During this past fall insurance open enrollment period, my wife and I were informed by her employer that I would not be eligible to be covered as a spouse under their health plan. This they say was caused by me being eligible for insurance coverage from my former employer. This was in fact true, that as a person living with hemophilia, HIV and for a peiod of time HCV, I did pay for healthcare coverage in the past from my wife's employer, Medicare and my past employer. As a person living with several now chronic illness (if you can afford them) it was better to be over insured then under and I would often offer a quip that "I was insurance poor" when presenting my insurance cards at the doctors office or other medical facilities. Over the course of the past thirty one years I have maintained eligible for the various insurance policies because of fear of reaching the lifetime caps on one policy or better copay options. At the time I went on long term disability, my employer's policy was considered secondary to Medicare. Because my wife's employer has always employeed more then 100 workers their policy was considered primary to Medicare. And so it has been for the past eighteen years until now. This ineligibility to be covered as a spouse after 31 years of marriage has started a strange chain reaction which just took another unforeseen turn.
Now that I was left with just Medicare and my former employer's medigap policy it was necessary for me to evaluate the plan and my options. I looked at my former employer prescription drug plan and found that they would pay 55% of the cost, leaving 45% of the cost to me to pay up to $5,000 at which time they will pay 100%. I was told, I could opt for Medicare part D and that this would be considered my drug plan. I spent several days researching the Medicare website and entering my current list of prescription drugs and found a plan that offered savings over the $5k plus premiums that my former employeer's policy offered. So I opted into the Medicare part D plan only. Since I needed to fill a prescription several weeks ago just after the new year I called the part D plan company and was given the new insurance information over the phone and executed the transaction at my local pharmacy for my HIV drugs. Today I get a suprise in the mail from my former employer that states that because I have opted for a Medicare part D plan to save a little bit of money on my prescription drugs that this action also causes them to drop my major medical coverage from them and that I will not be able to reenroll until the next open enrollment or some other defined live change event (divorce, marriage, birth, etc.) of the policy.
Nowhere in any of the materials provided either on-line or by mail was it stated that my prescription drug plan option would effect the major medical (Medigap) insurance until the letter today which was dated 31 December 2010. So now I am forced exploring if there is a resind date on the execution of my opting for a part D plan or not. It seems strange to me that after healthcare reform that I would have less options to pay for myself then before and I believe the companies involved are misreading or at the very least misinterpreting the healthcare reform law by taking these various positions while waiting for more clarity on the law from federal agencies. Some wiil take away from this tale that this is example of what happens when government gets invovled with reforming healthcare in the country. I would oppose any such point of view being drawn from this current tale of woe because I know full well the fear that one lives under when they have a chronic condition and cannot obtain or retain health insurance coverage from an employer or the open market. And the ecomonic impact that not being flexible in career choices has on one working and living with a chronic condition.
At the very least this strange chain of events should be a cautionary tale to others who may not be as engaged as I have been, to be careful in this period of flux in healthcare reform and try not to be surpised as I have been to these unforeseen consequences.
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