2...maybe 3 questions

Discussion in 'General Parenting' started by DammitJanet, Jul 19, 2005.

  1. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Im losing medicaid the end of this month because Cory turns 19 this month and while, he can continue to get it, I cant as his caretaker. This means I have to apply for it on my own as a disabled adult. I have done so but the same people who decide Social Security Disability also decide Medicaid for Disabled Adults, and I am not banking the farm on them approving a medicaid application before a disability application. Seems like it would almost force social security's hand.

    So...on to question 1:
    Has anyone ever seen the above happen? LOL.

    Question 2:
    Im thinking of getting a medical insurance policy just to cover myself because of how darn sick I am and I really cant afford to be without insurance since I just had surgery. HOWEVER...Im worried about the pre-existing clause. Would that come into effect if I went straight off medicaid onto another insurance?

    Question 3:
    I have looked at several policies and they list prescription coverages as follows:
    $10 generic, 25/50 - $2000 maximum coverage

    This cannot mean that they only cover $2000 in prescriptions total per person per lifetime or per year can it? My gosh...my topomax is like 800 a month. Its not even worth it to me to buy insurance if the prescriptions are gonna be gone in two months...well...I mean I would have the docs...but what do I do about the scripts because the needymeds folks all say you cannot HAVE prescription drug coverage. I would have it just be out of it.

    Or am I reading it wrong and its just 2000 at a time. That would make more sense, because we all know medications are high.
  2. OTE

    OTE Active Member

    1. Not sure. Every medicaid application I've seen has been done in the state, not through feds. Could you send me a link to where you see this kind of Medicaid?

    2. I had applied to and was approved for UNC specific "Charity care" though I think they had a different name for it. With this all of your medical work goes through UNC. So I saw reg dr in the "family practice clinic", did blood tests in their lab, did the echocardiogram in their lab, see their psychiatrist, get my medications at their pharmacy, etc. So I didn't have and didn't need medication insur. Now obviously where I live I can get any kind of service.. is there a UNC near you? Obviously ECU but anything closer? If they've got TEACCH in fayetteville see what else they have. Anyway, I don't know about pre-existing conditions in NC. In NJ they outlawed all pre-existing conditions clauses.

    3. call and ask what it means. But I'm sure it means / yr.

    Again, I got all free medications from UNC. Well, there was a $2 or $4 co-pay per mo per medication I think.

    As to needymeds.com... as I recall that's not true of all of the companies. I think I used Merck and Forrest. At least one of them looked at all the finances and if you plan screwed you they gave you what you needed. Try Merck as an example. Call their 800 number and ask.
  3. DammitJanet

    DammitJanet Well-Known Member Staff Member

    We have UNCPembroke but I dont think they have any sort of medical school attached to it.

    ECU and UNC would probably be just about the same distance...maybe. Would have to mapquest them. I wasnt aware ECU had a low income clinic.

    I would try our county mental health dept but last time I did they wouldnt cover my topomax. Refused to rx it. In fact, said the only two BiPolar (BP) medications they prescribed were lithium and depakote and I just wont take them. I have been stable on my regimen for too long to screw with it for anyone.

    I might be able to go thru one of the local free clinics...or sliding scale clinics here for family practice stuff, and then hike up to UNC if I needed ortho stuff. I think I may ask my family practice doctor which sliding scale clinic he would recommend that would continue my medication regimine. We do have one or two here I believe. I dont know what they do about medications though.
  4. Hi Janet,

    I only have one answer for your questions. I have several booklets about Soc.Sec. and it says that - once you get SSDI you are automatically eligible for Medicaid, in MOST states. Then, after two years - you are automatically enrolled in MediCare.

    They have a great web-site, with all sorts of information:


    Hope this helps!

  5. OTE

    OTE Active Member

    Amy... just to clarify... I believe that is 2 years from onset of illness. And there's a period of illness before you qualify for SSDI and then there's the long wait you know about. So practically speaking I think most people end up with the Medicare. But I hear you.

    Other problem I haven't figured out yet is once you get SSDI and the medicare for yourself what do your kids get? I know the answer is not medicare. The medicaid would then fall into normal medicaid rules about assets and income. And if you don't meet those (which I won't on SSDI) then what do I have for my one kid who is NOT on SSI? And when they fall off of SSI because of the income/ assets what happens to my 2 others for medication insur? Haven't spent a lot of time worrying about this because I know I can get the hospital here for them as above. But it could cost me a bundle. Thankfully mine are really healthy so I'm not all that worried. But I still think it's an issue.

    Janet, you may end up with a hodgepodge of sliding scale docs. But the UNC plan will give you the labs and hospital. And I can tell you that people come from all around the state to use the hospital and plan near me. The pharmacy there is a nightmare wait!
  6. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Well talked to my psychiatric today and he told me that the local health dept should be able to help me get my medications until I get approved for medicaid for the disabled. First I have heard of this but he says they do it all the time. They just send him some forms and he fills them out and they get them from the manufacturers.

    He is also convinced I will have no problem getting disability. LOL. Ok doctor. Your mouth to gods ear. I have two docs now telling me this so maybe. My biggest hope is the fact that I have the arthritis of the major weightbearing joints. That is the number one reason listed for getting it and bipolar is number 6. So I have number 1 and number 6. And two docs saying I cant work. Number 3 is the gp who is going along with the specialists opinions.

    Im gonna call my health dept tomorrow to see about the pharmacy stuff.
  7. OTE

    OTE Active Member

    yes, the pharmacy that the health dept is using is going through the same programs as on needymeds.com.
  8. GoingNorth

    GoingNorth Crazy Cat Lady

    When husband was approved for SSDI two years before his death (having a terminal illness is sort of a gauranteed approval, by the way) all the 'medicare' stuff came to him automatically. We did not go with medicare due to the costs and the like and due to the fact that my employee ins. picked up the stuff SSDI and medicare didn't cover.

    Drugwise, it can be a bad scene. SSDI and regular medicare do not cover drugs. You have to go with some sort of 'part B' provider. It was in part the 25K per year for husband's medications that cost me our house.

    I am not sure how it works for arthritis though I should be as I am facing multiple joint replacements in my future. I do know that medicAID as is done for folks on welfare has gotten really stickly about arthritis as involves overweight of any kind, past history and the like. One sort of has to prove that one hasn't brought one's problems on oneself.
  9. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Kat...that simply isnt true.

    Morbid obesity is also a disabling condition if it is severe enough and is in the top 40 conditions disability is awarded on.
  10. GoingNorth

    GoingNorth Crazy Cat Lady

    Janet, MORBID obesity is indeed, based on BMI and concurrent symptoms, a qualifier. It is 'obestity' or being 'overweight' or what makes people percieve you as 'fat and lazy' as opposed to 'can't help it, you're ill' that makes the difference.

    The thing with arthritis is that you can be fifty or so pounds overweight, it is beating crap out of your joints, but if you don't hit that BMI figure, tough luck.

    It is almost as if you are expected to gain more weight intentionally in order to be 'really sick' as opposed to 'just' being fat.

    My 'dad' died of morbid obesity in '81. He was 48 years old.

    Thing of it is that at least for me, I can feel as little as a five pound change in weight on my joints, and feel it strongly.

    With ins you get this sort of 'chinese menu' thing where they might say, BMI of xxx+symptomology+MH status...and yes, with ins caps, lobbying, and all the like, there IS a strong movement towards 'you caught it, you clean it' when it comes to benefits.
  11. OTE

    OTE Active Member

    Janet, I don't know anything about the Medicaid for disabled adults that you refer to.

    But Kat does make a point which is that SSDI and SSI use the same qualifications in terms of approving disability. The Medicaid that you are referring to I assume is administered by the state rather than fed. So it's possible that the state could be using different rules for qualification. eg my difficult child gets SSI/ Medicaid on the basis of the qualification we did several years ago in another state.... which refers to functional ability. The Residential Treatment Center (RTC) which is paid by state authorized Medicaid is a different process and doesn't look at the same qualifiers as SSI. They're looking at psychiatric reports referring to depth of illness, chances of recovery, safety of community, etc.