What type of help can I get to make sure that my medical needs are covered?

1 answer | Last updated: Oct 02, 2016
A fellow caregiver asked...

I am currently receiving SSI Disability Benefits. I am not able to receive Medicare or Medicaid until two years after my first benefit check which will be this comming December 2011. I have Dementia possibly leading to Alzheimer's. What kind of coverage should I get to be sure to cover my medical needs and prescription needs and any other related needs. I am totally in the dark about any of these coverages.


Expert Answers

Barbara Steinberg is the CEO and founder of BLS Eldercare Financial Solutions, which specializes in helping families pay for long-term care for their loved ones. A registered financial gerontologist, she speaks regularly on the topic of paying for long-term care and is a financial expert for Caring.com.

In the past, based on your status and your condition, you would have been considered "uninsurable with a pre-existing condition". This made it nearly impossible to get coverage for your medical needs. However, with Health Care Reform and the passage of the "Patient Protection and Affordable Care Act" in March, 2010, you do have options. Prior to the Federal Reform Act, there were 35 states that sponsored "high risk health insurance pools". These were implemented for people in situations like yours. You need to find out if your state is one of the 35 and what the benefits and costs are. If your state has such a plan, this is one option for you. Another option is the Federal High Risk Pool created by the Reform Act. This law calls for a federally funded, temporary high risk pool to provide health insurance coverage to individuals with pre-existing medical conditions who cannot otherwise qualify for affordable health insurance. The federal government subsidizes the premiums using $5 billion that has been appropriated for this purpose. The program ends at the end of the year 2013. The federally funded premiums are less than the state premiums. For those individuals already in a state pool, they can opt to leave this pool and participate in the federal pool. One requirement of the federal pool is that the individual has been uninsured for at least 6 months. If you drop out of a state pool, you must wait the 6 months before being eligible for the federal pool.