$2000 Out of Pocket Maximum

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I ran into Bill Sublett the other day at Staples. He was my safety runner (pacer) at the 1999 Old Dominion 100 mile, my only attempt and finish at that distance.

For many of the over 20 years that I was an aid station captain at the Massanutten Mountain 100 mile, he was the Virginia Happy Trails volunteer driving the setup truck with drop bag tubs.

Like me, he has completed many ultras.

I was telling him about my heart arrhythmias and m7 recovery progress. To my surprise, he, too, had multiple ablations for an arrhythmia. In addition, he had back problems that kept him from exercising for 6 months.

We’re both in our late 60s. We wondered why so many taller runners our age are experiencing heart issues. After all, we exercised frequently, didn’t smoke, and ate a healthy diet.

Our recoveries have led to more walking. Perhaps the 6 months without long runs have reduced leg strength that can’t be recovered.

At least with Medicare, most medical procedure bills are covered. Then, I went to pick up my first prescription refill in 2025.

New this year, Medicare recipients maximum out-of-pocket money paid for prescriptions is $2000.

My prescription copays for the past three years have been $649, $1789, and $1407. So, unless something drastic happens, I should not get to that $2000 number.

Insurance companies and Medicare managers had to change their calculations to offset the new law. My deductible went from $90 to $295, and the copay percentage increased. I’m sure the total I will pay out this year will be $2000. Somebody has to cover the projected shortfall. Luckily, that is the number I budgeted.

That first prescription was $374 this year compared to $126 in 2024; a second was $6 versus $2. Both were generic drugs.

The benefactors of the new law will be those with catastrophic drug needs and those with no prescriptions.

I warned the pharmacist of the patients coming to pick up their first prescriptions of the year.

Bill told me of a book, Haywire Heart, that warns endurance athletes of potential heart issues and provides workarounds. I’m past those days to avoid issues. It may be a good read for other old people who have yet to have a problem.

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