Touchy Subject

I am going to talk about something I hate to talk about. It’s something political, to a point, and it’s about the ugly truth of healthcare from my perspective. I am not going to badmouth anyone because that’s not who I am, I am going to tell you my healthcare struggle. Maybe you’re where I’m at. Maybe you can relate. Maybe we can all get together and tell local and federal government our stories of struggle and get something changed. That’s my hope.

Medicaid and Heath-care marketplace is great if you have these things going for you:

  1. you work and can get a tax credit for the healthcare marketplace
  2. you are 133% at or below poverty level you can get medicaid in a lot of states
  3. you are elderly, a mother of children under 18, or a child.
  4. you have SSI or SSDI or some other form of disability ruling (this get’s tricky)
  5. you are blind

If you are like me,  you’re stuck.

I have Arthritis, Scoliosis of the lower back, Peptic Ulcer Disease, Hidradenitis Suppurativa, IBS, and Diverticulosis that keep me out of work, lower my quality of life, and and cause me to be disabled. I am lucky to go to a local clinic for primary care that is based on income. However, I go to 3 specialists outside my clinic that I get charged full price for. I see a digestive health specialist, a dermatologist, and a surgeon. Soon, I might have to see more specialists for my allergies, scoliosis, and arthritis. I have put those off due to lack of insurance and only taking care of the most major issues right now. My diseases will never go away and I will need ongoing care. My hospital,  who bills for my specialists and surgery, is trying to get me approved for patient financial assistance, but that might not take care of all my bills. I am over $6,000 in debt with the hospital and that is BEFORE my upcoming surgery. I also have to pay for all my medications out of pocket and rely on GoodRX or other discount coupons to cover just some of the costs. With a fixed income, this is hard to do. After bills, food, and toiletries, we only have about $264-314 a month left. That’s not including any medication cost, car repairs/up-keep that may be needed, or clothing. This just includes rent, electric/trash, cable/internet, cell phone (prepaid), doctor copay, laundry, car loan payment, food, gas for the car, and toiletries/cleaning supplies. We don’t get to go out and have fun like most people. If we go out to eat, like for my husband’s upcoming 40th birthday, we take the money out of the grocery funds. Hey, it’s food, right.

My husband is a disabled veteran and get’s a non-service connected pension with aid and attendance. He is fully covered under VA healthcare but, because he is not service connected, I do not qualify for VA healthcare. If he was 100% service connected I would qualify. It has to be 100% connected, though. This needs to change. He served his country just 7 years after a traumatic brain injury that almost killed him and left him in a coma for months. He now has seizures, sleep apnia, PTSD, Bipolar, Intermittent explosive disorder, psychosis (sometimes), high pitch hearing loss and wears hearing aids, memory issues (short and long term), communication problems due to brain injury, and depression/anxiety. All those things except the TBI where diagnosed after serving, but the VA argues that it was not aggravated by service. That, I feel, is a load of bull, but they at least give him a non-service connected disability pension with aid and attendance and full healthcare. Bottom line, veteran wives should be allowed healthcare with a non-service connected disability. I am the one caring for him anyway. Thankfully, he does not need physical help unless he’s having a seizure and then only to turn him on his side and remove anything that can hurt him during the event or tend to injuries if he, God forbids, ever fell and hurt himself having a seizure.

My husband does not make taxable income so, we do not get any tax credits for the healthcare marketplace. The lowest healthcare for me would be $400 a month premium, $9,000 deductible a year BEFORE insurance paid, and then insurance would only pay 50% of anything. That’s over half my husband’s pension each year! This needs fixed so more people like me with preexisting conditions and chronic illnesses can get the care they need. It should be based on income (taxed or not).

I am 42 years old and was a stay at home mother a lot when my kids were young. I applied for SSI and SSDI to be deemed disabled and get medicaid. I did not work enough to get the credits I need for SSDI. Therefore, I am not insured. My husband makes too much in unearned income for me to get SSI so, the social security office sent me a letter stating they are refusing to go further to even RULE if I am disabled or not. I would have to be awarded just $1 to get Medicaid. I am not, so I can’t get medicaid that way. I feel Social Security should at least finish the disability determination and deem someone disabled or not just so they can AT LEAST get healthcare through medicaid. I, like a lot of people in my shoes, did not want money, I need help with my healthcare.

My last option is to apply for Disability Medicaid with my state, which my Primary care doctor’s office advocate and the hospital advocate is helping me do. I have to prove to Medicaid that I am disabled and need help by providing financial documents, hospital and doctor records, and medication receipts. I have done this. Here’s the catch with that. They may say my husband makes too much and approve me for the spin down program. This means I will have to pay monthly for my medicaid premium each month. This is based on two things: Income and medical expenses. If my medication and medical bills that month are the same or more than my monthly premium, I do not have to pay that month. If it’s not, I have to pay all the premium or the difference. This would be great IF we had more than $264-314 a month. They don’t care about your bills that you pay either. They only look at your rent, a small % of your utilities, and MAYBE transportation costs. I am actually not 100% sure on this and just assuming it’s the same as it is for food stamps (which we don’t get). Either way, if I am approved, that’s better than no healthcare. If I am denied, I am appealing this all the way!

I hope and pray some government official reads this and does something to help our citizens that fall through the cracks like I do. Do you have the same problem? tell me your story. Email me. We can take out stories to Washington and MAYBE someone will fix this on a federal and state level. *not holding my breath*


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