Getting individual insurance in ER with history of cancer

[tnedator]

I'm not quite at the early retirement stage, but hopefully in the near future. My wife and I are 37 and 38 respectively. She was diagnosed with Stage III melanoma 5 1/2 years ago, and after a couple surgeries and 14 or so lymp nodes removed, she now has a clean bill of health.

She and I have always had insurance via work and have never had a lapse in insurance. When the time comes we retire and don't have access to group insurance via work, how much trouble, or how expensive, is it going to be to get her an individual insurance policy?

Thanks

[Edited title typo - was Getting individual retirement in ER with history of cancer]

 

[Dawg52]

Re: Getting individual retirement in ER with history of cancer

It's gonna be extremely difficult for her. If your state provides a high risk pool policy she can go that route although that can be expensive.

She might be able to get on an individual policy at some point but many years will have to pass before an insurance company will consider her a normal risk.

 

[tnedator]

Re: Getting individual retirement in ER with history of cancer

It's gonna be extremely difficult for her. If your state provides a high risk pool policy she can go that route although that can be expensive.

She might be able to get on an individual policy at some point but many years will have to pass before an insurance company will consider her a normal risk.

With work-based group policies, as long as she has not been without coverage for 60 days, the cancer is not considered pre-existing. I guess once you start looking at individual policies, the 60 days without a lack of coverage doesn't matter, as they just look at her as high risk?

Is this a situation where it might be she needs to keep working even if I retire early, just to keep insurance coverage?

 

[Dawg52]

Re: Getting individual retirement in ER with history of cancer

With work-based group policies, as long as she has not been without coverage for 60 days, the cancer is not considered pre-existing. I guess once you start looking at individual policies, the 60 days without a lack of coverage doesn't matter, as they just look at her as high risk?

Is this a situation where it might be she needs to keep working even if I retire early, just to keep insurance coverage?

Unfortunately many people have to work for the insurance. But, she might be able to find part time work that offers health benefits.

It certainly won't hurt to apply for an individual policy when the time comes. You might consider a high deductible plan. Many plans offer deductibles as high as 10k. I've been told that can help as you are taking a portion of the risk away from the insurance company. Good luck with it all!

 

[tnedator]

Re: Getting individual retirement in ER with history of cancer

Unfortunately many people have to work for the insurance. But, she might be able to find part time work that offers health benefits.

It certainly won't hurt to apply for an individual policy when the time comes. You might consider a high deductible plan. Many plans offer deductibles as high as 10k. I've been told that can help as you are taking a portion of the risk away from the insurance company. Good luck with it all!

Thanks

 

[REWahoo]

Re: Getting individual retirement in ER with history of cancer

With work-based group policies, as long as she has not been without coverage for 60 days, the cancer is not considered pre-existing.

I don't think this is the case. Based on my experience and the situations cited here by many other posters, it is a virtual certainty that any and all insurers will consider this a pre-existing condition once you apply for an individual health policy. I think you may be confusing this with COBRA coverage, which allows you to continue your existing work-based insurance coverage for 18 months (more in Calif.) if you pay the full cost of the insurance.

Martha, a forum member who is very knowledgeable on health insurance is on vacation and hasn't been around much the past few days. I think what she would tell you is that the coverage and cost of insurance available to your spouse once you exhaust COBRA depends on your state of residence. Take a look at http://www.healthinsuranceinfo.net/ to see what your state rules are.

You should be able to get coverage under your work policy for a minimum of 18 months using COBRA. You will pay the 'full boat' for the coverage and it will likely be expensive, but no additional exclusions will apply.

Once you exhaust COBRA, you will be able to get coverage under HIPPA rules based on your state requirements. Some states mandate insurers provide coverage for all with no exclusions regardless of pre-existing conditions, but the coverage is very expensive for both those with and without health problems. Other states allow insurers to exclude pre-existing conditions, but provide a high-risk pool where anyone who has exhausted COBRA and who meets HIPPA requirements (60 day rule) can get coverage. Once again, the risk pool coverage is expensive.

Is this a situation where it might be she needs to keep working even if I retire early, just to keep insurance coverage?

Unfortunately, this may be the case, but as Dog52 points out there are other possible options (not many).

I suggest you use the search button to look for the many, many other threads on the forum where health insurance has been discussed. Good luck on this issue, the Achilles heel of early retirement.



Edit: Corrected URL

 

[tnedator]

Re: Getting individual retirement in ER with history of cancer

I think you may be confusing this with COBRA coverage, which allows you to continue your existing work-based insurance coverage for 18 months (more in Calif.) if you pay the full cost of the insurance.

Thanks for the reply.

I wasn't so much confusing it, as just asking if there was anything similar in health insurance for individuals. My only experience has been group plans through employers.

I suggest you use the search button to look for the many, many other threads on the forum where health insurance has been discussed. Good luck on this issue, the Achilles heel of early retirement.

Ahh, the advice so frequently give on forums, use the search button I did actually do quite a few searches, but was still a bit confused, so I figured I would post.

I will check out www.healthinfo.net.

I appreciate the advice.

 

[REWahoo]

Re: Getting individual retirement in ER with history of cancer

Ahh, the advice so frequently give on forums, use the search button I did actually do quite a few searches, but was still a bit confused, so I figured I would post.

Those of us who have wrestled with these issues for years are still confused. If you are only a "bit" confused, consider yourself very well-informed when it comes to health insurance.

 

[tnedator]

Re: Getting individual retirement in ER with history of cancer

Those of us who have wrestled with these issues for years are still confused. If you are only a "bit" confused, consider yourself very well-informed when it comes to health insurance.

Bit might have been a weee bit of an understatement.

 

[mykidslovedogs]

There is hope, depending on which state you live in.. '

First of all, I would like to thank Old McDonald for opening my eyes to World Insurance. Although they are not as large as some of the other carriers out there, I thought I would check into them in greater detail as they seem to be a bit more lenient in their underwriting than some of the other larger carriers such as Humana and United Healthcare. They do use a reputable network, Great West, so I went ahead and got licensed with them even though I usually prefer to work with the bigger names, as it is possible to place certain people with coverage who are unable to get insurance elsewhere.

As a broker, I've found that "World Insurance" will consider people with a history of cancer after the cancer has been gone for at least five years. They will want to see the medical records, of course, before they offer coverage, and there are no guarantees, however, with a clean bill of health, there is a chance that you might be able to obtain coverage on an individual basis. This is why it is so importat to consult a broker, because most people would assume they have to stay in a risk pool or in a group, which is not necessarily the case.

Good luck!

 

[Meadbh]

Unfortunately, melanoma is notorious for recurring many many years after an apparent cure. I'm sure that the actuaries would be aware of this. If your DW can get health insurance it is likely to be expensive. I wish her well!

 

[mykidslovedogs]

Here are the underwriting guidelines for World Insurance:

Cancer
Skin (basal cell or squamous cell)
a) Present............................................................... RNA
b) Operated, less than 5 mm
• Within 2 years............................................... ER
• Over 2 years.................................................. STD
c) Others................................................................ IC
Melanoma
a) Present............................................................... RNA
b) Operated, Clarks Level III or less
• Within 5 years............................................... RNA
• Over 5 years.................................................. IC
c) Melanoma in-situ 0-2 years.............................. RNA
• 2-5 years........................................................ ER
• > 5 years........................................................ STD
d) Clarks Level IV or V......................................... RNA

IC means "Individual Consideration"
RNA means "Risk Not Acceptable" or decline
ER means "Elimination Rider"
STD means "Standard"

 

[tnedator]

Here are the underwriting guidelines for World Insurance:

Cancer
Skin (basal cell or squamous cell)
a) Present............................................................... RNA
b) Operated, less than 5 mm
• Within 2 years............................................... ER
• Over 2 years.................................................. STD
c) Others................................................................ IC
Melanoma
a) Present............................................................... RNA
b) Operated, Clarks Level III or less
• Within 5 years............................................... RNA
• Over 5 years.................................................. IC
c) Melanoma in-situ 0-2 years.............................. RNA
• 2-5 years........................................................ ER
• > 5 years........................................................ STD
d) Clarks Level IV or V......................................... RNA

IC means "Individual Consideration"
RNA means "Risk Not Acceptable" or decline
ER means "Elimination Rider"
STD means "Standard"

Thanks, this helps. They never gave a specific clarks level, but I think it would be considered III. III is compression of the reticular dermis, IV is invasion of the reticular dermis. My wife's path report said "occupies papillary dermis and at some points line up at the interface of the papillary and reticular dermis".

She is + 5 1/2 years, so that would put her as IC if she is indeed classified as Clarks III. However, the problems is that it was found in one lymph node, and when reading about the Clark's staging, one of the guidelines is "If there is involvement of lymph nodes or distant metastases, another staging system must be used. "

On the bright side (besides the fact she has been cancer free for 5+ years), after reading some of the other responses, I did some research and found that Arkansas does have a high risk pool that she could be a part of if all else fails. Paying a lot for insurance worries me, but not as much as not having any insurance for her.

So, it looks like in a worst case, when the time comes for her to retire, she can do Cobra for 18 months, then attempt to get individual insurance, and then if that fails, go into the Ark high risk pool.

By the way, what does "DW" mean? I have seen that in countless threads, and assume it is referring to wife or spouse, but am not 100% sure.

 

[Dry Socks]

By the way, what does "DW" mean? I have seen that in countless threads, and assume it is referring to wife or spouse, but am not 100% sure.

see:
http://early-retirement.org/forums/index.php?topic=5392.0

 

[eridanus]

I believe REWahoo! meant http://www.healthinsuranceinfo.net/.

 

[REWahoo]

I believe REWahoo! meant http://www.healthinsuranceinfo.net/.

Yes I did. Thanks for posting the correct URL.

 

[tnedator]

I believe REWahoo! meant http://www.healthinsuranceinfo.net/.

Thanks. Yes, I found the correct link in another thread and downloaded a PDF with all the state insurance regs.

 

[martyb]

If you or your wife were to go to work for the federal government (Civil Service, Postal Service etc.) she/you would be able to get full medical insurance and keep it into retirement. There are no pre-existing condition exclusions for federal employees. A person could have an active condition at the time of hire and still would get full coverage at the same group rate as everybody else. Either you or your wife could go to work for Uncle Sam and the two of you would have the coverage under a self and family policy, and after the fed employee retires, you could keep that coverage in effect, with the government continuing to pay around 75% of the premium. Not for everybody, but it's a helluva deal, I'd say. I currently pay less than $250 per month for Blue Cross Blue Shield Standard Option, and if I retired today it would still be about that amount, with small increases most years in January, the same as the rest of the fed work force. Best of luck to you & your wife.

 

[tnedator]

If you or your wife were to go to work for the federal government (Civil Service, Postal Service etc.) she/you would be able to get full medical insurance and keep it into retirement. There are no pre-existing condition exclusions for federal employees. A person could have an active condition at the time of hire and still would get full coverage at the same group rate as everybody else. Either you or your wife could go to work for Uncle Sam and the two of you would have the coverage under a self and family policy, and after the fed employee retires, you could keep that coverage in effect, with the government continuing to pay around 75% of the premium. Not for everybody, but it's a helluva deal, I'd say. I currently pay less than $250 per month for Blue Cross Blue Shield Standard Option, and if I retired today it would still be about that amount, with small increases most years in January, the same as the rest of the fed work force. Best of luck to you & your wife.

Not sure that is an option for either of us, but out of curiousity, how long do you have to work for in a government job before you can retire with these health benefits?

 

[Robert the Red]

Not sure that is an option for either of us, but out of curiousity, how long do you have to work for in a government job before you can retire with these health benefits?

At least 5 years, and be age 62 at retirement, and have had continuous coverage under the Federal Employees Health Benefits (FEHB) program for the last 5 years. The place to start your research is http://www.opm.gov/retire/

 

[vic]

Hubby and I are 37 y/o. I am as healthy as it gets. Howver, hubby had cancer in his 20's. I already left megacorp. He is unexpectedly leaving too, so we will be on our own for health insurance very soon. I peddle around in my sole proprietor stuff for all our tax write offs. I just asked my TX insurance agent to give me some individual/group quotes. She is working on it now, this is her preliminary response what I should take:

".....The individual plans cover maternity. If maternity is not an issue then
you would want to go with the small group. The benefit is that it is an
automatic issue whereas the other you would both have to qualify
individually....."

Maternity is out of the question for me, so it would be better if I don't even have to pay for that. I like the automatic approval. We will be HIPAA eligible anyway I think. I will let you know what type of stuff she comes up with.

Vicky

Vicky

 

[tnedator]

Hubby and I are 37 y/o. I am as healthy as it gets. Howver, hubby had cancer in his 20's. I already left megacorp. He is unexpectedly leaving too, so we will be on our own for health insurance very soon. I peddle around in my sole proprietor stuff for all our tax write offs. I just asked my TX insurance agent to give me some individual/group quotes. She is working on it now, this is her preliminary response what I should take:

".....The individual plans cover maternity. If maternity is not an issue then
you would want to go with the small group. The benefit is that it is an
automatic issue whereas the other you would both have to qualify
individually....."

Maternity is out of the question for me, so it would be better if I don't even have to pay for that. I like the automatic approval. We will be HIPAA eligible anyway I think. I will let you know what type of stuff she comes up with.

Vicky

Vicky

What does "you would want to go with the small group" mean in this context? Would that be a group of two, you and your husband, working for your sole proprietor company, or joining some other kind of group? Since whenever my wife retires, she will be HIPPA eligible, staying in a group would be ideal, based on what I know at this point.

 

[vic]

Small employer plans are at least 2 employees I believe and that would be a group plan. Yes, it would be me (the sole proprietor) and I will create some BS position for hubby. Going from one group to another group health plan will give you the greatest protection with HIPAA from what I understand.

Vicky

 

[tnedator]

Small employer plans are at least 2 employees I believe and that would be a group plan. Yes, it would be me (the sole proprietor) and I will create some BS position for hubby. Going from one group to another group health plan will give you the greatest protection with HIPAA from what I understand.

Vicky

That could certainly be an option for us when we finally do retire. When that time comes (not sure how soon it will be), I/we will likely want to do something anyway, and having some part time business could keep us occupied.

 

[mykidslovedogs]

Some states allow you to have a "business group of one" if you have been in business for at least a year. Colorado is one of those states. Although "group of one" insurance is guaranteed issue, you are limited to only four plan designs if you have any pre-existing condtions. Those four plan designs are the Standard or Basic PPO and the Standard or Basic HMO plans. Open enrollment dates include the date when you involuntarily lose other coverage, the date when your COBRA has been exhausted and the time frame within 30 days of your birthday. The open enrollment periods protect the insurance carriers a little bit from adverse selection by making it only possible to enroll when certain qualifying events exist.

If you have a group of 2 or more, you can have access to any group healthplans, anytime. However, the catch is that your second employee must pay income taxes, and you must show that as employer, you are paying unemployment insurance taxes on your employee in order for that person to qualify as an eligible employee. Secondly, that person must work a minimum of 24 hours/week to qualify as an employee, and he or she MUST show enough income on the quarterly wage and tax report as proof that they are making at least minimum wage on a 24-hour work week in order to qualify as an employee. You can't just make up some BS position and qualify as a group of two. There will be underwriting requirements to prove employment. Proof of payroll or proof of quartery unemployment insurance taxes will be required before coverage will be offered.

Granted, the various states have differing underwriting guidelines, but my guess is that you won't be able to just create some BS job title and automatically have a group of 2. You will have to be paying some kind of employment taxes, FICA, FUTA and SUTA on your employee(s) in order to prove employment.