I meant to blog about being BRCA+ and obtaining life insurance a while ago, but an article that appeared yesterday in the Sydney Morning Herald gives me occasion to remedy this oversight. Although the piece touches on all aspects of genetic testing (and how the results might effect insurance coverage), for our present purposes, it features a BRCA+ woman who struggled to get life insurance after her positive result.
Eventually, [Dianne Fisher] was able to obtain cover but at the cost of a high premium. "I [subsequently] had both my breasts removed and my ovaries removed," Perth-based Fisher says. "But I still had difficulty getting my insurance dropped down to a normal rate, even though I now have no risk whatsoever of getting breast cancer or ovarian cancer."
Now, forgiving for the moment that she is a little misguided about her breast and ovarian cancer risk (even risk-reducing surgeries don't eliminate entirely the possibility of cancer), she has a point: on the one hand, yes, we have a genetic predisposition to developing certain types of cancer, but on the other, that information allows us to make choices about our health to lower our risk below that of the average women. So how should we be classified by insurers? High risk or low risk?
The article was out of Australia, and it illustrates that different countries regard genetic test results differently. In the UK for instance, the article reports, "Insurers abide by a voluntary ban on access to predictive genetic tests that was agreed with the government in 2001. The moratorium applies to policies of up to £500,000 ($858,400) of life insurance." In the US, it reports, "The 2008 Genetic Nondiscrimination Act now states health insurers can't deny coverage or charge higher premiums on the basis of genetic test results." But, of course, GINA does not apply to life insurance, so it's a bit of a mystery how it is factored in in the US. (A spokesman for the American Council of Life Insurers says in the article, "In general, insurers are not quick to embrace new technologies such as genetic testing." Which seems a little absurd to me, but moving on...)
So how does it work on the ground? My experience with life insurance was positive, even after testing positive. In fact, although I recommend getting life insurance BEFORE you get your test results, it is far from impossible to get good coverage at a good rate AFTER your test. To be honest, life insurance was the furthest thing from my mind before I tested; all I was focused on was the result. It wasn't until I learned my status and decided to proceed with prophylactic bilateral mastectomy that I recognized the need to buy a new policy (I have one through work, but it's not very big). At this same time, G and I were in the process of buying our first place, and I realized that we both needed policies, should something happen to either of us, to help with mortgage payments, student loan repayment, etc. All of our insurance policies are through State Farm, and our agent is wonderful, so last summer, G and I went to her office to discuss life insurance. I was completely honest about my genetic test results. She had never encountered such a situation before (just goes to show how rare we really are), but thought that it wouldn't affect my rate at all. I was completely honest about my health history and went through all the requisite physical examinations. And in the end, she was right -- my genetic test results didn't affect my rate at all. I did not, however, qualify for the preferred rate (and instead was covered at the standard rate) not because of BRCA but because of three other little letters that have haunted my life: OCD. I've been treated for the condition since grade school, and apparently, a history of an anxiety disorder is more damning that a genetic prediction of my future cancer risk. (On this note, there have been a spate of fascinating articles and studies published recently debating the efficacy of antidepressants, and a recent essay by Louis Menand in the New Yorker, which asks whether psychiatry can be a science, points out that treatment of mental illness can affect insurance rates for those that might not be sick, only different. I definitely had no idea my history with anxiety could be a black mark on my medical record in this way.)* Incidentally, G wasn't covered at the preferred rate, either, because he takes blood pressure medication (medication I secretly don't think he needs). It just goes to show you that it's always something (in the words of the Roseanne Roseannadanna).
I've now got life insurance, yes, but it likely isn't enough. It's enough for now, of course, but going forward, as G and I start a family, we'll need to revisit the issue. We also bought term policies instead of whole life policies (which accrue cash value), mostly because we felt we couldn't afford the latter right now. But in the future, this is likely something we'll invest in. Also, we didn't necessarily shop around; we went directly to someone we like who represents a company we trust. Maybe next time we'll do more research. But the questions remain: How will my rate be affected now that I've had preventative surgery? How will my rate differ now that I'm off meds (that's the subject of a very happy post that's yet to be written)? I'll let you know when I find out. But for now the message is this: even if you are BRCA+, you can get life insurance. And if anyone wants the number of my agent, I'd be happy to share. She's a doll.
* In researching this post, I also came across a new study that suggests antidepressants may block Tamoxifen. Not that this has anything to do with the topic at hand, but suffice it to say that's another reason why chemoprevention would not have been right for me.