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  1. #1

    Default Medicaid Eligibility while Receiving SSDI

    It has been a long time since I have been back on this forum possible a few years I do not recall or remember. Anyways I am on SSDI and have been for maybe two years now. I am a little confused on the insurance part all together. I was getting Tenn Care and Medicare both for almost two years, Recently when it came time to renew Tenn Care dropped my insurance since I am getting SSDI instead of SSI this is how I understand it anyways. I have tried several times to contact social security and medicare and it always seems as though I am unable to speak to a live person on the phone other then some kind of voice recording. I am needing to know what or how much I will be required to pay when I go to my Dr like for a Dr visit. I understand that the card states on it that I have A and B and D which is extra help for med's but this is all that I know.

    The reason I am asking is because Tenn Care failed to notify me prior to dropping my insurance coverage and now I have bills that have been non paid, Tenn Care is pretty pathetic there could not notify me they just let the provider and Dr bills roll in instead to me is how I even knew the insurance had dropped pretty shady there if you ask me. Can someone please help clarify this for me and how it works. I have always been required to pay some on my med's but since Tenn Care dropped me will I now be required to pay a co pay when I see my Dr for a visit also? So if I am hospitalized in the near future will I be required to pay a huge hospital bill that I already cant pay too? I presently have all my med's filled at my local CVS. I presently see my primary Dr every six months for blood work or when I am sick. I presently see a spine and back pain Dr once a month. Thank You

  2. #2
    Join Date
    Feb 2014
    Location
    RTR/WDE
    Posts
    1,724

    Default Re: SSDI Insurance Confusing

    What did the doctors' offices say when you called and asked them your questions? I'm willing to bet their billing clerks would know.

    https://www.medicare.gov/sign-up-cha...are-works.html

  3. #3

    Default Re: SSDI Insurance Confusing

    It is a voice recording and five days later no call back lol

    I have not even received anything from medicare saying what I will pay but I am still going to Dr's its like they don't want you to have any health coverage at all.

  4. #4
    Join Date
    Jun 2014
    Posts
    3,212

    Default Re: SSDI Insurance Confusing

    Have you applied for Medicare Savings Program and Extra Help ? Depending on your income and resources. Medicaid may or may not help with your Medicare expenses. Thid form of Medicaid is not the same as the Medicaid you receive when receiving SSI.

    You have to file an application for Medicare Savings Program and Extra Help. The link below gives more info. If you are approved. You will be reimbursed for what you have paid in some if not all of your Medicare expenses


    https://www.medicare.gov/your-medica...-programs.html

  5. #5

    Default Re: SSDI Insurance Confusing

    When I received Social Security two years ago they gave me medicaid and medicare both. This September medicaid asked me to renew my insurance which we did and mailed the package back to them. Here it is December now and this whole time I thought I still had Tenn Care ( Medicaid ) Come to find out the Tenn Care ( Medicaid ) Dropped the insurance without giving me a notice. So this whole time I have been going to Doctors I have not had insurance except medicare this is all I am aware of. The Medicare card shows Hospital A Medical B and I have a wellness card which is classified as D for my medicine, They say this wellness card is the extra help. If I had the money I would take Tenn Care (Medicaid ) to court over these bills these idiots should of pro rated back to September and paid the bills in the first place since they did not notify me of anything. Yeah I know our system really sucks and is not getting any better, Is what I see anyways.


    That being said if I had known that Tenn Care ( Medicaid ) had dropped the insurance maybe I would of not went to the Doctors in the first place for treatment without knowing the cost it would cost me. I only make $1150 a month this to me in minimum wage and now these bills are hitting me. Medicare has not sent me anything saying that I pay 20% and that they pay 80% of anything, I have heard this from other people but I have not received a letter or notice that I will be required to pay this and to pay that. Our system really has some serious flaws in it as it is obvious. A person going to the Dr and then not knowing what he or she will pay out of pocket is a complete flaw in the system. Insurance being cancelled without notice is also a huge flaw as well. When a Dr tells you about a bill before your insurance does then there is a huge flaw. They need to make laws that penalize both Tenn Care ( Medicaid ) and Medicare when they do there jobs half *** I do not get SSI I get SSDI.

  6. #6
    Join Date
    Jun 2014
    Posts
    3,212

    Default Re: SSDI Insurance Confusing

    You need to contact your Medicare Savings Program and find out the status of your application. It is possible they did not receive it. When did you mail it ?

    If you have Medicare and Medicaid, you have to reapply for Medicare Savings Program and Extra Help every year. The Medicaid that helps with Medicare Expenses is not the same Medicaid as when someone does not have Medicare.

    Those with Extra Help will not pay more than $3.30 for each generic prescription that is covered in 2017. And no more than $8.25 for each brand prescription that is cover in 2017. In 2018 it will be $3.35 for generics and $8.35 for brands.

    Medicaid may or may not cover your premiums, co/pays and deductibles. It will depend on your household income and resources. Income and resource limits for the different categories are at the Medicare Savings Program link below. Are your Medicare premiums being taken out of your monthly benefits ?

    Are you doctors refusing to see you ? It takes time for applications to be processed. If you are approved. You will be reimbursed for money you have spent on the Medicare Expenses Medicaid will cover for you.

    Medicare Savings Program-
    https://www.medicare.gov/your-medica...-programs.html

    Save on drug costs-
    https://www.medicare.gov/your-medica...rug-costs.html

  7. #7

    Default Re: SSDI Insurance Confusing

    I do not have Medicaid anymore they dropped it in September without giving me notice or a letter. What application I have not received a application? I presently only have medicare and only medicare. I do not know if they are taking premiums out or not. I get $1150 presently and have for two years now is my only monthly income. I am not married. No my doctors see me and then they bill me, But when I ask if there is a co pay they say no there isn't lol

  8. #8
    Join Date
    Jun 2014
    Posts
    3,212

    Default Re: SSDI Insurance Confusing

    If you want to know why you no longer receive Medicaid. You will have to call your State Medicaid Office in your county

    To find out how much your monthly Medicare Premiums are. You can create a my social security account at www.ssa.gov. That info will be listed under what is deducted from your monthly SSDI benefits.

  9. #9

    Default Re: SSDI Insurance Confusing

    Quote Quoting Mercy&Grace
    View Post
    If you want to know why you no longer receive Medicaid. You will have to call your State Medicaid Office in your county

    To find out how much your monthly Medicare Premiums are. You can create a my social security account at www.ssa.gov. That info will be listed under what is deducted from your monthly SSDI benefits.
    I forgot what program Medicare said that I had but they did say that Tenn Care does still pay my premium which means they do not take it from my monthly check, Guess they take it from my earnings automatically then. Since I get $1150 a month instead of $1005 Tenn Care dropped my medical. I was told to reply again anyways since I did not receive any paper work prior to any change. Thank You Mercy&Grace for the feedback and information.

  10. #10
    Join Date
    Jun 2014
    Posts
    3,212

    Default Re: SSDI Insurance Confusing

    Medicaid is paying your Medicare Premiums. If Medicaid paid you Medicare Premiums,co/pays and deductibles before. And there have been no changes in income or resources. They are still paying them. Be sure and fill out the applications. Remember, you will have to til out a new application every year

    The Medicaid you receive because you also have Medicare is Not the same Medicaid you had before you had Medicare. The Medicaid you had before you had Medicare paid for all of your medical. Now, Medicaid only helps with your Medicare Expenses.

    I know it is confusing. But, don't give up.

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