Insurance Troubles when You Have a Pre-exisiting Condition like RA

Insurance is an ongoing, surmounting battle, particularly in America. Even for those without pre-existing conditions (like RA), navigating the insurance landscape is arduous and terrifying. Thankfully, I’ve been able to keep on my mom’s insurance she receives through her work. It’s a great insurance plan and has made my Humira medication—among others—very affordable.

Finding health insurance

I am very fortunate and grateful for having this insurance plan; however, a problem is right around the corner. Starting in April, my mom will be on Medicare since she has reached retirement; and because you cannot claim dependents on Medicare, I’ll be taken out of that plan (because we also cannot afford the $2000 a month that it would cost to maintain that plan, which is a ridiculously high price, to begin with). I’ll now have to find my own insurance plan.

An estimated 5 months without coverage

Here’s the crux of the problem: I’m hoping to enroll in a fully-funded Ph.D. program soon (assuming that I am accepted into one), and that program will cover my health insurance. But that coverage would not start until September 2020, so there’s this period of time with no coverage from April to September. Some preliminary research and digging around has proven that this is a much more complicated process than I initially thought.

Pre-existing conditions and short-term health insurance

A quick solution would be to just enroll in a short-term health insurance plan for those months without insurance; however, the problem is that many short-term plans refuse to cover patients with pre-existing conditions because these patients are more likely to use insurance services.

Higher co-pays, deductibles and premiums

In addition, those short-term plans that do cover pre-existing conditions only do so at a higher price, which means my co-pays, deductible, and monthly premium would all be higher than if I did not have RA.

And yes, this is allowed because short-term plans are not subject to the same parameters and regulations outlined by the Affordable Care Act. I don’t know what I’m going to do at this point because most of the short-term plans are either too expensive or won’t accept me.

Health insurance to accommodate RA neccessities

Clearly, this is a landscape filled with potential landmines (and those landmines have several dollar signs attached to them). As someone with a pre-existing condition, I now have to find the right plan that: has a relatively low deductible, a non-exorbitant co-pay, has coverage for specialty medication, and that works with Humira’s co-pay assistance program. Which all comes after getting approved for the plan in the first place, which is difficult by itself. It’s incredibly frustrating.

The limitations of health insurance

Periods of uncertainty like this really remind me how even our medical ailments, our corporeal realities, have become politicized. People in Congress are talking about my reality, my body, my experience without ever having experienced this disease.

An insurance company’s worse nightmare

In reality, I am an insurance company’s worse nightmare with rheumatoid arthritis, clinical depression, potentially lupus, and more. Thankfully under the Affordable Care Act, it’s still illegal for American insurance companies to deny medical coverage to those of us with pre-existing conditions. Otherwise, I would be out of luck, as sick as I was at the very beginning of having RA.

Removing existing protections will affect many lives

But it’s scary to think how the things that keep us alive—medications and medical services—are inherently limited by insurance. What’s even scarier is that in our current political climate, there are discussions of removing these protections for pre-existing conditions (for major insurance companies), something that would drastically affect my life and many of our own community members' lives.


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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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