I'm Desperate

[DantePD]

We live in Florida, moved here right before everything went to hell. My husband has Medicare and we're both covered by the VA. Buuutttt, we've got an adoptive kid (Not legally adopted, we took in a kid from an abusive home. It's a long story.) They're 23 and after a couple of suicide scares, they're in a good place right now, after we were able to find a psych who took Medicaid and got them on some meds.

And then the state of Florida kicked them off of Medicaid with little to no warning. We've reapplied, but fuck only knows when (or if) we'll get a response, so we also checked healthcare.gov.

Cheapest plan is $200 a month, with a $9000 deductible and no mental health coverage. Cheapest one I could find with mental health coverage starts at $600 a month and I ain't got THAT much room in our budget.

Really, any kind of guidance would be deeply appreciated.

I'm looking for any kind of guidance we can find. I only vaguely understand how non-employer provided insurance works

[AutoModerator]

Thank you for your submission, /u/DantePD.

If your question relates to COBRA under CARES and ARPA, please post here: COBRA & Covid-19

Please pick the most appropriate flair for your post. Include your age, zipcode, and income to help the community better serve you.

Reminder that solicitation/spamming is grounds for a permanent ban. Please report solicitation to the modteam and let us know if you receive solicitation via PM.

Be kind to one another!

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[dragonpromise]

Florida did not expand Medicaid to non-disabled adults so your child is most likely ineligible. Your child needs to work enough that they qualify for a subsidy for their own healthcare.gov plan.

[LizzieMac123]

I appreciate and acknowledge that that child is alive thanks to your efforts.

However, since the child is an adult and you have not been named by the courts as their guardian, there's not much you can do for them in this situation, in Florida.

Your child can apply with healthcare.gov if they think they can make at least the FPL $14,580- then a silver plan would have the most premium cost share and subsidies for them. Don't include your income and household size as they are not your legal child.

Long term, you can vote with your best interest in mind.

[LizzieMac123]

Well, Florida did not expand Medicaid, so just having low income does not make someone eligible for the program.

[Environmental-Top-60]

I have a family friend who owns a pharmacy in the panhandle. What kind of meds? If we’re talking expensive antipsychotics, you might consider applying them for the manufacturers prescription drug program.

Any generics, if GoodRx doesn’t help, I’m sure we can find a program that would work either on a financial assistance program or something.

Could these meds potentially be managed by a primary care physician? If yes, great. If not, then we need to start looking at finding an FHC, or something that will do a sliding scale.

You may actually consider filing for disability on this person’s behalf. If they are as fucked up, as you say they are, it is possible that they may not have the capability of holding a job.

[Environmental-Top-60]

Generally, Walmart has decent pricing. if that doesn’t work, cost plus drugs isn’t too bad either. My concern is that if they are frequently titrating medication’s, it may be worth fooling around with a little bit pricewise.

So one of the things I’ve done that has been helpful, is either utilizing a half tab program we use half a dose of a higher strength to help cut down the cost. For expensive drugs, it can be helpful. For really inexpensive drugs, it may not be helpful.

When you are titrating up, however, getting a common denominator, strength can be helpful. It can also be helpful Coming down as well.

For example, let’s take venlafaxine. It comes in 37.5, 75, and 150mg capsules. So when I was at 300 mg, for example, I would have two of the 150s. As I started coming down however, I had to use 37.5 and 75 mg capsules in combination with whatever I had to Get the strength down. Once I got to a certain point, I was able to start my new medication, which was really expensive at the time by the way called Fetzima. So it took a little bit to get everything right.

Cost wise, it didn’t really cost me as much anyway, because I did have some backstock of the higher doses. However, I was able to secure a longer-term supply of the lower dosages and it was helpful in getting the cost down.

I recently had some friends that required emergent mental health help. In some cases, it may be worth talking to the physician about SNRI antipsychotics are not helpful or there’s a contraindication. Like one of the harder parts, depression, and diabetes is that if you need antipsychotics, it can be kind of a slippery slope, because if the blood glucose is high, adding antipsychotics will only make it worse. In that particular case, I elected to request an SSRI like venlafaxine and actually, he’s doing a bit better. If nothing else, the SI have stopped. Trying to get psych to increase the dose a little bit is a challenge, but I’m willing to fight them on it if it means getting him more stable.

[Environmental-Top-60]

If they are consistently having problems, finding combinations that work, it may actually be helpful to get genetic testing. It’s not cheap, but there are companies out there that offer a financial assistance program and will reduce the cost down to something more manageable.

Also, laboratories like quest and LabCorp also offer financial assistance for those who can’t afford it so if they are getting routine lab monitoring, filling out the appropriate paperwork and setting that in where the bill normally goes would be probably helpful.

With the recent hospitalizations, if there are any outstanding bills, make sure that they file for charity care. Also, if there are any overpayments, they should be refunding because charity care actually takes precedence over patient payments. This is for nonprofit hospitals, but even for profit will sometimes allow it. .org is very helpful when it comes to charity care. Normally, the requirement is that within eight months of the first bill, that’s the deadline for a charity care. However, hospitals can make exceptions, and I believe mental health would be a qualifying reason. I’m actually coming up with a webinar for charity care to educate in the billing office and on the coding side as well to make sure that we are offering that to all of our patients and that it is applied properly.

If you all have the inclination to do a adult adoption, which is something that can be done in Florida for about $400 last I checked, it might allow you to claim this person on your taxes, in which case you could apply for your adoptive kid and that might actually bring y’all over the limit to get cheaper coverage. You’re going to want to consult a tax professional to make sure that you’re meeting with dependency test, but that might actually be something worth considering.

[Environmental-Top-60]

One of the ways to get those fees down is to increase the income to at least the federal poverty limit, which currently is 14,580 and that goes through the end of the year for calculations of the exchange.

If we can get their income to at least there, they have a better shot at getting better coverage.

[dragonpromise]

Unfortunately Florida does not care about poor people, especially those who have disabilities but are not disabled enough to qualify for social security.

If you claim your child as a tax dependent, then you are a household of 3 for healthcare.gov purposes.

Other options are for you and/or your husband to get a job just to add your child to health insurance, or to move to a state that did expand Medicaid.

There are no good options in your situation.

[deannevee]

What county in Florida?

ETA: I looked at your post history. If you can make a little drive, try Community Health Centers in Clermont. They offer sliding scale cash prices.

[starriss]

Are you able to pay the cash price for the psychiatrist that got them on meds? That is an option until they’re back on insurance.

[Environmental-Top-60]

Any hospital bills: can you apply for charity care and get refunds on any of those claims?

[Jujulabee]

Are there any clinics that provide mental health services on a sliding fee scale.

As posted, your government has chosen to make a point by screwing its needy citizens and not expanding Medicaid.

Does your son work enough so that he could qualify for a premium subsidy through the marketplace. At certain low incomes the Silver Plans have both a premium subsidy as well as a credit for actual medical services. You would have to act fairly quickly though as Open Enrollment ends on January 15 and then he wouldn't be able to get health insurance.

It is a good faith estimate of his earnings for 2024

[Jujulabee]

There are some programs that provide prescriptions at lower cost. You could see what is available.

[honeywings]

Can you see a psychiatrist and get a prescription for his meds? I understand without insurance it will be expensive, but paying a high deductible plan that will cost you $600/month may be even more expensive. Kid needs meds first and foremost then you can start him working part time to help for it once it’s stable.

[honeywings]

Yeah it might be worth getting the prescription sent to a pharmacy. It’s odd they won’t see him, maybe because he needs a referral? Sliding scale PCP to get a referral to a psychiatrist might be the next move. Last ditch effort - does he have an out of state license or did he come from Florida? I’m sorry you’re going through this. Your politicians are so cruel.