Health Insurance After PCa?

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sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted 5/21/2009 5:46 PM (GMT -7)   
Has anyone had to get individual health insurance post-PCa.   I'm covered by group now (and was during treatment), but might be in a situation where I'm no longer in the group coverage (at least 18 months after COBRA runs out).   Anybody deal with this?  Tips?
 
Sterd82
Age 48 - pre-surgery PSA 39 (at age 45)
Open Radical Prostatectomy 6/9/2006
Pathological Stage T3a, Positive Surgical Margin
Gleason 3+4
PSA rose to .24 in November of 2006
6 month hormone therapy initiated December 1. 2006
36 sessions of IMRT Ended Feb 1, 2007
PSA as of May 25, 2007 undetectable
PSA as of November 29, 2007 undetectable
PSA as of May 14, 2008 undetectable
PSA as of November 25, 2008 undetectable


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/21/2009 6:16 PM (GMT -7)   
I did Sterd,
I had surgery, started HT and completed RT on COBRA. It was pretty costly. I had been with the previous employer for 16 years. So it was pretty scary to know my COBRA would eventually run out. Lucjily, I was hired by a new employer that had a 3 month grace period before benefits would kick in. This was just before I started my RT. So as a new employee, I missed an hour a day while I was in treatment, then just as I ended my new insurance kicked in and took over the pre-existing condition. Even though I was out of pocket 20g, I was covered moving forward with co-Pays and excellent coverage. I lucked out.

I am very thankful to the new guys that hired me...

Tony
 Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 5/21/2009 7:39 PM (GMT -7)   
I believe the laws differ state to state, but you are better off maintaining some sort of coverage all the time, even if you buy something that does not cover a lot before COBRA runs out.

Previous 5 biopsies over 4 years negative

Dx Nov 2007, age 46

PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke

6 rounds of chemo (Taxotere+Avastin)

1/8/2008

33.90

1/11/2008

29.50

1/31/2008

38.20

2/21/2008

32.00

3/13/2008

26.20

4/3/2008

26.60

4/24/2008

20.60

followed by surgery at Duke (Dr. Moul) on 6/15/2008

Gleason downgraded 4+3=7, T2b N0M0, one small positive margin

PSA undetectable for 8 months, then

2/6/2009

0.10

4/25/2009

0.17

 


sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted 5/21/2009 7:58 PM (GMT -7)   
Thanks guys....always such great responses here....

I'll clarify. I may quit my job where I am covered by group health, and become self employed. I can buy COBRA from my former employer for 18 months. I was wondering if anyone had ever shopped post-PCa coverage if self employed. I know it won't be cheap--- I'm just trying to build a cost into my business plan.
Sterd82
Age 48 - pre-surgery PSA 39 (at age 45)
Open Radical Prostatectomy 6/9/2006
Pathological Stage T3a, Positive Surgical Margin
Gleason 3+4
PSA rose to .24 in November of 2006
6 month hormone therapy initiated December 1. 2006
36 sessions of IMRT Ended Feb 1, 2007
PSA as of May 25, 2007 undetectable
PSA as of November 29, 2007 undetectable
PSA as of May 14, 2008 undetectable
PSA as of November 25, 2008 undetectable


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/21/2009 9:20 PM (GMT -7)   
I did.
I had to be covered by COBRA for a year for a pre-existing in anything I could buy before I could be covered by a private policy. We had lined up a new insurance carrier just as I was hired and never had to pay the second policy. We knew we would be paying double coverage to have uninterupted coverage I needed. That was a key to why I re-elected to join a group coverage, per se.

tony
 Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 5/22/2009 6:38 AM (GMT -7)   
Hello Sterd,
 
I was in the process of getting a private policy when I was diagnosed. I was able to get a 10 month policy but it would not cover preexisting conditions. The rule is that if you get a policy whithin 60 days of expiration of the existing policy (assuming you are now insured) the new policy will cover preexisting.  I footed the bill for my treatment on my own and applied for a policy when my 10 month ran out. Only $8400 per year with a $5000 deductible and 40% copay and preexisting not picked up for one year. What a deal! Needless to say I am not covered right now. The policy that was available was an assigned risk policy. As I understand the rules you cannot be denied insurance but you can be charged heavily for it and it does not have to be all that good.
 
Good luck with the search. If you find something reasonable let the rest of us know.
 
Take care,
Don
Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones 
 
 
 


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 5/22/2009 7:06 AM (GMT -7)   
The other alternative is to set up an entity (corporation or LLC) and buy group insurance. Even if you have you and your SO on the policy it could be group. I believe there is no check for pre-existing conditions in this case, just ages of the covered members. I have done this in the past, but this was before I was diagnosed with PCa.

Previous 5 biopsies over 4 years negative

Dx Nov 2007, age 46

PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke

6 rounds of chemo (Taxotere+Avastin)

1/8/2008

33.90

1/11/2008

29.50

1/31/2008

38.20

2/21/2008

32.00

3/13/2008

26.20

4/3/2008

26.60

4/24/2008

20.60

followed by surgery at Duke (Dr. Moul) on 6/15/2008

Gleason downgraded 4+3=7, T2b N0M0, one small positive margin

PSA undetectable for 8 months, then

2/6/2009

0.10

4/25/2009

0.17

 


broker59
Regular Member


Date Joined Apr 2007
Total Posts : 88
   Posted 5/22/2009 10:45 AM (GMT -7)   
nono  Sterd
States differ as far as pre-existing conditions.  New Jersey is a "guaranteed issue" state.  NO Questions asked, but you pay dearly.
Chamber of Commerce membership will usually have an open enrollment where you can pick up a policy with again; no medical questions.
Under the "Pork-u-less" package the mighty government will pick up 65% of your cobra premium for 9 months.  At the end of cobra you can stay with that insurance company, just pay the rate.
Good Luck!!! yeah
Broker 59


Date of Dx 3/20/07

PSA: 2.5
Gleeson: 3+4
Stage: T2
Bone Scan: Clean

Date of Surgery: 6/21/07  Open RP
 
Post Opp: ALL NEGATIVE margins & L/N, S/V.
Cath out after 18 days = BIG RELIEF!!!
 
PSA: 7/23/07 0.01
PSA: 9/04/07 0.01
PSA: 12/04/07 undetectable.
PSA: 3/12/08 UNDETECTABLE!!!!!
PSA: 6/13/08 UNDETECTABLE!!!!!!
PSA: 12/11/08 UNDETECTABLE!!!!!


sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted 5/22/2009 11:47 AM (GMT -7)   
Great stuff, guys.....

Geebra, the but my spouse in my LLC to get group was an idea I had found....does that work with just 2 people in the group?

Broker59.... Don't you have to be fired or laid off to get the "pork-u-lus" subsidy of 65%....plus, I think its phased at at 250k in income if you're filing jointly...sound right?
Sterd82
Age 49 - pre-surgery PSA 39 (at age 45)
Open Radical Prostatectomy 6/9/2006
Pathological Stage T3a, Positive Surgical Margin
Gleason 3+4
PSA rose to .24 in November of 2006
6 month hormone therapy initiated December 1. 2006
36 sessions of IMRT Ended Feb 1, 2007
PSA as of May 25, 2007 undetectable
PSA as of November 29, 2007 undetectable
PSA as of May 14, 2008 undetectable
PSA as of November 25, 2008 undetectable


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 5/22/2009 11:58 AM (GMT -7)   
I believe it works with just 2 ppl in the group - but call a health insurance broker and find out.

Previous 5 biopsies over 4 years negative

Dx Nov 2007, age 46

PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke

6 rounds of chemo (Taxotere+Avastin)

1/8/2008

33.90

1/11/2008

29.50

1/31/2008

38.20

2/21/2008

32.00

3/13/2008

26.20

4/3/2008

26.60

4/24/2008

20.60

followed by surgery at Duke (Dr. Moul) on 6/15/2008

Gleason downgraded 4+3=7, T2b N0M0, one small positive margin

PSA undetectable for 8 months, then

2/6/2009

0.10

4/25/2009

0.17

 


engineer55
Regular Member


Date Joined May 2009
Total Posts : 121
   Posted 5/22/2009 12:10 PM (GMT -7)   
I assume every state is different but the California policy is as follows

With Cancer you are totally uninsurable on an individual policy, but don't fel bad becausee just about everyone is too, doesn't take much, blood pressue, cholestrol, allergies etc, you basically have to a marathon runner to pass but then you would have skin cancer so you still wouldn't pass, maybe a nightime swimmer could do it.

so you can continue cobra for 18 months thru your old employer, than another 18 months directly from the provider with the same policy and cost. After that they switch you to a state manadated program where they have to accept you, in my case the insurance company is the same, the cost is slight less, but the deductable is higher ($1500) and the co pay is higher 30%. Its really not that bad.

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 5/26/2009 8:21 PM (GMT -7)   
Most chambers of commerce offer group through the chamber, i.e. they take a bunch of small businesses ( 1 or more employees ) and combine them into a large group. In Ohio, the chamber plan is very competitive. Our plan doesn't even require a medical.
Age 58
PSA 4.47
Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09
Nerves spared
0/23 lymph nodes involved
pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.
Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Thankful for early diagnosis, and U.S. healthcare
 

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