Medicaid and Medicare

Author disclaimer: I'm a lawyer licensed in the State of Florida only. Nothing in this post (or any other post) constitutes legal advice. If you are considering an application for public benefits or are unsure as to whether you might qualify, consult with a lawyer. Please, consult a lawyer.

Yep, I'm biased. I have been a lawyer since 2002 and I've learned a lot. I learned how to think and analyze like a lawyer in law school, I studied all the laws of the State of Florida to pass the bar exam and I've spent the last 17 years immersed in the practice of law, sometimes making law myself. I know a few things and I'm totally biased towards engaging an expert, generally, and specifically when one needs benefits.

I'm more aware than I care to detail that cancer decimates the patient and that patient's family financially and in every other way. Hiring a lawyer is an expense that is difficult for the average family, let alone families who are dealing with the high cost of health care. I've seen this discussion too many times in the cancer support groups online.

The good news is that most public benefit programs are user-friendly enough that a layperson can experience much of it without representation. The number of people who need formal representation is relatively small.

In this post, I want to discuss Medicaid and Medicare, which are federally funded (somewhat) programs designed to accomplish different things. Please understand by giving some tips and general explanations may mean that some of the details will be lost in translation. Most of this is not an issue, but please please do your own research and ask questions.

What is medicaid?

This program is both federally and state-funded. It gets complicated because under the Affordable Care Act (ACA) and its revisions, much of what the individual states do is up to them.  We are, more and more, moving away from a program that is consistent across state lines to a program that looks very different in different states. The bottom line, check to see if you are eligible in your state. Medicaid is generally the program that provides medical care to low-income families. All of the kiddos in foster care have Medicaid. It's an amazing program for those who cannot afford health insurance.

Medicaid has a lot of restrictions and rules. It can be hard to navigate. My best advice for anyone dealing with Medicaid is to ask questions, confirm and confirm and confirm, and keep lots of notes and details. The only way to deal with the consistent morass of paperwork and hoops to jump through is to become an expert yourself.

What is medicare?

Medicare is federally funded and is available for seniors and those who are receiving Social Security Disability (SSDI). One is automatically eligible for Medicare when one has had SSDI for 24 consecutive months. Medicare has multiple parts (A, B, C, and D). Part A doesn't cost anything and is important for the coverage of hospitalizations. Part B is when you pay a premium based on your income that is deducted from your monthly SSDI payment. For me, since I have private health insurance through my husband's job, I declined Part B and Part A becomes my secondary insurer.

Medicare also has a lot of restrictions and rules. Just like you can only get limited pairs of glasses under Medicare, you can only have so many tests, like PET scans. These limitations can be anxiety-producing; however, I've also observed that the cancer centers and doctors are pretty knowledgeable about how to work within Medicare.

Tips to navigate healthcare benefits

Here are some other things to think about:

1. Copay assistance programs available to those of us with private insurance are usually not available with Medicare or Medicaid. I'm still not entirely sure why, but there it is.
2. Medicare often has high drug costs and it is usually recommended to get a private plan that works with Medicare. The American Association of Retired People (AARP) has some great forms and checklists available online. They will also endorse particular companies and policies based on feedback from its members. I would strongly recommend that anyone looking at supplemental plans when Medicare is involved finds an insurance broker.
3. Budget Budget Budget. Medical costs are often unforeseen and, when all is said and done, can be sky-high. Attempting to set a budget, attempting to figure out how much a medication will cost, when everything is added up can feel like an exercise in futility.
4. FSA/HSA plans can be a welcome addition, but are not always available once one is no longer working.

Navigating benefits

Benefits, whether public or private, can be complicated. Attempting to navigate said benefits while sick can feel abusive. I know from personal experience that when it feels as though the decision may mean your life or death, having a rational conversation with anyone can be impossible. The best thing any of us can do is get educated about our rights and responsibilities, take good notes, and be persistent. That squeaky wheel gets a lot done.