preexisting conditions

[ripper1]

We are looking for an alternative to ACA. At 62 and wife at 64 we have a bronze plan from Ambetter here in Indiana. Our premium for this year actually went down 10 dollars a month but still paying about 1500 a month. The last couple of years we have only went to the doctor for our annual wellness visit which is free. I would like to like at some private insurance which for us would be about 500 a month. The only thing that I am worried about is what might be for us preexisting conditions. I am a celiac. Meaning I have to be gluten free. I have no problems because I just follow the diet and have not had to be hospitalized or treated after the condition was first diagnosed about 12 years ago. My wife on the other hand had a stage 3 kidney cancer. So one kidney was removed about 8 years ago and after 5 years of follow up is considered cancer free. I've heard there is like a 6 month look back for preexisting conditions. I would assume that we are ok. Any thoughts friends. Thanks

 

[MBSC]

We are looking for an alternative to ACA...here in Indiana.

According to this site, Indiana limits Short-Term Medical (STM) plans to 6 months. The link within that site indicates Indiana allows a 12 month pre-ex lookback period.

STM restrictions: https://www.healthinsurance.org/so-long-to-limits-on-short-term-plans/

A quick check of e-healthinsurance.com confirmed 6 months. If the 6 month STM expires mid-year and cannot be renewed due to a new medical condition, you do NOT get a Special Enrollment Period (SEP) to enroll in an ACA Marketplace plan. The SEP is reserved for losing creditable coverage and STMs do not qualify. You would have no coverage for the remainder of the year.

Another option may be Health Care Sharing Ministries (HCSM) which is not insurance.

 

[ivinsfan]

According to this site, Indiana limits Short-Term Medical (STM) plans to 6 months. The link within that site indicates Indiana allows a 12 month pre-ex lookback period.

STM restrictions: https://www.healthinsurance.org/so-long-to-limits-on-short-term-plans/

A quick check of e-healthinsurance.com confirmed 6 months. If the 6 month STM expires mid-year and cannot be renewed due to a new medical condition, you do NOT get a Special Enrollment Period (SEP) to enroll in an ACA Marketplace plan. The SEP is reserved for losing creditable coverage and STMs do not qualify. You would have no coverage for the remainder of the year.

Another option may be Health Care Sharing Ministries (HCSM) which is not insurance.

Given your family history I would worry about this scenario. I'm happy your DW is doing well, but I know from my own extended family you are cancer free until you're not. Some are cancer free forever and some have a recurrence or technically a new cancer after 10 or 15 years. There is no in between and worrying about a possible reoccurrence would keep me on the traditional plan.

Celiac can be really expensive to treat if problems do come up. Can you hold on for another year till your spouse hits Medicare?

 

[pb4uski]

$1,500/month for a bronze plan for two isn't bad... I recently priced out HI in FL for us (both 63) and it was about that cost... part of the cost of freedom.

Can you manage your income down to qualify for subsidies?

 

[Bamaman]

Congratulations on you being able to handle your condition. My hat is off to you. And your wife has past the 5 year milestone being cancer free.

But you I'll find it difficult to find private insurance because of the past.

I am a stable type II diabetic and my wife had cervical cancer 12 years ago, and as are uninsurable. I am just thankful to be on Medicare wit h a good Megacorp retired supplement.

You may have the best alternative form your position already.

 

[ripper1]

Thanks everyone so far for the input. The 1500 for us is affordable and no way to reduce income as pension alone is more than 64k. When I retired from city of Chicago we were told we would have health insurance for life but they threw us under the bus a few years ago. Wife will be on medicare in July of next year. So that should help bring pricing down somewhat. I tried to do this last year too and it just seems like we are stuck with ACA. When I investigate some of these companies I find a lot of them have dreadful reviews and in fact some of them really are not healthcare insurance but life insurance with health riders on them. Oh well.

 

[explanade]

There were suppose to be short-term plans which could last a year.

That was suppose to come out in October.

But looks like states are regulating them, from outright bans to other limits:

https://www.cnbc.com/2018/11/02/the...lth-plans-arent-available-in-every-state.html

 

[MBSC]

A quick check of e-healthinsurance.com confirmed 6 months.

Wife will be on medicare in July of next year.

When I investigate some of these companies I find a lot of them have dreadful reviews and in fact some of them really are not healthcare insurance but life insurance with health riders on them.

Since your wife will start Medicare in July, she could apply for the 6 month STM and you could remain in an ACA Marketplace plan. Your local independent auto/home/life agencies usually sell STMs or can refer you to a broker. They can give you specific information to make an informed decision. Try to stay with UHC/Golden Rule, National General, or Petersen International if you go this route. Avoid "limited benefit" plans that try to pass themselves off as an STM. Those junk plans generally pay $250 for an ER visit or $1k/day for a hospital stay.

Some STMs do not offer drug coverage but only a discount card similar to GoodRx. Do not provide personal information (address, phone #) on a website to get quotes.

 

[ripper1]

Since your wife will start Medicare in July, she could apply for the 6 month STM and you could remain in an ACA Marketplace plan. Your local independent auto/home/life agencies usually sell STMs or can refer you to a broker. They can give you specific information to make an informed decision. Try to stay with UHC/Golden Rule, National General, or Petersen International if you go this route. Avoid "limited benefit" plans that try to pass themselves off as an STM. Those junk plans generally pay $250 for an ER visit or $1k/day for a hospital stay.

Some STMs do not offer drug coverage but only a discount card similar to GoodRx. Do not provide personal information (address, phone #) on a website to get quotes.

Thanks, MBSC, might be something I can look into. But are they going to consider her cancer from 8 years ago as a preexisting or something they will not cover.

 

[MBSC]

But are they going to consider her cancer from 8 years ago as a preexisting or something they will not cover.

Indiana limits the pre-ex lookback period to 12 months. Receiving medical advice for the cancer within the past 12 months counts as still having the condition.

"...a condition for which medical advice, diagnosis, care, or treatment was recommended or received during the twelve (12) months immediately preceding the effective date of the plan."

There would still be time to renew the ACA family plan if you decide an STM is not appropriate.