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Author Topic: Need advice on filling in the holes in my medical coverage  (Read 1254 times)

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Offline livingmmy9lives

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Need advice on filling in the holes in my medical coverage
« on: December 29, 2013, 11:19:29 PM »
I have only medicare for insurance - would like to have better coverage so I can afford to go to all my doctors appointments. I don't go to all my doctors appointments because my doctor sends me to a lot of specialists and the 20% co-pays have quickly gotten to the point where I cannot afford to pay them all. How do you find out if your state's ADAP program helps cover health insurance premiums? Usually when I present questions like this to the local ASO they have no idea. The local ASO advised their clients to not sign up for the affordable care act because they said I'm better off with just medicare.
Diagnosed 1988.

Offline tednlou2

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Re: Need advice on filling in the holes in my medical coverage
« Reply #1 on: December 29, 2013, 11:53:37 PM »
I just responded to this in the other thread.  Have you checked to see if you qualify for the Extra Help QMB program?  It pays your Part B and D premiums, deductibles, etc.  Many also qualify to have Medicaid pay the 20% that Medicare doesn't.  And, the donut hole doesn't apply.  Here in KY, the income limit to get Medicaid to pay the 20% is something like $960 a month. 

Here are the income and resource requirements for the main Medicare Extra Help.

http://www.q1medicare.com/PartD-LISWhaIsPDP-ExtraHelpIncomeLimit.php

Offline Miss Philicia

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Re: Need advice on filling in the holes in my medical coverage
« Reply #2 on: December 30, 2013, 12:00:57 AM »
It's different in every state -- I pay $98/month for a Medicaid wrap around policy that acts as my secondary insurance to cover that 20% that Medicare doesn't pay, but that's because Pennsylvania has a program that allows this.

It might help to state where you live.
"Iíve slept with enough men to know that Iím not gay"

Offline Jeff G

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Re: Need advice on filling in the holes in my medical coverage
« Reply #3 on: December 30, 2013, 08:59:40 AM »
I responded to this question in the other thread as well . There is no need to post the same question in multiple threads . It much better to have all your concerns addressed in one thread so you can read them all in one place .
« Last Edit: December 30, 2013, 09:27:03 AM by Jeff G »

Offline darryaz

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Re: Need advice on filling in the holes in my medical coverage
« Reply #4 on: December 30, 2013, 09:23:51 AM »
I would encourage you to press your ASO case worker to research further how ADAP and Medicare work together.  From what I've experienced it is quite complicated and very few case workers have experience navigating through it.

It took several months, but my ASO finally managed to get ADAP to pay my Part D/medicare supplement premium plus any copays that aren't covered by the supplement.

Offline Miss Philicia

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Re: Need advice on filling in the holes in my medical coverage
« Reply #5 on: December 30, 2013, 10:17:46 AM »
I don't think he's inquiring about Part D coverage, he's asking about the 20% of Parts A & B that Medicare doesn't cover.

Some states don't have a mechanism for the under 65 crowd on disability while some states do, and it also depends on your SSDI monthly income. Mine is too high to qualify for Medicaid (technically) so Pennsylvania has a program called M.A.W.D (Medical Assistance for Workers on Disability) that covers patients under 65 on disability for this 20%, but you pay a monthly premium which is based on your income -- but there are other requirements to qualify like having any assets under $10,000 or something like that. I forget all of the details and I would never have known about this if my ASO case manager had not walked me through it.

That said, in PA you can purchase on the open market Medicare supplemental insurance as well if you are on Medicare and under 65 (whereas, for example, in Alabama you can not). The premium will depend on how the coverage works. I've had friends pay anywhere from $45/month (but have to pay co-pays at any doctor) to $245/month (no co-pays) so it depends on your health as well and how much you expect to go to doctors.

For me, my $98/month additional coverage for this 20% Medicare doesn't pay provides 100% coverage with no co-pays, but I go to a lot of doctors so it is worth it to me -- plus it makes it easier for me to budget myself on a limited income.

As far as my Medicare Part D prescription coverage my monthly premium is paid by some entity but I forget who exactly. I never see any bill -- I think the PA Dept. of Health pays it just as they did when I was on ADAP, but now that I am on M.A.W.D I can't be on ADAP. It's very complicated and I'm sure nothing I just said makes much sense. But I agree that  livingmmy9lives needs to be more insistent with his/her case manager -- unless he/she lives in a state that has no program to provide for this 20% coverage then I don't have any recommendation except to move elsewhere.
"Iíve slept with enough men to know that Iím not gay"

Offline livingmmy9lives

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Re: Need advice on filling in the holes in my medical coverage
« Reply #6 on: December 30, 2013, 11:44:40 PM »
I live in Rhode Island. I checked with the local ASO and they don't know of any program to help me - they don't even have a resource guide or manual for case managers to check. I make a miniscule amount over the limit for QMB & make too much for medicaid. I did get partial extra help to help with part of medicare D copays because I'm under the income limit.  As far as I know there is no wrap-around coverage available here - I've asked about it and I keep getting "not sure - will have to check into that".  I am very insistent with my case manager and I think that she has the best of intentions but just not aware of anything that could help me. Thanks to those of you who responded. Sorry for posting this in 2 threads but Jeff G is it really necessary to scold me?
Diagnosed 1988.

Offline tednlou2

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Re: Need advice on filling in the holes in my medical coverage
« Reply #7 on: December 31, 2013, 12:50:53 AM »
I live in Rhode Island. I checked with the local ASO and they don't know of any program to help me - they don't even have a resource guide or manual for case managers to check. I make a miniscule amount over the limit for QMB & make too much for medicaid. I did get partial extra help to help with part of medicare D copays because I'm under the income limit.  As far as I know there is no wrap-around coverage available here - I've asked about it and I keep getting "not sure - will have to check into that".  I am very insistent with my case manager and I think that she has the best of intentions but just not aware of anything that could help me. Thanks to those of you who responded. Sorry for posting this in 2 threads but Jeff G is it really necessary to scold me?

Sorry to hear that.  I know many of the people I've talked with about these programs only found out about them, because they signed up for food stamps.  Here in Louisville, your SNAP case manager also handles the extra help and the 20% Medicaid.  There could be a wrap-around program here.  I did not know that exists, but each state is different.  Do you know where the office that handles SNAP is, where you live?  I bet they know where to send ya, if not right at their office.  Folks here say it is almost impossible to call their office and actually get someone.  You have to go downtown to their office and take a ticket.  For those without transportation, that can be difficult just to get an answer on the different programs and guidelines.  You may have a better experience getting someone by phone. 

 

Offline Ann

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Re: Need advice on filling in the holes in my medical coverage
« Reply #8 on: December 31, 2013, 06:59:12 AM »
Sorry for posting this in 2 threads but Jeff G is it really necessary to scold me?

He didn't scold you, he was only trying to help you. It really does make it easier for everyone - you included - if you don't ask the same question across multiple threads. Also, it's always best with something like this (specific questions about your own specific situation) to have your own thread, rather than piggy-backing it onto someone else's thread about their own specific situation.

I'm not scolding you either, I'm just explaining. I want you to be able to get the most out of your participation here.

I don't live in the states so I can't offer you any practical help, but I am wishing you the best and I sincerely hope you can get this sorted out. May 2014 be a better year for you and your partner.

Ann
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Offline Miss Philicia

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Re: Need advice on filling in the holes in my medical coverage
« Reply #9 on: December 31, 2013, 07:01:25 AM »
I live in Rhode Island. I checked with the local ASO and they don't know of any program to help me - they don't even have a resource guide or manual for case managers to check. I make a miniscule amount over the limit for QMB & make too much for medicaid. I did get partial extra help to help with part of medicare D copays because I'm under the income limit.  As far as I know there is no wrap-around coverage available here - I've asked about it and I keep getting "not sure - will have to check into that".  I am very insistent with my case manager and I think that she has the best of intentions but just not aware of anything that could help me. Thanks to those of you who responded. Sorry for posting this in 2 threads but Jeff G is it really necessary to scold me?

1) livingmmy9lives, Jeff is just doing his job -- multiple threads on one subject by a new member become confusing for all involved. I don't think he scolded you (I know him personally and he's a very sweet, polite old man), but I do realize that you are under stress with this Medicare issue (I would be) so perhaps you're feeling more on edge than you realize. We are here to help you, not antagonize you.

2) Now that I know you live in Rhode Island (which fortunately is one of 25 states that require insurers to provide "medigap" insurance to under-65 beneficiaries), I would recommend googling "rhode island disability medicare supplemental insurance" and see what you come up with. You'll have to shop around by making calls to various insurance companies -- never an enjoyable task.

Perhaps start with this .pdf file: THE RHODE ISLAND GUIDE TO BUYING MEDICARE SUPPLEMENT AND MEDICARE ADVANTAGE PLANS

Rhode Island is uber-liberal and must have some sort of Medicaid wrap-around program similar to what I have in Pennsylvania, I would be very surprised if they do not. Are you using an ASO in Providence, as in the largest one? If not, I would change ASO's' and start over with this issue -- a case manager not knowing this issue is quite strange, frankly. It's not something unusual.

Perhaps also read this: Choosing a  Medigap Policy: A Guide to Health Insurance for People with Medicare

I am trying to recall someone here on disability that lives in Rhode Island and am not coming up with anything (small state and all, as lovely as it is). I think AIDS Project Rhode Island is the largest ASO: http://aidsprojectri.org/  Is this where you are going for information?

Please keep us up to date on what happens, as I know when I encountered all of this it was a very stressful time for me, but it should get sorted out in due time and you'll be able to relax about it. Best of luck.
« Last Edit: December 31, 2013, 07:04:20 AM by Miss Philicia »
"Iíve slept with enough men to know that Iím not gay"

Offline livingmmy9lives

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Re: Need advice on filling in the holes in my medical coverage
« Reply #10 on: January 03, 2014, 12:02:50 AM »
I apologize - I didn't mean to snap at anyone. Yes I am on edge from this and I also have multiple stressful situations all going on at once including not getting treatment for anxiety/depression/insomnia. The ASO is Aids Care Ocean State which I am hearing is as good as APRI. I havenít been able to make calls about this yet- nearly impossible to get ahold of anyone from Christmas to the new year. Iím looking into all of the info everyone has kindly me and will be making some calls this coming week - I appreciate all of your help and again apologize for snapping and will keep you posted.
Diagnosed 1988.

Offline tednlou2

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Re: Need advice on filling in the holes in my medical coverage
« Reply #11 on: January 03, 2014, 12:57:36 AM »
I apologize - I didn't mean to snap at anyone. Yes I am on edge from this and I also have multiple stressful situations all going on at once including not getting treatment for anxiety/depression/insomnia. The ASO is Aids Care Ocean State which I am hearing is as good as APRI. I havenít been able to make calls about this yet- nearly impossible to get ahold of anyone from Christmas to the new year. Iím looking into all of the info everyone has kindly me and will be making some calls this coming week - I appreciate all of your help and again apologize for snapping and will keep you posted.

It is often hard to interpret tone in text.  I know I've replied to friends on Facebook and they thought I was mad, when I wasn't.  Anyway, hope things work out.  Let us know.  All the best!   

 


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