Accessing health insurance

Since my multiple sclerosis diagnosis in 1997, I have been mostly uninsured. Before my diagnosis, I worked as a bank trust officer. I bought a minority share in a private business in the mid 1990’s. This did not work out, I wasn't able to get back into my former profession, and I was also unable to secure a position in a related field that would provide health insurance coverage.

Being uninsured, I typically self-pay for most of my medical treatment. As a person with MS, I’m sure I don’t have to tell you how expensive this can be. Thankfully, I have been able to receive my disease modifying therapy (DMT) at a reduced cost through a patient assistance program. If this program didn’t exist as a safety net, who knows where my disease would be today without treatment to slow its progression.

For me, the Affordable Care Act (ACA) means a chance to finally be able to afford insurance. Before the law was passed in 2010, my diagnosis was considered a pre-existing condition, which meant that when I was diagnosed with MS, insurance either became completely unaffordable or completely unavailable. The ACA prohibits insurers from discriminating against people with pre-existing conditions in this manner — first for children and more recently for adults. Because of these changes, in 2014, I will be able to afford insurance for the first time in 17 years.

When the Health Insurance Marketplace first launched on October 1, I went to to enroll, but like many others reported in the news, I had a pretty frustrating experience at first. After looking at the site and making a bunch of phone calls to try and get my questions answered, I decided to broaden my search to include individual insurance company websites. I went to one of the Nebraska company sites and found out that one of their policies covered my doctors and my DMT. This was a huge breakthrough in the process for me!

The very same day, I received a letter from my current patient assistance program, advising me that they had people who could help me with the Health Insurance Marketplace application process and that I could call them directly for support. All of this to say, the information is out there — you may just have to do a little digging. The best news is that once I had the right information, I returned to and successfully enrolled in the plan I had identified that gives me access to my current medication and doctors. Now, I’m working through the payment process, making sure that there are no coverage lapses and getting prior authorization from my doctor.

I’m beyond excited to have health coverage for the first time in 17 years. I will keep you posted on my progress in future blog posts. If you’re in the same boat as me and are looking for or have gotten coverage through the Marketplace, please share your experiences and tips in the comments section below.

-John R. O'Neal II

John is a former self-help group leader and National MS Society Nebraska chapter board member. He has been active in advocacy for the Society for 15 years and is a member of the Mid America Chapter’s Government Relations Committee. He is a retired lawyer and bank trust officer. He became a vegetarian in the last year to help him lose weight and improve his cardiovascular health, and he has lost 25 pounds and feels better since the change.

Editor's Note: To purchase coverage for 2014 through the Health Insurance Marketplace, you can enroll during Open Enrollment — now through March 31, 2014. If you miss the initial Open Enrollment opportunity, you will have to wait for next year's annual Open Enrollment unless you qualify for Special Enrollment due to certain circumstances such as getting married or having a baby. For coverage to begin on January 1, 2014, you must enroll by December 23, 2013. For more information about the Health Insurance Marketplace and the Affordable Care Act, click here.
Tags Activism & Advocacy, Insurance & Money Matters      6 Appreciate this

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