Posted by: guinness222 | April 22, 2010

“…..and it starts!” Part II

       For years, particularly the last ten as I approached 65, I began to look forward to Social Security and Medicare as a way to at least “equalize” my income to costs as they soared in every sector of living. Medicare was a particular interest for me, because of my heart situations last year, and the thought of having paid in and now after 50+ years of paying I was at least going to be able to get something out of it. So I started getting deluged with mail, calls, and buddies all telling me about “medicare supplement” insurance. Seems there is no free lunch, and despite the fact that I am paying $162 a month in medicare premium, I need to carry “a supplement policy” to cover where medicare leaves off as well as prescriptions.

       After reading three dumpsters full of advertising and “ooow,…Pick me, I’m better” paperwork and e-mails and all that I decided to do the really intelligent thing. Talk to the guys at the Pub who had been on it for two to twenty years already and see what their experience and advise dictated I do. (Much better method as you can sip a pint while you chat, and stop them occasionally and say something like,…”so you’re saying they will pay for “x” but not “X’ plus “y”,..right?”.

           The unanimous consensus was grab a “Plan J” program as it offered the highest and best coverage on everything and get an accompanying prescription insurance plan for the medications. Soooo, that’s what I did.

           Now this week I received an “Explanation of Benefits” report from the prescription folks on my account. It starts of easy enough, telling me that for the month of  March I had paid $210.60 out of my pocket toward the prescriptions. It went on to tell me that, “What the Plan and Others Paid” was $542.78 ( the “others” being defined as “unqualified others; see definitions for more details”) WHAT FRICKIN’ definitions you horse’s asses!   are none on this paperwork you sent. Ok,….I’m still relatively calm here. Therefor the total cost of my “drugs” was $753.38 and I saved $15 by ordering by mail. WOW!!! be still my heart a two % savings!

           It then goes on to show my “Coverage Stages” (WTF???). It tells me my plan has “no deductible”, that be a good thing in “stage 1.

           Now stage 2, my “Initial coverage” (again WTF???) is a maximum of $2830 in total drug costs, and minus the $753.38 of “Total Drug Costs” from above, I have a balance remaining of  $2,076.62 “before Stage 3”.

          Now Stage 3 is is called my “Coverage Gap” and I get to pay “…100% – (but) Plan discounts still apply”. WHAT DISCOUNTS? AND,….I get to pay “after $2830 in total drug costs; up to $4550 in Tr0OOP” (Hey all by myself I figured out that TrOOP is my “True Out Of Pocket Amount”! So in plain English I get to suck it up and pay for the next $1,720 of medications all by myself. Again using simple English, and please let me know if I get too technically oriented here for you, Of the first $4,550 worth of prescriptions I am privileged to consume to stay alive, stay healthy, etc. I am going to pay out of my pocket, the Stage 2 amount of $1,720, PLUS my “TrOOP” (out of pocket cost) of approximately $850, OR a total of  $2,570 of the total of $4,550. Now I did not win any Einstein awards in Math, but that is 56% of the total cost of all these damn pills!! That is about $214 a month in TrOOP (Out of pocket costs)

        All I can say is thank God I’m “retired” so I can go get another job to cover the $50 a week I have to pay! (Anyone need a pissed off old man to rant and keep them awake? Call 1-800-who cares for help with that.)

    END of Today’s rant!

          “Aside from that Mrs. Lincoln,…how was the play?”  (sick humor)

          “What’s black and white, and black and white, and black and white? A nun falling down stairs. (Childish humor)

           “Trust the government. ”  (very late stage dementia humor)



  1. It becomes very interesting when one examines how much (how much less usually) drugs cost in other countries. So, any good deals in insurance or other such plans can easily be offset by simply raising the price of the drugs. Must be great to do business the way these guys do…

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