Hello,
I'm hoping someone can provide any further info here. My father neglected to sign up for Medicare Prescription during open enrollment last year. And, earlier this year, he was diagnosed with Pulmonary Fibrosis. There is medication to help with his severe case of Pulmonary Fibrosis. But, without Medicare Prescription, the medication costs over $30,000. Does he really have to wait until Open Enrollment at the end of the year to sign up for Medicare Prescription (Part D) so that he can get his medication? Can anything be done to where he could sign up now for Medicare Prescription and pay the penalty so that he can get his medication? Any advice or guidance here would be greatly appreciated. Thank you!
My stepmom and sister have been running into dead-ends over the past month in dealing with this situation. And, all of the tips and suggestions here are very much appreciated.
I am following up on a number of these suggestions. And, I will supply an update as soon as I have more information.
But, again, thanks everyone! What a great forum!
My dad's "Advantage" plan had an annual deductible that was more then twice the annual premiums for the supplemental plan and prescription plan. He was not getting proper care because of this, when he went to Medicare with supplemental and script plans he KNEW the monthly cost and was therefore able to get proper medical care by taking the unknown cost away.
I, personally, would discourage anyone that is sick and needing care from switching from regular Medicare. Just my experience and opinion.
They carry both OFEV (Nintedanib Esylate) brand name and a generic version that is much cheaper
https://www.northwestpharmacy.com/product/ofev
I did reach out to an insurance broker for Medicare yesterday. But, he informed me that enrollment is locked until October 15th. And, that other than paying cash for the medication, there's nothing that he could do.
But, I'll definitely explore calling the Mark Cuban Pharmacy site and the SHIP State Health Insurance Assistance Program, along with reaching out to the drug manufacturer for compassionate use.
Again, thank you everyone for the advice and tips. It's very much appreciated.
(Honestly, they make it sound like someone could just push through on Medicare Plan Finder and do this without the agent/broker. That might be worth *partially* exploring just to learn, even if you don’t finalize there, just to make sure you know the process.)
https://www.aarp.org/health/medicare-qa-tool/part-d-sign-up-penalty-after-first-eligible/
https://www.markcubancostplusdrugcompany.com/
You should contact the insurance broker to help you find a plan that offers the lowest co pays for this drug. BTW, because he missed the opportunity to enroll for part D. He will pay a slightly higher premium as a penalty. The broker may also inform you that because of this lapse, his plan might have to be underwritten. This is an important reason that you now need a broker. There should be no cost for this appointment. Please search for an independent broker and not one who specializes in a specific insurance to an advantage plan. He may do best with traditional Medicare. Advantage plans are for healthier people without a serious chronic illness. Good luck
Exactly!
SHIP State Health Insurance Assistance Program
https://acl.gov/programs/connecting-people-services/state-health-insurance-assistance-program-ship