14
Columbia Gorge News
Wednesday, June 2, 2021
www.columbiagorgenews.com
Senior
news
June 2021
Through the Eyes of an Elder
A cautionary tale:
Medicare and drug prices
Through the Eyes of An Elder,
a monthly column in the Columbia Gorge News, is
sponsored by the Aging in the Gorge Alliance. Guest
writers address a variety of topics with a focus on older
adults, their families and loved ones, and caregivers.
Suggestions for future columns are welcome and can be
emailed to tdcastanares@gmail.com.
BY SUE ANN ARGUELLES
This month’s columnist, Sue Ann Arguelles,73, retired
from The Dalles-Wasco County Library and is now the
local coordinator for SHIBA. SHIBA is the federal
Medicare counseling program administered by the
state of Oregon and locally by the Mid-Columbia
Senior Center.
This vignette is fictional. But behind their colorful
aliases, the insurance companies described here are real,
as are the approximate drug prices.
Data are taken from https://www.medicare.gov/
plan-compare/#/?lang=en&year=2021.
Mary, Molly, Maud, Tru and Victoria were meeting for
breakfast. These five retirees had met every Wednesday
morning for years. When the pandemic restricted their
coffee shop, they continued on Zoom.
On this particular Wednesday, Victoria shared that
she was going to have to start taking insulin. Giving
herself shots would not be pleasant, but paying for them
could be devastating. Like the others, she had Medicare,
but she had never signed up for drug insurance. She
hadn’t planned to take anything but natural medicines,
and insurance didn’t cover them, so why should she pay
the premiums? But this insulin was another matter.
“I’ve heard that insulin is expensive,” she worried.
“How much does it cost?”
Mary, who had learned how to share her screen and
never missed a chance to practice, showed the first
Google search result — a GoodRx coupon to pay $96.75
for Victoria’s brand-name insulin at Pharmacy X. But the
coupon wasn’t good if the person had Medicare — did
that mean Part D, the drug part of Medicare?
Everyone else had drug coverage and an opinion
about Victoria’s situation. That’s how they learned they
were all on that same brand-name insulin. (It hadn’t
ever been mentioned before during their Wednesday
morning crepes with extra whipped cream.)
Maud paid $35/month for it on her no-deductible Nir-
vana Insurance prescription drug plan. She thought that
was a good deal for her $72/month premium.
But Tru said that wasn’t such a good deal. With her
Utopia Insurance plan she didn’t have to pay anything
for the same brand-name insulin, and her monthly pre-
mium was only $30. The plan said it had a $445 deduct-
ible but didn’t apply it to the insulin.
Victoria had a friend with a horror story about Utopia
Insurance. Admittedly she didn’t have to pay anything at
Pharmacy X for the insulin at first, though Pharmacy Y
would have charged her $7...
Tru interrupted, “That’s because Pharmacy X is a pre-
ferred in-network pharmacy for Utopia and Pharmacy
Y was just a standard in-network pharmacy. If she had
chosen a different insurance plan it could have been the
other way around.”
“That wasn’t the point,” said Victoria, irritated by the
interruption. “The point was that my friend didn’t have
to pay for the insulin at first, but after a few months she
went to pick up her insulin at Pharmacy X and this time
they charged her $126! I can tell you, that did her health
no good! By the end of the year their prices got more
reasonable, but she’d had it with Utopia. She switched to
a different drug plan for this year.”
Apparently Tru had an answer for that too, based on
the way her lips were moving. She must have known she
had offended Victoria and had put herself on mute.
Molly chimed in. “I thought I had a good deal with
my MedicareAdvantage plan in Appleburg. That plan
covered both doctors and drugs, so I didn’t have to shop
around for different drug plans. That brand of insulin
cost $47, which sounds kind of high after listening to
Tru and Maud. Then I had to change Advantage plans
when I moved to Cherrydale, and no plan in Cherrydale
County covered insulin. So I was going to have to pay full
price, $113. My doctor had to switch my insulin to a dif-
ferent brand. So, Mary — hey, Mary, where’d you go?”
Mary reappeared on screenwith a file folder in her hand.
“I never paid much attention. My husband signed us up
for Seventh Heaven drug coverage. It looks like I pay $96
for my insulin, after meeting the deductible.”
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Mary’s daughter appeared in the background. “Mom,
what’s the problem? You all have Medicare — doesn’t
that pay for your prescriptions?”
Molly, Maud, Tru and Victoria stared at her as best
they could on Zoom. “Yes, we’re on Medicare. It’s com-
plicated!”
•••
If you, too, have been confused about how Medicare
and drug coverage work together, why it is so compli-
cated, and what you might be able to do to simplify it for
yourself… please talk to your local SHIBA volunteer who
will help you to navigate the situation. Also, tell your
friends, your kids and grandkids about this! Most people
(even some doctors!) think that Medicare covers more
than it does, and we ALL need to learn the facts.
SHIBA counseling is free, and counselors do not sell
or endorse any insurance. Call 541 288-8341. Se habla
español — Spanish counseling is available, too — so
please tell your Spanish-speaking friends.
•••
Sue Ann Arguelles, retired from The Dalles-Wasco
County Library, is the local coordinator for SHIBA, a fed-
eral Medicare counseling program administered by the
state of Oregon and, locally, by the Mid Columbia Senior
Center. She figures an endocrinologist would roll her
eyes at the diabetic therapy in this vignette. However, the
insurance companies are real behind their aliases, as are
the drug prices, except for rounding and some probable
stray transcription errors. Data are taken from https://
www.medicare.gov/plan-compare/#/?lang=en&-
year=2021 .
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