Medicare Plus Medicaid Equal A Migraine! (medical, plan, deductible, Virginia)

[claymoore]

My wife and I help out a widow that lives next door to us.
Usually the 'help' is in the form of mowing the grass, taking her shopping, fixing leaky faucets etc. etc.

The lady is turning 65 next month and she is going nuts over medicare!
(Me Too Now!)

I'll try to make this as short and as understandable as possible.
(yeah ... Right)

Last month she received her medicare card from the SS admin. with a bunch of paperwork.

The paperwork informed her that since she had such a low monthly income (doesn't work and gets less than $800.00 a month in SS) that they had sent her income and other 'relevant' information to the state's social services.
(Virginia)
(Something about helping to pay premiums and deductibles)

Well yesterday she gets paperwork from social services that says that they enrolled her in Medicaid for extra help?

Then today she gets a letter from 'The Department of Medical Assistance Services" which says, in part: "Medicaid records indicate that the family members listed below were recently enrolled in the medicaid program ... blah, blah, blah.

They go on to say that her health care services "may" be provided through a Managed Care Org (MCO) and that she has to pick out an MCO that is available in the area and if not .. they will pick one for her?

Well ... All Day I have been on the computer searching for the answer to: Why does the lady have to pick a provider for this MCO when, I'm guessing here .. she will have a provider (or have to pick one under Medicare?)

I know nothing about medicare or medicaid because my wife and I have our own insurance.

All I've accomplished in the last 8 hours searching for answers is to get my neighbor and myself even more confused!

It looks like I'll be eligible for medicare before I get to understanding this mess.

[AZgarden]

Have you been on this page yet?

https://www.medicare.gov/people-like...xtra-help.html

Maybe it will help sort it out and thank you for helping the woman too.

[claymoore]

Originally Posted by PhxBarb

Have you been on this page yet?

https://www.medicare.gov/people-like...xtra-help.html

Maybe it will help sort it out and thank you for helping the woman too.

Thank You Barb.

I'll check the site out but it seems that the more I read about this stuff ... The more my head hurts!

The poor woman doesn't know if she needs to enroll in a provider or whether medicare enrolls her automatically.

She knows that she is getting two cards (medicaid and medicare) but has no idea what to do with them!
This is one time I'd rather be fixing a leaking faucet! Oy Vey
Anytime you have to dig around in government related stuff .. it becomes a horror show!

I feel bad that this time I may be of very little help!

[Qwerty]

You can also check at a local senior center or look in the phone book for a senior ombudsman. They will have resources and contact people with experience navigating this process to help walk you through what needs to be done. These services are free.

I agree, the process is overly complicated and as a result, way too many people get signed up for plans that are not what they need or miss critical deadlines and miss out on care they need. Heck, I have taken many classes on Medicare and without my cheat sheets, I can't keep it straight. I rarely work with Medicare so that is part of it, but usually after my "refresher" courses, my mind is swimming.

For future reference, about 6 months before you are eligible, start researching Medicare brokers in your area. Ask your friends and neighbors if they have used one to get recommendations. Let them do all of the work pricing plans, figuring out what is best for you, helping you with the various deadlines, etc. Their commission is built into the cost of your plan already so there are no additional fees to you and you are paying for their services whether you use them or not, so might as well take advantage of their experience. Just make sure they are good at what they do.

[genesiss23]

For dual eligibles, Medicare is primary. Medicaid is technically paying the premiums. You will have to see if your state's Medicaid requires duals to be in Medicare advantage. If you do absolutely nothing, the state will pick a plan. The auto-enrollment issue comes from being dual eligible.