Medicare Mystery...

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I've been trying to contact social security to no avail and the guy at the Medicare number didn't help much... Anyway I've been getting SSI for years and have been on Medicaid. I get a couple of mysterious letters in the mail today that freak me out... One says "your Medicare (not Medicaid) starts Nov. 2012" and the other is about applying to reduce perscription costs... I'm confused and concerned. First right now I don't have medical costs, are they trying to take away my Medicaid? Second I checked, to get Medicare younger than 65, you have to be on SSDI. I don't get that at all. Anyway I called the Medicare number and they insisted I've been getting Medicare since 2012! They told me to call the main Social security line but I can't get through right now.

I am seriously worried about what they are trying to do! My bipolar meds and treatments are very expensive!

Try to calm yourself and don't get worried, because that will only make you suffer.

There may be a limited amount you can get done over the phone. Sometimes, a trip to the Social Security office for a face to face meeting is better. Request an appointment, that's better than dropping in.

If you had a disability before age 18 you get put in a different category and get more money. This is one reason to consider an official autism diagnosis. Autism by its very nature is present from childhood. Troubles in school or with peers, or other traits such as toe walking, hand flapping, meltdowns, can support the diagnosis retroactively. But as you no doubt are aware, this all takes quite a bit of time, and you can't expect it to take care of your immediate situation.

Please re-assure yourself that if your meds become affected, there may be avenues where you can get financial assistance. But the primary thing right now is not to let yourself stress about this issue.

They claimed i qualified for Medicare because I had enough work credits even though I don't qualify for extra cash beyond my SSI. Anyway all I can do is apply for extra help from the state but it looks like I'm going to have to pay out of pocket some stuff. But it says on the web ssi people don't qualify for Medicare until 65 so I still think something is wrong somewhere.

Medicare is a separate program than Medicaid. Some people receive both. Medicare will cover some expenses while Medicaid covers others.

It is hard to interpret what these letters are telling you over the internet. Medicare tends to send out a lot of letters. It may be telling you that you have enough credited work quarter that as of November 2012, you qualify for Medicare once you meet the age eligibility.

Since the Medicare office said you have been receiving Medicare benefits since 2012, perhaps Medicare is currently picking up some of your drug prescription costs. If that is the case, you should be receiving a quarterly report from Medicare that summarizes your prescription benefits that you received each quarter. [This report will read "Medicare Summary Notice" along the top.]

Anyways to clarify, it might be important to visit the nearest Social Security Office and talk to them yourself. This is no longer an easy task. Generally you cannot just walk into the office and ask a question. I had to make a reservation weeks ahead of time over the internet. They may request that you bring in some paperwork. Then I showed up at the office and pulled out a number from a machine to check in. Then I waited for an hour. Then they called me in and I had a face to face meeting. All the people you want to talk to are walled off and there is a guard in place to prevent you from seeing them unless you have an appointment.

Before you go to that much trouble, you might take the letters to someone currently receiving Medicare and see if the two of you can figure it out. Or make a few more phone calls to your Social Security Office.

No - this would be too misleading. The two people's situations (yours and whoever you talk to) could be completely different.

I did go to the social security office. The first person I talked to tried to insist I must be mistaken, I must get SSDI and thought it was SSI. I demanded to talk to someone else. That person said it had to do with my work credits ( I was told when I first got benefits I was only one work credit from getting SSDI instead of SSI). Then the lady told me according to my case I was supposed to be receiving Medicare since 2012. Anyway I've gone to having my prescriptions completely covered to now they will not be and I have no idea how high the copays will be. The letter says my premiums are covered at least.

One of my prescriptions has a Medicare copay minimum of at least 75 dollars! How do they expect me to pay that when I was getting them for free?

Most people on Medicare buy a "drug supplement" or a Part D premium. I think that's what you would need to do.

But some people - I think - though I could be wrong - get BOTH Medicaid and Medicare.

Contact your local social services agency (usually a county or state agency, that administers SSI, Medicaid, etc.) and ask them.

If you get both, you have to pay the Medicare prescription copays. I tried calling someone again and they keep telling me over the phone I have to accept it!

My ex has SSDI. He gets both Medicare and Medicaid. The Medicaid covers his prescription copays which are extremely expensive, so he doesn’t pay anything out of pocket. Coverage might vary depending on the state you’re in.

I’m a little confused about your situation as well. It was my understanding that people on SSI were covered by MA only.

I asked my local pharmacy about this and they said "we will counsel you if you cannot afford your medicine anymore." Why should I have to deal with this when up until now my medicine was completely free??? I even posted this on a legal advice forum and they are just treating me like I'm stupid...

I had a meltdown over this issue that made me want to go to the er but I can't afford to end up in the psych ward again or my husband will miss his appointments like last time...

I've been told wrong or conflicting information by some of these organizations as well and have been told issues have been rectified only to later discover they have not. On some occasions I have been lead on a wild goose chase, directed to no less than 7 different phone numbers and have been on hold for hours trying to get them to fix or properly address these issues. The Ombudsman was of no help and the case workers run in to the same problems I do.

I found out Michigan has this wonderful intergrated health program for duel eligables that covers meds... Except it only applies in certain counties! If I literally lived only two miles south of my present location I would be covered under this program but no... Grrrrrr.....

The local AmeriCorps position I applied to is in this covered County, I mean, am I going to have to move a little south of here to get medication coverage? That's rediculous!

You may want to speak to an attorney versed in SSA and Medicare/Medicaid law.

For example, I’m covered by both Medicare and Medicaid. However, in PA, the only thing Medicaid will pay is my Medicare Part B premium.

The dual Medicare/Medicaid policies are usually SNP policies. They are normally used to cover people that considered to be catastrophic coverage (usually severe metabolic (diabetes), cardiopulmonary and neurological disabilities. With this program type, you end up joining an HMO, and all care is determined by the HMO. If your preferred primary physician is not a member of that HMO, you’re SOL. I much prefer a PPO, where you can get services from whomever you want, provided they will take that insurance carrier.

As for Medicare Part D, since you are already receiving Medicaid in addition to Medicare, you might want to inquire about Medicare’s Extra Help program, where you pay $3.35 for generic prescriptions, and $8.50 for name brand. It is usually offer once you become eligible for Medicare, and you are still being covered by Medicaid. Check with SSA for the application and income limits.

Oh, I'm sorry you had this meltdown. If you go back to near the top of this thread, you'll see I advised you to try not to worry or it would just punish you. I know these damn administrative mix-ups can really stress a person.

One time when I was very pregnant I showed up for my pre-natal appointment and had high blood pressure. My doctor was puzzled and asked what was going on in my life. I said I had just been on the phone for two hours with Blue Cross Blue Shield, getting a run-around. She sympathized and said she fully understood how that can screw up a person's body.