Social Security Disability

[William769]

I have been on Social Security Disability 22 months and on June 1st I go on Medicare. Right now I have Medicaid in the State of Florida Under the PAC (Project Aids Care) program.

I qualify for assistance to have my premiums paid for from Medicare due to my income (also to have my prescription plan paid for), but the Federal Government is telling me that I do not qualify for this benefit. As it stands now in the first two months of being on Medicare I will have exhausted what they will pay for on my medicine (I'm screwed!).

Senator Bill Nelsons Office is helping me through this redtape on the Medicare side of it, but because the State Medicaid is involved there is only so much they can do, they have referred this to my State Senator and I can tell you his office doesn't seem interested in helping me with this problem.

Anyone else having this problem?

[pinto]

1. It's a maze, that's for sure.

I was "late" in signing up for Medicare Part D prescription drug benefit, but was able to access ADAP funding for my meds and was able to get Medicare to fast track approval as a medical necessity.

Took a lot of phone calls, some paperwork, support of an established HIV/Medicare/ADAP savvy pharmacy and local benefit counselors, but it worked before I had to shell out much of my limited cash funds.

MediCal (our Medicaid) took three months to pick up my Part D and Part A/B premiums, which is pretty standard lag time, but was eventually reimbursed by Medicare a month or so later for the difference.

All has since fallen into place, 'though some of it I'm still unclear on. I ended up with a different Part D provider than I had originally chosen, but there's been no out of pocket costs and *no* lapse in med supply.

Encourage you to call any and all HIV knowledgeable organizations in your area - Florida - and let them know your predicament. Sometimes people already versed in the system can get better results than your state or federal representatives.

Hang in there. Good luck.

[William769]

3. ICAN (Island Coast Aisds Network) is where my case manager is.

They are clueless to this situation which scares the hell out of me right off the bat.

I am on Full Medicaid right now which would stand to reason I would qualify for the extra help but getting Social Security, Medicare and Medicaid on the same page is the problem.

Since I posted this, Senator Nelson's office assured me that in the event this is not rectified by the time my Medicare kicks in, His office will insure I do not go without medicine. With dealing with his office in the past, I have no reason to doubt this they have been a big help to me in the past.

[pinto]

5. Glad Sen. Nelson's office has been so supportive. (thumbsup)

Yeah, getting the three to mesh is a pain.

How it works here is that folks on Medi/Medi pay no Part A/B Medicare premiums, and any share of costs for Medicaid drug coverage is picked up by ADAP. With the advent of Part D, there were plans here with premium assistance, based on income.

I'm straight Medicare via my SSDI (no Medicaid), so it was a little simpler for me, in a way. I just came in under the income limits for Part D premium assistance, so I didn't have to pick that up, and in reviewing my case turned out I was eligible for a medical necessity Medicaid coverage that, once approved, picked up the Part A/B premiums I had been paying out of my SSDI. One big difference here, perhaps, is that Medicaid is additionally funded with State funds, so the benefit is a little higher here than in other states.

Anyway, that's what SSDI reimbursed me for - turned out to be about 3 months of premiums, once the medically necessary Medicaid coverage kicked in. So, I kind of put it together bass ackward, and it took some creative assistance from knowledgeable folks.

Hang in there. Doesn't sound like you'll have any gap in your med supply, that's one bright note.

[dogonarug]

2. ADAP Fla.

Check the link below for ADAP info for Fla. If you qualify for premium assistance you will qualify for ADAP. Most states have access to this fed. program.

http://www.atdn.org/access/states/fl/fl.html

[William769]

4. I do not qualify for ADAP right now because I am on Medicaid.

It seems to be a catch 22 right now.