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Tina
Tina, Lawyer
Category: Legal
Satisfied Customers: 8775
Experience:  JD, BBA Over 25 years legal and business experience.
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I am preparing my appeal 4 the determination that my Extra

Customer Question

I am preparing my appeal 4 the determination that my Extra Help will be discontinued. I am disabled with peripheral neuropathy, insulin-dependent diabetes, and 5 bulging discs. It took me five years to win my case, the first one was denied. Recently I was awarded my social security disability income as of March 2016. I had been on Medicaid. Since my income has increased I do not receive Medicaid and now I use my medicare, which to me is appropriate.
However, if I don't continue to have my Extra Help I am worried about getting by month to month. I have 23 prescriptions, and my co-pays are in the thousands of dollars per month. I am familiar with the catastrophic care for Medicare medications. I still would have trouble making that $4,800 payment that would be required each year.
Is there anything helpful you can suggest to me to write in my appeal. I am making a list of all my medicines and their cost. But of course I have no idea what the appeal judge is looking for in a patient and their finances. Any suggestions or things to emphasize in my appeal. It is due October 1st and I plan on completing it this week if I can. Thank you very much, Baylor Van Meter Capers,
Submitted: 9 months ago.
Category: Legal
Expert:  Susan Scott replied 9 months ago.

I practice Social Security Disability law. However I am very familiar with Medicare Law and the Affordable Care Act. You need to call Healthcare.gov st 1(###) ###-#### It concerns me that you are being told that it will still cost you $4800 per year for your medications/copays. I suggest that you do not try to do through the website but CALL and explain that you are on disability and medicare and you need assistance paying the copays and medications.

Customer: replied 9 months ago.
Thank you for getting back to me. I have just called the number you provided @ healthcare.gov. The representative seemed polite and thorough, however she said that she would not be able to help me because this entity only assists with applying for private "marketplace" insurance.
Customer: replied 9 months ago.
Hi there again Ms. Scott - would it be possible to get specific assistance with my Medicare Part D "Extra Help" Discontinuance Appeal?
The $4800.00 payment I mentioned earlier is part of Medicares "Catastrophic Coverage" plan. I was wondering if you are familiar with these particulars? This would apply to my situation if I lose my Extra Help. I am hoping since I have so many medicines (23 Rx) I could receive some exception as I would reach this bar in about 1-2 months as opposed to a more average Rx consumer might take 8-11 months to hit this bar, spreading their costs over more time.
Thank you very much, Baylor