I am disabled, live in Florida, and started receiving SSI and Medicaid back in 2001 when I was 18. A few years ago I started drawing off my father, due to him retiring, because I still live with him. So I suppose I get SSDI now. This also entitled me to Medicare as well. I am, or was, full "dual-eligible" (I receive, or received, both Medicare and full Medicaid). I suppose I am only partial dual-eligible now. According to information I have read and was told, a single person is eligible for Medicaid if they have income less than $885 a month, mine is $803. Yet the people I have spoken to at the agency that handles Medicaid applications and eligibility (Department of Children and Families) say I have too much income! The $803 is all I get and I have no other assets. Another person said it was because of having Medicare.
I still don't understand why I am losing my Medicaid. I have a monthly "share of cost" of $603. Once I meet the share of cost my Medicaid kicks in for the rest of the month. Medicaid does not reimburse anything you have paid for.
DCF keeps telling me there is no use to filing an appeal. I called a local attorney that has offices close to the social security offices that handle disability cases and they say they don't handle Medicaid cases. Who the heck am I suppose to contact? Whenever I type in "Medicaid lawyers" in google I keep seeing Elder and Estate lawyers, but I am in my 30s. Has anyone else been through this rigamarole before?
Is it possible that you are making more income than you think you are? Medicare premium is usually taken out of your check when you get Social Security or disability. Medicare premiums average $109-$134 per month so if your check has a premium deducted and the income you receive is $803 AFTER Medicare is taken out, then you might actually be making more than $885 per month ($803 plus $109 is more than $885). If the premium for Medicare is being paid for you by the government because you are low-income, the cost of the Medicare premium may be added added back into your "income" calculations for your state as a benefit and it makes you not eligible (there is NO PARTIAL eligibility for Medicaid - it's yes or no). Try a disability lawyer if the DCF offices are not explaining your situation to you - they file claims all the time. If you are not eligible, a disability attorney's office will know why very quickly.
For example, my previous insurance covered my test strips 100%, and the insurance company required me to use a mail order company. Okay, so Medicare also allows me to use this same mail order company, but if they only pay the first 80% and my old insurance company pays the remaining 20%, what happens if I haven't yet paid Medicare's $140 deductible? Since my insurance covered 100% of the test strips with no co-pay or deductible, will my old insurance company pay for the strips?
Next, since Medicare doesn't pay for vaccines or immunization shots and my old insurance company does, then when I got a tetanus booster in September, and Medicare refused the claim since they don't pay for immunizations, shouldn't my old insurance cover it, even though I haven't met Medicare's $140 a year deductible? I mean, a tetanus shot isn't covered by Medicare so it shouldn't be included in their $140 a year deductible, so my old insurance company should pay for it.
Then if Medicare has a $140 a year deductible and I started Medicare September 1st, does that mean that I only have to pay the first $140 of any medical bills and after that $140 is paid, then I don't pay another deductible until Sept. 1st of next year, or does the insurance start all over January 1st? That doesn't seem right....to pay a $140 deductible that starts Sept. 1st, then 4 months later (Jan. 1st) I have to start all over and pay another $140 deductible for the new year.
I know, you'd think that I could get the answers to these questions by calling 1-855-800-8227Medicare and my old insurance company, but it's not that easy. See, when you try to contact 1-855-800-8227Medicare, you get get put on hold by their automated answering system, then if you do manage to get through, you get shuffled around until they finally tell you that you need to contact your insurance company.
Then, the insurance company puts you on hold, then transfers you around until they finally tell you that you need to call 1-855-800-8227 Medicare. You just get fed up and you give up. I figure that I'll find out when the bills come in.