I'm stressing over the medicare drug plan!

Discussion in 'Fibromyalgia Main Forum' started by Rose_Red, Sep 8, 2005.

  1. Rose_Red

    Rose_Red New Member

    I should know better than to think anything the government does would be simple to understand - including their websites. this whole Medicare drug thing has my brain running in circles.

    According to what I read if I just sign up for the drup program I have to pay $3600 out of pocket before they cover anything. OK - I'll hit that in 3 months.

    According to the Medicare plans that I'm eligible for the cheapest one is still $69 on top of the $78 for Part B and it won't cover 100% until you've reached about $750 a month in ou-of-pocket expenses. Hey - that's great except for the fact that I'm raising my daughter on less than that!

    Not to mention that there are no 'in-plan' doctors anywhere near where I live.

    So now I'm stuck in this prescription plan because I also get Medicaid thru SSI. (I was a bartender & a hairdresser - my SSD isn't as high as it could've been) and apparently automatically enrolled in it but you have to enroll through a network pharmacy?

    HUH? I feel like a complete idiot. None of this makes any sense. I really don't think this is fibro-fog. I just don't get it.
  2. NyroFan

    NyroFan New Member

    I have a plan called PAAD (Prescription Assistance for the Aged and Disabled). I pay $5 for every prescription.
    Then I get enrolled in the new Medicare plan. The pharmacy has to double bill. Part gets paid by PAAD, part by the Medicare Drug Plan. So--he has to double bill.
    Good part: I max out the Medicare plan in three months and then just stay on PAAD. My meds come to about $1000/mo.
    (Seizure meds, BP, not all fibro or CFS related).
    My experience only.
  3. Rose_Red

    Rose_Red New Member

    Hi Nryofan !

    My grandmother had PAAD in NJ but they don't offer it in Florida. If they did I would've tried part-time already.

    Being trapped in the system sux! thanks tho
  4. pam_d

    pam_d New Member

    ...and it seems to be something available only in New Jersey...???

    I was looking for information for my elderly parents, but they're in NY state. Is there anything like this for the other 49 states??

    Thanks, if anyone has any info!

  5. lea

    lea Member

    Does your double coverage change what you would pay if you only had Paad alone?
    Why does the Pharmacy double bill?
    thank you
  6. proteinlady

    proteinlady New Member

    My mother lives in NY state and she has EPiC.It sounds similar to PADD. Hope this helps.
  7. GinnyB

    GinnyB New Member


    In Pennsylvania you pay $6 for a generic prescription, $8 for a brandname on their PACE plan. I think you use Medicare until you get into paying the $3600 out of pocket, then PACE kicks in. You have to be 65 or older with an income lower than about $14,500 if single, $19,500 for a married couple. The PACENET plan is for age 65 or older, income between (approximately) $19,500 and $30,000. On PACENET you pay $40 a month plus $8 for a generic drug and $15 for a brandname. You don't have to go on any of the Medicare plans. Call your local Office of the Aging for complete information.

  8. JLH

    JLH New Member

    I don't know much about the Medicare Drug Plan.

    I am retired and have prescription coverage through my former employer that I pay for monthly--it's included in my medical insurance plan that I pay $300/month for.

    I am on Medicare due to being on SSDI - it is my primary coverage; and my employer's plan is my secondary.

    I pay $10 for each generic drug.
    $15 for each brand name drug IF it's on their "formulary".
    $30 for each drug not on their approved formulary.

    So ... I think what I have is better than Medicare, isn't it????????

    I take 23 things/day. I am still paying out A LOT EACH MONTH in my copays for my meds.

    Does anybody figure that I will need the Medicare drug coverage????

    If so, please explain to me how and why - I can't figure the Medicare plan out.


  9. puppyfreak

    puppyfreak New Member

    I'm stressing about this, too! I just got on SSDI and since it was retroactive almost 4 years, I was automatically enrolled in Medicare, too. [I'm 53]
    I've joined AARP [$12.50/year] so I'll get info from them but I also called Medicare [the number on your card] and the woman I talked to is sending me info on the different plans available here [WA State] and which ones Costco takes [where I go now].
    There's also the Free Medicine Foundation [.com]. You can go online and request an application. They charge $5 per med but I'm not sure if they do narcotics.
    Anyway - it's a REAL headache! Especially after being on Medicaid where all my meds were paid for. I now have the SpendDown, too - what a joke!

  10. Leenerbups

    Leenerbups New Member

    I don't understand what is going on. Can someone explain it to me?
  11. fibrotina

    fibrotina New Member

    you should check out your state to see if you qualify for this too.
    I'm not exactly sure of the name of the form I filled out, but after reading everything over and over again on the medicare website I called my local social services to ask some questions. I actually was able to talk to someone who told me the truth. If you are on medicare and have to pay the premiums every month you could qualify for help paying the premiums. I don't remember how much money you can make in order to qualify, but I am sure each state is different anyway. So anyway, I qualify for the state to pay my premiums and so come January I will be on the medicare coverage for prescriptions and yes the letter stated that my cost for ANY prescription will be $5.

    Don't be embarrassed to go to your local social services and ask them about help for paying your medicare premium.
    I held off for 2 years until I just couldn't take it any longer.

    Hope this helps someone.

  12. NyroFan

    NyroFan New Member

    Lea & Others:
    When after the summer I have to use the Medicare Drug Plan whether I want it or not---they will put me on the PAAD Medicare Drug Plan. It says that on the plastic card.

    I still only pay my five dollars, but evidently PAAD and Medicare split the bill to pay the pharmacist.

    No matter what: my co-pay is $5 (generic and if name brand the doc writes brand name medically needed on the script).

    I hope I answered your question. And yes, the program is run (in NJ) by the Division of the Aged or whatever they call it. We also get a lifeline check of $225 twice a year to help with energy costs.

    It's the one thing this state knows how to do right.

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