When I was nearing 65 and becoming part of Medicare, I thought I had done my homework. I had performed comparison studies on what Medicare was going to cover and what additional insurance I would need to cover me during the Medigap or times when Medicare Parts A. B and D were not going to cover me. I consider myself to be a fairly intelligent individual. I have a college degree, graduate hours and worked as a professional for almost 25 years. I really believed I had done my homework. Wow, was I ever wrong!
I turned 65 in the summer, so the first year, or for me six months in
the program, I rolled merrily along, pleased with the low amount of
costs occurring because I suffer from chronic conditions including
fibromyalgia, side effects of shingles and on-going pain in my back and
hips due to avascular necrosis and osteoarthritis. As I said, when I
applied for my Medicare supplement plans, I heard about co-pays, Tiers
1,2 and 3 drugs and somewhere in my conversations with potential
providers, the term "Medigap". However, I guess I did not listen
As I said, I was just fine the first six months in the program. I was
not concerned because I thought I knew what everything was going to
cost. I knew I was covered because I never paid any co-pays for doctor's
visits, tests or labs and I was careful to have my routine drugs filled
on the 90-day prescription program offered by my Part D coverage. I
believed I was doing everything right. My drug costs seemed reasonable
and I was always careful to choose generic or lower tier drugs as much
as possible. Two of the drugs I must take do not have generic
equivalents so I always expected my co-pay for those to be higher than
for my other drugs.
In early October, my doctor called in a one-week supply of one of my
Tier 1 drugs while I waited on my mail- order prescription to arrive.
When I went to pick up the prescription, the cost was several hundred
dollars. I was told I was in the Donut Hole. I thought I was going to
pass out. A second shock happened when, a few days later, my 90-day
prescription bill showed up on my bank card. I thought the Medigap Donut
Hole was going to ruin us financially.
I began checking to determine exactly what had happened. I telephoned
the Part D provider and that time I learned, the hard way, what I had
not learned in the beginning. Each time I got a drug filled, no matter
the co-pay, the additional cost of the drug was being charged to a
pre-determined amount of charges. I had reached that magic number and
from that time until I paid out a total of over $4,000 in additional
drug costs, I was responsible for the total cost of the drug. I was just
lucky the same thing had not happened also with Medical Costs.
Learn from my mistakes. Please learn the terms, learn how they apply to
your Medigap or Supplement Insurance, in particular you Part D
Insurance. Ask questions and don't be afraid to sound stupid. I only
wish I had not been so smug.