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Medicaid - what's it really worth?

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  • Medicaid - what's it really worth?

    Hello all,

    C5/6 here, 23 months post. ​​How much is Medicaid really worth to folks that are a couple of years out and beyond? I'm considering moving out of Massachusetts to save on housing, but won't be eligible to buy-in in other states.

    I have private BCBS insurance through my employer with Massachusetts MassHealth Medicaid buy-in as a backup ($730/mo), and will become eligible for Medicare this fall. It will take the place of Medicaid as my secondary backup, but I will still have the option to buy into Massachusetts Medicaid as a tertiary coverage. Medicaid currently provides me 70 hrs/week of PCA support, as well as support for my medications and hospitalizations. In these first two years of recovery I think it has been a great asset, and I've barely paid anything out-of-pocket despite a whole host of early health problems. I've heard Medicare isn't nearly as generous, though admittedly I haven't experienced it yet. Would it all balance out with the less generous Medicare for free vs. the more generous Medicaid at an expensive buy-in cost, or would only a fool throw away one of the most generous Medicaid programs in the country? Everyone complains about Medicare, but I don't have a great sense of how much I'd really lose.

    Thanks,
    Emmett
    C5/6 complete (maybe) circa June 2018

  • #2
    Medicare is a wonderful program. I have a secondary with AARP/United Healthcare Ins co and pretty much everything in my hugely expensive past has been covered.

    But I seem to remember hearing something about Medicaid, which is generally poorer insurance than Medicare, covering things like PCAs better than Medicare.
    I advise real clarity lest you cut off a needed benefit, but IMO, everybody in us US should have Medicare!

    Whimsical thought: When Medicare came about, the insurance companies must have celebrated! Uncle Sam cleared the field of the halt, the lame and the geriatric cases, or put otherwise, the very most expensive people to insure, leaving the insurance companies with the young and healthy.............and still they screwed the pooch!

    I still can't understand how Medicare for all could not work. It is slowly going bankrupt while tending to folk that must cost ten times as much as other folk!
    If everybody was in it would have to work. In most developed countries, they have socialized medicine, their outcomes are better than ours, and the cost is about 1/3 of ours.
    What IS the problem?

    Sorry for the thread-crap. Due to recent events, some old wounds are getting scratched!
    The revolution will NOT be televised!

    Now, back to our usual programming
    69yo male T12 complete since 1995
    NW NJ

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    • #3
      Medicare does not cover PCAs at all. They will cover very limited home skilled nursing visits (such as catheter changes or wound care) but not personal care like dressing, bathing, transfers, etc. I would be surprised if this is covered by your BCBS either.

      Why would you not be eligible for Medicaid in other states? Most do have a wait time for you to establish residency before you can apply (in my state it is 30 days), but if your income is low enough and your assets low enough, you would be wise to apply. Technically, Medicaid does not pay for PCA care in most states, but being eligible for Medicaid allows you to apply for the state's Medicaid waiver program that covers PCA care. How much care you get varies widely from state to state, and even between counties. In CA, a social worker determines how many hours you get, which can be problematic if they don't understand SCI care needs.

      You can compare state Medicaid program coverage here: https://www.kff.org/statedata/collec...caid-benefits/

      In addition, if you quality for Medicaid, it pays your premium for Medicare Part A and becomes your secondary insurance for Part B and D.

      I would strongly encourage you to contact a benefits counselor at the Independent Living Center closest to where you are considering moving to discuss your options before you make a move. You can find a list here: https://www.ilru.org/projects/cil-ne...tion-directory

      (KLD)
      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      • #4
        medicare for me is good but I am healthy its cost me 145.00 a month my meds are 29.00 for 3 months , but again I am very healthy c6c7 my supplies are 129.00 for 3 month but I I pay my caregiver 15.00 a hr but I use her 1 hr a day for 5 days. I love florida no property taxes which is a raise for me 2500.00 a year I don/t have to save for. I would not be able to afford 730. a month ins

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        • #5
          Medicare and Medicaid are very complex. I would advise having both as Medicare is the disability. I would call Medicare and ask them questions. If you are 23 months post injury, you will be eligible in a month for Medicare. Each state is different and it is all based on income. And if possible have Medicare for disability then Medicaid for back up. But if you leave the state then you would not be covered but Medicare is national, some even international.
          My brother has Medicare disability and he loves the Advantage Plans. And personally Medicare is better than my BCBS policy. They started charging 15% for any outpatient surgery. I never have any procedure/minor surgery without paying $1500. AND I have the "best" policy with their PPO. I can't wait till I am old enough for Medicare- Part A is free-or that is what you paid into, Part B & D are what you pay for.
          Or as KLD recommended a financial counselor.
          CWO
          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

          Comment


          • #6
            Originally posted by SCI-Nurse View Post
            I can't wait till I am old enough for Medicare- Part A is free-or that is what you paid into, Part B & D are what you pay for.
            CWO
            Haha, be careful what you wish for, my dear. There could be some downside to that...

            Comment


            • #7
              If you get Medicare, it will be considered your primary insurance and only covers 80% of what it approves. NO homecare except hospice. 2 years ago I got 10 in home therapy sessions which were useless. No stretch, they just watch you exercise. Supplemental ins. to cover the 20% and RX cost me $420 a month plus $145 for medicare. Also I have noticed Medicare is cutting what they pay. Example; 2014 I got a powerchair, retail over $45k, Medicare allowed about $25k of which I was responsible for 20%. 2019 got a new chair, retail $72k, Medicare allowed $20k. This year Medicare stopped paying for my INR tests (2 x a month). I've wanted to call them about this but dread the hoops you have to jump through.

              In my state, Medicaid requires you have $2k or less in the bank plus other restrictions.
              Last edited by Gearhead; 06-07-2020, 07:40 PM. Reason: Last sentence, Medicare was ment to say Medicaid
              Attack life, it's going to kill you anyway
              Steve Mcqueen (Mr Cool)

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              • #8
                Really useful information here across the board. Thanks everyone for your insights! I was actually hoping for an excuse to move, but it sounds like that will inevitably be a really hard decision. Got to put on my thinking cap...
                C5/6 complete (maybe) circa June 2018

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