[Forum_Newbie]

Hi!

New to FL and mom currently has Medicare and Blue Cross. The later of which I have been paying for and can no longer afford. She is 90 and lives on SS income. The Blue Cross bill is 187/month.

But with that Blue Cross, she has never seen a bill and received phenomenal care - both hips replaced, two falls - one of which tore her rotator cuff and she was in the hospital for a week and rehab for 3 weeks.

I just don't understand how all this stuff works. I have her qualified for Medicaid, just terrified to let go of that Blue Cross policy.

Any advice would be so very, very welcome.

Thank you.

[expatCA]

Originally Posted by Forum_Newbie

Hi!

New to FL and mom currently has Medicare and Blue Cross. The later of which I have been paying for and can no longer afford. She is 90 and lives on SS income. The Blue Cross bill is 187/month.

But with that Blue Cross, she has never seen a bill and received phenomenal care - both hips replaced, two falls - one of which tore her rotator cuff and she was in the hospital for a week and rehab for 3 weeks.

I just don't understand how all this stuff works. I have her qualified for Medicaid, just terrified to let go of that Blue Cross policy.

Any advice would be so very, very welcome.

Thank you.

If she only has medicare she will pay a portion of every visit, treatment etc not to mention prescriptions.

If she has a plan "F" don't let it go. It is Gold and no longer available. Anyone who has it can keep it but no new ones allowed.

[remco67]

My understanding is if she has both Medicare and Medicaid , Medicaid will cover her copays but all Doctors don't take Medicaid in which case she would have to pay copays to some Doctors if she wishes to see a particularly Doctor

[expatCA]

Originally Posted by remco67

My understanding is if she has both Medicare and Medicaid , Medicaid will cover her copays but all Doctors don't take Medicaid in which case she would have to pay copays to some Doctors if she wishes to see a particularly Doctor

Try https://www.medicaremadeclear.com/ba...re-vs-medicaid

[LifeIsGood01]

Originally Posted by remco67

My understanding is if she has both Medicare and Medicaid , Medicaid will cover her copays but all Doctors don't take Medicaid in which case she would have to pay copays to some Doctors if she wishes to see a particularly Doctor

I know someone on Medicare and Medicaid and all of their medical bills are covered as well as their medicine. They have to pay a few small copays at the start of the year with the meds but it's only like $10 for name brand and $5 for generic. I think it may be until their medication costs reach a certain point. But that's just because of the plan they are in, I guess they could change and choose a different plan, they have regular Medicare though but it's managed thru a plan for the meds part. If you do choose a Medicare type HMO then your doctor selection may be limited.

All lab work is covered too. I have been told that any doctor affiliated with a hospital or hospital heath system will accept medicaid, which is really for any copays if you have both.. Just about every doctor will accept Medicare. I've heard they don't like to accept just Medicaid because it pays too low that's why some doctors opt out if they can.

Also since Medicare if for the poor she can't have more than about $3 K in her savings or checking accounts, something like that if she's disabled and like $2K if she's not and then she may also qualify for food stamps.

[Bert_from_back_East]

"Dual-eligibles" (i.e., those with Medicare as their primary insurance carrier and Medicaid as their secondary insurance carrier) are responsible for zero cost sharing at all times, regardless of the state in which you reside. Therefore, you should never be billed by a provider, except under one of the following circumstances:

--You execute a "no-show" policy at your provider's office and assume financial responsibility for any unexcused missed appointments. Most provider offices have a set fee for unexcused missed appointments, typically ranging between $10-35 per visit.

--You request print or electronic copies of your medical records for your own purposes. The provider's office will likely charge you anywhere from $25-50 dollars to cover the administrative costs of printing and binding your medical records.

--You ask your provider to complete disability-related paperwork on your behalf. This fee can be in excess of $100 per request, depending on provider location and specialty, because this type of paperwork takes a long time to complete.

Please note it is illegal to bill or balance-bill Medicaid patients for care services in all 50 U.S. states, regardless of whether that patient is primary or secondary with Medicaid.

If you ever receive a bill from a provider as a Medicaid recipient following the denial of your medical claim by insurance, then you must immediately contact the Member Services Department at your health plan and file an appeal or grievance. By the time you receive a statement in the mail, your account at the provider's billing office may already be on the second or third statement cycle and, at this point, your account is in danger of being sent to collections. Typically, providers will only send 3-4 statements to patients before turning an account over to collections, and sometimes, there are mailing issues that create further delays in you receiving the first statement in the mail.

If you qualify for secondary Medicaid coverage, it implies that your annual household income (AHI) is at or below 100% of the federal poverty level (FPL) for your state of residence. Since Florida did not expand Medicaid, your estimated AHI must be below $12,060 in 2018 for you to qualify for Medicaid coverage. For states that expanded Medicaid, such as Arizona and California, for example, single individuals qualify for Medicaid if their estimated AHI is at 138% of the FPL.

Contact your County Eligibility Worker or visit healthcare.gov for additional information on enrolling in Medicaid coverage.