My 46-year-old brother-in-law has been on disability since he contacted a heart infection six years ago and was placed on the transplant list for a new ticker. For a number of years, he was not able to work and had to declare bankruptcy.
Because the doctors have been able to keep his heart beating with a variety of very pricey drugs, he’s actually doing fairly well now and has been able to resume most activities. Work is now a possibility. However, insurance is not.
He has been covered by Medicare since the government deemed him to be “disabled.” His wife works two jobs and has insurance coverage at one of those jobs. However, no insurance company will insure my brother-in-law because he is a million dollar liability just waiting to happen. (He will eventually need a heart transplant with or without the drugs.)
His disability status is up for review this month and it is most likely that given his current condition the government will rule that he no longer qualifies for disability — thus ending his Medicare coverage as well. Even with a job, without Medicare or private health insurance, he can not afford the pricey drug cocktail that is keeping his heart pumping.
As a result, he’ll most likely end up back in the hospital on life support again within a few months of stopping the drug regimen he’s currently on. Here’s the kicker, though: Because he can not get private insurance on his own and Medicare (funded by the feds) is kicking him to the curb, he will then be covered by Medicaid (also funded by the feds and state government) — assuming, of course, he survives the inevitable cardiac incident that will land him back in the ICU.
So here’s what I don’t get, the government is going to end up paying his health bill one way or the other, so why must he nearly die to have that medical coverage kick in?
5 Responses to “Someone please explain the sense in this…”
Karen, I did social security law for 20+ yrs. Your brother does not have to lose his disability status. The fact that his illness is catastrophic should be enough to keep his DIB coverage. There is high reasonable expectation of transplant, thus continued disability.
Is he represented? Tell him to get to a social security savvy lawyer now. The standard is one who cannot work and is not expected to be able to work for a period of 12 or more months.
Yes, the system sucks.
Silvieon2
Thanks for the advice, Sylvie. I’ll tell him that.
Craziness.
Hope the above advice helps!
That is terrible. I don’t get it at all. I could go into a rant about insurance so I will stop.
Our government suck!
Aaaaaaargh. Stories like this make me want to scream. I am so sorry to hear that he is having to go through all this. I imagine his illness is plenty stressful already – so sorry to hear this – and he is so young