Trying to get Medicaid...Desperate

[frankswife]

I guess this is more of a rant than a real question, so please bear with me. I have employer provided health insurance covering Frank, for which I pay almost $500 a month. In addition, we were forced to accept Medicare Part B, which adds another $104 to the pot. Frank is racking up up Dialysis copays at the rate of $25 3 times a week in addition to all his doctor visits and prescriptions. His medications alone cost me over $200 a month. We owe his center over $11000. I talked to his SW about this, and he seemed really surprised that Medicare covers NOTHING for us. He suggested we apply for Medicaid. He says the majority of the patients at the center have Medicaid and everything is covered, even transportation costs! To make a foolish story short, we applied and I was told that basically the only way Frank can get Medicaid is if I sign a Spousal Refusal to make my income available for his care, or if I deposited the bulk of MY income into a Pooled Trust and let someone else pay my bills for me. Neither of these options are very palatable to me. If I wasnt working, Frank would be taken care of. But I can't not work. Has anyone here ever done the Spousall Refusal or Pooled Trust thing? Thanks for reading.

[iolaire]

That doesn't sound right. Did you apply for Medicare via the Social Security department?  Maybe you are applying under the wrong program.

I'm employed in a professional job making good money and have both my employer's insurance and Medicare. I do pay extra on the Medicare quarterly payments due to my income, but it's less than my overall insurance copayment.

Also I understand that after 30 months I will be forced to move to Medicare as the primary payer for dialysis, so having active coverage will insure a smooth transition.

[Michael Murphy]

I go to a fresenius clinic and they have a insurance expert to help you navigate insurance, issues the social worker is the person at my clinic that schedules time with the insurance person.  In January I have to go on Medicare and what I am looking at is purchasing a medigap policy to cover the difference between medicare and what dialysis costs.  Y other choice is to keep paying 200 a month for my company insurance. Insurance is a nightmare and very complex.  It may be cheaper for your husband to use all of medicare as primary and your insurance as secondary.  It may be better to drop him from your policy and purchase medigap..  If your clinic does not have access to a insurance person  I would google "help with insurance problems on dialysis"  this should get you the American Kidney Fund" page and they discribe your options.  The search will also return other sites that offer insurance advise..

[iolaire]

Sorry I see you were told to apply for Medicaid which is income based. Has Medicare told you why they are not paying the copayments?  I've yet to see that they paid dialysis copayments but davita has not billed me for them this year. I have seen they paid the doctors bills.

[Simon Dog]

You need to see an attorney who specializes in medicaid asset protection.   There are tricky rules regarding allowable assets for what a medicaid recipient can have, as well as what assets the spouse can have as assets while medicaid is paying the bills (at least in the case of a nursing home admission).    An office consult is cheap insurance to make sure you don't get burned.