Now that I've joined Harry in the donut hole

Now that I've hit the Aetna donut hole (meaning that I'll be paying for all of my prescription costs for the rest of the year because I won't hit the $3,850 out-of-pocket limit that would get Aetna back to paying for my medication), I did some math.

Since Aetna uses two sets of books, one to count ALL the prescription charges paid by Aetna and by me to get to $2,400 and a second to count only what I pay (which makes me pay everything till I get to $3,850), it figures out this way:

$791.63 -- What I have paid so far for co-pays.
$2,010.18 -- What I will pay for the rest of the year, based on the total charges for my
prescriptions.
$2,801.81 -- My projected total cost for 2007. (Keep in mind that this is for 11 months,
since Aetna didn't kick in till Feb. 1.; for 12 months, it pro-rates to $3,054.54.)
$198.00 -- Amount I would have paid for prescriptions under UHC.
$2,603.81 -- Increased Aetna cost compared to UHC cost
$1,750.00 -- Savings for the lower Aetna medical deductible ($250) compared to the higher
UHC deductible ($2,000).
$853.81 -- Increased Aetna prescription/medical cost compared to UHC.
Again, for 11 months; for 12 months, it would be $1,188.84.

In theory, Aetna would come back in when I hit $3,850 in true out-of-pocket costs (includes everything I will have paid for prescriptions), but I will fall about $1,000 short of that, so Aetna in effect stops paying for my prescriptions once I hit the donut hole of $2,400 in the total cost of the prescriptions, regardless of who pays for it.

If Aetna changes the medical deductible from $250 to a higher amount, then it may be time to look around for cheaper net costs. Tom Moore has the Summa plan, which requires premium payments. But if the Summa plan, including premium payments, results in a better net than the Canadian's Aetna plan, then it might be time to look around for a better deal. We hope to compare Aetna and Summa (and others) at the end of the year.

I hope this helps other BJ retirees to get a handle on the impact that the Canadian's switch from UHC to Aetna will have on them. I would welcome comments, or information on how much you have paid under Aetna for prescriptions and medical care. The more we learn about each other's situations, the better we can decide what we will do for 2008.

If you don't want to post your prescription financial information on this blog, email me at

jo4wvu@sbcglobal.net

Thanks.