I need input re insurance for my son.

[WheatenLover]

My son wants to get health insurance -- he got kicked into a Medicaid determination, and didn't get it. He has 57 days to sign up for plan.

The plans offered on our state's health insurance marketplace cost between $400 and $600 per month, with a $7K to $9K deductible, after which the plans pay 100%.
Best case scenario is that he would have to pay a max of $11,800, at $400/mo with a $7k deductible.

He is healthy and 30 years old. His upcoming medical needs include testing and prescription for ADHD meds, and hopefully some therapy (we haven't found anyone who is actually trained in treating adults with autism and the waiting list at the most trustworthy place is closed because it just got too long).

He has the money to pay the medical bills. It seems to me that it would be cheaper for him to do that than to buy health insurance.

I haven't found anything about getting catastrophic coverage on the state website. Also, I have only looked at plans that get 4 and 5 stars, thinking what is the point of getting horrible health insurance.

What would you advise my son to do? I want to give him good advice. At the same time, I am horrified at the potential cost of insurance because it would eat through his savings quickly. He does not have a job. He keeps applying and going on interviews. He is autistic, and has auditory processing disorder as well as (very likely) ADD. He thinks once he gets diagnosed with ADHD and gets medicated, he will be able to function a lot better in terms of getting and keeping a job. He wants to work and to get a college degree.

He teaches a foreign language to clients who approach him via a social media site. He doesn't make more than maybe $4K/year between doing that and getting paid by the social media site because of the number of followers he has.

Please help me. I'm so worried about giving him bad advice because he would bear the consequences. Thank you in advance!

 

[StarSong]

With such a low income, and being basically unemployable due to autism, why was he kicked off Medicaid? Can that decision be appealed, or is it based on his assets?

Assuming he lives in Georgia. Without getting political, are there good ACA options in your state?

 

[Imogene]

1. My only thought is to check with your homeowners and/or auto insurance agent. Many times they either write health insurance or can refer you to someone that can and may be more affordable.

2. I just want to say how deplorable it is that states (plural) offer so little help for adult autistic people. I could curl your toe nails with stories my BFF up in PA has told me regarding her 19 yr old grandson who is on the autism spectrum. The facility she did finally find also has very long waiting waiting list and the grandson is still waiting.

The PT therapist at my chiropractic clinic here in Middle Tennessee had to send her son away to get get him decent help. But she did that was he was still underage and I think he has aged out of the facility by now.

“You people” with any sort of influence in these areas - why hasn’t more been done to help get care for those on the autism spectrum. And if you’re in Georgia, damn it, do something to help @WheatenLover ——-

 

[CooCooforCoCoPuffs]

@WheatenLover
"Please help me. I'm so worried about giving him bad advice because he would bear the consequences. Thank you in advance!"

Your son is 30. I understand he has some challenges. Those are what he needs help with and Insurance advice is something you do not need to be giving him at this point.

If he can teach a language on a computer, he could apply for translation jobs with health care facilities. What type of jobs is he looking for?

Is he still living with you? Does he have a firm diagnosis from at least THREE different MD Psychiatrists that he has all you state he has?

I would not be concerned about his medical care insurance as much as finding him a group home so you can stop worrying the rest of your life way.

Perhaps you need to find him a group home instead of insurance, and stop worrying the rest of your life away. Step away from his problems. The group home will assist him as will a social worker in the Dept of Human Service adult center.

Tough love works regardless of what challenges a child and parent has.

“You people” with any sort of influence in these areas - why hasn’t more been done to help get care for those on the autism spectrum. And if you’re in Georgia, damn it, do something to help @WheatenLover ——-

@Imogene: Autism spectrum covers A LOT of territory. Getting a definitive diagnosis is imperative. Medicaid is inundated with people who claim to have ADHD and autism and it has gotten to the point it just doesn't "fly" anymore as policy makers are finding MUCH fraud, waste and abuse of this and other diagnosis'.

I have children on the autism spectrum and who have ADHD they all have jobs and live in their own homes. I have a good friend who has THREE sons with autism and who have ADHD, they ALL three are employed and living on their own.

 

[Imogene]

@WheatenLover
"Please help me. I'm so worried about giving him bad advice because he would bear the consequences. Thank you in advance!"

Your son is 30. I understand he has some challenges. Those are what he needs help with and Insurance advice is something you do not need to be giving him at this point.

If he can teach a language on a computer, he could apply for translation jobs with health care facilities. What type of jobs is he looking for?

Is he still living with you? Does he have a firm diagnosis from at least THREE different MD Psychiatrists that he has all you state he has?

I would not be concerned about his medical care insurance as much as finding him a group home so you can stop worrying the rest of your life way.

Perhaps you need to find him a group home instead of insurance, and stop worrying the rest of your life away. Step away from his problems. The group home will assist him as will a social worker in the Dept of Human Service adult center.

Tough love works regardless of what challenges a child and parent has.

@Imogene: Autism spectrum covers A LOT of territory. Getting a definitive diagnosis is imperative. Medicaid is inundated with people who claim to have ADHD and autism and it has gotten to the point it just doesn't "fly" anymore as policy makers are finding MUCH fraud, waste and abuse of this and other diagnosis'.

I have children on the autism spectrum and who have ADHD they all have jobs and live in their own homes. I have a good friend who has THREE sons with autism and who have ADHD, they ALL three are employed and living on their own.

And my friends grandson is 19, still wears a diaper, yet has a beard.

He has Occasional violent outbursts.

I could go on. I hardly think there’s any fraud involved there, yet there is virtually no help for the mom. They are a lonnng way from 2-digit IQ looking for a check in the mailbox.

 

[CooCooforCoCoPuffs]

And my friends grandson is 19, still wears a diaper, yet has a beard.

He has Occasional violent outbursts.

I could go on. I hardly think there’s any fraud involved there, yet there is virtually no help for the mom. They are a lonnng way from 2-digit IQ looking for a check in the mailbox.

Was only referring to your imploring the powers that be to do more. The govt does what it can do, weeding out the truly needy is a process, not a guarantee. The child could be put into a State home at 19 years old.

 

[Muskrat]

You could do a quick check of local community health centers. I know manycharge sliding scale fees for care. Thencall the hospital and talk to social services. In arizona if an uninsured person is admitted to the hospital the staff will jump thru hoops to get that person covered thru our “medicaid” which is income based. Social services should be able to tell you if this would apply in this situation. Kuddos to you trying to help. As a healthy person I think I might of had health insurance maybe 5 years total before I recieved medicare.

 

[Imogene]

Was only referring to your imploring the powers that be to do more. The govt does what it can do, weeding out the truly needy is a process, not a guarantee. The child could be put into a State home at 19 years old.

I figured a state home would be the reply. Yes, that is what everyone but the family wants to do. The mom won’ let that happen. Somehow, by some miracle she did manage to get the child’s medicine change or reduced, I don’t know which, and it has helped immensely. This family is far from being on the dumb list. She does a lot or research and finally got a doctor to at least listen.

This should not have to be a government issue - it’s a medical issue and one that seems nobody wants to deal with so it gets shoved under the rug. It’s the lack of availability of care for these people that tisses me off. We have Urgent Care facilities on just about every corner for snotty noses that we as parents managed quite well in our youth. It seems the popular answer for these adults is to “just put them in a state home” and be done with them, instead of trying to truly help them.

I watched the mom of this young man grow up. She occasionally was my son’s babysitter . She also has an older son who is perfectly normal and has a great job. I honestly don’t know how she maintains her sanity but she does and does it with little-to-no help from the medical profession.

She has close to zero professional medical help within a 100 mile radius of her home —- something is horribly wrong with that picture.

 

[Jeni]

Sad to say on most states exchanges for insurance the cost is ONLY one consideration ... they did away with catastrophic coverage when they passed the ACA.

In my area finding a provider who will take it is the real trick. Many do not take it for low reimbursement and those who do are booked 3months out for any visit.
in some cases it will be less expensive to pay up front then pay for insurance. if you are able to many doctors now are moving in direction of subscription for patients cutting insurance out.

 

[Aunt Bea]

I would seek legal advice to see exactly what will happen if he decides to go naked and self insure.

If he has no income and no assets he is essentially judgement proof.

In the event of some sort of catastrophic accident or illness he should be able to receive emergency medical care even if the bills go unpaid.

The difficulty will be in the smaller day to day expenses that don’t require the emergency room or hospitalization.

 

[CooCooforCoCoPuffs]

I figured a state home would be the reply. Yes, that is what everyone but the family wants to do. The mom won’ let that happen. Somehow, by some miracle she did manage to get the child’s medicine change or reduced, I don’t know which, and it has helped immensely. This family is far from being on the dumb list. She does a lot or research and finally got a doctor to at least listen.

This should not have to be a government issue - it’s a medical issue and one that seems nobody wants to deal with so it gets shoved under the rug. It’s the lack of availability of care for these people that tisses me off. We have Urgent Care facilities on just about every corner for snotty noses that we as parents managed quite well in our youth. It seems the popular answer for these adults is to “just put them in a state home” and be done with them, instead of trying to truly help them.

I watched the mom of this young man grow up. She occasionally was my son’s babysitter . She also has an older son who is perfectly normal and has a great job. I honestly don’t know how she maintains her sanity but she does and does it with little-to-no help from the medical profession.

She has close to zero professional medical help within a 100 mile radius of her home —- something is horribly wrong with that picture.

My heart really is out for the parents who have disabled children. However, it is a choice to continue physically, financially, and emotionally caring for these adult children our system can take care of. It is a difficult decision for a parent to make.

If she has zero help within 100 miles then she has another decision she needs to make: should she move CLOSER to more available resources to help herself out?

We all have to make choices in life.

My DH makes a choice, as do other veterans as to whether to live near or far from VA medical resources to make life bearable when medical services or other support services are not available in remote places. His sister had a disabled child and when the child was 9-10 the child became too much for his sister to manage alone, so she placed her in a special state paid for home where she lived to be 44 years old. The daughter had her own team she was placed on and all the medical, financial, and social support needed.

Life isn't always about asking "the powers to be" to accommodate us; but rather: "What do we need to do to make life work in our individual situation with the system available"?

And I do not believe it is a "popular choice", either. It would be a very difficult CHOICE for anyone concerned. It isn't like we other parents think it would be easy or the popular way to go. It would be heart wrenching, yes. But common sense needs to take hold sometime. What are the sons supposed to do when MOM isn't there to be the backstop anymore; there will come a day.

 

[Jeni]

I would seek legal advice to see exactly what will happen if he decides to go naked and self insure.

If he has no income and no assets he is essentially judgement proof.

In the event of some sort of catastrophic accident or illness he should be able to receive emergency medical care even if the bills go unpaid.

The difficulty will be in the smaller day to day expenses that don’t require the emergency room or hospitalization.

Insurance is not mandatory.
Health Insurance does not = health care.
The insane part of the ACA is you CAN sign up while in an ER ( a friend did) ...... handy huh imagine calling around for quotes on car insurance at the scene of the crash. SMH

 

[CooCooforCoCoPuffs]

I would seek legal advice to see exactly what will happen if he decides to go naked and self insure.

If he has no income and no assets he is essentially judgement proof.

In the event of some sort of catastrophic accident or illness he should be able to receive emergency medical care even if the bills go unpaid.

The difficulty will be in the smaller day to day expenses that don’t require the emergency room or hospitalization.

When I was young and had no choice, I had no insurance because I could not afford it and certainly didn't need it.
If one has no income and goes into an ER, the hospital will and can usually write it all off when they see you have no way of paying.

 

[Imogene]

My heart really is out for the parents who have disabled children. However, it is a choice to continue physically, financially, and emotionally caring for these adult children our system can take care of. It is a difficult decision for a parent to make.

If she has zero help within 100 miles then she has another decision she needs to make: should she move CLOSER to more available resources to help herself out?

We all have to make choices in life.

The family is very clannish and sticks together.

When the maternal grandfather passed many years back, he was an alcoholic and had gotten to be on the mean side. Their mom had long since divorced him and he lost everything thanks to his drinking.

All three sisters (one of whom is the grandmother to the boy I speak of) took turns caring for him at one of their homes. It was grueling and hard on all of them, but they hung in there until he passed at the one sister’s home. A remarkable testimony to family loyalty.

The mom of this young man has all their blessings to put him in a state funded home, but she won’t. And you’re spot on about what-if the son outlives her. I try not to think about it——-

 

[Axel Slingerland]

The child could be put into a State home at 19 years old.

I don't know about anywhere else, but in California, I wouldn't wish that nightmare on anyone. It would be like One Flew Over the Cuckoo's Nest Live...