50% or Discount

As you may know, I have the Medicare part d prescription plan to help with my drug cost since I am on disability with the heart-lung transplant. I am now in the ‘donut hole’ where I have to pay full price for the medication because of the gap in coverage. I wasn’t told of how the insurance company would figure your cost as combined with you pay and what they pay for the drugs. Say your drug costs $400. You pay $100 and the insurance pays $300. The cost that us added to your cost to reach the gap is not the $100 that you pay but $400, what both you and the insurance company pays. It sounds right, but of course, the insurance doesn’t really tell you that that is the method they use. You reach the gap and they stop paying until you reach the threshold where they pick it up again.

This has got to stop. The insurance company has to disclose the whole cost to you and so this up front, before you chose a plan. I’m sure others, especially seniors don’t always understand what the insurance companies are doing to them. I consider myself reasonably intelligent. If I can be fooled, I can imagine what an older less educated person must feel when hitting the gap. Food or drugs: make a decision.

I would propose a change to this: Let the insurance companies pick up 50% of the cost of the drug or have the pharmacy only charge you 50% of the cost of the drug, until you reach the gap, for those who have the Medicare Part D coverage. I might be able to take on the burden of the cost for a couple of months, but others are not as lucky as I am. If we pay the premiums, let’s get the costs down. Stop treating the older and disabled as second- class citizens and make the system work for them, rather than having the system work only for the drug companies and the insurance companies.


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