Medicare open enrollment starts today...

Medicare open enrollment is just around the corner Oct. 15 - Dec. 7. Whether you’re a person with Medicare, a caregiver, or professional helping clients to review their coverage options, we’ve got some helpful tips for you to keep in mind this season.

Tips for Consumers

1. Start early - Yes, open enrollment runs until Dec. 7. But the best time to start thinking about whether you want to change your drug or health coverage is now. If your circumstances have changed—for example, you’re taking different medications, or you’ve heard that your plan is changing—it’s important to have time to review all your options. And if you need personalized assistance, it’s easier to schedule an appointment now than if you wait until after Thanksgiving.

2. Pay attention to your mail - This is the time of year that you’ll start to get a lot of information.
Your Part D or Medicare Advantage plan sends out an Annual Notice of Coverage in September, which explains any changes happening to your plan and/or to your benefits in 2013.
If you get help paying for your Medicare, such as through the Medicare Part D Low Income Subsidy (Extra Help) or Medicare Savings Programs, you may receive mail from Social Security or Medicare asking you to verify your income or informing you of changes to your subsidy. You may also get a letter if your plan is ending service in your area, or has not met quality standards for three years. Save all of these letters, and have them on hand as you discuss your options with an SGIA (Strategic Growth Insurance Associates) counselor.

3. Review, review, review - Many people are happy with their current coverage, and would rather not check what other options are available to them. But this is a very important step, and can save you money. What should you look for? We like to remind people of the 4 Cs:

• Cost - How much have you spent in premiums, deductibles, and co-payments in 2012? How will these amounts change in 2013??
• Coverage - Does your plan cover all of the medications you believe you will need in 2013?? Do you want to get your health care and drug coverage through one single plan? If so, you should review your Medicare Advantage options.
• Convenience - To what extent will your plan restrict access to certain medications you need in 2013, such as through prior authorization or quantity limits? Can you use the plan at the pharmacy of your choice? Can you get your prescriptions through the mail if you prefer to?
• Customer service - Is your plan responsive when you have a question?

Obamacare offers choice...support kids or aging parents

What will we do?

While most Americans wait to find out how Obamacare will affect their own health care situation, Martha R Gore, Watch Dog Politics Examiner, Examiner.com, speculates that those who are most likely to bear the brunt of the legislation are the demographic who care for aging parents as well as adult children. 

Medicare cuts could pose a conflict for those “middleagers,” writes Gore as they choose between health care costs for themselves and their parents while weighing the option of a multigenerational household to help keep costs down. 

The follow is a sample of cuts to Medicare:

• Home health care
• Diagnostic imaging like MRIs, CT scans
• Ambulances
• Diagnostics labs
• Durable medical equipment
• Power wheelchairs unless rented for previously rented for 13 months
• Long term hospitals, nursing homes and inpatient rehab facilities
• Dialysis treatment
• Inpatient psychiatric hospitals
• Hospice
• Hospitals that treat low income seniors

According to an article in NPR the number of elderly Americans needing expensive care is going to surge as more Baby Boomers retire and begin to depend upon Medicare to meet their health needs. This is the age group born between 1946 and 1964 and many of them are expected to live to live 85 years or older. Today there are 6 million Americans in that age group.

As more cuts to Medicare are made it may mean many Americans that are still supporting children may be expected to shoulder more of the cost of taking care of the health and medical needs of elderly parents.

In some cases, this may require that the aging parent move into the family dwelling in order to cope with the financial challenges. The Pew Research Center reports that this is already happening with about 20% of older people living with another generation. However doubling up to split living costs may fall short of what is needed to care for an aging parent. Three generations in one household may become the rule rather than the exception.

Wake up people...

Financial problems in the U.S. stemming from the aging baby boomer generation are only going to get worse, says NPR in its Family Matters series, and government entitlement programs won’t be able to sustainably provide care for the growing senior population.

Roughly 78 million boomers (a staggering number) are entering their retirement years, and while they’re “young” seniors now, their health likely won’t last—and neither will their resources.

For individuals, families, local government officials and federal taxpayers, this demographic shift will drain dollars and attention, and force extremely difficult decisions about living arrangements, as well as end-of-life care.
The government is running short of funds for existing programs. Medicare’s trustees recently said the program that provides medical care to the elderly will remain solvent only until 2024. The Social Security system already is paying out more than it is taking in.

More than 50 million Americans reside in multigenerational homes. And in many of these households, middle-aged “children” are caring for elderly parents, as well as providing shelter for their own grown children. In many cases, family members are making big financial sacrifices to help each other.
But the squeeze may get even tighter for future households because boomers generally had fewer children, and more divorces, compared with the World War II generation. A Pew Research Center analysis of census data found that the boomer generation “offers its elderly parents about 50 percent more grown children with whom they can share a household.”

Providing aging Americans with long-term care “is a bona fide need and growing concern,” said David Walker, a former U.S. comptroller general and an expert on federal spending. “But we have to recognize that the U.S. government has overpromised in the area of health care. We can’t make more entitlement promises.”

About 20% of older people are now living with another generation, according to the Pew Research Center, and that number is expected to keep rising. But doubling up to save on living costs “may fall far short of the trillions of dollars that would be needed to hire all of the care needed to cope with all of the long-lived elderly,” NPR says.

Elderly patient hospitalizations decrease under the watchful eye of a primary care physician

As the primary-care workforce continues to be strained, new research shows that areas with higher levels of primary care have fewer patient deaths and preventable hospitalizations, according to a study in The Journal of the American Medical Association.

Researchers evaluated seniors with Medicare benefits who live in areas with higher levels of adult primary care physicians and physicians providing primary care. They found that elder patients were less likely to die or land in the hospital.

"A higher level of primary-care physician workforce, particularly with an FTE measure that may more accurately reflect ambulatory primary care, was generally associated with favorable patient outcomes," said the study authors.

Experts agree that graduating medical students electing other specialties other than primary care results in a primary care vacuum that must be filled.

If the United States could fulfill the primary-care need, it would result in 50,000 fewer deaths and 436,000 fewer hospitalizations in a year, notes Reuters.

You can make a difference!

In the latest effort to enlist seniors in the fight against Medicare fraud, federal officials have overhauled Medicare billing statements to make it easier to find bogus charges without a magnifying glass.

The new, more consumer-friendly format, which goes online Saturday on Medicare’s secure Web site, www.mymedicare.gov, includes larger type and explanations of medical services in plain English. The revised paper version, which is mailed to seniors every three months, will be phased in early next year.

“You can make a difference!” the revamped statement says. “Last year Medicare saved taxpayers $4 billion – the largest sum ever reported in a single year thanks to people who reported suspicious activity to Medicare.”

And for those who might need an incentive to scour their bills, the new statements promise a reward of up to $1,000 for a tip that leads to uncovering fraud. Although the bonus isn’t new, there’s no mention of it on current forms, which are sent to about 36 million beneficiaries in traditional Medicare.

“We approached this redesign from the standpoint of making it a more consumer-friendly document for beneficiaries and also a better fraud-fighting tool,” said Erin Pressley, director of creative services for the Centers for Medicare and Medicaid Services. “If they are paying attention to these documents, they are going to be the best defense we have.”
“It shouldn’t be a scavenger hunt,” she added.

The 2012 best and the not so best nursing homes

A recent USA Today report reveals that 560 of the nation’s nursing homes have not budged for the past three years from a one-star federal government rating — the lowest on a five-star scale.

The star ratings are part of a broader federal effort to increase transparency for consumers of health care. When introduced in late 2008, nursing home industry groups called them simplistic and unfair. Some consumer advocates say nursing home quality can change quickly, and no ratings system is perfect.

The share of nursing homes receiving one or two stars overall fell to 35% in 2011 from 40% in 2009. At the same time, four- and five-star homes increased to 43% from 38% of nursing homes. The share of three-star homes remained steady.

Click to access the ratings of over 15,000 nursing homes

Read full article...

Do you know what Medicare covers?

A significant number of retirees on Medicare lack a solid understanding of the health insurance program’s coverage and costs. Two out of three, for example, did not know if Medicare covers long-term care. This lack of knowledge results in unexpected financial surprises, according to research by the Bankers Life and Casualty Company Center for a Secure Retirement.

The study, Retirement Healthcare for Middle-Income Americans, focused on 400 pre-Medicare Baby Boomers (age 47 to 64) and 400 senior citizens (age 65 to 75) with an annual household income of between $25,000 and $75,000.

It found that one in three Medicare enrollees still did not know how much the program covers for doctor's visits (33 percent) or hospitalization (31 percent), which are the basic components of the program's health benefits.
The CSR study also found nearly half (49 percent) do not understand their benefits for vision care and hearing care, both which are services typically not covered by Medicare.
Long-term care was found to be the least understood and the greatest perceived threat to financial security for middle-income Americans. Two out of three (66 percent) Medicare recipients did not know if the program covers long-term care or overestimate its long-term care coverage.

Medicare has long been labeled as an entitlement program but middle-income Americans say it is not the free ride many assume it is. Two-thirds (65 percent) of those on Medicare report paying the same or more for healthcare now that they are on Medicare, resulting in unexpected financial surprises.
The most common financial surprises for Medicare enrollees is the cost of monthly Part B premiums with nearly half (44 percent) who report paying more than they had expected.
The unexpected financial surprises coupled with the uneasy economy have forced 78 percent of middle-income Americans on Medicare to take at least one action to reduce their healthcare expenses, including -
● switching to generic prescriptions (69 percent),
● holding off going to the doctor (22 percent),
● changing to a less expensive health plan (15 percent) or
● splitting pills to make their prescriptions last longer (12 percent).

"Financial fallout from healthcare related expenses can devastate savings and strip away the enjoyment of one's retirement years," said Chris Campbell, vice president of strategic marketing and business development for Bankers Life and Casualty Company, a national life and health insurer.

"Review your Medicare plan options annually and look into new health and prescription drug plans that better meet your needs. Also, consider purchasing additional healthcare insurance to address services not covered by Medicare and

2012 Best US Nursing Homes

Each year, U.S. News and World Report releases its list of “Best Nursing Homes,” determined by quarterly ratings from the Centers for Medicare and Medicaid Services (CMS), and it also issues an Honor Roll which consists this year of 39 nursing homes that earned the highest possible ratings in all four quarters of 2011.

The 39 nursing homes on the Honor Roll are the only ones out of more than 15,500 that U.S. News reviewed to receive the four straight quarters of perfect five-star ratings from CMS in all three areas of consideration: health inspections, nurse staffing, and quality of care.

View the list...

Three ways to cut down on hospital re-admissions

Hospitals are taking a close look at care transitions in preparation for reimbursement changes that will penalize hospitals for high readmission rates. To avoid Medicare cuts and penalties, hospitals across the country are experimenting with how to better care for patients after discharge.

Offer transition coaches
According to a recent study published in the Archives of Internal Medicine, a Journal of the American of Medical Association, programs designed to help older patients transition from the hospital to home can cut readmission rates. Hospitals that provided a transition coach for patients had a 12.8 percent readmission rate, compared to 20 percent for those without coaches.

New Jersey's Robert Wood Johnson University Hospital Hamilton in October launched a similar program, in which a transition coach visits patients at home, reports NJ Spotlight. The coach provides patients with a daily health record to monitor weight gain, track medication, write down questions for providers and map out personal goals. Although that responsibility has traditionally been on the healthcare provider, the transitional coach program encourages patients to actively manage their own care.

Implement post-discharge clinics
Some hospitals, including Boston's Beth Israel Deaconess Medical Center, are identifying patients who are likely to be readmitted and directing them to post-discharge clinics. At Beth Israel, providers at the post-discharge clinic, located near the hospital, check on patients to make sure they are taking medications and making follow-up appointments, reports Kaiser Health News.

Similarly, Barnes-Jewish Hospital in St. Louis recently launched its post-discharge program, called the Stay Healthy Clinic, for Medicare-eligible patients with chronic obstructive pulmonary disease, pneumonia, heart attack and heart failure. The Stay Healthy Clinic even goes as far as offering patients transportation to the clinic. Still, the program isn't a cure-all for one persistent challenge: Only half of patients show up to their appointments.

"We'll continue to try to tweak" the program, Barnes-Jewish Hospital Chief Medical Officer John Lynch said in the article.

Keep patients out of hospital from the start
Hospitals in areas that have high admission rates also have a high propensity for readmission rates, according a study published last week in the New England Journal of Medicine. The study suggests that more can be done in the beginning of patient care, that is, keeping patients out of the hospital from the get-go.

"I think the notion that we can do better at the point of transition are pretty obvious, but I think what this is saying is that it's really just a start of what we have to do," Dr. Arnold Epstein, one of the researchers at the Harvard School of Public Health, said in a National Journal article.

Researchers of the study don't discourage improvements in discharge planning, but they do suggest that Medicare and other payers reward hospitals for keeping patients out of the hospital altogether, according to the article.

What every senior needs to know about hospital observation care.

How do I know the status of my hospitalization stay?

Ask your doctor or other hospital officials if you are in the hospital for observation or as a regular inpatient. If you are an observation patient, ask why. Even if you are admitted as an inpatient, the hospital can switch you to observation status; in that case, the hospital is required to notify you.

You may not be eligible for post hospitalization skilled Medicare benefits.

If you do not have three consecutive days of hospitalization as an inpatient -- excluding the day of discharge -- Medicare will not cover a subsequent stay in a nursing home. For those who do qualify, Medicare pays for up to 100 days of rehabilitation or skilled nursing care.

How long can the hospital keep me for observation?

Medicare expects patients to remain in observation status for no more than 24 to 48 hours. But there are no rules limiting the time; some patients spend several days in observation.

What can I do if the hospital won't change my observation status to inpatient?

"You cannot directly appeal the hospital's determination that you are or were an observation patient," says Ellen Griffith, a Medicare spokeswoman.

If you think you should be considered an inpatient, ask your personal physician to call the hospital and request a change in status, although your doctor cannot mandate this. If that is not successful, there are other steps you can take.

Cuts in Medicare and Medicaid major concern for nursing homes

The following is an article written by Alyssa Gerace for Senior Housing News.

In the past 10-plus years, there has been a trend away from nursing homes and to other, more home-like forms of long-term care for American seniors. Most say the shift is due to nursing homes’ high costs, but also some of the traditional qualities that nursing homes have represented over the years and the rise of alternative options.

Between 1998 and 2008, the number of Americans living in nursing homes shrank 6.1% to slightly more than 1.2 million, says a Brown University study published in the July 2011 edition of Health Affairs. During this same time frame, there was 18.1% increase in the number of Americans aged 65-69, and 8.7% rise in those aged 70 and older, according to U.S. Census Bureau estimations. MetLife estimates that today’s nursing home care costs upwards of $83,000 per year for a private room, on average.

Jodie Spiegel, a lawyer for consumer advocacy organization Bet Tzedek, says in her experience from speaking with clients, the nursing home population is decreasing because there are so many other options available, like assisted living, which has experienced rapid growth. There are more than one million people living in assisted living facilities, according to the Assisted Living Federation of America, even though it’s a relatively new concept that was developed about 25 years ago.

“Previously, when someone required care outside of their home, their only choices were hospitals or nursing homes,” says Spiegel. “Now, there’s assisted living, continuing care, adult day healthcare, senior centers, receiving care at home—there are more choices, and choices are more home-like, which in general is more appealing to people.”

Something else that may be keeping seniors out of nursing homes is the multitude of stigmatized issues attached to those establishments. As a consumer advocate, Spiegel encounters many recurring complaints regarding nursing homes, many of which she says are due to staffing shortages.

“Nursing homes are businesses and they’re trying to make a profit,” says Spiegel. “In a perfect world, nursing homes would be hiring more staff to provide better care, but unless they’re required to do so, they’re unlikely to do so.”

Missouri-based Cheryl Parsons, who’s a registered nurse and a licensed nursing home administrator and consultant, admits staffing can be a major issue for some facilities.

“The problem is, the acuity level has gotten a lot higher in the long term care setting,” says Parson, referring to the level of severity of a resident’s illness. “Hospitals just are not keeping patients, so we’re seeing higher acuity levels,” which translates to higher levels of care and attention being needed. “Couple that with reimbursement issues, owners are having a hard time keeping the bills met, and the staff paid, in order to keep that staffing where it needs to be,” she says. “It is a concern, it’s a big issue.”

Now that nursing homes are facing an 11.1% cut to Medicare payments, the challenges abound. Although both Medicaid and Medicare programs apply to nursing home residents, reimbursement rates from the government-funded programs aren’t as high as what a nursing home could receive from a private pay resident, says Spiegel.

Since many nursing homes have a high population of Medicare- and Medicaid-eligible residents, these facilities could be especially affected by funding cuts, since it will affect their ability to subsidize lower Medicaid reimbursements with Medicare funds.

“You need to pay the bills to keep the doors open and let patients in,” Parsons says. “It weighs heavily on those of us who are committed to the industry and to our residents. Most facilities work very hard and diligently to do so, but it’s always a challenge because of the reimbursement issue.”

Greg Crist, the Head of Affairs for (AHCA) says the important thing to remember is that nursing homes want residents to be in the least-restrictive setting. They’re not trying to pull in large numbers of residents to give them lesser-quality care for a profit, if those residents are better off living at home or at an assisted living facility.

“There will always be a need for long term care,” he says.”We just want to make sure there’s a cost-effective, and least-restrictive method as well. We only want them in our facilities if that makes the most sense.”

Confused by Medicare? Join the club.

Only 46% of seniors and baby boomers have a solid understanding of how Medicare works, and half of people over the age of 60 say they have a poor understanding of healthcare reform, a new report finds.

What's more, 39% of all seniors say their ability to navigate the numerous Medicare options is fair to poor, according to a survey of 1,500 seniors released by UnitedHealthcare and the National Council on Aging.

This lack of knowledge leaves seniors poised to make uninformed choices about their own healthcare, particularly low-income seniors, investigators say. According to the survey, 47% of limited-income seniors have heard of Medicare's Extra Help program, and only 13% have ever applied for help, through it. Fewer than 31% have heard of the Medicare Savings Program.

Depending on the state they live in, seniors who have trouble meeting Medicare premiums and deductibles can apply Medicare Extra Helpand the Medicare Savings Program for assistance with coverage.

Enrollment Period for Medicare Starts Early This Year

The open enrollment period for Medicare will begin earlier this year, so seniors need to start looking at their current plans to decide what coverage they want in 2012, U.S. health officials said Thursday.

The good news is that while benefits will remain essentially the same for the 99.7 percent of Medicare recipients who have access to Medicare Advantage, premiums for that program will fall 4 percent, according to the U.S. Department of Health and Human Services (HHS), which oversees the program.

Meanwhile, overall enrollment is expected to increase 10 percent, health officials said. Although the enrollment period will last longer this year it will end earlier, on Dec. 7 instead of Dec. 31, they added.

"As we continue to implement the Affordable Care Act, we are taking the right approach to Medicare," HHS Secretary Kathleen Sebelius said during a Thursday morning news conference. "An approach that begins by improving benefits instead of cutting them, and continues to slow the growth in costs."

All beneficiaries will have access to Medicare-covered preventive services without a co-pay or deductible, including Annual Wellness Visits, in 2012, Sebelius added. Also, people who reach the donut hole in their drug coverage will get discounts on brand name drugs and expanded coverage for generic drugs as part of the Affordable Care Act, she noted.

Premiums for the Medicare Part D, the prescription drug plan, will remain the same, Sebelius said.

"The Centers for Medicare & Medicaid Services [CMS] is encouraging beneficiaries enrolled in Medicare Advantage and Medicare Prescription Drug plans to review their current health and drug plan coverage for any changes their plans may be making for 2012 before the annual open enrollment period begins on Oct. 15," the agency said.

Speaking at the news conference, Jonathan Blum, deputy administrator and director of CMS, said that in 2012 Medicare Advantage patients will have "better benefits, consistent number of choices and lower average premiums."

For the first time, CMS will reward Medicare Advantage plans with high quality scores through its so called "Five-Star" rating system. Plans that earn these financial rewards will also be allowed to market to and enroll new patients all year long, Blum said.

Those currently enrolled in a Medicare Advantage plan will be automatically switched to original Medicare if they do not choose a plan. But to keep prescription drug coverage, everyone will need to enroll in a Part D plan, the agency stressed.

To learn more about Medicare and Medicare Advantage, visit the Medicare.gov.

Concern Is Growing That The Elderly Get Too Many Medical Tests

Kaiser Health News and The Washington Post collaborated on an article that appears on the KHN website today September 13.

My feelings on this article vary...certainly some very good points made on the issue of over testing. However, I struggle with the fact that the US Preventive Task Force is evaluating what tests are necessary and for whom. I believe this certainly embodies the slippery slope analogy.

Sandra G. Boodman - journalist, Kaiser Health News

Every year like clockwork, Anna Peterson has a mammogram. Peterson, who will turn 80 next year, undergoes screening colonoscopies at three- or five-year intervals as recommended by her doctor, although she has never had cancerous polyps that would warrant such frequent testing. Her 83-year-old husband faithfully gets regular PSA tests to check for prostate cancer.

"I just think it's a good idea," says Peterson, who considers the frequent tests essential to maintaining the couple's mostly good health. The Fairfax County resident brushes aside concerns about the downside of their screenings, which exceed what many experts recommend. "Most older people do what their doctors tell them. People our age tend to be fairly unquestioning."

But increasingly, questions are being raised about the overtesting of older patients, part of a growing skepticism about the widespread practice of routine screening for cancer and other ailments of people in their 70s, 80s and even 90s. Critics say there is little evidence of benefit -- and considerable risk -- from common tests for colon, breast and prostate cancer, particularly for those with serious problems such as heart disease or dementia that are more likely to kill them.

Too often these tests, some doctors and researchers say, trigger a cascade of expensive, anxiety-producing diagnostic procedures and invasive treatments for slow-growing diseases that may never cause problems, leaving patients worse off than if they had never been tested. In other cases, they say, treatment, rather than extending or improving life, actually reduces its quality in the final months.

"An ounce of prevention can be a ton of trouble," observed geriatrician Robert Jayes, an associate professor of medicine at George Washington University School of Medicine. "Screening can label someone with a disease they were blissfully unaware of."

Read full article...

Once in donut hole, seniors buy less

About 12 percent of people receiving the Medicare prescription drug benefit in 2009 fell into the gap in coverage — the much maligned “doughnut hole” — according to a study released today.

While in the doughnut hole beneficiaries bought fewer drugs, including about 11 percent fewer monthly prescriptions in 2009, compared to when they’re still getting prescriptions subsidized, said the study by the Kaiser Family Foundation. Other studies have shown a similar effect.

Excluding low-income Medicare enrollees who qualify for financial assistance and are not subject to the doughnut hole, there were 19 percent of beneficiaries in the coverage gap in 2009, the study said. That percentage has been shrinking, most likely due to the increase in cheaper generic drugs being offered, the study said.

The doughnut hole in 2009, the latest data in this study, started after the plan and the beneficiary paid a total of $2,700. Then, an individual was responsible for all of their medication costs until he or she had paid $4,350 in out-of-pocket costs.

After they come out of the “hole,” Medicare picks up about 95 percent of the costs. Less than 3 percent of Medicare drug beneficiaries, excluding low-income beneficiaries, reach that catastrophic-coverage level, the study found.

This year, because of the federal health law, beneficiaries are getting a 50 percent discount off brand name drugs while in the doughnut hole. The benefit is important because few Medicare drug plans provide any gap coverage, and those who do charge much higher rates, according to a separate study released by the Kaiser Foundation. This year, beneficiaries also get a 7 percent discount off generic drugs.

In 2012, the 50 percent brand discount remains and the generic drug discount doubles from 7 percent to 14 percent.

The cost of medicine continues to be a problem for the elderly

Approximately 10% of Medicare beneficiaries do not comply with their prescribed medication regimen because they simply cannot afford it, researchers from Harvard Medical School reported in the Journal of Cancer Survivorship. They added that elderly Medicare patients, whether or not they are being treated for cancer, commonly skip taking a pill so that they can last longer, or forgo filling a prescription completely because it is just too expensive.

The authors believe that their findings suggest that seniors with cancer or those who survived it do not face greater medical costs than other patients.

The rise in medication costs has occurred in parallel with an aging population, leading to greater financial burdens for the patient. Cancer costs have risen considerably. Patients being treated for cancer face considerable out-of-pocket expenses while they are being diagnosed, treated and receiving follow-up care. Comorbidities are common among cancer survivors, who may be taking medication for diabetes, hyperlipidemia, hypertension or osteoporosis.

The researchers set out to understand what medication issues cancer patients have to face. They gathered data from the 2005 Medicare Current Beneficiary Survey and Medicare claims from 2005.

They looked at reasons why patients may not stick to their prescribed drug regimen, whether they spent less on basic needs, or even did without to cover their out-of-pocket medical expenses. They analyzed both cancer survivors and non-cancer sufferers.

Dr. Larissa Nekhlyudov and colleagues found that the rate of cost-related non-adherence among those without cancer was 11%, compared to 10% for cancer survivors - not a statistically significant difference.

6% of cancer survivors said they spend less on food, heating and other basic needs in order to be able to pay for their medication, compared to 9% of individuals without cancer. More than half of all Medicare beneficiaries were involved in some kind of cost-saving strategy, such as buying generic drugs, asking for free samples and shopping around from pharmacy-to-pharmacy for the cheapest prices.

Christian Nordqvist
Medical News Today

The elderly are better off than advertised

The following is a very good article that appeared in the Washington Post on May 15 by opinion columnist Robert Samuelson

When House Speaker John Boehner calls for trillions of dollars of spending cuts, the message is clear. Any deal to raise the federal debt ceiling must include significant savings in Social Security and Medicare benefits. Subsidizing the elderly is the biggest piece of federal spending (more than two-fifths of the total), but trimming benefits for well-off seniors isn’t just budget arithmetic. It’s also the right thing to do.

I have been urging higher eligibility ages and more means-testing for Social Security and Medicare for so long that I forget that many Americans still accept the outdated and propagandistic notion that old age automatically impoverishes people. Asks one reader: Who are these “well-off” elderly you keep writing about? The suggestion is that they are figments of my imagination, invented to justify harsh cutbacks in Social Security and Medicare on the needy.
Just the opposite. We see every day that many people in their 60s and older live comfortably — and still would if they received a little less in Social Security and paid a little more for Medicare. The trouble is that what’s intuitively obvious becomes lost in the political debate; it’s overwhelmed by selective and self-serving statistics that cast almost everyone over 65 as being on the edge of insolvency. The result: Government over-subsidizes the affluent elderly. It transfers resources from the struggling young to the secure old.

To correct the stereotype, consult a government publication called “Older Americans 2010, Key Indicators of Well-Being.” It reminds us that Americans live longer and have gotten healthier. In 1930, life expectancy was 59.2 years at birth and 12.2 years at 65; in 2006, those figures were 77.7 and 18.5. Since 1981, death rates for heart disease and stroke have fallen by half for those 65 and over. In this population, about three-quarters rate their own health as “good” or “excellent.”

“Most older people are enjoying greater prosperity than any previous generation,” the report says. Consider:

l From 1959 to 2007, the proportion of the 65-plus population with incomes under the government’s poverty line ($12,968 for a couple in 2009) dropped from 35.2 percent to 9.7 percent, which was half the poverty rate for children under 18 (18 percent).

l  The proportion of elderly living in the “high income” group — defined as four times the poverty line, or almost $52,000 for a couple in 2009 — rose from 18.4 percent in 1980 to 30.6 percent in 2007.

l  In 2007, the median net worth (that is, assets minus debts) of 65-plus households was $237,000, about twice the amount for households aged 45 to 54. Among 65-plus married couples, median net worth was $385,000.

Indeed, half the nation’s wealth is owned by people 55 and older (a third of the adult population), report Eugene Steuerle and Stephanie Rennane of the Urban Institute. The old feel more secure. The National Opinion Research Center regularly surveys Americans about their financial “satisfaction.” In 2010, 82 percent of those 65 and over said they were “satisfied” or “more or less” satisfied. For those under 65, the comparable figure was 66 percent.

Older Americans also fared better in the recession, a 2009 Pew survey found. Among those 18 to 49, 68 percent reported that they “cut back spending” in the past year; for those 65-plus, that was 36 percent.

Social Security and Medicare explain much of this well-being. For millions of older Americans, they are essential; among the poorest two-fifths, Social Security provides 83 percent of their income. But among the richest fifth, its share is only 18 percent.

The problems of old age (chronic illness, outliving savings, loneliness) are real, but age by itself is not an indicator of need. The blanket defense of existing Social Security and Medicare isn’t “liberal” or “progressive.” It’s simply a political expedient with ruinous consequences. It enlarges budget deficits and forces an unfair share of adjustment — higher taxes, lower spending — on workers and other government programs. This is the morality of the ballot box.

People do not lose their obligations to the larger society by turning 65. We need to refocus these programs on their original purposes. Social Security was intended to prevent poverty, not finance recipients’ extra cable channels. Medicare provides peace of mind as well as health insurance; wealthier recipients can afford to pay more for their peace of mind. Burden-sharing needs to include the elderly. This is the crux of the budget problem.

Facing it is both a moral and financial imperative. With the 2012 election looming, major overhauls of these programs seem unlikely. Still, more modest changes (slow increases in eligibility ages, added taxation of Social Security benefits, costlier Medicare for upscale beneficiaries) could produce significant savings. If even these are absent, the meaning will be plain: Old stereotypes continue to trump new realities.

Medicare Part D - prepare to do your homework

The following is an excerpt from an article in SmartMoney Magazine, written by Glenn Ruffenach

Medicare Part D

Spending on prescription drugs in the U.S. totaled about $250 billion in 2009, more than six times the $40 billion spent in 1990. Here are some of the reasons why:
Increased use and demand. From 1999 to 2009, the population grew 9 percent, but the number of prescriptions purchased jumped 39 percent.

*Types of prescriptions written. The best-selling prescriptions are newer, higher-priced brand-name drugs, which have replaced older, less-expensive drugs.
Price increases. Retail prices for prescription drugs increased an average of 3.6 percent annually between 2000 and 2009, versus an inflation rate of 2.5 percent.
Research and development. Only one in five drugs in clinical tests reaches consumers. Manufacturers try to recoup R&D costs for drugs that make it to market—and those that don't.

Picking the right drug plan under this program could save you a bundle—if, and this is the key, you stay on top of changes in your plan.

Typically, you sign up for Part D when you first enroll in Medicare. Ideally, the plan you select will be one that covers the medications you take at the most affordable prices. (Each Part D plan, offered by private insurers, covers different drugs with different premiums and co-payments.) The problem: The plans can (and do) change, dropping drugs here, adding others there, and raising or lowering fees. If you fail to notice, for instance, that your plan no longer covers one of your medications—and if you don't take advantage of the annual opportunity to switch plans—your nest egg takes a hit.

It's a pain in the neck, but you have to do the homework—every year. "A mistake here, depending on how long you allow it to go on, could cost you thousands of dollars," says Joseph L. Matthews, coauthor of Social Security, Medicare and Government Pensions.

*Kaiser Family Foundation

Home Health Agencies up in arms over new Medicare regulation

The following is an article written by Phil Galewitz Kaiser Health News.

Home health agencies, hospitals and consumer groups are complaining that a new rule intended to curb unnecessary Medicare spending will make it harder for senior citizens to get home care services.

Under the requirement, which is to take effect Friday, Medicare beneficiaries will have to see doctors 90 days before or 30 days after starting home health services in order for the home health agencies to be reimbursed. Those face-to-face visits may be a burden for some home-bound frail seniors, as well as those who live in rural areas, the industry says.

Some Medicare experts have little sympathy for industry complaints.

"Home health is a benefit that is out of control," said Dr. Robert Berenson, a health policy expert at the Urban Institute.

Medicare home health care typically consists of services such as skilled nursing, physical therapy and speech therapy. Unlike most services in Medicare, patients don't have co-payments or deductibles. The services can be prescribed for 60 days at a time, although there's no limit on the number of times they can be renewed.
Medicare home health costs doubled to $19 billion from 2002 to 2009. Cases of Medicare fraud also have been rising, and federal officials have launched a crackdown that includes prosecuting home health agencies that bill for services that weren't provided.

Under current law, doctors must prescribe home health care for patients to receive services, but the physicians don't have to see the patients to make that determination.

Medicare advisers to Congress say the regulation doesn't go far enough to reduce waste and fraud because it allows patients to start getting home health services before first seeing doctors to ensure that they need it.

"Such a large window ... does not ensure that beneficiaries receive an examination in a timely manner before home health care is delivered," the Medicare Payment Advisory Commission wrote in a report to Congress this month. Berenson is a member of the commission.

The doctor-visit rule, which was included in the health care overhaul, initially was to take effect Jan. 1 and was to require providers to see patients within 30 days before or two weeks after the start of home care. In December, the Centers for Medicare and Medicaid Services delayed implementation until April because of complaints from providers, who claimed that the rule was too stringent and most doctors were unaware of the change. At that time, the CMS also announced that it was expanding the time frame for patients to meet with doctors.

Now a coalition of home health industry, hospital and doctor groups and the AARP is pushing for another three-month extension.

CMS spokesman Tony Salters said the agency was listening to concerns, but he refused to say whether another extension will be granted. Salters said the agency didn't have any data to show what percentage of Medicare patients now got home care services without having recent visits with their doctors.

"There is a lot of confusion out there, and patients may lose access to their care," said Nora Super, an AARP lobbyist.

Dr. Roland Goertz, the president of the American Academy of Family Physicians, said the new rule added documentation requirements for physicians. "It makes our paperwork burden even more onerous," he said.

Under the rule, doctors would have to fill out forms that certify that they or other health care providers such as nurse practitioners had seen patients for the specific purpose of determining the patients' needs for home care. This would be in addition to doctors' current duties of prescribing home health care and signing off on care plans, which the home health agencies typically develop.

"A home health face-to-face encounter contradicts the purpose of home health care," Hoosier Uplands Home Health Care & Hospice in Mitchell, Ind., a rural area about 85 miles south of Indianapolis, wrote the CMS last year. "This would impose on the patient the need to leave home for increased and unnecessary physician visits."

But the home health agency voluntarily has tried out the new rule over the past three months and found only minor problems, such as doctors not filling out forms correctly, said Melissa Jeremiah, the director of operations for Hoosier Uplands.

Rochelle Archuleta, a policy expert at the American Hospital Association, said her organization was "hearing concerns from providers ... and that tells us this policy is not ready for enforcement." Hospitals are worried that patients who are discharged may not be able to get home health services immediately and hospital-owned home health agencies may have trouble complying with the law.

Home health agency groups said they understood Medicare's need to reduce unnecessary care but that the new rule was too onerous.

"We want to make sure beneficiaries who really need the services are not denied it," said Peter Notarstefano, the director of home and community-based services at Leading Age, which represents nonprofit home health agencies

Medicare expert says healthcare reform won't hold down costs

The Affordable Care Act would not keep healthcare costs down, testified David Foster, chief actuary for the Centers for Medicare & Medicaid Services, before the House Budget Committee.

Foster also said that healthcare costs might actually increase if Medicare cuts to nursing homes, hospitals and home health agencies wind up being politically unpopular, the Associated Press reports. These cuts, Foster said, could push 15% of providers out of the business. Additionally, he said that the healthcare law funnels savings from Medicare to coverage for the uninsured.

White House officials have disputed Foster's analysis throughout the healthcare reform process. His assessment came last week in direct response to President Obama's State of the Union address.