I was wondering the real world sequence of events is for someone who gets ill and loses their ability to make an income.
I’m 44 and have high deductible ( 2,500 per person) health insurance plan that costs 3000 year to cover myself and two kids. I am unmarried (divorced), make a fairly good income and am pretty solidly middle class socio-economically. Let’s say I got very ill and could not make any money and the illness is expensive to treat. What happens after the money runs out? What are the social safety nets that will catch me? Do I wind up on the street? What happens to me? Can anyone diagram the process for me.
If you are sick enough to qualify for SSDI, two years later you would also be eligible for Medicare. In my state, although I don’t know if this is true for all states since Medicaid is state administered, if you qualify for SSI you automatically qualify for Medicaid.
Depending on what state you live in, you may also qualify for Medicaid, whether or not you get SSI. If your job was your only resource you might also be able to get Medicaid. If not, then if and when those other resources dry up you might qualify.
In the interim, there is likely an indigent program (people who have no money and either do not qualify or do not yet qualify for mcr or mcd) in your city or county.
If you already have a good relationship with a physician, it’s quite likely they would continue to see you even if you have no resources, especially if you will eventually qualify for assistance. Also, in order to qualify for Medicare funds, all hospitals are required to provide a certain percentage of charity care, so if you are truly indigent they will see you anyway as a charity patient.
The long and short of it is, the horror stories the Clintons tried to scare up about how many poeple were dying for lack of health care did not exist for a reason - it’s becuase if you are truly ill (not just a cold or the flu, I mean) there is a way to get healthcare. Even the one expample they did find was false - not only did her husband readily admitted she was able to find providers that treated her despite the fact that she couldn’t pay, but those providers readily admit that her disease was so deadly all the money and health care in the world still would not have saved her.
But it really all depends on what are you live in as to what safety nets are available and how soon they will be there to catch you. But there are safety nets.
By the way, I speak as someone who is ill and has on occasion been unemployed due to that illness and due to lay offs, and as someone who has been in medical reimbursement for 13 years.
This may be a stupid question but is there such a thing as Long Term Disability in the US? (I really have no idea.)
For example, with my current employer lets say that all my luck goes down the toilet and I get cancer, for example.
I receive 100% of my salary for the first 175 days of absence from work and then receive 80% indefinantly for the rest of my life (well, maybe until 65 then I think it switches to CPP).
In the OP’s hypothetical he would have to cover medical expenses (although hopefully his medical insurance would cover most of it?!?!?) but for at least 6 months he would be earning his regular salary.
Yes, there are long term disability policies avaiable in the US.
If the OP is paying $3000/year for a policy with a $2,500 deductible then he/she is probably buying the policy as an individual and not receiving it through work. In such circumstances, buying the additional long term disability coverage would be very difficult as they are very expensive when bought by an individual (as opposed to a company provided policy). And if you have any pre-exisiting condition - back problems, bad knee, asthma, allergies, or even just a family history of some problem - the price goes even higher. And there are frequently a multitude of exclusions. For instance, if you have a history of abnormal pap smears the policy may exlude disabilities due to cancer, even if you’ve never actually had cancer. They may also exlude things like injuries from sports you voluntarially engage in, or injuries suffered on motorcycles, or similar stuff.
As a result, very few folks in the US have long term disability coverage, and most who do are on employer-paid plans.
My sisters-in-law both have no insurance. One was on medicaid and they took care of all her medical bills until she died. The other one had a mastectomy and has chronic asthma-related problems, and she just pays what she can. They can’t take her house in Illinois, and she really doesn’t have any other income, so what are they gonna do? They have to provide minimum medical care.
After reading the above replies all I can say is thank God for the National Health Service we have here in the UK.Even with all its faults it ensures that even the poorest of people get good health care and nobody has to worry about losing their house to pay for medical bills. Also my employer pays 100% salery for the first 6 months of sickness and then half pay afterwards. All this takes away much of the worry of falling sick.
One problem in the U.S. is that you really have to be pretty bad off before you qualify for true charity care. Yes, you can often negotiate with physicians and others for payment plans, but not always. If it’s not an emergency, they don’t have to treat you.
Also, once you are being covered by charity, Medicare, or Medicaid, you don’t always have the same choices of doctors, and you sometimes don’t have the leverage that private payers or people with “real” insurance do. If you are sick, don’t have money, and don’t have someone to run interference for you with the bureaucracy, Lord help you.
Continuing care, rehabilitation centers, and assisted living facilities, for example, only have a certain number of Medicare or Medicaid beds. It can be a real chore to find one if you don’t have insurance that will cover this. The really good ones go fast and have waiting lists. You may have to settle for a facility that is legal and licensed, but is not as good or as pleasant as one that you could get into if you were insured.
Another problem is the relative difficulty of finding non-emergency and preventive care when you are without private resources. Many programs will pay for the treatment of a disease or disability, but not for the measures that might have kept you healthier. Ditto for so-called elective procedures that are not necessary for survival but would help a person remain productive, mobile or more free of pain.
[sup]Just ask GOOGLE[/sup]