Insurance questions

[naturaleigh]

I hate to be whinny, but I am hoping that my questions will help others who may be in my situation.

I am single, working a full time job. I am too young to retire (50ys of age), but my body is very tired and my memory is not even half of what it used to be. I am no longer able to keep up with the duties and demands of a full time job. I am seeking a part-time job and something that is way less demanding. Unfortunatley, a part time job does not offer insurance. I am trying to find a way out but everywhere I turn, I hit a brick wall. My oncologist will not approve disability because I have not had a reaccurance. I have tried to by early retirement, which will take everybit of my retirement funds like 401K, Roth and a stock that I own. I am willing to do this, but once again, because of my age, I will not get insurance.

For those of you out there that understand this insurance stuff, can you tell me if I buy my early retirement, get a part time job and work without insurance coverage, will I still qualify for medicaid, medicare or Social Security down the road when my health starts declining or I get a reacurrance of cancer?

There has to be some anwsers and help out there somewhere for a single, low income person which now has pre-existing health issues. I tried calling my insurance company to find out about single coverage, but they will not even talk to me until I am over 5 yrs out of being cancer free. Even after the 5 years, the cost is way more than I can pay. Do any of you fight this beast with no insurance?

Being at the job is very detrimental to my health, so for my health's sake, I don't mind going with out insurance for awhile, but I need to know if I can get help when I need it again.

[Darlene Denise]

Anita: Would you be eligible for COBRA when you leave your current job? If so, you would have coverage extended for 18 months. The premiums will be higher and your HR dept should be able to give you the costs. Once that is exhausted, you will receive a Certificate of Continuous Coverage that will enable you to purchase individual insurance without any pre-existing exclusions. You will probably experience a higher premium level rating due to the cancer and then may have it re-evaluated for a lower premium once you have met their guidelines for number of years without recurrence.

Perhaps you would be eligible for MediCaid which is for low income situations. It is not the same as Medicare for seniors and the disabled. Your state may also have some programs that you would qualify for. Some employers have group insurance available at reduced hours, with the full cost payable by you. Having Metastatic BC and knowing the costs associated with the ongoing treatments, I encourage you to maintain continuous insurance coverage.

Good luck as you make these changes.

Darlene

[Lani]

Just to consider--As I understand it, you only qualify for Medicare TWO YEARS
after Medicare finds you disabled--and Medicare uses different criteria than others--you cannot be able to do ANY job--and they take a long time and sometimes several appeals to do so, as I understand it. I think there may be a clause that if you are Stage IV you don't have to go through as long a process to be considered disabled, but there still is the TWO YEAR wait thereafter before you can qualify for Medicare assistance itself!

Please correct me if I am wrong in any of this--I wish I were, but I am afraid I am not!

[Darlene Denise]

Lani: Medi CARE is for seniors and the disabled. Medi CAID is a state program for low income individuals that qualify. Medi CAID does not have a waiting period, Medi CARE does.

Liz: Would you be able to take a leave of absence and keep your health coverage while you take a much needed break and explore your other work and insurance options?

Darlene

[naturaleigh]

Thanks Darlene and Lani for your reply.

All I can say is Health Care in this country is for the birds, that is putting it nicely and mildly.

I have called Medicaid and Social Security and for the most part, they won't even talk to me because I am still working, so I do not qualify for either. Another thing I have learned since my diagnosis is the people who do talk to you, (Human Resources, disabilities and the State Retirement System) tells you what you want to hear.

Our insurance programs need to be re-evalutated in my humble opinion. If I were married, I could be transfered to my husbands insurance. If I made more money, $400 or more a month would not be an issue. But neither are the issues. It really is a shame that people in my circumstances get lost between the cracks with no help from no one. One thing is for sure: cancer does not discriminate, it does not care if you are young or old, rich or poor, too bad insurance companies are not the same way.

Sorry for the venting.

[krisvell]

Anita,

I don't know much about Medicare/Medicaid. I hope you can hang in there at work to keep your insurance. I am just finishing up on my treatment and was astonished how expensive treatment is. I'm rooting for you.

[Sheila]

Anita
I remember I had to be on Social Security Disability for a year before I qualified for Medicare...I started on my company disability, then after 6 months I had to apply for SSD, then when I was awarded SSD, Cigna, my company insurance dropped me as a disability recipient...a huge drop in income, but I am fortunate that my husband has amazing health insurance...he pays about 500.00 a month for it. Make sure you get everything promised in writing before doing anything...these companies find a way to twist the words to their advantage.

[Carol.hope]

Anita,
It sounds like you may have a "chemo brain injury," as I do. There are several studies showing that these severe cognitive deficits often last more than 10 years (in 15% or more of chemo patients). Recently I learned about the Job Accomodations Network:

Under the 1990 Americans with Disabilities Act (ADA), employers with 15 or more employees must make reasonable accommodations in the workplace for employees with disabilities. Accommodations are to be made through a confidential, collaborative process with the employee, and may be as simple as a flexible work schedule.


Part of the U.S. Department of Labor, the Office of Disability Employment Policy offers the Job Accommodation Network (JAN). JAN staff are available to discuss accommodation options, at (800) 526-7234. JAN fact sheets are produced by topic. A fact sheet on accommodations for people with cognitive impairment lists possible accommodations to help employees in:

• Maintaining Concentration
• Staying Organized and Meeting Deadlines
• Handling Memory Deficits
• Handling Problem Solving Deficits
• Working Effectively with Supervisors
• Handling Stress and Emotions
• Handling Change
• Maintaining Stamina During the Workday

If they can help you make your job bearable, you can keep your employer-based insurance. If you leave the job, they have to offer you insurance for 18 more months (under COBRA), at the price they set.

Social Security Disability is very challenging to get. They do not recognize chemo brain injury (yet - work for us to do!). Do NOT hire a national firm to help you. If you pursue this, hire someone (attorney who specializes in this) who can see you and believes what you say about your life. It can take two years. You can file now and start the process, but it takes a lot of energy. The disability payments are not enough to live on. Medicare is not available until you've been officially disabled for 2 years.

Anyone could sign on to Medicare (or a similar org) if this option gets passed by Congress. The vote is soon and people are saying enough Senators and Representatives are willing to vote for it, if it's in the bill that gets voted on. I just got a notice to call Nancy Pelosi to tell her we want her to do this (put the public option in the bill about to be voted on).

For anyone who wants all sisters and brothers to have access to reasonably-priced medical insurance, here's the number to call: Speaker Nancy Pelosi: (202) 225-4965.

Unfortunately, I have lots of experience with insurance issues, so feel free to email me your questions, either in the thread or privately.

Also I have been studying chemo brain injury and have lots of info about that.

Best wishes.

- Carol

[Carol.hope]

Anita,
Another thought. Your oncologist may not be familiar with chemo brain injury (and should be). You could write down what your life is like, give some examples of how the fatigue keeps you from being able to accomplish daily requirements, and how your memory problems interfere with your abilities. Give these to your doctor to try to get her/him to understand.

If you want them, I can tell you some ways to increase your energy and some background on chemo brain to share with your doctor.

Good luck.
- Carol

[Darlene Denise]

Anita; Joe has referred to a particular Disability Legal Rights firm. I think they used to be listed on the site, but, I don't see them under resources. Perhaps, you could e-mail him for conact info.

Hope this helps in some way.

Darlene

[naturaleigh]

Thank you so much for all the replies. Carol, it is so good to know that I am not the only one going through this.

If you don't mind, I would love the information about energy and chemo brain

Thanks again Ladies for the replies!!

[Jackie07]

Anita,

From my experience - having had two brain surgeries and two chemotherapies - our brain is a 'use it or lose it' situation.

'Walking' and any form of exercise increases blood supply to our brain and helps reconnect our nerve cells - 'synapse' is the word, like an electrical sparkle. So please keep on exercising - including doing puzzles, learning new languages (I took 2 English composition classes 3 years after my first brain surgery and 3 Spanish courses after my 2nd brain surgery (GKRS). It's amazing how I could actually 'feel' the improvement of my brain fuctions.)

Even with my medical history and work (job loss)history, I had been turned down by the Social Security Administration when I applied for disability by myself - twice. The letter I received stated that because I had worked - gainful employment... It's really weird that the system seems to have been designed for the benefit of the lawyers. [The lawyer had told me that they wouldn't take the case until it had been turned down.] I followed their advice and then one of their attorneys petitioned for me - it got turned down again. But my attorney told us that it was expected and the next step was to go before a judge. That was almost a year to the date when I first talked to the attotney.

It's almost like an 'act' in a show - like in the movies. Three and half months after the hearing, I received a check of the back pay - it's not very much because the attorney had taken away about the same amount already (It's been deducted from the back payment - the Judge had signed an approval of the payment method as part of his 'decision' on my disability status. A certain percentage and no more than $5000.00.

My Sister-in-law had done the application for her husband a couple of years ago by herself. He was on disability with his company at first. She's a PhD and a professor, so they did not hire a lawyer. [I think the judge probably took into consideration of her title. She does know how to write well in a professional way. But she lives 4-hours drive away and is very busy, so we tried not to bother her.]

My attorney took my case pro-bono. The senior staff looked at my medical history and felt it was a sure-in. I've lost every job I had since having my first brain surgery in 1990. After three more surgeries and two full doses of chemo, I had to admit that there's some deficits/problems that are obvious to others but not myself...

You will need some kind of evaluation to prove that you are no longer able to do what you were capable of in the past due to the treatment you had received. Perhaps even your job performance or your annual evaluation can serve as the evidence. If you have never done a neurophsychological profile, you need to get one done as soon as you can and do another one in 6 months or a year so they can see if there's an obvious decline.

My postings look 'normal', but in essence, it takes me twice, three times longer than others to write (and then I need to make corrections constantly.) Most jobs do not allow me the time to compensate my deficits, and there's no other 'gainful' work I can do in the national economy. I think that's how my case got approved. There was an impartial 'disability specialist' present in the court to observe the whole process and give her opinion on my case. She did not speak, but her opinion was very important because my first two applications had been turned down with statements like "your disability does not prevent your from performing the tasks..."

Good luck to you. I just wanted to share my experience.

By the way, Joe was the one who had told me that I definitely had a case. That had helped. Thanks, Joe.

[Shobha]

To add to Carol's info for Public option: Here is a link to send petition to Nancy Pelosi:

http://dfa2.convio.net/site/R?i=vnvmcYQlk_MEuTpmn1U_1Q..

-shobha

[Darlene Denise]

Anita: I just noticed it on the side of the page, DRLC. Disability Rights Legal Center. You can click on it for additional info. I had looked under resources.

Darlene