Should we get a divorce to help with upcoming bills?
September 12, 2015 3:18 PM   Subscribe

Should my wife and I, who still want to be married, get a divorce to better pay some LARGE bills that will be coming?

My wife and I are a happily married middle class couple, but have started talking about divorce to help cover some bills that will be coming our way.

She is having some health issues and will be need a heart transplant. She will get an artificial heart pump in the short term, but will (if one becomes available) need a heart transplant.

According to the National Foundation for Transplants (NFT), the average cost of a heart transplant and the associated first-year expenses is $1 million. Costs for anti-rejection and other drugs can easily exceed $2,500 a month. Follow-up care should be around $20,000 per year.

Right now we earn too much to qualify us for assistance from a program from pretty much anybody. Yet, with the bills from past treatments (already thousands of dollars), we cannot afford this expense - even with insurance. We are in that horrible middle class space where we don't earn enough to cover this (even with insurance) and earn too much to get any help.

She suggested staying together as a couple, but divorcing so she only has her insurance and with the lower income she would qualify for assistance programs and ~~worst~~ case, could actually go bankrupt without affecting both of us.

Has anybody else considered/done this? How did it work?
posted by Leenie to Human Relations (21 answers total) 1 user marked this as a favorite
I don't have a good answer but I suggest you email the mods and make this anonymous.
posted by pyro979 at 3:25 PM on September 12, 2015 [27 favorites]

Yeah. This is fraud, and probably a bad thing to broadcast to the Internet, let alone actually do.
posted by furnace.heart at 3:29 PM on September 12, 2015 [1 favorite]

I know someone who did this. It was hard to do emotionally and I would suggest that you don't really tell anyone that is what you are doing.

It also was very helpful.
posted by cairnoflore at 3:38 PM on September 12, 2015 [11 favorites]

I suggest talking with an attorney to make sure this will work the way you want it to, and isn't fraud.
posted by J. Wilson at 3:46 PM on September 12, 2015 [2 favorites]

I'm sure you are better versed in the ins and outs of health insurance than I am, but are you sure you don't have an out of pocket annual cap now that Obamacare is the law in the US? (Or are you blowing past the insurance company's max amount and getting stuck covering what they won't?)

Rumor has it that hospitals often accept something like twenty-five cents on the dollar from individuals, after you wrestle with them for awhile. But that's an argument for after the surgery, not before.

Some employers fire sick people when they are recovering from surgery. That can mess up health insurance in exciting new ways, maybe.
posted by puddledork at 4:02 PM on September 12, 2015 [5 favorites]

I know that there's some amount of belief that people on Medicaid get less good care than people with private insurance. I don't know that it's true, and I don't know if that's the kind of assistance you're thinking of, but it might be something to consider.

My sympathies for what you're going through. FWIW, my brother went through the same thing about a year ago (heart pump, then transplant) and is doing really well now. But he did have the benefit of good insurance.
posted by still_wears_a_hat at 4:38 PM on September 12, 2015 [2 favorites]

I'm skeptical your insurance won't cover most of it. I only know one person who had a transplant and couldn't pay for it and they were uninsured (charity paid their out of pocket costs - another option.) I'd talk to your rep/hospital business office before the divorce lawyer.
posted by michaelh at 4:41 PM on September 12, 2015 [1 favorite]

I only bring that up because if you're wrong about insurance costs, that would be really good for you, and insurance is confusing.
posted by michaelh at 4:42 PM on September 12, 2015

Divorce is expensive too. As is jail time if you get caught for fraud. Call the insurance company 12 times a day a demand coverage. Ask your community to help raise the money. Bankruptcy isn't that bad.
posted by myselfasme at 5:24 PM on September 12, 2015 [1 favorite]

Are you 100% certain that her insurance won't cover it? Most plans have an out of pocket maximum, beyond which they cover all charges at 100% until the next plan year when you have to pay up to the out of pocket maximum again. For example, I chose my plan for its low out of pocket maximum since I knew I was facing some pretty serious surgery. It turned out I needed even more serious treatment than I originally thought, but since I've met my $1500 OOPM the $125,000 of surgery and hospital charges have cost me $0. And since it's now looking like I'll need chemo that will hopefully be covered too, up until the end of December when I'll have to pay another $1500 before the OOPM for the year kicks in again.
posted by MsMolly at 5:33 PM on September 12, 2015 [4 favorites]

To those saying this would be fraud: how would this be fraud? I get that pretending to be married for insurance purposes, or marrying for immigration purposes, is fraud. Not clear on how this is fraudulent, though.
posted by amtho at 5:34 PM on September 12, 2015 [9 favorites]

Not clear on how this is fraudulent, though.

If the OP is still living in a household with the claimed-to-be-ex-spouse, sharing income and bills and suchlike, then divorcing to make it look like their incomes are separate could easily be seen as fraudulent.
posted by Etrigan at 5:49 PM on September 12, 2015

Legally, though?

I could see that this might be an issue in a common-law marriage state, where a couple is automatically legally married after sharing their living situation for enough time. There are only a few states that do that, though.
posted by amtho at 5:56 PM on September 12, 2015 [1 favorite]

My child required medical care that ran upwards of $1 million in her first year of life. My husband and I made too much to qualify for assistance. However, there are health conditions for some forms of financial assistance that override any income caps, and those kicked in for us. We ended up paying only our deductible and co-insurance to the OOPM (around $6,000) and everything else was covered by insurance and state medical assistance and SSDI. Obviously each state will be different, but I think there might be qualifications for assistance that you are not aware of.

Also, have you considered what it might mean if you divorce and things go badly medically? You will no longer be next of kin and will not have the right to make medical decisions with/for your partner, and might be restricted in terms of visiting, among other issues.

It is not clear to me from your question if you have applied and been turned down for assistance, or if you have spoken in depth with a financial counselor at your hospital regarding your specific situation, or if you are making assumptions based on the large dollar amounts. I would also look for support groups for patients and family members who have had the same condition and treatment, and ask them for specifics about how it was paid for. I would rule out every option before divorcing in this type of circumstance.
posted by peanut_mcgillicuty at 6:11 PM on September 12, 2015 [4 favorites]

According to the Ocala Star-Banner in 2008, an elder law attorney in your jurisdiction may have an opinion on this:
Clardy, who specializes in elder law, said nothing in the law prevents such types of divorce from happening. "If you're a single person and don't have a lot of assets, you can get on Medicaid. There's nothing in the rules that says you can't get divorced for Medicaid,"
A consultation with an attorney who handles trusts and estate planning could help figure out the current rules that apply to your situation, and your local or state bar association may offer a lawyer referral service. The MeFi Wiki Get a lawyer page has general information about finding an attorney.
posted by Little Dawn at 7:20 PM on September 12, 2015

I would try to get this covered and not go through the emotional stuff of an even technical divorce, but I work in this space and, I could be wrong, but I don't really see how this would be insurance fraud. I mean, unlike marrying someone for immigration reasons, marrying someone for insurance reasons doesn't violate any federal or state law I'm aware of.
posted by Pax at 7:45 PM on September 12, 2015

Oftentimes public aid looks at the "household" rather than the legal relationships. So I would make sure that divorce - without de-cohabitation - would be enough. Re bankruptcy: credit scores of spouses are separate, so bankruptcy of one party to the marriage would not affect the other party's credit rating (unless you have joint debt, which is an issue in bankruptcy regardless of marital status). I'd meet with an attorney in your area who is familiar with bankruptcy and public assistance qualification to see if divorce really is the magic bullet you're assuming it is. They can also advise you about which forms you should avoid signing to contain the medical debt to the spouse that needs care (i.e., don't sign something saying you'll accept responsibility for the bills).
posted by melissasaurus at 10:07 PM on September 12, 2015

When she came up with this, I said that I didn't want to do it. After seeing some of the posts here, a lot of information confirmed what I was thinking. I am marking this as resolved to close it, but with no best answer.
posted by Leenie at 11:13 PM on September 12, 2015

> If the OP is still living in a household with the claimed-to-be-ex-spouse, sharing income and bills and suchlike, then divorcing to make it look like their incomes are separate could easily be seen as fraudulent.

That's quite a bit different from "This is fraud", as furnace.heart incorrectly claimed. Divorcing for financial reasons is not fraud.
posted by IAmBroom at 8:56 AM on September 13, 2015 [3 favorites]

Leenie, you are getting uninformed advice and need to consult an eldercare attorney to discuss your options, even if you are not elderly. Medicaid divorce is a thing, and it is a valid planning tool. The New York Times has more on this, including the tools of spousal refusal and pooled trusts.
posted by DarlingBri at 3:38 PM on September 13, 2015 [9 favorites]

Seconding DarlingBri -- this was dicussed in my very first hospice volunteer training.
posted by janey47 at 4:26 PM on September 13, 2015 [1 favorite]

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