Wednesday, October 28, 2015

Insurance Is Preemptive, Except When You Need It

For many people, insurance is preemptive, it’s for the what ifs in life.  What if I’m in an accident?  What if I’m diagnosed with cancer?  The list goes on. 

But for me, and most other chronically ill people, having insurance is vitally important.  It’s not for the what ifs but for the right now.  I didn’t ask to get sick, so it’s frustrating that there are so many hoops to jump through, not only to prove that you deserve help, but also that you aren’t playing the system. If you know someone who is hard up enough to fake having lupus or RA, will you please hit them in the head for me?

When I first got sick, I had amazing health insurance.  Because I was a graduate student and teaching, I had faculty level insurance.  I had no premium, and very small co-pays.  And truth be told, a small reason as to why I stuck out my PhD program was that I had insurance that allowed me to walk into any of my doctors’ offices, have any tests and procedures they required, and I never had to worry about what it was going to cost me (and my parents didn’t have health insurance at the time).  I think the biggest amount I ever owed at one time with that insurance was $75.   

I realize now how blissfully lucky I was, and also how blissfully unaware I was of the troubles that plague people who don’t have good insurance or who don’t have insurance at all.  But now, I’m right there with the masses of people who are trying to get adequate health coverage. 

My student health insurance wasn’t the greatest.  I needed referrals for everything.  I paid a $3,600 a year premium, which seems kind of high now that I think about  it, and had co-pays, plus I paid 20% co-insurance.  It was a big headache, especially compared to the plan I had in my first stint in graduate school, but it was insurance and it was guaranteed.  The school couldn’t strip me of my coverage for any reason.   

Because my current employer is not offering me health insurance, I was without insurance for the month of September since my student health insurance through school only lasted until the end of August because I graduated in May.  And because the Exchange required a letter from my employer verifying my on and off employment with them, I missed the deadline to get insurance starting in September (that’s a whole other issue).

I lived through September on pins and needles.  I was able to afford, just barely, my medications out-of-pocket, and received financial assistance for the one that I couldn’t.  And I hoped and prayed that I wouldn’t need to see a doctor, which I didn’t. 

I found a plan that I can marginally afford through the Exchange, meaning that I am getting a great deal on an otherwise expensive plan, but it still means having to really save to cover it every month.  But that’s okay.  I struggled to find a plan that I liked, and more importantly, that my current rheumatologist accepts.  Then, another snag.  My insurance company will be closing as of January 1st, meaning I’m back to the drawing board to find a new plan, and it’s proving a lot harder than I imagined because there are no plans available that are even comparable to mine.  Now why they even let me enroll in a plan for October when they knew full well that they would be folding is a whole other story, and a whole other frustration! 

I’m looking at plans where the lowest deductible is $2,000.  While I would quickly hit this, it means that I have to have that money up front in order to pay for it, which I don’t  Most of the plans I’ve seen also have very high co-pays for hospitalizations, for example, $1,500 after deductible.  That’s just not affordable for someone who has a part-time, temporary job, and could become unemployed at any time.  For me, the hospital coverage is for the what ifs.  In the last eight years, I’ve had two hospitalizations.  But as far as my doctors’ appointments and medications are concerned, those are non-negotiable.  I need those if I’m going to live some semblance of a life.    

I don’t want to get political here, but there is something fatally wrong with the system. Until now, over the past eight years, I’ve had a variety of coverage, but none of them have put me in danger of not being able to afford my rent.  Sure, my health comes first and in the last eight years of being chronically ill, I’ve had to make some sacrifices, but those were more personal than out of necessity.

I don’t want to sound whiny or like a bleeding heart, but this is a serious issue, and I realize now that I am lucky that this is the first time since I got sick that I am facing it.

Right now I am paying $151 a month premium, my deductible is $250, and my co-pays are reasonable.  So some might say that this is the exact reason for why the company is going out of business.

I wish I could go back to being blissfully unaware, but I can’t.  And I can’t keep quiet because the struggle is real, and it’s real for a lot of people, and not just me. 

The other issue at work here is that a lot of employers are keeping employees just below full-time so that they don’t have to pay for insurance.  In my mind, if someone is working 15 hours a week, I get that.  But if someone is working 27, 28, or 29 hours a week, they should be eligible to receive at least something.  In my mind, this shouldn’t be allowed. 

I wanted to write this post long before now, but worried that if I posted it in September and put it out to the universe that I didn’t have insurance, something catastrophic might happen.

1 comment:

  1. Oh Leslie I can sympathize with how stressful your situation is!

    I've been T1 diabetic since I was 16 months old. At a very early age I can remember my parents arguing with the insurance companies about my insulin. Every time my Dad changed jobs, it was a huge ordeal.

    In college my insurance benefit maxed out at $500 a term - laughably less than one term's worth of insulin cost. Then after grad school, the bottom fell out. I had no insurance, I was panicking. My parents and my husband's parents came together and said "We will buy you a policy. Whatever it costs, we will find a way to make it work." But guess what? I COULD NOT PURCHASE HEALTH INSURANCE AT ANY PRICE! This is something I tell people, and no one ever believes it right away. Surely, no? But yes, it was legal and it was real. They can't do that anymore, thank goodness.

    Even once I managed to get a job with insurance I got hit with the pre-existing condition clause. No coverage for my diabetes for 12 months. Well that's reasonable! (It is so not!) Thank goodness that is also now illegal.

    Now I am very lucky, in the best position I have ever been. I get insurance through my employer (I don't contribute to premiums for my policy), I have a $1000 deductible and the best part is that I have an out of pocket maximum of $1000 for prescriptions - so partway through every year all of my meds become free. (I feel strange as I walk out of the pharmacy with $1000+ dollars of free meds - lets leave quick, before they change their minds!!) I also have a Flexible Spending Account (FSA) that I load to the max each year ($2550) to cover my deductible and scripts. I have extra insulin in the fridge right now, which gives me a feeling of security that nothing else ever could. I realize how extremely, amazingly lucky I am right now.

    Access to healthcare is a right, not a privilege. Single-payer would solve so many deep problems in this country. I was really hoping for at least the public option out of healthcare reform. But what we got was miles better than nothing. Chronically ill people can buy insurance at rates that are the same as everyone else. They can't deny us our treatments because our conditions are "pre-existing."

    Sorry for the novel length comment - I hope you find a workable plan!