Changing Mom’s Rx Drug Plan – A Saga…

My mother retired from a preeminent university with pension, medical, dental and vision benefits, for life. In 2013 with the help of Obamacare, the university’s regents saw fit to push out-of-state retirees onto the exchange. The regent’s lives were suddenly simplified. Mine, however, became suddenly more complicated.

When mom got notice of this, she was still enough with-it to be (rightfully) pissed, and understand she had no ability to make the choices that now confronted her. She found her way to the senior center where there were counselors to walk folks through this maze. Before I was conferenced in to the meeting, the counselor called me with grave concerns, “Your mother has zero capacity to make these decisions, let alone understand them.” I agreed.

We found a Medicare supplement and prescription coverage plans whose premiums were well within the stipend the university was giving to their out-of-state retirees. Did I mention that before this change, the regents covered 100% of premiums? Don’t get me wrong… I am All About Obamacare. I was/am somewhat miffed the organization my mama gave her career to saw it as an ‘out,’ and made, probably, many 1000’s of other people’s insurance lives a pain in the patootie.

For five years things went well. In late September of each year a collective ream of paper would arrive from the collective insurance carriers instructing me to make sure all of her docs and drugs were still part of their plans. If everything looked up to snuff, I didn’t need to do a thing. I triple checked this shit. Particularly when mom was still living independently. Did I know all the meds she was taking?? Since being in care, it’s easier because I know absolutely who her doctors are, and they email me with medication changes.

This fall NOTHING arrived from any of the carriers, NOTHING, not via snail or email. And, my bad, work has been distracting me all around the state. So, last week I realized I needed to initiate some discovery.

Mom’s dental and vision are still handled through the university. I literally just now checked, and found that her vision coverage premium drafted today. 5th of December, like clockwork. Dental is paid for for life, so no need to hunt, but it causes latent anxiety for sure. These people need to hire me to fix their damn communication inadequacies!!

Ah prescriptions… The third party administrator who oversees the out-of-state retirees’ supplemental and prescription plans had a little tool on their website: Rx Plan Checker! So I checked. They found a plan they thought would save mom money. My next step was to get online with mom’s current Rx carrier.

The carrier is cancelling mom’s current plan, and replacing it with one that will, among other coverage decreases, charge $42 a month for a med that now costs mom $13 a month. Fuckers… It was then that I knew I needed advice.

Mom’s AL community uses a local pharmacy that specializes in long-term care, SNF, and AL communities. Like, I only have to manage her OTC meds. Costco, Baby.

Keep in mind that Open Enrollment deadline is ticking down (my fault). I leave the pharmacy voicemail, which is answered 24 hours later. Anna and I have 3 phone calls in the space of an hour, which concludes in her sending me a list of all plans in mom’s zip code that the pharmacy is a provider under.

Next I have to call the third party administrator. They are the gatekeepers/advisors:

1st call: Intake person updates a few things, like taking the councilor from 2013 off of mom’s authorized ‘person’ list. She puts me in queue to talk to an approved insurance advisor. Over two hours later, Larry picks up the call! Larry is amazing, sorts through a batch of plans and concludes that the plan the pharmacy recommended is indeed the right one! Larry suggests I call back the next morning, as early as 5AM my time, to conclude the transaction. Yes, a human must be involved.

2nd call: I called back the next morning just before 6AM. Aren’t I lucky that these days a speaker phone allows me to keep working! I tell the intake person exactly which department I need to talk to (thank you Larry). She spends a few minutes going over things already gone over (this is insurance, after all), wishes me a lovely day, and tells me I’ll be on hold for about 15 minutes. I must have mis-understood her, because it was most of an hour before the next person picked up the line. This call took a solid 30 minutes. The poor gal had to read me each and every definition through each tier of coverage in the policy. This was something I’d already done. Then there was the l-o-n-g recorded disclaimer I had to listen to… Bottom line…

Mom has a new prescription drug plan whose overall cost, premium, plus co-pays, is estimated to increase only $200 per year. The increase on the one med, alone, on the replacement policy her incumbent Rx carrier offered was $348. The premium would have increased as well. This is why we do our homework, hang out on hold, and are thankful that cellphones are no longer charged by the minute!