Anyone out there having issues with Medicare part D?

[JustDucky]

I ask this because it profoundly affects my med coverage. Even with my disability, I make too much for Medicaid and Medicare, yet I can get Medicaid because of my extremely high med. costs only with a spend down of about 1000 a month..that's right, 1000 a month! Medicare usually paid for my nebulized meds, such as TOBI, which I know all of you are aware of how much that one costs, Xopenex as well as Mucomyst 100% with my medigap insurance. Now...once January 1st comes rolling around, that won't be so, I have talked with at least a few folks from Medicare myself. It all falls under the Medicare part D prescription plan. I will now have to pay a substantial co pay for my meds, especially the TOBI...I have narrowed my choices down to 3 insurance companies as I am also on several other meds. Pancrease was another one I have had to consider as well...that bottle of 100 caps costs $200 a bottle!!!

I am just wondering what all of you folks on SSDI are going through with the Medicare issues, especially those who aren't on Medicaid or state help. My social worker from my Medicaid office is supposed to get back with me, she is doing the best she can, she feels terrible for me as far as my med plight goes. IV meds are a nightmare, I have found some companies that will cover them, so I am not complaining there....I just plugged in the most common IV meds I am on and looked at the costs...some are actually reasonable and I would gladly pay those co pays to avoid a hospital stay any day. But its the nebs and pancrease I am worried about....any other suggestions out there? I am so worried about this financially, as I know others on this board are as well. Dont get me wrong, I am glad that I do have insurance and that Medicare does indeed pick up a huge amount of my tab as far as my ventilators go and their supplies ($60,000 a year just f or that)...but I am a single parent, live on SSDI and have two kids to raise (do get child support to help thank god!). Mom is home full time to make sure that I am safe and to help me physically...so I really am in a pickle as they say. Like I have said in the past, I feel very comfortable talking to all of you here, I know alot of you have walked in my shoes and can relate to my problems. Thank you all in advance for your consideration and help here...as Jan 1st gets closer, I am getting more frustrated. Hugs to all, Jenn <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[debs2girls]

Jenn, I am relatively new here and to cf so I am not too sure about this...but have you tried CF Solutions? It is based in Tulsa, Ok...about 30 minutes from me...I have heard, if your insurance doesnt pay for all of it and you cant, they will wave the remainder...it cant hurt to look into it.
Debbie

 

[cdale613]

Hi Jenn,

I work for a public policy "think tank" doing health policy stuff, and do a lot of work with Medicaid Eligibility, and have learned a lot about how it will interact with Medicare Part D.

First of all.... everything that was covered under your Medicare Part B, including your TOBI, will continue to be covered under Part B. I don't know how your IV's were covered in the past, but if Medicare Part B paid for them as well, it should continue to do so, even after Part D starts.

Moving on.....If I understand you correctly, right now you are "spending down" into Medicaid coverage... in otherwords, you spend enough money so that Medicaid pays for your remaining Medicare costs, until you have to spend-down again. I can't tell from your post if you qualify for "Full" Medicaid Coverage -- this would depend strongly on what state you live in, etc. If you receive Full Medicaid coverage, in addition to Medicare cost sharing from Medicaid, you should qualify for the Low Income Subisdy provisions of Medicare Part D, which would pay for your monthly premium, your deductible, and erase the "doughnut hole" gap in coverage, leaving you only responsible for a nominal ($3 or so) copay for your RX's. If you are indeed fully eligible for both Medicare and Medicaid, you should have received a yellow notice from the Center for Medicaid and Medicare Services (CMS) saying that if you did not select a Part D plan, you would be automatically enrolled in one. You can change this auto-assigned plan to one that better fits your needs.

If you only qualify for Medicare Cost Sharing (Partial Medicaid) you may still be eligible for assistance with your drug costs through Medicare Part D. I am not familiar with the specifics on this, but will try to find some information for you tomorrow at work. I will also post a bunch of handy links, which will hopefully be of some help.

My recommendation to you as you pick a plan, is to pick plans that 1) cover the drugs you need - again, don't worry about the drugs you get through Medicare Part B - that coverage will not change. 2) Charge specific Co-payments ie. $10 per prescription, not Co-insurance (20% of each prescription) . When you compare plans, make sure to check not only what drugs are covered, but also how they are tiered, etc. The same drug may be far more expensive under one plan than another.

If you have any specific questions, feel free to PM me.

Chris

25 w/CF

 

[cdale613]

I don't know much about CF Solutions, but my understanding is that it is for those without any insurance.... If you are covered by Medicare/Medicaid, you may not qualify for the assistance they offer. Feel free to check it out, but don't be suprised if that's what they tell you.

Chris

 

[cdale613]

Hi Jenn -

Here are a couple things...

1) This link is on the CFF website, and provides a phone number to help CFers pick a plan, and deal with other issues. I haven't called it, but it looks promising...

http://www.cff.org/legislative_action/public_health_and_reimbursement/#Medicare_Part_D



2) This is a link to the Medicare Handbook - you may have already received it in the mail. As you probably know, it isn't as helpful as it could be, but I'd like to direct your attention to Page 60 - there is a phone number for people to call if they think they qualify for assistance with Part D costs... it isn't the usual Medicare number, I think it is the Social Security Administration. You should definitely call it.

http://www.medicare.gov/publications/pubs/pdf/10050.pdf

I hope it helps!

I won't be able to check email for a few days, as I'm going out of town for the New Year, but I will be back on Tuesday.

Chris

25 w/CF

 

[anonymous]

Anyone can use CF Solutions, insurance or not. They accept all major insurance as well as medicare and medicaid.

 

[anonymous]

Hi Jenn,
I was given the same information Chris was by Medicare, that all nebulized meds are still covered under Medicare part B because they are considered durable medical equipment.

Kim
40 w/cf

 

[JustDucky]

Whew, that's good to know..I didnt know that nebs were considered DME by Medicare? When I check their formulary, I keep seeing TOBI and other nebs on them so it made wonder if it was going to go under Medicare Part D....confusing huh? All of you have been very helpful, thank you so much...Hugs, Jenn <img src="i/expressions/face-icon-small-smile.gif" border="0">