The Best-Laid Plans of Mice and Men...

[Maurice]

About two weeks ago I was diagnosed with a rare genetic disorder that will require continuous treatment for the remainder of my life. This will effect my ER plans in two ways - first, the treatment is quite expensive, so I will be uninsurable except through state high-risk pools and guaranteed issue states like NY, NJ, ME, VT. Secondly, I will be tethered to a single geography because the treatments are weekly. The second is a bigger deal for me, as I have always been an inveterate traveler. On this second point there may be light at the end of the tunnel as a self-administered treatment option is in Phase III clinical trials.


So having this diagnosis (which includes a reduced life expectancy) makes me want to accelerate my ER plans - possibly even retiring now, which we could do if we leave NYC. So I'm trying to figure out where we'll go. Insurance availability and cost will heavily influence our decision.


Anyway, a couple of questions...

Has anyone priced out individual plans in NY, NJ, ME, or VT? I understand these are the states where individual plans must take all comers and cant price-differentiate among pre-existing conditions, therefore it would seem the costs would be pretty standard or maybe variable by age.


I'm sure it varies by state, but, in general, how do high-risk pool plans work? I know there are state subsidies involved, but are they means-tested? Do high-risk pools have a single price for all or do they price-differentiate among pre-existing conditions?


Thanks for any help you can provide.

 

[Moemg]

Maurice , Sorry about your troubles .

 

[Rich_by_the_Bay]

I'm also sorry about your recent health setback. Best wishes on your recovery and treatment.

Suggest you be alert to residency requirements before moving to a different high risk pool state. I think some require residency for 6 months before eligibility. Also, depending on the illness in question, you may be eligible to enroll in a clinical trial which could provide the treatment at no cost to you - check with local medical schools and research institutes.

Black swans... A reminder how fragile even the best of plans can be in the face of health setbacks.

 

[haha]

Sorry Maurice. I hope you will do well.

Ha

 

[bbbamI]

I'm sorry. This must be a very difficult time for you. I wish you well.

 

[FinanceDude]

Maurice, I am so sorry. Hopefully those Phase III clinical trials are positive..........

best wishes.........

 

[brewer12345]

Individual plans in NJ are pretty expensive, as you might imagine. I priced out a plan for 4 of us at $1600 a year, with hefty deductibles, co-pays, etc. In your case, I would look very closely at the lifetime maximum policy limit on any policy you are considering.

Sorry to hear about this. If you end up seriously considering Jersey, I'd be happy to answer what questions you might have, although being in NYC its not like we are talking about a foreign land.

 

[megacorp-firee]

Sorry to hear about your health problems Maurice. Best wishes to you.
I have no experience with healthcare in the NE.

 

[Ronstar]

Best wishes for successful treatment and a healthy future! but I cant offer any info on your questions.

 

[Maurice]

Thanks for the well wishes, everyone.


Brewer - thanks for that data point. If I could find a plan for anywhere near 1600 a year I would be ecstatic. From what I've been reading I should expect to pay closer to 1-2k a month. (for example, from this thread http://www.early-retirement.org/forums/f38/help-me-out-27532.html )


In that quote you received, do you remember how that co-pay and deductible worked? In my case treatment is ~2k per week (not a typo) so even barring whatever else gets thrown at me (like the not-insignificant consequences of my condition) I can already run up a pretty hefty bill on even a moderate co-pay.

Its also a near certainty I'll hit lifetime policy limits - I'm 26 years away from Medicare eligibility. Health care in the US could change pretty radically by then, but insofar as we have the same system as today then I'll probably have to switch plans after a decade or so, once I approach the limit.

Anyway, I'll be putting some serious time into researching this. Hopefully I'll be able to put together a good library of info on "how to retire early when you're responsible for your own health care and have a nasty pre-existing condition".

 

[Moemg]

I'd also research Social Security disability which I believe qualifies you for medicare now .

 

[Rich_by_the_Bay]

I'd also research Social Security disability which I believe qualifies you for medicare now .

That's a good point but, unfortunately, is limited to just a handful of diseases such as chronic kidney failure.

Maurice, understanding that you may wish to keep the details private, feel free any time to PM me if you think I can offer anything from the health care perspective given more information.

And, not to be pessimistic about it, but a good attorney may be able to begin Medicaid eligibility preparation with miminal collateral ramifications. Such things often require years of lead time to avoid being disqualified.

Sounds like you'll be an expert on all this by the time you have done your homework. I hope you'll share what you learn.

 

[Maurice]

Fortunately I'm not disabled in the least - I'm ostensibly healthy and could work to my heart's delight. I'll probably get there at some point, but with treatment and full-time focus on my health I can keep it at bay for years. Hence the need to ER!!!

 

[brewer12345]

Thanks for the well wishes, everyone.


Brewer - thanks for that data point. If I could find a plan for anywhere near 1600 a year I would be ecstatic. From what I've been reading I should expect to pay closer to 1-2k a month. (for example, from this thread http://www.early-retirement.org/forums/f38/help-me-out-27532.html )


In that quote you received, do you remember how that co-pay and deductible worked? In my case treatment is ~2k per week (not a typo) so even barring whatever else gets thrown at me (like the not-insignificant consequences of my condition) I can already run up a pretty hefty bill on even a moderate co-pay.

Its also a near certainty I'll hit lifetime policy limits - I'm 26 years away from Medicare eligibility. Health care in the US could change pretty radically by then, but insofar as we have the same system as today then I'll probably have to switch plans after a decade or so, once I approach the limit.

Anyway, I'll be putting some serious time into researching this. Hopefully I'll be able to put together a good library of info on "how to retire early when you're responsible for your own health care and have a nasty pre-existing condition".

$1600 is from a year or two ago and had pretty hefty co pays and coinsurance.

No "frequent flyer discount" available on treatments, eh? I think lifetime max would be the thing I would concentrate very heavily on.