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options for medicare disabled individuals
Sep 7, 2001

I am on full disability-medicare is my health insurance. I live in california and have been told other than medicare hmo's no other insurance will be granted to me, due to my pre-existing condition. Are there any other options for me. My hmo-limits my meds. and aptm'ts ,I'm lucky to have 15 minutes every three months. Plus I have 1,000 of prescription coverage-gone already on 2 prescriptions- I'm concerned I am getting substandard care when I have a life threatening illness-Any suggestions? I know I'm not alone-I worked hard my whole life and now when I need help due to an illness-I feel like a thorn in everyones side-

Response from Ms. Donnelly

You are in a very frustrating situation. To the best of my knowledge, you should not be forced to take only Medicare managed care. Typically, Medicare is available as fee for service, the type of insurance coverage where you choose your doctor and are reimbursed for each covered service, or managed care. You are generally allowed to choose which plan you want.

Also, if you live in California, you may very well be eligible for the AIDS Drug Assistance Program (ADAP) to cover your prescription drugs. In California, you can make up to $50,000 each year and still be eligible for some assistance under ADAP. You don't need to be uninsured to be eligible for ADAP, just underinsured (not having enough insurance to cover your necessary prescription drugs).

You should definitely consult with a benefits counselor to sort out what is available to you. If you have trouble locating a benefits counselor or a case manager in your area, call the Project Inform hotline at 1-800-822-7422 and ask for the Access Coordinator.



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