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Author Topic: Question On Medical Coverage... Anyone know ??  (Read 2105 times)

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Offline brooklynpoz

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  • My Babies, Pepper (8) & Rocko (3)
Question On Medical Coverage... Anyone know ??
« on: September 06, 2006, 07:51:03 AM »
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.
Diagnosed, Monday,  8/9/2004, 1ST year was ruff , now I am well adjusted .
Current Med's ; Kaletra & Truvada
Undetecable,<48 ,  531 tcells, 21%
Keeping the faith, that they will get a cure in our lifetime.

Offline aztecan

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  • 32 years positive, 60 years a pain in the butt
Re: Question On Medical Coverage... Anyone know ??
« Reply #1 on: September 06, 2006, 10:52:00 AM »
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.


"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline Eldon

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Re: Question On Medical Coverage... Anyone know ??
« Reply #2 on: September 06, 2006, 10:45:48 PM »
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!

Offline brooklynpoz

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  • My Babies, Pepper (8) & Rocko (3)
Re: Question On Medical Coverage... Anyone know ??
« Reply #3 on: September 07, 2006, 05:27:28 AM »
Thank you for replying , I will start my " homework "

Diagnosed, Monday,  8/9/2004, 1ST year was ruff , now I am well adjusted .
Current Med's ; Kaletra & Truvada
Undetecable,<48 ,  531 tcells, 21%
Keeping the faith, that they will get a cure in our lifetime.

Offline IzPoz

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  • God, grant me the serenity...
Re: Question On Medical Coverage... Anyone know ??
« Reply #4 on: September 07, 2006, 06:35:10 AM »
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
The reason angels can fly is that they take themselves so lightly. ~ Chesterton G. K.

Offline Miss Philicia

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Re: Question On Medical Coverage... Anyone know ??
« Reply #5 on: September 08, 2006, 03:06:37 PM »

It will vary state by state.  ADAP still exists but it's mandated by Congress to be payer of last resort.  If you don't qualify for the federal "extra help" program then ADAP will probably pick up whatever Medicare Part D does not as New York state has a one of the most well-funded ADAP programs, or at least it did when I moved away a couple of years ago.  Their formulary list is MUCH larger than here in Pennsylvania.

GMHC has a F.A.Q. section on ADAP and Medicare Part D:  http://www.gmhc.org/policy/benefits/adap_medicare_partd.pdf

If you have any further questions or need particular questions answered I'd recommend calling GMHC and making an appointment with whatever department there handles it.  GMHC can be a bit of a hassle as they're always busy, sometimes under-staffed, and unless you have a really acute problem you'll often see a volunteer instead of a staff member.  Just be persistent.

ALSO:  I don't know if NY state still does this, but when I was in your position (on SSD and waiting that 2 years for Medicare coverage) ADAP actually paid for all my monthly premium to be on a private HMO individual coverage policy with Blue Cross, which is something I don't think many other places will pay for.  This was because I was receiving too much SSD to qualify for other state programs, but not enough to pay for things myself.  There's a whole formulary for figuring this out and why I still recommend GMHC.  I just dug up my old GMHC file and if you are not already a member you will need to go and register.  You get an ID card and this will enable you to specifically request that they open a "intensive case management" file for you and evaluate your finances, medical needs and qualifications for programs, etc.   Advocacy Dept. is on the 7th Floor. 
"Iíve slept with enough men to know that Iím not gay"


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