Are you self employed in the US and if so how are you managing healthcare costs?
I have been without health INSURANCE since 2022 when BCBS raised rates. Then Sept 2024 I got mHSPCa with extensive bone mets, gleason 9, stage 4, I'm self-employed. I live in the US but I'm not old enough for Medicare yet, so am shopping health insurance in the private market during annual open enrollment (nov-Dec). Deadline of Dec 15, 2024 for some plans. Premiums and deductibles are high, getting approvals can cause treatment delays. I spoke with a health insurance broker and she said what i suspected, that I might be BETTER off to simply continue getting estimates for 100% self-pay, they give a discount and I have an interest free monthly payment with the Cancer Center. She said to ask my DO billing office if they know which insurance plan/in network seems to cover better. She asked whether I get most care in one place or if I travel, I stay in one city. Or I could enroll in insurance and after a few months cancel it if its not covering costs. Maybe I will be eligible for a clinical trial as I'm otherwise in excellent health?
I've discovered that some things are cheaper at the hospital which is not a trauma one center like the Cancer Center. My DO keeps costs in mind when prescribing generic drugs and I also use an online pharmacy for Abiraterone. My current high costs are Chemo and Eligard with a PSMAPet perhaps next yr.
Then wait a few years til i am old enough for Medicare.
Written by
ELOfan
To view profiles and participate in discussions please or .
are you being treated at a cancer center? Do they have a social worker? They might be able to help with getting you in touch with a navigator that works with cancer patients and understands. I don’t recommend going without. My husband was hospitalized last year and we had a $400k bill. You should at least get a catastrophic plan with a high deductible.
OMG $400k. You are right inpatient costs are so much more than out patient. The billing ofc already told us we don't qualify for financial assistance if you earn more than 75k a yr. My wife is still working for us.
Yes, he was hospitalized for neutropenia and neutropenic fever during chemo. We would be bankrupt if we didn’t have insurance. You never know and that’s why I say at least get a low cost bronze plan. Also talk to the social worker. They want to help.
That’s great. You will be thankful if you need it. We just never know. Stupid things at our age can lead to hospitalization. I helped my cousin sign up for market place insurance last year because he is self employed. The year before he was hospitalized for a piece of steak lodging in his esophagus and he had a $75k bill just for emergency surgery to remove it. He has since been diagnosed with a GI problem. If you’re over 50 you need it. Good luck and I hope it’s not to much of an expense.
Unfortunately, insurance increases with age until you become Medicare-eligible. Chemo and Eligard involve infusions in the hospital, and there are usually multiple CT scans. It becomes very expensive.
I'm uninsured currently so 100% self pay. I'm shopping during the open enrollment period for a plan to begin Jan 1. 2025 , now leaning toward Sentara or Anthem.
I reluctantly signed up for a Anthem plan on the exchange in our state. Will see how it goes with premiums and deductible. I've not had much experience with going to the Dr. til now, so comparing insurance plans is like a blindman shopping for art. I don't really understand what I'm looking at.
Oh man. I wish I didnt know how that feels. Im lost too with insurance.
I have pulled thru this by the hair of my chin these 5 years when it comes to insurance. My son helped me with the AHCA in 2016 when the company I had been with for 23 years shut its doors and I started a small business based off my old company. I was "poorish" so my premiums were about $400/mo. ? or less when I was diagnosed in 2019 and onward all my chemo, scans, visits, drugs were almost completely paid by insurance. When we left Chicago in late 2020 for the twin cities I owed for health care about $550.00 out of pocket for all my care I had had.
Then it gets complicated or actually easy. My son already had a very helpful insurance broker who set up my insurance in Minnesota. Rather than AHCA Minnesota's health insurance for low income is better than AHCA and it served me well. Covered everything. Then a couple years later I got on medicare. Used the insurance broker to figure that out also.
I'd like to help but all I can offer is maybe a broker could be of help. You got your insurance so still a broker could go over what cancer related treatment you covered for. Our broker even seems to know all the loopholes. We missed a payment (thought we made it autopay) for my wife's medicare and would have had to wait about 8 months before we could get her back on medicare. The broker knew what the exceptions were and helped us make the case to get her insurance back. It wor
Unfortunately/sadly the US does not have universal healthcare like most industrialized countries! For instance, for a noncitizen in Denmark the healthcare plan is 50€ per month. My wife’s glaucoma medication Zioptan is around $250 per month. We have Medicare, but still have to jump through hoops with the insurance company for coverage! My wife’s Ophthalmologist in France told her that the exact medication cost pennies. People should not have to be in debt for healthcare.
We too are self employed. I strongly advise you to get insurance. The premium,no matter how high, will be less than your treatment costs. We pay over $2200 per month for the 2 of us combined, which is a savings over what we’d pay in medications alone. The adt injections and second generation anti androgens are EACH around $10,000. These are recurring charges too. The scans, bloodwork, and doctor visits just add to that.
While the insurance is expensive, it alleviates at least a significant portion of costs. I will warn you that you still often need to argue with them over coverage for some of the gold standard treatments. We’ve been at this for 7 years and have learned how to work with them.
Wife32, Thank you we reluctantly signed up for Anthem and will see how it goes. Our DO is in network with them. Its hard to know what to do when I don't know how fast the mHSPCa with extensive bone ments, stage 4, gleason 9 will progress and what treatments I will need in the future.
Abiraterone is available through Goodrx and Mark Cubans Cost Plus pharmacy, I have used them them BCBS almost annually stops paying for my abiraterone and makes me file and appeal. Prices at both places were reasonable.
Agreed, Good experience with Mark Cubans Cost Plus pharmacy online, they my mailorder my abiratetone. Their emails even remind me to reorder, and give shipping updates.
Yes, good idea and I have applied for disability and await their decision. I hve worked hard my whole life and during the time of CoVid I just kept working and didn't take any handouts. I LIKE being totally absorbed in work, so not working is hard for me and gives too much time for worry about things like whether the Chemo nurse will be able to find my vein for the next Docetaxel.
Currently, get injection of 25 mg. Eligard every quarter (and have forthe past five years). Cannot say it's been effective or not. I just finished chemo and wonder why my provider still prescribes it. All my costs to date have been covered by Medicare. Good luck.
dear fan, I don’t know about your situation, but I can tell you about mine. I was diagnosed about age 60, and was an early retirement and in need of health insurance.
I found out that by enrolling in the local university, and I was in South Carolina at the time it qualified me to be on the student health plan, which was a Blue Cross plan and very affordable. It also covered my wife.
it paid quite a bit towards most of my early treatments, including radical prostatectomy and radiation. I’m now over 65 so Medicare has stepped in and I’m no longer in school. I was able to earn my masters degree during the process in the area of American history, which are greatly enjoyed.
Some of the classes were online, and my knowledge there was no requirement that you passed the class or even that you attend them all, and since I was over 60 in the state of South Carolina, there was no cost for the tuition either. Win-win!
check it out in your state, it might just be the answer.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
One-Year In -- Looking for help with a medical plan
UCLA MO Recs
Paying for Prostate Cancer Treatment if 65 or older in the US - Medigap Insurance
US Medicare Part B users, do you have concerns regarding an upcoming change to Medicare called "Most Favored Nation?"
What to do when Medicare doesn’t cover your prescription drug
