Health Insurance - Information &/or Advice Needed PLEASE

Given the current uncertainty in Washington D.C. over potential cuts to ‘entitlements’ in efforts to pass a ‘debt ceiling’ decision as well as there are some of us without health insurance, I am seeking everyone’s help in pointing us in the right direction in efforts to reduce the HIGHLY stressfulness of not having health insurance. Some of us are covered under a spouse’s or parent(s)'s (health insurance) plan, others are still covered under his/her employer’s health insurance, and some of us have lost all health insurance coverage; therefore, I am seeking to list potential options for all the people whom are NOT covered and BEG that EVERYONE will help ease/resolve this stressful burden on the ones whom do not have health insurance coverage. PLEASE, PLEASE help provide some ideas for people!!!

Note: Medicaid coverage is ‘income based’ and sometimes a person’s SSDI amount puts a person over the income limit; therefore, rendering that person unqualified for coverage. Additionally, there are different group/policy names of Medicaid (at least in GA there are) and one can easily not qualify to be covered. (For example: I can qualify for CCSP (a name of a certain type/group/program of Medicaid) BUT I would have to pay $705-$715/month for home health services in order to be covered… and paying my monthly expenses (housing, food, debt, necessary items, etc.) AND the $705-$715/month for home health services is NOT doable on my sole income from my SSDI. Not being able to do that ‘option’, I would loss Medicaid coverage. Another ‘option’ I have learned is that one can qualify for ‘medical needy’ Medicaid IF he/she has enough medical bills (I was told the figure is $1000.00 in medical bills); however, MOST non-emergency medical facilities will NOT see a person if he/she does not have medical insurance - a ‘catch 22’ there.)

Additionally, I wanted to inquire about whether any of you know if vascular malformations that have been removed are or are not considered a pre-existing condition. (I’ve read other posts regarding determination in getting life insurance that they are considered as a ‘pre-existing condition’ and a ‘high risk’ but I have not read whether a health insurance company would consider it so or not. (I would think it would be the same ‘classification’ for both (life & health insurance); however, things aren’t always the same in all areas/‘across the board’.))

Thank you all, in advance, for any & all information you help provide!

Two things I forgot to add:
(1) I am in the USA (so anyone replying for another country, please state what country so people will know if it’s applicable to them - thank you).
(2) In the US, disabled individuals must wait 25 months before he/she is eligible to see if he/she qualifies for Medicare (Federal) coverage. (Medicaid is state coverage.)

Have you looked into PCIP coverage? I had my AVM removed, doc said it was no longer considered a pre-existing condition since it was removed, but tell that to the insurance companies… I was denied by Blue Cross but got onto the PCIP–Pre-existing condition Insurance Program–mandated by “Obamacare” which is a huge life-saver, in my opinion. It is a PPO and the monthly cost for me is $260 and I think is comparable nationwide, in fact they just lowered premiums in many states because they were SAVING money by actually insuring people instead of leaving them to rot until their condition got so bad they HAD to get to an ER for care. The only problem is, you have to be 6 months without insurance to qualify and be denied by a major healthcare company.

Oh and the funny thing is: the PCIP program in my state is under the Blue Cross umbrella…

Hi Cindy. Thank you for bringing this subject up. This link has so much good info on it…

I love this organization…

Just found a new and interesting site…

Thank you, Nicole & Barbara! I know there are many non-covered individuals among us and all pieces of information would be helpful. Thank you SOOOOOOOOOOO very much for sharing information that will be of help to people while in such need.

Nicole: Where do people go or who do people need to call to find out about PCIP plan(s) (individual insurance companies, his/her state health dept. or community service dept., his/her county office, etc.)? is the website to find more info about the program.

Thank you, Nicole!

I am in NJ but I thin this is now in all states in US. I applied for NJ Protect which is ins FOR preexisting conditions, my neuro dr filled out the form showing it is pre existing… you can read about it here… then find the protect in your state. This is part of the healthcare program and it is ins ONLY until the other kicks in in 2013…

Just to add to my post above… the ins is thru Horizon Blue Cross. I pay 585.00 for the better policy and unlike most government programs… it was easy and not alot of forms… truly look into it if you are uninsured with preexisting… it is slowly rolling out in each state not sure yet what states are up and running.

Thank you, Q!

Just read the (health insurance) definition of ‘pre-existing conditions’ from the site Q provided and this is what it says:
"What is a pre-existing condition?

For purposes of NJ Protect a pre-existing condition is defined as a medical condition clinically present prior to the date of coverage, whether or not symptomatic or treated, and whether or not currently symptomatic or in a state of remission, for which treatment has been or will be medically necessary and appropriate.

New Jersey does not allow carriers to deny coverage because of pre-existing conditions, but carriers can exclude benefits for treatment of a pre-existing condition for a period of time. So, if the medical condition is one that a carrier would have excluded from coverage under a health plan other than NJ Protect, then the medical condition is probably a pre-existing condition for purposes of NJ Protect, too."

Nicole: I agree with you on your doctor’s view = if it’s gone, it’s done/complete & it’s should NOT be classified as a ‘pre-existing condition’ still. (Case in point: If a person breaks a toe and gets it treated & fixed or get treated for a cold or the flu, then ‘technically’ that could be considered ‘pre-existing’ too by health insurance companies - it’s so very sad & disheartening that common sense has REALLY been lost in soooooooooooo many important areas these days.)

I wasn’t turned down for reg. ins… but it would have been almost 800.00 a month if approved and a one year waiting period for preexisting…I could never afford 800. more than my mortgage… this NJ protect was a god send and a very good plan cheaper… it is in other states so please check … I have been without ins. since 2004… my avm surg was in 1999… now possibly more testing and who knows what next… sure hope you guys can get this in your state… you have to be without ins for 6 months prior… sure hope it helps some… sure did me. This was basically put in place for people who need care NOW testing or other things on a chronic pre existing problem with no ins.

Great idea for a post well done!

Thank you.

Daniel A Sadler said:

Great idea for a post well done!

Don’t mean to be cheeky but maybe you should
Marry a Canadian and move here. It is alarming
To read how so many AVM survivors are left
Blowing in the wind. It’s bad enough to have
One, but to have to struggle to live afterwards.
I find it exasperating, I feel very fortunate.

Thank you, Gillian. Yes, it is horrible for one to have to deal with.
Oh, just fyi: Find me a good one (no matter where) and that wouldn’t be a problem - LOL. (j/k - but always on the lookout for/open to the possibility of a good one.) :wink: