Welcome, Guest. Please login or register.
July 20, 2017, 09:36:42 PM

Login with username, password and session length

  • Total Members: 31089
  • Latest: jd90523
  • Total Posts: 716134
  • Total Topics: 57739
  • Online Today: 308
  • Online Ever: 1421
  • (August 13, 2016, 05:18:44 AM)
Users Online
Users: 4
Guests: 253
Total: 257


Welcome to the POZ 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 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: Medicare Part D, donut hole. What's being done. HELP! In the State of California  (Read 3861 times)

0 Members and 1 Guest are viewing this topic.

Offline just_joe

  • Member
  • Posts: 42
I've been a Medicare/Medical recipient since 94. Three years ago when I was forced into the Medicare Part D program I was skeptical. The plan has been changing each year. This year because of the increase in cost of living I receive $1542.00 a month which just takes me out of the bracket to qualify for extra help from Medicare because I am no longer considered low income. With Medical my share of cost per month is $900.00. I'm now told that because of all this any drugs that I'm on that are not covered by ADAP my co-pay is 20% for what the drug cost. Ex: Allegra, which I've been on for years now will cost me $240.00 a month, Oxandrin is $45.00 a month, Serostim is $1200.00 dollars a month. The pharmacy can't even tell me if this will change when I've reached catastrophic coverage because they have raised that amount. Everything changes year to year. Who do write? Is there a program in California to help? What's being done. This is all so ridiculous. Can anyone please help or tell me what to do or where to go to get some assistance with this.  ??? >:( 

Offline Miss Philicia

  • Member
  • Posts: 24,793
  • celebrity poster, faker & poser
Isn't serostim an HGH drug and oxandrin a steroid?  I know for the latter if you have the injection done in a physician's office, instead of taking the pill oxandrin, it would be covered by Medicare. 

But yes, once Medicare Pt. D pays for something, if the med is not on your state ADAP formulary (obviously this varies from state to state) you will be left picking up the remainder.  You may wish to look into alternatives that are on your formulary for now, and inquire with whatever entity took these items off your formulary, as it sounds like from what you are saying that they were at one time on there, but as of 12/31/07 something changed on that list.

I do recall reading recently about the Governator doing something with the ADAP stuff in your state.  Have you contacted your case manager at your local ASO, assuming you have one?  I can't imagine that you're the lone person dealing with this in all of San Diego.
"Iíve slept with enough men to know that Iím not gay"

Offline just_joe

  • Member
  • Posts: 42
That's why I posted this because when I go to the pharmacy they tell me that they don't have that many cases that are like mine. Who lives on 1500.00 a month and if there drugs are not covered under the ADAP formulary... HOW? I've tried several times to go back to work and the stress of the jobs only knock my health back down and I end up getting sick and having to quit. It's like I'm being punished for working in my lifetime and for paying into the system. In my eyes 1500.00 a month is low income when you take out the day to day costs of living. Just the basics like rent and food alone. Are we suppose to live in a car and eat peanut butter and jelly sandwiches? I just don't get it. We put these people that are educated into office and they come up with this hair brained Medicare Part D and it's like they really didn't think it through and they put insurance companies in charge who only look at the bottom line. So, now the only people that get things at no cost are those on welfare that have never paid a dime into the system. I bet if they had to live it or one of their loved ones were living it, things would be different.

Offline Miss Philicia

  • Member
  • Posts: 24,793
  • celebrity poster, faker & poser
I still think you should contact your ASO/case manager and don't just go by what a pharmacy is telling you to be the final word.  Your call though, not mine.
"Iíve slept with enough men to know that Iím not gay"

Offline just_joe

  • Member
  • Posts: 42
I will thank you.


  • Member
  • Posts: 281
do you recieve social security only?do you not qualify for disability?

Offline BT65

  • Global Moderator
  • Member
  • Posts: 10,784
I think Joe is talking about SSDI.  People who are receiving SSI only are receiving that because they don't qualify for having ample work history credits for SSDI. 

I agree Joe, your income is definitely low.  I will tell you that I get $783 on SSDI; and in the state of Indiana, that only qualifies me for $10/month in food stamps.  Yes, the idiots (Bush) who dreamed up Medicare Part D certainly left a lot of people screwed.  This year I have high co-pays that I didn't have last year.  And because I get Medicaid, I'm not covered by ADAP.  However, the Medicaid will not pick up the co-pays.  My ASO has been covering them the past couple months. 

I agree with Philly about contacting your ASO.  Pharmacies make mistakes all the time, especially about the 'new rules.'  ASO's have more concrete knowledge.  I certainly would not try to go it alone; but that's me.
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Condom and Lube Info http://www.aidsmap.com/Condoms/page/1044833/
Please check out our lessons on PEP and PrEP. http://www.poz.com/factsheets/fs_2014_09_prep.pdf



Terms of Membership for these forums

© 2017 Smart + Strong. All Rights Reserved.   terms of use and your privacy
Smart + Strong® is a registered trademark of CDM Publishing, LLC.