Main Forums > Living With HIV

Question On Medical Coverage... Anyone know ??

(1/2) > >>

Hello everyone,

I am currently on SSDI, in NYC. I  am on a medicaid spendown program with ADAP.
They pay my spendown ($1006) a month & then Medicaid is opened up for the month for other medical needs ( dentists, etc ).

I am not entilied for Medicare for 2 more years. But, when I am, does medicare & adap still join together to help with med's? Or do I loose ADAP, and only have Medicare?  ???                                                                                      Please advise & thank you for taking the time to read my question.

Howdy Brooklyn,

The way I understand it, when you become eligible for Medicare, Medicaid and ADAP go out the window and you enrollin Medicare Part D, which covers the prescriptions through a private contractor (such as Humana, AARP, etc.)

Since you are low income (I am presuming), you would immediately sign up for what is called "extra help," which will cover your premiums, deductibles and the dreaded donut hole in the Part D coverage.

If you aren't eligible for extra help, you will be stuck paying those costs, which are considerable, unless another program is in place in your area to cover those costs.

This may vary from state to state. I have heard, or maybe read here, that some states are allocating some Medicaid funds to cover the deductibles/donut holes.

IF you qualify for extra help, Part D works pretty well. If not, it can suck big time.

I would contact your local ASO for more info on exactly what is available and how it works in your area. I know New York is one of those state potentially hard hit by the current funding allocations, so that may also have a part to play in this.



Hello Brooklynpoz,

I further agree with Mark that you should check with your local ASO and talk with a counselor regarding your medical coverage.

Have the BEST Day!

Thank you for replying , I will start my " homework "


My husband was on SSDI, had medicare and was eligible for part B (if I remember correctly, don't want to dig out his card).  He was receiving his medications through the local health department and receiving benefits of ADAP.  He never paid for anything (no medications or doctor's visits).  He also participated in Ryan White.  Of course, there is the quarterly renewal of the benefits, but it helped a lot.

Now, I don't know if things have changed since then, as he passed away 13 months ago and we all know how things can change in a blink of an eye, especially when it concerns the governmental subsidised health insurances.

Also, get yourself set up with a social worker.  They might be able to tell you if you are eligible for other programs.  Good luck


[0] Message Index

[#] Next page

Go to full version