Woman can’t afford her prescriptions.

Just a few days to go until the end of the Medicare Open Enrollment period and I have a few observations and questions.

Why are Part D plans allowed to change drastically from one year to the next?

I’ve written about the First Health Part D plan going from $26 this year to $53 in 2014. How many people will be shocked in January or February to realize their premium has doubled – and that they should have read the Annual Notice of Change they received back in late-September?

And what ‘s the deal with the Humana-Walmart plans? The plan that has been around for three years is going up to $22.60 next year, but now there is a new Humana-Walmart plan that will cost just $12.40 per month. These plans looks alike, but one is more expensive. The lower-cost plan has a $310 deductible, but it does not apply to generics. Why didn’t Humana just roll people from the current, more-expensive plan to the lower-cost plan?

Why are drugs so expensive that people can’t afford them?

People need insulin to live, but I have run into several people who are having a hard time paying for their insulin and their other brand drugs.

A lady told me just the other day that she is in the donut hole and is not taking all her medications because she can’t afford them. Her Social Security check is just a bit above the limit for getting help with her prescriptions. She takes insulin and two other brand drugs as well as several generics. Her prescription costs are very high, especially once she goes into the donut hole.

What kind of country is this that we tell her she’ll just have to figure out which pills to take and which ones she should skip?  This woman is not a taker. She worked her whole life and saved some money for retirement, but she got unlucky when it came to her health.

This woman could enroll in a Medicare Advantage plan that will not charge her for her insulin, but she would have to give up several of her doctors because they are not contracted with these “special needs plans”. That’s a tough choice, so she’ll keep going through her savings to pay for her pills and insulin.

I talked to a woman yesterday who said she might have to sell her house in order to pay her medical bills – and she’s fairly healthy. She needs surgery on her ankle and knows she won’t be able to afford the co-pays for physical therapy that come with her Medicare Advantage plan. She’ll have to make do with one or two visits to the physical therapist and skip the rest of the recommended treatments.

Listening to talk radio as I drive to appointments, I have heard Rush Limbaugh talking about how people expect everything for free – including health care. I have a feeling Rush has the money to pay for his health insurance co-pays and prescriptions.  But he’s part of the 1% for whom cost is not an issue.  Most of the people I meet are very concerned about how co-pays for their drugs and medical care go up each year… as their life savings go down.  It’s not a pleasant picture of getting old.



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