Sunday, July 3, 2011

Down the rabbit/donut hole

Mom's friend Lois passed early morning last Thursday. The aneurism surgery didn't go as well as expected on Tuesday and she declined after the procedure. I went out to church this morning with mom thinking that it would be hard for her but she was in good spirits. It's sad that Lois is gone but you just can't be sad when you think of the type of person she was - giving, enthusiastic and always ready to step in and help. I used to think my mom volunteered a lot, but Lois had a one-up on her. Lois' obituary called her a "professional volunteer" and I think that about sums it up.

Otherwise, mom has been feeling ok except for her feet. The hot weather (and we had some doozies last week) really irritate the soles of her feet. And she has been on her feet quite a bit last week as well so that doesn't help. And she will be on her feet a lot this week helping with Lois' visitation and funeral so she is in the mindset that she has to deal with it for now. She has been going to see Ralph, Lois' husband in extended care at the hospital, every day as well.

I don't even know where to pick up about the "Donut Hole" prescription insurance issue. Mom believes she is going to go with Blue Cross Blue Shield, as it really doesn't matter who the insurance carrier is - it's all Medicare Part D and it's all the same. She is learning more of the nuts and bolts of the plan, and now there seems to be not only donut hole (they like to call it a GAP) issue, but now there are Tiers of co-pay coverage: Tier 1, Generic Drugs; Tier 2, Preferred Brand Drugs; Tier 3, Brand Drugs; Tier 4, Specialty Drugs.

And guess what Tier the Lovenox is - yep the two highest Tiers.

They have two plans, a "Value" plan and a "Plus" plan, and depending on the plan she selects, will depend on her monthly premium, deductable and then the co-pays for the drugs. Both indicate that that when the GAP hits, she will receive a discount on brand name drugs, but I can't imagine what they think a "discount" is. After the gap she will pay whichever is the greater amount - flat copay or 5% coinsurance for the drug.

At (another issue) is the original letter from Caterpillar stating that she has reached the lifetime maximum benefits of the prescription insurance plan. If Obamacare is intended to do away with caps, then technically mom should be reaching a "cap," unless the government made a deal with Caterpillar that allowed them to have a cap. Now I need to read more about the health care reform.

That is what turns the donut hole into a rabbit hole.

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