Medical insurance is a vital part of the support Dave needs to live independently. We are lucky that Dave is relatively healthy. He has a single daily medication, and a medicated shampoo, for chronic conditions, but he doesn’t get sick very often. He got COVID a few years ago after attending camp and stayed with us for a few days, but his symptoms were quite mild. Because of his sleep apnea, he requires regular supplies for his CPAP machine (or, as he calls it, his sleeping machine). Still, the importance of health coverage cannot be overstated. Dave is a “Dual Eligible Beneficiary,” meaning he receives both Medicaid and Medicare.
Medicaid (aka Medical Assistance)
As mentioned previously, Dave has received Medicaid, which is funded by both federal and state sources, since he was a young. Each state has different guidelines for Medicaid. In our state, eligibility requirements for a person’s income, which includes wages and social security benefits, cannot exceed 2.5 times the poverty income guidelines. There are no premiums or deductibles for Medicaid.
Prior to becoming eligible for Medicare, Medicaid covered 100% of almost all of Dave’s doctor’s visits and medications. He is also eligible for reduced dental costs through Medicaid, though it is very difficult to find a dentist that accepts it. Dental care has been one of our biggest challenges, but I’ll save dental adventures for another post.
Finally, as I mentioned in my post on benefits that support independent living, Medicaid also funds the support system that Dave needs to live independently.
Medicare
When Dave had worked enough to qualify for Social Security Disability benefits, he also became eligible for Medicare. Rather than replacing Medicaid, Medicare was added to his insurance benefits. Medicare pays first and Medicaid picks up the remainder. The two benefits together still cover 100% of his medical needs. I’ve only noticed one difference since Dave began receiving Medicare. When we order supplies for his CPAP machine, they now ask why he needs the new items. Are the current ones broken, or worn out? They never asked those questions when he was only covered by Medicaid.
If you have Medicare, you know that it requires a monthly premium. In Dave’s case, Medicaid pays that premium.
Because of Medicaid and Medicare, I don’t worry at all about health costs. That enables me to focus my worrying on other challenges related to Dave living in his own apartment!