Without Adequate Health Insurance: A Personal Story

I never truly realized how fortunate I was when I worked full time and had full medical coverage at no cost to me through my employer. During those 15 yrs, I could afford to be proactive--scheduling preventative medical, dental and vision appointments yearly, making sure I got necessary immunizations and exams and, when I did become ill, taking medication exactly as prescribed because my company also provided a prescription benefit so I had no need to worry about whether filling a prescription might take food off of my table.

All of that changed about eleven years ago when I was forced due to health issues to apply for social security disability and was ultiimately approved. Although it granted me a survivable monthly disability check, I have seen my health gradually decline as I now rely solely on Medicare for health insurance.

I suffer from the following conditions: high blood pressure, obesity, Post Traumatic Stress Disorder, Anxiety and Panic Disorder, Major Depression and Irritable Bowel Syndrome. Over the years, these conditions have necessitated being on a variety of medication as well as periodic hospitalizations. My condition also warrants psychotherapy and at times I have needed case management services. These things would have been funded without question under my previous health insurance when I worked full time. That is not always the case with Medicare!

For example, at one point I was on an antidepressant that worked very well for me. So well in fact that after several years I was given permission to go off of it. Due to circumstances beyond my control I suffered a relapse not that long ago and so my doctor, upon being reminded of the medication I'd been on that worked, quite naturally prescribed the same thing only to find that this particular medication is not covered by Medicare. This led to trying a different medication that had little to no positive impact on my condition and finally a third medication that is currently giving me some relief.

Last spring, my therapist advised that the time had come to utilize case management services once again. Much to my dismay, virtually every single agency I called in my city and within a 40 minute drive does not accept Medicare. These are mental health and social service agencies serving primarily low income persons with a diagnosed mental illness! These are persons that are falling between the cracks and who's condition may in fact worsen enough to necessitate a more expensive treatment such as hospitalization as a result of not being able to afford services within the community. I was fortunate to be told about a grant that I qualified for in order to receive time limited case management services during my time of need. But the recent downturn in the economy has all but taken such opportunities away for the current consumer.

Although Medicare does reimburse for psychotherapy services, it does so at a greatly reduced rate so that for many providers also struggling in this economy, it is not worth accepting patients with Medicare as the sole form of insurance. In addition, there is limited coverage for psychiatric hospitalizations. I personally have 97 days of in patient hospitalization coverage left. Granted, that seems like a long time--over three months actually. But what if, over the course of time I remain on Medicare, my condition were to deteriorate in such a way that I needed more? What then, a state run institution where conditions and quality of care are less than stellar?

Aside from all that, there is the preventative care that in my opinion we all have a right to. I've not had my teeth cleaned or dental work done in about 10 yrs. Why? Because I only have Medicare and Medicare does not cover routine dental services. They WILL however, pay to have your own teeth pulled. Where is the sense in that? Why not at least provide basic preventative care so that people may keep their own teeth as long as possible? And what about dental emergencies? We all know how painful toothaches can be. Imagine having to call almost every dentist in the phone book to find one that will take you as a new patient without insurance AND accept a payment plan. Not only are they few and far between but I have been put in that position and it is by no means pleasant. This is a current issue for me as well because I have some dental work to be done and want to look and feel my best when I return to the workforce but it is a vicious circle. Without insurance you can't always afford preventative care or routine dental work. And without looking the part in a professional setting, what company is going to hire you to give you the chance to GET health and dental insurance?

I have similar concerns regarding vision care. I am supposed to wear corrective lenses --either glasses or contacts daily. I've not had my eyes checked in over five years because although Medicare will help with the exam they do not pay for the glasses or lenses. I do not yet have my driver's license and I know I am restricted to corrective lenses. Without going for the exam and getting the glasses, I cannot drive. Without being able to obtain a license, again it is a vicious circle as my job choices if and when I do return to work are quite limited.

As it is, if I am fortunate enough to be able to return to the workforce, a good chunk of my initial paychecks will go towards obtaining the medical, dental, vision and mental health services that Medicare somehow does not see fit to be able to afford or provide for myself and countless other disabled or senior Americans. As our population ages, this is a very real concern as every American should be entitled to adequate health insurance coverage!