My apologies for the complexity of this question; research has been fruitless. My brother has traumatic brain injuries (TBI) and has been on Medicaid (New Mexico) for years. His only income is his small SS retirement benefit. He was recently notified that his Medicare enrollment is automatic, effective 06/01/19---the month he turns 65. He lives alone with fragile health that requires prescriptions, home-aide visits, and 3 or 4 hospitalizations per year (followed by short stays in SNF rehabs). Without extra help from Medicaid, his low SS-retirement income will not support Medicare premiums, copays, and other out-of-pocket expenses.
(1) Since he is a current Medicaid recipient, will the system automatically recognize him as dually-eligible for Medicare/Medicaid? (If not, what should he do now to ensure coverage?)
(2) How does dual eligibility affect his decisions about Advantage plans, medi-gap coverage, Part D, etc.?
(3) Who can help us with this?
Thank you!
2 Answers
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My brother has a Care Coordinator through the managed-care org. that provides his medical services. I will call her ASAP. I also submitted the question to a NM Medicaid Service Rep on the NM Medicaid Portal website. Perhaps one or both of them can tell us the next step.
There is some good information here as well:
https://www.aarpmedicareplans.com/medicare-education/medicare-medicaid-dual-eligibility.html
His Medicaid services are delivered by a managed-care organization (Presbyterian Health Care). He has a Care Coordinator through this organization. I will call her Monday. I also submitted the question to a NM Medicaid Service Rep on the NM Medicaid Portal website. Perhaps one or both of them can tell us the next step.
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