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How Many Stage 4 Girls are getting SS disability..

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  • denny123
    denny123 Member Posts: 1,445
    edited January 2007
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    I am not eligible for Medicaid since I make a tiny bit above the level because of a disability insurance policy that will pay me for another year.
    I am now eligible for Medicare. But I only have Part A- the hospitalization part because it is free.
    Meanwhile, I am paying $452 a month for my Blue Cross policy that used to pay for everything.
    So now Medicare keeps sending me bills for my surgeries but Blue Cross should be picking up the remainder after Medicare pays a portion.
    Very confusing and making me crazy..............
  • Shepgirl
    Shepgirl Member Posts: 28
    edited January 2007
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    Okay so Medicare and Medicaid are not the same. I thought they were one in the same! I will look up the differences. thanks

  • denny123
    denny123 Member Posts: 1,445
    edited January 2007
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    In Pennsylvania, Medicaid is available to those people who are under an income guideline-approx. $12,000 a year for a single person living alone, who is over 21, I believe. With a spouse and children, the income level goes up.
    And if the income is low enough-approx less than $450 a month, then that person is eligible for food stamps, monetary assistance, and heating assistance.

    Medicare is available either after 2 years on disability, or if one is over the age of 62.
    I prefer not to have Medicare since it is so restrictive with the medications that it pays for. Xeloda, which might be my final chemo if my liver mets return, is not currently covered under Medicare.
  • KariLynn
    KariLynn Member Posts: 41
    edited January 2007
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    Can your primary insurance force you to take medicare if you're eligible?? I will be two years disabled later this year but am happy with my current ins and don't want to pay for anything else.

  • denny123
    denny123 Member Posts: 1,445
    edited January 2007
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    Kari,
    I refused Medicare but after my Lat Flap, I started to get massive bills. It seems that Medicare declared themselves to be my primary, so Blue Cross decided not to pay for my surgery.
    I had to then accept Medicare as a primary and Blue Cross then became my secondary. Those Lat bills now seem to have been all paid.

    But now that I have had my exchange, and although Medicare was designated as my primary, I am once again receiving bills from my surgery.
    But I am going to try not to panic and wait to see if Blue Cross pays the rest.

    My Medicare part A is hospitilization only and is free. If I wanted Medicare part B, it would cost me about $90 a month. I don't have B, and they aren't forcing me to subscribe to it at this point.
  • KariLynn
    KariLynn Member Posts: 41
    edited January 2007
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    Cool - thanks!

  • PaulaBeth
    PaulaBeth Member Posts: 6
    edited January 2007
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    My insurance agent said to check the primary insurance policy before deciding to continue it. Many have a clause that says if you are eligible for Medicare the private policy starts covering only what Medicare would have covered, so there is no benefit to keeping the private policy.

  • Shepgirl
    Shepgirl Member Posts: 28
    edited January 2007
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    Thanks ladies I will check this out. I know with hubby income we can't get medicaid; but I might run into the first /secondary issue Denise mentioned... in 2008.

    We just switched to Blue Choice for our other plan (Preffered Choice) in-network was very restrictive. Luckly my hubby company provide the options and we could switch even with a pre -exisistng condition.

    Denise, BTW my sister works in health care insurance fraud market in PA.... she a very valuable source of info! She gave my a copy of NY state' s formal complaint process form and I'm going after my old insurance company due to a Lupron charge. My sister said the insurance company HAS to reply in 30 days! so we will see if I got my $400 back!
  • denny123
    denny123 Member Posts: 1,445
    edited January 2007
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    Shepgirl,

    Interesting...I might need your sister's help some day!

    I am also interested in the fact that I may no longer need Blue Cross since I have Medicare. But from what I have heard, Medicare is a lot more restrictive with treatments and might not approve of my doctors.
    I have asked these questions repeatedly, but no one knows or will tell me the answers.
  • PaulaBeth
    PaulaBeth Member Posts: 6
    edited January 2007
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    You can get Medicare no matter what your income is. It's Medicaid that's limited to low-income recipients.

  • flea
    flea Member Posts: 3
    edited January 2007
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    I got the letter from SS that I am getting it. I didn't know if I should be happy it went through so quickly or depressed (that must mean they think I am really sick)

    Anyway, I did the application on November 14th and I got the letter letting me know when it would begin on December 27th or so. I think that is pretty quick. I'm glad I don't have to worry about it anymore.
  • KariLynn
    KariLynn Member Posts: 41
    edited January 2007
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    F - I was the same way. I told DH that part of me wanted them to tell me I was too healthy - DENIED! Oh well, the money has come in handy.

  • denny123
    denny123 Member Posts: 1,445
    edited January 2007
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    Paula,
    Regarding whether to drop your primary, one consideration is the fact that Medicare won't pay the whole bill. I think that they pay 80%, and my secondary picks up the rest, so far.
    From my exchange, I am now receiving bills that Medicare won't pay, which makes me nervous and hoping that Blue Cross will pay them.
  • PineHouse
    PineHouse Member Posts: 24
    edited January 2007
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    Hi,

    Shepgirl & those who may need the info:

    You can get Medicaid right away IF you're receiving SSI. Medicaid is administered by the State, so requirements may vary from state to state. SSI is federal support for low income, low asset people, you don't have to have cancer or sick or anything. They would consider your husbands' income and asset to determine your eligibility.

    If you're on SSDI (federal benefit for people who have worked but then become disabled), you will automatically get Medicare Part-A 24 months after receiving benefit (this means it kicks in after 29 months since you don't draw any benefit for 5 months). They will give you an option to buy Part-B then.

    From the SSA website, I saw that you're allowed to earn $900 per month in 2007 (or $860 per month in 2006). I think they adjust this number for inflation.
  • happy2bme
    happy2bme Member Posts: 13
    edited January 2007
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    I dont know if it is okay for me to respond but I am stage 3 and okayed for disability .I worked a very physically demanding job and I have lympedema and I can not do it anymore. I have been on ss disability(not eligible for ssi dis) and l/t dis through company insurance for 7 months .

  • denny123
    denny123 Member Posts: 1,445
    edited January 2007
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    Happy,
    That is a good point. When I first had my bi-lat mast with bi-lat nodes, I was mis-dx'd at Stage 2. (I was really Stage 4 from the get-go, but that wasn't confirmed until a year later.) BTW, I also now have bi-lat LE.
    Since I was divorced, had 2 daughters, one in college, I applied for assistance since I had been self employed with a cleaning business. That business had come to a screeching halt and I suddenly had no income. I was immediately approved for SSDI, and then 5 months later was approved for SSD.
    Once I was dx at Stage 4, I called SSD to make sure that I would continue to receive SSD, and was assured that it wouldn't be taken away from me unless my income increased dramatically (not a chance!).
  • Buzz
    Buzz Member Posts: 21
    edited January 2007
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    Quote:

    "I prefer not to have Medicare since it is so restrictive with the medications that it pays for. Xeloda, which might be my final chemo if my liver mets return, is not currently covered under Medicare."


    Medicare does indeed cover Xeloda. They cover it under chemotherapy in Part B, not as a prescription drug.

    When one becomes eligible for Medicare, people should be very careful about turning it down. Many medical insurance policies have fine print that says if you become eligible for Medicare, then it becomes your primary insurance. If you turn it down, you may find yourself with no insurance at all. And getting INTO Medicare later, after first turning it down, costs an amount of money. It's a penalty they charge for not taking it in the first place.
  • Brenda_R
    Brenda_R Member Posts: 52
    edited January 2007
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    Thank you girls for starting this topic and keeping it bumped.
    I never even considered SSD until I read this thread.

    My doctor wrote up a statement for me saying I'm StageIV IDC breast cancer with mets to bone, and medically unable to work, so I just got signed up. I went to the local office and took all my medical reports and the doctor's statement. They set me up for a phone interview in a couple weeks.
    The lady at the office asked if I'd worked 5 out of the last 10 years (yes) and how much my husband made monthly. Not sure why they need to know that since I'd be drawing off my own earnings?
  • KariLynn
    KariLynn Member Posts: 41
    edited January 2007
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    Maybe they asked to see if you'd qualify for ssi too??

  • Brenda_R
    Brenda_R Member Posts: 52
    edited January 2007
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    Quote:

    Maybe they asked to see if you'd qualify for ssi too??




    I hadn't thought of that. Thanks Kari.
  • denny123
    denny123 Member Posts: 1,445
    edited January 2007
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    Buzz,
    It is good to know that Xeloda is now covered by Medicare. My friend was on Xeloda and she had to pay for it herself, but that was 1 1/2 years ago.
    Hopefully, that has changed in PA.
    Thanks for the info.
  • Mena
    Mena Member Posts: 263
    edited January 2007
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    Hi girls...just reading through all this and want to let you know that once you get Medicare, it automatically becomes your primary! And, they do only cover 80%. That remaining 20% can add up, as we all know. So a secondary is a big help.

    But Medicare is a pain in the ass, too. On Friday, I waited over an hour for my aranesp injection because of the "coding"...The nurse said, "Now you wouldn't want us to give it to you and then you'd have to pay for it..." hahahah...I said, "I wouldn't"..."They'd have to wait until I was dead." I thought she was going to cry. Clearly not a seasoned onc nurse...

    I mean I was already there for a three hour infusion, so I was a little more than not chipper about this added wait.

    For those of you who don't qualify for Medicaid, don't just take that as an answer. No one is going to offer info. You have to DIG. Some states/counties have special programs for breast cancer patients. I can get Medicaid if I work part-time (I know, assinine...on Disability, but go to work and we'll give you some insurance!).

    So, I sell Avon and that makes me eligible for Medicaid as well. So Medicare pays 80%, Medicaid usually picks up the balance..."usually" being a very big operative word here, but it's better than nothing.

    Call your local Social Services departments and ask questions. That's the only way I even got to this point. Otherwise, I'd be in the street, or someone's basesment, I'm sure...

    It's kinda funny when you can't afford to keep yourself alive...sad, actually...

    I do have a resource with Xeloda for anyone that has to pay out-of-pocket and cannot afford it. Please pm me...Mena...xo
  • denny123
    denny123 Member Posts: 1,445
    edited January 2007
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    Thanks for writing, Mena.
    Okay, tomorrow, I am going to bite the bullet and sign up for Medicare Part B. Since I refused it before, I will now have to pay more. And I am already paying $452 a month for Blue Cross. But I am afraid to drop Blue Cross unless I can find another secondary that will pay the rest.

    Does anyone have AARP as a secondary?


    Friday evening, I was looking over the accident disability policies that I have since I am self-employed, and found that one of them stated that if I am eligible for Medicare, that they won't pay on a claim. Well, I have been paying them $94 a month-for possibly no reason????

    Sigh-this stuff is still so confusing.....
  • Mena
    Mena Member Posts: 263
    edited January 2007
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    I'm writing again because I did more reading and can't believe that any of you are having trouble getting SSD.

    First of all, a Stage IV dx automatically qualifies you for SSD. Period. No one can deny you, unless you never worked a day in your life. Then there might be a problem.

    Secondly, you cannot earn more than $880/month and collect SSD. This is federal law. You can still bring in your entire SSD amount and earn $880 a month or less. Don't let anyone tell you otherwise.

    Oncs cannot tell you that you don't qualify. If they've given you a Stage IV dx, you qualify! If they are resistant with helping, then you get an attorney or a new onc.

    I just hate to hear that some of you are having trouble with this.

    And remember, it is retroactive as someone pointed out, from the date of your dx!

    There's nothing to be ashamed of. Many of us still work in different capacaties. For two years I kept sub teaching because I could come and go as I wished, depending on chemo days and good days...now I don't want to be around all the boogers anymore...for now anyway...xo
  • mrsjck
    mrsjck Member Posts: 4
    edited January 2007
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    Okay, ladies, I read these posts and am now confused and nervous...I qualified for SSD based on Stage IV and having worked enough quarters. I received a retro check and then started on monthly payments. A few weeks ago I received a notice saying I was eligible for Medicare...I accepted only the free Part A because DH has a pension and private insurance through the state of MA which is adequate for our needs. Now my confusion stems from comments made stating that Medicare declares themselves primary and private insurance may stop paying certain bills. Is that when I accepted only Part A? Is that an issue that can be fought/argued against? Where on my private insurance does it say they can back off if I'm eligible for Medicare? Anyone help?

  • denny123
    denny123 Member Posts: 1,445
    edited January 2007
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    Jan,
    I ran into the same situation. I pay $452 a month for Blue Cross and they have always paid for everything with my surgeries. I accepted Medicare part A, since it was free.
    But after my Lat surgery, I was getting bills saying that Blue Cross refused to pay them since Medicare had declared themselves as primary.
    No amount of arguing could get rid of Medicare, but they seemed to pay the 80% of the bills, and I have not gotten any more bills. So I have to assume that Blue Cross paid the rest as a secondary.

    Medicare told me that Blue Cross would pay the rest and I hope that this continues.

    But I have just gotten a notice that I might have to pay full price for my prescriptions.
    So I am going to give up and take on Medicare parts B and possibly D.

    Since you just were eligible for Medicare a few weeks ago, and you decide to accept it, you should enroll now.

    Since I refused it several months ago, I will now have to pay more for it. The previous amount would have been $78 monthly, but now it will be more.
  • Mena
    Mena Member Posts: 263
    edited January 2007
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    Jan, why didn't you accept both Plans A & B? Your husband's insurance becomes your secondary, anyway, and they will pick up the remaining 20%...I'm pretty sure...they should.

    I'd call Medicare and ask. You may not be eligible for Part B for some reason, and why aren't you elgible for Medicare Part D, which covers prescriptions?

    I'd want answers to all these questions. I have A & B and am on the prescription plan as well. This is a federal program, and as I've said, you have to be proactive. No one offers the info...that would just be too easy...and too kind...it's not bad enough that you need it, they have to make every aspect of getting help another nightmare.

    Get on the phone and ask why you don't get A&B&D and your husband's insurance becomes the secondary. I'm interested in seeing if the laws have changed since I applied. Good luck...Mena...xo
  • auntgina
    auntgina Member Posts: 6
    edited January 2007
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    I don't know about all of this. My husband had a stroke in 1999 and has been on disability ever since. He turned 65 in May, and I have been informed that I am no longer covered under his jobs insurance,because medicare kicked in because he turned 65 even though it is still his secondary. Any answers for this? Virginia

  • vab
    vab Member Posts: 3
    edited January 2007
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    Mena and auntgina - the information above is correct. You get Medicare Part A (not a needs-based program) after you have been on Social Security Disability for long enough. You do NOT get Medicare if you're only on SSI (a needs-based program), but you may qualify for Medicaid (another needs-based program) if you meet the income and asset restrictions, which unfortunately are very restrictive. Medicare Part A is primary after you stop working. However, I have seen two situations where the person was over 65 and Social Security mixed it up or was not informed that the individual had stopped working, so they mistakenly left Medicare as secondary, when it should have been primary. Result: nobody paid until it was all straightened out, which took a lot of noise-making. Theoretically, your private/employer-sponsored insurance becomes a supplement once Medicare is primary, and your premiums should go down, but again, I've seen situations where that hasn't happened, perhaps because of lack of information. I deal primarily with the elderly, and while the costs of Medicare Part B are going up, they are a bargain compared to the alternative, which is often paying for out-patient doctor visits and durable medical equipment out of pocket. I would suggest you look into that and also Medicare Part D IF, and only IF, you don't have other prescription coverage.

  • denny123
    denny123 Member Posts: 1,445
    edited January 2007
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    Post deleted by denny123