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MS and Health Insurance Providers

I was wondering if anyone had any good information on health insurance providers.  A friend of mine was recently diagnosed with MS and is trying to wrap her mind around the whole situation.  She currently does not have any health insurance and I am trying to help out by learning all I can about MS, [url=http://www.goldenrule.com]health insurance[/url] , treatments , etc. I am new to MS as well as this forum.  Any information that you can provide would be of great help.  

BL
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667078 tn?1316000935
I was at a meeting discussing this issue today. The main thing is not to panic. They can not squeeze blood from a turnip. My fear with diagnosis was not oh my I have this wretched disease it was how can I pay for this?

Under the Affordable Care Act the pre-existing clause does not come into play for adults until 2014. Each State has to set up a federal High Risk Pool until the health exchanges come in in 2014. If the state will not set these up the federal government will but it will take time.

You can not be eligible for any other insurance to qualify for a High Risk Pool. You can not turn down private insurance because it is too expensive and go into the HRP. Many states such as NC also have HRPs but it is first come first serve until the money runs out. It is a great deal and a disease like MS sends you to the front of the line provided you are not eligible for private insurance and the pool still has money. I am ineligible since my husband works for the state.

You can get medicaid with Social Security Disability as soon as you get SSD. If you are approve for SSI because of low income you have to wait two years for Medicaid after you are approved.

Many hospitals have paperwork you can fill out to reduce your payments if you have insurance but low income. In any case you can set up payment plans.

Sometimes local Chapters of the national MS Society have insurance specialists who can help. It depends on each chapter. We have a large and well funded chapter.

Many States are seeing tremendous cuts in Health and Human Services and State Health Care Programs.

Beware of the fine print of any plan off the internet who would insure someone with MS.  They will take your premiums but when it comes time to for you to file a claim they will have a reason not to. Most insurance is very tricky. If it does not have a really high premium or deductible it is probably to good to be true.

Also never with hold a condition on an insurance application. The insurance company can take your premium money and then when you need to use the insurance not pay on the grounds you with held a condition.

Most medical insurance companies are set up to make money for shareholders not to pay out claims. With the cost of medical care increasing taking on someone who will be chronically ill for the rest of there lives is not a smart bet.

Unfortunately is hard on the State and Federal level. The best is to get insurance through an employer, if not the HRP, or a apply for SS Disability if you can no longer work.

The system can't keep going this way. There will be no choice but to change it.

If you are like me you just do your best. I can not afford health care but I really have no choice. I just have to give up a lot and make endless payments to my local hospital and there clinics.

Take care.

Alex




Helpful - 0
198419 tn?1360242356
Hi there,

Popping in to say hello and welcome to the forum!  I 2nd the check w/your state comment. Many states (including mine) cover the uninsured in one way or another like Jess mentions. Start from the top (i.e., state health and human/social services depts) and then go from there. '

Was she dx'd by a participating state doc?

-Shell
Helpful - 0
211940 tn?1267881266
Yeah, I'm feeling the non-insured crunch myself.
I have no health insurance, and am on Social Security Disability, I was awarded it, in May, but retroactive to January 2010.  Since, I was awarded it, I am eligible for Medicare, but not until January 2012 (you have a two year waiting period).

I also had filed for Medicaid, which is suppose to help with health care coverage until Medicare takes over.

I wasn't told I was awarded it (until this month), no confirmation letter and no Medicaid cards, etc.  It turns out, I have had it, since February 2010.

However, here is the "kicker"
I have what they term a "spend down" of $2,835 for six months (or $5,670 for 1 year).
Which means, I first must "spend down" (meaning spend out of my own pocket), that amount, the $2,835 during that six months, after I have spent that money (of my own), then Medicaid will cover any additional health care costs I have.
Then, when that 6 months is up, I must do it again, "spend down" an additional $2,835, before Medicaid will cover any additional health care costs.

So, I ask you what good is Medicaid, to me?

I don't have $6,000, sitting in a bank, to use for anything, let alone to cover health care costs, and if I did, would I be asking for help, in the first place.

I found out about this, because I'm currently taking Rebif, and because I have no insurance, the Pharmaceutical Company gives it to me, at no cost.
Well, my year is up (since my initial request) so they asked me to renew my request, which includes forcing me to apply for Medicaid, since I don't have Medicare or any other health care coverage.  Now, since I actually do qualify or have Medicaid, they are threatening not to give me the medicine, at no cost, anymore.

I will let you know, how it turns out.

--Socrates2k1
Helpful - 0
1207048 tn?1282174304
Jen, I live in NY. I highly recommend the state insurance. I'll pay the higher taxes to have the wonderful insurance we have. To compare: the insurance offered at my DHs last employer would cost us $480 a month, 20% co-pay on meds, and $50 co-pay on office visits to my neuro. The month we were eligible to sign up for the insurance I saw my neuro 3 times, plus was in the office infusion center 3 times for steroid treatment. That one month would have seen us spend $300+ on me, money we don't have. Instead we stayed with the state insurance (premiums calculated by income), $2-$5 co-pays for meds (though a lot have been free), $5 office visit co-pays, nothing for steroid treatment visits, and my Copaxone costs a whopping $1 a month.

BL, sorry to go on a tangent :-)
My biggest advice for your friend is to talk to her local department of social services and see if she qualifies for any state insurance help. If not, they may be able to steer her in the right direction. Oh, and also if her state has an insurance commissioner, contact them, they can probably help also. I'm only 1 year into my MS journey, and I'm quickly learning it is not a cheap disease to have, unfortunately.
~Jess
Helpful - 0
338416 tn?1420045702
Wow.... just went looking on that website, and people who live in Texas are evidently SOL!  Maybe I need to move to New York or something.
Helpful - 0
338416 tn?1420045702
That's a good question...  Fortunately reforms to the health care in this country means that people with MS can now get health insurance.  Pre-existing conditions are heck.

There's also some changes in the works for those that don't have insurance, and don't have an employer who provides it.  Looks like I'll have to investigate insurance options myself, as my employer keeps raising the rates for my health insurance.  I suggest looking at this site to see what's up.

http://www.healthcare.gov/
Helpful - 0
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