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Medical Forum / Diseases and Disorders / Arthritis / May 2005

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SSI, SSDI and Medicare

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Carole - 15 May 2005 02:16 GMT
Can someone tell me when you SSI and medicare, are prescriptions
covered. I've applied for both SSI and SSDI and am waiting to hear on
their decision. In the meantime, I've been declared 100% disabled by the
State of Washington and am presently getting general assistance, food
stamps, and medical coupons. I am wondering about my prescriptions
though as they are very expensive. I still have my medical coverage from
my job as I'm still listed as on medical leave. At this point, my doctor
says my disability is indefinite, so I've applied for everything just in
case I can't go back to work (which looks like what is happening now).

Carole
d'huit - 15 May 2005 02:35 GMT
> Can someone tell me when you SSI and medicare, are prescriptions covered.
> I've applied for both SSI and SSDI and am waiting to hear on their
[quoted text clipped - 7 lines]
>
> Carole

i did a quickie google about this, cuz i have to leave in a minute.  don't
know how accurate or good this site is.  hope this link helps.  if it
doesn't, perhaps somebody else has a better  url for this topic.  --kate

http://www.cms.hhs.gov/medicarereform/drugcard/
Harvey R. Stone - 15 May 2005 14:01 GMT
>> Can someone tell me when you SSI and medicare, are prescriptions covered.
>> I've applied for both SSI and SSDI and am waiting to hear on their
[quoted text clipped - 13 lines]
>
> http://www.cms.hhs.gov/medicarereform/drugcard/

Here are a couple but I do not know if they are better or if they even still
work.   They are from old posts.
some updates at this site that may be helpful to a few people.

Harv

http://www.disabilitysecrets.com/social-security-disability-carpal-tunnel-syndro
me.html


http://www.disabilitysecrets.com/disability-quality-branch.html

http://www.disabilitysecrets.com/social-security-medical-exam.html

Here is a link to the SSA disability web site.

http://www.ssa.gov/disability/

Here is some general information.

http://www.ssa.gov/pubs/10153.html

Here is a list of frequently asked questions about SSA disability.

http://www.nosscr.org/faqind.html

Here is a disability planner.

http://www.ssa.gov/dibplan/

Here is information on utilizing outside doctors/psychologists should
the data you submit not substantiate your claim of disability.

http://www.ssa.gov/pubs/10087.html

Here is the "Red Book" that may answer many of your questions.

http://www.ssa.gov/work/ResourcesToolkit/redbook.html

Here is the "Blue Book" that will provide the criteria for determining
disability/eligibility. This is considered the "bible" of disability
determination for SSA/DDS.

http://www.ssa.gov/disability/professionals/bluebook/

Here is information on family benefits in case you have family living
with you.

http://www.ssa.gov/dibplan/dfamily.htm

If you also receive Workers Compensation, here is information on how
that affects SSA disability.

http://www.ssa.gov/pubs/10018.html

Here is information specifically if you are blind.

http://www.ssa.gov/pubs/10052.html

Here is information on the representative payee program if you have
difficulty with managing your own money.

http://www.ssa.gov/payee/

Here is the Medicare web site if you would like to learn more about
that aspect of being on SSA disability.

http://www.medicare.gov/

Depending how in depth you care to research, here is the operations
manual that all SSA employees must operate under. It keeps your DDS
representative on their his/her toes when you start citing poms. <g>

http://policy.ssa.gov/poms.nsf/poms?OpenView

You will find that most state benefit programs tend to be income based
intended for those in need. Depending on your own personal financial
situation, you may want to research your state agencies that handle
Title 19. Here is information on the federal Title 19 program.

http://www.ssa.gov/OP_Home/ssact/title19/1900.htm

Or go to Yahoo and type in title XIX and your state name to find who
out more information for your local area.

If after reading all of the above and you feel overwhelmed, here is
information on having a representative assist you.

http://www.socialsecurity.gov/pubs/10075.html

Here is a link to the SSA disability web site.

http://www.ssa.gov/disability/

Here is some general information.

http://www.ssa.gov/pubs/10153.html

Here is a list of frequently asked questions about SSA disability.

http://www.nosscr.org/faqind.html

Here is a disability planner.

http://www.ssa.gov/dibplan/

Here is information on utilizing outside doctors/psychologists should
the data you submit not substantiate your claim of disability.

http://www.ssa.gov/pubs/10087.html

Here is the "Red Book" that may answer many of your questions.

http://www.ssa.gov/work/ResourcesToolkit/redbook.html

Here is the "Blue Book" that will provide the criteria for determining
disability/eligibility. This is considered the "bible" of disability
determination for SSA/DDS.

http://www.ssa.gov/disability/professionals/bluebook/

Here is information on family benefits in case you have family living
with you.

http://www.ssa.gov/dibplan/dfamily.htm

If you also receive Workers Compensation, here is information on how
that affects SSA disability.

http://www.ssa.gov/pubs/10018.html

Here is information specifically if you are blind.

http://www.ssa.gov/pubs/10052.html

Here is information on the representative payee program if you have
difficulty with managing your own money.

http://www.ssa.gov/payee/

Here is the Medicare web site if you would like to learn more about
that aspect of being on SSA disability.

http://www.medicare.gov/

Depending how in depth you care to research, here is the operations
manual that all SSA employees must operate under. It keeps your DDS
representative on their his/her toes when you start citing poms. <g>

http://policy.ssa.gov/poms.nsf/poms?OpenView

You will find that most state benefit programs tend to be income based
intended for those in need. Depending on your own personal financial
situation, you may want to research your state agencies that handle
Title 19. Here is information on the federal Title 19 program.

http://www.ssa.gov/OP_Home/ssact/title19/1900.htm

Or go to Yahoo and type in title XIX and your state name to find who
out more information for your local area.

If after reading all of the above and you feel overwhelmed, here is
information on having a representative assist you.

http://www.socialsecurity.gov/pubs/10075.html

This should keep you busy for a couple hours. <g>

--
Carole - 15 May 2005 15:05 GMT
Thanks, Harv. I actually found the paragraph that I was looking for. I
had been told that an ejection fraction of less than 30 qualified for
ssdi and under Cardiovascular - Adult I saw:

"B. Documented cardiac enlargement by appropriate imaging techniques
(see 4.02A) or ventricular dysfunction manifested by S3, abnormal wall
motion, or left ventricular ejection fraction of 30 percent or less by
appropriate imaging techniques . . ."

I definitely have that as my E/F is in the 20's and the symptoms that
they listed after the above, I have. The really scary part of all this
is that I'm starting to understand all the medical language :)  In
addition to monitored exercise that I have at the cardiac rehab center,
they also have classes for us once a week on different cardiac topics.
They have really helped me to understand all of this. I think at this
point I know more about human hearts than I ever wanted to know :)

Carole
Duckie - 15 May 2005 16:10 GMT
And that is not a bad thing... :(  sad but not a bad thing.
Duckie

..... I think at this
> point I know more about human hearts than I ever wanted to know :)
>
> Carole

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Nann Bell - 16 May 2005 14:22 GMT
well, I hate it that you have cause to learn all of this stuff, but it's a
real sign of how doctors are changing their focus to include the patient when
these classes are available!  It's good to know what you're dealing with if
you gotta deal with it.

Oh, and in my experience, docs stay generous with samples of meds.  They know
how ridiculous the current situation with getting meds is.  Heck, I've had
docs call drug reps to get samples for me that they were out of in their
office.  It does get to be a real drag calling for more samples and going by
for them - they can't always give you as large a supply as you'd like.

(speaking of which - anyone else watch the last "Survivor"?  One person
was/is a drug sales rep and she is really, really pretty.  Think she has any
trouble getting in to see the male docs?)

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Nann
remove the Gator cheer to email me
Simply the thing I am shall make me live --- William Shakespeare

> they also have classes for us once a week on different cardiac topics.
> They have really helped me to understand all of this. I think at this
> point I know more about human hearts than I ever wanted to know :)
>
> Carole
Adelle - 16 May 2005 20:15 GMT
> well, I hate it that you have cause to learn all of this stuff, but it's a
> real sign of how doctors are changing their focus to include the patient
[quoted text clipped - 15 lines]
> any
> trouble getting in to see the male docs?)

Depends on how she treats the watch dragons at the desk. They are the true
gate keepers.

I've been in the office when the receptionist has paged a doc to say a drug
salesperson was there (pretty, slim blond wearing a suit I would have loved
to have worn in court. Beautifully tailored!). After a hushed conversation
made excuses for the doc but asked for specific samples.

Adelle
Jo Firey - 16 May 2005 21:15 GMT
>> well, I hate it that you have cause to learn all of this stuff, but it's
>> a
[quoted text clipped - 27 lines]
>
> Adelle

Drug companies use every means at their disposal to increase sales.  Pretty
much like any business does.  It is just plain good business to make sure
the doctors have plenty of samples of your particular version of a drug to
give out, even enough to keep a few patients with no insurance supplied.
Because then it is bound to influence his choice of which version to write
for the rest of his/her patients when the time comes.

Drug reps have to be likeable and knowledgeable.  A willingness to leave
sample and leave the doctor alone once in a while is a good thing.  And
hardly anyone is likeable to everyone.

The staff in a busy medical office gets a lot of "free" lunches.

Jo
Gwen Love - 15 May 2005 02:49 GMT
Carole, Medicare does not cover any prescriptions; however, Medicade does.
From what someone posted, if you are on SSI and SSDI you would be eligible
for Medicade.. Some drugs they don't cover; you would have to check which
ones.
Gwen

> Can someone tell me when you SSI and medicare, are prescriptions
> covered. I've applied for both SSI and SSDI and am waiting to hear on
[quoted text clipped - 7 lines]
>
> Carole
Smokie Darling (Annie) - 15 May 2005 03:29 GMT
> Carole, Medicare does not cover any prescriptions; however, Medicade does.
> From what someone posted, if you are on SSI and SSDI you would be eligible
> for Medicade.. Some drugs they don't cover; you would have to check which
> ones.
> Gwen

In Colorado, if a person receives $1 in SSI benefit, they are entitled
to Medicaid (state insurance).  There are co-pays (for doctor visits
and such) and if I remember my job (I used to determine Medicaid
eligibility for those NOT on SSI) well, they only covered generic
prescriptions.  I *think* there may have been a loophole for meds that
have no generic available, but can't remember for certain.

Carole, I believe that Washington had (at least in 2002) a pretty good
state Medicaid program.  Contact your assistance worker and ask about
it (they'll know).  Were you told at application whether you "may" be
eligible for SSI, or did they say that SSDI was the route you would
take?  On mine, they knew right away that I was SSI ineligible
(husband's military pension).  Monetary guidelines for it are extremely
low.  Perhaps they can look at giving you some "temporary" medical that
covers Rxs, if it appears that you will be SSI eligible.

Smokie Darling (Annie) - Western Colorado

> > Can someone tell me when you SSI and medicare, are prescriptions
> > covered. I've applied for both SSI and SSDI and am waiting to hear on
[quoted text clipped - 7 lines]
> >
> > Carole
Rosemarie Shiver - 15 May 2005 03:34 GMT
http://fortress.wa.gov/dshs/maa/Eligibility/Index.html

There are subtopics specific to your situation.

In general, those eligible for SSI are eligible for Medicaid, too. As soon
as you get SSDI you'll want to sign up for one of the discount cards.

Hugs from Rosie

Signature

"If you wanna get it done, you gotta fight for yourself" -- Meat Loaf, Bat
Outta Hell II

> Can someone tell me when you SSI and medicare, are prescriptions
> covered. I've applied for both SSI and SSDI and am waiting to hear on
[quoted text clipped - 7 lines]
>
> Carole
Cindy - 15 May 2005 12:54 GMT
I have a question...Mike and I both just got our Medicare due to getting our
ssdi...We have another insurance as well...does this mean we will not be
able to take advantage of the discount cards...
Our copays are a little high, but I would assume that if you have rx
coverage at all you wouldn't qualify for the discounts...
Cindy
> http://fortress.wa.gov/dshs/maa/Eligibility/Index.html
>
[quoted text clipped - 16 lines]
>>
>> Carole
Rosemarie Shiver - 15 May 2005 18:27 GMT
http://tinyurl.com/de78u

from the www.medicare.gov site.

Hugs from Rosie

Signature

"If you wanna get it done, you gotta fight for yourself" -- Meat Loaf, Bat
Outta Hell II

> I have a question...Mike and I both just got our Medicare due to getting our
> ssdi...We have another insurance as well...does this mean we will not be
[quoted text clipped - 22 lines]
> >>
> >> Carole
Carole - 15 May 2005 21:22 GMT
> http://tinyurl.com/de78u
>
> from the www.medicare.gov site.
>
> Hugs from Rosie

Thanks, Rosie!  I'm not sure if I get to keep Medicaid once I get
approved for SSDI, but I'll have to find out. Even when I checked that I
had it, it said I'd qualify for a plan. So I might be OK :) And my
doctor is great about giving me samples of my two most expensive meds.
I'm just not sure how long that will last :)))

Carole
 
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