CR 189: 22nd infusion; insurance for 2016

I've found that the early appointments at Hopkins are far more likely to be on time or even early, as opposed to the later morning or afternoon appointments where delays are the norm. Today I left home before 7 am and rolled into the hospital in less than an hour, since there was relatively light traffic. My appointment with Dr. Hahn was routine. My rash continues to come and go; nothing serious. I mentioned how I recently had read a journal piece that he co-authored entitled "New Strategies in Bladder Cancer: A Second Coming for Immunotherapy". He said that it was a pleasure to publish a piece that had such broadly hopeful news.

While the pharmacy compounded my does of Opdivo, I got one of those 3 pound omelets that the Hopkins cafeteria is so adept at preparing. While I ate, I looked through the weekly list of new bladder cancer related postings on inspire.com, and added my comments to those questions that fell within my zone of experience. I frequently will get one-on-one follow-up questions, and am happy to share my experiences with fellow bladder cancer warriors and their caregivers. BC is one of the more complex cancers, and is the single most expensive cancer when measured on an average cost-per-patient, because the risk of recurrence is so high. It can take a while for those newly diagnosed to wrap their brains around their new reality.

My infusion was the fastest yet, probably because the nurse gave the pump 30 minutes to push the drug into my body instead of the usual hour. I was out the door by 11:30 am.

Meanwhile, I've spent much of past two weeks assessing my health insurance options for 2016. I recently have decided that I will take a disability retirement from my law firm. I have not been meaningfully practicing law for some time, and am at peace with the idea of retiring. I'm looking forward to spending the time that I have with those that I love. For the firm, my retirement helps make it slightly more nimble as it looks to merge with another firm. I've been grateful for the firm for carrying me since 2012, and in fairness I can't ask it to continue doing so, especially during this time of transition.

In considering my options for future health insurance, the most important criterion to me is that I am able to continue in my clinical trial through Johns Hopkins. I also need to ensure that my family has continual coverage. Cost is a lesser concern, although it is still relevant. I've determined at my options include 1) continuing with my firm's insurance through COBRA; 2) buying Obamacare health insurance through the health insurance marketplace; 3) activating my Medicare eligibility, and my family getting insurance through the marketplace; and 4) enrolling the whole family through GMU, where Jennifer, Spencer, and Kirsten are all enrolled. There are pros and cons to each, as well as a big difference in cost.

Option 1: By virtue of the federal COBRA law, I have the legal right to continue buying health insurance through my law firm for up to 29 months after my retirement. I get an extra 11 months since I am considered totally disabled by the federal government as a result of my mets BC. Continuing with the firm's health insurance through COBRA does not make the insurance more expensive, since as a partner I was paying full freight anyway. I was nevertheless surprised to learn how much our firm's premiums would increase in 2016, however: family coverage for UHC's Choice Plus would run more than $2500/month. While expensive, this option would ensure that I would have continuity of coverage.

The greater risk, however, is that my law firm is acquired by another firm.  If that happens, then my firm likely would be legally dissolved. An employer that is no longer in business does not have an obligation to provide health insurance under COBRA. Whether that would happen with my firm is out of my control, so I feel obligated to examine my alternatives.

Option 2: Obamacare for everyone in the family. I've now determined that this is not an option, because I am eligible for Medicare, which rules out my getting Obamacare.

Option 3: Medicare for me, and Obamacare for the family. Exploring this option has forced me to do a deep dive into Medicare. After a good deal of research and a number of phone calls with both Medicare and the Social Security Administration, I have verified that I can activate Medicare outside of the normal enrollment periods, since my retirement constitutes a "special enrollment period." I activate Parts A and B of Medicare by sending to SSA a one page enrollment form, along with a certification from my law firm on Form CMS-L564. I also have been told that there are no Medicare Advantage plans in Fairfax, Virginia (my home county and state) that cover Johns Hopkins Hospital in Baltimore, Maryland. Original Medicare does cover Hopkins, however, and would ensure my continued participation in my clinical trial. Part B will cost about $120/month. I've tentatively decided that's the path that I am going to take, and put my Medicare enrollment forms in the mail this morning. I still need to figure out which prescription drug plan (Plan D) is best for me, but I can't sign up for that until I'm officially enrolled in Medicare.

As for the second half of the question -- Obamacare for the wife and kids -- I spent most of the drive up to Hopkins this morning on the phone with a representative from the health care marketplace, trying to find out the cost of health insurance in 2016 for them. The preliminary answer is that a "gold" plan (80/20 coverage) will run about $1100/month. Because my taxable income for 2016 likely will be limited to my SSDI income, my family would qualify for a $700/mo subsidy. I need to review the plan details some more, but this looks like a viable option. Their enrollment would not take effect until February 1, however, so it makes sense to pay for at least one month of COBRA coverage through my firm.

Option 4: Insurance through George Mason University. Jennifer, Spencer, and Kirsten all are students at GMU. The school offers health insurance for students.  For a single student from January-August 2016, it costs about $1600. For a student and two or more dependents, it costs about $5000 for the 8 month period. The scope of coverage looks similar to the Obamacare gold plan, and the net cost is slightly higher. But because Jennifer and Spencer are graduating in 2016, they would not be able to continue getting GMU insurance past August. So there is little reason to go down that pathway for such a short duration.

In sum, it looks like I'll exercise my COBRA rights for January 2016, then go with option 3 thereafter. Hopefully it all will work out.

After I finished at Hopkins, I went to my dentist for a crown and another filling. After spending the past couple of weeks studying my health insurance options, it actually felt good to numb my skull.