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Will new insurance cover treatment?
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Will new insurance cover treatment?

I'm getting ready to retire next month.
My insurance coverage will be changing.
How can I be sure my new insurance will cover treatment.

If it does not cover Hep C treatment what are my options?
Generally, speaking most of my colleagues who have retired
have found their coverage to be adequate, but with
Hep C expensives I need to know for sure.

My insurance coverage has been changing constantly over the years since I treated.
As my workplace is a hostile environment and I also have two sick parents
I would like to leave sooner than later.

Reva
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13 Comments Post a Comment
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Avatar_m_tn
Seems to me the only real way to know for sure is to call them.
Have the exact meds and doseages and they should be able to give a definate answer.
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1669790_tn?1333666195
Employers generally review their health insurance plans annually to look at potential increases in premiums.  They are often provided a menu of options to consider and the premiums vary according to the amount of deductable paid, copays, cost per hospital visit, etc., etc.  A plan offered by the Insco one year may not be available the next, which forces the employer to make some unpopular choices as the plan shifts.  

If you're retiring and you will be provided continued coverage, I'd think your treatment should be covered.  However, the only way to be sure it to either ask the individual who coordinates your benefits at work, or if you want to keep this confidential, talk to a representive with the Insco.   Best of luck.
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1815939_tn?1377995399
You do not say how old you are. If you are 65, you will have Medicare. Parts A and B of Medicare cover 80% of approved treatment. Parts A and B do not cover medications. You need other insurance to cover meds. Also, if you have other insurance, they will usually pick up a certain percentage of what Medicare does not pay.

If you are younger than 65 then you will have only the insurance you mentioned. If your company has a retirement insurance benefit, I do not think the insurance company, even if it changes (to another company), can deny you coverage if you are already insured. If it is the same company and they keep changing the benefits, that is another story. The only way you are going to know what type of coverage you will have is to talk with someone in your company's retirement benefits section (every company is different so I don't know if you would talk with someone in personnel or if your company has a separate retirement office). You should be able to get a copy of an insurance benefit booklet and it should outline the benefits you will have, including deductibles and co-pays. Hep C is a recognized disease and it should be covered by insurance if you have insurance. Some insurance companies require pre-approval for certain procedures and meds but that is usually just a matter of going through the approval process and not getting the procedure/treatment/med until it is approved.
You do not have to tell anyone at work you have Hep C. You just need a copy of the insurance benefits booklet and you also need to talk with the retirement or personnel person about whether the ins. company can deny coverage if you retire. (I suppose it is possible there is a pre-existing disease clause, except that should not apply if you are just transferring from active worker to retired worker.) After you do all of those things, and you have a copy of the benefits booklet, then contact the insurance company itself and ask them the details of your coverage. Getting that information will probably ease your mind.

Once you have all of the information about your benefits and coverage, then you can work on any gaps in coverage (if there are any). There is help from the drug companies for the meds and there are other options too, but it is difficult to suggest anything until you know exactly what your insurance will cover.

Don't be afraid to be the squeaky wheel. Keep asking until you find out.

Be sure you keep your insurance current and never let it lapse.

Just from personal experience, my coverage continued when I retired. It was a different benefit plan (from the one I had when I worked), but they never tried to deny anything based on pre-existing conditions.

After I was diagnosed last summer, I drove the insurance company nuts (I think) calling them and asking about drug coverage, pre-approvals needed for procedures, etc. But one needs to know in advance so one does not get a procedure done and then have the coverage denied because one did not get the procdure pre-approved.

I wish you the very best for the future and hope this works out well for you.



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1815939_tn?1377995399
Well, as usual, it took me so long to type my post that two people have already given you similar information and posted while I was typing, lol.
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Avatar_n_tn
That's my ? too.  I'm taking short term disability which will move into long term disability which will take me into social security.  I will also apply for social security disability.  My boss will pay my current insurance premium for 6 months.  After that what will I do?  I'm sure I can go to the county social services and get some type of medical assistance but will it be sufficient for the treatments.  I will get prescription assistance for the meds but what about the doctor?  So much to try to figure out.
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446474_tn?1404424777
'My boss will pay my current insurance premium for 6 months.  After that what will I do? '
So your company will pay your full coverage for 6 months after you leave the company?

When you say you are taking 'short term disability'... is this 1) company disability or 2) state disability?

You are eligible for COBRA (you must pay the full cost) for at least 18 months up to 36 months (it may depend on the state you live in) after your employer stops paying for your insurance. If you need to you can use COBRA as a bridge to Medicare should you need to.

'After that what will I do? '
As pooh said, Basic Medicare (Parts A & B) cover doctor and hospital care. Parts C or D which are optional, cover drug costs.

For more details please read the official US Medicare Handbook 2012...
http://www.medicare.gov/publications/pubs/pdf/10050.pdf

Yes, Medicare and changes to health insurance is no easy task. You need to be pro-active and start putting your future coverage plan together. It will dictate your medical options in the future. Should you have extensive liver damage this is even more important.

Pooh can probably direct you more as I, as I am in the learning phase myself as I will be going from COBRA and SSDI to Medicare this year after being on COBRA for over 2 years.

Good luck to you!
Hector
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1815939_tn?1377995399
It is unclear to me how sick you are now, before treatment.

You probably know your short term disability rules and your long term disability rules. I would be certain all of my ducks were in a row before I quit my job. Are you certain you will qualify for short term disability and long term disability. There are usually some criteria that one has to meet.

I would be most concerned about Soc. Sec. disability. Perhaps you have already discussed this and researched it but Soc. Sec. disability is not a given. You will need to qualify for it. My take is that Soc. Sec. Disability is more rigid or strict with its criteria than short term or even long term disability. Also, sometimes the wait for approval for SS Disability can be long. Others on the forum may know more about this. Regardless, start your applications early. Even regular Soc. Sec. takes 3 months from application to first check. Actually, it tkes longer. I applied in August and got my first check at the end of January even though I turned 62 in Nov.

When you get close to 65, like 64 1/2, start applying for your Medicare as it also takes a while to process.

As Hector said, you can continue your medical coverage through COBRA. I would recommend that because you surely do not want to let your medical ins. coverage lapse. The meds are expensive but the doctor visits and labs and tests add up too. When you reach age 65 you will have Medicare. Part A you get, period, no cost. Part B you do have to pay for, about $100 a month (they take it out of your check). You need both A and B. One covers hospitalizations and one covers outpatient tests, labs, doctor visits, etc.   In addition, you will need Part D for the medication coverage. I would recommend that everyone get the medication coverage. You can get it when you get Medicare but you will have to choose which plan you want. The longer you wait to get the medication coverage, the more it will cost. Some people think they can do without the medication coverage. That is extremely foolhardy. A person can be healthy as a horse one day and get a serious or fatal diagnosis the next day. (I thought I was healthy as a horse on July 5th, but was diagnosed with Hep C on the 6th. I had very few medical expenses prior to my diagnosis. I could have made the mistake of thinking I did not need the medication part except I am a medical professional and I knew I needed it). ) As we see with Hep C, the meds are extremely expensive. So are meds for cancer treatments. I know a couple of people who opted not to get the medication coverage and had to pay for cancer treatments and meds from their savings. Blew a big hole in their savings.

Perhaps you have already researched these points, but I am raising them in case you have not thoroughly investigated. Better to be prepared so you can have plan B and plan C if your intial plan A does not go smoothly.

I wish you the very best with treatment.
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446474_tn?1404424777
Pooh makes all excellent points. Especially critical is to get all your duck in a row BEFORE making ANY changes to job or your healthcare coverage. Once the deed is done their is no going back. I have seen a number of people come on this forum after quitting there jobs and having no insurance. Depending on your personal circumstances making a mistake like that will cause you 10 times the grief to get any medical care in the future. Because you will have to navigate through alternative ways to get any healthcare at all. And in the long run it will cost you in time, money and heartache if you have or will have extensive health problems due to hep C.

If you have any awareness of the political situation right now you may know that there are many who want to take away all medical services you can not personally pay for. Not only Social Security but all medical programs designed to help the average American. So you want to be part of the main stream with the most other people in the same boat as you and have at least some say before they cut your benefits. I am 59 years old and still have a chance of getting back what I have paid into the system over my entire working life. So we are lucky to be near retirement age so it will take soon time to bit by bit take away our health services. But the future looks quite bleak  at the present time.

A word about State Disability. It is particular to the state you live and work in. The California State Disability Insurance (SDI) is a partial wage-replacement insurance. State disability only requires a doctor's note saying you are under their care and are unable to perform your job functions due to your illness, treatment, etc. State Disability at least here in California pays about $1,800 every two weeks (depending on your salary from what I remember.

SSDI, Social Security Disability Insurance is completely different. It is a Federal government program. As pooh said you have to prove the you are limited in what you can do not only at work but in your personal life. You have to be disabled and it can be a long process organizing all the information SSDI requires to prove you are disabled. You have to prove that you have a condition or illness that they consider you could be diaabled by and then you have to prove that you are disabled by it. For example just because you have cirrhosis of the liver that doesn't qualify a person for disability. To cut to the chase....if you are talking about disablity because of hepatitis C treatment. Hepatitis C treatment is NOT considered a disability. To prove that you are disabled by it is would be a daunting with very low odds of success.

I had End-Stage Liver Disease when I qualified for SSDI. I have literally boxes of medical treatment diagnosis, tests, over about 4 years at that time. I got mine within maybe 3 months. I was very very lucky but it took months of work to organize my case. At lot of my story was backed up by that fact that I am waiting for a liver transplant. So if you have a fatal illness as a result of Hep C you will have the best odds of success. ESLD and/or liver cancer will expedite things.
Also you do realize that SSDI pays according to how much you put into the Social Security system maybe $1,500 per month. So you have to figure out how to live on that.

You need to starting learning and planning for the future now. If you really are ill the chances of getting health coverage in the future is very low. So whatever you do don't let your health insurance expire for one day. One day and you have a "per-existing condition" is a nightmare now and will probably only get worse in the future due to the current political situation.

Good luck!
Hector

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1431734_tn?1333920149
  i finished tx one year ago and had no trouble with cobra covering me. my monthly cobra was less than $500. and covered also dental and eye care. maybe i was just lucky. i was very careful that only one person in the personnel dept was aware of my situation but i got it lined up before retirement. blue cross was my carrier and i picked the plan that would allow me to go out of network if necessary. hope u have this kind of luck too. babs
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1986676_tn?1329866071
I will be retiring with benefits, including health insurance, from the state.               I will also have a prescription program.
I'm not 65 and won't be for awhile so do I still need to investigate all this
stuff. Blue Cross will be my carrier but I will look to see which prescription carrier I will have.

I will also let you guys know who my prescription carrier is. Maybe someone
knows them and their policies. I've only got about 10 days before I have to sign
off I'f I'm retiring. My policy will not lapse for any period of time. We have to notify the state 45 days in advance so that our coverage remains in place without gap.
The only change I'll have will come in prescription coverage.That will change

Thanks
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1815939_tn?1377995399
Retiring from the state with benefits (pension?) and health and prescription drug coverage is probably excellent.

The coverage may be quite good. I cannot say for sure without knowing the details of your policy. Even government policies vary considerably.

I retired from a SF City and County job with health and prescription drug coverage. It is pretty good coverage, although I moved out of area so I do have to pay a bit more than I would have to pay if I had stayed in SF. For out of area, they pay 85% of medical care and there is a copay for prescription drugs (prescription copay is very reasonable). That 85% could get to be a problem if one has large medical bills (like Hep C bills). Lucky for me, I did not have large medical bills until I got on Medicare. Then I had my initial (free) Medicare health exam and guess what, Hep C. So in many ways, my diagnosis was timed right, at least for insurance purposes.

You will have to really scrutinize your policy to see exactly what they cover and how much. Also, many insurances require pre-approval for certain procedures and meds. If you fail to get pre-approved, you pay. I can go on line and look up all of my benefits. I can also go on line and check prices for meds. Most insurance companies have tiered drug coverage, with rising co-pays as you go up the tiers.  

Knowing which company covers your prescription drugs is not enough. They have many different levels of coverage depending on what your job negotiated with them. Even the prescription drug company cannot give you an answer until they know your insurance ID and group number. (At least, I believe this is the case with most insurances.)

I think Blue Cross is one of the better ones. There are some that are known for denying needed care but I doubt you have one of them since you work with the state.

I hope everything works out well for you.

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Avatar_n_tn
Thank you for responding.  I turned 63 in November.  I had been talking to the comptroller about short/long term disability which our company's insurance covers.  He found out that our company was having some cutbacks which would affect me; the other person in the office who does basically the same job as me is 25; I would be the one to go.  Short term disability pays more than unemployment.  When I took Interfuton treatments which did not work in 2008 I was wiped out.  I suffered from depression, fatigue, unusual tiredness and weakness, flu like symptons, nausea, vomiting, headaches, swelling of the mouth, mouth sores, feeling cold, and joint pain.  My doctor kept asking if I could make it or if I wanted her to sign papers for me to take disability but I wanted to be a trooper.  Even after I stopped taking the treatments I still felt bad for a long time.  I'm trying to think all of this through thoroughly.  
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1815939_tn?1377995399
It is unfortunate that at 63 your position will be cut. It seems unfair that you, being 63, would be the one to go, although if you are doing treatment you may not be able to do your job anyway (as you stated you were very ill before when doing treatment in 2008).

If your company covers short term disability benefits that sounds like a good option. I know it is usually fairly easy to qualify for company disability insurance and some other disability insurances (like California's SDI which is deducted from workers' pay checks) because basically all you need is the doctor to fill out and sign the paperwork. (Of course, you have to have something wrong with you that makes you unable to work or they can charge you with fraud.) (If I recall correctly, the Cal. State Disability starts after you are off work for 2 weeks and the employer integrates the sick pay benefits with the state disability in order to make your entire check (as long as your sick pay holds out; after that you only get the State, Disability). It appears your long term disability benefit is company insurance also. I don't know how long each wil run (how long short term dis. will run and how long long term dis. will run. If you can stretch them to your Soc. Sec. benefit date, that would be good. Well, you won't have any trouble getting plain Soc. Sec. necause you are already 63. It is the Soc. Sec. disability that could be the major problem, I think. As Hector said, Hep C may not qualify you for the Soc. Sec. disability, even if you feel like crap and cannot work.

You have about two years to go to get to Medicare. With a birthday in Nov. you will get your first check in either Dec. or Jan. following your 65th  birthday.

I know you are looking into all of your options and what will work for you. I guess I would mainly keep in mind that you may not qualify for Soc. Sec. disability (and may end up with just plain Soc. Sec.). I also would try excessively hard to keep your medical insurance, including drug coverage, current and do not let it lapse. You really do not want to be without med. ins. during treatment or even after treatment. Also, you will still need some medical and drug insurance even after you are on Medicare. I do not know your financial circumstances and I realize one cannot get blood out of a turnip (just a saying, I am not calling you a turnip) (although, someone once said I could, in fact, get blood out a turnip, lol). If your living expenses and insurance premiums are larger than your income and any financial reserves you may have, that is a problem and I am not sure what you would do in that case. It is good you are researching your options now so at least you have some idea of what is available.

I really hope things work out well for you and that your treatment is successful this time.
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