Medicare is a good deal if you are healthy, but for the unlucky 10-15% who have serious problems, healthcare costs and drug costs can add up quickly.
Frank is turning 65 in May and had planned to keep working, but he got laid off – perhaps because his health affected his job performance. The day I met with Frank, he had just found out he has diabetes and his doctor had prescribed an insulin pen.
High drug costs can really hurt.
I put Frank’s drug list into the Medicare.gov Plan Finder and found that he will go into the donut hole in five months. Because the full cost of his drugs is over $800 per month, he will reach $2,960 in just over three months. At that point he is in the donut hole/coverage gap, so he will pay $405.70 per month for his prescriptions. He gets a 55% discount on the retail price of brand drugs, otherwise he’d be paying twice as much.
Add the $405 for drugs to his Medicare premium ($104.90) and his Medicare supplement premium ($148), and he will be spending almost half of his Social Security check on his healthcare.
Poor Frank was overwhelmed by the news about his diabetes and his drug costs. He said he will not take Zetia. I told him he’d better talk to his doctor – but he was pretty insistent on dropping Zetia. He knows he needs to take insulin, but thinks he can get away with not treating his high cholesterol.
I told Frank that the donut hole/coverage gap in Part D was designed to push people like him to ask why their doctor prescribed such expensive medication – and if there isn’t a lower-cost drug for their condition. Unfortunately, that donut hole can also force people like Frank to forego medication that might keep them healthy. What a dumb system!