My mom makes barely too much to qualify for Medicaid to supplement her Medicare, but can not afford her co pays and prescription drugs. Any advice? - AgingCare.com

My mom makes barely too much to qualify for Medicaid to supplement her Medicare, but can not afford her co pays and prescription drugs. Any advice?

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My mom receives a little over $1,500 a month from Social Security disability. Her medical bills and prescription drug costs are roughly $800 right now doing the bare minimum. Her heart doctor needs to run more tests to figure out why her blood pressure is staying in such a dangerous range but we can not afford to pay what Medicare won't cover. She has a Medicare replacement plan through United Healthcare and they cover only about 50% of her drug costs and have high co pays for doctors visits. She has thousands of dollars in unpaid medical bills and her doctors are threatening to stop treatment if we can not afford to pay. If she received about $200 less in Social Security she would qualify for supplemental Medicaid. I do not know what to do to help her. She is severely depressed and wants to just give up since she is suffering with no medical relief and it's breaking my heart. Is there a way to reduce Social Security payments so that she can qualify for extra assistance? Should she stop receiving Social Security altogether and go completely on Medicaid, Food Stamps, utility assistance, etc...? She just moved in with us since she has no ability to afford rent and medical care together but we can not financially support her. Any guidance would be greatly appreciated.

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As for the Part D penalty, I also just dealt with this. Because she had UH Medicare Advantage plan, or almost any type of health coverage, they do NOT apply a penalty. I know these warnings are everywhere.
I just enrolled into Part B and Part D, 6 months after I was eligible. Because I had Medicaid, they consider this comparable health insurance coverage (tho most website and people will tell you differently!), and I got no penalty at all.
I had to take proof of my Medicaid coverage to the local SS office, they said the Fed. govt. can't see you get Medicaid (right!), show that I was covered. Local office faxed it in to Fed. level, I was approved in 1 day.
The penalties from what I have experienced are mainly if you refuse any coverage, Part A-D, when you are eligible AND have no other health coverage. Medicaid counts, so do pretty much all other health insurances. I hope this helps, I spent hours with SS figuring all of this out, but in the end, thankfully I have no penalties.
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Reply to asylum23
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I hope this will help you. I am on SSDI, my check each month is about this amount. I am "dual eligible". With that, I should have been auto-enrolled into this program by SS, but I was not.
Have you looked into the Extra Help thru The Medicare Prescription Drug Program?
I should have been auto-enrolled, was not, applied right on the SS website. They approved me over a weekend. It covers the Part D monthly premium, drives the price of Generics down to $3.35 each at the pharmacy, some have mail order.
Please apply for her if you have not. I had never in my life heard of this, found it doing research, and surprise. Applied and now most of my script issues are gone.


"You should complete this application for Extra Help on the Internet if:
You have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance); and
You live in one of the 50 States or the District of Columbia; and
Your combined savings, investments, and real estate are not worth more than $28,150, if you are married and living with your spouse, or $14,100 if you are not currently married or not living with your spouse. (Do NOT count your home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts or back payments from Social Security or SSI.) If you have more than those amounts, you may not qualify for the extra help. However, you can still enroll in an approved Medicare prescription drug plan for coverage.
EXCEPTION: Even if you meet these conditions, DO NOT complete this application if you have Medicare and Supplemental Security Income (SSI) or Medicare and Medicaid because you automatically will get the extra help."
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Blankstm, she should be able to pick another Part D and switch to regular Medicare during open enrollment this fall.
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Reply to Becky04473
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She is on the UH Medicare Advantage plan. When we enrolled two years ago it provided the best coverage for her Vyvanse and Adderall which were her highest expense. Now she needs a lot more care. We plan to pick a new plan during open enrollment but we're trying to figure out something in the meanwhile.

She is 62.

Regular Medicare would be a better option but if we discontinue the UHC plan right now, she will lose drug coverage and we were told that she would have a penalty for not having part D. I spoke with her pharmacist about how much her out of pocket drug costs would be if we dropped UHC and they would go up by around $400 so it doesn't help solve the situation.

Carelink was no help what so ever. They said that recieved too much money to qualify for anything. I can not believe $18,000 a year with nearly $10,000 a year out of pocket medical costs does not qualify for any assistance. I'm at my wits end.
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Reply to blankstm
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Barb, UH is notorious for luring people into their advantage plans. Most have very low or no premium. But the drug plan is not the best and the co-pays for specialists are high. Blankstm needs to calculate the costs very carefully. If she goes to regular Medicare her premium will go up to $134.00 per month and she will have to select a part D drug plan and Medicare supplement plan. The part D may have a premium of $40.00 or so. The supplement may be difficult as well because of all of her health conditions. Most people don't realize that Medicare supplemental programs have the right to deny coverage for pre-existing so conditions if changing plans. That was one of the negotiation giveaways to the insurance companies in Obamacare. That would need to be shopped for very carefully. She could check online during open enrollment to use one of the drug plan selectors based on the medications she takes to see which program would be best. also, shop very carefully for the pharmacy. Prices can vary widely.
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Reply to Becky04473
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Becky, thank you for the correction.

Would original Medicare be a better option, or a different Medicare Advantage plan?

I hope the Carelink folks can give you some guidance.
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Reply to BarbBrooklyn
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She's on SSD not SSI. If she gets regular SS disability of $18,000 ($1500 mo) she is over the income limit. Is she on a UH Medicare Advantage plan? That would also include her Part D drug plan which UH has very restricted formularies for advantage plans. Also UH advantage plans have high co-pays. Advantage plans are not a good option for someone with extensive health problems.
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Reply to Becky04473
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I'm confused. The Arkansas Medicaid website states that if you qualify for SSI, you can get Medicaid.

I think you need to go with mom to your local Medicaid office and talk to a caseworker.

Also, look into a qualified income trust if she is truly over the income limit .
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Reply to BarbBrooklyn
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How old is your mother..is she under 65 ? Have you researched your states website for their Assistance to Seniors Program? Or is  P.A.A.D:  Pharmaceutical  Assistance to Aged & Disabled  program available? To clarify P.A.A.D is available in my state but something similar may be available in AR.
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Reply to peace416
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I'm certain she is not recieving Medicaid. She receives too much money monthly to qualify. I contacted an organization called Carelink today and she could only qualify for a Medicaid spend down program if her monthly medical bills are over 3 times her monthly income which they are not. I have talked to her therapist office and they offer sessions with interns for $5 a visit which is great except that they are all young and my mom really wants to talk to someone closer to her age 60+.

The plan she is on was the best plan at the time for her prescriptions but it's not great for doctors visits. The therapist office told me that if she has original Medicare instead of the UHC replacement plan, her visits would only be $18 instead of $50. We plan to look for a new policy during open enrollment but I'm trying to figure out something in the meanwhile so she doesn't have to stop most of her medical care.

Unfortunately, the doctors offices will not accept a payment plan that she can afford ($5-10 a month) After all her bills come out each month she is usually in the negative and I usually cover the overdraft amounts. She has $300 spending allowance each month for gas, groceries, toiletries, clothes, and all other necessities. The rest goes entirely to bills.

We live in Faulkner county, Arkansas.
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