Ann-medicare does not pay for long term placement. If the person has a qualifying 3 day hosp stay MC will pay for the first 20 days a full rate in a SNF. Up to 90 days at a reduced rate as long as a skilled service such as PT is needed and progress is being made.
Right, but I'm sure I'll need to sign him up for additional coverage through BC/BS or the like......Some have suggested part E or J..........I'm so confused!
Guess I'm not confused any longer! Been on the phone all afternoon to try to figure this one out.......Seems that now that we have waited and waited for Medicare, it won't do a thing. Not with the costs of his medications anyway. So, the best situation seems to be to keep our private insurance (after COBRA and under my name) and pay the extra for Medicare. If not, he will be penalized for not signing of for Medicare during the enrollment period. So, instead of of saving money by being eligible, we will pay over $110 a month more!
Now he expects me to take him for a car ride.............
AnnMW 1157, I am becoming confused. You posted that you have been told that your husband needs immediate NH placement??? Are you going to place him??? if so and if you think he will be getting Medicaid then you will not need a supplement on him, Medicaid would be the supplement. He WILL be penalized for not taking Medicare part D ( the RX part of Medicare) if he does not enroll during his open enrollment also, Medicaid even requires that you have part D if you have Medicare. If you DO WANT a supplement to Medicare and do not plan to apply for Medicaid then he also will have a hard time getting the supplement if you do not get this for him within 6 months of getting Medicare part B.
Clear as mud I know, that is what the government does, makes things so hard to understand the people who need it most get lost in the maze of paper work.
I hope to place him, but I can't see how it can be done.....Still waiting to hear from the person who handles LTC in this area.
He will be eligible for Medicare on March 1st.......(he's 62). I received a letter that the deduction for both Medicare parts A and B will be deducted from his SSD check. I asked about part D and the least expensive for covering his medication will be an addtional $800/month (approx). That's what they quoted for Vermont anyway. I double checked with our private insurance company and it was cheaper to keep it rather than pay for part D.
He isn't in the hospital, so it is doubtful his placement will be until there is an opening. I still have no idea how he will qualify for Medicaid at this point. We seem to be stuck in this donut hole.
I've been told that he receives too much money to qualify for any programs with the possible exception of Choices for Care. But again, we can't handle nursing home care AND a mortgage. I'm still waiting to hear from the one person who is in charge.I'm sure the office is tired of hearing from me by now..........
I don't know where to turn, Jane. I'm grouchy and tired. I have to wonder what would happen if I was not able to care for him. His family certainly wouldn't step in to help.
Thanks for letting me vent.........Just another one of those lonely days..
Ann, I'm puzzled by your statement that Part D (the Medicare portion that "covers" medications) would cost $800 per month. I pay $58.20 per month and my wife pays $41.10. It depends upon what plan you pick, put I have not heard of any costing that much. I suggest you check with AARP. Our insurance is through a company called "Advantra Rx" in Carol Stream, IL. We got it through a local agent.
That's what I thought, too, Marsh..........The woman asked for the list of medications that my husband was taking and then matched them up to available plans in Vermont. I told her it was an outrageous number and she suggested keeping our private insurance too.........but not canceling the Medicare Coverage.
Silly question, but I'm not eligible for anything at age 53, right????? Wishful thinking......
Gosh, I sure hope that she AND I am wrong about this!
Ann, there is definitely something wrong with that $800 figure. I just searched for "Vermont medicare D", and it brought up all the plans for Vermont - all much less than $100 per month. You are getting some bad info. Please check further.
I'm really wondering here..........She plugged in each drug, but now I'm wondering if she gave me the actual cost of the medications, but not the plan? Does that make any sense? Maybe she's new, or it's Friday, or even a full moon?
The sad part is that my husband (a pharmacist) had to learn all of this before he was diagnosed. And I thought it was the disease that confused him........hmmmmm
Ann, the only reason for checking on all the medications your husband is on is to be sure the plan you pick has them on its formulary. Each plan has a different list of drugs that it prefers. That's why my wife and I have different plans. The figure you were given must have been for the total cost per month of the drugs your husband is on. The only time you would have to pay that much is in the "donut hole" of the plan. If the drugs are really costing that much you might discuss this with his doctor and see if any of them can be eliminated or switched to generic. I got my wife switched from Lipitor at several hundred dollars to Simvastatin at about $30 per month. The we decided that there was no need for this type of drug since it is designed to protect her from heart disease in the long-term, and with her stage of AD there is no "long-term".
Thank you, thank you! I am going to slow down and call about this tomorrow. Just talking to you all have made me see that this MUST be a mistake. If so, I received incorrected information from both Medicare and BC/BS. Now that you have put this into common sense wording.....I think that it has to be wrong!
I will let you know what happens. Anyone have any experience will MedCo?
I hope I have figured out what the problem is here........because of YOUR help here!
I do believe the woman gave me the average cost of prescriptions per month because of the gap. So, the first 3 months would be lower, but we hit the donut hole in month 4 and then it becomes catastrophic.....settles down again in month 9-10.
So, now I'm wondering if all of this even matters if he will be placed within that 3 month time frame and hopefully be eligible for Medicaid. Of course the other question would be whether or not to continue the medications, as mentioned by Marsh. Since the BAP study will end in 4 weeks, certainly that will be an option. It was even suggested that most be stopped 6 months ago, but since my DH wanted to continue with the study, we continued........
Thank you all for your help. I wouldn't have made it without you all......You know when you get to that point when NOTHING makes sense anymore? Well, yesterday was one of those days......and I thank you for getting me through it.
Guess it is Caregiver Burnout.....been doing many silly things.....like using my directional light and then going straight. Obviously my mind is on overload. I'm making so many little mistake that could have lead to a big one. I even have to remind myself of how to walk now...especially with stairs.......Have had several falls already....But, I do make sure my husband stays upright! lol
Again, thank you for being so patient with me......I can't believe that I used to be the "go-to" person. Now look at me! Yikes!
I don't know if this information will be of any help to you but my brother (he's 43) is disabled by arthritis and is on Medicare and Medicaid. Medicare is his primary insurance with medicaid being his secondary. He has Part D for his prescriptions and doesn't have to pay a monthly premium for part D and only small copays for any of his prescriptions. He takes injections of Enbrel which without insurance would cost over $1200 a month but with his part d and medicaid he only has to pay $3.50 for the drug. I know this is income related so I don't know how this would translate to your case.
deb112958 most people on Medicaid do get the Part D paid for by medicaid, Medicaid can pay a premium for the part D benefit with less expense than paying for the drugs without part D, that is why they require a Medicaid patient to have part D.
AnnMW1157----I'm 53 also, my husband on Medicare b/c he qualified for SSDI, but to answer your question about US, you are right, we are on our own re health care insurance. That is the #1 reason I'm still working, not to mention my 22 and 19 year olds are still on my policy. My husband's situation has totally opened my eyes to the deficiencies in our system, not to say I have any idea what the answers are, but the holes are numerous.
Ann, as Marsh says, PLEASE check into generics. And reconsider what your husband really needs. Forgive me, but you are NOT trying to keep him alive forever. He does NOT need lipitor, for instance. He needs generics that will keep him comfortable and managable. But there have been plenty of us on here who have cut back on heart meds, haven't replaced batteries in heart regulators, etc.
Not to belabor the issue....but my attorney is on a little vacation. I was wanting to know....John is being qualified for Medicaid. Right now, I carry his Part D coverage through AdvantraRx. I also pay a supplemental policy for him through Blue Cross/Blue Shield. When he IS finally qualified for Medicaid, am I still to be responsible for those payments? Will they be necessary to maintain at all? What about the costs of his medications (that are significant....one of the things I want to talk about in my next meeting). Do I still pay for those, out of pocket? I ask because.....well, I have NO MONEY after all this. And, the rest of my bill-paying life (somehow) ahead of me.
So far the info is......The insurance we carry has prescription coverage and considered credible coverage by Medicare, so I'm going to hold onto it for now. We will have until June 30th to sign up for another plan. Because so many things may change before June, and my husband will for sure go into the donut hole in 4 months, hopefully this will be the right decision. --This insurance will also pick up the payments not covered by Medicare. It may not make sense right now, but should we have to pay totally out of pocket, it will.
Thanks for your support.
Jen.....If John qualifies for Medicaid, I don't think that you will have to continue to make payments on another plan......Medicaid would be the plan....BUT---don't take my word for it!
I've also talked to the pharmacies in the area and it seems that with our prescription plans, the co-pays would be less for any drug, including generics. But, one that note, I'm going to ask every time anyway. We don't have a Walmart or anything of the like within 90 miles.
Walmart does have a mail order program for $10 - 90 day generics with free home delivery. The link for the mail order drugs that are available is at: http://i.walmartimages.com/i/if/hmp/fusion/HomeDelivery.pdf
Ann, I get all of the meds for my wife at Medco. I also have BC/BS. She takes Namenda, Aricept, and Folic Acid. I pay $130.00 for a three month supply. They have been very good at getting them to us. I have had no problems with them at all so far and have been using them for about a year or so.