Dad needs help paying the bills

May 1, 2008 6:22 AM

Health insurance options for 65-year-old diabetic in Massachusetts?

My father's health has been failing for some time; he's 65, a type 1 diabetic and is constantly in and out of hospitals and care homes. He is, of course, permanently disabled; unfortunately, so is his wife, so neither of them have insurance through work.

His wife, J, is working on various ways to get him insured; he recently lost his state disability ("Mass Health", I think my brother called it), and Medicaid says that they make too much money from Social Security to qualify. J has applied for AARP Supplemental, but says that unfortunately, none of the insurance companies pay beyond the 120 days that Medicare will allow (I'm not sure what that means). She's working with a social worker at his current nursing home to reapply for state health programs, as a long-term nursing home stay seems likely in his future.

Are there any other options, state, federal or private, that she should be looking into? I realize, considering his pre-existing condition and the fact that he lives in the US, the answer's probably a resounding NO, but I figured it couldn't hurt to ask. Any Mass. residents with similar situations found solutions? Thanks in advance!

posted by Koko to health & fitness (5 comments total)

Go look at Commonwealth Connector, the health care portal for MA. The state created it to assist people in finding coverage, now that insurance is required of all MA residents.
posted by NotMyselfRightNow at 6:38 AM on May 1, 2008

If your father is 65 and an American citizen, I imagine he should be covered for acute health care by Medicare. (This isn't true for every 65-year-old, but for well over 95 percent of them.)

I think what his wife and your brother might be talking about is long-term care insurance, as Medicare (and most regular health insurance policies) don't cover long-term care services, such as stays in nursing homes or rehab hospitals past a few weeks--the 120 days you refer to. Unfortunately, private long-term care policies are extremely expensive, as well as pretty hard to qualify for if you're not young and healthy. There's not really much of a market there, and getting access to it is exponentially harder than getting regular (acute-care) health insurance.

The vast, vast majority of older Americans who are lower- to middle-income, on Medicare, and end up needing long term care services eventually end up on Medicaid, which is folded into "MassHealth" in Massachusetts. The rules for how much of one's assets or income that need to be "spent down" before qualifying for Medicaid vary from state to state, and I'm sure the social worker who you are working with is the absolute best source of info on this--any halfway decent social worker in a nursing home should be well-acquainted with all the programs out there to pay for nursing care.

Another really good source to contact would be your local Area Agency on Aging (AAA); some states have started nursing home diversion programs to catch people who might be able to live in the community, to try to prevent them from going into a nursing home and eventually ending up on Medicaid. This is one area where a social worker employed by a nursing home might not look for a whole variety of reasons, so it's worth contacting an AAA--you can find a local one at this website, under "general aging resources". They can help you figure out if your father might qualify for home health care (which Medicare provides more coverage for than nursing homes, although it does have to be "medically necessary") or other programs outside of nursing homes.

The lack of a federal program for covering long-term care is a HUGE and unrecognized problem in our country--most people think it's covered under Medicare, but Medicare is like private health insurance and for the most part doesn't deal with it at all. States are left to pick up the slack, and how they do that really varies. Given the suckiness of the situation, it's probably good that your father is in MA, which is a pretty enlightened state when it comes to innovative programs for covering people's health care needs. I'd be surprised if the social worker or your local AAA can't come up with something, although it may (unfortunately) require burning through whatever assets or income your father holds in order to qualify for MassHealth again.
posted by iminurmefi at 7:20 AM on May 1, 2008

Another link for you, from the Massachusetts state website: long term care information. Note the link at the bottom, under "coordinated care systems"--that's the sort of program I was referring to that attempts to divert the frail elderly from ending up permanently in a nursing home. It might be worth a call to MassHealth to inquire about what the income & asset eligibility limits are--in some states, income limits for diversion programs are a bit higher than for the rest of Medicaid, so it's worth a shot.

Also the CommonHealth program on that page looks like it might be worth looking into--it's for disabled adults above 65 who are living in the community, and has no income limits (but a sliding-scale premium for people above the poverty line). If your dad is able to function at home with regular visits from nurses and other supportive personnel rather than going into a nursing home, that might be an option.
posted by iminurmefi at 7:30 AM on May 1, 2008

Wow, thanks iminurmefi, I'll look these over in the next few days.
posted by Koko at 10:28 AM on May 1, 2008

What iminurmefi said, essentially every single word, is spot on.
posted by drpynchon at 8:25 PM on May 1, 2008