Any way to get Health Insurance now?

sweebyJanuary 16, 2008

The young adult child of a good friend just got the very distressing news that she has cancer. Fortunately, it was caught early, and is a type of cancer with a very high cure rate. But unfortunately, she does not have health insurance, and her treatment regimen is likely to cost upwards of $100K.

She's over 21 but under 25, recently graduated from college, so not a full-time student, and has minimal income, no assets to speak of. Her mother recently married a man who is financially secure, but there's some question whether the husband would agree to spend that much of his money to treat her daughter (they are not close) since it would endanger his retirement and the college fund for his own son. Also, the girl had not settled into a career-track job with benefits, and this had already been a bone of contention between her mother and stepfather. StepDad was already complaining about supporting the girl financially -- now this.

My question is if anyone knows of a way for her to get health insurance - perhaps by returning to school as a full-time student? Since she has already been diagnosed, any policy would need to NOT have an exclusion for pre-existing conditions. Do they even MAKE those policies anymore?

Any ideas? My friend is very, very worried, and is focusing on treatment first -- how to pay later.

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momj47

It's going to be hard, if not impossible for her to get health insurance with her diagnosis. Returning to school might work, and if she's a full time student, she might be able to get on a policy with her mother and/or stepfather.

If she can get a job with a really big company or university or government agency - state, federal, municipal, she might be able to get insurance through her job. Most big companies don't have an exclusion for pre-existing conditions, though some do have a waiting period. She may have to start treatment before she starts a job, if she's ill, she probably won't be able to get a job. You can usually find employee benefit handbooks online, they are an important recruiting tool now.

The obvious question is "why didn't she have health insurance?" I paid for individual policies for my kids between college and their first job, no one can afford to go bare. I paid for a couple of years for one child while she tried to start her own business. Those policies, while not inexpensive, are worth every penny if something like this happens.

Good luck to her.

    Bookmark   January 16, 2008 at 10:20PM
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blue_velvet_elvis

She is not able to be claimed by the parents as a dependant. She has minimal income. She should be able to get state medicaid. I'd have her go apply at the local department of human services.

    Bookmark   January 17, 2008 at 8:46AM
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imamommy

Blue, I almost suggested that but she's over 21 and unless she has a child, she may not be eligible (the laws may be different depending on the state). But she could apply for Social Security Disability and get medicaid that way.

    Bookmark   January 17, 2008 at 11:25AM
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mom_of_4

If she has a minimal income (which albeit has to be significantly minumal for a single person) she should be able to get medicaid. I would tell her though that that is not a pleasant process. My experiance (when I first had my daughter and needed it) was not a pleasant one. The people are mean and well downright awful and their first response is NO. I went in knowing exactly what I qualified for and didn't except no for an answer. I already knew what forms to fill out so when they told me I had to do certain things (which basically just make you life more difficult and are not a requirement) I told them flat out No, I don't have to do that I only need to fill out this this and this. Visit your state resource to find out the income requirements and such in your specific state. They are different for each.

Also -

I happen to find this as well

In the US, there are a few alternatives that you may want to investigate. The first is Medicaid, if you financially qualify. If your income level is over the Medicaid limit, you may still qualify for Medicaid by using a spend down equation (usually the amount of income you receive over and above their income guidelines). To become eligible for Medicaid your allowable medical expenses must be more than your spend down amount. Expenses for medical care that may be considered in this equation include care from hospitals, doctors, clinics, dentists, drugs, medical supplies and equipment, health insurance premiums, transportation to get medical care, personal assistance services, and adult home help services that are related to your medical care. Read more on this here:
--> Medicaid Eligibility

http://www.rare-cancer.org/health-insurance.html

    Bookmark   January 17, 2008 at 12:32PM
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sweeby

Thank you so much for these excellent suggestions.

Getting a job with insurance was tough before, so I'm thinking that is probably the least likely of the options (sadly).

I'm thinking that if she's not yet quite broke enough to qualify for Medicaid she soon will be. (Treatment has already started.) Thanks for the web site Mom_of_4. It's worth looking into.

And as to why no health insurance? That's a darn good question -- but of course, not a helpful time for me to be asking it...

    Bookmark   January 17, 2008 at 1:53PM
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mom_of_4

Everyone has a reason for not having health insurance. I didn't have it for a while... between switching jobs (courtesy of being laid off) and trying to support a kid on my own and being totally on my own insurance was not the highest on the list it came after food rent and lights. Which meant no insurance. I am just glad that I have worked my way out that situation.

    Bookmark   January 17, 2008 at 3:15PM
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mom_of_4

on a side note: I just reread my post and I apologize for my grammar and missing words. Typing fast gets me everytime.

    Bookmark   January 17, 2008 at 3:19PM
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pfllh

Call the state Insurance Department and ask them what options are available to her. Some states have a type of insurance for persons in need besides medicaid.
The Cancer Society will probably have good information as they deal with all aspects of cancer patients.
I certainly hope she finds the help she needs and does not decide on no treatment due to the cost. Where she goes for treatment may have a patient assistance program.
Wish her the best.
Lynn

    Bookmark   January 19, 2008 at 11:56PM
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june0000

Hi Sweeby,

What a terrible situation for this young girl to be in.

Questions/Comments:

1. When was she last covered for health insurance? If she was on her mother's employers health plan as a student and that coverage ended within the last 63 days, she may be able to elect COBRA. Employers with 20 or more employees (who are not a government plan or church plan) are required to offer COBRA. It is a Federal law. If this is the case, time is of great essence in signing up for COBRA.

2. Some states have a Comprehensive Health Insurance Pool that is for uninsurable residents. There is a pre-existing clause in these contracts but in some states they will waive the clause if the person had previous coverage that expired (usually within the last 60 days). It depends on the state - the state insurance department can help on this.

3. Most health plans, regardless of size, will have a pre-existing condition clause. This is because of HIPAA (which allows a pre-existing clause) and because the plans do not want to pick up a $100,000 or $1,000,000 claim if they do not have to. The plans without a pre-existing clause are a small minority and definitely an exception to the rule.

As you can see, there are a lot of factors. HIPAA also allows for erasing the pre-existing clause under a group health plan if the individual had prior credible coverage within 63 days.

Do you have more info? I can fine tune an answer/possible solution for her if I had more details.

June

    Bookmark   January 23, 2008 at 12:24PM
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finedreams

I hope she gets her treatment and feels better.

Now about insurance:
I had a friend who was just out of college and didn't have full time employment. he had no insurance, and he was diagnosed with brain cancer, large tumor. It needed to be operaed etc. Hewas able to get Medicaid. His claim was that he was unable to work (due to severity of his condition). he had Medicaid during his treatment and few years after that because he could only work part time, he was physically unable to keep full time employment. So state insurance is the only way. As about going back to school: student insrances do not treat pre-existing conditions.

    Bookmark   January 27, 2008 at 6:31PM
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bigideaslittlefunds

these are some good ideas and if you can do a state Medicaid type of plan they would cover you from the first day that you tried to get it. If I remember correctly - cause I have friends on the state plan ( mom dad and 2 kids)

also another suggestion would be Mayo Clinic.

    Bookmark   April 24, 2008 at 11:46PM
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