Tag: insurance
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For more than 24 years, The Medicare State Health Insurance Assistance Program (SHIP) has advised, educated, and empowered individuals to navigate their state-specific Medicare choices. In addition, SHIP helps beneficiaries resolve fraud and abuse issues, billing problems, appeals, and enrollment in low-income health assistance programs. In 2015, SHIP provided assistance to more than seven million individuals with Medicare.
The Medicare State Health Insurance Assistance Program (SHIP) network is a critical resource for the elderly, disabled and families needing help to make informed decisions about their Medicare coverage options and enrollment decisions. Today’s Medicare beneficiary must choose among more than 20 prescription drug plans, 19 Medicare Advantage plans, and various supplemental insurance policies, all with different premiums, cost sharing, provider networks, and coverage rules.
Last week the Senate Appropriations Committee targeted two critical programs for significant cuts, and/or elimination for Fiscal Year 2017. The two programs targeted are The Medicare State Health Insurance Programs,(SHIP) which is slated to lose all of its $ 52.1 million in funding. The second critical program is The Senior Community Service Employment Program. (SCSEP)
Eliminating SHIPs would leave millions of older Americans, people with disabilities, and families who need help applying for benefits, comparing coverage options, filing appeals, and navigating a complex program stranded without assistance. Max Richtman, President and CEO of The National Committee to Preserve Social Security and Medicare stated “Senate appropriators have turned their backs on a growing number of people who will need SHIP services to navigate the complexities of Medicare coverage by proposing to eliminate program funding.”
The Senior Community Service Employment Program, (SCSEP) which is funded by the Older Americans Act provides subsidized, service based training for low income persons aged 55 and older who are unemployed, and have poor employment prospects. Cutting this program could result in fewer seniors receiving services, and less income due to deceased working hours. It would be devastating to the seniors who work and depend on this program.
Final decisions to cut the programs have not been made. The full Senate is expected to vote on the budget bill in the fall. If this is important to you, please take action by contacting your congressman to reject the imposed cuts, and to take steps to secure The State Health insurance Assistance Programs and The Senior Community Service Employment Programs are funded.
For more information on our featured article visit http://khn.org/topics/medicare/
What happens if you take your Social Security benefits before your full retirement age? This is the question many seniors are pondering.
According to a recent Associated Press Center for Public Affairs Research poll found that 44 percent reported that income from Social Security will be their biggest income source during their retirement years., and that Americans 50 and older have access to multiple sources of income, but Social Security is the most common source.
According to the Social Security Administration, if full benefits begin at 65 or 66 and you were born between 1943 and 1954; you can begin collecting social security at 62, but at a reduced benefit rate by up to 30 percent. The average age that most people expect to start or have started collecting Social security is 64. If you could wait in this case past 66 years of age and even to 70 to claim your benefits, your benefits would rise around 8 percent more.
There are advantages and disadvantages to taking your Social Security early. One advantage is that you collect your benefits for a longer period of time. The downside to that option is your benefits are reduced.
Your circumstances are just like your fingerprints, no two are alike.
The average retirement age for men is 64, and for women 62. There is no set answer as to when it is best for you to take out Social Security, in that it varies across all ethnic groups.
Click here for further statistics and information regarding what your full retirement age would be, and important factors you should consider regarding your social security benefits and retirement.
June is Men’s Health Month. The Purpose of Men’s Health Month is to heighten awareness of preventable health problems, and to encourage treatment and early detection of diseases among men and boys.
There is a health crisis in America in Men’s health. The crisis references the management of medical diseases such as diabetes, hypertension, heart disease and high cholesterol. These common and treatable health issues are causing men to die prematurely in the prime of their life.
According to a recent poll by the centers for Disease Control and Prevention. Men are 80 percent less likely than women to use a regular source of health care. Most men go to the doctor only when they feel sick or have a medical emergency and that’s not nearly as often as they should.
Let’s focus on tips and ways for men to stay healthy at any age in celebration of Men’s Health Month. It’s never too late to take care of your health. Six things that will help you maintain good health are : Getting 7- 9 hours of sleep,quit smoking, more physical activity, eating more fruits and vegetables, avoiding drugs and alcohol, taming stress by taking care of yourself , and connecting socially with family and friends on a regular basis.
For National Men’s Health Month, here are six recommended health screenings, most of which can be done in your local doctors office, that men should add to their list to ensure better health.
Recommended Health Screenings for Men
Blood Pressure Test
Cholesterol Test
Prostate Cancer Screening
Colon Cancer Screening
Skin Cancer Check
Diabetes Check
National Men’s Health Month has a primary goal of educating and encouraging men and boys to feel better about taking steps to stay healthy. Not all men avoid there screenings or doctors appointments , but the disparity between men seeking health care , and women has a large enough gap for a men’s health crisis to be declared. Take charge of your health today.
Check out https://www.men’shealthmonth.org for further information on details for screening and further statistics on men’s health.
This month is Better Hearing and Speech Month. According to the National institute on Deafness and Communication Disorders, an estimated 26 million Americans have hearing loss in some capacity, due to noise.
The good news is that noise induced hearing loss is preventable. Hearing loss due to noise is not exclusive to the senior population, it affects seniors, children and young adults, and the good news is that it is preventable.
Our Hearing and speech are essential to being productive in our daily lives, and we must take proper care to assure that we are functioning at our highest and healthiest capacity.
How We Hear
Being one of our five senses, hearing is a process of picking up sound, and attaching meaning to the sound. The ear is divided into three parts leading up to the brain. The outer ear, middle ear and inner ear. How we hear is a pretty complex process. I will summarize the three major parts and their functions.
Outer ear – The ear canal and eardrum – sound travels down the ear canal, to the ear drum causing vibrations.
Middle ear – Three small bones connected in a cluster behind the eardrum at one end and to the inner ear at the other vibrate and creates movement of the fluid in our inner ear.
Inner ear –movement of the tiny hair cells sends electric signals from the inner ear to our auditory/hearing nerve to the brain, which causes what we know as sound.
Listed are a few steps to prevent hearing loss:
- Turn down your stereo volume
- Limit your exposure to unsafe sound levels.
- Wear earplugs
Speech
Speech is crucial to our daily existence. Being able to communicate and express ourselves is crucial. Approximately 40 million Americans experience speech communication disorders. Seniors may also experience voice disorders often as a result of medical conditions such as cancer, stroke, Parkinson’s or traumatic brain injury. You may also be subject to voice disorders that have existed since childhood, such as stuttering.
If you are diagnosed , or through sudden illness you develop a speech disorder, you should seek treatment from a Certified speech–language Pathologist .
After a successful program at YMCAs nationwide, Medicare will cover programs that help prevent diabetes among those with prediabetes.
What is Prediabetes?
Prediabetes is the condition when blood sugar levels are higher than usual, but not high enough to be considered diabetes. One in three adults has prediabetes in the United States, and 90% don’t know they have it. Without action, about 15-30% of those with prediabetes will develop Type 2 diabetes within 5 years.
What will Medicare cover?
If approved, Medicare will pay for certain “lifestyle change programs,” where a trained counselor leads a class focused on preventing Type 2 diabetes with eating habits and exercise. These programs were implemented in YMCAs across the country with a federal grant with a CDC-approved curriculum.
The YMCA programs saved Medicare $2,650 per person enrolled in the program over 15 months. Participants lost about 5% of their body weight, which significantly lessened the likelihood of diabetes.
Need convincing? Here are more results:
In one of the first studies on healthy eating habits and exercise on diabetes, the results were so strong that the study was ended early. About 3,000 participants between ages 25-75 were randomly sorted into three groups. Group 1 was treated with a healthy diet and exercise. Group 2 was treated with metformin, and Group 3 was given a placebo medication.
Groups 2 and 3, with medication, reduced their risk of diabetes by 31%. Group 1, with diet and exercise, reduced their risk by 58% and the patients lost at least 7% of their body weight. Those age 60 or older, reduced their risk by 71%. These rates of reduction have been seen in studies since.
The program will likely be covered by Medicare soon, as it doesn’t require congressional approval.
This infographic is f CDC.gov.
You can take the CDC’s quick test online
to see your risk of prediabetes here.
For more on the YMCA prediabetes program,
see this New York Times article.
Let’s take a look at what Medicare covers in regards to whether your doctor’s appointment is a Physical Exam or a Wellness visit. The NIH, The National Institute of Health defines the physical exam as when a doctor / health care provider studies your body to determine if you do or do not have a physical problem. This exam would include inspection, feeling the body with hands or fingers, listening to you take a deep breath, while touching your back, sticking out your tongue, and checking your reflexes. Any tests resulting from this physical exam will not be covered under the cost of the exam.
Medicare Part B covers a Welcome to Medicare Visit and Annual Wellness Visits. Your Welcome to Medicare Visit is called an Initial Preventive Physical Exam (IPPE) This benefit is available for a single visit once you are eligible for Part B within the first year of your enrollment.
Services completed by your provider during your IPPE include recording and evaluating your medical history, current health condition and prescriptions. Checking your blood pressure, vision and weight. Making sure your health screenings and any shots are up-to-date, and ordering any further tests. There is no copay for this visit, and Part B does not apply to the cost of the visit. After the visit you may have to pay a co-payment for recommended services, and your Part B may apply.
Your Annual Wellness Visit is developed to provide you with a personalized prevention plan. This visit would include an assessment for future health risks and any preventive measures that may be needed. Your provider will compose a list of risk factors and treatment options just for you. There is no co-payment for your Annual Wellness visit, and they are not a part of your Part B deductible. However, you may have to pay a share of the cost for recommended tests or services.
Hepatitis C is an infection of the liver. There are many forms of the virus. Symptoms include Jaundice, stomach pain, loss of appetite and nausea. The Baby Boomer population from 1945 – 1965 most often are not aware they are infected and / or need screening for the virus; as noted by senior study author, Dr. Ellen Carmody, an infectious disease researcher at New York University.
Hepatitis C is only spread through exposure to infected blood; which would include sexual contact with an infected person, and sharing needles or equipment to inject drugs. There is no vaccine to prevent the Hepatitis virus, however, new medicines are available that make the virus easier to treat. Left untreated Hepatitis could lead to serious liver problems such as cirrhosis, which is scarring of the liver, liver cancer, or death. It is recommended by the Centers for Disease Control (CDC) that all Baby Boomers get tested for Hepatitis C at least once as part of their standard medical care. Testing is the only way to detect Hepatitis. Take charge of your health today, and get tested.
Get ready for a long read. Last week, the Obama Administration announced a five-year program to test alternative payment models for Medicare Part B drugs. The program will try new methods relating to drug prices, patient outcomes and physician payments starting next year.
Currently, Medicare pays doctors an extra 6% of the price of the drug they administer, which gives providers a bigger payment when they choose medications that cost more. This can lead to prescribing more expensive drugs, which sometimes differ from cheaper drugs only in price.
What is a Part B Drug?
Not all prescriptions are filed under Part D. Drugs that beneficiaries don’t take on their own, like those that are administered by injection or infusion at a doctor’s office, fall under Part B.
This image is from ModernHealthcare.com.
What will the program do?
There will be two phases. The first phase, which would go into effect later this year, would decrease Medicare’s additional payment from 6% to 2.5%, and use a flat payment of $16.80 per drug per day. The Centers for Medicare and Medicaid Innovation are looking to see how these changes affect the way doctors prescribe medications.
The next phase, which could begin as soon as early next year, will include a series of value-based purchasing options, based on price and effectiveness of drugs. Each strategy will be tested in a different geographic area:
- Decreasing or ending cost-sharing for Part B drugs, so that beneficiaries may access effective drugs more easily
- Creating tools for providers to choose drugs with evidence of their effectiveness and other information
- Options for different payments based on the effectiveness of a drug
- Using a benchmark, or standard rate or payment, for similar drugs
- Connecting patient outcomes with drug prices by partnering with drug companies
What are people saying?
The Obama Administration, Centers for Medicare and Medicaid Services and advocates say that the decision for which drug to prescribe should be made with factors such as effectiveness, quality, the patient’s need, and price.
Those against the payment models call it an “absurd experiment,” and believe that doctors know what’s best for the patient, and should be free to prescribe without government oversight. Some doctors in certain specialties are concerned about losing major percentages of their profits.
Comments can be submitted on the program until May 9th.
Will any group be negatively affected?
Some specialists will be more impacted than others by the program. Oncologists, Ophthalmologists, and Rheumatologists, who make a significant profit with Medicare’s drug payments, would see the biggest change in money earned. Primary Care and Family Practice Physicians would see a 44% rise in Part B drug payments, as they typically prescribe and administer cheaper drugs than other specialists.
This image is from ModernHealthcare.com.
To read more about the Part B payment program, see this NPR article.
The full proposition of the program is available online at the Federal Register.
About 20 new generic drugs will be on the market at the end of this year. The patents on the brand drugs have expired, allowing drug manufacturers to create generic versions. Most aren’t on the Medicare Plan Finder yet, and won’t be released until later in 2016.
Sometimes, companies will try to expand their patent, allowing for more time before a generic can be produced. Revenues for brand drugs drop dramatically when their generic versions are introduced. Generic drugs can take over 90% of a brand drug’s sales.
Here a few popular drugs that will soon have a generic version:
- Crestor – Rosuvastatin Calcium
Treats high cholesterol. Available in May. - Benicar – Olmesartan Medoxomil
Treats high blood pressure. Available in October. - Zetia – Ezetimibe
Treats high cholesterol. Available in December. - Proair HFA – Albuterol Sulfate
Treats asthma, COPD and others. Available in December. 
This image is from RxPreferred.com. Click on the image or link to see it enlarged
Fast Facts
- The price of generics is usually 80-85% less than brands.
- Once introduced, generics take about 90% of a brand’s sales.
- Generics must match the brand’s active ingredient, strength, type of medicine, effects, performance, and standards of testing.
- Generics can differ from brands in color and shape, label and packaging, and flavors and preservatives.
- There are two types of generics: Generic Equivalents, with the same active ingredients, and Generic Alternatives, with different active ingredients. Generic Alternatives are not prescribed as often, and require a separate prescription to be filled.