Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group To cancel private insurance or not to?

A little background, I was diagnosed with AS last January and have been on Enbrel since. I went from being on crutches for the prior 3 months to being able to walk normally and participate in normal activities (I try not to overdo it.) I went to my Rheumatologist last May and haven't needed to go back to her since, except to call in for prescriptions.

So, I recently joined a new company which has great benefits. I get PPO medical insurance (out of pocket max $1,000, 100% thereafter) w/ no pre-existing medical condition limitation for $33/month after tax. The prescription benefit provides an Enbrel 90-day supply for $50, which I can use with my flexible spending account, so it works out to approx $11 for a month's supply.

I still have private insurance which costs $131/month ($500 deductible, then 80% thereafter) and Enbrel costs $100 through it.

To mitigate the possibility of a job loss and not being able to acquire new insurance due to the AS, would you keep both insurances and just purchase the Enbrel through my new employer's prescription plan or cancel the private, hope to obtain new employment with good benefits and take advantage of COBRA if need be?

Wow, that is INCREDIBLE insurance you are getting from your employer! I fully understand your point about the private insurance though--if you were to lose that job for any reason, it might be hard to qualify again for any insurance due to the pre-existing condition. While it is hard to justify the extra expense for that "extra" insurance in most situations, the insurance you are getting from your new employer is so darn cheap that I must might keep it if I were you. Heck, the cost of both your insurance packages combined is still cheaper than my employer-offered insurance, and I've always considered our insurance to be very good. You are definitely very lucky to have this conundrum!

Brad

Well that's a good question. I'm sure you will get many different outlooks on it. The insurance you have through your current employer, are you able to purchace the same insurance when you leave or would it just be limited time Cobra? My husband was a teacher and resently retired and the insurance we had, we were able to continue on our own, not Cobra, the same exact plan we had when he was teaching. We were lucky, all my meds are paid for. It costs us $10,000 a year, very salty, but considering my medical bills have been exceeding $100,000 a year lately, it's been a God's send. There are a lot of things to consider, age, single or married, your physical condition and employment prospects.
I hope you find some help with your decision here.
Cindy

I have a question. Will your new employer still offer the insurance to you if they know you are already covered by private insurance? Can you have both at the same time....private and group? I know somebody in a similar situation and they are concerned the new employer won't want to spend the money covering somebody who is already covered. He is afraid to give up his private insurance also. What to do?

Cris

Cool Tech,

If you can afford it, I'd keep both. Sign-up for the company insurance plan, but keep your private policy. If you leave or get laid off you will still have the private plan to fall back on, which sounds like a very good plan in and of itself. I wouldn't buy the Enbrel on the private plan, I'd use the group insurance for that. Keep both active, remember every year you age the more expensive private insurance is, so just hang to your private policy.

My husband who was 51 when he was laid off, me, age 48 and my daughter 12 - now have a private plan with Kaiser Permanente. We had to do something when the Cobra benefits ran out, and we were two years older than when he was laid off. Our Kaiser Permanente PPO costs us about $11,000 per year for the insurance and another $2,000 or $3,000 in out of pocket co-pays.

The cost of health insurance in the US plus not being able to afford house helpers and the like as I get more stiff, is one of the main reasons we are planing to relocate to Costa Rica. We just can't afford to retire here with the cost of insurance so high.

Gay

As far a I know, the insurance through an employer is a part of the benefit package and can not be denied to an employee for any reason. The employee may opt not to have insurance through his or her employer.

One thing to consider is which insurance would pay first on a claim? When I file an insurance claim, it asks if I have any other insurance. You have to answer this honestly or risk the possibility of being charged with insurance fraud. It may be that your work insurance will require that your self paid insurance is billed first. This may not make any difference to you, but it might. Just check out how it will work with two insurances.

I agree that the low cost you're paying for your private insurance makes it worth keeping. There have been times in my past when I was out of work or working at a job that didn't offer insurance and it's scary.

Sounds like you have a good job now. Good for you.

I don't live in the States and am not as familiar with the ins and outs of things regarding medical insurance, but I have to ask the same question as Janet.

If you keep both, will that impact how much of a claim your benefits will cover? When I put a claim in there is a question on the form asking whether I have coverage under other insurance, or if this is a workers compensation claim (due to accidental injury at work). And when I was hit by the car back at Christmas 2000, because I have auto insurance and am covered under that if I am a pedestrian involved in an accident, different things were covered by my insurance than were covered by my benefits. My benefits only covered something if my auto insurance didn't and neither covered things that were already covered under the provincial medicare plan. So, my benefits covered prescriptions, my auto insurance covered transportation to and from all doctors appointments/physio and the provincial plan covered doctors appointments and physio.

I hope you can work this out with the best possible outcome for you.

Hugs,

My group prescription plan at work would end up paying a total of $15,664/year on my behalf for Enbrel. I am not sure how this is classified as far as compensation goes, but I dont want to jeopradize a bonus of some sort(generally 10-15% of salary) because the company has paid out so much for my prescription meds. I could continue to use my private insurance at $100/month for Enbrel and use my flex spending account which would save me 35%. What would you all do in this situation?

HI -
Can you pay for your private plan with your flexible spending account? That might save you a little, and any break you can get is helpful. If I had two insurances, I think I would keep them both if I could afford it. Especially if your job is relatively new.

Also, I wouldn't think that the use of your insurance would affect your bonuses. They don't affect my husband and our insurance has been paying for Remicade for almost a year. And I've always had pretty high medical bills, just by nature of this disease. Of course, the insurance sends us forms to fill out periodically to find out whether we have a secondary insurance, which we dont. You would probably find it pretty hard or expensive to replace that insurance if you needed to, now that you've been diagnosed. Do you know someone(not involved with your case) in the insurance business that you could consult? Wanda