Is cancer a non-starting precondition?

[teejayevans]

Is there any cancer survivors out there that were able to get individual
health insurance (not group insurance via megacorp, govt) when they ER?
If you were able to get it, what was the approximate cost and which
company? And about how long was it after your treatment did you apply?

I've read that pre-existing conditions have a 6-12 month lookback, but
if you are no longer being treated, do they still consider you are high
risk?
TIA
TJ

 

[Rich_by_the_Bay]

With the possible exception of basal cell skin cancer, yes.

 

[Zathras]

I am not sure about cancer, but with Type 1 diabetes I was advised (by Blue Cross as well as an non-affiliated insurance agent) that I would only be able to get into the high-risk state pool unless I used a little loophole which allows people on COBRA to shift into an individual plan without any further review or opportunity for the health insurance company to turn you down.

 

[Martha]

I am not sure about cancer, but with Type 1 diabetes I was advised (by Blue Cross as well as an non-affiliated insurance agent) that I would only be able to get into the high-risk state pool unless I used a little loophole which allows people on COBRA to shift into an individual plan without any further review or opportunity for the health insurance company to turn you down.

The loophole is under HIPAA, which allows people with 18 months of continuous coverage to move from a group plan to a plan or plans designated by your state as the state's HIPAA option. Sometimes it is the risk pool. Sometimes it is a plan offered by an insurer, like BCBS. Sometimes (rarely) it is any plan. Usually it costs a lot.

 

[Martha]

With the possible exception of basal cell skin cancer, yes.

That is consistent with what we have heard here from insurance agents.

 

[farmerEd]

It is one of the things I like about Massachusetts...if I understand it correctly, if you start a business, any business, even a single person business, you can immediately (and without health exam) get a group plan coverage for yourself with no pre-existing condition exclusions. Underwriting is based on age only, at least as far as the first year - after that I suppose they may take into account your claim history.

 

[Buckeye]

Our application for individual health insurance had "in the last 5 years" questions and I think some "have you ever" questions.

It's sad/frustrating to know that quitting my job and moving to FL was possible because we haven't had any major medical problems and therefore we are able to purchase individual health insurance at a reasonable cost (with a $5,000 annual deductible per person).

I have a job offer brewing but I am considering not taking the health insurance if hired. I don't want to give up our individual health insurance because we will have to reapply and requalify for individual health insurance if I hate the job and want to leave. While on my employers group policy, we could have something happen which would make me uninsurable as an individual and I am stuck at the job until I am 65. What a horrible thought!

I have to check if I am allowed to keep my HDHP and HSA if other insurance through an employer is available. I think there is something in the rules about health insurance being available but I can't remember exactly what it is.

How bizarre to think about turning down a good job because access to affordable healthcare might trap me in the job! Of course, healthcare legislation might make this issue moot but as of today I have to take it into consideration.

 

[Zathras]

Wow, had never considered that, but it makes sense.
If you do pass up the job, please let the employer know why. Business leaders and our representatives need to hear what a mess the system currently is.

 

[Rich_by_the_Bay]

I have a job offer brewing but I am considering not taking the health insurance if hired. I don't want to give up our individual health insurance because we will have to reapply and requalify for individual health insurance if I hate the job and want to leave. While on my employers group policy, we could have something happen which would make me uninsurable as an individual and I am stuck at the job until I am 65. What a horrible thought!

Good thinking. I was obligated to switch my employer of record here when the financial piece of the hospital and university parted ways. Part of that was switching health carriers. The first employer had a retiree provision on their policy and the 2nd one did not.

I officially retired from employer 1 and enrolled in their retiree health policy. The next day I was hired by employer 2 as planned, but I declined their health benefit. I pay my retiree insurance personally, but I cut a deal with employer 2 to reimburse me for the grossed-up premium amount.

Bottom line is that I opted to go with the guaranteed issue choice. When I FIRE , this will carry me through to medicare without missing a beat. Had I switched, I'd be on my own -- no thanks.

Here's another tip: if you pay your own premiums and work in a situation where you are not eligible for health insurance through that employer, your personally paid premiums are tax deductible. If you are eligible and decline, they are not tax-deductible. Depending on the employer's policies, you may want to stay under a certain percent FTE so that you won't be eligible for group health insurance, and thus will be able to deduct your premiums.

At least that's my understanding. Maybe one of the experts around here can verify if I have that right.

 

[John Galt III]

I have a job offer brewing but I am considering not taking the health insurance if hired. I don't want to give up our individual health insurance because we will have to reapply and requalify for individual health insurance if I hate the job and want to leave. While on my employers group policy, we could have something happen which would make me uninsurable as an individual and I am stuck at the job until I am 65. What a horrible thought!

Buckeye,

Not to be a nattering nabob of negativity, but wouldn't your individual HDHP possibly increase your premium dramatically, or just cancel your policy altogether ( or not renew it) , if some bad medical problem came upon you while already enrolled with them ? I suppose it depends on the state laws.

I am in a somewhat similar situation. Am employed, with employer health ins, but could be retired, and buy HDHP. I just went for a routine physical, and the doc noticed "atypical moles" and wants me to see a dermatologist, because I have blue eyes and fair skin. So now, I have yet another "pre-existing condition". If and when I quit and apply for HDHP, I'll have to mention the atypical moles, I guess.



It IS sad. The only reason I go for a physical every year is because my doc will not write me a needed prescription without seeing him at least once a year. It would be in my best interest ( from a "cost-of-insurance-premium" viewpoint) to never see any doctor, ever, just to avoid the dreaded "pre-existing" condition curse.

Now I am actually thinking of shopping around for a different doc / clinic who will write me a script without any physical! Incredible.

 

[Alan]

Not to be a nattering nabob of negativity, but wouldn't your individual HDHP possibly increase your premium dramatically, or just cancel your policy altogether ( not renew it) , if some bad medical problem came upon you while already enrolled with them ? I suppose it depends on the state laws.

This happened to the in-laws of a friend at work. The FIL of my friend has been a sharecropper all his life and had an individual insurance policy for himself and family. In his 50's he had a heart attack that he survived but after that the insurance company ramped up the payments each year until at $3k/month he couldn't afford it so now he and his wife are uninsured and when they need medical treatment drive over an hour to a charity hospital and sit in line for hours. He still has about 3 years to survive before he's eligible for Medicare.

 

[Martha]

Here's another tip: if you pay your own premiums and work in a situation where you are not eligible for health insurance through that employer, your personally paid premiums are tax deductible. If you are eligible and decline, they are not tax-deductible. Depending on the employer's policies, you may want to stay under a certain percent FTE so that you won't be eligible for group health insurance, and thus will be able to deduct your premiums.

Yes, I believe that is the case. If there wasn't any employer insurance a self employed person can usually deduct 100% of the premium as a business expense but if the person can get insurance from an employer he can't use this deduction.

However, I don't know if this prohibits them from deducting the premiums to the extent the premiums and other medical expenses exceed 7.5% of AGI. This is a separate set of rules applicable to everyone, employed, self employed, or not employed at all.

 

[youbet]

In his 50's he had a heart attack that he survived but after that the insurance company ramped up the payments each year until at $3k/year he couldn't afford it

Everything is relative to the person doing the paying I guess, but $3k/yr doesn't seem all that high for an unsubsidized, individual policy. I pay significantly more than that for an employer subsidized retiree individual plan.

Fixing this individual's problem is going to involve subsidizing his payments. I haven't seen any data on proposed healthcare reform plans indicating that cost per individual will be less than $3k.

 

[Alan]

Everything is relative to the person doing the paying I guess, but $3k/yr doesn't seem all that high for an unsubsidized, individual policy. I pay significantly more than that for an employer subsidized retiree individual plan.

Fixing this individual's problem is going to involve subsidizing his payments. I haven't seen any data on proposed healthcare reform plans indicating that cost per individual will be less than $3k.

Sorry, my bad mistake, I meant $3k/month - $36k/year

 

[Buckeye]

No, I don't think the insurance company is allowed to price us as individuals once we are part of the pool. On the flip side, I don't think there is a cap on the annual increase for everyone in the pool. I think they can increase the premiums 100% if they feel like it just as long as they do it to everyone.

Or they may try to go back to our healthcare records to disqualify us due to failing to mention the hangnail I had which was obviously a pre-cursor to my claim for some gigantic and expensive disease in the future!

Once we decided I was going to quit my job and move to FL, there was no reason to go for any check-up type visits. Any news would be bad news in more ways than one!

I'm very interested in how the pending healthcare legislation will affect things but I don't hold out much hope those who need help the most (and that does not include me and DH at this time) will get it.

 

[Rich_by_the_Bay]

No, I don't think the insurance company is allowed to price us as individuals once we are part of the pool. On the flip side, I don't think there is a cap on the annual increase for everyone in the pool. I think they can increase the premiums 100% if they feel like it just as long as they do it to everyone.

And while they can't drop an individual due to medical events as long as premiums are up to date, they can choose to eliminate a whole "product line" in a certain market once the contracts expire.

So you are never really certain to have coverage available when you are on your own. Best bet is to have that coverage as part of a large, stable group rather than individually if you can (not always the case).

Only a system overhaul will fix that.

 

[Meadbh]

This thread makes me feel so sad for so many people....including some of my US relatives who are afraid to retire because their families need the health insurance. I'm happy to pay my share in taxes and not have to worry what happens if I leave my job or move to another province. And I'm happy for my patients too, most of whom could not afford to purchase private health insurance. Yes, we have wait times in Canada. But I see plenty of evidence of self rationing of health care on this thread, too.

 

[Alan]

This thread makes me feel so sad for so many people....including some of my US relatives who are afraid to retire because their families need the health insurance. I'm happy to pay my share in taxes and not have to worry what happens if I leave my job or move to another province. And I'm happy for my patients too, most of whom could not afford to purchase private health insurance. Yes, we have wait times in Canada. But I see plenty of evidence of self rationing of health care on this thread, too.

My thoughts exactly. DW just got an e-mail today regarding her Dad in England. We only just left him after 2 weeks of being there for her mother's funeral. He seems to be extremely fit at age 85 and he certainly does not feel ill but he had some routine tests done that showed an enlarged prostate, blood in the urine and blood in the feces. The e-mail was to tell DW that over the next 2 weeks he is scheduled to see a urologist, have a GI examination and a CT scan. Not much waiting time there or any evidence of rationing because he is too old to spend money on.

We have already been very impressed with the treatment that my sister (cancer) and DW's mother (cancer, COPD, and various other stuff) have been receiving this year.

 

[Notmuchlonger]

Im curious. Anyone know the average wait times in England or Canada to see a Dr about a non emergency. Someone told me it was 11 weeks in England. I find that hard to believe.

 

[Alan]

Im curious. Anyone know the average wait times in England or Canada to see a Dr about a non emergency. Someone told me it was 11 weeks in England. I find that hard to believe.

My and DW's families' recent experiences this year to see a GP for non-emergencies (bladder infections, stomach viruses, fevers etc) have been next day or within a few days in England and there have been plenty of examples this year unfortunately. We were over in May and my Aunt, visiting from Australia got sick and we called and made an appointment next day - she had flu, and was shocked to find to find that she was charged 75 pounds for the visit and drugs.

In 2007 I was in England running some meetings when one of my managers from Spain took ill late in the afternoon. Since his very strong accent was very hard to interpret I made the call to the 800 NHS after hours care number, discussed his situation and got an appointment at an after-hours clinic close by, drove him there an hour later for a 7pm appointment- he saw the Doc with no wait and got a prescription which we filled at the clinic and it did the trick - no charge as he was had an EU card. Very impressive.

I hear all the horror stories in the press about the UK NHS and simply cringe. There is plenty wrong with it but it works for the most part. Now, if you need a new knee, you'll have many weeks to wait unless you have insurance, which many folks have including us when we used to live there. Can be up to 18 weeks according to this recent article.

 

[Notmuchlonger]

My and DW's families' recent experiences this year to see a GP for non-emergencies (bladder infections, stomach viruses, fevers etc) have been next day or within a few days in England and there have been plenty of examples this year unfortunately. We were over in May and my Aunt, visiting from Australia got sick and we called and made an appointment next day - she had flu, and was shocked to find to find that she was charged 75 pounds for the visit and drugs.

In 2007 I was in England running some meetings when one of my managers from Spain took ill late in the afternoon. Since his very strong accent was very hard to interpret I made the call to the 800 NHS after hours care number, discussed his situation and got an appointment at an after-hours clinic close by, drove him there an hour later for a 7pm appointment- he saw the Doc with no wait and got a prescription which we filled at the clinic and it did the trick - no charge as he was had an EU card. Very impressive.

I hear all the horror stories in the press about the UK NHS and simply cringe. There is plenty wrong with it but it works for the most part. Now, if you need a new knee, you'll have many weeks to wait unless you have insurance, which many folks have including us when we used to live there. Can be up to 18 weeks according to this recent article.

I dont know if the system is any good or not. However, waiting for 18 weeks to see a Dr is way too long.

 

[youbet]

if you need a new knee, you'll have many weeks to wait unless you have insurance, which many folks have including us when we used to live there. Can be up to 18 weeks according to this recent article.

That seems to be an issue....... Why should you have to have insurance in order to avoid the wait time? It sounds a bit like an oxymoron. "We have great national health care........ and we buy insurance just to make sure....."

Perhaps I'm misunderstanding what you're saying Alan?

 

[Alan]

I dont know if the system is any good or not. However, waiting for 18 weeks to see a Dr is way too long.

That's why you have health insurance or have the money to pay - the NHS is not the only option and many UK employers provide Health insurance as an employee benefit. You have to compare apples with apples - what does a US person do if they need a new Knee and doesn't have insurance?

What does a US person do if they have cancer and don't have insurance? In June my sister in England was diagnosed with cervical cancer from a routine test. By end of August she had already had follow-up tests, and 2 surgeries. (she is now declared clear and is on a 6 month check-up regime instead of annual). She has no insurance and over here would probably now be bankrupt or dead as she probably wouldn't even be paying for her annual check-up.

 

[Buckeye]

I dont know if the system is any good or not. However, waiting for 18 weeks to see a Dr is way too long.

Wasn't the 18 weeks specific to getting a knee replaced? People usually put it off for years. Waiting 18 weeks to get it done once you decide to do it (and it is medically necessary) doesn't seem like a huge deal. It sounded like routine care appointments were instant to a day or two.

 

[Alan]

That seems to be an issue....... Why should you have to have insurance in order to avoid the wait time? It sounds a bit like an oxymoron. "We have great national health care........ and we buy insurance just to make sure....."

Perhaps I'm misunderstanding what you're saying Alan?

"We have great national health care........ and we buy insurance just to make sure....."

If you are going to quote me please use my words - I believe I actually said -

There is plenty wrong with it but it works for the most part.

I never said we had great national health care - but it doesn't leave folks bankrupt and the UK has a much higher life expectancy than the USA. I heard that in 2008 62% of all personal bankruptcies in the US were due to medical bills and 50% of those people actually had insurance.

When I moved to the USA in 1987 I thought the system here was fantastic, and the treatment still is fantastic for those able to get good insurance.