Commercial Insurance

Commercial insurance.

You may become eligible to change your medical insurance under certain circumstances.

You may also be able to enroll in a different plan at an annual enrollment period.

There may be a better option for you other than your current plan.

Therefore, when you are working with your financial advocate at your health care facility and you know what your current insurance covers, ask what other options may be available to you at open enrollment time.

Open enrollment periods are generally available with employers toward the end of the year between October and December, and become effective the following January 1st.

Other circumstances that can affect your insurance coverage that will allow you to enroll outside of the annual enrollment period are if you are covered through a spouse and a spouse loses coverage, or you lose your employment and your coverage through your employer.

Most people get health insurance in one of two ways: one through their employer, or two through a government program.

Government health insurance programs include Medicare and Medicaid.

If you are not covered at work or through your spouse, or did not qualify for Medicare or Medicaid, there are options available for you.

Visit healthcare.gov. This website may offer other options for health care insurance.

Keep in mind that there are different options and benefits available because of the 2010 Patient Protection and Affordability Health Care Act.

The coverage rules have changed since origination and may change again.

Types of private health insurance.

The two most common types of private insurance are health maintenance organizations or HMOs or preferred provider organizations, PPOs.

In an HMO, you must use contracted providers within a network in order to be covered.

This doctor oversees your health.

Your doctor must also refer you to specialists. Make sure they are in-network so you will not be caught paying out-of-network costs.

HMOs often have the lowest patient cost for private health insurance.

But also keep in mind HMOs generally limit coverage in these ways.

You have fewer choices of doctors and hospitals, which means only doctors and hospitals contracted with the HMO are covered under the plan.

Remember, insurance companies may make exceptions for emergencies and medical necessities.

For example, in the event you cannot get needed treatment but it is not offered in your network or even city, you may be covered outside.

This is called an exception.

Call your health insurer and get all notes of the conversations as well as confirmation of treatment.

Generally, the doctor's office will be setting up the arrangements and they will get the free certifications necessary.

Get a copy of the Free Cert statement.

Access to a specialist requires a referral from your primary care doctor.

When you have myeloma, your primary care doctor will probably become your oncologist.

You may need recertification for some services, such as non-emergency hospital visits and some specialist care.

Pre-certification means getting the HMO approval before receiving care.

HMO also may require notification within 24 hours of emergency care.

Again, your doctor will reach out to those referrals and generally they will be getting the pre-certification necessary.

Let's review the PPOs, preferred provider organizations.

This healthcare type contracts healthcare providers to provide services at a reduced fee.

Providers include doctors, hospitals, and other healthcare providers and specialists.

People typically have a larger pool of network doctors than HMOs.

Most of your medical costs are covered when visiting in-network doctors.

You may pay a small set fee. This is called a copay.

Also, PPOs allow visits to any doctor without a referral.

PPOs may provide you the ability and freedom to visit out-of-network doctors.

Keep in mind you will be required to pay a larger portion of the bill.

Savings accounts.

Flexible savings accounts, FSAs and HSAs, health savings accounts are two types of special bank accounts.

They can help you plan for future medical expenses, and you may also receive tax benefits.

Many employers offer these types of accounts through private health insurance plans.

Keep in mind that the funds you place in the FSA will expire at the end of the enrollment period.

If you don't use the funds, you will lose them.

Health savings accounts or HSAs are funds you put into a health savings account do not expire.

The funds you deposit in the account carry over to the next year.

You can also keep these funds after you leave your job.

These funds may be invested.

Unfortunately, these plans are only available in high deductible health insurance plans and a high deductible plan.

You are responsible for 100% of cost until meeting the rather high deductibles.

Usually, this is a taxable estate of thousands of dollars.

After you reach this amount, your insurance will pay 100% of covered medical services.

You start with the new deductible every year.

If you have cancer, you need to do a side-by-side comparison to make sure the plan you have is the right plan for you, based on the overall out-of-pocket costs and the kind of care you'll be getting and need.

COBRA.

COBRA is also known as a Consolidated Omnibus Budget Reconciliation Act, and was enacted into law in 1986.

COBRA is used as a cap insurance that employers are required to offer to employees after they terminate their employment, through voluntary or involuntary termination and loss of hours to qualify for insurance, except for termination in cases of gross misconduct.

Spouses can also qualify for COBRA coverage if covered by an employee becoming entitled to Medicare, divorce, or legal separation from covered employee and death of covered employee.

Employers who have fewer than 20 employees, or for employers who are closing their businesses, cannot offer COBRA benefits.

COBRA gives coverage for up to 18 months normally, except in certain circumstances, where it can be extended up to 29 to 36 months from the date of the qualifying event.

The employee has 60 days to make a decision to either enroll in coverage or get insurance through marketplace.

The cost of the insurance will be much higher than the premium you are paying with your employer, because you will be picking up the entire cost of the premium and an additional 2% for administrative cost.

Partnering with a medical insurance specialist will allow you to compare other insurance plans, including the COBRA plan, so that you can make the best decision for you and your family.

Be aware that if you let the enrollment phase expire, you do not have the ability to go back and enroll in COBRA.

The majority of bankruptcies occur as a result of medical costs, so it's important to keep insured.

Life insurance with multiple myeloma.

When my husband was diagnosed with MGUS in 2001, I was in the process as a licensed insurance agent of getting him an additional life insurance.

Keep in mind that underwriters rarely, if ever, contact the agents on behalf of the applicant, but in this case, they did.

They told me they were not able to issue life insurance for him because of his blood test results.

Generally, life insurance is no longer available when you've been diagnosed with an illness such as myeloma.

However, if your spouse is covered through their employer, you may be covered through supplemental insurance through your spouse without underwriting requirements.

If you currently have a life insurance policy, it will be very prudent to review the policy benefits, just as there are many types of life insurance.

There are also varying benefits associated with them.

Let's take a few moments to go over a few.

If you have a cash value policy, such as a whole life policy or variable universal life policy, you may be able to access cash value either through a loan or withdrawal, depending on the policy type.

If you have a term policy, they do not accrue cash value, but you may be able to access part of the death benefit under certain circumstances.

If it has an accelerated death benefit rider attached to it.

It is always a good idea to do an annual review of your life insurance policy with your provider.