Single in Sickness and in Health: Prepare for Medical Emergencies

No, Singletude isn't running out of things to say. It takes a fever, a migraine-level headache, a cough that sounds like something thick and foul-tasting bubbling in a pot, and a throat that feels like it's been stuffed with fiberglass to shut this single up. Yes, I was stopped in my tracks for several days straight by a nasty cold.

That sparked a question. As singles, we're used to relying on ourselves for the daily necessities--shopping and food prep, cleaning and household maintenance, transportation and car care, budgeting and bill paying. But sooner or later, along come those wicked little bacteria that you see on anti-fungal commercials, leering as they munch their way into your mucous membranes. Or perhaps you fall, and a limb gives way under the pressure. Or your immune system feels left out and starts acting up with a chronic condition like asthma or lupus. When you're the only one on duty, who holds down the fort when you're incapacitated?

It's a difficult enough question to answer when you're living off toast and ginger ale for three or four days. When you're facing a life-threatening battle with cancer, heart disease, or another serious condition, that question can be as stressful as the diagnosis.

Case in point: Over the past several years, my widowed uncle has been plagued with health problems and has needed a hip replacement and a rotator cuff repair. Now his knee is failing. Each time he's had surgery, my mother, who lives three hours away, has spent several weeks at his house cooking for him, driving him to appointments, running errands, and generally taking the place of a visiting nurse. At this point, my uncle is disabled and has to use a walker. In addition, because his shoulder didn't heal properly, he has only limited use of his arm. My cousin, who lives an hour away from him, visits him every week or so to clean house, make meals, and do the laundry.

Without his extended family, I'm not sure what my uncle would do. Some singles aren't fortunate enough to have family members who are willing or able to act as home health aides. Those who have good insurance may be able to afford nursing care, but not everyone is so lucky. To be sure that you're prepared for a medical emergency, consider taking these steps:


1. Make a plan with family or friends.
Discuss your health concerns with your family or friends. Plan in advance who will help you out in case of a medical problem. Preferably, this should be someone who lives nearby and doesn't work 70 hours a week in order to minimize the strain on everyone. Decide now so that there won't be any confusion or squabbling in case the worst occurs. If possible, choose a backup who can relieve the appointed family member or friend in case he or she is unable to care for you or needs a break. Offer to assume the same responsibility should your health care volunteer need you, especially if he or she is also single.

2. Get disability insurance.
Disability insurance kicks in when your health gives out to ensure that you still have an income if you can't work. Many employers offer short-term and/or long-term disability insurance. Find out if yours does as well as how long you'll be covered and for what percentage of your income. Typical short-term coverage continues for up to six months, while long-term coverage extends for five years to life. Most plans will pay approximately 60% of your income. If you live in New York, New Jersey, Rhode Island, or Hawaii, your employer must provide short-term disability insurance for 26 weeks, but no states have mandated long-term coverage yet. If your employer doesn't offer long-term disability insurance, you can buy a policy privately. Check with your state's department of insurance or with the agency that sells your life, home, or auto policy.

3. Buy long-term care insurance.
Long-term care insurance covers individuals in need of a nursing home, assisted living facility, or home health care. Your current insurance policy may or may not include some of these things. If not, you should be aware that Medicare covers only nursing care and not home health aides to assist you with the so-called Activities of Daily Living (ADLs), such as washing, dressing, and eating. Medicaid does pay for home health aides, but you have to qualify. If you don't qualify for Medicaid, it's recommended that you either purchase a private long-term care policy or, if your assets total more than $1.5 million, plan to pay for any long-term care expenses out of pocket. If you live in New York, Connecticut, California, or Indiana and buy a state-approved policy, you'll be eligible for Medicaid anytime you exhaust its benefits, even if you wouldn't qualify for Medicaid otherwise. Don't wait too long to take action on this. By age 50, 11% of long-term care insurance applicants are rejected, and by age 70, that figure is 43%.

4. Prepare a living will and health care power of attorney.
As uncomfortable as it is to think of your own mortality, it may be more discomfiting to think of becoming the next Terri Schiavo. A living will allows you to spell out how you do or don't want to be cared for should you be unable to express your wishes, while a health care power of attorney appoints someone to advocate for the directives in your living will. You can download a living will and power of attorney and have them notarized, or you can visit an attorney who specializes in estate law. Be careful with anything you download off the Internet, though, as it may or may not meet the legal regulations of your state.


Decisions regarding your future health care can seem daunting, but it's better to tackle them now, while you have your health, than later, when they can be overwhelming to someone stressed by illness or injury.

On a lighter note, please take a minute to respond to the Singletude poll above and let us know where you turn when you're on your sickbed.


What do you do when you're sick? Who do you call on to nurse you back to health, or what are your strategies for nursing yourself? Do you have an arrangement with a friend or family member to help you if you're physically incapacitated? Have you made provisions for disability, long-term care, a living will, and/or a health care power of attorney? What other options would you recommend to singles who might need help when ill or injured?


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Singles and Health Insurance, Part III

As Singletude noted yesterday, uninsured singles do have options for obtaining affordable health insurance that aren't publicized as widely as private, employer-sponsored PPOs. As more single Americans than ever find themselves walking in a shower of medical bills without an umbrella, their research has proven that there are more healthcare choices than Aetna, Blue Cross, and welfare.

But sometimes, for some people, insurance is out of reach, and no amount of flailing and grasping is going to make it any more accessible. If you're one of these sinking singles, read on to learn what you should (or shouldn't) grab onto to keep you afloat.



1. Health Savings Accounts (HSAs)

HSAs have gained a reputation as the wave of the future. Think of them as the IRAs of healthcare. They're administered by insurance companies as part of a low-premium (around $50.00 a month), high-deductible (around $1,000-5,000 a year) plan that allows you (and your employer, if he or she chooses) to set aside tax-sheltered income for medical expenses. When you have a medical bill, you can use the money you've saved toward your annual deductible. After you meet the deductible, you pay nothing more that year. If you don't meet the deductible, your savings roll over for future use. Lots of major insurance companies have jumped on the HSA bandwagon, so they're not hard to find.


2. Medical Benefits/Discount Cards
In other words, scams. You may recognize these as the only healthcare services that need to advertise on TV. That's because real health insurance providers don't need the business; with inflation rates at over 20% a year, they're doing just fine. You can also pinpoint a scam by the absence of the word "insurance." Their ads are sprinkled with other buzz words--health, benefits, medical, coverage, protection, prescription, care--but they never call their product insurance because that could get them sued.

These mysterious benefits that have nothing to do with insurance are actually discount programs, which promise card-carrying members up to 60% off on a variety of services from participating doctors. The problem is there aren't too many participating doctors, and the 60% discount is a hypothetical, like the 50 million jackpot you could win in the next lotto. A 15-20% discount, which is a drop in the bucket for most medical bills, seems to be more standard.

Now, there may be medical discount programs out there that are aboveboard all the way. But to find them, you may have to weed through a lot of phonies and hope none of them trip you up in their lies.


3. Financial Aid

Last year, I had some disturbing symptoms of a serious genetic medical condition, which landed me in the ER...uninsured. A few months later, the bills started trickling in. There was the bill from the ER for warming one of their stiff, narrow beds with my body heat for an hour or two--$500 right there. This was followed by a bill for the tests I'd had, an EKG and some other readout I'd never heard of. On its heals came the bill for the interpretation of those tests by an affiliated cardiologist. And then, just when I thought the last bill had come knocking, another one showed up, this time from the attending physician in the ER. All in all, I owed close to $1,000, and I knew it could've been much worse. Thankfully, the hospital had a financial aid program for the uninsured and ultimately reduced the bill by more than 50%.

If you, too, are swamped with a tsunami of a hospital bill, find out if the hospital can assist you. Lots can. Call the number of the billing department on your statement and ask to schedule an appointment with a financial counselor. Along the way, you may need to prove that you're ineligible for Medicaid, which also provides emergency assistance. If you don't qualify for Medicaid (and unless you're below the poverty line, you won't), the hospital will probably waive or reduce its fee if your income is no more than 400-500% of the federal poverty level (that's in the neighborhood of $40,000-50,000), regardless of your assets. Here's an example of a hospital financial assistance program. Notice that this one also gives a standard 15% discount to those who don't qualify for financial aid, as well as special exemptions for those who incur more than $50,000 in expenses in an emergency. Here's another. And one more.

However, if your hospital balks at reducing your bill, know your legal rights as a patient. Hospital Victims, run by the nonprofit Fairness Foundation, is a web site dedicated to helping the uninsured combat hospital price gouging and negotiate a fee waiver or reduction.

Or maybe it's not a hospital that's got you strapped but a private practitioner. Don't be afraid to call the doctor's office and ask for a discount, especially if you've been a long-term patient. Doctors know that insured patients pay only a fraction of the physician's charges via healthcare providers and so are often willing to extend a comparable discount to the uninsured. Prior to purchasing insurance, I was charged $60-80 a visit by my longtime family doctor though I'm sure his fee was well over $100, and my dentist still does complimentary work for me when I need something minor in addition to my regular cleaning since I have no dental coverage.


4. Low-cost Clinics

As soon as they feel a sore throat and fever creeping up, most people head to a traditional private practice, where they visit their family internist. Instead of this, uh, knee-jerk reaction (no pun intended), why not visit a low-cost clinic? Yes, you’ll wait in line for awhile, but if what you care about is saving money, a clinic is the place to be.

A few years ago, while I was uninsured, a stomach bug moved into my digestive tract and just wouldn’t vacate the premises. About a month into it, I finally acknowledged that I needed some help evicting the intruder and went to the family clinic at a local hospital. They didn’t even require me to fill out copious forms detailing my income, savings, stocks, bonds, CDs, place of birth, grandparents’ nicknames, and contents of my stomach. They just informed me that it would be $40.00 for the first visit, and after that, I could apply for financial aid. Luckily, I didn’t need to do that. I waited an hour or two, saw a doctor, and got a prescription for an antibiotic, which cleared out my little invader posthaste. Simple.

Clinics can be public or private, paid or volunteer, general practice or specialty, open 24/7 or just one day a week. Some of the them, like the one I went to, are affiliated with hospitals, while others are run by small towns, in which a family doctor or nurse practitioner volunteers one or two afternoons a week to treat basic health concerns, administer immunizations, and dispense medication. Others, like Planned Parenthood, which provides gynecological exams, STD testing, birth control, and pregnancy termination, are funded by private, nonprofit organizations. There are clinics that specialize in prenatal care, mental health treatment, pediatrics, and geriatrics, as well as those that treat anyone who walks in the door. Their only common denominator is that they offer healthcare at a fraction of the cost one would pay at a private practice or hospital.

Call your state's Department of Health, your town's Department of Social Services, or your local hospital for more information.



Hopefully, if you’re single and uninsured, by now you’ve found a cost-effective way to get the care you need. But there's still one more thing you can do.

Write to your senators and representatives and let them know that universal healthcare is important to you. Also present your case to your local representatives, who serve in your state legislature. With the federal government dragging its feet on a national health plan, numerous states have taken up the torch and created statewide plans of their own. Let yours know that you want in on healthcare, and you elected them to provide it!


Have you or someone you know resorted to any of the above methods of obtaining affordable health care? If so, what was your/their experience? Have you explored any other alternatives to traditional health insurance to meet your healthcare needs? Would you recommend any of these alternatives to uninsured singles?


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Singles and Health Insurance, Part II

If you're single and uninsured, the specter of a health crisis takes on an added dimension of anxiety. Not only might your very life be in danger but your livelihood as well. And unless you have wealthy parents, siblings, or grown children who can bail you out of impending financial doom, it may take you the rest of your days to pay back that doctor you owe your life to.

When you're an uninsured single, it's easy to fall into a pattern of resignation and daily prayer or crossed fingers. It may not occur to you that just because your job doesn't come with insurance doesn't mean you have to go without. Here are six avenues to affordable insurance that you may want to investigate:


1. Medicaid
Medicaid eligibility varies from state to state. For example, if you live in New York, like I do, and are single, you can't earn more than $700 a month or have resources totaling more than $4200. You'll need to prove your eligibility by meeting with a Medicaid counselor and completing an extensive inventory of your income and assets. This can take several hours, both in preparation and at your nearest Department of Social Services, so be sure you meet the requirements before you apply.

2. Low-cost State Insurance
If you're not eligible for Medicaid (insurance at no cost), you may still be eligible for a state-run plan for low-income residents (insurance at low cost). A handful of progressive states now offer policies with discounted premiums for those who can keep themselves out of a homeless shelter but won't own a McMansion anytime soon. These policies are usually the dreaded HMOs and may provide only basic, no-frills coverage, but they're better than nothing. For example, Health NY, the New York State plan for singles who make no more than $2,167 a month, regardless of their assets, covers diagnostic and treatment services, including surgery, for a wide range of medical conditions, but it doesn't cover dental, vision, mental health, or "preventive" care. Premiums vary based on the details of the chosen plan but are in the $200-300 range. Massachusetts, Maryland, North Carolina, Illinois, Washington, and Oregon are among the states with similar plans.

3. Catastrophic Coverage
If you don't qualify for a low-income plan, consider obtaining catastrophic coverage in case of a medical emergency. These bare-bones policies generally cover hospital visits only, but it's that unexpected trip to the ER that's most likely to bruise your bank account. Since you're only expected to use your benefits in a crisis, your deductible will probably be high, in the $500-2,000 range. Premiums are about $100 a month. Blue Cross Blue Shield and GHI are two insurance companies known for their popular catastrophic coverage, or hospital indemnity, plans. This PDF edition of Managed Care Week lists many more around the country.

4. Union Plans
Perhaps you're self-employed and are a member of a union. If so, your union might offer low-cost insurance options. The Freelancers Union, the National Writers Union, the Screen Actors Guild, and the American Federation of Television and Radio Artists, are a few unions for creative professionals through which members can access health insurance. Believe it or not, there's even a new National Singles Association promising medical benefits on the horizon! Whatever your line of work, if you're an independent contractor, check out Unions.org. It has a comprehensive list of unions in all industries. A reasonable annual or one-time membership fee could be your gateway to healthcare.

5. Small Business Plans
Or maybe you're an employee at a small business, and your employer can't afford the average $7,000-8,000 yearly cost of an individual plan. Your employer may be interested to know that a number of insurance providers have recently created plans for small businesses of two to 50 employees. Some low-cost state programs, such as Healthy NY, also allow small employer contributions. If your employer doesn't have the resources to pay for your premium in full, talk to him or her about sharing the burden 50-50 or 60-40. Use your irreproachable track record as leverage! Small business owners hate to lose good workers.

6. Short-term Insurance
If all else fails and you're getting desperate, short-term insurance can give you peace of mind while you plan your next move, especially if you're starting over after losing a job or a spouse. Your deductible will be sky-high, and you won't be able to participate for more than six months or a year, but your enrollment will guarantee that if this is the year you win the anti-lotto and lose your job and your health, you won't also lose your life savings. Short-term Health Insurance, eHealthInsurance, and ConsumerBenefits.net are a few of the sites through which consumers can purchase temporary insurance.


And then there are those who slip between the cracks of the system. The freelancer who makes too much for state insurance but not enough to purchase his own. The loyal sole employee of a mom and pop store that can barely break even, much less offer benefits. The laid-off worker whose temporary coverage ran out before a new job arrived. The cancer victim who gambled on a high-deductible policy and lost. What happens to these singles when the medical bills pile up?

Next time, Singletude examines alternatives to traditional health insurance. Check back here to find out where uninsured singles are turning to pay the guy with the caduceus!


Have you ever been insured through one of the above providers or known someone who has? If so, what was your/their experience with this insurance coverage? Can you think of any other methods for an uninsured single to obtain insurance (besides getting married, of course!)?


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Singles and Health Insurance, Part I

Some 17% of the U.S. population wakes up every morning praying that today is not the day they get hit by a car or trip on the stairs or hear the doctor say "cancer." Because again today, they are uninsured, and a visit to the emergency room could bankrupt them.

Sixty percent of the uninsured are single. This probably surprises no one, but it should outrage everyone. Single adults in this country are the only minority who can still be discriminated against with the blessing of the law, and nowhere is this more obvious than in the private healthcare industry, in which singles subsidize the right of married employees to cover a spouse under their insurance plan.

When a married worker loses a job, chances are she can be covered under her husband's plan. If she can't, she has the cushion of her husband's income to fund COBRA until she can find another job. When a single worker loses a job and can't afford the aptly named COBRA, whose provisions are leaner and meaner than a viper, she has no recourse but to join the ranks of the uninsured.

That's if she had insurance to begin with. About three in five low-wage, hourly employees are single, and these low-income jobs are the least likely to offer health benefits.

But let's talk about a different single, who lucked out. He has a stable, salaried position that, up until a few years ago, provided full benefits. But in 2006, along with two-thirds of large corporations surveyed by Mercer Human Resource Consulting, his employer shifted part of the cost to him. Now the discrepancy between what he and his married coworker pay for insurance is visible in the big, boldfaced numbers on his paycheck.

According to a 2005 survey of 80,000 policies sold by eHealthInsurance, the national average on a monthly premium for an individual policy was $148, while the average for a family policy was $110 per member. That means our hypothetical corporate peon loses $456 annually to his smugly married coworker. If Single Schmo and Smug Married are chained to their desks for another 40 years, Single Schmo will shell out $18,240 more than Mr. Smug! In the meantime, Mr. & Mrs. Smug Married have two incomes to cover their substantially discounted premium, whereas Single Schmo has just one for his full-price coverage.

Let's not forget, either, that while a married employee is free to add a spouse and a whole gaggle of kids, singles are much more limited when handing out the healthcare goodies. Extending coverage to a parent, sibling, grown child, or other relative is simply out of the question. That's right. A single's blood relatives, his birth family, are deemed far less worthy to reap his benefits than an unrelated woman he's known perhaps a few years whose most durable tie to him is a piece of paper called a marriage certificate. And though some employers have seen the light and now cover unmarried domestic partners, that coverage is taxable. If the domestic partner were a legal spouse, he or she would be covered tax-free.

Then there's the double whammy of inadequate coverage, literally adding insult to injury when singles are already paying through the nose every month. Among the medical necessities that are often labelled unnecessary by the private healthcare sector are treatment of "preexisting conditions," dental work, vision care, mental health services, birth control, prescription medication, medical devices like pacemakers, wheelchairs, and prosthetic limbs, blood work, xrays and other scans, chemo and radiation, ambulances, emergency room visits, and that catchall category under which everything else falls, "preventative treatment." Little leaves a single as defeated as the realization that, after he's coughed up five or six thousand dollars a year for the last two decades, he's also going to have to cough up a lung before he gets coverage for a life-threatening disease.

For instance, last year I was evaluated for a genetic condition that would have required multiple risky, invasive surgeries had I tested positive. After testing negative on two out of three measures, I was advised to have one last exam to be sure, for which I was referred to a specialist in ophthalmology. However, when I called the ophthalmologist, I was informed that they wouldn't be able to conduct the test without also performing a standard intake exam. Unfortunately, a standard eye exam was not covered by my insurance policy because this was, you see, "preventative care." The out-of-pocket cost of this exam was about $300. I agonized over this for months until, one day, I found myself at the optometrist's to renew my contact lens prescription (also not covered, of course), and the sympathetic doctor agreed to perform the test at no extra charge. (It was negative.)

I don't know what I would have done if Lady Luck hadn't come to my rescue. I suppose I would eventually have forked over the cash--150% of my monthly premium--to ensure my peace of mind. But if that test had cost thousands instead of hundreds, or if I had been worse off financially, I might not have had that choice.

It's no wonder, then, that singles who can barely afford rent, transportation, and the pinstriped shirts on their backs are opting out of pricey premiums and applying that money to personal emergency funds instead. But unless you can hoard away a cool million or two, relying on personal savings is still a gamble.

So what's a single person to do? Anybody who claims there's an easy answer for this one would be lying, but if you're single and uninsured, Singletude can point you in the direction of some viable options. To find out more, check in again tomorrow!

Are you single and uninsured? If so, how did you lose your insurance? Do you agree that the current healthcare system discriminates against singles?



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