THE ISSUE
Stories from People Eligible for Medicare and Medicaid
Neither Medicare nor Medicaid can individually meet the complex needs of people who qualify for both. Yet, the two programs were not built to work together, leaving people generally among the nation’s most medically and financially vulnerable to face significant challenges navigating their coverage and accessing care.
These stories recount the frequent and unacceptable barriers that people who are dually eligible face when enrolling in, maintaining, renewing, or using their health coverage and demonstrate the challenges they face when trying to manage their own health.
The experiences of every person are unique, and all are instructive to improving integration between Medicare and Medicaid.
MMIA extends heartfelt thanks to everyone who shared a story about navigating dual eligibility.
To share your story or to get in touch with MMIA, please contact us.
Story Topics
Integrating Coverage: Limited integration between Medicare and Medicaid can cause difficulty using either or both at the same time, leading to frustration, delayed care, and worsening health.
Accessing Consistent, Quality Care: Inadequate provider networks and unclear coverage rules can make accessing care difficult for people who are dually eligible.
Navigating a Flawed System: Support for people who are dually eligible can be sparse, often leaving them to navigate a complex network of providers, rules, and exclusions on their own.
Getting and Staying Covered: Many people aren’t aware that they are dually eligible, while administrative burdens prevent others from maintaining their coverage.
Holly’s Story
Medicare left Holly paying for care out of pocket for 19 years. No one told her she might be eligible for Medicaid.
Katie’s Story
Katie worried she’d have to skip grocery shopping to afford her medication before she learned she was eligible for Medicaid, which covered what Medicare didn’t.
Maria’s Story
Maria spent three years looking for a plan that integrated her benefits and covered her medical supplies. She only got contradictory answers.
Mr. A’s Story
Mr. A, who is blind, lost coverage when his state failed to send his renewal paperwork in braille.
Diane’s Story
Every time Diane moved, different state Medicaid eligibility rules threatened her coverage.
Mr. G’s Story
After surgery, Mr. G’s Medicare and Medicaid plans each said the other should pay for his orthotic inserts, leaving him with the bill.
Kayla’s Story
The stressful hours Kayla spends trying to sort out her health coverage each month are making her sicker.
Ms. T’s Story
Ms. T’s limited-coordination special needs plan sent her to a therapist who did not take Medicaid, causing billing issues that cost her a trusted mental health provider.
Kathleen’s Story
When plans don’t ensure access to high-quality mental healthcare, people like Kathleen face the consequences.
Mr. Y’s Story
Mr. Y accidentally lost health coverage. His care manager immediately provided the support every person who is dually eligible should have.
Mrs. E’s Story
One missing recertification packet cost Mrs. E her Medicaid, Medicare Savings Program, and her dual-eligible special needs plan.
Mrs. W’s Story
When Mrs. W switched to a coordination-only dual-eligible special needs plan, the lowest standard of integration, she didn’t get the more seamless experience she was promised.