Medicare Vs. Medicaid

[Guest guest]

>

> I know someone who is in CA right now having open DS

> and she is on SSI disability. Medicare is covering her

> surgery. . . There have been others on this list who have had

> Medicare pay too,

>

> =====================================

>> From: Sharon

>> Subject: medicare

>>. . . Does anyone know of someone who will accept me

>> and my medicare?

;

I know this can be incredibly confusing but MEDICARE does not

pay any medical expenses for folks on SSI. Folks on SSI have

their medical expenses covered by the State Welfare program

where they live. In Washington State, the expenses are paid by

the Department of Social and Health Services. The Social

Security Administration has contracts with each state to cover

this.

MEDICARE pays for 80% of the covered medical expenses for

disabled folks on Social Security which is a totally different

program than SSI.

SSI is a program that gives the recipient about $500 per month if

the individual did not earn enough in their life time (or never had

earnings at all) to provide the normal social security income. The

State provided medical benefits are called, " MEDICAID " , not

Medicare.

Disabled folks on Social Security have worked enough years and

earned enough to collect their own Social Security, the same as

if they had retired at age 65. That is why people in this group of

the disabled are entitled to MEDICARE.

In general, MEDICARE is insurance, it costs $50 per month and

the cost is usually deducted from an individual's monthly social

security payment. MEDICAID is not insurance. It is technically

welfare and the recipient pays nothing for it.

I am disabled but am fortunate enough to have Medicare. I met

with Dr. Welker at OHSU right before he was cruely banished

from that facility. When he heard I had Medicare, he exclaimed,

" oh, that's excellent. At least we won't have any problem with your

insurance " . What he meant is this, Medicare does NOT

pre-approve anything. Their position is that a person must just

go ahead and have the surgery first. Then, IF the person met the

Medicare guidelines, the bill is promptly paid.

The Medicare guidelines are to be at least 100 pounds

overweight (I am 185 pounds over) and to have a minimum BMI

of 40 (mine is 55.5). In addition, I have multiple co-morbidities.

I'm fortunate to also have great insurance through my previous

employer. Contractually, they MUST pay the balence on anything

leftover. However, I've been in contact with another fellow

disabled DS pre-op. She's also disabled but is on SSI. She has

Medicaid rather than Medicare as I do. She's having a heck of a

time finding a surgeon who will accept them. She can go out of

state as long as the surgeon will accept them. If you think of the

surgeon you were referring to, would you mind emailing me? I

would love to help her out. Feeling powerless due to all this

bureaucracy is so aggravating!

Hope this discussion about the difference between MEDICARE

and MEDICAID helps.

gobo

pre-op DS

BMI 55.5

" Sometimes We Never Know How We Influence the Lives of

Others, Yet We Touch Those Lives Just the Same "