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Author Topic: MEDICARE OR MEDICAID?  (Read 1705 times)

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Offline angels4kelly

  • Member
  • Posts: 305
  • IT JUST IS!!.....OKAY!
MEDICARE OR MEDICAID?
« on: August 10, 2006, 01:42:15 PM »
Can anyone tell me if I should be on Medicare or Medicaid?
I live in Florida. I've been on Medicaid for about 4 years now.
I was on this program that the Health Dept. has for 2 years before this.

Even though I've been poz for 16 years I didn't begin to seek treatment and take meds until 6 years ago This, of course, was my reason for getting ANY kind of health insurance.

When I was doing my internship at a doctor's office in order to graduate from my Medical Coding & Billing Specialist course at a tech school, the doctor I was working with said I should get on Medicare.
He said that Medicare covers alot more and you have choices of doctors and things like that.

I have been very hesitant to change from Medicaid to Medicare because Medicaid has always been so great about paying for my meds and the P.T. I require because of the stroke. They also pay for any M.R.I.'s or CT scans, Ultrasounds...etc.

He said Medicare would also pay for everything. He never did know about my H.I.V. status though. He just knew about my stroke.
POSITIVE SINCE-10/1990
CD4-610
CD4%-29.3
VL-UNDETECTABLE
VIREAD,VIRACEPT, EPZICOM

MOST RECENT...
10/9/2006
CD4's-714
CD4%-30%
VL-Undetectable
DIAGNOSES POSITIVE 10/90
SAME MEDS, VIREAD, VIRAMUNE, EPZICOM.

SHOOT FOR THE MOON! YOU MAY MISS,
BUT YOU'LL LAND IN THE STARS :)

Knowing others is intelligence;
knowing yourself is true wisdom.
Mastering others is strength;
mastering yourself is true power.
 
Failure is not in falling down,
but the staying down

Offline Trish

  • Member
  • Posts: 332
Re: MEDICARE OR MEDICAID?
« Reply #1 on: August 10, 2006, 04:55:51 PM »
Hi Angel,

I'm pretty sure that in order to get Medicare you must be of retirement age or be on disability, and only after being on disability for 2 years will the Medicare kick in.  This is my understanding.  You don't just sign up for Medicare.  Someone correct me if I'm wrong, but I've never heard of anyone getting Medicare in any other fashion.  Are you collecting disability now?  If so, then you will be entitled to Medicare depending on when you were approved.

As for having choices of doctors, you can only go to those who accept Medicare.

I am collecting disability (have been for 6 years) and I have both M/care & Medicaid (because of my low income - $689.00 a month disability) and I fell just under the maximum allowed of monthly income by less than $6.00 in order to qualify for M/caid.  This is in Missouri.  I don't know the limits in Florida.

Also, being that I am on both M/care & M/caid, making me "dual eligible," I pay $1 or $3 for meds, which is usually waived anyways - so basically I get my meds for nothing. 

Hope this helps.

I'm sure others have some info for ya...

All the best,

Trish
"People grow through experience if they meet life honestly and courageously. This is how character is buit."  Eleanor Roosevelt

Offline angels4kelly

  • Member
  • Posts: 305
  • IT JUST IS!!.....OKAY!
Re: MEDICARE OR MEDICAID?
« Reply #2 on: August 10, 2006, 05:14:59 PM »
Hi Trish,
Thank you for that info.
Yes, I have been on disability for 4 years. Here in Florida the amt. is 603.00.
The good thing is that Medicaid pays the entire amount for my meds. Which is quite a sizeable amount of $ as I'm sure you know

Now that you mention you're on both, I remember him saying to me that I should get Medicare as my primary and Medicaid as my secondary. That way anything that M/care won't pay for M/caid will pick up.

I'm still not sure exactly what to do, but thanks so much, Trish! ;D

Peace,
Kelly 8)
POSITIVE SINCE-10/1990
CD4-610
CD4%-29.3
VL-UNDETECTABLE
VIREAD,VIRACEPT, EPZICOM

MOST RECENT...
10/9/2006
CD4's-714
CD4%-30%
VL-Undetectable
DIAGNOSES POSITIVE 10/90
SAME MEDS, VIREAD, VIRAMUNE, EPZICOM.

SHOOT FOR THE MOON! YOU MAY MISS,
BUT YOU'LL LAND IN THE STARS :)

Knowing others is intelligence;
knowing yourself is true wisdom.
Mastering others is strength;
mastering yourself is true power.
 
Failure is not in falling down,
but the staying down

Offline Gary85741

  • Member
  • Posts: 197
  • Native Virginian living in Tucson AZ
    • Good guy, good heart
Re: MEDICARE OR MEDICAID?
« Reply #3 on: August 11, 2006, 08:26:00 AM »

After two years' disability (SSI or SSDI) one with HIV qualifies.  If one's on SSD...then Medicare becomes available.  If one's on SSI...then Medicaid triggers.

In addition to an income cap, one is only eligible for Medicaid if they've no assets (savings.)

Gary
Poz since '89. 
Current regimen: Rescriptor, Emtriva, Kaletra, Invirase, Acyclovir, Lisinopril, Lipitor, Prilosec, Valium, Testim, Nandrolone, Loperamidr, Marinol.

Offline angels4kelly

  • Member
  • Posts: 305
  • IT JUST IS!!.....OKAY!
Re: MEDICARE OR MEDICAID?
« Reply #4 on: August 11, 2006, 08:59:17 AM »
Thanks Gary,
I am on SSI so does that mean I am not eligible for Medicare?
I have no other assets. No car, no savings, nothing but my SSI.
I am happy with my Medicaid. I am never charged for anything concerning my health.
POSITIVE SINCE-10/1990
CD4-610
CD4%-29.3
VL-UNDETECTABLE
VIREAD,VIRACEPT, EPZICOM

MOST RECENT...
10/9/2006
CD4's-714
CD4%-30%
VL-Undetectable
DIAGNOSES POSITIVE 10/90
SAME MEDS, VIREAD, VIRAMUNE, EPZICOM.

SHOOT FOR THE MOON! YOU MAY MISS,
BUT YOU'LL LAND IN THE STARS :)

Knowing others is intelligence;
knowing yourself is true wisdom.
Mastering others is strength;
mastering yourself is true power.
 
Failure is not in falling down,
but the staying down

Offline Gary85741

  • Member
  • Posts: 197
  • Native Virginian living in Tucson AZ
    • Good guy, good heart
Re: MEDICARE OR MEDICAID?
« Reply #5 on: August 11, 2006, 11:46:54 AM »
Thanks Gary,
I am on SSI so does that mean I am not eligible for Medicare?
I have no other assets. No car, no savings, nothing but my SSI.
I am happy with my Medicaid. I am never charged for anything concerning my health.

To be honest, I'm unsure as to the answer to your question.  I'm on Medicare via SSD...I don't qualify for SSI and Medicaid, so our situations are different.  As you know, a fair number of rules changed at the beginning of this year.  I don't want to mis-advise you, so I'd suggest the best thing to do is gather your patience (LOL!) and call Medicare at 1-800-633-4227, or visit their website: www.medicare.gov.  That way, you'll get a direct answer from those in the know, and hence, know exactly what you need to be doing, if anything would be different for you.

Good luck to you,
Gary

Poz since '89. 
Current regimen: Rescriptor, Emtriva, Kaletra, Invirase, Acyclovir, Lisinopril, Lipitor, Prilosec, Valium, Testim, Nandrolone, Loperamidr, Marinol.

Offline gerry

  • Member
  • Posts: 522
  • Joined AM Feb 2003
Re: MEDICARE OR MEDICAID?
« Reply #6 on: August 12, 2006, 01:10:02 AM »
Kelly,

If you have any dependents, that could be one reason.  Gary and Trish are correct in saying that generally, after being on SSI or SSDI for 2 years, you become eligible for Medicare.  If you are on SSI, when you do get your Medicare card, you will still retain your Medicaid.  Medicare will become your primary payor and those services that are not covered by Medicare (for instance, PT) will be covered by Medicaid.  You do need to know that when you get your Medicare card, you would be required to enroll in a Medicare Part D drug plan that will start paying for your prescription drugs.  There would be some co-payment involved ranging from $1-$5 per prescription.  So in this regard, it's actually more advantageous to remain on Medicaid.

Gerry

Offline angels4kelly

  • Member
  • Posts: 305
  • IT JUST IS!!.....OKAY!
Re: MEDICARE OR MEDICAID?
« Reply #7 on: August 12, 2006, 07:41:17 AM »
Thank you, Gerry!
You've made it pretty clear for me ;D
I guess I'll just remain on Medicaid.

Gary, I want to thank you too for providing the contact info for Medicare!
I was just very hesitant to go delving too deeply into Medicare because I was afraid I may lose my Medicaid in the process.

It's very clear what I need to do ;D
Thanks so much Trish, Gary & Gerry.

Peace,
Kelly
POSITIVE SINCE-10/1990
CD4-610
CD4%-29.3
VL-UNDETECTABLE
VIREAD,VIRACEPT, EPZICOM

MOST RECENT...
10/9/2006
CD4's-714
CD4%-30%
VL-Undetectable
DIAGNOSES POSITIVE 10/90
SAME MEDS, VIREAD, VIRAMUNE, EPZICOM.

SHOOT FOR THE MOON! YOU MAY MISS,
BUT YOU'LL LAND IN THE STARS :)

Knowing others is intelligence;
knowing yourself is true wisdom.
Mastering others is strength;
mastering yourself is true power.
 
Failure is not in falling down,
but the staying down

Offline Miss Philicia

  • Member
  • Posts: 23,990
  • celebrity poster, faker & poser
Re: MEDICARE OR MEDICAID?
« Reply #8 on: August 12, 2006, 02:19:05 PM »
There's a LOT of iffy and contradictory information in this thread, Kelly.  If I were you I'd go talk to someone who knows more at a local ASO.

I know, at least where I live, that with Medicare Part D for prescriptions, they are the initial payer but ADAP still pays for the remainder of the costs of the copays, generally the premium if your income qualifies you, as well as for the infamous "donut hole." 

I would assume that you were placed solely on SSI and not SSD because you did not have a long enough work history to have accrued personal contributions into the Social Security system.  When I went on disability I had worked for 20 years all on payroll, as well as having lived in NYC where salaries are much higher than most of the US, so my contributions had accrued to a decent number.  This disqualifies me for SSI and thus Medicaid.

I still suggest you talk to someone at an ASO so that they can assess you personally and make sure you are not missing out on any benefits you may qualify for.
"Iíve slept with enough men to know that Iím not gay"

Offline angels4kelly

  • Member
  • Posts: 305
  • IT JUST IS!!.....OKAY!
Re: MEDICARE OR MEDICAID?
« Reply #9 on: August 13, 2006, 01:53:17 PM »

I would assume that you were placed solely on SSI and not SSD because you did not have a long enough work history to have accrued personal contributions into the Social Security system. 

This is true, philly!
I will definitely go check out what ASO has to say/offer

Thank you!
Peace,
Kelly
POSITIVE SINCE-10/1990
CD4-610
CD4%-29.3
VL-UNDETECTABLE
VIREAD,VIRACEPT, EPZICOM

MOST RECENT...
10/9/2006
CD4's-714
CD4%-30%
VL-Undetectable
DIAGNOSES POSITIVE 10/90
SAME MEDS, VIREAD, VIRAMUNE, EPZICOM.

SHOOT FOR THE MOON! YOU MAY MISS,
BUT YOU'LL LAND IN THE STARS :)

Knowing others is intelligence;
knowing yourself is true wisdom.
Mastering others is strength;
mastering yourself is true power.
 
Failure is not in falling down,
but the staying down

 


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