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The "D"Hole


Is there any help for people like myself that have fallen into the Donot Hole {medicare partD}?
I make a mear $1200 a month and my medications will cost me $1100 a month till  I reach an out of pocket of$3600. I sometime feel that I am the only person that this affecting. I have written letters to all government Officals in the State of Tennessee and I have heard from one!!! It seems like the poorest of poor and wealthy are the only ones that will benefit from this so called fix to medicare!!! :(

Yes.  There is an option.   Some states have secondary coverage in the high risk insurance pool that pays all of the left over that Medicare Part D doesn't cover.   Washington State is one of those states, but i suspect that any state with a high risk pool will also have this.  Your best bet is to contact either the insurance commission of the state you are in or considering or to contact someone in the Department of Health who handles the ADAP Program.  ADAP folks are usually well versed on what is covered.  I had to go through the same worries recently. 

  If you are not covered by a high risk pool, you can only get into it if you are denied coverage by two companies in Washington State.  I don't know the rules in other states but believe it is pretty similar.  Usually just a couple of letters will take care of this problem.  I don't know if I would be too amenable to disclosing that you have existing coverage or the other insurance companies may not be inclined to deny you.  Some states have laws that require them to take you if you are already insured and don't have more than a 30 day lapse in coverage -- kind of like auto insurance.  You pay more for a new signup if you are uninsured.  Medicine is similar.

Thanks for your reply!!!! :) The issue in the state of Tennessee there is no medicaid or any other means to get any assistance. In my working years {started at 16} I have never been without insurance. In regards to the my so called case  manager with Ryan White, her responce was " I do not know what to tell you good luck". I have bills that have been sent to Ryan White for payment from 02/06. They still have not been paid. I fax the information to them and still they are not paid. I will be paying her office a visit today. I do not know if the insurance comissonar can be of any help.
I like more people in the state of Tennessee have been basically left out to dry!!!Advocacy is none exsisting in this area most people have there own adgenda and if a issue does not affect them then you are labeled as a BITCH if you bring up. Or better yet you are told to shut up  and listen. I spoke to another case manager and he stated that he has client to have fallen into the Donut hole and he stated that they were not concerned and they probably would just stop taking their meds..I wrote a letter to the person in charge of Ryan White funds and I did not get any responce back. I wrote the governer of Tennessee and there again no responce back. It is a waist of my time to send a letter to Bill Frist, his actions show that he could care less. So I will either be in debt for the rest of life or like other just stop taking my meds. I have an oppiontment this afternoon with my doctor and I will tell them what I am dealing with and tell him my oppiontions. I do not have a infectious diesease doctor mainly because there is one group in this area that cover a very large population.  All I can say about that is a had to divorce my infectious dieasease doctor.
Once again Thanks for your reply!!! ;)

Hi Mark,

You posted this thread in the Activism forum, but you'll get more responses in the Living forum so I moved it for you.


Hey Mark,

Wanna job in Arizona????  There are loads of us in the same boat you are.  I know that doesn't help you in this situation, but here in Arizona, I sit on the State Advisory Council and the ADAP Formulary Committee.  What I have observed is exactly what you are saying and that very few people really know the new setup, or are willing to even give a shit.  I know your case manager needs to be fired and not ever let back into HIV work, but that is not going to happen.

No, my friend, you have one option.  Get involved in the Ryan White work in your state, attend meetings on the state level, (they cannot refuse you as an HIV+ individual) take loads of notes, download the Ryan White CARE Act Manual at the Ryan White website, memorize this book, listen to everything, and because the system is not working in Tennessee, you now have your work cut out for you. 

I know here in Arizona, the ADAP coordinator has stated that NOBODY will have to pay full price for meds, NOBODY!  I see that is now working, and those of us like you, are now paying the state co-pay of $9.00.  I am not sure of the details, but that is the way Arizona is handling it.  Hence my quesiton about moving. ;D

In Love and Support.


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