Marriage

[jrodsun]

Hello,

Looking for helpful information, my fiance and I are scheduled to married May 2nd. We have been together for four years now and going strong. The problem we are having and kind of stressing over is: Jamie has CF and is currently insured under Medicaid as primary and Medicare as her secondary. We were recently told that after marriage, Medicaid takes our wages into consideration and the possibility of losing insurance rises. I just wondered if anyone has any recommendations, info., or can relate to this situation? I can say we already checked the option of adding her to my insurance through work but is entirely way to expensive (I basically would be working for insurance). So that option is off the board. Any info will be helpful, and I thank you for your time in advance.

 

[believingjesus]

I am not familiar with Medicaid or Medicare but I'm wondering why her Medicare would not cover everything if she already qualifies for it as a secondary? I believe Medicaid is based on your income, right? If she already has Medicare as a secondary then she is probably technically "disabled", right? I would think Medicare would cover everything then. I definitely would never want to be without insurance having cystic fibrosis, even if it meant living in a shack or with relatives, etc., as CF is such a high-cost disease and without needed medicines her health could decline significantly pretty quickly. If Medicare does not kick in to cover her - have you looked at insurance through the marketplace (Affordable Care Act)? If your insurance through your employer is so expensive there probably is another option through the marketplace hopefully. My son is supposed to be off our insurance this year. I am terrified of it all but I guess somehow we will manage to get through it but we will be sure he has insurance no matter what.

 

[jrodsun]

Yes she is considered full disability right now. Currently Medicaid is her primary and medicare is her secondary. When you are married medicaid takes into consideration your joint wages. We have been told by her case worker that depending on how much you make there will definitely be some sort of spend down through medicaid but also the possibility of being dropped completely from medicaid. If this happens Medicare would take over as her primary. We have been told if this were to happen Medicare would only cover 80% of the medical expenses, the other 20% is up to the insured. This is why we have begun looking at secondary insurance options. Having CF 20% could potentially be an overwhelming amount especially if she would need to be hospitalized. I looked through my work insurance but unfortunately is not an option because of the price. We also talked to her Medicare case worker but could not tell us anything until we are married which we thought was weird. So our feelings now are a crap shoot. We are gambling on tying the knot, and her healthcare.

 

[believingjesus]

That's sad that you both are in that situation. 20% of medical expenses for cystic fibrosis is tremendous and unmanageable unless you are very rich. I didn't know that Medicare only covered 80%. Maybe some others that are in the same situation out there will see this and let you know how they manage it. Does the 20% mean exactly that or is there a deductible and co-insurance and then they cover the expenses? I don't know if the health insurance plans on the marketplace are for secondary insurance or not? We have never had secondary insurance and have always had a lot of out-of-pocket each year but rarely could claim any of it on taxes as it never exceeded the now 12% of our income that the IRS requires to claim one cent, close though.

 

[ethan508]

Is there any out of pocket Max on that 20%? That would at least give you a cap, year to year. I believe there are some 'donut hole' insurances that might fill the medicare gap for you.

Secondly, your fiance's CF clinic should have a social worker. This person might have a better view of your options than the medicare case workers. See if all three of you could meet to discuss your health coverage options. It might be good to bring actual numbers to that discussion. Have your tax forms (so you know your exact incomes), maybe some private insurance quotes, as well as some insurance quotes from the ACA marketplace.

Being married is an awesome thing, but somebody made getting married a lot more effort than it needs to be.

 

[Cat in the Sunlight]

I am disabled and have Medicare. I believe that losing Medicaid coverage would be considered a "qualifying event" in the insurance industry world, and therefore, your fiancé should be eligible to buy a Medicare Supplement Plan. I have Part D, which is for Rx, and Part F which covers the 20% that Medicare doesn't cover after my deductible. The deductible varies by carrier, but it is worth looking into. What you need is an insurance agent who specializes in Medicare. Someone who is qualified to sell Medicare and Supplemental plans will have the answers you need. If there is a health insurance organization in your state, talk to them for a referral. You might look for the National Association of Health Underwriters.

 

[Cat in the Sunlight]

I spoke to someone who is in the insurance industry. His advice was to bypass an insurance agent and contact the insurance company directly. Nationally, Aetna and Humana have Medicare Supplement Plans. There may be additional plants in your state. They can answer all your questions. If more than one company is available to you, compare the plans. The supplemental plans are regulated by Medicare, but there are minor differences which, for us, having CF, can be important. Hope that helps.

 

[triples15]

Hi and welcome Jrod,

I'm really sorry that you guys are having to deal with the stress of insurance stuff when planning your wedding. Honestly, you sound pretty informed so I think you will be able to figure this out it will just take some work!

As "Cat in the Sunlight" (love that name, btw) said, I think a Medicare supplement would probably be your/her best bet. As you know, Medicare does not pay anything NEAR what Medicaid pays, so something is definitely necessary to bridge the gap. Also, as Cat says, losing her Medicaid should be considered a "qualifying event" that allows her to add Part D and a supplement. You've probably already crunched the numbers, but if you work full-time, between your income and her Social Security Disability money, she will most likely no longer qualify for Medicaid. They will also take your assets into consideration.

There is a program called "SHIP" that I consulted a few years ago when I had some questions about Medicare, it stands for State Health Insurance Assistance Program. They offer counseling and assistance to people who are on Medicare. They may be able to help. I believe they have offices in every state. You can use this link to find a local office: https://shipnpr.shiptalk.org/findcounselor.aspx?AspxAutoDetectCookieSupport=1

One other thing I reluctantly want to mention. I know of several CFers (a few are members on this site) who are married, but they are not LEGALLY married. This is for the purpose of the spouse with CF being able to continue their insurance benefits. They refer their significant other as their husband or wife, and consider themselves married, but just never had a signed/filed marriage license. So basically you can invite all the guests, she can wear the white gown, you can dance the night away, an no one ever needs to be any the wiser that you did not legally marry. If you are religious, you are married in the eyes of your higher power, he does not care about a piece of paper (my opinion) if you vowed yourselves to one another. Again, this is just something I wanted to mention. I hope it is not something you two have to make the choice to do, but in my opinion, CFers have got to do whatever they've got to do to be able to take good care of themselves. Luckily in my case, it has actually benefited me to be married as I have had his insurance as my primary (and Medicare as secondary) for years now. It works out pretty well!

Well I better run. Please let us know if you have other questions!

Take Care and CONGRATS!

Autumn 34 w/CF

 

[CFjeff73]

Hello,

Looking for helpful information, my fiance and I are scheduled to married May 2nd. We have been together for four years now and going strong. The problem we are having and kind of stressing over is: Jamie has CF and is currently insured under Medicaid as primary and Medicare as her secondary. We were recently told that after marriage, Medicaid takes our wages into consideration and the possibility of losing insurance rises. I just wondered if anyone has any recommendations, info., or can relate to this situation? I can say we already checked the option of adding her to my insurance through work but is entirely way to expensive (I basically would be working for insurance). So that option is off the board. Any info will be helpful, and I thank you for your time in advance.

I've been together with my significant other for over 11years and I call her "my wife" as we are committed. She wants more than anything to be married but understands the consequences of the medical situation when it comes to the State picking up the Tab. I use Medicare as my primary coverage in conjunction with GoldCoast INS. which I think is a medi-cal program, Medicare pays for 80% of my Doctor bills or medical costs. I also have a secondary coverage that also works with my medical provider it is another CA. State program called the GHPP(The Genetically Handicapped Persons Program) in which picks up the other 20% I cannot afford. I also receive SSDI(Social Security Disability Insurance) money every month and it is literally like only 40 dollars over the mark so it excludes the State from fully paying Doctors bills or prescriptions I have. Having been over the poverty line by just a tad(40bux a month), the State says I have something now called "a share of costs" it's something like 647.00 that I have to payout as a deductible and for my Doctors bills or prescriptions there are small co-pays per drug and for me it comes out to like 40bux a month for my share of cost on my prescriptions, so it isn't so bad... BTW I've even tried to do something called "offsetting the share of cost" so I wouldn't pay by getting Dental Insurance and telling the State I pay for it as a medical cost per month but they have rejected the notion twice so I have to live with the ridiculous fact that because I am getting monthly money 40bux over that I now have to pay 17times as much in medical bills subtracting from my living expenses so instead of getting 1200bux a month I now live on 600 all because the govt. counts down to the penny.

But here is the bad part.... "WE CANNOT GET MARRIED BECAUSE"... The State literally looks at incomes as being combined and you will for sure be over the poverty level if your spouse and you make like 35-40grand combined yearly... I know it doesn't make any sense that if your pulling in 15grand in disability a year and your wife makes like 22grand at a poverty type job that the state will consider the barely higher income to be able to afford the 20% cost that Medicaid or the secondary State program like a GHPP that covers but yes, you become your own problem at that point for the FULL 20% outside of medicare as you simply don't qualify for help. So yeah the State takes an inventory on how much you make as A COMBINED HOUSEHOLD or Married Income.

I go to the hospital 3 to 4 times a year for my tuneups and each visit is like 120-140grand meaning that the 20% the State Now pays for me minus my share of cost would all change after marriage and I would have to put up would be aprox. $28,000 times 4 trips a year equaling $112,000 per year. I couldn't even pay 10% of that on my disability a year. Plus also make note that the State and Aid programs take an inventory on your property as well so don't plan on owning a house because they need you to sell it off and be destitute before they will help out reasonably.

So sorry if this isn't the news you were expecting but all that other stuff I'm reading about people suggesting "Go See a Social Worker" or what not is baloney and the Government only sees in Black and white and counts down to the very penny and more and more there relief programs are just turning into crisis programs.

Hope this Information Helps as I know I have Cystic Fibrosis and I can't afford to take chances so I keep it simple. You don't need someones piece of paper and some hospital visitation Privileges to be married just some love in the heart. Peace, Love and Light!

 

[MomD]

I would put Jamie's medical needs above all else. If it means having a symbolic ceremony with close friends and family to "publicly commit to each other" in order to maintain her Medicaid/Medicare insurance benefits I would postpone marriage at this point in time. If you love each other and are committed to each other you don't need a piece of paper to prove it if it is going to sabotage her healthcare. The new Vertex drugs on the horizon are going to be very good but very costly. I would give it a few years to see how things shake out with these drugs and how insurance companies are going to deal with them. I'm sorry if this is a disappointing response but I would kick every social expectation to the curb to keep the one I loved healthy.

 

[cflawyer]

Approximately half of all states do not require an insurance company sell a Medicare Supplement policy to someone who is receiving Social Security Disability benefits. Therefore, that may not be an option in your state.
Medicare Part B is the section of Medicare that covers outpatient services and treatment. Medicare pays 80 percent of the cost for Part B services and there is no cap on out of pocket costs under Part B. If a person has Medicaid in addition to Medicare then Medicaid covers the Part B 20 percent co-pay.

The CF Legal Information Hotline can provide free and confidential information on issues related to Medicare, Medicaid and insurance issues. The Hotline is staffed by attorneys who have focused their work on issues people with CF face related to Social Security benefits, government benefits and insurance. You can contact them at CFLegal@sufianpassamano.com or 1-800-622-0385. The project is funded by the CF Foundation but the attorneys are not employees of CFF and all contacts are confidential. Benefit questions are complex and it is important to obtain information from sources that understand the complex issues people with CF face.

 

[cfgf28]

I work in medical billing, and I have never heard of medicaid being primary, it's always payer of last resort. Many patients ha e medicare, then medicaid with a spenddown. You would pay a certain portion to social services, or your medical provider or pharmacy and give social services the proof and Medicaid is turned on for the rest of the month, or year depending how much you paid. Most hospitals have charity care programs that are income based, that will give you a break on the uncovered portion of hospital bills. The state we live in also has a program for people with cf, that you pay 7 percent of your after tax income to, and they reimburse for everything related to cf including insurance premiums. You can also claim medical expenses on your taxes. My fiance and I are getting married in august, and we will end up paying more for somethings, as we both currently have insurance but I have 2 children and get mine reimbursed through medicaid.Neither one of us is rich by any means, and it may screw us as he gets older, and can't work any longer, but I guess we will figure that out later...

 

[ClassyMike]

you don't mind me asking but what state has the 7% percent program?

 

[ethan508]

As stated above you will have a Medicare/Medicaid impact to getting married. But there can be tax benefits to being married, typically when one partner makes considerably more money than the other. I suppose the benefits are more helpful to people in a higher tax bracket. As you figure out your life together, taking the tax advantages of marriage into consideration might take a little pressure off your budget.

 

[cfgf28]

New york has a program for adults with cf

 

[CFjeff73]

As stated above you will have a Medicare/Medicaid impact to getting married. But there can be tax benefits to being married, typically when one partner makes considerably more money than the other. I suppose the benefits are more helpful to people in a higher tax bracket. As you figure out your life together, taking the tax advantages of marriage into consideration might take a little pressure off your budget.

Okay People on this thread... How is an income tax going to offset the HIGH expenses of continuous medical treatments and unexpected emergency treatments?! If I get back a lousy $2,000 a year or even a higher tax bracket and get a $10,000 return how is that going to cover the 20% that Medicare wont pay when medicaid drops you as a client for having too much of a combined yearly income. Once again a STANDARD CF TUNEUP(for a 2 week stay, 10g's a day) is literally 120-140grand base cost per hospital stay without specialty circumstances as that is even extra. Do we have $28,000 a year to blow per visit on out of pocket medical coverage?... now that I'm older I go in 3 to 4 times a year, do we have $112,000 per year to cover the 20%, is a tax return going to be viable yearly?.. especially when you are on disability you get no return!

Then there is Disability that most CFer's end up on. If you're lucky enough to have earned enough "yearly points" working at a jobs over the years lets say from age 16 to 32 you might end up with what I get around $1,200 a month Soc. Sec. Disability Income(SSDI)[which I'm being penalized for overworking putting me slightly over the poverty level](the State doesn't fight fair only in Black and White). If you are not lucky enough to even qualify for SSDI because the State says you can't prove you are debilitating then you will have to lawyer up and cross your fingers and pay out to a lawyer some of the money that should be yours. So If you are sick too many times a year and can't hold down a job steadily your point system will lower and if you do qualify for SSDI you might end up with luckily $600-700 a month but the good part is you will be in the poverty level and the state will pick up that extra 20% assuming you don't have a house or nice car first or a nice savings account OR ARE MARRIED raising your income.

If you Can't qualify for SSDI then even worse you will end up on welfare where they will give you like 80bux in food stamps and maybe $300 a month to live on until your lawyer wins your case.

Okay so we know the government deals in Black and White and LITERALLY counts your income to the dollar even cent, they will assist you but if you MARRY someone like I said your Black & White outlook changes. It drives me wild to see all the comments being made on this post "Talk to a Lawyer", "talk to a Social Worker," "Rely on income tax returns," "look into diff. insurance programs"... I'm giving you the playbook w/o sugarcoating it, and the simple truth is Marriage is not for CFer's unless you have a cool couple million TO BLOW on medical expenses outside of your assets, and even at that 2million might not be enough...

You can have all the aspects of a wedding you want in a commitment ceremony but if you make it legally binding on paper the simplest truth is it will absolutely effect your insurance coverage and it will absolutely effect your income thus effecting the insurance THE STATE will cover for you. I'm not trying to break hearts and hurt feelings but this is the truth for my safety and the top notch care that I deserve when being treated for CF and my wife AS I CALL HER is hip to what is going on in the world before entering a binding contract.

May all the Love in the world carry you and your partner safely and truthfully when it comes to dotting your i's and crossing your t's when living with CF. Love and Light always!

 

[welshwitch]

What about California's Genetically Handicapped Program (GHPP?) Could this protest us Californians if we wanted to get legally married?

 

[believingjesus]

CFJeff - I was going to recommend that he not get married in my post at the beginning of this thread but I did not want to sound negative and am working on this really hard - to see the good side, not just the bad. I also did not know any way to help him other than to tell him about different insurance programs through the ACA. I know people are just trying to help - just like you are - and may not know all that you know so I am glad you are giving us your experience. I believe the SSDI is so screwed up already. I didn't know you couldn't make too much money or it affects how much disability you make someday? I also didn't know that a person only will get around $1,200 a month! I don't know how anyone can live on that. Thank you for sharing what you know.

 

[CFjeff73]

CFJeff - I was going to recommend that he not get married in my post at the beginning of this thread but I did not want to sound negative and am working on this really hard - to see the good side, not just the bad. I also did not know any way to help him other than to tell him about different insurance programs through the ACA. I know people are just trying to help - just like you are - and may not know all that you know so I am glad you are giving us your experience. I believe the SSDI is so screwed up already. I didn't know you couldn't make too much money or it affects how much disability you make someday? I also didn't know that a person only will get around $1,200 a month! I don't know how anyone can live on that. Thank you for sharing what you know.

Happy to help through this experience. Yes there is a capp. in which the govt. see's a poverty level, in the State of California it is something like $1,210 a month at present and like I said I make barely over it so THE SYSTEM really is Black and White and if you cross the line it's simple... you pay. In fact I got a job for 7 years on the ticket to work program and I was also making a little over the limit of $780.00 a month outside of receiving SSDI and didn't know this until the government told me so a year later and they threatened to take away my monthly disability for 9months to pay back the 9grand(as you literally get zero money SSDI monthly for going over even a buck which is a maximum like a 2grand a month income) and I told them I couldn't survive so they made a deal with me back in 2008 to pay them $100.00 a month out of my disability monthly deposit until the year 2016 so technically I originally make like 150 dollars over poverty level but I don't get the 1,360Dollars monthly until after next year as that will complete the 9year repay of 1,200 a year for being over my monthly limit for 9 months of the observed yearly 12 months back in late 2007...needless to say I cut down on my work hours and took smaller money making shifts at noon instead of night. Make no mistake the government seems to reward laziness as I might have retired from working earlier had I have know it would effect my medical coverage and "share of costs." Essentially I screwed my self twice over for not knowing the rules.

And to "WelshWitch" question as to weather GHPP will cover all cost that the secondary medicaid program wont because of "The Share of Cost deductible" the answer is "NO" GHPP the medicade program requires you to pay your "Share of Cost" for being over the poverty level and GHPP cannot and will not pickup the full difference because GHPP is a State run program and so is medicade or Goldcoast so they all work in junction with one another. It's mandatory that you use your monthly SSDI disability to cover the copay/"share of cost" and in my case the "share of cost" is $667.00 a month deductible for Doctors/Hospitals and a per cost prescription deductible which for me comes out to $40bux a month. However GHPP still is covering there part for me but medicare is still requiring a deductible so until they get that strait I'm in the clear for a bit. BTW this whole share of cost nonsense only started a couple years back so I'm not so in the hole but I don't care about my credit and let it all go to collections, I figure the CF clinic isn't going to refuse me since I'm such a good customer and still pay almost the full amount with Medicare & GHPP;-).

Oh almost forgot, the reason why this "share of cost" scenario is happening to me is because in the past, prior to the last couple years I was deemed as "A Floater" by the State and what that means is that some months I would make under the poverty level and others I would make over... it really hit me hard when I went in for some dental work and I was approved through GHPP and after doing half the work of a root canal they went to check my payment status and it said I owed the $667.00 deductible before they would cover the rest and it just so happened that the work it self was about that same amount but either way I didn't have the money so my mom had to help out.

So to once again not scare you "At this point in time" GHPP still is picking up some of the difference but Goldcoast/Medicaid is insisting on a Share of cost deductible but I think they are paying some of it too, not 100% but I still go in for tune-ups 3 times a year without a problem.

Yeah a little bit about my background, I started working minimum wage jobs from age 16 in high-school all the way to age 38 I was healthy enough to have a waiter job which paid minimum plus tips so I was making almost 30grand a year and in some years I would have 2 waiter jobs and make like 55grand so it was easy for me to maintain a good point system but it isn't the amount of money you make that determines points its just the fact that you work yearly that does. I tried to push myself at a cashier job last year as I was able to ween off using oxygen for periods but it became too much and I had to quit so I'm just focusing on my health in my retirement ;-).

Hope this info helps you out on the system at large cause the Govt. doesn't mess around. In fact, here is a story off topic... in 1998 I owed $1,300 in taxes because my restaurants said I under allocated my amount(which i did) of declared tips I got but instead of paying the government I bought a computer LOL. Man the Govt. even garnished my wages when I was making a lousy $250bux a week and it scared me so much that I didn't want to file for a few years and it was stupid to think this way because the newer restaurants didn't allocate me for my tips as the law changed and you are required to report 8.9% of your sales. I was entitled to like 5grand back because I was working 2 jobs. Then when Bush took office he had a special break on paying your taxes that I did as it made it so there was no interest and also the price was reduced for back taxes but when I was filing I was not entitled to the 5grand and other thousands from other years because the State has a 2year "statue of limitations" to collect your money so I lost out even though the government actually owed me 8 times as much as I ever did. errrrrr where was my responsibility but the computer was fun! hehehehe

 

[ethan508]

... How is an income tax going to offset the HIGH expenses of continuous medical treatments...

This is a misinterpretation of what was said. A person isn’t going to cover all of his health cost with tax savings, but a person sitting on the bubble of affordability would surely like to look into any tax saving he/she might get. For me personally, my health care coverage is +$150/month more because of a spouse. That is in the ballpark of tax saving I get from filing my taxes jointly.

... I'm giving you the playbook w/o sugarcoating it, and the simple truth is Marriage is not for CFer's unless you have a cool couple million TO BLOW on medical expenses outside of your assets, and even at that 2million might not be enough...

Marriage can be for CF-ers. Actually the only CF-er I know personally (nine total) that isn’t married is still in 5[SUP]th[/SUP] grade, and not one of them had $1M (note: the preceding anecdote is a product of my social bias, i.e. I meet CF-folks the same way I meet other folks, in the neighborhood, at work, and at the occasional social thing, therefore my sample is a self select of middle class utah/idaho folks).

Now marriage might not be for all CF-ers, but I feel it is up to each individual CF-er to do his homework and figure that out. Not all insurances are 80/20, not all employees offer terrible coverage, not all states regulate the marketplace the same, and not all state social programs have the same rules. That is why you have to do your homework prior to taking the plunge. No doubt this sucks. But at least after doing your homework you will know if you need to postpone legal marriage (maybe indefinitely), or find a different job, or move to a different state. Not great options, but options indeed. And some of these options that have worked for some CF-ers.