Single and Happy About It

Dear Linda,
I’m 60 and have multiple sclerosis.  I am recently divorced and will lose my group insurance through my husband’s plan.  I live in Texas, but am considering moving back to New York.  What should I do for health insurance?

Single and Happy About It (except for the health insurance part)

Dear Single and Happy,
The simplest option is to continue your coverage for 36 months through your husband, if his plan offers it.  This is commonly called “COBRA coverage”, and not all employer plans are required to offer it.
After the 36 months – or sooner, if there is no COBRA — you will need to find a plan.  Here are some options for you:

  • As an MS patient, you can join Texas’s High Risk Pool.  Contact them at 1-888-398-3927.
  • If you apply for health insurance on your own (“individual” or “non-group” plans) in Texas, the insurer will most likely send you to the high risk pool.
  • New York’s high risk pool requires that you be uninsured for six months.  Going without insurance would not be a good idea for you, because you have MS.
  • New York requires insurers to have “open enrollment” once a year.  During open enrollment, insurers accept new customers no matter what their health condition.  Each insurer can choose which month they have open enrollment.  Sounds great, but insurers in New York are allowed to charge you more because of your illness.  Prices might be very high.  Contact the New York State Insurance Department Consumer Assistance Unit at 1-212-480-6400, Option #4.
You should apply to Social Security Administration for disability benefits, even if your MS has not yet caused you to lose any functioning.  It takes a long time – years even – for Medicare disability applications to get completed.  Visit the Social Security Administration’s disability website for an excellent step-by-step guide.
Once you are considered “disabled”, you will start a 29-month waiting period; after the waiting period, you will get Medicare, the public health insurance plan.  After five months, you will qualify for disability benefits from Social Security.  (The disability benefit is a monthly cash payment.)
While you are waiting, you can get Medicaid if you have low income and very little money in the bank.  You can get more information from Texas Medicaid’s website and New York’s Medicaid website.  Different states have different rules on who can get Medicaid.  
You will automatically get Medicare at age 65, unless you or your husband is one of those rare government employees who did not pay Medicare taxes.
Based upon what we know today, your best bet is COBRA coverage for three years, then high risk pool until you qualify for Medicare. (If you simply must move to New York, time it with their annual open enrollment and be prepared to pay a lot.)
You might have more options, if the U.S. Supreme Court upholds the health reform law. The law will require everyone to have health insurance, and insurers to accept all comers. Stay tuned – a decision is expected in mid-2012.
Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.