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Thread: How do you guys deal?

  1. #11

    How do you guys deal?

    Hi! For people on Medicare, check out Extra Help. Just google it. it is for "low income" medicare recipients, but the income limits are not too bad. it will cover all meds on your medicare RX formulary for less then $10 a piece. also, if a drug is not on your formulary, you can request an exception or during open enrollment each year (jan through march?, you can change your part D (the RX part).the good thing about extra help is that unlike QMB, there is no limit on assets. Medicaid QMB is an option if your income is low enough. it covers premiums and deductables. and if your income is even lower, you may qualify for full Medicaid as well. If you qualify for even $1 of SSI, you can get medicaid. look it all up on the official websites and call your local social security office. hopes this helps <img src="i/expressions/face-icon-small-smile.gif" border="0">

  2. #12

    How do you guys deal?

    BTW- this EXtra Help is to cover that donut hole.

  3. #13

    How do you guys deal?

    btw- the Extra Help covers the doughnut hole. i am a case manager, so i deal with medicare/medicaid a good bit, message me if you need help finding the info i mentoned.

  4. #14

    How do you guys deal?

    btw- the Extra Help covers the doughnut hole. i am a case manager, so i deal with medicare/medicaid a good bit, message me if you need help finding the info i mentoned.

  5. #15
    Senior Member
    Join Date
    Aug 2009
    Posts
    598

    How do you guys deal?

    Like everyone else mentioned, Patient Assistance programs are what helped me obtain my medication. You should really take the time to check it out.

  6. #16

    How do you guys deal?

    I work with my pharmacists, and my grandmother helps pay when I can't. Otherwise, great insurance is a blessing. GL with all the meds! <img src="i/expressions/face-icon-small-smile.gif" border="0">

  7. #17
    Super Moderator
    Join Date
    Apr 2006
    Posts
    20,913

    How do you guys deal?

    In terms of how out of pocket expenses have increased and it seems nominal, but it does add up...

    For us with medications we used to pay 10% plus a $10 copay for medications until we reached $1000 out of pocket maximum then we were just responsible for a $10 copay per med. Then the copay amount increased to 20% and a $15 copay. And more recently $15 copay for up to a months supply of meds then $30 for a 32 day - 3 month amount.

    Costs of drugs have increased significantly -- tobi, pulmozyme, enzymes.... vitamins have never been covered under our plan. In January, I end up spending about $550+ out of pocket for DS tobi copay -- that's for a 1 month supply and a similar amount for pulmozyme.

    Insurance copays for office calls have increased.

    Insurance is getting funnier about what they'll cover. The formulary/non-formulary issue. Use the meds that are on their list or come up with 50% of the costs. With suspensions it's become trickier -- they call it compounding and they refuse to cover it at all despite there not being any comparable medication.

    I get a single policy paid 100% thru work, but DH has a single with dependent policy in which he has to pay 25% and insurance premiums have gone up about 10-20% each year.

  8. #18
    Junior Member
    Join Date
    Feb 2008
    Posts
    1

    How do you guys deal?

    Along with all the assistance programs we are on, we also use the Costco pharmacy. You don't have to be a member to use the pharmacy, call them, I can't believe how much cheaper they are on prescripts than walgreens/walmart. I get "regular" meds there. As for specific CF meds, I use the CF Pharmacy, I can make payments online to them so we don't miss out on meds. They deliver to my house within 2 days of order- no charge. Hope this helps.

  9. #19
    ck
    Guest

    How do you guys deal?

    Last week i got a call from the pharmacy that my son's Pulmozyme was no longer going to be paid for by insurance-medicare and medicaid -and that the insurance told the pharmacy it wouldn't help to have the Dr apply because they would not be paying for it period. He has been on pulmozume since it came out in the 80's. He is 26 so it is in his hands but with school and his ministerial duties he hasn't pursued it fully. What do you think about this. It seems kind of arbitrary....I'm quite upset. Thanks, claudia

  10. #20
    tarheel
    Guest

    How do you guys deal?

    Every night I thank god my dad takes home a six figure salary. Even with good insurance the expenses are staggering. We pay a $60 charge for things like drs appointments and a chunk for stuff like plumozyme and tobi. There are still things they won't cover like proton pump inhibitors for very arbitrary reasons. For now I just hope the stupid republicans don't repeal the healthcare bill that Obama passed. Oh yeah, I went there.
    But I guess here we're all one issue voters pretty much.

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