SSI and Medicare

[Birdcrazy]

Michigan

I have been receiving SSI since 2010. I do not have enough work credits to receive SSDI. I have had the Medicaid that goes along with it for just as long. Anyway I get a couple of letters in the mail today, one saying I've been enrolled in Medicare and the other saying I can enroll in Extra Help for prescriptions. The letter even said I should have been getting Medicare since 2012! I looked up the laws and a 35 year old on only SSI shouldn't qualify for Medicare. I'm unhappy because Medicaid has been paying all my medical expenses but now I'll have copays and I only live on SSI and my husband gets no income at all (he's trying to get SSI). I'm tired of living in poverty but jobs haven't wanted to hire me because I'm disabled for so long and now it seems social security is trying to drive me further into poverty! They keep saying I qualify because I have been getting disability for long enough but my direct deposits and award letters clearly say SSI and I only get 750! What do I do?

 

[justalayman]

I'm tired of living in poverty but jobs haven't wanted to hire me because I'm disabled for so long

If you’re capable of working you don’t qualify for SSI.


Since Medicaid is a income based entitlement, if you qualify for Medicaid financially there is no reason you should be removed from receiving it. If you qualify for SSI you are generally qualified for Medicaid.

I suggest you contact your case worker for Medicaid and ask them what’s up.

 

[Birdcrazy]

I am going to be dual enrolled in Medicaid/Medicare, from what I understand I have to pay copays on my meds under that condition.

And I have a mental illness severe enough I keep ending up in paych wards and they say I can't work but I was trying for a part time job because I'm getting tired of the poverty.

 

[Birdcrazy]

And I've looked up the laws, someone not on SSDI and under 65 on SSI should be getting Medicaid, not Medicare. All the advice I've been getting is to "get help" with the copays but why should I be in this situation when up until now my meds were free? Medicare says there would be "consequences" if I protest social security s decision on this matter. I got to have rights somewhere! And I'm on expensive meds too for my bipolar, if I can no longer afford them I would quickly end up in a very bad state.

 

[Birdcrazy]

My award letter that I got just last month clearly says I'm getting Supplemental Security Income and I will continue to get my Medicaid. I am protesting I should have never been enrolled in Medicare. I cannot afford medication copays and this is unjust.

 

[laurakaye]

My award letter that I got just last month clearly says I'm getting Supplemental Security Income and I will continue to get my Medicaid. I am protesting I should have never been enrolled in Medicare. I cannot afford medication copays and this is unjust.

Does it say exactly why there will be a change from Medicaid to Medicare? It would help to read the non-identifying parts of the letter. However, from the research I've done, I think it might be a mistake, Birdcrazy.

From the MDHHS: "Usually, once approved for Medicaid, you continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, or household size changes, let your county agency know within 10 days of the change. You can do this in person, by phone, or by email. When you report your changes, the county tells you whether you continue to get Medicaid or if you have new health coverage options..." ​

It doesn't sound like anything has changed for you. My suggestion would be to contact the MDHHS on Monday and explain your situation/ask questions about the change. It may not be necessary to protest the change - it may just be a mistake that needs to be corrected. There may also be a way to email them about the situation.

You can find the correct number for your county here: https://mdhhs.michigan.gov/CompositeDirPub/CountyCompositeDirectory.aspx

I wish you the best. Let us know how it works out.

 

[Janke]

What did SSA tell you? I also do not understand how you could have gotten a Medicare card as an SSI only recipient. Your state decides if you get Medicaid as an SSI recipient, many states do.

Makes no sense to me either. You should bring your letters to your SSA office. First.

 

[Birdcrazy]

This was explained to me. I used to be a Government employee years ago. MQGE is the correct abbreviation. During these jobs, I payed into Medicare but not disability. So I qualified to get Medicare for the disabled but not SSDI payments. This is bad because I got a letter this morning saying I was enrolled in a Part D plan automatically. This plan doesn't cover a medication I take because it's horribly expensive (without insurance it's over 3000 dollars a month). The medication used to be covered by Medicaid, but now I have to try to find a way to get my medication because I need it to function with my disability. I'm not happy but there is nothing I can do.

 

[laurakaye]

This was explained to me. I used to be a Government employee years ago. MQGE is the correct abbreviation. During these jobs, I payed into Medicare but not disability. So I qualified to get Medicare for the disabled but not SSDI payments. This is bad because I got a letter this morning saying I was enrolled in a Part D plan automatically. This plan doesn't cover a medication I take because it's horribly expensive (without insurance it's over 3000 dollars a month). The medication used to be covered by Medicaid, but now I have to try to find a way to get my medication because I need it to function with my disability. I'm not happy but there is nothing I can do.

I was hoping it was a mistake.

However - there are places to help. Most large pharmaceutical companies have patient assistance programs.

Here's a website that you can search. https://www.pparx.org/

I hope this helps.

 

[Janke]

Aha! MQGE. You don't say, but don't you also get a small government pension? Or did you withdraw all those funds before applying for a pension? I know that you would be required to apply for all cash benefits from other sources in order to remain eligible for SSI cash benefits (https://secure.ssa.gov/apps10/poms.nsf/lnx/0500510001). Medicaid may require that you be on Medicare because it allows Medicaid to be secondary.

I think you are going to have to figure out how to navigate through both programs as a dual entitled SSI recipient. And unfortunately, they are not consistent in their coverage. Usually, you have more options when you have Medicare, but there could be specific coverage issues that are better with Medicaid.

 

[laurakaye]

Janke - you bring up an excellent point:

• Medicaid as Secondary. When there is "other" coverage, Medicaid is always secondary.

You mention dual eligibility: Do/will/can they coordinate benefits (COB)? Can Medicaid serve as her "Medicare supplement"?

(It's been a number of years since I have worked with coordination of benefits (COB) provisions [and I never worked with or
contemplated COB between Medicaid and Medicare], but generally speaking, when two policies coordiate, you almost always end up
with benefits being paid at 100 percent.)

Birdcrazy writes: "This is bad because I got a letter this morning saying I was enrolled in a Part D plan automatically. This plan doesn't cover a medication I take because it's horribly expensive (without insurance it's over 3000 dollars a month). The medication used to be covered by Medicaid, but now I have to try to find a way to get my medication because I need it to function with my disability. I'm not happy but there is nothing I can do." *

Birdcrazy - this might not be as bad as you think. I did some research based on Janke's wise input.

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"Dual eligibility: Some people who are eligible for both Medicare and Medicaid are called 'dual eligibles.'

If you have Medicare and full Medicaid, you'll get your Part D prescription drugs through Medicare. And, you'll automatically qualify for Extra Help paying for your Medicare prescription drug coverage (Part D). *Medicaid may still cover some drugs and other care that Medicare doesn’t cover." (Emphasis is mine) This is directly from a government pamphlet: https://www.medicare.gov/your-medicare-costs/help-paying-costs/medicaid/medicaid.html

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​

*So it's possible, Birdcrazy, that Medicaid will still cover your medication since you have both Medicare and Medicaid.

"Effective January 1, 2006, Medicaid enrollees who are entitled to receive Medicare benefits under Part A or Part B no longer receive their
pharmacy benefits under their state Medicaid agency, except for drugs that are not covered under Medicare Part D. (Each state has
the option to cover these drugs for their Medicaid beneficiaries who also have Medicare coverage. Each state has a list of excluded
drugs.) https://www.medicaid.gov/medicaid/prescription-drugs/excluded-drug-coverage/index.html

This clause makes me believe that you can still get the pharmaceutical medication you need because Medicaid has been covering it already.

So hopefully, that will work out for you! Keep us posted.




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For reference, excluded drugs - Medicaid - Michigan
https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Prescription-Drugs/Downloads/MIExcluded_11-2009.pdf

Medicare & Other Health Benefits: Your Guide to Who Pays First
(https://www.medicare.gov/Pubs/pdf/02179-Medicare-Coordination-Benefits-Payer.pdf)