I need help understanding Medicare plans as a person with autism on SSDI
I’ve tried researching answers to my questions as well as asking my parents to no avail. Hopefully you guys can help me out by explaining plainly. I have a hard time understanding legal language.
(Long post ahead, I apologize)
I’m 29f in Oklahoma and I’ve been on SSDI for about a year. It’s open enrollment time for medicare and I’m trying to decide what plan I want. I’m autistic and too many descriptive details tend to confuse me.
Some background:
I struggled to work retail for about 10 years. I was diagnosed with OCD at 3, Tourette’s at 17, and autistic last year. As well as CPTSD which severely impacted my job performance and caused me to become agoraphobic. I was granted about $980 for monthly income and the next year my medicare kicked in with Parts A&B automatically. With that there was also the cost of living adjustment to social security and my income was raised to about $1070. Medicare takes roughly $170 out so I get about $900 when it hits my bank account.
The year prior I had been on medicaid until October of this year. I went to reapply for the next year(2024) but ultimately I wasn’t able to. A lot of confusion surrounding it because my sister had helped me and my dad sign up for it, as well as herself (I guess we were all grouped together the same main account but our individual applications were separate). She got a raise at her job and no longer was eligible. My dad let his run out due to having medicare and retirement (he is physically disabled because of a back injury). I tried calling the numbers I was supposed to and getting on the state website, but I got no where.Now onto what I’m having trouble with: I take about 6 medications for a variety of things, some expensive, some not. I’m needing drug coverage.
Part D seems sensible enough. I live in a really rural area and the closest clinic is about 20 minutes away. The closest hospital is 40. I don’t have a lot of options to pick that are close to me so Part D sticks out for that reason since I can keep seeing my preferred doctor. I’m looking into the medicare advantage plan, and while I like that it includes MOST medications with the added benefits of possible dental, vision, etc., I would have to go to their preferred doctors and hospitals. I see it includes both A&B.
What I’m wondering is, with medicare advantage plan, would I still be paying A&B separately from the advantage plan, or would it be combined?
I guess my second question is the same as the first. Would I pay part A&B separately from part C?
And there’s also Medigap, which I also don’t understand. I know it’s supposed to help cover medicare cost, but is it also another plan that I’d pay for ontop of original medicare (A&B) and Part D?
Would would be the most cost friendly option? I live with my parents (I can’t live on my own) and I spend about $250–$300 for my groceries, about $150 for gas, $110 for all my medication, and $240 for therapy every month currently (~$800). I’ve never had my own health insurance before (my parents helped me understand medicaid while I had it) and I don’t pay rent, my phone bill, or car insurance. I live paycheck to paycheck so I’m trying to see how I can adjust my budget while also paying my expenses. I don’t have any credit cards and I struggle to save money (I live in a 100+ year old farmhouse we inherited and we all have to pitch in to help each other when we need it. An example would be being short $50-$100 on a bill or gas money or household repairs. We always pay each other back. I’m not financially responsible for my folks.) I usually end up with less than $10 at the end of the month. Can I afford to even get drug coverage? My grocery budget is the most flexible. I buy at the beginning of the month and stretch it until next pay day. I need a minimum of $200 for groceries so I have wiggle room there.
Does medicare also help cover talk therapy? I saw/see a therapist every two weeks to help manage autism, agoraphobia, OCD, & CPTSD and it’s pretty essential to my treatment plan. The medicore book they send in the mail said physically therapy was, so I’m unsure if this is included as well. I was eligible for the sliding scale price based on my income that they offer at the clinic, but since I no longer have medicaid I don’t qualify for it, I think. For some reason it changed (it was explained to me but it confused me more than helped). It’s a state run low income health clinc for rural areas where my therapist, psychiatrist, womens health, and doctor are located. I tried to continue therapy but my visits went from $20 per session on the sliding scale fee, to $120 per session so I’m struggling to afford it every 2 weeks ontop of the retail prices of my medications. I wasn’t aware up until recently about all the different plans (I see them on TV but I never paid attention to them because I thought they were just for after retirement). I’m trying to get prepared and understand everything since there’s only a week left until open enrollment ends. I’ve only found all this out a week ago and thought I had until the end of December.
In a perfect world, it’d be much easier for me to understand if there were fixed prices with a quick description with bullet points of what is and isn’t included for each plan. All the different variables to remember and take into account make everything murky as far as my understanding goes. I wish there was an H&R Block for insurance help like there is for tax help lol.
TL;DR: Need simplified explanations on drug plans/medicare health plans and how they would be billed so I can deduce whether or not I can afford paying for coverage while also affording monthly expenses.
Is there any other options out there available for me?
I appreciate any and all help and advice 🙏🏻 if this is the wrong group to post this in, could you suggest the appropriate groups I could go to?
Many thanks 💜