Navigating Health Systems to Find Her Own Independence: Maria’s Story
Meet Maria
As someone with complex health conditions, Maria credits the benefits she receives through her dual eligibility for Medicare and Medicaid for her personal independence. But those benefits didn’t come easily.
Navigating two health care systems and finding the right health care plan took more than three months of phone calls, dead end leads, and countless denials.
Since moving from Ohio to Orlando three years ago, Maria struggled to find the right health care plan—one that integrates her Medicare and Medicaid benefits and covers the services and urological supplies she needs to stay healthy. After trying three different Medicare Advantage plans, a local branch of the national organization SHIP (State Health Insurance Assistance Program) helped her find a Medicare Advantage plan that covers all of her specialists and her medical equipment.
With a Little Help, and a Lot of Work
Even with the support of a case manager, the connections made through SHIP, and endless internet research, Maria still found herself struggling to find a plan that would work for her unique needs.
Whenever she got close to coverage, Maria would run into surprise copays, administrative errors around her insurance status, and sudden denials or delays.
Maria isn’t alone: these recurring issues create unnecessary stress and barriers to the care many people in this country need. Some 12 million people are eligible for both Medicaid and Medicare—sometimes referred to as “dually eligible individuals.” Many providers don’t accept Medicaid or Medicare, and those who do often don’t reflect the communities they serve.
This is a reality Maria knows all too well.
What should be ready access to medical care has become an ongoing battle to become the self-advocate for the care she needs. “It’s like a full-time job,” she shares.
No one should be defined or restricted by their health care needs. Through the countless research and phone calls and the connections she made along the way, Maria today has a plan that better serves her needs. But most importantly, she has her life back.
I really tried to structure my life and my lifestyle so that I can do everything that I want to do…all the benefits that I receive are really what allow me to be as independent as possible.
It may seem like just paperwork, but for many people—like Maria—this full-time job translates into another barrier between their independence and health. Help is a start, but what we need now is change.
If you or someone you love relies on Medicaid and Medicare, your voice can make a difference.
Record a short video sharing how these changes could affect your life—whether you’re a caregiver, an older adult, someone with a disability, or just trying to stay healthy and housed.
Your story will show policymakers what’s really at stake and can help us demand better.
