How to Handle 81 YO No Part D

[yorkriver1]

Caller today, referral from a financial services friend. Caregiver for 81 year old on several prescriptions. Stated there is no prescription drug coverage. Income and assets rule out Extra Help and Medicare Savings Program.

Between now and fall, for rest of 2017, I suggested resources like GoodRX and checking with the RX manufacturers. We looked up Restasis and got a coupon in caregiver's email.

I don't want the LEP estimating for Part D to be on me come this fall at open enrollment for an MAPD $0 to low cost HMO, which most likely could help, even with penalty, so will show penalty info from Medicare, refer them there to deal with situation.

Anyone have suggestions?

 

[Northeast Agent]

Do they live in a State that has a State Pharmaceutical Assistance Program (SPAP)? In PA we have Pace (knocks out the LEP and gives them a SEP), PaceNet (gives them a SEP) and the Pennsylvania Patient Assistance Program Clearinghouse, which can help during the Donut Hole even with much higher incomes.

 

[yorkriver1]

Do they live in a State that has a State Pharmaceutical Assistance Program (SPAP)? In PA we have Pace (knocks out the LEP and gives them a SEP), PaceNet (gives them a SEP) and the Pennsylvania Patient Assistance Program Clearinghouse, which can help during the Donut Hole even with much higher incomes.

No, Virginia doesn't have that. Patch together a combo of various discount programs, manufacturer's help, Goodrx coupons, etc. One of my clients is using a Canadian pharmacy, but is pretty savvy, wouldn't work here.
I still have hope for the MAPD, I just don't want a situation where they think the penalty will be "x" and it turns out higher. I want to dodge that one, stay out of it.

 

[vic120]

No, Virginia doesn't have that. Patch together a combo of various discount programs, manufacturer's help, Goodrx coupons, etc. One of my clients is using a Canadian pharmacy, but is pretty savvy, wouldn't work here.
I still have hope for the MAPD, I just don't want a situation where they think the penalty will be "x" and it turns out higher. I want to dodge that one, stay out of it.

I give brief description but Stress that they Need to contact medicare or SS to get specific amounts

 

[yorkriver1]

I give brief description but Stress that they Need to contact medicare or SS to get specific amounts

I wonder if they could get the amount before applying for a PDP or MAPD?

 

[DS4]

I don't want the LEP estimating for Part D to be on me come this fall at open enrollment for an MAPD $0 to low cost HMO, which most likely could help, even with penalty, so will show penalty info from Medicare, refer them there to deal with situation.

If this man has never had Part D coverage, and, he enrolls effective 1.01.18, his LEP is +$44.80

 

[Boy Howdy]

If he was born in 1935, he turned 18 in 1953 and the draft was taking pretty much everyone. Heck ELVIS got drafted!

If he has had VA Rx coverage, that is credible and he wont have to pay LEP

If he can GET VA coverage---I checked Medicare.gov and used Newport News as the town

Humana has a $0 premium RPO and a $33 PFFS that do NOT have Rx so he would not have to pay LEP

Please post if either of those strategies work

 

[DS4]

Please post if either of those strategies work

Both work!..........................No LEP.

 

[Boy Howdy]

Both work!..........................No LEP.

Ya I wanted to know from the guy in VA if it worked

Always worked for me--then we lost all the MAs with PD

 

[yorkriver1]

If he was born in 1935, he turned 18 in 1953 and the draft was taking pretty much everyone. Heck ELVIS got drafted!

If he has had VA Rx coverage, that is credible and he wont have to pay LEP

If he can GET VA coverage---I checked Medicare.gov and used Newport News as the town

Humana has a $0 premium RPO and a $33 PFFS that do NOT have Rx so he would not have to pay LEP

Please post if either of those strategies work

Will check on the VA possibility. Thanks! Also, thanks to others, and for the estimate of the penalty. In a no/low premium MAPD/HMO, especially, the penalty would not kill off the savings, + there would now be a max out of pocket that isn't there now. This prospect also has assets, so MOOP is good.