8 replies to this topic

[JPD]

Long of the short of it - when I got my DX I was in the initial stages of getting a divorce. 

 

I own my own business & am insured by my wife's state insurance (she's a teacher).  Now, if I get divorced, I have to insure myself.  And by what I can tell it will cost me about 10 grand a year for insurance.  And by what I can read and have been told - Tasigna and my tests are covered, but its all a bit hazy seeming... and I certainly dont want to buy the insurance and get hit with some surprises. 

 

The wife and I have been seperated since before my DX, but we are kind of in purgatory at the moment (as far as moving forward with anything).

 

Anyone have any idea as real world costs of being self insured?  I know the resounding reply might be "dude, find a way to make it work out with your wife" but Im just trying to see if its even possible to be self-insured.

[mikefromillinois]

I have self-insured since long before my diagnosis.  I am subject to the (ACA) (Affordable Care Act / Obamacare) insurance provisions.

 

ACA plans vary from state to state, so you will want to investigate your particular state's ACA plans.  Premium prices are income relative so you will have to go through all of those calculations on the ACA website to see how much of your premium the government will subsidize.

 

I self-insure four in my household and my annual insurance premium cost is way below $10K.  For individual coverage in my state I would only be paying about $250 a month under ACA for a really good policy.

 

You will spend a lot of time researching all this but it's worth it.  The window to apply for 2015 coverage is now closed and will open again in the Fall - but you will probably be able to apply before then if you do lose your current insurance.

 

The good news is that you now know what your medical and medicine needs are, so you will be able to select a policy that is the best match for your specific situation.

[tadly]

If you lose your wife's insurance, it looks like you get a special time period to enroll for the then current year. "loss of another insurance" qualifies you for a "special enrollment period", which means a different deadline.

[Dom]

Mikefromillinois, I'm paying about $560.00 a month for cobra, but there is zero copay for gleevec at all dosages, and all the other tkis have the same deal. That's useful, if something changes. $250 a month sounds good, but what is your copay?

[pammartin]

I have been self insured since March of 2013.  My first BC/BS premium was $480 a month and we paid that on a COBRA plan through my husband's former employer.  The COBRA ended last Sept, and my husbands current employer picked me up but we had to pay my premium out of pocket.  The new cost was $590, in November of last year the company decided they were no longer offering coverage to spouse or family even if it was paid by the employee, so I went on a hunt again.  I did qualify for coverage through the Affordable Care Act, but did not take the reduction subsidy because I was unsure how much my husband's income would be.  I did not want to owe a huge amount at tax time.  In Jan of this year I changed once again and now pay $660 for BC/BS, but I am fortunate to qualify for a program through my Adcirca (PH med) that helps with the premium.  I have to pay the monthly premium, receive the Adcirca, then forward to Caring Voice Coalition and they reimburse for a portion of the premium paid.  The only real headache is I have to pay for the insurance at the beginning of the month and the Adcirca proof does not come till the end of the month.  Once I have both proofs I email copies to the company and within 48 hours they have the reimbursement amount in my husband's checking account.  I am and consider myself very lucky to have found help with the coverage.  It is a good policy, I still have copays and additional costs but nothing like the ones I had in the beginning with the COBRA insurance. 

[chriskuo]

Regardless of what income your claim for ACA subsidy purposes when you enroll, the subsidy will be trued up based on your actual income when you file your tax return the following year.    It is probably best to estimate your income on the high side to minimize the chance you could get hit with a big subsidy repayment at tax time.

[mikefromillinois]

Mikefromillinois, I'm paying about $560.00 a month for cobra, but there is zero copay for gleevec at all dosages, and all the other tkis have the same deal. That's useful, if something changes. $250 a month sounds good, but what is your copay?

There are no "copays" for expensive meds with my policy.  Instead I have to satisfy a $500 annual deductible and then pay 25% of the med cost until I reach my out-of-pocket max of $3,500 per year.  I meet that in February due to the high med cost.  For the entire year I end up paying the out-of-pocket max of $3,500 by February and then for the rest of the year I pay nothing for anything.

[Gail's]

I dont remember if you've mentioned your age, but is medicare coming any time soon? I know tki producers offer scholarships for copays. LLS also offers stipends for cancer patients and can be used for insurance premiums. My understanding of my ow situation is that once i reach out of pocket maximum for healthcare, i still pay the monthly premium but do not pay any medical care copays. The cost of my medicare premium is about $120 a month, and the co insurance will be $250

[Gail's]

Oh, another thought. My marriage is in the same separated but not divorced state. My attorney has told me that often judges require the spouse with insurance to cover the cost of the ex's medical insurance as part of the settlement. Since my situation is the reverse of yours, where i cover my spouse, it is an incentive to remain married legally regardless of where each person lives. I would have to pay about 2 grand a month sunce he would be awarded spousal support and i would have to cover his insurance until he remarried. Thats what oregon requires for the spouse who has a devastating illness and cant work, which is his situation.
Hey, wait a minute, maybe it wouldnt be that way any more since i have my own big illness!