This is a personal story and I am “the source.” Before the law was passed for the government to pay for your medicine, I was doing okay in getting the medicines I needed to stay alive. The manufacturer of Plavix, a blood thinner necessary to keep my blood pressure down, was providing the medicine at NO COST to me. After the law was passed, it started costing me (my co-pay) $150 a month. The law makes it ILLEGAL for this maker to continue to supply it, and I cannot take advantage of the deals some drug stores offer to provide certain medications at very low prices, as low as $4 a month because it’s against the law while I am “on this program.” I would “resign” from this “program” if I could, but I can’t. so I’m stuck. I can no longer afford Plavix and several other medicines necessary to keep me alive because of this law. Further, what happens when I reach that “donut hole” they, in their wisdom, built into the law where, after they’ve paid $5,000 for my medicine, my “coverage” stops completely until I have bought another $5,000 worth of medicine. Remember, this is only ONE medicine I must take daily to stay alive, and ALL are very expensive. The first year after I was FORCED onto this “program” against my will (they wanted to fine me for not signing up), it was okay.
They paid for much of the cost of my medicine. Each year they changed me to different “providers” without asking me if I wanted to change them. With each change, my “co-pay” went up. I had no choice. I MUST use what they give me, and what they “give” me today is little or nothing while my very existence “on this program” makes it impossible for me to get my life-saving medicine from anywhere else. Today, my “insurance” pays about $6 of the cost for one necessary medicine while I pay $32 each time I refill the prescription. This is a medicine I MUST have or calamity (which I will not describe) results. If I run out of money and cannot afford it, don’t get near me until I can get some. Frankly, I think this “program” is about as worthless as are many other government “programs” that PRETEND to make things easier for seniors, but actually make it more difficult. Deaths from this cannot be accurately gauged, and that’s the way the politicians like it. If I DIE because I can’t get Plavix or some other medicine, they can claim no responsibility. But they WILL be responsible. (Just common sense)
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28 comments:
What "program" are you talking about? Medicare? Medicaid?
Anon: The one where the government "promised" to pay for the medicine seniors needed to stay alive. they didn't tell you about the "details." Like making it illegal to get your medicine from anywhere else except at full price. It was passed by liberals during the Bush administration and he was conned into signing it.
What law is that? I have not heard of it. I am still young enough that I have not heard of this. I am inches from so-called "retirement", but do not know what you are talking about. I am also not on medications so have not been educated ab0ut these things. I work in marketing in the health industry. If you give me more details I will talk to my boss about this. There must be some way around this.
Can't your doctor switch you to something that is covered?
Anon: I don't know the name of the law. Something that sounds good, no doubt. I'm only a victim of it. Ask Medicare about the "we'll pay for your medicine" law passed during the Bush administration, supposedly to pay for most of a senior's medication, but does not. It just makes it impossible to go on any OTHER program. As to my doctor putting me on another program, forget it: it's illegal. They FORCED me onto this "program" and I can't get off it. They even wanted to fine me for not signing up for it during its first two years. You didn't hear about it? surprise, surprise! That's what this blog is for: to tell you about it so you can do some of your own research.
Anon: It's now called "Medicare Part D." Here's a URL about it:
http://en.wikipedia.org/wiki/Medicare_Part_D
Ok. I will see if my boss has any input on this. He deals a lot with medicare/medicaid programs and know a lot about how they work. I will let you know if I find out anything helpful.
By the way, most drugs are the same price regardless of dose. You can save a lot of money by buying pills that are double the dose and splitting them. The health industry calls it "Tablet Splitting". Just buy a little pill splitter from your pharmacist. You can tell you pharmacist that you want to tablet split so make your pills double the dose.
Anon: I already have one. Thanks.
My boss said you should join a Medicare Advantage Plan. I asked him how much it costs and he said "It's free. Medicare pays the premium and it includes drugs and does a much better job of covering drugs. Check out the Medicare Advantage Plans in Denver. Denver Health is one I know of."
I hope this helps you. Do let me know.
My boss just also said you should check out Aetna and Humana in your area as they are the best. He also said this better handling of your care is why managed care is better.
I am back at work this morning and just finished my boss' and my traditional early morning call to catch up on what we have on our agenda for the day/week. He brought up your issue, about which I had e-mailed him several times, and told me that it sounds like you are "still on the 'fee-for-service' and thus are getting jacked around. It does not pay much." You can get on a Medicare Advantage Plan that you do not pay for. Medicare will pay the premium for that plan. My boss also said he knows someone at Denver Health, which has a Medicare Advantage Plan, and said if you wanted to look into that one he would be happy to get on the phone with you and that guy to make sure you are navigating the system successfully and can get on a plan that actually helps you as a Senior Citizen get the medical care you need. We can set up a conference call. My boss knows people in many, many health plans all around the country since our company is a carve-out for them as well as for major corporations and State agencies. Each plan is a little different. My boss is also a Senior Citizen and is fully acquainted with the frustrations of navigating the system as a Senior. So. You have help available to you.
Anon:
Thanks. I'll look into it.
Anon: I'm already a member of a "Medicare Advantage Plan" and it's not "free." It costs me $90 out of my SS check. they didn't ask me if I wanted that, either. they just deducted the money.
You do have a choice, though. There are a few Medicare Advantage plans that are not free. But most of them are free. My boss says to go with the larger companies like Aetna or Blue Cross (BlueMedicare HMO, which is a Medicare Advantage plan). Check into what their coverage is and check to see that your doctor and your formulary is included in the plan. Really big plans like Blue Cross have everybody and their great grandmother in the plan. You can switch your Medicare Advantatge Plan company to one that is free and that covers more. I think it is like most insurance plans in that you have to switch during 'open enrollment' once a year. Keep after them so you can get switched to a plan that serves YOU.
Anon: I'm WITH Blue Cross. That's when my co-pays went through the sky. I think they're punishing me because I ignored their "enrollment period." I didn't ask for this and I don't really want to waste time on it.
Blue Cross?? Wow. I'm goint to tell my boss and see what he says. He knows people in plans all across the country. I will let you know if I find out anything useful. ARe you with Blue Medicare HMO Medicare Advantage Plan?
My boss says you can file an appeal and/or grievance. You do have rights. I think this is where you can start that process:
http://www.anthem.com/health-insurance/home/overview#
If I were you I would start shopping for one of the free Medicare Advantage plans.
Here is Denver Health, where my boss knosw somebody. It is a small plan but a very good one that covers well.
http://www.denverhealthmedicalplan.com/MedicareAdvantagePlans/MedicareRx/MoreInformationaboutMedicare.aspx
I know insurance plans have 'enrollment periods'. I find it very frustrating trying to decide what to sign up for every time my company changes plans. I spend several days pissed off about having to change, about how much more expensive the new insurance will be, and how much less it covers, and on and on. Our plan changes every year. I now how you feel about not wanting to 'waste time' on it, but we do have to have good insurance and that means really looking at the plans unless, of coures, we are wealthy and not worried about costs. I am not a wealthy person so have to really look. It seems to me that they make it as complicated as possible, too.
Anon: Yes, they DO make it as complicated as possible, hoping fewer people will wade through all the red tape. Mine changes every year, too. And my co-pay goes up. On one necessary medicine, my co-pay is $30 while my "insurance" "saves" me $4.65. I don't understand half of what they send me, and I don't think they do, either.
More info from my boss. He said it sounds like if you "ignored the open enrollment" (as you mentioned you had) you have been put on straight "fee-for-service" which would then raise your premiums quite high and yes, would certainly feel punishing. He said you should get back on a Medicare Advantage Plan (Part C) which would take care of every thing (doctors, hospital, medication).
He also said there should be Health Care Advocates in your area who would help you navigate the different plans and land on something that works for you. That person would sit down with you and figure out all the details of what your needs are and match it with the plan that works for you.
Anon: It's not the HMO version, but I'm not sure. I can't find the paperwork they sent me. I think if it were the HMO version, it would operate differently.
Anon: Thanks. I'll look into it.
Anon: I filled out no forms. After two years of the "plan" being in operation they "enrolled" me and wanted to fine me for not signing up I told them to stuff it.
Who wanted to fine you? Who is 'they'? BlueCross? Medicare? If you did not sign any papers I am not sure how you got signed up[ with Blue Cross' Medicare Advantage plan. It sounds like you could do with a Health Care Advocate. There will be HCAs in your area and their job is to help Seniors navagate the plans, rules, options, etc. that can be very confusing. The programs really are there to help you, but can also be so difficult to understand that you end up where you are now. Do look for hellp in getting properly enrolled so that the program actually helps you.
Anon: I was told (in the letter telling me they had "enrolled me") they were fining me for not signing up in the two years after the law was passed and the time THEY "enrolled me." It is MANDATORY, you see, for me to be "signed up." Like if Obama's health care swindle ever starts being enforced on us, they will want to fine me AGAIN. My answer will be the same: "stuffit!" If they then want to send me to prison, fine. They can then feed me, clothe me, provide a roof over my head, and FULL medical coverage.
That's one way to get medical coverage a person can afford....
Anon: What person? Obama?
I meant you could afford prison health care because it is "free". All it costs is your freedom...
Anon: Yes, you could "afford" it. But what kind of quality?
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