Health Insurance After age 19 when they leave high school

[Chuck-PA]

I took this thread idea from the Community Board. I am hoping someone may have experience with health insurance for their older children with disabilites.

My son will soon be 18 and he is still in high school in the 11th grade. He has Cystic Fibrosis.

He is currently under my group coverage at work. He also has Medical Assistance from the state whichcovers most of what the primary does not pay.

I am starting to think about his health insurance after high school graduation in another year. Not sure if he is going to college or not. I have read several posts on the Community Board where colleges offer health insurance with high deductibles, which I think is probably fine but he will have lots of medical visits and over 23 medications, copays and deductibles will be extremely high.

If he doesn't go to college, what happens next? I am sure he will the have to find a job. But ll they loop him under 'pre existing conditions" for a year before covering him. Would his medical assistance pick up all expenses for the year until his coverage kicks in?

Any info would greatly be appreciated or any direction you can send me to
Thanks in advance
Chuck

 

[ducklite]

My son has disabilities as well. He has not applied for Medicare (Medicaid?), although he is eligible. We've been covering him under our BC/BS, as of the end of this month he's no longer eligible. We'll pick him up COBRA until he is eligible at his job, which should be next September, maybe a little earlier.

Anne

 

[JenJen]

WIth his disabilities he should be covered by the state or government.

 

[HopperFan]

Our DS is covered as long as he lives with us because he is considered disabled. Not sure if CF falls in the "disability" category in a situation like ours that will pay regardless of age. DS also has Medicaid (since age 18). Our insurance pays first, then Medicaid will pick up if we are using a Medicaid provider. All of our group plans will cover through age 22 IF they are in school, even without a disability.

 

[SueM in MN]

Our younest DD, who is considered totally disabled, will remain under our insurance as long as we have it. There is a clause in the insurance that requires them to continue coverage for a dependent who is disabled.
I think things work differently when the dependent has a chronic condition, but us able to work and support themselves. I'd suggest you check with your individual insurance policy because it may vary state to state and by what the exact policy is. You/he should also check with MA. Usually if the person is covered by insurance, the insurance pays first and then MA pays (Insurance is primary). If there is no insurance, then MA would become primary.

 

[kathyk2]

Does your son receive Social Security? In Massachusetts people who receive SSI are automatically eligible for Masshealth. I would contact your local office to see what the rules are for your state. There is also a toll free number for Medicare 1 800 633-4337 that you could call for information.

 

[Chuck-PA]

Thank you for your info. It will definitely give me a place to start to find answers.

 

[Juliah]

My understanding is that when he gets a job, he cannot be denied coverage for a pre-existing condition under a group policy if he had coverage from another policy immediately before he started the job per the federal HIPAA rules (well, actually there can be a gap of a certain number of days, but I don't recall how many). Also, I believe that Medicaid counts as coverage; in other words, so as long as he can keep his Medicaid at least until he gets a job, he should be able to move right onto a company's insurance policy. Mind you, I'm no expert on this, so you may want to do a search on HIPAA and read the details for yourself.

As to whether he can keep Medicaid, that may depend on your state. Since it's a joint state/federal program, the states can set some of their own rules.

Another possible option, if he can't keep his Medicaid and he doesn't find a job right away, is that some (most? all?) states have high-risk pool insurance for people insurance companies typically won't cover. I know someone in our state who used it, and he said the premiums were not as high as what he feared.

Finally, if your son can't keep his Medicaid and doesn't find a job right away, he might be able to keep your insurance under COBRA as a bridge to when he does find a job. The down side of COBRA is that you have to pay more for this coverage than you would normally pay for insurance through an employer because you are paying the whole premium with no contribution from the company. Oh, and you can only keep it a certain number of months (if you opt for COBRA, be sure to ask your employer if your son qualifies as disabled, because if he does, he can keep it longer--but be aware that you have to make some kind of written declaration right up front).

As for insurance through a college, my daughter who is disabled looked into this and found there was a pre-existing condition clause, so she would have had to pay for it for a year before she could use it. Don't know how that fits with the HIPAA rules; since the insurance wasn't very good, we didn't pursue it. Of course, I'm sure the insurance is different for every college. But if he goes to college, it's likely he will be able to stay on your (or your spouse's) policy anyway.

I think your best bet is to make friends with your employer's benefits coordinator. He or she can tell you if your son will remain covered or, if not, how COBRA works.

Good luck figuring it all out.

 

[Chuck-PA]

Thank you for all your input.

I am just trying to get as much info as possible. I work for a small company, there are 7 employees. When I got married I had to be very firm with the office manager about putting my wife on my policy. It took a a lot of talking before she would allow her to get on our policy, luckily my wife had her own but she had to pay for it until she joined our group policy.

The Benefits Coordinator is always looking for ways to cut costs with health coverage, she has changed plans which raised the co-pays twice on us so far in the past 2 years. So I know she will be looking to drop him from the group policy as soon as she can.