By Marla James
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Marla James speaks up about her predicament in the donut hole. My name is Marla James. By the time you read this, I might be dead. I am disabled, going blind and in a wheelchair. I live on SSDI , my husband’s early retirement and his part-time minimum wage job. We don’t live excessively, we try to get by as many do in this economy.
I am on Medicare and I am lucky enough to have a medicare advantage program which is an HMO. I go through SCAN. I love my doctor and have been a patient of hers for years. I have just run into a situation where my insurance company could kill me. This is a situation many on disability or social security face, but I didn’t realize that I would face it this soon.
It is the DONUT HOLE. The donut hole is a period of time where you have spent so much on your prescriptions that the insurance company no longer covers your expenses until you pay out of pocket $4700.00 more, after which you are only responsible for 5% of the cost.
I have to take 17 different drugs to stay alive. My most expensive being insulin, as I am a type 1 diabetic, I do not produce my own insulin. Diabetes has already given me flesh eating bacteria, a leg amputation and I am legally blind. My biggest problem being in the donut hole is that I can not afford my insulin. The pharmacy wants $300 per month for the insulin I need.
My doctor gave me her entire supply of Lantus (which is the type I need). My husband and I make a little over what it takes to be eligible for Medical, medicaid or any other programs in the state. I called the drug company that makes Lantus and was told that if I have insurance (even within the donut hole) They could not provide me with the medicine I need to stay alive.
When I spoke to my insurance company they basically said “too bad how sad” No go. Obama Care is on hold right now while the Republicans duke it out in Senate. Even if it goes through they only pay $250 for those in the donut hole which would not even pay for one month of insulin.
So, what’s a girl to do?
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