Medicare Rx Maze ©


 Medicare Rx coverage is a subject for which I claim no expertise; but I can tell you a personal story you may find interesting.


A few months ago my wife handed me a letter from our Medicare Rx provider, Company A, for the purposes of this story. The letter, which had been misplaced for awhile, said we lost our Rx coverage for “Non-Payment”. I immediately called and explained what had happened and the sympathetic agent said that if I would make up the missed payments she would reinstate our coverage. Perfect! Case closed…..    I thought.


Until, I went to pick up the next order of Rx’s that I order quarterly (to avoid a monthly hassle). Oh no, the bill was $1000’s, not $100’s, as usual! This precipitated hours of phone conversations with various agents of Company A. No record of our reinstatement, and no coverage! Finally, a sympathetic agent noticed that the address I gave him over the phone differed from the address in his computer database and he asked “Have you moved”? I said “No, but apparently you have moved us in your computer”! Then I asked “Would that qualify us for re-enrollment during this open-enrollment season”? His reply: “Maybe, but you’ll have to hang up, dial another 800 number for the sales department and ask them”.


Upon calling the sales dept. for Co. A, whose agent was anxious to make a sale, I agreed to move to a “Better Plan”; he would get credit for a sale, and my coverage would resume on Dec. 1, 2018. For the record, I held back no information with this agent re the original letter that informed us that our coverage had lapsed.


I waited until the morning of Dec. 3rd to give their computers time to catch up to my most recent phone conversations and agreement to purchase the new “Better Plan” with Co. A. Unfortunately, the pharmacist said “You have no coverage; you still owe us $1000’s! That was the “Bad News”. But, providentially, there was an independent Medicare Rx agent in line right behind me who overheard the conversation with the pharmacist (not surprisingly because my exclamations were a bit louder than I normally speak!!!). She said , “Stop by my office, I may be able to help you”.


So, on the promise of potential help, I very skeptically went to her office whereupon she showed me a few alternative plans from other providers. After punching into her computer the Rx’s that I have to take on a regular basis to keep this ancient heart of mine from revving beyond its redline on occasion, she convinced me that if I changed plans to Co. B, effective Jan. 1, 2019, I could save money. I signed the papers right there and got confirming paperwork on the spot. Subsequently I’ve received confirming paperwork in the mail as well. The proof will be when I go to get my first Rx refills in 2019. I hope I don’t have to write another column with bad news!


Before I left her desk, the independent agent gave me an Rx “Discount card” to present to the pharmacist to help with my immediate dilemma.


By that time it was Dec. 3rd, PM. I went back to the pharmacist, and without presenting the “Discount card”, I re-inquired about my Rx’s. Good news! Co. A’s computer had caught up to my conversation with them the prior week and now I owe $100’s, not $1000’s! I go home with Rx’s in hand to keep my heart as happy as it is right now for the next 90 days!


A few take-aways:

  • Our healthcare delivery system is such a mess that it behooves seniors to check with an INDEPENDENT agent who represents more than one company each year during “Open enrollment” season.
  • You must be persistent when you get into a dilemma as described above. It can cost you $1000’s if you’re not.
  • Many seniors are not capable of handling this for themselves and will need an advocate.
  • The plans with both Co.’s A & B include “Silver Sneakers” gym memberships to help you keep fit, especially after all the good food from the holidays.


Merry Christmas, and thanks for reading All About Seniors…..see you next week!


Bill Milby is a Director of Visiting Angels® of Central Georgia, a non-medical, living assistance service for seniors. If you have questions or comments about this column you can reach him at william.mercylink@gmail.comor searchfor us at



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