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pnbplus1
Family
Member since 5/09 5751 total posts
Name:
Mommy
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Medicare Donut Hole HELP
Just wondering if anyone knows how I can best help my dad approach this situation.
My dad has medicare and gets his coverage through a medicare advantage plan (Part C). He went to fill a prescription last week only to find out that he's already in the donut hole. He is currently battling cancer and found out that one of the meds prescribed for nauseau (its a "pack" of 3 pills) costs the insurance $1100 And the worst part is that my dad was instructed to only take the 1st of those 3 pills, the other 2 were discarded. Each pill has a diff dosage of a combo of 2 meds. He filled this prescription twice. He's really upset that the doctor prescribed something so insanely expensive with no warning but really just more upset that he doesn't know how he is going to afford his meds (bp meds and Spiriva) going forward. My parents are on a limited income and were doing fine until my dad's diagnosis 11 months ago. He received 7 round of chemo, 28 days of radiation ($50 copay each), had a major surgery and hospital stay, and now the cancer is back and he's on round 4 of chemo and is all goes well, faces another surgery. The copays have resulted in $1000's in medical expenses which my dad is paying slowly. And LIJ does not offer debt forgiveness or reductions like Wintrop and other hospitals do.
Wondering if anyone knows of any options. I know the drug companies have programs for people who can't afford meds but those always excluded people with medicare. I just really want to try to help my dad bc he's fighting his hardest to survive and now this happens. He needs his bp and breathing meds
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Posted 4/8/15 11:10 AM  |
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SusiBee
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Member since 3/09 8268 total posts
Name:
S
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Re: Medicare Donut Hole HELP
EPIC
Look into this. It is the Elderly Pharmaceutical Insurance Coverage program that is available in NYS.
My dad has this.
Also, ask the oncologist for samples of the anti-nausea drugs. Explain the situation.
And this is an application for help paying for Spiriva. It has to be filled out by his doctor and faxed to the manufacturer.
Message edited 4/8/2015 1:01:43 PM.
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| Posted 4/8/15 1:01 PM |
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LIRascal
drama. daily.
Member since 3/11 7287 total posts
Name:
Michelle
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Medicare Donut Hole HELP
I was going to recommend EPIC, too. Is it too late for an add-on for Part D?
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| Posted 4/8/15 4:03 PM |
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busymomonli
Resident Insomniac
Member since 4/13 2053 total posts
Name:
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Medicare Donut Hole HELP
My mom is in the same hole. She had about 10 melanoma's removed from her face and keeps getting more. There is a medication they want to put her on to keep them at bay. But the cost is $1200 per month. Even with letters of medical necessity, they won't cover it. The doctor even wrote to the manufacturer and they won't give her any assistance.
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| Posted 4/8/15 4:08 PM |
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sunnyflies
LIF Adult
Member since 9/09 1757 total posts
Name:
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Medicare Donut Hole HELP
I had a wildly expensive anti - nausea pill pack when I had chemo too, but my insurance covered it, luckily. Its instructions said to take one pill a day for three days - on chemo day and the next two days. Why was he told to take only one?
Have you considered switching doctors and hospitals? I did that when my insurance wouldn't completely cover a certain surgeon's costs.
Does his plan have complete coverage for certain cancer hospitals? Mine does. I have to go to one of its "cancer centers of excellence" to have my treatments covered with no co-pays, but there are three in NYC, one of which has branches on Long Island - Memorial Sloan Kettering. You should call his insurance and ask, or call Sloan Kettering to ask them.
If I have learned anything since getting cancer, it is that it is a huge business. Hospitals are happy to get your business.
Good luck!
Message edited 4/9/2015 12:26:56 AM.
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| Posted 4/9/15 12:22 AM |
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Medicare Donut Hole HELP
Check out EPIC
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| Posted 4/9/15 8:31 AM |
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pnbplus1
Family
Member since 5/09 5751 total posts
Name:
Mommy
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Re: Medicare Donut Hole HELP
Posted by sunnyflies
I had a wildly expensive anti - nausea pill pack when I had chemo too, but my insurance covered it, luckily. Its instructions said to take one pill a day for three days - on chemo day and the next two days. Why was he told to take only one?
Have you considered switching doctors and hospitals? I did that when my insurance wouldn't completely cover a certain surgeon's costs.
Does his plan have complete coverage for certain cancer hospitals? Mine does. I have to go to one of its "cancer centers of excellence" to have my treatments covered with no co-pays, but there are three in NYC, one of which has branches on Long Island - Memorial Sloan Kettering. You should call his insurance and ask, or call Sloan Kettering to ask them.
If I have learned anything since getting cancer, it is that it is a huge business. Hospitals are happy to get your business.
Good luck!
Sounds just like the medicine my dad has taken, 3 pills. They told him not to take the other pills if he felt he didn't need them. And he's actually been feeling great so he didn't take them. His insurance covered it, his copay was like $4 but the problem is that after getting it twice plus his other prescriptions, he's already in the medicare donut hole.
Hope that you are doing well!!! Thanks! Oh, and I can definitely see how it's big business. I'll find out about the complete coverage.
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| Posted 4/9/15 4:46 PM |
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pnbplus1
Family
Member since 5/09 5751 total posts
Name:
Mommy
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Re: Medicare Donut Hole HELP
Thanks everyone for the replies. He has EPIC but this post reminded that I should call them to get more info. Tried calling today but wait times were 15 minutes and I had to run out. Will call tomorrow.
Being sick and dealing with insurance is the worst nowadays. My dad gets really upset that he paid into Medicare for decades and now in addition to $104 per month plus his premium for the Part C plan, he still has to pay so much money in co-pays and medicines. The donut hole really upsets him. I feel so bad bc he worked hard all his life, retired and then 5 years later, cancer and now all the expenses that come with it.
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| Posted 4/9/15 4:49 PM |
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MM2004
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Member since 5/05 1854 total posts
Name:
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Medicare Donut Hole HELP
Make sure that the pharmacy is sending his information to EPIC. We found out that her pharmacy wasn't sending the info and she was being charged the wrong amount when she picked up her meds.
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| Posted 4/9/15 7:53 PM |
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MM2004
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Member since 5/05 1854 total posts
Name:
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Medicare Donut Hole HELP
Make sure that the pharmacy is sending his information to EPIC. We found out that her pharmacy wasn't sending the info and she was being charged the wrong amount when she picked up her meds.
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| Posted 4/9/15 7:55 PM |
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