According to the law: a multiple coverage strategy for major medical needs.

I constantly hear from people with MS who don't think they can get any kind of health insurance anymore. But it probably isn't true. It may help to do some "out of the box" thinking.

Most people envision health insurance as one big package designed to take care of all health-care needs. Indeed, most insurance obtained as a benefit of employment is a big-package deal.

But multiple sclerosis is not insurable at the same rates as other health needs. And it may not be necessary to subject your entire coverage needs to the expensive rates MS requires. There are some advantages to dividing your needs into five categories: 1) major medical expenses not due to MS; 2) hospitalization expenses not due to MS; 3) major medical expenses due to MS; 4) hospitalization expenses due to MS; and 5) expenses of long-term services.

Advance planning is the critical element here. The strategy I propose takes a period of years to mature, and requires some investment. You may need to carry multiple policies simultaneously to achieve continuity of coverage. But it may allow you, eventually, to avoid the trap of insurance that determines where and how you are employed ("job lock") -- or prevent you from having to leave the work force to accept Social Security disability benefits in order to meet your health insurance needs with Medicare coverage.

[Editor's note: This strategy has no relation to the recent federal law allowing a pilot program to test "medical savings accounts" for individuals.]

Here's how the multiple coverage strategy works for major medical needs. (In a future article, I will explain a hospitalization coverage strategy.)

First, don't let your current insurance lapse -- whatever it is. Then, as back up, seek out a second portable, preferably nonemployment-based, major medical and hospitalization policy for all health risks except the MS. These are often called policies with "waiver" or "exclusion" provisions.

Next, seek insurance to cover risks attributable to the MS only. One insurance product that can help is a "catastrophic" or "excess" major medical policy. After a high deductible has been met (usually $25,000 to $50,000), this product usually provides 100% coverage.

Many people are understandably put off by the high deductible, but these deductibles don't work like regular deductibles. Because you are not covered by the "catastrophic" insurance until your condition has been declared catastrophic, the deductible does not have to be measured by the amount that you have paid out of pocket. Instead, these deductibles can generally include all amounts paid toward your MS expenses.

For example, a catastrophic policy with a $25,000 revolving 36-month deductible simply requires that $25,000 be paid toward a given health condition within a 36-month period by any accepted payer -- including you, another insurance company, worker's compensation, VA benefits, even Medicare. If your MS has cost an accumulated amount equal to $25,000 in expenses to all of your payers, your condition could be declared catastrophic, and MS expenses would then be covered, usually at 100%.

Catastrophic plans tend to be inexpensive. The best buys are available through very large groups; for example, you might be able to buy good major medical coverage, with a catastrophic deductible of $25,000 and $1 million of maximum coverage, for an annual premium of about $200.

Since such plans almost always have waiting periods of a year or two for pre-existing conditions, you will have to hold out during the waiting period, and during the time you are accumulating deductible expenses. Over this period other health insurance would have to be available to pay for MS-related health-care costs.

But, if you can find and lock in a guaranteed renewable catastrophic plan early enough in the course of your disease, you can ultimately limit your lifetime liability. When combined with any other form of health insurance (including employer-sponsored group major medical), a catastrophic plan can reduce your overall exposure to financial risk for health care to a fixed amount even in the absence of continuation of coverage.

Group catastrophic or excess plans can typically be obtained only through large associations or groups, so you need a bit of luck. I found mine through the American Bar Endowment. Check whether group-rate catastrophic or excess major medical coverage is available from any professional or trade associations, religious or fraternal groups to which you belong or which you are eligible to join.