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Topic: COBRA runs out in five weeks, looking for alternative insurance

Forum: Employment, Insurance, and Other Financial Issues —

Employment, insurance, and financial concerns are common. Meet others here to discuss and for support.

Posted on: Jun 25, 2010 01:04PM

MaryNY wrote:

My COBRA coverage will end at the end of July.

I'm looking at getting coverage under a low-cost plan, Healthy NY. Premium would be about $300/month. There are some disadvantages such as needing a referral for every consultant visit, only certain doctors covered and my nearby hospital and my breast surgeon not covered as they're over the state line. But at least it's insurance.

Healthy NY is sold by a number of providers and I narrowed the list down to three—Aetna, Blue Cross Blue Shield and Oxford. Then I found that BCBS are currently involved in a dispute with a number of area hospitals which means that until it's resolved their clients have no coverage at those hospitals. So that leaves Aetna and Oxford.

Would like to hear from others who use Healthy NY or your state's equivalent plan.

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4 Dx 5/19/2009, IDC, 1cm, Stage IIA, Grade 2, 2/6 nodes, ER+/PR+, HER2-
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Jun 25, 2010 04:09PM otter wrote:

Hi, Mary.  I don't have any answers for you -- I just wanted to acknowledge your post, because it has been here for a few hours without an answer.

This is a brand-new forum, on a topic BCO members have been interested in for a long time.  I think the forum might be so new that few people even know it's here.  Hopefully, when people get home from work or school and log on this evening, they'll see your post and be able to offer advice.

In the meantime, hugs to you...

otter

Dx 2008, IDC, Stage IA, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Jun 25, 2010 04:53PM lorrhaw wrote:

Hi Mary, I had posted a thread awhile back where I received a lot of helpful information.  The title of the thread was "My Cobra runs out".   It was in the Stage IV section of the forum.  You can search for it with those words or by my login - lorrhaw - to see what everybody has to say.  I don't know anything about the company that you are considering but thought the responses to my question may give you some help.

Good luck and keep us posted if you learn any new information.

Diagnosis: 1/8/10, Stage IV, 1 met ER,PR +, HER2 negative Dx 1/8/2010, 3cm, Stage IV, 0/0 nodes, mets, ER+/PR+, HER2-
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Jun 25, 2010 04:56PM karen333 wrote:

Dear Mary, my COBRA runs out July 24, was your last payment almost twice the usual amount?  I too am trying to get Healthy N.Y.  I am in W.N.Y. and the only insurance available is Blue Cross/Blue Shield.  They do not cover my Breast Care Center or my surgeon, both of whom I had great faith in, since my cancer was not visable on the mammogram, but was palpable and showed up on ultrasound and an MRI.  I don't know if the 1yr. mammogram will show enough.  I haven't heard from Healthy N.Y. or the BC/BS insurance.  I don't have any aswers for you, just wnted to let you know I'm in the same uncertain boat as you. Karen333  sending good thoughts your way

Dx 8/8/2009, 2cm, Stage IIA, Grade 1, 0/1 nodes, ER+, HER2+
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Jun 25, 2010 05:42PM MaryNY wrote:

Thanks Otter. I suggested to the mods that they add this forum. It took a couple of PMs but we finally have somewhere to discuss money issues. Sometimes it doesn't seem appropriate to talk about these matters on other threads as it brings them off topic.

Hi Lorrhaw. I have read the thread My COBRA runs out in 6 months (adding a link here as the info there might help others too). And I did comment over there a couple of times. I hope you get your insurance sorted out soon. I know it must be much more pressing for you with surgery coming up.

Hi Karen: Are you finishing 18 months of COBRA on July 24. Any chance that you are eligible for the additional 18-month extension? - you should be if your former-employer was fully insured. My last payment was three times the usual amount. Because of the ARRA subsidy, I was paying 35% of the premium but for this month (June) and next (July), I'm back to paying the full premium again. Healthy NY will be less expensive than that. I do have some questions before I submit the application. One thing that concerns me is language they use about pre-existing conditions: 

Your Healthy NY policy will exclude coverage for that [pre-existing] condition for up to 12 months. ... This period may be reduced or eliminated if you are transferring from other health insurance coverage, which terminated no more than 63 days prior to the date that you submit your Healthy NY application.

Note that it just says "may be reduced or eliminated."

That's lousy that you only have one provider option. I have eight to choose from, but of those only three work with most of my doctors. At least BCBS has a good reputation and I think most doctor's offices have a good relationship with them. 

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4 Dx 5/19/2009, IDC, 1cm, Stage IIA, Grade 2, 2/6 nodes, ER+/PR+, HER2-
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Jun 25, 2010 08:56PM Jelson wrote:

http://www.ins.state.ny.us/cobra/cobra_ext_36.htm

here is a link about the NYS 18 month COBRA extension. I had my son on Healthy NY last year and chose the drug rider. Biggest issue for him was lack of mental health service coverage. We were lucky that one of the Healthy New York Insurers in our area was the same he had been with when he was covered under our insurance, so he was able to keep his primary. 

I am sorry you have to deal with this. 

Julie E

Dx 4/17/2009, DCIS, <1cm, Stage 0, Grade 3, 0/0 nodes, ER+/PR+
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Jun 25, 2010 10:01PM MaryNY wrote:

Hi Julie: Thanks for that link. I looked into the 18-month extension already but I'm not eligible as my employer was self-insured. It only applies to fully-insured plans. Which provider did you use for your son's Healthy NY coverage?

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4 Dx 5/19/2009, IDC, 1cm, Stage IIA, Grade 2, 2/6 nodes, ER+/PR+, HER2-
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Jul 25, 2010 10:02AM - edited Aug 2, 2010 08:47AM by lovemygarden

Hi Mary, I too am in NY, a/k/a the Insurance Affordability Nightmare State. Which is why I have had no medical insurance for years: I don't qualify for HealthyNY but can't afford the cost of an individual policy.

EVERY insurer in NY enforces the 12-month waiting period for pre-existing conditions that you quoted. The last time I checked rates, which was in January, a POS policy for a single individual was around $1400/month, give or take a hundred or so per company.

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Jul 25, 2010 12:25PM - edited Jul 25, 2010 08:00PM by MaryNY

Hi lovemygarden:

So you earn too much to qualify for HealthyNY, but the price of individaul policies is astronomical. Applications for the state-run program are expected to be collected starting on 15 August 2010. I'm hoping that you will be able to work out something that way.

I qualified for HealthyNY and got my membership card this week. The effective date is 1 August 2010. On the phone, they told me that the waiting period is waived as there will be no lapse in insurance. I would prefer something in writing, but don't know how to request that without putting all my cards on the table and saying I was treated for breast cancer in the last year.

I am due for my three-month onc visit in August, my six-month mammo/ultrasound and return visit to BS. I know the visit to the BS will not be covered as she's in CT, but I'm hoping the others will be. But if they decide to enforce the 12-month waiting period, can they say they won't pay for the other appointments. I'm really worried now. 

I contacted my local congresswoman about health insurance. In a letter I received from her this week, it says

      "...in New York, state law bans health insurance providers from denying coverage based on a pre-existing condition and requires premiums to be based on community ratings, which cannot take into account age, sex, health status or occupation to calculate its rates. Unfortunately, the law does allow an insurer to delay coverage for a specific medical condition for up to 12 months."

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4 Dx 5/19/2009, IDC, 1cm, Stage IIA, Grade 2, 2/6 nodes, ER+/PR+, HER2-
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Jul 25, 2010 03:00PM karen333 wrote:

I too was covered by COBRA until July, but did qualify for Healthy NY as Mary did. I never heard of the 12 mo. waiting period until I got on site today.  I too am due for mammo., Us, and MRI for my first year anniversary in August, also my BS in Sept.  I'm worried now too. Karen

Dx 8/8/2009, 2cm, Stage IIA, Grade 1, 0/1 nodes, ER+, HER2+
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Jul 25, 2010 04:12PM MaryNY wrote:

Sorry Karen! I just got the letter from the Congresswoman a couple of days ago and my jaw dropped when I read that. I wish I had something in writing from Aetna HealthyNY to back up what they told me verbally. Also I'm wondering if they will cover our mammos as they are preventative but their real issue would be covering further treatment.

Also neither of us have a gap in coverage so hope that means that there won't be any denials.

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4 Dx 5/19/2009, IDC, 1cm, Stage IIA, Grade 2, 2/6 nodes, ER+/PR+, HER2-
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Jul 25, 2010 06:49PM karen333 wrote:

Mary, do we just have to wait and see?  I didn't give any info on my breast cancer to Healthy NY or to Univera either?  Karen  More uncertanty, we didn't need.

Dx 8/8/2009, 2cm, Stage IIA, Grade 1, 0/1 nodes, ER+, HER2+
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Jul 25, 2010 06:55PM - edited Aug 2, 2010 08:46AM by lovemygarden

Hi MaryNY, it's the employment criteria that disqualifies me. One of the requirements is that the person (or their spouse) must be either employed or have been employed within the previous 12 months. That's not the case for me.

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Jul 25, 2010 07:53PM MaryNY wrote:

lovemygarden: I sent you a PM.

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4 Dx 5/19/2009, IDC, 1cm, Stage IIA, Grade 2, 2/6 nodes, ER+/PR+, HER2-
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Jul 25, 2010 08:00PM MaryNY wrote:

Karen: yes, I think we'll have to wait and see. I think they couldn't be so heartless as to deny us both coverage for the mammos we are due.

Just thinking back -- I switched health insurance providers at the beginning of March when I was midway through treatment. The new provider didn't deny any of my claims. And they were hefty claims as I had just started rads. So this is really like a change to another provider and I'm hoping it's treated the same way. The switch in March wasn't voluntary on my part. My former employer switched plans so I had to go with the flow.

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4 Dx 5/19/2009, IDC, 1cm, Stage IIA, Grade 2, 2/6 nodes, ER+/PR+, HER2-
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Jul 25, 2010 10:34PM carol1949 wrote:

Not only did we lose our Cobra, my husband lost his job as the company was closed  and therefore there wasn't even anyone to administer the Cobra had we been able to afford it!  I feel that when we are in a position like this... I, at least am grateful for any medical coverge I can get... so I am not so caught up in where we can go.  Something is better than nothing. 

I wonder if there are any programs in your community that reach out to people.  For instance in my community I qualified for a discount on at least basic medical care for which I am grateful.

Perhaps through a county service or Senior Center?

Dx 4/4/2008, IDC, 6cm+, Stage IIIB, ER+, HER2-
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Jul 29, 2010 12:42PM lago wrote:

Good information here: Pre-Existing Condition Insurance Plan (PCIP)
http://community.breastcancer.org/forum/113/topic/754874?page=1
DONE!! goo.gl/IoaN6U • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010 Dx 7/13/2010, IDC, 5cm, Stage IIB, Grade 3, 0/14 nodes, ER+/PR+, HER2+
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Aug 10, 2010 07:04PM Medigal wrote:

MaryNY:  I was under the understanding that "if" the insurer had this delay in coverage for up to 12 months they were supposed to inform you about it.  I remember calling a company for my daughter when I saw this and she had a pre-existing disease. However, they told me since she was constantly insured by jobs or COBRA etc. they would not impose that on her so everything was fine for her insurance.  The way I think about it is if you get the pre-existing waiver then why should they even have a right to ask you if you have any pre-existing conditions.  Now if they asked you on your forms to list all your medical conditions and you did not that's another story.  Hope everything works out ok for you.

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Aug 15, 2010 02:23PM MaryNY wrote:

I still have to wait and see how the new insurance works out. I had a visit to my oncologist on Friday so I'm hoping that will be covered. I have an appt on Thursday for mammo and ultrasound but although my PCP gave me a referral to the breast center at the local hospital, I'm still not sure it will be covered. The trouble is that this breast center is not one of their listed providers and it's in CT rather then NY. The center do not pre-validate for insurance purposes. The insurance company told me over the phone that it would be covered but I have nothing in writing.

Mary ~~ lumpectomy 8/10/2009, Oncotype DX 18, Chemo 10/28/09--2/1/10 AC*4, CMF*4 Dx 5/19/2009, IDC, 1cm, Stage IIA, Grade 2, 2/6 nodes, ER+/PR+, HER2-

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