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Author Topic: Medicare advantage..or so it's called! Screwed Again, and bending over.  (Read 5044 times)

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Offline Jeffreyj

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  • Posts: 1,403
I was having a great day. I'm in my local pharmacy, talking to MOFFIE while waiting for my prescription's...Life is good! My name is paged And I go to pay for my # drugs. Last month, these same exact 3 drugs cost me $8 each.$24 total... Not this month.

"That will be $149.50 sir."  " Excuse me Mame I think you have made a mistake. The same 3 drugs were $24 and have been that price for the last year.

"Oh, it's our mistake? Don't blame us it's your insurance company." She could not have been more rude if she tried.

" I'm no longer talking you. Get me your boss. And while your at it, you can loose the attitude."     I guess since I was yelling and there were 4 people behind me, the pharmacist came over. He was very polite.
"Sir, your in the doughnut hole"...I looked at him and suddenly it had the feel of a TWILIGHT ZONE episode. He continued to explain.

"{We tried to tell all of our customers not to sign up, it's a bad deal" ....Knowing I was about ready to blow a MAJOR FUSE he immediately was kind enough to get my insurance company on the phone. After 5 minutes of voice mail hell i got to a live person. I asked her why my 3 scripts were now $149.50
"Oh you re in the doughnut hole."
I am? I thought to myself what the fuck is going on. Two people have just told me I'm in a doughnut hole. I was eager to learn more. She asked me for my address. Oops ...she had a 3 year old address 3 moves ago. no wonder why I have not received any of the info I had been begging for since January! At least we got that cleared up. She went on to explain my ADVANTAGE PLAN C (i think)...
I had reached a LIMET of $2250 for the alreadyAnd now i have to wait until I go over $3600, to get to be at that wonderful co-pay of $8 again.

So I have to spend $1250 to get back to my $8 co-pay. I'm so fucking excited.

So anyone one up for uhm...doughnuts and coffee at my place. ????

This is my wonderful plan I have been forced to take by my insurance company, who automatically "assigned" me the program since I was a previous "ADVANTAGE " member.

This program is costing me $1250 more then last year already,..., AND THIS DOES NOT EVEN INCLUDE MY HIV/AIDS DRUGS... Thanks Ryan White, if it weren't for you I have no idea what I would be doing to get by.

People out there who have HIV/AIDS....Be grateful you are working and not on disability. This is what you have to look forward to when you get too sick too work.

I find out if I get approved for RYAN WHITE in a few weeks(I'm up for re-newal)

I will keep you posted. If anyone has any thoughts I'm ALL EARS...
Love you all!
Jeff



PS Try to stay Healthy
Positive since 1985

Offline jkinatl2

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #1 on: August 30, 2006, 11:21:53 PM »
I am appalled at your experience, but not surprised one bit.

I imagine that several other people here will experience that donut hole.

I hope you figure out a way to work this out. Have yhou told you doctor? Have you talked to a social worker at your ASO? Regardless, there ARE compassionate med redistributors in the USA. Our own Lisa is one of them. There will be a way to get your meds, though until you get out of that hole, it's going to be an uphill battle.

God/dess help people who do not have the energy or enthusiasm to fight the system, or who did not research their plans before starting med therapy. It's tough enough to fight these battles healthy.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline Jeffreyj

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #2 on: August 30, 2006, 11:32:59 PM »
Thanks JK...I will get through it I always find a way...Now I understand why my case worker could not explain it...(he prolly did not want to LoL.) But thanks for the concern
Positive since 1985

Offline Life

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #3 on: August 30, 2006, 11:39:17 PM »
Jeffrey,  Jesus, I am sorry you have to deal with this..  I am at a loss, I am mad, sad and pissed..  This is not right..


Offline Robert

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #4 on: August 30, 2006, 11:41:58 PM »
Hi Jeffery. 

Interesting.  Same thing happened to me today.  I went to pick up my Norvir.  When she tried to price it, nothing showed up.  She told me it would take her a few minutes to get the correct price.    I told her I had a Dr's appointment in 10 minutes but I would come back later and pick up the prescription.  A hour later I showed up and it still wouldn't price.  I asked her what she had been doing for the last hour.  No comment.  Then she told me my Ryan White had expired and I told her that was news to me.  As far as I know, here in California your enrollment is good for 1 year and you have 60 days prior to your birthday to renew. I told her my birthday is in Dec (Dec. 21) so I still have 2 more months before I even think about renewing.  So she went to make a phone call and came back 30 minutes later and handed me the pills.  She said the ADAP people had told her their computers were down and she would have to call back.  she knew I had waited long enough (we're going on 2 hours at this point), gave me the pills and told me she would figure out the billing later. 

I know I'm not home scott free.  It will be interesting to see what they charge me next month when I go back.

By the way, I'm with Kaiser.  As you know with ADAP you only get a 30 day supply.  Well, in Feb. (remember Medicare Part D went into effect in Jan) they gave me a 90 day supply.  They did it again in May.  I chalked it up to the new Medicard Part D shenanigans. Today they only offered me a 30 day supply which I had been expecting all along so that didn't bother me.  There are still a lot of wrinkles that need to be ironed out.

Oh, and I heard a report on NPR last week exactly about what has happened to you.  Now is the time when everyone is coming to the "donut-hole" and boy is the shit hitting the fan.

robert

(whose Dr told him to give up donuts because his cholesterol was too high.  Talk about high!)
..........

Offline Jeffreyj

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  • Posts: 1,403
Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #5 on: August 30, 2006, 11:51:42 PM »
Good luck man with Ryan White I think u will be ok there...The prescriptions that has cost me $2250 are a cumination of my pain pills for my neuropothy, and other various other things. The $2250 does not include ANY AIDS HIV drugs, as that is now being covered by Ryan White (for now) Fingers are crossed for both of us! Robert, and anyone else who is in the doughnut hole!
Positive since 1985

Offline Eldon

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #6 on: August 30, 2006, 11:56:16 PM »
Hey Jeff,

Doughnut Hole? That just isn't right. Hope you work things out.


Have the BEST Day.

Offline Dachshund

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #7 on: August 31, 2006, 12:13:04 AM »
Here in TN we have to apply for Ryan White every six months...if we don't act-up very soon, we will all be dead.

Offline LatinAlexander

  • Member
  • Posts: 599
  • Bogota, Colombia
Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #8 on: August 31, 2006, 01:06:13 AM »
Well...Why do not you just come to my country? Here, the government HAS the obligation to give us medicines...If our Health Clinics say something, and you cannot get it right away, you begin judicial action and in 72 hours you have your medicines. The government pays for them internally.

Jesus, the more I read this HORROR STORIES in THE US ,the more I love my so-called-thhird-world-country :D

Alex
Poz since Jul 19 2006
Initial numbers : CD4-250 VL 3500
First labs after HAART (Dec 04-2006) : CD4-432 VL-<40 (Undetectable)  cd4%=25.11%
Started HAART: Combivir+Efavirenz Aug 26 7:38 pm
Feb 08 2007 - Gradually stopping HAART cause of Myalgia. Protecting Efavirenz. Stopped Efavirenz, ahead with Combivir....
February 17 Combivir stopped.
April 3 -07 : Started ddi+3tc+efavirenz...
Gay and positive (What a lack of Identity...:) )
Looking for my Ben....

Offline Ann

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    • Num is sum qui mentiar tibi?
Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #9 on: August 31, 2006, 05:18:20 AM »
Hey Jeff,

No thoughts (other than "what the f$$$!!!"), just ((((hugs))))

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline bobik

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #10 on: August 31, 2006, 06:06:00 AM »
The longer I am here, the weirder I consider the USA health insurance system.

Sorry to hear this Jeff, this is so crazy and cruel.

Coen
Coen Honig at Facebook

Offline Moffie65

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  • Posts: 1,755
  • Living POZ since 1983
Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #11 on: August 31, 2006, 07:08:57 AM »
If anyone has any thoughts I'm ALL EARS...
Love you all!
Jeff
PS Try to stay Healthy


Jeff,

Please call Laura today, you can use the main HIV number I gave you for RJ.  Call her too, she will be a true light for your day.  ;)

Your meds might be covered by our new formulary, but I ain't too sure.

Keep up the good fight.

In Love.
The Bible contains 6 admonishments to homosexuals,
and 362 to heterosexuals.
This doesn't mean that God doesn't love heterosexuals,
It's just that they need more supervision.
Lynn Lavne

Offline Jeffreyj

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  • Posts: 1,403
Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #12 on: August 31, 2006, 09:58:33 PM »
Thanks Moff...I will call her tomorrow (Friday) I just got a recorded message from Medicare advantage...It was a recorded message asking me if I have any other coverage. UGH I wonder why and wonder what this is all about. ???
Positive since 1985

Offline ImagineFL

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #13 on: August 31, 2006, 10:46:35 PM »
Shit... this kind of thing sucks.  Like Ann... thats about all I can say.

Thank God I am still able to work and get insurance through there. 

We had a meeting yesterday with our insurance agent and they are changing to Blue Cross/Blue Shield because the companies annual premium went up by almost 40% for the renewal.

We were told it was from two employees that had spend a lot of time sick and in the hospital and "one other employee with expensive meds".... 

Wonder who that would be...   ::)

Anyway, best of luck to your buddy!! 

Thinking about you,
Patsy

Offline Ann

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  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #14 on: September 01, 2006, 04:12:14 AM »
We were told it was from two employees that had spend a lot of time sick and in the hospital and "one other employee with expensive meds".... 

Wow, they actually said that in your meeting? Isn't that kind of specific comment illegal? I realise they didn't name names, but I can see where it might start an awful lot of office gossip and speculation, resulting in resentment. Sheesh!

Ann
(who hates that kind of gossip-encouraging thing)
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline jmorti

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  • Posts: 5
Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #15 on: September 01, 2006, 09:24:55 AM »
Ahhh...the lovely bureaucrats and overpaid executives deciding our fates.  Gotta love it!  I just got a call from my Rx Insurance Company (MedcoHealth) telling me that they're dropping the specialty pharmacy that I get my meds from.  My situation isn't as dire as yours, but just thought I'd share since everybody else is.  They recommended that I go to a Retail Pharmacy or order my meds via their mailorder pharmacy.   Well, I decided to do mailorder since it's going to save me about $400 a year.  Unfortunately with my co-pays retail costs me $100/mo, whereas mailorder is $200 every 3 months.  I'm fortunate enough to get my insurance through my partner's work, as they have domestic partner benefits.  Hopefully the insurance doesn't change much as open enrollment is coming up.  I sometimes wonder if being unemployed would be less expensive. *sigh*
"Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind." -- Dr. Seuss

Offline Moffie65

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  • Posts: 1,755
  • Living POZ since 1983
Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #16 on: September 01, 2006, 09:38:23 AM »
Hey Jmorti,

Yes, it is less expensive when you are unemployed.  However, one must be aware that living on whatever you might get out of SSI or SSDI, is far more tenuous than living with employment, and a paycheck.  I would literally give you my left or right nut, if only I could go back to work and make a decent wage.  I really miss work the most, and when one gets tempted to think about throwing in the towel, remember, you might never be able to work again, once you quit.

I know what you wrote was a passing comment, but some of us really miss what you have.  By the way, because of the quantity of my medications, my co-pay for three months is only three dollars less than yours, and I am on disability, and get my medications from the Veterans' Administration. 

Please don't let negative thoughts creep into your mind, they are sometimes the seeds of much more dire conditions in life.  Stay up, stay happy, and count the blessings you have in life as the greatest gifts you posess.

In Love and Support.
The Bible contains 6 admonishments to homosexuals,
and 362 to heterosexuals.
This doesn't mean that God doesn't love heterosexuals,
It's just that they need more supervision.
Lynn Lavne

Offline Joe K

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  • 31 Years Poz
Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #17 on: September 01, 2006, 02:15:20 PM »
Sorry to say, but what do you expect from a drug program that was written by the drug companies?????

Stephen has government insurance and it switched to the Medicare D type of plan so he also has a donut hole, but his breaks down to $1,600 out of pocket before the donut hole and then the hole costs him another $4,000 because his co-pays only apply to HIV drugs.  So far this year, we have had to scramble to pay $5,600 just to keep his meds.  Fuck Bush and all his cronies.

One other caution.  Here in Florida, if they find out you have enrolled in Medicare D, they WILL NOT let you use either ADAP or Ryan White funds at all.

I used to almost joke that the government wanted us all dead, but now I am beginning to think that is true.

Offline Jeffreyj

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #18 on: September 01, 2006, 02:48:18 PM »
Who came up with the fact that if you are on part D, you can not use Ryan white? That is a fucking joke! I can't believe that. If they did that here, i would have to move! Insane.
Positive since 1985

Offline Bartro

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #19 on: September 01, 2006, 02:58:17 PM »
This "donut hole" doesn't bode well for the republican-controlled congress.  Many medicare part D recepients will find them selves falling into the "hole" right around election time.  Many recepients, especially the elderly, are unaware of the "donut hole" until they find themselves falling into it.  Hopefully they will vent their anger and frustration at the voting booth. 
Rusty

Offline Joe K

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #20 on: September 01, 2006, 03:02:34 PM »
Jeff,

Who came up with that?  None other than Bushette II, Jeb and his Republican cronies.  They have designed the absolute worst public health care programs that I have ever seen.  For those of us lucky enough to be on ADAP or RW we have to use specific pharmacies, that could give a crap about you and your meds.  I picked up my monthly supply last week and they shorted me on two drugs.  You'd think they would just fill it when they got the meds, but no, they waited until I came in today and they did their magic and it only took them 45 minutes to count out 50 Coreg pills and 16 Sporanox.

The program is specifically designed to be the most humiliating, degrading and awful experience, in the hopes that you will either move, or better yet, die.  I moved from Michigan and our programs used the big local pharmacies, where you got your drugs and they billed the state.  Nothing like that will ever occur here, because Republicans absolutely hate sick and poor people.  Drain on the budget you know.

Added for Barto.  Most seniors will never get to the doughnut hole because many of their drugs are generic or they only take 4 or 5 per month.  The ones with catastrophic diseases are the ones who will fall into it, because just a month or two of HIV drugs will push you over the limit.  Especially since the program is strictly prohibited from negotiating any kind of bulk prices or discounts on the drugs they buy.  Essentially the Republicans have given their friends in the drug industry an open spigot to the US Treasury.  They can charge whatever they want, can change formularies on a whim and are not held accountable to anyone.

We can only hope that Americans will wake up to the disaster that Bush has forced upon this country.

If anyone should be tried for treason it would be him.  Treason and crimes against humanity, but Congress has no backbone so nothing will happen.  We can't even get rid of our less than useless Sec of Defense Rumsfield so don't ever expect Congress to do what is right, at least not with the Republicans controlling both houses.
« Last Edit: September 01, 2006, 03:08:45 PM by killfoile »

Offline Jeffreyj

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #21 on: September 02, 2006, 12:55:50 AM »
It is crappy enough to deal with George Bush. To have to deal with two, well that is just horrific. When will people wake up in this country? Jesus Jeb sounds worse than Geoge W. I feel for everyone in Florida. Safe to say, you will never see me there. Wait till some of the seniors there  reach the doughnut hole. I think they will. I did, and my hiv drugs were covered by Ryan White. It may be coming sooner then you think. But basically it is true. This Medicare D plan screws Those of us who have hiv/aids first. I am disgusted and truly mystified how our U.S. Congress ever voted for this grossly unfair, misguided plan that only does one thing: Fucks those of us who need the help the most.
I sent a scathing email to the reporter at the Daily paper here in AZ. Damn, We all need to make noise on this one. It stinks, and it clearly SUCKS. I'm pissed, I'm going broke, UGH! I urge everyone to make noise on this. How ever you think. Please do SOMETHING. Email your senators, congressman, please if we all do something it can only help those HIV+ people down the road. I know most of you can work now. But there will be a day when you can't. That's reality. You will all have to deal with it sooner, or later.
Frustrated BEYOND BELIEF.
Jeff
Positive since 1985

Offline Eldon

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #22 on: September 02, 2006, 01:05:10 AM »
Hello Jeff,

Don't let the politics consume you and get you down. No one likes the way things are managed on Capitol Hill. The BEST thing you can do to make a difference is when you go to the polls and vote to put these people in their respective seats.

I too will write to my congressman about this. I do live in Florida and YES Jeb is running things at the moment and there ARE a lot of seniors here in this state. I'd hate to see them get put in a predicament after they have worked so hard for many of these years.


Have the BEST Day!

Offline randym431

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  • Posts: 1,125
Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #23 on: September 02, 2006, 02:43:15 AM »
Oh boy... here we go.
Donut holes? Not just bakery term anymore.
Many old elderly people will discover this "donut hole" thing around Jan-Feb of 2007 (most estimate). You think people are mad now? Just wait till your grams and gramps, mom and dad discover their donut hole in a few months.
And ALL this so the insurance co.s can rake in BILLIONS (and naturally, donate more $$ to the republicans who allowed this to happen). Welcome to "morals" from the right. Heck, they will have us eating our young before we know it.

And...AND, also... The republicans wrote this "law" so that the gov CAN NOT shop around for the best drug prices any longer. Have you noticed you meds, whatever your meds, have went up 100, 200, 300 % since last spring?

All I can say is THIS can be fixed. We all need to vote these bastards OUT of control come election day 2006. Thats a start. Call your friends, family and let them know this can be fixed, but we all HAVE to do our part, and VOTE & pass the word.

(dont get me started...)

BTW, I am not sure, but I am thinking being "retired" and being on "disability" are treated different. I was thinking I seen somewhere people on disability do not have this "donut hole" curse. But I need to look into that. Ask your doc or pharmacy if they realize you are on disability (if you are?). It might make a difference on coverage. (but I could be wrong)

And btw, people working and with med coverage, well let me just say that is looking very rocky in the next few years. Insurance thru employment can not and will not be able to continue paying these high costs. Nore will your employer. So just hold on tight for a rocky ride in the next 1 - 2 years.
That is, unless we vote these demons out of office...
Its just not an hiv thing, its anyone on any kind of meds. Young, old, hetro or gay... makes no diff. Its the money and, well, the money.
« Last Edit: September 02, 2006, 02:45:31 AM by randym431 »

Offline Jeffreyj

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  • Posts: 1,403
Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #24 on: September 02, 2006, 03:42:03 AM »
According to my insurance co. It was clearly explained that I'm in the "donut hole" And I'm on disability...just to clarify. However, I will make sure they know this next week. I'm also meeting with my Case worker. I will lay it all out in front of him. I guess I'll explain it to him, since he had a hard time explaining it to me last month. Seat belts fastened ....Here we go....
Positive since 1985

Offline Moffie65

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #25 on: September 02, 2006, 04:53:11 AM »
The Donut hole applies to anyone making over $14,000. As seen above, Steven in Florida has to pay his out as a total of $4000.  If you do the math, this pulls his gross income, after medical expenses down to $10,000, which places him right at or below poverty level which should yank his income well below the dounut hole level.  What a stupid way to persecute those of us who cannot do anything about it.  If I were not getting all my drugs from the Veterans Administration; I would be $4000 poorer each year also.  It would also have caused me to loose my home.

This whole thing is horrifying, and needs to be completely dropped from the plans.

In Awe of the most Stupidity I have ever witnessed in this country!
The Bible contains 6 admonishments to homosexuals,
and 362 to heterosexuals.
This doesn't mean that God doesn't love heterosexuals,
It's just that they need more supervision.
Lynn Lavne

Offline ademas

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  • Posts: 1,151
Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #26 on: September 02, 2006, 09:46:42 AM »
Jeffrey,

I'm so sorry you're going through this--I'm so sorry we're all going through this.

I have my own horror story, and it's still playing out...so I won't bore you with all the details.

This plan is absolutely insane.  It has caused me more stress, grief, sleepless nights, and grey hairs over the past six months than my initial diagnosis did.  The thought HAS crossed my mind that someone out there seriously wants me dead.  I have had to fight tooth and nail to get every single prescription I've had filled since March 1st.  It has taken no less than 50 phone calls and 4 conference calls between my PDP, my secondary insurance, my caseworker and myself just to get my last two shipments of HAART medications, and it's still not certain that Medicare will pay for them.  (Medicare claims I was never enrolled, and that they won't pay...even though I have the paperwork to prove my enrollment.)  There's an unpaid bill out there in excess of $3,000, and I know I haven't heard the last of it.

Finally, my caseworker got the okay to cancel my enrollment in the PDP and switch back to my old plan.  Medco took care of their side, and told me I needed to cancel with Medicare also.  Medicare says they can't cancel something I was never enrolled in.

Regardless, yesterday I picked up a medication at my pharmacy and paid the $5 copay--it was just like the good old days.  One things for sure...I'm going to fight to the bitter end to NEVER enroll in a PDP again.  I only wish all of us had that option.

Sorry...I didn't mean to rant or hijack.  I do want you to know that you are not alone in your frustration, and I'm sure you're hearing that loud and clear from some of the responses here.

Craig
xox

Offline ademas

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #27 on: September 02, 2006, 09:57:31 AM »
an interesting article that touches on this wonderful "doughnut hole" we are experiencing (to add to some of what killfoile already pointed out):

http://www.cepr.net/pressreleases/2006_08_15.htm

Merck, Pfizer, Wyeth Making Billions
For Immediate Release: August 15, 2006

Washington, DC: Pharmaceutical companies are making billions in excess profits under the new Medicare drug benefit, according to a report by the Center for Economic and Policy Research. In the first year of the Medicare Part D program, Pfizer will make $1.2 billion in excess profits on Lipitor and $585 million on Zoloft; Wyeth will make nearly $1 billion on Protonix; and Merck will make $1.6 billion on Zocor.

The report, "The Origins of the Doughnut Hole: Excess Profits on Prescription Drugs," by economist Dean Baker, calculated the difference between the average cost of 20 common drugs used by seniors and the cost when obtained through the Veterans Administration. It found excess profits totaling more than $7 billion in the first year of the program. The study also calculated prices for prescription drugs such as Actonel, Aricept, Celebrex, Fosamax, Nexium, Norvasc, Plavix, Prevacid, Toprol XL, and Xalatan. To read the report, see: http://www.cepr.net/publications/par...ts_2006_08.pdf

Thousands of drugs cost more than necessary under the Medicare drug plan because Congress prohibited Medicare from negotiating drug prices directly with the pharmaceutical industry, as is done by the Veterans Administration. In the case of many drugs, the prices paid by insurers participating in the plan are more than twice as high as the prices paid by the Veterans Administration.

Millions of seniors and disabled Americans enrolled in Medicare Part D drug plans are discovering the "doughnut hole" - the $2,850 gap placed into the plan in order to save the government money. The Center for Economic and Policy Research has pointed out that this gap was only necessary because the plan's overall design added significant costs and complexity.

"The excess profits from just a small number of drugs account for a very large portion of the doughnut hole," said Baker. "The excess profits for the drug industry as a whole will be close to $50 billion in the first full year of Medicare drug benefit program. This is more than twice the size of the doughnut hole.

Offline Jeffreyj

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #28 on: September 02, 2006, 11:28:06 AM »
Thanks Ademas for that info. Oh My..How is the average Joe ever going to survive this truly hideous situation? I hope we can all find a way to transform our anger into action. This is just getting my blood pumping. I don't know how yet, but I plan to take my anger and somehow find a way to use it to my advantage. I will not give up, and I will use this anger in some positive way. I don't want to make the situation worse by just getting pissed off. I think this may be the "fuel" that will propell my activism to the next level. Indeed. This may be just what the DR ordered, in a strange way. I will try to make this negative, into a positive thing. It is the only way to go. It may be the kick in the ass I have needed!
Positive since 1985

Offline gerry

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #29 on: September 02, 2006, 12:36:35 PM »
Hi Jeff,

Not sure if this helps but if you did not have to pay out the $250 deductible when your Medicare D kicked in for the prescriptions you got, then you should not be subjected to the "donut hole."  There is subsidy for lower-income individuals, including those on disability, to cover the coverage gap, sometimes, fully.  So the first thing to clarify would be whether or not you qualify for the subsidy.  If you were drawing SSI (different from SSDI), then you automatically qualify for the subsidy and should not have to be subjected to the donut hole.

Gerry

Offline Miss Philicia

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #30 on: September 02, 2006, 04:34:58 PM »
Gerry, do you know where on the internet one can go to find out specific information on this?

From what I can tell you must be below 150% FPL (Federal Poverty Level), which I'm not but only by a little bit as I'm just on SSD and not on SSI.  It just seems odd that Ryan White funds, since they are supposed to be a last resort, will not continue to pay the difference.  I can't imagine that it was the intention that previously ADAP fully covered people would be suddenly thrust into a situation where we must pay yearly premiums, co-payments and a donut hole.  Is this really the situation?  If so, my ASO is run by [insert expletive].

A cursory search on google though shows that in DC they've advised folks with less than $1809 (150% FDL is actually around $1400) per year income to apply for assistance.  I guess it's all done by state.  For some reason they've not made this information easy to find in Pennsylvania.

Quote
How ADAPs will work with Medicare Part D
ADAP is allowed by law to cover premiums, deductibles, co-insurance and co-pays. However, not all ADAP have the money or the set up to pay all these cost-sharing obligations. Each state ADAP will make a decision about what assistance it can provide to Medicare beneficiaries. The requirements for receiving assistance will also differ by state. To find out how your state ADAP will work with Medicare, call your ADAP and ask for their policy. Be aware that the policy may not be in place yet, and ask how you can find out when it will be.

http://www.projinf.org/healthcare/medicare_under.html

edit:  I've now found the PA information and it looks like I'm fine except for paying the monthly premium.  So basically the federal government found a way to decrease my already meager income by $700/year.  Thanks President Bush!  Actually I need to investigate this further to make sure this is how it's supposed to be.  It seems that Ryan White funding would allow my state ADAP to pay my premium but they've elected not to do so.  I guess that this is a funding decision but I will traipse to my ASO this month to make sure.
« Last Edit: September 02, 2006, 05:18:16 PM by philly267 »
"Iíve slept with enough men to know that Iím not gay"

Offline Eldon

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #31 on: September 02, 2006, 05:56:48 PM »
Jeff, it is Eldon. This thing is out-of-hand. I have done some research and look what is going on:

http://www.washingtonpost.com/wp-dyn/content/article/2005/12/23/AR2005122302040.html

AND

http://www.cbsnews.com/stories/2006/07/26/eveningnews/main1839288.shtml

i'm going to have to write to Florida Senator Bill Nelson who wants to get this thing fixed by negotiating the drug prices with the pharmaceutical companies.

ALSO

http://www.webmd.com/content/article/88/99741


Have the BEST Day! (The Doughnut Hole is Revealed)

Offline blondbeauty

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #32 on: September 02, 2006, 08:49:26 PM »
I am learning a lot about private insurance. Here in Spain, private insurance companies donīt pay for meds unless you are in the hospital. Only Social Security pays for them.
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Offline Jeffreyj

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #33 on: September 03, 2006, 03:28:30 AM »
Eldon,Those articles do a good job in explaining medicare part d.  It will help anyone who cares to Learn more. Thanks for posting Eldon.
Positive since 1985

Offline Ann

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #34 on: September 03, 2006, 04:11:19 AM »
Multiple choice pop-quiz:

What does the "D" in Medicare part D stand for?

  • 1. Degradation
  • 2. Debilitation
  • 3. Deadly
  • 4. Donut-holes
  • 5. Dumb-asses in DC
  • 6. All of the above

This shit pisses me off no end!

Ann
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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

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Offline gerry

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #35 on: September 03, 2006, 11:14:57 AM »
Gerry, do you know where on the internet one can go to find out specific information on this?

edit:  I've now found the PA information and it looks like I'm fine except for paying the monthly premium.  So basically the federal government found a way to decrease my already meager income by $700/year.

If you have resources (excluding a house and a car) of < $11,500 (single), you should qualify for subsidy ("extra help") with your income level.  This subsidy will take care of paying for premiums, deductibles, and most co-pays.  The application, even though processed by people from your state, actually goes through the Social Security Administration.

Here's the link: Extra Help for People with Limited Income and Resources

Offline Miss Philicia

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #36 on: September 10, 2006, 04:35:37 PM »
Thanks Gerry.  Will check that out.
"Iíve slept with enough men to know that Iím not gay"

Offline Iggy

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #37 on: October 06, 2006, 08:07:47 PM »
.
« Last Edit: January 12, 2007, 08:29:05 PM by Iggy »

Offline Miss Philicia

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #38 on: October 25, 2006, 10:41:41 PM »
Donut hole is FULLY covered by ADAP here in Pennsylvania.  If it's not being covered in your state find out why.
"Iíve slept with enough men to know that Iím not gay"

Offline Oceanbeach

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #39 on: October 26, 2006, 05:41:50 AM »
Hi Jeff,

I got sucked into the Donut Hole already too.  The bill was passed, knowing there were problems and with hopes to fix them later.  My letter was sent to my Los Angeles address, five years after the move.  Medi-Cal was cancelled.  Got ADAP immediately when the pharmacy said, "We can't let you leave with $3000.00 in pills and no payment."  The next month, the local ADAP clerk had neglected to send in the forms and cancelled again.

One of the benefits I enjoy from being on the Commission on AIDS is the contact with other Commissioners.  I have monthly conversations with a lady who is the Director of our DHS office and another from the State Department of Health, Office of AIDS.  These ladies get things done.  So far this year, I have lost my Medicare, Medi-Cal and ADAP and have never gone a day without meds.  It's kind of like the finger of Gawd...  Have the best day
Michael

www.Commission-on-AIDS.org

 

Offline Jeffreyj

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #40 on: October 26, 2006, 06:08:16 PM »
Iggy thanks for posting that NY Times article. I had to smile when they said...Politicians were " irresponsible". DUH!

Which brings me to this point:
I can not WAIT to vote in two weeks. All incumbent get voted off the island. FUC*&%G worthless bastards.  And the donut hole is only one of a dozen reasons.
I urge everyone here in the USA to vote this year.

Thanks,
Jeff (who is living off DR office samples for the moment)
Positive since 1985

Offline Lis

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Re: Medicare advantage..or so it's called! Screwed Again, and bending over.
« Reply #41 on: October 26, 2006, 06:22:50 PM »
I dont know if this will help... but thanks to Allen i have started getting my meds through www.1800medexpress.com..

they have cut my copay in half!!! it goes on income so you may have no copay at all!!!  the phone # is 1-800-808-8060
incase i F'ed up the URL.... they also work with your doc and ASO!!! GOOD COMPANY!!!! call them!!

lisbeth
poz 1986....

 


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