Quantcast

Subscribe to:
POZ magazine
E-newsletters
Join POZ: Facebook MySpace Twitter Pinterest
Tumblr Google+ Flickr MySpace
POZ Personals
Sign In / Join
Username:
Password:
Welcome, Guest. Please login or register.
July 22, 2014, 04:04:25 PM

Login with username, password and session length


Members
Stats
  • Total Posts: 631470
  • Total Topics: 47800
  • Online Today: 279
  • Online Ever: 585
  • (January 07, 2014, 02:31:47 PM)
Users Online
Users: 5
Guests: 223
Total: 228

Welcome


Welcome to the POZ/AIDSmeds Community Forums, a round-the-clock discussion area for people with HIV/AIDS, their friends/family/caregivers, and others concerned about HIV/AIDS.  Click on the links below to browse our various forums; scroll down for a glance at the most recent posts; or join in the conversation yourself by registering on the left side of this page.

Privacy Warning:  Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If you are HIV positive and disclose this in our forums, then it is almost the same thing as telling the whole world (or at least the World Wide Web). If this concerns you, then do not use a username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.

  • The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own physician.

  • All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.

  • Forums members must behave at all times with respect and honesty. Posting guidelines, including time-out and banning policies, have been established by the moderators of these forums. Click here for “Am I Infected?” posting guidelines. Click here for posting guidelines pertaining to all other POZ/AIDSmeds community forums.

  • We ask all forums members to provide references for health/medical/scientific information they provide, when it is not a personal experience being discussed. Please provide hyperlinks with full URLs or full citations of published works not available via the Internet. Additionally, all forums members must post information which are true and correct to their knowledge.

  • Product advertisement—including links; banners; editorial content; and clinical trial, study or survey participation—is strictly prohibited by forums members unless permission has been secured from POZ.

To change forums navigation language settings, click here (members only), Register now

Para cambiar sus preferencias de los foros en español, haz clic aquí (sólo miembros), Regístrate ahora

Finished Reading This? You can collapse this or any other box on this page by clicking the symbol in each box.

Author Topic: Advice on choosing Medicare Part D?  (Read 1676 times)

0 Members and 1 Guest are viewing this topic.

Offline YaKaMein

  • Member
  • Posts: 368
Advice on choosing Medicare Part D?
« on: December 15, 2008, 12:24:48 AM »
Anyone with experience with plans in New Orleans area or in general since many are national? Am eligible for Medicare 1/1/09 and qualified for LIS/extra help. Am looking at Medicare advantage plans and not Rx only. Am open to suggestions about companies that have been easiest to work with. i've used the mymedicare website and put in list of drugs. Mostly concerned about Atripla since I'll no longer be eligible for ADAP. Thanks. YaKa.
09/11 Endocrine Consult
08/11 CD4 328 14.9% VL 0
 Disc'd Bactrim DEXA -3.1 Tscore
03/11 CD4 338 14.7% VL 0
11/10 CD4 300 14.3% VL 0 <20copies
07/10 CD4 336 14.0% VL 0 DEXA -2.7 Tscore
03/10 CD4 308 13.4% VL 0 Vit D normal
01/10 Began FOTO
11/09 CD4 274 13.7% VL 0 Chol 173 Trig 131
07/09 CD4 324 13.5% VL 0 DEXA -3.1 Tscore lumbar
03/09 CD4 207 10.9% VL 0
11/08 CD4 227 10.3% VL 0 Chol 176 Trig 156
04/08 CD4 228 9.5% VL 0
01/08 CD4 194 9.0% VL 0
09/07 CD4 176 8.3% VL 0
03/07 CD4 130 9.5% VL 0 Chol 261  Trig 227
12/06 CD4 109 6.4% VL 0
09/06 CD4  88 5.5% VL und desens'd rtd to Bactrim
08/06  Began Atripla
07/06 CD4  59 5.0% VL 145 Chol 117 Trig 104
06/06  Bactrim rash, X2 Dapsone
 EFV & Truvada Chol 128 Trig 131
05/06 CD4  6 (2.0%) VL 78667 only V179D mutation Dx PC MAC

Offline BT65

  • Global Moderator
  • Member
  • Posts: 9,836
  • Vegas baby!
Re: Advice on choosing Medicare Part D?
« Reply #1 on: December 15, 2008, 08:55:26 AM »
Yaka, I honestly couldn't advise about a particular plan.  I would suggest you contacting your ASO and working with someone there who could better assist you.
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline bill1322

  • Member
  • Posts: 17
  • this summer after I cut off the pony tail
Re: Advice on choosing Medicare Part D?
« Reply #2 on: December 15, 2008, 09:50:43 AM »
YaKa,

are you sure you won't be eligible for ADAP? Here in Kentucky they tell me KADAP continues even once your on Medicare.

I'm not sure I trust the case workers to know what they are talking about though - they are all barely in their thirties! Any more info from you and your situation would help me, and I'm sure, lots of others.

Obama and Daschle may be our best hope to straighten out the insanity of Medicare 'Part D', Insurance Companies and The Drug Companies, if we can survive that long.

Bill

Offline aztecan

  • Member
  • Posts: 5,382
  • 29 years positive, 56 years a pain in the butt
Re: Advice on choosing Medicare Part D?
« Reply #3 on: December 15, 2008, 10:01:51 AM »
Hey YaKa,

I would get in touch with your case manager regarding this.

 I don't know what things are like in the New Orleans area, but most of the plans cover the HIV meds. You can find out for sure by going to the Medicare Web Site, clicking on Part D plans and then follow the instructions.

What you need to be on the lookout for is choosing a plan that includes premiums in excess of what extra help will pay.

That could leave you paying a monthly premium.

As I said, get with your case manager.

HUGS,

Mark

"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline allopathicholistic

  • Member
  • Posts: 3,258
Re: Advice on choosing Medicare Part D?
« Reply #4 on: December 15, 2008, 12:04:34 PM »
YaKa,

are you sure you won't be eligible for ADAP? Here in Kentucky they tell me KADAP continues even once your on Medicare.


Hi Yakamin- Bill1322 might have a point because I have Medicare A, B and D, LIS, catastrophic coverage, ADAP(?)RW(?) and I'm a Medicaid dual. I wish I was an expert on all the different funding streams but i don't want my head to explode.  My understanding (via anecdotes from other pozzies) is this: You will pay co-pays on Medicare Advantage when you see your doctors, even your regular one. Confirm that with the professionals cuz it could be right or wrong I don't know. I'll bet the farm that co-pay structures vary from plan to plan so if you look at different websites, remember to compare.  :) A.H.

Edit: Strikeout in first sentence
« Last Edit: December 16, 2008, 11:38:30 PM by allopathicholistic »

Offline YaKaMein

  • Member
  • Posts: 368
Re: Advice on choosing Medicare Part D?
« Reply #5 on: December 16, 2008, 12:54:38 AM »
BT, Mark, Bill, and Allo, You guys are the best with sage advice. I omitted I checked with my ASO case management which loves that I'm pretty proactive. I've gotten my Medicare and me book, scoured the website, and my state's Insurance site too. Was looking for some anecdotal info from experienced compatriots on the forums. LOL.

Various plans offered in Louisiana are underwritten by Advantra, Cigna, Humana, Peoples Health, Sterling, Unicare, Universal American, Universal Health Care and WellCare. Any of these rise to the top? Any dogs?

My HIV health care is managed via a clinic at my ASO. I'll still qualify and I'm quite pleased there. But if things change or I have a non-HIV related illness or get hit by a streetcar, OUCH, that's where Medicare will be my friend. LOL. So I can't go sky-diving til after Jan 1st. ::)

I'm told with LIS, my out-of-pocket costs will pretty much be covered or greatly reduced post standard deductibles along with the dreaded coverage gap. Don't look forward to copays but hope to manage them.

Mark's right about possible premiums. However, LIS eligibility also qualifies me for CDAP [CoPayment and Deductible Program] which should pay any part D insurance premiums in Louisiana, but not Medicare part B [$96.40/mo] premiums. However, I must have the part D ins bill me directly.


09/11 Endocrine Consult
08/11 CD4 328 14.9% VL 0
 Disc'd Bactrim DEXA -3.1 Tscore
03/11 CD4 338 14.7% VL 0
11/10 CD4 300 14.3% VL 0 <20copies
07/10 CD4 336 14.0% VL 0 DEXA -2.7 Tscore
03/10 CD4 308 13.4% VL 0 Vit D normal
01/10 Began FOTO
11/09 CD4 274 13.7% VL 0 Chol 173 Trig 131
07/09 CD4 324 13.5% VL 0 DEXA -3.1 Tscore lumbar
03/09 CD4 207 10.9% VL 0
11/08 CD4 227 10.3% VL 0 Chol 176 Trig 156
04/08 CD4 228 9.5% VL 0
01/08 CD4 194 9.0% VL 0
09/07 CD4 176 8.3% VL 0
03/07 CD4 130 9.5% VL 0 Chol 261  Trig 227
12/06 CD4 109 6.4% VL 0
09/06 CD4  88 5.5% VL und desens'd rtd to Bactrim
08/06  Began Atripla
07/06 CD4  59 5.0% VL 145 Chol 117 Trig 104
06/06  Bactrim rash, X2 Dapsone
 EFV & Truvada Chol 128 Trig 131
05/06 CD4  6 (2.0%) VL 78667 only V179D mutation Dx PC MAC

Offline YaKaMein

  • Member
  • Posts: 368
Re: Advice on choosing Medicare Part D?
« Reply #6 on: December 16, 2008, 02:28:51 AM »
Regarding Bill's/Allo's concerns about ADAP.  Here's my understanding.

Both are correct that we will still qualify for Medicare ins [parts A & B & C] and ADAP. Medicare Part C is Medicare Advantage Plans which expands parts A&B [ordinary ins] into like an HMO or PPO and may have an additional cost or premiums depending on plan.

Medicare part D adds Prescription Drug coverage and has its own set of rules, copays, coverage gaps and also may add additional premiums depending on the plan.

So it seems that one cannot have both Medicare part D and ADAP since they are both programs for Rx drugs. Even though, ADAP only covers HIV formulary drugs.

One rationale is that both part D & ADAP duplicate Rx drug coverage.

Another rationale is that ADAP is funded through Ryan White [part B] funds. RW funds are used as funds of last resort, meaning when one does not have other resources, i.e. income, assets, private insurance, etc to pay for HIV or other Rx drugs.

Each state determines its own criteria for eligibility for its programs so I cannot address any specifics.

I admit that this is all confusing and is my take on it. So, feel free to correct me here.

I endorse that we be able to get access to affordable health care and best treatments ... damn stupid eligibility.

Remember:
It's always best to run things by a case manager and ask a lot of questions. As we know, a good one can be hard to find.

In the meantime, I"m asking for practical info on specific part D insurers. PM's welcomed
Like who's easy to deal with, any problems with claims, do they require mail order, 3-months supply, etc?

Thanks, YaKa
09/11 Endocrine Consult
08/11 CD4 328 14.9% VL 0
 Disc'd Bactrim DEXA -3.1 Tscore
03/11 CD4 338 14.7% VL 0
11/10 CD4 300 14.3% VL 0 <20copies
07/10 CD4 336 14.0% VL 0 DEXA -2.7 Tscore
03/10 CD4 308 13.4% VL 0 Vit D normal
01/10 Began FOTO
11/09 CD4 274 13.7% VL 0 Chol 173 Trig 131
07/09 CD4 324 13.5% VL 0 DEXA -3.1 Tscore lumbar
03/09 CD4 207 10.9% VL 0
11/08 CD4 227 10.3% VL 0 Chol 176 Trig 156
04/08 CD4 228 9.5% VL 0
01/08 CD4 194 9.0% VL 0
09/07 CD4 176 8.3% VL 0
03/07 CD4 130 9.5% VL 0 Chol 261  Trig 227
12/06 CD4 109 6.4% VL 0
09/06 CD4  88 5.5% VL und desens'd rtd to Bactrim
08/06  Began Atripla
07/06 CD4  59 5.0% VL 145 Chol 117 Trig 104
06/06  Bactrim rash, X2 Dapsone
 EFV & Truvada Chol 128 Trig 131
05/06 CD4  6 (2.0%) VL 78667 only V179D mutation Dx PC MAC

Offline Joe K

  • Global Moderator
  • Member
  • Posts: 3,492
  • 30 Years Poz
Re: Advice on choosing Medicare Part D?
« Reply #7 on: December 16, 2008, 12:41:21 PM »
Health care can be daunting, especially when there are so many programs, but what matters are your needs and then finding the best plan to meet those needs.  When I lived in Florida, I had Medicare A&B, which covers doctor, hospital and treatment services and Medicare Part D, prescription drugs.  However, my income was so low, that I also qualified for Ryan White services, even though I had drug coverage through Medicare.  What I got was called a "waiver" that said, I was unable to pay my copays under the Medicare plan, so I could get all my HIV and related meds, under Ryan White and I could still use the Medicare part, to buy other drugs that were not covered under Ryan White.

You should also be aware that there are two primary programs for us pozzies, outside of the Medicare and private insurance arena and those are the ADAP and Ryan White programs.  ADAP is generally reserved for those who are working, or have an income that excludes them from Ryan White coverage.  ADAPs have a formulary of drugs, that they cover and various requirements for eligibility.  Ryan White, is for those who either have an income too high, for the ADAP program, or those with minimal assets or insurance and many times Ryan White can work in tandem with Medicaid, but that's another conversation.

So what this means to you, is you will get Medicare Parts A, B (that's the $96.40 monthly) and if you choose, Part D, you really don't have a choice here, and that will cost about $30.00 per month.  Fortunately, the Medicare program, at least for now, gives you the option of enrolling with a private health care company, that contracts with the federal government, under Medicare, to provide health care plans.  These Medicare Advantage programs, as they are sometimes called, are paid an extra premium, by the government, which allows them to provide more inclusive coverage and many include benefits for vision, dental and other things.  Some even provide drug coverage, but if you are using a state program, then you won't need this part.

What I suggest, if you can't find a knowledgeable case manager, is try the Medicare website, where they have a program that will walk you through picking a plan and show you the options.  There can be real benefits to the Medicare Advantage plans and most of them do not cost any more than the Medicare premium you are already paying (the difference comes from those extra government payments).  I would seriously consider such a plan, assuming it covers the providers you want for your primary care.  Also, in some states, doctors are being squeezed on Medicare payments and many now limit the number of Medicare patients they can see.  That is why a private company, can be the better coverage to have, because their payments are generally higher than traditional Medicare and that makes you, as a patient, more attractive to a doctor.

So now your head is spinning... welcome to the wonderful world of health insurance.  Give it time and it will become clearer which plan pays what and the options you have in your state.  I suggest you read the Medicare manual so you understand what Parts A B and D provide in benefits.  Armed with that, you can determine where you might need extra coverage, or you may opt for an Advantage plan, assuming you can get the same level of health care, you might as well take advantage of the extra benefits, for the same premium price.  You should also review the requirements of any ADAP or Ryan White plan you may be eligible for, to make sure that there are no restrictions on your basic health care plan.
Life is what happens, when you are busy making other plans.

Though you may be only one person in the entire world, to one person, you may be the entire world.

I wish to become half the man, that my dog thinks I am.

Remember me with simple acts of kindness and I will live forever.

Offline AndyArrow

  • Member
  • Posts: 1,196
Re: Advice on choosing Medicare Part D?
« Reply #8 on: December 18, 2008, 03:27:18 AM »

You should also be aware that there are two primary programs for us pozzies, outside of the Medicare and private insurance arena and those are the ADAP and Ryan White programs.  ADAP is generally reserved for those who are working, or have an income that excludes them from Ryan White coverage.  ADAPs have a formulary of drugs, that they cover and various requirements for eligibility.  Ryan White, is for those who either have an income too high, for the ADAP program, or those with minimal assets or insurance and many times Ryan White can work in tandem with Medicaid, but that's another conversation.


I just needed to make clear this really depends on where you live.  I live in Indiana (which considering Ryan White lived here) you'd think there would be great Ryan White programs or other ADAP funding.  Unfortunately, there is NO Ryan White funding or ADAP.  You are enrolled in the states medicaid program (and if you are working or make too much money then you have a spend-down).  The state uses the money from the federal programs and channels it through Indiana Medicaid.

AA
It is not the arrival that matters.  It is the journey along the way. -- Michel Montaigne

Offline edfu

  • Member
  • Posts: 1,084
Re: Advice on choosing Medicare Part D?
« Reply #9 on: December 18, 2008, 04:30:47 AM »
So it seems that one cannot have both Medicare part D and ADAP since they are both programs for Rx drugs. Even though, ADAP only covers HIV formulary drugs.

I am more than sorry to have to add to the confusion about this, but I cannot emphasize enough that the rules about this nightmare vary EXTREMELY from state to state.  For example, in New York State it is imperative that one enroll in Medicare Part D to be eligible for ADAP if one qualifies for Medicare and does not have other "creditable" insurance.  ADAP in New York helps with the co-payments and deductibles that are part of most Medicare Part D plans, but ADAP acts like a secondary insurance, with Medicare Part D as the primary.  ADAP's payments, however, cannot be counted toward Part D's "donut hole."  So for most of ADAP's Medicare members in New York, it is never possible to reach the "catastrophic level" of Medicare Part D; they remain in the donut hole for most of the year, and ADAP pays for their formulary prescriptions. 

It's all a horror show. 
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline BT65

  • Global Moderator
  • Member
  • Posts: 9,836
  • Vegas baby!
Re: Advice on choosing Medicare Part D?
« Reply #10 on: December 18, 2008, 09:06:31 AM »
I just needed to make clear this really depends on where you live.  I live in Indiana (which considering Ryan White lived here) you'd think there would be great Ryan White programs or other ADAP funding.  Unfortunately, there is NO Ryan White funding or ADAP. 
AA

This is not necessarily true.  I talked to my care coordinator at the local ASO a little while back about this.  There is Ryan White and ADAP in Indiana (and a couple other programs).  But, if one qualifies for Medicaid, then these programs are closed off to them.  It sucks, since there is a spend-down with Medicaid here, which in some other states is covered by Ryan White.  Anyway, just wanted to clear that up.
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline allopathicholistic

  • Member
  • Posts: 3,258
Re: Advice on choosing Medicare Part D?
« Reply #11 on: December 19, 2008, 12:04:35 AM »
remain in the donut hole for most of the year, 

oh snap. my catastrophic coverage will end at midnight on Dec 31st. i was under the erroneous impression that it was "for life" Uggghhh ugghh ugghh  how dreadful (puke)

Offline YaKaMein

  • Member
  • Posts: 368
Re: Advice on choosing Medicare Part D?
« Reply #12 on: January 06, 2009, 05:32:41 PM »
Update:
Medicare enrolled me in RX America Advantage Star part D plan eff. 2/1/09. It's purely a Rx drug plan. nothing more. Any experiences with them??

Am willing to give them a try but am still interested in a Medicare Advantage plan because of the additional health care benefits. Have my eyes on a locally administered plan, Health Select [5826] from Peoples Health. Chime in, any NO locals with them?

With 'extra help'/LIS I understand I can enroll at any time with any plans without penalty at will; even though part D enrollment period ended 12/31 and advantage plan enrollment ends 3/31.

Besides being still currently in ADAP, i've have a multi-month supply of my drugs to ensure no interruptions in my drug treatment. I resolve to resolve this confusing insurance matter soon. Best to y'all.
09/11 Endocrine Consult
08/11 CD4 328 14.9% VL 0
 Disc'd Bactrim DEXA -3.1 Tscore
03/11 CD4 338 14.7% VL 0
11/10 CD4 300 14.3% VL 0 <20copies
07/10 CD4 336 14.0% VL 0 DEXA -2.7 Tscore
03/10 CD4 308 13.4% VL 0 Vit D normal
01/10 Began FOTO
11/09 CD4 274 13.7% VL 0 Chol 173 Trig 131
07/09 CD4 324 13.5% VL 0 DEXA -3.1 Tscore lumbar
03/09 CD4 207 10.9% VL 0
11/08 CD4 227 10.3% VL 0 Chol 176 Trig 156
04/08 CD4 228 9.5% VL 0
01/08 CD4 194 9.0% VL 0
09/07 CD4 176 8.3% VL 0
03/07 CD4 130 9.5% VL 0 Chol 261  Trig 227
12/06 CD4 109 6.4% VL 0
09/06 CD4  88 5.5% VL und desens'd rtd to Bactrim
08/06  Began Atripla
07/06 CD4  59 5.0% VL 145 Chol 117 Trig 104
06/06  Bactrim rash, X2 Dapsone
 EFV & Truvada Chol 128 Trig 131
05/06 CD4  6 (2.0%) VL 78667 only V179D mutation Dx PC MAC

 


Terms of Membership for these forums
 

© 2014 Smart + Strong. All Rights Reserved.   terms of use and your privacy
Smart + Strong® is a registered trademark of CDM Publishing, LLC.