Insurance Question

Discussion in 'The Watercooler' started by house of cards, Feb 9, 2008.

  1. house of cards

    house of cards New Member

    My sister is recovering from brain surgery. She had disability insurance through her old job which pays her a small amount of money monthly, but it is too much to get medicaid. She needs the medicaid desperately for the insurance, her medications cost alot. Does anyone know any way out of her dilema?
    She now has no insurance.
  2. house of cards

    house of cards New Member

    Well, I guess on one knows any thing that could help, she is in such a bad way...may I have your prayers and good thoughts?
  3. klmno

    klmno Active Member

    Prayers are being sent- with many cyber (((HUGS)))

    Unfortunately, I did not know of anything that could help in this situation. I think the health care/insurance system is in pitiful shape- just like schools for difficult children

    Sorry you and your family are going through this- I can only think of calling state services and asking for their advice.
  4. flutterbee

    flutterbee Guest

  5. DammitJanet

    DammitJanet Well-Known Member

    Let me ask a few questions.

    You say she gets a small disability check...who from?
    Does she have kids at home?
    Is she married and living with hubby?

    Depending on the answers to the above...well...medicaid has a program called Medicaid for the Disabled. To get that coverage you have to meet certain criteria. Mainly you have to meet Social Security's definition of disabled and income guidelines. However, if you can meet the disability definition but are slightly above income level you can get on the medicaid program using what is known as a "spend down".

    Now...if she has kids at home but no hubby that makes things so much easier. She would qualify under Medicaid for Families and the income limits are higher, but if she still made to much there is the spend down.

    2 parents, kids, higher income, makes it much harder.
  6. house of cards

    house of cards New Member

    She has Traumatic Brain Injury (TBI) but has been refused by medicaid for making 2,000 a month instead of 1800 they allow. It is from a private disabilty insurance. The private company fights for SSDI for you cuz they then take that out of her check. She has found a program for Traumatic Brain Injury (TBI) that will provide cash assistance but no insurance company that will insure her without a 6 mth wait. She is still married but her husband is not in this state and they have been seperated over 5 yrs, no kids. She lives with my 76 yo mother. Her medications are over 2500 a month. It is hard to get her to take the right steps to get help so I am starting to look into whatever I can find but with limited information from her, sometimes she can be her own worst enemy, ugh. She is dealing with injury from a brain tumor and that surgery as well as severe depression/possible BiPolar (BP). She needs MRIs but isn't getting them, has her severe headaches back and vision problems. Her doctor has been great and gives her whatever medications he can, she wont take the prescribed anti psychotic becuz of weight gain and her refusal to see a problem with her mental health besides depression..there is a big problem, but she is an adult. thanks for the help and prayers, they are appreciated.
  7. DammitJanet

    DammitJanet Well-Known Member

    Ok....from what you say, she should qualify for social security by definition. Dont worry about the husband since he is not in the picture.

    She is considered a family of one. If NJ medicaid's limit is 1800 then she should be able to get on the spend down. I could explain that but its lengthy. Basically she has to "incur" and at least be paying on XXX amount of medical bills during a period of time before medicaid kicks in.
  8. house of cards,

    Here in my state there is a program called the " Adult Medically Needy "program. You apply for it through your county welfare office, although it is administered through the state. If you have a documented disability (sounds like your sis does) as well as large outstanding medical bills - they will certify you for Medicaid. The $ amount of the outstanding bills varies state by state. It is , unfortunately a monthly certification and it requires a good bit of paperwork. She probably would need some help jumping through the hoops.

    It's a little known program - but it sounds like she could possibly qualify.
  9. house of cards

    house of cards New Member

    Thanks all, i'm looking into it all.