Anyone enrolled in Medicaid as "Medically Needy With Share of Cost?"

Discussion in 'Random Ramblings' started by Sunny Side Up, Jan 2, 2010.

  1. Sunny Side Up

    Sunny Side Up Count your many blessings...

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    And if so, could you explain how it works?

    My understanding is that the number listed after "share of cost" is like a deductible for each calendar month. Any medical expenses we incur over & above that number in a single calendar month will be paid/repaid by Medicaid. And the conditions remain the same for the next month, that share of cost/deductible must be reached again before Medicaid will pay. But that each month we are expected to pay that share of cost before Medicaid will begin to pay the remainder.

    But Mister says that 2 different workers on the phone at Medicaid said that the share of cost number is the amount of medical costs that must be reached before Medicaid will pay for EVERYthing. He says he asked them again & again to explain and that is what they both said, that if your medical expenses meet or exceed that share of cost amount then Medicaid will pay for it all and your expenses would be zero.

    That would be great if it's true, but it doesn't make sense to me. I need someone to monitor my high blood pressure & cholesterol, to get the lab work done to make sure the prescriptions are working correctly, and to prescribe the correct medications for that. The regular doctor I was seeing would charge about what our share of cost is, and that number is high for me. I thought I could instead go to the county health clinic and get helped there for less. Mister couldn't understand why I was looking for a low-cost clinic because of the explanation of benefits he received. I said if that were true I should go to the most exclusive private doctors on Palm Beach because Medicaid will pay the whole bill after our share of cost is passed. Which could happen after I tipped the valet & doormen at the Palm Beach doctor's office.

    Please let me know what you know about these benefits. It's been so difficult to get information from the local offices, and especially during the holidays.
     
  2. Imp

    Imp All things share the same breath- Chief Seattle

  3. Sunny Side Up

    Sunny Side Up Count your many blessings...

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    Thank you for the links, Imp, they're both helpful & confusing. For example:

    How Does it Work? Each month certain medical expenses... are counted toward your "share of cost". When your allowable medical expenses are equal to your “share of cost”you may be eligible for Medicaid for the rest of that month.... Before using any medical services, you must be sure the provider is willing to accept Medicaid as payment.

    So that makes it sound like the share of cost is like a deductable, an amount you have to pay yourself. But then they say:

    The following example is how “share of cost”works. If your “share of cost”is $800 and you go to the hospital on May 10thand receive a bill for $1000, you have met the “share of cost”and are Medicaid eligible from May 10ththrough May 31st. If the bill from May 10th is a Medicaid covered service received from a Medicaid provider, Medicaid will pay the bill. This is only an example

    Now that makes it sound like what Mister was told, that Medicaid would pay the whole bill after the share of cost amount was reached.

    At least I have some printed info and some phone #s to use to try & clarify. My mantra when dealing with any of these types of entities is "It's not supposed to make sense, it's the Government!"
     
  4. Imp

    Imp All things share the same breath- Chief Seattle

    You're right. It is as clear as mud.
     
  5. Sunny Side Up

    Sunny Side Up Count your many blessings...

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    [​IMG] Must be written by the same folks who produce the IRS forms & handbooks...
     
  6. Imp

    Imp All things share the same breath- Chief Seattle

    Here's another link to a thread talking about it. Remember these aren't officials explaining, just people talking.

    I did a little reading, and my take is that the SOC is like a deductible. Until you hit the $ limit, then Medicaid will cover from THAT day forward. It sounds almost like it retros back to midnight THAT day. So you may not be out of pocket for the entire SOC, just the amount BEFORE the day, you hit the $ limit.

    So to maximize your benefits. It would seem like you would want to hit the SOC $ limit as early in the month as possible and preferably the full amount on the 1st. Then you may not pay anything.

    Keep in mind I'm about as far from Florida as you can get in the continental U.S. Good luck

    http://www.topix.com/forum/health/medicaid/TGCE3RB33KRRQ1P9U

    Imp
     
  7. sonew123

    sonew123 Poultry Snuggie

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    Ok I may help a little it used to be called a "spend down". When I got pregnant for my first DD ( 14 years ago)we did not have medical Insurance...SO I had to do something and went to medcaid for help. We had to go through many appointments and paperwork but it was worth it. I was given a spend down amount-which was 2500.00$ Once I could prove that we spent 2500.00 ( paid in full) tey would then step in and pay ALL medical bills for me and my DD for the full calendar year. Now what sucked was she was born Nov 21-so we had to spend another 2500.00 come jan 1st before they would help again. We did not have to reach that amount every month once per calendar year...
     
  8. EweSheep

    EweSheep Flock Mistress

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    It is so confusing at times!

    I am on Medicare and have Medicaid as secondary carrier which they do cover my deductibles after paying for my co payments if I get any bills owed on it.
     

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