Insurance "watching" xPAP users

[lazer]

Don't even get me started on Obama care but I will add this:

Thinks about it regarding xpap and equipment. If one does not prove compliance but so chooses, they can very easily keep getting the masks, parts, ect... at the 3 month intervals or whatever and even the machine(s) and resell them rather easily on ebay/craiglists, ect... so I would imagine the insurance companies are aware of this and trying to reduce fraud.

No, I don't side with or agree with ALL insurance company policies as I'm in the middle of one now myself just trying to meet the criteria for a machine which has already proven helpful to my health/sleep...

[Shellie_p]

If your insurance covers physical therapy and you don't regularly practice the exercises the physical therapist gives you, your insurance can't/doesn't stop covering your PT appointments..

Mine did, because I missed 3 appointments(By recomendation OF the PT company! , and didn't have any place at home suitable to do one of the excercises (Was doing the rest) the PT company told them I wasn't complying. And the insurance co. sent me a letter about them cancelling it and refusing to pay for it. So some companys do, some dont.

[Janknitz]

If you are poor you don't get medical care. I see it right now if you own any land you can't get Medicade. So I know people who own their own home but only draw $600 in Social Security a month-age is over 70. No help because they own their home.

This is ABSOLUTELY UNTRUE! I don't like to get involved in political healthcare debates, but I want to correct this misinformation. Medicaid is a FEDERAL program, administered by the individual states. Rules may vary between states, but under FEDERAL rules, the recipient's primary residence and a vehicle are EXEMPT assets. They do not count against an individual for qualification for Medicaid. If that individual is to go into a nursing home, under the Defecit Reduction Act (DRA) there is a limit to the amount of equity a person can have in the home to qualify for Medicaid to pay for it, and it varies by state from $500,000 to $750,000.

Incidentally, California has NOT adopted DRA provisions, so individuals on Medi-Cal (California equivalent of Medicaid) can have a home of ANY value. This leads to some crazy situations where people who have a million dollar or more home can still qualify for nursing home coverage, but that's unusual. Most Medi-Cal recipients own a modest home at best.

Someone who claims they don't qualify for Medicaid because they own their home is either lying or they got bum advice from someone who doesn't know what they are talking about. Too many people think this is true and never even apply, because of rumors like this. That's why it's important to know the truth.

[purple]

Rules may vary between states, but under FEDERAL rules, the recipient's primary residence and a vehicle are EXEMPT assets. They do not count against an individual for qualification for Medicaid.

For those who are not in the US. Medicare is the Federal Program that is to provide medical care for those who receive Social Security Benefits, either from old age or disability. Medicaid is an adjunct program that is administered by the state government (there are fifty states.) Medicaid can be for those who do not receive Medicare, and are simply poor. Medicaid can provide payment for some types of services which Medicare does not, like eyeglasses or limited dental care, or perhaps prescription benefits. (Medicare Prescription benefits is a separate program than the other two, and is in my experience, not as helpful to the individual as Medicaid Prescription benefits.)

In Texas, which is dominated by conservative Republican state legislators, it is a bit hard to know the real truth of what the system will regard in what way. Let me say that in another way: A year ago I was applying for Medicaid and Food Stamps, and the lady who does the qualification for food stamps put it this way, "I do the "Food Stamps program that is put on a debit card once a month, usable where it is accepted. The only people who actually know the rules of the Medicaid program work in the in the one office which evaluates all the Medicaid cases." As she told me, and seems to be true, the state decides who is eligible for Texas Medicaid based upon gross income. However, there are two types of Medicaid for one such as myself, a Social Security Disability recipient. The lowest level used to be called QMB (Qualified Medical Beneficiary) which pays for my Social Security monthly Premium, and my Social Security drug Premium. The deeper level makes my deductibles and co-pays, which for Social Security is 20 percent of what Medicare calls Assignment, what Medicare decides a doctor/clinic/hospital should be allowed to charge for a particular service/procedure.

Texas Medicaid does not allow one to have any property other than the one the person lives on. You can have the million dollar house, you can not have a vacation property, or even a vacant field. Medicaid recipients can not have a recreational vehicle, whether it be motor home, or even a 4 wheel drive vehicle meant to drive around in icy weather. Medicaid recipient have limits of other assets, like bank accounts or stocks.

However Texas Medicaid does allow, if I pay rent, that it will count towards the Medicaid which would pay for my Medicare Premium. So in effect, owning ones own home might be seen to disqualify a person from Medicaid, when they could qualify if they rented.

On the other hand Food Stamps does allow more food stamps dollars based upon some expenses. Like rent, which a person who owns his own home does not have. Food stamp allowances for other expenses are rooted in numbers from a far earlier time. Like how is much one can deduct for power.

Medicaid has another provision or two that is sorta relevant. If one goes into a nursing home, on Medicaid, then the home is an asset, and it either must be sold and the money spent on health care before Medicaid can be applied, or the title given over to the state. There appears some other rules about my obtaining Medicaid if I will sign an agreement so the state gets my house when I die or move out of the house.

On some level that favors the rich obtaining the property of those who previously took Medicaid at a cut rate. If a person dies, the state takes the house. It will be sold at Auction on the court house steps. Working class people are not able to make a good judgement what the property is worth, or likely to be able to take off work to attend the auction, and most importantly the full price is due immediately at the end of the Auction. Meaning the buyer will most likely be a speculator who has the cash to buy, and intends to resell the property at a huge profit. Not to the poor working slob who will need to take several weeks getting a mortgage together. Oh wait, my bad, most working people today can not get a mortgage in todays market.

Once again, there is no one to talk to about Medicaid rules. If one can get someone from the Medicaid qualification office on the phone, they will first say, that if what they verbally tell you in the conversation is incorrect, the state can not be held to what they say. Truth is, the State legislature is constantly tweaking the rules to save the state money, meaning to disqualify people from Medicaid. Until one trips over the exact rule that keeps them from qualifying, then it is a bit hard to know much.

A good example of how the programs are actually administered. Food Stamps will demand to know how much a recipient spent on authorized deductions between January first and January fifth to determine the dollar amount of Food Stamps that an individual is entitled to.

The gross income to qualify for Medicaid (and I still do not know which level of Medicaid) for a single person is 900 dollars, or more accurately, about 120 percent of 900 dollars. The 2012 Social Security adjustment for inflation took me a bit more than out of the shadow of obtaining Medicaid. I now get $880.00 for Social Security, and $500.00 for selling a piece of real estate. Apparently from the letter Medicaid qualification sent me, by Medicaid rules, that is about $120.00 too much to get the lowest level of Medicaid. Of course, I really need to cover not only the Premiums, but also the deductibles and co-pays. Medicare rules are meant to discourage recipients from seeking health care that they can get along without, and, if recipients intend to be responsible for paying their bills, not to seek health care when they need it. May I say, often a person who can be helped by competent medical care is not qualified to make the judgement of whether they need it or not.

I am convinced that the state hires administrators for programs like Medicaid, who carry into their office a library of Ayn Rand so they will not forget how to push clerks to make decisions. Until the state creates a program to evaluate the decisions of "earned benefit" programs, and has negative consequences for individuals who find ways to make inaccurate decisions that are against the individual (but which save the state money.) For now, I know the state web site which is to explain food stamp program is not accurate, so I can not possibly know if I should qualify for state Medicaid, but have been denied. Maybe I do know, because I can know the intent of the legislators who make the rules.

[Janknitz]

Medicaid has another provision or two that is sorta relevant. If one goes into a nursing home, on Medicaid, then the home is an asset, and it either must be sold and the money spent on health care before Medicaid can be applied, or the title given over to the state.

Again, NOT correct. A home remains exempt while the Medicaid recipient AND his or her spouse is alive. In 2005, congress enacted the Deficit Reduction Act (DRA) which limited the equity you can hold in an exempt home to $500 - $750k (depending on the state) and still qualify for nursing home care. Incidentally, California never adopteD DRA, so there is no limit to the equity exemption in California at the present time.

Yes the state may recover against real property held in the medicaid recipients name, but not until the recipient AND his or her spouse have died. And in most states, they impose a recovery lien if the recovery cannot be paid immediately, they don't force a sale. Perhaps it's different in Texas?

Medicaid is available to people with incomes below the federal poverty limit. Living on $900 or less a month is hard (SSI will make up the difference between your income and the FPL). If you have an income over the FPL, you may still be eligible for Medicaid but with a "share of cost" that means you'd have to spend all but about $600 of your income on medical care each month before Medicaid will start paying anything. It's pretty hard to live on $600 a month! I don't know about other states, but in California rent paid is not deducted when determining eligibility or share of cost, so people who rent don't have it any "better" than homeowners with or without mortgages.

Medicare recipients may qualify for "extra help" programs to help with Medicare premiums and co-pays (like QMBY and SLMBY) with higher income and resource limits. So it always pays to ask if you're having trouble with those expenses.

It's not great and far from perfect, but the poorest people are covered while some of the people in between are not. That's part of what the healthcare initiative is aiming to fix.

If you need help to determine if you qualify for public benefits, don't rely on word of mouth. Call your state SHIP program (if you are on Medicare) or a public benefits or elder law attorney.

[VikingGnome]

OBAMACARE in Mississippi: My state has chosen to NOT implement the federal mandate of coverage for more people under Medicaid. The population of Mississippi is just over 2 million. Under Obamacare, it would add 400,000 people to those already on Medicaid. The result would be 50% of Mississippians on Medicaid. Doctors are refusing new Medicaid patients and many have dumped Medicare patients.

Mississippi is the poorest state in the USA with the lowest per capita income. The food the poor buy is cheap to stretch food stamps over the month. Their diets are high fat, high carb. Lots of kids are fat. Mississippi has the highest rate of obesity in the country. Diabetes, heart disease, and strokes are rampant. 50% of babies are born to unwed teenagers who get coverage under Medicaid for their obstetric and pediatric care. With these health problems, half the population cannot afford to pay their own health insurance and copays PLUS medicaid for the other half in taxes.

[MidnightOwl]

Medicaid is available to people with incomes below the federal poverty limit. Living on $900 or less a month is hard (SSI will make up the difference between your income and the FPL). If you have an income over the FPL, you may still be eligible for Medicaid but with a "share of cost" that means you'd have to spend all but about $600 of your income on medical care each month before Medicaid will start paying anything.

It's not great and far from perfect, but the poorest people are covered while some of the people in between are not. That's part of what the healthcare initiative is aiming to fix.

That's California and some other states. In other places the poorest people are not currently covered. At least not all of them. You have to be in a special category as well as poor. Elderly, disabled, pregnant, child, parent of an eligible, refugee. If you are just plain poor - no medicaid. That's part of what the reform act is supposed to change.

And I believe what assets you are allowed to have depends on what special category you are in as well as what state you live in.

[dragon672]

I know in Kentucky at least when my Mom went to try and Medicaid she didn't qualify because she owns a house that is probably only worth about $60,000 and some land her father left to her and her siblings. She gets $683 in SSI. She didn't qualify so I guess for Kentucky the rules are different.

[Janknitz]

I know in Kentucky at least when my Mom went to try and Medicaid she didn't qualify because she owns a house that is probably only worth about $60,000 and some land her father left to her and her siblings. She gets $683 in SSI. She didn't qualify so I guess for Kentucky the rules are different.

She didn't qualify because of the other land, NOT because she owns her home. It is a problem when other land is owned, because if her share is worth more than $2000 she will not qualify. There are hardship exceptions if she isn't able to sell her share of the land because it's owned with others, but she'd have to go through the appeals process.

[Suddenly Worn Out]

Well, if it makes you feel any better, I am watching the health insurance industry. The health insurance industry is under surveillance, trust me. A lot of folks dont care for the industry, trust me on that. I would not mind watching them go down the tubes, myself.

Eric

[snuginarug]

oh man... if you think this is bad... wait until "Obama - care" kicks in. The "death-squads" will bump us off cpap coverage like there's no tomorrow.

Sheriff

A "death squad" is an armed military, police, insurgent, or terrorist squad that conducts extrajudicial killings, assassinations, and forced disappearances of persons as part of a war, insurgency or terror campaign.

"Death Panel" is a term first used by Sarah Palin when she claimed that Obamacare would create a panel of bureaucrats who would decide which Americans were worthy of medical care.

I don't think you meant that Obama would send out squads of killers to forcibly snatch infants out of ICU cribs or pull the plug on grandpa in the dead of night.

Or did you?