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On medicaid but just received medicare

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Old 11-11-2008, 08:01 AM   #1
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On medicaid but just received medicare

I am SO! confused and need someone's advice if possible.
I thought I'd come here first instead of calling my social security office. You know how hard THAT can be just to get a person on the phone.

Here goes......

I am on disability for almost one year now. I am also on Medicaid to help pay for my medical visits and to pay for my prescriptions.
I was told I"d be automatically getting MEDICARE after a 24 month period, automatically.
I see by my mother and father in laws prescription costs that just because you're on medicare, they don't really help pay that much money for RX's.

By me being on MEDICAID, it pays for almost 100% of my prescriptions plus 100% of my copays at my doctors offices.
With MEDICARE, one has to pay a co-pay for office visits, PLUS pay an outrageous fee for medications if you don't have the part D program. I read you have to pay a monthly fee for part D?
why should I get on MEDICARE when I dont' have to pay for a dime by being on MEDICAID?
Is it by law that I have to accept being put on MEDICARE when all I really want to do is to stay on MEDICAID?
Am I allowed to have a choice? or does Medicaid automatically stop once I get put on MEDICARE?

I know this sounds confusing and I"m probably making it sound more complicated, but I'm freaking out here ever since I got my mail last night with a MEDICARE card in my name that I did NOT apply for. No one even sent me letter ahead of time explaining this whole change.

I'm worried sick now that I won't be able to pay for my monthly prescriptions if I dont' qualify for help that MEDICARE offers to assist a person with their prescription bills even though they are on medicare. with the card they sent me, they also stuck in an application for me to fill out for assistance if I qualify for it.

First I was on Medicaid for medical insurance being I was unemployed and very sick. Then I applied for disability last year which I qualified for. I got to automatically keep my medicaid to help pay for my dr. visits, hospitalization and my medication bills. Medicaid makes you pick out an insurance plan from multiple ones. Not just straight medicaid. I like my HIP insurance carriers and dont' want to drop them. Do I have to?

I hope someone has gone through this here or are going through it so you can offer me advice or at least explain this to me.

I sincerely appreciate anyone's help.


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Old 11-11-2008, 04:31 PM   #2
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Re: On medicaid but just received medicare

If any of your disability benefit money comes from SSI, even as little as $1, you may be able to keep the Medicaid. They call it dual eligibility.

Last edited by roses4lace; 11-11-2008 at 04:31 PM.

Old 11-12-2008, 06:28 AM   #3
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Re: On medicaid but just received medicare

I believe if don't receive but a certain amount SSDI then you can receive both Medicare and Medicaid. I think it depends on the monthly amount of SSDI you receive.
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Old 11-12-2008, 09:26 AM   #4
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Re: On medicaid but just received medicare

In my case, medicaid pays the medicare premium, and i have dual coverage. Dont call social security; besides being on hold forever, you'll get rerouted to medicare. Call medicare, and they'll help quicker.**********REMOVED*********
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Last edited by Mod08; 11-13-2008 at 12:10 AM. Reason: please read the posting rules - phones numbers are disallowed.

Old 11-13-2008, 04:38 AM   #5
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Re: On medicaid but just received medicare

Thank you Roses, Rayefaye, and Hiyati for your quick answers.
I took the advice and called a number that was given at a gov. site for medicare and sure enough I got a person right away on the phone and they answered my question asap.
they said that medicare picks up 80% of a medical bill and my HMO/Medicaid picks up the 20% and that it's called a DUAL STATUS.
She said I can continue using my HMO card that Medicaid distributes for my RX's because the $1-$3 I pay for a script would be the same if I used Medicare.

I think I have to pay a monthly fee for having medicare pay for my scripts, right?

with my medicaid/hip I don't have to pay a monthly premium and no copays for my dr's visits.

THATS another thing I forgot to ask do I have to pay a copay when I visit my dr's or dentist with Medicare?

Do any of you have to pay a copay with Medicare?

I'm still confused with all of this new info. I don't like feeling unsettled like this. It only gets me agitated not knowing 100% of how things work for me.

The woman said since i won't be using medicare card for my scripts that there's no need to fill out the application they put in with my medicare card to apply for assistance in paying for my prescription drugs. I know they do help people who have low income or on disability.

Being on disability gives us advantage with certain things.
we are allowed more help. Thank God for this, otherwise I don't know where I'd be.

Thank you all again for your quick replies.


Old 11-13-2008, 06:57 AM   #6
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Re: On Medicaid but just received Medicare

Besides picking up the 20% Medicare co-pay, your Medicaid will also pick up your Medicare/medi-D premiums and carries you through the "donut hole".

The program is called QMB, qualified Medicare beneficiary. I'm pretty sure that if you're on SSI you automatically enrolled.

QMB and two other premium paying programs, SLMB and QI (I'm on SLMB), are explained here: [url][/url]

Whether or not you have to pay the 20% co-pay at the doctors office depends on your doctor - some do not accept Medicaid. I pay 20% at one doctor's office, at another they simply accepted the medicare and waived the remaining fee. There is very limited dental coverage under Medicaid and almost none under Medicare.

Last edited by AuntieLeela; 11-13-2008 at 07:06 AM.

Old 11-13-2008, 09:19 PM   #7
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Re: On medicaid but just received medicare

first, you're welcome! Im honored to help. Second, as far as dental, that varies dentist to dentist. When you call for an appt. and they ask what insurance, they'll tell you at that time whether they accept or not. I have yet to find a dentist to take medicare, but a few in my city take medicaid. Good luck!
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Old 11-25-2008, 08:14 AM   #8
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Re: On medicaid but just received medicare

Thank you again Hiyati and thank you too auntiLeela,

I hear you on the dental coverage Hiyati, because I only had a few choices with my medicaid. I'm so GREATFULL that i have medicaid.

I'm on SSD and don't know if I automatically qualify for QMB? Do I have to fill out an application to see if I qualify for this?
No one has contacted me yet from medicaid.
I even called them last friday and it's now tuesday and he hasn't returned my call. It seems like he's not interested in answering my questions.
I'm hoping they'll send me soemthing in the mail.

I also went onto the gov. site which has SO much information that one can spend an hour in the blink of an eye. I find it so frustrating and nerve wracking.
I found an old letter in their archive section about information when one is on medicade and just got on medicare.
the letter scared the day lights out of me in fear they will cut off my medicaid totally if I don't listen to them.

In the old general letter that they send out to everyone who gets on medicare, it states that if the person does NOT switch over to the medicare prescription plan, the person can lose ALL of their medicaid benefits.
I almost started crying when I saw that.
they have such control over the people and it feels like they're the police ready to make an arrest to an innocent victim who was mistaken for a crime committed.

I think it sounds very good what you mentioned Auntie and I hope to God that I automatically qualify. they don't mention these things to the person which makes me freak out all the more that I am not made aware of this helpful information.

I know I can fill out an application to get some sort of assistance for them to pay my copays and such. I'm almost positive that I'd qualify because i have very little money that comes from my disability and it's the only incoming money i have. I don't work and have no other programs helping me.

It's just a matter of contacting the proper place and having enough patience till I get the literature in the mail that they mentioned i"d be getting in the near future.
so wish me luck ladies, because I REALLY need it!

I'm so scared.

thanks again,


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