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Question of the Week
July 9, 2009 • Volume 9, Issue 27
Will health reform help these people?
My husband is 62 years old and has been on Social Security Disability for seven years due to heart disease, arthritis and diabetes. He takes 13 prescription drugs daily, plus aspirin to manage his health, including two injectable insulins. I worked in an office and covered us with health insurance for years. When Medicare Part D came into effect I was told by BlueCross/BlueShield that since he was eligible for Medicare Part D, they would no longer pay for his prescriptions. I subsequently lost that job and the coverage. We are not "insurable" on a private policy.
By the first week of March each year, he is in the "donut hole" and his medications cost between $800 and $1,000 per month until approximately the middle of June, when he has spent enough to move to the catastrophic category. We have used credit cards to do this and now the credit card companies are reducing our available credit and/or closing our credit card accounts because of the economy. Our house is now worth less than we owe on it, so there is no equity to tap to consolidate debt. We have not yet paid off last year's donut hole expense and are now adding $4,000 to it.
My husband's $21,000/year social security disability puts him over the financial limitations to be eligible for additional help through the State of Georgia or any of the prescription help programs out there, including the manufacturers of the insulin he needs to keep him alive.
How are we supposed to pay for this? I can't make enough money to keep my husband alive and we do not qualify for any help.
I am terrified. I don't know how to do this.
I applied for Partnership for Prescription Assistance; I applied online for help through the State of Georgia; I talked to our doctor; I have searched the internet for help. We don't qualify. —Kimberly Z, Georgia
I am a 57-year-old male who was diagnosed with an acoustic neuroma. I am disabled and it took me two years or more to get disability. I have been put on all kinds of medication and I can not keep up with my copays. Since I was diagnosed with this tumor, I have seen two ear, nose, and throat specialists and both of them have said that they could not do anything about it because of its location. I have been given medicines to deal with the effects it causes me. I have other health issues also for which they prescribe medicine. High blood pressure, high cholesterol, and nerve problems caused by the tumor. I cannot afford all the copays I have to pay. I have had MRI's done and I still have to get another and each copay on that alone is 70 dollars, and of course I have specialists I see at 40 dollar copays and my prescription drug copays.
I really need help here. I have a Humana Medicare plan but I get nowhere with them either. So what should I do? I don't know where to go and I am tired of the runaround. —Clarence B, Florida, Age 57
We need comprehensive health reform now. Please write your senators and representative and tell them to Remember People with Medicare when they pass health reform.
“We must remember that there are substantial gaps in Medicare. Savings from Medicare should also be dedicated to closing those gaps, especially for people on limited incomes and people with disabilities, by improving Medicare programs that help those with low incomes pay their medical and prescription drug bills and ending the two-year wait for Medicare for people with disabilities.” (Statement by Medicare Rights Center President Joseph Baker on the White House Agreement on Hospital Savings, July 2009)
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Medicare Part D Appeals Help for Advocates Is Here!
Medicare Rights Center’s new Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.
Register for a FREE copy of this great resource.
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Medicare Part D Monitoring Project
would like to hear about your experience, or that of someone you know, enrolled in a private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed. Medicare Rights Center
Submit your story at http://www.medicarerights.org/issues-actions/tell-your-story.php.
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The Louder Our Voice, the Stronger Our Message
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Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.
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