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Affordable Care Act/Obamacare Questions

The company I work for is going bankrupt and I won't be able to do COBRA with my current health insurance with them because the plan will be closed when the company closes. My husband's employer does not offer health insurance. I am in the process of looking for another job but we will need to have health insurance with no gaps so I am looking at Obamacare/Affordable Care Act insurance in Oklahoma to cover us until I find something else. I am stage 4 and on XGEVA, Faslodex and Ibrance. I was looking through the ACA plans and none of the plans cover XGEVA and Faslodex. I live close to another state and our healthcare comes out of there but none of those plans in the state I live in cover our providers that are 25 miles from us because they are in a different state. I wondered if anyone else had these issues and if they were able to get it resolved?

Comments

  • ctmbsikia
    ctmbsikia Member Posts: 749
    edited April 2023

    I would look into private insurance which maybe your best bet, or even a short term policy. The Market Place (ACA plans) are a complete nightmare. Wish you the best.



  • maggie15
    maggie15 Member Posts: 765
    edited April 2023

    This is a problem with no good answer. Private insurance often requires underwriting and they won't accept you with cancer. Short term insurance does not cover many things.

    The ACA has its downsides but it is better than being left with no health insurance which has happened to my family several times over the years. You could change providers (at least temporarily) to one in Oklahoma. Faslodex can be bought with GoodRX for about $135 a shot. XGEVA is a tougher med to afford. If your income is low enough you can get manufacturer assistance but many people are not poor enough but not rich, either. Alendronate is an oral bisphosphonate which is cheap and would most likely be covered; there might be something else available.

    The other option is to move across the state border and become residents of your provider's state (Kansas?) If you own a home and don't want to sell it you can rent it to pay for a rental for yourselves. It would require getting new driver's licenses and everything else but it might be worth it to stay with your doctor. You would need to check out the new state's ACA plans to see what would be covered.

    Employer provided insurances are not all equal. Some just pay towards your ACA coverage and only those with at least fifty employees have to provide it. Only my last job covered me in five contiguous states. When I lived in Arkansas my job insurance (an HMO) did not have a specialist my son needed in network. They sent us to Little Rock (4 hours away) rather than Fayetteville (a 45 minute drive) because of their provider agreements. At the time my husband had moved across the country for a new job (no insurance but was on mine for emergencies only) and was living in a room while I finished the majority of the school year and sold the house. I did get a teaching job in the new state (with insurance) for the following school year.

    It's too bad that you can't get COBRA since that would give you more time to work things out. All the best resolving the tough situation you are in.

  • sunshine99
    sunshine99 Member Posts: 2,474
    edited April 2023

    Cowgal, I can't even imagine! Does your MO have any suggestions? Maybe your pharmacy?

    I'm so sorry. This just isn't right...

  • cowgal
    cowgal Member Posts: 625

    Thanks everyone for your responses. One person private messaged me and I read it but didn't have time to respond back and that private message is not there any longer. I guess it was lost in the switch over to the new format. I have been AWOL from these boards a little bit lately as I was covered up with work trying to get everything shut down for my employer and ready to hand off to the new owner. I was able to find out that my XGEVA and Faslodex will be covered but that because they are not a prescription drug (they are administered by a doctor's office) they didn't show up in the list of covered drugs. My MO has been great. He told me no matter what not to worry about him. He would treat me for free! He does show up in the plan so he will be covered as well. It's going to be a learning process with my new insurance.

  • aprilgirl1
    aprilgirl1 Member Posts: 743

    Cowgal, I was on a vacation so am out of the loop and catching up. Medical Insurance changes with a stage IV life is scary and complicated. I am so thankful to read your update and love your MO's response! Thank goodness for oncologists with a lot of compassion. I am planning on joining the tuesday zoom this upcoming week.

  • maggie15
    maggie15 Member Posts: 765

    Cowgal, what a wonderful MO you have! I'm so glad that you can get insurance that works. You have enough stress in your life right now without having to worry about how to pay for your medical care.

  • sunshine99
    sunshine99 Member Posts: 2,474

    I'm a little late here but Cowgal, that's great news. What a wonderful MO you have. It must be quite a relief to you.

    Carol

  • cowgal
    cowgal Member Posts: 625

    Aprilgirl1, I am planning to be at the weekly Zoom call Tuesday night.

    I am still nervous how all this insurance is going to work and hope that I have been told correctly by the Blue Cross Blue Shield representative. You all are right, I do have a wonderful MO. He always listens to me and answers my questions. I feel like he really cares about his patients.