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Medication & Medicare
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Medication & Medicare

I am not on medicare yet since I still work. I have a part A card but have not applied for part B or part C etc, since I use my work health insurance. Later this year I plan to retire. I could get laid off before then so I am trying to get things in order. For those on medicare or not do you have any advice should treatment become necessary in the future? Thanks  
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253566_tn?1219683299
I cant assist with medicare but maybe you should try to get on disability first. For me, and I dont know if each state is different (I am in Pennsylvania), medicaid has been nearly perfect.

I think that if you apply for disability they put you on medicaid immediately as the waiting list for a hearing is very long.

Wish I could be of more help with medicare but best of luck with your health.
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Avatar_m_tn
Thanks, I have not started treatment and I may not if test results are still ok. My plan was work until later this year and find a carrier between now and then. Since it is pre-existing that may be difficult. I still work so I doubt Medicaid is an option but that is good to know. Can I work and be on Medicaid? My concern is what happens down the road. For instance if disability is not an option what plans are best? I thought perhaps someone here may have a carrier that they recommend. This is all very new to me and realize I may not get all questions answered. So any suggestions are appreciated.
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Avatar_f_tn
Medicare part A is for hospitalization (100% after deductible is met)  No drug coverage.  Medicare part B pays for out patient tests and doctors visits (80%)  No drug coverage.  Medicare part C which I am not very familiar with but do know it's an advantage plan where the insured has additional benefits besides what part A & B will pay. It also includes paying a premium and may include drug coverage with a limitation.  Medicare Part D prescription coverage does pay for drugs and you will be charged a monthly premium which is taken out of your social security check.  Part D prescription coverage has a cap which is usually around $3000 depending on the provider.  Antiviral treatment drugs are very expensive and $3000 would barely skim the surface.
You must be 65 or older to qualify for Medicare.  If you retire are not disabled you do not qualify for Medicaid.

There are prescription assistance programs that will help with the drug costs if you decide to treat.

Good Luck
Diamond_Lil
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Avatar_m_tn
My phone went dead during a call to Social Security. Its fixed now so I made the call. I was told part C or Advantage is a supplement to cover the 20% that part B does not cover. At this point I would not qualify for Medicaid. I believe the rules are it has to be documented for 6 months along with treatments, tests, drugs etc. I guess one way would be to start treatment while working. Then when I am unable to work, which no doubt would happen I may be able to go on disability and apply for Medicaid. SS said I have up to a year after legal retirement age (66 for me) to file for Disability. I thought I would post this just in case it would benefit someone.

I did not know about the appx cap on part D. At some point if I choose to treat it is good to know this. I've read the cost can approach 200k. Since I'm Geno Type 2 it could be less. I would never spend that amount. If I decided to treat it will have to be a trial or get assistance. Other than that I'll try do the right things for my health and if it gets me then it does. I'm not in the greatest health anyway. I'd rather enjoy life as it is in my last years than be miserable in treatment and spend all of my retirement. Only time will tell, perhaps I may change my thinking but I doubt it. Thanks for your help.
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87972_tn?1322664839
An important note regarding the Medicare part D cap; this is also known as the ‘donut hole’. Per my plan D this year, when my drug costs reach $2700, I then pay 100% of costs until my yearly out of pocket drug costs reach $4,350; at which point catastrophic coverage begins. Then, my costs are $2.40 for generic, and $6.00 for all other drugs. This whole process resets on January 1 of the following year.

I started Medicare through SSDI and opted for a Part A and B supplemental plan that costs more up front, but doesn’t have copays or coinsurance, etc. I pay roughly $200.00/month for premiums, but nothing per visit for office visits, hospital stay, labs, imaging, etc. Virtually *all* costs are included in the premiums; well worth it if you’re planning on interferon Tx.

I find Medicare to be an excellent program; really no complaints, other than the Part D coverage gap. Here is a webpage for patient assistance programs, if the need ever arises; I use these every year when I hit the Part D wall :o). This site isn’t Hep C specific; it covers patient assistance for over 4500 different drugs:

http://www.needymeds.org/

Best of luck to you—

Bill
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Avatar_f_tn
I had forgotten about the donut hole Bill.  Interferon and Ribavirin would be considered specialty drugs and depending on the provider once you reach catastrophic coverage you will pay around 5% of the cost of a specialty drug and will stay at that payment stage until the end of the calender year. I can't recall exactly what the monthly cost of treatment drugs are but I know it's very expensive and that's without adding Neupogen or Epogen to the mix.
It could be very costly for those on a fixed income and if seniors must rely on Medicare Part D for drug coverage looking into pharmaceutical assistance programs would be the best route to go.

I agree with you about Medicare being an excellent program and despite our governments huge appetite for money, ie: taxation, it does give back to the seniors when it comes to health coverage.  Most older folks have worked all their lives and are certainly entitled to it.

Diamond_Lil



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Avatar_m_tn
Thanks for the link, just in case. This is very good to hear. If I had to pay roughly 5k to cover the drugs that would be great. I'm curious though what insurance company are you covered through? Is it the same for part A,B&D? I read some are not so great so I hope you don't mind me asking. Someone said blue cross/bs was good. Just trying to prepare and get opinions of companys. $200 sounds real fair considering what you get. Thanks again
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Avatar_m_tn
Curious here, if you don't mind if i ask but what is the cost per month for medicare? And does the 200.00 also cover your part D and do you have to pay any deductables for medicare part A, B, or D or are they covered by your supplemental plan?

Thanks
Zach
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87972_tn?1322664839
My supplemental policy is with Health Net; I think it’s their Health Net Orange plan.

I pay $212.00/month for A&B supplemental alone; I think the part D is around $90.00 or so? It’s an auto deduct from my SSDI, so I don’t remember the precise amount. And then another $90.00 or so is also deducted for the cost of primary A&B; so I guess I’m paying nearly 400.00/month for insurance. Still, all told, it’s really good coverage, and I don’t have copays or deductibles to meet.

Cash price for interferon/riba alone runs nearly USD$ 2500/month; and Procrit and Neupogen, if needed can make the interferon seem very reasonable :o). Diamond_Lil is right; this stuff is pricey…

I don’t recall all the details now, but I used Commitment to Care; Schering-Plough’s patient assistance for HCV meds the last time I treated. They sent the interferon/ribavirin free of charge, and didn’t question when the doctor ordered treatment extension for an additional 48 weeks. I’d definitely give them a call when the time comes.

If I can help answer questions, be sure to ask; you can send messages in here as well, by clicking on a profile picture; an option for messages will show up when you click.

Good luck—

Bill
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87972_tn?1322664839
Oops, sorry Zach- I didn’t see you’d posted a question until afterwards. I hope that answers your question too; if not, be sure to drop me a note, ok? Great to see you around—

Bill
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