Medicaid/Medicare/Extra Help/Early termination of policy
 

This is really odd. I just found out that my state is paying part for my monthly Medicare health insurance premium as part of full Medicaid and Extra Help, doing this since April this year.

I had received a notice in March that I was denied full Medicaid and Extra Help, because my monthly income exceeded the allowable limits.

So, I called Medicare yesterday. Medicare said I had full Medicaid benefits and Extra Help.

Called Social Security Administration. SS said I had no Medicaid benefits nor Extra Help.

Called State Medicaid office and they said I never qualified for Medicaid or Extra Help. I told them that they were paying my monthly premiums, they said they had no record of doing this.

Called my medicare advantage health plan and they said that Medicare was paying my health insurance premium since April, 2019

Called my case worker for the state and she looked into my file and said my case was never completed, there were alot of clerical errors done and she was going to have to re-evaluate everything to figure out what is going wrong. She will call me back later on this afternoon.

Originally I wanted out of my Medicare Advantage plan because most providers and hospitals have dropped this plan and my psych doc wanted me to go into Partial Hospital for stabilization and medication change, which I was not allowed as all the hospitals in my area have dropped this particular contract.

I called Medicare to see if I qualified for a special election plan to get out of this plan. They instructed me to call my Medicare Advantage plan to get permission to get out. My Medicare Advantage plan wrote me back and told me I did not qualify for the Special Election plan and yet this plan knew I had benefits from Medicaid and Extra Help. As long as I have Extra Help, I qualify to get out of the plan thru a Special Election Process.

Now, if it comes down to the fact that the state withdraws it's monthly contribution because I do not qualify for Medicaid or Extra Help, after their re-evaluation, then I will still get the Special Election Plan because I was forced out of Extra Help. Then I can go forward with getting out of this Medicare Advantage Plan and take out a Supplemental Plan + Part D and get into Partial Hospitalization in August. I have already applied for the Supplemental Plan anyway just to get the ball rolling for August.

The remaining part that is out of my control is that I now have to go thru medical underwriting, with the new supplemental plan. If they find I have 2 or more medical issues, they will increase my monthly premium 3X which I could never afford. If that happens, I will have two choices... one to stay with my current deficient Medicare Advantage plan or go straight Medicare + Part D and pay the out of pocket 20%.

Sigh.................... I should know something this afternoon. What a can or worms.

Blue

i am so sorry what a mess.

I heard from the state case worker. She went in and re-certified me. She will mail me the letter.

She told me that I am now eligible for partial Medicaid called The Spend Down Program. I have to pay out of pocket $6,000.00 for medical care, send in the receipts to her and I will be eligible for Full Medicare for two months and then it begins all over again. I laughed, sure, no problem, lol. I only have $5.00 in my savings account.

Then I asked her if this means that Extra Help will go away and she said she doesn't know. I asked her who is paying for my medicare advantage plan premiums, per Medicare, she does not know. According to Medicare, the state is, but she said nope.

So, what I will do is to serve Medicaid, Medicare, Social Security and my case worker with a certified letter notifying them what has been happening, I want to document that I notified all parties. If nothing happens and some agency continues to pay my health insurance premiums, that's on them. I am walking away. It is a mess, but I tried to straighten it out.

So, waiting now to hear from the Supplemental Plan if I am approved or not and will go forward with them, get rid of the Medicare Advantage Plan and that should end whomever is paying, fingers crossed. There is nothing else I can do.

Shrugging my shoulders at this point, shaking my head:mad:.

Blue

What a mess. I'm sorry that you are going through this. BF:hug::hug::hug:

Re-called all the agencies and no one can give me the correct information.

Going to leave it alone, as long as Medicare says I qualify for Extra Help and I got a written letter today from my health insurance plan verifying this, then just going to go forward. At least I have it in writing from someone.

I did my best.

Blue

that sounds really good.
bobby

Thank you Bobby ~

Blue

A case manager should have all of this information down in writing and cleared up.

I'm glad that you have it in writing. BF:hug::hug::hug:

Hi Brokenfriend ~ Stranger than fiction, lol. Got a check deposited in my bank account for all the out of pocket prescriptions I paid from Social Security from April until now. As of April 2019 I have partial Medicaid and Extra Help.

Called Social Security and was told that yes, I have Extra Help dated back to April 4, 2019 and a letter will be coming out to me July 31st explaining all this. I told Social Security about my denial letter dated March 9th denying me Extra Help and they could not find a copy of that letter. It was definitely from Social Security, it had all those crazy stamps on the top and up the side. When I called my state case worker, she told me yesterday she knows nothing about Extra Help that I have to call Social Security, which I did yesterday and Social Security said yesterday that I don't have Extra Help, now I do.

Stranger than fiction.

Blue

Blue

When you get that letter make sure you keep this copy
put up were you can get it when you need it.

Both my boys get the extra help in prescriptions too.

And Derrick got a check back because they messed up and
were over charging him by mistake at the pharmacy. And we
had no clue. But it was still something he could afford so we
just paid it.

Imagine the surprise when that check arrived with no explanation
till it came.

Donna :hug::grouphug:

Hi Donna ~ Yeup, just sent away for folders to update all this information in, so I don't loose it. I know about the surprises too, however, I have heard that if Social Security makes a mistake in their favor, they will deduct that amount from your very next check, which is a bummer.

Just got approved for my Supplemental Plan. It starts August 1st and with Extra Help, they will help pay for the monthly everything, except Part B for Medicare.

Passed Medical Underwriting, yay !!

Next to add Part D and Dental/Vison and I'll be all set. It's about time for some good news.

Blue

that is great
bobby

Yes, very good news.
donna

That is wonderful!!! BF:hug::hug::hug:

The insurance agent that put in my application put the date for September, instead of August. Trying to correct that today, should know something on Monday.

I need to get into Partial Hospitalization, I really need stabilization and to get away from this place, a break from everyone who lives here. I need to start the process of mental health care as my mood is soo wonky and unpredictable.

Found out that I got 100% acceptance for this plan which means I can afford it. The plan didn't triple my monthly premium. And Extra Help will help pay for Plan D so that will be a financial relief. That was one good thing that came out of today.

I just texted my new psych doc to inform him about my insurance changes, I hope he takes my plan as I am settling in with him and like him.

It's been alot to deal with last two months, I really need to go inpatient soon for help.

Blue

I soo dislike finding out issues that cannot be corrected and have to wait over the weekend......................

My insurance agent and myself agreed that my plan would start on August 1st and yet he made a mistake and put down September 1st.

Sigh................... leaving things upside down over a period of time is, very difficult. Especially since I was depending upon going Partial Hospitalization next week. If I have to wait until September, then my paratransit will be battling with the school buses which will delay getting there and back again. Trying to keep issues at bay to keep calm.

Blue

Blue

I hope you can get it resolved soon. It sounds like it was
his fault so you should be okay.

Donna :hug::grouphug:

Are you okay Blue? Have a peaceful evening. BF:hug::hug::hug:

are you okay? Are you finally sleeping?
fondly
bobby

Hi Bobby ~ I am okay, thank you for asking. Saw my psych doc yesterday and he upped my medication so I can finally sleep. Thank you for checking in.

Blue

Hi Friend ~ Thank you for thinking of me and inquiring.

My psych doc upped my medications to help me sleep and for more mood control. I can now sleep more than 1-3 hours per day which was causing me to become Hypomanic. Now back to my regular sleep schedule.

How are you doing?

Blue

Hi Donna ~ Yes, everything is corrected now. Had to call all my plans to correct insurance agents mistakes (the agent that send in my applications). So, all my policies are effective this month, thankfully. Thank you for asking, Donna *smiles*.

My Part D will come into effect as soon as Medicare approves it. I applied but it takes several weeks to go thru Medicare. Once Part D is approved then that new Part D Plan will dis-enroll me from my former Medicare plan.

Then I had to request a Coordination of Benefits and that takes a month to get that started. That means that after Medicare pays for a claim, it is automatically sent to my Supplemental Plan. Now, a provider will have to submit twice, one to Medicare and one to my Supplemental Plan.

There should be a class to take to understand all these Medicare policies and procedures for each plan. LOL.

Blue

ooops, I don't know why my computer sometimes does this.
but I'm glad your sleeping.

I agree, that there should be a class for all the things that medicare
makes you do to get through the loops.

Donna :hug::grouphug:

Thank you Donna for your response ~ What a difference sleeping more than 1 to 3 hours a night makes. I feel soo much better !! Mood is better too today.

Have been reading thru the Medicare Handbook to get a greater understanding about some things. And yet, when I call Medicare for clarification I get confusing responses.

Interesting point to share about my cat. When I am struggling with mood and can't sleep, it affects my cat too. When I am restless and agitated, so is he. He does have a grumpy expression with his face at these times. When my mood is better, he has what I call "happy eyes", lol, but it's true. This morning, he actually sat beside me on the floor and purred and looked at me with happy eyes. He's now my mood monitor too, lol.

Have you found this with your dogs, that they can sense changes in mood?

Blue

I'd say yes, at least Derrick's dog Doby for sure.

And I'd say Nipper the oldest does.

Now my dog Jake, he is a funny dog. I think he has anxiety issues
of his own. And its really hard for him to do more than notice if
I am missing from a room, and try to find me. But I can get a real
laugh if I come out of the bathroom, and he is going from room, to
room, trying to figure out were I went and because he doesn't
see as well. Can't figure out were I'm at. Just sometimes walks by
me.

Donna :hug::grouphug:

Oh that is soo cute about Jake, I got a chuckle out of your comments. Have you tried the Thundershirt with Jake for his anxieties?

Sam goes from room to room with me too. When I am in the kitchen and cooking he will lay down right behind my feet and so now I have to look down before I move.

Today, my groceries were delivered, so Sam had to lay right in front of the refrigerator.

Blue

I'm hanging in there. I saw a government house where I may be living soon. There is not much room for anything to be brought from here. I hope that my niece will store the stuff that I have. BF:hug::hug::hug:

Hello Friend ~ Good to hear from you *smiles*. I live in a Section 8 home and my square footage is 480. Had to give up most of my possessions to move in here, so I understand what you might be facing. Eventually, I got used to the square footage, now it's just another home, but the rent is reasonable, so I will stay here for awhile.

Hoping your niece can store your possessions for you.

Thank you for all the hugs !!

Blue :hug::hug::hug:

Update on insurance:

I am all set. Now have the Supplement in place, Part D was approved by Medicare yesterday, Extra Help is all set and Dental/Vision/Hearing is in place.

So, I am all set, however..................

It seems no therapists in my area take Medicare plans :( :( :(

I have done an exhaustive search and where they are all listed on the Medicare website and Psychology today and just doing a general research, the replies coming back is "nope" or no returned phone calls at all.

Don't want to go to community mental health as they choose who you get. I would prefer to select a specialized therapist tied in with a certain background. Most of the general therapists at this mental health clinic do not know what I am looking for. It seems there is no point in even trying the community mental health system at this point, as I think it would be a big waste of time and triggering for me as well not to mention the time getting there and back again which can also be very triggering.

I have written to my state federal senator for help with this, but not holding out hope there.

Blue

that is so great except for the therapist problem.
fondly
bobby

Thank you Bobby *smiles*

Blue

Good news !!! I have an appointment with a new therapist and she has all the qualifications I am looking for. She called me last night and I think it's going to be a good fit.

She is 20 miles from home and will have to arrange for a paratransit to take me and bring me home which will add 2 hours of traveling time each way and then I get dropped off one hour before my appointment. She has a nice waiting room, so I will bring my Kindle and read.

Coincidentally I got a book from Amazon called DBT for BiPolar. We will be doing DBT exercises during the time together.

It's time I got some good news !!!

Blue

that is so great
bobby

The new therapist never sent me the forms to fill out and fax back to her. I have been calling to get her to respond and, nothing. So, guessing, she changed her mind about me.

I have done an exhaustive search for a new therapist and it seems no one is accepting Medicare, until, I got a phone call this morning. Finally a psych group will let me come to start psycho-therapy with them. And I start next week with a psychologist. I don't know what happened with the other therapist, as she was such a good fit for me, which was a hugh disappointment.

Still looking for a new psych doc. The psych doc I have now insists he sees me once a week and will only give me 7 pills a week. I have been seeing him 4 months now. He said, initially, that he wants to see me frequently until he gets to know me, but I have been seeing him weekly last 4 months, would hope that by now he would feel more comfortable with prescribing medication to me. I am not at risk, so I don't know what the problem is with him, but it's costing me transportation fees to go to his office frequently and to pick up my medication weekly. All these out of pocket costs are keeping me away from seeing other specialists I need to see and keeping me on Meals on Wheels as I can't afford what he expects of me. I explained all this to him, but he doesn't seem to want to hear me.

This new psych group has psych doctors, but I have to see the psychologist first and then make the appointment. I did get a call from our large teaching hospital and they have an opening in December, but that is with one psych doc who is there infrequently and I need a full time psych doc. So, I took it anyway.

I worry about the state of Medicare and why soo many providers are opting out not only Medicare but insurance and doing this concierge type medicine. I have contacted my Federal Senator and waiting for a reply back.

Well, thank you for listening :)

Blue

Today I met with a new therapist. Will be seeing her once a week.

She also referred me to a new psychiatrist in her group.

I'll be seeing each one once a week.

Forgot to inquire if there were any groups. When I see her next will ask about this.

Blue

Blue

Sounds good. I'm glad you found a therapist you like.

And a new psychiatrist. Maybe they can meet the same day.
That would help with the travel.

Donna :hug::grouphug:

Thank you Donna ~ Wasn't able to get both appointments same day, but will try next time.

Blue