Marriage or Medicaid?

Surviving a double lung transplant after being diagnosed with a rare lung-attacking autoimmune disease, I couldn’t see beyond the moment. I was grateful to be alive thanks to the advancements in medical technology and the superior health care I received. I wouldn’t have been able to receive that care if it weren’t for my medical insurance. Fast forward 18 months later and I am making plans for my future. Or am I?

It never dawned on me that accepting my fiance’s marriage proposal would mean I could lose my medical coverage. Becoming disabled at 40 years old and no longer able to serve as a medical courier, I qualify for disability benefits and medical assistance. There are income eligibility requirements for Medicaid. The government-funded program is offered to those who need it most, low-income individuals.

When it comes to Medicaid, if one spouse applies for Medicaid and the other does not, the entire household income is considered to determine eligibility. My future husband’s income would be included and likely disqualify me for continued coverage. I will become a victim of the Medicaid Marriage Penalty, where I will lose my medical benefits as a result of changing my marital status.

In order to qualify for Medicaid in Pennsylvania, an applying individual’s gross household income for six people cannot exceed $47,322 annually. My future husband’s income exceeds the threshold just enough to disqualify me for coverage but not enough to make the copays for doctors’ visits and prescriptions affordable. Hence, the dilemma.

My future spouse is a hard-working man who earns a modest living as a single man, but his income would be stretched a bit thin in a new household with a new wife and four stepchildren if he has to pay for my medical expenses. I am physically incapable of performing activities that will allow me to sustain employment that will provide for my household. So my income will remain low.

According to HUD, the 2020 average household income in America was $78,500 for a family of four. According to Pew Research, middle-income Americans are “those whose annual household income is two-thirds to double the national median” or up to $157,000. Those with such an income can afford medical expenses. If your income falls short of that yet exceeds the maximum allowed for Medicaid, you’re out of luck. To receive Medicaid, I have to remain impoverished and single.

We’ve decided to remain in separate households until our nuptials. He’s hopeful that things will work themselves out but I have so many concerns about what the future holds because of the restrictions placed on disabled individuals like myself. I don’t want the rest of my days lived to be solely about my disability. I don’t want the bulk of my spouse’s income to be spent on keeping me alive rather than on truly living.

When you plan a life with your loved one, you imagine being swept away by the romance of it all like in the movies. But in reality, you have to logically consider the consequences of the decisions you make. When you come together, you want to improve your lives not make things harder for one another.

I have regular appointments with my Lung Transplant Specialist, Rheumatologist, Endocrinologist, Sleep Doctor, Dermatologist, Gynecologist, Primary Physician, and Therapist. I’ve even had increased dental appointments requiring two root canals and crowns due to my medication causing tooth decay. I take numerous prescription medications that I’ll have to take for the rest of my life. There are breathing tests, bone scans, frequent blood draws and whatever else my doctors deem necessary to order for my care. All of these things are necessary for my survival.

Being put on my soon-to-be husband’s health insurance would hike up his premium and trigger costly deductibles and copays for the abundance of care I require to survive. My medical needs will become a financial burden on my spouse. That’s if the health insurance even accepts me with my preexisting conditions.

So, I find myself grappling with the question: Marriage or Medicaid? Do I risk my health by losing my guaranteed medical coverage with hopes of receiving coverage from my husband’s medical insurance? Do I put a financial strain on my husband due to my expensive health needs? Or do I dismiss my dreams of happiness as Mrs. Powell?

My Love says he’d marry me anyway but is that the practical thing to do? The fear of losing the health coverage I need to keep me alive may prevent me from getting married. My double lung transplant gave me a second chance at life just to leave me contemplating whether I can freely live it happily.

If you’d like to see more from me, kindly give a coin of encouragement.

Resources:

Benefits.gov Pennsylvania Medicaid Program

HUD FY 2020 Median Family Incomes for States

Where Do I Fall in the American Economic Class System?

What is the Medicaid Marriage Penalty?