# Is "maintenance" for a thyroid cancer patient considered a pre-existing condition?



## teri2280 (Feb 7, 2012)

The hubby is planning on going on his own business wise, and if things pick up how we hope they will, he's planning on hiring me as his helper/runner/secretary. (YAY!)

BUT, we just thought of something the other night. Since I'll have to have routine maintenance due to my recent TC diagnosis, is that something that an insurance company would consider a pre-existing condition that we'd have to wait out their waiting period? Or are there special exemptions for cancer patients?

IF everything goes the way we're hoping it will, I could be working for him in as little as 2 years, and since we'd technically be self-employed, we know we'd have to get our insurance privately. I know it may or may not work out that quick, but ya never know.  He's an independent contractor now, with no insurance, so my insurance through work is our only current option.


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## susieintexas (Mar 4, 2012)

I hate to be the bearer of bad news but just getting an individual policy with a history of cancer will be near impossible. Unlike group plans they pick and choose who they will sell individual plans to.

My husband was going to start his own business but when we looked into the cost of an individual plan it was a joke! Yes at the very least the TC would be a preexisting condition and depending on the way the plan is written it may not be covered at all. Things like maternity, labor and delivery are also usually not included on non-group plans. I would plan/budget on having to pay it out of pocket.

I would bet you will have some serious sticker shock if you can find someone at all willing to write a policy for anyone who has had cancer.


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## teri2280 (Feb 7, 2012)

Ruh-roh.  LOL. Good to know! LOL. Not what I wanted to hear, but at least I'm hearing it now, and not AFTER I tell my current employer to shove it!!

Out of curiosity, how are other group plans as far as previous cancer patients? Just, say, hypothetically, of course, that I get a job somewhere else. Can their group plan deny me coverage since I'm a cancer patient?


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## webster2 (May 19, 2011)

Our company switched insurance providers in January. I had big concerns about getting covered but so far, it has not been a problem, and I have had a ton of doctor's appointments.

I wish you well.


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## susieintexas (Mar 4, 2012)

No. If you have had *no* lapse in coverage (aka: take and pay for cobra from the old job until the insurance at the new job starts -usually 90 days) there is no waiting period or prexisting condition.

If you lapse in coverage you may have a waiting period for anything related to the cancer but it must be related (your endo & scans, etc). If you let your dr know, most will let you push off your appt and blood-work for after the 9 months.

Your best bet is to never let your insurance lapse. We have considered me getting a part time job that had benefits -Weight Watchers or UPS, so hubby can do his own thing but that would require me to feel well enough to actually work part time.


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## teri2280 (Feb 7, 2012)

I'm starting to think that MIGHT be our best bet - for me to drop down to part-time (I'm full time now), and just work enough hours to keep our insurance, or pay out of pocket the difference, and work for him the rest of the time.

Definitely some things to think about. And VERY glad we thought of this now rather than later!!

Thanks!!


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## Octavia (Aug 1, 2011)

susieintexas said:


> I hate to be the bearer of bad news but just getting an individual policy with a history of cancer will be near impossible. Unlike group plans they pick and choose who they will sell individual plans to.
> 
> I would bet you will have some serious sticker shock if you can find someone at all willing to write a policy for anyone who has had cancer.


I have looked into this, and here's what I found...in Missouri...your state may be different. If your husband hires you, then you are both employees of the same company, which means you can apply for group insurance (you have to have 2 or more people to be considered a "group"). You fill out a VERY basic application with each person's date of birth and gender, and they quote you a price, with the caveat that it could go up 100% based on your medical history. They cannot deny you group coverage based on your medical history, but they can charge you double (possibly more).

Like I said, this is for Missouri. Each state may be different...I have no idea.


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## susieintexas (Mar 4, 2012)

There is a difference between small group (2-50 employees) and group (51 or more) insurance policies. Small group is much more like an individual plan. The insurance company can deny to write you a plan if you don't do _(ex: health and wellness program)__ and they can also deny to continue to the policy if they are not making money on your business.

You would also have to lie, saying you were separate households and you would have to pay two separate premiums to count for small group.

I agree that part time with benifts and work for him for part time will be your best bet.


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## teri2280 (Feb 7, 2012)

Octavia said:


> I have looked into this, and here's what I found...in Missouri...your state may be different. If your husband hires you, then you are both employees of the same company, which means you can apply for group insurance (you have to have 2 or more people to be considered a "group"). You fill out a VERY basic application with each person's date of birth and gender, and they quote you a price, with the caveat that it could go up 100% based on your medical history. They cannot deny you group coverage based on your medical history, but they can charge you double (possibly more).
> 
> Like I said, this is for Missouri. Each state may be different...I have no idea.


Yeah, I checked out small business group ins. for Ohio stuff today on the net. He'd be considered the owner, plus I wouldn't count, even if he had more true employees, since we're married. :-(

On the plus side (maybe, I'm not sure yet lol have to do more research on it), Pres. Obama's healthcare reform offers a "high-risk" insurance for people with pre-existing conditions, like cancer. I need to do more research on it, but it doesn't look too bad for someone in my shoes. I'd have to be completely without ins. for 6 months before I'd qualify for it, BUT the premium isn't HORRIBLE, and the deductible (even the higher of the 2 for Ohio) is less than my deductible now, so while the premium would be more than I'm paying through my employer, with the lower deductible, it's almost "six of one, half a dozen of another". Something to think about, since I don't think that going for just 6 mos. without insurance would be HORRIBLE, especially seeing that my endo is only planning on running labs every 3 months or so. I figure that, if I time it right, or explain to my endo what's going on (if/when it gets closer, of course), we can schedule things so that I'd only have to pay out of pocket for one office visit and one set of labs.


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## teri2280 (Feb 7, 2012)

Not wanting to turn this into a political thing - just stating benefits I'm seeing after doing some research into Obama's healthcare reform.


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## Octavia (Aug 1, 2011)

Also not wanting to get political... I appreciate the state-based, no-denial coverage, but are you POSITIVE you'd have to wait six months to get a policy? That is crazy!!! I'm 99% sure that in Missouri, there's no wait, but you cannot get it until your 18-month COBRA period runs out.

Making an unhealthy person wait 6 months for insurance coverage is abysmal, I don't care what party anyone is affiliated with! We can do better than that, don't you think?

Regarding the small group versus individual...as I mentioned, I don't know about other states, but I have two friends in Missouri who have both spouses working for their small company as legitimate employees, and they qualify for small group insurance just for the two of them--no lying, no scamming the system. Oddly enough, with one of the couples, the wife's premium is $300 more per month than the husband's simply because she is of child-bearing age, despite the fact that she is perfectly healthy, and he has cystic fibrosis and has had a double-lung transplant. They cannot deny coverage to a group member (if they could, he'd be a huge denial) in Missouri, even a group of 2 as husband and wife.


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## teri2280 (Feb 7, 2012)

That's the thing. I'm doing research possibly 2 years ahead of time, mostly because I'd rather know now if it's just not going to be possible for me to ever *just* work for him. If I were to try to sign up for Ohio's high risk plan today, I wouldn't be able to because I've had insurance for the past 6 months. I have no way of knowing what it'll be like in 2 years (or more) when it actually happens.

Don't think this is just wishful thinking. I'll admit that it kinda is, and I can't go into too many details, but it has the potential to take off like mad where he'd need to "hire" me within the next 6 months, but it could possibly take some time too.

From what I understand, even private insurance can't deny me for having a pre-existing condition (at least as of 2014, when this all will more than likely be happening) as long as there are no gaps. I'll check around into small business insurance when the time comes, but worst case scenario, I'll carry Cobra until we get private insurance. I know we're talking a higher premium for private over group, but, for obvious reasons, if that's something we have to do, IF we're planning on me quitting my job, we'll be more than able to cover the raised premium of private insurance. (I'm not planning on quitting my day job as soon as he is...I know it'll take some more time before he's making enough for me to quit too, I just have no idea how long that'll be.) Granted, IF we can get small business group rates, great, but worst case scenario, we'll be able to swing paying a little more for private insurance.


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## Octavia (Aug 1, 2011)

I wish all of this was easier! (And I hope your husband's business really takes off!!!)


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