I've been on my husband's insurance plan for the past several years. During that time I have become disabled (bipolar disorder). We are going to get our own insurance for him, myself and our daughter because he quit his job. I called Blue Cross Blue Shield and explained that I am eligible for Medicare and she basically told me I HAVE to go on Medicare because of the expenses I would have with my disabilty that they would deny me. Doesn't Hippa protect me in this situation? Does anyone know? I know that I can get on another plan WITH a preexisting condition according to Hippa law, but from what this lady told me, is it true, or does Hippa protect me too, being eligible for disability?
Does anyone know?
Does anyone even know a number where I can contact Hippa?
I could not find anything on the internet.

Hi --

I am no expert by any means, but wanted to try to address a couple of things regarding HIPAA from my own experiences.

HIPAA is NOT an organization -- it's a law/regulation (act if we get technical about it). The purpose of HIPAA, originally anyway, is to protect people's privacy rights pertaining to their medical information. As is pretty typical in our society, the original intention of HIPAA got messed up by having too many hands in the pot and now HIPAA is about as confusing as anything else in the world.

My experience with insurance was that as long as you do NOT have a break in coverage, an insurance company is required to take you and cover you. They cannot deny you coverage based on your disability BUT they CAN cover you at their absolute highest premium.

For example, I was covered under my husband's group plan through his job. When he opted to quit and go into business for himself, we looked into private, individual policies. Because I was still covered under his plan through his job and we were having no break in coverage, the individual plan took me, but at what they called Level 4, meaning I was basically uninsurable (I am disabled as well), but HIPAA laws required they take me for the reasons I already stated.

Since there is a 2-year waiting period for Medicare if a person is on disability, we had to stick with the individual plan at their exorbitant rates for 2 years. Once Medicare was available, I went on that and cancelled my individual plan.

To the best of my knowledge, I was NOT required to take Medicare over my private insurance. The cost savings to me was so significant that it didn't make any sense not to.

I hope this helped. And please keep in mind this was my personal experience.

Thank you so much for replying. My situation sounds much like yours, except that I am able to get on Medicare at anytime, I had my waiting period.
So, if we get our own insurance plan, do I have to disclose that I am bipolar?

I really don't know if you have to disclose that, but I know my questionnaire for private insurance was huge and I was honest about everything. I figured they'd find out anyway and I'd probably lose my insurance if I didn't tell them everything. I believe the questionnaire asked about any possible problem and/or doctor visit that I'd had in the last 10 years!!

Like I said, I told them the truth about everything and they classified me as "uninsurable" because of my medical problems (Muscular Dystrophy being the main one). But because I was coming off a group plan without a break in coverage, HIPAA regulations required them to take me, but at their absolute highest monthly premium. And believe me, it was HUGE.

Just as another note, when I became eligible for Medicare, I actually contracted for a Medicare Advantage plan through a reputable insurance company (one of the big names). Medicare pays them my premium and I have an HMO type insurance arrangement now. I have set co-pays for everything. I had a serious illness in February that landed me in the hospital for emergency surgery. When I was recovered, I looked at my paperwork for the insurance to try to figure out what that illness was going to cost me. My hospital bill was EXACTLY what my paperwork said it would be and believe me, it was pretty reasonable, all things considered.

Something else to think about --

Thanks again. I think I will probably just go with Medicare. I was also interested in the Advantage Plan. From what I read up on, this would be the best plan for me.

If you qualify for Medicare then yes you HAVE to apply for Medicare medical insurance first ...then other insurance is secondary and is also required. This is what is wrong with reaching the age of qualifying for Medicare...it isn't right that you can no longer choose what insurance you get. Absolutely everyone HAS to sign up for Medicare and if no one in the medical community...hospital, clinics, private can NOT take money from you for treatment ...it must first go through the Medicare system for payment then of course you then must pay for what Medicare doesn't pay which is always more than what Medicare pays. This recent rebate everyone in the nation is suppose to get is coming out of the Medicare/Medicaid system so the elderly rebate is half and some services will be canceled. The poor and the elderly have always paid for these kinds of programs...thank you Mr. Bush. But anyway so yes you must sign up for Medicare first then you also MUST apply for secondary insurance...which can be whomever you chose...but it is mandatory. It is tough getting any clinic to take Medicare patients and some refuse to take any and some limit how many Medicare patients they will take simply because Medicare doesn't pay squat. HIPAA has nothing to do with insurance...it is just to my knowledge a law that protects your medical information privacy.

I can tell you without a doubt that I had a choice if I wanted Medicare. I automatically got Medicare Part A (at no cost) but I had complete freedom to turn down Part B and stick with private insurance. I also did NOT have to get a supplemental insurance policy once I decided to go with Medicare.

As I said in another post, HIPAA was originally intended to protect patients' privacy, but it blossomed into many other things, one of which IS that an insurance company is required to accept you if coming off of a group plan without a break in coverage, or at least that is true is certain circumstances. When the original poster (I'm sorry I don't remember your screen name and can't go back and look without losing this) posted her question, she indicated that her husband was quitting his job and they were looking into private insurance, which is exactly what my husband did. The insurance company told me flat out that I was uninsurable and had I NOT been covered at some point, they could turn me down, but HIPAA REQUIRED them to take me since I was coming off a group plan with no break in coverage.

I also had a choice. I received part A and turned down part B because I chose to stick with my husband's insurance. It was a very good plan.

Madalot, I also was told flat out that because of my condition I wouldn't be able to get insured. The man I spoke to on the phone said no one will insure me, I could try, but they will all deny me. I was shocked!

I just hope I am able to stay on Disability for the Medicare. I should be due for my first review soon. I would hate for them to take it away from me.

Always Smiling --

This discussion may need to move to the disabilities board, but I have the same issues as you. I'm on disability and am up for review in July. I would be shocked if they found me NOT disabled, but stranger things have happened. The insurance issue would be a serious problem if that were to happen as I am pretty certain I would be unable to get back on my family's individual plan.

Let's hope that doesn't happen to either one of us. :)

There is a thread on the Disabilities Board that discusses SSA Disability review dates in detail. You might want to check it out.

Just wanted to chime in to correct some misinformation above. 1) You do have a choice about Medicare. You receive part A but it is up to you whether or not to sign up for part B. However, you should note that if part B is not elected, and then 3 years down the road you decide that you want it, you have to pay the back premiums from when it was initially offered. Also, 2) it is NOT mandatory to have a secondary insurance with Medicare, but if you're Medicare eligible then it is in your best interest to get a good Medicare plan rather than just straight-up Medicare, or even a supplement to fill in some of the gaps.

HIPAA does have to do with both protecting your privacy and it can also guarantee you coverage in certain situations. It is usually moving from group or govt sponsored plans to the same -- not moving to an individual plan. There are a handful of states though that do have individual HIPAA plans that would be required to accept you if you have had continuous group/govt coverage without lapsing for more than 63 days -- I don't know if your state is one of those. It's really a good idea to work with a local independent ins. agent to find out your best options are - there is no cost to do this, and they should be very familiar with the laws and options available in your state. Good luck!