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MEDICARE

Grandma and
her Medicare

By Jeffrey Pyle, Alamo Area Council of Governments

Grandma had to go to the doctor the other day for her usual follow up appointment.
She has had diabetes and high blood pressure for many years. The doctor said she was
doing good, to keep up the good work, and renewed her prescriptions.

While Grandma feels good physically, she worries about her med- every month is like this, thankfully, because the deductible is a one-
ical costs. Since it is the beginning of the year, not only does she have time thing. But, wow, she is in real danger when that coverage gap
to pay the part B premium of $104.90, but also the deductible of hits or she has some emergency. It would be catastrophic to end up
$147, and then she has to pay the 20 percent coinsurance which is in the hospital. I mean, she has some savings but nothing to cover
$24 for the doctor visit. being in the hospital.

The stand-alone part D prescription drug coverage plan she se- So, I decided to start looking around and see what there might be
lected covers the two drugs she needs: Levemir Flextouch for her di- to help her. Someone recommended I call the local area agency on
abetes and Diltiazem to handle her high blood pressure and the aging. I called and explained the situation and how worried I am.
minor angina she experiences. Unfortunately, the plan doesn’t cover They said there are Medicare Savings Programs and Extra Help Pro-
the brand name version which helped her better than the generic. grams for low income seniors that will help pay those Medicare costs
for them.
The plan has a premium of $42 per month and she has to pay at
least $38 per prescription refill; that will change when she hits the If you are between 135 percent and 100 percent of the poverty
coverage gap requiring her to pay 65 percent of plan costs for her level — which in 2015 is $1,345 to $1,001 — there are funds to pay
prescriptions. Thankfully, she does not have a deductible on this plan. the premium for that Medicare beneficiary. If one makes less than
All of this got too confusing for her, so she called me over to help $1,001, then basically all the costs, including the coinsurance and
sort all this out. deductibles are paid. The same goes for the Extra Help which will
provide a subsidy for those between 150 percent and 100 percent of
So, I checked to see what she is living on every month. I found poverty and for those below 100 percent, it will pay for deductibles
she lives on a Social Security check of $1,234. This means that she and copays (unfortunately it does not cover that coverage gap).
paid $355 for her health costs this month, leaving only $879 to pay
the rest of her expenses. Her rent is $455 per month and her groceries Well, I tell you, that was such good news. We got Grandma signed
are about $200, so that leaves $255 to cover all the bills and whatever up: so now, she will get to save at least $150 per month. She feels
else she might need like clothes or the things she likes to buy for the much better because now she has a little more wiggle room in her
grandkids. costs. Now, I tell everyone I can about these programs so that my
friends’ grandmothers can get the help they so richly deserve.
My eyes bulged out. I couldn’t believe she was living like this. Not

32 San Antonio Medicine • April 2016