I have been losing sleep, stressed to the MAX, had a few breakdown 'episodes' and have even pondered the thought of "Am I worth all this". I have medicare part A & B. My part B plan will cover my prograf with a 20% copay which ends up being roughly $220 a month. I wouldn't have to worry about the "donut hole" as it does not apply to part B coverage. I also pay extra and I have a Part D plan (prescription costs) Under my current D plan Prograf is a covered formulary drug with a copay of around $7.50 HOWEVER, they denied paying for my prograf due to the fact they could pass the buck to my part B. I just feel like I am on a sinking boat sometimes. A slowly sinking boat. My premiums for my coverages comes to $120 month. . .so now my out of pocket expenses are already at $340.00 I take a lot of other meds than just prograf! I am not sure what those copays will be this year, but hopefully most of my generics will be cheap. It's hard not to feel like my drug cost puts a hardship on Bryan and I. . . .I feel guilty sometimes. I get $889 from medicare subtract the $340 and I end up with only $548, it's just hard to feel like I contribute enough.
Life after transplant has many wonderful things that I get to do. . . unfortunately it also has some pretty stressful and unfair things too. I wish we had more money, I wish I didn't have to deal with insurance, but don't we all? I AM blessed so much to be so healthy and alive & to have the fight to call HUMANA and Medicare and give them a fight. I for one DO BELIEVE that changes in Medicare/Healthcare need to be addressed. Things like what I am dealing with is just a crack in the system. There is no "RULE" so HUMANA can or can't choose to cover it, and ME the patient who has the prescription coverage pays the price for it.
I have even looked into the drug companies "extra help" plans to make sure the patient gets the medication they need. . . .however, patients on Medicare or Medicaid don't qualify for the help. I just wonder sometimes if I am worth all this. Bryan tells me every day I am. I guess to him I am worth it and he is who matters.
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2 comments:
I was told by Part D and Part B that if a drug is covered under Part B,Part D cannot pay for it. Just like medicaid cant pay for something Part B or D will cover. Sorry you have to deal with insurance headaches!!
Jamie,
I empathize with the loops, jumps, hoops, research, calls, letters, understanding, babysitting etc. that all plays a role in the insurance smorgasboard. We are not on Medicare but I know there is alot more of it involved with Medicare. I am glad you posted this because I am going to be a little more careful of speaking of or complaining about insurance woes around my children. You are certainly worth whatever it takes! So are my kids. Until we were able to get insurance coverage of one of my sons elemental formula...it was on average $950.00 a month. That was just to keep up his nutrition. All out of pocket. We now have coverage for his formula that he has been on for 8 years, however, many families with the EoE diagnosis still pay it all out of pocket. It has changed my perspective forever about insurance. I remind myself often that medical insurance is such a blessing in our life....literally a life saver...and gift. I thank my Heavenly Father that I have had people put in my path along the way to help us figure it all out and "go to bat" for us, so to speak when we have needed it. I hope my children will always feel thier worth could never be measured by money or lack thereof or cost or lack thereof. Just my thoughts.
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