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mantaray

New member
Joined
Nov 17, 2009
Messages
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Loved one DX
Country
US
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ga
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alpharetta
Hi everyone...
I have been reading this forum since my husband diagnosed ALS sept.09. I did get a lot of info and support from this forum.
Recently my husband is getting his Medicare, but we found there are only cover partA & partB for $110.50 per month.
I read some threads said it is very hard to choose the right one.
Since we are now totally confused and new about Medicare, could any of you amazing people would be kind enough to offer some advice to a newbie member, it’d be much appreciated.
We live in Atlanta Ga, he is not VA, we don’t have any other insurance and we don’t have any income.
My questions are:
How to choose Part C and Part D? How much will be pay for them per month?
Which one does cover Rilutek? And how much will be pay for Rilutek after coverage?
Do we need to purchase a supplemental insurance besides Medicare in our case? And how much will it be per month?

If you have any helpful tricks or tips that would also be very helpful.
Thanks for your time and your reply is really appreciated.
 
mantaray, sorry about your husband, but welcome to the forum.

It is very confusing trying to decide about Medicare plans! Have you been to the Medicare site that will help you try to choose a plan?

https://www.medicare.gov/find-a-plan/questions/home.aspx?AspxAutoDetectCookieSupport=1

Part C is simply a Medicare Advantage Plan or a plan through an insurance company that is reimbursed by Medicare. My husband uses Secure Horizons/United Healthcare. This part C would replace your original Medicare plan. It would be hard to give you any specific advice, as the plans vary by the county one lives in. However, when you look at the plans in you zip code, look especially hard at the durable medical equipment coverage and home health care.

Part D (rx coverage) can also be covered through a Medicare Advantage Plan or chosen separately. The Medicare site has an online tool you can use to enter the name of any drug, in order to find a policy that covers that particular drug. I think all plans are supposed to cover Rilutek, since it is the only drug approved for ALS. Here is some info regarding this from ALSA:

Riluzole Coverage
People with ALS do have coverage for Riluzole through the Medicare prescription drug benefit in 2010. Thanks to The ALS Association’s outreach, the drug has been covered by Medicare plans since the prescription drug benefit was first added to Medicare. However, coverage may vary, including copays and network pharmacies, so it is important to evaluate these factors when deciding on a plan.

It is important to note that Medicare prescription drug plans may not discriminate against beneficiaries on the basis of their medical condition. Because Riluzole is the only drug approved to treat ALS, plans effectively would discriminate against PALS if they denied coverage for the medication. Therefore, if you are unable to identify a plan in your area that covers Riluzole, please contact the Advocacy Department ([email protected] or 1-877-444-ALSA) so that we can immediately bring this to the attention of the Centers for Medicare and Medicaid Services (CMS) and ensure that you will have access to Riluzole. Please also let us know if your Rx drug plan imposes additional restrictions on coverage for Riluzole, such as higher copays or prior authorization requirements. This feedback is important and will help us to resolve any problems PALS experience accessing the only drug approved for the treatment of ALS.


If you need more help than you can get with the online Medicare site, you can get in touch with SHIP (State Help Insurance Assistance Program) @1-800-669-8387. If I remember correctly, the Agency on Aging also provides help in each county for those trying to choose a Medicare plan.

Hope that helps a little.
 
Thank Brooksea. I truly appreciate of you taking the time to help me.
 
Check out the forum and post more! As you post more, we will be able to private message you.

I know Medicare is VERY confusing!
 
Hello Brooksea,
I found out that since I have been living in a cloister for 25 years, and have not "worked" for pay, I do not qualify for social security diasability, but have to apply for SSI, do you or any other pals know how SSI and my own private insurance (paid by my community) interface? I was amazed that you cant have any income over $449 a monht or you dont qualify? Who could possible live on that? Any pals who have used SSI have any helpful info I would appreciate it!
Love and Prayers,
Seqouia
 
Sequoia, SSI is a cash "supplement" to help people meet basic needs. Someone correct me, if I'm wrong. I think most people that qualify for SSI, qualify for Medicaid, so I don't think it has anything to do with "insurance." You may want to take a look at whether Medicaid is more beneficial than your private insurance.
 
Yep your are spot on with your description Brook-sea.. It is sad for those who were stay-at-home. Good explanation.
 
Seqouia, please know you are in my thoughts as you go through this maze.

How you could dedicate yourself to service like you have takes a wonderful will of strength. You will now be able to use that same strength to battle this monster. We all will help you, if we can!
 
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