I need some answers re: Medicare/Medicaid

[Mighty Favog]

O.K., first off I'm really frustrated!!

 

I have had Type I Diabetes for 27-years (thanks mom and dad). I inject myself 4X per day. I REFUSE to use an insulin pump (why? A neighbor lady of mine had one and it malfunctioned resulting in her death).

Because of the Diabetes (IDDM), neuropathy and occasional glucose drops I am on Social Security Disability for 5-years. I've almost died 3X because of it in the last 6-years, but my girlfriend/wife saved my life each time. I've been on Medicaid for (going on) 5-years now and I am now being forced to go on Medicare (Parts A & B). Part D was not  1.) not financially possible since SS is all I get for an income, and 2.) the plans cost more than the other prescription pills I take. From what I've read on AARP (not a member) a person can have both Medicaid AND Medicare at the same time till they're 65-years old.

 

Medicare will only pay for my insulin and the delivery method IF I get an insulin pump. Where Medicaid paid for everything (vials, syringes, etc.). SO if I refuse to get the insulin pump can I just continue to get the vials and inject myself as I'm doing now? And it gets billed to Medicaid instead of doing it Medicare's way? I'm told in the Medicare hand book I received to today that Medicaid is a secondary payer for what Medicare won't pay.

 

I've tried calling both Medicare and Medicaid but I either get conflicting answers OR just flat out WRONG answers. It seems like both are like the IRS where they are not required to give correct answers. Or should I just blindly trust both organizations NOT to kill me?

 

I need to talk to someone that is not connected to either organization (i.e.- trying to sell me their services)

BTW - I live in Ohio

 

[Jeff Matthews]

I could be wrong, so consider it worth the money you paid me.  

 

If a provider accepts Medicaid, I don't think you can be billed for a copay.  So, the best thing would be to find a provider who accepts Medicaid and ask what they can supply. 

 

It should be that easy.  Good luck!

[Mighty Favog]

1 minute ago, Jeff Matthews said:

I could be wrong, so consider it worth the money you paid me.  

 

If a provider accepts Medicaid, I don't think you can be billed for a copay.  So, the best thing would be to find a provider who accepts Medicaid and ask what they can supply. 

 

It should be that easy.  Good luck!

 

I've been going to the same doctor using Medicaid just fine. And I'm happy with her. The last time I saw her (every 3-months) I asked if she takes Medicare too. The answer was "yes".

[Seadoc]

On 1/3/2023 at 6:47 PM, Mighty Favog said:

Or should I just blindly trust both organizations NOT to kill me?

 

Old Russian proverb "trust but verify".  Do you have any other supplemental coverage like a Medicare select plus (***) plan or access to the VA?  If you look at the formularies of the plans, it should be spelled out what pharmaceuticals are covered and what are not.  My Medicare *** plan costs me nothing and my Drs. are all in network.  Ohio has some good supplemental plans for Medicare you just have to research them to find one that meets your needs (to include your meds and your favorite Drs. AND costs).

[Mighty Favog]

Well, I signed up for one of those Dual plans (United Healthcare taking over for Medicare). So far it looks like they have coverage than just Medicare by itself.  Medicare was telling me the only way they will cover my insulin is if I get and insulin pump. I told them No Way! I had a neighbor friend that was elderly and had a pump. The pump malfunctioned and it put all of it's reservoir into her and killed her.

 

With the United plan, I can do the same regiment as before AND with better insulin. 

[Marvel]

@tommiek  You obviously didn't read the first post. He's had type 1 diabetes for 27 years, has a doctor he likes, understands the drill.

[Mighty Favog]

Here's an update:

 

The lady I spoke to at Medicare was/is completely 100% WRONG. I am not forced to use an insulin pump. And I also have Part D coverage with no cost to me.

 

I still have my same doctor and I now have better quality meds/supplies than before. The next time I see the doctor, I'm going to ask for 90-day supplies/meds. United Healthcare (they took over for Medicare) has given me a 90-day supply of the Lantis insulin I take. I just hope they do the same for the Glargine I take as well.

 

The nice thing about United is that I'm assigned a single person to handle my problems or questions. AND English is her primary spoken language!

 

Fingers crossed, but it looks like it's going to work.

[MassiveG]

I understand your frustration. You should be able to use both Medicaid and Medicare simultaneously until you're 65, with Medicare being your primary insurance and Medicaid picking up the slack for what Medicare won't cover.
Every situation is unique, and the best course might be to seek independent advice to avoid any errors in understanding. Try this health insurance marketplace, I got my own health insurance from them. I found it to be a reliable source where you can compare various health insurance plans, and they might be able to help you with your questions.

Edited September 15, 2023 by MassiveG

[JohnJ]

'caid dropped me when I moved home from Florida.

But it wasn't that bad for me because I didn't need any type of durable goods anymore. I have verified dead wrong answers to things I've asked of them for about four or five years now. Glad The situation got better for you.