Senior citizens don't qualify for Medicaid if they have Medicare?

Question

Someone in my family, although enrolled in what appears to be HMO_at least as far as I know it is what could be considered a complete medical plan_as well as having Medicare, does not have enough money for the co-payments, which appear to be incrementing now, as well as suddenly having to pay almost three times more for Albuterol pump cans than she was five or six months ago.

At some point years back she did have Medicaid. Years went by and she re-aplied. And apparently through negligence from social worker, was kept waiting for six whole months, and there was such a confusion as to whether she qualified or not. In the meantime then she spent hundreds of dollars, apparently unecessarily, simply because she had not wanted to buy the generic brands. Today she's in great need, and although monthly government income is pretty low and only supplements her husband's low Social Security payments which it's around 650 dollars or less, it's even extremely hard to qualify her for foodstamps.

Answer 1

As far as I know, once you are 65 you have to be enrolled on Medicare. Medicaid is a program for people of low income, I don't know how much are the earnings of a person to qualify for Medicaid. But first you have to have Medicare and then apply for Medicaid. Call your local Social Security office to get the right information

Answer 2

Medicare is a very confusing health plan . Now that is to one side,, You can get medicaid and medicare, if you qualify and supply all necessary papers. For low income people they can also apply for extra help with medical cost, including medicine. You need to talk to the Social Security office and also to the Social Service Office. Medicare takes into consideration what a person earns for a year according to Federal Income Tax.
You can also see if there is a pharmacy that works for indigent care patients. They also have programs to help with cost of drugs after Medicare.
Wal-Mart is also low priced prescriptions. Generics for a 30 day supply cost $4:00 per prescription. Generics are just as good as name brand, A lot of generics are made by the same company that makes the name brand.
I hope this has helped in some way.

Answer 3

I don't know what state you live in. If they are low income, they can qualify for medicaid and food stamps. This takes into consideration total income from 2 people. less expenses.
Medicaid will pay the part d, which is the RX plan, RX 's run between 1 - 6 dollars.

I dislike HMO's after having worked for one.

On another note, medicaid can reimburse for up to 1 year of Rx's.

Why will she not use generics? They meet all federal standards, they are exactly the same active ingredients, except the patent has expired for the major drug manufacturers. The reason the price is so high is research and doctor incentives plus stock dividends paid

Answer 4

I just got a letter about this from SS in the mail TODAY ...I had written to them because last year I was on a low income program (I think it's thru the state) where they pay your premiums (usually 40or 50 mo.) They had said I was approved..but evidently they weren't paying it because Aetna rx people kept sending me a bill. I kept sending it back. So maybe..finally ...they're going to take care of this...else I'll have to pay about $500 which I don't have. You can work a little..but have to be below a certain income. Hope they straighten this out for me. Some medicines I take don't come in generic..so if they don't pay it...I probably won't take it. P.S. I think this is part of the state Medicaid program...but you only get the prescription part. Hey...has she ever tried the pres. ins. Montel Williams talks about? Call 1-800-4PPANOW and ask them. They'll pay for all pres. if she qualifies. I know someone who is using this....instead of Medicare rx programs. Maybe I'll try it too if this doesn't work out for me.

Answer 5

I believe that while social security and medicare are based on earning the benefit from working or a spouse, social security known as SSI and medicaid are totally based on financial needs.

The biggest issue these days is the co-payments for medicare but I don't think you can have both. Read on internet or call the Social Security Office to answer your questions. They will answer general question, not those specific to a person, due to HIPPA

Answer 6

Ok, this is just between me and you. Don't tell anyone else. Here's how to do it.
If your family member's total
monthly income is less than
the federal poverty level, He/she can apply for SSI.
This is a state program that
fills in the gap to bring the
person up to the poverty level.
Now, if said person gets even
$5.00/month (here in Cal.)
of SSI, this person then will
get Medicaid (Cal) here in Cal. Then the MediCal will
pay all the Medicare deductibles,co-pays,the Part
D insurance (only minimum
coverage) and all meds.
Caveat: The meds that are
on that insurance Cos
formulary, which is usually
generic. But the Senior is
then pretty well covered.
Albuterol is covered...when
a person gets SSI in Cal,
they are not eligible for
food stamps.
Note: you apply for SSI at your local Social Security Ofc.

Answer 7

I have complete empathy for your family.
I have a Medicare Advantage Plan which is great for me. Before, I had to pay full price for medications.

I received a letter from Medicare stating that I was qualified for receiving extra help. I was supposed to go to DHS( Department of Human Resources) to apply. I did this and never heard back from them. I was called a few months later by a Health Benefits counselor and I explained the problem. Truthfully, it is hard to get because there are some who work in that DHS department who just throw your paperwork away. I will never go back for help.

Get your parents on a good program for insurance help. I highly recommend a Medicare Advantage Plan. You have no paperwork to fill out. The plans works with Medicare. You may have to choose a provider (doctor) from a list but that is better than paying a fortune. My plan charges $10 for doctor visit, $25 for specialist (with referral) and as low as $2-3 for generic drugs and as high as ($5-6) for brand names.

Contact Medicare for a booklet listing the best plans for seniors. I truly hope I have helped you. This happened to my neighbor and she was paying over $140 a month for an "advantage plan" but she also had Blue Cross and she got screwed big time.

EDIT: After reading Slk answers, I would agree. The generic drugs are just as good. Most brand names have a patent on the name anyway; for example: Claritin used to be a prescription drug. Now it is over the counter. But, the strength is less. You can purchase Alavert for a cheaper price and it is the same ingredient as Claritin. This is just an example.

By the way, to answer your question, Yes, you can qualify for both. Best wishes.

Answer 8

Can't speak to the specifics of your family member and will restrict my comments to the law.

ALL people age 62 and older qualify to draw down on Social Security - IF one has enough quarters on record of employment.

Medicare is available to all persons age 65 or older and is not income based

Medicaid is available to some elderly, disabled and children of parents receiving TANF [old AFDC]...Medicaid is income based and if there are earnings in the household [social security payments high enough to count; employment; other assets] the person may not quality.

Answer 9

In California, if you are 18-64 you can get medicaid if you have a serious medical condition like cancer, epilepsy etc. (Or be a minority) As for foodstamps, their real funny w/ this.
My aunt in Maine gets medicaid because she has had cancer & quadrupal bypass. She gets like $500 from ssi and only $30-40 mth in foodstamps!

Answer 10

The elderly who are on Medicaid CAN apply for Medicaid, but unfortunately the spend downs can be so expensive that it's not worth it.