Choosing between staying in an abusive marriage or escaping and leaving yourself without health insurance for the rest of your life is not a decision anyone should be forced to make.

But this is how Sarah finds herself at the age of 80 - and now she struggles to make do on the Government Health Insurance Plan (HIP) which pays for two office visits per year plus four home visits per month. But it won't cover medicine or most dental work.

This is a problem for Sarah who is on several medications for arthritis. She recently suffered the humiliation of having to refuse medication at the chemist after it had been packaged when she was told the price.

“They said it was $70 - I told them I hadn't got it, you will have to take it back. The assistant looked at me like I was crazy.

“I have to decide whether to eat or buy medication or buy electricity. I have to decide every month what I can afford.”

A doctor's visit can be up to $60 while her medications, cost upwards of $45. “Some are probably $100,” she says.

“I haul around the insurance companies but I can't get anything. I get very angry. I tell them you should be ashamed. They are awash with money.

“The insurance companies are wealthy - because we have paid in all our lives but by the end of the month I am gasping.

“For the love of God, when you are young and healthy you don't need anything. Now I do there's a glass door in my face. It's absolutely scandalous, a disgrace.”

A visit to the credit office at the hospital didn't do Sarah any good.

“He looked at me and half laughed. I look a bit establishment. If I went in in rags I might do a bit better.”

Investments provide Sarah with her only income - around $1,200 a month which puts her annual income at just over $14,400.

The Government statistics department say they don't have an official poverty line while the social insurance department also told this paper the same. But Sarah says an official told her that it was around $27,000 - nearly twice her current income. She has life tenancy in her cottage, so she cannot sell her cottage to get cash.

She has been urged to cash in her investment but she says this would be irresponsible because if she lives another ten years she would be nearly penniless.

“I would be getting $200 a month.”

The Seniors and Disabled Office expressed concern but were unable to help, neither could financial assistance, said Sarah. “Nobody was able to help me.”

She has spoken out not for personal gain but because she knows there are many more like her, including those who also struggle to pay rent.

“A lot of people are in a worse situation and they are getting nothing.

“It should be the social conscious of a country that you look after the elderly; don't smack them in the face when you have been a good citizen and paid your dues.”

The situation is doubly ironic for Sarah who worked as a nurse and answered many an emergency call. Now she's worrying about health care in the twilight of her life.

“I must have been called out a thousand times at a weekend but always went when I was needed. But now I am not needed. I am too old.

“All I am asking for is medication. I don't expect a bigger hand out.”

She says the decision to leave her abusive husband of 23 years wasn't one she took lightly or quickly.

“I was extremely happy apart from the violence, eventually I realised I had to separate from him.”

Her children live abroad and now struggle for work as the US economy declines.

Many young people are unaware of health issues but she says they should realise their power and refuse to pay into companies who cut them loose at 65.

“Some people get help from their children. My children are abroad. You should not have to go cap in hand to your children and humiliate yourself. It's disgraceful in such a wealthy country.”

She has lobbied every insurance firm on the Island and visited key politicians on both sides and had support.

In November, Government promised reform but it is still at the working party stage as statistics are gathered.

Now Sarah hopes it will become an election issue for both parties - if it finally leads to change. “It's something they should hang their hat on.

“I didn't want it to be a political issue but they can do what they like with it. They should all jump on this bandwagon.”

Age Concern executive director Claudette Fleming said she had no idea how many people lost insurance benefits on retirement but she said it was a massive issue which had been raised years ago in the 1996 Oughton report. Yet nothing has changed.

“We need a timeline for change. We don't need promises any more. We need implementation.”

Basing coverage on marriage had tremendous implications said Ms. Fleming. “She would have to maintain that relationship just to carry on with her medical insurance.”

A couple both dependent on one spouse's earnings for medical insurance were doubly hit when that spouse retired, said Ms Fleming.

She said seniors were suffering a tremendous loss of dignity - either having to beg for charity or appeal to relatives who had their own financial worries.

Mark Selley, of the think tank Bermuda Health Care Consortium, is helping organise tomorrow's demonstration outside BUEI.

He said many pensioners can't afford the $900 a month to buy individual insurance and called for HIP, which currently costs pensioners $133-a-month, to be expanded into retirement for all.

He said: “Insurance companies and doctors are getting rich under the current systems but patients are getting poor and paying through the nose.”

He said it was time to allow foreign insurance companies to compete in the local market to provide serious competition.

TOMORROW: The UBP outline their policies for the elderly.