Caremark, the online drug service owned by pharmacy giant CVS, handles part of the drug benefit for Polly’s group health insurance plan. Caremark tracks insurance-approved medical expenditures with a graphic on their website. This graphic shows how much money you have paid in a particular year for out-of-pocket medical expenses. This year, the maximum out-of-pocket is $6,750.
The company Polly works for pays about $18,000 a year per employee to provide each employee with medical insurance. On top of that, married employees with children pay $3,900 a year for insurance — $150 every two weeks. This means that if an employee reaches the maximum out-of-pocket this year, the total cost of health insurance is almost $29,000.
The past fifteen months have been a medical nightmare for Polly. And we are not done. She now has serious bladder pain, and is getting up in the night numerous times to use the bathroom. She’s up more often than I am during the night, and that’s tough to do since my prostate/bladder just love making life miserable for me. In previous years, I have had my own medical nightmares, leading to exorbitant medical expenditures. Over the past decade, we have met the maximum out-of-pocket five times; all while trying to make ends meet on Polly’s income. (That’s why me being able to draw Social Security beginning in June will be a big help to us.)
Polly’s insurance provider finally paid the last of her bills from her January hospitalization for acute ulcerative colitis. This put us over the maximum out-of-pocket for the year. Woo hoo! right? The good news is that everything is FREE — to us anyway — the rest of the year. The bad news is that we have accumulated $6,750 of new medical debt over the first ten weeks of 2019. On top of that is the $50 a month we have to pay for Lialda, a drug Polly will be on the rest of her life. When the gastroenterologist first prescribed Lialda, we took the script to the local Meijer Pharmacy, only to find out it would cost $890 a month. Well, that sure as hell wasn’t going to happen, regardless of its benefit to my suffering wife. We simply couldn’t afford it without being forced to sleep in our car. Fortunately, we found a service that works with lower income families to provide expensive drugs for them at a reduced cost. Prescription Hope was able to procure the drug for $50 a month. Since the cost of the drug is not run through insurance, we will have to the monthly cost regardless of meeting our maximum out-of-pocket for the year. I plan to contact the insurance about being reimbursed for the $50 a month cost. We do have a tax-free HSA account. Polly’s employer kicks in $138.47 every two weeks and we set aside another $100.
As the above graphic shows, Caremark congratulated us for reaching our maximum out-of-pocket. This, evidently, is what Caremark is congratulating us for: in 2019, 30 percent of our net income will go towards medical costs. That’s the “prize” for reaching the maximum out-of-pocket finish line. And this doesn’t include dental costs.
I look towards the future and ask myself, how will we manage? I don’t have an answer. I told my counselor that I had finally figured out how to get our medical costs under control: death. I am grateful that we can still keep our head above water financially, but if medical costs continue to increase (and they have increased every year over the past decade), it leaves me wondering how in the hell we are going to make it. Of course, the answer is single-payer insurance/socialized medicine. While there are a handful of champions of this cause in Congress, Republicans and many Democrats are in the pockets of insurance, medical, and pharmaceutical corporations. Our political leaders actively work against our best interests, health-wise. This leaves the rest of us scrambling to figure out how to pay the price for living.
About Bruce Gerencser
Bruce Gerencser, 61, lives in rural Northwest Ohio with his wife of 40 years. He and his wife have six grown children and twelve grandchildren. Bruce pastored Evangelical churches for twenty-five years in Ohio, Texas, and Michigan. Bruce left the ministry in 2005, and in 2008 he left Christianity. Bruce is now a humanist and an atheist. For more information about Bruce, please read the About page.
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