I’m so glad I found this sub! I’ve got a tricky health insurance question that I’m hoping you lovely people could guide me on. I recognize that I made some insurance-related mistakes, but also don’t want this to come off as some sob story. Here’s the ugly deets:
My fiancé (38M) and I (27F) have been living together for 6 years and are registered domestic partners. I’m the main breadwinner for our household, especially now that the fiancé has been diagnosed with Multiple Sclerosis (read: expensive pre-existing condition). Thankfully he was able to start treatment right away with a daily pill (read: expensive prescription) prescribed by his neurologist.
Here’s where it gets fun. In fall 2019, we moved from OH to IL, but decided to keep his MS care in OH because he was already established with a solid care team / treatment plan, and they only needed to see him 2x/year for an MRI (read: expensive test) and lab-work (read: less expensive tests). We didn’t have any trouble with this plan for the first year in Illinois. My company’s insurance covered him and everything he needed, including the out-of-state specialist provider.
Then in June 2020 I was laid off due to COVID and lost our health insurance. Okay, no big deal, the ACA and “special enrollment” exist. My projected income for the year was low enough to qualify for Medicaid (greaaat) instead of the Marketplace plans. At the time. I didn’t realize that meant (outside of travel emergencies) any out-of-state providers would not be covered, including the prescriptions they write, and tests they order. I’ve also started freelancing full-time since then, so do not have employer insurance coverage available.
Because of this, we opted to just keep his MS care pretty hands off in 2020 (COVID meant we wouldn’t be traveling anyway), got his important prescription covered by a sponsorship through the drug manufacturer, and had his primary care doc (in IL) write a new script for the other drug that his neurologist (in OH) had prescribed.
This seemed to work just fine until the fiancé had an MS flare-up in September 2020. Medicaid covered all the ER costs and everything no problem. But after that flare, the Ohio neurologist called on Christmas Eve to talk about a more rigorous treatment plan as a result. He wants to have him get an MRI and some labs done to decide. But if the OH neurologist orders an MRI and bloodwork, it won’t be covered by IL Medicaid, even if the fiancé goes to an IL facility to have the tests done.
So now I am looking for something that may not exist. I’m looking for some sort of secondary insurance that: * Covers pre-existing conditions * Allows out-of state specialists without a referral * Bonus points if I don’t need a “qualifying life event” to sign up for it
Where would I look to find something like that? Are there other options I should consider in light of my situation?
Thank you all!
submitted by /u/abbiemazing
[link] [comments]
I’m so glad I found this sub! I’ve got a tricky health insurance question that I’m hoping you lovely people could guide me on. I recognize that I made some insurance-related mistakes, but also don’t want this to come off as some sob story. Here’s the ugly deets: My fiancé (38M) and I (27F) have been living together for 6 years and are registered domestic partners. I’m the main breadwinner for our household, especially now that the fiancé has been diagnosed with Multiple Sclerosis (read: expensive pre-existing condition). Thankfully he was able to start treatment right away with a daily pill (read: expensive prescription) prescribed by his neurologist. Here’s where it gets fun. In fall 2019, we moved from OH to IL, but decided to keep his MS care in OH because he was already established with a solid care team / treatment plan, and they only needed to see him 2x/year for an MRI (read: expensive test) and lab-work (read: less expensive tests). We didn’t have any trouble with this plan for the first year in Illinois. My company’s insurance covered him and everything he needed, including the out-of-state specialist provider. Then in June 2020 I was laid off due to COVID and lost our health insurance. Okay, no big deal, the ACA and “special enrollment” exist. My projected income for the year was low enough to qualify for Medicaid (greaaat) instead of the Marketplace plans. At the time. I didn’t realize that meant (outside of travel emergencies) any out-of-state providers would not be covered, including the prescriptions they write, and tests they order. I’ve also started freelancing full-time since then, so do not have employer insurance coverage available. Because of this, we opted to just keep his MS care pretty hands off in 2020 (COVID meant we wouldn’t be traveling anyway), got his important prescription covered by a sponsorship through the drug manufacturer, and had his primary care doc (in IL) write a new script for the other drug that his neurologist (in OH) had prescribed. This seemed to work just fine until the fiancé had an MS flare-up in September 2020. Medicaid covered all the ER costs and everything no problem. But after that flare, the Ohio neurologist called on Christmas Eve to talk about a more rigorous treatment plan as a result. He wants to have him get an MRI and some labs done to decide. But if the OH neurologist orders an MRI and bloodwork, it won’t be covered by IL Medicaid, even if the fiancé goes to an IL facility to have the tests done. So now I am looking for something that may not exist. I’m looking for some sort of secondary insurance that: * Covers pre-existing conditions * Allows out-of state specialists without a referral * Bonus points if I don’t need a “qualifying life event” to sign up for it Where would I look to find something like that? Are there other options I should consider in light of my situation? Thank you all!
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