The healthcare system in the United States is abysmal, especially where mental health is concerned. As of 2014, almost 4 million citizens with mental illness still do not have health insurance, and paying for treatment can easily bankrupt some patients. Without insurance, a bipolar disorder patient can pay at least $500/month for minimum treatment. That’s just for two bipolar disorder medications and one psychiatric meds-management appointment. Most patients need more than the minimum. It’s just not feasible, but if you have bipolar disorder, you need treatment. Otherwise the outcome keeps getting worse. So what can you do before you have to decide between paying for food or paying for medication?
Here’s a scenario: You’re 27 and have been dropped from your parents’ insurance. You were fortunate enough to be one of the 30% of people your age to get a bachelor’s degree, but you have $35,000 in student loan debt, high credit card debt, car payments and housing payments. You have a full-time job with benefits, make around $35,000/year and your net worth is at around $8,000. Not a fantastic situation, but you’re getting by. That’s an average scenario.
People with bipolar disorder are not average.
Here’s the revised scenario: You’re still 27 and have been dropped by your parents’ insurance. You attempted a college degree, but the academic and social stress triggered your first manic episode. You tried your absolute best to soldier on, but you’re not one of the 16% of people with bipolar disorder who finish an undergraduate program. You still get the debt, though maybe less so depending on how long you were in school. You’ve managed to be in the 60% of people with bipolar disorder to be employed on a regular basis, but your symptoms are bad enough that you can only work part-time. You end up making only $300/week. You don’t have health insurance.
There are ways to combat the financial costs of bipolar disorder. Here are a few:
The Affordable Care Act
Running the previous scenario through healthcare.gov using Austin, TX as a location, the cheapest plan came up at $0 monthly premium, $0 deductible and $850 maximum yearly out-of-pocket. Specialist visits are $25 and generic prescriptions are $10. For the two prescriptions/one visit minimum, that’s $45/mo instead of $500. This will obviously vary depending on where you live and what your income and family situation are. Enrollment typically starts in November, but you can apply for special enrollment.
Our example individual would most likely qualify for Medicaid. Medicaid is a federal-state funded program for citizens or legal residents under 65 that provides health care for low-income individuals. Nationally, people with mental illness living at up to 133% of the poverty line will typically qualify for Medicaid. That’s approximately $1300/mo for an individual.
Thirty-one states and the District of Columbia have enacted a Medicaid expansion, so in these states you can make a little more and still qualify. To see if you qualify, visit your state’s health care website or healthcare.gov.
For citizens or permanent residents either over 65 or that have become chronically disabled by mental illness, you may qualify for Medicare and Social Disability Insurance. For insurance, you can expect to pay a premium, but there are supplemental insurance programs as well as disability. Disability benefits will help supplement lost income as well as provide health coverage. You can work while on disability, but only up to a certain income level.
Now, disability can be hard to get. It’s a long and heavily scrutinized application process. Among the qualifications are two years of documented periods of unemployment due to symptoms as well as a limited ability to maintain social and occupational activity. I recommend having a lawyer or mental health social worker on hand to help with the application process.
Community Health Centers/Free clinics
Community health centers provide care to people who cannot otherwise afford it. There are no qualifications and no application processes. Generally, you pay what you can. Depending on the clinic, they may offer everything from family practice and pharmacy services to dental health care. Some also offer counseling. What services they provide depend on what staff and resources are available. To find one near you, you can either do a search for your location and “community health center” or “free clinic” or you can visit http://findahealthcenter.hrsa.gov/.
Make some phone calls
People generally want to help you out. Call your local psychiatric hospital for information on free services or support groups. You can also talk to your current doctors and pharmacists about discounts or payment plans if you can’t afford the self-pay option. If you’re a student, your school/university likely has resources for mental health care.
Photo credit: Richie Diesterheft