Re: Medicare and Special Assistance

[Guest guest]

JB,

Yes, many of us face this kind of experience. We live in a nation with a

bizarre, convoluted, barrier-ridden healthcare system. Everything is a moving

target with change always a factor.

The silver lining is that HIV is just about the only disease that has its own

national healthcare plan for low income individuals in the U.S. It's not

perfect, but there are way more options for us.

- - -

There are various levels and kins of " extra help " for Medicare Part D insurance.

It sounds like you are a bit confused about the qualifications. In general, you

are eligible unless your income exceeds 150% of the federal poverty level. Even

partial extra help is a big amount.

The rule you refer to actually says

" You may qualify [for extra help] if you have up to $16,755 in yearly income

($22,695 for a married couple) and up to $13,070 in resources ($26,120 for a

married couple). "

Don't confuse " income " (what comes in regularly in pay or benefits) and

" resources " (combined savings, investments, and real estate EXCLUDING the home

you live in, vehicles, personal possessions, burial plots, irrevocable burial

contracts or back payments from Social Security or SSI).

You can also qualify if you already get SSI (not SSDI) or Medicaid.

You can also qualify if you are eligible for certain state assistance programs

(to apply, go to your state's equivalent of the department of human services and

say you want to apply for everything for which you are eligible, including

Medicaid, foodstamps and help with Medicare premiums.)

If you haven't already, I highly recommend getting the guidance of a qualified

case manager to help you.

If it becomes absolutely certain that you do not qualify for extra help, your

many states' White programs have benefits that help pay for part or all of

out of pocket Medicare Part D expenses.

If yours does not, you can apply for the help of pharmaceutical assistance

programs. Do not, I repeat, DO NOT let anyone tell you these programs don't

assist people who have Medicare Part D. Most (and particularly those for HIV

meds) absolutely do. Applying successfully requires persistance, and having

help from someone with experience can make a difference.

Good luck!

mark

Mark Hubbard

Nashville TN

>

> Hey everyone. I just recently applied for Medicare Part D. I have applied for

the special assistance .. I just cannot afford the co-pay on these expensive HIV

meds. I was told you could not have more than roughly 16,000 in assets, meaning

savings, checking and/or any other income. I am fretting over them denying this

help. I found out there is a waiting list for ADAP, with a thousand already on

the list. My private insurance is canceling my policy as of May 18th. Anyone

else go through this experience?

>

[Guest guest]

Mark, thank you so much for your response. I have been fighting Insurance companies and medical bills since I found out I was HIV poz. So 25 years .. of that will drive a person crazy. I am already on disability. Unfortunately the money I has only been accumulated within the last year due to back payment from Social Security. Although my VL and CD4 are looking better, I still suffer from depression and anxiety .. it doesn't take much to tire me out. I am waiting for a response from Medicare .. and also running out of medicine. HA HA it's always something. I have been using the coupons from the pharmaceutical companies, and although they help .. I still have to pay hundreds out of pocket expenses for medication. I was told that these coupons are only good if you already have private health insurance. So there you

go.Thanks to everyone for your attention and advice .. I really, really appreciate your help ..Mark! JB From: mark_h_hubbard <mhubbard@...> Sent: Wednesday, April 4, 2012 9:34 AM Subject: Re: Medicare and Special Assistance

JB,

Yes, many of us face this kind of experience. We live in a nation with a bizarre, convoluted, barrier-ridden healthcare system. Everything is a moving target with change always a factor.

The silver lining is that HIV is just about the only disease that has its own national healthcare plan for low income individuals in the U.S. It's not perfect, but there are way more options for us.

- - -

There are various levels and kins of "extra help" for Medicare Part D insurance. It sounds like you are a bit confused about the qualifications. In general, you are eligible unless your income exceeds 150% of the federal poverty level. Even partial extra help is a big amount.

The rule you refer to actually says

"You may qualify [for extra help] if you have up to $16,755 in yearly income ($22,695 for a married couple) and up to $13,070 in resources ($26,120 for a married couple)."

Don't confuse "income" (what comes in regularly in pay or benefits) and "resources" (combined savings, investments, and real estate EXCLUDING the home you live in, vehicles, personal possessions, burial plots, irrevocable burial contracts or back payments from Social Security or SSI).

You can also qualify if you already get SSI (not SSDI) or Medicaid.

You can also qualify if you are eligible for certain state assistance programs (to apply, go to your state's equivalent of the department of human services and say you want to apply for everything for which you are eligible, including Medicaid, foodstamps and help with Medicare premiums.)

If you haven't already, I highly recommend getting the guidance of a qualified case manager to help you.

If it becomes absolutely certain that you do not qualify for extra help, your many states' White programs have benefits that help pay for part or all of out of pocket Medicare Part D expenses.

If yours does not, you can apply for the help of pharmaceutical assistance programs. Do not, I repeat, DO NOT let anyone tell you these programs don't assist people who have Medicare Part D. Most (and particularly those for HIV meds) absolutely do. Applying successfully requires persistance, and having help from someone with experience can make a difference.

Good luck!

mark

Mark Hubbard

Nashville TN

>

> Hey everyone. I just recently applied for Medicare Part D. I have applied for the special assistance .. I just cannot afford the co-pay on these expensive HIV meds. I was told you could not have more than roughly 16,000 in assets, meaning savings, checking and/or any other income. I am fretting over them denying this help. I found out there is a waiting list for ADAP, with a thousand already on the list. My private insurance is canceling my policy as of May 18th. Anyone else go through this experience?

>

[Guest guest]

I had to figure my own way recently through the Medicare maze, including the Extra Help program. The program eligibility guidelines regarding resources is as follows: Your combined savings, investments, and real estate cannot be worth more than $26,120, if you are married and living with your spouse, or $13,070 if you are not currently married or not living with your spouse. (DO NOT include the home you live in, vehicles, personal possessions, burial plots, irrevocable burial contracts or back payments from Social Security or SSI.) If you have more than those amounts, you may not qualify for the extra help. Also of note, The amount of your Extra Help is based on your marital status, the number of people living in your household, the resources you own, and your income. I am single, living alone and on disability. The income limit the SSA used to determine my subsidy eligibility was $16, 335. Since my annual disability income fell below this, I qualified and pay $6.50 out of pocket per scrip. Hope this is of help to you. -

[Guest guest]

For current and authoritative information on Medicare, check out the Center for Medicare Advocacy's website at http://www.medicareadvocacy.org/. This is a public interest law firm that advocates on the behalf of Medicare and Medicaid clients. It is NOT affiliated with the Center for Medicare Services.

Jerome

In a message dated 4/5/2012 10:41:04 A.M. Eastern Daylight Time, ejockey@... writes:

I had to figure my own way recently through the Medicare maze, including the Extra Help program. The program eligibility guidelines regarding resources is as follows:

Your combined savings, investments, and real estate cannot be worth more than $26,120, if you are married and living with your spouse, or $13,070 if you are not currently married or not living with your spouse. (DO NOT include the home you live in, vehicles, personal possessions, burial plots, irrevocable burial contracts or back payments from Social Securit y or SSI.) If you have more than those amounts, you may not qualify for the extra help.

Also of note, The amount of your Extra Help is based on your marital status, the number of people living in your household, the resources you own, and your income.

I am single, living alone and on disability. The income limit the SSA used to determine my subsidy eligibility was $16, 335. Since my annual disability income fell below this, I qualified and pay $6.50 out of pocket per scrip.

Hope this is of help to you.

-

[Guest guest]

Thank you for the information . I realize that I have made a huge error in that I did not specify that the money I have accumulated is due to back payment by Social Security. So that would definitely qualify me for Special Assistance. The patient advocate that helped me fill out the form online .. actually is to blame. He was not very pleasant in helping me .. and at one point raised his voice. I was merely trying to understand if back payment was included in total income. I would have mentioned this to his superiors, however he is also HIV poz and has severe Lypodystrophy. So I guess I will have to give him a break on that. Like it would do any good ..ha ha From: <ejockey@...> Sent: Thursday, April 5, 2012 6:13 AM Subject: Re: Medicare and Special Assistance

I had to figure my own way recently through the Medicare maze, including the Extra Help program. The program eligibility guidelines regarding resources is as follows: Your combined savings, investments, and real estate cannot be worth more than $26,120, if you are married and living with your spouse, or $13,070 if you are not currently married or not living with your spouse. (DO NOT include the home you live in, vehicles, personal possessions, burial plots, irrevocable burial contracts or back payments from Social Security or SSI.) If you have more than those amounts, you may not qualify for the extra help. Also of note, The amount of your Extra Help is based on your marital status, the number of people living in your household, the resources you own, and your income. I am single, living alone and on disability. The income limit the SSA used to determine my subsidy eligibility was $16, 335. Since my annual disability income fell below this, I

qualified and pay $6.50 out of pocket per scrip. Hope this is of help to you. -