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Health insurance hoop-jumping with a pre-existing condition

May 24th, 2013 at 08:37 am

Since my Cobra ends 6/30/13, Iíd been focusing on what my options were. Iíd assumed Iíd have to go on Charter Oak, the state high risk pool plan at $589/month. But then I got this new contract job where I start work Tuesday, and like most recruiter employment agencies, they offer health coverage to their contract employees. I went to check it out and saw they offered 5 options for health plans but all but two of them required you to be a New York resident. Of the two, one was a high deductible plan which didnít suit my needs and the other, well, I spent quite some time yesterday filling out their application, reviewing the plan benefits and talking to a rep. I had a lot of questions as this plan is offered through a union which you have to join to enroll in the health plan and there was a ton of forms. But I thought the monthly premiums were pretty decent, at ďjustĒ $500 (compared to the $562 Iím paying now thru Cobra), plus you had to pay one-time union dues of $95.

Then, I learned very late in the game that they donít provide prescription drug coverage for the drug Iím on for the MS! Iíd have to pay out of pocket to the tune of $4,000 a month for this very expensive drug. (It used to cost about $1,000 a month when it first came out, but the drug-maker will lose its patent soon and is trying to recoup its R&D costs now, especially since 3 or 4 other drug-makers have released, or are about to release, an oral form of this medication, which will obviously be much more popular with patients than needles).

But of course thereís no way I could pay $4,000 a month for Copaxone, so after spending all this time preparing to apply for the union plan, I had to back out and return to Option B, which was the state Charter Oak plan.

That application will go out in todayís mail and the rep told me I should be able to be effective on it July 1.

Now yesterday when I spoke to a rep at my current Cobra plan, he suggested delaying my payment for the last and final month Iíll be on the Cobra (June) until late June. If I could avoid seeing a doctor or otherwise incurring any healthcare expenses, then he advised I simply donít make any payment for June at all. Although I usually would mail payment a week before the first of each month, they have a 30-day grace period for receipt of payment, so as long as the payment was postmarked by the last day of June, they would accept it and retroactively cover me for month of June.

If I didnít incur any healthcare expenses for June, then I could just skip payment for June entirely and be accepted onto the new state plan effective July 1. Under HIPPA rules, as long as thereís no interruption in healthcare coverage for more than 63 days, they canít deny you coverage for a pre-existing condition like MS. So my 30-day lapse in coverage wouldnít affect my coverage moving forward AND I would have avoided paying for the last month of my COBRA in June, and as it happens they increased the fees from the $562/month Iím paying now to $770/month, incredibly.

Iíve been stockpiling my expensive Copaxone meds for years just to ensure I have the meds I need in exactly this kind of in-between jobs scenario. While it looks like renewing my meds down the road wouldnít be a problem based on what I just said above, I was always nervous about this becus this drug is incredibly expensive. But by ordering my meds a little earlier than really needed, Iíve been able to accumulate a 7.5 month supply of Copaxone. (The expiration dates are long out, so no problem there.)
In fact, I was able to reorder the drug yesterday and already have it delivered. Now usually this particular mail order pharmacy would only give me a 30-day supply at a time, even though my neurologist writes me a prescription good for a year at a time. So I was surprised when I got the shipment that they included 3 months in it instead of 1. They must have changed their policies. Many other pharmacies DO ship 3 months a time. So that really helped me with my stockpile.

At least thatís one thing I donít have to worry about til probably October, which is when open enrollment begins for 2014 and the new healthcare exchanges made possible by Obamacare. At that time, unless Iíve gotten a salaried job that provides benefits like health insurance, I foresee myself shopping around once again for health insurance. It would be nice to get something cheaper than $589 a month under Charter Oak, but who really knows. I also noticed that the Charter Oak plan does not include my neurologist as an in-network provider, so while I have plenty of medication supply left to see me through 2013, if I had an unexpected MS problem/relapse, Iíd have to find a new neurologist.

Luckily, since Iíve been going to a bunch of physician lecture/dinners sponsored by the drug company that makes Copaxone, thereís a doctor I like and have become familiar with who is on the Charter Oak network. Heís maybe 30 minutes away, further than Iíd like in the middle of a MS relapse, but it would work.

I canít believe Iíve had to devote so much time to figuring out this whole health insurance mess. Mainly because Iím 1. Lacking in employer sponsored health coverage and 2. I have a pre-existing condition that requires expensive drugs.

2 Responses to “Health insurance hoop-jumping with a pre-existing condition”

  1. snafu Says:

    When the patent expires on Copaxone, how do you feel about using a generic if that becomes available? I was surprised to discover that the long awaited generic equivalent of Lipitor was more expensive than the original. While you may dislike your medical insurance and associated costs, you'd likely dislike or system even more.

    No premiums in a government organized system nor are providers allowed to charge a co-pay. BUT .48 cents of every dollar paid for gas for our cars goes to pay for our medical services. Funnily, tourists, visitors and people who do not benefit from medical services in any way, inadvertently help pay for our services. Likewise our tax rate is higher as an negotiated formula sweeps a percentage into hospital and medical care. Very few hospitals here are private, for profit business. Those mostly offer procedures that are considered not medically necessary like cosmetic or personally desired practices.

  2. scfr Says:

    Is my memory correct that you are a Costco member? Have you looked in to the Costco Personal Health Insurance? https://www51.aetna.com/iqs/costco/aimquote.do

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