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Old 12-19-2008, 12:25 AM   #1
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hugg724 HB User
Question Medicaid/Medicare dual eligibility and Prescriptions

I am really confused about something and hope someone can help clarify this for me.

I was just approved for Medicaid via my SSI application that was submitted with my SSDI claim (which was approved in October). Medicare will be primary with Medicaid secondary.

Today I received a letter. It states, "You now have Medicare to pay for your prescription drugs. So, starting January 17, 2009: Tenncare Medicaid will STOP paying for your prescription drugs. You'll have NO prescription drug coverage through Tenncare Medicaid."

Medicare doesn't have a prescription drug benefit which is why we have to get a Part D supplement. What the heck are they talking about? Is there some type of program with Medicare for those who are disabled with dual eligibility?

I am trying to determine if I need to get a Part D supplement or if there is something in all this that covers my prescriptions. This is all so confusing to me.

Thanks for any help you can offer!!

 
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Old 12-27-2008, 09:33 PM   #2
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Re: Medicaid/Medicare dual eligibility and Prescriptions

Hello,
I receive social security disability from my father's record due to being born with cerebral palsy. I just became eligible for medicare on 11/1/08. Previously, medicaid Michigan covered my prescriptions, but no longer does, because I have a medicare D plan. You need to sign up for one, or (from reading your post) it is my understanding that you will no longer have drug coverage. When I signed up for my drug plan, I talked with a medicare representative, who asked me my current medications, and then told me the plan that was best for me. (Some plans cover drugs that others don't, and vice versa.) When you tell the rep your meds, it is important to remember to include the as needed drugs (if any) or you may run into problems getting those covered when the need arises. I am new to medicare myself, and it is all very confusing, so don't worry. I had/have to learn as I go along. I hope I was able to answer at least a few of your questions. Take care.

Kelly
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*~*Kelly*~*

 
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Old 12-28-2008, 01:07 AM   #3
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Re: Medicaid/Medicare dual eligibility and Prescriptions

Thank you Kelly! I will find a Medicare Part D. I am not sure I will ever completely understand how medicare works. I am sure I am going to learn the hard way lol

Hope you have a happy new year!

 
Old 12-29-2008, 09:10 PM   #4
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Re: Medicaid/Medicare dual eligibility and Prescriptions

YES, it is very confusing! I also have both Medi-cal and medicare , i n Ca. it is called Med-Cal. It has to do with your income. WHat you are eligibe for. It sound slke you are eligible mainly for medicare which is very good too.
My prescription drug plan was picked for me, and I do not have to pay anything. Medicare did it for me, so it maded things easy. You can call medicare and see what your choices are, or to see if they picked for you. That iswhat i would do. Also, if they pick for you, you should recieve a perscription drug card in the mail.

 
Old 12-30-2008, 01:55 AM   #5
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Re: Medicaid/Medicare dual eligibility and Prescriptions

I received a letter today from the Department of Health & Human Services. Because I have Medicare and Medicaid, they enrolled me in a prescription drug plan. There is no premium, no deductible....my copay is $1.10 for generic or $3.20 for brand name.

All it states is that as long as I am eligible for Medicaid, this will be my prescription plan. I will always be eligible for Medicaid because of the pass along amendment here in TN.

I am relieved to have this part taken care of. After the huge stack of medical bills I still have to pay, it will be comforting to know that I don't have to worry about any more bills and can get my prescriptions!

Thanks for the info mscat, I was ready to do that until I checked the mail today lol

Last edited by hugg724; 12-30-2008 at 01:57 AM.

 
Old 12-31-2008, 01:18 PM   #6
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Re: Medicaid/Medicare dual eligibility and Prescriptions

I am glad it all worked out for you You have a low co-pay! That is very nice. I believe medicare will take care of your medical bills too. But, I do not know how far back. Possibly when u were eligible. Medicaid should pick up the rest.
I have no co pay for now, on the perscriptions, but, i think i will in 09. Best wishes to u.

 
Old 01-06-2009, 09:08 PM   #7
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chicubs HB User
Re: Medicaid/Medicare dual eligibility and Prescriptions

I live in Wisconsin and my understanding is; If you are approved for SSI you receive Medicaid and your prescriptions are paid for. Now if you are approved for SSDI and have Medicare, then you need to find a prescription plan (Supplemental D). I have SSDI and I pay $96 a month for the Medicare and I pay $35 a month for my prescription plan. You are so right though, this is very confusing. There were so many companies and plans to choose from. It was difficult to choose the right one that would work for me. I actually went and asked my pharmacy what they thought would be the best for me. They looked all my medications, printed out all the different options and companies. They told me that it would be my decision of course but, they did put in their two cents on which ones they have had experience with and which of those companies may have the best plan for my situation.
I appreciated their help. They cleared some things up for me. But I was thinking, I am only 49 years old. How in the world do these elderly people that have to deal with this do it? It just seems to me that they could come up with some other way that would be easier and less confusing. Does there really need to be so many companies and so many different plans? Why can't Social Security have drug plans for people that have SSDI? Because if the people that have SSI do not choose their prescription plan and company couldn't something for the people with SSDI have something like they do? How does Social Security know which plan is best for the SSI people? Why couldn't they do that for the SSDI people?
Or do people that have SSI choose their own prescription company? Perhaps I am wrong about people that have SSI. Perhaps they do choose their own plans and then Social Security just pays for whatever plan they would choose? I'm sure someone will be able to straighten me out on this. And I thank you if someone would help me get my facts straight. I guess that's the only way I learn the facts is if someone lets me know the correct information. I hate going around be wrong
Chris

 
Old 01-07-2009, 04:08 PM   #8
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Re: Medicaid/Medicare dual eligibility and Prescriptions

People who qualify for SSI automatically recieve Medicad. In CAlifornia it is called medi cal. People who qualify for SSDI have to wait for 2 years in able to qualify for Medicare insurance. Depending on the individuals income , their is a Co-pay. I am on SSDI, and had already waited long enough to qualify for Medicare insurance. My Perscription drug plan was picled for me, and i do not have a big co pay. Some people, however do each month .

 
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