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Congratulations! Your Situation is Catastrophic!

101_2532Never did I think that being in a catastrophic situation would be a good thing, but when it comes to Medicare and prescription drug coverage, it isn’t bad.

Since Steve is permanently disabled, last year he became eligible for Medicare. We selected a Medicare Advantage plan.  His plan has four drug payment stages, but Stage 1 does not apply to Steve’s plan, so he starts in Stage 2. He stays in that stage until year-to-date “total drug costs” reaches $2,970.

At the end of Stage 2, we’ve hit the “donut hole”, or Stage 3. This means Steve receives limited coverage, and he stays there until we’ve paid $4,750 in out-of-pocket costs. Stage 4 is called “Catastrophic Coverage” and here most the plan pays most of the cost for the covered drugs. I knew our costs would reach this point this year, but I didn’t know when.

Well, we’ve hit it already! It’s sort of a “Good grief!” feeling but paying the bill at the pharmacy last night was exciting! A prescription that last time cost  over $250 for a two month supply only cost $27 for the same amount last night. Yeah!!

About G-J

Profile photo of G-J
I am a caregiver for my 59-year-old husband, Steve, who was diagnosed with Mild Cognitive Impairment in December 2009. His employer put him on disability and he had to retire one year later when he couldn't return to work. I am also the mother to our son who is now a high school senior. We have a cat, Sagwa, who rounds out our family. In addition to blogging here, I volunteer at my son's high school in the scholarship office, teach a class I created called, "Keep Your Brain Buff" at our city's Senior Center, lead a writing group at the Alzheimer's Association, and advocate for people with all types of dementia. In November, I will be participating in my third Walk to End Alzheimer's.

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  1. Profile photo of Pegi

    GJ, I know right where you’re at. Love the other side of the donut hole; always a good day when we hit it! My husband is on about 11 RX’s,losing count with recent changes. Celebrate!!! :) I must admit, your title scared me when I saw it! Glad the news is good.

  2. Profile photo of ejourneys

    Congratulations on crossing the donut hole! I get that feeling when my partner has met her deductible, which she does without fail every year.

  3. Profile photo of Trish

    Yay for catastrophic!! What a relief when you hit that threshold. I say you celebrate with a donut. :-) (Hey, you got my mind on donuts!)

  4. Profile photo of Kathy

    Oh my G-J,

    I don’t know if I should laugh or cry!
    It feels bad to feel good about something bad that makes a situation good.

  5. Profile photo of Denise

    Your headline just makes me laugh. I, too, am kinda crying and laughing about this. :( :)

  6. Profile photo of tiredamy2007


    My dad takes so many medications that each year by May or June he hits the catastrophic stage. I think it is awesome that medicare has that so the at least one thing is less for you. i am so glad it was better this month. YAY.

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