Story Bank: Sam, Augusta

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Sam, Augusta

Sam’s family spent some time living in Connecticut, where they were happy with their health care coverage. They had access to dental and vision services in addition to health coverage for more critical challenges. When they moved back to Maine, they realized health coverage would be more difficult to come by.

Sam and her husband live in Augusta with their five children. She works at home, caring for her family, and her husband works part time at Walmart.

"Walmart's benefits are extremely overpriced for what they are,” said Sam. "Their deductibles are ridiculously high, their copays are high, they don't really cover a lot, and the monthly charge for the premium is ridiculous."

Sam’s husband was paying nearly $300 per paycheck for their two oldest children to have the same Walmart health insurance plan. To insure their whole family, it was going to cost nearly $800 every paycheck.

Sam looked over her husband's pay stubs and realized his health insurance plan was devouring 75% of his income.

Sam and her family enrolled in MaineCare.

“I wouldn't trade MaineCare for the world," said Sam. “I love the preventative care and that we can get our day-to-day things especially for the kids, so they stay vaccinated. They can go to the doctor when they need it. When I had pneumonia, I was able to go to the doctor and get treated.”

Sam and her family are happy with the preventive coverage MaineCare offers. However, when major medical challenges arise, they have found it difficult to get the health care that they need.

Sam's husband has two herniated discs in his back as well as degenerative disc disease. He has almost no cartilage in both of his knees.

"It's really bad because every year, at least once or twice, he winds up having to be out of work for something," said Sam.

Last year, he slipped a disc in his back. His doctors did not realize his health challenge would be a permanent condition.

"They thought it was a muscle spasm and he was put on muscle relaxers for almost two months which left him in a vegetative state on my couch," said Sam. "They didn't realize he has a pinched nerve because his disc had slipped."

Sam's husband quickly developed fractures from his knees down to his ankles.

"He literally walked to and from work every day until he physically could not move anymore," said Sam. "He had to be out of work for months for those fractures to heal."

Sam's husband was administered medications that altered his mood. He wanted something that would work long-term that did not impact his personality significantly.

"What they give him is narcotics and that's it," said Sam. "He didn't want it and I don't blame him. He would rather live in pain than have a narcotic addiction and I can't argue with that logic."

Sam's husband tried to seek out alternative options that would help him address the root cause of his medical challenge.

"He saw a surgeon who asked him what insurance he had, and then refused to see him again," said Sam. "Literally just walked out. It's really hard because he can't get the medical help that he needs."

Without MaineCare, Sam’s family would not have health insurance. They are happy to be covered, but disappointed that some of their major health challenges are not being met.

“I am extremely grateful that we have MaineCare," said Sam. "Something as simple as getting our flu shots or something like that would be extremely difficult. But, after seeing what Connecticut has and then seeing what we have, it doesn't make sense because there are so many people here in need.”