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Author Topic: Drug Coverage  (Read 881 times)

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Offline sammy

  • member
  • Posts: 2
Drug Coverage
« on: October 26, 2007, 12:30:28 AM »
Hi- I'm on Medicare, Social Security Disability, and also receive a disability pension from my previous employer. Next year my employer is no longer offering their standard RX coverage for which I paid $30 monthly copayments for each of my HIV meds. This means I need to enroll in Medicare Part D. When I priced drug plans on the Medicare web site, the cheapest plan would cost me $4,650 per year (primarily because of the doughnut hole where coverage drops after retail drug costs reach $2,510 and doesn't resume until you've paid $4,050 out of your own pocket). This amount doesn't take into consideration non HIV meds that I additionally need during the year. My income is about three thousand dollars over the ADAP eligibilty limit so I cannot get help there. After paying Medicare and Medigap premiums of over $300 per month, rent, dental costs (so high that I can't afford to see a dentist anymore and am going to a dental school for treatment), car insurance, etc., I just don't know how I'm going to come up with an extra $5,000 next year, and then every year going forward (I don't qualify for drug company help either based on their income limits). Is there anyone else in a similar situation to mine that can share their experience or suggestions? Thanks

Offline brooklynpoz

  • Member
  • Posts: 71
  • My Babies, Pepper (8) & Rocko (3)
Re: Drug Coverage
« Reply #1 on: October 26, 2007, 06:27:51 AM »
Hi,
I am on SSDI, I will be getting Medicare as of January 2008.
I called medicare and enrolled with H I P Standard Of NY.
I am not sure what the cap / max amount for ADAP is for your state, but, they are paying for premiums, co pays, spend down amount, etc.
I went to the GMHC here in NY, registered as a client, then they got in touch with ADAP for me, they worked something out, and now I am ok.
Not sure if this reply helps you, but, I wanted to at least share my story.
Diagnosed, Monday,  8/9/2004, 1ST year was ruff , now I am well adjusted .
Current Med's ; Kaletra & Truvada
Undetecable,<48 ,  531 tcells, 21%
Keeping the faith, that they will get a cure in our lifetime.
LIVE , LOVE , LAUGH

Offline sammy

  • member
  • Posts: 2
Re: Drug Coverage
« Reply #2 on: October 29, 2007, 12:11:44 AM »
Thanks for responding to my post. I read up on your plan and it is similiar to other Medicare Part D drug plans in its design. If I was below the ADAP limit they would, as you stated in your case, cover my premiums, co-pays, and the coverage gap/doughnut hole/spend-down amount. Because my annual income is just a few thousand dollars over the eligibilty limit for ADAP I can't use it, and will have to pay all premiums, co-pays, and full drug costs during the coverage gap out of my own pocket. This will result in thousands of dollars per year for me that I don't have. The gap in coverage after you reach a certain amount in costs is the real killer in Medicare Part D (unless you qualify for ADAP).
I wasn't sure when you stated that GMHC worked something out for you with ADAP, if you were over the income limit and they were able to do something despite that, or if you were within the limit and they just coordinated between ADAP and your Medicare drug plan to get you the benefits to which you are entitled.

Offline brooklynpoz

  • Member
  • Posts: 71
  • My Babies, Pepper (8) & Rocko (3)
Re: Drug Coverage
« Reply #3 on: October 29, 2007, 07:45:47 AM »
Hi Sammy,


I wasn't sure when you stated that GMHC worked something out for you with ADAP, if you were over the income limit and they were able to do something despite that, or if you were within the limit and they just coordinated between ADAP and your Medicare drug plan to get you the benefits to which you are entitled.
[/quote]

what I mean by that, is, when I was still working, I was over the limit by $4k.
and they worked something out, how they did it I don't know, but they did, thank God.

Diagnosed, Monday,  8/9/2004, 1ST year was ruff , now I am well adjusted .
Current Med's ; Kaletra & Truvada
Undetecable,<48 ,  531 tcells, 21%
Keeping the faith, that they will get a cure in our lifetime.
LIVE , LOVE , LAUGH

Offline loneratheart

  • Member
  • Posts: 4
Re: Drug Coverage
« Reply #4 on: October 29, 2007, 08:16:57 AM »
Sammy,     why do u not talk to your case manager about getting help thru ryan white to pay for drugs///

 


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