Countdown

As of next Monday, I will be officially on Medicare. Getting there has been long anticipated. But the process has not been easy, as anyone who has gone through it can attest. The plans are complicated, the rules byzantine, the language seemingly designed to confuse (though more likely just written in so many layers that getting to the basic facts is like going on an archeological dig).

To figure this out, Al and I went twice to see a SHINE counselor here in Massachusetts (Serving the Health Information Needs of Everyone—who thinks up these acronyms?) to sort through all the options. I knew from the get-go to avoid Medicare Advantage plans, since these can significantly restrict physician choice through narrow networks. Living with a chronic disease like scleroderma, that was a non-starter for me. We knew we wanted to get a Medicare supplemental plan to cover what Medicare Parts A and B do not. And I needed to be certain that all my expert specialists would be included in the plan.

Fortunately, the best plan we were interested in, offered by Massachusetts Blue Cross/Blue Shield, does cover all of my wonderful physicians. I made sure to check with them as well as with the BC/BS customer service rep. The premium costs about $200 per month, but the plan has no deductible, no copays, and excellent in-patient and skilled nursing coverage. Any provider or hospital that accepts Medicare is covered. Given how much I spent on copays, alone, with employer health insurance coverage, that will be a savings. So that is one load off my mind (at least, unless the plan changes at some point).

The bigger issue has been wading through Part D coverage options for my meds. Learning what’s involved with these plans has been a huge shock. I certainly had read about issues for drug costs for seniors and knew something, in general, about the “donut hole” problem (which I won’t even try to explain here). But I was stunned when I realized how much I would be paying for some of my medications: one Tier 5, and four Tier 4s (or two Tier 4s and two Tier 3s, depending on the plan).

Even with the excellent help of staff at the Massachusetts College of Pharmacy and Health Sciences (MCPHS), which offers a free service to state residents to sort through all the Part D plans, I learned that we would be paying about $10,000 annually. And that includes falling into the catastrophic coverage category. This prompted me to bring up the issue to both my Boston Medical rheumatologist and cardiologist. So we are now reevaluating my meds and alternatives. We’ve come up with a new plan that will cost about $,4,500 annually—certainly an improvement, but still three times our out-of-pocket expenses under our prior insurance.

One could argue that this is appropriate. Shouldn’t we all be making cost-conscious consumer decisions for our health care? Problem is, the cost of my Tier 5 medication is exorbitant. It’s been covered by a patent for years, and is going off patent later this year. As a result (I learned from the Part D Medicare web interface), its negotiated monthly cost, which forms the basis of what is paid by the patient and Part D, has increased more than 100 percent in the past few years, from around $5,000 up to more than $11,000. That’s monthly. The drug isn’t costing more to make. The pharmaceutical company is milking the patent  before it expires and a generic becomes available—which could still be costly. As my cardiologist noted, if they find another, slightly modified application, the patent could still be renewed. This is common practice.

One way or another, we’ll make it work. But it is high time that the high cost of drugs in this country, especially for seniors who cannot afford them, should be regulated. All it takes is one look at a Canadian drug website to know that what we’re paying is ridiculous.

For more than a year, Al and I have been paying a hefty COBRA premium to retain our excellent health insurance, which I really need or we’d go bankrupt. We’ve been waiting and waiting until my 65th birthday to drop that expense for a much more reasonable monthly premium (Al switches over in July). But it’s still not clear to me, given the drug situation, how much we will save. And this makes me angry.

There are other countries on this planet that make comprehensive health care available for all of their citizens. Let’s get past all the scare mongering, clarify and understand the true costs, and seriously consider universal health care here in the U.S. What we have now is just a confusing, inequitable mess.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com. Please view Privacy Policy here.

Image: SpaceX

First Attempt

I’m turning 65 this April. The time has come to apply for Medicare. Especially after a recent scare—when our COBRA plan failed to contact our insurance that we’d renewed our coverage for 2019 and we had no active health insurance for about a week—I don’t want to take a chance on missing any deadlines.

Back in December, Al and I met with a benefits counselor at our local council on aging to find out next steps. Since I have not yet applied for Social Security benefits, and don’t intend to until I’m 70, I did not receive a Medicare card automatically in the mail in January. The counselor advised, if that happened, to apply for Medicare in March. However, I recently read an excellent article in the New York Times that explained the rules in greater detail and found that I could enroll up to three months in advance.

Especially given the threat of yet another government shutdown this coming weekend, I figured I should take care of it this week. So down I went to the local Social Security office on Monday morning to apply. Al had warned me to get there early. I thought I was doing pretty well, arriving around 10:15 (I am so NOT a morning person).

What a mistake. The first sign that I had totally misjudged the situation was the parking lot. Every space in the upper lot next to the office’s front doors was taken. As I looked for a parking spot below, I noticed a steady trickle of people walking to the upper lot, and just a few coming back down.

Even with those hints, I was not prepared for what I found when I stepped inside. The place looked like a crowded airport terminal, with bland, beige walls and rows of people packed into every black vinyl seat. They were all waiting patiently, as if they had been through this many times before, facing a large video screen that streamed information about Social Security benefits and what number was next. I asked the guard who checked my bag how to get a number, and he pointed me to two kiosks. When I typed in my SSN, I got a receipt. My number was 74. On the board, the number was 23.

Within a few minutes, I was lucky enough to secure a seat. I was surrounded by families with screaming kids, a lot of adults chatting with friends or partners, and an atmosphere of pure drudgery. There were three staff members seated at desks only visible beyond glass windows in the wall that separated us from them. I started reading the news on my phone.

At least, when you go to the Registry of Motor Vehicles, there are usually a dozen staffers, and you can pretty quickly judge how long the wait will be by how often someone is called up to a window. Here, it quickly became obvious that numbers didn’t get called in sequence (we went from 24 to 27 to 4), and the wait between numbers was at least ten minutes. I did a little math in my head. At that rate, it would take me at least three and maybe four hours to have my turn.

Now, when you are in a waiting game like this, you have to decide early on whether you’re going to invest in sticking it out. Any longer than about 15 minutes, and you begin to feel you’ve invested so much time already, you might as well go the whole way. I left.

When I got home after running a couple of errands (so the time spent wasn’t a total waste), I went online to find out how to make an appointment for my next venture to Social Security. Lo and behold, I discovered that I could apply for Medicare benefits online. Of course. I hadn’t even thought to look in the first place. I guess that’s because I’m almost 65 and still think in terms of doing important business in person.

The whole process took about 15 minutes. I can check status of my application online through my Social Security account. I assume I filled everything out correctly. We shall see. At least I applied with enough time (I hope) to correct any errors. And if I do have to get back down to Social Security in person, I will make sure to force myself out of bed early, get there when the doors open—and bring a book.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com. Please view Privacy Policy here.

Image: Social Security Administration via Wiki Commons