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Medicare Plans

easyrider

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Does anyone know how to use Medicare Part D ? We are providing elder care for a woman who is now in the "donut hole". Her prescriptions are running about $2200 per month. Her plan D is through Regence. I have worked with a person with AARP coverage that seemed to cover all of the prescriptions.

This woman is impoverished and should qualify for Medicaid. Can Medicaid cover her through the donut hole. Who should I call ?

Thanks
Bill
 

camachinist

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My rememberence from when Medicare slammed my mom to Part D, the Part D provider picked up the entire med cost as a result of her being on MediCal (California's iteration of MedicAid). This was done completely without my knowledge. I remember going to pick up a prescription for some anti-psychotics which cost about 1K per month and didn't have to pay anything. I kept telling the druggist they were wrong, but they weren't. Part D and MediCal meant no co-pay or deductible, in her case anyway.

The reason I remember this is because she had complete health coverage through Medicare and PERScare (Cali employees health care) and was paying a small co-pay for meds prior to the slam.

The problem? PERScare cancelled her due to another provider paying benefits. I had to get a lawyer involved to clean up the mess and deal with Medicare to opt her out of part D due to her being incompetent. MediCal then continued to deduct medication co-pays from her share of cost after it was all fixed. She had retirement benefits (income) so it was a share of cost situation and not a total benefit situation.

IMO, get the person qualified for MediCaid and then talk with the part D provider. There might be some loose ends to tie up but my remembrance was it was seamless. Medicaid will come in handy when the big bills hit, especially skilled nursing. Good luck.
 

rapmarks

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I take care of two aunts, and one has insurance with the donut hole. she is running close to 1000 a month now, plus 5000 plus for assisted living As she has Alzheimer's , i can't get any answers as to why she has that kind of policy. I have sent POA to the insurance company but they keep claiming they didn't get it and won't answer any questions. i would love to find an alternative (state of arizona)
 

easyrider

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Thanks Cam

This woman does qualify for medicade but had her estate put into a trust. She has 2 years until she is past the 5 year look back by medicade. Her trust would have to pay back all medical expence paid by medicade. So her trust might as well pay it now.imo

I think maybe she could use a better medicare plan d for her perscription drugs which cost over 3k per month or maybe use generic drugs.

Im now looking for a way to close the donut hole either with a new plan or change of medication. I am some what familar with the AARP plan and the Regence plan as these are the comon plans that people use in my region.

Has any one used Humana ? I see it advertised.
 

easyrider

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I take care of two aunts, and one has insurance with the donut hole. she is running close to 1000 a month now, plus 5000 plus for assisted living As she has Alzheimer's , i can't get any answers as to why she has that kind of policy. I have sent POA to the insurance company but they keep claiming they didn't get it and won't answer any questions. i would love to find an alternative (state of arizona)

Some times the insurance company, in my case it was Trans America for long term care and Regence or AARP Medicare plans, has a few addresses and faxes. It took a few tries for us to be a designated agent with permission to look at the policies and pay bills. The POA may have gone to the wrong number or fax. Call them and find out exactly where it is suppose to go. It really is time consuming.

Medicare has been tough as well. One person that we help had a broken back and was denied coverage at the nursing home because she was not admitted to the hospital for a three day stay with a procedure but instead admitted for observation for three days. This cost her family over 20k.
 

Hophop4

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Yes, I have a Medicare Plan D with Humana only. My Supplement Medicare Policy is with Bankers Life. Humana also has Advantage Plans that include Prescriptions but Supplements do not include Prescriptions therefore I had to purchase a separate policy thru Humana. My premium for 2012 will be $39.90 which is $5 cheaper than I am paying this year.

I go into the donut hole every January since the chemo prescription drug I am on actually cost over $7K. They charged me around $2775 for January and then 5% in February for $365. I get in and out real fast. I think while in the donut hole they charge 50% instead of the 100% but I got out so fast I only paid the 5%. Not sure how that happened. I am charged 5% for all other prescriptions I need until the end of the year then in January it starts all over again. Last week my pharmacy called me when she filled my prescription and said she will not do it any more after December. She is dropping their contract with Humana the end of December. She claims she loses too much money filling it thru Humana. So where does that leave me. So far I found out the regular pharmacies are not allowed to dispense this drug. I can only get it thru an onocolgy pharmacy.
 
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