Ok, I have Medicare due to being on Disability. I also have Tenncare, Tennessee's state Medicaid. Now, apparently I only had it because of some lawsuit that was on the books for 21 years. Seems it finally got decided and they are terminating all the people who were on it until it was decided.

Trying to keep this as simple as possible, it is very complicated (at least for me) Medicaid paid everything Medicare didn't. My Medicare premiums, my Part D premiums, etc. They paid the 20% that Medicare didn't also. Now, when I lose my Medicaid, I will be responsible for all of this, as well as having to find other insurance for the 20%. I am freaking out right now because we really cannot afford to do this. My check (disability) pays the mortgage on our home. And that's it. It really doesn't even cover all of it.

I was wondering if anyone here has any experience with Medicare/Medicaid and if perhaps anyone may have some ideas of what I could look into. I will also be losing my transportation to/from my doctor's appointments. I cannot drive due to my disability, and well, hubby has to work. Tenncare has a transportation programe. I will lose that. I just need something that will help with what Medicare doesn't pay. I don't know if I qualify for any Medigap policies or not. Some insurances do not count Medicaid as "credible coverage" so they will look at it like I didn't have insurance for the past 10 years.

Sorry for the long post, I just wanted to provide as much information as possible. I hope someone has some ideas for me to start with.

Thanks!

Is there anyway you could be put on your hubbys insurance? Its been a while since I have had to deal with Medicaid/Medicare. My mother (a widow) had MS and was totally disabled and back then, I remember how difficult it was to deal with the entire issue. I guess I don't understand why are losing your Medicaid. My mother had both, they went on if you were totally disabled and also your income, has either of those things changed with you? Perhaps with your dh working, your income is considered too high?

I think you have mis-understood the Cluster-Daniels Lawsuit and how it affects you. The lawsuit was for people who used to get Supplemental Security Income (SSI) from Social Security and were terminated and they kept them on the TennCare roles without re-certifying them as they do others.

If you are on Social Security Disability Income (SSDI). have medicare premiums, Part D you aren't in the affected class. Nor are people who are currently receiving SSI.

Did you actually get a letter from TennCare about being up for re-evaluation for the program?

There is a link to a letter from TennCare/DMRS which explains the lawsuit that follows. I don't think you should be affected. Federal law requires States to automatically cover SSI recipients and to have categorically eligible groups for those who are disabled and qualify under the various groups like the SLMB,QMB,QDWI, QI that take care of some or all of your medicare premiums plus the categorically eligible groups for blind, disabled, elderly, the waivers , etc. Some people get one part just Medicare B& D premiums paid for them others get both the premiums and Medicaid coverage others have to have a spend-down or in some states its called cost-sharing to get medicaid coverage.

Here is the link http://www.tennessee.gov/dmrs/provid...%20lawsuit.pdf

Unless you have gotten a letter saying you are due for re-certification under this lawsuit I would not worry about it.

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Yes. I got the letter stating I would be terminated on July 31st unless I was eligible for a "different" kind of tenncare. I called Tenncare and gave her my SS and she told me about the suit being settled. I didn't even know any thing about the Daniels thing until now. Had no idea I was even on Tenncare because of that. Apparently I did draw SSI during one of the years or something. And, I am worried that hubby makes too much money for me to keep my Tenncare. So are you saying that even if hubby makes too much to qualify me for what I have been getting, I may still be able to get another kind of Tenncare? If I could just get the one that pays Part D, I would be happy. Or even if I could get the one that pays the Part B premiums and deductibles. I just need "some" kind of help.

Oh yes and also..sorry to keep adding to this but it's very messed up as I said...I will not be able to afford my meds during that donut hole thing. I am on a few pretty strong opioid pain relievers and one of them I know costs over $300.00/month. It doesn't have a generic either. I cannot just stop taking them, as I am sure most know.

My first thought is, if you are truly deemed "Disabled" by the US Government, then HOW can you lose that disability? They must have decided you were NOT disabled after all. May I ask what type of disablity you have? I have heard of some people who get temporary social security, but a blind person cannot have their disability taken away, since they will always be blind! I was born legally blind myself, and have had SS all my life. And then I've known people who've only got one leg, an accident did this, and they are truly struggling, and I mean STRUGGLING with life, and they cannot get disability! Sometimes I don't get WHAT the governemnt is doing. And a lot of that Meidcaire/Medicaid part D is regulated state by state. Maybe you need to contact the medicaid office and talk to them. There is an 800 number, sorry I don't have it on me!

I'm not losing my disability. I am losing the state of Tennessee's Medicaid. I was what they call dual eligible or QMB. They paid what Medicare did not. They also paid my Part B premiums. They also covered my medicine during the "donut hole" where Medicare Part D won't pay for drugs until you reach I believe it is around $4,000 in drug costs, then they start paying again. Again, I am not too sure on the specifics as I haven't had to deal with it until now.

The nature of my disability, well tbh I am not very comfortable disclosing that on a public forum. Suffice it to say that my disability is two-fold. Part of it is physical and has to do with nerve damage in my spine along with losing the use of one of my legs and the other one down the road and other issues that have come to light because of that, the other part is well the part I don't want to talk about here. I hope you understand. My SSDI isn't what I am worried about losing, so I really don't want to discuss that part here.

My husband is going through the same thing and never recieved ssi to start with. The folks who are replying are not understanding what is happening. I've talked to the DHS, Nashville, the mental health service provider in our area, and a lawyer. Here are the facts,

TennCare is stable but not profitable at this point, so they requested a federal judge to overthrow the Daniels ruling which prevented TennCare from disenrolling any disabled person who either recieved or would have qualified for ssi except for income. (my husband never revieved a penny because a family of two must make less than 869.00 a month and have less than 3000 in resources. If you own a home, even if you owe more than it's worth you fall into this catagory like we do.)

Tenn care did this in order to disenroll as many of the 150,000 people covered under this rule as possible, because these disabled people traditionally have higher medical bills than those covered under other classes and eliminating them would put the system on a profitable level they think.

The people who will be able to get other forms of tenncare are unwed mothers or couples who don't work and their children, those in nursing homes or institutions, those with breast cancer or cervical cancer, and those who are severely impoverished enough to recieve ssi. (For a couple like our families, that is under $1469 gross per month including the social security benefit.)

The people who will not be able to get another form of tenncare are permanently disabled adult who do not meet those criteria.

So you will still have your social security benifit of course and your medicare. Your are probably not old enough to sign up for part B yet, so you will have hospitalization subject to the deductible, copays, and limits. What you will not have is medicine, cancer or other specialty treatments, mental health services, diabetes supplies, doctor office visits, lab tests that don't result in hospitalization, emergency room coverage, rehabilitiation or convalescent services, transportation, or outpatient services.

There is nothing that can be done unless a miracle occurs and the state grows a conscience or the president steps in and keeps one or two of those campaign promises he made. My company I work for does not provide spousal health insurance and my husband is ineligible for private health insurance. I can't start whelping out babies because I had a hysterctomy, so we have only a few choices:

Move to another state that still has medicare/medicaid or to Canada
Put him in an institution until he dies
I can quit my job, let the house foreclose, spend every penny I have and then apply for ssi and foodstamps and a house in the projects.

Or

I can watch my husband weaken and die without his medicines and medical care.

So what I will actually do is just pray to God for a miracle for both our families.

Dont go to Canada, they may have standardized health care but it is a wreck.

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Yes, z, you understand my problem exactly. I love how they give us SO much warning about this. I am scrambling trying to find out what I am supposed to do now, while trying to get their "peach forms" filled out and mailed back by the deadline. I do have Part B and Part D coverage, however since I was QMB all of it was paid by Tenncare, now I will have to find a way to come up with that money myself...as well as my other bills like food, housing, etc. And, judging by your answers, I too will lose my Tenncare, regardless of what I do.

The medicines I take I cannot just stop taking. They are pretty strong opioid pain medicines. I will either end up in the ER or the morgue if I do. I am thinking about visiting my pain doc before the 31st and see if he can give me a step down procedure along with enough meds to at least get me through that step down. I think this whole situation sucks.

I can sympathize with the stress this causes but one of the biggest out of pocket expenses when it comes to healthcare is just the medications. Here are some options:

Make sure you are using a pharmacy that offers the $4.00 generics (like Wal-mart) and check with your providers to see if you are able to get a generic medication.

You can ALWAYS ask your doctor for samples. Most name brand medications offer medical offices samples. The samples are to get feedback on the drug as well as get them used to the medication. With my being in the healthcare field the reps for drug companies will usually have a supply at home and will help those who can't afford the prescriptions to give them some personally. We do orthopedics and most of our reps will comp us a $500.00 box of 1 injection for someone's knee if they have arthritis - most are more than willing to bend over backward for us.

There are drug companies that will help you with your medications. Like Pfizer, Merck Merck Programs to Help Those in Need, Social Security, Partnership for Prescriptions, Astra Zeneca.

I hope this gives you some help. It never hurts to ask your doctors and tell them your situation. Most of them do have a heart and do have compassion when it comes to situations like this. There are websites out there to help with prescriptions. Just make sure you do not start buying drugs off the internet as some drugs are not the same from one country to another. Some of the online medications are not FDA approved, therefore you need to worry if the active ingredients are really what you are needing; it is the same strength, inactive ingreadients are all listed and there is not something strange listed in there.

Good luck and I hope this helps.

Your Medicare counts as creditable coverage

HTH

Laurie

Thank you very much for the suggestions. My pain doc is very nice,. we have a good relationship and he isn't one of those robot docs. He usually gives me samples of my lidocaine patches because my insurance won't pay for them anymore. So I would guess he would perhaps be willing to do that with some of my other meds.

And thank you for the links. Someone else suggested I go to the drug companies themselves so I will look at that also. I wouldn't go to the internet and buy any drugs anyway, as I signed a pain contract with my doc. It's pretty strict as to what I can and cannot do. And I don't want to break that trust we have built over the years.

Thanks. I was just told by Medicare that my Medicaid wouldn't be considered as credible coverage so far as other insurance companies are concerned. Some companies in some states do not consider Medicaid as credible coverage.

Working on it

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Mary

LOL we were just posting/doing things at the same time I just deleted my request lol

Thank you

I have zippo knowledge of Medicare/Medicaid/SSI/etc. but I do have a suggestion for medical transportation.

Here in my area we have a local ambulance service that sells memeberships every year. The way the membership works is that if you have to use the ambulance service, you pay nothing. If you have insurance, they accept whatever your insurance gives them as full payment, if you have no insurance there is no charge. The membership also includes a certain number of medical transports every year which can be used for dr. appointments and if you're disabled, they pick up up in a specially equipped van, bring a wheelchair, etc. Once you use your allotted amount of free transports you can pay a reduced fee to use the service.

Check to see if there is a program like this in your area. A membership here isn't that much, something like $40 for a year. I know it won't help much but any thing you can get to help out is better than nothing, I suppose.

Good luck. I wish I could be as irresponsible with my money as the gov't is. Taking health benefits away from disabled people, crazy!

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That is good info Targetgirl. Is there anyone here that lives in Tennessee and knows if this is available there? I have an 84 year old friend there that has a LOT of DR apts and she had mentioned last week that she was running out of ins covered transportation trips. It is about a 4 hr trip one way so there just isn't feasible for me to help out with getting her to DR apts and her children live even farther outta state. OK, I already admitted that I wasn't the sharpest crayon in the box, the OP is from TN, right? OP if you find out anything on this could you let me know?

Apologies. I thought I had replied to your post when I read it earlier today. I want to thank you for all the great suggestions. I am going to be spending most of the day tomorrow trying to find out what I can do and if I have any recourse against Tenncare. I will also be calling drug companies and transportation companies around here to see if any of the offer the type of service you are talking about. There has to be someone around here that does it.

I did hear about something called "Carta Care-van". Supposedly it is just for people with disabilities to get them to/from their doctor appointments. They only charge $2.50 each way. If this is the case, that is one problem solved. Now the only one I still have to deal with is the medicines. I have been looking at the Medigap policies on the Medicare website, and OMG...the cost of some of them is crazy. Then there is the "donut hole" period where they won't pay ANYTHING until you have paid like $4,000 out of pocket. How can they do this? I mean, I am sure I will still have to pay my premiums to them every month. But for what? If the aren't paying for my meds, what am I paying them for during that time? Simply crazy.

The other thing I am going to try is talking to my doctor. I know he will work with me. Just trying to figure out the best way to do that. Whether he can switch me to less expensive meds, or give me samples, or if all else fails, I will need to get a "step-down" procedure to safely stop taking my meds. Of course, that will have it's own problems because then I will be left with the pain that they were holding at a barely tolerable level. Maybe if I end up in the ER every night at the state's expense they will think twice about this stupidity.

Yes, I am in TN. Chattanooga to be exact. There is a service for people who are on Tenncare called Tenncare Transportation. Is your friend on Tenncare? If so, let me know and I will send you their phone number. That is who I use as of right now. I will lose that also. They use either a van service or a cab service, depending on your medical needs.

Total spammer shame on you ..... Catherine

Why do I seem to be attracting spammers and weirdo's in my post?

Duchess, my friend is in Portland, a little bump in the road just off the Kentucky line. I sent her the info Targetgirl posted last night and she was gonna talk to her DR about it today. She was using the Tenncare thingy for rides if I hven't got what she wrote confused. She is 84 years old and they left her sitting on a bench outside her DR's office for FIVE hours and then tried to blame her for not being on the bench where she was supposed to be, and this was on one of those miserably hot June days. That just broke my heart when I found out about it. She paid I think it was $2.50 a ride and still got left and is still losing that option. She told me last night she had already canceled part of her DR apts because she didnt have transportation to them.

I have to tell you it just breaks my heart to see people that have worked hard all their lives and then they get tossed out with the dishwater and told to just go home and die.

Yea that sounds like the Tenncare transportation thing. They use two different companies for their rides. One of them is STS transportation and they really SUCK. Sounds like what she has. They are always late, etc. The other is an actual cab company ...Mercury cab. They are awesome. I have been using them for about three years and have had no problems. But you have to ask for them. Tell her, if she is getting to keep it, to ask for them. The only thing is I don't remember ever having to pay for the rides. The one by Carta that I am trying to contact now is $2.50 each way to Dr. appts. But that isn't through Tenncare...

Thanks Duchess, she said she has spent all day on the phone, but will send her the info, just to make sure she has checked those also.

Like I said, if it is the Tenncare Transportation, tell her next time she calls in an appointment, to specify she wants Mercury Cab.

I have friends and family in Canada, and they get excellent care. Within the 6 families, one has been treated for breast cancer, another that has horrible arthritis, and one member of the family was born a premie with a cleft pallet -- not to mention all the regular stuff everyday families need - and all of them say they have had excellent care. Never had to wait for anything. Never been turned away. Never been denied anything.

Two of the families travel down here twice a year to visit for the holidays, and they buy temp insurance policies that would be honored in the states, because their biggest fear is they will get down here, have something go wrong and get stuck in our system. One family, now that they have small children, won't travel to the states at all because one of their children is a severe asmatic and they are in the emergency room on a regular basis in Toronto.

I think that there is a perception that the system in Canada is a wreck based on some of the horror stories we here.

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