Cancer and COBRA and Obamacare

[sillygoosegirl]

My dad is a few years away from being able to get Medicare, but would otherwise be able to retire and would like to. My mom is full retirement age and already on Medicare, although she was a SAHM my whole life, so there is no income replacement portion of the retirement equation for her.

My dad was just diagnosed with prostate cancer. I am cautiously optimistic that he's probably gonna be okay (only around 1 in 10 men who get prostate cancer actually die of it), largely because I don't want to think about any other possibility, but they didn't catch it very early and his desire to retire soon has become more urgent. If he might only have two years to live (likely his prognosis will be better than that, but this is a possibility), he doesn't really want to spend them at work, he wants to spend them with my mom. But of course health insurance is suddenly more important and more impossible to buy than it ever has been for him before.

A quick Google search says the no discrimination based on pre-existing conditions portion of Obamacare goes into effect in January 2014. So theoretically he could get COBRA until then, and then buy a plan on the open market. My biggest concern is that we haven't a clue what this open market will really look like or how much it will really cost. Another possibility is that he holds on until he is 63 and 1/2 and then buys COBRA until he qualifies for Medicare. I think he is 61 now. Before I suggest this to my dad, what might I not be thinking of here?

Please don't quote. I may delete.

[awkwardpenguin]

I'm sorry to hear about your dad's diagnosis. There are a lot of possible variables in play here, and it can be hard to do "what ifs", but I think your fundamental idea is sound. I'm totally biased, but I think if he can manage it, your dad should retire. My dad died at 61 and all my mom wanted was more time together. But he shouldn't retire if it puts them financially at risk if he fully recovers, so there's a lot to consider.

1. Your dad will be able to buy health insurance via the health insurance Exchanges in January 2014. The Exchanges only have an income test, not an asset test, so he may get a subsidy. He'd get a subsidy if their income is less than around $60k.

2. Insurance you buy through the exchange will be age rated, so he will pay more than a younger person. A person in the highest age band (your dad) can pay up to 3x more than someone in the lowest age band (18-30 year olds). As a "worst case scenario", I can tell you a plan in Michigan that can't turn down people based on pre-existing conditions and is age rated is $570 a month for a plan with a $2500 deductible, 20% coinsurance, and prescription drug coverage. Lowering the deductible to $1500 raises the premiums to $838 a month.

3. In the case that he does have progressive cancer, he will qualify for SS disability automatically. He will then qualify for Medicare 24 months after he is determined to be disabled. This is a worst case scenario and obviously not what you want to have happen.

4. You may live in a state that already has an option for people with pre-existing conditions. Look into this - I know it's true in Massachusetts, New York, and Michigan.

5. He does not qualify for the Pre-Existing Condition Insurance Plan, because you have to have been uninsured for 6 months to qualify.

All that said, I am a health policy analyst. Before he makes any decisions, you should talk definitely talk to a lawyer or several lawyers. Elder care attorneys are well-versed in these issues, or maybe an estate planning attorney or disability lawyers. I'm hoping the lawyers will chime in with the right kind of lawyer to talk to.

[imojoebunny]

My parents were in a similar situation, except heart problems, not cancer. For about five years, they paid insane premiums for crap insurance through a program in our state (Georgia) that requires insurance companies to offer coverage to everyone in the state, if they offer it to anyone. You can find out about it by calling your states insurance Commisioner's office. My parents paid in the area of $25,000 to $30,000 a year. It worked out ok for them. My dad retired at 46. He had insurance as a board member of some companies until he was about 60, then had to go with the expensive insurance until 65. He took cobra as long as he could. Preexisting conditions did not matter, as long as he did not not let insurance lapse between cobra and the expensive insurance.

Good luck to your father in his fight against cancer. Hugs to you.

[SusanBAnthony]

Ugh, this is my worst nightmare. In fact, we moved xcountry for a new job for DH bc our cobra was running out, and we could not get individual plans.

If it was me, i would encourage your dad to stick it out until he is 63.5, possibly going down to part time. A lot of companies will continue to offer insurance at a much higher price (but still a group plan) for part time employees. I would feel better about that (and if he gets a clean bill of health he may want to start working more again at some point) than risking an individual plan, which is just such an unknown right now.

My uncle died of cancer last year, and he went on cobra, then went on an insurance plan that a former employer offer to retirees. It was expensive, but again a gourd plan that he could not get dropped from. That was going to tide him over until Medicare from his SSDI kicked in, unfortunately, he died before that happened (differs type of cancer, highly aggressive with zero chance of recovery).

[SusanBAnthony]

Jan 31, 2013 21:29:22 GMT -5 Catlawdy said:

My dad was in a similar situation (and has fully recovered from prostate cancer). I tried to get him to enroll in college at enough hours to get the cheap insurance.

I looked into this for our family, and the cost of tuition plus the insurance cost was very high.  It was not cost effective at all.  Most schools require you to be taking a certain credit load to qualify for their insurance, and it is often fairly terrible insurance.

[sillygoosegirl]

He's been trying to go to part time at work for ages, and they won't let him. :-( He'd hoped that given the cancer they would be more sympathetic, but no dice so far.

He doesn't have any symptoms. They found it with a PSA test, but he's had a biopsy now too. Gleason score of 6, which is middle of the road, and I think pretty good news. But they are saying 50/50 chance it has spread. I don't know how much that should freak me out, but it sure doesn't sound very good.

Those prices are a lot less bad than I imagined.

[awkwardpenguin]

sillygoosegirl, YGPM. Try not to freak out as you wait for more test results, there's a good chance he will be okay. *hugs*