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Thread: MediCare and MediCaid/Medi-cal clarified

  1. #1
    Join Date
    Aug 2012
    San Francicsco Bay Area

    MediCare and MediCaid/Medi-cal clarified

    To clarify about MediCaid and Medi-Care:

    If you are on SSDI (Social Security Disability Insurance) then, after you've been disabled for two years, you are Medi-Care eligible. Medi-Care ONLY covers 80% of your medical costs. It also costs $110 per month. It does not cover prescriptions either.

    If you are on SSSI (Social Security Supplemental Insurance) - this is the program for people who do not have enough work credits to get SSDI - then you are put onto MediCaid (called Medi-Cal in California). This is a very limited program and sometimes hard to get treatment. However, it does pay for everything. You usually have to sign up for a plan within MediCaid. These plans are offered by county.

    If you are on SSDI AND SSSI, as I am - called "Co-eligible" then you are put onto MediCare, which only pays 80%, and for the remaining 20%, enrolled in one of three programs called the "QMB programs," or "MediCare Savings Programs," or "Extra Help MediCare." These are run by the state and are MediCal. So, you then have to find a doctor that takes BOTH MediCare AND MediCare. For all intensive purposes, you are still in MediCaid, as who can afford to go to a MediCare doctor and pay the 20%. I also can't afford to buy a supplemental plan. I am WAY below poverty level.

    Sound complicated? It is. I spent two solid weeks on the phone and I still don't have all my questions answered. I need to try to not choose a HMO plan and be in "Original MediCare," so I can see whoever I want. However, that leaves me with a 20% co-pay, which is not feasible. At the moment, I am in a HMO that will not send me to a Scoliosis doctor except for a very old one who didn't know anything, and the only pain management practice they sent me to is so overwhelmed with patients that I have only had one epidural in over a year.

    All the other pain management practices I've contacted don't take Medcaid, only MediCare. Same thing with spinal surgeons. Good thing I stockpiled pain medicines the past two years. I never throw any medicine out in case I need it later.

    And to clarify about the Affordable Care Act: MediCare has NOTHING to so with ObamaCare, neither does SSSI-linked MediCaid.

    Insurance wise, I was better off before I got myself on SSDI and SSSI because, on January 1st, the Affordable Care Act went into effect and anyone who was low-income, regardless of any assets, went onto FREE MAGI (Modified Adjusted Gross Income) Medi-Caid. This is DIFFERENT FROM the Disability or SSI-linked Medicaid.

    Thank you.

  2. #2
    Join Date
    Mar 2005
    Ukiah CA
    Hi table one I do have partnership medical. I had it shince the age of 9 or 10 when I had my back surgery 4 years ago I had the California children services both pay my whole medical bill
    Brace 4-15-05-5-25-06
    Posterior Spinal Fusion 3-10-10
    Before 50T
    After 20T

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