Individual Health Insurance with Bipolar? Help!
February 6, 2008 5:34 PM Subscribe
I am in the process of switching jobs. I need health insurance (likely individual health insurance) but I am Bipolar... help
I Have bipolar. Medications are not a huge concern since mine are (fortunately) all cheap to purchase out of pocket and/or I have a huge stockpile. Main concerns for medical coverage is my Therapy Sessions, my psychiatrist and MOST OF ALL the nightmare scenario if I go Manic again and end up in a hospital (last time the bill for 5 days was $28k, fortunately I was covered at the time)
Old job and prior coverage: Never had a gap in coverage and my old job was a group (I think?). In any case, I am covered by them without any "pre-existing conditions"... until I quit. I have not decided when I am quitting but within the next month or so.
New Job: Is a low paying, experience building position until I go back to school in a year or two. As such the employer does not have a group plan (though I am *possibly* in a situation to convince them to get Assurant Group Health, if that would drastically change the situation). He has offered to pay 50% of whatever Individual plan I choose.
I live near Raleigh NC.
What should I do? If I need individual medical who is trustworthy to talk to and how do I broach the subject of my Mental Health? How do I get mental health covered without breaking the bank? What else should I consider given my situation?
I Have bipolar. Medications are not a huge concern since mine are (fortunately) all cheap to purchase out of pocket and/or I have a huge stockpile. Main concerns for medical coverage is my Therapy Sessions, my psychiatrist and MOST OF ALL the nightmare scenario if I go Manic again and end up in a hospital (last time the bill for 5 days was $28k, fortunately I was covered at the time)
Old job and prior coverage: Never had a gap in coverage and my old job was a group (I think?). In any case, I am covered by them without any "pre-existing conditions"... until I quit. I have not decided when I am quitting but within the next month or so.
New Job: Is a low paying, experience building position until I go back to school in a year or two. As such the employer does not have a group plan (though I am *possibly* in a situation to convince them to get Assurant Group Health, if that would drastically change the situation). He has offered to pay 50% of whatever Individual plan I choose.
I live near Raleigh NC.
What should I do? If I need individual medical who is trustworthy to talk to and how do I broach the subject of my Mental Health? How do I get mental health covered without breaking the bank? What else should I consider given my situation?
I second COBRA. I have bipolar and have switched jobs a couple of times, and used COBRA in-between to keep gaps out of my coverage. I had no problems starting up insurance at the new jobs, granted they had group plans, but the gap is the main issue that you want to avoid.
Another thing, though I know that switching therapists is difficult, especially if you have a good one: look for a psychiatric nurse. I am currently seeing someone who is not a doctor, but is able to prescribe meds, and works under the guidance of a doctor. I was not using my insurance with her for the past couple of years, and though what I paid was more than a co-pay would have been, it was still less than half what a doctor would have charged.
posted by veronitron at 6:04 PM on February 6, 2008
Another thing, though I know that switching therapists is difficult, especially if you have a good one: look for a psychiatric nurse. I am currently seeing someone who is not a doctor, but is able to prescribe meds, and works under the guidance of a doctor. I was not using my insurance with her for the past couple of years, and though what I paid was more than a co-pay would have been, it was still less than half what a doctor would have charged.
posted by veronitron at 6:04 PM on February 6, 2008
Response by poster: Thanks for the input so far, just to clarify...
COBRA is expensive, for one. Secondly, I already have a new job lined up and like I said, he is probably only going to cover me 50% under an individual plan... thus my problem. Even if I did COBRA he would likely not pitch 50% to it (just a guess but he would question why I was paying so much) and the job could possibly last longer than 18 months... end of COBRA
Basically I am really looking for advice about the feasibility of individual health coverage given my condition, and advice on what are good plans with the coverage I need.
posted by DetonatedManiac at 6:40 PM on February 6, 2008
COBRA is expensive, for one. Secondly, I already have a new job lined up and like I said, he is probably only going to cover me 50% under an individual plan... thus my problem. Even if I did COBRA he would likely not pitch 50% to it (just a guess but he would question why I was paying so much) and the job could possibly last longer than 18 months... end of COBRA
Basically I am really looking for advice about the feasibility of individual health coverage given my condition, and advice on what are good plans with the coverage I need.
posted by DetonatedManiac at 6:40 PM on February 6, 2008
COBRA allows you to keep your current coverage at a cost of no more than 102% of what you and your employer were paying for ins. In your case you'd get 18 months.
If COBRA is expensive (under group coverage), an individual plan is probably going to be even more expensive.
posted by andrewdunn at 6:47 PM on February 6, 2008
If COBRA is expensive (under group coverage), an individual plan is probably going to be even more expensive.
posted by andrewdunn at 6:47 PM on February 6, 2008
Another consideration...
Opt COBRA for the next year or so, and go back to school and more than likely you'll be eligible for a cheap group plan through your school.
posted by andrewdunn at 6:48 PM on February 6, 2008
Opt COBRA for the next year or so, and go back to school and more than likely you'll be eligible for a cheap group plan through your school.
posted by andrewdunn at 6:48 PM on February 6, 2008
Pre-existings conditions don't matter if you buy your individual policy within 50 days or so of the old one ending.I don't remember the exact number of days. As long as you buy before then, and buy one that covers what you need, you'll be fine. However, the individual policies usually have much higher deductibles than the group plans. Expect to pay the first $1000 (at least) out of your own pocket and have higher copays than you had before.
posted by COD at 6:58 PM on February 6, 2008
posted by COD at 6:58 PM on February 6, 2008
Don't offer information about your mental health unless you have to disclose it. It's nobody's business, not even your boss's. You said he is "probably only going to cover [half] of an individual plan" - has he specifically said this? I would bring it up directly with him. "Joe, I really liked my insurance at company X, and I can keep the insurance through COBRA for $xxx per month." See what he says. If he doesn't go for it, why don't you ask your therapist/psychiatrist which insurance companies they accept? Explain the situation and perhaps they will tell you which companies are easiest to deal with/most trustworthy. I don't see any ethical violation here, but I'm not in either the insurance or medical professions.
posted by desjardins at 7:03 PM on February 6, 2008
posted by desjardins at 7:03 PM on February 6, 2008
I haven't had to do this but my best thought would be to use an insurance broker. They represent a number of different companies and could help you find a good deal. At least you can get a price that you can use as a comparison. The one thing I have heard is that you don't want any gap in coverage - it might be worth getting COBRA for a month or two is if there is any glitch with your new policy you have time to fix it.
posted by metahawk at 7:24 PM on February 6, 2008
posted by metahawk at 7:24 PM on February 6, 2008
Pre-existings conditions don't matter if you buy your individual policy within 50 days or so of the old one ending.I don't remember the exact number of days. As long as you buy before then, and buy one that covers what you need, you'll be fine.
This is true for group plans, but may NOT be true depending on what state you live in for an individual plan. Most states allow insurance companies to write pre-existing condition riders for plans in the individual market, which means that the insurance company can elect to not cover any and all pre-existing condition you disclose, no matter how long you have a plan or whether you were in group coverage before with no interruptions. Additionally, any claim you file in the first couple of months you have the plan (set at 12 months in many states, but could be 24 months or 6 months, depending on where you are) is allowed to be investigated as a potential pre-existing condition, and if found to be pre-existing (EVEN if it was never diagnosed) can be excluded from coverage. Which means it's not a good idea to fail to disclose your bipolar disorder in hopes that they won't exclude it.
In short, your protection in the individual market is really, really crappy, unless you happen to live in one of the handful of states (like MA, NY, or NJ) that has at least made an effort to apply some of the same protections to the individual market that you get in the group market (although no states provide all of the same protections you get in the group market to the individual market). You can find a summary of your protections here. That site also has a lot of information on different options for insurance in each of their state guides--it's a fantastic resource for figuring out exactly what laws apply to you and if there's any options for coverage that are state-specific, like Healthy NY in New York.
Good luck, and keep in mind that most people are aware of the limitations and laws surrounding group coverage, but the individual market is a whole different ballgame, so you need to be really careful not to assume you're protected--in all likelihood, you have very little protection if you choose to go into the individual market. If you have to take a pay cut at your new employer in exchange for him getting a group plan, it's almost certainly worth it, particularly if you have a pre-existing mental health condition.
posted by iminurmefi at 8:02 PM on February 6, 2008
This is true for group plans, but may NOT be true depending on what state you live in for an individual plan. Most states allow insurance companies to write pre-existing condition riders for plans in the individual market, which means that the insurance company can elect to not cover any and all pre-existing condition you disclose, no matter how long you have a plan or whether you were in group coverage before with no interruptions. Additionally, any claim you file in the first couple of months you have the plan (set at 12 months in many states, but could be 24 months or 6 months, depending on where you are) is allowed to be investigated as a potential pre-existing condition, and if found to be pre-existing (EVEN if it was never diagnosed) can be excluded from coverage. Which means it's not a good idea to fail to disclose your bipolar disorder in hopes that they won't exclude it.
In short, your protection in the individual market is really, really crappy, unless you happen to live in one of the handful of states (like MA, NY, or NJ) that has at least made an effort to apply some of the same protections to the individual market that you get in the group market (although no states provide all of the same protections you get in the group market to the individual market). You can find a summary of your protections here. That site also has a lot of information on different options for insurance in each of their state guides--it's a fantastic resource for figuring out exactly what laws apply to you and if there's any options for coverage that are state-specific, like Healthy NY in New York.
Good luck, and keep in mind that most people are aware of the limitations and laws surrounding group coverage, but the individual market is a whole different ballgame, so you need to be really careful not to assume you're protected--in all likelihood, you have very little protection if you choose to go into the individual market. If you have to take a pay cut at your new employer in exchange for him getting a group plan, it's almost certainly worth it, particularly if you have a pre-existing mental health condition.
posted by iminurmefi at 8:02 PM on February 6, 2008
I doubt you are going to find anyone who will sell you a policy as an individual. Because of the bipolar.
Do your Cobra if you can and then transfer to your other job's insurance, if you really must switch jobs....but the truth is that if insurance is important to you you need to make totally sure you know what you are doing.
And you need to figure out NOW how to stay insured when you go to school because once you lose your insurance, you are screwed. The best you can hope for is to get another job with insurance and gut out a year with your preexisting condition.
If I were you I would go to a GOOD bipolar forum (I used to hang out at the one about.com had; haven't been there in awhile BUT when I was there they were excellent) and ask folks there about their insurance situations.
posted by konolia at 8:04 PM on February 6, 2008
Do your Cobra if you can and then transfer to your other job's insurance, if you really must switch jobs....but the truth is that if insurance is important to you you need to make totally sure you know what you are doing.
And you need to figure out NOW how to stay insured when you go to school because once you lose your insurance, you are screwed. The best you can hope for is to get another job with insurance and gut out a year with your preexisting condition.
If I were you I would go to a GOOD bipolar forum (I used to hang out at the one about.com had; haven't been there in awhile BUT when I was there they were excellent) and ask folks there about their insurance situations.
posted by konolia at 8:04 PM on February 6, 2008
COBRA. You won't find the LEVEL of coverage you currently have under your current plan/COBRA for less cost per month.
You might find a cheaper individual plan that has an extremely large deductible with a very restrictive cap on therapy visits, if they cover therapy at all. It is not unusual for individual plans to "carve out" (this means not cover) anything related to mental health. So, yes, you'd be paying less per month for insurance premiums but you would also be paying for therapy visits out of pocket as well as other treatment related to your diagnosis, possibly.
Not disclosing your current diagnosis so as not to get hit with restrictions on your coverage might not get you very far. Once you file your first claim related to your bipolar condition, it is possible that the insurance company will require the treating practitioner to put down the date of your initial diagnosis and sign off on that. Since that was before you applied for individual coverage, the fact that you didn't disclose a pre-existing condition would be uncovered and this may result in the termination of your coverage under that plan. That is the most drastic situation, and every insurance company is different, but insurance companies exist to make money, especially on individual policies. They will try to mitigate their risk.
All this to say that your best bet to continue having your meds and therapy and psych doc visits and the reassurance that you would be covered for an inpatient stay is with COBRA.
posted by jeanmari at 8:54 PM on February 6, 2008
You might find a cheaper individual plan that has an extremely large deductible with a very restrictive cap on therapy visits, if they cover therapy at all. It is not unusual for individual plans to "carve out" (this means not cover) anything related to mental health. So, yes, you'd be paying less per month for insurance premiums but you would also be paying for therapy visits out of pocket as well as other treatment related to your diagnosis, possibly.
Not disclosing your current diagnosis so as not to get hit with restrictions on your coverage might not get you very far. Once you file your first claim related to your bipolar condition, it is possible that the insurance company will require the treating practitioner to put down the date of your initial diagnosis and sign off on that. Since that was before you applied for individual coverage, the fact that you didn't disclose a pre-existing condition would be uncovered and this may result in the termination of your coverage under that plan. That is the most drastic situation, and every insurance company is different, but insurance companies exist to make money, especially on individual policies. They will try to mitigate their risk.
All this to say that your best bet to continue having your meds and therapy and psych doc visits and the reassurance that you would be covered for an inpatient stay is with COBRA.
posted by jeanmari at 8:54 PM on February 6, 2008
Your old employer's group plan may offer a conversion option. When you quit, you convert from the group plan to an individual plan with the same carrier. You will not get the same benefits, and your premiums may go up depending on how much of your group premium your employer paid for you, but conversions are generally not subject to underwriting. That means no medical questionnaires to fill out, no gaps in coverage, no pre-existing condition exclusions, and no need to find a new provider on a new network.
If you are eligible for COBRA and can afford the full price of what your old employer was paying for coverage, that's your best bet. You have a month or two to decide to enroll, and if you meet that deadline, you can enroll retroactively to the date you quit.
If you can't afford COBRA premiums, conversion premiums may be lower (but you'll have higher out of pocket expenses). Also you can convert to individual when your COBRA expires.
Or is there a professional association you could join that offers a group plan?
If all else fails, your state may offer a high-risk pool for people who have been denied individual insurance.
posted by expialidocious at 10:11 AM on February 7, 2008
If you are eligible for COBRA and can afford the full price of what your old employer was paying for coverage, that's your best bet. You have a month or two to decide to enroll, and if you meet that deadline, you can enroll retroactively to the date you quit.
If you can't afford COBRA premiums, conversion premiums may be lower (but you'll have higher out of pocket expenses). Also you can convert to individual when your COBRA expires.
Or is there a professional association you could join that offers a group plan?
If all else fails, your state may offer a high-risk pool for people who have been denied individual insurance.
posted by expialidocious at 10:11 AM on February 7, 2008
This thread is closed to new comments.
you don't have to be fired to take advantage of it--i used it when i quit a job a few years ago. piece of cake.
posted by thinkingwoman at 5:41 PM on February 6, 2008