Major health issue - finding new employment with health coverage

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Elemental
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Major health issue - finding new employment with health coverage

Post by Elemental » Wed Apr 26, 2017 12:04 pm

I'm trying to figure out how I can find new employment when my family has major health insurance needs. I'm currently employed (USA) with excellent health insurance, but wishing for employment with a different company.

One of my family members has a medical condition that requires expensive tests multiple times per year, and requires medication to the tune of $80,000 per year (retail cost). This is not going away, and will most likely get worse as time goes on.

Here are the questions I want to figure out. I'm grateful for any insights you have.
  • How do I find out if a potential employer offers health coverage that would cover my pre-existing conditions?
    Would a potential employer cover the medication that I need on their prescription meds plan, and at what cost to me?
    How do I go about researching a potential employer - would it be prior to interviews or an employment offer?
    Is it even moral or ethical for me to seek employment with another company, knowing they will get huge insurance bills for my family?
    If the employer is small (fewer than 50 employees), would the added insurance cost to cover my family bankrupt them, or force them to drop coverage?
    Can my current employer decide to let me go because I cost so much to cover (current employer is very large and self-insured)?
I recently passed on en excellent job opportunity because it was so difficult to get the answers to these questions, and I was concerned with the current government health care system. I know that is a political issue, so I won't go there, but it plays a factor here.

Thanks for helping me navigate this situation.

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dm200
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Re: Major health issue - finding new employment with health coverage

Post by dm200 » Wed Apr 26, 2017 12:15 pm

Elemental wrote:I'm trying to figure out how I can find new employment when my family has major health insurance needs. I'm currently employed (USA) with excellent health insurance, but wishing for employment with a different company.
One of my family members has a medical condition that requires expensive tests multiple times per year, and requires medication to the tune of $80,000 per year (retail cost). This is not going away, and will most likely get worse as time goes on.
Here are the questions I want to figure out. I'm grateful for any insights you have.
  • How do I find out if a potential employer offers health coverage that would cover my pre-existing conditions?
    Would a potential employer cover the medication that I need on their prescription meds plan, and at what cost to me?
    How do I go about researching a potential employer - would it be prior to interviews or an employment offer?
    Is it even moral or ethical for me to seek employment with another company, knowing they will get huge insurance bills for my family?
    If the employer is small (fewer than 50 employees), would the added insurance cost to cover my family bankrupt them, or force them to drop coverage?
    Can my current employer decide to let me go because I cost so much to cover (current employer is very large and self-insured)?
I recently passed on en excellent job opportunity because it was so difficult to get the answers to these questions, and I was concerned with the current government health care system. I know that is a political issue, so I won't go there, but it plays a factor here.
Thanks for helping me navigate this situation.
While it may (not sure) not be fully "legal", I am guessing that asking too many questions about high health claims might be viewed negatively by the prospective employer.

Unless changes are implememted in the future, I suspect that almost all employers do not exclude pre-existing conditions.

I am guessing that larger employers would pose the lowest risk (on average).

My guess also is that a government entity employer might have the lowest risk in your case.

Yes, despite possibly not being "legal", I believe there is a risk of being let go for this reason. I am guessing that this is higher risk with smaller employer.

I would not ask about such benefits details until an offer is made. Then, ask for retirement plans, ehalth insurance details, etc. You would hope that the health insurance details would address pre-existing conditions. Also, watch closely when the new coverage goes into effect. It might be several months, so make 100% sure to have COBRA in effect.

Since you have a good situation now (health insurance related), I can certainly see your concerns.

Dottie57
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Re: Major health issue - finding new employment with health coverage

Post by Dottie57 » Wed Apr 26, 2017 12:17 pm

Elemental wrote:I'm trying to figure out how I can find new employment when my family has major health insurance needs. I'm currently employed (USA) with excellent health insurance, but wishing for employment with a different company.

One of my family members has a medical condition that requires expensive tests multiple times per year, and requires medication to the tune of $80,000 per year (retail cost). This is not going away, and will most likely get worse as time goes on.

Here are the questions I want to figure out. I'm grateful for any insights you have.
  • How do I find out if a potential employer offers health coverage that would cover my pre-existing conditions?
    Would a potential employer cover the medication that I need on their prescription meds plan, and at what cost to me?
    How do I go about researching a potential employer - would it be prior to interviews or an employment offer?
    Is it even moral or ethical for me to seek employment with another company, knowing they will get huge insurance bills for my family?
    If the employer is small (fewer than 50 employees), would the added insurance cost to cover my family bankrupt them, or force them to drop coverage?
    Can my current employer decide to let me go because I cost so much to cover (current employer is very large and self-insured)?
I recently passed on en excellent job opportunity because it was so difficult to get the answers to these questions, and I was concerned with the current government health care system. I know that is a political issue, so I won't go there, but it plays a factor here.

Thanks for helping me navigate this situation.

Health insurance market Is part ofb the compensation package. Any large employer should give you information on health coverage before or during an interview offer. Once again it is part of cmpensation. I would not want to work for a small company who self insures as they may end up knowing about your health issues.

The best idea to get thhe desired info is to ask about ALL benefits.

Grt2bOutdoors
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Re: Major health issue - finding new employment with health coverage

Post by Grt2bOutdoors » Wed Apr 26, 2017 12:21 pm

They aren't going to tell you that. If they disclosed it to a potential candidate it could open them up to liability issues, no corporate attorney would sign off on that. As far as cost, your guess is as good as mine, typically when times get tough the first things employers look at are compensation and benefits costs. I don't believe they can turn you down for pre existing issues due to the ACA law that was passed a few years ago. As far as ethics and morals, IMO there should not be an issue here. Can you bankrupt a company? Not likely, what may happen is they may curtail future coverage options and/or raise costs across the entire pool of employees to absorb the costs or they may give employees a voucher and have them purchase a plan on a healthcare marketplace.
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Rupert
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Re: Major health issue - finding new employment with health coverage

Post by Rupert » Wed Apr 26, 2017 12:26 pm

When you say you are "currently employed (USA)" and are frustrated with the "current government healthcare system," do you mean you work for the federal government? Because the federal government offers its employees a choice of multiple insurance policies, most of them very good.

If what you mean instead is that you work for a private company in the USA and are frustrated with the country's healthcare system in general (or Obamacare in particular), then that's another matter, and you are not alone. I think it's perfectly appropriate to ask a potential employer about the health benefits they offer during the hiring process. It is not appropriate, however, for them to ask you about your or your family's health conditions during that process. It is also not appropriate for you to volunteer that information.

Each employer's health plan is going to be different; so it's not possible for anyone here to tell you what a potential employer's prescription drug plan will cover and at what cost to you (unless you name the employer and someone here happens to work for them). The best way to find out that sort of information is to talk to present employees of the companies you are considering working for. I actually don't know of any other way to find out that information that wouldn't set off red flags for a company considering hiring you. Obamacare stopped insurance companies from denying coverage due to pre-existing conditions. So long as Obamacare remains the law of the land, you shouldn't worry about that. Prior to Obamacare, small businesses (less than 50 employees, I think) were allowed to deny coverage for pre-existing conditions for specified periods of time under HIPAA. My understanding is that this aspect of HIPAA was replaced by the no-prexisting-conditions-exclusions provisions of Obamacare.

You seem to think small employers self-insure or something? Why would you ask if your family's medical bills would bankrupt the company? The cost of a company's insurance doesn't necessarily increase because one family covered under the plan is high cost. The cost of their coverage might increase, but it's complicated -- too complicated to explain here. No, your current employer can't fire you because someone in your family has a medical problem that is expensive to insure.

Note that very small employers (less than 20 employees, I think) aren't covered by COBRA, which means they don't have to permit you to continue coverage under their health plan when you terminate employment. So you'd have to find new employment immediately or find insurance on the open market if you were to lose your job. So I agree with the previous posters that sticking with large employers or government employers would be a safer choice for you.
Last edited by Rupert on Wed Apr 26, 2017 12:31 pm, edited 1 time in total.

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dm200
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Re: Major health issue - finding new employment with health coverage

Post by dm200 » Wed Apr 26, 2017 12:27 pm

I thought (could be wrong) that under the ACA there were or are some provisions that reduced the risks for small employers being hit as hard when an employee incurred large health/medical expenses.

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Re: Major health issue - finding new employment with health coverage

Post by Grt2bOutdoors » Wed Apr 26, 2017 12:29 pm

Dottie57 wrote:
Elemental wrote:I'm trying to figure out how I can find new employment when my family has major health insurance needs. I'm currently employed (USA) with excellent health insurance, but wishing for employment with a different company.

One of my family members has a medical condition that requires expensive tests multiple times per year, and requires medication to the tune of $80,000 per year (retail cost). This is not going away, and will most likely get worse as time goes on.

Here are the questions I want to figure out. I'm grateful for any insights you have.
  • How do I find out if a potential employer offers health coverage that would cover my pre-existing conditions?
    Would a potential employer cover the medication that I need on their prescription meds plan, and at what cost to me?
    How do I go about researching a potential employer - would it be prior to interviews or an employment offer?
    Is it even moral or ethical for me to seek employment with another company, knowing they will get huge insurance bills for my family?
    If the employer is small (fewer than 50 employees), would the added insurance cost to cover my family bankrupt them, or force them to drop coverage?
    Can my current employer decide to let me go because I cost so much to cover (current employer is very large and self-insured)?
I recently passed on en excellent job opportunity because it was so difficult to get the answers to these questions, and I was concerned with the current government health care system. I know that is a political issue, so I won't go there, but it plays a factor here.

Thanks for helping me navigate this situation.

Health insurance market Is part of the compensation package. Any large employer should give you information on health coverage before or during an interview offer. Once again it is part of compensation. I would not want to work for a small company who self insures as they may end up knowing about your health issues.

The best idea to get the desired info is to ask about ALL benefits.
Large employers are not going to hand you a 150 page+ description of health benefits along with an offer letter. Usually they will state your offer of $X dollars including eligibility to participate in comprehensive healthcare coverage (but they don't go into details) including dental coverage, life insurance, X weeks or days of vacation, etc. Most large employers have a PBM manager which offers a series of Tier medications, what you are using today may or may not be the preferred medication and your co-pay or deductible may be higher based on medication used and you may need to go through either healthcare counseling or pre-approval each and every time you need to fill the prescription. Don't underestimate the ability for large or even mid size employers to maximize cost savings for them. There is a whole industry built around this.

As for last question of OP - employer can not discriminate based on health status, it's against the law and you can sue if termination was solely based on your health status.
"One should invest based on their need, ability and willingness to take risk - Larry Swedroe" Asking Portfolio Questions

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dm200
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Re: Major health issue - finding new employment with health coverage

Post by dm200 » Wed Apr 26, 2017 12:35 pm

Rupert wrote:When you say you are "currently employed (USA)" and are frustrated with the "current government healthcare system," do you mean you work for the federal government? Because the federal government offers its employees a choice of multiple insurance policies, most of them very good.
If what you mean instead is that you work for a private company in the USA and are frustrated with the country's healthcare system in general (or Obamacare in particular), then that's another matter, and you are not alone. I think it's perfectly appropriate to ask a potential employer about the health benefits they offer during the hiring process. It is not appropriate, however, for them to ask you about your or your family's health conditions during that process. It is also not appropriate for you to volunteer that information.
Each employer's health plan is going to be different; so it's not possible for anyone here to tell you what a potential employer's prescription drug plan will cover and at what cost to you (unless you name the employer and someone here happens to work for them). The best way to find out that sort of information is to talk to present employees of the companies you are considering working for. I actually don't know of any other way to find out that information that wouldn't set off red flags for a company considering hiring you. Obamacare stopped insurance companies from denying coverage due to pre-existing conditions. So long as Obamacare remains the law of the land, you shouldn't worry about that. Prior to Obamacare, small businesses (less than 50 employees, I think) were allowed to deny coverage for pre-existing conditions for specified periods of time under HIPAA. My understanding is that this aspect of HIPAA was replaced by the no-prexisting-conditions-exclusions provisions of Obamacare.
You seem to think small employers self-insure or something? Why would you ask if your family's medical bills would bankrupt the company? The cost of a company's insurance doesn't necessarily increase because one family covered under the plan is high cost. No, your current employer can't fire you because someone in your family has a medical problem that is expensive to insure.
Note that very small employers (less than 20 employees, I think) aren't covered by COBRA, which means they don't have to permit you to continue coverage under their health plan when you terminate employment. So you'd have to find new employment immediately or find insurance on the open market if you were to lose your job. So I agree with the previous posters that sticking with large employers or government employers would be a safer choice for you.
1. In the 90's to early 2000's I worked for a small company whose health insurance premiums were higher because one employee's husband incurred very high health/medical expenses and those costs were passed along. I think that may have changed, but who knows what the future will bring.

2. The point about COBRA is very important. In your situation, I would not work for an employer that was not required to offer COBRA.

3. Many companies (in my opinion) may discriminate (unfairly of not within the law/regulations) for this kind of issue. These probably would be smaller companies.

4. If you know current employee(s) at a prospective employer, such folks might be able to give some feedback on the issue.

5. If this family member is a child/minor, be aware of if/when he/she may not be included in the insurance plan.

6. Even if coverage is OK for you, the provider network might be an issue/problem.

Elemental
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Re: Major health issue - finding new employment with health coverage

Post by Elemental » Wed Apr 26, 2017 12:40 pm

Thanks for your replies and follow-up questions
Rupert wrote:When you say you are "currently employed (USA)" and are frustrated with the "current government healthcare system," do you mean you work for the federal government?
No, I was just indicating I am a citizen and employed in the USA
Rupert wrote: You seem to think small employers self-insure or something? Why would you ask if your family's medical bills would bankrupt the company? The cost of a company's insurance doesn't necessarily increase because one family covered under the plan is high cost. The cost of their coverage might increase, but it's complicated
I'm just thinking if they were to hire an "expensive" employee and see their rates skyrocket, it could be a problem for them financially. If it were family-owned or tight-knit or something, I would think that would be bad for all employees, and maybe especially the new guy.

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Re: Major health issue - finding new employment with health coverage

Post by peek » Wed Apr 26, 2017 12:42 pm

I have a family member with some health issues. They are not as high cost as yours but we need to have decent medical coverage. I've changed jobs 3 times in the past 5 or 6 years and had no issues from any employer getting a pretty comprehensive list of their insurance and drug coverage prior to accepting an offer. I currently work for the state and their information was all available on the public website so I could see it before I even interviewed. I would have no hesitation to ask for this information as it is part of your compensation package. I've even asked for it prior to interviewing when a small company is involved that may have low quality health coverage. Once you get the information on the insurance company (or choices of companies) you can call them and get detailed information if it's not in the packet provided. As far as cost to the employer it will cost them in some way if you have a cost this high. My current employer buys their health insurance directly (as far as I know) but the employer I recently left self insured. They had a pool of money set aside for insurance costs and they shouldered up to a certain amount. Above that amount the actual insurance would kick in. Essentially they were gambling that they wouldn't have high claim costs. In researching companies (if they are public) you can see how they pay for insurance on their financial statements. In your situation I would be looking at large companies with deep pockets that could shoulder the costs. Even then they could let you go due to the costs but I believe it would be illegal to do so.

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Re: Major health issue - finding new employment with health coverage

Post by jalbert » Wed Apr 26, 2017 12:58 pm

How do I find out if a potential employer offers health coverage that would cover my pre-existing conditions?
A preexisting condition exclusion would not be legal under Title 45 › Chapter A › Subchapter B › Part 147 › Section 147.108 of the Affordable Care Act, which remains the law of the land at the time of this writing:

https://www.law.cornell.edu/cfr/text/45/147.108
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Re: Major health issue - finding new employment with health coverage

Post by KlangFool » Wed Apr 26, 2017 1:20 pm

Elemental wrote:
One of my family members has a medical condition that requires expensive tests multiple times per year, and requires medication to the tune of $80,000 per year (retail cost). This is not going away, and will most likely get worse as time goes on.
Elemental,

Not the question that you asked, but if I am you, I would start a new thread and ask how to reduce that cost. Or, where can you go to find that kind of information.

KlangFool

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dm200
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Re: Major health issue - finding new employment with health coverage

Post by dm200 » Wed Apr 26, 2017 1:26 pm

jalbert wrote:
How do I find out if a potential employer offers health coverage that would cover my pre-existing conditions?
A preexisting condition exclusion would not be legal under Title 45 › Chapter A › Subchapter B › Part 147 › Section 147.108 of the Affordable Care Act, which remains the law of the land at the time of this writing:
https://www.law.cornell.edu/cfr/text/45/147.108
Could be wrong, but I thought there were some "grandfathered" exceptions.

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Re: Major health issue - finding new employment with health coverage

Post by jalbert » Wed Apr 26, 2017 1:34 pm

Look at the last section d of the text at the end.
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Re: Major health issue - finding new employment with health coverage

Post by junior » Wed Apr 26, 2017 1:41 pm

Grt2bOutdoors wrote:They aren't going to tell you that. If they disclosed it to a potential candidate it could open them up to liability issues, no corporate attorney would sign off on that.
At a large employer presumably OP could locate a retired employee or two and ask them off the record about the health plan. OP might even find a current employee willing to have an off the record conversation.

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dm200
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Re: Major health issue - finding new employment with health coverage

Post by dm200 » Wed Apr 26, 2017 1:44 pm

jalbert wrote:Look at the last section d of the text at the end.
Thanks. That explains it.

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Re: Major health issue - finding new employment with health coverage

Post by tech_arch » Wed Apr 26, 2017 2:03 pm

Elemental wrote:I'm trying to figure out how I can find new employment when my family has major health insurance needs. I'm currently employed (USA) with excellent health insurance, but wishing for employment with a different company.

One of my family members has a medical condition that requires expensive tests multiple times per year, and requires medication to the tune of $80,000 per year (retail cost). This is not going away, and will most likely get worse as time goes on.

Here are the questions I want to figure out. I'm grateful for any insights you have.
  • How do I find out if a potential employer offers health coverage that would cover my pre-existing conditions?
    Would a potential employer cover the medication that I need on their prescription meds plan, and at what cost to me?
    How do I go about researching a potential employer - would it be prior to interviews or an employment offer?
    Is it even moral or ethical for me to seek employment with another company, knowing they will get huge insurance bills for my family?
    If the employer is small (fewer than 50 employees), would the added insurance cost to cover my family bankrupt them, or force them to drop coverage?
    Can my current employer decide to let me go because I cost so much to cover (current employer is very large and self-insured)?
I recently passed on en excellent job opportunity because it was so difficult to get the answers to these questions, and I was concerned with the current government health care system. I know that is a political issue, so I won't go there, but it plays a factor here.

Thanks for helping me navigate this situation.
My $0.02...

At some of the smaller companies DW and I have worked for (<100 employees) they've had employees submit health questionnaires that are sent to the insurance companies so that they could get pricing for the group plans. We've definitely seen spikes in costs before when the insurance was "used" heavily in the previous year. I don't think this would bankrupt a company or force them to drop coverage, but if they can only afford to contribute $X toward the premiums then the increase in premiums would be spread out over all employees. But that's how insurance works - everybody pays a bit and sometimes you need a lot.

As for researching employers: Big ones might have the benefits readily available on their web site. If not, ask about *all* benefits at the appropriate time during the interview and learn what plans are available. I've never seen a company withhold that information and I would never accept a job offer without that knowledge.

Overall, I would feel safer at a larger company if I was worried about insurance.

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Re: Major health issue - finding new employment with health coverage

Post by runner3081 » Wed Apr 26, 2017 2:18 pm

I used to work in HR in the past and we never had a problem handing over the Summary Plan Description to candidates we were well into the process with.

And actually, for my last two positions, I asked and received the plan document and rates prior to accepting the offer. No issues (one is a MegaCorp and the other was around 150 employees).

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Re: Major health issue - finding new employment with health coverage

Post by JGoneRiding » Wed Apr 26, 2017 2:29 pm

I think you could have a significant issue with a small employer. They have no obligation to cover family members and the smaller pool could massively drive up costs for them. I would avoid any company with less than 100 and for sure less than 50 as that level has no obligation to cover you at all.

This could be an issue with any medium size company as well because my understanding of current law is family isn't included in obligations. A large company isn't going to care. They either offer it or don't and unlikely to pick on you

Elemental
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Re: Major health issue - finding new employment with health coverage

Post by Elemental » Wed Apr 26, 2017 4:02 pm

Thank you everyone for your thoughtful replies. I've learned a lot today, and have some good notes for follow-up research. I wish I would've consulted this group earlier!

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dm200
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Re: Major health issue - finding new employment with health coverage

Post by dm200 » Wed Apr 26, 2017 4:04 pm

JGoneRiding wrote:I think you could have a significant issue with a small employer. They have no obligation to cover family members and the smaller pool could massively drive up costs for them. I would avoid any company with less than 100 and for sure less than 50 as that level has no obligation to cover you at all.
This could be an issue with any medium size company as well because my understanding of current law is family isn't included in obligations. A large company isn't going to care. They either offer it or don't and unlikely to pick on you
Good point! I had forgotten that family/dependent coverage is not a requirement.

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Re: Major health issue - finding new employment with health coverage

Post by Artful Dodger » Wed Apr 26, 2017 4:20 pm

I'll give you my take.

How do I find out if a potential employer offers health coverage that would cover my pre-existing conditions?

As noted above this shouldn't be an issue. ACA did away with pre-ex clauses, and even before ACA, the HIPAA regs from the 90s gave full credit for meeting a pre-ex wait if covered for a minimum year with current employer.

Would a potential employer cover the medication that I need on their prescription meds plan, and at what cost to me?

Without access to the employer's health plan RX formulary, you won't know for sure. From experience, all plans I've seen will either cover the drug you mention or an equivalent. They may require yyour dependent try some other drugs (step therapy) and at least go thru prior authorization.

How do I go about researching a potential employer - would it be prior to interviews or an employment offer?

It seems to me that if you are looking at a larger employer, almost all 50+ (and most 25+) employee entities have health insurance. The outliers are those that hire lots of low wage folks: restaurants, lodging, retail, etc. If you're applying for a professional level position, almost all will offer coverage. I would make the determination based on the actual job duties and compensation, then if interested ask to review their benefit programs as part of your evaluation. If you find a position you really like, but it doesn't offer coverage, then calculate the cost to buy a plan through the marketplace (also guaranteed issue / no pre-ex due to ACA), and take that into consideration.

Is it even moral or ethical for me to seek employment with another company, knowing they will get huge insurance bills for my family?

You don't know if they will get huge bills or not. The type of claim you mention is common and most employers in the 50+ category will have one or two similar situations. For large employers, 150+, you would see very little impact. For the 500+ category, that is an insignificant claim.

If the employer is small (fewer than 50 employees), would the added insurance cost to cover my family bankrupt them, or force them to drop coverage?

Here is the way insurance works under ACA. In most states, the small group rules apply to employers with under 50 lives, the rest use 100 employees as the cut off. The vast majority of these employers now have community rates under the ACA, which means they are 100% pooled with other similar sized employers, and the medical costs from one employee have no impact on the employer's rates.

There are some exceptions - grandfathered plans (insurer can use past claims history in setting future rates), and small / medium size partial self-funded employers. This is a small subset, and usually limited to employers whose demographics (younger, especially younger males) will generate costs below the community rated ACA plans. Pre-ex is waived in these partial self-funded plans to be compliant with the ACA, but as noted above, when the employer shops for new coverage they may ask their employees to complete health questionaires, and the insurance company will use the info in rate setting.

Once above the 50 (or 100, depending on state) level, underwriting (medical conditions evaluation) is allowed for fully insured groups for rate setting.

Long answer short - No you won't bankrupt them. If they fall into the grandfathered or partial self-funded type, they can always go to the community rated ACA rates that most smaller employers already have.

Can my current employer decide to let me go because I cost so much to cover (current employer is very large and self-insured)?

Legally, no. In practical terms, very unlikely.

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Re: Major health issue - finding new employment with health coverage

Post by rjbraun » Wed Apr 26, 2017 9:43 pm

Something I haven't seen mentioned but that could be an issue to OP, I would think: in my experience, companies can change their healthcare coverage terms as well as their healthcare providers. In that regard, I would think that OP may want to consider the prospect of said employer's coverage possibly becoming less attractive at some future date (for whatever reason, unrelated to his situation). All else equal, that would seem to be (yet) another reason to work for a larger employer, as they would presumably be more likely to have a more stable plan than a smaller outfit.

Not an expert on this topic, so more experienced BHs should feel free to address any incorrect assumptions I may have made.

Note: I realize that one can only deal with the information they have presently, but given rapidly escalating healthcare costs, it doesn't seem crazy to me to assign some probability to a change in healthcare benefits (for the worse).

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Re: Major health issue - finding new employment with health coverage

Post by WolfgangPauli » Wed Apr 26, 2017 9:49 pm

I would check with a lawyer to be sure but, under the law as it currently exists, they have to take you and cannot deny you for pre-existing conditions.

Many employers have a 60 or 90 day waiting period but you can cover under COBRA during that time so you would have full coverage.

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Re: Major health issue - finding new employment with health coverage

Post by Elemental » Thu Apr 27, 2017 2:40 pm

KlangFool wrote:... if I am you, I would start a new thread and ask how to reduce that cost. Or, where can you go to find that kind of information.

KlangFool
Yes, I would like to find a lower cost alternative. As it is, our insurance covers 99% of the cost, and the drug company financial assistance program helps with the majority of our copay. We are very fortunate to be in that situation.

We are at the beginning of this journey, so I'm not even sure this particular medication will be effective (it takes 6 months or so for it to become effective). We may need to try different medications in the future. This is the first medication prescribed by our healthcare team. It is a newer drug on the market, but they all seem to be extremely expensive.

Thanks again everyone for such thoughtful and helpful replies.

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dm200
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Re: Major health issue - finding new employment with health coverage

Post by dm200 » Thu Apr 27, 2017 3:57 pm

rjbraun wrote:Something I haven't seen mentioned but that could be an issue to OP, I would think: in my experience, companies can change their healthcare coverage terms as well as their healthcare providers. In that regard, I would think that OP may want to consider the prospect of said employer's coverage possibly becoming less attractive at some future date (for whatever reason, unrelated to his situation). All else equal, that would seem to be (yet) another reason to work for a larger employer, as they would presumably be more likely to have a more stable plan than a smaller outfit.
Not an expert on this topic, so more experienced BHs should feel free to address any incorrect assumptions I may have made.
Note: I realize that one can only deal with the information they have presently, but given rapidly escalating healthcare costs, it doesn't seem crazy to me to assign some probability to a change in healthcare benefits (for the worse).
While most employers (especially smaller and private) offer one health insurance provider and may change from one year to another, some larger employers and government entity employers may offer several.

freebeer
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Re: Major health issue - finding new employment with health coverage

Post by freebeer » Thu Apr 27, 2017 4:09 pm

In your shoes I would definitely skew towards bigger companies if possible but a 100 person company or even a 50 person company is unlikely to see any major hit since they are almost certainly part of a group plan so are in effect just a piece of a larger risk pool that includes other companies. So I don't think there is any reason to fear that not disclosing this will put the company in a bad way or you in bad standing later. You probably can get the medical coverage details and even the plan documents before accepting an offer but I wouldn't ask for them until an offer was in hand. While shopping companies probably all you need to know is whether their medical benefits are considered "good" and you can probably get that from glassdoor if not the company's own website.

mouses
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Re: Major health issue - finding new employment with health coverage

Post by mouses » Thu Apr 27, 2017 5:13 pm

I haven't had time to read all the replies.

I have read of scenarios like this:
small company
one employee has giant medical bills
insurance company raises the small company's rates through the ceiling
small company has to let the employee go as it just can't afford the rates.

Jackson12
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Re: Major health issue - finding new employment with health coverage

Post by Jackson12 » Thu Apr 27, 2017 5:32 pm

My spouse's employer ( a large company) discloses health benefits and employer matches for insurance, pre-tax retirement plans, , etc.,,during interviews.

The rationale is that it helps motivate potential employees to accept job offers. And it seems to work.

Ther is plenty of competition for jobs offered and candidates are often above those applying for the same types of jobs at similar companies with less generous benefits.

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Re: Major health issue - finding new employment with health coverage

Post by Elemental » Thu Apr 27, 2017 5:34 pm

mouses wrote:I haven't had time to read all the replies.

I have read of scenarios like this:
small company
one employee has giant medical bills
insurance company raises the small company's rates through the ceiling
small company has to let the employee go as it just can't afford the rates.
This is the scenario I'm concerned about. From earlier replies, it sounds like this may not be legal (but probably hard to prove). I do wonder how much the employer is made aware of specific claims or the cost to cover a specific employee. If this information is shared between employer and insurance provider, it seems like an employee could be targeted.

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munemaker
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Re: Major health issue - finding new employment with health coverage

Post by munemaker » Thu Apr 27, 2017 8:25 pm

Elemental wrote:
mouses wrote:I haven't had time to read all the replies.

I have read of scenarios like this:
small company
one employee has giant medical bills
insurance company raises the small company's rates through the ceiling
small company has to let the employee go as it just can't afford the rates.
This is the scenario I'm concerned about. From earlier replies, it sounds like this may not be legal (but probably hard to prove). I do wonder how much the employer is made aware of specific claims or the cost to cover a specific employee. If this information is shared between employer and insurance provider, it seems like an employee could be targeted.
Health claim information is protected by HIPPA regulations. I doubt that the employer is even going to know which employee's spouse is making the big claims. An exception is self insured plans where employers will have more insight into the person making the claims; even then, only a few specific employees (e.g. HR) are authorized to the HIPPA protected info. If a company dismisses an employee due to medical claims, file a complaint with the DOL, as this is illegal.

Fortune
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Re: Major health issue - finding new employment with health coverage

Post by Fortune » Thu Apr 27, 2017 9:53 pm

Elemental wrote:
mouses wrote:I haven't had time to read all the replies.

I have read of scenarios like this:
small company
one employee has giant medical bills
insurance company raises the small company's rates through the ceiling
small company has to let the employee go as it just can't afford the rates.
This is the scenario I'm concerned about. From earlier replies, it sounds like this may not be legal (but probably hard to prove). I do wonder how much the employer is made aware of specific claims or the cost to cover a specific employee. If this information is shared between employer and insurance provider, it seems like an employee could be targeted.
I faced this situation a few years ago, when one or two employees had a "large" expense, premiums for everyone in the small company (150-200) increased. And you can justify and number with a reason!

JGoneRiding
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Re: Major health issue - finding new employment with health coverage

Post by JGoneRiding » Thu Apr 27, 2017 10:11 pm

munemaker wrote:
Elemental wrote:
mouses wrote:I haven't had time to read all the replies.

I have read of scenarios like this:
small company
one employee has giant medical bills
insurance company raises the small company's rates through the ceiling
small company has to let the employee go as it just can't afford the rates.
This is the scenario I'm concerned about. From earlier replies, it sounds like this may not be legal (but probably hard to prove). I do wonder how much the employer is made aware of specific claims or the cost to cover a specific employee. If this information is shared between employer and insurance provider, it seems like an employee could be targeted.
Health claim information is protected by HIPPA regulations. I doubt that the employer is even going to know which employee's spouse is making the big claims. An exception is self insured plans where employers will have more insight into the person making the claims; even then, only a few specific employees (e.g. HR) are authorized to the HIPPA protected info. If a company dismisses an employee due to medical claims, file a complaint with the DOL, as this is illegal.
Have you never worked for a small company (I mean less than 50 employees)??? we have about 30 at ours, spouses can purchase coverage at full price, first off most "laws and protections" are limited at this size. Second everyone knows everything about everyone. It would be highly unlikely not to know exactly who is causing rates to increase. Plus owner=HR most of the time. Good luck suing, these are tiny companies. The op question clearly doesn't want to be in that situation--he should stick to larger employers and he will be fine, avoid startups

tj
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Re: Major health issue - finding new employment with health coverage

Post by tj » Fri Apr 28, 2017 10:28 pm

Have you checked lowestmed and goodrx prices for the drug?

Rupert
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Re: Major health issue - finding new employment with health coverage

Post by Rupert » Sat Apr 29, 2017 8:36 am

tj wrote:Have you checked lowestmed and goodrx prices for the drug?
When you take a drug this expensive, your insurance company usually requires you to buy it from one particular specialty pharmacy that they have a contract with. You don't have the option of shopping around. Just fyi.

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dm200
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Re: Major health issue - finding new employment with health coverage

Post by dm200 » Sat Apr 29, 2017 9:41 am

munemaker wrote:
Elemental wrote:
mouses wrote:I haven't had time to read all the replies.

I have read of scenarios like this:
small company
one employee has giant medical bills
insurance company raises the small company's rates through the ceiling
small company has to let the employee go as it just can't afford the rates.
This is the scenario I'm concerned about. From earlier replies, it sounds like this may not be legal (but probably hard to prove). I do wonder how much the employer is made aware of specific claims or the cost to cover a specific employee. If this information is shared between employer and insurance provider, it seems like an employee could be targeted.
Health claim information is protected by HIPPA regulations. I doubt that the employer is even going to know which employee's spouse is making the big claims. An exception is self insured plans where employers will have more insight into the person making the claims; even then, only a few specific employees (e.g. HR) are authorized to the HIPPA protected info. If a company dismisses an employee due to medical claims, file a complaint with the DOL, as this is illegal.
In a very small company, this is no "secret". If it is common knowledge that an employee's family member has significant health/medical needs, then the situation is obvious.

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