Health insurance for two soon-to-be uninsured cancer patients...
October 1, 2019 10:18 AM   Subscribe

My parents both have cancer. Mom just lost her job and, as such, her employer-provided insurance that covered her and my dad. They've got COBRA now but can't afford to keep paying the insane premiums for that. There are no ACA plans available that are accepted by their treatment providers and they don't qualify for our state's Medicaid. What do and holy god, does insurance in this country just suck or what...


Both my parents have cancer and are currently undergoing (insanely expensive) treatment. Dad was forced to retire and was covered on my mom's insurance plan through her state employment. She was recently terminated (we've filed the proper complaints as the reasons laid out for such were clear discrimination due to her disability) but that means she lost her insurance at the end of July (though she wasn't informed of this until the end of August).

Mom and dad are both being treated at a great teaching and research hospital that's quite a distance from us but is worth it, given the standard of care they get. They've paid for COBRA this month and can probably afford it next month but after that, the $1700 premium will be something they just can't afford any longer.

Mom has a little over a grand she's getting in long-term disability benefits from her old job. Dad gets a little over $2 grand in SSI benefits. My state (Missouri, if that helps) has not expanded Medicaid and their income puts them over the max. They could get coverage but they'll have a spend-down that will suck up the entirety of their monthly income so that's not really a viable option. Paying the spend-down means they literally won't be able to eat.

The hospital where they're treated only takes one kind of insurance, Cigna, and on the ACA marketplace, Cigna plans aren't offered to folks outside of a few counties where my parents, unfortunately, don't live. There ARE plans on the Marketplace they might be able to afford but again, they're not accepted by their hospitals, their doctors, and even the best plans only cover 2 of the multitudes of drugs they take.

We've worked with the hospital's social services people but they're just not seeing a way they can help.

So, in this horrifically depressing and seemingly hopeless situation, what are my parent's options? With no Marketplace plans available that are accepted by their medical providers and no state health coverage option, what should they do here? We've planned to apply for financial assistance through the hospital and I'm fairly certain their income means a good chunk of the cost of their care will get knocked off but given how expensive cancer treatment is, they're still likely to be on the hook for hundreds of thousands of dollars in a very short period of time.

Any help, thoughts, or advice is appreciated! Thanks in advance.
posted by youandiandaflame to Health & Fitness (13 answers total) 4 users marked this as a favorite
Worst case scenario is that they are billed for hundreds of thousands of dollars, complete treatment, and then join the rest of the middle class and declare medical bankruptcy. That will discharge bills but it won't address ongoing meds issues. Also note that they should consult a bankruptcy attorney immediately, as it may be more expedient to not spend the $1700 on next month's cobra but instead put it towards legal fees or meds.
posted by DarlingBri at 10:43 AM on October 1, 2019 [17 favorites]

The Medicaid spend-down can be pretty brutal, so you're right to avoid that route if you can help it. I'm assuming they're not able to get on Medicare yet? Both Parts A and B include some coverage for cancer treatment. There are some limits limits, but it's something.

Based on the scenario you've painted, I'm not seeing any possibility for them to keep going to their current hospital. I doubt they take Medicare, either.
posted by Thorzdad at 10:48 AM on October 1, 2019 [3 favorites]

How much does a private policy with Cigna cost outside of the Marketplace? See if you can call the Cigna customer service number (or maybe a number on the website?) and ask if an individual can purchase a policy. Also see if it's more cost effective for them to each have an individual policy rather than both be on the same policy.

Another option is to see what other independent policies one can purchase even outside the Marketplace (check with Ambetter and BCBS directly...I'm in Arkansas and they are widely used here. Heck, Ambetter's claims address is in Farmington MO). See what their out of network reimbursement is and then sit down and do lots of math. It may be that your parents will wind up paying less out of pocket (overall) by choosing an insurance that will cover their meds and that also reimburses something for out of network hospital visits as opposed to having zero coverage at all. You may have to talk to the billing office at the hospital that only accepts Cigna (which is rather odd to me) and see if they do out of network billing or if they require you to pay the bill in full then submit for reimbursement from your chosen insurance.
posted by MultiFaceted at 11:33 AM on October 1, 2019 [3 favorites]

A number of pharmaceutical companies offer "scholarships" for expensive cancer medications. You'd need to call the companies and ask, but I know of several people on my cancer board who've gotten their drugs covered this way.

There are charities that specifically help cancer patients with the cost of treatment. This page lists some of them.

These may not be great long-term fixes, but they might help as you figure out the insurance.
posted by FencingGal at 11:36 AM on October 1, 2019 [4 favorites]

Maybe reach out to Advocates for Family Health--looks like there's a project of this kind in Western, Mid, and Eastern Missouri. Their focus is definitely on making sure Medicaid-qualifying patients get Medicaid, but they also may have referrals, hidden resources, or ideas in trying to hook your parents up with care or insurance.
posted by peppercorn at 12:11 PM on October 1, 2019 [2 favorites]

Your parents might appeal directly and individually to their doctors. Do this at a regular appointment, with names and notes from everyone you’ve spoken to. Business minded doctors will shut this conversation down immediately but many will reach out to the business office to pull strings.

This is more likely to work if your parents have always been flexible with appointments, on time, never rude or short with staff.

It is unlikely to work at all, but it may be worth a shot.
posted by bilabial at 12:15 PM on October 1, 2019

For issues related to bankruptcy, employment discrimination, and SSI/SSDI benefits (for both parents), more information is available at the MeFi Wiki Get a Lawyer page. The MeFi Wiki ThereIsHelp page also lists resources related to finding help with health insurance.
posted by katra at 12:45 PM on October 1, 2019 [3 favorites]

Have they called Cigna and asked for the cost of plans?
1700/month for 2 sick people is not a lot for good insurance, so it may be worthwhile to try to find a way to keep it. Other plans will not have a negotiated agreement, but will pay something.
The hospital almost certainly has some form of sliding scale or financial assistance.

With no or low income, they should be eligible for a subsidy from the ACA for health insurance. The subsidy is actually a tax credit that is paid monthly for the insurance. In 2018, I screwed up my ACA application and paid 900/month for (crappy) insurance. I got most of it back in my tax refund, though it was not easy to figure out. So they might be able to keep the COBRA plan if they can pay it and get the tax credit later.

Every state has an insurance commission; it will be under the Attorney General's web site. They may be able to help.
posted by theora55 at 1:31 PM on October 1, 2019 [1 favorite]

Unfortunately, because they did take COBRA they will not be eligible for Marketplace coverage until open enrollment this fall (even if they stop paying the premiums this month or next). Yeah, it's a shitty little caveat.

I think the hospital billing department's patient assistance programs are your best bet. Check with GoodRx or other online drug coupon sites to see if meds can be covered.

Realistically, if the hospital can't help I think it's going to come down to family and friends working together to help cover the premium costs. Better $1,700/mo than $17,000.

Or helping out with rent, food and other living expenses so they can spenddown to the Medicaid limit. (If you do that, don't write them a check, since that will then count toward their income -- pay their bills and rent directly to the utilities and landlord.) They will want to make sure all paperwork regarding income and medical receipts are carefully organized so that the overworked Medicaid people can process their application as efficiently as possible.
posted by tivalasvegas at 2:06 PM on October 1, 2019 [3 favorites]

I can't find any direct info on the Missouri medicaid website (unsurprisingly) but I am guessing that the spenddown is 100% of the poverty line (about $1800 for a household of 2). Given current monthly income of about $3000, that would work out to about $1200, or savings of $500 over the COBRA coverage (plus there should be no or very small copays for services, which may save them even more compared to COBRA). They could also directly pay-in that spenddown every month (or every month they need it) to save on paperwork.

*The above advice assumes that they do not have any savings, since there is typically an asset test and they may have to spend down assets as well. Those rules also vary by state and I can't speak directly to the MO rules.*

Are you sure your father is on SSI and not SSDI? SSI is $733/mo (or slightly higher, I don't have the 2019 number memorized) and it's for folks who are disabled but aren't able to get more from SSDI based on their (low) work history. If your dad recently became disabled, he's probably in the two-year waiting period before Medicare kicks in.

If that's the case, then at least he will be able to get much cheaper coverage through Medicare soon and that will help with costs a lot.

If they do have to go off COBRA, make sure they get 90-day supplies of their medicines as close to the date of their coverage ending as possible.
posted by tivalasvegas at 2:20 PM on October 1, 2019 [1 favorite]

Oh. I just remembered! In Illinois, at least, you can use medical expenses for up to six months before the spenddown month to apply toward the spenddown. If the rules are the same in Missouri, the cost of their COBRA premiums (and any other medical expenses incurred in the last 6 mo.) can be applied toward spenddown.

I'm just not sure if you can get *back* on COBRA coverage once they no longer qualify for the spenddown, and I suspect that would be a huge bureaucratic fight at best....

It is something to consider, though, if there really is no other way to make the premium payments going forward.
posted by tivalasvegas at 2:25 PM on October 1, 2019 [2 favorites]

Livestrong might be able to help them negotiate this or to connect them with another medical center. Definitely worth a call.
posted by fshgrl at 2:33 PM on October 1, 2019 [2 favorites]

I sympathize wholeheartedly. That said if you did a little more research I'm sure you might find a decent hospital that accepts the ACA provided health care. Blue Cross had a ACA coverage plan that covered my ex during his Chrohns disease surgeries, which included an intestinal resection, colostomy, and two month long hospital stays. Having lost her job qualifies for a life changing event which should put the Medicaid option back on the table. Good luck
posted by The_imp_inimpossible at 8:17 AM on October 2, 2019

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