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Beth Witten Posted At 23:39:46 12/11/2001
With few exceptions, Medicare does not pay for take-home medications. One exception is EPO if provided to a home dialysis patient under specific circumstances. Another exception is immunosuppressant medications. The National Kidney Foundation website has information about the most recent legislation expanding immunosuppressant medication coverage for people who are 65 or older or disabled. The fact sheet includes information on claim filing and can be found at http://www.kidney.org/recips/statement.pdf. There is also information on the NKF website about pending legislation that would extend Medicare coverage of immunosuppressant medications indefinitely for everyone. Talk with your clinic social worker or financial counselor and let him/her know about any difficulty you have paying for medications. There are pharmaceutical assistance programs that can help but each has its own guidelines and limitations.
William Lee Re: MEDICARE PAYMENT FOR DRUGS (Currently 0 replies)
Posted At 17:58:04 09/12/2003

I recieved a bilateral lung transplant 06/09/03. I was on Medicaid/Medi-Cal at the time. I will be on Medicare 10/01/03. My wife is in the process of filing for disability and what we are being told is that not only will my share of cost go up from zero to the amount of her benifits but also $316.00 of my benifit which is $1259.00 before Medicare part B is deducted. I find this hard to believe. That would mean that the two of us would have to exist on $934.00 a month. If Medicare does pay for my medications then the Share of Cost would only apply to other than medications for me.
I also can't find out if Medicare pays for the tests etc. That I have to have performed regularly. Please let me know if this can be helped.


William C. Lee
Beth Witten Re: MEDICARE PAYMENT FOR DRUGS (Currently 0 replies)
Posted At 00:59:06 09/15/2003

State Medicaid limits vary somewhat. Medicaid guidelines are based on the federal poverty level (FPL). In CA, it's my understanding that you qualify for Medicaid without share of cost if your income is at the poverty level (100% of FPL) which is $12,120 per year for a family of 2 in 2003.

Unless you are sure that your wife is going to be found to be disabled, wait to see whether she receives disability and how much she receives before you worry about it. You should not be obligated to report the change in family income until it actually occurs.

Typically, you can report a number of things that apply to your share of costs such as medical expenses: health insurance premiums, transportation to/from doctor visits, prescribed medications, bills you have to pay for medical expenses, etc. Be sure that your caseworker gives you information so you know everything that you should report.

People who are disabled and work can have higher income and still get Medicaid. If you receive SSDI and are 18-65, you may have received a "ticket" from Social Security and certain work incentives (including continuation of Medicare). You can use your ticket to get help from your state vocational rehabilitation department or other "employment network." People who work with a disability can have family income up to 250% (instead of 100%) of the federal poverty level. This means you can have a family income of up to $30,300 and still get Medicaid. You'd have to pay a premium for it ($20-$250/month). The amount you'd pay depends on your income. This is much less than what you will have to pay if you don't work. Talk with the Benefits Planning Assistance & Outreach agency in your area about the pros and cons of working with a disability in your case. See

Unless the Medicare prescription drug bill passes Congress and is signed by the president, since you didn't have Medicare at the time you got your transplant, Medicare will not pay for your anti-rejection medications. If you do not have other coverage for these medications, you may qualify for a patient assistance program. Your social worker or financial counselor should be able to tell you what Medicare will cover of tests and other medical care that you will need as a transplant recipient as well as where you should try to get help for medications.

On the Internet, you can find information about drug discount cards, medication assistance programs, etc. at www.needymeds.com or www.medicare.gov/Prescription/Home.asp. California reportedly has a state specific program for drugs if you have Medicare - Drug Discount Program for Medicare Recipients. Show your Medicare card at participating pharmacies to get drugs at Medi-Cal prices. This is changing (or may have already changed) to Golden Bear State Pharmacy Assistance Program. Call Medi-Cal 916-657-1280. This was not in effect in 7/03.

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