Asclepios
Affordable Coverage During the Wait for Medicare
October 1, 2009 • Volume 9, Issue 39
Thelma B. is a 59-year-old living in Missouri who began receiving Social Security Disability Insurance (SSDI) last year. Thelma’s SSDI payment is $1884 per month, but after paying for rent, utilities and food, she doesn’t have enough money to afford insurance, which is particularly critical for her to treat her high blood pressure and glaucoma. She was forced into bankruptcy; she lost her house and car, and auctioned off everything she had earned over 30 years’ work.
Like all people with disabilities, Thelma must wait two years before her Medicare coverage begins. Thelma’s monthly SSDI income adds up to an annual income of about $22,600—just over 200 percent of the Federal Poverty Level, and just barely too high to qualify her for Medicaid coverage, leaving her with no affordable option to purchase health care coverage. More than half of the people who receive Social Security Disability Insurance (SSDI) earn even less. One third of the 1.6 million people with disabilities in the two-year wait for Medicare go without health insurance at some point while they wait for Medicare coverage.
How would the health care reform legislation now before Congress help Thelma and the millions of Americans like her who lack affordable health insurance?
With no options for health care, Thelma would be better off if either the Senate or House bill were in effect today. One major provision in both bills states that no insurer could deny or cancel her coverage because of a pre-existing condition, putting an end to the discrimination that now prevents people with disabilities from buying insurance on the private market.
Under legislation passed by the House Energy and Commerce committee (HR 3200), Thelma’s monthly premiums would be about $111 a month, thanks to new tax credits that reduce the cost of premiums. This amount would be slightly higher under the Senate Finance Committee’s proposal, which would leave Thelma with premiums of $140 per month.
Under the Finance Committee bill, her insurance would cover on average 73 percent of medical costs (about equal to the standard Medicare benefit) and her out-of-pocket spending on copayments and deductibles would be capped at roughly $3,000 per year. The House bill would further reduce her cost-sharing expenses for medical care.
Affordability means access. One in five people in the Medicare waiting period for people with disabilities forgo care because they cannot afford it. Please write your senators and representative and urge them to make health reform deliver high-quality health coverage that we can afford.
Medical Record
“Subsidies to help people pay for premiums and cost sharing for private health insurance are an integral part of most health reform plans, including the campaign proposal from President Obama, the Senate HELP Committee Affordable Health Choices Act, the America’s Affordable Health Choices Act offered by key House committees, and the policy options distributed by the Senate Finance Committee. Premium subsidies (including the cost of Medicaid coverage for very low-income people) are important because they are the key determinant of how many people will gain coverage under reform options, and will likely comprise a very large portion of the total cost of any health reform proposal that substantially increases coverage.” (Explaining Health Care Reform: What Are Health Insurance Subsidies? Kaiser Family Foundation, August, 2009).
Interested in calculating your own premiums under health reform? Check out this Health Reform Subsidy Calculator -- Premium Assistance for Coverage in Exchanges/Gateways, created by the Kaiser Family Foundation. The tool allows the user to select one of several health reform proposals and examine its impact at different income levels.
“During the months following his diagnosis [of small-cell lung cancer], Raymond’s Medicaid coverage paid for four cycles of chemotherapy. Raymond responded well and was about to begin radiation when he began to receive SSDI checks of about $768 per month. The SSDI income pushed Raymond over the income limits for Texas Medicaid assistance and he lost his coverage. Without health insurance, the hospital refused to provide radiation treatments. When he asked what would have happened if he had begun to receive SSDI benefits while receiving chemotherapy, the hospital told him that they would not have been able to continue treatment. Raymond ironically recalled, ‘I got lucky that I did not get [SSDI] until I was through chemo.’” (Too Sick to Work, Too Soon for Medicare: The Human Cost of the Two-Year Waiting Period for Americans with Disabilities, Medicare Rights Center, April 2007).
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Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.
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