[RCH1961]

After I went on SSDI, I had a waiting period of a year before I got Medicare and the state of Indiana would not recognize my disorder as a disability, I did not get Medicaid. I got most of my psych health care and meds for cut rates or free.
After I got my Medicare, I had to go off of most of my meds. The newer ones with fewer side effects are all tier 4 or 5 drugs and I can not afford the copays. The older drugs, with lower copays, have so many negative side effects that I usually go off of them. This is not to mention the trouble of trying to get an appointment with a pdoc that both takes my Humana (Medicare) and is excepting new patients. In the middle of a bad cycle, I had to wait 3 months to get into a pdoc after I finally found one. All of the free or low income facilities turn you away if you have insurance, even though you can not get in anyplace else. In a lot of ways, I was better off with no insurance...

[gayleggg]

That's terrible. It hurts so many people. I have regular insurance and can't pay the extra cost of the tiers. I had to have my doctor totally redo my meds to get me on generics and no I don't think they work as well, but at least I'm stable.

When I signed up first for insurance I tried the Humana HMO plan until I found the closest pdoc was over 80 miles away. I switched to BCBS, but I don't think you have a choice being on Medicare. Best wishes to you. i wish we had a better system.

[DePressMe]

RCH, been there done that! Wish I had an the answer...I'm from Indiana too. I currently am paying out of pocket for a pdoc.

[nbritton]

Originally Posted by RCH1961

After I went on SSDI, I had a waiting period of a year before I got Medicare and the state of Indiana would not recognize my disorder as a disability, I did not get Medicaid.

That's odd, what is your diagnosis? Did they literally tell you your disorder is not recognized, or are you being figurative? If it's just a matter of them not knowing what schizoaffective disorder is then have your doctor change the diagnosis to bipolar disorder or schizophrenia. I find it hard to believe they would refuse to recognized a serious mental illness as a disability.

In Illinois, the state is helping with my Medicare premiums and drug copays. Lutuda now costs me like $3, it's been a godsend. I have no knowledge of Indiana's system, but the following links might offer some assistance.

I have never had a problem with a provider refusing Medicare part B reimbursement, what they typically refuse is Medicaid. Your part B benefits are not through Humana. it sounds like your problem is with your Medicare part D plan (which I assume is Humana), which is not the same as your part A or B benefits. You need to enroll in a different Medicare part D plan, there are more options then Humana. Use the Medicare plan finder (link below) to find a new part D plan.

Save on drug costs | Medicare.gov
State Pharmaceutical Assistance Programs
https://www.medicare.gov/find-a-plan...ions/home.aspx
https://www.humana.com/medicare/prod...are-drug-list/

What you need to do is print out your Medicare part D provider's formulary and take it with you on your next appointment, with the formulary your doctor will be able to swap your current medications out with tier 1 medications that your plan covers. If there is no tier 1 equivalent sometimes doctors will give out free samples indefinitely, or the pharmaceutical company will offer a patient assistance or discount program. Don't forget to consider over the counter treatment options.

[RCH1961]

You can go with a traditional Medicare plan or you are offered to go through an Insurance Company. The Insurance plan you go through includes a part D plan. By having my Medicare through Humana, only places that except Humana will take me as a patient. Believe me I have tried. Each plan offered by your Insurance Company's policy (part D) has different tier systems on their medications. The Medicare Insurance plans vary from carrier to carrier. You have pick the one that most closely addresses your needs and what most medical facilities will except in your area. I had a medical office quit seeing me when I switched from my Medicare plan through Blue Cross Blue Shield to my Medicare plan through Humana because they would except a Blue Cross but not Humana. You are allowed to kick in extra for a better plan while Medicare pays for the base plan. That is why every October, you get a booklet in the mail to evaluate each plan offered and you can change carriers from October to January 1st. The plans can change year to year. My first plan through Blue Cross Blue shield was at first wholly subsidized by Medicare. After the first year, they started to charge an extra amount over what they got from the government. I believe it was something like 35.00 a month for the exact plan I had the previous year at no cost to me. That is when I switched to a Humana plan wholly subsidized by Medicare.

[RCH1961]

Also, as I noted in my original post, most places I have gone to only offer the free sample drugs to people with no insurance. Most of the newer drugs with fewer side effects have not yet gone generic and have no equivalents on the market. Geodon just went generic this year but is still a tier 4 medication in its generic form. Also, Indiana is not as progressive as Illinois and has no state program to help pay for medications. They leave that to county extension agents and they can only help if their budget allows.

[RCH1961]

It may vary from state to state. I do know each state has their own laws regarding insurance companies and each company offers different policies in each state.

As far as my diagnosis, when I first went on disability, I was diagnosed with Bi-Polar with psychotic symptoms. It was the Bi-Polar that the state did not recognize as a serious enough disability to warrant Medicaid.