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Any Health Insurance Options for Spouse Caregiver
dude47
Posted: Thursday, May 28, 2020 6:35 PM
Joined: 5/28/2020
Posts: 4


My mother started showing signs of dementia almost 8 years ago now.  It has been a slow progression with a long stretch of very little change after she lost her memory.  She just turned 69 a few days ago and is the later stages now, she is no longer very mobile and it is getting harder and harder to get her to maintain body weight.  My father is currently still working but is considering retiring to become a fulltime caregiver.  Currently we have caregivers that come in during the day that we pay while he is working as my mother needs full time assistance but it is costing 80% of what his income is to pay the caregivers.  The only thing holding him back is health insurance for himself.  He is 63 and would not yet qualify for medicare.  

Basically what I am trying to find out is if anyone knows of any programs to help pay for health care for family members that quit working to become fulltime caregivers for their spouse/parent.


Marta
Posted: Thursday, May 28, 2020 7:41 PM
Joined: 6/3/2013
Posts: 819


Your father, if he retired, may be able to keep health insurance through his employers via Cobra. He should speak with Human Resources. 

Besides that, there is Obamacare. 


Ed1937
Posted: Thursday, May 28, 2020 7:41 PM
Joined: 4/2/2018
Posts: 2887


Hello dude. Welcome to the forum. Sorry your family is going through this now. I don't know of any help to pay for insurance, but there is probably help to pay for a family caregiver. But if you do a google search for your state AND family caregiver pay, you might find something there. I think most states have some type of help.
Ed1937
Posted: Thursday, May 28, 2020 8:01 PM
Joined: 4/2/2018
Posts: 2887


Sorry, I should have added that she will likely have to be ready to meet medicaid guidelines for nursing home care.
SuzD
Posted: Thursday, May 28, 2020 9:17 PM
Joined: 3/26/2018
Posts: 88


Saddly he won’t have many options... he can probably continue on his current employer plan thru Cobra, it’s usually fairly spendy since the employer no longer kicks in for the coverage and it will only cover for up to 18 months, that might take him to 65.   You could look at Obama care and depending on annual income he may qualify for a subsidy.   I had to retire early to be a 24/7caregiver and my Cobra plan ends in a couple months.. since I have another 18 months until I turn 65 I’m keeping my income as low as possible to qualify for subsidies.  Good luck.
dude47
Posted: Friday, May 29, 2020 1:05 AM
Joined: 5/28/2020
Posts: 4


Yea doing research I know my mother will not qualify for medicaid in California, you basically had to have spent everything and only have a house left before they will help.  My father has been a hard worker and saving all his life to get ahead with plans of retiring at 55 but when my mother started showing signs of dementia it was apparent that his plans were not going happen, but he does still have a decent amount in IRAs and 401Ks so Medical is out of the picture.  Now we are just trying to make sure he will have enough of his retirement savings left to enjoy his retirement comfortably when his role as a caregiver will come to an end in a couple years.  He is very proud and does not want financial help from us kids.  I am figuring that buying a plan through covered California is most likely his only option. if we end up going down this road.  They really should have at least medicare coverage for spouses that retire early to become caregivers.  Our system in this country saddens me.  If you do everything right and need a little help they will turn away but if you fail to plan they will swoop in and help you.
SSHarkey
Posted: Friday, May 29, 2020 6:47 AM
Joined: 3/15/2018
Posts: 533


Dude, do consider the option of continuing as is. His social security benefits will continue to increase as he stays on the job. Yes, he’s spending most of his income on caretakers, but in return he’s protecting his own future financially and physically. Early retirement will cost him more in the long run. The current arrangement is the same as if she’s been placed in a facility. But he’s still maintaining a daytime life away for himself as well as insuring he’s covered for his own retirement in the future. Even if he needs to hire a night caretaker, it will be worth it in the end. He’s now able to be her husband, and not carry the heavy burden of 24/7 care. It will only increase as time passes. He really needs to do what is best for him in this situation. It sounds selfish but it’s important.
Ed1937
Posted: Friday, May 29, 2020 8:54 AM
Joined: 4/2/2018
Posts: 2887


Has a certified elder law attorney been consulted? If not, that should be done ASAP. This can save thousands of dollars because they know how to protect assets in the best way possible.
Rhonda59
Posted: Friday, May 29, 2020 9:28 AM
Joined: 5/30/2016
Posts: 35


Hi Dude,

I am 63 and had to stop working last March to take care of my husband who has late stage 6 Alz.  I had gone to part time about a year ago and lost all of my benefits.  When I went to part time I signed up for Covered CA insurance.  It was good and I was happy with the doctor.  In March, when I retired, I contacted them to let them know my income had changed.  I have not yet signed up for social security so I have 0 income and my husband has a very small pension and ss but we have saved and have investments.  They said I will have to go on Medi-Cal due to our low income.  I'm still paying for my Cov Ca as I haven't yet heard from Medi-Cal.  They may be overwhelmed due to Covid.  I don't know if any of this helps you, but I saw the similarities in our ages and situations and thought I'd add my 2 cents.  I wish your parents well.


Peter5
Posted: Friday, May 29, 2020 1:25 PM
Joined: 5/30/2013
Posts: 1191


SSHarkey wrote:
Dude, do consider the option of continuing as is. His social security benefits will continue to increase as he stays on the job. Yes, he’s spending most of his income on caretakers, but in return he’s protecting his own future financially and physically. Early retirement will cost him more in the long run. The current arrangement is the same as if she’s been placed in a facility. But he’s still maintaining a daytime life away for himself as well as insuring he’s covered for his own retirement in the future. Even if he needs to hire a night caretaker, it will be worth it in the end. He’s now able to be her husband, and not carry the heavy burden of 24/7 care. It will only increase as time passes. He really needs to do what is best for him in this situation. It sounds selfish but it’s important.
Having been in a similar situation, I agree 100% with SSHarkey.  He needs to hang on to his job for another 18 months or whatever it is, for all the reasons stated above.  

Marie58
Posted: Friday, May 29, 2020 3:01 PM
Joined: 12/31/2018
Posts: 415


DH was dx with EO and retired within months of dx. I was still working so it wasn't a problem keeping him on my insurance and it wasn't not too expensive. But then I retired early to be his 24/7 caregiver and had the option of keeping insurance for just me or for both of us for as long as I wanted, as long as I paid the whole cost.  Needless to say it was quite expensive but we didn't have a lot of options. Once he was eligible for medicare, the supplemental plans for people under 65 were very expensive as well. This disease is expensive in lots of ways. Has he considered using FMLA? He may be able to maintain the insurance benefit and wouldn't have to retire yet.
dude47
Posted: Saturday, May 30, 2020 1:39 AM
Joined: 5/28/2020
Posts: 4


Thanks for the input everyone.  Social Security says if he was until he is 65 is will only ad another $15 a month to his check.  So the benefit is not much.  A change in management has led him to increased stress at work and unfortunately his company only employs 33 people so FMLA does not apply as the company has to employee at least 50 employees.  He is weighting wether his stress from being a full-time caregiver will be more or less than his stress from work.  He has about a month and a half until he will be 18 months from 65 so cobra might be an option.
Crushed
Posted: Saturday, May 30, 2020 8:27 AM
Joined: 2/2/2014
Posts: 5636


dude47 wrote:
Yea doing research I know my mother will not qualify for medicaid in California, you basically had to have spent everything and only have a house left before they will help.
 
 

AN ELDER CARE LAWYER TOLD YOU THIS? 


dude47
Posted: Saturday, May 30, 2020 12:30 PM
Joined: 5/28/2020
Posts: 4


Crushed wrote:
dude47 wrote:
Yea doing research I know my mother will not qualify for medicaid in California, you basically had to have spent everything and only have a house left before they will help.
 
 
AN EDLER CARE LAWYER TOLD YOU THIS? 
Early on we talked to one.  He basically said the same thing we had researched.  Only allowed up to 108k in assets plus a house and one vehicle.  At the time he suggested that My father transfer everything into my name  so when we did need full-time care he wouldn't have any assets In his name and they would qualify. But we were still dealing with everything and a little in denial and our entire family was dealing with depression And we never acted on his advise.  We really should have.  There is a look back period of 3 years where they make sure that you don't do this so if we did it today it wouldn't be useful for 3 years.

lizziepooh
Posted: Saturday, June 6, 2020 1:49 AM
Joined: 5/2/2019
Posts: 234


Hi Dude,

I work in health insurance and my husband is an early retiree so this is what I am going to suggest assuming two things are true: 1) your dad is not attached to his current health plan or doctor and 2) the first year after your father retires and each year thereafter, your parents do not file as married filing separately and their adjusted income amount on their taxes will be at least 138% of federal poverty level and no greater than 400% of federal poverty level. If under 138% of poverty level, then a person is not eligible for Obamacare since they are eligible for medicaid (called medi-cal in California but it is medicaid. Medicaid is state insurance that sometimes has clever names like Medi-Cal and has slightly different rules by state. And we wonder why people are confused by health insurance. Lol!) If greater than 400%, a person is not eligible for the subsidies. 

 

If these things are true, then I suggest your father do the following.

 

1) Quit when his health coverage will end on Oct 31.

2) Sign up for health coverage through coveredCA during open enrollment for an effective date of Jan 1.

3) In the meantime, your father will receive a letter about his right to elect COBRA. Do not have him elect yet. He has the right to elect within 60 days from the date of his letter or his qualifying event date, whichever is greater. Once he elects, that 60 day window goes away and he will have 45 days to pay his premium, including the retro premium (November). So keep COBRA as an option for November and December if he incurs medical expenses greater than his November and December COBRA premium.

Hope that helps.

* I have edited this post quite a bit. It is like a dream come true. I do not know what it is but in my work emails, I can read my email a few times and think it is great, but as soon as I hit send, I find something I wished I could change. With this post, I got this wish. This felt like a work email but I got to modify it. How awesome is that?! 

** If your dad does decide to go the route of qualifying for subsidies for an individual plan through Obamacare, let me know before he proceeds with the application. There are things he should know about to make things smoother. 


Rhonda59
Posted: Saturday, June 6, 2020 9:19 AM
Joined: 5/30/2016
Posts: 35


This is basically, exactly what I said I did.  You don't have to try and figure out where you are on  the poverty level.  Just apply and they will let you know whether or not you can get the subsidies through Covered Ca (Obamacare) or will be directed to apply for Medi-Cal.
lizziepooh
Posted: Saturday, June 27, 2020 3:56 AM
Joined: 5/2/2019
Posts: 234


Rhonda59 wrote:
This is basically, exactly what I said I did.  You don't have to try and figure out where you are on  the poverty level.  Just apply and they will let you know whether or not you can get the subsidies through Covered Ca (Obamacare) or will be directed to apply for Medi-Cal.
I should have been clearer. Someone may not want medicaid and if someone is smart in retirement they can figure out a way of being right over the state income limit for Medicaid and qualify for Obama care and the highest subsidies. If one is smart.
Every system can be exploited and most systems are exploited. Sad fact of life.

Victoria2020
Posted: Saturday, June 27, 2020 6:08 AM
Joined: 9/21/2017
Posts: 332


Nothing beats having an elder care lawyer and an accountant who actually sees your parent's real situation give their opinions and suggest options about something that is this important. Since your parents have retirement savings an accountant can determine if withdrawing IRA money now early when your Dad has your mother's care costs to make itemizing an option saves him long term.

Many moving parts.

And laws change.


ScottyTom
Posted: Saturday, June 27, 2020 10:09 AM
Joined: 5/12/2016
Posts: 69


I can only add my experience, and I think this has been well covered in the earlier comments:  When I retired I was 61.  I needed to take care of my wife with EOAD.  Health insurance was a major problem.  There was no possible way I could afford the COBRA plan.  So, I looked into Obamacare (ACA).  We are in CA and the exchange was brand new and there were a few hiccups in using it.  But it really helped us.  Due to our limited income we qualified for a substantial amount of assistance and were able to keep good insurance for both of us.  We are now both on Medicare and of course much has been lost to the program, but depending upon what state you live in it is worth a try to see what is still in place.  It was a game-changer for us and I'm glad it was available for the few short years in its full capacity.
Jo C.
Posted: Saturday, June 27, 2020 10:30 AM
Joined: 12/9/2011
Posts: 10865


Dude47:   If your father is concerned about which stress would be greater for him; remaining at work versus being a fulltime caregiver, he can use Family Leave for a period of time as he chooses to be a fulltime caregiver to see how the stressors compare for him.

AND . . .

Dude47; you have very inaccurate information regarding qualifying for Long Term Medi-Cal (California Medicaid) which addresses custodial care as well as providing waivers for receiving community care in the home to enable keeping the Loved One (LO) in their home rather than a NH.   Sincerely; the information you mention is absolutely not correct - of this I am absolutely certain..

Here is the scoop on Medi-Cal for the year 2020 and the amounts permitted a person to keep goes up each year. If you are going to search criteria for Medi-Cal Long Term Care benefits, be certain to use the year 2020 in your search phrase otherwise you will get old inaccurate information.  Long Term Benefits are different from regular Medi-Cal, so be sure to include those words in your search.

In California, Medicaid is Medi-Cal. In this, the home is not considered a countable asset for qualification.  Neither is an automobile counted.

Any retirement income in the community spouse's name only, (that would be your father), would not be countable as that income in his name only is ALL his.  This includes any IRAs, 401s, his pension, etc.  Remember, in his name only.

As for mutual liquid savings, the community spouse (your father) may keep up to $128,640; the applicant (that is your mother) can keep up to $2,000.  If Medi-Cal is used, it is far best for each parent to have their own bankng accounts to keep things crystal clear for Medi-Cal accounting purposes.  Your mother's Social Security, etc. will be taken by Medi-Cal as her 'share of costs," for her care services.  She will be left with a small amount each month for her toiletries, etc. That amount at this time is $35.

There are other assets that are kept, do read up on this, Google has a lot of information,  BUT be sure you are looking at year 2020 with term, Medi-Cal Long Term Care.  I have also provided a link re this.

Income for qualification appears to be applicant spouses income only; not the community spouses; but do check the criteria on the following link which is very accurate.

https://www.medicaidplanningassistance.org/medicaid-eligibility-california/

I have experienced this twice with LOs who received Medi-Cal and as an RN whose career encompassed being Administrator of Patient Care Management, I worked with this dynamic quite frequently.

It should be mentioned that COBRA insurance is most often dreadfully expensive and not affordable for many.  In California, there is also medical insurance through "Covered California." This coverage is subsidy for "Obamacare." Qualification for this will be assessed by using income levels both high level to low level. If one falls into a category of income, they will qualify for Covered California subsidy for insurance.  If a person's income falls very low based on the Federal Poverty Level, then that person will be qualified for Medi-Cal rather than Covered Care.

None of us here are practicing attorneys in Elder Law and you want to be assured of absolute accuracy re all of this.  It would be by far best, BEFORE your father retires, to have an appointment with a Certified Elder Law Attorney to ensure all protective legal paperwork is in good and timely order AND to get accurate information re Medi-Cal, etc. and to position your parents as best as can be.  Yes; there is a fee for this CELA; but it will save much distress and lessen unnecessary financial costs in the future.

Hope all goes well for your family, getting things set into place certainly takes a bit of thought and effort but is is absolutely worth it for the long haul and will prevent unforeseen problems down the road.

J.


lizziepooh
Posted: Saturday, July 4, 2020 11:53 PM
Joined: 5/2/2019
Posts: 234


Just wanted to add a friendly service comment about COBRA insurance.

There is no such thing as COBRA insurance. COBRA is a law that just means under certain conditions someone has the right to continue their group health plan for a certain amount of time at a certain cost.

That cost that people complain about is just 102% of the cost, by law. People do not realize how much of the cost their employer pays towards their health plan while they are an employee. Once they lose that eligibility and are offered COBRA, they are in for a jolt.


LovingAwareness
Posted: Monday, July 6, 2020 4:56 PM
Joined: 6/3/2019
Posts: 75


I truly hate to even bring this up, because I don't want to be political, but I'm not sure if anybody should count on the ACA exchanges or Medicaid being there in the future. The Trump administration's lawsuit to overturn the ACA is due to be heard in the fall, and if it is successful the exchange plans, Medicaid expansion and protection for pre-existing conditions will all go out the window.

Lizzie, since you work in health insurance (I think you said), what do you think the chances are this could happen? There are probably a lot of caregivers depending on the ACA already, and more coming to the ends of their ropes being able to maintain full-time jobs and caregive. If affordable/subsidized health plans are no longer available, a lot more Alzheimer's LOs may have to go to MC.