I hate talking about my private life but I think I'll risk it. My monthly benefit is $575. $100 of that goes to Medicare. I normally see my doctor twice a year. For each visit I pay almost $75 while Medicare pays $25. I haven't used the hospitalization part but I suspect that it wouldn't cover much more percentage wise than what they pay my doctor. It just doesn't seem worth it. Am I doing it wrong or is Medicare just really not worth the cost?

[Yoda]

George, have you talked to your state's DHHR to see if you qualify for assistance to help pay for the insurance and/or help with copays?

I live in Texas... not even sure we have a DHHR. Our leaders don't even want to accept Medicaid funding from the feds.

[Yoda]

Well that sucks. I live in WV which has better funding for medicaid and low income benefits. My son works minimum wage about 25 hours/week (his employer keeps him under 30/week so they don't have to pay benefits ) and he gets medicaid coverage for doctor, hospital and prescription meds.

You should move here.

[Raindropvampire]

My dad called SHIP (State Health Insurance Assistance Program). The guy he talked to was able to cut what he paid by 75% per month. I got this number from their website because it is state specific Phone: 800-252-9240, there's a number for Austin but it's missing a digit sorry

I hope if you try them they can get you a deal like my dad got but I don't know what differs state to state.

[Perna]

Insurance is for the bigger, more expensive problems that we can't know when/if they will happen, just like car insurance is for accidents. My husband was fond of saying he could afford a broken arm but not a heart transplant :-) When I was self-insured I had to pay $400-$500 a month and my deductible was so large that I never met it. How much the doctor can bill is governed by insurance whereas if one doesn't have it the fee is much larger; one is part of a group with insurance so gets the group rate.

[unaluna]

If youre disabled you are eligible for medicaid. I dont know HOW disabled you have to be, but this is what it looks like from the first screen.

[Yoda]

Originally Posted by unaluna

If youre disabled you are eligible for medicaid. I dont know HOW disabled you have to be, but this is what it looks like from the first screen.

If you're disabled you may be eligible for medicaid.

I get SSDI disability and have medicare but not medicaid.

.

[Nammu]

I live in tx too. If you are low income and disabled you can get help....even here. They have three different programs. You apply through tx health and human services. ( google that and the web site will come up and give you the info) All three of the program will pay the premium for you. The more you qualify for the more they cover. The basic one just covers the premium, the next one help pay for medications and the most comprehensive one cover both plus the co-pays.

[unaluna]

Originally Posted by Yoda

If you're disabled you may be eligible for medicaid.

I get SSDI disability and have medicare but not medicaid.

.

Thanks. Same here. Georges benefit looks like it might qualify. I found more - its confusing! - but basically you have to apply to the state if you will be disabled for more than a year, and see if you fulfill their other disability requirements, to get texas disability medicaid.

Originally Posted by George H.

I hate talking about my private life but I think I'll risk it. My monthly benefit is $575. $100 of that goes to Medicare. I normally see my doctor twice a year. For each visit I pay almost $75 while Medicare pays $25. I haven't used the hospitalization part but I suspect that it wouldn't cover much more percentage wise than what they pay my doctor. It just doesn't seem worth it. Am I doing it wrong or is Medicare just really not worth the cost?

That's pretty outrageous. I understand, now, what you mean about Medicare "premium" - Part B coverage. I thought that you were paying that to a PPO/HMO for Medicare administration.

In my state, you would receive your SSDI benefit, a state SSI benefit and Medicaid. And a plethora of other benefits. That $575 SSDI benefit must be the across-the-board low-ball for SSDI as that's exactly how much one of my neighbors draws. But he receives a $423 SSI monthly benefit which is in addition to receiving Medicaid, which makes his monthly Medicare Part B (& D?) payment. He also receives $180+ in "food stamps" monthly, gets the frozen meals-on-wheels cases weekly, has a housekeeper out 3 times a week and he pays no medical or pharmaceutical co-pays.

I'm not eligible for any food assistance or SSI but I do have Medicaid which, along with my Medicare, pays for everything else health related. I just wish that I could get some false teeth. No one covers teeth, it seems.

Texas is Texas, I know. My late father's ancestral homeland for 200 years. It just seems as if you should be able to draw more benefits than you currently do. I don't know your disability but there are frequently just generalised non-profit agencies for the disabled who know of programs that might help and may even be so good at getting through the applications and red tape that it may be a matter of signing your name on a 40-page document.

I started out withe such a non-profit, something Independent Living Agency (or close). In the end, the only thing that they did for me was to find me a nice used sofa. I did everything else from my nursing home bed with an old laptop.

A lot will depend on your current living conditions, but surely you would qualify for more assistance! If you like, I can check with some of the agencies that I've dealt with here and see if they have counterparts in Texas?

You're not doing anything wrong... you just didn't have anyone to give you a jump-start.

Thanks but at this point i don't really care anymore. I'mjust about done here

[flockpride]

Originally Posted by George H.

I live in Texas... not even sure we have a DHHR. Our leaders don't even want to accept Medicaid funding from the feds.

Texas says it all.

[Nammu]

Is there someone IRL you can talk to George? You sound utterly dejected. You can always pm me or other on PC you know.

Thanks, that's very kind. I'm fine. I'm not happy and have had plans for drastic change for a long time. It's only the time frame that is unsettled. There always seems to be a cat to consider

[Nammu]

May a kingdom of cats find their way to your home then.

[jaynedough]

This is a copy and paste of what I just posted on another thread. Sorry for the redundancy.

As a low income person, I'm eligible for partial Medicaid. It's called Special Low income Medicare Beneficiary (SLMB- not sure where the "I" went ). They pay for my Medicare premiums. There's also Qualified Medical Beneficiaries (QMB). Not sure what that is.

I am by no means an expert on this, and I believe it may vary from state to state, but it is worth looking into. They don't count things like a car or house ownership against you. It's been a godsend for me.

I also have "special help with Medicare pt D" (Rx insurance) that pays most of that premium, as well as a fair chunk of copays and deductibles.

You should be able to find information on these programs, including income limits, online.

Those managed care, hmo-type plans are something to look into, as ciderguy mentioned.

This will give you a lot of places to help you with your questions:

https://www.medicare.gov/contacts/

Thank you. I've only looked at a few things there but I wanted to share something.
I clicked this link https://www.medicare.gov/contacts/#resources/msps and then clicked on Texas. The first thing you see is an announcement for an "...initiative will strengthen the effort to root out fraud, waste and abuse in Texas Medicaid by building a community policing framework structured on a statewide integrity network.
I clicked on some other states and they begin with a welcome and info about services and things they are doing to improve.

[Travelinglady]

I know it's frustrating, but don't give up! Live long enough and you'll beat the system. I find Medicare to be a blessing, given I didn't plan on becoming disabled in my middle years. Is there a medicare office near you?

[shortandcute]

Originally Posted by George H.

I hate talking about my private life but I think I'll risk it. My monthly benefit is $575. $100 of that goes to Medicare. I normally see my doctor twice a year. For each visit I pay almost $75 while Medicare pays $25. I haven't used the hospitalization part but I suspect that it wouldn't cover much more percentage wise than what they pay my doctor. It just doesn't seem worth it. Am I doing it wrong or is Medicare just really not worth the cost?

Well, the whole Medicare system is wacky nowadays. My brother in law is in very poor health. He gets 900 dollars a month, and $450 goes to Medicare. And then he has a $7,000 spend-down! And he and my sister are very studious with book keeping. So, it's not you.

[anxiety247]

Medicare IMO is great if you need surgery. If you need continuous mental health care not so good. I get SSDI and depending on my financial situation the state will pay the Medicare premium. However with the income I get from SSDI - I "could" get Medicaid if I met a spend down of over 600$ a month.

More of the services I need are on the Medicaid approved side
~ Rides to appts
~ Home care (none mental health related spine injury)
~ IOP/PHP programs (Medicare you still have to pay the daily co-pays)
~ Dental (no teeth - that does wonders to someones mental health)

From my understanding
SSI is for those who do not have the needed work credits (SSDI) they get medicaid
SSDI - is for those who have earned the work credits. We get Medicare.

To me it seems those who get Medicaid(through SSI) have better access to health care than those who busted their butts most of their lives and are giving this broken insurance they call Medicare.

We all should have equal health opportunities