Regarding Medicare and Medicaid and Me

[Sugarbleus]

Can someone lead me to a site or give some tips on where to look for the best deals in prescription coverage for those of us on Medicare and Medicaid together??

I'm getting paperwork from Medicare stating that medicaid will no longer pay for my medicines starting in Jan '06. Supposedly, mediCAID is picking up the office visit bills, but dropping the drug coverage.

MediCARE will also no longer pay for "specialty" doctors visits; specialists that will not accept medicaid either.

Medicare is not going to pay for a whole lot of "items" they once did--let alone lack of drug coverage. Like Oxygen tanks, CPAP machines, respiratory items, mental health visits, and so forth!!! I think Diabetic items are still covered.

While in my "special" doctors office yesterday, he asked me whether I'd chosen a plan. WHAT PLANS??? I don't see no stinking plans anywhere. I need some guidance please. Any info and tips are welcome.
............................................
Dontcha just love it. First they gut the Medicare instead of improving it. They tell folks that if they are below a certain level of income that MediCAID will pick up the drug costs. THEN they cut medicaid so that it won't pay for drugs either, if I have MediCARE; so it's been one giant circle. THE OLE' BAIT AND SWITCH.

I only make $628 per month. How in the world will I be able to afford the medical 'equipment' AND the drugs and rent and Auto insurance and food and RENT on that income? What's wrong with this picture?

Thanks, SB :scared:

[astonamous]

1. Here's what I would suggest...

I would make an appointment with your medicaid case worker. Gather up and take with you a list of all your medications, equipment, rent and other expenses that you currently have. You may also want to get a list from all your doctors about any possible changes or procedures that you may require in the next year or two. (ie: cataracts, new glasses, joint replacement) Make sure you include your utilities and gas or transportation expenses.

When you meet with your case worker, you can then ask them what your options are and what you are suppose to do.

[Sugarbleus]

3. Aston'...that is a terrific idea!

I did consider calling the medicaid office to see what my options were. They DID help me last year when money started coming out of my disability check for Medicare.

I guess I just "assumed" I was dead in the water at this point. I'll call them forthwith.

Thank you so much, :hug: SB

[Horse with no Name]

2. Unfortunately

I think you are screwed.
I am assuming you have some pretty serious health issues.
I would ask for a case manager to be assigned to your case and hopefully it can be resolved. I don't know what state you are in, but these might be helpful.
Try this:
http://www.a2zmedline.com/
They might be able to help you with free medicine.
You might try this for medical equipment assistance:
http://www.charities.org/memberdir/index.cfm?fa=MembrInfo&id=32214

Good luck!

On edit:
Might I also suggest Meals on Wheels or something of the like to help with your nutritional needs?

[Sugarbleus]

4. Thanks HNN

Actually I don't have many serious conditions...nothing life threatening. BUT, that's not to say that next week things won't change. With all the stress of this admin, I could have a stroke!!

I do use medical "equipment" of a specific nature and a couple drugs that are extremely costly; unnecessarily so. Each office visit for preventative care, such as an eye exam, mental health, or mammo, is "special" aka extraordinary. These types of things will no longer be totally covered.

The whole MediCARE thing is soooooo confussing. They TAKE money from your paltry income AND THEN make you give a co-payment for goods and services on top of that...after you've reached a certain point. :crazy:

I live in Calif.

One things for sure; if something isn't "fixed" like it SHOULD be, I'm resorting to "other means" to support my self/my needs. That's just the way it is..... In America, the greatest third world country on earth.

Thanks for the tips anyway... SB

[deek]

5. Do you qualify for IHSS?

In home supportive services through Dept of Human Services?

If you qualify for 1 hour of help per month, you are entitled to no share of cost Medicaid.

Call your local office and refer yourself. They can not assess you over the phone. They have to come to your house and meet with you.

http://www.pai-ca.org/pubs/Index.htm

[Sugarbleus]

7. EXCELLENT info Deek

Funny, >I< work for IHSS for S.O. lol

Last year I told the SW that I wasn't able to do all that I could before; asked about reducing my hours OR quitting altogether. Somehow, she and I missed each other's message and nothing got changed.

The SW DID suggest I could apply for myself...I forgot that. However, I had no idea I could get any special treatment from medicaid/medicare behind that move. Thanks for the info :toast:

[deek]

9. splendid!

Don't forget--IHSS, once approved, is retroactive to the date you first applied.

:bounce:

[Sgent]

6. I'm not sure

where all this info is coming from, have any links?

As far as I'm aware (and I keep my ear to the ground), Medicare coverage of durable medical equipment and psychological help has not changed. Medicaid's coverage of the same may have.

In the perscription drug program, generally, Benzodiazapeins will not be covered -- which could affect some people -- espcially with nevous conditions. Certain individual private plans may choose to cover it.

Since you are in in Medicaid, you will be eligible for perscription drug programs without any "donut" or monthly premium, and will owe a nominal (although potentially more than Medicaid's) copay with each purchase -- $2 to $5 dollars.

If you do not choose a plan, one will be randomly assigned. Since plans could just start releasing their coverages and other issues Oct. 1, many still haven't.

Go to www.medicare.gov to see plans available in your area, and their benefits (note that this is still limited, and should get better in thenext week or so).

[Sugarbleus]

8. Hi Sgent

I'm not entirely sure about ALL durable medical equipment but absolutely the medicare program does NOT cover eye exams, hearing, dental...........and with Medi/Medi, as I have="Dual" coverage, medicaid USED to pick up the drug coverage and all of those other things I mentioned. In Jan '06 all of that is over.

Just a year and a half ago, I went in to Medicaid to ask for an electric scooter; they wanted me to use an electric wheelchair instead. However, when they discovered I can't use neither inside the house (can't even get it into this cramped little space)...THEY SAID NO WAY. I need a new breathing machine; I'm afraid to find out if they will cover that now. My sister was telling me that someone she knows couldn't get their oxygen tanks covered by Medicare now either. Yikes.

One who is on Medicaid solely will continue with whatever coverage this admin will allow them to have--with input output from your state's leaders. CUTS CUTS CUTS...read someplace where "cutting" from the medicaid budget was a suggestion to defray costs for Katrina damage. :crazy:

I was just reading about these MediCARE/MediCAID "changes" in two places tonight:

http://www.100percentcampaign.org/priorities/medi-cal-m...

And

http://www.californiahealthline.org/index.cfm?Action=ds...

Hope this helps. Best, SB

[deek]

10. Info from ADAPT-CAL newsletter

Your Weekly Medicare Consumer Advocacy Update
> >> ACT NOW: Insist Congress Extend Medicaid Drug
> >> Coverage for People with Medicare
> >> September 29, 2005 • Volume 5, Issue 39
> >>
> >>
> >> This Saturday Medicare prescription drug plans
> >> will start marketing their wares via the mail, television, radio
> >> and telephone.
> >>
> >>
> >> At the same time, the Centers for Medicare and
> >> Medicaid Services (CMS) is completing a massive
> >> data transfer from the states, downloading
> >> information about the 6.4 million people with
> >> Medicare who currently are so poor that they
> >> also have Medicaid, including comprehensive
> >> prescription drug coverage. By act of Congress,
> >> these Americans will lose their Medicaid drug
> >> coverage on December 31st when they are supposed
> >> to be transferred to the Medicare prescription
> >> drug benefit. Key word: “supposed.”
> >>
> >>
> >> With no margin for error, multiple public
> >> agencies, including 51 state Medicaid agencies,
> >> the federal Centers for Medicare and Medicaid
> >> Services (CMS) and the Social Security
> >> Administration (SSA) are to exchange precise
> >> data regarding all 6.4 million people with
> >> hundreds of private drug plans and thousands of pharmacies.
> >>
> >>
> >> If a ball is dropped, and we expect an avalanche
> >> of fumbles, the poorest, oldest and sickest
> >> Americans face a loss of the medicine they need
> >> to survive. Sure, glitches can get fixed over
> >> time. But for many Americans the fix may come too late.
> >>
> >>
> >> This is not the first time that a federal agency
> >> has had the responsibility of transferring,
> >> literally overnight, millions of poor people and
> >> those with disabilities from a
> >> state-administered to a federal benefit program.
> >> In 1974, SSA launched the Supplemental Security
> >> Income (SSI) program to replace
> >> state-administered adult public assistance
> >> programs for people with disabilities.
> >>
> >>
> >> SSA was mandated by Congress to shift 3.2
> >> million Americans—half the number to be
> >> transferred from Medicaid drug coverage to
> >> Medicare drug coverage this year— by January 1,
> >> 1974. On January 2, thousands of people who had
> >> not gotten their SSI checks descended on SSA district offices.
> >>
> >>
> >> At the time, SSA prepared itself for 20,000
> >> queries a day: it received 60,000. The system
> >> breakdown led to blocks-long lines outside of
> >> Social Security offices in freezing weather.
> >> People rallied and protested, requiring police
> >> security at Social Security offices.
> >>
> >>
> >> And what was SSA’s success rate in 1974? One
> >> report cited by SSA noted that 95 to 98 percent
> >> of the 3.2 million people got their checks on
> >> time. But tens of thousands of people did not,
> >> causing a chain reaction of panic and protest.
> >>
> >>
> >> Thirty-one years later, following the federal
> >> government’s frightening response to Hurricane
> >> Katrina, one wonders if this administration can
> >> do better. Medicaid is a lifeline for many of
> >> American’s poorest and must vulnerable citizens.
> >> Even a 95 percent success rate for the 2006
> >> transition will leave more than 300,000 of the
> >> frailest Americans without access to needed medicines on January
> >> 2, 2006.
> >>
> >>
> >> Doggedly CMS refuses to acknowledge publicly
> >> that anything could go wrong. It is akin to denying that summer
> >> will end.
> >>
> >>
> >> Congress should extend the availability of
> >> Medicaid as backup drug coverage during a
> >> reasonable transition period. With a safety net
> >> in place, CMS, states, health advocates, drug
> >> plans and providers would have time to implement
> >> a comprehensive education and transition plan
> >> that would ensure that people are successfully
> >> enrolled in Part D plans; that they would know
> >> how and where they can obtain necessary drugs;
> >> and that their doctors have had adequate time
> >> and information to review and, if necessary, appeal new formulary
> >> guidelines.
> >>
> >>
> >> To read more about this transition, see
> >> “<http://www.medicarerights.org/drugtransitionreport.pdf>6.4
> >> Million at Risk: Protecting the Poorest
> >> Americans During the Medicare Drug Transition,”
> >> an update on the problems and solutions for the
> >> transition from Medicaid drug coverage to Medicare drug coverage.
> >>
> >>
> >> Click <http://www.medicarerights.org/action>here
> >> to send an e-mail message or letter to your
> >> representatives in Congress asking them to
> >> extend Medicaid drug coverage for a reasonable
> >> period during the transition to Medicare Part D.
> >>
> >>
> >> Medical Record
> >>
> >>
> >> State Medicaid directors say that the time frame
> >> for moving “dual eligibles” into Medicare drug
> >> plans poses major challenges. Some used the term
> >> “disaster” to describe the ambitious timetable
> >> and the likely outcome of its implementation.
> >> From their perspective as program
> >> administrators, participants indicated that the
> >> time allotted to get dual eligibles into private
> >> Medicare drug plans is not sufficient, even
> >> without accounting for the time these men and
> >> women would need to learn how to use them
> >>
>
(“<<http://www.kff.org/medicaid/loader.cfm?url=/commonspot/security/>http://www.kff.org/medicaid/loader.cfm?url=/commonspot/security/
> >> getfile.cfm&PageID=50422>Implications
> >> of the Medicare Modernization Act for States:
> >> Observations from a Focus Group Discussion with
> >> Medicaid Directors,” Kaiser Commission on
> >> Medicaid and the Uninsured, January 2005).
> >>
> >>
> >> The amount of time allocated for the switch from
> >> Medicaid drug coverage to Medicare drug coverage
> >> for dual eligible individuals is not enough to
> >> ensure a smooth transition. The Medicare Payment
> >> Advisory Commission (MedPAC), an independent
> >> federal body that advises Congress on Medicare
> >> issues, notes that accomplishing the tasks of
> >> transitioning people from one drug plan to
> >> another in the private sector takes a minimum of
> >> six, and preferably, nine months
> >>
>
(“<<http://www.medpac.gov/publications/congressional_reports/>http://www.medpac.gov/publications/congressional_reports/
> >> June04_Table_of_Contents.pdf>Report
> >> to the Congress: New Approaches in Medicare,”
> >> Medicare Payment Advisory Commission, June 2004).
> >>
> >>
> >> People eligible for both Medicare and Medicaid (“dual
eligibles”) are
> >> * Sicker. More than 50 percent of dual
> >> eligibles are limited in activities of daily
> >> living, and they have higher rates of
> >> Alzheimer’s disease, diabetes, pulmonary
> >> disease and stroke than other people with Medicare.
> >> * Cognitively impaired. Nearly 4 in 10 have
> >> a mental or cognitive impairment. That means
> >> that 2.5 million dual eligibles may not be able
> >> to navigate program changes even if education
> >> and communication efforts are appropriately
> >> implemented for an older population.
> >> * Underserved. More than 40 percent of dual
> >> eligibles are racial/ethnic minorities, and
> >> dual eligibles are more likely to live in rural
> >> areas than other people with Medicare.
> >> * Institutionalized. One in four dual
> >> eligibles lives in a nursing home or other long-term care
facility.
> >>
> >>
> >> Fast Relief: What You Can Do
> >>
> >> Let everyone—your colleagues, friends,
> >> families—know how we can improve the
> >> prescription drug benefit for people with
> >> Medicare and American taxpayers. Help us build a
> >> national network of concerned citizens who want
> >> to create the Medicare prescription drug benefit Americans
deserve.
> >>
> >> Click <http://www.asclepios.kintera.org/>hereto
> >> help build a national campaign for a real Medicare prescription
> >> drug benefit!
> >> *****
> >>
> >>
> >> Don’t Let Your Suffering Go Unnoticed
> >>
> >> Are you struggling to pay for your prescriptions
> >> drugs or get the health care you need? Work with
> >> the Medicare Rights Center to bring your story
> >> to the ears of policymakers, the press and the
> >> public in an effort to expose the shortcomings
> >> of the American health care system. To learn
> >> more about how to make your voice heard in the
> >> national Medicare debate, visit
> >>
> <<http://www.medicarerights.org/>http://www.medicarerights.org/
> >> maincontenthiddenlives.html>www.medicarerights.org/
> >> maincontenthiddenlives.html.
> >> The Louder Our Voice, the Stronger Our Message
> >> Asclepios—named for the Greek and Roman god of
> >> medicine who, acclaimed for his healing
> >> abilities, was at one point the most worshipped
> >> god in Greece—is a weekly action alert designed
> >> to keep you up-to-date with Medicare program and
> >> policy issues, and advance advocacy strategies
> >> to address them. Please help build awareness of
> >> key Medicare consumer issues by forwarding this
> >> action alert to your friends and encouraging
> >> them to
> >>
> <<http://www.medicarerights.org/>http://www.medicarerights.org/
> >> maincontentsubscribeasclepios.html>subscribe
> >> today.
> >>
> >>
> >> Medicare Rights Center (MRC) is the largest
> >> independent source of health care information
> >> and assistance in the United States for people
> >> with Medicare. A national nonprofit founded in
> >> 1989, MRC helps older adults and people with
> >> disabilities get good, affordable health care.
> >>
> >> Visit our online subscription form to sign up
> >> for Asclepios at
> >> <http://www.medicarerights.org/subscribeframeset.html>http://
> >> www.medicarerights.org/subscribeframeset.html.
> >>
> >>
> >>
> >>
> >> SO WHAT DO YOU WANT TO DO ABOUT IT?
> >>
> >> To Subscribe: Send a blank e-mail to ADAPT-CAL-
> >> [email protected]

[Sugarbleus]

11. Again, FANTASTIC Deek!!

I'm booking this page for full review later tonight. Right now, I'm Off to a Dr. appt!!;)

So much reading, so little time. Better get on it eh?

:hug: :yourock:

[Sgent]

12. Hmm...

Ok, I see what your getting at re/ dual eligibles.

At least in the states I'm working with, dual eligibles aren't being cut of Medicaid at all -- they are just losing all perscription drug coverage. The dental, hearing, eye exam, and medicare copay coverage is still in effect.

[Sugarbleus]

13. Thanks Sgent.....It's all very confussing..

What my tired eyes were reading was, yes the drug benefits of Medi-Cal/caid was being removed and rolled over to MediCARE, but it also appeared as though the dental..yadda yadda were also going to fall under MediCARE meaning I'd have to pay for those too.

So, in essence, I don't have a CLUE what Medicaid/Medi-cal (calif.) will actually be paying/covering?? Office visit? What about Durable medical equipment? Under MediCARE, will I also have to pay for things like oxygen tanks and wheelchairs and other medical assistive devices that were once no cost?

Geez, a lot of us are running around like Keystone Kops trying figure this shit out before the door slams shut.

I read someplace (ADAPT I think) that DUAL ELIG. would be forced into MediCARE plan D unless we could find a plan before a certain date. :scared:

[deek]

14. web based tool for dual eligibles

Ensuring Continuity of Care for Dual Eligibles: A Guide to Transition
From
Medicaid to Medicare's Prescription Drug Coverage is now available at
_http://www.theDesk.info/PartD_
(http://capwiz.com/thearc/utr/1/JXSUFCHTNT/AUHNFCHTPY/) This guide
was developed by the Disability Policy Collaboration, a
partnership of The Arc and United Cerebral Palsy and the Web-based
tool was
developed by TheArcLink Incorporated.

For more than six million dual-eligibles, their Medicaid prescription
drug
coverage will end as of December 31, 2005 and be replaced on January
1, 2006
by the new Medicare Part D coverage, provided by private prescription
drug
plans (called PDPs). The new Web-based tool addresses complex
questions, such
as:
* Who is a Dual Eligible? _Find the answer by clicking here_
(http://capwiz.com/thearc/utr/1/JXSUFCHTNT/NSCAFCHTPZ/) .
* Is Medicare prescription drug coverage voluntary? Can a dual
eligible decide not to participate in it? _Find the answer by clicking
here_
(http://capwiz.com/thearc/utr/1/JXSUFCHTNT/HBZDFCHTQA/) .
* What are the key differences between Medicaid prescription
drug
coverage and the new Medicare Prescription Drug Plans (PDPs)? _Find
the answer by
clicking here_ (http://capwiz.com/thearc/utr/1/JXSUFCHTNT/AMHYFCHTQB/)
.
* What are the key things to think about when choosing a PDP?
_Find
the answer by clicking here_
(http://capwiz.com/thearc/utr/1/JXSUFCHTNT/EYLJFCHTQC/) .

This Web-based tool also has a downloadable PDF copy of the guide, a
timeline of key dates, a glossary of terms, and additional resources
to guide users.
The Disability Policy Collaboration will continue to update the
website with
additional information about this critical issue.

What you should do: Visit the Web site at
_http://www.theDesk.info/PartD_
(http://capwiz.com/thearc/utr/1/JXSUFCHTNT/GXFMFCHTQD/) , download the
PDF copy
of the guide, and develop an understanding of this information, which
is
vital to transitioning dual eligibles from Medicaid to Medicare's new
prescription drug coverage.