Donut hole. Sounds like something to enjoy with morning coffee; it is! But there is another donut hole…and it’s not as sweet.
This is my first calendar year on Medicare. Selecting a plan was daunting. I had professional assistance from the HR director prior to my retirement date. We are now in the period referred to as “open enrollment.” Again.
While I was employed, open enrollment was fairly simple because there were fewer choices.
As a Medicare recipient there are so many options from which to choose. Basic. Part B. Part D, Part XYZ. Advantage plan. HMO, PPO, POS. Drug plan. Medigap. Dental. Vision. Hearing. The deadline fast approaches…December something.
In the beginning, they told be about the donut hole. I heard them. I had no idea I’d fall into the dreaded hole. Here I am. The worst part of being in the hole – well the whole thing is not good. It was two months before the mail order pharmacy communicated the situation with me. Robot calls to me from pharmacy.
Me calling my physician’s office to tell them what the robot said. Nurse assuring me the robot was not telling the truth. Me putting call into the pharmacy unsuccessfully contacting a human, live voice. Back and forth. Forth and back.
Finally, some one to exchange conversation and get explanations and answers. Did I want to authorize the co-pay of more than $700 for my regular cholesterol med and an additional more than $500 for Lyrica (for the return of trigenimal neuralgia). Uh, no.
Okay. So the customer service representative from the mail order pharmacy politely explains that the donut hole is a Medicare thing, not a Humana Advantage thing. In the meantime, I’m sure I can feel the cholesterol clogging my arteries. When the new year begins, I will be out of the donut hole, she says. I thank her and express that I am aware it is not her fault.
Resourceful and an out-of-the-box thinker with creative problem solving abilities – critical thinking – I start considering plan B. Not Medicare Plan B, rather plan B for this donut hole issue.
I research the label on Welchol (there is no generic equivalent) to identify the manufacturer. Got it. Google search. Seems as if their corporate office is in Japan. It doesn’t appear that they have any patient assistance or complimentary drug program for which I qualify. Donot hole my problem, not theirs.
The Google search did find drug assistance program contacts. The guy was really nice. There are about 800 programs for assistance. Oh, I just now fell into the donut hole? Some of his clients hit it in February!!! He was willing to take my information but advised me that it would be about six weeks before anything would be authorized. Geez, gotta plan ahead for this donut hole gig!
Moving on to next option. Call primary care provider and beg for samples. Score! The nurse had a small supply of samples and left them with the receptionist for me. I have an appointment tomorrow and maybe there will be more samples…
So now, I’m evaluating plan options for 2017. Looking for a way to not fall into the donut hole. No guarantees or promises. Depends on the cost of the drugs which depends on the availability of generic and the tier on the formulary. Many have a calculated month based on drugs’ costs, when you will fall into the coverage gap, aka donut hole. This is overwhelming for anyone, let alone seniors!
There are websites for Medicare. https://www.medicare.gov/find-a-plan/questions/home.aspx
If you are interested in an Advantage Plan, the Medicare approved plans also have websites. There are professionals who will assist in evaluating the myriad of plan options. Just have to find one. Sometimes there is a representative at local hospitals. Maybe even the library. There are help lines, too. Some folks are more knowledgeable than others; some sound like they read from a prepared script and have little or no understanding of what they read.
Bottom line, one size does not fit all. Advantage plans offer Silver Sneakers – free gym memberships for preventative health. I need a dental plan and a vision plan is good, too. At this point I don’t need any hearing benefits – but by 2018 who knows.
One size does not fit all.
Tomorrow morning is weekly coffee at the clubhouse…I’m having a donut too. The good kind.