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My $45,000 Per Month Inhaler

It shouldn't be this way, but every year between 15 October and 7 December, Americans who use Medicare for their health coverage, most of whom are 65 and older, can change their coverage for the coming year during the “open enrollment” period.

That sounds accommodating but the real reason is not for insureds' benefit; it is for insurers and big pharma. Not to mention that it has always been a teeth-grinding, boring task each year to compare current coverage to what is available for the next year, but at least it was close to accurate.

Not so this year.

It has never been a good idea to just go with the coverage you've got because insurers are allowed to and may have:

• Raised premiums
• Raised deductibles
• Raised co-pays
• Changed the prices of drugs you use
• Removed some of those drugs from the formulary
• Limited the size of prescriptions

To make it even more adventurous, they might also move drugs around among the four “tiers” which can change the price too.

(There is no law against reducing the prices of drugs. Someone tell me why it is that I doubt that would happen.)

When the new Medicare materials arrived in the mail from the federal government this year, I was appalled to see that there are 28 Part D (prescription drug) plans available in my area for 2020. Count them: 28.

(Am I the only person who knows that too many choices is no choice at all?)

There are also just as many Medicare Advantage programs in case I want to switch from traditional Medicare. No thank you.

What this means is that I needed to look at each of the 28 drug plans on Medicare's website, figure out the cost of each and compare them to my current plan.

The process of finding a reasonably priced plan is so tedious it could make you cry. But this year is worse than previous ones. Truly awful, I would call it, because it turns out the Medicare website is broken this year. ProPublica reports:

”The federal government recently redesigned a digital tool that helps seniors navigate complicated Medicare choices, but consumer advocates say it’s malfunctioning with alarming frequency, offering inaccurate cost estimates and creating chaos in some states during the open enrollment period.”

Inaccurate? You want inaccurate? How about $45,000 per month for an inhaler? Yes, I really meant to put all those zeroes on the price.

(I spoke about this recentlyi on The Alex and Ronni Show. If you really care about additional details, you can view the show here.)

No matter which plans I tested, the same price came up for the inhaler. $45,000.

Well, that's just a joke, isn't it. Even if it were correct. But I didn't believe all 28 providers would just happen to assign an identical price. Okay, I only checked six or eight plans before I sought outside help. But still.

It took several days of calling around to Medicare, insurers and others – all useless - until I found a savior, an extremely well-informed woman who told me to change the number of doses per month on the Medicare website chart from 60 to 1, and explained what Medicare had got wrong:

The Medicare website assumed that each dose, two-a-day in my case, was a separate inhaler so that according to them, I needed 60 inhalers a month instead of one inhaler containing 60 doses.

Whew! But why didn't the customer service representatives know this when I telephoned?

ProPubica goes on to report that Nebraska shut down a Medicare network of 350 volunteer telephone helpers because the website is so problematic. One insurer sent a warning email to insurance brokers nationwide because Medicare's online tool was producing too many errors, reports ProPublica, and

”Minnesota’s Association of Area Agencies on Aging said in a news release on Nov. 14 that the Medicare Plan Finder 'continues to produce flawed results,' including inaccurate premium estimates, incorrect prescription drug costs and inaccurate costs with extra help subsidies.”

Medicare told ProPublica that they tested the redesigned site before its launch. Really?!?

AARP has also written about the mistakes on the Medicare website. Their advice is to call the insurer to double-check the website prices, drug availability and

”For people who have already picked a plan and thought they were finished with open enrollment, advocates say they too should go back, call the plan they have selected and make sure the prices and other information on the website were correct.”

Been there, done that and all I got was, “If that's the price on the website, that's the price.”

I'm sorry that I have no other suggestions for you.

Being old is hard enough. Reading pages and pages of fine print online, mostly numbers, while trying to sort out what one's healthcare will cost in the coming year and then having to wonder if it is accurate is really unkind – even nasty.

The holiday got in my way last week and I'm late posting this story. Open enrollment is in effect only through next Saturday, but that still leaves time to double-check your plan selection for 2020.

I'm going to give the insurer I selected for next year another call and then hold my breath until January to see if I am charged $90-something for that inhaler instead of $45,000.

You should probably do that too – the phone call, I mean, not hold your breath. Good luck.



Comments

And you're not suffering from dementia. And you're highly literate. I don't know what those people are doing. "Medicare for All" is a good idea, maybe...but first, demonstrate that they can make the current Medicare work.

And I thought it was me! One of my drugs rolled out a $10,000 number, from one Part D supplier to another. I still don't really know.

Good luck to everyone.

It is a headache-inducing nightmare! I am reviewing it for myself and for my sis as her caregiver. She takes a number of meds including for high blood pressure, heart and dementia. I try to keep us both on the same plan for ease, but must be sure it's best for each of us. Thankfully my needs are fewer but could, of course, change anytime.

An article in Forbes back in September listed 15 problems in the new plan finder that I saved. Sounds like nothing has been fixed.

Thank you for this important message. Every year you have helped us know about and navigate Medicare.

I had the same thought as Mary Jamison above. If this exercise is challenging for the most intelligent and savvy among us — I put you in that category, Ronni — what about folks who have some sort of intellectual impairment? Or who just don’t have full-time access to a computer?

It’s a shame that more people can’t see that some form of health-care-for-all or single-payer system would ultimately be better than the mess we’ve got.

My husband and I are still a couple of years away from figuring this out. I plan to re-read all your columns on this topic before then. Thanks, Ronni.

May I post a pet peeve here? It’s those people who ask both in person and online, “does Medicare cover XYZ?”

People, it doesn’t really matter! Everyone of the hundreds of different Medicare plan iterations can result in vastly different out-of-pocket payments ranging from zero to thousands, depending on what plan you have. So there is little value in asking does Medicare cover blah blah blah. Apparently there are still many people out there who think if Medicare covers something it means it’s “free”.

Just had to get that out. I have heard it so many times in the past couple of months. Sorry!

All too familiar. As corporations rely on computers MORE, real people do not have the knowledge necessary to answer real questions. In fact, it seems to be a challenge to actually communicate with the one knowledgeable person at an insurance company. That person has been extremely diluted by corporate's greed. Taking processing into the manufacturing level, square pegs are ignored; only round pegs get handled. With the arrival of the "boomer" generation into retirement, this method will not fly. Too many new retirees with too many new questions for the diluted person. Hence, $45,000, inhalers. Well, the next few years will be quite interesting, huh? B

Having so many choices drove me crazy when I first signed up. I went to an insurance agent who specializes in Medicare for help. She's saved me money every year. This year she pointed me to a Part D plan that would save me a fair amount of money, even though it was one that wouldn't pay her a commission. I've never been disappointed with her recommendations. And think of the time and money saved and headaches avoided!

I've often thought, as I counted and sorted pills into my weekly pillboxes, that if I were one bit less lucid than I am now, I'd need a nurse or someone else to do it for me.

As for Medicare, I've been lying awake nights trying to decide what to do. My current Medicare Advantage plan will no longer be accepted by my beloved primary care physician. They will accept a certain other MA plan, but it's the one I've been begged by several doctor's offices to avoid (and my oncology center won't accept them at all anymore). And original Medicare doesn't have out-of-pocket limits, a real concern if my cancer comes back.

I guess if I let the clock tick down the decision will be made for me. And I'll have to find a new PCP to treat the ulcer I'll have by then.

I can relate, but after about a couple hours over several days with the Medicare comparison tool, I figured out, on behalf of my wife, that I had to adjust the dosage on one of her daily meds so that the software could calculate one packet from a box of 60 daily vs 60 packers or one box daily (number of packets in a box is 60). I can't recall the total dollars but it was many thousands. After that, everything seems to have fallen into line and we switched part D plans for her and I think it will all work out to an annual cost saving for her.

The problem is that I am a former technical sales rep and fairly literate with computers, programs and how to work through their sometimes complicated quirks; She is not so good and would never be able arrive at an informed drug plan decision. This is probably true for many, if not most, elders. And, even I, self-proclaimed-computer-problem solver, will gradually face diminished capabilities and will be "screwed" without help, and the problem is even the helpers often don't know what they are doing or talking about. But, I'll not worry for a while--famous last words as it may be later than I think.

I first became aware of the nightmare of selecting Part D when I was my mother’s caregiver. I am an RN but was totally lost and had so much trouble figuring out what to do. I am highly suspicious of Advantage Plans because despite all the frills they come with some private insurer is making a lot of money or they wouldn’t be offering the plan. Advantage plans are another boondoggle for the insurance industry.

Now as a senior I stay with traditional Medicare and a supplemental. Fortunately I only need cheap common drugs now and I shutter to think of the problems that will probably occur when that changes.

There has to be a way for this country to transition to a single payer plan that is robust enough to give people the care they require without private insurers walking away with such a big piece of the healthcare pie. Thank you for providing Medicare information. It is a crazy maze every year.

Maybe someone thinks that the more negative publicity Medicare gets, the less people will want to vote for Medicare for All?

Cindy, that was my thought too. Very cynical of me of course, but this is a federal program and I wouldn't doubt that it's been messed with under this administration just to make Medicare for All look bad. Don't believe it! I'm Canadian so perhaps I should criticize your system, but honestly...!!! I take 8 different perscription medications, for heart, blood pressure, thyroid, etc. A 3-month perscription that includes all of them is about $150 and by the end of the year it drops to roughly $50. That includes the dispensing fee from the pharmacy.

I meant to say that "I should NOTt criticize) sorry.

How do I get to keep my name and number in your blog registry?
G got great volumes of inhqlers through Blue cross. It was good whole it laasted.

I think Medicare has been made more difficult by the current regime. Plus the constant nibbling away of some benefits. Vote people.

I'm super-appreciative of the fact that my husband worked for an HMO that offered a truly "platinum" retiree health plan. We've never had to struggle through what sounds like a nightmarish Medicare system with far too many "choices". We have a Medicare Advantage plan. There's no premium, no deductible, no co-pays and almost no out-of-pocket costs. (I worry every year that they'll cancel it--which they reserve the right to do, of course--but so far, so good.)

A potential downside, which has not been a big problem for us so far, is that we must use in-network doctors (including specialists), hospitals and pharmacies. There can be a fairly long wait to see a specialist for a non-urgent issue. Some services are quite limited; i.e., we're allowed only 10 physical therapy, chiropractic, massage therapy, acupuncture or mental health visits per year. PT rarely provides ongoing therapy--just instructions on what to do at home. I have several non-life-threatening but chronic, incurable medical conditions that cause significant pain on a daily basis. Coverage for much-ballyhooed "alternatives" to a mild opioid medication is limited, which is O.K. since they didn't work for me anyway.

I consider us WAY on the fortunate side in that we have basically acceptable care at very low cost without having to wade through the Medicare Maze every year. There MUST be a better way for older people to find a plan that is right for them!

(BTW, I wish there weren't a 30-minute time-out on posting comments. If I walk away to feed the cats, I then have to start all over. Guess I should plan better!)

Ronni, every time I deal with a large corporation, be it insurance, electronics, appliance suppliers, power companies, etc. etc., I assume they are out to screw me. And I have limited tolerance for long hold times and people who don't know what they are doing. I have to be really, really motivated to persevere with these jerks.

I just signed up for Medicare Advantage. As my Scottish friend says, "I hae me doots", but I thought I'd take a year out from regular Medicare and federal retiree insurance. Probably stupid of me, but I just got overwhelmed and gave in to all the mailings I have gotten about this plan. And it had four and a half stars!

I echo others' comments, too. And who knows, if Trump is re-elected, maybe Medicare won't even be available any more.

Remember the days when you could just call someone at a company and they knew what you were talking about and you could resolve the problem within 5 minutes or so?

I was new to Medicare in June. Can't stand going over it all again so I am just leaving the decision I made in April. I bought traditional Medicare with a supplemental plan because after an insurance broker carefully explained the differences, I could see that even with good health now, I am probably better off this way than going with an Advantage plan in the event I ever have a serious issue.

Family history on one side supports a long life with few or no medical complications. The other side is more problematic.

Forget Medicare for all. I wish we'd just go full bore and do a national health program that doesn't incorporate private insurance..

Another reason to enjoy retirement in Canada. I will spend tomorrow reviewing my requests for donations to charity on "Giving Tuesday" with nary a care about my health coverage. I just drop in to my doctor, specialist or laboratory, show my card and walk out whistling. This year was a drag because I had to go to the provincial office, prove who I was to get my new 5-year card.

This stupidity gets me so riled up I start swearing. Many years ago, long before I retired and had to deal with it myself, I witnessed an elderly gentleman in a local drugstore, trying desperately to both understand and be understood as he waged war with...the pharmacist? No. His doctor? No. With the damn system! It was all too confusing and my heart broke for him.

And now it's even worse! The elderly, the frail and failing, those with limited funds and resources should be the LAST people on earth to have to deal with 'the system'. Because we all know 'the system' stinks to high heaven. It's all about the money. Follow the money. Private insurers don't give a flip about you.

I'm with Elizabeth. A national health program that gives the boot to private insurers.

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