Before I retired, I received financial assistance for my cholesterol medication, which would have cost me approximately $2,400 per month without assistance. With the financial assistance, the medication cost me $10 each month.
I received this assistance through a program called a copay card. The card was issued by the drug company that sold the medication. When I reached 65 and went on Medicare, I received notification that I could no longer use the copay card to pay for my cholesterol medication. I checked with my Medicare insurance company and they told me the medication would cost me $2,400 per month for about six months at which point I would enter the catastrophic drug cost, or whatever it was they called it, and then the drug would cost me about $50 per month.
I did a little more research on this and found that the Federal Government had put regulations in place that forbid the pharmaceutical companies from allowing anyone to use the copay card program if they received government assistance on their medical insurance.
In essence our own government is stopping them from helping us. Has anyone figured out how to get around this?
I understand your pain, I have the same situation with expensive migraine meds; I’m not looking forward to Medicare. I have experience managing mom’s finances, she was a disabled senior with a kidney transplant in upstate NY. There are a couple of options to investigate.
You may want to look for patient assistance programs not funded by the drug companies (at least directly, who really knows). I found some for mom a few years back to help with anti-rejection meds. Google “patient drug assistance programs”, quite a bit will come up for you to sift through to figure out which ones can be used with Medicare. There are also income based state programs, for example in NY they have EPIC which brings down the copay significantly based on your income. Another resource could be income based clinics with social workers; they usually keep their ears to the ground.
A social worker told me about the “nuclear option”, Special Needs Trust. There are specific eligibility rules which vary state to state as the program is state run not the feds (your mileage may vary from my experience). In a nutshell you fork over your income & assets to become Medicaid eligible. There are fees involved based on who administers the program, I found a non-profit with low fees.
Any income over the medicaid threshold goes into the trust and the trust to pay bills on your behalf. You become dual eligible (both Medicare & Medicaid), in Medicare speak - QMB. They pay your Part B premium as an added benefit. There are special QMB rules on what can be billed to you & what little estate you have is protected from Medicaid claw back when you pass.
For mom she was in assisted living with a hefty rent payment, the money went in on the 3rd and rent was paid on the 4th. The catch is when you die, they keep whatever money is in there. On the asset side, I’m not sure how a primary residence would be handled.
When mom passed, Social Services came with their hand out looking to recover Medicaid funds; I quoted chapter & verse, they went away pretty quick.
Good luck, it’s a full time endeavor to find the assistance programs; unfortunately there is no magic bullet. I hope this gives you some ideas.
Thanks for the information. I’ll look into the programs you mentioned by searching Google. I’m not ready to hand everything over to an agency and let them manage my income and bills. It sounds like a good way to loose my house and vehicles. My mother in law was in a nursing home and everything she owned was turned over to DHS to pay for her medical and her room and meals. But it didn’t matter to her because she had Alzheimer’s and could barely recognize us.