OK, I know, some of you don’t like political posts.
And this is political, in the sense that, all the candidates who are pushing “Medicare for All” are not candidates that should be voted for, amen.
But, really, this is a look at how Medicare “works”—as someone who is currently going through the incredibly difficult work of selecting a plan.
Here’s why it’s hard:
I take a medication that must be the brand medication. I cannot take the generic because we can’t get what’s called a “therapeutic level” with it. The drug in question? Prograf. The drug that basically keeps me alive. So, I have to take brand name Prograf, which is expensive.
I see all the normal doctors people see—dentist, eye doctor, etc. But I also see special specialists. Meaning, doctors that are not normal run of the mill doctors.
I also see these doctors in two separate hospital systems—The Resort, and OSU (Ohio State).
So, we must find a plan that covers my meds, my doctors, and my hospitals.
Under private insurance, this was not hard at all. I just typed in names and meds, saw they were covered, signed up. Done. It took less than a half hour.
Private insurance did not like to pay for prograf, but it did. And if it didn’t, then the manufacturer had a Prograf saver card I could use to reduce the out of pocket costs.
Now, I have Medicare.
And here are all the problems.
There are plans that refuse to cover prograf. It’s not even in their formulary. It just says, “not covered.” Even though this med is basically what keeps me alive. There are many, many plans who do not cover it in any way, shape, or form.
There are plans that cover the med, but not my doctors. As in, one entire group of plans refuses to cover any OSU doctors. OHIO STATE! One of the top-ranked systems in the country!
These are, to put it mildly, big problems.
My dad and I have spent at least three days—as in, hours upon hours!—on the phone with people, looking at plans on line, until our eyes have crossed and our brains have melted.
Because a plan will cover some of these things—but then we’ll see, oh, there’s no out of pocket max. Well, that’s gonna get expensive, quickly.
They’ll cover my endocrinologist, but not my transplant doctor!
They’ll cover doctors, but not meds!
Or meds, but not doctors or hospitals!
Do we see the problem here?
Oh, and to make it even better, Medicaid will cover Prograf. But Medicare plans don’t!
And the copay card? Doesn’t work for Medicare patients. Only private insurance patients—when Prograf was covered by my private insurance!
This is insanity.
They’ll cover things like acupuncture and chiropractic, but not the med that keeps me alive. Not top doctors at top medical facilities. Nah. That’s too hard.
Also, it’s insanely complicated to compare plans. They don’t always list what doctors are covered, or what meds are covered. They don’t mention facilities. They put in stuff like Silver Sneakers—well, goodie, a free gym pass!—but not stuff that is actually life saving and vital!
How about we not cover gym costs, and instead, cover medications that keep people alive?
Oh, and. This is the good part.
Here’s an NYT story on this issue. Medicare will cover transplant meds if the transplant occurred while the person was on Medicare. NOT BEFORE.
This is the biggest piece of insanity I have ever seen. These are drugs that we know work. They are not new therapies, they’re not snake oil. They are proven. And yet, no, I’m sorry, we won’t cover that.
We have presidential candidates saying that this insanely complicated, twisted, insane system should be the one health care provider for the entire nation?
No.
Or, to be spicy, HELL NO.