We are listed in Guidestar:

You Caring



Under the Affordable Care Act, Obamacare… You have to have AT LEAST $11,000 per year adjusted gross income before you are penalized for not carrying health insurance. If you make less than that, you are not fined for having no insurance

Deb, I sell the stuff. The threshold is different in for each state or area based on the Federal poverty area, zip code, etc.

Under the ACA, if you have ZERO income, the cheapest insurance is $700 per month!!!

Actually, if you have zero income you are not qualified for a Premium Tax Credit. They will send your application to your state’s medicaid office for review.

Correct, but if you live in a State (such as Oklahoma) that opted out, then what? Well, there is no answer.

Exactly! The ACA is NOT a good option. Even if you can get a PTC the plans offered can and often are worthless, like in *****, where I live. That’s why Church’s are given a tax free status, so they can help the sick, widowed, poor, etc.

I hadn’t really heard it put that way before. I know what the Bible says, but I hadn’t seen this reasoning for nonprofit status for religious entities put this way before Ostomy 2-1-1 Inc is a nonprofit, specifically to serve ostomates. We need all the help we can get to obtain funding to help these people we are talking about in this thread.

Agreed, that’s what is so ridiculous about allowing tax free status to churches, especially since many have millions in assets, planes, etc. The point of the tax free status was because they used to help people. that’s why many hospitals have church denominations in their names.. that’s what they USED to do.

I didn’t know that before…

Don’t most hospitals have a charity care program set in place?

Yes, but not for profit hospitals are required to have charity options.

In NJ, we have NJ Family Care for those who have no or minimal income.

Tell me more about the hospital charity programs? How does that get ostomy supplies into the hands of the patient? And fyi, please do not think I am being sarcastic in this thread – I am sincerely trying to find answers and solutions

It may not. Again, for things like DME, often times you have to figure that out. Life isn’t fair, figure it out.

Is that NJ’s Medicaid program? And ostomy supplies do not fall under DME – they are Prosthetic according to Medicare

Yes it is. So what does one do? My supplier just upped their prices and I have to pay half and I have insurance. I pay $370/month to be covered. The system really sucks! Medicare is approaching for me very soon.

It’s not a prosthetic. Who comes up with this analogy?! geeze!

To answer your question, “so what does one do” is what I am trying to get answers for here.

I am aware of that. Maybe that person should reach out to her physician or nurse for some direction.

So if a person is not yet determined by the Social Security Administration to be disabled, and they are under 65, how do they get supplies?

That’s one problem with the ACA. There are plenty of people who fall within the cracks of the Law and medicaid. Espeically for the more than 20 states who did not expand medicaid. I am not a support of the ACA, for the record.

I’m one of those people & it’s scary because I have no way to get supplies unless I keep asking companies for samples. 48 yrs old & not yet approved for disability.

I know this will make many angry with me, but why isn’t getting one’s own supplies someone else’s responsibility?? I don’t get that. We do, as sick people, have some personal responsibility. for the record.

There is something like solidarity!

No it’s something like PERSONAL RESPONSIBILITY!!

No problem with paying for them. However some plans do not cover them at all. The same thresholds should be in place for that are in place for medication. If a script costs $200 my copay is $50. But was not the case for supplies until I lost hrs at work and qualified for medicaid in my state. If I wasn’t in NY I have no idea what I would of done. $500 a month is just rediculous.

I have been sick since I was a child. I have known I always needed insurance so I made plenty of sacrifices to do so. SMH in disgust! Yep, welcome to my world. So, I have an IV in my chest and I am on TPN, not asking for sympathy, Though I get medicare, which won’t pay for TPN outside of an hospital setting, I work so I Have health insurance. I have an Out of Pocket max I have to meet every year. So that means $5k. Not sure how I will pay it, but bet your hiney I will. The more the gov’t is involved in our health care, the more we lose. Look at the problems with the ACA for example. Please dont’ use the UK or any other socialized medicine program as an example. They have plenty of problems. Life isn’t fair folks.

Ostomy 2-1-1 is in place TO HELP. That meaning that if there are resources available for people to help themselves, what are those resources. For example, if someone woke up from surgery with an ostomy and didn’t have insurance, where would I direct them? I don’t really think that is doing it for them – It’s more of pointing them in the right direction. Kind of like giving someone a roadmap when they are travelling…

You sell insurance, so I am going to go out on a limb and ask a question that I hope you don’t view as being a stupid question. I am honestly and sincerely searching for answers…
Are there certain companies that you would say are “better” in regards to coverage for ostomates? How would someone go about finding the best insurance company for themselves if they have an ostomy? And are there supplemental policies (one better than another) to supplement what someone already has?

Good question! I’m 62 and still working but would like to know for when I retire.

That’s a good question and this is very important so there are no stupid questions. The answer is YES. BCBS seems to be the best to me, but, there are other insurance companies that are in some states and not in other’s there is an organization that rates carriers based on customer and provider experience. I will have to find it, I get emails at work. Supplemental? I have found this difficult to have. One can have 2 insurance policies but that doesn’t mean they the secondary policy will pay what the primary doesn’t pay. I have 2 with medicare, and the law won’t let them pay my deductibles and copays, in most instances. I was considering having both my companies insurance and my husbands, but financially speaking, I didn’t think it would be worth it. Otherwise, there aren’t many options.

 I can speak from personal experience with UHC and BCBS: BCBS has covered everything I have ordered. UHC did not (no lubricating deodorant for example, much smaller quantities of supplies unless I had a letter from a dr and then they had to review and approve it, etc). My experience with UHC (thru employer) and my supplies was so horrid on top of the cancer bills was literally killing me financially that I finally decided I had to leave a job and company I loved for better insurance. I know have BCBS and have had a MUCH better experience. Anything I have ordered (thus far) has been covered by my plan, the quantities have been far more liberal (so I now have an emergency backup stash of supplies). I cannot say I have enjoyed the change in jobs because it has been hugely stressful l, but I pull my BCBS card out about once a week and remind myself “this is why I am here” and when my supplies are delivered without issues or question or my provider calling to tell me that insurance won’t cover xyz, well, that sure has been a relief.