Insurance for pre- existing condition?

Question

My friend was recently diagnosed with a brain tumor, she has scheduled a MRI for march and then they will determine whether she can go through surgery. The problem is she had recently exchanged jobs (just prior to the tumor news), and apparently cannot be covered with her present Insurance company as her condition is pre-existent. Now, the tumor is located in the fourth entricle of the brain (where the spinal/cerebral fluid is housed). She will probably need Chemotherapy. Can she be re-insured or covered by a different plan.? Can a single mother qualify for medi-care instead?

She is in TX

Answer 1

I don't know about Texas but in Illinois if you switch from a group policy to another group policy with no more than a 90 day break in coverage (called credible coverage) you won't have a pre-existing condition put on you.  

If that doesn't apply has she found out if it isn't covered by the new insurance?  A preexisting condition is a condition in which you have sought treatment for, or a normally prudent person would have sought treatment for.  

If she can't get medi-care or medicaid, has she tried the state plan for uninsurable individuals?  That would probably be a good bet, but it might have a 6 month wait on pre-existing if she can't show credible coverage.

Answer 2

Are you sure she's not covered?  Has she been denied?  Usually a preexisting condition is defined as one for which you have sought medical advice.  If she hadn't seen a doctor about symptoms or concerns before she got the new insurance, she should be covered.  

Not knowing her financial situation, I couldn't say if she would be eligible for Medicare/ Medi-Cal/Medicaid.

Answer 3

Without knowing the dates of termination of her previous coverage and the acceptance of her new coverage, it's hard to know if it should be pre-existing or not. Generally, if she went from employer to employer and signed up as soon as she was eligible with the new coverage, there would not be pre-existing--especially if it was an HMO. Check with your state's insurance commisioner to find out the specifics for your state.

Secondly, she should qualify for medicaid medically since she has a cancer diagnosis and a child. She will have to meet the financial guidelines as well.

Answer 4

She should apply for medicaid and diability. If she qualifies for disability she can get medicaid. Also I know of another benefits plan, IM me and I can give you the name. Tell her good luck and my prayers are with her. My second child had cancer twice, it's a hard road, and can be painful but she can do it. Just do all you can to help her and support her, she's going to really need you and her family. My son was only 13mths when he was first diagnosed, but he's healed now and doing great. He was stage five when they found it, and he make it through, don't let her give up and you don't give up on her. Best wishes to you and her!

Answer 5

Sorry to hear this news for your friend. I have heard that COBRA can be picked up well after leaving the former job by catching up on the premiums that would have been paid if she had picked it up from the beginning. In her case, it would be well worth the past premiums. Please look into this fine print and let all of us know.

Answer 6

Yes

I am a license Illinois insurance producer. I know she lives in Texas, but the laws shouldn't be to different.

Did she have insurance then lost it after she changed jobs?

Has she applied for insurance with her current employer?

I would say first try to see if she can get Cobra.

Second see if she can get the current insurance her company offers,

If that doesn't work, if she has the money to get private insurance. Something I would like to add here on a personal note. Private insurance is not as expensive as the public thinks. It is not an easy subject to explain easily. But private insurance is affordable. She would just have to pay an offset in the form of a rating. You can still find policies that will cover cancer. They will put limits or restrictions, but they will cover it.

Same thing with life insurance. She can still get life insurance even if it is terminal. If she were in Illinois I could find her a reasonable policy for both life and health insurance.

She just needs to find a knowledgeable insurance veteran who can help her.

If she cannot afford her own insurance, then she needs to look into medicaid. Or what Texas has.

I absolutely hate to say this but sometimes it is cheaper to quit work to be able to be on welfare and have the government pay your medical bills. Then it is to work your but off and risk losing your job because of doctors appointments and treatments. Only to have all of your money to go on insurance, medicine and co pays and deductibles. I have had many elderly cancel insurance because they were borderline with income. I can't say I blame them. You have to look out for yourself. Life is about survival.

I wish her luck.