heart breaking story, posting for a friend. can we help her ? please ?

[debra]

Anne,hi... No exclamation mark, this time. Anne, I myself still can't keep up with whats what in terms of Medicaid here. Basically I need to pay 409.00 per month out of pocket, before my Medicaid is even open.. Anne, that would be impossible with me, unless I didn't have rent,and everyday bills. So the doctor er or whatever can use this as an excuse to notget to the bottom of whatever is going on. They are questioned on everything. I believe, this is a big reason for not being treated. Pass the buck and let doctor who ever deal with the mess. Anne they know what i have, and I know this. They don't want that up here, which is why its easy for them to day, go to Boston specialist. The old, oh it will kill you trick, is crazy. And not treating does what? Pass the buck to who ever. Anne I will say this, when working with aetna,then blue cross, I was treated like royalty. Tests run for migraines.. No compaints that's for sure! Pure bliss, medically speaking... Didnt need it then much though.... It's a very unfairsystem, and they dont care. Maybe some do, you're lucky, cause not here.... True Anne.....

[debra]

Typos,so sorry...

[annekat]

So is it that your income, from disability and whatever else, is too high for you to qualify for Medicaid, so you have to make up the difference? My scenario was that I couldn't qualify for Medicaid because I had too much money in the bank, having borrowed some from my sister; therefore, my assets were too high. And since then have heard lots of other negative things about being on Medicaid, like having to pay them back for services rendered if you are eventually in a financial position to do so. And having a lower limit on the amount of income you can make, say by selling pottery. So I know they cover some stuff that Medicare doesn't, but I figure what's the point? Wouldn't you be better off ditching Medicaid and not having to pay them the $409, and stay on Medicare and use that money for copays and stuff, and see if you qualify for 'extra help', which isn't necessarily Medicaid. And have a drug plan with no deductible and low out of pocket costs, for most of the drugs I've been on. It seems like with Medicaid they have an eagle eye on you but if you were free of that and just on Medicare, you'd be operating out from under their thumb. I could try again to get Medicaid here, just am not sure the trade-offs would be worth it and am managing to make it work with my Disability payment, from which is subtracted my Medicare premium and my low drug plan premium, a total of a lot less than $409, and getting to make up to $1000/mo. net income at my pottery (not enough for them to consider it a real job or significant income) and I think the income limit for medicaid is $760 or something. And with Medicare and SS Disability they don't care how many assets I have, as long as they aren't much work income, I can have 3 cars and rental income and 2 pieces of property and whatnot. Not that I have all that. But my payment is based on what I paid into the system and that's that.... they don't get to go snooping around about my assets and how much money I have in the bank. So I probably could qualify for Medicaid at this point but hesitate to get involved in all that. I know it might be a loss for you to get no Medicaid benefits, but you wouldn't have to pay anyone the $409 just to open your case, you'd just go to the docs, pay your copays, work out payment plans if necessary like we talked about before? Like I said, I don't know that much about it, but is this making any sense? Is there any rule that you HAVE to be on Medicaid at all? If it just stands in the way of your getting the treatment you need, why not just ditch it? Gotta go feed cats across the street now.

[debra]

Anne, can't tell them they tell you. Some people are on Medicaid without Medicare, they actually get better treatment because of mo spendown. But because I have a strong work history, I'm in a different bracket. You'd think that would be a good thing right? Wrong... It's mind blowing. So because I worked hard, and have a good work history, my check formmedicare is higher, so heres where they screw ya... Damned if you do and fanned if you don't... Icant just go out and buy insurance or part d, plan,its assigned... I would have been better off, with no work history, then get just Medicaid.... I hope that helped a little? Others may be looking for how Medicare work's, even though I'm up here.... All states are different.

[debra]

Oh boy! So sorry! Should not ever assume my phone is going to actually print what I type.....

[annekat]

Medicare is federal and is supposed to work the same everywhere, though different staff and personnel may handle things differently in different states, not necessarily because the state told them so. Medicaid IS different in different states, I realize that. I don't see how anyone could have forced you to get on Medicaid if you qualified for Medicare and a good disability check based on your work history. I do NOT have a good disability check (as a potter, are you kidding?) but manage to get by on Medicare and the Part D plan, with about $140 total deducted from my disability check each month, pay the copays, etc. and don't know that I want to touch Medicaid for all the reasons you describe.... it could be just as bad in this state, too, for all I know. I feel lucky to qualify for what I do get even though it is probably inadequate if I get into real trouble like need a $100,000 surgery or worse. I know I'd qualify for more if I'd worked harder at real jobs throughout my life. It sounds like you were responsible and worked hard. I understand about not having any work history and getting everything paid for, but then you'd have nothing like the disability check you probably get and they'd be snooping in every corner of your life to make sure you didn't have assets stashed away somewhere. I am obviously no authority on this subject. I just think we all have to pay something for whatever health insurance we get, unless we are those who never lifted a finger in their lives and really have very little to be proud of. I still don't understand why you can't drop Medicaid if it doesn't serve your needs. Or maybe it could, in some other state. It is all too convoluted for me to go back and forth on this when you just need to get the medical care you need however you can. The $409/mo. would be impossible for me, so I would get off Medicaid. Even if I had to pay for my own meds I'd be better off than what you describe. But not if my meds got really expensive. So it is a gamble, whatever plan you end up settling for. I'm on the most basic Medicare plan there is because I can't face joining one of their more expensive advanced plans that are mostly HMO's and would limit the docs I could use. But I'm taking a risk on being underinsured if I ever get really big medical bills and my 20% copay would be like $12,000 or even way more. There is no out of pocket limit with original Medicare. I can get just as screwed as you could, and it would be largely my own fault for not having maintained a good enough work history. I suggest, use the Disability and Medicare benefits that you earned with your GOOD work history, and screw Medicaid and their $409 pay down and do without them, and get the help you need! WG treatment doesn't have to be expensive. Mine isn't so far. Yours might be more. We just don't know. We just have to take it as it comes. But we have to take a step forward for anything to happen! Not trying to lecture you, I'm not a great example of taking steps forward. We are all in tis together, in many ways. If at some point you have something really big and expensive going on, medically, you might be glad you have Medicaid as a safety net and the $409 might be worth it. Or maybe not! So drop them! Who am I to say? This is about the limit of the energy I can put into this tonight, I know you didn't ask my viewpoint, and I really wish you relief from all the aggravation you've been going through. I love and care about you. XXOO

[debra]

Anne hi... Fell asleep for a couple hours. To bad I woke up... Anne, I do have Medicare. I'll go back and read this again, maybe I got it wrong. The work explanation is theirs not mine. I've never bragged about a single thing in my life. But I'm proud of my work history whatever the case. Medicaid goes with Medicare. Medicare covers 80% cost. After this, providing spendown is met and open, that's the 409 part, Medicaid kicks in and picks up rest. I believe the part d prescription plan is through the Medicare not Medicaid. There wasn't a choice in terms of the Medicaid add on, say versus bluecross. I wish. But nevertheless I'm grateful for insurance, just wish if I had to be sick, it was something different. Something that all doctors are educated in and something that can't hide? For example anca. Wish the Medicaid stigma didn't exist. Wish the system was more fair, but whatever... I hope I can get back to sleep. Woke up sweating. Couple hours just doesn't cut it..... Anne I love you... Sorry if I'm not explaining this clear, still..... Deb. XoXO

[debra]

And Anne,thank you... I care for you as well.. a lot.... Anne, my aggravation, has been real mild in comparison to where I'm headed now! These tests and appointments with this new problem to add, plus all the other crap, I'm on the verge of blowing a gasket..... If this isn't a bug issue, then real cool... Anne, this is also a really big travel problem, maybe not in bora bora, but all over. Even cruise ships. If you travel to a hotel, on business or vacation, inspect the room, cabin. Check paintings on wall, crevices. And most important keep you're suitcase CLOSED!!!!! I can't tell you how big an issue this is, its been pretty bad. If the suitcase is laying open, say on the chair or something,and there are bugs, they can climb in, hide and come home with you, then breed. Then you're life changes. My sister in law went through it last year,she wasn't aware her son had brought in some stuff, I guess in his room, and ended up with them pretty bad. My brother doesn't live with his own wife, but he was telling me, and he was real pissed cause he bought the furniture I guess. Then he didn't know how they work, so was complaining that she's not cleaning enough. I told him it had nothing to do with cleaning, google it Dave. It's carelessness, or unlucky, to be near the carelessness..... Anne, I love you..... Don't forget the pictures, if you're up to it......... Me. XoXO

[annekat]

It is not your job to explain it all clear. I have read the stuff over and over and they don't explain it clear. I DO know you have Medicare! Not everyone with Medicare has Medicaid, unless it's different in NH. Either because they don't qualify or they haven't applied. I realize if you do get it there are limitations, and if you have over a certain income (from disability payments, work, e.g.) there will be spend-downs. That is one of the reasons I don't apply for it. In a state like yours with NO TAXES, as I understand it, it would follow that the spend downs would be bigger, and the state could not afford to provide as high a level of Medicaid benefits, and some of your spend down would go to people who have lower or no incomes. At least disability isn't taxed by the feds, but in a sense, it is, for you, by the state, since you are being asked to pay a spend down out of it. If I applied here, I'd likely have a spend down, too, possibly for a smaller amount, depending on my income and how it works here. That is a reason I haven't gone there and just stick with Medicare. A difference between us is that I CAN work now, though to a limited extent, which they allow. You are probably too sick. My work income will be taxed by the feds, but not by the state, since we don't have state income tax. But we have sales tax, which I must pay on all non-food items and collect from customers and turn in. You will not be taxed on anything like that in NH, as I understand it, and I may be wrong, but the money has to come from somewhere, like your spend downs, to keep the Medicaid program afloat.

You keep saying things like I don't understand them, like about part D. I understand that under Medicaid, Part D doesn't apply, as meds are all paid for right? As long as you've paid the spend down? Well, I don't have a spend down or get my drugs paid for that way because I haven't opted for Medicaid. Instead, I pay everything that Medicare doesn't cover, roughly 20%, plus the Medicare Part B premium and the Part D premium and a reduced cost for the drugs themselves. I don't know if that adds up to anything like $409 a month or not, probably not at this point, but it could. So no matter how we slice it, we pay something, and maybe more than we feel we can really afford, for what we get! Unless we are destitutely poor with no work record or assets. Same here, if I had no work history and nothing, I'd be on Medicaid and get everything free. No difference there.

I think you SHOULD be proud of your work record, as I thought I tried to convey. What I don't get is that you seem to imply you ARE REQUIRED to have Medicaid, in addition to Medicare, that it is not an option not to have it. So no one in NH is just on Medicare and pays the premium for that and the Part D and the 20% copay, the lowered cost of drugs, and anything else that Medicare doesn't pick up? So this apparent mandate, as you seem to convey it, for you to be on Medicaid and pay the $409, is what keeps you from getting health care. But most of us with good or even average work records do pay something for our health care, whether it's through Medicare premiums and copays, Medicaid spend downs, or a private health insurance company. There are some who pay little or nothing because they have nothing, or because of service to their country, military or otherwise. I understand, in your position, the difficulty of paying anything at all. A lot of us, including me, would like to see health care be free for everyone, as it is in a lot of countries. But the money has to come from somewhere, and that means taxes, hopefully more on the rich than the middle class or poor.

I'm just saying that we pay either way! Nothing is free! I don't have a spend down but I pay things you don't pay. If you went off Medicaid, and just went with Medicare, you would pay for things the spend down would now cover.... whether they would amount to $409 a month, I don't know. They might amount to more than that for you, depending on your needs for treatment. So in that case, sticking with Medicaid might be a better option. I don't know the answer! Please just let me know if everyone in NH with Medicare is REQUIRED to have Medicaid as well, and if so, if they are REQUIRED to use it, or if they can just go with Medicare and pay THOSE associated costs.

I was sleeping fitfully and got up for a cup of chamomile tea and to go over my recent income from the Market. It's OK, but will be gone in a flash. There is a little other income floating around, the Market will start up on Saturdays only, in January, and it will be slow. I will probably have some seasonal work in processing flower bulbs, but need to wait to hear from her til she returns from vacation. People who can afford vacations! Hard to imagine. FYI, my disability payment is about $760 a month and out of that comes $104 for Part B and $35 for Part D. And I have a mortgage payment of around $750. So the disability doesn't even pay for the mortgage, which I stupidly got on a little house I inherited. I could get that lowered, if I get the paperwork together, which is very difficult for me. But that is why I need to do the pottery, which is hard on me, the other seasonal work, and have RV tenants and a little help from family here and there. I'm not saying poor me. it's a New Year and I have more time now to work on all of this, rethink things, etc., but it all takes gigantic amounts of time. I wear out pretty easily. We all do. You put a lot of energy into these discussions, and I get carried away, for which I apologize, and we don't have to talk about this anymore at all if you don't want to! If you think I am seriously misinformed and a complete doofus, go right ahead. It's better than you being burdened with this stuff any more than you already are. At some point, neither of us may care anymore about making the other understand our point of view. And it is true, I am nuts, as nuts as you or Birdie or anyone, to be going on and on instead of just dropping it like most people would do. I wish you peace and resolution of your issues, and most of all, a chance at returning to better health. With love. XXXOOO

[annekat]

And Anne,thank you... I care for you as well.. a lot.... Anne, my aggravation, has been real mild in comparison to where I'm headed now! These tests and appointments with this new problem to add, plus all the other crap, I'm on the verge of blowing a gasket..... If this isn't a bug issue, then real cool... Anne, this is also a really big travel problem, maybe not in bora bora, but all over. Even cruise ships. If you travel to a hotel, on business or vacation, inspect the room, cabin. Check paintings on wall, crevices. And most important keep you're suitcase CLOSED!!!!! I can't tell you how big an issue this is, its been pretty bad. If the suitcase is laying open, say on the chair or something,and there are bugs, they can climb in, hide and come home with you, then breed. Then you're life changes. My sister in law went through it last year,she wasn't aware her son had brought in some stuff, I guess in his room, and ended up with them pretty bad. My brother doesn't live with his own wife, but he was telling me, and he was real pissed cause he bought the furniture I guess. Then he didn't know how they work, so was complaining that she's not cleaning enough. I told him it had nothing to do with cleaning, google it Dave. It's carelessness, or unlucky, to be near the carelessness..... Anne, I love you..... Don't forget the pictures, if you're up to it......... Me. XoXO

Very sorry that last reply got so long. Yes, I am nuts. Don't bother yourself to reply to it now, if at all. And don't worry, I won't be going on any vacations or opening any suitcases. Please do not blow a gasket. Settle down and let it go for now if you can. I realize your issues are overwhelming, please realize that. Mine are too, maybe on a lower level. i care about and love you, too. Going back to bed. XXOO