sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
I'm finally doing a little better after a long winter of illnesses from being off IVIG. My antibiotics can finally do their job and I'm seeing much needed progress.
Now I learned that I'll be losing my insurance in September.
I'm afraid that I'll lose my IVIG again and I'll relapse back to being nearly bedridden. I don't know what to do.
I am very sick and have to live on a small amount of SSD so resources are limited. I currently have regular Medicare as secondary ins but it doesn't seem to pay for much (I'm losing my Primary Cigna).
Not sure about how to get an advantage plan or if one would cover my IVIG and meds and MD specialists. How do I find this stuff out? What should I do? I have such little time and energy.
I would appreciate any ideas. Thank you!
I feel like I can't think because my family is going through something extremely traumatic right now so this is just one more burden that I cannot carry. I feel like I can't make it... but I have to get through this somehow. So please please help if you can.
Thanks
Posts: 5237 | From here | Registered: Nov 2007
| IP: Logged |
www.goodrx.com :you input your zipcode and search for the Rx. It gives you discounted prices at all pharmacies in your area.
Just click on the "coupon" button and print out the paperwork that you take to the pharmacy to get that price. You have to sign up for an account for free.
I hope and pray that you find the answer! God is good!
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96239 | From Texas | Registered: Feb 2001
| IP: Logged |
Dekrator48
Frequent Contributor (5K+ posts)
Member # 18239
posted
I cannot help with how to find out all of that info, but I can pray for you and your family, that this all works out for the good...so that's what I'll do.
Hugs to you sammy!
-------------------- The fibromyalgia I've had for 32 years was an undiagnosed Lyme symptom.
"For I know the plans I have for you", declares the Lord, "plans to prosper you and not to harm you, plans to give you hope and a future". -Jeremiah 29:11 Posts: 6076 | From Pennsylvania, USA | Registered: Nov 2008
| IP: Logged |
poppy
Frequent Contributor (1K+ posts)
Member # 5355
posted
This is a complicated situation and it seems to me that you need help from some kind of health insurance advocate who knows the ropes. Not sure how you find such a person, hopefully one that will work pro bono. In some states there will be consumer helper type people hired to do this work as part of Obamacare.
The new insurance exchanges should be firing up, and low income people get subsidized. But you already have Medicare, which if I recall correctly does not pay for home visit IVs. Or has this changed?
Here is an article that discusses Medicare vs. Medicare Advantage, and medigap.
"Intravenous Immune Globulin (IVIG) provided in the home: Medicare helps pay for IVIG for people with a diagnosis of primary immune deficiency disease. A doctor must decide that it's medically appropriate for the IVIG to be given in the patient's home. Part B covers the IVIG itself, but Part B doesn't pay for other items and services related to the patient getting the IVIG in his or her home."
So, I am assuming that the usual co-pays apply, which is what you want someone else to cover, along with the service/items that aren't covered.
Don't understand why part B pays, rather than part D. Also don't know what medicare coverage you have, which parts, and why medicare is secondary for you, if you are getting it because of social security disability.
[ 07-25-2013, 06:45 PM: Message edited by: poppy ]
Posts: 2888 | From USA | Registered: Mar 2004
| IP: Logged |
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96239 | From Texas | Registered: Feb 2001
| IP: Logged |
sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
Thank you, I could use more advice from anyone with experience please!
Anyone have a Medicare Advantage Plan? Are they better than regular Medicare? Found out I'm too young for any Medigap policies in my area.
poppy, to answer your questions I have parts A, B, and D. IVIG is usually covered under major medical because it is approx $10,000 per dose per month. Not sure why they don't cover home health for it yet as that would be cheaper for them than a hospital or infusion suite, less risk of infection for me with my immune deficiency.
Medicare is secondary because the Primary ins that I'm losing is through a large employer. Rules...
So as you can see, my biggest most expensive need is IVIG. I'm not sure if I should try switching to an advantage plan or stay with regular Medicare. Not sure what will cover me the best.
Then maybe I could be able to pick up a better cheap private plan to go with it in Oct when the Obama rules come into effect?
Posts: 5237 | From here | Registered: Nov 2007
| IP: Logged |
lax mom
Frequent Contributor (1K+ posts)
Member # 38743
posted
sammy: I think you will find that Medicare covers more than you think. Especially since there is the Medicare IVIG Access Act.
I only have Medicare Advantage (Anthem Preferred Select PPO). Whatever you do, do not choose a PFFS plan nor an HMO plan. With a PFFS plan you will be stuck with massive out of pocket costs. With an HMO, your care is more limited.
I applied for Extra Help for Prescriptions and pay a very small copay.
IMO private plans have much more room to deny, deny, deny in order to make a profit.
Click on your state to find a Ship counselor to guide you to the correct Advantage plan in your state.
I used a Ship counselor, and it was very helpful.
You will be given a number to call. You may have to wait for them to call you back.
Ship stands for State Health Insurance Professional. (Not sure the p is for professional. The rest is correct)
Posts: 1358 | From Midwest | Registered: Apr 2009
| IP: Logged |
sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
lax mom, what is a PFFS plan that I am supposed to avoid? I am new to this, sorry!
Thank you all so much for your help. It really means the world to me.
I feel better knowing that some of these medicare advantage plans are good. So are they better than sticking with original Medicare and getting a part D plan?
Posts: 5237 | From here | Registered: Nov 2007
| IP: Logged |
lax mom
Frequent Contributor (1K+ posts)
Member # 38743
posted
Private Fee for Service (PFFS as opposed to say PPO). You can get stuck with massive out of pocket expenses.
I love my plan. I know that sounds weird, it's Medicare afterall. There's a reason seniors don't want any changes whenever there's an election.
I prefer it over Original Medicare because I would never have the $ to pay 20% of everything, and I'm too young for a decently priced Supplemental plan.
I pay a copay for Dr visits and even when I had surgery, I just paid $150 copay and that's it.
I even get a free gym membership through Silver Sneakers (not that I'm well enough to use it).
lax mom
Frequent Contributor (1K+ posts)
Member # 38743
posted
Regardless of which type plan you choose, make sure you apply for Extra Help with prescriptions. That way you will only have a small copay on RX's...unless you are wealthy, then it won't apply.
MADDOG
Frequent Contributor (1K+ posts)
Member # 18
posted
Well,Medicare should be the primary ins when you are on SSD.In my state ohio if you have less than 600 a month income, medicaid will pick up the 20 percent medicare does not pay .
If you make more than 600 a month you have to pay the diference to medicaid then they pay what medicare does not pay.
So if you get lets say 1000 a month then you have to pay 400 to medicaid and they will then pay what medicare doesent pay,and that is EACH MONTH.
If you pay your 400 bucks on the 20th of the month and the month has 28 days you get 8 days medicaid for 400 bucks.
Obama care would raise that to 133 percent of poverty levil so you would have to only pay medicaid the bucks if you made over 1400 bucks a month. BUT THE OHIO REPUBLICAN SENATORS TURNED DOWN THE Obama care bucks.
MURDERERS!!!!
MADDOG
Posts: 4083 | From Ohio | Registered: Oct 2000
| IP: Logged |
sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
I pulled up the plans on the Medicare website yesterday and it looks like for my county I'm only eligible for a couple Humana and Anthem advantage plans. Not much choice!
The Humana gave me info about med coverage but not the Anthem plans, how do I find out more info?
Posts: 5237 | From here | Registered: Nov 2007
| IP: Logged |
sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
MADDOG, I completely understand your frustration!!!
I had Medicaid for a year but recently the county decided that I didn't qualify any longer?!? I don't understand this because I haven't had any financial changes.
I've been too sick and busy with doctor visits and major family crisis to fight with the county to try to get my Medicaid back.
Plus, I don't know how I lost it so I don't know how to get it back...
I no longer have an individual caseworker either, they moved me to the "caseworker pool" which is apparently a voicemail system that doesn't get answered routinely!
But I need the secondary ins coverage so I have to figure the system out eventually. Somehow. After I get my Medicare primary coverage straightened out.
Now I'm freaking out a the enormity of the task ahead of me. So much to do in so little time! And I don't know what I'm doing!
Posts: 5237 | From here | Registered: Nov 2007
| IP: Logged |
lax mom
Frequent Contributor (1K+ posts)
Member # 38743
posted
sammy: is it possible that you lost Medicaid when you got the private insurance plan?
posted
Sammy, yes, like Rivendell said there are people in every state that take a list of your meds and treatments and match you with the plan that pays the best, according to your treatment plan. one of the agencies here is senior solutions, but the ins. people help people match a plan that meet their needs even if they are not seniors, but young disabled, etc. good luck
Posts: 211 | From In my house | Registered: May 2007
| IP: Logged |
Sammi
Frequent Contributor (1K+ posts)
Member # 110
posted
sammy, I am sorry you are dealing with this.
I would try to pursue Medicaid again. You need to know why you were denied. Maybe it was a mistake.
Is there anyway you can go back on this insurance you were on prior to the recent one?
I am sure this is a huge burden knowing you need your infusions. I am praying you get this sorted out to your benefit very soon.
Posts: 4682 | Registered: Oct 2000
| IP: Logged |
The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:
The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/
UBBFriend: Email this page to someone!
Printer-friendly view of this topic