my jaundiced eye

the absurdities of life

Category: medicare

medicare/rx sux

medicare:rx sux

I just received, via the failing us postal service, my most recent medicare/rx supplemental insurance statement which shows that my plan has paid precisely zero toward any of my prescriptions this year. Yet this coverage is, according to the incessant anxiety inducing advertisements, the only thing standing between me and the monstrous vortex of the dreaded “prescription donut hole” that will suck my bank account dry and leave me lying destitute and infirm on the side of the road clutching a tattered cardboard sign that reads “will work for plavix if I don’t stroke out first.”

So, I pay about $600 a year in premiums, with a $405 annual deductible…so just from the get go MJE is out a cool thousand bucks. As any typical overmedicated boomer, I ingest at least five prescription meds daily, as well as a few almost certainly useless nutritional supplements primarily to offset the results of ingrained unhealthy lifestyle choices, which I have no intention of changing.

So in order to try to sort out the vexing question of why am I spending money on supplemental insurance, which does not appear to supplement anything, I went in search of some answers, However, the federal government, which administers medicare has, in the interest of cutting government spending, deleted customer service entirely. This move, in addition to reducing governmental employee salaries and benefits, offers the added benefit of hastening the demise of legions of doddering lowlifes living off the government’s pharmaceutical tit. But my third party insurance provider, recommended by none other than the esteemed aarp, still employs customer service agents who do ultimately pick up the phone, but not before subjecting callers to a muzak loop obviously intended to force them to hang up and speed dial dr kevorkian instead.

However, MJE don’t scare that easy…I finally got connected to j joey who assured me most heartily that he could without a doubt answer any and all of my questions to my full and complete satisfaction. And true to his word he provided a lengthy and intricate explanation of exactly how each perceived expense had actually been a benefit that actively reduced my deductible, which currently stands at $35.97 thanks to my having spent $369.03 in cold hard cash.  I then got an unsolicited tutorial on the pricing tiers of various medications should the elusive deductible ever be realized: tier 1 for example would only cost $1 for a 30 day supply, tier 2 would cost $3 for a 30 day supply and so forth. As the tiers get higher the formulas revert to random percentage coverages, which are then sliced into tranches, bundled with other medication pricing structures and sold as derivatives on the big pharma futures markets.

So according to the gospel of joey, two of my meds are tier 1, (theoretically cheap), one med was tier 2 (less cheap theoretically) should I ever meet my deductible, which unfortunately lies somewhere between the end of the rainbow and my shallow grave. My three other widely prescribed medications are not covered at all. The good news is that the pharmacy I use is not a preferred vendor so my costs are much higher. Why is that good news…because in the through the looking glass reality of insuranceland the more expensive the drug the faster I will be able to claw my way to the top of mount deductible!

When I suggested that perhaps I should look for another rx supplement provider, joey patronizingly advised me to simply take different meds. Well, that was the pill that broke this camel’s back. MJE’s response was as follows, “You sound as though you are about 22 years old and since you’re working the graveyard shift (in whatever your time zone is) at an insurance company customer service desk I’m gonna guess that you haven’t been to either pharmacy or medical school. And furthermore you are most likely not suffering from high blood pressure, high cholesterol, anxiety, depression, arthritis, bursitis, fallen arches, bleeding gums, tingling in your hands and feet, dry skin, memory loss, or swollen ankles, just to name a few common afflictions of your client base. So please leave the prescribing to the professionals and stick to convincing your pathetic geriatric medicare dependent customers that they are not being taken to the cleaners by your employer, you little prick.”

To which he replied “Thank you ma’am for that excellent feedback which I will certainly pass on to my supervisor, and have a wonderful rest of your day.”



medicare ma


MJE just “enjoyed” another birthday. It was actually pretty great, my sistahood feted me with a wonderful surprise party. I ended the evening wearing a napkin wimple, a palm frond crown like the lemur king in madagascar and a pink sequined bra. I will leave the rest of it up to your depraved imaginations you sickos.

The next day, after a somewhat ragged morning I received an email from medicare ma letting me know what wonderful things she was bestowing upon me to keep me hale and hearty:

Name Eligibility Date
PAP TEST DR 02/01/2018
PELVIC 02/01/2018
MAMMOGRAPHY 01/01/2016
COLORECTAL 01/01/2016
PAP TEST 01/01/2016
DIABETES 01/01/2016

Well if that didn’t let the air out of my balloon I don’t know what would. It started out happy enough…annual wellness visit. Great! But it turns out that ma suspects that I am actually far from 100% given the rest of the recommended tests and screenings. I had no idea I was at such high risk for so many afflictions. Plus I am a year late on most of them which does explain a thing or two.

Alcohol misuse screening: MJE uses ethyl alcohol exactly as it was intended.

Depression screening: Not until I saw the above list.

High intensity behavioral counseling: I have no idea what that even means. Am I low intensity (or in PET’s words “low energy”)? It is true that I haven’t been exercising as much as I should which is probably why ma feels I might be in need of the obesity counseling.

Cardiovascular disease behavioral therapy: I hope that doesn’t mean I have to lay off the triple cream brie, butter and foie gras. If so I really don’t see the point in going on.

Mammography: Ma’s a day late and a dollar short on that one as you know if you’ve been a loyal MJE follower. And if she truly cared she’d know that too.

Colorectal: Ha ha, already did the crap in a box thing (ask your doc, it’s so much better than a colonoscopy, and I might add a real testament to american ingenuity) and I’m clean as a whistle.

Pap test (twice!) AND pelvic: Seriously? a speculum is the only thing that’s been in that neck of the woods for ages.

Abdominal aortic aneurysm: Does that mean that ma suspects that my stomach is about to blow? Yikes, better haul out the spanxs.

Diabetes: The only sugar I ingest can be attributed to the above proper use of alcohol.

Then one more cardiovascular something or other which I thought we took care of with the aforementioned behavioral therapy.

What about the fact that I am blind as a bat, deaf as a post and walk like chester in gunsmoke because of the arthritis in my hip. Or that my skin is thinner than japanese mulberry paper and I bruise like a week old banana. Or that my brain is like a magic 8 ball and every effort to remember anything results in “perhaps but ask again” or “signs point to yes” or “very doubtful” which is decidedly unhelpful when trying to find my glasses or think of my grandchildren’s names. What about those things ma? What about quality of life, huh? Why are you so focused on stuff like exploding abs and behavioral therapy for my heart, which frankly could use it as it has been in intensive care since nov. 8.

I appreciate your concern, but MJE’s got it all covered. Don’t need you to tell me how to behave, or what to eat or drink. I’ve made it so far without your “support” and suspect that I’ll manage to hang on for a few more years. Now if you would care to cover important things like botox, liposuction or facial peels then I am all ears.

oh no! bama care


MJE is going to take a quick commercial break from politics and tackle another topic just this once. Obama care.

This program is in the headlines right now because it has been announced that premiums may go up as much as twenty five percent in the coming year…. AAAAGGGGHHH….zombies are on the front porch, help me! They’re eating my dog and tromping on my landscaping!

I’m not sure where people get their health insurance but from a lifetime of paying premiums to BC/BS I can state without fear of contradiction that my premiums rose about 20% on average every year. And hello, did I hear anyone screaming about it, no I didn’t because the fact of the matter is that insurance companies of every stripe have you by the short hairs. What are you going to do, say screw you and get insurance somewhere else…oops, then you get into the whole pre-existing condition fun house, or the you’re pretty old to be shopping around septic tank, or whatever other excuse they can haul out to either deny you coverage or to charge you ten times what your current provider does. Better the devil you know than the one you don’t. And when they get tired of you because you actually filed a claim, you’re dropped like one of the conald’s wives…I was lucky enough to get sick when I was 64, maxed out my annual and lifetime deductions and finally got a portion of my pound of flesh out of my long and costly association with BC/BS…and the best part of it was that as of 1/1/16 I was on medicare and they couldn’t drop me…and people don’t believe in karma?

But BTW, medicare ain’t no picnic either, lower premiums, really? Single payer!!!! Woo hoo!!!! By the time I pay the regular (income adjusted) premium, add the extra part Z to cover the dreaded “donut hole” and the prescription add-on I am at about 140% of what I was paying BC/BS. Which unbeknownst to me is not even available to those of us who have survived long enough to enjoy our golden years unless we are covered by a major corporate insurance plan. You’re in, like it or not. Wanna contest a claim denial, opt for an IRS audit instead, it’s far less labor intensive and stressful.

So the conald (commercial break is over kids) is touting (or trouting in the vernacular) the tired repeal and replace trope. Part of his plan is to offer health savings accounts. Yo, dono! head’s up, HSA’s have been around for decades…and they are great. You sign up for a high deductible health insurance plan and you sock away $5K or so a year into an account that is untaxed as long as you pay medical bills with the funds. But, just so you know, that $5K doesn’t arrive on your doorstep like a publisher’s clearinghouse sweepstakes check, you actually have to have the money to put in there. So say you’re living on $50K a year before taxes, does it seem likely that you might have a spare 10% of your gross income to put in an HSA? Thanks for the thoughtful and incisive input conald.

Then there is the “erasing of state lines” thing…not sure about other providers but BC/BS seems to cover medical expenses incurred over state lines without a problem as long as your doctor is within the BC/BS network. Admittedly, coverage expenses can vary greatly from state to state so MJE is going to give the conald a passing grade for that, although he get’s an f for originality.

I can’t actually remember what the other parts of his plan were because when he reads from the teleprompter it’s like watching a hostage video, and I have to turn it off and lie down.

But the upshot of the conald’s plan is that everyone is going to have great, really great medical care for a low, really low price and we’re all going to beat the house at black jack. Speaking of which, how does a casino lose money…seriously, how does that happen? Maybe we’ll find out if the conald gets his hands on the us treasury’s checkbook…

the magic kingdom of medicare

the magic kingdom of medicare

Upon MJE’s first feeble step over the age 65 threshold I was presented with the compulsory red white and blue key card to the gates of the magic medicare kingdom. Whoa nelly, thanks but no thanks to the federal government’s largesse, I’ll take that in dodgy tax deductions if it’s all the same to you. Mind you I am not some right wing republican fiscal hawk…I am a card carrying liberal who truly believes in the social safety net for those in need. But what about the rest of us? Don’t we have rights too?

It boggles MJE’s mind that even those of us who (in our dotage) are foolishly willing and fully able to pay for our own health insurance are forcibly mandated to be wards of the federal government. I frankly feel that my constitutional right to grossly overpay Blue Cross/ Blue Shield in return for unbelievably crappy health insurance coverage has been trammeled. I demand justice!

The pols in Washington are terrified of touching the “third rail” of politics aka medicare and social security. MJE for one, insists that someone up there grow a pair and speak up for the disenfranchised high income bracketeers. We need someone to courageously speak out, “Fellow lawmakers, this isn’t a red issue or a blue issue, this matter goes to the very heart of our fundamental values. Old rich Americans, of all political stripes are being denied their inalienable right to choose to be over charged and underserved by the private health insurance industrial complex. Our well-heeled patriots deserve better! They have dutifully contributed to medicare for decades only to have their right to refuse it repudiated! This is a travesty!”

But not one politician, left, right or center is willing to stand up to The Man and say:


But all is not lost. At least MJE still has the incomprehensible medicare supplement and prescription benefit programs. I can continue to pay a few overpriced premiums and have most of my claims for legitimate medical expenses denied. It’s not much but it’s better than nothing.