I'm hoping that the board community can help me out.

A friend of mine unloaded a bunch of serious problems to me tonight. Although she has a skilled trade, her income is meager and the cost of her Cadillac health insurance (a relic of a prior marriage) is killing her financially. IMO the cost would be unsustainable no matter what, but it runs out in May anyway.

She has serious, chronic medical issues including Lupus. She often pursues exotic medical treatments that at times, again IMO, have bordered on quackery. Her excellent medical insurance has given her push-back on the bills connected to some of these treatments, perhaps understandably so.

She has told me that she is eligible for combined Medicare/Medicaid. From what she has told me, this seems to me to be the only rational financial choice for her. But she has concerns about physicians not accepting Medicaid or not authorizing certain treatments.

If you, or a family member or friend have experience with Medicaid, I'd like to hear about it. Post anon if you need to. I realize that a lot of this is state-dependent (we are in Maryland,) but I am mainly interested in experiences regarding access to health providers and appropriate treatment.

Thanks in advance for any advice you can give. I would like to help her sort out these issues as best I am able.

In the area in which I live, most doctors don't want to take anymore medicaid patients, so the unlucky ones are stuck with urgent cares.

I've had medicaid for years. There are plenty of doctors who take it in my area, but not as many specialists. It's supposed to cover everything considered medically necessary, but anything considered cosmetic or experimental will not be covered.

There's also a difference between having straight medicaid and medicaid managed care, which is what I have. With managed care you become a member of a specific plan (blue cross, kaiser, etc.) and get a card from them. It's supposed to make it impossible to distinguish medicaid patients from everyone else on the plan and lead to better care. I have noticed an improvement in my care on managed care over straight medicaid.

Never been on medicare, so I can't speak to what that's like.

Does your friend work, is she retired, or is she on disability?

I ask because, if she has a so-called Cadillac health plan and is paying for it out of her own pocket, she needs to find out if, depending upon her income, she is eligible for a healthcare plan (there are often several plans to choose from) through the Affordable Care Act. Before being promoted to Medicare because of my age, I got ACA health insurance and it was A Very Good Thing. My payments were based upon my income, and pre-existing conditions are not taken into consideration, which are common when you are an older person.

Advise your friend check into these alternatives. And, yes, the sketchy medical treatments likely won't be supported by any new insurance.

Not knowing how your state works, I can say that in my state (Nevada) people applying for Medicaid do so through the county welfare office.

Whatever route she chooses, she needs to apply now so as to discern her options before her "Cadillac Plan" terminates.

She is in her 40s and is working to the extent that her health allows. She said that she is not eligible for the ACA since her small employer offers (not very good) health insurance. I am not sure if that is true or not, but that is what she is saying.

From what she tells me, Medicaid in Maryland is contracted out to United Healthcare. But the time to qualify can evidently be lengthy -- 2.5-3 years.

I appreciate the advice from those who have helped, both on and off the board. I have passed the major points of your advice on to my friend, but right now she is feeling overwhelmed and is shutting down on me. So I will give her the space that she seems to need at present.

I wish that I could do more for her, but as a single school teacher the best I can do is take her out for a movie, coffee, etc. every now and then. She tells me that's what she needs, distraction from her problems. It distresses me that I can't do more.

I know that it is frustrating when you want to do something major to fix a problem. All too often, we feel overwhelmed by the size of the things that need fixing. Try to keep in mind that even a seemingly small action can ripple out in a way that will have a big effect.

In my life, when I lost everything, the truth is that I lost everything except for one friend. And that friendship was the basis for the entire new life that I have built since. When you do anything, anything at all that is positive in your sick friend's life, you are giving her more than you might imagine.

Even a movie, a snack, anything that comes with the knowledge that a person is not alone in the world can be a lifeline.

Sometimes just being there when you can is the very best help that anyone can give.

If she's not eligible for ACA, then I'm unclear on how she'd be eligible for Medicaid?

She says she's not eligible because her employer offers health insurance. I think the Medicaid comes into play because she has chronic health issues and her medical insurance payment and bills are overwhelming compared to her income. Right now her insurance payment is eating up a third of her small income. Even though she reports that it is very good insurance, there are things it doesn't cover, and she simply can't afford the additional bills.

"She says she's not eligible because her employer offers health insurance."

Yep, that's how it works, but supposedly, under the ACA, your premiums are supposed to max out at a certain percentage of your income, like 9.5% or something.

"I think the Medicaid comes into play because she has chronic health issues and her medical insurance payment and bills are overwhelming compared to her income. Right now her insurance payment is eating up a third of her small income. Even though she reports that it is very good insurance, there are things it doesn't cover, and she simply can't afford the additional bills."

Unfortunately, that's happening to a lot of working people now. Since my wife and I were forced onto the ACA two years ago, our payouts for premiums, co-pays, etc., have risen from about 1/5 of our net income to about 1/4. We are 61 and 57. We're going into our "golden years," when we're supposed to be saving for retirement, but health care costs are eating up our income. Your friend might have to quit her job and try to go on medicaid and disability.

A lot of people don't understand the difference.

Medicare is associated with Social Security. People over 65 who get Social Security can get Medicare (and most do.) Also, people under age 65 who are getting Social Security due to disability are eligible for it. This is the little white card with a blue stripe and a red stripe across the top. The rules for it are the same all over the country.

Medicaid is a state-by-state program that tends to be associated with welfare-type (limited income) programs. Often, eligibility is determined by what other income and/or assets you may have. The rules are different from one state to another. Call your local Medicaid office and talk to an eligibility worker to learn the rules in your area. They may insist that you come in and file an application before they will discuss much about it. (I've heard of this happening.)

Good luck.

"She has told me that she is eligible for combined Medicare/Medicaid. From what she has told me, this seems to me to be the only rational financial choice for her. But she has concerns about physicians not accepting Medicaid or not authorizing certain treatments."

Unfortunately, that's the way things are in this day and age. If your friend gets on Medicaid, she'll have to do the legwork to find doctors who will take her. I hear nothing but complaints about health care from everybody these days, from providers to insurance agents to patients. Premium costs, co-pays, and deductibles are higher, but it's harder to find doctors who'll even take you. My own personal doctor just quit his practice because he said he got tired of the ACA telling him what to do. I daresay that things won't get any better until the ACA is reworked or collapses.

There are doctors that are no longer taking Medicare/Medicaid in the area of CA where I live. I always check to make sure they will take my Medicare and my supplemental insurance. So far, so good. The key is to have supplemental insurance, I think. They know they will get paid that way.

I'm guessing (because you and I are in pretty much the same boat, age-wise) that you have Medicare from all your years of work, and an employment-related, solid supplement. So do I.

But I think these Rocks of Gibraltar are becoming a thing of the past. Employers don't want to offer insurance any more.

Before going to a new doctor (usually a specialist), I ALWAYS ask if they take my type of Medicare supplement plan. And because it is a good one, I've never had anyone turn it down.

But that's going the way of the dinosaur. My heart aches for the younger generations.

Same here. I remember even when my mom was alive, maybe 15 years ago, there were physicians who refused to take Medicare patients. And she always had a good supplemental. Her primary care doc referred my mom to his wife, who is a respected specialist in our area. The wife refused to take her because she does not accept Medicare patients. So I refused to go to that specialist as well, and I explained why to my own physician.

Fortunately, I can keep my current insurance at a reasonable cost when I retire from teaching. I will likely use that as my supplemental. The older I get, the more I am grateful for the benefits that my union has negotiated. My salary might be awful, but the benefits are rock-solid.