This is a tale about something I know nothing about. The main characters are my mother-in-law (MIL) and my husband (Hub). The chief culprit is a non-human entity – Medicare - although if corporations can be people, mega-bureaucracies like Medicare can be people too. Why not?
Hub manages my MIL’s life now, including monitoring her medicine and medical care. Prescriptions are filled by her assisted living facility (ALF) via a local pharmacy. We receive the bills and disburse payment with my MIL’s funds.
The story begins sometime back in December. My MIL’s ALF decided to change pharmacies used to fill patients’ prescriptions. It is convenient for the facility to order, store and disperse the pills.
The facility began a new contract with the new pharmacy in December and ordered a one-month supply of pills for my MIL on December 2nd. My MIL ended up with two sets of pills for December - one from the old pharmacy and one from the new. The ALF returned the unused pills to the fired pharmacy for a refund.
Medicare is a complicated program. It pays for prescriptions, except for a deductible in the beginning of the year. Later in the year when the cost reaches a certain dollar amount recipients pay 25% of the cost of prescriptions, then 100%, and then nothing if another monetary amount is reached. The arrangement starts all over again on January 1st of each year.
My MIL paid 25% of the cost of the December prescriptions from the old pharmacy. We expected a rebate for the cost of the unused pills. We did not get anything. The entire refund went to Medicare. Apparently her 25% was allocated to the cost of the pills consumed, and the cost of the returned pills refunded to Medicare.
The ALF ordered a one-month supply of pills from the new pharmacy again on December 29th. The bill arrives in the mail. My MIL reached a new threshold and has to pay more than the 25% copay.
For December my MIL received no refund for the pills returned and paid more money for the new pills. Who do you argue with? The pharmacy? The assisted living facility? They should have waited for the New Year to order new pills. Medicare? Are you kidding?
My MIL was a victim of Medicare’s donut hole. A Medicare-eligible person pays a monthly fee for Medicare Part D drug coverage. Medicare initially covers the full cost of prescriptions. When the amount of the prescriptions filled reaches a certain dollar amount, another Medicare provision kicks in. The patient pays 25% and Medicare the remainder. The donut hole is a metaphorical dollar-driven spot where patients pay for a portion of their prescriptions. Patients in 2011 received a 50% discount on drugs when in the donut hole and less on generics. Once the next threshold is reached, $2,840, the patient pays 100% of the cost of prescriptions until the next level is reached - $4,550. Then the patient pays just 5% of the cost of the prescriptions.
Honestly, I am not even sure all these figures are correct. I am not an expert on any government program, and Medicare is as convoluted as they come. This is a disclaimer – I really do not know what I am talking about.
This website has a chart and maybe you can figure it out. The chart compares Medicare costs in 2011 and 2012. It is a good website if you need or want to understand the Medicare program.
The medical system is messed up and the elderly, who cannot, do not want to, or are unable to understand the intricacies of the system have no choice but to go along. Hub attempts to supervise my MIL’s medical life, but it is difficult. Too many questions, changes, and too many parties involved. My MIL believes the medicine is ‘free’ because the pills magically appear when needed. She does not have to pay cash, write a check or hand over her credit card. All the buying and prep work is done behind the scenes.
Medicine is not free and many drugs are expensive. Medicare pays a portion, my MIL pays a portion - although she is unaware of the expense - and hub gets the aggravation and frustration of dealing with the on-going situation. It is persistent. One issue is solved and another problem arises. ALF bills, pharmacy bills, Medicare disbursements, insurance bills and copays, doctor bills…
We wonder if the situation will be any better when we are in need of a great deal of medical and personal assistance. We do not want to burden our kids.
There ought to be a better way. We just do not know what it is, now or in the future.