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Insurance/this disease is awful.

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Ulcerative Colitis
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Posted 8/13/2017 7:09 PM (GMT 0)
So I'm planning to quit my job next year and have been researching what I want to do with my life. If my disease is under control by that time (fingers crossed), I'm considering applying to graduate school for the following fall. However, during my research I've stumbled upon some devastating information.

Most of the schools in my state offer a school-sponsored health insurance plan that is generally very affordable. However, the school I really want to go to does not offer any health insurance and instead recommends students use the exchange/marketplace. This would be fine, except I will not be able to work during my program which means I will be automatically referred to Medicaid. I checked my state's Medicaid info for covering biologics and turns out they won't cover any biologics unless you try/fail budesonide for 6 MONTHS first. I've already tried budesonide and it did nothing for me. My doc told me that if I was going to respond to budesonide it would happen within 6 weeks so I have no idea why Medicaid requires a 6 MONTH trial.

Additionally, if you do get approved for a biologic after all that, the Medicaid guidelines recommend a "trial withdrawal" from the drug if you achieve stable, clinical remission.

This graduate program is expensive, so there is no room in the student loan budget to buy private insurance. So basically, I feel like this graduate program is off the table because of the health insurance situation - it would essentially require me to stop treating my UC (and give up Remicade). How bonkers is that?? This disease really does control your life - in more than just the obvious ways.
Posted 8/13/2017 10:51 PM (GMT 0)
Alice, it is true that I could get regular marketplace insurance for a couple months but I called the marketplace hotline and they said the IRS checks your income every few months and once they find out my income is $0 (since I will be in school), I will get referred to Medicaid. So, that is not a long term solution.

Additionally, you are not eligible for Remistart if you have government-subsidized insurance (Medicare, Medicaid, VA, etc), so that is not applicable. I do, however, utilize Remistart currently since I have regular commercial insurance.
Posted 8/14/2017 4:54 AM (GMT 0)
I imagine they check it the same way they check for other government benefits. For instance, I was on food stamps in college. Within days of getting my first big paycheck after graduating and starting work, I got a letter stating I was no longer eligible for food stamps because my income was x. I'm sure it's just a computer system that automatically flags people who make above or below a certain amount of money.
Posted 8/14/2017 6:40 AM (GMT 0)
(Ignoring any possible changes due to goverment), You can sign up for and use one of the marketplace Affordable Care Act plans even with no income. Just because you are *eligible* for the state's Medicaid does not mean you *have* to use that. You can always pay for a plan. You just won't get any subsidy/tax refund if you don't meet the minimum income requirement.

I haven't worked for a good while now, and in my state the Medicaid plan just doesn't cut it for me. So I'm paying for a plan out of pocket, from the marketplace, even though I'm eligible for my state's free Medicaid plan.

It's costing me an arm and a leg, out of my savings, but it has been worth it the last couple of years for me.
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