Hi Selina,
I just wanted to throw my 2 cents worth in as I see this from 2 different angles. I am not an adult with CF, however I do have 2 children with CF and I work in medical underwriting for a major insurance company so I know the insurance industry pretty well. I also had to weigh the marriage issue at one time. I had 3 children, 2 with CF, as I said. Their father was very abusive to me and I finally, after 10 years, managed to get out of the relationship alive and with my children (not much else, but the children were all I really wanted). I got the children on medicaid which worked out well, since I didn't have to worry about copays or anything. However, later on I met a very nice man who treated us very well and wanted to get married...Of course that threatened the medicaid for the girls. It worked out for me because I landed the job at the insurance company so the girls would be very well covered and really didn't need the medicaid. If I ever quit or lose my job, I'll probably have to get legally divorced so the girls can get medicaid again because I don't think I could find another insurance policy like I have now. I know that really sucks to say and even more to have to do, but this is the world we live in and we are forced to make choices that we don't necessarily like. I agree with the other posters who say that maybe you should only have a ceremony to be married but not do it legally. It's a hard pill to swallow that the world forces you to do that, but having lived with CF for 20 years already, you've probably swallowed some pretty hard pills as it is.
As far as the insurance goes, it really depends so much on the employer and the insurance they offer. One thing to keep in mind is that most large companies, ie Target, Walmart, etc... are self-ensured, meaning that they write their own insurance policy. (MOST...not necessarily all)...The company they hire to administer their benefits, ie, Blue Cross, HealthPartners, Medica, etc, simply do just that...administer the benefits according to what the company chooses to have. The actual insurance company does not set the benefits, the employer does. I didn't know that until I started this job a few years ago. Also many large groups like that do not have pre-existing clauses so they do not consider your health history when adding you to a policy. You'd have to verify with the insurance company whether his particular employer does have one.
All that totally changes when you go to work for a smaller employer (less than 50 employees). They are usually fully-ensured, which means that the insurance company such as Blue Cross or Medica actually does determine the benefits and they do have pre-existing clauses. However, as someone mentioned before, medicaid is considered a previous insurance and if you've been covered for at least a year, they cannot put you under a pre-exist clause, so they cannot deny you or your claims due to your illness. This is a federal law, so it does not matter what state you live in. Unless you have no insurance coverage for 63 days or more, they cannot put you under a pre-exist clause. However, that being said, you may get the insurance, but in my opinion, you probably won't find insurance through an employer that will cover you as well as medicaid does. Of course I don't know the medicaid program in Georgia, so I am just assuming that they cover everything you need. With an employer's insurance you're likely to have considerable copays for prescriptions that you probably don't have now. Also, you have to consider the lifetime maximum of the policy. Most non-government insurances policies have a lifetime max of 1, 2 or 3 million dollars. Sounds like a lot, but with the expenses we all know are involved here and the fact that CF patients are living much longer these days, and that is going to continue to improve, those bills can really add up...It would really suck to work so hard to keep yourself healthy and live to be 75, only to have your insurance company drop you like a hot potato because you've exhausted your benefits. And they will do it...
I wish you the best and I know what an emotional experience this is and how unfair the system is. And things are more complicated by insurance laws and clauses that seem to be beyond understanding. I still learn new things every single day that just blow my mind. The loopholes that are out there...things like that. Everyone's out to protect themselves, whether it's an employer or an insurance company. And if you don't fight for yourself, you'll get lost in the shuffle. It's unfair and unfortunate. But knowledge is power, so learn everything you can about the policy you would be taking before even risking the medicaid. Sorry for rambling....I guess this is still more of an emotional issue for me than I realized...
Take Care,
Renee
