (1 year after you sign the policy? 1 year in general?) but this looks like my best option right now.

[homer]

OK, so my job situation became rather tenuous recently so I've been researching different options on this. Like I said, I have a pre-existing condition but I've also not had problems for about two years and have been continuously covered for like 11 years. I reached out to Aetna for a quote and of course read through the exclusions. It reads as follows:

 

during the first 12 months following your effective date of coverage, no coverage will be provided for the treatment of a pre-existing condition unless you have prior creditable coverage. A pre-existing condition is an illness, disease, physical condition, or injury for which medical advice, or treatment was recommended or received and/or the use of prescription drugs of any kind within six months preceding the effective date of coverage. services or supplies for the treatment of a pre-existing condition are not covered for the first 12 months after the member’s effective date. if the member had continuous prior creditable coverage within the 63 days immediately preceding the signature on the application and meets certain other requirements, then the pre-existing condition exclusion of 12 months may not apply.

 

So it seems like if I've had insurance, I'm covered although I'm wary about the "other certain conditions". I sent the sales rep an email asking for clarification in writing. Anyone else deal with this before?

[endaround]

Its hard to say. It will depend greatly upon the risks associated with your condition. For example I have a thyroid problem and have had it for years. In general that would be covered since its basically a $10 90/day prescription and a blood test now and again. But if it was cancer, no way could it get covered.

[dadofandrew]

If you've had coverage Homer, they should cover the pre-existing from day one. They are protecting themselves against you not having insurance for a while and now having issues and buying insurance.

[homer]

Thanks, Al. Yeah, pretty sure I'm covered but we'll see....

 

End, that makes sense. I have Crohn's disease which I treat with a $40 prescription every 6 weeks or so. I'll keep my fingers crossed.

[FVBrewerFan]

I could be wrong, but I thought most states (I don't know about IL) can not deny coverage to samll business (under 25 EE.) They can charge a ton, but not deny you for coverage. Your best chance is to get an HSA plan with a very large deductible ($5,000). And just expect that Dr. visits, Rx, etc. will be pais out of pocket. A tax deduction at least. But at the same time you're covered for major health expenses.

[endaround]

Are you going to go school full time now? If so your best bet will be getting insurance through the school if you can.

[mothershipconnection]

When I was in grad school they offered all students insurance for just under a grand per year. It wasn't great insurance (very limited providers, had to go through health services to get any kind of off-campus referral in most cases), but the price is pretty fantastic.

[homer]

When I was in grad school they offered all students insurance for just under a grand per year. It wasn't great insurance (very limited providers, had to go through health services to get any kind of off-campus referral in most cases), but the price is pretty fantastic.

Yeah, I've looked into it. They offer it, but it also has the pre-existing condition exclusion and they won't cover anything for 12 months after signature date. I talked to the Aetna rep about it and he said that's unusual.

[LouisEly]

In a past life I sold health insurance to self-employed persons and small businesses. Don't take what I say as gospel, as it has been over a decade and laws may have changed. In general, it probably will be difficult getting an individual plan with coverage of pre-existing conditions. Like Al said, last I knew there was a state program but it is expensive.

 

As far as group plans go with large employers, I don't think that large group plans have any exclusions for pre-existing conditions. I'm not sure what the limit is in terms of size of the group, but I believe there are laws that require large groups to cover anyone who joins that plan which is why those plans can be expensive for employers. They operate under the law of large numbers - the larger the group, the more accurately they can predict what their health care expenses will be and they know that a certain percentage of group members will have pre-existing conditions and major expenses. Thus why large groups usually don't have exclusions or pre-existing conditions - one person won't have a significant impact on the total expenses of the group. With our company, they send out an annual report of premiums paid and expenses and the total health care expenses of the group are something like $20M/year over a couple thousand employees, so one person really isn't going to change that number much.

 

I would recommend three things:

1) Find out what the annual cost would be for your expected health care in terms of cash price (prescriptions, medication, lab work, etc.). Find out average and worst-case scenarios for your conditions.

2) Talk to an independent agent about a plan with a high deductible (at least $1000, preferrably $2500 or more) with a copay for doctor's visits and prescriptions. Apply for the one that sounds best; if it comes back with riders/exclusions for pre-existing conditions you can decline it. I had this happen several times. Never hurts to see what they come back with, as you are not obligated. This way you know your options. Explain to your agent first what your situation is.

3) Look into a reinsurance plan; there are plans out there that don't cover anything under a large deductible (say, $10,000) but cover everything above that up to $1M or more. This may be your best chance for not having any riders/exclusions for pre-existing conditions; if you can absorb up to $10,000 in health care costs (thus knowing the cost of your care) but have anything catastrophic covered (100% over the deductible) you can limit your risk. If by starting your own business you are netting over $1000/month more and can get a reinsurance plan with a deductible of $10,000 you are financially ahead (i.e. possibly spending $10,000 more but making $12,000 more).

[sgtcluels]

Transfer to a Canadian school? http://forum.brewerfan.net/images/smilies/wink.gif

[craigharmann]

Try to shop around. My wife was covered under my insurance, however, I had to pay the premium. She had a "pre-existing condition" that kept her from becoming pregnant. Through diet and medication she was able to get pregnant. I figured out that this year, to continue under my employer's plan for my wife and daughter, would be $850 monthly. We could barely afford the $750 for the two of them last year, so adding another $100 was out of the question. I have a life insurance policy through a fraternal agency, and in checking with them, they offer health insurance and for the two of them, it is $388 monthly. Granted the deductible is a bit higher, but we're banking the savings. As for for the pre-existing condition, there is a 2 year rider from the last "treatment". After that, she should be covered. Don't know if that helps you in your situation, but check around.