Calling all self employed Diabetics with health insurance

Diabetes Advocacy Self Advocacy
#1

I am currently not working outside of the home and hubby is an independent contractor. My COBRA is running out and individual insurance will soon be burning holes in my pockets as I sleep. Anyone have any tricks or tips for navigating INDIVIDUAL health insurance with Diabetes. I’d like to stay home with my children but right now that is not looking like an option. I have been blessed in that I have all the conveniences of diabetes management and have always had them covered by insurance. I would hate to have to get rid of my pump and CGM.

PLEASE HELP! Thoughts of those living in the state of Virginia are especially welcomed!

Sara
T1D

#2

Hey JohnG,

That’s part of the problem, as an independent contractor, you don’t get benefits because you are not an employee. In the state of Virginia, you have to have 2 employees to constitute a small business, that is eligible for group health insurance. He is a business of one. Even, if he did add two employees, the cost would be just as devistating to his company as it is to our household.

#3

I wish I had something to offer you besides a hug.

This issue is one of the top three reasons I “had” to move back to Seattle in 2005. The state of Washington requires companies here to cover people who have exhausted their COBRA, with no preexisting condition exclusion clauses. We also have Group Health here, an HMO which has a lot of limitations, but which is about half of the cost of “the Blues” for an individual plan.

I’m so sorry for your sake and mine that we don’t have comprehensive, universal healthcare in this country – for ALL. People shouldn’t be put in this position when they change jobs, or be forced to take jobs they don’t want, or to move to states far, far from their families, just to get covered.

I wish you all the best in finding a workable solution.

#4

My husband left a big 8 Accounting Firm to start his own consulting company. At first we joined a collection of small businesses called COSE and we got pretty good rates on insurance. This was 15 years ago. He suspended his company in the early 2000’s because of the Economy and went to work for someone else. After 1 1/2 years he was fed up with the politics and went back to work for himself bringing several independent contractors with him. We did Cobra for 18 monts at $500 per month.We tried to get insurance as individuals and were totally shocked at the prices we were quoted. Since my husband was in his mid 50’s and diabetic the prices were 3 x what we had been paying. We finally went through an Insurance broker who found us a high deductible HSA policy for $600 a month. Well each year the policy has jumped and the deductible has jumped. Our last premium increase brought us to over $1000 a month with a $6000 deductible. We have never met the deductible even with 2 diabetics . So we pay everything out of pocket. It stinks. We’re about one rate increase away from dropping insurance. I even checked out the Federal government website but you have to be uninsured for 6 months and be denied by 2 insurance companies. Even with that the premiums are sold as individual policies, so we would still be paying almost $1500 a month and have to buy a separate policy for my daughter. So that is not an option. My husband uses independent contractors in his business and doesn’t put them on salary because the Insurance would be way too much for everyone. Does he have an incorperated business? He can pay the insurance premiums from his company check book, so it is not taxable income. You still have to pay it, but it hurts a little less. We have Anthem Luminous HSA polivy.

#5

Hey Jeannie,
You sound just like us and it doesn’t help that, hopefully, I will need maternity coverage soon. We make enough money to raise and care for a child but not to take care of the child’s parents. How ridiculous is that? The Anthem Luminous plan is one of the plans we are considering and just for myself and my husband it starts at over $1200/month with a $6000 deductible.

#6

Thanks JeanV, for your support. I am sorry too…

#7

Hang in there, Sara!

#8

My niece and her husband were forced to quit their jobs when my grand-nephew, their (at that time) 13-month-old son, was diagnosed with leukemia. They moved the entire family to Memphis and cared for him round-the-clock at St. Jude Children’s Research Hospital. At that time they had two kids and she was already pregnant with their third at the time of diagnosis.

This was a couple of years ago, and they were getting quoted $1,800/month for post-COBRA insurance for their little family, with no coverage for his leukemia or any other pre-existing condition. Thank God for St. Jude’s policy of never turning away a child for lack of money!!!

My grand-nephew is in full remission and my niece and her husband are back to work, with insurance through their employers, but what young family can afford $1,800/month? And what if my grand-nephew had been 23 instead of 13 months? What would they have done without St. Jude?

Our lack of funding for healthcare in this country – the whole profit-motive-driven healthcare meme – is appalling. We should be able to provide our people with healthcare without bankrupting family after family after family by the tens of thousands every year, coast to coast.

It’s a scandal.

#9

The Luminous Plan is the only one we can afford and the price is ridiculous. In the 7 years we have had it we have never met the deductible once. So we pay the big premiums and still pay out of pocket. You may want to double check on the maternity coverage. Our Luminious plan doesn’t cover maternity, you have to purchas a rider. They get you coming and going. Even though my husband and I are both Type 2’s we are very healthy and have never been hospitalised for anything besides child birth. We now buy my husbands high priced ACTOS in Canada, we save 60%. I really wished there was a plan we could buy for reallly cheap that would only cover hospitalization.

#10

Jeannie,

How do you like the Luminous plan other than the ridiculous deductible? I am concerned about being able to afford my pump and CGM supplies or getting them covered at all. I know you said that you are T2 but do you have any pumps or CGMs that you use? The Luminous and Premier plans will only cover maternity if you have a deductible of $2500 or more. I just don’t understand their logic. Oh, that’s right… there is not logic. Its called bottom line sense.

#11

Also known as plain, old fashioned greed.

#12

Check to see if your state offers a high risk insurance pool that you might be eligible for.

#13

That sucks. Actually their logic makes sense to them because they are only in this to make money. They know if request maternity coverage you are planning to have kids, and if you plan on having a baby you will have claims that year. They keep collecting your premiums until you’ve paid your $2500 deductible. This could take many months and they still have your premiums coming in before they’re paying benefits out. If your nine month pregnancy spans over 2 calendar years then ouch you are paying 2 years of deductibles. I have a real love/hate with insurance companies.

#14

I don’t know about the coverage for pumps since I don’t use them. But I do know I have to pay up front for all my strips, all my lab tests and all my doctor visits. If we have to go to the hospital we have to pay the first $6000 and then they pay 80% . Once we have paid $10,000 a year they will pay 100% in network. If you go to a doctor out of network they don’t kick in until $30,000 WTH. We have crunched the numbers and find we are paying almost $20,000 in premiums and deductibles before they pay a dime. The only thing it protects us against is if we are in an accident or get cancer or heart disease. Then we get the insurance adjusted rate. But I have heard lots of people who are uninsured have negotiated prices down at hospitals, too. I checked out the high risk pools in Ohio, you have had to be denied insurance by 2 companies. So far we are still insurable just at a very high cost… Also the prices quoted are for individual, there are no family policies. I found for our age the cost would be at least $750 for each one of us, so that is more than Anthemn. Plus they have a $2500 deductible , I think.

#15

Hey Midwest Mommy,

I am sad to the state of Virginia does not have a high risk pool. It sucks!

#16

Gina brings up an important point - there is a requirement that you were previously insured before a group plan has to take you as is, may be the same for private plans. Please check this out - I don’t remember all the exact timelines - but I had to get a letter from our Cobra insurer before my husband’s plan would take us when he changed jobs. If we didn’t have the letter we would have had to wait until regular group enrollment to get coverage instead - like an 8 month wait in our case.

#17

It’s not that I can’t get insurance. The issue is the amount that is going to cost me. I will end up paying $20,000 out of pocket in one year via premiums, doctors visits, pump and CGM supplies and prescriptions before, I see any payouts from the insurance company. I was hoping that there were other alternatives to going back to work or getting individual insurance. I really want to stay home with my children but it is not looking like an option that I will have. I am just trying to find a more economical way to do this.

I will correct myself… VA does have a high risk pool but the requirement is that you have to be denied individual insurance first. No one is denying me. They just want me to pay through the nose for it.

#18

Sara, we are in the exact same position but we are older which makes it worse. I even had our insurance agent search every possible plan and Anthem Luminous was the cheapest . I don’t even think what the increase will be next year. People who get thier insurance through large sized companies have no idea what employees of small companies have to pay. I really don’t think it will get any better under the new health care system

#19

Well I am not sure what programs Virginia has to offer but in California there are two programs that are offered to people with pre-existing conditions. One is a federal and one is a state program but both offer insurance coverage by a major company. I am currently not employed by a company and have paid alot of money for my diabetes supplies until I found out about these programs. I recommend that you google pre-existing programs offered by your state.

#20

I think you can purchase your policy when COBRA runs out. I would expect you to pay $12,000. The pump is expensive, you could let that go to decrease costs. Not ideal. Maybe work part time to offset the costs, but I think you are on the least expensive track. Troubling.