what about insurance?-USA

Hi Slim,

My husband is pretty much self employed and his benefits before we got married were pretty minimal.

My friend in MA is self insured it is $800pp not including prescriptions. It is pretty expensive. I pay $160 a month at work and coverage is pretty good for my husband and I. My company contributes approx. additonal $800 a month to the plan (this is for two of us).

The whole pre-existing condition thing scares me, b/c I will be carrying the benefits and I don't want universal healthcare but if I can't get insured if/when I leave my current co. that will really stink.

I'm a little scared because I'm covered by my boyfriend's insurance as a domestic partner (we've been living together for over five years now.) I'm freelance, which means no health insurance on my own.

The thing is...on Friday he just got a notice that we're being audited and have to prove we're really domestic partners. We can do this, obviuosly we have the proof...but the timing is a little suspicious. I JUST had the colonoscopy and got diagnosed with UC. I have to imagine that we're being audited because of my recent diagnosis. I mean, I've been covered under his plan for over four years now...it's fishy.

Though we're not engaged yet, the backup plan is to get a quick marriage if they deny my coverage and have the reception later (or perhaps another wedding and just not tell people we already got married.)

Sorry I don't have advice...

Kasey, that sucks, I'm sorry. It definitely seems like they're trying to get out of paying UC costs... That seems to be a common thing with a lot of insurance companies. What proof would there need to be?? I mean, what constitutes as being an official domestic partner... isn't it just if you're dating and living together?

My advice would be to hold onto the insurance you have now, because however poor it is  your uc as pre-existing condition wouldn't be an issue.  I suppose they could just drop you, but if they agreed to cover you without any riders then they would have to pay under the terms of the policy. 

My family switched once when we weren't on a group plan and our new carrier put riders on just about every condition we had been treated for the year before.  Really picky stuff,  such as migraines and ear infections.  They are brutally unfair to the self employed/insured.  You might want to look into supplemental insurance.  My sister just signed up for a supplemental health policy for accident, cancer and vision.  It pays over and above what her regular plan doesn't.  It might be worth talking to an insurance agent to check it out and they might have something for people with chronic conditions. 

My husband is self employed and we have had a terrible time trying to find someone to cover me.  He is actually in the process of enlisting in the army reserves mainly for the health benefits.  In VA, where we are, there are two companies that offer insurance without underwriting.  I found out about this on one of the state websites.  It is very expensive though so we decided it was not our best option.  You'll definitely have to do research on your specific state, as you will probably be denied from most private insurance companies.  It is awful.  Good luck in your search.

Kasey, my cousins did that back in 1982.  If I remember correctly, my cousin's wife needed major dental work. So they got married secretly (just their immediate families) on New Years Day. Their "real" wedding was Memorial Day.  Most people never knew and even those that did find out, thought it was great.

I know this has been discussed before but now is when I am thinking about it for my son.  Right now he is under our insurance until he is 23 if he stays a full-time student.  If he gets a job that has group health insurance, can they turn him down?  Or limit him?  It would be very similar to what we have now (my husband works for a school district, my son is trying to get a job in a different school district).  I know the best thing is for him to get group health insurance.  Unfortunately that means giving up working as an auto mechanic (which is what he has gone to school for and what he likes) because most small garages (including the one he works at now) don't have insurance. And because he has Crohns (at least the doctor thinks so) he would have a pre-existing condition.

Also, right now he is working as a substitute for the district. No benefits (yet). He does have to get a physical form filled out by his regular doctor. One of the many questions asks about gastrointestinal issues (they ask about every system of the body).  It asks "Have you ever had any of the following diseases, complaints, or injury or disease of the following organs?  Stomach or duodenal ulcer, recurring indigestion, vomiting of blood, bloody stools, colitis, or any other disease of the stomach or intestines?"  Does he have to acknowledge he may have an IBD?  What would happen if he answers no (assuming his pediatrician doesn't mark it off)?

Sorry if I highjacked the thread. I know the thread was about self-coverage but my son finally has a chance to be covered by group insurance (and not have to stay a full-time student for the next 3 years ).

Slimcook,
I have had the same problem as you getting coverage. I was denied by every individual policy carrier in my state. Have you looked into whether your state has a group plan for small business owners? If you are self-employed, you should qualify as your own small business. If you can get on a state's group plan that is far better since it will cover pre-existing conditions.

If your insurance agent didn't consider that option, I would bring it up. Sometimes they don't think about all the possibilities and need a push to find a better option like group insurance through your state.

Most (maybe all) states have high-risk insurance for people who just can't get other insurance. These plans aren't great, but it's better than nothing. They usually have a low-income rate for people who can't afford the full price.

Kasey,
Domestic Partnership requirements vary by insurance company and employer. Usually you just have to be living together for 1 year, show that you are finanically interdependent, and sign an affidavit agreeing that you are in a committed relationship.
If you are being audited by the employer (which is likely since audits of their plans is pretty routine) then they would have no knowledge of your diagnosis since that would be against the law. Privacy of health information laws (HIPAA) require that insurers never divulge your medical info to anyone other than you and people you have authorized. Employers never get that info. If the audit is being conducted by the insurer, I would be surprised.

*** I feel that there's been some hijacking of this thread with the domestic partner discussion. If anyone wants to discuss it further, we should start another thread. ****

Slim, I don't understand what your saying or maybe I do???? Is it that BCBS will cover you only if you have your colon removed after 5 years?

Okay I used to sell insurance. I can't vouch for the entire country but this is how it works in New Mexico (though I'm pretty sure that it is similar thorughout)


Most companies will insure for pre-existing conditions after they have been treated for a certain period of time. Treated meaning that they are no longer causing the insured (thats you) problems. Thus the BC/BS beign willing to insure you after you've had your colon removed for 5 years doesn't supprise me at all.

Having an ongoing pre-existing condition will not always disqualify you from getting insured, but outside of group insurance 99.9% of the time will not be covered and any condition that could stem from the pre-existing condition will also probably not be covered. Even if you do get insured you will pay a lot more than someone with out the pre-existing condition for the same ammount of coverage.

Group insurance IE the insurance you get through your employer is magjor medical insurance. Odds are you pay a 30/70 split with your employer, you might even be lucky enough to see a 20/80 split. If you want the exact same coverage except on a private/ self employed ticket, you'd need to find yourself a MMI writer. To find one, the quickest way would probably be to ask one of your friends who has insurance through their employer who their insurance is and then speak to that company directly.

Odds are with MMI you will pay anywhere from $700-$800 USD a month.


There is one other option for you.


It is called private pay.

When you go to the Dr. be it a GI or anything you tell them you are private pay (DO NOT SAY YOU ARE UNINSURED). With private pay you pay everything out of pocket (dependign on the Dr. you may be able to start a "tab").

Okay sorry for the caps above but it is important to never ever ever ever say that you are uninsured. The cost difference between someone who is private pay and someone who is uninsured (at least in New Mexico) is between 10 and 20%. The person who says they are uninsured pays MORE for the same health care as someone who says that they are private pay. On the quick glance it seems very unfair if not a very questionable business practice, but if you look deeper you might see some sence in it. (it still seems unfair though) The people who are uninsured are seen as a payment risk and are charged more because the Dr. wants to get as much money as they can before the person stops paying. Similar to someone with good credit and someone with bad credit who are trying to buy the same exact car from the same exact dealer.

If you can afford it, go for either the private pay or the MMI.

Doz, the MRMIP program is what I was talking about. I believe that many states have this. If someone googles "high risk medical insurance" and their state name, they should find the program in their state. They all have different names, costs, rules, etc. I have a feeling that the California plan is one of the better ones.

Sometimes its worth getting a job just for the group health insurance. Once you quit, you can stay on their policy through COBRA if the employer has more than 50 employees and is required to offer you COBRA coverage. Seems like an awful lot of trouble, though, just to get health insurance. But maybe you'd wind up liking the job. :)