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Disability and Health Insurance

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I am researching disbability. My lawyer thinks that I have more than enough to qualify. (and be better off financially). My biggest concern, however, is health insurance. The cost of my prescriptions is greater than my salary. Is there a way to get reasonably priced medical insurance that would cover obvious pre-existing conditions? I know group insurance can be extended 18 - 36 months through Cobra, but then what? Does something else kick in, like Medicare for those over 65. Is there any help to be had through HIPPAA?


I'm afraid that disability may not be a viable alternative without sufficient health insurance.


Any thoughts?, publications that I ought to be reading or...?





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Hi Craig,


That's a good question. In most states it is impossible to get health insurance coverage for a pre-existing condition like scleroderma. Cobra rates are usually sky high. Some states have insurance pools for those who are uninsurable, and they charge an extra percentage on top of regular rates for the coverage.


Medicare doesn't kick in for several years AFTER the start date of social security disability benefits. There's no help to be had through HIPPA, that I know of. Start with your state's insurance commissioner's website; find out what your Cobra coverage will cost (probably more than your house payment); and, if your state does have an insurance pool, find out if they allow applications from people who have Cobra coverage available to them. I believe many (or all) will disallow applications if there is Cobra coverage available, even if it is unaffordable.


You've just discovered the two-year "donut hole" in our health care system for the disabled. Now, if you are totally broke (which can happen in a big hurry under these circumstances), you may qualify for state Medicaid programs or SSI income. But odds are if you've been in the workforce a long time, you will have too many assets to qualify.


That's why many adults who do not have large savings or investments end up living back at home with parents, or with their grown children, or trade down from a luxury home to a small apartment, or file bankruptcy. It's quite common for people to file bankruptcy several years into a severe illness due to the unavoidable costs of medical care and medications during the time they are waiting for benefits.


I don't think I've ever met anyone who was better off financially from being disabled, although I suppose it would be possible if there is an excellent long term private disability plan available, that doesn't penalize for social security benefits. And even with Medicare, a person really needs a Medicare Supplement plan, plus medication coverage on top of that.


Good luck and let us know what you find out!

Warm Hugs,


Shelley Ensz

Founder and President

International Scleroderma Network (ISN)

Hotline and Donations: 1-800-564-7099


The most important thing in the world to know about scleroderma is sclero.org.

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Don't want to discourage you, I but have done some research regarding my own alternatives with health insurance and have also worked in that industry. It is hard to obtain coverage as an individual with pre-existing conditions. Either the rates tend to be higher or you are considered uninsurable. With COBRA rates, you pay 100% of the employers cost for the plan plus an additional 2% (in my state). After COBRA, your state may have the "POOLING" option which will allow you to transition from COBRA into a conversion policy. However, many of these policies are basic in nature, are not at the same benefit level of your employer's plan and they often times cost more than the COBRA policy.

I may have Scleroderma, but Scleroderma doesn't have me!

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This just happened to me when they terminated my position because I was still out sick.


I have applied for disability and am currently waiting for a decision. I was put on COBRA at $660/month. I am told it's actually extendable up to 26 weeks based on certain conditions. At that point, the two year waiting period would be over for the state and you would go on Medicare.


When I called the insurance company (BC/BS) to question the high rate, I was told I could shop around at insurance companies for rates as long as the coverage hasn't been broken by a time lapse. Another words, if you have BC/BS and decided to switch directly over to Aetna, then our condition would be covered and not considered pre-existing. You could call your insurance to confirm whether this is true with their organization.


I hope this helps.





It is what it is...........

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I was offered Medicare after being on disability for less than a year, but I didn't do it. I am fortunate in that I get health insurance through the state because I was a teacher. Best of luck to you!


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If your disability is retractive at least two years then you will be eligible for medicare. My disability was retroactive for three and a half years(that's how long it took me to get disability) and I now have medicare. There are health insurance companies with medicare plans that are very reasonable. Good luck.




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