Something I'm suddenly seeing covered in a lot of venues.
Something I'm suddenly seeing covered in a lot of venues. I knew that there were situations where the government could take your estate after you died to cover medical costs incurred before you died. Specifically, I knew that there were issues related to people who ended up in nursing homes.
I did not know that the ACA had created a situation where people could be forced onto medicaid and then basically put into a coverage gap between 55 and 65 where you are essentially required to pay for your medical care, now or later, but they can come and get it, and apparently will.
That's not health insurance, people.
http://www.wsj.com/articles/medicaid-cost-recovery-law-spurs-fears-of-asset-seizures-1428880153
http://www.dailykos.com/story/2013/10/18/1248425/-Medicaid-Estate-Recovery-ACA-Unintended-Consequences
I did not know that the ACA had created a situation where people could be forced onto medicaid and then basically put into a coverage gap between 55 and 65 where you are essentially required to pay for your medical care, now or later, but they can come and get it, and apparently will.
That's not health insurance, people.
http://www.wsj.com/articles/medicaid-cost-recovery-law-spurs-fears-of-asset-seizures-1428880153
http://www.dailykos.com/story/2013/10/18/1248425/-Medicaid-Estate-Recovery-ACA-Unintended-Consequences
Would genuinely like to know from those of you outside the US - if you have any form of national health insurance, or government subsidized health care - is there a difference as to what the poor vs the wealthy are offered, and can they then take your assets or estate away from your family to pay for your care?
ReplyDeleteMy Mom fell into this gap until her disability coverage kicked in. It was a scary time.
ReplyDeleteTo an extent, yes. A) there are private clinics not covered by insurance, for the very wealthy. Think celebrity-wealthy or Old Money rather than merely upper upper middle class, for the most part. Maybe upper middle class for specific procedures like cosmetic surgery etc.
ReplyDeleteBefore the current system came in (the current system, by the way, is pretty much literally the prototype of Romney/Obamacare), the regular folk would be covered under "Ziekenfonds", and people above a certain income limit (which was essentially most of the middle class and up) would be on private insurance. That would cost a lot more but it would mostly just be Ziekenfonds except with more generous limits on reimbursing physiotherapy and glasses, and private or at least more private rooms in hospitals rather than wards. So, same care, but more privacy.
These days that class difference has gone out the window, you have to be in the private-clinic jet set to get much special treatment.
Wards have been abolished anyway, and private rooms for the most part as well, for reasons of efficiency.
B) Medical/hospital care is pretty much by definition insured. Even if you're a deadbeat who doesn't pay your bills, you're still mandatorily insured at the insurer of last resort if nothing else, which is very expensive — as much as 150-200 a month, I think, where normal is more around 100 — so there isn't much to garner in that respect no matter what (although they can and will come after your estate for the bill if you haven't paid that for a while).
Long term care, though, is a different matter. If you end up in a home or similar, I believe the current rule is you're required to pay a significant fraction of the costs yourself if you have significant assets. In practice that mostly means you need to "eat your house" — sell the house and move into rental accommodations, then draw down the cash until a certain sum remains, or take out a mortgage, and ditto.
Similar thing with the Bijstand, I accidentally looked up recently, (the guaranteed income if you can't find a job when your Unemployment runs out or if you've never had one) — if you have more than 50k of assets tied up in your house you can be forced to take a mortgage or sell before they'll give you money.
So it's entirely possible for your long term care to eat most of your estate — the limits on these sort of things are typically 10-20k or so of savings, and above that, you're considered capable of paying.
These are not, however, short-term, completely unpredictable costs like ending up in the hospital and coming out with 200 grand of debt two weeks later. This is more like your care is costing three grand a month of co-pay and your income is 2 so you're eating a grand of savings a month, or whatever actual numbers, until you have few enough assets that they will leave you alone.
Naturally, it is always possible to not accept an inheritance, or accept it under the proviso that you only do so if it turns out to be a net gain, in which case the creditors are SOL if net assets are negative.
In Norway, nursing homes can take 85% of your pension, so there may not be enough left to keep your house in the long run. And until a couple years ago we had "death tax", so the state might take the house even if you had never been sick a day in your life, unless the heirs had enough cash to pay the inheritance tax.
ReplyDeleteBut medical expenses are paid for by a forced insurance that is indistinguishable from income taxes. The higher your net income, the more you pay, but it is not an extreme amount even for the rich. Health care costs are overall lower in Norway than in the US, although higher than in most of the rich world.
(We have a rule that state-paid doctors shall let patients die if it would cost more than approximately $100 000 a year permanently to keep them alive, but some doctors sneak around this in various ways, causing budget problems. Norway can live with that kind of budget problems though, at least for now.)
As usual, it's a little more complicated than that (and very much a work in progress):
ReplyDeletehttp://familiesusa.org/blog/2014/03/cms-issues-letter-state-medicaid-directors-estate-recovery-medicaid-enrollees