CR 175: 21st infusion; health insurance questions

To work around the holidays, my biweekly Thursday appointments at Hopkins were moved to Tuesday (Dr. Hahn's clinic days are Tuesday and Thursday). I drove up to Baltimore at the crack of dawn for an 8:30 am vitals check, then met with the good doctor. I noted how the itching on the back of my neck and scalp had gotten more intense in the past couple of weeks, approaching the level of mosquito bites. He suggested topical ointments if it became unbearable, but I'm not yet at that point. I'm assuming the itching will come and go as it has before. He said to let him know if it got much worse, because that could be a sign of an autoimmune reaction. Other than that, everything was normal.

While the pharmacy was compounding my dose of Opdivo, I had breakfast in the Hopkins cafe. Their custom-made omelets are a good way to pass an hour. The infusion was routine. I'm glad my port is working properly.

After I was finished at Hopkins, I met with my insurance agent to review my life and disability coverage, as well as discuss options regarding health insurance in 2016. It looks like my law firm soon will be merging with a larger firm, and partners are bring asked to make a multi-year commitment to the new enterprise. I have been on full disability since late 2012 and barely working since then, and do not believe it would be fair to the new firm for me to make such a commitment going forward. As a result, I anticipate taking a formal disability retirement from my firm's partnership. I am grateful to my law partners for how they have supported me for the past few years.

The question is, where do I get my health insurance for 2016. As a law firm partner, I pay 100% of the cost of my family health insurance, which for 2015 is about $28,000. My currently law firm likely will be dissolved, and if that happens, there will be no entity that holds the obligation to provide health insurance through COBRA. I'm currently assessing whether the new firm will assume the COBRA obligations of my current firm, and if so, exercising that option likely will be the most seamless option. But it will also be the most expensive option.

Other options include my exercising my Medicare insurance. I have been Medicare eligible since October 2014, but have not exercised it since I was technically still employed and receiving insurance through my law firm. If I trigger that option, then I'd have to start paying my Part B costs, plus figure out whether I'd doing a Medicare Advantage plan, and if so, which one. That's a pain. Plus, Medicare covers just the individual; it would not provide insurance for the rest of my family.

For them, I could go into the health insurance marketplace set up by Obamacare and see what coverage I could get. I have been told that it's illegal for anyone to sell me insurance in the marketplace if I am Medicare eligible. But I've also been told that there is an exception to that rule, so I could participate in the marketplace, but I would not be eligible for any subsidies. 

Assessing all of these health insurance options gives me a headache. But at least I've got options, the tools to assess them, and the means to pay for the insurance. For that I am grateful.

After meeting with my insurance agent, I went to my dentist. Every time I go to a dentist I think of the scene in Marathon Man ("Is it safe?") I've gone to the dentist only once since I was diagnosed in 2011, thinking that I'd probably die before I needed a root canal. But now that there is a chance that I might live with metastatic bladder cancer for longer than 5 years, and since I don't know what my dental insurance will be in 2016, I thought I might as well bite the bullet (so to speak) and find out why my rear molars occasionally hurt. It turns out that three of my 4 rear molars have large fillings that are cracked, chipped, and with some decay underneath. Two will need new fillings, and one will need a crown. I'll get one side done next week, and the other the week after. Having dental work done is a pretty tangible suggestion that I'm thinking I might live a little longer after all. I think it will be worth it.