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Posted 9/4/2015 9:18 PM (GMT 0)
Hi,

I have been working outside the country for many years, but will return soon. I learned that I would qualify for special enrollment since I am returning.
I heard you can get insured even with the pre existing PC. I understand each state has its own networks, but does anyone know if one can get top tier coverage (see any Dr you want) or is it all HMO type.

Happy Labor Day!!

Age at detection 58
PSA at detection 9
Biopsy 3/2015, 4 of 10 cores positive, Gleason: 3+4
Bone scan negative,
DaVinci 6/26/15
Pathology: 41.5 g, %involved by tumor 20%, no seminal vesicles involvement, Apical margins involved Gleason same 3+4
PSA 7 weeks post op 0.275
PSA 8 weeks post op 0.49

Post Edited (CLDCR) : 9/4/2015 3:22:05 PM (GMT-6)

Posted 9/4/2015 9:23 PM (GMT 0)
The law eliminates pre existing condition exclusions. You'll have to check with your state exchange to see what you can get.
Posted 9/4/2015 10:15 PM (GMT 0)
As Andrew says, there are no longer any limits on pre-existing conditions. As for "top tier" coverage you can buy any policy you can afford that is offered where you are moving. You are not limited to the exchange, although you do have to buy from the exchange if your income is low enough to allow you to take advantage of the tax subsidies. (And you can still buy from the exchange no matter what your income. Some just find that easiest.)

On the California exchange there are several PPO options that will let you see any doctor, although the coverage out of network is generally not as good and the networks are typically not real broad. The less expensive policies are generally HMOs.
Posted 9/4/2015 11:24 PM (GMT 0)
I believe all the state exchanges have different levels of coverage you can choose from, so its just a matter of how much you pay
Posted 9/5/2015 3:41 PM (GMT 0)
I suggest you first determine whether you will qualify for a tax subsidy. If you don't then it is best to buy in the open market rather than the exchange as you will have many more choices of companies and networks. All the plans must follow the same rules whether through the exchange or outside.

Depending on your state you will have both HMO and PPO oriented plans available.

The main reason to go through the exchange is in order to get a currently subsidized premium. If you qualify for a subsidy you can buy in the open market and then claim you subsidy as a tax refund when you file your taxes. If you buy through the exchange and claim a subsidy, it still has to be reconciled at tax time. In 2015 about one-half of the people who claimed subsidies in 2014 had to pay money back because thy received more subsidy than they were entitled to Thus be careful. If you are eligible for any employer sponsored insurance, you can not qualify for a government subsidy.

Best advice I can give is to go to www.ehalthinsurance.com to do your research. There you can determine whether you will qualify for a subsidy and view all the plans that are in the exchange and the many that are in the open market.
Posted 9/5/2015 9:51 PM (GMT 0)
I was on the ACA insurance program via the healthcare.gov websit for one year prior to turning 65 and going to Medicare. Would rather have stayed on ACA. There are four levels of coverage: bronze, silver, gold and platinum. I chose a gold policy that had a preferred provider network. Both hospitals, labs, and most doctors were on the preferred provider list so I had no trouble finding an in network doctor. I did not have to disclose any pre exisitng conditons and it never was a topic of conversation. My insurance was subsidized due to income that year.I wound up getting a refund on the taxes that year as I did not make as much as intended. (sometimes it is nice to have control over income timing) Before any one howls about this I paid plenty of taxes during my working years... just getting some back.

True story, right after the insurance went into effect I had a heart attack. The hospital charges were $86K. Here is the part that made my blood boil. With insurance the bill was reduced to $20K and I paid $2K. In the past I would have paid the entire amount out of pocket. So, know that uninsured get no "free ride". The $2K met my deductible and I did not pay a cent the rest of the year.

Humana was the insurer and they gave me some of the best service and coverage I have ever had even while working in a professional field.

Go to the goverment website and see what is available for your situation you may be surprised at the quality and the cost.

Good luck,
Don
Posted 9/5/2015 11:49 PM (GMT 0)
Hi, Don explained the affordalbe HealthCare Act very well. Yes, you can still qualify for private insurance as pre existing conditions can no longer be excluded from coverage. You may want to apply through your states Health Insurance Exchange because you may qualify for tax subsidies that you would not be offered through a private network.

I am currently on the plan and would have not received the treatment I have without it. Nor would I be able to afford coverage. It is income based and depending on that, your co pay, max out of pocket expense will vary widely.

Post Edited (Almost a 10) : 9/7/2015 7:23:41 PM (GMT-6)

Posted 9/8/2015 1:14 AM (GMT 0)
We got ours through healthcare.gov, it's been a godsend. Paid the lions share of everything including Provenge without any argument. We have the top tier coverage through a local blue cross/blue shield affiliate. It's not an hmo arrangement (there is a primary care physician but no referrals), and we have not found a dr. yet who doesn't take it. They've even covered doctor visits at a cancer center more than an hour away. We had a pretty good choice of plans.

Having said that, it really does depend on what state you're in, and your local medical situation. Worth checking out healthcare.gov, it's really not that bad (though you will have to learn way more about insurance than you want to). And as mentioned if you qualify for subsidy you have to do it through the website.
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