I'm sure this is a question heterosexual couples in the same situation have to ask as well. However, I'm particularly sensitive to it as 1) it's only been legal for same sex couples to marry in Massachusetts for just over 5 years, 2) we're only married in Massachusetts, not at the Federal level (talk about screwing up your tax situation), so we really don't reap all the benefits possible from our married status and 3) we're officially not married in most states in the US and most countries around the world.
This question came up because I started doing some digging into the health coverage that's available in Massachusetts for the disabled. Massachusetts is the only state in the US, to my knowledge, that requires every citizen to have health coverage, and they have a lot of state-sponsored options to help individuals get access to coverage. Anyone who is disabled can have coverage through a plan called CommonHealth.
I started looking into the provisions of CommonHealth last week to see if Skip should change to it. One amazing thing is, if you have CommonHealth, you're eligible for 40 hours of paid Personal Care Attendant services per week! Yippee! Visions of someone to help out with some of the "heavy lifting" danced through my head.
The plan seemed fairly complicated if you're eligible for Medicare. It was hard to tell what you needed to keep and it sounded like you needed to get drug coverage through Medicare Part D, which would be a viable option. But, nowhere could I get the details on premiums.
Yesterday, I finally found a highly legalistic, technical document that outlined premiums. Premiums are indexed relative to the "family unit's" household income in relation to the Federal Poverty Level. If your family's income is below the FPL, your coverage is free. The higher your income in relation to the FPL (an unbelievably low number), the higher your premium. So, if Skip counted only her income, CommonHealth would be close to free. Add me in and it rockets through the roof.
I need to get more details before I can truly understand how CommonHealth coverage works in coordination with Medicare. I spent 30 minutes on hold with the Massachusetts Health plan folks last week, never getting through to a live operator. I'll try again this week so I can speak with someone concerning how the plans work together and find out what the premiums really are.
This is a troubling quandary. I can understand the logic behind setting up premiums in a way that reflects ability to pay. But, with the stroke of a pen on a divorce decree, we could establish a different legal relationship that would dramatically change the income used to determine premiums. And, it would alter the legal protections we automatically receive (albeit only at the state level) due to our married status. (And, I'm just starting to get used to introducing Skip as my wife instead of my partner!)
I'm sure we won't get divorced, but I'm made crazy contemplating Skip's medical options and costs if we did. What a terrible dilemma for couples like us.
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7 comments:
BR and I passed on our opportunity to get (re-)married in California last year mainly because I couldn't see myself trying to "break new ground" with all the government agencies while trying to keep the household afloat. I'm definitely sticking to the beaten path unless there is a strong reason not to.
I wish some of the marriage equality groups would offer advocacy services to help us through this transitional period until there is federal recognition of gay marriage.
What an adventure. The state thinks you're married, but the feds don't. You're married here, but not there. Yow. And you can bet the people who have to administer this stuff will be at least as confused as you are. This could be fun. Really. it'll be fun.
Steve - there's some sense to that approach. To me, there are a lot of advantages to being married (both legal and psychological), but there's a lot of frustrations as well.
Zoom - all I can say is you must have a pretty interesting sense of what qualifies as fun! :-)
Hi Cranky,
I'm a new lurker to your blog and decided to come out on this topic. My partner and I are facing similar issues. We have been together for almost 15 years and had a beautiful commitment ceremony years ago. But we are worried about the financial risks of getting married (romantic, I know) now that it is legally recognized in our state. My partner was diagnosed with MS recently and her progression has been fast and furious. We have health insurance and retirement savings but uncovered medical costs (e.g., a nursing home, home care services, etc. for which we are now in a high risk category) could devastate us financially. In the event of a worst case scenario, the financial hit would be much worse if we were married. It is crazy for same sex couples for the reasons you mentioned and a few more such as Medicaid eligibility and "look back rules" (federal program--no you're not married--but state administered--oh, oops you are married) but it is almost as crazy for straight couples too, Nicholas Kristoff recently wrote an essay about this issue that I found worth reading: "Until Medical Bills Do Us Part" published August 30, 2009 in The New York Times.
P.S. Thank you for your blog, I read it with one eye shut because I'm not quite brave enough to go down this road with both eyes wide open.
Upstater - welcome and thanks for your message! I'm glad for the info on the Kristoff Op-ed piece, it was good reading.
You sound pretty brave to me, no matter how many eyes are open. Caregiving ain't for sissies!
Hi Cranky! Marriage and pragmatism now there is a mix for the ages. Then again, it is part of caregiving. To my knowledge, each State is different as each State manages their own Medicaid funds. In our story it made no difference, because the urgency of 24/7 care for Patti required application for medical assistance (Medicaid) to help pay for it. Application involved a retrospective "look back" period of 5 years of family finances which did not care whether we were divorced, married, or living together. Since then I have learned that if you are a psychic caregiver and can 'divorce' the person you care for at least 5 years before they need to apply for assistance then you may fare a little bit better financially.
Caregivingly Yours, Patrick
http://caregivinglyyours.blogspot.com/
Patrick - I like the idea of the "psychic caregiver." Wish I had one of those crystal balls to see ahead. Interesting that in your state the 5 year look back doesn't care about marital status at all.
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