Wednesday, October 27, 2010

Donuts I Don't Like

I'm in the donut hole which none of you know anything about unless you're over 65 or are a pharmacist. This explanation and chart from Wikipedia (not always a reliable source as we know but is in this case) gives you the idea.

The following table shows the Medicare benefit breakdown (including the donut hole) for 2009, for 2010 the total TrOOP has increased to $4,550 before catastrophic coverage begins.

  • "Total drug spend" represents the actual cost of the drugs purchased, factoring in any Medicare discounts.
  • "TrOOP" (true out-of-pocket expenses) represents the amount of their own money that the patient has paid.
  • The donut hole is shown below in grey.

2009 Medicare Part D payments

Total drug spend TrOOP Out-of-pocket cost Portion covered by Medicare
$0–$295 $0–$295 Deductible is out-of-pocket No Medicare coverage of costs
$295–$2,700 $295–$896.25 25% out-of-pocket 75% covered by Medicare
$2,700-$6,154 $896.25-$4,350.25 All costs are out-of-pocket No Medicare coverage of costs
over $6,154 over $4,350.25 5% out-of-pocket 95% covered by Medicare

Last year I got in the donut hole a little over a month before the year was over. This year I got there in July, which means I pay full price for all my prescriptions from August until the end of the year. I won't reach that out-of-pocket amount (thank goodness) which would let me get more coverage later on. This means I'm stuck paying around $500 for my prescriptions a month along with what I pay for Medicare and the Advantage Plan I have. That brings it to over $700 a month. That's a big chunk out of my teacher retirement and social security, which together is maybe 70-75% of my salary as a teacher, which in rural Tennessee isn't that much to begin with.

The Healthcare Plan is supposed to do away with the donut hole next year. I hope the Republicans that get elected don't do away with the new plan. Can they? Since this donut hole idea started in 2006, we know who was president and which party had the majority in the legislature.

I would be happy and willing to pay more in taxes to help provide national healthcare coverage. I believe it is part of being a caring, concerned citizen to help those who need it however we can. Any taxes I'd pay would definitely be less than I'm paying now for my meds, which is not the whole point but a factor for sure. I can't wrap my head around personal and corporate greed and am glad I can't. There's help out there for those who can't pay for their meds, but typically, I make too much for that but not enough to comfortably pay it. I'm making it but will do better next year when this isn't an issue.

What is a major concern are those people who pay much more for their meds than I do and have to decide between medication and food or heat. This is just wrong. People shouldn't lose their homes and businesses because of medical costs, but it happens. We fall short in so many ways "compared to other industrialized countries" - a phrase seen too often in vital issues.


froggy said...

It shouldn't be this hard!!!! Or confusing. Or just plain strange!

Wonder Man said...

oh wow, now I'm scared