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: