Edna Garcia thinks she’s paid her dues. For 34 years, she worked as a public high school teacher in Bridgeport, Connecticut, while serving as a local legislator for eight years. In retirement, she volunteers at her church, where she helps members with health insurance issues.
“I’ve been beneficial to my community,” she told CBS MoneyWatch.
But for Garcia, 73, enjoying retirement has been difficult. Although she has health insurance for retired teachers through UnitedHealthcare, she struggles to afford medical treatment. Garcia is diabetic, has Crohn’s disease, for which there is no cure, and suffers from a vision problem that has caused his vision to deteriorate over time.
Garcia, who also gets Medicare Part A and B so he can keep his private plan, said his health insurance can’t cover his medical costs or pay for the treatment recommended by his doctors.
“My eye doctor told me that the medications she wanted to prescribe for my problem are not covered by insurance. And I certainly can’t afford them,” she said.
Instead, she uses prescription eye drops that her insurance covers, but which don’t properly treat her condition. “They don’t meet the needs of my eyes. So today I’m going blind,” Garcia told CBS MoneyWatch.
Garcia is just one of many Americans who say they can’t get the medical care they need despite having health insurance. In the United States, about 30% of working-age adults with health coverage reportedmaking it difficult to access essential goods like food, utilities, car payments and loans, according to a recent Commonwealth Fund survey. This forces millions of people to go into debt to pay for their care or .
Garcia also said his insurance plan did not cover Ozempic, a drug used to treat diabetes that has also become popular forand it can cost hundreds of dollars a month out of your pocket. During that time, she said her UnitedHealthcare plan suddenly stopped covering Remicade, the medication she was taking to control her Crohn’s disease flares.
“I was doing well, then all of a sudden the insurance decided not to pay because it was too expensive,” Garcia said. “So my doctor stopped me and put me on something different, and I got sick as a dog, and I’ve been sick ever since.”
She has since been put back on treatment, which UnitedHealthcare covers again, according to Garcia.
UnitedHealthcare declined to comment.
Still, Garcia said she was often forced to choose between essentials like groceries and more expensive medications that might help her stay healthy but couldn’t afford out of pocket.
“I go without medication because I have to choose between eating and taking care of my medical needs,” she explained.
No birthday trip
Eddie Vader, 45, a veteran with insurance through TriWest Healthcare Alliance, said he sometimes has to shoulder costly expenses alone because his plan doesn’t cover them. Vader is scheduled to undergo a root canal this month, a procedure he told CBS MoneyWatch he will have to pay for out of pocket and will cost him about $1,300.
“I can’t really afford it, but we have to make it work,” he said. “It’s going to be a tight month.”
For this to work, he’ll have to give up an annual trip he and his wife usually take for his birthday. “Usually we’ll spend a night in a hotel somewhere, leave town and go somewhere. That won’t happen until we can afford it,” he said.
TriWest did not respond to CBS MoneyWatch’s request for comment.
Adam Rollings, a North Carolina dock builder, is covered with his two children under his wife’s insurance plan. A school teacher in Onslow County, his wife receives health benefits through the Blue Cross Blue Shield plan for state employees.
This plan costs the family about $10,000 per year. They spend an additional $3,000 to $5,000 a year on additional health care costs, most of which are related to their nine-year-old son’s Type 1 diabetes.
“We are fortunate to not have to worry about medical debt, but our frustration is that the coverage offered to her as a county employee seems to be inadequate compared to what is expected of her as a county employee. “teacher and public servant,” Rollings told CBS MoneyWatch. . “We would expect to be fully covered, or at least for coverage not to be as expensive as it is for a typical family of four.”