Re: Medicare Pt D>Medically Needy program in Florida

[Guest guest]

We need somehow to find a way to fight this. I agree. I just wonder where we should start...

travis32824@... writes:

The medicare part D "donut hole" must go away. It targets people with chronic illness, ie HIV, cancer, lupus etc, Our HIV meds have no generics to speak of so we are stuck. My co pay for January would be $3700 due to all my HIV meds and my procrit and neulasta. Who can afford that living on a fixed income like me? Start the year off right. Easy ways to stay in shape in the new year.

[Guest guest]

We need somehow to find a way to fight this. I agree. I just wonder where we should start...

travis32824@... writes:

The medicare part D "donut hole" must go away. It targets people with chronic illness, ie HIV, cancer, lupus etc, Our HIV meds have no generics to speak of so we are stuck. My co pay for January would be $3700 due to all my HIV meds and my procrit and neulasta. Who can afford that living on a fixed income like me? Start the year off right. Easy ways to stay in shape in the new year.

[Guest guest]

Is "medically needy" the same as ADAP in Florida? I know they don't have the best rep in FL, but it seems you'd be a candidate for ADAP. Of course it varies state to state, but covering HIV meds is a big part of the program. I know their income cap in NYState ADAP is still $44,000/year.

Is there an organization that can give you case management? Sometimes it helps to have someone in your corner who won't take "tough luck" for an answer. Even a lawyer who specializes in Social Security issues?

BG

[Norton AntiSpam] Medicare Pt D>Medically Needy program in Florida

I'm on disability with SS too high to qualify for medicaid. In Florida, they have the "medically needy" program for people in my situation, and it will cover meds IF the total is high and you meet your "share of cost"(in my case about 1000 per month). Last year they pushed everyone on the medically needy program to medicare part D, and tho I'm still enrolled in the medically needy program, medicare pt D covers my meds (I pay 240.00 per month co pay).

Because of the "doughnut hole", in january last year my co pay was approx.$3000.00 (Thanks to fuzeon!) Medically needy "kicked in" for that month. However this year, medically needy says "if you have Part D" we're not paying anything.

It seems they would have let us know we'd be smacked with such a huge co-pay before hand.

Is anyone else dealing with this? I can't pick up my meds (can't afford to!) and when I call the medically needy "helpline" they basically say "tough luck". They won't transfer me to a superviser even!

Any knowledge of this situation would be much appreciated!

[Guest guest]

Is "medically needy" the same as ADAP in Florida? I know they don't have the best rep in FL, but it seems you'd be a candidate for ADAP. Of course it varies state to state, but covering HIV meds is a big part of the program. I know their income cap in NYState ADAP is still $44,000/year.

Is there an organization that can give you case management? Sometimes it helps to have someone in your corner who won't take "tough luck" for an answer. Even a lawyer who specializes in Social Security issues?

BG

[Norton AntiSpam] Medicare Pt D>Medically Needy program in Florida

I'm on disability with SS too high to qualify for medicaid. In Florida, they have the "medically needy" program for people in my situation, and it will cover meds IF the total is high and you meet your "share of cost"(in my case about 1000 per month). Last year they pushed everyone on the medically needy program to medicare part D, and tho I'm still enrolled in the medically needy program, medicare pt D covers my meds (I pay 240.00 per month co pay).

Because of the "doughnut hole", in january last year my co pay was approx.$3000.00 (Thanks to fuzeon!) Medically needy "kicked in" for that month. However this year, medically needy says "if you have Part D" we're not paying anything.

It seems they would have let us know we'd be smacked with such a huge co-pay before hand.

Is anyone else dealing with this? I can't pick up my meds (can't afford to!) and when I call the medically needy "helpline" they basically say "tough luck". They won't transfer me to a superviser even!

Any knowledge of this situation would be much appreciated!

[Guest guest]

The medically needy program in Florida is actually medicaid. Here there are strict income guidelines and if you're over the limit to qualify for medicaid...by any amount...they put you in medically needy (I'm over by $60.00 per month). Medically needy will kick in only if your monthly total reaches your "share of cost". With medicare paying 80% of dr bills and hosptial...it's rare to never that my share of cost has been met ($1080.00 in one month).

Last year my share of cost did get met in Jan and Feb with the "doughnut hole" and medically needy kicked in and basically covered the doughnut hole. The rest of the year, I had to pay the Pt D catastrophic 5% each month which amounted to about $230.00 out of pocket.

This year, medically needy has changed it's guidelines to: medically needy doesn't pay for any medication...no matter what. That's why the huge copay won't be covered this time.

And ADAP, at least where I'm at in Florida (panhandle) is out of money... ADAP's policy anyway has been to reject anyone with medicare pt D (here...I understand it might not be that way everywhere).

A nice memeber said I should check into AWAP...but no one around here knows what or how to find that program and I can't find anything online about it either. If anyone has any info or contacts to this program it would really help. Thanks...it's nice (but unfortunate) to know I'm not the only one facing this.

Start the year off right. Easy ways to stay in shape in the new year.

[Guest guest]

The medically needy program in Florida is actually medicaid. Here there are strict income guidelines and if you're over the limit to qualify for medicaid...by any amount...they put you in medically needy (I'm over by $60.00 per month). Medically needy will kick in only if your monthly total reaches your "share of cost". With medicare paying 80% of dr bills and hosptial...it's rare to never that my share of cost has been met ($1080.00 in one month).

Last year my share of cost did get met in Jan and Feb with the "doughnut hole" and medically needy kicked in and basically covered the doughnut hole. The rest of the year, I had to pay the Pt D catastrophic 5% each month which amounted to about $230.00 out of pocket.

This year, medically needy has changed it's guidelines to: medically needy doesn't pay for any medication...no matter what. That's why the huge copay won't be covered this time.

And ADAP, at least where I'm at in Florida (panhandle) is out of money... ADAP's policy anyway has been to reject anyone with medicare pt D (here...I understand it might not be that way everywhere).

A nice memeber said I should check into AWAP...but no one around here knows what or how to find that program and I can't find anything online about it either. If anyone has any info or contacts to this program it would really help. Thanks...it's nice (but unfortunate) to know I'm not the only one facing this.

Start the year off right. Easy ways to stay in shape in the new year.