Are you looking for tips for the Medicare open enrollment season?

[Jill Upshaw]

I cannot stress enough, check your insurance EVERY year on EVERY important part. The plans usually last until the end of the year. This year on 10/15/2023, I lost the hospital I use, my pulmonologist , my cardiologist, my interventional cardiologist, my PCP and my new endocrinologist. I still have my Adempas with a large copay. In order to keep my Adempas, the options for doctors is very limited and I live in a great area 30 minutes out of Nashville with lots of options normally. I had a two day notice of all the changes. I am sure I will figure it out after hours of research or at least I hope.

[jen-cueva]

OMG, @Jill Upshaw, this is so horrible! I hate to hear this happened to you. Unfortunately, things like this happen more often than we can imagine. This year, my kidney doctor alarmed me that my current insurance was trying to work on their contract with the hospital system. I freaked out because everyone except one of my doctors was in that system.

Will they not offer you a “continuity of care” to cover the specialists that you have been under?

Thankfully, they signed a new contract the day before it was to end. This was only a few months ago. I was so stressed, knowing that was a possibility. I finally figured out all my new medical team members from moving here from Texas.

Have you tried any copay assistance plans for the Adempas? I’ll see what I can find and tag you in any tips that could benefit you. My thoughts and prayers are with you, my dear PHriend. Please keep us posted on how we can best support you.

[Jill Upshaw]

They did come back and say I had 30 days instead of 2……I am still working on all of this. I can only stand it for a while and then I stop. I do need to get my anger, fear and frustration under control. I was already working on next year when I got this pile of letters all in one day. I have such confidence in my current team and I don’t want to lose them…….I know most everyone feels that way and I will be fine until I am not but the aggravation factor and fear is so a part of all of this. I have the assistance fund and that comes up for renewal in late November. I hold my breath every time I make a change.

[jen-cueva]

Ughh, @Jill Upshaw, I relate and can feel the pain and feeling of being overwhelmed. I want to scream at them when they think we should be thrilled when we are given more days to figure this out. What would make us happy is leaving our insurance coverage alone, especially when we are at a great place and have faith in our medical team.

They have no clue how much effort, stress, and energy goes into finding a trustworthy care team and getting to know them as they learn our stories.

I’m sorry you’re still working on this, Jill. Please let us know if we can do anything to help support you. Positive thoughts and prayers are with you. Thanks for taking the time to update us despite your busy days trying to handle this. 🤗

[Colleen Steele]

@Jill Upshaw I read your update like I watch scary movies, covering my eyes and peeking. Seriously, it’s so upsetting this happened to you and frightening that it could happen to any of us! I’m so sorry!

[Jill Upshaw]

I really was shocked that is happened before the end of the year. I always thought when something was valid 1/1/2023 to 12/31/2023 that it was valid but obviously not. Hopefully , this won’t happen to anyone else.

[jen-cueva]

Hi, @Jill Upshaw, you would think so. But when mine was “iffy” and renegotiating contracts, all but one of my healthcare team members would not have been in the network. I like you thought it would be after the effective year.

Hopefully, this will not happen to you again or anyone else.

[Roger Bliss]

To be honest, I don’t understand much about all this insurance deal. I guess we got our insurance through blind luck????? We have medicare part A which is free for hospital. We also have part B which is for medical and they charge us for that. We would have to pay 20% of costs. We have a supplemental insurance to cover the 20% through AARP (United Healthcare). Our insurance is good anywhere in the US that takes medicare. We have had the same set up since we started getting it in 2019 and never had to pay a dime for anything other than prescriptions.

I feel terrible for Jill but I am not sure how that happens??? Have heard the same thing from others. Is it the supplement that causes the problems or is it medicare itself? As far as I know we are ok??? Just want to make sure I check the right things.

[jen-cueva]

It sounds like you are doing well with your Medicare and supplemental plan, @Roger Bliss! That’s great and I hope this continues to be the case for you and Mary Ellen! Thanks for sharing your experience.

Like you, I helped my dad set up his supplemental plan a few years ago and he continjues the same one each year with good luck, so far. But my mom has had me look at some of the paperwork on here and it’s too confusing. I told her to call because she gets a different plan each year. I told her to stick with one she likes and hopefully it won’t change coverage every year.

[Jill Upshaw]

I have Cigna Premiere HMO which is great for the Nashville area. I have some great doctors and have been very happy with it until I got the notices saying everything that had been cut out almost immediately. I have been staying with a medicare advantage plan because of my Adempas. They don’t pay all of it but they pay a lot toward it. There are so many guidelines with Adempas as I am sure there are with others…….

[jen-cueva]

Hi @Jill Upshaw, yeah, Cigna plans like Aetna (my current plan) are both well-known coverage plans and widely accepted. We had Cigna for years before Manny changed jobs here.

Yes, unfortunately, most of our PH treatments have so many guidelines. Does The Assistance Fund (TAF) help with your Adempas? Most copay assistance programs are due to renew in November and December. This is a nail-biting time for many of us.

Please keep us posted, Jill and let us know if we can do anuthing to help you get through this stressful time. Onr suggestion, is to maybe call your speciality pharmacy and aks hat you are suppose to do if this is not resolved and you have to wait longer for any assiatnace. I know when I used Accredo for years, they were always helpful in offering any other esources if needed as a backup plan.

[Joanne Sperando]

I get so incredibly stressed out every year since I’ve become a Medicare recipient. Renewing assistance on meds and understanding the policy changes. Makes my pressures rise just thinking about it. I swear here and now that if I ever win the lottery, one of the first things I do is donate to the organizations that help us afford our meds. I live in terror of losing my insurance coverage. 😖

[Colleen Steele]

@Joanne Sperando I haven’t used medicare but it might be in my future. Do they have consultants that can help people understand it and figure out what is best for them?

[Jill Upshaw]

I think it helps to go with what is best for your local area. Nashville has so much to offer.

[jen-cueva]

Yes, going with a local plan is a great idea, @Jill Upshaw. Also, many local plans have offices in the area where you cango and talk to a representative in person, if needed. They also often set up outside hospitals and clinics, even in places like Walmart and local pharmacies, to answer questions and help people sign up.