Transforming the Health Care Experience for the Patient – Elijah’s Patient Story

Walking older man with glasses.

Elijah is a 77-year-old Medicare beneficiary who felt that his body was failing him. Since retiring, he has struggled to fill his time since there isn’t much to do in the small, rural town where he lives. He would love to spend his time with his daughters and their families, but they live in the city, and it’s too taxing to frequently make that trek. After a visit with them, he usually needs a day or two of recovery. His daughters constantly nag him about going to the doctor. They tell him that he should not be this exhausted from the drive and short visit.

After the latest visit, he decided that he would get his shortness of breath and extreme fatigue checked out. After several tests and needle pricks, Elijah was diagnosed with coronary heart disease.

Elijah had difficulty coming to terms with this diagnosis and was overwhelmed by the instructions from the doctor. He was now on so many medications that it was hard to keep track of them. He wished one of his girls could have been at the appointment, but they were unable to be there.

He had one thing for which he was grateful. A couple of years ago, his daughter had helped him make some important decisions about his Medicare coverage. The piece of paper she left with him said he was on Traditional Medicare Part A and B, Part D for prescription coverage, and a Part F supplement. Elijah was unsure what that meant. To him, it sounded like coverage that would help with the cost of managing his heart disease.

When he went to the pharmacy to pick up his medication, he was shocked by the cost, although he had enough saved to afford it. After a few months of paying what seemed like a mortgage payment, he decided to stop taking some of his medications. He could not keep spending that much every month.

CHESS received a ping from its system that Elijah was not refilling his prescription. The team reached out to see how they could help. When a pharmacist reviewed his medical history and medications, she found that his income was above the typical limits for medication assistance support. She also discovered that his Part D plan had changed vendors in 2021, and he had mistakenly thrown away the letter thinking it was junk. Upon calling this new vendor, CHESS learned that Elijah was past the date to re-enroll.

To cover his medication in the short-term, the pharmacist located coupons to lower the cash price of his prescriptions. By now, Elijah was thankful for the lower cost, but frustrated that throwing a single letter away had caused so many problems. He wished his daughter could help him understand what to do.

Fortunately, Elijah had a team at CHESS to help him navigate this process. Through calls with Medicare and one-on-one discussions, CHESS helped Elijah understand all his options to make an informed decision. Elijah decided to enroll in a new Part D plan for 2023 and disenroll in the Part C plan so he could keep his Part F supplement. The CHESS social worker spent hours on the phone with Elijah to make the necessary calls to make these changes.

Without CHESS’ guidance, Elijah wasn’t sure what he would have done. He still can’t fathom why it is so complicated, but he is thankful to have someone explain it and help him get the coverage he needs to stay healthy.