Help with part D

[Gary]

So in yesterdays mail I got a notice that I no longer qualified for help with my Part D since January. Because my disability check is $33.33 a month above the Federal poverty guidelines. Starting next month I have to pay everything back at the tune of $300 a month and my premiums will go up $50 a month. They cant tell me how much that is because they don't know yet. I can sue medicare but I have to get a lawyer and pay him and the court costs up front because it is a civil matter.

Due to the fact that it was terminated due to making too much money I will not qualify for help from the drug companies. And since my renters flaked on me we are now $950 a month short. There are a lot of meds that I will no longer be taking as they are waaaay out of my price range. I just figured that I will fall into the donunt hole within $8.00 I will have to pay 100% of the cost. And everyone of them are generic as it is.

Sorry for the rant but I am past angry.

[Jeanie Z]

:) That is awful Gary. I hope the agency who says it paid you $33 too much will be able to make it doable for you. You are in my prayers. Jeanie :)

[agate]

Gary, it sounds as if you could be considered a hardship case. If you make a lot of persistent phone calls you might be able to find a special provision for hardship cases that will help you out of this.

You usually have to put up with being put on hold a lot and being given other numbers to call but if you're willing to put in the time and energy, there may be help out there. The trick is to find it.

[Howie]

Gary, I'm sorry they pulled the rug out from under you. It's not fair. Fight and jump through the hoops they present you. Don't let it get to you, it will work out!

[SalpalSally]

Oh Gary, I'm so sorry...that stinks!!! I hope they don't get by with this,
Get in there and fight and stay calm...Yeah right. Saying a prayer for you.

[Earth Mother 2 Angels]

((((((Gary)))))) ~

You have every reason to be steamed! This kind of bureaucratic baloney is quite stressful, so first and foremost, take a deep breath and try not to let it rile you up too much to affect your health.

I have spent decades advocating and battling government agencies. In your shoes, I would approach your situation thusly:

1. Gather all of your documents relevant to the disability income, SSI, and Medicare.

2. Make a list of your drugs, including their cost without Part D (the cost to you privately) per month.

3. Make a list of your monthly bills/expenses to compare with your monthly income.

4. Make a list of your arguments:

a. You didn’t know that you were $33.33 over the poverty level with your SDI (assuming it is SDI). The government should have informed you that this amount would put you above the poverty level and might affect other benefits, such as Medicare, Supplemental Insurance for Parts B and D, and/or Social Security payments (if you receive those). If this began in January, then did you receive a cost of living increase in your SDI? Is that what suddenly put you over the poverty level?

b. If your $950/month rental income affects your benefits, note that you no longer receive that income.

c. If you’re receiving SDI, that is part of Social Security, as is Medicare. So it’s all one big agency. I guarantee you that the right hand doesn’t know what the left hand is doing. And the left hand doesn’t even know that the right hand exists. You have a right to expect coordination among the departments within Social Security, and to be notified before 9 months have passed that you have surpassed the threshold by $33.33/month.

d. On good faith, without knowledge that you were $33.33 over the limit, you paid your Part D premiums. You didn’t default.

5. Take action:

a. Call SDI. Ask to speak to a supervisor, if you don’t get a helpful person on the line. Explain your situation. Ask if they can solve this for you. State that you are willing to forego the $33.33 per month to continue to have Part D coverage at a lower rate. Your premiums will go up $50/month, so $33.33 doesn’t help you there. If you can get back down to the poverty level, your premiums should not go up.

b. Call Your Part D provider. Explain your situation and ask them to explain their action to you further. Take copious notes, include name of person, time, date, and length of call. (Actually do that with all of your calls. Ask the person's name and to spell it for you. Ask their extension number.)

c. Call Medicare. Explain your situation. Etc.

d. All Federal programs offer appeals for due process. When you file in a timely manner for a hearing on your case, you should get a “stay put” order. A “stay put” order means that nothing changes for you until after the hearing decision is rendered. The Part D people can’t charge you $50/month more or demand $300 a month in repayment, unless they prevail in your hearing. Ask Medicare about your hearing rights, or go to their website and see what you can find out there.

e. This is open enrollment season, so start shopping around for a different Part D provider. Compare rates and coverage of the drugs you need.

It’s a lot of work, but it can be done at home, on the phone and the internet.

You may have to schlep down to your local Social Security office and meet a real person to get any action. If you ask for a due process hearing, you’ll have to appear wherever it is held. These are generally given to administrative law judges and occur in informal (not court) settings. It costs you nothing, and if you have all of your ducks in a row, you shouldn’t need an attorney. Still, we all know that the government isn’t the most forgiving or caring institution, so if you don’t prevail, it’s definitely not your fault!

I do hope that some of this is helpful. I don’t mean to intrude. I just know that the government has made my life very difficult for decades, and I essentially had to become "as good as a lawyer” to protect my sons. Once I became well-versed, I counseled/represented other parents and their children. I am not a lawyer, but I am an experienced advocate.

The government counts on us not to have the energy to pursue or the awareness of our rights, when they pull this garbage. Most people give up and don’t know their rights to due process. The government counts on that lack of knowledge, and good, law abiding, deserving people, like you, get stung.

Fight ‘em, Gary! You have many people here, who are on your side and rooting for you!

Love & Light,

Rose

[renee]

They screwed up.
Somewhere in that notice should be a statement that because they screwed up,
you are not required to pay back their mistake.
Plus, your income has changed.

Shoot, they may owe you.

I have been through all those things and once upon a time received a check for $28,000-
No explanation and they never demanded it back.

The forces of good are with you.

[Lazarus]

Earth Mother gave you specific and great advice...one more thing...be nice

((((((Gary)))))) ~

You have every reason to be steamed! This kind of bureaucratic baloney is quite stressful, so first and foremost, take a deep breath and try not to let it rile you up too much to affect your health.

I have spent decades advocating and battling government agencies. In your shoes, I would approach your situation thusly:

1. Gather all of your documents relevant to the disability income, SSI, and Medicare.

2. Make a list of your drugs, including their cost without Part D (the cost to you privately) per month.

3. Make a list of your monthly bills/expenses to compare with your monthly income.

4. Make a list of your arguments:

a. You didn’t know that you were $33.33 over the poverty level with your SDI (assuming it is SDI). The government should have informed you that this amount would put you above the poverty level and might affect other benefits, such as Medicare, Supplemental Insurance for Parts B and D, and/or Social Security payments (if you receive those). If this began in January, then did you receive a cost of living increase in your SDI? Is that what suddenly put you over the poverty level?

b. If your $950/month rental income affects your benefits, note that you no longer receive that income.

c. If you’re receiving SDI, that is part of Social Security, as is Medicare. So it’s all one big agency. I guarantee you that the right hand doesn’t know what the left hand is doing. And the left hand doesn’t even know that the right hand exists. You have a right to expect coordination among the departments within Social Security, and to be notified before 9 months have passed that you have surpassed the threshold by $33.33/month.

d. On good faith, without knowledge that you were $33.33 over the limit, you paid your Part D premiums. You didn’t default.

5. Take action:

a. Call SDI. Ask to speak to a supervisor, if you don’t get a helpful person on the line. Explain your situation. Ask if they can solve this for you. State that you are willing to forego the $33.33 per month to continue to have Part D coverage at a lower rate. Your premiums will go up $50/month, so $33.33 doesn’t help you there. If you can get back down to the poverty level, your premiums should not go up.

b. Call Your Part D provider. Explain your situation and ask them to explain their action to you further. Take copious notes, include name of person, time, date, and length of call. (Actually do that with all of your calls. Ask the person's name and to spell it for you. Ask their extension number.)

c. Call Medicare. Explain your situation. Etc.

d. All Federal programs offer appeals for due process. When you file in a timely manner for a hearing on your case, you should get a “stay put” order. A “stay put” order means that nothing changes for you until after the hearing decision is rendered. The Part D people can’t charge you $50/month more or demand $300 a month in repayment, unless they prevail in your hearing. Ask Medicare about your hearing rights, or go to their website and see what you can find out there.

e. This is open enrollment season, so start shopping around for a different Part D provider. Compare rates and coverage of the drugs you need.

It’s a lot of work, but it can be done at home, on the phone and the internet.

You may have to schlep down to your local Social Security office and meet a real person to get any action. If you ask for a due process hearing, you’ll have to appear wherever it is held. These are generally given to administrative law judges and occur in informal (not court) settings. It costs you nothing, and if you have all of your ducks in a row, you shouldn’t need an attorney. Still, we all know that the government isn’t the most forgiving or caring institution, so if you don’t prevail, it’s definitely not your fault!

I do hope that some of this is helpful. I don’t mean to intrude. I just know that the government has made my life very difficult for decades, and I essentially had to become "as good as a lawyer” to protect my sons. Once I became well-versed, I counseled/represented other parents and their children. I am not a lawyer, but I am an experienced advocate.

The government counts on us not to have the energy to pursue or the awareness of our rights, when they pull this garbage. Most people give up and don’t know their rights to due process. The government counts on that lack of knowledge, and good, law abiding, deserving people, like you, get stung.

Fight ‘em, Gary! You have many people here, who are on your side and rooting for you!

Love & Light,

Rose

Gary, when I am steam producing angry and start calling I am my own worst enemy by being angry with the poor Medicare worker (or other person I have to call). I have learned to end conversations with unhelpful employees (nicely) and simply call back and often I get a more helpful person !

Before making the first phone call, craft your initial comments. Otherwise you will flood the person you are speaking with... I always start by saying I need help with a problem. Then I explain the problem when they ask me to...in your case you could say that you need help with a problem that has cascaded into a waterfall of problems and you need advice on what to do. Something like that and you have an earnest employee on your side.

Let us know what happens...and how you got help...that advice will be useful for everyone.

Sorry this situation exists...but I expect a solution can be found.

[Gary]

Apparently being denied is the kiss of death. As well as being married and owing property. One outfit suggested selling out and getting a car that is more than 20 Yeats old. My newest car is 14 years old by the way.

Talked to the pharmacy he gave me some web sites. The state does not allow the pharmacy to discount drugs as I am on federal ''aid'' meaning social security. Then the pharmacist leaned over the counter and said in a whisper, ''look how about I pay it out of my pocket and then you guys can pay me?'' This is a small town our kids went to school together and my wife has bussed his kids and now his grandkids to school.

Anyway most of the help organizations are required to utilize the same guidelines and you have to be careful what you take and how much as you can end up loosing $$ off your monthly check. The farm hurts us as it is considered potentially income producing. I am dead. serious I was told that twice.

It will cost around $5,000 to appeal it to Medicare. Once this decision is made you have to follow their list for the appeals process. And suing them is number one.

I look at this like not qualifying for Medicare for the first two years of social security. The government hope you will die off and save them some money.

I have some meds left so I am weaning myself off them. Maybe I will stand outside Walmart with a sign that says will work for prescriptions.

[agate]

Gary, have you looked into whether you qualify for Medicaid? Those hefty premiums you pay are taken into account as part of the medical expenses they consider. If you have big medical expenses, your total available resources go way down and that might qualify you.

You might also qualify for SNAP benefits, formerly known as Food Stamps.

Local chapters of the MS Society often have a fund available to help bail out people with MS who have financial need. You might want to ask.

[Lazarus]

Gary,
Agate gave you good advice. Seems some juggling could help your income fall into the right spot...at least next year. Farmers never make a fixed income.

Agate gave you some very good advice. Around here the society also helps with locating a sympathetic lawyer.

Linda

[renee]

Gary-
Have you looked into any Idaho based legal aid organizations.

Idaho Legal Services, Inc. - Phone (208) 336-8980
The Idaho Volunteer Lawyers Program - Dial (208) 334-4510

Looks like there are some available with age or disability eligibility
as well as for the general public.

I used to have a crack medical social worker who was a money wizard when
it came to making SSD, Medicare and Medicaid work in my favor.

[Gary]

Thanks everyone
I have looked into Medicaid . I cant believe that anyone could ever live on the amounts they use to qualify people. But my daughter said that most of the people get housing subsidies and food stamps. The biggest hurdle in our state is owing property. Basically if you own your house you don't qualify for much of anything. The max amount of income, from any source is 1$125 less than my house payment.

It has been suggested that we sell the house and get a divorce. I called the first number on the list and turns out that the lawyer when through school with my son. He was very sympathetic to our plight. But pretty much told me the same thing that the SS office told me. You have to civilly sue medicare. He is more than willing to do it pro bono. He also said that he could get the court costs down to a VERY reasonable price. Problem is that out of the 166 cases filed in Idaho in regards to the federal poverty guidelines filed in the last 9 months in Idaho (federal) court 2 have been held over for more investigation, the rest have been denied. I may still take him up on his offer. One case was 29 cents over. And they DID NOT even round it down.

According to our state senators office it is extremely difficult to buck the poverty guidelines.But they will see what they can do.

In today's mail i got a rejection notice from a couple of different drug companies (fast service) telling me that as I am rejected from medicare there isn't anything they can do.

I can use credit cards or borrow money from someone but that is a stop gap solution that just postpones the enviable. Meaning next month I will be in the same boat. So I will make an appointment with my doc next week to get advice on tapering off the handful of blood pressure, pain meds and anti depression meds. While they are already generic they will amount to several hundred dollars a month. I am $18 away from the doughnut hole.

Thanks everyone. I hate to whine and complain. And I am not going to dwell on this any more. Getting frustrated at the system is not going to do anything except raise my BP.

Howie got any beer? If not I have some and I will share.

[Earth Mother 2 Angels]

((((((Gary)))))) ~

My heart goes out to you! I'm so sorry that you are being put through the wringer for this paltry amount of money.

Sell your home, get an older car, and divorce your wife? Wow, there's some Family Values! Not exactly "The American Dream" eh? Gaah!! You're trying to get medical coverage not join the witness protection program!!

What the heck is wrong with our System that it treats citizens with disabilities and/or are elderly this way?! And you're a farmer, for crying out loud! Where is the respect for your contribution to our food supply?

Somehow, you will find a way through this, and that's where my prayers are focused for you. With all of the stress surrounding this situation, I am very touched by the kindness of your friends, the pharmacist and the attorney.

I was going to suggest that you contact your elected officials, because laws need to be changed, but I guess you've done that. Good for you. Keep contacting them and letting them know that laws do need to be changed.

When you see your doc next week, maybe you could ask him to toss you some of his samples for your meds. Because docs always have a good supply of samples, and drug reps visit every week. Perhaps there are other meds you could switch to, which might be less expensive? Just thinking out loud.

Stay strong, Gary!


Love & Light,

Rose

[Howie]

I just went through the wringer to try and get help to buy glasses before my year old prescription runs out. I even contacted the NMSS. Today, they finally answered, giving me the names of places that "help", but not one phone number. I'm on Medicaid, I need someone to pay for it all. I can't afford to pay anything. It's all I can do to pay my bills, and feed myself and the cats.

I thought about eating the cats, but one has too much fat, and the other has too little meat on her bones.

Today, I officially gave up. I can do without a few more years until I need to get my drivers license renewed, and by them, will be in a better position to get glasses. Thanks a bunch Medicaid and NMSS, you were a big help.