Question for those who have gone through this experience and on similar meds..

[blackwingbear]

In August my Medicare kicks in, as I have been on disability for 2 years. I take Atripla for my HIV, and it and epilepsy are my main current health issues. Given that I am on an EXTREMELY limited income ($947 per month), what would be the best Medicare plan to choose to cover most, if not all, of my expense for the Atripla? From estimation, Atripla costs approximately between $800 - $1600 a month for a 30 day supply (FAR more than I make). I pay $395 in rent now and electric/internet runs about $260 per month. I AM on food-stamps (frankly, I'd starve otherwise). What plan would be the most inexpensive for me yet still cover my medication?

[Jeff G]

I have found little difference in the plans offered . I might suggest going to your pharmacy and tell them what you are taking , they can advise you .

[tednlou2]

I can't answer your question, but I had a question.  I hope you won't see it as a hijack as it is related.  I know SSDI pays more per month usually.  If a person can only get SSI, does the Medicaid that comes with it cover HIV meds.  I ask because I know someone trying to get disability.  He ran out of credits for SSDI, so SSI seemed the only option.  However, his lawyer is trying to make the case he became disabled before the credits ran out, so he can get SSDI and Medicare instead of SSI and Medicaid.

Reading your question about HIV meds with Medicare, it got me wondering whether Medicaid would be the better option for HIV meds.  I know SSI only pays like $670, but do you not have to worry about meds?  You make about $300 more with SSDI, but I would be interested to hear how much you have to pay for the drug plan and will it cover the meds in full.  So, I'll be interested to hear your thoughts blackwingbear and others.   

[Miss Philicia]

I pay nothing monthly for my Medicare Part D premium, it's picked up the state of Pennsylvania/Ryan White as are any of my co-pays.

[leatherman]

what you want to do is use the SS Medicare site to find a drug plan that covers your area and includes your meds in it's forumlary
http://www.medicare.gov/MPDPF/Public/Include/DataSection/Questions/MPDPFIntro.asp

when I lived in OH, ADAP paid my $96 part D premium, but I had $15 in co-pays each month.
in SC, ADAP pays my part D premium (for a plan that still runs out of OH  ) and reimburses my ASO which covers my co-pays

BWB, does GA have medicaid and are you eligible for that? before part D was created, the OH state medicaid covered the cost of my co-pays

Given that I am on an EXTREMELY limited income ($947 per month)

my ssD that I've been living on for about 12 yrs, is $200 a month less than that, so your amount isn't quite to the "extremely" limited point yet. ROFL

I AM on food-stamps

just out of curiosity, what ball park amount do you get on those? In OH, I got the $176 like the federal calculator determines. SC however puts non-earned income (ssD) into a different place in the equation and only provides $96 a month. I was pretty shocked in my move to find that I was losing half my foodstamps but that is the average amount provided thru this state. Scary though, to think they believe someone earning about $700 a month needs less than $100 a month for food.

[blackwingbear]

Thanks,everyone, for your input on this...

Reading your question about HIV meds with Medicare, it got me wondering whether Medicaid would be the better option for HIV meds.

Hmmm... Don't know. There is a "supplemental" version of Medicaid offered (through DCFS, not SS), but I don't yet know if it helps that much.

I pay nothing monthly for my Medicare Part D premium, it's picked up the state of Pennsylvania/Ryan White as are any of my co-pays.

Hmmmm. I wonder if GA does the same? Thanks!

what you want to do is use the SS Medicare site to find a drug plan that covers your area and includes your meds in it's formulary
when I lived in OH, ADAP paid my $96 part D premium, but I had $15 in co-pays each month.

just out of curiosity, what ball park amount do you get on those (food stamps)?

So, I am able to stay on ADAP? I could afford the $15 co-pay ($15 a month for a medicine that runs $850 is a bargain)

I bring in about $240/month FS for both Willie & myself, due to lower rent on the new apartment.. I downsized to a 1-bedroom

[Miss Philicia]

I should have been more clear -- I am on both Medicare Part D and ADAP.  ADAP acts as a secondary insurance, as by law it must be the payer of last resort.  So at the pharmacy they first bill Med-D, then ADAP for anything not paid in full by Med-D, which takes care of the co-pays. 

So indeed I am on both and have a card for both.

Because Pennsylvania pays for my Med-D premium I get a letter near the end of every year informing me what plan they've selected for me, and they handle all of the paperwork should it be necessary to switch from one Med-D plan to another (obviously they pick out the cheapest for the state). 

I've read enough posts on here to know that what's done in my state isn't necessarily how it's done in other states, so I'm not sure how useful all of this is for someone living in Georgia.  That's what a local ASO is for.  Is there some reason you're not procuring this information from them?

[blackwingbear]

I should have been more clear -- I am on both Medicare Part D and ADAP.  ADAP acts as a secondary insurance, as by law it must be the payer of last resort.  So at the pharmacy they first bill Med-D, then ADAP for anything not paid in full by Med-D, which takes care of the co-pays.    Is there some reason you're not procuring this information from them?

Actually, they had not explained any of that....

[leatherman]

in my case (in both OH and in SC), I have medicare and part D (ADAP pays the premium), and state medicaid. so Medicare pays first and medicaid pays the balance. In OH I paid the co-pays; in SC the ASO pays the co-pays and ADAP reimburses them as my meds come through a program between my ASO and a state pharmacy rather than by me acquiring them at a local pharmacy.

Actually, they had not explained any of that....

it takes a while to learn all the ropes, and what questions to ask. up in OH where I lived, there was NO ASO so I learned to do all this on my own. A "family services" agency in town controlled the ADAP program - to the extent that IF you were smart enough to inquire about it (the only HIV doc in town doesn't know to tell you, the human services/welfare case managers don't know about it, and there is no ASO, so no case manager there either to tell you), they took your filled-out form, signed it and faxed it to the state. After the first year, they would mail me a signed form to fill out and fax/mail by myself to continue my ADAP.

It was pretty funny coming down to SC where there was an ASO (in an area with a population about the size, across three counties, to my city in OH). I actually taught my case manager things to apply for, and forms to fill out. She didn't know that ADAP would pay the part D premium. And she had no clue about helping with the food stamps. I learned about SC's weird formula from the Dpt of Health and explained the situation back to my ASO. They "always wondered" why people got so little. I also got them to start a letter writing campaign to our state legislators to ask for the full federal amount of food stamps for SC citizens. But it's been hard enough getting SC to keep funding ADAP much less paying out more in food stamps. (it "almost" makes me wish I had stayed with the Yankees. ROFLMAO )

There is a "supplemental" version of Medicaid offered (through DCFS, not SS), but I don't yet know if it helps that much.

state medicaid is actually a SS federal and state funded program, usually run and administered by the state's health dpt. If you are receiving food stamps, theoretically you should be eligible for medicaid also. Talk to your case manager about this. (or if they don't know enough about that program, by pass them and just go apply at the health dpt yourself )

I thought the Yankees ran these programs much more efficiently - probably due to the larger populations along with more experience as there have been more years of unemployment etc (from steel mill closings) up there. Medicaid and food stamp programs are usually administrated through one dpt - human services/welfare - since the information and forms are nearly identical to determine eligibility. In the south, these programs are run under different auspices of the state's health dpt which have little to no interaction or communication between themselves. (In my county these "different" parts of the health dpt are actually located nearly 20 miles from one another. )

I bring in about $240/month FS for both Willie & myself

sounds like GA might be a little skimpy on the food stamps too, depending on W's income into the household. Goodness knows, if I wasn't living with my Mom, who "subsidizes" my food budget, I would have already starved or had to move back to OH to stay alive.