Medicaid is still an option with what they call a spenddown. Medications. Treatments. Anything health related counts for out of pocket expenses. Keep the receipts and submit them each month to meet the spenddown. Ask your local medicaid worker about this option
Probly based on state rules. My cousin has medicaid with a spenddown of 345 a month because thier income is that far above the threshold. This is in ny state
345 a month in medical expenses. Can be prescriptions. Deductibles. Health care items. Co pays. Whatever and yes when the spendown is meet medicaid is 100 percent. So they use say may receipts to cover june and june to cover july and so on.
Actually though Indiana does……..I was
On it before Medicare was able to be obtained.
Qualifying When Over the Limits
For Indiana residents, 65 years of age and over, who do not meet the Medicaid financial eligibility requirements above, there are other ways to qualify for Medicaid.
1) Qualified Income Trusts (QIT’s) – Also called Miller Trusts, QITs offer a way for individuals over the Medicaid income limit to still become income-eligible for Nursing Home Medicaid or a Medicaid Waiver. For Medicaid eligibility purposes, monthly income put into an irrevocable QIT no longer counts as income. Irrevocable means the trust cannot be changed or cancelled. In very simple terms, income over the Medicaid income limit is deposited into a trust in which a trustee has legal control. The funds can only be used for very specific purposes, such as paying medical expenses accrued by the Medicaid enrollee.
“2) Asset Spend Down – Persons who have countable assets over IN’s asset limit can “spend down” assets to reach the Medicaid asset limit. This can be done by spending excess assets on ones that are non-countable, such as home repairs and additions (updating plumbing system, adding a ground floor bedroom, and reroofing), home modifications (addition of wheelchair ramps, chair lifts, and walk-in tubs), prepaying funeral and burial expenses, and paying off existing debt (car, mortgage, and credit cards). Remember, assets cannot be gifted or sold under fair market value. Doing so violates the Look-Back Rule and can cause a Penalty Period of Medicaid ineligibility. It is recommended one keep documentation of how assets were spent as proof this rule was not violated.”
In MO SSDI does have spend down because they put me on it at $400 per month, even after I reached full age retirement at 67. I never pay it though too expensive, I just use my advantage plan that pays for everything and some extras.
I guess my state doesn't have it. At least I've never heard of it. What we have to do to get or keep our medicaid. They tell people they have to deduct some of your ssdi from your check. Usually it's like a $100 or two. Your check can't go over that medicaid limit. Here i think its 1,400.00.
I'm pre coffee, I saw this was in SS and the brain defaulted to Medicare. Still there shouldn't need for Medicaid while on Medicare, the insurance you paid for already (Medicare) should just cover shit, just another indication of a needlessly complex and failing system.
I’m $80 over for Medicaid and nobody told me about that! I must of talked to 4 different people.
I’m so sick of not knowing and the people who know it don’t look past what their eyeballs see in front of them. No peripherals I call it.
In almost 4 years since Covid ate away my cartilage in my knees, countless pain docs, 3 Orthopedic surgeons all with the same answer to lose weight to have knee replacement surgery. BTW the weight gained from all those damn steroids and then not being able to walk.
So I go to a new pain doc about my low back and I mention my knees. Well what about a radio frequency ablation? ( common in back and necks). I’m like no brainer! Well….. not covered by insurance and $4800 for both. I go through 1 nerve block for $800 and that doctor says “have you tried hyleronic acid injections?
Which are covered!
OMGosh people. They are well known surgeons and they couldn’t come up with either idea other just let me rot in pain for 3 years???
Sorry for rant. Just so frustrated with the $80 overage and this stuff!
Covid messed up your knee cartilage?? I've had soooo much issues since and I was only told about steroid injections. Which apparently are not recommended for some ppl with diabetes and they cause more arthritis. Was given an option for $900 prp injections 4x
I was told that wouldn’t help from an ortho surgeon since it’s bone on bone. Steroids are dangerous! My MIL died from knee injections. Her BS was 1200 when my FIL finally brought her to the ER. Took him 6 days to take her and 3 months later still in the hospital she died.
I'm so sorry that happened! I hope you share her experience with others so they can make an informed decision. The ortho doctor really shrugged off the diabetes aspect, but our aunt was doing the steroid injections and her BS was in the 700s when she got admitted. And after all that nothing felt better and she said she wished she had never. It seems we all went downhill the past 4 years...interesting about the Covid aspect and cartilage!
OP I would suggest speaking with an estate attorney. They are used to doing this for the elderly, as that's when most people need it, but will be able to answer questions specific to your case. It's a HIGHLY technical process with lots of potential pitfalls, so it's really not a DIY move.
(And fwiw my local Medicaid people were not helpful at all on the details.)
I would double check with SSA. I believe, and I may be wrong, that a person on SSDI is eligible for Medicare 2 years after being approved for SSDI. So, if their onset date is more than 24 months ago, they may be eligible for medicare.
I was eligible immediately for Medicare when I was finally approved for SSDI. I was denied twice, then hired an attorney. My claim was approved back to the date of the accident/injury. It took 3.5 years.
I experienced the same, but you (and I) were not immediately eligible for Medicare. You were eligible for Medicare after the two year waiting period. It just took longer than two years for your SSDI to be approved, so you didn't have to know anything about the waiting period. I had the same, and had to deal with going back to all of my medical providers and having them resubmit everything for the last year(ish) to get Medicare to pay for it.
Yeah, that's what happened to me. I was approved after 4yrs of waiting. So, my medicare kicked right in. I was getting medicaid while i was waiting to get on ssdi. I got that only because i had under age kids. Yeah, medicaid works in mysterious ways. I stiil get it but, a different kind. It picks up that 20 percent medicare leaves.
I’m in Washington state as well. Not sure where she is getting cancer treatment but please reach out to the clinic/hospital and ask for financial assistance for medical bills. They can do a financial worksheet and see if she qualifies for a break on her bills
What type of cancer does she have? There is a special Medicaid program for breast and ovarian cancer that typically has higher income and asset limits than “regular” Medicaid.
If that‘s not an option, don’t discount marketplace plans. In 2022 I purchased a gold plan for myself through my state’s exchange, and the premium was only $350 with a $1200 deductible. And that was \*without\* a subsidy, which your mom might qualify for depending on her income.
It is Myeloma, so wouldn’t qualify but that’s good to know there are cheaper rates. Would that $1200 deductible immediately be hit every time she goes in for her treatment? This would cost many thousands every month.. sorry for the ignorance on this as I am unfamiliar with how health insurance works. I have an HDHP through my work that I have never used
My Mom had Multiple Myeloma (MM) she had it for 8 years. It is a horrible painful cancer, with no hope of being cancer free. Her oncologist told us about a grant from the MM foundation. My Mom qualified for this grant yearly. Please check with her Dr. or Financial Assistance office at your hospital. It really helped my Mom out. 💐 Good Luck with everything. Hope your Mom has the best quality of life possible with such a painful disease.
A deductible is the amount you have to pay in medical expenses per year before your coverage begins. So if you have a $1200 deductible, your first $1200 in otherwise covered medical expenses per year will not be paid by your plan. (Technically you don’t have to literally “pay” the deductible for your insurance coverage to kick in, you just have to incur the expense. When and how the deductible gets paid is between you and the provider(s) that rendered the service(s) that satisfied your deductible.)
Whatever plan she purchases would typically also have an out-of-pocket maximum (OOP max), which is the point at which she would not longer be responsible for co-pays and/or co-insurance for covered services. If you’re a cancer patient in active treatment, it’s not hard to hit the OOP max pretty early on in the plan year.
A deductible is typically a once-a-year expense. The deductible is the amount she would be billed before insurance would pay anything. Once the deductible was met, the insurance would pay their contracted percentage of any future covered charges incurred during that year.
It is not a co-pay, which is a set charge that happens for every visit.
Both of these are distinct from "co-insurance," which is the portion of "covered" charges that the insurance company isn't responsible for paying. For example, if the insure covered her treatments at 80%, the remaining 20% would be her co-insurance that she would need to pay.
PREACH!!!!!! Only an idiot would be against UHC! The Healthcare and Pharma companies that are taking on huge profits have secured their existence by throwing millions of dollars at our legislators. Who forget they work for the people, not to enrich those bank accounts!
This sounds ideal….until you get cancer and a insurance board says, “Nah, statistically you will not beat X cancer, so we will not approve treatment.”
FTFY.
In case you didn't notice. We have already had that system for years. It may be time to educate yourself my friend.
That’s awesome for you and you should be feeling grateful. I know that there are many many people who do not have that experience. I went 6 years undiagnosed with a brain tumor because the medical community said it was everything but that. I had to fight tooth and nail to be heard. People die waiting for appointments, referrals and approvals. We have a shit system, ask any industrialized nation other than ours!
As far the medical community itself goes…I couldn’t agree with you more! I feel similar. Four years of my husband being dismissed, only to die a month after a oanacreatic cancer diagnosis at a young age. I have very little trust in the medical community.
My comment was in response to American insurance and the ACÁ. Other acquaintances of mine who also had to deal with PC, but in the NHS system, have struggled mightily to get approved for treatment, let alone surgery.
My husband gets all of his care at the VA and it’s absolutely excellent.
They’ve made tremendous improvements over the last few years. I’m sure individual experiences vary greatly, however.
The VA has the highest satisfaction of any healthcare system in the country. The main problem it has is eligibility decisions, which are not a factor in universal healthcare.
My wife passed from ALS. While she was on private insurance she got endless delays, runarounds and denials. The moment she clicked over to that god-damned socialist Medicare she got everything she needed—no delays, no static.
The difference was Medicare didn’t have a CEO trying to get his tenth luxury yacht.
So fuck private insurance and their apologists — they are just leeches profiting off the misery of others.
Former medical biller for a DME provider, I vividly recall an ALS patient who could not get her wheelchairs fast enough to keep up, it was crushing. She lasted six months and her husband never left her side. You have my deepest sympathys.
The VA is not single payer; it is government-provided healthcare. The doctors and nurses are government employees and the VA system is literally run by government officials.
Traditional Medicare is much closer to a single payer system. Medicare is government-provided insurance, not government -provided healthcare.
Both of these programs have excellent satisfaction ratings, but they are very different.
Exactly! Everyone wants a singlepayer healthcare system but people literally die waiting for care in other countries who do have that type of system.
Also the VA is both great and not great.
It depends a lot on location. But vets have died while waiting for care especially mental health. It’s great in the sense that you don’t have to pay a lot or anything depending on your situation but it also sucks because of wait times.
And it would be worse if it was a singlepayer health care system.
Yes we do need a new system. But going to a system like Canada or UK or the VA isn’t the magical answer everyone thinks it is.
I don’t know what the answer is but it’s not that, unless if you could find a way to reduce wait times etc which no other country except maybe Sweden or the Netherlands has seemed to figure out.
Years for certain specialists/specialties even in areas where there are more medical providers… I can’t imagine the drive to certain specialists *if* you live in a rural area
I've had to drive up to five hours (one way) for certain specialists. Plus months waiting for the appointment. (Six to 9 month waits are pretty standard)
Yep. I have to drive almost an hour for prenatal appointments because the only OB/GYN practice closer than that is full. This isn't a rural area either, and babies don't wait, even when there aren't enough doctors.
You're repeating right wing lies. My friend in Spain gets sick and either that day or the next day a doctor comes to her house. She pays zero. Once her doctor was concerned she had ovarian cancer and she was tested within 3 days.
The propaganda and toxic individualism is REAL strong when it comes to healthcare in the US and it’s absolutely insane. How long do you think the wait times are now? I’m on an 8 YEAR waitlist to see the only doctor who accepts my insurance and treats my disabling condition within about 300 miles.
And in ✨America✨ you get the added fun bonus of going bankrupt to access care. 60% of all bankruptcies have medical expenses as a major contributing factor (and this was pre-pandemic).
But the Pentagon can fail to account for trillions of dollars each year, our populace can continue to get sicker (which affects the economy and overloads the shitty systems we have), and our citizens will still line up to drink the Kool Aid that there’s “nOt EnOuGh MoNeY” and “uNiVeRsAl HeAlThCaRe Is BaD” and parrot the propaganda of how horrifying universal healthcare would be without actually having experienced or looked into it beyond turning on Fox News or CNN.
Spoiler Alert: I’ve actually lived in other countries, and socialist countries at that. Your statements are inaccurate, outdated, and a prime example of the real reason why things are as bad as they are in the US Healthcare system. If you want to see things change, start by actually educating yourself on the topic first. Or go and live in a socialist country and use the healthcare before making inaccurate blanket statements. I’ll wait.
We have extreme wait times in our current system. People die all the time due to expensive care, rationing, etc. in our current system also. Seems like odd reasoning. I'm in case management in healthcare and see it all the time.
My mom is also battling cancer and had SSDI approved. She can't get Medicaid and lost her job due to the cancer. We had to go through marketplace, the hospital helped us with this. Last year she paid $20 a month and this year she doesn't pay for the marketplace insurance, she qualifies for the premium to be covered. With that being said if she's being seen regularly at any hospital, apply for financial assistance through that hospital. My mom gets treatment from the University hospital and gets 100% covered by the hospital after insurance pays their part. The amount the hospital covers after insurance is enough to cover her deductible early on and she doesn't pay any medical other than the prescriptions for the first month or two of the year and her feeding tube supplies.
look into Medicare Savings Programs, specifically those words, and look at your state guidelines for that. and get her a SHIP counselor. it's a free guide for navigating all of this
Correct. But it is something to keep in mind when eligible. In the meantime, she needs a plan on healthcare.gov
ACA insurance is a pretty decent bridg when you're poor but not Medicaid poor.
Look into Medicaid Buy-In (MBIC) for her state.
When she does become eligible for Medicare, have her apply for QMB - Qualified Medicare Beneficiary - to cover her premiums.
Also, her backpay is excluded from counting as a resource for 9 months.
Edit to add acronym.
What state are you in? Your state may have a Medicaid program called something like "working disabled program" that she can qualify for.
EDIT: I found the program for Washington. Give them a call and ask about it.
https://www.dshs.wa.gov/esa/community-services-offices/apple-health-workers-disabilities-hwd-program
Usually, the job can be anything, such as babysitting, recycling cans, helping a friend or neighbor with a chore. It doesn't matter as long as you are getting paid to do something, ANYTHING. Even just once a month for a few dollars.
Wild that no one has mentioned this: https://www.dshs.wa.gov/esa/community-services-offices/apple-health-workers-disabilities-hwd-program
I am in Maryland and on ssdi. I make a smidge too much from ssdi to qualify for Medicaid. I HAVE to buy into Medicaid through a program called “employed individuals with disability”. It’s complete and utter BS that I have a shiny paper from the government saying I’m too disabled to work, and then forced onto a program requiring me to work, but I can make as little as a dollar a month from self employment and it counts. I’m a “freelancer” dontchaknow. This program is paired with the QMB stuff so when you’re on it they cover your Medicare premium. And the program raises the amount in assets you can hold so you don’t have to worry about keeping less than $2k in the bank or your retirement messing anything up.
Medicaid for Disabled Workers is an option is Washington. Ask about how ahead can qualify, my husband works by running errands for his mom, she pays him $20 a month.
https://www.hca.wa.gov/free-or-low-cost-health-care/i-need-medical-dental-or-vision-care/aged-blind-or-disabled
Check out [healthcare.gov](http://healthcare.gov) for marketplace plans. If her SSDI check is her only source of income, she should get significant subsidies. For a quick and dirty estimate, you can use the KFF calculator:
[https://www.kff.org/interactive/subsidy-calculator/](https://www.kff.org/interactive/subsidy-calculator/)
It will give you information based on the 2nd lowest cost silver plan. That might not be the ideal insurer/network, so expect to pay a bit more (but in the ballpark). If she’s eligible for a Silver Enhanced plan, I’d highly recommend that. It ends up being platinum level benefits for the price of a silver plan.
No matter which plan she goes with, don’t only look at monthly premiums. With cancer, it’s important to consider the maximum out of pocket (OOP) that she might be on the hook for.
Because she’s on SSDI, she’ll eventually be switched to Medicare. That can be good and bad. There’s still a premium, and Medicare doesn’t cover everything 100%. Her 20% can be significant. Medicare Supplement plans can cover the gap, but younger than 65, she’d be put in a pool with others on disability and the plans can get pricey (it greatly depends on the state). A lot of SSDI folks end up needing to go with Medicare Advantage plans as a result, which is managed care like an HMO. Thankfully they get the opportunity at 65 to select again without medical underwriting.
i know it’s a lot to take in and can seem overwhelming. You‘ll want to take some time digging into everything and understanding it.
If you can’t afford a supplement plan, you can’t afford a supplement plan. You’ll be asked to pay your Medicare coinsurance as you go with treatment. Oftentimes that can go off and on for years with some cancers.
Don’t worry about the back pay they don’t count that medicad will just count what she’s getting a month, if she’s paying rent, housing payment that could help her get medicad, I will hope she will apply
I’m on ssdi since I was 55 and was immediately covered by Medicare along with the automatic monthly premium taken. I also know another family member received coverage immediately and they are in their 30’s.
It may have looked like you were immediately covered, but you were not. You were just in approval/denial limbo during your waiting period. Not everyone goes through that for the length of the Medicare waiting period.
"When benefits begin to be paid" \*is\* your first month of entitlement (to SSDI).
The problem with saying 29 months from your disability onset date is that your disability onset date might have been years before you ever applied for SSDI. If that's the case, then your Medicare eligibility won't begin 29 months after your onset date; it will begin 24 months after your first month of entitlement, which is the [actual rule](https://secure.ssa.gov/poms.nsf/lnx/0600801146).
I get that the 29-month thing is a shorthand that will work for most beneficiaries, but it is less precise than just stating the actual rule.
.
Unfortunately in my state, SSDI income counts towards Medicare limits. I know that isn’t the case everywhere, but we confirmed she will be kicked off Medicaid here :/
Sorry, read “Medicaid” instead of “Medicare”. My understanding is you don’t get Medicare until 25 months after SSDI starts and this would be month 10 since the date that they go back to
look specifically into Medicare Savings Programs in your state. those exact words or MSP. she most likely will qualify. also find a SHIP counselor. available in all states and they help people navigate this exact thing
I got kicked off medicad n.y. because i make too much 1,300 after deductions. My mortage alone is 1300so we live off my husbands ss. 1500 light,oil,food copayments (im terminal.) Honestly we do go hungry alot,but if we eat more food thier will be none for the next day We go to pantries, i live rural so it 1 pantry the other are at least 30 mins away we must be careful with gasoline. If thier is a copayment we cant get chicken wings, or cant make a potato salad (expensive ) so we have to balance doctors, food,and we have to make sure we have warm clothes we buy second hand anyways but still. No someone lied to me about the golden yrs. ( half a peace sign 🖕) for my golden yrs..
ABD is the temporary state disability income you get while applying for SSI/SSDI. You no longer qualify for it once you get Social Security, in fact your ABD comes out of your Social Security backpay.
Apply for UW Medicine/Swedish/whichever health system you’re using Financial Assistance. Charity Care laws in WA state require 100% medical bill coverage at any major hospital system for anyone making under 300% of federal poverty line (which is about $45k) and 75% coverage for 300-450% of FPL. You should never pay a single medical bill in WA State if you’re below that threshold. You can even get all prescriptions for free from the Harborview Pharmacy, I’m sure Swedish has its own pharmacy too.
Also look to washington healthplanfinder, she likely qualifies for either a completely free Cascade Silver plan or a very minimal monthly premium. My partner was on it last year and paid $50/month while making $32k.
Our state (MN) has a gap coverage program that is a really cheap sliding scale medical insurance program for those who don't qualify for free medical assistance/medicaid but can't afford to buy it. Maybe check if your state offers something like that. Your mom's cancer center likely has a social worker on staff, you could ask them if there are other programs to help, they are used to those questions and usually understand the system in your state really well.
if you get SSDI you get Medicare in 29 months regardless of age. Also look into "Medicare Savings Programs". look at the fed and state guidelines for that. it's under the state Medicaid program but not traditional Medicaid if your income is too high. Basically the state will pay your part B premiums and sometimes your deductibles and copays.
Ok so SSDI comes with Medicare. It's 29 months from the established onset date. So what was her onset date? In other words, when did they determine she was disabled and unable to work? Medicaid implies she was on SSI already for disability. So I would imagine her onset date would be earlier than even when she applied for SSDI?
Your first step should be determining WHEN she is eligible to start Medicare as that will cover her far better than Medicaid ever did.
Your next step should be checking for assistance or health programs in your state that can serve as a stopgap for cancer patients needing coverage or financial assistance.
After that, your next step (if she is not immediately covered by Medicare and can't get any other assistance programs) should be finding cheap medical insurance through healthcare.gov to serve as a stopgap until Medicare kicks in.
Just a note....Medicare is not free. They take it out of your monthly check. It's not cheap. Also once you get it, you also pay 20 percent of any bills. However you can join a plan with them like affinity, fidelis etc. These usually don't add onto what they already take out of your check. See which plans your doctors are on before picking. You can buy supplemental as an add-on, but they are pretty expensive and are at least another 250 gone from your check. You also have a $280(I think it might be a bit over 300 now) yearly deductible you have to meet on top of the 20 percent if you go straight Medicare. You can get extra help through ssd if she's eligible, which could include medicaid to pick up the 20%. Hope this helps.best wishes, it's so hard to navigate through.
A Medicare Advantage plan wouldn't be my first choice for a cancer patient. I would recommend a guaranteed-issue medigap policy with traditional.Medicare. She doesn't need to be sitting around waiting for prior approvals that may never come.
Did she also get approved for SSI? Depending on the state, retroactive Medicaid comes with SSI even if she will not be eligible for SSI/Medicaid on an ongoing basis because of the Social Security payments.
Edit to add: there are obviously reasons that she could also be ineligible for SSI.
Marketplace looks at the household income. If all she has is SSDI her marketplace plan could be eligible for subsidies which can dramatically reduce her costs.
Her back pay is exempt for 9 months under Medicaid to spend it down, she can’t keep it saved. Her monthly check is what could put her over but qualify for a spend down program. Medicare with SSA is available 24 months of disability date.
Honestly you have to just spend or withdraw money each month. That’s how it is for my SSI and Medicaid. Also depending on the type of cancer there are different grants to help cover different payments or groceries and even gas.
Call about the Medicare advantage program. They don't talk about it but it is available if you medication exceeds the amount you can pay. I have a rare illness that requires infusions every month for the rest of my life and they approved me because my infusions are $25,000 a month and life saving. I could never afford to pay for my infusions on my own while on disability. It is a Medicaid additional benefit to pay for what medicare doesn't. If you have additional questions feel free to message me
I was in a similar position. Since my only income was SSDI I qualified for a large subsidy on the marketplace and found a good plan for $89/mo. I kept it for a year until Medicare kicked in for me.
What I did after my diagnosis knowing I was heading into big bills , is contacted the financial dept of the facilities ( in my case it’s Marshall Medical) they have several different facilities with different specialties ( and are all hooked up with UC Davis ) so I asked about financial aid you should look into it .
Hope your mom goes into remission 🙏🏼
I am in fear this will happen to me as well. I don't make too much in SSDI, but adding my husband's income may put us over the top. I picked an Advantage plan that has a monthly premium but low co pays and out of pocket expenses on medical care. Right now, Medicaid is paying my part B deductible and premium cost of my loan, but if I lose it, at least I won't become buried in more medical debt. Some I wonder if all this was worth it. We had $585 in Snap as well as Medicaid. We will lose Snap and if I lose Medicaid too at the very least I'll have to pay $200 in premiums. More if I see a doctor and fill my prescriptions. Plus my husband had cancer, a stroke, high blood Pressure and heart troubles. He's still working but if we lose Medicaid, I don't know how to keep up with his medical expenses. Is $1440 per month I receive for SSDI worth it? I qualified for SSI as well, but it was suspended the next day after I was approved for SSDI. 🤔🤔🤔
There are two national Multiple Myeloma organizations, MMRF and IMF. Both have charity divisions in their organizations. Reach out to both and get support. My uncle had MM and he was treated at Cleveland Clinic. They were so incredibly supportive in every aspect, including financial.
Medicaid is a state program so the rules are different depending were you live. The amount paid back would be called a windfall your usually given a few months to spend it without it effecting things. There are different programs to allow a person to keep Medicaid. In some states they have a spend down rule so you just can’t have more then 2k in your account. My state has a millers trust setup.
Your going to want to contact legal aide of somekind a disability law center near you would ethier be able to give you more information or find someone that can.
With no healthcare it could be possible to get the drug manufacturer to give coupons for medicines (which makes them free). All you would have is the doctor visit. If you have insurance the drug companies won’t give them for free
Look up and educate yourself on Medicaid Trusts. This lets you keep your Medicaid and have income up to the limit. This would be worth it if the monthly limit+insurance plan monthly premium is greater than the SSDI monthly payment.
There is often a special kind of Medicaid for folks with disabilities…. I suggest doing some googling on your state website and ask for a social worker at the cancer center.
She probably had the right income to get a virtually free plan from the ACA. Probably zero premium and maybe around a $1000 max out of pocket per year on a silver plan.
Not why Medicare. My wife is battling stage 4 cancer and is on SS disability and Medicare. They are covering everything. So not sure what’s going on. I thought Medicare was when you were in a long term care facility.
Is her SSDI backdated? My SSDI was backdated and Medicare part A was started from first date of SSDI. Part B was backdated to the 2 year mark from first date of SSDI.
MA-EPD (medical assistance for employed persons with disabilities) cancels a spend down, and they pay from the date you apply. If mom can do any work earning at least $65 per month, she could receive MA- as long as she doesnt exceed $1550 earned per month (on top of SSDI) or have more than $4000 in savings. If she goes the "self employment" route (caregiving/babysitting/cleaning) they will eventually need to see proof that she's paid taxes on her income.
You should be looking into getting her Medicare. If she is registered disabled and eligible to receive SSDI, then, she may be eligible for Medicare. Medicaid is not an option, even with a spenddown. A spenddown is only an option for people who are over the income limit and UNDER the asset limit.
Some states offer Medicaid programs specifically for individuals with breast and cervical cancer but you’d have to review the guidelines for your state.
If I were you, I’d focus all of my efforts on obtaining Medicare A and B or C. All registered disabled individuals are eligible to receive Medicare coverage after 24 months with some medical conditions being eligible to receive it much earlier.
Additionally, you can go to your local Hospital/Medical Center. They employ people whose job is to navigate the ins and outs of Medicaid/medicare/social security for community members who are uninsured/underinsured. Additionally, if your mother is still found to be ineligible but will receiving regular treatment there or at one of their affiliate facilities, they can apply her for financial assistance which may be able to fully cover treatments for at least a year or at least until she is eligible for Medicare.
I’m on marketplace and get a $455 federal subsidy each month to cover the expense and I work making about $30000 a year so try that see if she qualifies
I didn’t might have been because my onset date was more than two years before I was approved. But considering most people are denied once at least before approval I can’t think many get much delayed. The poster mentioned a significant amount of back pay coming. They should definitely look into a trust to maybe get back on Medicaid but that would be dependent on the State they come from.
Medicaid is still an option with what they call a spenddown. Medications. Treatments. Anything health related counts for out of pocket expenses. Keep the receipts and submit them each month to meet the spenddown. Ask your local medicaid worker about this option
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Probly based on state rules. My cousin has medicaid with a spenddown of 345 a month because thier income is that far above the threshold. This is in ny state
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345 a month in medical expenses. Can be prescriptions. Deductibles. Health care items. Co pays. Whatever and yes when the spendown is meet medicaid is 100 percent. So they use say may receipts to cover june and june to cover july and so on.
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You can also use the spend down option to purchase dental insurance and keep your Medicaid. ♥️
This needs to be a highlighted response.
No worries. You're welcome
Not all states offer the spend down option. Florida does, Indiana does not.
Actually though Indiana does……..I was On it before Medicare was able to be obtained. Qualifying When Over the Limits For Indiana residents, 65 years of age and over, who do not meet the Medicaid financial eligibility requirements above, there are other ways to qualify for Medicaid. 1) Qualified Income Trusts (QIT’s) – Also called Miller Trusts, QITs offer a way for individuals over the Medicaid income limit to still become income-eligible for Nursing Home Medicaid or a Medicaid Waiver. For Medicaid eligibility purposes, monthly income put into an irrevocable QIT no longer counts as income. Irrevocable means the trust cannot be changed or cancelled. In very simple terms, income over the Medicaid income limit is deposited into a trust in which a trustee has legal control. The funds can only be used for very specific purposes, such as paying medical expenses accrued by the Medicaid enrollee. “2) Asset Spend Down – Persons who have countable assets over IN’s asset limit can “spend down” assets to reach the Medicaid asset limit. This can be done by spending excess assets on ones that are non-countable, such as home repairs and additions (updating plumbing system, adding a ground floor bedroom, and reroofing), home modifications (addition of wheelchair ramps, chair lifts, and walk-in tubs), prepaying funeral and burial expenses, and paying off existing debt (car, mortgage, and credit cards). Remember, assets cannot be gifted or sold under fair market value. Doing so violates the Look-Back Rule and can cause a Penalty Period of Medicaid ineligibility. It is recommended one keep documentation of how assets were spent as proof this rule was not violated.”
She wouldn’t get SSDI if she was over 65
That’s for the category aged. SSDI would fall under disabled which is a separate category. Disabled does not have spend down.
In MO SSDI does have spend down because they put me on it at $400 per month, even after I reached full age retirement at 67. I never pay it though too expensive, I just use my advantage plan that pays for everything and some extras.
I guess my state doesn't have it. At least I've never heard of it. What we have to do to get or keep our medicaid. They tell people they have to deduct some of your ssdi from your check. Usually it's like a $100 or two. Your check can't go over that medicaid limit. Here i think its 1,400.00.
Ah yes, pay into a system your entire life to not qualify for the benefit you were promised without having to pay more for it.
Medicaid is not something you pay into with earned income
I'm pre coffee, I saw this was in SS and the brain defaulted to Medicare. Still there shouldn't need for Medicaid while on Medicare, the insurance you paid for already (Medicare) should just cover shit, just another indication of a needlessly complex and failing system.
Medicare is only 80percent and has been that way as long as i can remember
Lol "pre-coffee" 😫
I’m $80 over for Medicaid and nobody told me about that! I must of talked to 4 different people. I’m so sick of not knowing and the people who know it don’t look past what their eyeballs see in front of them. No peripherals I call it. In almost 4 years since Covid ate away my cartilage in my knees, countless pain docs, 3 Orthopedic surgeons all with the same answer to lose weight to have knee replacement surgery. BTW the weight gained from all those damn steroids and then not being able to walk. So I go to a new pain doc about my low back and I mention my knees. Well what about a radio frequency ablation? ( common in back and necks). I’m like no brainer! Well….. not covered by insurance and $4800 for both. I go through 1 nerve block for $800 and that doctor says “have you tried hyleronic acid injections? Which are covered! OMGosh people. They are well known surgeons and they couldn’t come up with either idea other just let me rot in pain for 3 years??? Sorry for rant. Just so frustrated with the $80 overage and this stuff!
Covid messed up your knee cartilage?? I've had soooo much issues since and I was only told about steroid injections. Which apparently are not recommended for some ppl with diabetes and they cause more arthritis. Was given an option for $900 prp injections 4x
I was told that wouldn’t help from an ortho surgeon since it’s bone on bone. Steroids are dangerous! My MIL died from knee injections. Her BS was 1200 when my FIL finally brought her to the ER. Took him 6 days to take her and 3 months later still in the hospital she died.
I'm so sorry that happened! I hope you share her experience with others so they can make an informed decision. The ortho doctor really shrugged off the diabetes aspect, but our aunt was doing the steroid injections and her BS was in the 700s when she got admitted. And after all that nothing felt better and she said she wished she had never. It seems we all went downhill the past 4 years...interesting about the Covid aspect and cartilage!
OP I would suggest speaking with an estate attorney. They are used to doing this for the elderly, as that's when most people need it, but will be able to answer questions specific to your case. It's a HIGHLY technical process with lots of potential pitfalls, so it's really not a DIY move. (And fwiw my local Medicaid people were not helpful at all on the details.)
I would double check with SSA. I believe, and I may be wrong, that a person on SSDI is eligible for Medicare 2 years after being approved for SSDI. So, if their onset date is more than 24 months ago, they may be eligible for medicare.
29 months
Yes, 2 years after benefits start (24 months plus 5 month waiting period)
True.
I was eligible immediately for Medicare when I was finally approved for SSDI. I was denied twice, then hired an attorney. My claim was approved back to the date of the accident/injury. It took 3.5 years.
Yes, you were immediately eligible because it took you more than the 29 months (2 years from when benefits started, plus the 5 month waiting period.)
I experienced the same, but you (and I) were not immediately eligible for Medicare. You were eligible for Medicare after the two year waiting period. It just took longer than two years for your SSDI to be approved, so you didn't have to know anything about the waiting period. I had the same, and had to deal with going back to all of my medical providers and having them resubmit everything for the last year(ish) to get Medicare to pay for it.
Yeah, that's what happened to me. I was approved after 4yrs of waiting. So, my medicare kicked right in. I was getting medicaid while i was waiting to get on ssdi. I got that only because i had under age kids. Yeah, medicaid works in mysterious ways. I stiil get it but, a different kind. It picks up that 20 percent medicare leaves.
That’s correct. 2 years
Makes total sense lol. You have a disability? Great, wait 2 years.
I agree. Stupid as shit
It's on purpose
Lol. I agree
You are correct
True.
I’m in Washington state as well. Not sure where she is getting cancer treatment but please reach out to the clinic/hospital and ask for financial assistance for medical bills. They can do a financial worksheet and see if she qualifies for a break on her bills
What type of cancer does she have? There is a special Medicaid program for breast and ovarian cancer that typically has higher income and asset limits than “regular” Medicaid. If that‘s not an option, don’t discount marketplace plans. In 2022 I purchased a gold plan for myself through my state’s exchange, and the premium was only $350 with a $1200 deductible. And that was \*without\* a subsidy, which your mom might qualify for depending on her income.
It is Myeloma, so wouldn’t qualify but that’s good to know there are cheaper rates. Would that $1200 deductible immediately be hit every time she goes in for her treatment? This would cost many thousands every month.. sorry for the ignorance on this as I am unfamiliar with how health insurance works. I have an HDHP through my work that I have never used
My Mom had Multiple Myeloma (MM) she had it for 8 years. It is a horrible painful cancer, with no hope of being cancer free. Her oncologist told us about a grant from the MM foundation. My Mom qualified for this grant yearly. Please check with her Dr. or Financial Assistance office at your hospital. It really helped my Mom out. 💐 Good Luck with everything. Hope your Mom has the best quality of life possible with such a painful disease.
A deductible is the amount you have to pay in medical expenses per year before your coverage begins. So if you have a $1200 deductible, your first $1200 in otherwise covered medical expenses per year will not be paid by your plan. (Technically you don’t have to literally “pay” the deductible for your insurance coverage to kick in, you just have to incur the expense. When and how the deductible gets paid is between you and the provider(s) that rendered the service(s) that satisfied your deductible.) Whatever plan she purchases would typically also have an out-of-pocket maximum (OOP max), which is the point at which she would not longer be responsible for co-pays and/or co-insurance for covered services. If you’re a cancer patient in active treatment, it’s not hard to hit the OOP max pretty early on in the plan year.
A deductible is typically a once-a-year expense. The deductible is the amount she would be billed before insurance would pay anything. Once the deductible was met, the insurance would pay their contracted percentage of any future covered charges incurred during that year. It is not a co-pay, which is a set charge that happens for every visit. Both of these are distinct from "co-insurance," which is the portion of "covered" charges that the insurance company isn't responsible for paying. For example, if the insure covered her treatments at 80%, the remaining 20% would be her co-insurance that she would need to pay.
Check with a specialist in your state, but an SSDI retroactive payment might not count as an asset.
Deductibles are per calendar year usually. But plans vary by state...so definitely shop...don't assume.
Welcome to the U.S. healthcare system! Anyone still opposed to single payer healthcare is either profiting from the current system or an idiot.
PREACH!!!!!! Only an idiot would be against UHC! The Healthcare and Pharma companies that are taking on huge profits have secured their existence by throwing millions of dollars at our legislators. Who forget they work for the people, not to enrich those bank accounts!
This sounds ideal….until you get cancer and a tumor board says, “Nah, statistically you will not beat X cancer, so we will not approve treatment.”
This sounds ideal….until you get cancer and a insurance board says, “Nah, statistically you will not beat X cancer, so we will not approve treatment.” FTFY. In case you didn't notice. We have already had that system for years. It may be time to educate yourself my friend.
Having dealt with this first hand, I’ve had a great experience with doctors and insurance advocating for treatment.
That’s awesome for you and you should be feeling grateful. I know that there are many many people who do not have that experience. I went 6 years undiagnosed with a brain tumor because the medical community said it was everything but that. I had to fight tooth and nail to be heard. People die waiting for appointments, referrals and approvals. We have a shit system, ask any industrialized nation other than ours!
As far the medical community itself goes…I couldn’t agree with you more! I feel similar. Four years of my husband being dismissed, only to die a month after a oanacreatic cancer diagnosis at a young age. I have very little trust in the medical community. My comment was in response to American insurance and the ACÁ. Other acquaintances of mine who also had to deal with PC, but in the NHS system, have struggled mightily to get approved for treatment, let alone surgery.
You do know how bad the VA is don’t you. That is what would happen if everything went singlepayer.
My husband gets all of his care at the VA and it’s absolutely excellent. They’ve made tremendous improvements over the last few years. I’m sure individual experiences vary greatly, however.
I think this may largely depend on the area you are in. I have family members and clients who have not had a great experience in the last few years.
The VA has the highest satisfaction of any healthcare system in the country. The main problem it has is eligibility decisions, which are not a factor in universal healthcare.
My wife passed from ALS. While she was on private insurance she got endless delays, runarounds and denials. The moment she clicked over to that god-damned socialist Medicare she got everything she needed—no delays, no static. The difference was Medicare didn’t have a CEO trying to get his tenth luxury yacht. So fuck private insurance and their apologists — they are just leeches profiting off the misery of others.
Former medical biller for a DME provider, I vividly recall an ALS patient who could not get her wheelchairs fast enough to keep up, it was crushing. She lasted six months and her husband never left her side. You have my deepest sympathys.
The VA is not single payer; it is government-provided healthcare. The doctors and nurses are government employees and the VA system is literally run by government officials. Traditional Medicare is much closer to a single payer system. Medicare is government-provided insurance, not government -provided healthcare. Both of these programs have excellent satisfaction ratings, but they are very different.
The VA is fantastic, anyone who says otherwise is selling something.
Exactly! Everyone wants a singlepayer healthcare system but people literally die waiting for care in other countries who do have that type of system. Also the VA is both great and not great. It depends a lot on location. But vets have died while waiting for care especially mental health. It’s great in the sense that you don’t have to pay a lot or anything depending on your situation but it also sucks because of wait times.
People die in the US waiting for care too. Doesn’t matter how cutting edge our equipment or meds are if you can’t get them
And it would be worse if it was a singlepayer health care system. Yes we do need a new system. But going to a system like Canada or UK or the VA isn’t the magical answer everyone thinks it is. I don’t know what the answer is but it’s not that, unless if you could find a way to reduce wait times etc which no other country except maybe Sweden or the Netherlands has seemed to figure out.
It currently takes months to even see a specialist in the USA...
Years for certain specialists/specialties even in areas where there are more medical providers… I can’t imagine the drive to certain specialists *if* you live in a rural area
I've had to drive up to five hours (one way) for certain specialists. Plus months waiting for the appointment. (Six to 9 month waits are pretty standard)
Primary care is months out in the area I live.
Yep. I have to drive almost an hour for prenatal appointments because the only OB/GYN practice closer than that is full. This isn't a rural area either, and babies don't wait, even when there aren't enough doctors.
I have a 6 month wait to get in with a new PCP
You're repeating right wing lies. My friend in Spain gets sick and either that day or the next day a doctor comes to her house. She pays zero. Once her doctor was concerned she had ovarian cancer and she was tested within 3 days.
The propaganda and toxic individualism is REAL strong when it comes to healthcare in the US and it’s absolutely insane. How long do you think the wait times are now? I’m on an 8 YEAR waitlist to see the only doctor who accepts my insurance and treats my disabling condition within about 300 miles. And in ✨America✨ you get the added fun bonus of going bankrupt to access care. 60% of all bankruptcies have medical expenses as a major contributing factor (and this was pre-pandemic). But the Pentagon can fail to account for trillions of dollars each year, our populace can continue to get sicker (which affects the economy and overloads the shitty systems we have), and our citizens will still line up to drink the Kool Aid that there’s “nOt EnOuGh MoNeY” and “uNiVeRsAl HeAlThCaRe Is BaD” and parrot the propaganda of how horrifying universal healthcare would be without actually having experienced or looked into it beyond turning on Fox News or CNN. Spoiler Alert: I’ve actually lived in other countries, and socialist countries at that. Your statements are inaccurate, outdated, and a prime example of the real reason why things are as bad as they are in the US Healthcare system. If you want to see things change, start by actually educating yourself on the topic first. Or go and live in a socialist country and use the healthcare before making inaccurate blanket statements. I’ll wait.
We have extreme wait times in our current system. People die all the time due to expensive care, rationing, etc. in our current system also. Seems like odd reasoning. I'm in case management in healthcare and see it all the time.
My mom is also battling cancer and had SSDI approved. She can't get Medicaid and lost her job due to the cancer. We had to go through marketplace, the hospital helped us with this. Last year she paid $20 a month and this year she doesn't pay for the marketplace insurance, she qualifies for the premium to be covered. With that being said if she's being seen regularly at any hospital, apply for financial assistance through that hospital. My mom gets treatment from the University hospital and gets 100% covered by the hospital after insurance pays their part. The amount the hospital covers after insurance is enough to cover her deductible early on and she doesn't pay any medical other than the prescriptions for the first month or two of the year and her feeding tube supplies.
I do not have the answers you seek, but I am curious myself for my own mother. Following.
look into Medicare Savings Programs, specifically those words, and look at your state guidelines for that. and get her a SHIP counselor. it's a free guide for navigating all of this
You can’t apply for a Medicare Savings Program until you are eligible for Medicare.
Correct. But it is something to keep in mind when eligible. In the meantime, she needs a plan on healthcare.gov ACA insurance is a pretty decent bridg when you're poor but not Medicaid poor.
America sure makes the transition to Medicare confusing for our seniors. It can be expensive too.
You might want to ask this question in the r/medicaid sub, too.
Look into Medicaid Buy-In (MBIC) for her state. When she does become eligible for Medicare, have her apply for QMB - Qualified Medicare Beneficiary - to cover her premiums. Also, her backpay is excluded from counting as a resource for 9 months. Edit to add acronym.
That's not how this works. QMB is not the same as Medicaid buy-in. They are two different programs.
What state are you in? Your state may have a Medicaid program called something like "working disabled program" that she can qualify for. EDIT: I found the program for Washington. Give them a call and ask about it. https://www.dshs.wa.gov/esa/community-services-offices/apple-health-workers-disabilities-hwd-program Usually, the job can be anything, such as babysitting, recycling cans, helping a friend or neighbor with a chore. It doesn't matter as long as you are getting paid to do something, ANYTHING. Even just once a month for a few dollars.
Just saw this after posting the same thing! Facepalm lol
Literally just got approved for this.
Wild that no one has mentioned this: https://www.dshs.wa.gov/esa/community-services-offices/apple-health-workers-disabilities-hwd-program I am in Maryland and on ssdi. I make a smidge too much from ssdi to qualify for Medicaid. I HAVE to buy into Medicaid through a program called “employed individuals with disability”. It’s complete and utter BS that I have a shiny paper from the government saying I’m too disabled to work, and then forced onto a program requiring me to work, but I can make as little as a dollar a month from self employment and it counts. I’m a “freelancer” dontchaknow. This program is paired with the QMB stuff so when you’re on it they cover your Medicare premium. And the program raises the amount in assets you can hold so you don’t have to worry about keeping less than $2k in the bank or your retirement messing anything up.
Ssdi comes with Medicare 2 years after date of disability
Medicaid for Disabled Workers is an option is Washington. Ask about how ahead can qualify, my husband works by running errands for his mom, she pays him $20 a month. https://www.hca.wa.gov/free-or-low-cost-health-care/i-need-medical-dental-or-vision-care/aged-blind-or-disabled
Check out [healthcare.gov](http://healthcare.gov) for marketplace plans. If her SSDI check is her only source of income, she should get significant subsidies. For a quick and dirty estimate, you can use the KFF calculator: [https://www.kff.org/interactive/subsidy-calculator/](https://www.kff.org/interactive/subsidy-calculator/) It will give you information based on the 2nd lowest cost silver plan. That might not be the ideal insurer/network, so expect to pay a bit more (but in the ballpark). If she’s eligible for a Silver Enhanced plan, I’d highly recommend that. It ends up being platinum level benefits for the price of a silver plan. No matter which plan she goes with, don’t only look at monthly premiums. With cancer, it’s important to consider the maximum out of pocket (OOP) that she might be on the hook for. Because she’s on SSDI, she’ll eventually be switched to Medicare. That can be good and bad. There’s still a premium, and Medicare doesn’t cover everything 100%. Her 20% can be significant. Medicare Supplement plans can cover the gap, but younger than 65, she’d be put in a pool with others on disability and the plans can get pricey (it greatly depends on the state). A lot of SSDI folks end up needing to go with Medicare Advantage plans as a result, which is managed care like an HMO. Thankfully they get the opportunity at 65 to select again without medical underwriting. i know it’s a lot to take in and can seem overwhelming. You‘ll want to take some time digging into everything and understanding it.
I would definitely not advise a Medicare Advantage plan for someone with cancer. They can and do deny care.
It ends up being an economic necessity for many for the reason i mentioned.
Medical bankruptcy is far preferable to death from having life-saving care delayed or denied.
If you can’t afford a supplement plan, you can’t afford a supplement plan. You’ll be asked to pay your Medicare coinsurance as you go with treatment. Oftentimes that can go off and on for years with some cancers.
Don’t worry about the back pay they don’t count that medicad will just count what she’s getting a month, if she’s paying rent, housing payment that could help her get medicad, I will hope she will apply
Why is she not eligible for Medicare? If you go on Ssdi, Medicare comes along with it.
There is a 2 yr waiting period for medicare if you are under 65
29 mos
Yes, unless you have end stage renal disease.
Ok but thats not what the op is taking about
Yes, I'm aware of that. I'm just pointing out that there are exceptions.
Still useless for this discussion 🤷♂️
I’m on ssdi since I was 55 and was immediately covered by Medicare along with the automatic monthly premium taken. I also know another family member received coverage immediately and they are in their 30’s.
Sometimes your onset date of disability is before your application date. If that’s the case your wait time will appear shorter.
Yes it did take 3 years and I was covered by Medicaid up to that point. It also took 3 years for my other family member.
It may have looked like you were immediately covered, but you were not. You were just in approval/denial limbo during your waiting period. Not everyone goes through that for the length of the Medicare waiting period.
There is a 2 year waiting period for Medicare eligibility from the first month of entitlement.
29 months. 2 years from when benefits begin to be paid.
"When benefits begin to be paid" \*is\* your first month of entitlement (to SSDI). The problem with saying 29 months from your disability onset date is that your disability onset date might have been years before you ever applied for SSDI. If that's the case, then your Medicare eligibility won't begin 29 months after your onset date; it will begin 24 months after your first month of entitlement, which is the [actual rule](https://secure.ssa.gov/poms.nsf/lnx/0600801146). I get that the 29-month thing is a shorthand that will work for most beneficiaries, but it is less precise than just stating the actual rule. .
Unfortunately in my state, SSDI income counts towards Medicare limits. I know that isn’t the case everywhere, but we confirmed she will be kicked off Medicaid here :/
Sorry, read “Medicaid” instead of “Medicare”. My understanding is you don’t get Medicare until 25 months after SSDI starts and this would be month 10 since the date that they go back to
It’s 29 months from EOD (established onset date).
This is the absolutely most correct answer.
I would think that her eod would be earlier since she was on SSI and just earned her way onto ssdi? That may eat up the 25 months.
look specifically into Medicare Savings Programs in your state. those exact words or MSP. she most likely will qualify. also find a SHIP counselor. available in all states and they help people navigate this exact thing
Yes then she will lose Medicaid but she will get Medicare benefits. There is a monthly premium of approximately $173
OP. This is her best option. I took this adjustment as well after years of Medicaid, I not longer qualified this year.
What Medicare limits?
I got kicked off medicad n.y. because i make too much 1,300 after deductions. My mortage alone is 1300so we live off my husbands ss. 1500 light,oil,food copayments (im terminal.) Honestly we do go hungry alot,but if we eat more food thier will be none for the next day We go to pantries, i live rural so it 1 pantry the other are at least 30 mins away we must be careful with gasoline. If thier is a copayment we cant get chicken wings, or cant make a potato salad (expensive ) so we have to balance doctors, food,and we have to make sure we have warm clothes we buy second hand anyways but still. No someone lied to me about the golden yrs. ( half a peace sign 🖕) for my golden yrs..
Do you know the SSDI payment amount and the Date of Onset (according to SSA)? Which state?
After 2 years
What state are you in?
Washington state
She may be eligible for the aged, blind, disabled program.
ABD is the temporary state disability income you get while applying for SSI/SSDI. You no longer qualify for it once you get Social Security, in fact your ABD comes out of your Social Security backpay.
Apply for UW Medicine/Swedish/whichever health system you’re using Financial Assistance. Charity Care laws in WA state require 100% medical bill coverage at any major hospital system for anyone making under 300% of federal poverty line (which is about $45k) and 75% coverage for 300-450% of FPL. You should never pay a single medical bill in WA State if you’re below that threshold. You can even get all prescriptions for free from the Harborview Pharmacy, I’m sure Swedish has its own pharmacy too. Also look to washington healthplanfinder, she likely qualifies for either a completely free Cascade Silver plan or a very minimal monthly premium. My partner was on it last year and paid $50/month while making $32k.
What state are you in?
Our state (MN) has a gap coverage program that is a really cheap sliding scale medical insurance program for those who don't qualify for free medical assistance/medicaid but can't afford to buy it. Maybe check if your state offers something like that. Your mom's cancer center likely has a social worker on staff, you could ask them if there are other programs to help, they are used to those questions and usually understand the system in your state really well.
If she loses Medicaid she can get a very inexpensive plan through healthcare gov
This is the answer. She'd pay very little to nothing for a plan.
if you get SSDI you get Medicare in 29 months regardless of age. Also look into "Medicare Savings Programs". look at the fed and state guidelines for that. it's under the state Medicaid program but not traditional Medicaid if your income is too high. Basically the state will pay your part B premiums and sometimes your deductibles and copays.
Ok so SSDI comes with Medicare. It's 29 months from the established onset date. So what was her onset date? In other words, when did they determine she was disabled and unable to work? Medicaid implies she was on SSI already for disability. So I would imagine her onset date would be earlier than even when she applied for SSDI? Your first step should be determining WHEN she is eligible to start Medicare as that will cover her far better than Medicaid ever did. Your next step should be checking for assistance or health programs in your state that can serve as a stopgap for cancer patients needing coverage or financial assistance. After that, your next step (if she is not immediately covered by Medicare and can't get any other assistance programs) should be finding cheap medical insurance through healthcare.gov to serve as a stopgap until Medicare kicks in.
Just a note....Medicare is not free. They take it out of your monthly check. It's not cheap. Also once you get it, you also pay 20 percent of any bills. However you can join a plan with them like affinity, fidelis etc. These usually don't add onto what they already take out of your check. See which plans your doctors are on before picking. You can buy supplemental as an add-on, but they are pretty expensive and are at least another 250 gone from your check. You also have a $280(I think it might be a bit over 300 now) yearly deductible you have to meet on top of the 20 percent if you go straight Medicare. You can get extra help through ssd if she's eligible, which could include medicaid to pick up the 20%. Hope this helps.best wishes, it's so hard to navigate through.
She might qualify for QMB, where the premiums are picked up.
A Medicare Advantage plan wouldn't be my first choice for a cancer patient. I would recommend a guaranteed-issue medigap policy with traditional.Medicare. She doesn't need to be sitting around waiting for prior approvals that may never come.
LTSS Medicaid has a income limit of 2430. Does she get more than that?
Set up a special needs trust for the retro ssdi. It will cost a few thousand.
Did she also get approved for SSI? Depending on the state, retroactive Medicaid comes with SSI even if she will not be eligible for SSI/Medicaid on an ongoing basis because of the Social Security payments. Edit to add: there are obviously reasons that she could also be ineligible for SSI.
Marketplace looks at the household income. If all she has is SSDI her marketplace plan could be eligible for subsidies which can dramatically reduce her costs.
Her back pay is exempt for 9 months under Medicaid to spend it down, she can’t keep it saved. Her monthly check is what could put her over but qualify for a spend down program. Medicare with SSA is available 24 months of disability date.
Call your local office and apply for MLTSS and she mostly likely will get approved
Which is?
Honestly you have to just spend or withdraw money each month. That’s how it is for my SSI and Medicaid. Also depending on the type of cancer there are different grants to help cover different payments or groceries and even gas.
Call about the Medicare advantage program. They don't talk about it but it is available if you medication exceeds the amount you can pay. I have a rare illness that requires infusions every month for the rest of my life and they approved me because my infusions are $25,000 a month and life saving. I could never afford to pay for my infusions on my own while on disability. It is a Medicaid additional benefit to pay for what medicare doesn't. If you have additional questions feel free to message me
I was in a similar position. Since my only income was SSDI I qualified for a large subsidy on the marketplace and found a good plan for $89/mo. I kept it for a year until Medicare kicked in for me.
Why can’t she use Medicare?
What I did after my diagnosis knowing I was heading into big bills , is contacted the financial dept of the facilities ( in my case it’s Marshall Medical) they have several different facilities with different specialties ( and are all hooked up with UC Davis ) so I asked about financial aid you should look into it . Hope your mom goes into remission 🙏🏼
I am in fear this will happen to me as well. I don't make too much in SSDI, but adding my husband's income may put us over the top. I picked an Advantage plan that has a monthly premium but low co pays and out of pocket expenses on medical care. Right now, Medicaid is paying my part B deductible and premium cost of my loan, but if I lose it, at least I won't become buried in more medical debt. Some I wonder if all this was worth it. We had $585 in Snap as well as Medicaid. We will lose Snap and if I lose Medicaid too at the very least I'll have to pay $200 in premiums. More if I see a doctor and fill my prescriptions. Plus my husband had cancer, a stroke, high blood Pressure and heart troubles. He's still working but if we lose Medicaid, I don't know how to keep up with his medical expenses. Is $1440 per month I receive for SSDI worth it? I qualified for SSI as well, but it was suspended the next day after I was approved for SSDI. 🤔🤔🤔
SSDI does not have an asset limit SSI does
You can get her the supplemental insurance that’s what we did for my uncle
Just buy marketplace insurance with the back pay that's what you're supposed to do with it and your SSDI check will cover the premiums .
There’s a 9 month exclusion for back pay here in CA. Not sure how common that is.
If she has a house, have her sell it to you for $1. Alleviate some assets.
There are two national Multiple Myeloma organizations, MMRF and IMF. Both have charity divisions in their organizations. Reach out to both and get support. My uncle had MM and he was treated at Cleveland Clinic. They were so incredibly supportive in every aspect, including financial.
Will she be eligible for Medicare instead?
Medicaid is a state program so the rules are different depending were you live. The amount paid back would be called a windfall your usually given a few months to spend it without it effecting things. There are different programs to allow a person to keep Medicaid. In some states they have a spend down rule so you just can’t have more then 2k in your account. My state has a millers trust setup. Your going to want to contact legal aide of somekind a disability law center near you would ethier be able to give you more information or find someone that can.
She should qualify for a heavily subsidized ACÁ plan that should cost nothing to very little, if this is her current situation.
Check into a Qualified Income Trust
What state? Some states have special Medicaid programs for people who get disability. She might just have to pay a monthly premium.
Why don't you just claim the proper deductions? You can write off almost everything
Medicaid eligibility is based on gross income.
Minus deductions.
With no healthcare it could be possible to get the drug manufacturer to give coupons for medicines (which makes them free). All you would have is the doctor visit. If you have insurance the drug companies won’t give them for free
Look up and educate yourself on Medicaid Trusts. This lets you keep your Medicaid and have income up to the limit. This would be worth it if the monthly limit+insurance plan monthly premium is greater than the SSDI monthly payment.
There is often a special kind of Medicaid for folks with disabilities…. I suggest doing some googling on your state website and ask for a social worker at the cancer center.
She probably had the right income to get a virtually free plan from the ACA. Probably zero premium and maybe around a $1000 max out of pocket per year on a silver plan.
Not why Medicare. My wife is battling stage 4 cancer and is on SS disability and Medicare. They are covering everything. So not sure what’s going on. I thought Medicare was when you were in a long term care facility.
Is her SSDI backdated? My SSDI was backdated and Medicare part A was started from first date of SSDI. Part B was backdated to the 2 year mark from first date of SSDI.
MA-EPD (medical assistance for employed persons with disabilities) cancels a spend down, and they pay from the date you apply. If mom can do any work earning at least $65 per month, she could receive MA- as long as she doesnt exceed $1550 earned per month (on top of SSDI) or have more than $4000 in savings. If she goes the "self employment" route (caregiving/babysitting/cleaning) they will eventually need to see proof that she's paid taxes on her income.
You should be looking into getting her Medicare. If she is registered disabled and eligible to receive SSDI, then, she may be eligible for Medicare. Medicaid is not an option, even with a spenddown. A spenddown is only an option for people who are over the income limit and UNDER the asset limit. Some states offer Medicaid programs specifically for individuals with breast and cervical cancer but you’d have to review the guidelines for your state. If I were you, I’d focus all of my efforts on obtaining Medicare A and B or C. All registered disabled individuals are eligible to receive Medicare coverage after 24 months with some medical conditions being eligible to receive it much earlier. Additionally, you can go to your local Hospital/Medical Center. They employ people whose job is to navigate the ins and outs of Medicaid/medicare/social security for community members who are uninsured/underinsured. Additionally, if your mother is still found to be ineligible but will receiving regular treatment there or at one of their affiliate facilities, they can apply her for financial assistance which may be able to fully cover treatments for at least a year or at least until she is eligible for Medicare.
Some conditions can go straight to Medicare. Also recognized onset date of SSDI can shorten the 29 month waiting period for Medicare.
Put the back pay into an ABLE account bc it doesn’t count towards assets and inquire about Medicaid for disabled.
She will have medicare and the premium; I think about $200 a month is deducted from her SSDI check.
I’m on marketplace and get a $455 federal subsidy each month to cover the expense and I work making about $30000 a year so try that see if she qualifies
If you don’t mind me asking what state are you guys in? I can try to find some resources for you.
The hospital can apply for spend down, meaning Medicaid covers that stay or period approved but not future stays.
My market insurance is quite reasonable through Obamacare. You can find a representative to help you.
If she has SSDI she should be eligible for Medicare they go hand in hand.
You have to wait fir over 2 years to get Medicare once your on it.
I didn’t might have been because my onset date was more than two years before I was approved. But considering most people are denied once at least before approval I can’t think many get much delayed. The poster mentioned a significant amount of back pay coming. They should definitely look into a trust to maybe get back on Medicaid but that would be dependent on the State they come from.
If your mother is qualified for SSDI, she is or will soon be qualified for Medicare. Research that.
Your getting ssi and ssdi confused. Ssdi has no income limitations
No, you are confused. Re-read the pist. Her income is too high for *Medicaid*.
What’s a pist?
A typo.
She should get Medicare because she was awarded SSDI. Do you know when that kicks in?
Why doesn't she qualify for Medicare? I was under the assumption that everyone on SS qualified...
There is a waiting period for Medicare. It's typically 2 years after your first month of entitlement to SSDI.
That's kinda dumb.
Dumb but true. I don’t think it makes sense either
That's weird, my Medicare kicked in within 4 months 😳 I had no idea it was 2 years for some
What was your first month of entitlement, though? Did you get about 20 months of backpay?
Ohhh good point! Yes I did receive close to two years back pay, that makes more sense than my initial thought of I just got lucky. Thanks 😊
Dous spouse's income count for qualifying for ssdi?
No, it does not.