The "The Government Entitlement Lie", edition.

iPad shuffled to Al Green, "Call Me".  I am always and forever an Al Green fan.  Health insurance update. It's been an adventure since the Detroit emergency manager forced the retirees off the health insurance program.  I fell into the "you're fucked" zone.  Let's get a backstory going. I wasn't feeling well for over a year and was getting worse. Going to work was a painful chore. I decided to retire.  I had 28.5 years. The optimum length of work is 30 years in order to get the health insurance benefit. However, I was covered by my husband's insurance. His DPD plan was better and less expensive.  I'd been covered for over 20 years.

"Stay in My Corner",  The Dells. A classic.  Marvin Junior hanging on that note forever.... :-)   Once the City filed for bankruptcy, the City would not offer the health insurance. For those of us ineligible for Medicare, we'd get a $125/month stipend to offset whatever we were able to get from the health insurance marketplace.  Except I got shifted to Medicare, which covers End Stage Renal Disease. For the record, I'd have been shifted over to Medicare by my provider after 3 years anyway.  I wasn't eligible for the $125 anyway.  I had been on my husband's plan. 

I applied for Medicare. I was accepted almost on the spot for Medicare and disability, due to the ESRD.   Although I now understand the reason behind all the lawyers advertising for assistance getting disability...story for another day.  Medicare..the entitlement that "certain" politicians revile, pays for 80% of the medical care. That would be Medicare Parts A and B.  I'd be be responsible for at least 20% of $75,000.  The average cost dialysis per year.  Yay?  I have to pay a premium, because I'm not 65. But that is deducted from the monthly disability check. However, drugs are not covered by Medicare Parts  A and B. 

I need something to take care of that 20% difference...and drugs. I can purchase a Medicare Advantage Plan. Yay?  It takes care of the 20% difference and the drugs!!!! The Medicare lady walked me through the process. Then there was an issue which I never fully understood, but I eventually received the card. I am covered. And yes, there is a premium for that also.  The premium is also automatically deducted from the disability check.  That's fine. The good news is I have a disability check to offset these additional costs. 

The Stylistics, "Stop, Look, and Listen". Yep, I played this one the piano. It was too pretty to not to try.  I added my own embellishments. :).    So far all is well.  Until I fill prescriptions. The first one came back at a cost of $700.00 to refill. WTF?  Fortunately the pharmacy called me way ahead of me actually needing the refill.  I tell my social worker. There are programs to offset the costs. Guess what.  I'm not eligible because of our income. Another prescription gets refilled.  It comes back at a $13 refill.  After $700, we jump to get it refilled.  The final med that needs the refill comes out to $438. Another WTF?  

I call my Medicare Advantage provider. Here's the deal. The 2 astronomical drugs are "specialty drugs". Tier 5 drugs. Well yes.  They are for ESRD patients. Nice penalty there. >:-(   $1100/month to stay alive.  Well I have a little out.  Medicare, doughnut holes.  Blah blah.  Listen carefully.  I have $310 deductible on drugs.  (Just one of the two drugs will take care of that on 1 refill).  After the deductible is met, then I only pay 25% of the cost. Well, hooray for me. One drug drops to $109/month, the other drops to $196/month. Now my drugs will cost $305/month. Yay?  Well it is significantly less than $1100/month.  Once I've paid out of pocket costs of $4550, I get a reasonable copay. Check my math. That won't happen. 

Roy Ayers, "You Send Me". It's the strings.  It's the vocals. It's the arrangement.  Well I go back to the disability check.  That's what it's there for.  Thank goodness.  I think that when the enrollment period opens, I will review the plans.  I had to rush into this health insurance quagmire quickly and uninformed.  But betcha I know now and am learning more.   I will talk with my nephrologist this morning if we can switch to generics. The idea that I am paying these crazy copays boggles my mind.  At least I can afford it.  Here's the deal.  Your social security payments are commiserate with your lifetime earnings. Think about that. That kinda blows my mind.  Entitlements ... Really?

I'm at the point that I have to do what I have to do.  I'm good. Signing off with Kem, "You're On My Mind". All my double folks are here today. :-)   My stick went smoothly.   My watercolor class is fun. I have water aerobics tonight. Oh yeah, health fair at Bert's at Eastern Market Saturday, March 29, 2014.  Brian and I will be manning the National Kidney Foundation booth from 10 AM to 1 PM. Hope to see you there!!!