Medicare and the Donut Hole - My Medicare Experience

Three months ago I started on Medicare, and what a nightmare it has been! The first month I was having difficulty getting Medicare set up. Now the second and third months my challenges have been about pharmacy and medication issues; they don’t want to pay for specialty drugs at all! And somehow I’m already in the donut hole even though I just started July 1st. I thought I would miss that donut hole because I wasn’t starting at the beginning of the year but now here I am stuck in the donut hole!

Don’t get me wrong, I LOVE donuts! I have always thought it was cruel that Medicare has called this bad thing being stuck in the donut hole. How could they do that to this innocent sweet thing and make it dreaded by so many Americans now!

The worst part of being on Medicare is that decisions are being made by non-medical professionals. Actually, I’m not even sure that they’re professionals to be honest. Some “bean counter,” sitting in a cubicle has decided what’s good for me and not good for me. Other than definitions of medical care and prescriptions, I’m sure that is all this person really has for education.

I have been working with a surgeon all year and was ready to schedule the surgery then found out that I picked a surgeon who doesn’t take Medicare! I was told 96 percent of all physicians take Medicare. What are the odds I end up with a surgeon in the 4 percent? Then the next thing I want is a specific surgical procedure that is new. Medicare won’t cover that either! So, I am over to here and just trying to get a basic carpal tunnel surgery. The good news is I did find a surgeon now that will do part of what I need but it’s amazing how these decisions are based purely on cost not on the benefit for the patient.

I have talked to other people about what their experience has been on Medicare. Very few have had the issues I had, and what I have found is that these individuals have basic conditions like heart disease, high blood pressure, high cholesterol, COPD and general age-related conditions that affect many Americans more than 65 years old. I do not have any of those conditions! My medication needs are specialized due to my MS, so they are expensive if covered at all.

My first two months, I spent a lot of time on the phone trying to figure all of this out and get medications covered to the best of my ability. It shouldn’t be like this where I am fighting for every dollar just to get simple coverage from Medicare.

I had excellent health insurance before, as I have worked for the state for more than 15 years. It covered everything beautifully. And I was able to find a Medicare plan with a low monthly premium, but I’m not saving any money because I’m spending so much money on the drugs now that are not covered well by Medicare.

Americans have truly been sold a bill of goods on this Medicare. Crap!