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'Pre-existing condition' fears

Hello again...I've gotten a little happy with the posts, and I hope no one minds. OK...this one is complicated. I am currently on Medicare/Medicaid and social security disability (I'm 28). I am wanting to go back to school (I have 2 bachelor's degrees) and get a masters in teaching grades 5-8. Thing is, the insurance company that covers teachers in South Carolina is Blue Cross/Blue Shield. They have a lovely thing called a "pre-existing condition" clause which, as I understand it, says  anything I have (ie., type 1 diabetes, also bipolar-ish) won't be covered by them for a year after I get their policy. Meanwhile, I will have to pay these people ~$250 or more a month. I thought about setting up a savings account just for insulin, but I do not see how in the world I am going to make a year with no coverage and yet shelling out huge money for the privelege(sp?). Also, if your income is above $600 in SC, you are no longer eligible for Medicaid. I think I would make more than that as a teacher (I hope!). I live basically check to check, but am ready to MOVE ON with my life. I firmly believe there is a solution. I have checked with the Vocational Rehabilitation office and met with great resistance in help with them because I already had two undergraduate degrees which was slightly daunting. I am not certified to teach and would have to go back to school (not that I mind :)...This program has a 100% hiring rate after graduation, and when I came in to interview, the director said she had 3 type 1's enrolled! I think the minute I am hired somewhere, both Medicare and SSD ends-help!
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Avatar universal
Hello again,

Thank you for your follow up post!
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Avatar universal
Hello again...
I went online and found some really useful sites ,inclusing one which has grants available through the US government. Actually, I improved my reading skills and exercised my brain considerably! Grants as a rule seem to be written in the most legalistic language I have ever seen! I am not complaining, though...it gives me good practice for the Praxis reading comprehension exam lol.

Anyway, I noticed that for South Carolina where Medicaid is not very 'good,' people on SSI (Supplemental Security Income) and SSDI (I think this is for family members) have different rules to follow than those who have SS-something...argh.

In any event...and here's another level of irony...if I had gotten less original disability, I would have ended up with SSI which has a greater amount of leeway in terms of programs and assistance that you qualify for...in South Carolina, after three years on Social Security Disability, you get Medicare, but not before.

I happened, however, upon a fact that I think some people here might need to know. Those people who have both Medicare and Medicaid are going to be forced to drop Medicaid prescription coverage and 'switch' to Medicare prescription drug coverage on January 1, 2006.

Medicare prescription drug coverage has some very odd and confusing rules, to say the least: I remember reading something about there being $600 coverage for (I love this) "medically necessary" (like some people just take prescription medication for fun--like a hobby!) prescriptions. And then, after you hit the $600 max, Medicare takes a 'break' from covering your medications and you end up having to fork out $800-$1000 for the stuff you need to live.

Then, after you are good and broke, Medicare will deign to pay for another $1000 or so of medication. I'd like to go up to Washington and put each Medicare policy writer through an elaborate and painful process where I determine which of them are "politically necessary." Then I would change my mind at the last minute and not make it knowledgeable to them.

They'd only find out when they came to got their paychecks--when it was too late to take any meaningful action. Oops...sorry--I hope I didn't offend anyone. Oh, and their insurance policies would have a $50 deductible which would take them eight months and several thousand dollars worth of life-or-death medical expenses to "meet."
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Avatar universal
Hello kneazlelady,

First I want to apologize that I did not answer sooner, but I was hoping to find out some information for you.

I am a volunteer and give input based on experience in caring for my son, now 10, who was diagnosed at age 3.  My sis is also type 1 and was diagnosed 9 yrs. ago at age 24.  (She is currently filling out paperwork for social security disability, I believe.  (Diabetes, bipolar, fibromyalgia, possible arthritis, so she has a lot of pain)

I am glad to hear that you feel like you are ready to move on and want to go for it with teaching!  You will be an inspiration to others who read your posting.

So, while you are in school, you can still have your medicaid and social security disability, but as soon as you are working and generating an income it will be terminated?  I think I understtod you correctly.

So, the bad part is that with the pre-existing conditions, you have to wait ONE YEAR as you still pay your monthly ins. premium and diabetes and bipolar / mental health would be your 2 BIG reasons for even going to the doctor getting prescriptions, so it all seems pointless.

The good part, is you still have time, so this is not going to happen immediately and eventually, your pre-existing conditions WILL be covered.

Please copy and paste this link and read about pharmaceutical asistance programs.  I am unsure what the income guidelines are, but here is what the heading says:

"State Pharmaceutical Assistance Programs
(includes seniors, disabled, uninsured and others)"

http://www.ncsl.org/programs/health/drugaid.htm
(You will not be uninsured, but you could fall into the others category - You Never Know)

It is really not fair that you have to wait one year.  Where I live it is the same thing.  When filling out the app. for Blue Cross if I put all of the anti-depressants I have been on, etc. then BOOM, wait one year before they would cover mental health.  Well, I was able to find a psychiatrist who is reasonable - well $75 for a 10 min. medication follow up, but, hey I need my meds. (but the visits are not put through the insurance) Yet, I still fill 2 of my meds through the ins. and have a $10 co-pay.  Luckily, he keeps giving me samples of the other med because there is no generic.

I do not know if Lilly is the manufactureer of your insulin, but, if it is here is a link:
http://www.lillyanswers.com/en/index.html

I do not know what type of glucometer/strips you use, but here is a link to lifescan's page about assistance:
http://www.lifescan.com/company/about/together_rx

I hope some of this helps you.
If I were you, I would prepare myself by searching for the manufacturer's assistance program for each of your meds. (diabetic adn mental health meds) All of the manufactureres have assistance programs and possibly you will fall into a category to be eligible for help.  Call them and explain your upcoming situation and find out information.

I am certain you will have many other comments.

Keep us posted.  You might find out something that will be helpful to someone else n your shoes!  I wish you luck in your teaching endeavor.  Do not let the insurance prob.  (although a biggie) stop you from GOING FOR IT!


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