Health Insurance, Medicare & Self-Employment, Oh My!

When I awoke at 5 am this morning, I found myself unable to go back to sleep. When I got up, I realized I was on the verge of crying. It took a while before I realized why.  Today is the day I pay full price for my most expensive medication.

The path to my state of no health insurance is a bit bizarre but does highlight some of what’s wrong with health insurance in America today. Couple that with my husband’s Medicare and disability status and I have a tale to tell.

I’ve tried to keep this blog on business matters this year but I have to take a break and write for my sanity!

The path.  Um, well, it starts like many of us out there with the recession.

I moved to Charlottesville in 2009 to take a job in order to survive the recession.  My health insurance (I was self-employed then) had risen to heights that made it obvious that I was going to have to start choosing whether to pay the insurance or the house payment.  So I took a job and moved 500 miles to this wonderful town.

I don’t regret the move at all but the job ended abruptly some months later and I went on COBRA.  Self-employment seemed to be my best choice at the time so I forged on.  The COBRA payments were reduced due to federal intervention. 18 months later it ended on Oct. 1.

Now in Georgia when this happened to me 13 years ago, I was able to convert my group policy to an individual policy and life went on. Here in Virginia the state has not made such advances.

I had to apply for insurance.  My former workplace suggested that I use their insurance broker to navigate the waters. And so my saga really begins.

The broker provided a web link so that I could apply on line, thank heavens.  There’s no way I could have physically completed that many page application with my arthritic fingers! So application to Anthem done.  Check.

Mistake number 1:  for some reason that I cannot remember now, I actually applied for the best policy available, i.e., the most expensive.

The broker informed me that while the policy was still in underwriting (before acceptance) that I could call and change to the less expensive policy.

Mistake number 2: I spent my time trying to find cheaper insurance, applying for an AARP policy. I did not call Anthem to change my policy.

AARP turned me down flat – I guess you have to be an extremely healthy old person to get that one.

So the Anthem policy was in place but I did change the start date to a month later since I incurred no health expenses in October. (Thinking ahead I got 3 months of each medication in September through mail order – a normal way to get and save money on most group policies.)

But then I tried to get Anthem to change my policy. The more expensive policy was $1600 a month.  The next policy was only $800 a month.  The broker sent me a letter to sign and return to get that done.

Weeks later in November, I received an email from the broker saying that Anthem needed the request done differently so I immediately completed and returned the attached form via email.  Well, time went on and I’m being dunned for $1600 a month. I finally called Anthem to find out why and they said they had not received any request to change that.

Mistake number 3: leaving the situation in the hands of the broker who assured me it was okay.

Well, I was getting worried about being canceled to lack of payment so I paid $1600 which should have been for 2 months, Nov. and Dec.  Right before Christmas I found that not only had the broker not filed the form but also I had passed through the “look up” period.

I could no longer change the policy.

So a wonderful Anthem customer service representative dug in and started working on it.  The broker assured me they were working on it.

I took the Anthem rep’s advice and filed for a new policy.  I did not follow the broker’s advice – pay to keep the expensive policy in force. I couldn’t afford to pay another $1600.

So last week they canceled my insurance.  I am now uninsured – hopefully temporarily. But today I plunk out the big bucks for a med.

And I wait to see if Anthem will approve the new policy.

On to the next insanity: Medicare and my disabled husband.

He was fortunate not to have to wait too many years to get on disability, but one does have to wait for 18 months for Medicare to kick in. That happened last March. Yippee!

And oops, since he’s under 65 (which means everyone on disability), he cannot buy a Medicare supplemental policy.  So, friends, all disability recipients in this state (maybe in the nation) are under insured.

Then the next reality hit home.  Yes, the big drugs that are what he is supposed to be on have a copay of $250 a month on Medicare. (That’s with some discounting taking place, folks.)

And then, one company says they provide free drugs for 6 months. Yippee!  Oops, but not if you are on Medicare.  Medicare recipients are prevented by federal law from receiving free anything.  I guess that’s for his protection?  So he’s opted to not take the drugs.


It obviously does not go far enough. I’m sure it’s adding more layers of this convoluted thinking and may not help us as a married couple at all.

Being self-employed?

Highest income I”ve ever had.

Being an insured self-employed person?

Still can’t afford the insurance if I actually want to have money left over at the end of the month for saving or putting towards that retirement that is never going to happen.

That policy I’m dying to get?

The worst insurance I’ve ever had.  I’ll not be able to afford continuing the treatments for my disintegrating spine that I need to stay at a pain level that allows me to work. Why?  Because of the total cost of the policy and copays for my meds is so high and the deductible a major hurdle.

And now?

Now that I”ve vented, I’ll dig in and get to work to make more money in the insane hope that this will all work out to the good in the end. Have a nice day!

UPDATE, February 27, 2011

I ended up denied health insurance since my HIPPA eligibility had expired. So I had gotten bad advice from the Anthem customer representative.

I asked the sales representative if that meant I was screwed due to no fault of my own.  She said yes.

She also contacted her supervisor and several hours later, they reinstated and changed my policy as I had requested in November.

So now I am insured with a policy that is expensive and has a high deductible which means I can’t afford to use the policy. Go figure.

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