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Old 10-22-2011, 07:06 AM   #1
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Question I have a question about Medicade/Medicare

My friend has a brother who is on disability and Medicade and Medicare. Unfortunately he has cancer but holding his own so far.
However he has had a few hospital visits and he keeps saying his bills are huge and he can not aford it.
I thought when you had Medicade that they took over most payments of this kind. Also his RX's are high. His sister is sending him thousands of dollars to help him pay these bills and putting herself in a slim spot if she gets ill.

Iworry for her but she says she can't say no. Of course she doesn't want him to have the worry of paying all this when his income is small. I understand that just thought he wouldn't have such high bills with all the help he has.
Can someone help me with this? Thanks...

 
Old 10-22-2011, 08:59 AM   #2
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Re: I have a question about Medicade/Medicare

More things should be paid for I imagine if you have both medicare and medicaid than just basic medicare alone. I don't know that much about medicaid but I have heard Mscat and others say medicaid really is not that great. Unfortunately, if you are really sick critically that requires a lengthy hospital stay, most people on disability income are going to leave with a hefty bill after the insurance pays what it is going to pay.

Just basic Medicare unfortunately will leave you with a certain percentage (co-insurance) + co-pay and you often have to meet a deductible too before it will even pay anything. For example in my case if I am admitted into the hospital for inpatient care, for each benefit period, here is what I will pay.
Quote:
Days 1 - 60: an initial deductible of $1,132
Days 61 - 90: $283 each day
Days 91 - 150: $566 each day
150 days: All costs
Many people sadly probably can't even pay the deductible $1132 for the 1st 1-60 days of stay. I imagine a lot of these things simply have to be written off by the hospital if you can't pay what medicare doesn't.

I really think you must try and stay as healthy as you can. This is the best way to keep medical costs as low as possible. I know things like cancer happen to people that take good care of themselves but more often than not, there is a bad lifestyle component like smoking or many years of eating too many foods that are not good for you. Currently, I only have a mental health problem, minor gerd, and some minor low back pain. I am doing things like seeing my doctor every 3 months so I can potentially head of any other problems before they have a chance to develop and if they do, try and catch them early. I am also doing this with my mental health now and also my dental health even if I might have a pay a little more out of pocket for prevention. I think this will save me in the future, perhaps not but I am just trying to increase the odds in my favor. I have a friend who is still working full-time, has a terrific job and great private insurance yet he is about to go bankrupt because of some chronic medical issues. It just adds up after awhile despite the best medical insurance.

 
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Old 10-22-2011, 11:11 AM   #3
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Re: I have a question about Medicade/Medicare

He needs to talk to a social worker.

If he has medicare and medicaid his care should be pretty much paid for. In Iowa there is a copay of $3 for drs visits and medications. ER is covered 100%.

Medicaid is great insurance coverage, there are few things that cost.

People dislike medicaid because many drs won't accept it for payment and they may have to travel far. Drs also dislike it because you need to get prior approval for about everything.

If you have a serious illness medicaid is awesome. If you want plstic surgery-not so much.

I think your friends brother is taking money to spend on other things.

Pup

"A provider that chooses to participate in the Medicaid program must accept the payments that Medicaid makes and make no additional charges to the recipient for services covered under the program. However, some services covered by Medicaid do require a small co-payment be paid"

Last edited by pupcake; 10-22-2011 at 11:19 AM. Reason: added quote

 
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Old 10-22-2011, 11:11 AM   #4
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Re: I have a question about Medicade/Medicare

Thank Blueskies,
I know I am Medicare now and things are costly. I just wasn't sure about the Medicade and such huge expenses for him.
Your good to take care and do preventive as much as you can.
I suppose the dentist is the most expensieve and yet it the one we all have to pay attention to because not taking care of our mouth can lead to many problems. I am currently struggling to have the deep cleaning done on me and it is very expensieve. I hope you stay healthy and again thank you for your words. I just hate to see her being taken advantage of but maybe they don't pay so much?? I told her to ask him to send her the bills this way she would know for sure, but she seems hesitant on that. I thought this would be a good place to ask. Thanks again!

 
Old 10-22-2011, 11:25 AM   #5
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Re: I have a question about Medicade/Medicare

Copays in MO

Co-payments will apply to the following hospital and physician related services:
$10.00 Inpatient Hospital Services
$ 3.00 Outpatient or Emergency Room Services
$ 1.00 Physician Services
$ .50 Clinic Services
$ 1.00 X-ray and Laboratory Services
$ 1.00 Nurse Practitioner Services
$ .50 CRNA Services
$ 2.00 Rural Health Clinic Services
$ 1.00 Case Management Services
$ 2.00 Federally Qualified Health Care Services
$ 2.00 Psychology Services

That's the copays if they only have medicaid, if they are dual covered they may noat have any.

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Old 10-22-2011, 11:48 AM   #6
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Re: I have a question about Medicade/Medicare

sunshine12, My brother in law is on medicaid in Texas he pays nonthing for DR's visits and had a heart procudure done and didn't have to pay for it and it was at a great hospital where I have been going to a hospital for low income people but I was shocked that he didn't have to pay anything but sadly in mine and my husband case we are going to have medicare and have to pay deductables but I am happy things could be a lot worse for us and I know it. We both are going to pay the medicare preuims and co-pays his begins in NOv and mine begin in Feb. so its a total of 280.00 out of both our ssdi checks but hey at least we are approved and have ssdi comming in each month its just we both worked so hard and my brother in law barely work if any in this 58 years of life. Yet he has medicaid and not paying any preuim are co-pay and nonthing for his bills. While I'm very glad he is taken care of seems like something is wrong with this picture.

 
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Old 10-22-2011, 01:21 PM   #7
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Re: I have a question about Medicade/Medicare

Medi caid vary's from each state. I am in Ca and have Medi Cal , and also Medi Care. I have been in the Critical Care unit in the Burn Unit before, and after that a year later I would be getting a Medicare Summary , I saw the huge bill and everything, So What MediCare did not pay Med Ical did. Medi Care is the most expensive , so it was good Med ical picked up the rest. I have Co-pays for Medicare Perscription and not on Med Cal. I don't have to pay a medicare premium.
Dental is not covered by any of these programs as of now, Medi cal Use to have coverage then stopped. People under 21 have Dental but thats it.

 
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