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

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> 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?

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