Monday, January 28, 2013

Navigating the Maze

I just got my Medicare card.  When my husband lost his job, we lost our health insurance, so Medicare here I come!

I've decided I will need a Medicare Supplement.  So, I look at this chart to decide which plan I want to buy.  This has to be purchased from an insurance company.

Not all plans are sold by all companies in all geographical areas, so you have to find the right one for your circumstances.  Also, you have to consider how much premium you want to pay.

Okay, then you need a plan to cover prescription drugs.  That means you have to purchase a Plan D plan.

Part D is more confusing than the other parts.  I haven't quite mastered it yet, but at least I know what a web site is (see above).  Not all plans are sold in all areas, and different drug companies have different formularies.  What are formularies?  Well, that's a whole different question!  Each insurance company lists all the drugs in its formulary, then groups them into tiers based on their price.  Tier One drugs are the least expensive and Tier Four are the most expensive.  Sorry if this is boring, but I'm just learning about it.  I used to live in blissful ignorance about all of this!

To make a long story short, you list all of your drugs, then plug them into each plan available in your area, then find out how much it's going to cost to buy Part D.

Then, after a while you hit the "donut hole".  That's a period of time where Part D stops paying and all of your drugs are paid for out of your own pocket.  Look at the diagram below.  Does this make sense?

I spoke to a Medicare adviser and found out my donut hole expenses are going to be really high!  So now I've been looking up all of my medicines to see if I can switch to generic versions.  I also found out there are coupons and discounts you can use while you are in the donut hole.  This is a whole new world for me.  I have found a handful of discount cards and coupons that I can take to my pharmacy.  It remains to be seen how much I will be able to save when I hit the donut hole!  But at least it gives me hope that there is help out there.

I've been experiencing a whole new learning curve, spending a lot of time, doing research and making phone calls.  I keep thinking about how naive I used to be, not questioning that I had health care coverage, just walking into the doctor's office or the pharmacy and handing them my card.  It was all taken care of, just like that!  All of a sudden, that safety net has been taken away.  It's eye-opening.  Now when I hear politicians talking about what to do about health care coverage in this country, I come to attention!

A friend of mine had a pillow that said "Aging isn't for sissies".  Well, now I really know what that means!


Pam said...

I cannot believe how over-complicated things are getting Judy. It borders on insanity, and we are all being dragged into the net as unwilling participants.
It strikes me that only the most persistent and knowledgeable can understand these areas, so others are left vulnerable.
Donut hole? I mean really! More like the black hole of the Bermuda Triangle.
Someone is getting a lot of money designing these concepts, while the struggling majority get lost in them!
Good luck Judy. I had to navigate two online courses over the weekend for future employment, which, once upon a time, used to be school site based - drove me crazy.

judy in ky said...

Your words are so true, Pam. I have been able to use my wits and persistence to navigate these waters, but I wonder about those who are less able. It seems like it has been designed to keep us in the dark as much as possible.
You made me laugh about the Bermuda Triangle. Best of luck to you as you navigate your own course to future employment.