Pre-existing condition
 

How long does a pre existing condition affect your ability to get health insurance ? My wife had cancer a couple of times with the latest being in 2004. When we were down on our LSP in April 2010, we went to The Villages Insurance to discuss if my wife could get health insurance. They said the only way they could write a policy was one that excluded cancer because of her preexisting condition. I am several years older than my wife and we want to move to the Villages when I retire in 3 years. If we do that, she would have to quit her job here which also provides her health insurance. I would no longer be employed so I couldn't just put her on mine. The only solution that seems to work if the pre existing condition continues, is for us to move there while I am still working (I can work from home), put her on my insurance and then hope she can find a job that offers insurance that she can sign up for so I can retire. Anybody have any other insight into this ?

Would COBRA from her employer or from yours if she was on your policy give her enough time to reach age 65 and be eligable for medicare? Company policies are different but almost all provide at least 18 months of COBRA coverage and some allow as much as 36 months.

No, in 3 years she will only be 54. I have been thinking and looking around and it seems they can only waive coverage for the preexisting condition on a new policy for 18 months. As long as you stay healthy during that time, you can then get that preexisting condition covered. So, I guess an alternative would be to go ahead and sign up for the limited policy 18 months before leaving her job so she could have full coverage while she is still working from her work policy and then gan full coverage with the other policy due to the time she had it. Then she could leave her job. Convoluted thinking, most likely pretty costly and I am not sure it would work with all the restrictions regarding purchasing policies across state lines.

If you put a search on "medical pre-existing conditions" you will find a plethora of sites to learn about this. I do believe the following link may help you:

http://Pre-existing Conditions Health Insurance

We are in a similar situation, effective July 1, 2010 with all the new government backed healthcare changes if you are unable to obtain insurance due to a pre existing condition you can apply for coverage as a FL resident (or whatever state you are in). You do have to be without coverage for 6 months (risky-but...) You just have to provide proof of being denied by a carrier, proof of citizenship and other basic info. I would be hesitant to leave a job that provided it, bound to be cheaper but if you really want to move this is an option. Don't know your profession but a job making much money and with benefits in The Villages won't be easy to land either. Good Luck!

6 months with no insurance for someone who has had cancer twice is a risk we can't afford. You know what I am talking about if you ever saw bills related to chemotherapy and other cancer treatments.

I think I did find something though. With HIPAA a new group policy has to accept her if she can prove she has had continuous coverage with a break of only 63 days or less. On top of that, group coverage can be purchased in Florida if you open a company with as few as 1 employee that will enroll. Therefore, we could open a business and have her get her insurance through the new group policy purchased for the business. That would work I think since we had been discussing opening a business when we moved anyway.

For information on this ---> http://www.diabetes.org/living-with-...ps-of-one.html

These states guarantee issuance to small groups ---> http://www.statehealthfacts.org/comp...?cat=7&ind=350

hlanders, where did you read that change in the new health care bill kicks in July 1? I'm not saying that isn't correct.

The only thing I can find is the pre-existing condition for children goes into effect around Sept. 23, 2010 (six months after the bill was signed). And the pre-existing condition requirement for insurance companies providing for adults isn't mandated until January 2014. That gives the states run exchanges time to get up and running.

http://www.csmonitor.com/USA/Politic...ing-conditions

bkcunningham1 - take a look at this article

http://www.insurancejournal.com/news.../01/111230.htm

pauld315, thanks. I found this government site that gives state-by-state information. I truly wish you both the best and pray your wife stays healthy. We forget how blessed we are when we have our health.

https://www.pcip.gov/StatePlans.html

Pauld315,
I'm sorry to hear of your wife's former cancer and I hope she stays in remission forever. Under the circumstances, I don't think I would give up her job and health insurance benefits until you are certain that you have secured adequate coverage elsewhere.

Insurance policies can be tricky-- you have to read the fine print. My former employer once purchased a group policy with assurance that mammograms were covered. When women in the office filed claims for the procedure, the claims were denied. The policy stated something to the effect that mammograms and other routine office procedures were covered. The "trick" was that mammograms are never actually performed in a doctor's office. The insurance company's argument was that mammograms were covered as long as they were performed in a doctor's office. Gotcha.

The "gotchas" with insurance companies can be almost beyond belief; so before you give up her work coverage for any other coverage, I would have a competent insurance attorney or adviser review the policy.

Wish you all the best.

I have a similar insurance problem but not as delicate. I have a life insurance I took out 20 years ago. It is expensive but I've always paid the policy every year. I could cash in the policy and take a big dent out of the expenses we have from new furniture, the cost of a golf cart and a possible new car. I could get another policy from my wife's teachers union, just as good for half the price. But, because I had prostate cancer 7 years ago, no insurance company wants me. I am in better shape now than I was ten years ago, and otherwise in perfect health. There is no sign of cancer returning as my last PSA was 0.21. Uroligist said I have some of the lowest numbers he seen. So Paul, cover your ass. Insurance companies are a rare breed.

Pturner
Soaring Eagle member Join Date: Oct 2009
Location: Atlanta
Posts: 2,043



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Pauld315,
I'm sorry to hear of your wife's former cancer and I hope she stays in remission forever. Under the circumstances, I don't think I would give up her job and health insurance benefits until you are certain that you have secured adequate coverage elsewhere.

Insurance policies can be tricky-- you have to read the fine print. My former employer once purchased a group policy with assurance that mammograms were covered. When women in the office filed claims for the procedure, the claims were denied. The policy stated something to the effect that mammograms and other routine office procedures were covered. The "trick" was that mammograms are never actually performed in a doctor's office. The insurance company's argument was that mammograms were covered as long as they were performed in a doctor's office. Gotcha.

The "gotchas" with insurance companies can be almost beyond belief; so before you give up her work coverage for any other coverage, I would have a competent insurance attorney or adviser review the policy.

Wish you all the best.

Pauld315:

I agree with pturner. Insurance companies have their own rules. I would make sure that she is covered by calling them and asking for a secific clarification on their policies. Trying to figure out the way these policies are written can be extremely difficult as they seem to be written by lawyers to protect the insurance companies. A competent insurance attorney or adviser review the policy is a great idea..
If you ask me, I think insurance policies are a lot of double talk.

I had a family doctor tell me he retired because he got tired of talking to a insurance rep, (possibly a former nurse), who would tell him why a procedure was not covered. He felt that as a doctor, he knew better what needed to be done than the insurance rep.

Wishing you and your wife all the best with your decisions so that your wife stays healthy.

Thanks to all for your well wishes. We have been dealing with this since she was 38 and we never look at it as a liability or really even think about it all that much. We faced the possibilities of what could happen years ago and put it in God's hands. We always remain positive since we do believe that positive thinking will always help in your cure. We celebrate as each year passes. She is still a survivor after 13 years. That is all good.

I still haven't found out when, if ever, the insurance companies will remove you from "pre-existing condition" status. It affects health insurance and as mentioned above, procuring life insurance. I tried raising her life insurance once after she had cancer and that was also a no go. Do they ever drop that classification and actually consider you cured ?

It just doesn't seem right that the medical community considers you cured after a 5 year remission but the insurance companies really never consider you cured. Thanks to all for their advice.

My wife and I are a group of two. The business was here for a few years but inactive. When I decided to move here we simply got insurance under the dormant Florida company. I do not know if there are any restrictions on new businesses though so best to check this out. They might have some rules in effect to prevent people from doing what you outlined above. Insurance companies do not like to pay out if you haven't heard. :smiley:

New healthcare bill
 

Part of the new healthcare bill will eliminate the "pre-existing condition" clause. Insurance companies will not be able to deny or charge you more . Not sure what year it takes effect ( I think it is 2012). But there is movement to repeal the healthcare bill. We wish you the best.

MassHealth
 

the health care bill needs to be revised I am dealing with MassHealth the national bill is based on our bill here, so far it has not been the best experience

I was in the same position. Cancer in 2003. Treated and then lost insurance coverage in 2004. Fortunately, I was near 65 and we took out an insurance policy that did not cover cancer for a short period of time.

Hopefully when the new health insurance program kicks in, this won't happen to people.

I read thru the posts, and the health care highlights when it passed, appears to me (and maybe I've got it wrong) that in 2014 (can't remember if Jan. or July) they can no longer deny adults for pre-existing conditions (not sure if you need to have had continuous coverage) and put a cap on premiums - something like twice or three times as much as they charge the customer with the lowest premium.

I'm currently on COBRA from office closing in Dec. 2009 and will be looking for a private policy as of July, 2011. Won't be 65 until Oct. 2014. Makes me almost afraid to go to doctor for my yearly physical in case they detect high blood pressure or high cholesterol or something.

When I had a private policy about 10 years ago, they excluded a pre-existing condition for 2 years, but it was a minor, although chronic, condition. I know others who have histories of breast cancer who do have inclusive policies, but it is VERY expensive coverage (over $1,000/mo) and may also be high deductible policies. Not sure how long they had to be cancer free - 5 years? - and maybe it gets reviewed for type of cancer, prognosis, etc. Don't know if they had to get current cancer-free physicals or not.

Now you can see why we needed health care reform, and although it's certainly not perfect, at least it's a start (at least IMO).

ohiogirl, we feel your pain and your fears are well founded. My husband was on COBRA and never had health issues but as it was running out 2 years ago he went to get a private policy and was denied because his blood pressure and cholesterol were elevated. It was so slight that meds were not even required. Once denied you have to admit that on other applications which apparently raised flags to other carriers as he was repeatedly denied. He was then without insurance and within months was diagnosed with prostate cancer. Surgery, etc. all ended up being paid out of pocket and sealed his fate for ever getting insurance. He applied under this new healthcare bill July 1st, was approved and has just sent his premium in and waiting for confirmation of coverage. I am not a fan of government involvement however what is one to do, something has to change.

Another watch out for
 

My insurance carrier in WI did not have a license in Florida to provide insurance. I had Cobra but it was an HMO policy which was not accepted by doctors here. Had to change this to POS policy. More deductable ($5000) and still a big hassle finding a doctor that took it.
Now, my COBRA is running out 1 month before my 65 birthday, 7 months before my wifes. I called my "up north" carrier asking if they had a conversion plan for the one month, they don't. Had to apply to HIPPA, they turned us down saying we are eligable for a conversion plan with my present insurer. I called the HIPPA insurance provider who were very nice and are investigating.
All the plans the government is providing is after our needs. No help.
Point of this is, make sure you have this health care stuff figured out before you move. Would the problem prevented us from moving here, no. We just would have had a better plan.

We are in the same boat
 

I feel for you. I have a pre-existing condition and as covered by the Texas High Risk Pool. Florida does not have a risk pool and when I called they stated that they would not be opening one as the federal government plan kicks in in 2014. I was turned down by the new pre-existing pool as I have insurance. I just don't want to go thru the risk of no insurance for 6 months. The trouble would be is everything that has ever been treated for (even if 1 time) they could call a pre-existing condition. We are still hoping. Good Luck and if you find anything, please let me know. BJ

I am reading these posts with a look of horror on my face. How can anyone be against healthcare reform after reading this? The insurance companies sound like mid-way "hucksters" at a carnival who are willing to take your money in vast amounts but will not pay off if you win any of their games!
Think about it folks!

Pre-existing condition
 

The Villages Hospital is a good employer with excellent benefits - you can get get part time or full time benefits, with certain hours required for each. Depending on what your wife does, it might worth it to check out their website and look under careers. Best of luck and hope to see you here one day.

I don't blame the insurance companies. I blame the government as there is a federal law preventing transfer of insurance across state lines.

We are going to be in Florida in November and I do plan on taking my resume to The Villages Hospital. We can always hope. BJ

I DO blame the insurance companies. I lost my insurance after breast cancer.