This month’s newsletter shows more ways to save money when buying prescription drugs. Through Rx Outreach, patients pay only the published Rx Outreach price for medication you need. “No surprises!”. We also provide some medications for free. Going beyond your drug copay, there are non-profit, privately funded programs that help with insurance co-pays, office visits, transportation, nutrition,
medical supplies and more. Check out the Assistance for Health Care Costs story below. Why your copay at the drug store does not match the plan you bought? Drug copays quoted during Medicare open enrollment can rise. Medicare fraud costs all of us. When surprise bills show up in your mail, is someone paying THEIR bills with YOUR money? Did you know that seniors have to fight
their insurance company to get treatment covered? Managed care PPO plans can be hazardous to your health and your wallet. GET THE MEDICATION YOU NEED AT AN AFFORDABLE PRICE At Rx Outreach, we believe that everyone deserves access to affordable medications. No one should ever have to choose between filling a prescription and feeding his or her family. Rx Outreach offers more than 1,000 medication strengths that cover most chronic diseases. Since we are a mail-order pharmacy, we are able to ship medications directly to the provider’s office or our patients’ homes. To make it simple and cost-effective for our patients, we ship enough medication for 30, 60, 90, or 180 days at a time. Rx Outreach is available to qualifying individuals and families. We serve people whose income is at or below
400% of the Federal Poverty Level. Patients can quickly check their Eligibility online. Patients can be on Medicare, Medicaid, or other health insurance and still qualify for Rx Outreach. https://rxoutreach.org/our-story/ ASSISTANCE FOR HEALTH CARE COSTS
BY SPECIFIC DIAGNOSIS There are many private- or government-funded organizations offering programs that help with costs associated with specific diagnoses. Some programs are national in scope, while others are limited to people in specific states. Most have some type of eligibility requirements, usually financial ones. Some cover one specific diagnosis, while others cover whole categories (such as all types of
cancers) or even all chronic medical illnesses. These diagnosis-based assistance programs may cover many types of expenses, including drugs, insurance co-pays, office visits, transportation, nutrition, medical supplies, child or respite care. https://www.needymeds.org/copay-branch Many Americans Have Little Savings The median savings balance — not including retirement funds — of Americans under 35 is just $3,240, while it's $6,400 for those ages
55-64. Drug Copays Touted During Medicare Open Enrollment Can Rise Within a
Month Something strange happened between the time Linda Griffith signed up for a new Medicare prescription drug plan during last fall's enrollment period and when she tried to fill her first prescription in January. She picked a Humana drug plan for its low prices, with help from her longtime insurance agent and the Medicare Plan Finder, an online pricing tool for comparing a dizzying array of options.
But instead of the $70.09 she expected to pay for her dextroamphetamine, used to treat attention-deficit/hyperactivity disorder, her pharmacist told her she owed $275.90. Read more . . . https://www.npr.org/sections/health-shots/2022/05/03/1095946813/medicare-drug-costs-spike Someone is Paying THEIR Bills with YOUR Money Valerie Bennett rarely goes to the doctor, and she’s never had diabetes. So, it came as a troubling surprise when she noticed hundreds of dollars in diabetic supplies billed to her Medicare account and supplemental insurance in September and October. Bennett tried multiple times to call the San Antonio company listed on the billing summary. She had never heard of the company before seeing it on her bill. She said she never got a call back, so she reported the charges to the Centers for Medicare and
Medicaid Services, or CMS, and sent an email about her experience to KXAN investigators. “Medicare fraud has been around since Medicare started in 1965. Every single year, we lose $60 billion in Medicare fraud error and abuse,” Salazar said. Medicare receives over 4.5 million claims per day, Salazar said, so it is up to recipients to spot and report possible
fraud. She said people need to read their quarterly “Medicare summary notices,” or, if they use Medicare Advantage, their
“explanation of benefits.” https://www.kxan.com/investigations/i-was-angry-because-thats-taxpayer-money-familys-warning-after-getting-unexpected-medicare-bill/ Medicare Summary Notice Guidance Your Medicare summary notice (MSN) only comes to you every 90 days. By the time you get your MSN some of your claims may be 4 months old, if not older. You should make a habit of checking your Medicare claims at least monthly, plus every time you receive a bill from your provider. NEVER pay a provider bill until AFTER the claim has been adjudicated by Medicare. Failure to pay before Medicare has approved and repriced the claim may result in you OVERPAYING your provider. Once Medicare reviews your
claims they are AUTOMATICALLY forwarded to your Medigap carrier for them to pay their portion. Best to wait until both Medicare and your supplement plan have paid their portion before writing a check or paying online. When you enroll in a Medicare Advantage
plan, you ASSIGN your rights to use original Medicare, which has been prepaid for years via payroll deductions. Choosing a Medicare Advantage over a supplement (Medigap) plan has potential ramifications that can cost much more than the few premium dollars
you may save. Many who enroll in an Advantage plan may not be able to qualify for a supplement plan if they decide they want to leave the Advantage
plan. Fighting Your Medicare Insurance Carrier The following story, written by an agent, was copied from an insurance agent forum. There is no link since some of the information is PHI and a link could allow readers to discover the authors identity. I am an agent and bought an MAPD (Medicare Advantage with Prescription Drugs) with Aetna. I was very disappointed with this plan last year and had serious thoughts about changing plans this year. I had 5 cystoscopes over several months because my bladder was bleeding and nothing would stop the bleeding. I had a catheter and bag many times during this problem. My urologist had tried everything he knew and one day asked his nurse to get a price on a prescription. The nurse came back and said the prescription was $2,000. I asked how much my plan would pay and she said nothing. The doctor called another prescription to my pharmacy and
my wife went to get it and the pharmacist said he couldn't fill it unless my doctor called the company for approval. My wife asked, " how much is the prescription", and the pharmacists said, $14.00. She paid for the prescription and I took it. I feel it's pretty crappy for a company refusing to fill a $14.00 prescription. After the 5th cystoscope my doctor wants to
schedule time in a hyperbaric chamber at the hospital. I got a call the day before and the hospital nurse asked if I had previously had radiation treatment and I answered no. She then replied that unless I
had previous radiation treatment Aetna wouldn't pay and the cost would be $10,000. Needless to say I am not happy with Aetna right now. I read about and
encounter many issues with Medicare Advantage plans, but this is one of the most egregious situations I have seen. This kind of mistreatment does not happen with original Medicare but it is quite common with managed care PPO/HMO plans. Wishing everyone a HAPPIER New Year. Call or email anytime you have Medicare questions. Feel from to share the link to this newsletter with your
friends. Bob Vineyard Follow on Facebook & Youtube
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