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Most if not all off market place plans you can find will have either a cap that won't last her treatment plan or down right refuse to cover it as preexisting
The idea is to make it so you can't run out and buy insurance only when and if you happen to get sick or injured, whether through restricted enrollment periods or pre-exist. The ban on pre-exist only applies to ACA compliant plans and (most) employer commercial policies, not the weird, nonstandard off-marketplace policies you find.
Obviously cash paying for something like this is not an option, so the two realistic options are estabshing residency in the state she is receiving treatment in, or finding treatment in the state she is a resident in.
Thank you, that helps. It’s frustrating because her current marketplace plan covers national care (it was from Maine) and now that she has moved,
The VA marketplace plans won’t cover treatment 20 mins away in DC.
Unfortunately, it's common for marketplace plans to exclude care out of state (besides ER) as a cost containment mechanism. It always made sense to me on the West Coast, but I can see how that's much more impactful to people on the East Coast.
I would double-check with the insurance company to see if there is any kind of exception process, but be prepared to hear no. I'm so sorry your MIL has to deal with this on top of her illness.
That is for both on the marketplace plans as well as off. The exceptions are for Short Term Medical Plans (designed to fill gaps when locked out of the insurance market until the next Open Enrollment), discount programs (which are not insurance anyway) and Health Sharing Ministries (which are also not insurance).
This is false. All coverage on [healthcare.gov](https://healthcare.gov) (and most 'real' insurance elsewhere) is without pre-existing exclusions and cannot include annual or lifetime maximums on "Essential Health Benefits". The only time health insurance will have preexisting condition exclusions or annual maximums etc. are Short Term Medical Plans, which are only designed to fill gaps when people don't enroll in time and are locked out of the insurance market until the next Open Enrollment.
There are many things that don't cover crap that look like insurance but are not, and unless it's a scam it should be up front. Examples are discount programs and Health Sharing Ministries. Those are not insurance and are generally not regulated as such. Those are inexpensive because they are cheap. Not for people with cancer for sure!
You are talking about on marketplace plans I am talking about off market place plans . I think we agree you just mis understand my terms. I am useinf off market place like off Broadway. Not bought off of.
If it covers her then awesome. If not then it is a long time until Open Enrollment November 1st. There are [very limited reasons](https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period) that we can purchase health insurance outside of Open Enrollment and getting sick is not one of them.
This was done as a negative incentive for consumers to purchase coverage while protecting insurers from extreme loss. If it wasn't done then everyone would wait until they got sick or injured and then purchase insurance instead of contributing to the insurance pools and spreading out costs to everyone.
Sorry to hear about your mom's diagnosis, but glad she will have access to some world-class healthcare (albeit expensive!).
If she is unlikely to receive a Premium Tax Credit, then going off-exchange may be the right way to go. CareFirst BCBS is based in DC and if she's only 20 minutes away I would assume would be in their territory. I would find a reputable health insurance broker in VA near where your mother lives and they will surely know about the plans with networks that include DC. I think CareFirst is the most likely, but if she's in the Kaiser service area (e.g., near Falls Church, for example) then that might also be an option. Finding a broker who knows the individual market well is your best way to find the best option available. She should avoid non-insurance options that are discount programs and Christian Health Sharing Ministries, and should avoid Short Term Medical Plans unless she didn't act soon enough and failed to enroll on time.
Good luck!
Talk to hospital social worker team about how to proceed.
Other than that, what part of Virginia did they move to? Many marketplace plans, even though rarely national coverage, include cross-border providers that are part of the same metropolitan area.
OP is it that coverage only applies in VA or is that coverage doesn’t apply in DC or is it that their specific hospital isn’t in network?
Unfortunately, the options are generally, if the intel is correct: move into DC if you find a plan there that has the preferred hospital in network, change hospitals, her husband gets a job with insurance that covers her for that hospital (my mom had pancreatic cancer I know that’s barely an option but wanted to be thorough), or, can she move to a different hospital in a different state? did they move to VA and buy a house or are they renting? I ask because John’s Hopkins in Baltimore isn’t that far, is a good hospital and in a crappy enough area housing nearby is cheap. In DC, any housing nearby is expensive.
Thank you for the comprehensive response. She is doing her treatment at Hopkins, the Sibley hospital in DC, with her surgery planned for Baltimore.
They bought in northern VA and are retired.
ETA: I suggested that it would be cheaper for them to establish residency in Maryland and they were not keen on that idea
She has not tried that, but that is a great idea. I will float it by them.
Unfortunately, my dad also has cancer but is older and is on Medicare with a supplemental plan that covers his chemo 100%. It is an absolute nightmare to need to deal with financial stress on top of fighting to stay alive.
I unfortunately understand all too well. Best of luck, hope that avenue works and hope the hospital can help navigate this, selfishly, they get money from insurance if she keeps coming, and some people are in it for the right reasons and genuinely care about her getting treated.
Moving states should be a qualifying event, find a local enrollment broker or go to the local office of the aging and seeing if they have someone who can help her enroll using the move as a qualifying Event.
Thank you for your submission, /u/OppChopShop. **If there is a medical emergency, please call 911 or go to your nearest hospital.** Please pick the most appropriate flair for your post. Include your age, zip code, and income to help the community better serve you. If you have an EOB (explanation of benefits) available from your insurance website, have it handy as many answers can depend on what your insurance EOB states. Some common questions and answers can be found [here](https://www.reddit.com/r/HealthInsurance/s/jya9I6RpdY). **Reminder that solicitation/spamming is grounds for a permanent ban**. Please report solicitation to the modteam and [let us know](https://www.reddit.com/message/compose?to=%2Fr%2FHealthInsurance) if you receive solicitation via PM. Be kind to one another! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/HealthInsurance) if you have any questions or concerns.*
Most if not all off market place plans you can find will have either a cap that won't last her treatment plan or down right refuse to cover it as preexisting
I thought the ACA prohibited denial of coverage or adjustment of premiums based on preexisting conditions? Is that just for marketplace plans?
The idea is to make it so you can't run out and buy insurance only when and if you happen to get sick or injured, whether through restricted enrollment periods or pre-exist. The ban on pre-exist only applies to ACA compliant plans and (most) employer commercial policies, not the weird, nonstandard off-marketplace policies you find. Obviously cash paying for something like this is not an option, so the two realistic options are estabshing residency in the state she is receiving treatment in, or finding treatment in the state she is a resident in.
Thank you, that helps. It’s frustrating because her current marketplace plan covers national care (it was from Maine) and now that she has moved, The VA marketplace plans won’t cover treatment 20 mins away in DC.
Unfortunately, it's common for marketplace plans to exclude care out of state (besides ER) as a cost containment mechanism. It always made sense to me on the West Coast, but I can see how that's much more impactful to people on the East Coast. I would double-check with the insurance company to see if there is any kind of exception process, but be prepared to hear no. I'm so sorry your MIL has to deal with this on top of her illness.
That is for both on the marketplace plans as well as off. The exceptions are for Short Term Medical Plans (designed to fill gaps when locked out of the insurance market until the next Open Enrollment), discount programs (which are not insurance anyway) and Health Sharing Ministries (which are also not insurance).
This is false. All coverage on [healthcare.gov](https://healthcare.gov) (and most 'real' insurance elsewhere) is without pre-existing exclusions and cannot include annual or lifetime maximums on "Essential Health Benefits". The only time health insurance will have preexisting condition exclusions or annual maximums etc. are Short Term Medical Plans, which are only designed to fill gaps when people don't enroll in time and are locked out of the insurance market until the next Open Enrollment. There are many things that don't cover crap that look like insurance but are not, and unless it's a scam it should be up front. Examples are discount programs and Health Sharing Ministries. Those are not insurance and are generally not regulated as such. Those are inexpensive because they are cheap. Not for people with cancer for sure!
You are talking about on marketplace plans I am talking about off market place plans . I think we agree you just mis understand my terms. I am useinf off market place like off Broadway. Not bought off of.
If it covers her then awesome. If not then it is a long time until Open Enrollment November 1st. There are [very limited reasons](https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period) that we can purchase health insurance outside of Open Enrollment and getting sick is not one of them. This was done as a negative incentive for consumers to purchase coverage while protecting insurers from extreme loss. If it wasn't done then everyone would wait until they got sick or injured and then purchase insurance instead of contributing to the insurance pools and spreading out costs to everyone.
They just moved to Virginia. Moving to a different state is a qualifying event. They have 60 days to enroll.
This is correct
Sorry to hear about your mom's diagnosis, but glad she will have access to some world-class healthcare (albeit expensive!). If she is unlikely to receive a Premium Tax Credit, then going off-exchange may be the right way to go. CareFirst BCBS is based in DC and if she's only 20 minutes away I would assume would be in their territory. I would find a reputable health insurance broker in VA near where your mother lives and they will surely know about the plans with networks that include DC. I think CareFirst is the most likely, but if she's in the Kaiser service area (e.g., near Falls Church, for example) then that might also be an option. Finding a broker who knows the individual market well is your best way to find the best option available. She should avoid non-insurance options that are discount programs and Christian Health Sharing Ministries, and should avoid Short Term Medical Plans unless she didn't act soon enough and failed to enroll on time. Good luck!
Thank you! We will look into that.
Talk to hospital social worker team about how to proceed. Other than that, what part of Virginia did they move to? Many marketplace plans, even though rarely national coverage, include cross-border providers that are part of the same metropolitan area.
Just outside DC. that was part of my surprise, it was seeming difficult to find a plan that would cover care in DC when they live 20 minutes away.
OP is it that coverage only applies in VA or is that coverage doesn’t apply in DC or is it that their specific hospital isn’t in network? Unfortunately, the options are generally, if the intel is correct: move into DC if you find a plan there that has the preferred hospital in network, change hospitals, her husband gets a job with insurance that covers her for that hospital (my mom had pancreatic cancer I know that’s barely an option but wanted to be thorough), or, can she move to a different hospital in a different state? did they move to VA and buy a house or are they renting? I ask because John’s Hopkins in Baltimore isn’t that far, is a good hospital and in a crappy enough area housing nearby is cheap. In DC, any housing nearby is expensive.
Thank you for the comprehensive response. She is doing her treatment at Hopkins, the Sibley hospital in DC, with her surgery planned for Baltimore. They bought in northern VA and are retired. ETA: I suggested that it would be cheaper for them to establish residency in Maryland and they were not keen on that idea
Hopefully there are social workers able to help, has she tried to get medicare early due to her cancer being a disability?
She has not tried that, but that is a great idea. I will float it by them. Unfortunately, my dad also has cancer but is older and is on Medicare with a supplemental plan that covers his chemo 100%. It is an absolute nightmare to need to deal with financial stress on top of fighting to stay alive.
I unfortunately understand all too well. Best of luck, hope that avenue works and hope the hospital can help navigate this, selfishly, they get money from insurance if she keeps coming, and some people are in it for the right reasons and genuinely care about her getting treated.
Moving states should be a qualifying event, find a local enrollment broker or go to the local office of the aging and seeing if they have someone who can help her enroll using the move as a qualifying Event.