How To Get Help Paying For Prescriptions If Your A Middle-class
The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State program for seniors administered by the Department of Health. It helps more than 327,000 income-eligible seniors aged 65 and older to supplement their out-of-pocket Medicare Part D drug plan costs.
Even if you earn up to $100,000 filing joint you can enroll in EPIC.
InsuredMeds.com is an independent Health, Medicare, Life, Final Expenses insurance specialist. We work for you not the insurance companies to get you the best prices and insurance protection. IMC
A senior citizen got a call from someone claiming that his Social Security number had been “compromised,” according to report.
The “Robo type” caller told the senior to call a special number, in order to fix the so-called problem.
Instead, the senior did what police say a victim should always do in a case like this — call the police.
Law enforcement told him to get a free credit check, to confirm that his social security number had not been used in a fraudulent manner.
These types of robocall scams are happening across America.
The fraudulent schemers target senior citizens and Medicare Part D participants. The scams can occur anytime, but they tend to increase during tax filing time when getting someone’s Social Security number can provide access to a person’s tax return information.
1-800-772-1214 Comes On Caller I.D.
The Robo caller even has a way for the Social Security Administration’s national customer service line to come upon a person’s caller ID.
The schemer identifies themselves to the senior or veteran as an SSA representative. They then tell the senior or veteran that the SSA does not have all their required information, such as their Social Security Number, on file.
Another scheme is that the SSA need additional information to increase the senior or veterans benefit check, or that the SSA will stop the senior or veterans payments if they do not confirm their information.
“A legitimate caller will leave a message and you can call them back.”
An SSA staffer will never tell you that you can lose your benefits or increase your benefits in return for you providing the requested information.
If you get this robocall it is a fraud scheme and you should hang up. Hanging up is your best protection if you get this type of call.
Never give your SS number or banking information to someone that called you out of the blue either on the phone or over the internet.
Report this scheme to the Office of the Inspector General at 800-269-0271 or oig.ssa.gov/report.
Our female veterans deserve better care when they come home. They deserve treatment opportunities and care that is gender specific. Trying to tailor medical and mental health treatments designed for men to work with women is not an option. Systems must be designed so that women who serve are properly cared for in every aspect, with gender specific treatment options and devices.
Access to gender-appropriate care for these veterans is essential.
Gender Differences in Treatment for Disabilities
A troubling area where female veterans are not provided adequate and equal care after their service is in treatment for disabilities. Many women lose one or more limbs just like male veterans do, however prosthetic devices, support, and medical care for these injuries are based on male physiology. Women tend to have smaller arms and shoulders, with wider hips and legs than male counterparts.
Prosthetic used for women tend to fit improperly because of the physical differences between the genders. This can create many hardships, and cause considerable emotional distress as well as problems with confidence and self-esteem for female veterans. While customized prosthetic for women are available on the private market they are generally not offered by government agencies.
Vital Healthcare Services For Female Veterans are Lacking
The number of women veterans is growing, and the VA is simply not doing enough to meet their health, social, and economic needs.
As more women serve in the military, the rates of PTSD in women veterans continue to keep pace with male statistics. Although some of it is caused by combat or related stress, the effects of Military Sexual Trauma (MST) have an outsized effect on women.
The DoD and the VA still fall short of providing equitable health care services to all veterans. There are few, if any, gender specific care guidelines and services that are necessary for women such as breast and cervical cancer screenings. Policies must be changed and improved on so that women who serve are not left behind once they return home.
The best way for a female veteran is to have other health insurance other than the VA. Once a female veteran has been disabled for two years and receiving social security she can then apply for Medicare and receive additional medical benefits, those who turn 65 automatically qualify for Medicare.
What Services Does VA Offer Female Vets?
VA provides comprehensive primary care that includes services for acute and chronic illnesses, preventive services, and gender-specific care, and other services. VA’s medical staff are experts in providing medical care and services beyond primary care, including:
• Military sexual trauma-related care
• Military and environmental exposure
Women Veterans can apply for VA health care enrollment and other Veterans benefits by completing VA Form 10- 10EZ. To complete the form:
• Apply online at www.1010ez.med.va.gov •
Visit, call, or write to any VA health care facility or Veterans’ benefits office • Call the VA Health Benefits Call Center toll free at 877-222-VETS (8387)
• Get more information online about VA benefits (www.vba.va.gov) and eligibility (www.va.gov/ healtheligibility/)
Please share with any veterans who need this information.
Why does VA require you to provide information on your health insurance coverage (including coverage under a spouse’s plan)?
They ask for this information because they have to bill your private health insurance provider for any care, supplies, or medicine we provide to treat your non-service-connected conditions (illnesses or injuries that aren’t related to your military service).
They don’t bill Medicare or Medicaid, but we may bill Medicare supplemental health insurance for covered services.
What if my health insurance provider doesn’t cover all the non-service-connected care that VA bills them for?
You won’t have to pay any unpaid balance not covered by your health insurance provider. But, depending on your eligibility priority group, you may have to pay a VA copayment for non-service-connected care.
Does it help me in any way to give VA my health insurance information?
Yes. Giving the VA your health insurance information helps you because:
When your private health insurance provider pays them for your non-service-connected care, VA may be able to use the funds to offset part—or all—of your VA copayment.
Your private insurer may apply your VA health care charges toward your annual deductible (the amount of money you pay toward your care each year before your insurance starts paying for care).
Does your current health insurance status affect whether you can get VA health care benefits?
No. Whether or not you have health insurance coverage doesn’t affect the VA health care benefits you can get.
Note: It’s always a good idea to let your VA doctor know if you’re receiving care outside VA. This helps your provider coordinate your care to help keep you safe and make sure you’re getting care that’s proven to work and that meets your specific needs.
If You Are Accepted Into VA Health Care Program
Should you give up my private health insurance or other insurance (like TRICARE or Medicare) if you’r accepted into the VA health care program?
This is your decision. You can save money if you drop your private health insurance, but there are risks. The VA encourages you to keep your insurance because:
The VA doesn’t normally provide care for Veterans’ family members. So, if you drop your private insurance plan, your family may have no health coverage.
The VA doesn’t know if Congress will provide enough funding in future years for it to care for all Veterans who are signed up for VA health care. If you’re in one of the lower priority groups, you could lose your VA health care benefits in the future. And, if you don’t keep your private insurance, this would leave you with no coverage.
If you have Medicare Part B (coverage for doctors and outpatient services) and you cancel it, you won’t be able to get it back until January of the following year. And, you may have to pay a penalty to get your coverage back.
Should You Signup For Medicare When You Turn 65
Yes. The VA encourages you to sign up for Medicare as soon as you can. This is because:
The VA doesn’t know if Congress will provide enough funding in future years for it to provide care for all Veterans who are signed up for VA health care. If you’re in one of the lower priority groups, you could lose your VA health care benefits in the future.
Having Medicare means you’re covered if you need to go to a non-VA hospital or doctor—so you have more options to choose from.
If you delay signing up for Medicare Part B (coverage for doctors and outpatient services) and then need to sign up later because you lose your VA health care benefits or need more choice in care options, you’ll pay a penalty. This penalty gets bigger each year you delay signing up—and you’ll pay it every year for the rest of your life.
If you sign up for Medicare Part D (coverage for prescription drugs), you’ll be able to use it to get medicine from non-VA doctors and fill your prescriptions at your local pharmacy instead of through the VA mail-order service. But you should know that VA prescription drug coverage is better than Medicare coverage—and there’s no penalty for delaying Medicare Part D.
Having Both VA & Medicare
If you signed up for VA health care, and you also have Medicare, what’s covered by each?
You’ll need to choose which benefits to use each time you receive care.
To use VA benefits, you’ll need to get care at a VA medical center or other VA location. The VA also covers your care if they pre-authorize you (meaning we give you permission ahead of time) to get services in a non-VA hospital or other care setting. Keep in mind that you may need to pay a VA copayment for non-service-connected care.
If you go to a non-VA care setting, Medicare may pay for your care. Or, if the VA only authorizes some services in a non-VA location, then Medicare may pay for other services you may need during your stay. Check your Medicare plan so you know which care locations and services you’re covered for.
Health Savings Account (HSA) And VA Care
Can you use your Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA) to help pay for VA care for non-service-connected conditions?
Yes. The VA may bill and accept reimbursement from High Deductible Health Plans (HDHPs) for medical care and services to treat your non-service-connected conditions. If you have an HDHP linked to an HSA, you can use your HSA to pay your VA copayments for non-service-connected care.
The VA may also accept reimbursement from HRAs for care the VA provides to treat your non-service-connected conditions.
How To Best Take CBD Oil-The Best Way
It is best to take sublingually. Place it under your tongue and hold for 1-3 minutes then swallow. Do not drink, eat or smoke for at least 15-30 minutes afterwards for optimal absorption. eniorsJoints.com CBD Oil is the highest quality CBD on the market and provides a variety of benefits. This product is safe for use and legal in all 50 states. Available as a tincture, it is easy to use and integrates comfortable with your daily routine. ALL NATURAL FORMULA
Our CBD Oil uses proven, organic all natural ingredients that are toxin-free. Our CBD Oil is 100% natural and does not contain any dangerous synthetic chemicals, stimulants or pesticides. NO SIDE EFFECTS
Our CBD Oil does not contain THC, therefore you don’t have any side effects. THC is the cannabinoid in Marijuana that gets smokers “High”. Fortunately for you, the health benefit comes from the Hemp CBD and not from the THC. NO PRESCRIPTION REQUIRED
Being safe and legal, our Hemp CBD can be ordered from our website, so you can skip the long queues and expensive bills at the doctor. How To Best Take CBD Oil-The Best Way
Download PDF of Everything You Need To Know About Applying for VA Veterans Benfits
Click here: Applying For Veteran’s BenefitsHow To Apply For VA Benefits
In this article we share with you how to apply and what are the requirements to receive VA benefits.
Myths vs. Facts
• Benefits are not just based on war time service. For every Veteran who does NOT sign up, the VA loses in fact approx. $2,200 from their annual budget. Even if you do not use them, they’re there for you if you do. Active Component who have served two years.Reservists and National Guard members may be eligible for VA healthcare benefits if they were called to active duty (other than for training) by a Federal order and completed the full period for which they were ordered to active duty (typically 179 days).There are limited benefits available for spouses and family.
• What InsuredMeds.com offers is that I am trained in military healthcare benefits and my goal is to add value to your Veteran overall health choices and enhance your wellbeing. Most Veterans are unaware of their earned benefits. I will help you maximise additional healthcare services that compliment, not compete, with earned government benefit programs. You benefit from a streamlined health and wellness program, which may result in more efficient deliver of services across time and distance, increased flexibility, preventative care services, decreased wait times for care, and substantial monthly savings.
PLEASE SHARE WITH ALL THE VETERANS IN YOUR LIFE!!! PLEASE SUBSCRIBE TO OUR NEWSLETTER!!
majority of frequent (daily) CBD users find that a dose
between 10 and 20 mg (administered once or twice daily) is enough to provide effective relief from a variety of
ailments. However, a lot of people out there will find fantastic relief with as
little as 1-3 mg per day.
take too much CBD oil?
a small dose of high CBD/low
THC oil, especially
if you have little or
no experience with cannabis.
… Too much THC,
while not lethal, can amplify
anxiety and mood disorders. CBD has
no known adverse side effects, but an excessive amount of CBD could be less effective
therapeutically than a moderate dose.
How long does it take for CBD oil to work?
majority of cases, it takes about an hour to feel the effects of CBD oil after
you ingest it. However, effects may be felt in as little as 20 minutes on an empty stomach.
The more food you’ve eaten before consuming CBD oil, the longer the effects
will take to kick in.
What are the side effects of CBD?
Some research indicates that the use of CBD oil may trigger a number of
side effects, including:
Does CBD oil come in different strengths?
of CBD Oil. Even though there are dozens of different
CBD manufacturers out there to choose from, most of
them will offer oils in at least two or
three different potencies, or concentrations. … As of right now
they offer oil tinctures in three different strengths: 300 mg, 600
mg, and 1000 mg , etc.
How many mg of CBD is effective?
Cumulative doses of THC exceeding 20-30 mg per day – or a
single dose of 10 mg or more – may cause unwanted side effects. For
cannabis-naïve patients, it may be best to start with low doses of a CBD-rich
remedy with little THC and slowly increase the dosage – and, if necessary, the
amount of THC – one step at a time.
All the information in this video
is presented as personal opinion and does not mean to be medical advice nor in
anyway to be an endorsement of any of the treatments or items listed herein.
Always consult a physician for all medical advice. This video can contain errors or omissions and should not take the place of licensed medical care
Two years ago Gretchen Liu, 78, had a transient ischemic attack — which experts sometimes call a “mini stroke” — while on a trip to China. After she recovered and returned home to San Francisco, her doctor prescribed a generic medication called telmisartan to help manage her blood pressure.
Liu and her husband Z. Ming Ma, a retired physicist, are insured through an Anthem Medicare plan. Ma ordered the telmisartan through Express Scripts, the company that manages pharmacy benefits for Anthem and also provides a mail-order service.
The copay for a 90-day supply was $285, which seemed high to Ma.
“I couldn’t understand it — it’s a generic,” said Ma. “But it was a serious situation, so I just got it.”
A month later, Ma and his wife were about to leave on another trip, and Ma needed to stock up on her medication. Because 90 days hadn’t yet passed, Anthem wouldn’t cover it. So during a trip to his local Costco, Ma asked the pharmacist how much it would cost if he got the prescription there and paid out of pocket.
The pharmacist told him it would cost about $40.
“I was very shocked,” said Ma. “I had no idea if I asked to pay cash, they’d give me a different price.”
Ma’s experience of finding a copay higher than the cost of the drug wasn’t that unusual. Insurance copays are higher than the cost of the drug about 25 percent of the time, according to a study published in March by the University of Southern California’s Schaeffer Center for Health Policy and Economics.
USC researchers analyzed 9.5 million prescriptions filled during the first half of 2013. They compared the copay amount to what the pharmacy was reimbursed for the medication and found in the cases where the copay was higher, the overpayments averaged $7.69, totaling $135 million that year.
USC economist Karen Van Nuys, a lead author of the study, had her own story of overpayment. She discovered she could buy a one-year supply of her generic heart medication for $35 out of pocket instead of $120 using her health insurance.
Van Nuys said her experience, and media reports she had read about the practice, spurred her and her colleagues to conduct the study. She had also heard industry lobbyists refer to the practice as “outlier.”
“I wouldn’t call one in four an ‘outlier practice,’” Van Nuys said.
“You have insurance because your belief is, you’re paying premiums, so when you need care, a large fraction of that cost is going to be borne by your insurance company,” said Geoffrey Joyce, a USC economist who co-authored the study with Van Nuys. “The whole notion that you are paying more for the drug with insurance is just mind boggling, to think that they’re doing this and getting away with it.”
Graphic by Lisa Overton
Joyce told PBS NewsHour Weekend the inflated copays could be explained by the role in the pharmaceutical supply chain played by pharmacy benefit managers, or PBMs. He explained that insurers outsource the management of prescription drug benefits to pharmacy benefit managers, which determine what drugs will be covered by a health insurance plan, and what the copay will be. “PBMs run the show,” said Joyce.
In the case of Express Scripts, the company manages pharmacy benefits for insurers and also provides a prescription mail-delivery service.
Express Scripts spokesperson Brian Henry confirmed to PBS NewsHour Weekend the $285 copay that Ma paid in 2016 for his wife’s telmisartan was correct, but didn’t provide an explanation as to why it was so much higher than the $40 Costco price. Henry said that big retailers like Costco sometimes offer deep discounts on drugs through low-cost generics programs.
USC’s Geoffrey Joyce said it is possible that Costco negotiated a better deal on telmisartan from the drug’s maker than Express Scripts did, and thus could sell it for cheaper. But, he said, the price difference, $285 versus $40, was too large for this to be the likely explanation.
Joyce said it is possible another set of behind-the-scenes negotiations between the pharmacy benefit managers and drug makers played a role. He explained that drug manufacturers will make payments to pharmacy benefit managers called “rebates.”
Rebates help determine where a drug will be placed on a health plan’s formulary. Formularies often have “tiers” that determine what the copay will be, with a “tier one” drug often being the cheapest, and the higher tiers more expensive.
Pharmacy benefit managers usually take a cut of the rebate and then pass them on to the insurer. Insurers say they use use the money to lower costs for patients.
Joy said a big rebate to a pharmacy benefit manager can mean placement on a low tier with a low copayment, which helps drives more patients to take that drug.
In the case of Ma’s telmisartan, Express Scripts confirmed to PBS NewsHour Weekend that the generic drug was designated a “nonpreferred brand,” which put it on the plan’s highest tier with the highest copay.
Joyce said sometimes pharmacy benefit managers try to push customers to take another medication for which it had negotiated a bigger rebate. “It’s financially in their benefit that you take the other drug,” said Joyce. “But that’s of little consolation to the person who just goes to the pharmacy with a prescription that their physician gave them.”
But Joyce said the pharmacy benefit managers also profit when collecting copays that are higher than the cost of the drug.
In recent years, the industry has taken a lot of heat from the media and elected officials over a controversial practice called “clawbacks.” This happens when a pharmacist collects a copay at the cash register that’s higher than the cost of the drug, and the pharmacy benefit manager takes most of the difference.
The three largest pharmacy benefit managers – Express Scripts, CVS Caremark, and OptumRx – all told PBS NewsHour Weekend they do not engage in clawbacks.
But Howard Jacobson, a pharmacist at Rockville Centre Pharmacy in Long Island, NY, showed PBS NewsHour Weekend several recent examples of clawbacks. In one instance, Howardson acquired a dose of the generic diabetes Metformin for $1.61. He said if a patient paid out-of-pocket, he likely would sell if for $4. But in a recent transaction, the pharmacy benefit manager told Jacobson to collect a $10.84 copay from the patient, and it took back $8.91.
In the case of Z. Ming Ma and his wife Gretchen Liu, there was no pharmacist involved, because they purchased the medication directly from Express Scripts.
Express Scripts’ Brian Henry reiterated to PBS NewsHour Weekend that the company does not engage in clawbacks and opposes the practice. And he also blamed the health insurer, Anthem, for Ma’s high copay. “Anthem has its own Pharmacy and Therapeutics committee that evaluates placement of drugs on the formulary based on their own clinical and cost review – thus setting their own formulary and pricing,” Henry said in an email.
But Lori McLaughlin, a spokesperson for Anthem, pointed the finger back at Express Scripts. “Anthem currently contracts with Express Scripts for pharmacy benefit manager services and under that agreement Express Scripts provides the drug pricing,” she said in a statement. “Anthem is committed to ensuring consumers have expanded access to high-quality, affordable health care which includes access to prescription drugs at a reasonable price.”
McLaughlin also pointed to a lawsuit filed in March 2016 by Anthem against Express Scripts, for, she said, “breach of its obligation to provide competitive pharmacy pricing.”
As for Express Scripts’ contention that it doesn’t engage in clawbacks, USC’s Karen Van Nuys said it’s a matter of semantics. “Whenever the copay is higher than the cash price, and the difference isn’t reimbursed to the patient, someone else must be pocketing the difference,” Van Nuys said. “Maybe it isn’t technically called a clawback, but the principle is the same.”
So what’s a patient to do? Websites like GoodRx and WellRx can help consumers find the best prices at local pharmacies. They provide coupons and savings cards for certain drugs as well as out-of-pocket price information, which could be less than a copay.
It’s not always better to pay out-of-pocket, even if it’s cheaper. Patients need to look at the terms of their insurance plans and do the math.If a patient has a high deductible, it might make more sense in the long-run to pay the higher price and use up the deductible so insurance kicks in sooner.
Z. Ming Ma said he does find the Express Scripts home delivery service convenient. But he wasn’t happy about the price of his wife’s medication, and is glad he found another way to buy it.
“You have no choice, you can’t bargain,” he said. “I knew I wasn’t going to win.”
This story has been updated to reflect that Gretchen Liu is 78 years old.