Medicare Part D, Medicaid and prescription costs -

[pinto]

Got the monthly print out of my medications and the payments applied today. I'm a high ticket participant. Monthly medication costs for August, 2014 - $3,712. My payment obligation - $0. Personal context is that I participate in Medicare and Social Security, which is my sole source of income.

I mention this to encourage folks to look at available options for medication expenses. I realize all folks may not be able to access some of these programs. Yet, for those that may - worth a look.

"Extra Help" from Medicare. - 1-800-633-4227. It's a low income subsidy - they call it5 LIS in Medicare speak.

State Medicaid programs. Some fill the gap on co-pays. Best resource is your local Medicaid office. (Primarily income based).

State pharmaceutical assistant programs (SPAP). Local health departments or social service departments will probably have some info on access and application.

Pharmaceutical companies' direct subsidy or discounts. (Most have them, but you need to ask about it, and have some documentation of financial need. Docs will often sign on to a request for assistance.)

~ pinto

[Z_California]

1. Thanks for the info!

Kicked!

[Triana]

2. Thanks Pinto

My mom's doc gave her the pharma subsidy form - he's a specialist and told her to have her PCP sign it and send to GSK. When she gets into the damned 'doughnut hole', they will hopefully cover her asthma meds for free or at least much cheaper.

She gets into the doughnut hole EVERY YEAR around April and stays there rest of the year. Two meds she is on are very expensive and those are the ones she needs help with.

Of course it would make much more sense for them to just lower their damn prices wouldn't it?

[pinto]

5. Yeah it would. But in the meantime encourage you to access any and all programs.

Takes a bit of work, some (or a lot of) frustration and all that. But it can pay off for consistent healthcare.

[upaloopa]

3. I work for a county and we help with filling out

Medicaid applications. Right now if you are eligible under the ACA counties are reimbursed 100% for services to you. That is good because we still get the other funding we always got but now we can serve more people.
That is if you live in a state with expanded Medicaid.

[pinto]

7. +1

[TygrBright]

4. Good info, thanks Pinto. But if they'd keep the Part B providers from playing shell games...

...with "tiers" and copays and generics, etc., it would probably have a longer-term, more widely-experienced benefit.

How Insurers Are Finding Ways to Shift Costs to the Sick

We got our "Changes to your Plan B" update directory last week.

I use the word "directory" advisedly; the thing is about the size of a hardcopy small city telephone directory.

The co-pays for a few "Preferred" generic medications have been dropped from $5 to $3, yippy-skippy!

A LARGE number of other generics have been classified "non-preferred" and the copays raised from $5 to $10.

For "Tier 3" medications (mostly expensive proprietaries for which there are NO generic alternatives) the co-pays have ALSO been lowered a smidgen (from $45 to $40) BUT a separate $370 deductible has been implemented.

Various other bits of smoke and mirrors have been implemented, pretty much all the "lower costs" are in mandatory ACA-related areas and/or inexpensive or rarely-used services. Everything else has been jacked up in a manner I'm sure they believe is Machiavellianly subtle.

We plowed through this.

And we will be consulting with a specialist heath insurance agent to determine whether any other plans meet our needs better, and should that be the case, we will opt out of the current plan during the open period, and into a better plan.

We're comparatively young, education, middle-class and energetic and in generally good health, and we can do this.

I have to wonder about many older, sicker, more vulnerable seniors on Medicare who will allow the open period to come and go, and find themselves with escalating health care costs next year, because they don't have someone to help them through the process.

angrily,
Bright

[pinto]

6. Have you looked into Medicare Part D? That's the med prescription program.

And, yeah, kudos to all who help folks along the process.

Take care, TygrBright.

[TygrBright]

8. Ours is one of the combo plans that includes B&D.

Medicare appears to have been designed to discourage elderly people from understanding it and/or using it to full advantage.

Not too surprising, really.

cynically,
Bright

[pinto]

9. Yeah, it's frustrating and confusing. Encourage your friends to access support services for info.

Given the changes in our national health care systems, most have some info to help folks make an informed choice.

[nruthie]

10. Part D hell.

Got my updated information for 2015 last week and guess what! My tier 2 drugs that I have paid $5 for this year will change to tier 3 next year and the price will then be $45 for each. I am a senior on a fixed income and there is no way I can afford this extortion. The provider's advice: talk it over with your doctor and have him change your prescriptions to a cheaper drug. A visit to my doctor is just more money in his pocket. I will be looking for a new program....thanks a lot, AARP, you greedy s.o.b.'s. It's all a game. I am sick of it all.