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Payment responsibility of parents for adult child

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t74

Member
What is the name of your state? OK

We have a disabled but somewhat functional workwise child who now has significant health issues. Until the pandemic he held a low income job (approx $15K/year) and has purchased health insurance via the exchange. He is now unemployed and receiving unemployment benefits. His insurance premium is about 50% of these benefits so we are assisting him with additional funding for copays, prescriptions, and living expenses. I often pay these directly to the provider on my account or on a credit card on which he is an authorized user, We do not claim him as a dependent on our income taxes..

In the past when he was still a dependent student, we have signed financial responsibility documents for his hospital admissions, etc. His health has deteriorated significantly and I am anticipating significant costs of treatment in the future. As it is, our health care expenses including insurance exceed 50% of our income since we are now retired and on Social Security and savings (no pension). Our prescriptions are estimated to cost over $9000 next year without considering his.

Can our previous payments on his behalf make us liable for future payments? If so, what should we do to withdraw our agreements to pay his expenses?

While it is likely that he could qualify for Medicaid and SSI ( which is greater than his unemployment insurance payment), that would leave him without physicians since the ones he now sees do not accept it or, if they do , they are not accepting new patients on either that or even Medicare. His small retirement account would also need to be drained for him to qualify, and he would become homeless.

Keeping his current health insurance and providing for his increasing care while protecting our limited assets for our own care is my concern. Please suggest what we should/should not do.
 


cbg

I'm a Northern Girl
Can our previous payments on his behalf make us liable for future payments?
No. That doesn't mean a provider might not try to claim you're liable, but unless you have signed something agreeing to be responsible for the payments in question, prior payments do not make you legally responsible for future ones.

How old is he? There's a reason for the question.
 

t74

Member
No. That doesn't mean a provider might not try to claim you're liable, but unless you have signed something agreeing to be responsible for the payments in question, prior payments do not make you legally responsible for future ones.

How old is he? There's a reason for the question.
42 ; he has controlled cancer, rheumatoid arthritis and rheumatoid lung disease (recently diagnosed), and has significant LD and mental health (improperly diagnosed until mid-late 30s; finally on effective but incredibly expensive non-formulary meds)

He has enough work credits for a small SSDI benefit, but I do not know if his PCP or new psyc would support it since his cancer and mental health issues are currently controlled. The arthritis diagnoses are new. I believe that he has been imporperly evaluated and the arthritis attributed solely to gout for about 15-20 years.
 

cbg

I'm a Northern Girl
If he's 42 what I was going to propose won't work. If he were under 26, you would have the right to put him on your insurance, and many if not most carriers will allow a disabled adult to remain on his parents coverage after he would normally have aged off. However, that only applies if the disabled adult is already on the plan at the time he ages off.; it's not something that can be done after the fact. The two biggest carriers in my area require that the application for continued coverage be started before the 26th birthday.

Sorry, but it was worth a try.
 

t74

Member
He was on spouse's plan as disabled child until ACA, and employer became really obnoxious since they had so many under 26s added. He did get Cobra for 3 years which was odd. Spouse has retired now, and we get no retiree health plan just Medicare and a supplement; we purchase along with high cost drug plan since the low cost one estimated copays for just one of us at $38K per year because of insane insulin costs. We tried to keep him on a Gold plan because of the deductables for the Silver and Bronze so his insurance cost is higher than what it could be if he were healthy. None of his issues were identified before age 18 so the SS benefits for a disabled child do not apply.

In my community there are 2 basic clinic groups that most PCPs belong to. One in particular (unfortunately the one based in the hospital we like to use) is really hard on PCPs leaving to be hospitalists, dedicated rehab facility docs, and generally greener pastures. New doc is not part of a clinic group but uses a hospital that flips in and out of being in-network for the main insurer in the area for some reason. They are back in this year. This time of year when we have to pick new plans gives me headaches just trying to figure out what they changed this time.
 
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t74

Member
cbg, I will make sure he signs new financial responsibility forms with each of his providers. He has a SNT trust established but not funded. It was to be funded from life insurance primarily to pay for health insurance and a few allowable essentials like phone and internet. I guess I need to consider making contributions to it and abd let it pay the medical expenses that I now pay directly. I have not done that because another child is trustee and works as an ex-pat making it difficult for that other child.

My house of cards is really shakey right now! The lung disease and potential of metastasized cancer has created so much uncertainly especially with the doctors limiting access to other than the patient because of COVID. Even though child has given us the ability to discuss his health, the doctor wants the communications via the electronic medical records system so it is hard to have a "conversation".
 

t74

Member
Thanks for answering my main question.

I thought Cobra was for 18 months (at least that was what I recall being offered many, many years ago).

I do not know if the health care uncertainty here is countrywide. It existed prior to the pandemic and has only become worse with the limits health care facilities have enacted. My spouse has had a stroke and gets lost going new places. He had a procedure scheduled (at the hospital that I really dislike); it required someone to stay on the site (in 100 deg heat for several hours), and they would not allow that person in the building even to make sure the patient made it to the proper suite. He had a different procedure earlier and they allowed him to get lost in the building.

I do not have the patience to deal with the insurance and inflexible policies. I admire anyone who can figure it out!
 

Zigner

Senior Member, Non-Attorney
Thanks for answering my main question.

I thought Cobra was for 18 months (at least that was what I recall being offered many, many years ago).
There are different time limits based on the reason.
 

cbg

I'm a Northern Girl
Thanks for answering my main question.

I thought Cobra was for 18 months (at least that was what I recall being offered many, many years ago).

I do not know if the health care uncertainty here is countrywide. It existed prior to the pandemic and has only become worse with the limits health care facilities have enacted. My spouse has had a stroke and gets lost going new places. He had a procedure scheduled (at the hospital that I really dislike); it required someone to stay on the site (in 100 deg heat for several hours), and they would not allow that person in the building even to make sure the patient made it to the proper suite. He had a different procedure earlier and they allowed him to get lost in the building.

I do not have the patience to deal with the insurance and inflexible policies. I admire anyone who can figure it out!
It depends on why the insurance ended in the first place whether it's 18 months, 29 months or 36 months. If it's because you, the employee, lost eligibility due to losing a job or a reduction in hours, that's 18. A dependent who lost eligibility because of a divorce, aging off, or some other reason while the employee continues eligible, is 36 months.
 

stealth2

Under the Radar Member
@t74 Not having to do with your son, but... Several years ago, my parents switched to one of the Advantage plans vs Medicare + Supplemental. The premium is significantly less, and I've found the coverage to be as good or better. Even for Dad w/multiple hospital/rehab stays. We did go through a broker. You might want to give it some thought as it's that time of year.
 

t74

Member
@t74 Not having to do with your son, but... Several years ago, my parents switched to one of the Advantage plans vs Medicare + Supplemental. The premium is significantly less, and I've found the coverage to be as good or better. Even for Dad w/multiple hospital/rehab stays. We did go through a broker. You might want to give it some thought as it's that time of year.
Thanks for the suggestion. Some of the options on the plans would be useful especially if there were only one of us living alone or in assisted living. I have looked into them but none use the hospital we prefer. There was a new insurer last year that was low cost but had only one in-network hospital that we would never go to because of the location and staff choices. It really affected the cost of child's plan because it was the baseline Silver plan. We live less than 2 miles from one of two level 1 trauma centers in our part of the state. Others are significantly further and do not have the ER facilities, cancer treatment, specialist choices or urgent care affiliations.

Have you experienced annual changes in the plan specifics in both the Medicare supplements and exchange plans? We never had this (other than premium which actually decreased one year) on our employer sponsored plan with the same insurance company.

This year the drug plan we liked totally disappeared; the offered option cost less monthly but has a significantly larger deductible and copays so our net is much more especiall at the beginning and the end of the year. I do wish Congress would deal with drug costs especially for maintenance drugs for common conditions ($800 for one of the weekly insulin pens is unconscionable!). I don't thing the drug reps tell the doctors the cost of the pharmaceuticals. I wonder how much of a drug's cost is advertising and marketing. I understand why many have to choose between food and prescriptions.
 

stealth2

Under the Radar Member
I honestly had trouble making head or tail of any of it. Hence the broker. He was able to access the right networks to check access to their doctors and preferred hospitals, plus what their prescriptions would cost as compared to Medicare/Supplement. It could be that we just lucked out, All of our "local" hospitals accept the plan (living where we do, you trip over a hospital everywhere you go), as do their doctors. The only "problem" I had was when I started looking for a visiting doctor for Dad as they were few & far between and none took the insurance. But they worked with me and found a doctor who was technically on a hospice service who would come out apart from that. They've also called me several times during the pandemic to see if I needed any help setting up tele-med visits for Mom.

I agree on the drug costs. Luckily, all but one of Mom's meds end up free, but Dad had some hefty ones (also diabetic, though he only started needing insulin towards the end, and it wasn't a daily requirement - the pills were expensive enough...).
 

commentator

Senior Member
I do not exactly see why your marginally healthy and at best marginally employed son should work so diligently to "keep his retirement" and do not understand why filing for Medicaid would cause him to "become homeless." In these challenging times, it may be harder for him to find further employment and SSI with Medicaid (assuming he has not worked enough and would not qualify for SSDI) sounds like an on-going solution to his need for medical treatments. I do believe I'd be willing to try to give up his particular doctors. I am sure there are some medical facilities in your area somewhere that accept Medicaid.
 

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