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Thread: Health Insurance Coverage

  1. #1

    Health Insurance Coverage

    Hello All,

    I am 51 year old complete C6 quad...........31 years post. I work for a
    large computer company and have a 6 digit salary, but plan on quitting
    my job probably in 2008. After 31 years of quadriplegia my body cannot
    take the grind of 40-60 hour work weeks anymore.

    Since I am quitting and not retiring and not old enough to be eligible
    for any company health benefits I will be left with no health
    benefits.........currently have company sponsored Aetna policy.

    What do others do in this case ? I don't think any private company will
    take me on and I think Medicare could take 1 to 2 years to be approved.
    This leaves me with nothing. Any suggestions ?


  2. #2
    You can pay to cobra your work policy for up to three years. The price is 102% of their cost. They are required to offer this option to you.

  3. #3
    Senior Member Belle's Avatar
    Join Date
    Jun 2004
    NW Ohio
    I have not looked into this, but I thought perhaps that if you are forced to stop working due to your disability, that you could qualify for Medicare as disabled. You would need a doctor to certify you as unable to work, and there's a waiting period - but you could cover with COBRA in the meantime. Like I said, I have not looked into it (my husband is not there yet). But I think this is how it might work. Assuming also of course you have no suitable disability policy at your job that would allow you to remain on their insurance if unable to work due to disability.

    AB wife of T8 complete para

  4. #4
    Adding to what Belle said, try to go out on disability due to your SCI. You will then qualify for short term and then long term disability. I would ride that out for as long as possible. Meanwhile you will be applying for SSDI, you should get approved and as soon as 24 months have passed from the date you qualify for SSDI, then you can get medicare.

  5. #5
    Pay into a COBRA plan, ride it out for whatever the term is (12-18mo), and then apply for an individual policy w/ a company of your choosing. HIPPA laws require that insurance companies provide coverage in these situations. You'll pay for it, but you'll be covered. I'm 27, self-employed, and drop roughly $400/mo for my insurance (ouch, I know). I went through NASE, insurance underwritten by Mega.

    I'm not receiving diability benefits, etc. from the gov't. I'm avoiding that as long as possible.

    oh, and DO NOT allow coverage to lapse if you want private insurance.

  6. #6
    This is a good place to start, but I strongly suggest that you get some expert local advice. Expect to pay something for it too. Don't fool around with health coverage and make sure you maximize any 401K and Pension Benefits. Even the length of COBRA Coverage is open to question as in the following FAQ from Dept of Labor.
    Good Luck,
    How long does COBRA coverage last?
    COBRA establishes required periods of coverage for continuation health benefits. A plan, however, may provide longer periods of coverage beyond those required by COBRA. COBRA beneficiaries generally are eligible for group coverage during a maximum of 18 months for qualifying events due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.

  7. #7
    Senior Member Belle's Avatar
    Join Date
    Jun 2004
    NW Ohio

    Doesn't the availability of private insurance vary by state? I believe in Ohio we would NOT be able to get private insurance except in very tight and very specific circumstances (there's a tiny window of opportunity every January 1 when the insurance companies in Ohio are forced to take all comers, after that they can deny). $400 a month for private insurance for someone with SCI actually doesn't sound too bad.

    AB wife of T8 complete para

  8. #8
    I gotta say, $400 a month doesn't sound bad. The question is what do they cover?

  9. #9
    Pretty much what Scott said, especially his last sentence -VERY IMPORTANT!!. However, I'd suggest only staying on COBRA until you can find a different insurer, as COBRA is likely to be more expensive.
    - Richard

  10. #10

    I'm fairly certain that the HIPAA clause relating to this simply states that an insurance company can't turn you down for coverage based on pre-existing conditions IF you already maintain coverage elsewhere. It's a federal thing that Clinton instated during his presidency.

    No, I guess $400 isn't bad, but comparitively to other [single] friends of mine in my age range, I'm paying 300% of what they are, just b/c of the injury. Understandably so, but I'm not making 3x of their income to offset it... matter of perspective. I can't complain..

    Dan - as for coverage... um... it's not terrible. It's very similar to my pre-SCI coverage:
    • $5M lifetime max amount, $1M aggregate max amount
    • $1k deductible w/ PPO providers, $3k for non-PPO.
    • $4k coinsurance maximum
    • 80% coverage of inpatient services
    • 100% of physician visits while hospital confined
    • 80% of...
      • surgeon, ass't surgeon, anesthesiologist fees
      • outpatient surgery facility fees
      • DME equipment, prosthesis (b/c you'll ask: $5k max)
      • 2nd surgical opinion
      • outpatient diagnostics
      • ambulance transport
      • chemo, radiation therapies
    • 100% of transplant procedures in designated facility (including travel beyond 300mi), 70% in non-designated
    • 80% of chemical dependency, mental illness treatments
    • 100% childhood immunizations
    • 80% of hearing tests, diabetes treatment, TMJ
    • 80% of speech, occupational, physical therapy (b/c you'll ask: $50 copay, 3x/wk max)
    • 80% skilled nursing care, home health care, private duty nursing, hospice care
    • 80% air ambulance
    • 100% outpatient accident expense
    • 80% emergency services, $100 copay non-ER, $250 copay ER
    etc etc... but that's the basic outline of benefits... plenty more details involved though that I don't have time to read into at the moment.

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