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Health care

Private Fingers in the Medicare Pot

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A thousand curses upon the craven politicos who decided that private industry should get its sticky paws on anything related to Medicare. What a freaking mess! And it’s like this not because of the “government” the right wing so loves to hate but because of the programs that are run by private insurance companies.

No amount of federal regulation stops these SOBs from putting the screws on the customers.

A quick refresher course in the complexities:

Medicare consists of five programs. Medicare Part A covers hospitalization, hospice, and (in very  limited circumstances) some nursing home and home-health care. Medicare Part B covers doctors’ visits, some other types of health-care providers, outpatient care, durable medical equipment, home health care, and some preventive care. Each of these programs pays 80 percent and the patient pays 20 percent. Medicare Part C is a scheme roughly equivalent to HMOs and PPOs that strictly limit one’s choice in providers — something that can be very dangerous if you think you need a high-powered specialist and some insurance clerk says otherwise.

Obviously, 20 percent of the bill for catastrophic care or for a serious long-term disease such as cancer, MS, Parkinson’s, Alzheimer’s, or diabetes would quickly drain the savings of most elderly Americans. And since we all have to die of something, if you don’t go in an accident or by your own hand, chances are very high that the medical industry sooner or later will pauperize you. In the case of a married couple, this will mean that by the time one person dies, the other will be reduced to the most desperate kind of poverty, no matter how faithfully they have saved to support themselves in old age.

So, you’re pretty much forced to buy extra insurance, issued by private insurance companies, to fill in the gaps presented by traditional Medicare. This coverage is called “Medigap” or “Medicare supplemental insurance.”

You also are forced to buy one of the newer policies known as “Medicare Part D,” which supposedly covers prescription drugs but in fact covers almost nothing. A Republican scheme passed in 2003 and shepherded through Congress by a Louisiana representative who soon afterward retired into a $2 million-a-year-job with Big Pharma’s main lobbying group, Pharmaceutical Research and Manufacturers of America, Part D is one of the biggest rip-offs this country has ever seen. It seems to exist solely to clip the taxpayers and old people. George W. Bush’s Medicare administrator, Thomas Scully — now a lobbyist for the health care industry and general partner of an equity firm that invests in health care — threatened to fire Medicare’s chief actuary if he reported how much Part D actually costs the government. Medicare is forbidden to negotiate drug prices, a strategy that saves the Department of Veterans’ Affairs between 40% and 58% on its clients’ drugs. Between 2006 and 2013, this caused Medicare beneficiaries to spend an estimated $332 billion to $563 billion more than necessary.

My Part D carrier disallowed most of the generic drugs my doctors have ordered over the past 18  months and would not cover the full freight on the rest. To fill a prescription, you have to get prior approval before your doctor writes the prescription.

Once you’re in a Part D plan, you’re pretty well trapped in it, whether you like it or not. You’re allowed to disenroll or change carriers under very limited conditions, and — get this! — if your carrier stops covering a drug you need to take,  you can’t change to a carrier that will cover it!

That 85 percent of Part D patients claim to be satisfied with the scheme proves only that you can fool all of the people some of the time and some of the people all of the time.

If you are not permanently “on” some drug — as, for instance, I happen not to be — the monthly $20-plus premium pays for air. I would have been better off without Part D, because I could have purchased the antibiotic for the bronchitis, the steroid for the bronchitis, the double-strength omeprazole and sucralfate for the GERD kicked off by the steroid, and the muscle relaxant for the back pain cheaper had I been able to enroll in Costco’s cost-saving plan. But I’m not eligible for it or for Walgreen’s similar plan because, in cahoots with Big Pharma, by law these plans have been made off-limits for Part D customers.

However,  healthy Medicare beneficiaries decline to enroll in Part D at their peril. When (not “if”) you come down with some serious, expensive ailment, the cost of chemotherapy or meds for typical old-age hazards such as Parkinson’s could easily bankrupt you. And if you do not enroll when you become eligible at age 65 but delay until you’re more likely to need the coverage, you are gouged a penalty for late enrollment, in the form of permanently inflated monthly premiums.

Part C, which is an option, rips off the taxpayer with élan, to the enormous profit of the insurance companies that run the plans. Part C plans, which operate like HMOs, appear attractive to Medicare beneficiaries because they offer services like vision and dental care that are not covered by traditional Part A & B Medicare plus Medigap, and because at the outset they provided prescription drug coverage (the advent of Part D canceled that). The payment formulas overpay Part C plans by 12 percent or more compared to traditional Medicare. By 2006, these HMO plans had proved far more profitable to insurance companies than projected, at the expense of administrative costs that are far higher than traditional Medicare.

In summary: Part A and Part B (“traditional” Medicare) pay exactly as advertised, with no hassle. Traditional Medicare is rather expensive: $104/month (almost five times what I paid for better coverage through my former employer); it only covers 80% of your costs; and it does not cover prescriptions or long-term care. To take in the slack, you have to buy additional coverage from private insurers that jack you around and charge you through the wazoo while collecting money from the government for the privilege.

Okay. Now for the rant of the day.

Saturday comes in the mail a notice from Mutual of Omaha, the outfit that carries my Medigap coverage, a notice that my premiums are going up “due to the rising cost of healthcare.” Yes. My Medigap insurance will increase by $400!

“Please be assured,” we’re told, “that you are not being singled out for this increase; the premiums for all customers with coverage like yours are being adjusted.”

There’s a story I’ve heard before: when I carried my own insurance for a time. If you make claims on a policy, your premiums go up forthwith. Companies get away with this, even though it is illegal to raise your rates or cancel your policy because you made a claim, by assigning customers to relatively small groups, so that if one or two people in that group should have a spate of illness, everyone in that small group gets their premiums increased. This allows the company to claim it’s being “fair” while dumping customers whose care is beginning to cost something.

This increase comes as President Obama caves to the Republicans by cutting cost-of-living adjustments for Social Security beneficiaries. Ducky.

So now I need to find a new Medigap carrier.

Finding reasonably priced Medigap coverage is an astonishing horror show.

There’s only one given: each of the fourteen plans (designated A through N) has to offer the same benefits, and insurance companies are not allowed to screw with those guidelines or to deny the services specified in each one.

Otherwise…it’s raw chaos.

Rules are different in every state. So different insurers make different plans available in different states, at different rates. Availability of plans and their costs vary by county. Companies charge what the traffic will bear, and so rates for identical policies can vary by as much as $150 to $200 a month. For example, in Maricopa County the lowest price for a Part F policy issued to someone in my age range is about $137; the highest is $338. And there’s no difference in coverage!

The only way to find the rates available to you is to access a long, incomprehensibly complicated document issued by your state’s insurance department. To find the cheapest plan available to Arizonans, you have to download a FORTY-EIGHT-PAGE BOOKLET. This PDF provides each company’s rates for each of the 14 plans in the various counties within the state. Some insurers offer some plans but not others. Some insurers offer certain plans in some counties and not in others. Prices in rural counties are usually lower than prices in Maricopa and Pima counties, where the cities of Phoenix and Tucson reside. But this is not consistent. Nor is it in any way helpful.

In Arizona, FIFTY-FOUR COMPANIES offer Medigap policies. Every one of them offers the same effing policies for different rates scattered over two pages of figures. To figure out which one is cheapest, you have to sift through 42 pages of figures listed 7 columns to the page.

Once you’ve parsed this out, then you have to find out

a) how the company is rated (is the damn thing about to go belly-up?); and
b) whether they’re even still offering the plan, because some of them quit after the booklet goes to press.

Then you have to track down a phone number for whatever outfit you select to provide this coverage. Then you have to make your way through the infuriating phone trees and jump through hoop after hoop after interminable hoop to find out what they really charge, which is different from what the Insurance Department booklet says.

Last night it took me four hours to identify the dozen companies that claim to offer premiums lower than the new gouge from Mutual of Omaha.

I’m now paying $128 a month. After the increase,  I’ll be paying $165 a month.

Here, on a preliminary basis, are the companies that charge no more than $165 a month but are likely to charge me, at 68, less than that:

2013 Medigap figures

Some of these providers are outfits that no one ever heard of. So, before you start calling insurance companies, you have to track down their ratings, to see if they’re stable enough to be around over the next year or two. To do this, you can go to one or more of various rating agencies, such as A.M. Best or Standard & Poor’s.

So we’re told. But in fact, to look up an insurance company at some these agencies, you have to be a member! At Standard & Poor’s, you can look them up and be damned — many searches return a “not found” message, and those that are rated have so many tentacles you can’t figure out which one you need to know about.

This means you have to call your insurance agent — if you have one — and ask him or her to look up ratings for a dozen candidates.

My insurance agent, who has been a godsend, does not deal with Medigap coverage…for obvious reasons! Another guy I know who does claim to address Medicare referred me to a woman who tried to high-pressure me into a Part C plan; when I told her I did not want a Medicare Advantage plan, she persisted, even to the point of trying to tell me things that are untrue and that federal law specifically prohibits agents from claiming.

So in addition to the mind-boggling complication, the whole process is a minefield of scam operators trying to take advantage of confused and frustrated senior citizens.

It is just a freaking nightmare.

 

 

Physical Therapy and Ginger Oil

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So today the physical therapist recommended by Young Doctor Kildare saw me.

Much better than the “sports therapist” outfit across the parking lot from the Walgreen’s. Instead of a gymnasium full of clients besieging a couple of trained therapists and a bunch of not-too-bright assistants, this was one guy with his own office. He did have one assistant, who seemed to know what she was doing. And yeah, he was dealing with several patients at once, but at no time did I have to sit around for 20 or 30 minutes awaiting his attention.

But in the time department, he took the time to inquire in detail after the symptoms, to do an exam, and apparently to think about what he heard.

He agreed with YDK that whatever ails me is not “muscle spasms,” and he explained why he didn’t think so.

Hmmm… I seem not to have related the recent events here.

Backstory, then: After almost a year of back pain and foot pain, and after no visible improvement in the knee that I walloped two and a half months ago, I decided I needed to talk to someone who had more than 15 minutes scheduled to speak with patients. So I traipsed back out to the Mayo to see my doc of some 35 years.

He had me X-rayed and then, reading the radiologist’s report, said the X-rays showed some disk degeneration but not enough to cause significant back pain — and so he didn’t think the cause was a pinched nerve — and the knee didn’t seem to be seriously injured. He opined that the persistent pain is caused by “a muscle spasm condition” and prescribed a muscle relaxant, which proved impossible to get through Medicare Part D. After two more attempts, he finally came up with a drug I could afford out of pocket, cyclobenzaprine.

This dulled the pain a little, caused nightmares that verged on hallucination, and did nothing to eliminate the problem.

On reflection, “a muscle spasm condition” sounded kinda fishy — what kind of “muscle spasm” goes on for ten or twelve MONTHS, and if that’s what he thinks it is, why isn’t he testing me for MS, which in fact could cause something along those lines, or for diabetes, which can cause persistent lower-body pain? So I finally decided to try again with Young Dr. Kildare, who at least accepts Medicare.

After the usual brief interview, YDK begged to differ with the august opinions of the Mayo Clinic — he thinks it is a pinched nerve and advises the prescribed treatments are as follows, in this order:

1) Intensive physical therapy.
2) If this hasn’t worked after six weeks, epidural injection.
3) If that doesn’t work, do MRIs to determine a specific cause and attempt relief with surgery.

As for the knee, he believes the issue is prepatellar bursitis resulting from the fall I took, which would make some sense. If it doesn’t resolve over time, the course of treatment is exactly the same.

YDK is just a young fella on the run from patient to patient in a medical factory. However, to my ear he made a great deal more sense than the Honored and Elder M.D. This wouldn’t be the first time the Old Man has emitted a cattywampus diagnosis — years ago, when I was a bit younger than YDK, he tried to put me on beta blockers for the rest of my life, having decided I had a mitral valve prolapse. Before committing myself to permanent medicating, I asked my father’s cardiologist about it; he said if there was a valve prolapse (which he doubted), it was so minimal as to be virtually undetectable and I should ignore it unless I had some actual symptoms.

So…while Arizona sorely lacks top-quality medical care, the truth is, I’m no more star-struck by the Mayo name, despite their excellent hospital (one of the state’s few consistently rated excellent on a national basis), than by any other cluster of M.D.s around here. The Old Man’s theory didn’t hold water, the drug he prescribed did nothing more than briefly mask the pain, its maker specifically warned against its use for the elderly, and so I was willing to seek some other advice.

Hence, today’s physical therapist, whom Young Dr. Kildare recommended.

He scoffed at the “muscle spasm” theory. He explained the pain as a manifestation of compressed vertebrae brought on by the antic I got up to a year ago, which immediately preceded the symptoms. He decided the knee pain was unrelated to the back issue, and the heel pain may or may not be related to the back pain. In any event, said he, the first order of business was to address the back.

Damned if I know what he did, but whatever it was, it seems to have worked! He pushed on the back and pulled on the back in a way that felt a lot like a deep massage and that seemed reminiscent of chiropractic manipulation. When asked what exactly his procedure would do, he said the point was to “loosen up the joints,” whatever that means.

He recommended a half-dozen exercises, none of which caused any pain, unlike the other therapist’s contortions. By the time I walked out of his office, the back pain was almost gone, and the foot pain is significantly improved.

This evening when Cassie dragged me out the door to tromp around the block in search of cats, I was walking pretty much normally, something that hasn’t been so for months.

So what about the ginger snake oil I cooked up the other day?

Well, it did have a slight analgesic effect, so slight as probably to be wishful thinking. This evening I used some of it to stir-fry some shrimp with piles of onions, garlic, and Napa cabbage. Mighty good!

Probably the highest and best use of the stuff. 😉

Ginger Oil Painkiller…The Poor Man’s Emu Oil?

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Well, my friends, we’d better preface this with a little caveat:

You’re not reading a) science; b) a medical webpage; or c) even a mainstream woo-woo alternative medicine site. You’re reading a wacky little old lady’s blog, so you’re freaking nuts if you take any of this seriously.

Do not, do not, do NOT apply what follows to an open wound, to your acne, or to any source of pain whose cause you don’t understand. If you don’t know what ails you, GO TO A DOCTOR. This is an experiment, and I, Funny about Money, am not responsible for whatever happens to you if you fail to seek medical advice before fooling with your body.

emuOkay. That said, did you know there’s a new woo-woo alternative painkiller in the form of the fat of the emu? Yes. We’re told that oil derived from the thick layer of fat sported by the exotic Australian flightless bird will cure whatever ails you in the aches and pains department. Got arthritis? Rub it on your sore joints. Decided to go for a mile-long run without training? Rub it on your shin splints. Chiropractor tell you that your achin’ back is fibromyosis? Rub it in! Older than Methuselah and hurt all over your wrinkled, shriveled body? Slather the stuff on!

We’re even told it will cure your eczema (usually spelled wrong in testimonials) and cause your male-pattern baldness to go away.

Taken by the wonders of this particular snake oil, I wandered about the Web following the exclamations of joy and faith, and at one point even came across something that looked like actual science, suggesting (sort of) that the stuff may work. But given the number of people who remarked that it makes you smell of poultry, I wondered why not simply smear chicken fat all over your body. After all, emu, chicken: they’re both dinosaurs. What’s the difference?

{hey, Belagana! We Injuns used to favor oiling ourselves with fat, usually of the buffalo, and I expect if I chose to play that particular card, I could find a way to make myself  very rich, indeed. But let’s stick with the Down Under variant.}

The difference is that the Australian poultry fat sells for about $5 an ounce. Huh…anything that costs five bucks an ounce has gotta be good for you, eh?

Having absorbed this intelligence (such as it was), I went on about my business, munching on a piece of candied ginger to ease the aches and pains.

I’m allergic to aspirin, ibuprofen, acetaminophen, and presumably all other NSAIDs, so there are no little pills (not any that are legal, anyway) to help with growing collection of sore muscles and painful joints. Ginger, as it develops, has been proven to exert some anti-inflammatory action — it takes awhile to work, and the effect is mild compared to an NSAID, but it does help.

Following this train of thought… Some people swear that creams dosed with salicylates or NSAIDs soak through the skin and ease the pain of arthritis and spavined muscles; research suggests the effect is faint, but it exists. And we do know that lidocaine patches used off-label work on arthritic joints — by numbing the entire area.

What if ginger would soak through your skin, too? Would it dull the constant pain I’ve been enjoying over the past nine months?

Hm.

Bird fat. Olive oil. Both oily stuff you can rub on your body, right? Olive oil, we know, has a variety of salubrious effects when applied to the skin and the hair. And as for the ginger, a large chunk of it resides in the freezer. What if one combined ginger and olive oil and applied it to the pained spots in the manner of the vaunted emu oil?

Off to the lab! (Sometimes called the kitchen…)

 P1020061

The tools:

Small heat-proof sauce dish
Sharp knife
Blender or food processor
Stove
Fine-gauge sieve

The subjects of experimentation:

Olive oil
Fresh, raw ginger

First I cut off a couple of chunks from the ginger root…

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…then chopped them coarsely in a small mini-food processor.

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Then mixed this with about a cup of olive oil in a small heat-proof dish and placed it on the stove.

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The idea was not to cook it. Get olive oil too hot, and it denatures — makes it stink. Instead, what I wanted to do was just heat it to the point where it was barely starting to bubble. The stove needs to be turned on as low as it will go:

P1020067

When the compound is just this side of hot, turn off the heat and let the mixture sit for several hours. Probably all day would be good. I let it rest four or five hours. Then come back and run it though a sieve, pressing firmly on the oil-saturated ginger with the back of a spoon.

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The result is a clear, ginger-scented oil.

I strained it into a refrigerator container, planning to store the liniment in the fridge. Before putting it away, though, I applied some of it to the sore foot and the sore knee. Wrapped the medicated knee in athletic bandages.

How did it work?

Well, yesterday evening the choir performed for evensong. We had an hour-and-a-half-long rehearsal, then sat through about an hour-long recital (incredible! most awesome organ recital I’ve ever heard, and our choir director and his assistant director are beyond amazing themselves), and then we sang for the better part of another hour.

During that time, not once did I enjoy the sensation of someone driving a red-hot needle into the bottom of my heel. The foot was still sore, but it was mighty nice to be free of the breath-catching stabs. The knee: about the same. The back and hip: hurt like hell.

To be fair, I did accompany my large (and delicious!) mid-day meal with one of my favorite analgesics, gin and tonic. But by 5:30, the effects of that medicament had pretty well worn off.

Got home in time to catch Downton Abbey, during which I smeared more gingerfied snake oil on the knee, foot, and backside.

This morning, the knee hardly hurt at all. The foot: still sore, but no needling sensation. And the back and hip: hurt like hell.

The sun, alas, is far from the yardarm, and besides, I’ve got a ton of work to do today. So there’ll be no supplementation of the gingery regimen for several hours. But it’s interesting.

Possibly silly. But interesting.

Image: Head and neck of an emu. William Warby. Creative Commons Attribution 2.0 Generic license.

One Thing after Another

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Welp, I gave up on the resistance to the cyclobenzaprine. The back pain had about subsided to a normal level without a little help from my friends. Right now it’s just the standard stiffness of old age. But yesterday what should come along but a roaring flare-up of TMJ syndrome.

To my mind, the TMJ is worse than the backache. I can’t hear out of one ear, can’t close my jaw, can’t eat.

So yesterday morning out came the unopened bottle of pills. Took half of one in the morning. No little blue men materialized out of the air, so I figured it wasn’t going to have any psychoactive effects. Not soon, at least. Didn’t do much for the TMJ, either. So at night I swallowed a whole pill.

Slept all night. That was nice. Awoke refreshed. That was amazing.

Did it have any effect on the injured ear and jaw? Unclear. Still can’t hear well, but the jaw doesn’t have to be held open quite as far to ease the ear discomfort. Still can’t bring the teeth together without pain, which means I still won’t be able to eat without pain.

Shee-ut. This has become a pattern: Just get almost over one ailment and WHACK! Another one comes along. You can be sure that just as this starts to clear up, I’ll get the flu. Which probably will devolve into bronchitis again.

So this is old age, eh? Well. No wonder old people whine about their aches and pains all the time. I’d rather die than keep on like this, stumbling from one misery to the next. And seriously, if this sequence of ailment after ailment after ailment doesn’t quit soon, it may be time to think about how to make it stop. There’s really no future when you live from pain to pain and spend your days in doctors’ offices and ERs. Why bother?

Where’s Yore Sign? The joys of dealing with the public

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Do you have a job that brings you into regular contact with the public? If you don’t, thank your lucky stars. 🙄

This morning on the way home from my Thursday morning meeting, I wanted to get a flu shot. Even though Young Dr. Kildare had suggested I give the flu shots a rest after last year’s nasty reaction to the double-dose version the Safeway pharmacist was foisting on us old bats, the current hysteria about spreading flu and “thousands” of deaths (yeah — heard that one on the news this morning) spooked me. The thing may have no effect for me, given my advanced old age, and it may be too late, since it takes two weeks for the vaccine to kick in. But what the heck: it’s free, and the normal dose has no untoward effects.

So I drop by the Scottsdale pharmacy right across the road from where the business group meets. They’re out of vaccine. Pharmacist says one of the two pharmacies on my direct route home has the stuff.

So I drive across the city, maneuver a cutthroat dog-leg turn across three lanes of rush-hour traffic to get into the Walgreen’s parking lot, trot up to the pharmacy counter, sign up for a shot, get handed a form to fill out and get told to take a seat.

After about 15 or 20 minutes of waiting, I’m about at the point where I’m ready to leave. Just as I’m thinking, “How much longer should I waste my time here?” a fight breaks out.

No joke.

A mid-30ish woman has been standing in line for most of the time I’ve been twiddling my thumbs. Only she hasn’t been standing in line.

two_footprints_black_145148You know how Walgreen’s has this sticker pasted on the floor with little feet on it and big letters reading WAIT HERE? It’s right next to the sign that says

“For your privacy,
please wait here
for
the next available pharmacist.”

Well, this woman has parked herself about ten feet back of the sign. She’s way back at the eyeglasses and cold nostrums display, a good ten or twelve feet away from the “Please Wait Here” station.

One other patron has noticed this and is standing behind her. They’ve both been cooling their heels for quite some time, as have I. One of the two service bays at the counter is open — no one is at the counter.

Along comes an old buzzard: looks to be about 90 or 92. He dodders up to the empty space at the counter, not noticing the silly woman who’s standing halfway to Timbuktu.

When she sees him wander up there and sees the pharmacist start to wait on him, she has a sh!t-fit. First she starts to yell at the old man. Then she starts to scream at the pharmacist! He himself is pushing 75.

So at this point, I give up — I leave the paperwork on the counter and walk out.

There’s another Walgreen’s about two stoplights up the road. The pharmacists in this store are exceptionally nice, and all the hired help evince signs of intelligent life. Nobody is standing in line.

Since I’m presumably in the system and may appear to have just had the shot, I describe to the pharmacist what just happened at the neighboring store and ask if I could please get a flu shot at her store. The pharmacist is flabbergasted.

I say, “Just think of it: we get to drive around on the same streets with that woman!”

She laughs. “Yeah,” she says. “Sometimes the folks who come in here leave me thinking, are you really allowed to drive, too?”

We agreed: some people need to have a sign on their car.

Medicare Part D: The Biggest Rip That Ever Came Down the Pike?

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I’m beginning to think that Medicare D (which supposedly covers prescription drugs) is one of the biggest scams ever to profit the insurance industry. They’ve got old people over the barrel, they don’t cover very  much, and even the cheapest Part D plan is amazingly expensive.

The deal goes like this:

You sign up with a private insurance company to get prescription drug coverage. Premiums vary by insurer, but the cheapest is about $20 a month. The average is about $30.

If you decline coverage, you can climb onboard later…but to do so, you have to pay an extra gouge — for the rest of your life! If you don’t sign up for Part D the minute you become eligible for Medicare (at the age of 65) and you need it later, you have to pay higher premiums.

The deductible is exorbitant — mine is almost $400. If, like me, you don’t take prescription drugs every day of your life, this means you end up paying out of pocket for everything. Got that? If yours is an average premium, then you’ll shell out $600 or $700 before your coverage kicks in.

If you actually do fall ill, or if you have a very expensive chronic illness such as MS or Parkinson’s, then you will eventually hit the “doughnut hole.” After the costs of your meds hit $2,970, your insurer no longer has to cover you: you get to pay everything out of pocket.

In other words, Part D insurers collect a ton of money from you, but they really don’t have to pay out much. It’s a gold mine! Thank you very much, insurance lobby and craven elected representatives.

This is the scenario from the git-go. Then, to keep from having you cost them anything at all, Part D insurers impose all sorts of restrictions on the medications you’re allowed to use. Most companies try to keep you from buying brand-name drugs — they’ll only cover generics. For most consumers, this is probably OK, but the fact is that some generics actually are different from the brand-name versions, and for some people they don’t work as well.

Now we have this: pre-approval for prescriptions!

Yes.

When I went to the doc last week to find out why my back, leg, and foot have hurt nonstop for the past eight months, I was told nothing was broken and it appeared the issue was a stubborn muscle spasm. He prescribed a muscle relaxant.

I asked him to make the prescription for a generic. He said the stuff didn’t come in a generic.

I knew my Part D crooks wouldn’t cover a nongeneric drug but figured what the hell, I’d just pay for it out of pocket.

Not quite. When I got to the pharmacy, I was told that no indeed, Part D would not cover it. The price? A hundred and five dollars…for 24 pills! Which I was supposed to take three times a day: a week’s supply.

While there, I recalled why I was unhappy with my local Safeway’s pharmacy: they’ve hired an illiterate moron as an assistant. You can’t get past her, and after she’s greeted you with “I do got the pills but…”  you realize she’s every bit as stupid as she sounds every time she opens her mouth.

I called the Mayo, asked for a different prescription, and told them to please send it to the Walgreen’s, not the Safeway pharmacy. They jumped through the hoops required for that: this involved calling the insurance company and asking what muscle relaxant they would cover. Once they knew that, they called Walgreen’s and ordered it up.

The woman I spoke with at the Mayo said the price would be about $17, so even if it wasn’t covered, I could afford it. The multisyllabic name of this drug went right past me, so I couldn’t look it up online at that moment.

Before long, Walgreen’s machine called to say there was a problem. I drove over there to see WTF, and was told Part D wouldn’t cover the stuff because it wasn’t pre-approved!

How, exactly, are you supposed to get “pre-approval” — presumably before you even go to the doctor — for a medication you don’t know you’re going to need?

I paid for this generic concoction out of pocket. Remember, this is my doctor’s third choice: the first was rejected because it was not generic. The second, a generic, was not on their “formulary” — a list of the meds they will pay for. The third is something called cyclobenzaprine.

Once at home with the spelling of this chemical in hand, I sit down to read the package insert and look it up online.

And what do I learn?

It’s contraindicated for older adults! Yes, it says right here in their handout “CAUTION IS ADVISED WHEN USING THIS  MEDICINE IN THE ELDERLY because they may be more sensitive to the effects…especially confusion, hallucinations, and fast or irregular heartbeat.” That’s their all-caps, not mine.

Think of that.

I’m here by myself, all alone. The last time I needed help late at night, my son wouldn’t answer the phone and neither would anyone else. And the medication I’ve got here is likely to cause “confusion” and “hallucinations”? And it’s the only medication that my insurer, on a policy designed for the elderly, will cover?

So I’ve spent $17 on a bottle of 24 pills that I can’t use. And BTW I still hurt from stem to stern.

I’m really very angry about this. Seventeen bucks I can sustain, but that’s not what it’s costing me. This year I’ve still ponied up $240 in premiums, almost $400 in deductibles, plus whatever amounts Part D won’t pay toward meds that are covered.

Because 2012 has been The Year from Hell in the health department, with one ailment coming right on the heels of the last for the past 18 months, I in fact burned through the deductible, along about the start of November. The last Rx I ordered indeed was…uhm…”covered”: it cost $16, of which Part D paid two dollars.

What a rip-off.

I’m beginning to suspect that if you have no chronic ailment that requires you to take medications all the time, you might be better off not to buy Part D at all. Take a look at what this guy has to say:

The trick here is to add up your TOTAL cost, including premiums, deductibles, and co-pays, and see if that’s more than you’d pay out-of-pocket for your meds.

He wrote that in 2006, when the magic number was about $2,250. He figured, at the time, that if your predictable costs for medication are under $2,250 a year, Part D may make no sense. And if you take no regular drugs at all, this “insurance” makes no sense, period.

As for the premium penalty, he pointed out (again: six years ago) that the gouge is a 1 percent increase for every month you’re not on this exorbitant scam, and at that rate it would take eight years for your premium to double.

Another writer points out that if you’re on Part D, you may end up paying more for drugs out of pocket, for no other reason than that your pharmacist has your Part D card. If you have no coverage, it’s possible to negotiate lower prices; plus big-box stores like Walmart and Costco are now offering dramatically lower prices, as are stand-alone pharmacies with “membership” plans. In addition, even though buying prescription meds from Canadian and Mexican suppliers is technically illegal, Americans are still doing it — and contrary to Big Pharma’s protestations, Canada is not exactly a Third-World country.

What happens if you get cancer and need expensive chemotherapy?

Well, you certainly could be up the creek.

Maybe.

As it develops, Medicare Part B actually does cover certain drugs: injectable prescription drugs, which is how most chemotherapy is delivered. It also covers the pill form of certain cancer drugs, as long as they also are available in injectable form. Here’s a PDF describing these quirks. And Medicare B covers a bunch of outpatient drugs, such as oral anti-nausea drugs used in connection with chemotherapy, injectable osteoporosis treatments, immunosuppressive drugs for transplant patients, and oral drugs for end-care renal disease.

If you have a heart attack or develop high blood pressure, you’re out of luck: apparently the take-’em-forever drugs needed for those ailments are not covered.

However…one could take one’s chances. You can sign up for Part D during the month-long annual open-enrollment period, and they can’t turn you down. So, the longest you’d have to wait for coverage would be 11 months. It could be the longest 11 months of your financial life, of course…but then again, maybe not. Going bare would mean taking the chance that you would not run up more than about $2,250 in drug costs over any 11-month period, a period that shrinks steadily as each month passes.

The writer who posits that Medicare is a rip best avoided by people in good health is a little suspect as a source: he presents his theory at a single-post Blogger site. On the other hand, anyone can do the math, and so presumably with some research you could prove or disprove what he says. The second post, comparing the costs of drugs bought through Part D with those purchased on one’s own, appears at something called “The Hillbilly Report,” a title that, while cute, does render its contents questionable. But there, too: it’s easy enough to confirm or de-confirm the claims for yourself.

Be that as it may, I’ve paid $240 in premiums this year plus around $400 in deductibles, and my Part D still won’t cover the meds my doctor recommends.  And not only that, the Part D insurance is arrogantly telling my doctor what he can and cannot prescribe. Had I gone bare in 2012, during a period when I’ve been down with something almost nonstop, the cost for all my meds would have come to around $420: that’s $220 less than I actually have paid for prescriptions plus the fake “coverage” this year.

Would I be better off, assuming one day I get past this endless string of back-to-back complaints, to simply self-escrow about $100 a month for prescription meds, taking a chance that the really big stuff will be covered by Medicare B? I probably could afford it, since some months I’ve paid that much (between the Part D premiums and the meds Part D didn’t even touch). That would come to $1,200 a year. If I make it through, say, another three years without being stuck on some permanent, swallow-it-for-the-rest-of-your-life nostrum, I’d have $3,600 that could be used to cover prescriptions.

It wouldn’t go far in the event of a catastrophic illness. But then…neither would I. 😉