Good question, @MM1. Someone needs to validate my thinking on this. Let me try to step through it and see if understand it, myself.
1.) Knowledge of my policy and my State protect me here.
Iām scared to change policies OR States of residency because Iāve been troubleshooting where the system breaks for soooo long that I know where to anticipate failures and where to start fixing them. Say that the pharmacy wont sell me insulin - I know where the hang ups in the pharmacy computer systems and the medical clinics lie. I can generally differentiate if their doing something asinine, or if they just made a mistake, or if I made a mistake. I know what laws and safeguards and resources exist here. It took me decades of accumulating knowledge and experience to know where and why the system breaks. If I leave MN, I loose all of that. I will be back to square 1.
I might get a new job in a new state with a new policy, but I will have to re-learn everything through trial and error. Difficulties managing the system will accumulate and compound faster than I can troubleshoot them. I will make mistakes. They will be expensive mistakes. There will be dead ends. I will be working 60 hours a week in a new job where I need to learn constantly. If I need to stop work and troubleshoot an insurance problem for 20 hours, it could be the end me professionally. If I have to stay up all night trying to access insulin or giving myself little tiny bolus injections of R, it could ruin me professionally. I could have a resulting seizure and loose 2 weeks worth of memory. I would not be able to recover professionally. I could pass out in a snow bank and need to have my hands amputated. Thereās no professional recovery from that. I would simply never be able to work again.
2.) My friend who moved to the East Coast says that he need but walk down the block to find another programming job should he hate his current one. He says I should come there and all of this would go away. He has chronic medical problems, so I am watching him closely throughout his transition.
Right now I have a privately held, low deductible plan (one of the last in existence). I thought that HIPPA was supposed to make the plans āportableā over State lines. It doesnāt. I loose the plan if I leave the State. If I loose the plan, I will never get a price/quality comparable plan again. Rates will be much higher (especially after they bump up premiums in Jan due to covid). My current low deductible plan is unaffordable to me now, but much more affordable than anything I could hope to replace it with from the private marketplace.
Worst case scenario: Lets say I move out of State, get a new job, get a new plan, loose my State residency, loose my current planā¦and the new job is just a giant scam where they are stealing money and they get shut down (which happened last time I tried this during the recession)ā¦
If the ā ā ā ā hits the fan here, in MN, I can always go on the Stateās āpoor peopleā plan. We have excellent coverage here for Dexcom, pumps, etc for people with no income. Thatās not going to exist in other States. Last time I took a scam programming job out of State (the Dakotaās are ripe with computer companies doing illegal stuffā¦but I didnāt know that then), I avoided serious penalty. I maintained my MN residency and private policy by living right on the border and commuting hours each day to physical office location.
That strategy wonāt work if I move to the East Coast, as my grad school friend is suggesting. If the job ends up being a scam, I will return to MN with no safety net (no residency) and no privately held policy. I will have hung myself. I will have 3-6 months of no insurance until I re-establish residency. I could probably handle the diabetes care (now that I eliminated that drivers license requirement in State law). Worst come to worst, I just go back on NPH and R MI for 6 months. Thatās manageable. If I, however, have a Grand Mal seizure during that period, I will owe thousands of dollars because there will be a ambulance ride and a hospitalization that could last days or a week.
Cobra might cover me for a while, unless I get fired, right? If I get laid off, Iām ok. If the company goes under, Iām not sure what happens with Cobra coverage.
I donāt expect to be able to afford coverage through the Marketplace in this scenario. I would go without insurance in all likelihood, for 3 - 6 months. I might be able to do that just fine.
I would then be in a position of employer sponsored medical care, which has always made me nervousā¦especially after covid. Thatā why I have never taken insurance through an employer and I just maintain my private policy. But, it might be time to entertain this.