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Medication Coverage On Medicare


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#1 SleepingPhoenix

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Posted 11 August 2012 - 10:18 AM

Hello people:

I'm considering disability since diagnosed, but certain topics are scaring me away from it. First I was told thru a customer rep line of the SS that I can have an income higher than $1,000 monthly. At work they told me I have to be about six months without salary, and the worst of it I was told by my doc that Medicare may not cover thoroughly the Modafinil, nor my whole treatment. Monthly I have to consume about $3,000 of Modafinil if my medical care plan did not cover it. The idea of having to pay any difference, when now I only pay about $15 for all my meds thanks to my medical benefits scares me beyond my own imagination. Trust me my hypnogogic hallucinations were Disney/Pixar style.

The worst is that due to discrimination and the fact that I have cataplexy too my employer does not want to approve me a work schedule I requested since Ill be alone for and hour and a half in the office. My doc said already that Im no risk due to the therapy improve my condition a lot and I was about a year working after hours before they officially complaint, but The stress level and the fact that they are not allowing me to work my full time and I already have six months without a steady pay check has me concerned. I already filed for discrimination at the EEOC, but these things take time and it has no guarantees. I'm even considering getting a Narcolepsy Response Dog to achieve my independence and be able to continue living alone, and working.

Please help! I need a plan B just in case, I get fired cause I dont wanna loose my home nor my home rental business, which is now on hold so no income either, waiting for lawyers to help me for it. Thanks and bless you all.

#2 thecatnapper

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Posted 29 September 2012 - 11:21 AM

Hello people:

I'm considering disability since diagnosed, but certain topics are scaring me away from it. First I was told thru a customer rep line of the SS that I can have an income higher than $1,000 monthly. At work they told me I have to be about six months without salary, and the worst of it I was told by my doc that Medicare may not cover thoroughly the Modafinil, nor my whole treatment. Monthly I have to consume about $3,000 of Modafinil if my medical care plan did not cover it. The idea of having to pay any difference, when now I only pay about $15 for all my meds thanks to my medical benefits scares me beyond my own imagination. Trust me my hypnogogic hallucinations were Disney/Pixar style.

The worst is that due to discrimination and the fact that I have cataplexy too my employer does not want to approve me a work schedule I requested since Ill be alone for and hour and a half in the office. My doc said already that Im no risk due to the therapy improve my condition a lot and I was about a year working after hours before they officially complaint, but The stress level and the fact that they are not allowing me to work my full time and I already have six months without a steady pay check has me concerned. I already filed for discrimination at the EEOC, but these things take time and it has no guarantees. I'm even considering getting a Narcolepsy Response Dog to achieve my independence and be able to continue living alone, and working.

Please help! I need a plan B just in case, I get fired cause I dont wanna loose my home nor my home rental business, which is now on hold so no income either, waiting for lawyers to help me for it. Thanks and bless you all.


Going on disability is not an easy decision or process but I will tell you from personal experience that it is not as "gloom and doom" as people make it sound. I don't know why people feel the need to get in your business like that and over dramatize the situation but it happens a lot. When I filed everyone told me "Oh, no one ever gets approved the first time and people have to fight for years to get it" and they had lots of nightmare stories to back that up. Well, it turned out that I got approved the first time and within 3 months of my application. I was out of work for 1 year when I filed and had a ton of documentation in my medical records and my doctors at the time were well acquainted with the process as they had several patients on SSDI. My employer had been really harassing me and I ended up quitting on my own because I didn't want the stigma of being fired but being terminated by an employer because of health related issues, whether right or wrong on their part, may help you in getting approved for disability. I had gone on short term disability 3 times in that last 16 months that I had worked and that helped me.

As for your medicare questions, you have to realize that you will not get medicare until 2 years after the date that you are deemed disabled. I was considered disabled on the day that I quit my job because of my condition. I'm not sure what the criteria is now but when I filed your SSDI income had to be lower than $1,300 per month to qualify for Medicaid until the 2 years for medicare was up. I think they also take into consideration if you have any dependant children. If you get SSI you can get Medicaid but SSI is significantly less money than SSDI. Up until now that I'm in the process of getting Xyrem, I've not had any issues with Medicare paying for my meds including when I was being mistreated for mood disorders which require very expensive medications. Sometimes the co-pay is very high on meds depending on what "tear" they are assigned by the insurance co. Also there are numerous medicare insurance plans to choose from and you hav to choose the plan that's best for your needs. Right now I'm buried in red tape trying to get Xyrem but it is a ridiculously expensive drug. When I took Nuvigil they did not even bat an eye at paying for it but I did have to pay a high co-pay.

I just want to encourage you to hang in there and try not to stress too bad or let others scare you. I can guarantee you that transition from working to going on SSDI will NOT be a pleasant and swift transition. It's just not, but it's not as terrible as it sounds and you WILL survive it. When I had to quit working I had a huge house and had just bought a brand new car and had tons of "friends". Within 8 months it was all gone and I was penniless and living with my Dad. I thought it was the ultimate failure and that I would surely die of disappointment and shame but I didn't. Now that I have the SSDI I'm back to living on my own again but of course I don't live as comfortably as I did before. But, I had to realize that the material stuff does not matter and it doesn't make a person who they are. Once I learned to love and accept myself I finally became a happy person. Narcolepsy is just something I have to deal with but it doesn't define me in my own mind.