Multiple Sclerosis and Health Insurance Options - dummies

Multiple Sclerosis and Health Insurance Options

By Rosalind Kalb, Barbara Giesser, Kathleen Costello

Healthcare related to multiple sclerosis (MS) can be a major financial drain even when you have good insurance. No matter how you get your health coverage, make sure that you know the basic facts about the eligibility rules for your health plan. Without that knowledge, your healthcare costs could be higher than they need to be.

The Patient Protection and Affordable Care Act (ACA) was signed into law in 2010. This complex legislation — which is scheduled to take effect over a ten-year period — outlines major changes in federal and state laws that will reform the health insurance system.

However, the ACA is facing numerous legal challenges at this time, which means that knowing exactly what kinds of changes will take place and when they might occur is impossible. So make sure you get expert advice before making any major decisions about your health insurance coverage. Go to the government’s health insurance information website for reliable and detailed information about health coverage in your state.

Employment-based insurance programs

Most people in the United States have health insurance because they’re eligible for a group health plan from their employer or a family member’s employer. Members of trade unions (and their dependents) are usually eligible for group coverage through the union.

If you’re eligible for group health benefits from an employer or union, enroll as soon as possible. In most cases, you’ll pay a small portion of the premium through a regular payroll deduction, and your employer will pay the balance. Even if you don’t enroll in the health plan until after your MS diagnosis, you’re still eligible. Federal law guarantees that no one can be singled out and denied group health benefits on the basis of his or her health status.

Keep in mind that employers aren’t required by law to offer health insurance plans to their employees or their family members. And until 2014, when the major provisions of the health reforms kick in, most employers are free to make changes in their insurance packages whenever they want to.

If your company offers a long-term disability benefit, take them up on it (after you’ve reviewed the definition of disabled that’s being used by the plan — the definition tends to be very specific and very strict). This kind of insurance can go a long way in keeping you afloat longer term if you’re no longer able to work.

Public health insurance programs

Many people are covered by a government-funded, public health insurance program because they meet the established eligibility criteria. The public health insurance programs listed here are designed for people who work for the military or the government, and for those who don’t have access to other coverage because of unemployment, age, income level.

  • Government employee benefits: Federal government employees can enroll in the Federal Employee Health Benefits Program (FEHBP). State and municipal employees are offered comparable programs.

  • Medicare is a government entitlement program that provides health coverage for people who qualify. To be eligible for Medicare, you must meet one of the following requirements:

    • You must be at least 65 years old.

    • You must have been deemed “disabled” by the Social Security Administration (SSA) for at least 24 months.

  • Medicaid is a government entitlement program that provides health insurance for low-income people. Medicaid eligibility rules are scheduled to change with the new federal law in 2014, but until then you must meet the specific criteria determined by your state government. Although the states vary considerably, eligibility is based on your income, your assets, and your marital and immigration status.

  • SSDI: If you’re no longer able to work because of your MS, you may qualify for Social Security Disability Insurance (SSDI) or other long-term disability programs.

  • State Child Health Insurance Programs (S-CHIPs) are public insurance programs that provide coverage to children 18 and under, with income eligibility benefits determined by each state.

  • TRICARE is a program that provides benefits for people in the uniformed services (Active, Reserve, and Guard) and their dependents.

  • VA health benefits are provided by the Veterans Administration to people who have been honorably discharged from active military service.

MS and insurance for the self-employed

People who are self-employed — and therefore not eligible for coverage by an employer’s group health plan or a public program — need to purchase health coverage for themselves. Historically, shopping for individual insurance has been difficult because insurers are free to turn individual applicants down or charge more if they (or a family member) have a preexisting condition.

The Affordable Care Act will prohibit insurers from these practices, but not until 2014. In the meantime, people with preexisting conditions that have been uninsured for at least six months can get comprehensive coverage through a Preexisting Condition Insurance Plan (PCIP).

With individual insurance, you have to pay the full cost of the coverage yourself, although scheduled changes in the law will make that easier for most people. As of 2014, virtually everyone will be required to have health insurance, although tax credits applied in advance to the cost of health insurance premiums will help make health coverage more affordable.

Unfortunately, just because you’re eligible for a plan doesn’t mean it will fit your budget. But, it’s best to get yourself insured even if the only available plan has a very high monthly premium or annual deductible.

If you’re able to work, your best option is to find a job with an employer who offers health benefits. Even before the major health reforms kick in, you can’t be excluded from an employer-based health plan because you have MS.