MEDICAID TRANSITION TO MEDICARE RESOURCE S

[jr27196808]

Good morning,

I am working through the New Member Medicare Book I received in the mail.

Medically I qualify for Social Security Disability. The State of Florida has me on 100% benefits with Medicaid. I am working with a pharmacist to evaluate my medications needed over a 12 month annual period. She says she can look at those numbers with a program that checks it against the Medicare database. 

I would really appreciate any other resources anyone would like to share with the community,  that I can contact with regards to my transition? 

I know You know, how thrilled I am making a change to my new Medicare Insurance provider.

I am have been fortunate the State of Florida took care of me. Most all medications and treatments are covered by the State.  For the past couple of years, most of the experience has been very positive with working with the State.

However, working with Dedicated providers for Dedicated Areas around the state of Florida is an absolute nightmare. Each Dedicated provider has their ways of not paying the full billable rate to the "Doctors" and or their "Services" fee. This keeps the Client/Patient lacking in medical attention and extremely long wait periods to see a referral doctor. Enough said, I know I am not the only one feeling this rub by Big Business.

Please share any construction advice.

Have a fine day, and a better tomorrow,

Jack Robinson

"Faith Is Everything"

[GailL1]

Just a couple of points -

You said you were on disability - so I will assume that you have been declared disabled and receiving SSDI for the past 24 months - that’s when people on SSDI and are less than 65 can get Medicare in most cases.

Medicaid (only) for the disabled has different eligibility criteria than being dual eligible  - Meaning being on Medicare with Medicaid being the 2nd payer.  This MAY bring up some transition problems.  Problems MAY appear because what you are required to pay for Medicare Part B premiums unless your income is low and you qualify for a Medicare Savings Program.

The income eligibility limits at this Medicare link haven’t been updated yet - they are still showing the 2022 income eligibility for the different programs but your state Medicaid office should know the new income eligibility levels for the

Medicare Savings Program

The Medicare Part B premium for 2023 is $ 164.50 and it will be deducted from your Social Security Benefit unless you can qualify (income & resources) for one of these Medicare Savings Programs or some other way the state qualifies you for Medicaid, if there is one.

So your goal is to become a dual eligible for Medicare AND Medicaid.

Then you have to decide how you want to get your benefits - I don’t know the Florida choices for Dual Eligibles Medicare beneficiaries.  Depending on the plan, there MAYBE networks of providers that have to be utilized. There are specialized Medicare Advantage plans geared towards Dual Eligibles.  There are other specialized Medicare Advantage plans that are geared towards special health conditions, mostly chronic - Special Needs Plans.  And then there is Original Medicare but I do not know which, if any, Florida’s Medigap plans are open to those less than 65 years old.

Most Medicare Advantage plans have their own built-in formulary for their Prescription Drug coverage.  Traditional Medicare has free-standing Prescription drug plans from which to pick and choose - I will assume that is what your pharmacist is looking into - which plan is best for you and your care.  If he re commends a particular Medicare Advantage plan, double check it for your specific needs - remember the pharmacist is looking at medications - If you have specific docs that you want in your plan, you may need to check the network of providers in the plan.

Work closely with the Medicaid office and you also may want to contact Florida SHIP (State Health Insurance Program) for some guidance.  OR you can also talk to a local Medicare Independent Insurance Broker that is knowledgeable on your situation of dual eligibility.

Good Luck.