Lifetime Max on Insurance Coverage

[just1more]

I have studied this extensively, and not for CF. We have a son with Hemophilia and his medication alone runs $16-18K a MONTH (well over $200k/year).

In a nutshell the lifetime max is specific to the policy.

If you have the same policy for years, such as Becky discussed, then it is a cummlative of all care they pay for over her life (or until she aged out of your insurance).

If you change insurance companies then you get a fresh start.

I'm not sure if you switch and go back (Pam's condition) at the same employer. If you had Anthem and changed employeers it starts over even it you have Anthem at the new company. But at the same company I've never heard of changing plans like this so I'm not sure.

Ultimately, if you have a low max and your child reaches it you have a couple of options:

1) Convince your employer to change insurance companies (didn't say they were easy options).

2) Find a new job, this automatically starts you over.

3) Accept that once you reach the max insurance will no longer pay. As for eligibility for medicaid, it would be the as if you are not able to get insurance and whatever the criteria are.


For us, while I don't like it I realize that if the max were low (currently it is 5M) I could be forced to change jobs every 5-10 years while my son is in my home. Bigger is that he will live to 60+ and will have the same worry about needing to keep insurance under any given max for the rest of his life.

 

[just1more]

I have studied this extensively, and not for CF. We have a son with Hemophilia and his medication alone runs $16-18K a MONTH (well over $200k/year).

In a nutshell the lifetime max is specific to the policy.

If you have the same policy for years, such as Becky discussed, then it is a cummlative of all care they pay for over her life (or until she aged out of your insurance).

If you change insurance companies then you get a fresh start.

I'm not sure if you switch and go back (Pam's condition) at the same employer. If you had Anthem and changed employeers it starts over even it you have Anthem at the new company. But at the same company I've never heard of changing plans like this so I'm not sure.

Ultimately, if you have a low max and your child reaches it you have a couple of options:

1) Convince your employer to change insurance companies (didn't say they were easy options).

2) Find a new job, this automatically starts you over.

3) Accept that once you reach the max insurance will no longer pay. As for eligibility for medicaid, it would be the as if you are not able to get insurance and whatever the criteria are.


For us, while I don't like it I realize that if the max were low (currently it is 5M) I could be forced to change jobs every 5-10 years while my son is in my home. Bigger is that he will live to 60+ and will have the same worry about needing to keep insurance under any given max for the rest of his life.

 

[just1more]

I have studied this extensively, and not for CF. We have a son with Hemophilia and his medication alone runs $16-18K a MONTH (well over $200k/year).

In a nutshell the lifetime max is specific to the policy.

If you have the same policy for years, such as Becky discussed, then it is a cummlative of all care they pay for over her life (or until she aged out of your insurance).

If you change insurance companies then you get a fresh start.

I'm not sure if you switch and go back (Pam's condition) at the same employer. If you had Anthem and changed employeers it starts over even it you have Anthem at the new company. But at the same company I've never heard of changing plans like this so I'm not sure.

Ultimately, if you have a low max and your child reaches it you have a couple of options:

1) Convince your employer to change insurance companies (didn't say they were easy options).

2) Find a new job, this automatically starts you over.

3) Accept that once you reach the max insurance will no longer pay. As for eligibility for medicaid, it would be the as if you are not able to get insurance and whatever the criteria are.


For us, while I don't like it I realize that if the max were low (currently it is 5M) I could be forced to change jobs every 5-10 years while my son is in my home. Bigger is that he will live to 60+ and will have the same worry about needing to keep insurance under any given max for the rest of his life.

 

[just1more]

I have studied this extensively, and not for CF. We have a son with Hemophilia and his medication alone runs $16-18K a MONTH (well over $200k/year).

In a nutshell the lifetime max is specific to the policy.

If you have the same policy for years, such as Becky discussed, then it is a cummlative of all care they pay for over her life (or until she aged out of your insurance).

If you change insurance companies then you get a fresh start.

I'm not sure if you switch and go back (Pam's condition) at the same employer. If you had Anthem and changed employeers it starts over even it you have Anthem at the new company. But at the same company I've never heard of changing plans like this so I'm not sure.

Ultimately, if you have a low max and your child reaches it you have a couple of options:

1) Convince your employer to change insurance companies (didn't say they were easy options).

2) Find a new job, this automatically starts you over.

3) Accept that once you reach the max insurance will no longer pay. As for eligibility for medicaid, it would be the as if you are not able to get insurance and whatever the criteria are.


For us, while I don't like it I realize that if the max were low (currently it is 5M) I could be forced to change jobs every 5-10 years while my son is in my home. Bigger is that he will live to 60+ and will have the same worry about needing to keep insurance under any given max for the rest of his life.

 

[just1more]

I have studied this extensively, and not for CF. We have a son with Hemophilia and his medication alone runs $16-18K a MONTH (well over $200k/year).
<br />
<br />In a nutshell the lifetime max is specific to the policy.
<br />
<br />If you have the same policy for years, such as Becky discussed, then it is a cummlative of all care they pay for over her life (or until she aged out of your insurance).
<br />
<br />If you change insurance companies then you get a fresh start.
<br />
<br />I'm not sure if you switch and go back (Pam's condition) at the same employer. If you had Anthem and changed employeers it starts over even it you have Anthem at the new company. But at the same company I've never heard of changing plans like this so I'm not sure.
<br />
<br />Ultimately, if you have a low max and your child reaches it you have a couple of options:
<br />
<br />1) Convince your employer to change insurance companies (didn't say they were easy options).
<br />
<br />2) Find a new job, this automatically starts you over.
<br />
<br />3) Accept that once you reach the max insurance will no longer pay. As for eligibility for medicaid, it would be the as if you are not able to get insurance and whatever the criteria are.
<br />
<br />
<br />For us, while I don't like it I realize that if the max were low (currently it is 5M) I could be forced to change jobs every 5-10 years while my son is in my home. Bigger is that he will live to 60+ and will have the same worry about needing to keep insurance under any given max for the rest of his life.

 

[ladybug]

I have a private policy that I pay out of pocket for (a high amount) every month and have a lifetime max of 1M... I'm shocked others have such high lifetime maximums. Makes my insurance seem kinda crappy.

Either way, I started the 1M policy about 7 years ago I think and am halfway to meeting the maximum. So, if that's any indication of how long it will take. I'm on pretty much all the "usual" CF meds and on abx IV a couple times a year.

Remember though, that if you go to a provider/hospital/home health that contracts with your insurance, the amount it eats up of your maximum is much much lower cause they have to do the "provider discount". So, try to go with providers that contract with your insurance to stretch your policy dollars further.

 

[ladybug]

I have a private policy that I pay out of pocket for (a high amount) every month and have a lifetime max of 1M... I'm shocked others have such high lifetime maximums. Makes my insurance seem kinda crappy.

Either way, I started the 1M policy about 7 years ago I think and am halfway to meeting the maximum. So, if that's any indication of how long it will take. I'm on pretty much all the "usual" CF meds and on abx IV a couple times a year.

Remember though, that if you go to a provider/hospital/home health that contracts with your insurance, the amount it eats up of your maximum is much much lower cause they have to do the "provider discount". So, try to go with providers that contract with your insurance to stretch your policy dollars further.

 

[ladybug]

I have a private policy that I pay out of pocket for (a high amount) every month and have a lifetime max of 1M... I'm shocked others have such high lifetime maximums. Makes my insurance seem kinda crappy.

Either way, I started the 1M policy about 7 years ago I think and am halfway to meeting the maximum. So, if that's any indication of how long it will take. I'm on pretty much all the "usual" CF meds and on abx IV a couple times a year.

Remember though, that if you go to a provider/hospital/home health that contracts with your insurance, the amount it eats up of your maximum is much much lower cause they have to do the "provider discount". So, try to go with providers that contract with your insurance to stretch your policy dollars further.

 

[ladybug]

I have a private policy that I pay out of pocket for (a high amount) every month and have a lifetime max of 1M... I'm shocked others have such high lifetime maximums. Makes my insurance seem kinda crappy.

Either way, I started the 1M policy about 7 years ago I think and am halfway to meeting the maximum. So, if that's any indication of how long it will take. I'm on pretty much all the "usual" CF meds and on abx IV a couple times a year.

Remember though, that if you go to a provider/hospital/home health that contracts with your insurance, the amount it eats up of your maximum is much much lower cause they have to do the "provider discount". So, try to go with providers that contract with your insurance to stretch your policy dollars further.

 

[ladybug]

I have a private policy that I pay out of pocket for (a high amount) every month and have a lifetime max of 1M... I'm shocked others have such high lifetime maximums. Makes my insurance seem kinda crappy.
<br />
<br />Either way, I started the 1M policy about 7 years ago I think and am halfway to meeting the maximum. So, if that's any indication of how long it will take. I'm on pretty much all the "usual" CF meds and on abx IV a couple times a year.
<br />
<br />Remember though, that if you go to a provider/hospital/home health that contracts with your insurance, the amount it eats up of your maximum is much much lower cause they have to do the "provider discount". So, try to go with providers that contract with your insurance to stretch your policy dollars further.
<br />
<br />

 

[Skye]

I know that sometimes you have to take the policy that is offered at the job that works out for you; but, this is why it is important to ask a lot of questions in HR when you are job hunting. I DO! One of the most important questions I ask is what is the lifetime max on the health insurance policy. The really good ones have an unlimited lifetime max. I will take that job any day over a set amount. Ours is currently an unlimited amount and it takes a lot of stress out of our lives. We had a policy in TX that was 1M and it is just too hard for a CFer to stay in those parameters. Seems so unfair!

Another good question is....is it a self-insured policy. This means that all the money is pooled and claims are paid from that money. I want to know that because the laws and guidelines are different for a policy like that.

OK...I am getting off topic and could go on. I wish there were better answers for all of us.

 

[Skye]

I know that sometimes you have to take the policy that is offered at the job that works out for you; but, this is why it is important to ask a lot of questions in HR when you are job hunting. I DO! One of the most important questions I ask is what is the lifetime max on the health insurance policy. The really good ones have an unlimited lifetime max. I will take that job any day over a set amount. Ours is currently an unlimited amount and it takes a lot of stress out of our lives. We had a policy in TX that was 1M and it is just too hard for a CFer to stay in those parameters. Seems so unfair!

Another good question is....is it a self-insured policy. This means that all the money is pooled and claims are paid from that money. I want to know that because the laws and guidelines are different for a policy like that.

OK...I am getting off topic and could go on. I wish there were better answers for all of us.

 

[Skye]

I know that sometimes you have to take the policy that is offered at the job that works out for you; but, this is why it is important to ask a lot of questions in HR when you are job hunting. I DO! One of the most important questions I ask is what is the lifetime max on the health insurance policy. The really good ones have an unlimited lifetime max. I will take that job any day over a set amount. Ours is currently an unlimited amount and it takes a lot of stress out of our lives. We had a policy in TX that was 1M and it is just too hard for a CFer to stay in those parameters. Seems so unfair!

Another good question is....is it a self-insured policy. This means that all the money is pooled and claims are paid from that money. I want to know that because the laws and guidelines are different for a policy like that.

OK...I am getting off topic and could go on. I wish there were better answers for all of us.

 

[Skye]

I know that sometimes you have to take the policy that is offered at the job that works out for you; but, this is why it is important to ask a lot of questions in HR when you are job hunting. I DO! One of the most important questions I ask is what is the lifetime max on the health insurance policy. The really good ones have an unlimited lifetime max. I will take that job any day over a set amount. Ours is currently an unlimited amount and it takes a lot of stress out of our lives. We had a policy in TX that was 1M and it is just too hard for a CFer to stay in those parameters. Seems so unfair!

Another good question is....is it a self-insured policy. This means that all the money is pooled and claims are paid from that money. I want to know that because the laws and guidelines are different for a policy like that.

OK...I am getting off topic and could go on. I wish there were better answers for all of us.

 

[Skye]

I know that sometimes you have to take the policy that is offered at the job that works out for you; but, this is why it is important to ask a lot of questions in HR when you are job hunting. I DO! One of the most important questions I ask is what is the lifetime max on the health insurance policy. The really good ones have an unlimited lifetime max. I will take that job any day over a set amount. Ours is currently an unlimited amount and it takes a lot of stress out of our lives. We had a policy in TX that was 1M and it is just too hard for a CFer to stay in those parameters. Seems so unfair!
<br />
<br />Another good question is....is it a self-insured policy. This means that all the money is pooled and claims are paid from that money. I want to know that because the laws and guidelines are different for a policy like that.
<br />
<br />OK...I am getting off topic and could go on. I wish there were better answers for all of us.