Individuals with MS whose health insurance is not employment based, who have already retired, or who are attempting to obtain private health insurance for the first time, will need to consider using other products and techniques to protect themselves from the financial risks that accompany medical illness. For our purposes, it is helpful to break down the risks attributable to healthcare costs for someone diagnosed with MS into five distinct categories: (1) major medical expenses not due to MS, (2) hospitalization expenses not due to MS, (3) major medical expenses due to MS, (4) hospitalization expenses due to MS, and (S) long term services expenses.
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| Non-Employment Health Insurance For Multiple Sclerosis |
Many people who have MS find themselves looking for one ideal insurance package to take care of all five of their health-care risks, only to discover that they cannot obtain it after they are diagnosed. That is because MS is considered by the insurance industry to be a serious illness that carries a high risk of associated costs. Therefore, many insurance companies have historically refused to offer coverage to people with MS or have offered it only at a prohibitive cost. Nevertheless, there is no need to subject a person's entire range of healthcare needs to the lowest common denominator of coverage that can be obtained only for a pre-existing, high-risk health condition.
Thus, major medical coverage for conditions other than MS is often the most overlooked component. Just because a member of a family has MS (and therefore may not be able to obtain optimal health coverage for the multiple sclerosis) does not require that all other health needs should be subjected to the common denominator of coverage available for MS. The best way to deal with other health needs is to take a "waiver" or exclusion for MS. In that way, it may be possible to obtain good, thorough, long-term coverage for the person with MS (without the MS component) and other members of the family. This strategy requires payment for more than one health policy by the family, but the improvement in coverage should make the investment very worthwhile.
Thus, it often makes more sense to segregate your health coverage needs, and seek one good, portable, non-employment-based major medical (and hospitalization) policy for all health risks except MS (these are often called policies with "waiver" or "exclusion" provisions) . Then, the only risks left to insure would include the risks attributable to MS, and these should be separately insured.
Obtaining major medical coverage for MS is the most difficult challenge for people without employer-sponsored insurance coverage. Nevertheless, a number of strategies are available for persons who cannot obtain insurance through traditional individual sources. If your multiple sclerosis can be considered "benign," then your local insurance agent may be able to find coverage by consulting the book published by National Underwriters entitled "Who Writes What." If not, then you should consult your state options as noted above.
One type of insurance product that can still be obtained (regardless of pre-existing condition) to help cover the excluded MS includes large group "catastrophic" or "excess" major medical. This product will often, after a high deductible has been met (Usually approximately $25,000 or $50,000) provide coverage in full for a given condition. Many people are put off by the high deductible; but that is a mistake. These deductibles are not ordinarily measured by the amount that the beneficiary of the policy pays out of pocket; instead they can often be measured by the amounts that any other insurer has paid toward a given condition (including, for example, Medicare, VA, worker's compensation, or private insurance).
For example, a $25,000 revolving 36-month deductible simply requires that $25,000 be paid toward a given health condition within a 36-month period by any accepted payor (including another insurance company). If your MS has cost an accumulation of the policy deductible in expenses to all of your payers, you might qualify under the catastrophic plan. In that case. your condition could be declared catastrophic and would be covered (usually at 100% coverage) by the catastrophic plan. To find out more, you can check out Non-Employment Health Insurance For Multiple Sclerosis.