How does Medicaid spend down affect Medicare? ?

Question

I currently have medicaid, but do to my income I need to spend so much a month before it kicks.  I will be getting medicare do to being on disability for 24 month in Janruary 2009.   I can't figure out what will change and what I need to do before then to make sure my medical costs don't sky rocket or I miss any deadlines.

Thanks

Zarnev · Accepted Answer

First off, Medicare and Medicaid gets very complicated and there isn't enough room on this forum nor does anyone here have enough information to fully advise you. Visit a local agent that works with all the major Medicare Advantage plans in your area for assistance. There is no extra charge using an agent. You can also talk with your case worker and/or Medicare.

If you are getting Medicare because of disability I'm guessing you aren't 65. BCBS Medicare Supplement (Medigap) policies are not available to anyone under 65. Also, Medicare Supplements don't usually work well with Medicaid because they don't coordinate benefits. Supplements for people under 65 are few and far between and only available in a handful of states. Medicare Supplements do not have drug coverage so you'll need a separate stand-alone drug plan.

Some questions an agent will need to know if you do qualify for a Supplement in your state: Is Medicaid going to pay some or all of the premium for the Supplement? Does Medicaid pay just your part B premium? Do they pay any Part D premium and/or co-pays? 

If you are in a spend-down program I'll guess you are not designated QMB but are SLMB or QI-1. What you are can make a difference in what coverage you can get.

Medicare Advantage plans are county specific so what is available will depend on what county you live in. There are several different types of plans. There are Medicare Advantage plans specifically designed for Medicaid clients in most counties. They are called "dual eligible" SNP plans. There are also Medicare Advantage PFFS and MSA plans but, like the supplements, they don't coordinate benefits well with Medicaid and you may wind up paying a lot of money for medical care. The HMO plans will coordinate but may not work well because of the doctor network; it will depend on your doctor and the available networks in your area. The PPO plans may be your best bet because they will coordinate, however, your doctor will need to accept both the plan and Medicaid for it to work well. POS plans are little better than HMO.

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How does Medicaid spend down affect Medicare? ?