Changing US Health Insurance with MBC

[LDR1]

Friends in the USA - does anyone have experience with changing health insurance plans while in treatment for MBC? I currently have excellent insurance through my employer. If I leave my job I can continue that for 18 months through COBRA, then would have to purchase a new policy independently. I know the Affordable Care Act prohibits insurance companies from denying coverage based on pre-existing conditions, but I’m still nervous about whether I’d be able to secure coverage for the massive costs of treatment. Would be grateful for any advice or experiences you may have had.

[luckysmom13]

You might want to talk to an independent insurance agent who could help you look at options. COBRA was very expensive for me, but I had to wait to qualify for medicare due to disability.

[Hidden]

Hi! I’m self employed and get my insurance through the Affordable Care Act (Covered California) and have had not problems with getting good coverage. As you stated, the ACA providers cannot refuse coverage based on pre-existing conditions. Cost of coverage is related to age and type of coverage.

[LDR1 in reply to Hidden]

Thank you, this is encouraging to hear…

[hdhonda]

Have you tried to get Medicare and a supplement to that? You should be eligible due to stage 4 breast cancer. Would recommend getting the insurance problem solved before leaving employment. Best of luck to you. Blessings, Hannah

[LDR1 in reply to hdhonda]

Thank you - I’m only 54 so will not be eligible for Medicare until I turn 65 or am officially declared disabled.

[Tolife_18 in reply to LDR1]

Being diagnosed with stage 4 MBC automatically qualifies you for the Medicare regardless of age. However, while you can apply immediately after you stopped working, you’ll not receive it until 5 months later. As other said, try to sort things out while you’re still employed.

[1711JPD]

I second getting Medicare if you can and a supplemental plan. I got my supplement through United Healthcare (AARP). I thank God I got the best policy I could afford as three years after retiring, five years after BC, I was diagnosed with MBC.

I dont know your work situation, but if you have an HR department but are concerned about going to them with questions, perhaps a friend has a contact in HR department at her/his work who you could talk to privately and get advice on how best to approach your situation in your state.

I had COBRA for 4 months before I turned 65 (I wasnt sick then) and for single coverage it was over $750 per month!

I wish you the very best and will keep you in my prayers.

[LDR1 in reply to 1711JPD]

Great suggestion to inquire confidentially with HR experts, will do …. I’m too young for Medicare so that’s unfortunately not an option. Thanks so much for your kind wishes!

[hdhonda in reply to LDR1]

Please make an appointment with Social Security and go from there. You won't be able to work at all on SS disability, but it may be the best option for you. It will be good to talk with them and find what you will receive. Then you will be able to make an educated decision regarding what's best for you. Blessings, Hannah

[SMPG in reply to 1711JPD]

Question for people who are on Medicare and on Ibrance? Does Medicare cover Ibrance? My husband and I are both 67 and he is still working and we get our insurance through his work. The reason why we are not. on Medicare is Ibrance. I heard that if I got on Medicare, I would have to pay for Ibrance out of pocket. Right now, it is free to me. There is no copay even. What should we do? Is there a Medicare supplement that would pay for Ibrance?

[1711JPD]

But because of the MBC diagnosis, you may be eligible for Medicare regardless of your age. There are exceptions. An HR benefits person will know. 🙏

[LDR1 in reply to 1711JPD]

Oh great! Will definitely investigate, thank you 🙏🏼

[mbcfnp in reply to 1711JPD]

It's not Medicare, here in Maine it's the Mainecare for p under age 65 yrs. Definitely contact your local social security office. I applied for SSDI social security disability, any metastatic cancer is approved 1st try at SSDI. Check the ssi black book. It describes it all there

[MaryCos]

I see folks have entered comments about SSDI and Medicare coverage. Am providing some accurate info on that, and the bills that MBC groups are trying to get pushed through the House and Senate (and have been trying to do for years).

As for ACA, I was on it when diagnosed de novo in July 2020. I have since moved to Medicaid due to my lack of income during COVID. My ACA coverage was fine, and my out of pocket was capped at about $2600 (although I also did qualify for their patient assistance program prior to qualifying for Medicaid, so I paid no co-pays or deductibles). Just be careful which plan you pick under the ACA, if you are going that route.

Here is the info from METAvivor about SSDI and Medicare coverage. Most important to know is, you can't even apply for SSDI until you stop working. And you will most likely wait 5-6 month before you see a dime from Social Security. And, Medicare coverage is NOT immediate. It is two years after SSDI approval. That is why this legislation is so crucial. There is also another campaign for healthcare equity, in trying to get MBC meds covered the same way that chemo is. Meaning, NOT under the prescription side of insurance.

Info from METAvivor. Just posted yesterday.