Medicare and Insurance {blech}

Insurance is a wonderful thing. Negotiating your way through the various offerings, what they cost, and what they cover can be a true nightmare.

Take Medicare, for example. I don’t know why it has to be so complicated. I’ve talked to countless companies (Blue Cross, AAA, and Humana just to name a few); I’ve been to a few Web sites (including the official Medicare site) and could only get one to actually send a representative out to talk to us. Everyone else wanted me to just go out to their Web site and figure out the best coverage that I could get for Ron. Right now, he’s on my group plan at work but because he is turning 65 in January, he’s eligible to take out the supplemental plans with no medical questions being asked. For him, that’s a big deal. If I keep him on my group plan, he might not qualify later. But, my issue isn’t really the monthly premium (although paying over $300 per month to insure just him is not in my financial comfort zone, especially with “donut-hole” amounts for prescriptions on top of that, plus co-pays and deductibles) – it’s the prescription cost. Medicare supplemental plans have what is called a “donut-hole” in them. Drug coverage is up to a certain dollar amount and then you pay fully out-of-pocket until you reach another certain dollar amount. Then you go happily along until you hit another level and then you fall into that hole once again – only it’s larger this time. Once you crawl out of that hole, you can “hope” that the rest of the year your hole is no longer a crater-sized hole.

Right now, on my group plan, we pay $250 per month for the two of us (I know, that’s a great premium and I’m not complaining). The coverage is adequate for most people. I have a $1750 per person deductible and $7000 maximum out-of-pocket per family. Since April, I’ve met the deductible for both of us (that’s $3500) and I’m well on the way to meeting the $7,000 maximum for the year. After you meet your deductible, insurance pays 80% of reasonable and customary, leaving the other 20% for us. That has added up to another chunk of change (going toward the $7,000 amount). Prescriptions are $17 for generics (90 day supply in most instances) and between the two of us, we have 24 generic prescriptions. Doing the math - $17 * 24 * 4 – it amounts to over $1600. Insulin (this is the kicker) is $180 for 90-day supply – but he takes two different kinds, so that is $360 for 90-day supply. That math is over $1400. Added to the generic costs, our prescription out-of-pocket for the year is easily over $3,000. Just the premium ($3,000), plus the deductible ($3,500), plus the prescription costs ($3,000) put quite the bite in our finances (just in case you thought I was just out here blowing my money on trips and things… hahaha). Add in the co-pays and you have the potential to be spending a lot of money medically (just this week I found out the co-pay on Ron’s new socket liners is over $350 so I should be seeing a bill for that any time; just got another co-pay bill for $1298 and they’d like their money in full but will let me make 4 equal payments {choke, choke}).

Medicare will take $99 out of his Social Security check beginning in January (he will get a 1.7% raise on his check but that is nowhere close to $99). I could decline Part B but I’m not sure that it is a good idea to do that. Supplemental policies that I’ve looked at are up to $160 per month. Part D (the drug plan) plans are anywhere from $20 and up (one I looked at last night was $44). So, now I’m up to a little over $300 just for Ron’s insurance. One particular plan has no co-pay and no deductible. That’s good… a savings of $1750 right off the bat. Prescription co-pays are lower (mostly) but right off the bat, in January (because of the cost of insulin) we would fall into one donut-hole – our out-of-pocket for the month would be over $1400. Yikes! I don’t really “have” $1400 in January for prescriptions. February and March, we’re OK but in April it’s a CRATER – forget the donut-hole. Out-of-pocket estimates are in excess of $2300 for his meds for the month of April. Seriously? $2300??? Well, if I don’t have $1400 in January, you can bet your bippy that I don’t have $2300 in April either. (Plus, I’m sure there is something about federal income taxes that will hit me then…) In a nutshell, the annual costs for the insurance plus his prescription out-of-pocket is roughly $7600 (the best combination of medical and prescription coverage) but not sure that includes what the government will charge for Part B (which is another $1188). If we changed how his insulin is given (vials instead of pens – and I’d just have to draw up the syringes and leave them in the fridge for him), it might save us a little bit of money. The above out-of-pocket assumes that I would be refilling ALL of his prescriptions in January, April, July, and October. They don’t really fall that way so the dollars would fall a bit differently but still be substantial in the months we had prescriptions filled.

So, do I save any money by putting him on Medicare? If I took him off my group plan at work, I’d go back to my policy that I get as a benefit from him retiring from Boeing. The premium is… $10 (yes, that is a “ten”) per month. No deductible. $10 office call co-pay. Generics are $7 per month. That’s a big savings for my coverage but taking into consideration that his premiums and such would go up, not an overall savings. I think in the grand scheme of things, it would be a savings but maybe the overall amounts wouldn’t fall in such a way that it would benefit us.

I don’t know why the whole thing is so darn complicated. Why do we have to have a donut hole (or crater)? Why can’t it just be we pay X amount for prescriptions each month, every month, and not fall into those high dollar situations? It’s enough to make you want to stop taking medications. I can see why seniors sometimes have to choose to eat or to take their meds as prescribed. I can definitely see us cutting back just to stretch things a bit more. Getting (and staying) healthier is a smart move, but it’s already too late for Ron. The best he can do is maintain (and his A1C, which measures your glucose levels over a three month average, is down to 5.9%, which is outstanding; anything before 7 is diabetic in excellent control). His creatinine and potassium levels are excellent so what we’re doing is working. We just have to keep that up.

Back in the swing of things

Sort of...

I am so grateful for the messages of sympathy and support from my friends (both IRL and blogging). You all cannot imagine how much I appreciated all of your messages. You never know until something like this happens who your real friends are and who are the ones who disappear. I'm sure we've all experienced things like that.

The time following my mom's passing and up to the funeral seemed to go by so quickly and also to just crawl. I didn't want to say good-bye. I wanted to hear her voice one more time. I wanted to tell her how much I loved her one more time. Thursday (the 27th) she was still pretty alert and was having a lot of cramping in her left foot. It wasn't much but I was able to rub her foot when a cramp would hit and help it to go away. I get these same kind of toe cramps and I know how badly they hurt; the only real relief is to get up and walk it out. One time, it must have been too bad because she very clearly said, "let go." By Friday, she was pretty much unresponsive  and had mostly quit talking. I spent a lot of Friday afternoon and evening alone with her and I was able to talk to her quite a bit. I'm sure she heard and understood but she didn't really say anything. I know she was really uncomfortable and in a lot of pain so I made sure the nurses kept her pain medicine coming as often as she was able to have it and when she needed it.

My mom loved hummingbirds and always had one or two feeders up, plus she had a bird bath in her yard. My kids went together and bought this for me in memory of my mom. I was really touched and I think it's just beautiful.

The last week has been busy (getting back into the swing of things at work) but my mind hasn't been able to come to grips with the finality of "good-bye" and keeping the good memories front and center. Like her birthday present...In the last couple of years, Mom developed a liking for the slots at the casino. It was the one piece of entertainment she could do, she could afford it, and she could forget how badly she felt and how little quality of life that she had. She didn't look at it as gambling - she was just entertaining herself. I gave her $40 to spend on the Wheel of Fortune game and she smiled so big when I gave it to her - just like a kid in a candy store! She had a great time that day and I am so glad that I was able to go with her that last time (I was supposed to go back to KC the weekend of 9/16 and my sister and I were going to take her on my way back home).

I need to get back into a normal routine. Ron's doing OK - not great, but OK. His short-term memory is my biggest complaint right now. He just doesn't remember things that he needs to. Sometimes he acts like a child instead of an adult and that frustrates me quite a bit. He gets something in his head or on his mind and he just doesn't let go. He's been like this his whole life but lately it's been much worse. He'll interrupt people to ask questions or to have someone get him something or do something for him. He frustrates me a great deal these days. I told him Sunday that I didn't like us very well sometimes. I don't like feeling like this. I'm sure a lot of it is me - I'm short on patience these days.

In Loving Memory

Patricia (Pat) JoAnne (Dowdy) Keesee of Kansas City, MO (Northland) entered the arms of Jesus on Saturday, September 29, 2012, at Kindred Hospital. Visitation will be from 6:00-8:00 PM Wednesday, October 3 at D.W. Newcomer’s Sons White Chapel Memorial Gardens, Gladstone. Funeral Services will be Thursday, October 4, 2012 at 10:00 AM at White Chapel with burial following. In lieu of flowers, the family suggests contributions can be made to the American Diabetes Association.

Pat was born in Kansas City, MO on August 27, 1930 to Agnes Maude (Turner) and William G. Dowdy, Sr. She retired from Southwestern Bell Telephone Company in March 1987 after 30 years of service. Pat was a former member of the Northland Optimist Club and was recognized by the Salvation Army Consistent Giving Hero Society. Pat was preceded in death by her husband, William (Bill) Keesee; a daughter, Kathryn Anne (Keesee) Gold; a grandson, Justin Teal Roberts; her parents; and three brothers, Glen Dowdy, John Dowdy, and Robert Dowdy. Pat is survived by three sons and three daughters; William Richard Keesee (Susie), Robert Franklin Keesee (Kathy), Teresa Gayle Williams (Ron), Jerry Ray Keesee (Leasa), Valerie Michelle McKim (Mike), and Kristina Renee Page; one brother and two sisters, Gerald Dowdy, Lois Wells, and Judy Loman; 22 grandchildren; 27 great-grandchildren, as well as numerous nieces and nephews.

Pat and Bill met in the courtyard at the Alamo in San Antonio, TX, in January, 1949 while she was on vacation and he was on a one-day pass from basic training at Lackland Air Force Base. Pat was standing with a group of people when this Airman approached her and asked if she would take a picture with him. Thinking he was the cutest guy she had ever seen, she said yes. Pat and Bill had their photo taken together before they even knew the other’s name. They were married on September 8, 1949 and lived a love story that lasted over 56 years. Pat had recently relocated to the Garden Village Independent Senior Living community, where she was a well-loved resident. She was a much-loved mother and grandmother, and an amazing great-grandmother (GG) to all of her great-grandchildren. Grandchildren and great-grandchildren alike will all treasure the memories they created with her.
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Just how do you say goodbye to the most amazing, wonderful mother in the world? I don't know. I don't know how I'm going to do it. I already miss her - I miss the telephone calls and the visits and I know I'll miss watching her at Hollywood. The back-and-forth late night Facebook conversations... I'll cherish them all, especially my birthday message. I knew that I could talk to her anytime that I wanted to and could take her phone calls anytime she wanted to call. Heaven is a "long distance" call that I'd love to be able to make. I know that she was welcomed with open arms, hugs, and much rejoicing by those who have gone ahead of her. It's those of us left behind who will have to figure out a way to make it through our days without her presence, humor, and conversations. My mom and dad have left such a legacy in their children, grandchildren, and great-grandchildren. There's not any one person who ever crossed her path who wasn't affected in some way or another by her presence. She loved us all unconditionally and accepted us - faults and all - without reservation. I know that we all disappointed her at one time or another but she never held our shortcomings against us. She set a great example for others to try to live up to. She left some big shoes to fill and I don't think any of us will ever measure up. God knew that it was time for His earthly angel to come home.