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Thread: Help with part D

  1. #1
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    Default Help with part D

    So in yesterdays mail I got a notice that I no longer qualified for help with my Part D since January. Because my disability check is $33.33 a month above the Federal poverty guidelines. Starting next month I have to pay everything back at the tune of $300 a month and my premiums will go up $50 a month. They cant tell me how much that is because they don't know yet. I can sue medicare but I have to get a lawyer and pay him and the court costs up front because it is a civil matter.

    Due to the fact that it was terminated due to making too much money I will not qualify for help from the drug companies. And since my renters flaked on me we are now $950 a month short. There are a lot of meds that I will no longer be taking as they are waaaay out of my price range. I just figured that I will fall into the donunt hole within $8.00 I will have to pay 100% of the cost. And everyone of them are generic as it is.

    Sorry for the rant but I am past angry.

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  3. #2
    Distinguished Community Member Jeanie Z's Avatar
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    :) That is awful Gary. I hope the agency who says it paid you $33 too much will be able to make it doable for you. You are in my prayers. Jeanie :)

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  5. #3
    Distinguished Community Member agate's Avatar
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    Gary, it sounds as if you could be considered a hardship case. If you make a lot of persistent phone calls you might be able to find a special provision for hardship cases that will help you out of this.

    You usually have to put up with being put on hold a lot and being given other numbers to call but if you're willing to put in the time and energy, there may be help out there. The trick is to find it.
    MS, diagnosed 1980. Avonex 2001-2004. Copaxone 2006-2009.

    "Always put off until tomorrow whatever you think you should do today." --Anonymous



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    Gary, I'm sorry they pulled the rug out from under you. It's not fair. Fight and jump through the hoops they present you. Don't let it get to you, it will work out!
    "The Purest Blue".

    Love and Rockets

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  9. #5
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    Oh Gary, I'm so sorry...that stinks!!! I hope they don't get by with this,
    Get in there and fight and stay calm...Yeah right. Saying a prayer for you.
    Love, Sally


    "The best way out is always through". Robert Frost







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  11. #6
    Distinguished Community Member Earth Mother 2 Angels's Avatar
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    ((((((Gary)))))) ~

    You have every reason to be steamed! This kind of bureaucratic baloney is quite stressful, so first and foremost, take a deep breath and try not to let it rile you up too much to affect your health.

    I have spent decades advocating and battling government agencies. In your shoes, I would approach your situation thusly:

    1. Gather all of your documents relevant to the disability income, SSI, and Medicare.

    2. Make a list of your drugs, including their cost without Part D (the cost to you privately) per month.

    3. Make a list of your monthly bills/expenses to compare with your monthly income.

    4. Make a list of your arguments:

    a. You didn’t know that you were $33.33 over the poverty level with your SDI (assuming it is SDI). The government should have informed you that this amount would put you above the poverty level and might affect other benefits, such as Medicare, Supplemental Insurance for Parts B and D, and/or Social Security payments (if you receive those). If this began in January, then did you receive a cost of living increase in your SDI? Is that what suddenly put you over the poverty level?

    b. If your $950/month rental income affects your benefits, note that you no longer receive that income.

    c. If you’re receiving SDI, that is part of Social Security, as is Medicare. So it’s all one big agency. I guarantee you that the right hand doesn’t know what the left hand is doing. And the left hand doesn’t even know that the right hand exists. You have a right to expect coordination among the departments within Social Security, and to be notified before 9 months have passed that you have surpassed the threshold by $33.33/month.

    d. On good faith, without knowledge that you were $33.33 over the limit, you paid your Part D premiums. You didn’t default.

    5. Take action:

    a. Call SDI. Ask to speak to a supervisor, if you don’t get a helpful person on the line. Explain your situation. Ask if they can solve this for you. State that you are willing to forego the $33.33 per month to continue to have Part D coverage at a lower rate. Your premiums will go up $50/month, so $33.33 doesn’t help you there. If you can get back down to the poverty level, your premiums should not go up.

    b. Call Your Part D provider. Explain your situation and ask them to explain their action to you further. Take copious notes, include name of person, time, date, and length of call. (Actually do that with all of your calls. Ask the person's name and to spell it for you. Ask their extension number.)

    c. Call Medicare. Explain your situation. Etc.

    d. All Federal programs offer appeals for due process. When you file in a timely manner for a hearing on your case, you should get a “stay put” order. A “stay put” order means that nothing changes for you until after the hearing decision is rendered. The Part D people can’t charge you $50/month more or demand $300 a month in repayment, unless they prevail in your hearing. Ask Medicare about your hearing rights, or go to their website and see what you can find out there.

    e. This is open enrollment season, so start shopping around for a different Part D provider. Compare rates and coverage of the drugs you need.

    It’s a lot of work, but it can be done at home, on the phone and the internet.

    You may have to schlep down to your local Social Security office and meet a real person to get any action. If you ask for a due process hearing, you’ll have to appear wherever it is held. These are generally given to administrative law judges and occur in informal (not court) settings. It costs you nothing, and if you have all of your ducks in a row, you shouldn’t need an attorney. Still, we all know that the government isn’t the most forgiving or caring institution, so if you don’t prevail, it’s definitely not your fault!

    I do hope that some of this is helpful. I don’t mean to intrude. I just know that the government has made my life very difficult for decades, and I essentially had to become "as good as a lawyer” to protect my sons. Once I became well-versed, I counseled/represented other parents and their children. I am not a lawyer, but I am an experienced advocate.

    The government counts on us not to have the energy to pursue or the awareness of our rights, when they pull this garbage. Most people give up and don’t know their rights to due process. The government counts on that lack of knowledge, and good, law abiding, deserving people, like you, get stung.

    Fight ‘em, Gary! You have many people here, who are on your side and rooting for you!

    Love & Light,

    Rose
    Mom to Jon, 49, and Michael, 32, who were born with an undiagnosed progressive neuromuscular disease and courageous spirits. Our Angel Michael received his wings in 2003. Our Angel Jon received his wings April 2019. April 2020, Jim, the world's most wonderful Dad, joined them. Now, they all watch over me.

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  13. #7
    Distinguished Community Member renee's Avatar
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    They screwed up.
    Somewhere in that notice should be a statement that because they screwed up,
    you are not required to pay back their mistake.
    Plus, your income has changed.

    Shoot, they may owe you.

    I have been through all those things and once upon a time received a check for $28,000-
    No explanation and they never demanded it back.

    The forces of good are with you.

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  15. #8
    Distinguished Community Member Lazarus's Avatar
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    Default Earth Mother gave you specific and great advice...one more thing...be nice

    Quote Originally Posted by Earth Mother 2 Angels View Post
    This quote is hidden because you are ignoring this member. Show Quote
    ((((((Gary)))))) ~

    You have every reason to be steamed! This kind of bureaucratic baloney is quite stressful, so first and foremost, take a deep breath and try not to let it rile you up too much to affect your health.

    I have spent decades advocating and battling government agencies. In your shoes, I would approach your situation thusly:

    1. Gather all of your documents relevant to the disability income, SSI, and Medicare.

    2. Make a list of your drugs, including their cost without Part D (the cost to you privately) per month.

    3. Make a list of your monthly bills/expenses to compare with your monthly income.

    4. Make a list of your arguments:

    a. You didn’t know that you were $33.33 over the poverty level with your SDI (assuming it is SDI). The government should have informed you that this amount would put you above the poverty level and might affect other benefits, such as Medicare, Supplemental Insurance for Parts B and D, and/or Social Security payments (if you receive those). If this began in January, then did you receive a cost of living increase in your SDI? Is that what suddenly put you over the poverty level?

    b. If your $950/month rental income affects your benefits, note that you no longer receive that income.

    c. If you’re receiving SDI, that is part of Social Security, as is Medicare. So it’s all one big agency. I guarantee you that the right hand doesn’t know what the left hand is doing. And the left hand doesn’t even know that the right hand exists. You have a right to expect coordination among the departments within Social Security, and to be notified before 9 months have passed that you have surpassed the threshold by $33.33/month.

    d. On good faith, without knowledge that you were $33.33 over the limit, you paid your Part D premiums. You didn’t default.

    5. Take action:

    a. Call SDI. Ask to speak to a supervisor, if you don’t get a helpful person on the line. Explain your situation. Ask if they can solve this for you. State that you are willing to forego the $33.33 per month to continue to have Part D coverage at a lower rate. Your premiums will go up $50/month, so $33.33 doesn’t help you there. If you can get back down to the poverty level, your premiums should not go up.

    b. Call Your Part D provider. Explain your situation and ask them to explain their action to you further. Take copious notes, include name of person, time, date, and length of call. (Actually do that with all of your calls. Ask the person's name and to spell it for you. Ask their extension number.)

    c. Call Medicare. Explain your situation. Etc.

    d. All Federal programs offer appeals for due process. When you file in a timely manner for a hearing on your case, you should get a “stay put” order. A “stay put” order means that nothing changes for you until after the hearing decision is rendered. The Part D people can’t charge you $50/month more or demand $300 a month in repayment, unless they prevail in your hearing. Ask Medicare about your hearing rights, or go to their website and see what you can find out there.

    e. This is open enrollment season, so start shopping around for a different Part D provider. Compare rates and coverage of the drugs you need.

    It’s a lot of work, but it can be done at home, on the phone and the internet.

    You may have to schlep down to your local Social Security office and meet a real person to get any action. If you ask for a due process hearing, you’ll have to appear wherever it is held. These are generally given to administrative law judges and occur in informal (not court) settings. It costs you nothing, and if you have all of your ducks in a row, you shouldn’t need an attorney. Still, we all know that the government isn’t the most forgiving or caring institution, so if you don’t prevail, it’s definitely not your fault!

    I do hope that some of this is helpful. I don’t mean to intrude. I just know that the government has made my life very difficult for decades, and I essentially had to become "as good as a lawyer” to protect my sons. Once I became well-versed, I counseled/represented other parents and their children. I am not a lawyer, but I am an experienced advocate.

    The government counts on us not to have the energy to pursue or the awareness of our rights, when they pull this garbage. Most people give up and don’t know their rights to due process. The government counts on that lack of knowledge, and good, law abiding, deserving people, like you, get stung.

    Fight ‘em, Gary! You have many people here, who are on your side and rooting for you!

    Love & Light,

    Rose

    Gary, when I am steam producing angry and start calling I am my own worst enemy by being angry with the poor Medicare worker (or other person I have to call). I have learned to end conversations with unhelpful employees (nicely) and simply call back and often I get a more helpful person !

    Before making the first phone call, craft your initial comments. Otherwise you will flood the person you are speaking with... I always start by saying I need help with a problem. Then I explain the problem when they ask me to...in your case you could say that you need help with a problem that has cascaded into a waterfall of problems and you need advice on what to do. Something like that and you have an earnest employee on your side.

    Let us know what happens...and how you got help...that advice will be useful for everyone.

    Sorry this situation exists...but I expect a solution can be found.
    Linda~~~~

    Be the kind of woman that when your feet hit the floor each morning the devil says:"Oh Crap, She's up!"

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  17. #9
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    Apparently being denied is the kiss of death. As well as being married and owing property. One outfit suggested selling out and getting a car that is more than 20 Yeats old. My newest car is 14 years old by the way.

    Talked to the pharmacy he gave me some web sites. The state does not allow the pharmacy to discount drugs as I am on federal ''aid'' meaning social security. Then the pharmacist leaned over the counter and said in a whisper, ''look how about I pay it out of my pocket and then you guys can pay me?'' This is a small town our kids went to school together and my wife has bussed his kids and now his grandkids to school.

    Anyway most of the help organizations are required to utilize the same guidelines and you have to be careful what you take and how much as you can end up loosing $$ off your monthly check. The farm hurts us as it is considered potentially income producing. I am dead. serious I was told that twice.

    It will cost around $5,000 to appeal it to Medicare. Once this decision is made you have to follow their list for the appeals process. And suing them is number one.

    I look at this like not qualifying for Medicare for the first two years of social security. The government hope you will die off and save them some money.

    I have some meds left so I am weaning myself off them. Maybe I will stand outside Walmart with a sign that says will work for prescriptions.

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  19. #10
    Distinguished Community Member agate's Avatar
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    Gary, have you looked into whether you qualify for Medicaid? Those hefty premiums you pay are taken into account as part of the medical expenses they consider. If you have big medical expenses, your total available resources go way down and that might qualify you.

    You might also qualify for SNAP benefits, formerly known as Food Stamps.

    Local chapters of the MS Society often have a fund available to help bail out people with MS who have financial need. You might want to ask.
    Last edited by agate; 10-24-2014 at 09:43 AM.
    MS, diagnosed 1980. Avonex 2001-2004. Copaxone 2006-2009.

    "Always put off until tomorrow whatever you think you should do today." --Anonymous



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