Have been on Medicaid, just got Medicare: confused!

I have been on SSDI for about two years now.  I live in the state of OH, and I got Medicaid retroactive to the date that SSDI set as my date of disability once I was approved for SSDI.  Medicaid has been paying all my medical bills (doctors, hospitals-ER/outpatient/inpatient/surgery, ambulances, durable medical supplies) in full and my medications (generic and OTC w/written rx for free, brand name with a max of $2 copay) ever since.  Medicaid also provides me with taxicab transportation to/from my medical appointments (at no cost to me) and this month they are setting me up with home health services (also at no cost to me).  

I just received paperwork in the mail congratulating me that as of February 2009 I will qualify for Medicare, and informing me that I need to respond to make certain selections regarding my Medicare program.  When I called Medicare, they informed me that because I have Medicaid I won't have to pay premiums.  BUT, I will now have copays on every single one of my prescriptions.  (I take 20 medications right now.)  I wouldn't qualify for medicaid and food stamps in the state of OH if I had expendable income, so where do they expect me to get the extra money for my prescriptions from?  

Are there other problems I should anticipate now that Medicare is taking over as my primary insurer?  Will they refuse to pay for certain things?  Will Medicaid automatically cover something that Medicare doesn't, or will there be red tape involved that could delay care?

[Amir Mostafaie]

Dear Heiferly,

Medicaid helps with medical costs for some people with low incomes and limited resources. To qualify for Medicaid, you must have a low income and few savings or other assets. Medicaid coverage differs from state to state. In all states, Medicaid pays for basic home health care and medical equipment. Medicaid may pay for homemaker, personal care, and other services that are not paid for by Medicare. Medicaid has programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who are entitled to Medicare and have a low income.

For more information visit U.S. Department of Health & Human Services website at
http://www.hhs.gov/faq/medicaremedicaid/655.html .

Sincerely,

Amir Mostafaie

[Heiferly]

Sir,

I appreciate the information, but I think you misunderstood my question.  I have already qualified for Medicaid.  I have been on Medicaid since Aug 2006 and continue to be on Medicaid as my income has not (and will not in the forseeable future) increased.

My question is about suddenly having Medicare *in addition* to Medicaid, and Medicare taking over as my primary insurer.  I have heard many negative things about Medicare regarding them not covering various things (whereas Medicaid has covered everything in full for me).  I want to know if my Medicaid will seamlessly cover whatever Medicare denies, or if there is a lot of red tape and delays involved, or if things may get denied now entirely.  My original assumption would have been that with BOTH I would have at least as much coverage as I did with just Medicaid, but I was informed by Medicare that this is not the case as the way that they work together for prescription coverage will mean that I will now have to pay a copay for all of my prescriptions which I did not have to with just Medicaid.

All of the information I can find from the government websites involves how to qualify or apply for these programs, not how they will work once I am on them.  Even if you've just heard anecdotally of other people being happy or unhappy with this system, I'd be glad to have an idea of what to expect.

[SadieSunflower]

Hey Heiferly,

Good to see you here. I work in a clinic. My understanding is that if Medicare denies coverage for something, then the secondary insurance will also deny coverage. Now, being that they are both government programs you would think they would cover the same things. Hopefully if Medicare only covers something in part, then Medicaid will make up the rest. You might want to address the question to someone who manages billing at your doctors office. Those people are not always knowledgeable though. Keep asking around.

Good luck!

aka SunflowerPower

[Amir Mostafaie]

Dear Heiferly,

Thank you for responding. When you qualify for both programs (also called Medi-Medi), Medicare will become your primary insurance. Medicaid covers some or all of Medicare’s premiums, deductibles and coinsurance but like SadieSunflower said, to get more accurate information, your best bet is to pose the question to the provider (in this case your pharmacy since your main concern is with medications).

Sincerely,

Amir Mostafaie