Obamacare with a preexisting condition

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bobisacrohny

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Oct 9, 2012
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Anyone have a good grasp on starting a new job with a preexisting condition and the insurance will work when the Obamacare kicks in? Need some real world scenarios and time frames...
 
Private insurance cannot discriminate as of January 2014, assuming Republicans don't get their way and obstruct Obamacare.

If you are joining a group health plan through work it is my understanding they must accept all employees.
 
Whether your plan would cover or how much they would cover would depend on the type of insurance your employer offers. You can certainly call the insurance company and tell them the plan and ask whether they would cover these drugs if deemed necessary by your doctors.
 
Well, here in Canada (just for arguments sake).. private group coverage includes any/all pre-existing conditions, whereas private personal insurance does not. For example, when my prior employer learned of my illness, and cut me loose, I lost my group insurance. But I did have the option of buying private personal insurance (to cover what government provided health care doesn't... prescriptions, optical, dental, chiropractic care, etc., etc..). The catch is... a personal plan wouldn't pay for anything associated with any of my pre-existing conditions... drugs, hospital extras (like a semi private room vs a ward). Now, when I started working for my current employer, coming under their group policy gives me all that coverage. And, in this particular case, it is 100% coverage. There are caps.. for instance... dental plan provides 100% on up to $2000 per year. No deductible. (So, if anyone questions why this crazy old man works 60 hours a week at my age, here is one great reason). Anyway, don't want to hijack this thread. Some folks ... question... why the most powerful country in the world doesn't offer it's citizens universal health care... but... (and don't get me wrong, I cherish the coverage I get just by virtue of being Canadian) EVEN with universal coverage, there are gaps, pitfalls. So, question, investigate... double check, and find the loopholes that benefit you, take advantage of them.... and position yourself to get the most you can out of it. At least, that is what I'm doing... it helps me focus on getting out of bed every morning at 5 AM.
 
bobisacrohny said:
Do you know if it is the same for prescriptions? I wonder about biologic's?

I just found this article that discusses preexisting conditions and the new plan: https://www.healthcare.gov/what-if-i-have-a-pre-existing-health-condition/
Click to expand...

I can't tell you anything specific about biologics and whether they are covered, but Obamacare sets standards for healthcare insurance. As far as I understand it, this means an insurance company has to cover standard drugs such as remicade, humira etc. if a doctor says you need them. It could likely still be a hassle.
 
I have been hearing that with the Obama care, insurance companies cannot deny you coverage. But they call the shots on what they will and will not cover. I have already seen a couple changes in my insurance due to this. I had some blood work done and the insurance company would NOT cover it, I have to pay out of pocket. They use to cover this lab test. Well when I called and asked why it was not covered, like I thought maybe they billed it under a wrong code or something. But no, the lady said that Blue cross just is NOT covering that test at all period for anyone anymore. There will be loopholes for sure. I am pretty sure that they will not cover the biologics 100%. THey may offer some coverage for a limited time up to a limited amount. I mean think about it, they charge like $6000 for one infusion of Humira I believe and over $4000 for one infusion of remicade. They need to get on the pharmaceutical companies back and put an end to them charging soo much for these meds. I am a bit confused about the whole Obamacare thing. I am happy they are finally getting affordable health care for people who need it, this is great. I mean I think health care should be free for all. But I think there are some stipulations in this whole bill. My MIL is worried now because she says they are saying that for people over 70 years old, they are not going to cover a lot of life saving meds like Chemo and such saying it would be a waste to do so at that stage in life. Now I hope to God this is not true!
 
Wow, great question. There is so much confusion right now, I'm not sure if we would be able to get a good reliable answer on that. But, I'd sure like to know if/when someone gets the info.
 
Pardon me butting in... but a company refusing to provide coverage to one person (or group) based on age... that sounds like age discrimination. Isn't that illegal down there?
 
Kev said:
Pardon me butting in... but a company refusing to provide coverage to one person (or group) based on age... that sounds like age discrimination. Isn't that illegal down there?
Click to expand...

Welcome to America, where corporate greed happily discriminates wherever they can.
 
America from what I experience has written rules/laws of health related discrimination but unwritten ones and processes that are beyond most peoples which a lot of times override these rules/laws. Sadly a lot of it is hidden and is ignored.

When these laws first started they were effective but since the loopholes are many and in new America it is usually takes a special situation or the right connections to just be in defense. Don't get me wrong America is awesome and I love it but it can definitely be challenging if you have a disease/disability and being treated as an equal American.

I am concerned that people with health conditions will be just not hired at jobs when they find out they have them in conventional or non conventional channels. Hopefully this is being addressed in the new plan. How are our states Departments of Insurance going to deal with this? This should be a concern to all it is effecting as it can be life altering! Remember ignorance doesn't protect you in law.

I believe there needs to be a disability union or advocates of some sort to stand for common decency. I think Obamacare's plan has good intentions if it can survive the storm ahead of the republican and survival of the fittest mentalities Hopefully there will be a humane and morale force to adequately counter their arguments.

Hopefully a superhero or many superheros will come out of all this for a greater common good!
 
The Obamacare plan from what I am seeing is going against the American culture of sport where there aren't handicaps, except in bowling maybe. Usually the one's making the most money are the hero's of the game. Hopefully morality will see a difference in between a game and life and not sin. Let's hope it brings out the good for IBD sufferers as it needs not be a game! God bless!
 
An employer that hires you will not find out from the insurance company of which they have a plan about your illness. You can be closeted about your illness if you are able. I didn't tell my boss for a while that I have crohn's.
 
Ce12 you can begin looking up low prices insurance plans starting in October. There are supposed to be ones for around $100 a month.
 
I wonder how much the $100 plans will cover? I just have this feeling that the whole health care thing is going to be to good to be true. I mean there are already all these catches that I keep hearing about that scares me.

Kev, yes, here in America, discrimination is very well known, especially when it comes to politics and government stuff. I live in Chicago IL, in cook county. Everyone calls it "crook" county, Lol! I mean look at it this way, here in Chicago IL we have a very high crime rate that seems to be getting worse ( in certain areas that is), YET, we were the ONLY state that was not allowed to participate in the conceal and carry law. Now that has changed due to the Federal Government getting involved and deemed it unconstitutional to take away the peoples civil rights. I mean I am embarrassed to say that here in Illinois, we have 2 governor's back to back who are sitting in prison for being corrupt. Well, one just got out, he served his time. I mean it is a joke.

But anyhow, I am really happy they are coming out with affordable health care for everyone, this a step in the right direction. But I cant help feel that there are going to be things in this new plan that they are not telling, things that are not being said that may not be very good. I do not think they should force people to have to get health insurance. I mean I myself think people should get it, I mean everyone needs it, but still, this is America and people should Not be forced to buy insurance. That is getting to be kind of communistic in my opinion.







nogutsnoglory said:
Ce12 you can begin looking up low prices insurance plans starting in October. There are supposed to be ones for around $100 a month.
Click to expand...
 
Well, crooked politicians is not unique to America (Hmmm, crooked and politician seems to be redundant)... we have 4 (well, one still awaiting sentencing after changing pleas) local provincial (equivalent to State or Territory) politicians who were caught stealing thousands... Oh, and a couple of national Senators who ... allegedly.. took hundreds of thousands in bogus expense claims... Yeah, crooked and politician are redundant. Hope its of some comfort to know you are not alone.

So, it's a $100 US per month... and that is considered 'affordable' health care in the US?
Man... put things into perspective. A basic private plan here would start at 1/3 of that.
$50 a month would give a family a basic plan... (medical expenses not covered by our universal health coverage... plus dental, plus optical, plus pharmaceutical.. or things like chiro, massage therapy, ... just about everything except hearing aids.. why, I dunno)..
These plans usually come with caps... $2000 for drugs, $500 for chiro, $1000 for visits to psychiatrist, counselor, ... AND there is also typically a co-pay. Usually 80/20 split.

I know this may sound like Shangra La (OK, so I can't spell)... but, if you look at the tax load we pay here in Canada... Gas is about $6 for a US gallon... booze will run you $1 per ounce... or beer $1 a bottle. Cigarettes will cost about $12.. bread about $4.. milk about $5 a gallon... butter about $4 a lb.. Recently (like this past Tuesday) Target opened 3 stores locally... all of us Canucks who've been to their US counterparts lined up on opening day... expecting to see the same prices we'd seen down in the US stores. So much for expectations. Thing is... you get used to the tax load, the daily burden, and it spreads out the sting... somewhat. Especially since the bulk of it is levied on the non-essentials... yet the benefit is.. no matter how broke any of us here in Canada may be at any point in our life... we can walk into a doctors office, or a clinic, or a hospital, and there are no cash registers, no debit machines anywhere in sight. And no one has to raise $100 a month, or apply to a private company... or do without basic health care.
 
The plans that will be $100 a month will probably offer poor coverage. If you are paying the full cost for private insurance, you are looking at over $1,000 monthly for a good plan.
 
Kev,

Gee, I hate to say it, but the prices of things over there in Canada are high, but were about the same here! everything is super expensive. I mean it depends on what stores you shop in,and what county too. Cook county taxes are the highest. It is getting ridiculous. Noguts is right, people wanting a " good coverage" plan, you will likely pay an arm, a leg and maybe a few fingers ad toes even! :).

I have a girlfriend who is from Canada. She lives here now in the States, but her mom still lives in Canada. She said there sometimes is a waiting list when it comes to getting appointments, but still, it is free. Here, you usually don't have a huge wait, like you can get an appointment within 2 weeks. BUT, expect to pay. I still remember I went to see this one doctor located near Lake shore Drive over here in Downtown Chicago back when I first started having health issues. I will never forget what this doctor charged my insurance. She charged like $450 for a 30 minute office visit! What a joke. It is no wonder the insurance companies are denying coverage for certain things. I mean a CT Scan will cost like $5000. I had an MRE, they charged over $6000. My husband had to have an MRA of his head 6 years ago( similar to an MRI), they charged $8000 for it! And this was years ago, I can imagine with inflation, the prices have went up by now. The bad thing is that the insurance companies will only cover so much and then the patient is usually left with the remaining. So we are definitely in need of a better health care system here. I just am not sure they will be able to offer one that is truly "fair" and with no hidden issues( which I am certain there will be).
 
so I checked things out on healthcare.gov, and according to my income and living situation I should be able to get a silver plan(they apparently go bronze, silver, gold, then platinum) for $600 a year after the government subsidizes about $3200....apparently, as of October 1st, I will be able to go on healthcare.gov, apply online for a private health insurance plan, have no chance of being turned down for a preextisting condition, and will have "more options than ever before" according to the website....
So it sounds pretty good so far, only problem is my current health insurance is probably comparable to a "platinum" plan and my copays and whatnot are still causing the bills to pile up.
 
and kev if you want to any decent, nutritious food here you easily pay $4 for a loaf of bread and $6 for a gallon of milk...with our governments lack of interest in providing us with safe, nutritious food you can go get a gallon of ultra pasteurized homogenized bleached milk like product(wal mart brand milk) for less than $3 a gallon, but good milk is $6
 
And you might pay more for a gallon of gas in Canada but most cities in the US have virtually no options for public transportation
 
I had to wait 6 weeks for a CT scan... but I had 7 in a row after the initial one, and I paid ZERO. nada. I waited a year to see my current GI, but she saved my life. I could have seen other GI's (like, I could get in to see any GI SURGEON within 10 days/2 weeks). Blood work, X-rays, bone density scans, consults with multiple surgeons, and nutritionists, and oncologists, and dermatologists... the last 7, 8 years.. just a constant array of doctors, specialists, treatments, operations, hospital stays, clinic visits, doctor office visits... AND it never cost me one red cent. Hey, maybe Obamacare is the first rung in the ladder. I mean, if your poor cousins in Canada can have it, why not the US?
 
u got it exactly kev...obamacare is def not gonna be perfect but it's at least moving us in the right direction, the 1st rung in the ladder for sure
 
ce1210 said:
and kev if you want to any decent, nutritious food here you easily pay $4 for a loaf of bread and $6 for a gallon of milk...with our governments lack of interest in providing us with safe, nutritious food you can go get a gallon of ultra pasteurized homogenized bleached milk like product(wal mart brand milk) for less than $3 a gallon, but good milk is $6
Click to expand...

I hate that the government subsidizes all these unhealthy, bad for the planet and animal welfare businesses but won't invest a penny in farmers who are trying to produce fresh, safe and healthy food for us and the planet.
 
I know, it's crazy the extent to which the US gov is bought and paid for by corporations...since being diagnosed I have done a lot of research on the food that's available today and the amount of unsafe preservatives, pesticides, and other chemicals in food are SCARY. I only go for organic now and won't touch anything with sodium benzoate, EDTA, BHT, BHA, bromine, etc
 
Without deliberately trying to hijack this thread (at least any further)... but watching the documentary "Forks Over Knives" was a real eye opener for me. Not advocating it as a miracle cure... simply can't because I haven't tried it, but I'm contemplating trying 'some' of it.. AND because there have been those who have discounted it but to my eye... the positive changes in people with diseases (although not IBD) in relatively short periods of time... 13 weeks, 20 weeks, 22 weeks... incredible transformations based solely on this diet.. BUT, I digress... thing that really was food for thought was the connection/involvement of big business in the USDA... AND that it was intended to promote the farmers, the agriculture industry, the food industry.. and NOT the consumer. That, to my my 'untrained' eye, is a total conflict of interest. But, everyone accepts it.

I can't make a case for 'diet' being directly connected to IBD... but I 'believe' that diets like the SCD do that... prove conclusively there is a correlation, a connection. If not the smoking gun, cause/effect scenario... at least that diet abets certain diseases, limiting some foods.. complex carbohydrates, etc., improves symptoms, maybe eliminates issues.

Hey, we all know 'first hand' trigger foods... What if it really goes as far as the authors of "Forks Over Knives" would have us believe? Even if they are only party right, then the folks who are nay-sayers are wrong... maybe well intentioned accidents, or perhaps a chilling conspiracy. I don't know where the FOK people got their numbers, but in it they stated that treating illness in the US cost 2.2 TRILLION a year. Maybe if we could prevent or lessen disease by basic, simple, dietary changes... then maybe those dollars could be spent/focused on diseases that are beyond dietary control or influence.

I've rambled on too long... AND I'm diverting from the Obama care topic.. but it certainly is a topic worth kicking around.. in another thread. I wonder what would happen if people in a chronic state of health tried adopting the FOK diet, even just a bit at a time, gradually?
 
If people want the government to pay for stuff, that cash has to come from someplace. That means taxes, and the tax required to cover people with preexisting problems to get insurance under the Affordable Care Act will cost anybody with insurance $63 each year.
 
danygib said:
If people want the government to pay for stuff, that cash has to come from someplace. That means taxes, and the tax required to cover people with preexisting problems to get insurance under the Affordable Care Act will cost anybody with insurance $63 each year.
Click to expand...
Do you have any evidence of that? Are you talking about just people who's coverage is completely paid for by the government (as through Medicaid), who's coverage is supplemented, or who's coverage is not paid with any government money? My coverage is through my employer, and as best as I can tell, only my company and me are paying for it.
 

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