Prescription Drug Costs for Seniors

By Big Island Now

Posted August 3, 2017, 09:00 AM HSTUpdated August 3, 2017, 09:27 AM HST

Sens. Mazie K. Hirono and Amy Klobuchar (D-Minn.) introduced a bill to allow Medicare to negotiate the best possible price of prescription drugs to cut costs for nearly 41 million seniors enrolled in Medicare Part D.

Current law bars Medicare from bargaining directly with pharmaceutical companies.

“Our kūpuna deserve to have access to affordable prescription medication,” said Sen. Hirono. “This commonsense legislation allows Medicare to negotiate directly with manufacturers to bring down costs for Hawai‘i seniors and their families.”

The legislation would allow the Secretary of Health and Human Services to directly negotiate with drug companies for price discounts for the Medicare Prescription Drug Program, eliminating the “non-interference” clause that expressly bans Medicare from negotiating for the best possible prices.

With 41 million seniors, including nearly 70,000 in Hawai‘i, participating in Medicare Part D, Medicare could negotiate bigger discounts with pharmaceutical companies.

Sens. Chuck Schumer (D-NY), Patty Murray (D-WA), Tammy Baldwin (D-WI), Ron Wyden (D-OR), Richard Blumenthal (D-CT), Cory Booker (D-NJ), Sherrod Brown (D-OH), Tammy Duckworth (D-IL), Al Franken (D-MN), Kamala Harris (D-CA), Maggie Hassan (D-NH), Martin Heinrich (D-NM), Tim Kaine (D-VA), Angus King (I-ME), Patrick Leahy (D-VT), Claire McCaskill (D-MO), Chris Murphy (D-CT), Debbie Stabenow (D-MI), Ben Cardin (D-MD), Tom Udall (D-NM), Kirsten Gillibrand (D-NY), Michael Bennet (D-CO), Maria Cantwell (D-WA), Joe Manchin (D-WV), Jeff Merkley (D-OR), Bill Nelson (D-FL), Jeanne Shaheen (D-NH), Chris Van Hollen (D-MD), Mark Warner (D-VA), and Elizabeth Warren (D-MA) are also cosponsors of the legislation.

Kaine, Warner Move to Drop Prescription Drug Costs

AUGUST 2, 2017 9:49 PM0 COMMENTS

By FCNP.com

Virginia’s U.S. Senators Mark Warner and Tim Kaine joined U.S. Senator Amy Klobuchar (D-Minn.) and 29 of their colleagues to introduce legislation to lower prescription drug costs this week. The bill would allow for Medicare to negotiate the best possible price of prescription drugs to cut costs for nearly 41 million seniors enrolled in Medicare Part D. Current law only allows for bargaining by pharmaceutical companies and bans Medicare from doing so.

The legislation would permit the Secretary of Health and Human Services to directly negotiate with drug companies for price discounts for the Medicare Prescription Drug Program, eliminating the “non-interference” clause that expressly bans Medicare from negotiating for the best possible prices.

 

Udall, Heinrich Cosponsor Bill To Allow Medicare To Negotiate A Better Deal On Prescription Drug Costs

Udall, Heinrich Cosponsor Bill To Allow Medicare To Negotiate A Better Deal On Prescription Drug Costs

Submitted by Chris Clark 

on August 3, 2017 - 7:19am

U.S. SENATE News:

WASHINGTON, D.C. ― Yesterday, U.S. Senators Tom Udall and Martin Heinrich joined in cosponsoring legislation led by U.S. Sen. Amy Klobuchar (D-Minn.) to unleash the bargaining power of seniors for a better deal on prescription drug costs.

 

The legislation would allow for Medicare to negotiate the best possible price of prescription drugs to cut costs for nearly 41 million seniors enrolled in Medicare Part D. Current law prevents Medicare from directly negotiating for lower drug prices, a practice regularly used to bring down prescription drug costs for the Veterans Administration. In New Mexico, there are over 150,000 seniors enrolled in Medicare Part D.

 

“This bill will enable New Mexico seniors to get a better deal on the prescription drugs they need to stay healthy,” Udall said. “I’m committed to working to find common-sense solutions, like this legislation, to lower the price of life-saving prescription drugs for New Mexicans and people across the United States.”

 

“When it comes to the soaring costs of prescription drugs for seniors, there’s nothing more effective that we could do then to allow Medicare to negotiate lower drug prices,” Heinrich said. “Changing the law so Medicare is no longer banned from negotiating the best possible price of prescription drugs for seniors is a no-brainer. Older New Mexicans struggling to afford the medication they are prescribed deserve better.”

 

The legislation would allow the Secretary of Health and Human Services to directly negotiate with drug companies for price discounts for the Medicare Prescription Drug Program, eliminating the “non-interference” clause that expressly bans Medicare from negotiating for the best possible prices. By harnessing the bargaining power of nearly 41 million seniors, Medicare could negotiate bigger discounts with the pharmaceutical companies.

 

A copy of the bill is available here

Tampa Bay residents say Obamacare repeal would threaten lives and livelihoods

 

Richard Danielson, Times Staff Writer
TAMPA — A St. Petersburg woman who couldn't get insurance while a sinus tumor and associated infections ruined her health for three years.

A Sarasota woman born without arms who could lose health care and prescription coverage for autoimmune disorders that developed after she was seriously hurt in a car crash.

A Sun City Center business owner whose breast cancer treatments were paid for by Obamacare.

A South Tampa family whose disabled son can be cared for at home thanks to Medicaid, instead of in a hospital, despite living with a tracheotomy.

Each said Monday that their lives could be torn apart by Republican proposals to repeal the Affordable Care Act and reduce projected Medicaid spending by $800 billion over a decade.

"The ACA saved my life," Gina Hebert said during a roundtable health care discussion organized by Florida Democratic Sen. Bill Nelson.

Hebert, 60, had pre-existing conditions including severe arthritis and kidney stones when she received coverage through the ACA health care exchanges and started her own business as a construction estimator.

"When the ACA came up, I grabbed hold of that insurance policy first thing," said Hebert, who said she does not receive any government support to pay the premiums.

Having the insurance became especially critical, she said, when she was later diagnosed with Stage 2 breast cancer. She had two surgeries, months of chemotherapy, months of radiation and has been cancer-free for two years.

"The ACA saved my life," Hebert said. "If the cancer comes back and I don't have insurance" she would have to face going bankrupt and closing her business, "which means I'm not paying taxes, which means I'm not contributing to society."

The nonpartisan Congressional Budget Office predicts passage of the U.S. Senate's proposed health care bill would leave 22 million additional Americans without health insurance.

"If they repeal it, there is no insurance company that's going to insure me," said Olivia Babis, 40, who does not have arms and works as a peer mentor for other people with disabilities at a center for independent living. "I have two autoimmune disorders. My prescriptions are $200 a month. Without insurance, there's no way I can afford that."

Coverage losses are projected to especially affect people ages 50 to 64, before they qualify for Medicare, who earn less than about $30,300 for a single person.

Meanwhile, the budget office said, the Senate bill would eliminate two taxes aimed at wealthy Americans and levies on the medical-related industry, giving those groups savings of more than $540 billion.

It also would allow states to ease Obamacare requirements that insurers have to pay for certain specified services, including substance abuse treatments.

Nelson, who served as Florida's elected insurance commissioner, said he has seen health insurance companies deny coverage based on pre-existing conditions like asthma, but also something as simple as a rash.

He also said he's seen companies dedicate 60 percent of the revenue from premiums to health care, while spending 40 percent on administration and overhead. Under the Affordable Care Act, Nelson said, administrative costs are capped at 20 percent.

Still, he said, "The ACA is not perfect, and there are a bunch of things we ought to fix."

For example, he said, Affordable Care Act premiums could be reduced 13 percent in Florida if Congress changed the law to require insurance companies to buy re-insurance to cover the costs of catastrophic cases that cost millions of dollars.

Congress also could lower the price of some prescription drugs by continuing to use discounted Medicaid prices once patients with Medicaid turn 65 and go on Medicare, which pays more for the same drugs.

"There are fixes that we could do," Nelson said, "if we could ever get together."

Contact Richard Danielson at rdanielson@tampabay.com or (813) 226-3403. Follow @Danielson_Times

Tampa Bay residents say Obamacare repeal would threaten lives and livelihoods 07/03/17 [Last modified: Monday, July 3, 2017 10:31pm] 

The New War on (Overpriced) Drugs

MARIA LOKKE/WIRED

UNLESS YOU HAVE multiple myeloma, a rare and vicious cancer of the blood, chances are you haven’t heard of Revlimid. The immunomodulatory drug slows the growth of new blood vessels, and it’s a product of the kind of ingenuity and daring that once made the pharmaceutical industry among the most respected in America. It’s also a handy stand-in for everything that’s wrong with the business today.

In the early 1990s, researchers at Boston Children’s Hospital stumbled on an old sedative that appeared to slow the progress of myeloma. The drug, thalidomide, was infamous. It had been prescribed widely for morning sickness in the 1950s, but caused thousands of horrific birth defects. Still, nothing had ever been as effective against multiple myeloma, so a biotechnology company called Celgene took a risk and spent millions of dollars developing an analogue of the compound, transforming thalidomide into a more potent cancer drug.

It worked: When the FDA approved Revlimid to treat meyloma in 2006, it revolutionized the cancer's treatment. Average survival time jumped from three or four years in the late ’90s to almost a decade today. “There’s not one other disease where you can say we tripled survival in that period of time,” says Mohamad Hussein, Celgene’s head of scientific affairs. Through calculated risk and dedicated bench work, Celgene had turned poison into gold.

The story of Revlimid’s development is unique, even uplifting. But the story of what it costs is all too familiar. In the past decade, the drug’s price jumped from $78,000 a year to $156,000. Last year, the median myeloma patient on Medicare—a person supposedly shielded from extortionate drug prices—paid $11,538 out of pocket each year for the medication. (A majority of American families have less than $5,000 in savings.)

Revlimid has produced at least $20 billion in revenues since its release, but Celgene, and all pharmaceutical companies, say they need high prices to continue developing lifesaving medications. “You get what you pay for,” Hussein says.

The 25-milligram pill encapsulates everything that’s great and everything that’s terrible about the US pharmaceutical industry. In the past five years, the price of brand-name prescription drugs has doubled; cancer drugs, specifically, have gone up by a multiple of six since 2000.

Several promising new myeloma drugs have recently been released, including a new and improved follow-up treatment to Revlimid called Pomalyst. Each drug costs more than $150,000, and Pomalyst comes in over $195,000. “This is not a sustainable model,” says Brian Bolwell, chairman of the Taussig Cancer Institute at the Cleveland Clinic.

Many doctors and patients across the country would agree. So, at a moment when Congress and the Trump administration are grappling with revamping the entire health care economy, we should ask ourselves: How much should a drug actually cost, anyway?

 

It’s a strangely subversive question and one that Steve Pearson, an unassuming internist turned Harvard lecturer turned nonprofit chief, thinks he can answer. Pearson is one of the few people in this country who’ve had any luck getting the prices for individual drugs under control. The nonprofit he founded, the Institute for Clinical and Economic Review (known as ICER), has one purpose—to figure out whether a new drug is worth the price tag or if Big Pharma is taking us for a ride.

For the most part, Pearson says, Americans have no idea what they should be paying for medication. We don’t how much it costs to actually develop a drug; the FDA doesn’t require comparative effectiveness studies, so we don’t know if new drugs work better than existing competitors; and we have little information about how much other consumers are paying for the same products. “Patients in America are getting great value for drugs—and we're getting ripped off,” Pearson says. “The problem is we’ve had little way of knowing when it's one or the other.”

President Donald Trump has said that the pharmaceutical industry is “getting away with murder” and that he wants to let Medicare negotiate with drug companies over the prices we pay—something that was forbidden in 2003, part of a compromise with the politically potent industry to get the Medicare drug expansion plan passed. (Since 1998, Big Pharma has spent more on lobbying than any other industry.)

In The Art of the Deal, Trump says that you have to “know when to walk away from the table.” But Medicare—which covers some 57 million people—essentially can’t decline any drug the FDA approves, at least for serious diseases like cancer. It can’t walk away from the table. Furthermore, the agency doesn’t have any more comparative data than you or I do. When one party in a deal knows more about the goods than the other, economists call itinformation asymmetry. It’s a classic recipe for market failure and, as any seasoned negotiator knows, a great way to get a bad deal.

Pearson, with ICER, has taken it upon himself to fix this information imbalance, to generate the missing data and calculate a “fair price” for drugs. The team’s efforts involve a forensic approach to dozens of scientific studies and a Vulcan-eyed look at how we value human life and decide to allocate resources. It is straightforward yet radical work—a missing puzzle piece in the effort to solve our drug-pricing crisis.

The Centers for Medicare and Medicaid Services recognized this last spring, when they floated the idea of using ICER’s calculations if Congress ever let them negotiate prices. Pharma-backed groups acknowledged this when they launched a blitz to discredit the group last year. And so far, Pearson’s method has successfully checked the prices of a handful of drugs—something very few people can say they’ve done.

But as sensible as the exercise may look in a PowerPoint presentation, some of the people Pearson is trying to help aren’t buying in. “The new drugs are awesome,” says Matt Goldman, a myeloma patient in Long Beach, California, but if ICER were to decide his meds are overpriced, “our insurance company is going to read this and they’re going to start denying benefits—these are life and death decisions.”

Nick Van Dyk, a patient who credits Revlimid with keeping him alive, is more succinct. “I’m talking to you instead of pushing up dirt because of Big Pharma,” he says. “The ICER guy is a smug, rotten scumbag.”

Cold-Blooded Math

Figuring out if a drug is priced fairly is not a simple process. One of the first things you have to do is put a value on human life.

Kind of. A quality-adjusted life year, or QALY (pronounced “kwaly”), is the metric that health economists use to measure the value of medical treatments over time. One QALY is a year of perfect health thanks to a med; zero QALYs means you’re dead. Three extra months of life in great health, Pearson says, gets a higher QALY value than three months with terrible side effects.

So what’s a year of feeling healthy worth? Based on data from the World Health Organization and other sources, ICER puts the value of a quality-adjusted life year in the United States at between $100,000 and $150,000. (If it unnerves you that the health care system has decided a year of your health is worth the price of a tacky speedboat, know that QALYs are used everywhere life is taken into consideration; the Department of Transportation uses them when it decides how much it should spend on expensive safety features, like extra lanes or guardrails along freeways.)

Any drug that provides significant health benefits at under $100,000 per QALY is golden and ICER rates it as “high value.” Ones that cost more than $150,000 per QALY get “low value” or, at best, “intermediate value” if the drug provides a legitimate benefit to patients.

Cold-blooded as they may be, QALYs aren’t controversial for health economists, but the very idea of quantifying life upsets plenty of people—the approach carries a whiff of “death panels,” after all. Still, Pearson says, controversy is no reason to shy away from a useful metric. “The QALY just helps us compare apples to apples when we want to consider the gains we make with good new treatments,” he says.

For Pearson, paying too much for drugs matters not just because pharmaceuticals eat up a growing chunk of our total health spending—17 percent at last check—but because the money we spend on overpriced pills is money we could spend better somewhere else. “Health is a very important—perhaps the most important goal for us as individuals, and for our society,” Pearson says. “But it’s not the only goal. We also want good jobs, great schools, a safe environment.”

The money you spend on overpriced drugs, he argues, is money that doesn’t go to your kid’s school or the ambulance driver or fire department. “There are choices within the health care system: Should we get this machine or pay another doctor?” he says. “Then, step back and it’s: Another hospital or 10,000 more teachers?”

Pearson’s office in ICER’s downtown Boston headquarters is spare and unlived-in when we meet in August. He spends most of his time in DC; his family lives there, and he’s a visiting scientist at the National Institutes of Health. But Boston is ICER’s home, he says, across the river from Harvard, where Pearson is a lecturer and where he founded the institute back in 2007.

In conversation, Pearson is even-keeled and reassuring—like a doctor walking you through a mixed prognosis. Goateed and with tortoiseshell, geek-chic glasses, he’s wearing cufflinks embossed with the crest of the Royal College of Physicians, where he’s an honorary fellow. (His CV is a grab bag of elite institutions and includes a Stanford undergraduate degree, a master’s from Harvard, and an MD from UC San Francisco.) With his staff of 24 doctors and policy wonks, he aims to put out about nine reports a year, covering dozens of treatments.

 

https://mediamatters.org/research/2017/03/13/study-how-tv-news-ignores-prescription-drug-price-problem/215660

A Media Matters review of weekday evening news coverage on cable and broadcast networks since December reveals that the evening programs largely ignored the problem of escalating prescription drug prices in the United States, even though lawmakers have introduced legislation aimed to address the issue. 

Democrats Introduced A New Bill To Fight Escalating Prescription Drug Costs In The U.S.

The Hill: Sanders First Introduced Amendment Allowing Prescription Imports Last December. The Hill reported on December 6 that Sen. Bernie Sanders (I-VT) had introduced an amendment to the 21st Century Cures Act that would have allowed prescription drug imports from other countries while also allowing Medicare to negotiate directly with drug companies for lower prices. Republicans in the Senate blocked the amendment, which Sanders framed as a way to fulfill then President-elect Donald Trump’s promise to help lower drug prices. [The Hill12/6/16]

Wash. Post: Democrats Introduced A Bill “To Allow Commercial Importation Of Drugs From Canada.” The Washington Post reported last month that Sanders “and a slew of Democratic colleagues” introduced a prescription drug bill in the Senate “to allow commercial importation of drugs from Canada,” where they often cost substantially less than American pharmaceuticals do. The article noted that “through cheap imported drugs, the United States would be able to take advantage of the government levers and regulation that other countries have used to bring down pharmaceutical prices.” From the February 28 article:

Opening a new front in the war against big pharma, Sen. Bernie Sanders (I-Vt.) and a slew of Democratic colleagues introduced a bill Tuesday to allow commercial importation of drugs from Canada.

The appeal is obvious; through cheap imported drugs, the United States would be able to take advantage of the government levers and regulation that other countries have used to bring down pharmaceutical prices. It's a far more politically palatable way to attack the problem of soaring drug prices than opening up an even more contentious fight over whether the U.S. government should meddle directly in pricing — and it has had wide popular and bipartisan support, including from Hillary Clinton and Donald Trump during the presidential campaign.

[...]

In an afternoon news conference unveiling the bill, Democratic and independent lawmakers threw down the gauntlet, calling on President Trump — who has repeatedly said that he will do something to rein in rising drug prices — to support their effort.

“I want to finally say about our president, who has said a lot of talk about health care and has recently confessed how 'complicated’ he thinks it is. He has made promises to the American people about prescription drug prices; he has made promises to the American people, and now it's time for him to put up or shut up,” said Sen. Cory Booker (D-N.J.), who joined as a co-sponsor after voting against drug importation when it was an amendment. “It’s time for him to join with us, or, in my opinion, to confess his lies to the American people.” [The Washington Post2/28/17]

http://www.cnsnews.com/news/article/susan-jones/sanders-im-going-introduce-medicare-all-single-payer-program

By Susan Jones | March 27, 2017 | 7:29 AM EDT

 

 

Sen. Bernie Sanders (I-Vermont) says he will introduce a single-payer, Medicare for all bill. He appeared on CNN's "State of the Union" on Sunday, March 26, 2017. (Screen grab from CNN)

(CNSNews.com) – The Republican repeal and replace bill was a “disastrous piece of legislation” designed to give tax breaks to the wealthy, and it deserved to die in the House, Sen. Bernie Sanders, a Vermont socialist, told CNN’s “State of the Union” on Sunday.

He also admitted that the Democrats’ Obamacare has “serious problems,” including premiums and deductibles that are too high and areas of the country where people don’t have a choice of insurance plans.

“Ideally, where we should going is to join the rest of the industrialized the world and guarantee health care to all people as a right. And that's why I'm going to introduce a Medicare-for-all single-payer program,” Sanders said.

 

 

 

Sanders wants to give people in every state a “public options from which they can choose. Let's talk about lowering the age of Medicare eligibility from 65 to 55. Let's deal with the greed of the pharmaceutical industry.

“Those are areas that we can work together on,” Sanders said, ignoring the fact that Republicans will not back a government-run option.

 

Sanders: ‘I'm Going to Introduce a Medicare-for-All, Single-Payer Program’

By Susan Jones | March 27, 2017 | 7:29 AM EDT

 

Sen. Bernie Sanders (I-Vermont) says he will introduce a single-payer, Medicare for all bill. He appeared on CNN's "State of the Union" on Sunday, March 26, 2017. (Screen grab from CNN)

(CNSNews.com) – The Republican repeal and replace bill was a “disastrous piece of legislation” designed to give tax breaks to the wealthy, and it deserved to die in the House, Sen. Bernie Sanders, a Vermont socialist, told CNN’s “State of the Union” on Sunday.

He also admitted that the Democrats’ Obamacare has “serious problems,” including premiums and deductibles that are too high and areas of the country where people don’t have a choice of insurance plans.

“Ideally, where we should going is to join the rest of the industrialized the world and guarantee health care to all people as a right. And that's why I'm going to introduce a Medicare-for-all single-payer program,” Sanders said.

 

 

 

Sanders wants to give people in every state a “public options from which they can choose. Let's talk about lowering the age of Medicare eligibility from 65 to 55. Let's deal with the greed of the pharmaceutical industry.

“Those are areas that we can work together on,” Sanders said, ignoring the fact that Republicans will not back a government-run option.

 

 

 

 

The ABCs of picking a Medicare Supplemental Policy

Jim Miller, Savvy Senior4:05 p.m. MT March 5, 2017

 

(Photo: DVT)

 4CONNECTTWEET 1LINKEDINCOMMENTEMAILMORE

Dear Savvy Senior: Can you provide any advice on choosing a Medicare supplemental policy to help cover things outside of Medicare? I’ll be 65 in a few months and could use some assistance. — Looking for Help

Dear Looking: If you plan to enroll in original Medicare, getting a supplemental policy (also known as Medigap insurance) too is a smart idea because it will help pay for things that aren’t covered by Medicare like copayments, coinsurance and deductibles. Here are some tips to help you choose an appropriate plan.

Medigap Plans                                                                  

In all but three states (Massachusetts, Minnesota, and Wisconsin), Medigap plans, which are sold by private health insurers, come in 10 standardized benefit packages labeled with the letters A, B, C, D, F, G, K, L, M and N.

Plan F is the most popular policy followed by plan C because they provide comprehensive coverage. Plans K and L are high-deductible policies that have lower premiums but impose higher out-of-pocket costs. Plan F also offers a high-deductible version in some states. And a popular middle ground policy that attracts many healthy beneficiaries is plan N.

For more information on the different types of plans and the coverage they provide, including Medigap options in Massachusetts, Minnesota, and Wisconsin, see Medicare’s “Choosing a Medigap Policy” guide at Medicare.gov/pubs/pdf/02110-medicare-medigap.guide.pdf, or call 1-800-MEDICARE and ask them to mail you a copy.

How to Choose

To pick a Medigap policy that works best for you, consider your health, family medical history and your budget. The differences among plans can be small and rather confusing.

To help you choose, visit Medicare.gov, and click on “Supplements & Other Insurance” at the top of the page, then on “Find a Medigap policy” and type in your ZIP code. This will give you a list of the plans available in your area, their price ranges and the names, and contact information of companies that sell them. But it’s up to you to contact the carriers directly to get there specific pricing information.

You can also compare Medigap prices on most state insurance department websites (see NAIC.org/state_web_map.htm for links), or you can order a personalized report from Weiss Ratings for $99 at WeissMedigap.com.

Since all Medigap policies with the same letter must cover the exact same benefits (it’s required by law), you should shop for the cheapest policy.

You’ll get the best price if you sign up within six months after enrolling in Medicare Part B. During this open-enrollment period, an insurer cannot refuse to sell you a policy or charge you more because of your health.

You also need to be aware of the pricing methods, which will affect your costs. Medigap policies are usually sold as either: “community-rated” where everyone in an area is charged the same premium regardless of age; “issue-age-rated” that is based on your age when you buy the policy, but will only increase due to inflation, not age; and“attained-age-rated,” that starts premiums low but increases as you age. Community-rate and issue-age-rated policies are the best options because they will save you money in the long run.   

You can buy the plan directly from an insurance company, or you can work with a reputable local insurance broker.

Drug Coverage

You also need to know that Medigap policies do not cover prescription drugs, so if you don’t have drug coverage, you need to consider buying a separate Medicare Part D drug plan too. See Medicare.gov/find-a-plan to compare plans. Also note that Medigap plans do not cover vision, dental care, hearing aids or long-term care either.

Alternative Option

Instead of getting original Medicare, plus a Medigap policy and a separate Part D drug plan, you could sign up for a Medicare Advantage plan that provides all-in-one coverage. These plans, which are sold by insurance companies, are generally available through HMOs and PPOs. To find and compare Advantage plans visit Medicare.gov/find-a-plan.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, Okla. 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

 

Motley Fool on Medigap Plans.

There are a variety of Medigap plans, and while any one of them will add an additional expense to your retirement budget, they can be well worth it for the peace of mind they provide.

https://www.fool.com/retirement/2017/02/12/should-you-get-a-medigap-plan.aspx

Matthew Frankel

(TMFMathGuy)

Feb 12, 2017 at 7:07AM

One decision people need to make when they reach age 65 is whether to enroll in a Medicare Supplemental Insurance -- aka, a Medigap plan -- to help cover the healthcare costs that Medicare doesn't. Here's what you need to know about how much you can expect Medicare to cover, and the various Medigap options available.

How much will healthcare cost you after age 65?

Once you reach 65, you'll probably be covered by Medicare Parts A and B, which are hospital and medical insurance, respectively, and are collectively referred to as "original Medicare." Medicare Part A is free for most people, but you'll pay a premium for your Part B coverage; it's currently $109 per month for the majority of Medicare beneficiaries. In addition, there are several expenses you can expect to pay for out-of-pocket, such as dental care, eyeglasses, and of course, your copays.

SOURCE: 

 

However, it's important to recognize that these costs can vary significantly from person to person. For example, if you have congestive heart failure, you can expect nearly $4,000 added to your annual out-of-pocket expenses. In a Kaiser Family Foundation study, it was determined that the average Medicare beneficiary in poor health had about 2.5 times the out-of-pocket expenses of people in excellent health. Since it's impossible to know when your health might go from good to not-so-good, it's reasonable to assume that your actual out-of-pocket healthcare expenses in retirement will be unpredictable if you have only original Medicare.

What do Medigap plans cover, and how much do they cost?

Medigap plans are standardized, and must be clearly identified as "Medicare Supplement Insurance." In most states (Massachusetts, Minnesota, and Wisconsin are the exceptions), Medigap policies are identified by one of 10 letters.

Each of these 10 plan types provides a different package of benefits. Some cover copays and coinsurance, and some cover Medicare's deductibles, either in full or in part. For example, Medigap Plan A is required to be offered by any insurance company that sells Medigap policies, and pays for things like Medicare Part A and B coinsurance and copayments in full, but does not cover the Part A and B deductibles. You can compare what each plan covers on Medicare's website.

Medigap Plan F is the most comprehensive and covers virtually every copay and deductible you could face. While it's the most expensive plan, it's also the most popular by far, chosen by two-thirds of seniors who decide to buy a Medigap plan. It seems seniors are willing to pay for the peace of mind of not having to worry about healthcare costs.

Availability of Medigap plans varies by location and insurance company. As I mentioned, all insurance companies that offer Medigap plans must offer plan A. In addition, they must offer either plan C or F. Beyond that, the exact assortment of plans offered by each insurer can vary significantly. Costs also vary significantly, depending on your location and the plan you choose. For example, the most popular and comprehensive Medigap plan, plan F, has a national average monthly premium range from $159 to $239 per month for a 65-year-old male.

You can compare your options by using Medicare.gov's plan finder. If you have two addresses, such as a summer and winter home, it's a smart idea to compare the costs at both.

Should you get a Medigap plan?

Whether or not you should get a Medigap plan depends on how much risk you're willing to take with your healthcare costs in retirement. Medicare parts A and B cover a great deal, but don't cover everything. And, there is no out-of-pocket maximum. A serious illness could potentially cost you a tremendous amount of money if original Medicare is the only insurance you have.

While it is an additional expense to worry about, a Medigap plan can help you define your healthcare expenses more precisely, and set an upper limit on your medical costs in retirement.

 

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Americans Like Obamacare. They Just Don’t Know It

by RICARDO ALONSO-ZALDIVAR, ASSOCIATED PRESS

"Just because you need to do the top floor doesn't mean you level the entire complex." 

 

Although his signature law is in jeopardy, President Barack Obama's work reshaping health care in America is certain to endure in the broad public support for many of its underlying principles, along with conflicts over how to secure them.

The belief that people with medical problems should be able to get health insurance is no longer challenged. The issue seems to be how to guarantee that. The idea that government should help those who can't afford their premiums has gained acceptance. The question is how much, and for what kind of coverage.

 

A sign is held up that reads "ACA Is Here To Stay" front of the US Supreme Court after a 2015 ruling in favor of the Affordable Care Act. Mark Wilson / Getty Images

"The American people have now set new standards for access to health care based on the Affordable Care Act," former Surgeon General Dr. David Satcher says. "I don't believe it will ever be acceptable again to have 50 million people without access to health care."

Obama's influence will continue in other ways, less visible and hardly divisive:

  • Medicare is shifting to paying for value, not just volume.
  • The importance of prevention and front-line primary care is more widely recognized.
  • Doctors and hospitals have computerized their records systems, even if connectivity remains elusive.
  • The government has opened up mass files of health care billing data, enabling independent analysts to look for patterns of questionable spending.

But conflict is part of Obama's legacy, too. He leaves the country deeply divided about the government's role in health care.

Related: Will Obamacare Repeal Cost Millions of Jobs?

Passed with no Republican votes, the 2010 health care law broke the pattern of major safety net programs like Social Security, Medicare and Medicaid, which had bipartisan backing. Social Security has stood for more than 80 years; Medicare and Medicaid for more than 50.

"If Medicare had been repealed, stories about Lyndon Johnson would have been different," said Robert Blendon, professor of health policy at the Harvard T.H. Chan School of Public Health. "A legacy is whether you did something that was sustained." Johnson was the Democratic president who won approval of Medicare and Medicaid in 1965.

Already, the Republican-led Congress, taking its lead from President-elect Donald Trump, has started the process of repealing and replacing the health law.

“I really do credit Obamacare with saving my life.”

"Approaches that partisan are difficult to sustain as lasting, permanent features of the health care system," said Mark McClellan, Medicare administrator under Republican President George W. Bush.

Obama also failed to deliver on early promises to cut premiums. From 2009-2016, the amount employees pay in premiums for workplace coverage rose by hundreds of dollars, according to the nonpartisan Kaiser Family Foundation. And the average deductible — the annual amount patients pay before insurance kicks in — went from $533 to $1,221, an increase of nearly 130 percent.

Related: Five Things You May Not Know About Obamacare

The achievements and difficulties of the Obama years are reflected in people such as Karen Rezny.

"I really do credit Obamacare with saving my life," said Rezny, a massage therapist from Austin, Texas.

The health care law, or ACA, enabled her to get better treatment for advanced breast cancer. She was uninsured when diagnosed. Before the law, insurers would have rejected her because of her pre-existing medical condition. Even with a subsidized premium, Rezny said she still struggles with cost.

"What I would hope is that we would look back and say (Obama) got the ball rolling, and then we continue," said Rezny. "He took health care off the House and Senate floor — out of theoretical talk by people who are guaranteed lifetime health care — and actually allowed the people to experience it and have it."

When the law passed, 48.6 million people were uninsured, according to the government. Through the first six months of last year, that dropped to 28.4 million. While employer coverage also grew as the economy strengthened, experts credit the ACA for most of the progress. The law provides subsidized private insurance along with a Medicaid expansion for low-income people.

"It would have never been done without the focus and insistence of this president that we go big," said Kathleen Sebelius, Obama's first secretary of Health and Human Services.

Obama set his sights high, but execution was a problem. When HealthCare.gov went live in 2013, the computer system quickly froze. It took a high-tech rescue effort to get things working for consumers.

“Just because you need to do the top floor doesn’t mean you level the entire complex.”

The law's complexity also tripped people up. It uses the income tax system to subsidize premiums. Some HealthCare.gov customers saw their tax refunds reduced because they underestimated their incomes when applying for subsidies. Fines on those who remained uninsured hit people in their 30s trying to get traction in life. Officials in many states were alarmed by rising Medicaid spending.

When Republicans won control of the House in 2010, Obama was effectively blocked from legislating fixes. The administration used regulations to try smooth out the law's rough edges, while successfully fighting off two Supreme Court cases that would have gutted it.

Related: Obamacare Premiums Are Going Up

In the face of problems, the White House ceaselessly talked up the benefits of the law. Among the controversial claims was that the law deserved much credit for a historic slowdown in national health care spending from 2009-2013.

"Just nonsense," said Rick Foster, formerly Medicare's chief actuary, in charge of long-range estimates. "Far and away the biggest cause of the slowdown was the Great Recession. That is not to say that the Affordable Care Act didn't have some impact, but I think that was small compared to the effect of the recession and the weak recovery."

History shows that America's social programs got built in stages. Automatic cost-of-living increases weren't part of Social Security originally. Medicare didn't get a prescription benefit for nearly 40 years.

Kris Case of Denver hopes that somehow, something like that can happen with Obama's overhaul. She works in customer relations for a technology company and buys coverage through the Colorado insurance marketplace.

"Think of all the work that has gone into this imperfect thing," said Case, "and to just tear it down to make a point, rather than say it's flawed but we can fix it.

"Just because you need to do the top floor doesn't mean you level the entire complex." 

6.4M Have Signed Up So Far for Obamacare, Ahead of '15 Pace

WASHINGTON —   December 21, 2016 7:47 PM Associated Press

Obamacare seems to be holding its own. The administration said Wednesday that 6.4 million people had enrolled for subsidized private coverage through HealthCare.gov in this year's sign-up period, ahead of last year's pace.

Despite rising premiums, dwindling insurers and the Republican vow to repeal President Barack Obama's health care law, about 400,000 more people signed up through Monday than was the case for a comparable period in 2015, the Health and Human Services Department said.

"Today's enrollment numbers confirm that doomsday predictions about the marketplace are not bearing out," said HHS Secretary Sylvia Burwell.

FILE - Health and Human Services Secretary Sylvia Burwell speaks during a news conference at the HHS in Washington, Oct. 19, 2016. The Obama administration says 6.4 million people have signed up so far this year for subsidized private insurance coverage through HealthCare.gov.

Still, it's too early for supporters of the Affordable Care Act, or ACA, to say, "I told you so."

It's unclear whether the administration will meet its target of 13.8 million sign-ups. That's partly because the share of new customers is down when compared with current consumers re-upping for another year.

New customers are 32 percent of the total this year versus 40 percent around the same time last year. Administration officials said they're going to focus on getting more new customers between now and the end of open enrollment January 31.

No signs of 'collapse'

Other vital signs for HealthCare.gov were encouraging.

"There are zero signs that the ACA's marketplaces are in danger of imminent collapse," said Larry Levitt of the nonpartisan Kaiser Family Foundation, who has followed the health care law from its inception.

That carries an implicit warning for President-elect Donald Trump and congressional Republicans, who have promised to move quickly to repeal the law. That repeal would be followed by a GOP-inspired replacement. Although immediate changes affecting 2017 are unlikely, the whole process could take several years, creating uncertainty for people with coverage.

As if on cue, Democratic governors Wednesday fired off a letter to GOP congressional leaders, calling the repeal plan "nothing more than a Washington, D.C., bait-and-switch" that would leave millions uninsured and shift to states an estimated $69 billion in uncompensated care costs over a decade.

The statistics released Wednesday are for 39 states served by the federal online insurance marketplace. Numbers from states running their own markets have not been fully tallied and will be added later, raising the total. Toward the end of this month, several million current customers who are being re-enrolled automatically will be added to the count.

Red state sign-ups

Some of the biggest sign-up numbers so far are coming from states Trump won in the presidential election, including Florida (1.3 million); Texas (776,000); North Carolina (369,000); Georgia (352,000) and Pennsylvania (291,000). Vice President-elect Mike Pence's home state of Indiana had 119,000 residents enrolled.

Premiums for a midlevel benchmark plan in HealthCare.gov states are going up an average of 25 percent next year, driven by lower-than-expected enrollment and higher medical costs. At the same time, about one-third of U.S. counties will have only one marketplace insurer next year because some major commercial carriers have left the market, and many nonprofit insurance co-ops created by the law have collapsed.

The impact of premium increases has been softened by the law's subsidies, which are designed to rise if the cost of insurance goes up.

A study last week from the nonpartisan Center for Health and Economy found that the average monthly subsidy will increase by $76, or 26 percent, from $291 currently to $367 in 2017.

But that means taxpayers will fork over nearly $10 billion more for subsidies.

FILE - Arminda Murillo, 54, reads a leaflet on Obamacare at a health insurance enrollment event in Cudahy, Calif., March 27, 2014.

 

And subsidies don't help all customers. Some make too much money to qualify. And an estimated 5 million to 9 million people buy individual policies outside HealthCare.gov and state markets that offer financial assistance.

Independent analyst Caroline Pearson of the consulting firm Avalere Health said the administration should be concerned about the apparent slowdown in new consumers.

"At this time, enrollment appears to be slightly behind the pace needed to reach the administration's goal of signing up 13.8 million people," she said. "However, if more people who are currently in the market renew their coverage, then that goal could still be achieved."

Targeting new customers

HealthCare.gov's advertising in the closing weeks of open enrollment will be aimed at attracting new customers, said HHS Secretary Burwell. In addition, the IRS will be sending people who paid fines for being uninsured a not-too-subtle nudge, reminding them that they can avoid higher penalties for 2017 by signing up now.

Republicans plan to repeal Obamacare early next year, but it could take up to several years to replace it. During the interlude, party leaders have promised an orderly transition to a new system. It's unclear what that would involve, but presumably some of the law's popular provisions — such as subsidies and protection for those with pre-existing medical conditions — would be kept in place.

The 2010 health overhaul added coverage for about 20 million people through a combination of subsidized private health insurance and a state option to expand Medicaid. Several Republican states adopted the Medicaid expansion, including Indiana under Pence.

Column: Under a President Trump, Medicare reforms are a matter of when, not if

BY PHILIP MOELLERNovember 23, 2016 at 11:43 AM EST

Medicare’s annual open enrollment period has two more weeks to run until it expires Dec. 7. I would normally focus here on urging you to take advantage of this annual “do over” chance to improve your coverage and perhaps even lower your premiums. If you have private insurance for Medicare Advantage, Part D drug coverage or a Medigap plan, you can use Medicare’s online Plan Finder tools to see if there are better deals out there.

While open enrollment is a big deal, it’s being overshadowed by who else? The Donald-elect. His victory has put our entire health care system in play, if not up for grabs. Will Trump and a Republican Congress follow through on pledges to end the Affordable Care Act? In practical terms, what does this even mean? How might ACA changes affect Medicare and Medicaid?

Further, will House Speaker Paul Ryan have a green light to move ahead with plans to reshape Medicare? At the extreme, there are concerns that Medicare as we know it could be replaced with private insurance that seniors would have to buy, paid for in part – but only in part — by government vouchers of unknown size.

The “I’m right — you’re wrong” school of debate continues to dominate social media discourse on the Affordable Care Act. There are plenty of health care experts who have well-informed and sincere issues with our current health care system. We’ll have to wait and see whether any of them will be appointed to prominent positions in a Trump administration. Here’s the best summary I’ve seen of how the ACA could change.

Most Ask Phil Medicare questions continue to deal with specific problems people face in signing up for and using Medicare policies. But readers are also worried about how “their Medicare” could be changed and what they can do about it:

“I am scared about possible cuts to Social Security, Medicare and Medicaid with him [Trump] winning,” Greg writes. “I have a disability and depend on my Social Security disability check. I also have depended on Medicare and Medicaid. My mother also depends on Social Security retirement, Medicare and full Medicaid. She gets a really low Social Security check. Mine is a little higher, which is why I don’t get full Medicaid … I am not the only one who is worried about it.”

J.B. says, “I’m concerned about Ryan’s plan for the privatization of Medicare. Do you have any thoughts or comments on how this will unfold? Or how to help stop it?”

Paula from Montana: “Will Trump cut Social Security?”

Dennis from Arizona: “Now that we will have a new president with a negative focus on health care, what will happen? I am 70 and currently employed with a good job and good health care. I had planned to retire in March of 2017, but have put everything on hold due to uncertainty. Is my concern a valid concern? What are your thoughts on this issue?”

Lastly, there are Deborah and David. They live in California, but perhaps not for long. “The number of expat retirees are sure to grow over the next six months as a result of the presidential election. We have family in Melbourne, Australia and have plans in place to move there when I retire in early in 2017. The election results increased our resolve for moving as soon as possible … We will start our Medicare next year and maintain it until we move to Australia as permanent residents with medical coverage there. What are the options for stopping all or part of Medicare once we move? What are the options and impacts if we move back in 10 or more years and need to start Medicare again?”

By way of a spoiler alert, I have no idea what will happen nor do I think others do. There are too many unknowns right now. However, when Trump’s key appointments are in place, and both Republicans and Democrats have crafted their health care strategies, these are the important Medicare issues that will be moving front and center:

ACA and Medicare. The Affordable Care Act is largely a good thing for Medicare. I do not know where Speaker Ryan has been getting his “facts,” but his recent statement that the ACA is bankrupting Medicare is just not true. To the contrary, the ACA included additional taxes that higher-income taxpayers have had to pay to Medicare, which has helped fund Medicare’s trust fund, reduced subsidies to Medicare Advantage insurers and mandated other savings.

Before the passage of the ACA, the Medicare trust fund that pays claims for Part A hospital and nursing home expenses had been projected to run short of funds by 2017. The ACA has pushed that date out more than 10 years. Medicare certainly faces financial challenges, but they haven’t been caused by the ACA, and in fact, Medicare would face large revenue cuts if the ACA is repealed.

The ACA includes a substantial expansion in free and reduced-price wellness provisions for Medicare enrollees. It also has been reducing out-of-pocket drug prices in Part D plans through the elimination of the so-called “donut hole” by 2020. These are popular changes that are unlikely to be rolled back.

Who pays for Medicare and how much? Medicare is a terrific program, but there is no denying that there have been big problems with it, and there will be more to come. However, since its creation in 1965, Medicare arguably has been the nation’s most successful effort to help its citizens. Still, providing health insurance to more than 55 million people is not cheap and represents a huge and growing drain on the federal budget. Here’s the current projection of the federal Congressional Budget Office:

In 2016, federal spending for the major health care programs will amount to 5.5 percent of GDP [Gross Domestic Product], CBO estimates: Medicare spending (net of offsetting receipts) will equal 3.2 percent of GDP and federal spending on Medicaid and CHIP [Children’s Health Insurance Program], combined with outlays for the subsidies for health insurance purchased through the marketplaces and related spending, will equal 2.3 percent. In CBO’s extended baseline, federal spending for those programs rises to 8.9 percent of GDP in 2046, about 60 percent greater than it is estimated to be in 2016; net Medicare spending accounts for 5.7 percent of GDP, and spending on Medicaid and CHIP, combined with outlays for the marketplace subsidies and related spending, accounts for 3.1 percent.

When the CBO says these figures are “net of offsetting receipts,” it means that all those payroll taxes for Part A, premiums for Part B and everything beneficiaries pay for other parts of Medicare already have been subtracted from what Washington spends. Whether these rising deficits are “worth it” is, of course, the key question. And while Trump said during the campaign he did not want to touch Medicare, Speaker Ryan is hardly the only powerful voice in Congress that thinks the nation can’t afford to continue spending this much money on Medicare.

I don’t think anything will happen quickly, but the trend lines are clear: Medicare beneficiaries will be required to pay a growing share of their health care bills. Assuming otherwise would be a mistake. Expecting increased efficiency, innovation and other unproven benefits of more private-sector involvement in Medicare also would be a mistake. We’re going to pay for this, one way or another.

What does Medicare cover? Trump says he won’t touch the ACA ban on insurers using pre-existing conditions as a basis for denying coverage or charging people higher premiums. I still think there will some Congressional support for allowing insurers to go back to using pre-existing conditions as an underwriting tool, perhaps on a limited basis. Whatever happens, I don’t see this debate involving Medicare. The program would fall apart if it did not guarantee people access regardless of their health. But I can certainly see Medicare becoming less generous with how much of our health care expenses it covers.

If Ryan’s plan for a voucher system ever came to pass, it likely would lead to a multitiered Medicare system. Lower-income enrollees would get one level of coverage with their voucher and would not be able to afford more. People with more money would be able to augment their coverage with addition policies with private health insurers. This happens now with Medigap plans, which are supplemental policies that help pay for things not fully covered by basic Medicare. But a voucher system would create more pronounced differences in coverage linked to people’s financial resources.

How will private insurance plans change?Medicare Advantage plans already reflect the future shape of Medicare under a GOP administration and likely will benefit from any voucher and privatization efforts undertaken in a Trump administration. Nearly a third of Medicare enrollees already use Medicare Advantage. Dealing with a single insurer for all Medicare claims is easier than dealing with a government contractor for basic Medicare (Parts A and B), a private insurer for a Part D drug plan and yet another private insurer for a Medigap plan.

The plans often are cheaper than basic Medicare and frequently cover more things as well. The reason they can afford to do so is that most plans require enrollees to restrict their health care providers to doctors and hospitals in their plan’s provider network. This is a cheaper way for the plans to offer health care services, and so-called “narrow networks” will likely become more prevalent either to combat rising health care costs or should a voucher system be adopted.

Is it possible to deregulate Medicare? This topic doesn’t get much attention, but it could be the most important practical factor in determining the timing and extent of any changes to Medicare. The air has been thick with talk in Republican circles about getting rid of government regulations and freeing up the private sector to find better and cheaper ways to solve problems. But there is no free market for senior health care in this country. Medicare was created to provide government-run health care. It is hard to see how it even could function without layers and layers of regulation that have evolved over more than five decades. This reality will continue to be a source of frustration for those who would like to deregulate the program and a source of comfort to those who would not.

Details of Ryan’s “Better Way” Medicare proposals. As set forth in a series of proposals released in June, Speaker Ryan would make major changes to Medicare. These include combining Parts A and B into a new fee-for-service program, raising the age of Medicare eligibility to match that of Social Security (now 66 and scheduled to rise to 67 beginning in 2020), creating a premium support program to cap government spending and changing Medigap policies to limit the extent to which they can fill holes in basic Medicare. I will be returning to these items in depth in future columns, but for now, here are verbatim descriptions of these four proposals from the “Better Way” health care proposal:

It would combine Medicare Parts A and B [fee for service Medicare, or FFS] and would have a unified deductible. For example, rather than require the $1,288 deductible for a hospital stay and a separate $166 deductible for a physician visit, the beneficiary would be charged a combined deductible. Further, the policy would institute an annual maximum OOP [out of pocket] cap on the amount of money a beneficiary pays each year. This new feature of the FFS program would create parity between FFS and MA [Medicare Advantage private insurance plans] — as MA plans are required by statute to provide an OOP cap for beneficiaries. Our policy would also institute a 20 percent uniform cost-sharing requirement for all services.

One of the nation’s greatest achievements during the 20th century was the dramatic increase in the average life expectancy, increasing life spans by almost thirty years. As Americans’ health improves, extending their lives, many enjoy the benefits of employment later in life. As recognized by the Social Security program, and in order to further ensure Medicare’s long-term sustainability, our plan would gradually increase the Medicare retirement age beginning in 2020 to correspond with that of Social Security.

“Beginning in 2024, Medicare beneficiaries would be given a choice of private plans competing alongside the traditional FFS Medicare program on a newly created Medicare Exchange. Our plan would ensure no disruptions in the Medicare FFS program for those in or near retirement, while also allowing these grandfathered individuals the choice to enroll in the new premium support program. Medicare would provide a premium support payment either to pay for or offset the premium of the plan chosen by the beneficiary, depending on the plan’s cost. The Medicare recipient would choose, from an array of guaranteed-coverage options, a health plan that best suits his or her needs. This is not a voucher program. A Medicare premium support payment would be paid, by Medicare, directly to the plan or the fee-for-service program to subsidize its cost.

Beneficiaries often purchase Medigap plans because of the certainty these plans bring: predictable copays instead of coinsurance and protection against high out-of-pocket (OOP) costs. The Medicare Payment Advisory Commission (MedPAC) has found that Medicare spending is 33 percent higher when beneficiaries have Medigap insurance and 17 percent higher when beneficiaries have job-based coverage. Our policy would begin in fiscal year 2020. It would restrict Medigap plans from covering cost-sharing below a combined and limit the plan from covering no more than half of the cost sharing between the deductible and the OOP cap.

Lest I forget, here are some specific thoughts on Social Security for Greg and Paula. Congress will have not have much appetite for messing with Medicare and even less when it comes to Social Security. There certainly will be discussion of privatizing the program. But while Democrats are in the minority, their voices will be plenty loud enough to alert seniors, including many Trump voters, of the damages that would occur if such a change was enacted or if benefits were cut.

Further, I have never seen plans to change Social Security, even from scorched-earthers, that have a large effect on benefits for anyone age 55 and older. There could be some heartburn if a new formula was adopted to calculate the program’s annual cost of living adjustment. But even under the current formula, the COLA was zero in 2016 and will be only 0.3 percent in 2017. While higher rates of inflation may be on the way, it will take time for them to get here, so even a stingier COLA would not amount to a meaningful haircut for several years.

  • Medicare Maven Phil Moeller. Co-author of "Get What's Yours"
  • Philip Moeller
  • Phil Moeller is the author of “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs” and the co-author of the updated edition of The New York Times bestseller “How to Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security,” with Making Sen$e’s Paul Solman and Larry Kotlikoff. On Twitter @PhilMoeller or via e-mail: medicarephil@gmail.com.

Fill the gap with Medicare Supplement Insurance

Medicare provides a certain level of coverage for your medical expenses, but it won’t cover all of the expenses. 
Medicare supplement insurance plans are designed to help you cover certain charges, or “gaps,” that Medicare doesn’t cover, such as co-payments, deductibles and coinsurance costs. These charges can add up quickly during a sudden or unexpected illnesses or injury.

Medicare supplement insurance covers expenses not covered by Part A and Part B such as chiropractic services, deductibles, coinsurance, co-payments, and Foreign Travel emergency coverage.

Anyone who is eligible for Medicare and is enrolled in Part A and Part B may consider supplement insurance. Even if you are in good health and believe that standard Medicare will provide the coverage you need, it may be a good idea to purchase supplemental insurance. If your health status changes, your ability to enroll in Medicare supplement coverage may be compromised.

Not good news for Medicare Advantage plans...

HEALTH INC.

Audits Of Some Medicare Advantage Plans Reveal Pervasive Overcharging

August 29, 20165:00 AM ET

FRED SCHULTE

FROM

Careful audits of a representative sampling of bills from 37 Medicare Advantage Programs in 2007 have revealed some consistent patterns in the way they overbill, a Center for Public Integrity investigation finds. Nick Shepherd/Ikon Images/Getty Images More than three dozen just-released audits reveal how some private Medicare plans overcharged the government for the majority of elderly patients they treated, often by overstating the severity of certain medical conditions, such as diabetes and depression. The Center for Public Integrity recently obtained, through a Freedom of Information Act lawsuit, the federal audits of 37 Medicare Advantage programs. These audits have never before been made public, and though they reveal overpayments from 2007 — money that has since been paid back — many plans are still appealing the findings. Medicare Advantage is a privately run alternative to standard Medicare; it has been growing in popularity and now enrolls more than 17 million seniors. In 2014, Medicare paid the health plans more than $160 billion. But there's growing controversy over the accuracy of billings, which are based on a formula called a risk score; it is designed to pay Medicare Advantage plans higher rates for sicker patients and less for people in good health. In a series of articles published in 2014, the Center for Public Integrity reported that overspending tied to inflated risk scores has cost taxpayers tens of billions of dollars in recent years. In May, a Government Accountability Office report called for "fundamental improvements" to curb excess charges linked to faulty risk scores. In addition, at least half a dozen health-industry insiders have filed whistleblower lawsuits that accuse Medicare Advantage insurers of manipulating risk scores to boost profits.   SHOTS - HEALTH NEWS GAO Audit: Feds Failed To Rein In Medicare Advantage Overbilling The audits from the Centers for Medicare and Medicaid Services show that all but two of the 37 health plans audited for 2007 were overpaid — typically several hundred thousand dollars too much — for the sample of 201 patients examined at each plan. Among the insurers charging the government too much: five Humana Inc. health plans, three UnitedHealth Care Group plans and four Wellpoint Inc. plans. CPI reporters approached the administrators of these plans for an interview, but all declined to comment. The high rate of overcharging the federal government for many diseases could signal millions in losses to federal taxpayers, since many of the plans enroll thousands of people. Among other findings: Auditors, on average, were able to confirm only 60 percent of the more than 20,000 medical conditions plans were paid to treat. The confirmation rates were much lower for some conditions, such as diabetes with serious complications, depression and some forms of cancer. Overpayments triggered by unsupported medical diagnoses at the 37 audited plans topped $10,000 per patient for more than 150 patients. And the health plans overcharged the government by $2,000 or more per patient for at least 3,500 people in the 2007 sample group. Overall, the health plans were three times as likely to charge Medicare too much than too little for some of the 70 medical conditions examined as part of the audits. Two of the 37 health plans — Group Health Cooperative in Washington state and a Kaiser Foundation Health Plan in California — had no net overpayments. Michael Geruso, an assistant professor in economics at the University of Texas, Austin, said aggressive coding practices have had a "huge impact on taxpayer spending" for the Medicare Advantage program. Geruso, co-author of a study on Medicare Advantage billing, noted that error rates revealed in the audits suggest many overcharges have escaped scrutiny. "Clearly, there's room for more auditing," he said. Diabetes "without [medical] complications" was the most common disease code reported by the health plans, and auditors typically validated the payments as warranted in three of four cases. But extra payments made to health plans that claimed some diabetic patients also had complications of the disease — such as eye or kidney problems, for example — were reduced or invalidated in nearly half the cases, and sometimes more. In other words, the auditors found insufficient evidence that these complications actually existed. Some of these reductions in payment are still being disputed by the plans. Several other disease categories triggering large payments — including "major depressive bipolar and paranoid disorders," for example, and "drug/alcohol dependence" — also were rejected as unfounded by auditors nearly as often as they were confirmed. Overpayments were not a problem in the case of every medical condition examined. In more than 200 cases, auditors said the higher fees that plans charged were justified because of the severity of the patient's illness. But auditors were between three and four times more likely to slash payments than raise them for many medical conditions. The audits provide new evidence of how federal officials have struggled to stamp out inflated coding, which is known in health policy circles as "upcoding." None of the plans faced closer government scrutiny after the audits, no matter the size of the overpayment. The 2007 audits, which collected a total of $12 million in overpayments, are the only ones CMS has completed since officials adopted risk scores in 2004 at the behest of Congress. In some cases, health plans are still appealing the results, nine years later. The special Medicare Advantage audits, conducted at the behest of CMS, are called Risk Adjustment Data Validation. RADV audits involve a lengthy and secretive process in which medical records are selected from a sample of 201 patients enrolled in a health plan. Auditors review the medical files to confirm that the diseases billed for — and their severity — are properly documented. When they are not, CMS cuts or reduces the payment. Some plans have disputed nearly every pay cut, while others have chosen not to contest most of the findings. Yet the paucity of these audits, and their tendency to drag on for years unresolved, brought a stern rebuke from the GAO, the watchdog of Congress, in its May report. The GAO criticized the Medicare agency for not expanding the scope of the audits as was required by a provision of the Affordable Care Act in 2010. It also said that CMS had failed to home in on health plans with histories of charging too much, or cases in which plans have persistently exaggerated the severity of certain illnesses to jack up their fees. "We think that CMS has a lot of work to do," James Cosgrove, who heads the GAO's health care division, said in an interview shortly after the report's release. In response to written questions from the Center for Public Integrity, CMS officials agreed that some medical conditions are overbilled more often than others. But they said the results were "not conclusive, given that the audit samples were not designed to produce statistically valid results" of overcharges for each disease. Asked why overcharges are so much more common than underpayments, CMS said health plans have an "incentive to submit diagnosis codes to CMS and, as a result, are less likely to under-report these diagnoses." CMS officials said unconfirmed diagnoses could be caused by "incorrect" coding by the health plan's doctors, or by "incorrect diagnostic data" submitted to the government by the health plan. Agency officials said they expect to complete 30 audits of 2011 billings by specific plans this year, but declined to say how much they expected to collect in overpayments. In the past, officials have put the figure at as much as $370 million. That level of auditing would encompass about 5 percent of Medicare Advantage contracts for 2011. CMS has asserted that its goal is to audit every plan annually, but officials declined to say whether that's likely to occur. However, they said they plan to expand the auditing program in 2017. Medicare Advantage plans have challenged the validity of the audits from the start.Clare Krusing, a spokeswoman for America's Health Insurance Plans, an industry trade group, said that CMS doesn't allow health plans to submit "additional data" such as drug prescriptions, and such data could verify that patients have the diseases claimed. The group also has called the RADV audit process "not yet stable and reliable." Expanding Medicare Advantage audits also "could disrupt the care being provided by plans that are working hard to meet the needs of their enrollees," the trade group says. This piece comes from the Center for Public Integrity, a nonpartisan, nonprofit investigative news organization. To follow CPI's investigations into Medicare and Medicare Advantage waste, fraud and abuse, go here. You can follow Fred Schulte on Twitter: @fredschulte

Careful audits of a representative sampling of bills from 37 Medicare Advantage Programs in 2007 have revealed some consistent patterns in the way they overbill, a Center for Public Integrity investigation finds.

Nick Shepherd/Ikon Images/Getty Images

More than three dozen just-released audits reveal how some private Medicare plans overcharged the government for the majority of elderly patients they treated, often by overstating the severity of certain medical conditions, such as diabetes and depression.

The Center for Public Integrity recently obtained, through a Freedom of Information Act lawsuit, the federal audits of 37 Medicare Advantage programs. These audits have never before been made public, and though they reveal overpayments from 2007 — money that has since been paid back — many plans are still appealing the findings.

Medicare Advantage is a privately run alternative to standard Medicare; it has been growing in popularity and now enrolls more than 17 million seniors. In 2014, Medicare paid the health plans more than $160 billion.

But there's growing controversy over the accuracy of billings, which are based on a formula called a risk score; it is designed to pay Medicare Advantage plans higher rates for sicker patients and less for people in good health. In a series of articles published in 2014, the Center for Public Integrity reported that overspending tied to inflated risk scores has cost taxpayers tens of billions of dollars in recent years.

In May, a Government Accountability Office report called for "fundamental improvements" to curb excess charges linked to faulty risk scores. In addition, at least half a dozen health-industry insiders have filed whistleblower lawsuits that accuse Medicare Advantage insurers of manipulating risk scores to boost profits.

 

SHOTS - HEALTH NEWS

GAO Audit: Feds Failed To Rein In Medicare Advantage Overbilling

The audits from the Centers for Medicare and Medicaid Services show that all but two of the 37 health plans audited for 2007 were overpaid — typically several hundred thousand dollars too much — for the sample of 201 patients examined at each plan.

Among the insurers charging the government too much: five Humana Inc. health plans, three UnitedHealth Care Group plans and four Wellpoint Inc. plans. CPI reporters approached the administrators of these plans for an interview, but all declined to comment.

The high rate of overcharging the federal government for many diseases could signal millions in losses to federal taxpayers, since many of the plans enroll thousands of people.

Among other findings:

Auditors, on average, were able to confirm only 60 percent of the more than 20,000 medical conditions plans were paid to treat. The confirmation rates were much lower for some conditions, such as diabetes with serious complications, depression and some forms of cancer.

Overpayments triggered by unsupported medical diagnoses at the 37 audited plans topped $10,000 per patient for more than 150 patients. And the health plans overcharged the government by $2,000 or more per patient for at least 3,500 people in the 2007 sample group.

Overall, the health plans were three times as likely to charge Medicare too much than too little for some of the 70 medical conditions examined as part of the audits. Two of the 37 health plans — Group Health Cooperative in Washington state and a Kaiser Foundation Health Plan in California — had no net overpayments.

Michael Geruso, an assistant professor in economics at the University of Texas, Austin, said aggressive coding practices have had a "huge impact on taxpayer spending" for the Medicare Advantage program.

Geruso, co-author of a study on Medicare Advantage billing, noted that error rates revealed in the audits suggest many overcharges have escaped scrutiny. "Clearly, there's room for more auditing," he said.

Diabetes "without [medical] complications" was the most common disease code reported by the health plans, and auditors typically validated the payments as warranted in three of four cases.

But extra payments made to health plans that claimed some diabetic patients also had complications of the disease — such as eye or kidney problems, for example — were reduced or invalidated in nearly half the cases, and sometimes more. In other words, the auditors found insufficient evidence that these complications actually existed. Some of these reductions in payment are still being disputed by the plans.

Several other disease categories triggering large payments — including "major depressive bipolar and paranoid disorders," for example, and "drug/alcohol dependence" — also were rejected as unfounded by auditors nearly as often as they were confirmed.

Overpayments were not a problem in the case of every medical condition examined. In more than 200 cases, auditors said the higher fees that plans charged were justified because of the severity of the patient's illness. But auditors were between three and four times more likely to slash payments than raise them for many medical conditions.

The audits provide new evidence of how federal officials have struggled to stamp out inflated coding, which is known in health policy circles as "upcoding."

None of the plans faced closer government scrutiny after the audits, no matter the size of the overpayment. The 2007 audits, which collected a total of $12 million in overpayments, are the only ones CMS has completed since officials adopted risk scores in 2004 at the behest of Congress. In some cases, health plans are still appealing the results, nine years later.

The special Medicare Advantage audits, conducted at the behest of CMS, are called Risk Adjustment Data Validation. RADV audits involve a lengthy and secretive process in which medical records are selected from a sample of 201 patients enrolled in a health plan. Auditors review the medical files to confirm that the diseases billed for — and their severity — are properly documented.

When they are not, CMS cuts or reduces the payment. Some plans have disputed nearly every pay cut, while others have chosen not to contest most of the findings.

Yet the paucity of these audits, and their tendency to drag on for years unresolved, brought a stern rebuke from the GAO, the watchdog of Congress, in its May report.

The GAO criticized the Medicare agency for not expanding the scope of the audits as was required by a provision of the Affordable Care Act in 2010. It also said that CMS had failed to home in on health plans with histories of charging too much, or cases in which plans have persistently exaggerated the severity of certain illnesses to jack up their fees.

"We think that CMS has a lot of work to do," James Cosgrove, who heads the GAO's health care division, said in an interview shortly after the report's release.

In response to written questions from the Center for Public Integrity, CMS officials agreed that some medical conditions are overbilled more often than others. But they said the results were "not conclusive, given that the audit samples were not designed to produce statistically valid results" of overcharges for each disease.

Asked why overcharges are so much more common than underpayments, CMS said health plans have an "incentive to submit diagnosis codes to CMS and, as a result, are less likely to under-report these diagnoses."

CMS officials said unconfirmed diagnoses could be caused by "incorrect" coding by the health plan's doctors, or by "incorrect diagnostic data" submitted to the government by the health plan.

Agency officials said they expect to complete 30 audits of 2011 billings by specific plans this year, but declined to say how much they expected to collect in overpayments. In the past, officials have put the figure at as much as $370 million.

That level of auditing would encompass about 5 percent of Medicare Advantage contracts for 2011. CMS has asserted that its goal is to audit every plan annually, but officials declined to say whether that's likely to occur. However, they said they plan to expand the auditing program in 2017.

Medicare Advantage plans have challenged the validity of the audits from the start.Clare Krusing, a spokeswoman for America's Health Insurance Plans, an industry trade group, said that CMS doesn't allow health plans to submit "additional data" such as drug prescriptions, and such data could verify that patients have the diseases claimed. The group also has called the RADV audit process "not yet stable and reliable."

Expanding Medicare Advantage audits also "could disrupt the care being provided by plans that are working hard to meet the needs of their enrollees," the trade group says.

This piece comes from the Center for Public Integrity, a nonpartisan, nonprofit investigative news organization. To follow CPI's investigations into Medicare and Medicare Advantage waste, fraud and abuse, go here. You can follow Fred Schulte on Twitter: @fredschulte

I wonder what Obamacare will look like in 2017?? Stay tuned...

THE FINANCIAL PAGE

 SEPTEMBER 5, 2016 ISSUE

WHAT AETNA’S WITHDRAWAL MEANS FOR OBAMACARE

We’re a long way from the future that Barack Obama envisaged in 2009. 

 

By James Surowiecki

Few companies are as unpopular as insurance companies, and no tears were shed for the insurance giant Aetna when, a couple of weeks ago, it announced that it had lost more than four hundred million dollars on Obamacare policies since the Obamacare exchanges were set up, in 2014, and was going to pull out of most of them. The news, which followed similar announcements by United Healthcare and Humana, was greeted with talk of “whining” insurers who “put profits before patients’ health” and are “willing to deny care to make a few extra dollars.” But the recriminations are misplaced. Aetna’s decision reflects an awkward reality: the jerry-rigged, politically compromised nature of Obamacare has made the program unstable, and unable to live up to its lofty promises. It’s not that Obamacare has failed. As Larry Levitt, a health-care analyst at the Kaiser Family Foundation, told me, “The main goal of the law was to reduce the number of uninsured people, and twenty million more people are covered today because of it. It’s hard to call that a failure.” The reforms that Obamacare put in place have guaranteed access to insurance for people with preëxisting conditions, and have done away with caps on how much insurance companies will spend. Access to health care is less precarious than it used to be. Still, we’re a long way from the future that Barack Obama envisaged when, in 2009, addressing the American Medical Association, he called for “comprehensive reform that covers everyone” and provides “affordable health insurance to every single American.” Some thirty million Americans remain uninsured. Participants in the A.C.A. marketplaces are less numerous, and sicker, than anticipated: 8.3 million fewer people enrolled through the exchanges this year than the Congressional Budget Office had projected. As a result, insurers in much of the country are fleeing the marketplaces. Kaiser estimates that between twenty and twenty-five per cent of U.S. counties may have only one insurer offering coverage in 2017; there’s already a county in Arizona with no Obamacare insurer at all. And the insurers that remain in these markets tend to offer an increasingly narrow network of health-care providers. Lack of competition is a recipe for high premiums or low benefits (or both), further deterring younger, healthier people from buying policies. Which means that the risk pool gets still older and sicker, which means that more insurance companies lose money and leave the market, which means that competition is reduced even further, which means: see above. The U.S. could well end up with a two-tier insurance market, in which people lucky enough to get insurance through their employers will get much better coverage and wider options than those on the individual market, even when both groups are paying the same amount in premiums. Obamacare is being hobbled by the political compromises made to get it passed. The program’s basic principles were the right ones: everyone would be able to get insurance, regardless of preëxisting conditions, and everyone would pay the same price for a given policy, with upward adjustments made only for older people and smokers. In short, insurance companies were prohibited from managing risk by charging healthy, low-risk people less than frailer, high-risk people. Since managing risk is typically key to how insurers make money, it would have made sense to leave them out and just enroll everyone in a government-run program like Medicare. Politics, of course, ruled that out. Shoring up the private-side approach would require penalties stiff enough to get young, healthy Americans to buy health insurance, but politics ruled that out as well. ADVERTISEMENT Conservatives point to Obamacare’s marketplace woes as evidence that government should stop mucking around with health insurance. In fact, government hasn’t mucked around enough: if we want to make universal health insurance a reality, the government needs to do more, not less. That doesn’t require scrapping the current system: the Netherlands and Switzerland both demonstrate that you can get universal coverage through private insurers. But their examples also show that to do so we’d need to make it much harder to avoid buying insurance, and we’d need to expand subsidies to consumers. Alternatively, we could implement the public option, which Obama himself called for in that 2009 speech: a federal program, modelled on Medicare, open to anyone on the individual market. The public option would guarantee that there was always at least one good choice available in the marketplace, and would provide competition for private insurers. If it used the government’s bargaining power to hold down costs and expand access, it could offer good benefits at a low enough price to attract younger, healthier patients. There are solid arguments for both of these models. Either would work, if there were a shift in the political mood and it were given a shot. Even if nothing is done, Obamacare will continue to limp along, probably turning into something akin to Medicaid. But the departure of big insurers like Aetna has made it clear that, if we don’t do more to help cover people in the individual market, the program will never make good on its original promise of truly comprehensive reform. So don’t hate the players; fix the game. ♦

Few companies are as unpopular as insurance companies, and no tears were shed for the insurance giant Aetna when, a couple of weeks ago, it announced that it had lost more than four hundred million dollars on Obamacare policies since the Obamacare exchanges were set up, in 2014, and was going to pull out of most of them. The news, which followed similar announcements by United Healthcare and Humana, was greeted with talk of “whining” insurers who “put profits before patients’ health” and are “willing to deny care to make a few extra dollars.” But the recriminations are misplaced. Aetna’s decision reflects an awkward reality: the jerry-rigged, politically compromised nature of Obamacare has made the program unstable, and unable to live up to its lofty promises.

It’s not that Obamacare has failed. As Larry Levitt, a health-care analyst at the Kaiser Family Foundation, told me, “The main goal of the law was to reduce the number of uninsured people, and twenty million more people are covered today because of it. It’s hard to call that a failure.” The reforms that Obamacare put in place have guaranteed access to insurance for people with preëxisting conditions, and have done away with caps on how much insurance companies will spend. Access to health care is less precarious than it used to be.

Still, we’re a long way from the future that Barack Obama envisaged when, in 2009, addressing the American Medical Association, he called for “comprehensive reform that covers everyone” and provides “affordable health insurance to every single American.” Some thirty million Americans remain uninsured. Participants in the A.C.A. marketplaces are less numerous, and sicker, than anticipated: 8.3 million fewer people enrolled through the exchanges this year than the Congressional Budget Office had projected. As a result, insurers in much of the country are fleeing the marketplaces. Kaiser estimates that between twenty and twenty-five per cent of U.S. counties may have only one insurer offering coverage in 2017; there’s already a county in Arizona with no Obamacare insurer at all. And the insurers that remain in these markets tend to offer an increasingly narrow network of health-care providers.

Lack of competition is a recipe for high premiums or low benefits (or both), further deterring younger, healthier people from buying policies. Which means that the risk pool gets still older and sicker, which means that more insurance companies lose money and leave the market, which means that competition is reduced even further, which means: see above. The U.S. could well end up with a two-tier insurance market, in which people lucky enough to get insurance through their employers will get much better coverage and wider options than those on the individual market, even when both groups are paying the same amount in premiums.

Obamacare is being hobbled by the political compromises made to get it passed. The program’s basic principles were the right ones: everyone would be able to get insurance, regardless of preëxisting conditions, and everyone would pay the same price for a given policy, with upward adjustments made only for older people and smokers. In short, insurance companies were prohibited from managing risk by charging healthy, low-risk people less than frailer, high-risk people. Since managing risk is typically key to how insurers make money, it would have made sense to leave them out and just enroll everyone in a government-run program like Medicare. Politics, of course, ruled that out. Shoring up the private-side approach would require penalties stiff enough to get young, healthy Americans to buy health insurance, but politics ruled that out as well.

ADVERTISEMENT

Conservatives point to Obamacare’s marketplace woes as evidence that government should stop mucking around with health insurance. In fact, government hasn’t mucked around enough: if we want to make universal health insurance a reality, the government needs to do more, not less. That doesn’t require scrapping the current system: the Netherlands and Switzerland both demonstrate that you can get universal coverage through private insurers. But their examples also show that to do so we’d need to make it much harder to avoid buying insurance, and we’d need to expand subsidies to consumers.

Alternatively, we could implement the public option, which Obama himself called for in that 2009 speech: a federal program, modelled on Medicare, open to anyone on the individual market. The public option would guarantee that there was always at least one good choice available in the marketplace, and would provide competition for private insurers. If it used the government’s bargaining power to hold down costs and expand access, it could offer good benefits at a low enough price to attract younger, healthier patients.

There are solid arguments for both of these models. Either would work, if there were a shift in the political mood and it were given a shot. Even if nothing is done, Obamacare will continue to limp along, probably turning into something akin to Medicaid. But the departure of big insurers like Aetna has made it clear that, if we don’t do more to help cover people in the individual market, the program will never make good on its original promise of truly comprehensive reform. So don’t hate the players; fix the game. ♦

By Mary Nugent, Chico Enterprise-Record

POSTED: 08/12/16, 4:19 PM PDT | UPDATED: 2 DAYS AGO

Don’t guess: Medicare’s Part D needs some explanation

 

Chico >> Medicare’s annual election period begins Oct. 15. Seems like a ways away, but it’s not too soon to begin considering the tons of choices out there.

Part of those choices involve Medicare Part D, the prescription drug plan.

“I encourage all seniors on Medicare Part D to have their current plans reviewed to ensure that plan is still covering their drugs for the next year, and at the cheapest rate,” said Ronda Kramer, director of the Health Insurance Counseling and Advocacy Program, under the umbrella of Passages, a senior resource center in Chico.

 

 

“All Medicare Part D plans have some sort of change every year, from co-pays, deductibles, tiers, premiums and formularies.”

Just some of those terms — tiers and formularies — are reason enough to get advice from people who understand the daunting process.

“HICAP is the local Medicare advocate office and we are here to assist beneficiaries free of charge,” Kramer said.

The agency’s staff and volunteers have helped thousands of seniors choose health care plans and save money.

 

THE NUMBERS

 

“There are 65,000 Medicare beneficiaries in our five-county area. Last fiscal year, we did 3,100 one-on-one counseling appointments; 2,809 booths and exhibits; 123,634 targeted persons were reached; and we met 1,254 people in workshops.

 

 

“We have saved in five counties more than $1.5 million for (Medicare) beneficiaries. We offer good advice and be sure they’re not spending unneeded funds.”

Kramer recently took time to share her views about prescription drug plans in response to a press release received by this paper from the California Society of Certified Public Accountants.

“Americans laid out an estimated $457 billion on prescription drugs in 2015, according to the U.S. Department of Health and Human Services, up about 8 percent from 2014. And one-third of Americans reported facing recent hikes in their prescription costs, a Consumer Reports study found,” according to the press release.

 

 

 

OUT-OF-POCKET PRICES

 

The press release advised checking out-of-pocket prices for prescriptions, and to ask a pharmacist what the cost would be without insurance.

“That can be true, but be careful,” Kramer said. “Seniors need to know there are other options. Most importantly, to confirm that the prescription plan they enroll in is contracted with the pharmacy they choose and if a drug is not covered by their plan they can work with the prescribing physician to get an exception with the plan. You’d be surprised how many people don’t know that.

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The Society of CPAs also suggested comparing what different pharmacies charge for the same medication.

 

ASSISTANCE

 

Many drug companies, the society’s press release said, offer discount programs for those who can’t afford their medications.

“Here at HICAP, we assist beneficiaries with applying for Extra Help, a low-income subsidy through Social Security which lowers prescription cost substantially for those who are lower income but still do not qualify for MediCal.

“People may be lower income, but what they make is too high for MediCal. A lot of people get caught in between,” she said.

 

 

Kramer also said that prices for generic drugs can rise, too. She encouraged people to talk with their doctors. “Bring your plan so he can see what’s covered. He may manipulate the prescription you take. There are a lot of options.”

When it comes to prescription drug plans, veterans are their own category. “If they are eligible for veteran’s benefits, their drugs are $9 a prescription, whether they’re on Medicare or not,” she said.

Kramer had another suggestion. “People can seek assistance through the manufacturer through Patient Assistance Programs and you get that information from the drug manufacturer’s website or by calling them directly.”

 

 

Besides help with prescription drug plans, HICAP’s trained volunteers assist people in understanding Medicare, or resolving problems with benefits; compare Medicare supplemental insurance or health plans; and explore long-term care options.