I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: andrea on August 15, 2007, 11:59:44 AM
-
I apologize if this topic has been addressed somewhere - I did a few searches and didn't see anything that relates to what I'm looking for.
I am wondering if anyone here receives benefits through the VA. We had a patient start HD recently who wants to coordinate his care between the dialysis center and the VA outpatient clinic. Apparently, the VA pharmacy benefits only cover medications written by VA doctors, so none of this patient's care at the dialysis center is covered. He makes too much for Medicaid, can't afford the premiums and copays for Medicare D, and can't buy his meds out of pocket.
I have been calling various VA representatives all day, between searching online and working on things for other patients, and I have yet to speak to a real person who can explain things to me. This is a unique situation - I have only been in my position for five months, and none of our other patients are VA patients.
If any of you can shed some light on this, I would be SO appreciative! I really want to do what I can to help this patient, but for now I don't know what my options are.
-
I found this, not sure it helps but might direct you to find more info:
KIDNEY MEDICARE DRUGS AWARENESS AND EDUCATION INITIATIVE
What You Should Know about Medicare Prescription Drug Coverage
(Part D) When You Do In-Center Hemodialysis and Have TRICARE,
Veterans Administration, Federal Employees Health Benefits or Help
for Drugs from Indian Health Facilities
If you are on in-center hemodialysis, Medicare
pays for some drugs at your clinic. Your doctor may
prescribe other drugs to treat anemia, bone disease,
depression, diabetes, heart problems, high blood
pressure, high cholesterol, infection, itching, and pain.
To stay healthy, take your prescribed drugs in the right
dose at the right time. Ask your doctor before taking
new drugs.
Starting January 1, 2006, Medicare Part D can help
you pay for your prescribed drugs that are not covered
by Part A or Part B if you join a plan. Anyone with
Medicare can join, even if you are on dialysis.
If you have TRICARE, Veterans Administration, or
Federal Employees Health Benefits (FEHB), your
drug coverage is as good as Medicare Part D. You
don’t need a Medicare Part D plan now. If you lose
your TRICARE, VA, or FEHB plan, you can join a
Part D plan later as long as you join before 63 days
from when you lose your current drug plan.
If you get drugs from the VA, you can choose to
have a Part D plan also if you live far from the VA
hospital where you get your drugs, if you can get
a drug under Part D that you can’t get through the
VA, or if you have limited income and resources
and qualify for extra help to pay for covered drugs.
The VA and Part D cannot both pay for the same
drug so each time you fill a prescription you must
decide if you want the VA or Part D to cover it.
If you get your drugs from an Indian health
facility, nothing will change and you’ll still pay
nothing. If you have limited income and resources,
you may ask for extra help to pay for Medicare
Part D. Apply on Social Security’s Web site at
www.socialsecurity.gov or call (800) 772-1213 or
(800) 325-0778 for TTY. If you join a Part D plan,
the help you get from Medicare may save your
Indian health provider money.
If you have Medicare in 2006, you can join from
November 15, 2005 to May 15, 2006. If you join
between November 15, 2005 and December 31, 2005,
your plan will start January 1, 2006. If you join by May
15, 2006, your plan will start the first day of the month
after you join. If you get Medicare after January 2006,
your first chance to join a Part D plan is during the
same 7 month period you can sign up for Part B. Wait
to join and you could pay a higher premium. You’ll
only be able to join or change plans from November 15
to December 31 each year. Your new plan will start the
next January 1.
If you have limited income and resources, you
may get extra help to pay for your Medicare Part D
plan and drug costs. Apply for extra help on Social
Security’s Web site at www.socialsecurity.gov or call
(800) 772-1213 or (800) 325-0778 for TTY. With extra
help, you could pay as little as $1 for each generic or $3
for each brand name drug you buy. Otherwise, you will
pay the premium plus a deductible and co-payments or
coinsurance totaling $3,600 in 2006, for covered drugs
before Medicare will pay 95% for the rest of 2006.
Companies sell Medicare-approved plans. Some are
standard plans; enhanced plans cover more but cost
more. Plans can’t sell door-to-door. Look for the
Medicare-approved symbol on mailings.
All plans must cover certain drugs, like anti-
depressants or drugs to prevent transplant rejection.
Standard plans don’t cover everything, including
over-the-counter drugs, vitamins (except Vitamin D),
cold medicine and a few other drugs. A plan’s list of
covered drugs is called a formulary. Generics may be
cheaper but ask your doctor if you can take a generic
before you buy it.
If you choose to join a plan, choose a kidney-friendly
one. Your doctor can help you know what drugs to look
for. Make a list with drug names, doses, and number
you take a month. Ask your doctor if you’re taking the
best drugs to stay healthy. Ask what other drugs you
may need if your health or treatment changes and look
for them on formularies. Compare plans and costs.
Choose one that covers all or most drugs you take
now or you may need later if you need change to home
dialysis or get a transplant. Check to see what drug
stores you can use. Ordering drugs by mail may save
money on drugs you take all the time.
Review plans in Medicare & You 2006. Due to a
printing error “If I can qualify for extra help, will my
premium be covered” has YES for all plans. To be sure
which plans do, visit the Medicare Prescription Drug
Plan Finder at www.medicare.gov; or call
the Medicare Helpline at 1-800-MEDICARE (1-
877-486-2048 TTY). Ask Medicare how you can get
in-person help through your State Health Insurance
Assistance Program.
Apply with the insurance company that sells the
plan you like, use the Prescription Drug Plan Finder
or call the Medicare Helpline. Guard your personal
information. You can give them to Social Security, the
Medicare helpline, or plans if you call them. Report any
concerns to the Medicare Helpline.
Your Medicare drug plan must give you a list of rights
when you enroll. If you need a drug that’s not on the
list, your doctor can ask for an “exception” for the plan
to cover a drug you need. You have the right to appeal
a denial.
Your health care team wants you to know all you can
about Part D so you can make the best choice to meet
your needs. Be aware that most of what you read is
for the “average” person with Medicare. You can find
what you need to help you make an informed decision
at www.kidneydrugcoverage.org. Libraries have
Internet access if you don’t. Ask a neighbor or loved
one to help you get what you need on their computer.
The Kidney Medicare Drugs Awareness
and Education Initiative is a service of the
kidney community, designed to provide timely,
consistent, reliable, and up-to-date information
about Medicare and Medicare prescription drug
coverage (Part D).
If you’d like additional information, we can be
reached online at www.kidneydrugcoverage.org
or through the National Kidney Foundation at
30 East 33rd Street, New York, NY 10016,
212-889-2210/800-622-9010.
URL http://www.kidneydrugcoverage.org/PatientsDialysisInCenter.htm
-
I get my meds through the V.A. I spent my time in a VA hosp when I became sick with kidney failure. Now if my clinic suggests a new med, I just tell my VA Doc and he sends in the script to the VA pharmacy. I have no co-pay as I am not working. Also if one is working, the co-pay would be about $7.00.
While on the subject of VA, if there are any vets out there with end stage who don't get much on their SSDI or SSI, the Va will pay a pension of $910 per month to a single person and up to 1300 for married. You are considered totally disabled if you are end stage. You must have served at least 60 days and during one day of wartime and have a honorable discharge. This will also give you a top rating for VA services.
-
Thank you for that information. I'll be sure to pass that along to my patient!
-
I get my meds through the V.A. I spent my time in a VA hosp when I became sick with kidney failure. Now if my clinic suggests a new med, I just tell my VA Doc and he sends in the script to the VA pharmacy. I have no co-pay as I am not working. Also if one is working, the co-pay would be about $7.00.
While on the subject of VA, if there are any vets out there with end stage who don't get much on their SSDI or SSI, the Va will pay a pension of $910 per month to a single person and up to 1300 for married. You are considered totally disabled if you are end stage. You must have served at least 60 days and during one day of wartime and have a honorable discharge. This will also give you a top rating for VA services.
Can you tell me if my hubby who is on disability now would qualify for benefits? He was injured at work. He served in Nam during the war time. He is not ESRD but other dsability.
-
How disabled is he ? The Va compensation program is for vets who were disabled during military service. How disabled is he? The VA pension program is for any wartime vet who is totaly disabled. The income limit is 10,400. Depending wwhat the income is will determine the benefit rate. Those on SSI will lose the SSI benefit if they are collecting the pension, but the pension is at a higher rate. I am not sure about SSDI. The best way to find out about your situation is to contact your local VA rep. Every town has one
-
http://www.vba.va.gov/bln/21/pension/vetpen.htm
He should contact his Va rep as he can get services and meds at a VA clinic.