About 'united health care supplemental insurance'|VIVA FRENCH HEALTH CARE
Ray is in his middle fifties. I met Ray nearly fifteen-years-ago. I was managing a restaurant and he worked at a hardware store up the street. I had an account there and purchased tools and hardware from him. Eventually, we became good friends. We both belonged to the local Elk's lodge. We played golf together. We still see each other from time-to-time. A couple of week's ago, I called him up. It had been at least three years since I had talked to him. We met for coffee. Ray was raised along with his two brothers by his mom who worked in the same factory for forty-five years. His father left when he was three. His mom never remarried. Most of the time he stayed with his grandparents while his mom worked. Ray was the youngest in the family and rather sickly as a child. Later on in life this would manifest itself when he came down with severe hypertension and diabetes. Despite his health problems, he did well in school and actually got a partial scholarship to college. He was interested in medicine and wanted to be a doctor. Maybe that was because he had been so exposed to it when he was a child. But unfortunately, he had to put his plans on hold and get a job when he was eighteen. He moved out of the house a few months later. His job was working in a retail store for a large national chain. Eventually, he worked his way up to assistant manager. The pay was alright, but really not enough to get ahead. Despite the long hours and his health, he sometimes worked a second job on his days off to make ends meet. At first he intended to go back to school, but he never made it. He just didn't have the time or money. After about thirty years in the retail job, he found that he could no longer do the long hours standing on his feet. Besides the diabetes had started to take its toll. He had neuropathy in his feet and legs and vision problems that required extensive laser surgery. He went blind in each eye, but fortunately he eventually regained most of his sight. He also came down with severe end-stage kidney disease. Despite all of this, he still managed to keep his job, even though he was on the firing block a lot of the time. Finally, he had to give up when he was in his early fifties. He just couldn't do it anymore. He went on Social Security Disability, but he wasn't eligible for Medicare for two more years. During that time he paid $500/month to COBRA to keep his insurance active. During those years, he used up what meager savings he had and nearly starved. When he finally got Medicare, he bought a top tier supplement policy. That cost him two hundred a month, but he figured it was worth it as many times as he went to the doctor. Then his kidneys failed altogether and he went on dialysis. He was on dialysis two years before a kidney became available for transplant. During that time he switched to Medicaid as his supplemental insurance because it was free and he was struggling to make the United Health Care payment every month. The only way that he could get Medicaid was to have a spend down. The spend down was over seven hundred dollars a month. It's complicated, but if you incur medical bills over the spend down amount at the first part of the month, then you have coverage for the rest of the month. For the two years that Ray was on dialysis, it wasn't a problem as a single treatment cost that munch. He had the transplant and it didn't go well. There were a lot of complications and he was in and out of the hospital a lot. That, plus the expensive cost of the anti-rejection drugs met the spend down for several months after the operation. Then he messed up. He started to get better. He still couldn't go back to work because of the other complications from the diabetes. He had to face the fact that he would be disabled for the rest of his life. But he still managed to work a part-time job that paid about two hundred dollars a month. Then his Medicaid became inactive. He wasn't accumulating enough bills to cover the spend down. Suddenly he was responsible for twenty percent of his medical bills. Even though he was healthier, he still had weekly labs and other expenses that came to a lot more than he could afford to pay each month. None of the private insurance companies would take him back even during open enrollment. He lived in a state where the new laws against being turned down due to prior conditions didn't apply. His state opted out. He tried to get help through numerous other programs like "Ticket to Work" but he made too much money. Between his job and Social Security he made about $1600 a month and the cut off point for aid was $1279 for a single person. To get Medicaid without the spend down you have to make around $650 a month. Ray has no family left to help him. How can anyone possibly live on $600 a month? Even on $1600 a month Ray has trouble making ends meet sometimes. He doesn't qualify for food stamps, assistance with his utilities or rent because again, he makes too much money. His social worker suggested for him to ask the doctors if they would just accept the Medicare payment, but two have already said no and now require the twenty percent upfront. He needs an operation to help the vision in his left eye, but he can't afford it. He worries a lot about becoming an "emergency room patient" even though he has Medicare. The only solution is to reject the kidney and go back on dialysis. In other words, get sicker. Then everything would be paid for. Ray is being penalized for getting better and there is no way out in sight. He makes just enough money to not get the help he needs, but he's still poor and struggling. That's a tragedy for someone who has worked hard his entire life just trying to get by. |
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