Gioing on Medicare

[stillstANNding]

Yes, and I think if you don't take Medicare part D ( in my case because I had excellent commercial insurance) I was eligible for copay assistance. It saves me $95 every 3 months.

ANN

[Virginia]

I have Medicare part D, (like Cherie) and if I did not have it I would not be able to get patient assistance help with my medication. Apparently, they only help with the co-pays that your drug program does not cover. Thank goodness I had taken out the drug part as soon as it became available. In other words they are telling me that you have to have the drug coverage part to get help - at least that is what the Rebif people say. I have never applied for any assistance with any of my other drugs, nor would I be eligible to financially.

[Cherie]

My Medicare part D did not cover the cost of the copays on Rebif (33%) so copays were $2000/month. Because I was on Medicare and had "real property" as part of my retirement package, I could not get copay assistance. Now with the Patient Assistance Program, I get 100% of copays covered this year.

[Parsi]

Frankly I'm more confused than ever about the whole thing. :(

[Virginia]

Parsi, I was waiting to see who was going to say that!

[Howie]

Medicaid pays for all my prescription meds, and they used to be free, but now I pay like $2.60 at the most for each script.

[Parsi]

Parsi, I was waiting to see who was going to say that!

Happy to oblige.

[Cherie]

I am finding in reading the monthly statements that Medicare Part D pays about $3/month for scripts and I pay $41/month for the privilege for them to do it!
My Rebif was $2000/month but now I have a grant to pay my out of pocket Medicare for a year ($4500) so I can go back on it.
I thought I had a fairly good understanding of it till I went on it. I dont!

[newone]

I'm beyond confused!

[newone]

Cherie, how did you apply/get the Patient Assistance Program and what does ti cover?

[Virginia]

Newone, I have the Patient Assistance Program also and they only cover Rebif for me. However, there are other high priced drugs that are covered by them. Like Cherie, they had been paying my out of pocket expense for the Rebif, but as of about 10 minutes ago I received a call from the Pharmacy that sends me my Rebif and they said that the Patient Assistant Network says that I have reached my out of pocket maximum with them. I thought I was good until the end of the year. I have a little Rebif ahead, so I will address this next month.

For me personally, it was the people at MS Lifelines (Sorono) who originally got me covered through the Patient Assistance Network.

After the call I got earlier I am not sure what is going to happen.

[Virginia]

By the way, I forgot to mention I am on a number of other drugs and this is the only one that I am on that they cover. But I did read that they cover some others. I think it is for high priced drugs like our MS drugs and maybe other expensive diseases where the drugs are very high.

[Virginia]

Well, I am back with another post. I went on the website for the Patient Access Network and found that apparently they go by disease and Multiple Sclerosis is one of the diseases. It said they are not taking new or renewal applications. They are fully allocated. Don't know how long that will last.

There are 4 criteria that must be met to be eligible:
1. Patient must have Medicare Insurance Coverage and Medicare must cover the medication for which you seek assistance.

2. The medication must treat the disease directly.

3. Patient must reside and seek treatment in the US.

4. Patient's income must fall below 500% of the Federal Poverty Level.

The fact that it says they are not taking new applications should not deter you if you and your medication falls within the other guidelines because you just never know when something can change. I will try for the renewal application within the next few weeks, and maybe sooner to see what they tell me. Too important to me to just let it go.

[agate]

I also found the Medicare book to be helpful, but still had many questions.

My brother turns 65 next March and when he went to his Doctor last week the Doctor told him not to go on an Advantage Plan. I know there are a lot of people on here who are probably on Advantage plans and would argue that point. However, you have to choose a Doctor from their list (I want to choose my own). Also, if I had chosen an advantage plan I would not be getting help with my MS medication Rebif. Which means that there is no way I could have afforded it. At least that it is what they said.

I chose to take out a supplement through AARP. It is with United Health Care. I got the best supplement plan they offered and then I took out Medicare Part D. That I have changed several times, since you are allowed to do this once a year. I always read and see which plan is going to cover any portion of my Rebif and then if they will, I then look at all the other medications I am on to see what the overall cost will be.

It can get complicated. You just have to get use to it and try to deal with it.

Good Luck! If I can help in any way let me know.

I thought this thread had something about the Medicare Advantage plan. And here it is.

I've recently had some problems with cancelling my dental insurance plan, which was a rider on the AARP Medicare plan I have through United Health Care.

When Medicare Part D came along (2006?), people found they had to pick an insurance company. Mine (picked for me by Medicaid if I remember right) was United Health Care. A few years later I added the dental insurance rider, and from then on I paid a monthly premium.

At some point I must have signed up for the Medicare Advantage plan, also known as Medicare Part C. I just found out that the $56/month I thought I was paying in dental insurance premiums was actually $37/month in dental insurance premiums plus $19/month as Medicare Part C.

When I asked about Medicare Advantage (Part C) and looked it up in the Medicare book, it looks to me as if one of its features is getting to use out-of-network providers.

Now I'm more confused.

I'm not looking for answers. "My mind is made up--don't confuse me with the facts." And the system is entirely too difficult for my feeble brain to figure out.

[bkelli]

go to ssa.gov order handbook then get other phamlets at a local zip code ssa office-they are pretty nice-go when you have like three hours or so-then go cry and shop. bkelli