Wednesday, April 17, 2013

"Wayne, We'll Take Curtain Two!"

So, today's blog is about the unfairness that goes on when one needs help.
sip of coffee...
ok, here it goes...
I received my Medicare card in the mail today.  The effective date is 8/1/2013.  I already knew that my Medicare would start then. 
So, before I chose to add part B, or part D, or any other part, I decided to give them a call concerning the cost involved with choosing the different parts and to find out which plan would work for me.  Waited the entire 20 minutes on hold to talk to someone. 
"Hi, my name is Sylvia Olley and my Medicare number is _ _ _ - _ _ - _ _ _  - A.  I was wondering if I could keep my Medicaid in conjunction with my Medicare plan."
"Ok.  Let me check to see."


"It looks like you will be able to keep both Medicaid and Medicare.  But, to double check, I'd call your local Social Security office.  Would you like me to give you that number?"

I'm thinking that I've called my local SS office too many times to count.  So, no, I didn't need her to give me that information.

I wanted to give myself peace of mind.  You know me.  I can't rest till I know that all my ducks are in a row.

So, I dialed my local Social Security office and waited there for an additional 20 minutes before someone finally picked up.

I give the lady there my name, social security number, address, phone number, birth date, horoscope information....

I asked her the status of my renewal form when it was time to renew my Medicaid a couple of months back.  I haven't heard anything, so I was assuming  I was "all good".  I mean, I was still refilling my prescriptions and seeing my doctors, and none of those people told me I wasn't covered. 

more typing

I heard the lady sigh a few times.

And I'm thinking, "Gee.... I'm sorry to be calling you and ruining your day."
Of course, I don't say anything

She comes back with some terrible news for me.

"It looks like you will be losing your Medicaid at the end of this month.  John's unemployment compensation and your disability checks puts you over the income limit for Medicaid."

A whirlwind of thoughts hits my brain immediately.
I kept thinking of the expense of buying my own supplies and medications.  I mean, I spent the first 11 or so years of being a type 1 diabetic with absolutely no help from any agency.  I already had an idea of the costs associated with type 1 diabetes. 
I bought everything myself. 

Testing Strips
Ketone Strips
And not to mention all the other medications I was buying. 
High blood pressure medication
High cholesterol medication
Thyroid medication
Pain medication

On top of all of that, I also had to pay for getting my blood work done. 
All of this over a span of 11 or so years ADDS up to ALOT of money!
So, lets just say we've been poor for as long as I had type 1 diabetes and no health insurance. 
But, now, I'm on an insulin pump.  And the expenses there are way over what we can afford.   The tubing, the reservoirs, the insulin.  All of that costs great amounts of money.  And money is something that we're short on. 
Sure, there are programs out there to help.  They're called Patient Assistant Programs.  I was on one or two of them in the past. 
And they're also very hard to apply for.  You have to go to a doctor to fill all of those forms out. 
Plus you have the expense of said doctor's appointment.  And sometimes the company only allows for certain amounts of medicines at a time, no matter what you're doctor writes out for.  The red tape alone is frustrating. 
So very frustrating.
Headache inducing even.

I remember what my lawyer said when I first got disability. 
"You are a disabled Pennsylvanian.  Nobody can deny you health insurance.  You are legally not allowed to have no health insurance."

So, with those thoughts swimming around my head, it took a few seconds of "dead air time" for me to realize what the lady on the phone in my local SS office had said.

"Ma'am.  Are you still there?"

"Yes.  I'm here.  So, let me get this straight.  I have to wait till August for my Medicare to kick in, but Medicaid is dropping at the end of April?  Do you realize there will be a 3 month gap between that and actually getting Medicare?  Do you realize that I'm a type 1 diabetic??  Do you know what happens to type 1's if they don't get their insulin?  THEY DIE! DO THEY WANT ME TO DIE?????" 

Yes, I got loud.  Yes, I got angry.  Yes, I was very, very, very upset.

And why shouldn't I be?  I mean, I've been denied health coverage for years and years!!!!!  They said I was only approved Medicaid last year because I was busy fighting to get disability benefits. So, since I won my case, and now that it's all over, they can drop me.  And they will.

No health insurance company will ever pick me up.  I mean, you always hear how insurance companies can't deny you because of a pre-existing condition.  But, did you also know that you have to wait 12 months for them to start paying for treatment of those conditions?  What that means simply is, I'll be paying for private health coverage every single month, but still need to pay for my diabetic needs. 
Sure, I can appeal it.  But, if I lose that appeal, I'll have to repay all the doctor's appointments, prescriptions, blood work, tests, and diabetic pump supplies out of my own pocket. 

So, I had two options - well, three if you count that option of having no health insurance and dying because I can't afford my insulin.

Option 1
Get a what a lot of people call a "Medicaid Divorce". 
I read an interesting article on it online.

A Medicaid Divorce simply means that John and I divorce, and when that divorce goes through, only my measly disability checks would be considered assets and I could keep my Medicaid.
We have considered this option in the past.  Every time I was denied help of any sort, we'd talk about it, and then decide that nobody was going to break up our family.  And besides, even if we did do that, none of us would actually move out.  We'd still be living under the same roof.  And what happens if we got caught? 
So, every time we discussed it, we went on to talk about other things.

Option 2
A program called MAWD

or  Medical Assistance Benefits for Workers with Disabilities

It's a program that we'll qualify for, and it allows for me to keep my Medicaid till my Medicare goes through in August.  The only downside is that we would have to pay a premium each month to keep it.  It's also an income based program, but you can have a considerable monthly income and still qualify for it. 
So, I gave the lady on the phone at the Social Security office my information (what John makes and how much disability I get) and she quoted me a rough price of $90 to $100 per month to keep my Medicaid.

So, yes, that seems like a lot for someone like me.  But, I have to consider the alternative.  Paying for all my diabetic needs and other medications would easily cost in the thousands every month. 
I'm not prepared to do that.  Nor should I have to.

So, we'll be picking option 2.  We'll have to pay a little over $300 for three months till my Medicare kicks in.  Sure, money will be tight for awhile.  But, we are sort of used to that.  We've been poor for so long, it wouldn't much matter to us.

And when my Medicare does finally kick in, I'll be signing up for the Medicare Savings Plan.  That plan will help pay my monthly part B expenses and save us a bit of money every month.  I already know we qualify for that.

So, there you have it....

If I were single, I could get all kinds of help.  Food stamps.  Medical coverage.  Cash Assistance.  Housing help. 

I'm sorry, but I'm not prepared to divorce my husband to get a hand out.  It's just not going to happen.  And while I don't think less of those who actually had to do it for medical coverage (although there are those who do actually abuse the system), I simply cannot and will not sacrifice my morals or values to satisfy all the red tape to get help. 


  1. Government employees suck... I hope things aren't going the way they seem to be going and that it's just a simple misunderstanding and that you get all the care you need... <3 you!!!!!!

    1. right now, *all* people suck...
      And yeah, I hope this all gets worked out soon.
      John said to me today, "Sylvia, when you want something or need something, you don't stop till you get it. You're full throttle and I know you'll figure something out."

      How right he is! And I'm already almost done "working it out"...

      Fingers are crossed!
      Love you Ja!


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