BIG PROBLEM!!!!

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First. Yes, I have a lawyer(Disability lawyer), Doctor, and family looking into this. My state Pa. had dual eligibility for Medicaid and Medicare. I was pre-approved for both before the cost of living went up. Now the issue is that I make $31 more on social security for my county office to say that I qualify for Medicaid without an exemption.

Medicare will not allow me to sign up for a part D or a Part C plan due to my county office rejecting my Medicaid pending a review.

This leaves me with a huge problem. Medicaid is the only way for me to get part D and the only way to pay for my ostomy supplies.

I have gone so far as to call the secretary of human resources for the state of Pa. and only got a maybe but likely no response.

I explained to Local DHS my medical need to have a dual plan but they said that they only show me qualifying at a set rate.

So the issue is that if they do not set me at a different rate then I have no way to even get a part D plan and my ostomy supplies are too much money to pay for.

Mind you. I have spent the past week on the phone trying to get answers.


I have other family members that has duel eligibility and make a bit more than I do on SSDI.

Just don't know what else to do.

 

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Your disability attorney should be having these conversations with your government agencies, not you. The government actually respects attorneys but they don’t respect individuals (alas).

 

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Our system is so broken. The idea that when your income crosses a certain threshold you no longer qualify for certain benefits is ridiculous. Clearly your benefits should decrease as your income increases, but they've set it up so that your benefits completely disappear when your income hits a certain level, leaving you to suddenly be responsible for thousands of dollars in bills that there's no reasonable way anyone could pay.

Have you contacted your state legislators? They can sometimes be surprisingly effective advocates.

 

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I too reside in PA in Lehigh county. What difference does the county make is the ruling not statewide? You wouldn't happen to reside in Carbon county? Only reason for asking is because I may know someone there who might be able to help.
I just hope that the raise in the benefits does not cause me any issues the some of the benefits I receive. You would think that as the benefits increase so would the thresholds for receiving assistance. Bloody ridiculous!

 

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@Jgsvch @ltapilot I agree with both of you.

 

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The larger problem is there are powerful interests in America (i.e. the insurance industry) who want the system to stay exactly the way it is, where they have control over the all monies involved in healthcare not paid for by the government. The system gives people who are not trained medical personnel the power to make healthcare decisions-the most egragious being the denial of care. The logic is that insurance companies are supposed to ring inefficiencies out of the system and make it lean and cost effective. The results speak for themselves. The US is ranked 37th in the world on healthcare service and the most expensive in the world.

I would like the answers to two simple questions. Why should companies be in the business of providing healthcare to their employees? For example, why does a bank take on the extra expense of providing a service (i.e. healthcare insurance) which isn't what their business is all about? Banks are about banking, not healthcare.

Second, why does the current system favor larger companies that can provide group coverage? Small businesses can't compete in offering a similar benefit. Why do politicians and the government punish small businesses?

If there was a national health service, all businesses would be unburdened of this non-business operating expense. Big business would lose their competitive advantage over small businesses. Health professionals would provide services directly to patients, and there wouldn't be a labyrinth of people, processes, and paperwork for people to navigate. There also wouldn't be sudden changes in services because someone's bonus check depended on denying claims. This would remove the capricious capabilities of people who have no business deciding what kind of, or if you should even receive, healthcare.

I experienced a national health service for the first time in Japan in the 1980s and early 1990s, and then again in the U.K. in the mid-2010s, and both services were as comprehensive and as timely for important, urgent, or critical care, and the out-of-pocket expenses were negligible. There were longer wait times for elective procedures, so this is an area which could be improved.

I am now living in Italy which is ranked number 1 for healthcare worldwide. I haven't had the chance to use it, but I'll report back my experiences.

I wish America could have a non-hysterical conversation about how to provide healthcare in America as clearly-as I see it-the system is broken.

Ciao!
Chris

 

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@ChrisM Excellent points you made and I agree with you completely. If I had my way, having health insurance should have nothing to do with one’s employer. There should be far more in quantity, and more affordable, public health plans on the Affordable Care Act (ACA), and we should all be using them, buying whatever kind of health insurance we want. I have actually had to turn jobs down because their health insurance was so horrible. If everyone had public instead of employer health insurance, we would have farrrrrrr more collective bargaining power ourselves. I doubt it will happen, but at least I know what I dream of.

 

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This is disgraceful. Of course you should not have to pay for your own supplies. Because of $31.
I hope you feel the support from all of us who have written to you.
And I hope your disability lawyer and doctor go to bat for you and fight like hell.

 

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@ThatFLGuy Have you asked your doctors to write prescriptions for your supplies? Medicare actually pays for most supplies. They’ll even pay for an adjustable bed. You may not get your choice about the brand of the supplies, but you’ll get supplies.