Marriage and CF

ltlhook · Jul 21, 2011

I was married at 18 and my husband (now ex) was in college. I was receiving SSI and the amount I received was determined by how much he brought in each month. I had it figured out down to a the dollar how much he could make in order for me to still receive my SSI. The reason I was able to be on state medicaid was because of the SSI I was receiving. So I had it figured out how much he could make that would still allow me to still get at least a $1 of SSI which in turn means i would still get my medicaid. We made it work but then he quit school and started working more. I then started working in order to get medical insurance for myself to elminate the financial limitations we had. I worked for abotu 5 years and then quit. During this time my ex was self employed. We were NOT able to get insurance because of my pre-exisiting condition of CF. I then applied for disabilty and got denied and then filed an appeal with a lawyers aide and was awarded disability. That meant I got state medicaid once again. After a certain time (can't remember how long it is) medicare kicked in. I forgot to mention I got divorced after I quit working and was finally approved for diabilty. Fast forward 5 years, I married my sweetheart husband last year, whom I have known for 15+ years mind you, our paths met back up in life. He is in the Air Force. I now have yet another government insurance...haha. When we got married we I lost my medicaid but gained the Tricare. I have Medicare as primary and Tricare as secondary now. It has been a headache with the changes with billing issues. We had to try a few different things to try and cut our out of pocket costs. Yes I have "good" insurance but I still have out of pocket cost expecially since I have a lot of doc appts, am in the hospital and on home IV's often along with blood work, port flushes, etc.
 
 
 With all that said I think you need to look at EVERY outcome possible to see if it is a good decision to get married, financially. Me myself I could care less what people say if they think I am living in sin because I "cant'" get married due to financial/healthcare reasons. I had enough people asking when we were getting married and I would say maybe never, who cares! Love is love wheather you are married or not, commited relationships are where it is. I know from experience that a marriage cert does not make your marriage/relationship fool proof, hence getting divorced at age 25 because of my ex cheating multiple times. So nothing is a guarentee.
 
 
 Wow I think I went off on a tangent, sorry about that.

julie · Jul 22, 2011

How in the world do you have any out of pocket while on Tricare? They (not you) are NOT doing something right....

julie · Jul 22, 2011

How in the world do you have any out of pocket while on Tricare? They (not you) are NOT doing something right....

julie · Jul 22, 2011

How in the world do you have any out of pocket while on Tricare? They (not you) are NOT doing something right....

krisjohn53223 · Jul 22, 2011

I have been married for almost 8 years now. We were also very worried about waht would happen with insurance etc, but it all worked out just fine. For awhile, we both had insurance through our employers, so I was always double covered and he had single coverage (He carried family insurance/ I carried single insurance). Then he lost his job so I carried the family insurance. Then he got his job back with was unable to take the insurance since my employer offered it. Now, I just got approved for SSDI so I quit my job and now he was able to pick up insurance again. As far as Medicaid or any additional help, we do not qualify. However, they DO NOT take his money into account, only my assests. Because I have over $2000 in retirement funds, I do not qualify for any extra help. However, if I cash them out, I can get Medicaid (SSI). I am also enrolled in WI Chronic Disease Program which helps with any meds needed for CF. You could ask your CF center if your state has something like this. Also, I am enrolled in all the assistance programs through the drug companies. (TOBI care, Creon helps with my enzymes). Hope this helps.

krisjohn53223 · Jul 22, 2011

I have been married for almost 8 years now. We were also very worried about waht would happen with insurance etc, but it all worked out just fine. For awhile, we both had insurance through our employers, so I was always double covered and he had single coverage (He carried family insurance/ I carried single insurance). Then he lost his job so I carried the family insurance. Then he got his job back with was unable to take the insurance since my employer offered it. Now, I just got approved for SSDI so I quit my job and now he was able to pick up insurance again. As far as Medicaid or any additional help, we do not qualify. However, they DO NOT take his money into account, only my assests. Because I have over $2000 in retirement funds, I do not qualify for any extra help. However, if I cash them out, I can get Medicaid (SSI). I am also enrolled in WI Chronic Disease Program which helps with any meds needed for CF. You could ask your CF center if your state has something like this. Also, I am enrolled in all the assistance programs through the drug companies. (TOBI care, Creon helps with my enzymes). Hope this helps.

krisjohn53223 · Jul 22, 2011

I have been married for almost 8 years now. We were also very worried about waht would happen with insurance etc, but it all worked out just fine. For awhile, we both had insurance through our employers, so I was always double covered and he had single coverage (He carried family insurance/ I carried single insurance). Then he lost his job so I carried the family insurance. Then he got his job back with was unable to take the insurance since my employer offered it. Now, I just got approved for SSDI so I quit my job and now he was able to pick up insurance again. As far as Medicaid or any additional help, we do not qualify. However, they DO NOT take his money into account, only my assests. Because I have over $2000 in retirement funds, I do not qualify for any extra help. However, if I cash them out, I can get Medicaid (SSI). I am also enrolled in WI Chronic Disease Program which helps with any meds needed for CF. You could ask your CF center if your state has something like this. Also, I am enrolled in all the assistance programs through the drug companies. (TOBI care, Creon helps with my enzymes). Hope this helps.

ltlhook · Jul 22, 2011

If I have to get a script filled at an outside pharmacy I still have a copay, granted it is not much. When we signed me up on Tricare we opted for Standard not Prime so that I could continue to see my doctors without having to be seen on base and get referrals and all that. I was then in the hospital for a few days and then on IV's for 3 weeks. At the end of the IV's I had about $350 worth of "co-insurance/deductable" to pay. Some things aren't covered under Medicare therefore Tri-care doesn't want to pay either. Anyway we then decided to change to tr-care prime to see if it would change our out of pocket cost for when I am on IV's. I started IV's at home the day the Prime was effective. I have not yet seen any bills or EOB's for those 3 weeks yet. We were told that this should change the way they process things and Tri-care should pay more. You still have a family deductable, personal deductable and all that. I can't remember what they are. So I now have to see a doc on base which limits me a little because I have to get "approved" to see my CF doctor and the others. It's a good thing that my husband is a medic and works with the docs so he can usually just tell them what I need and it can get done.

ltlhook · Jul 22, 2011

If I have to get a script filled at an outside pharmacy I still have a copay, granted it is not much. When we signed me up on Tricare we opted for Standard not Prime so that I could continue to see my doctors without having to be seen on base and get referrals and all that. I was then in the hospital for a few days and then on IV's for 3 weeks. At the end of the IV'sI had about $350 worth of "co-insurance/deductable" to pay. Some things aren't covered under Medicare therefore Tri-care doesn't want to pay either.Anyway we then decided to change to tr-care prime to see if it would change our out of pocket cost for when I am on IV's. I started IV's at home the day the Prime was effective. I have not yet seen any bills or EOB's for those 3 weeks yet. We were told that this should change the way they process things and Tri-care should pay more. You still have a family deductable, personal deductable and all that. I can't remember what they are.So I now have to see a doc on base which limits me a little because I have to get "approved" to see my CF doctor and the others. It's a good thing that my husband is a medic and works with the docs so he can usually just tell them what I need and it can get done.

ltlhook · Jul 22, 2011

If I have to get a script filled at an outside pharmacy I still have a copay, granted it is not much. When we signed me up on Tricare we opted for Standard not Prime so that I could continue to see my doctors without having to be seen on base and get referrals and all that. I was then in the hospital for a few days and then on IV's for 3 weeks. At the end of the IV'sI had about $350 worth of "co-insurance/deductable" to pay. Some things aren't covered under Medicare therefore Tri-care doesn't want to pay either.Anyway we then decided to change to tr-care prime to see if it would change our out of pocket cost for when I am on IV's. I started IV's at home the day the Prime was effective. I have not yet seen any bills or EOB's for those 3 weeks yet. We were told that this should change the way they process things and Tri-care should pay more. You still have a family deductable, personal deductable and all that. I can't remember what they are.So I now have to see a doc on base which limits me a little because I have to get "approved" to see my CF doctor and the others. It's a good thing that my husband is a medic and works with the docs so he can usually just tell them what I need and it can get done.

lhkraus · Jul 22, 2011

For all of you who are LIVING TOGETHER UNMARRIED -- you should definitely SEE A LAWYER. I hate to be brutally frank, but you need to plan for contingencies of illness, or death, because otherwise your "spouse" may be treated like a stranger. If you become sick and unable to handle your affairs, you will want to make sure that your "spouse" can act on your behalf. This can be done by giving your spouse a Power of Attorney for financial matters and by designating him or her as your agent in an Advanced Healthcare Directive. Also, if you have children, you need to set up custody arrangements. And without a Will or Trust, your estate would most likely go to your parents or siblings.

lhkraus · Jul 22, 2011

For all of you who are LIVING TOGETHER UNMARRIED -- you should definitely SEE A LAWYER. I hate to be brutally frank, but you need to plan for contingencies of illness, or death, because otherwise your "spouse" may be treated like a stranger. If you become sick and unable to handle your affairs, you will want to make sure that your "spouse" can act on your behalf. This can be done by giving your spouse a Power of Attorney for financial matters and by designating him or her as your agent in an Advanced Healthcare Directive. Also, if you have children, you need to set up custody arrangements. And without a Will or Trust, your estate would most likely go to your parents or siblings.

lhkraus · Jul 22, 2011

For all of you who are LIVING TOGETHER UNMARRIED -- you should definitely SEE A LAWYER. I hate to be brutally frank, but you need to plan for contingencies of illness, or death, because otherwise your "spouse" may be treated like a stranger. If you become sick and unable to handle your affairs, you will want to make sure that your "spouse" can act on your behalf. This can be done by giving your spouse a Power of Attorney for financial matters and by designating him or her as your agent in an Advanced Healthcare Directive. Also, if you have children, you need to set up custody arrangements. And without a Will or Trust, your estate would most likely go to your parents or siblings.

dukeblue1206 · Jul 22, 2011

<div class="FTQUOTE"><begin quote>Originally posted by: lhkraus

For all of you who are LIVING TOGETHER UNMARRIED -- you should definitely SEE A LAWYER. I hate to be brutally frank, but you need to plan for contingencies of illness, or death, because otherwise your "spouse" may be treated like a stranger. If you become sick and unable to handle your affairs, you will want to make sure that your "spouse" can act on your behalf. This can be done by giving your spouse a Power of Attorney for financial matters and by designating him or her as your agent in an Advanced Healthcare Directive. Also, if you have children, you need to set up custody arrangements. And without a Will or Trust, your estate would most likely go to your parents or siblings. </end quote></div> I am one of the "unmarried" living together and have thought about doing this before but we both have really good relationships with out parents and they all know what needs to go where if I should pass away. So without getting a lawyer involved we decided to trust our parents.

dukeblue1206 · Jul 22, 2011

<div class="FTQUOTE"><begin quote>Originally posted by: lhkraus

For all of you who are LIVING TOGETHER UNMARRIED -- you should definitely SEE A LAWYER. I hate to be brutally frank, but you need to plan for contingencies of illness, or death, because otherwise your "spouse" may be treated like a stranger. If you become sick and unable to handle your affairs, you will want to make sure that your "spouse" can act on your behalf. This can be done by giving your spouse a Power of Attorney for financial matters and by designating him or her as your agent in an Advanced Healthcare Directive. Also, if you have children, you need to set up custody arrangements. And without a Will or Trust, your estate would most likely go to your parents or siblings.</end quote> I am one of the "unmarried" living together and have thought about doing this before but we both have really good relationships with out parents and they all know what needs to go where if I should pass away. So without getting a lawyer involved we decided to trust our parents.

dukeblue1206 · Jul 22, 2011

<div class="FTQUOTE"><begin quote>Originally posted by: lhkraus

For all of you who are LIVING TOGETHER UNMARRIED -- you should definitely SEE A LAWYER. I hate to be brutally frank, but you need to plan for contingencies of illness, or death, because otherwise your "spouse" may be treated like a stranger. If you become sick and unable to handle your affairs, you will want to make sure that your "spouse" can act on your behalf. This can be done by giving your spouse a Power of Attorney for financial matters and by designating him or her as your agent in an Advanced Healthcare Directive. Also, if you have children, you need to set up custody arrangements. And without a Will or Trust, your estate would most likely go to your parents or siblings.</end quote> I am one of the "unmarried" living together and have thought about doing this before but we both have really good relationships with out parents and they all know what needs to go where if I should pass away. So without getting a lawyer involved we decided to trust our parents.

julie · Jul 22, 2011

Yes, PRIME is the way to go with CF. Establish a relationship with your base Primary care physician and nurses so all you have to do is CALL IN to get a referral. I talked to my ex's doctors about it and made it clear we did not want to deal with the hassle/standard requirement of being SEEN first before getting a referral. I mean, for a dermatology referral NOT CF related, sure, I'll play by the rules.

But as far as CF care goes, his PCC coudn't do a darn thing for him so we got to "bypass" the requirment to have an appt. to get a referral and instead just left a msg on the nurse line saying what we needed, and it was processed ASAP.

You should NEVER have a bill with Prime!!! Glad to hear you switched!

julie · Jul 22, 2011

Yes, PRIME is the way to go with CF. Establish a relationship with your base Primary care physician and nurses so all you have to do is CALL IN to get a referral. I talked to my ex's doctors about it and made it clear we did not want to deal with the hassle/standard requirement of being SEEN first before getting a referral. I mean, for a dermatology referral NOT CF related, sure, I'll play by the rules.

But as far as CF care goes, his PCC coudn't do a darn thing for him so we got to "bypass" the requirment to have an appt. to get a referral and instead just left a msg on the nurse line saying what we needed, and it was processed ASAP.

You should NEVER have a bill with Prime!!! Glad to hear you switched!

julie · Jul 22, 2011

Yes, PRIME is the way to go with CF. Establish a relationship with your base Primary care physician and nurses so all you have to do is CALL IN to get a referral. I talked to my ex's doctors about it and made it clear we did not want to deal with the hassle/standard requirement of being SEEN first before getting a referral. I mean, for a dermatology referral NOT CF related, sure, I'll play by the rules.
 
 But as far as CF care goes, his PCC coudn't do a darn thing for him so we got to "bypass" the requirment to have an appt. to get a referral and instead just left a msg on the nurse line saying what we needed, and it was processed ASAP.
 
 
 You should NEVER have a bill with Prime!!! Glad to hear you switched!

stacielynn · Jul 25, 2011

I have been married before (currently dating a wonderful guy!) and getting on insurance with my ex- wasn't a problem. In New Mexico, there is this thing called Childrens Medical Services (CMS) that picks up the tab on all the co-pays and hospital visits, prescriptions, xray's, etc. CMS is for kids up to 18 or 21 or whatever, unless you have just a few genetic conditions, CF and diabetes being 2 of them. You have to have primary insurance first, but they cover everything else. Technically, I have CF, but I am not on any CF meds, inhalers, antibiotics, pretty much the only thing I have is birth control (which is actually covered because it's 'preventative' for CF people, because it's consdered family planning). I decided a few years ago that I was going to get myself healthy and not be on the 'hospital' program. Not being on meds is cool, but another bonus is that I don't make such an impact on the program and can 'give' someone else my $15000 yearly allotment that really needs it. So I say....move to New Mexico!
~~~~~~
Stacielynn
Diag w/ CF at 10mos old, 37 years old now. No transplants, no hospital stays, College grad, Certified Wholistic Kinesiologist

Marriage and CF

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