Re: Re: Medicare Part D Help

[Guest guest]

Yes it is a nightmare. Especially this doughnut hole crap. I am now receiving help to pay my health insurance premiums $500+ by the state community health department, not part of ADAP. My insurance company is ending my policy as of May. I am wondering if going on Medicaid wouldn't be a better option. I am not receiving much money through SS. I am unemployed and am reluctant to try to return to work. I mean, with HIV medications, you can hit the $4770 within a month. My prescriptions, including my HIV meds run almost $4000 a month already. I must meet a $2000 deductible at which the insurance co. will pay out 70% on most medications (not all). After $10,000 they pick them up at 100%. That will all end as of May '12. I am so depressed about the money situation I am ready to throw in the towel. I really am about to give

up. Trying to stay alive and healthy is just too much leg work for anyone. Trying to navigate through all of this bullshit. It would be so nice to have some relief. Seems as though when I start writing about things 'emotional' .. my posts never make it through the sensors. I am just one person living with HIV of thousands who have to go through this every day. Is Medicaid a better option? From: back2cali07 <back2cali07@...> Sent: Sunday, January 22, 2012 3:24 PM Subject: Re: Medicare Part D Help

A couple of thoughts on this! I am on a Medicare Part D plan with Bravo and they have worked well for me. Ask them if you qualify

to help with extra assistance that will cover your co-pays. The maximum you can make though is around $16,000 (just under $17,00 yrly) so I have to pay about $37 a month BUT ADAP picks up the major part of co-pay for my meds which runs about $600 a month and I cannot

afford to pay that out of pocket. Now once I hit $4770 in payment

on my meds then I fall into the donut hole and then will qualify

for extra assistance. It seems like a big nightmare but you can't

panic and it eventually all falls into place.....

The biggest factor is you need to be on ADAP, if you aren't then

you need to do it immediately, regardless of which Part D program

you are on. Check with your local ASO to see if they do it. I have

a link to a site can tell you but it only applies to a few states.

What state are you in?

Nena

>

> If you're shopping for a Medicare Part D plan, definitely go to

> http://www.medicare.gov/ to shop for both Part D & Medigap plans. Just

> enter in all your meds and it will calculate your estimated monthly cost.

>

> You didn't mention ADAP--do you qualify in your state? Even if you exceed

> the income limits, many states allow you in the program if you pay a share

> of cost--definitely worth checking out.

>

> Part D & MediGap plans can be very cheap--I pay $30 for a Humana

> Point-of-Service HMO that allows me to see me own out-of-network doc for a

> slightly higher co-pay. When switching over it may take a month or so to

> jump through all the hoops of getting authorizations for non-generic meds

> so that they are reimbursed at the best rate.

>

> Good luck!

> Jeff

>

[Guest guest]

I don't think it would hurt to be on Medicaid! What state are you in? Do you have a casemanager through a ASO who

can help you navigate this stuff? I totally get where you are coming from, I was in tears when I heard from Medicare

how much my portion of meds would be but then I had to just take a deep breath, and trust in the system and they came

through. But ADAP was essential. I am in California where it is called Medi-Cal and we are such a broke state that

once I was on Medicare they were of no help for medications. I would also check with pharmacetical reps of the

meds you take. So many now all offer patient assistance plans. I take Truvada (Gilead) and Kaletra (Abbott) and

both of my reps have said they now offer financial help. So I know it takes some footwork but the less you have to

pay out of pocket the better :-) Don't give up, there is always hope somewhere out there.....

Another option I didn't fully check out because I do have ADAP but you can purchase Medigap insurance that

Jeff mentioned. There are SO many insurance companies who have these plans and even if you paid $100

a month that would be far better than a couple of thousand upfront before your meds were covered.

Try HealthNet, AARP, Humana, Blue Cross, Blue Shield......and for generics of course there is always

Wal-Mart.

Returning to work might be a better option (if you at least live in a area that still has jobs!) if you can get medical

insurance that would pay for all your meds. That might help with some of your depression issues. Are you on

SSI or SSDI? Fortunately for me living on SSDI I am in a very affordable town in California. I couldn't live as

well in L.A. for S.F.

And unless something is really derogatory then is very fair about posting everything that gets sent.

I have to double check when I click "reply" and read who I am replying to, sometimes it's to an individual

and not to the group. We are all here to help and support each other :-)

From: Blakeman <blueeyes9455@...>back2cali07 <back2cali07@...>; o (zHealth " < > Sent: Monday, January 23, 2012 5:38 PMSubject: Re: Re: Medicare Part D Help

Yes it is a nightmare. Especially this doughnut hole crap. I am now receiving help to pay my health insurance premiums $500+ by the state community health department, not part of ADAP. My insurance company is ending my policy as of May. I am wondering if going on Medicaid wouldn't be a better option. I am not receiving much money through SS. I am unemployed and am reluctant to try to return to work. I mean, with HIV medications, you can hit the $4770 within a month. My prescriptions, including my HIV meds run almost $4000 a month already. I must meet a $2000 deductible at which the insurance co. will pay out 70% on most medications (not all). After $10,000 they pick them up at 100%. That will all end as of May '12. I am so depressed about the money situation I am ready to throw in the towel. I really am about to give up. Trying to stay alive and healthy is just too much leg work for anyone. Trying to

navigate through all of this bullshit. It would be so nice to have some relief. Seems as though when I start writing about things 'emotional' .. my posts never make it through the sensors. I am just one person living with HIV of thousands who have to go through this every day. Is Medicaid a better option?

From: back2cali07 <back2cali07@...> Sent: Sunday, January 22, 2012 3:24 PMSubject: Re: Medicare Part D Help

A couple of thoughts on this! I am on a Medicare Part D plan with Bravo and they have worked well for me. Ask them if you qualifyto help with extra assistance that will cover your co-pays. The maximum you can make though is around $16,000 (just under $17,00 yrly) so I have to pay about $37 a month BUT ADAP picks up the major part of co-pay for my meds which runs about $600 a month and I cannotafford to pay that out of pocket. Now once I hit $4770 in paymenton my meds then I fall into the donut hole and then will qualifyfor extra assistance. It seems like a big nightmare but you can'tpanic and it eventually all falls into place.....The biggest factor is you need to be on ADAP, if you aren't thenyou need to do it immediately, regardless of which Part D programyou are on. Check with your local ASO to see if they do it. I havea link to a site can tell you but it only applies to a few states.What state are

you in?Nena>> If you're shopping for a Medicare Part D plan, definitely go to> http://www.medicare.gov/ to shop for both Part D & Medigap plans. Just> enter in all your meds and it will calculate your estimated monthly cost.> > You didn't mention ADAP--do you qualify in your state? Even if you exceed> the income limits, many states allow you in the program if you pay a share> of cost--definitely worth checking out.> > Part D & MediGap plans can be very cheap--I pay $30 for a Humana> Point-of-Service HMO that allows me to see me own out-of-network doc for a> slightly higher co-pay. When switching over it may take a month or so to> jump through all

the hoops of getting authorizations for non-generic meds> so that they are reimbursed at the best rate.> > Good luck!> Jeff>