When Medicare Prescription Coverage Isn’t Enough

For years we have heard about the plight of seniors on very meager incomes who have to rely on Medicare and Social Security to survive and who have had to buy second-rate food – or even dog/cat food – so they can eat.

Medicare has been designed to help seniors with their medical expenses, especially prescriptions.  The prescription drug coverage, a supplement to Medicare, is essential to seniors, as much of their ongoing healthcare is dependent on their medication. 

This part of the Medicare coverage available should actually be the easiest to deal with.  No doctor, no hospitals, no tests, just medicine.  However, with the changes to Medicare, especially with Medicare Advantage on the scene, things have gotten somewhat dicey in the area of seniors and prescriptions.

On the surface, Medicare Advantage is a good idea, but once you look into it, there re dangers lurking just a little below the surface.  These dangers can leave seniors extremely vulnerable, because once seniors have reached a particular amount of coverage/paid claims for prescriptions, the bottom drops out.

What happens is that if a senior has a Medicare Advantage plan that pays up to $2500 in prescriptions, once they hit that amount, they must pay for further prescriptions out of their pocket – often to the tune of thousands of dollars.  Once they reach the next plateau, coverage kicks in again.

The problem with this situation is that if a senior on Medicare Advantage has spent the initial allotment of coverage for prescriptions in the month of August, they will be paying for medication out of pocket possibly for the rest of the year.  Many times, the cost of medication is more than their entire Social Security check or entire income that month.

Because of this, too many seniors are simply going without medicine.  Imagine being on insulin or heart medication.  How long could a senior with diabetes or a history of heart disease go without their medication before there are serious complications, or even fatal ones? 

Lawmakers are trying to fix Medicare.  This is one area where they have to pay close attention.  In the meantime, physicians can try to work with their patients on Medicare to prescribe generics – especially those that are $4 on many pharmacy plans – so that seniors don’t have to risk their health and their lives by going without.