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Seniors Sound Off: Learn About Part D and Get Involved

In the last 3 weeks, two of my friends have been diagnosed with very serious illnesses. One is enrolled in Medicare and has Part D coverage and one is not yet old enough to be eligible. Their experiences in accessing the medicines they need have been quite different and have led me to once again appreciate the security and strength that Medicare Part D coverage provides.

Of course the examples of two people cannot tell a whole story but I believe their situations do illustrate two points that all Medicare beneficiaries need to consider:

  1. How do we best learn about and utilize all of the benefits Medicare Part D provides?
  2. How do we support efforts to protect the Medicare coverage we have?

Over the next few weeks I have invited several people with great expertise in Medicare to help answer these questions. I also hope you will send in your questions, ideas, and concerns. I promise we will respond!!

Together we can work to protect against any threats to our Medicare Part D coverage.

Remember — your voice makes all the difference!!!



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Keeping Part D Strong: Protect a Program that Works

Have you used your Medicare Part D plan this year? I have, I changed pharmacies and refilled two prescriptions that I take regularly.  It took only a minute or two and I was on my way–just another errand in the course of a busy day.

But as one who worked for many, many years to advocate for prescription drug coverage in Medicare, I cannot help but reflect on how much Part D has changed the lives of older Americans and individuals with disabilities–providing peace of mind, enabling them to remain active, and, most importantly, restoring and maintaining their health! It’s almost inconceivable to think that just a decade ago, Medicare did not provide beneficiaries with coverage for prescription drugs. What a different world that was!

We have made much progress, but we also must safeguard it. This year is going to be a difficult one for Congress and, indeed, the entire government. There are lots of issues, lots of pressure to act, and enormous demands on our national budget, and, of course, lots of politics. As we have seen over the years, this kind of situation can lead to misguided actions that negatively impact Medicare.

From beneficiary satisfaction ratings nearly 90% or higher, to the steady premium costs, to the broad choice among plan options, Medicare Part D has been and remains a program that works — truly works– for almost 40 million seniors and disabled individuals who depend upon it.  Let’s be on guard and be ready to defend our benefit and redirect lawmakers and regulators to the many programs that don’t work and desperately need their attention. Part D should be off the table!



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Protect and Preserve the Medicare Part D LIS Program

Sometimes there is a double meaning to the term “Medicare reform.” “Reform” can mean improve and strengthen or it can mean change and weaken.  One example is a proposed reform of the Medicare Part D Low-Income Subsidy (LIS) Program, also known as Extra Help. This program saves low-income beneficiaries close to $4000 per year in prescription drug costs according to the Centers for Medicare and Medicaid Services (CMS).

The proposed reform would change and weaken the program by requiring low-income Medicare beneficiaries to pay higher copays for brand name drugs while lowering copays for generic drugs. The reform, first proposed by the Medicare Payment Advisory Commission (MedPAC), aims to drive more seniors and individuals with disabilities to use generic drugs, which in theory could lower costs to Medicare.

However, this proposed reform is flawed for a number of reasons. It fails to take into account that many patients, including those at or below the poverty level, require access to brand name drugs because their doctor has determined these medications will produce more positive health outcomes than generic medications would provide. In these instances, patients must have affordable access to brand name drugs or their health and well-being could suffer as a result.

Unfortunately, the proposal would increase cost sharing for these patients.  According to analysis by the Leadership Council on Aging Organizations (LCAO), this would deter access to needed medicines which could in turn lead to much higher Medicare costs on other types of health care services.

Further, even if this change provided some exclusion for certain therapeutic classes of drugs, the exclusion may not be broad enough to address the treatment of chronic diseases for which there are often no generic substitutes.

The LIS program must be protected and preserved. This program works to keep cost sharing low for the most vulnerable beneficiaries to ensure patients can access the treatments they need. Adding to those costs could make health care unaffordable for them. The most inappropriate way to celebrate Medicare’s 50th anniversary in 2015 would be to adopt an LIS reform proposal that increases costs for low-income people instead of maintaining its commitment to improve their quality of life.



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Stand Alone or Take Advantage?

A very important question you should ask regarding Medicare prescription drug coverage is what type of plan you want.  There are two very different choices.

The first is to enroll in Medicare Part D. This is a stand-alone plan that covers just your medications. You use this coverage in conjunction with the medical coverage you receive with Medicare Parts A and B (hospitalization, provider visits, testing, etc.).

The other option is to opt for a Medicare Advantage Plan that provides all of the health care services under Part A and B as well as coverage for your medicines in one plan. Examples of Medicare Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Medicare Medical Savings Account Plans, and Special Needs Plans.

Both types of plans have advantages, the right choice for you depends on many factors including where you live and your preferences regarding provider choice. Also, be sure to examine more than just the bottom line on premium costs when evaluating any program.

Some beneficiaries choose to enroll in traditional Medicare health coverage as wells as a stand-alone drug plan (Part D) because it gives them freedom to choose providers without having to coordinate within a network or get referrals. The Part D plans cover your medicines but do not include extra services or provide care. (Note: Some beneficiaries who have regular Medicare and Part D plans also purchase Medicare Supplemental Insurance to assist in copayments and deductibles for medical services.) Part D plans are available throughout the United States, so you have this option no matter where you live.

On the other hand, Medicare Advantage Plans provide health coverage through specific provider networks and facilities. Once you enroll, you are required to seek care within your network. In some cases, these plans also offer additional services not available to beneficiaries who aren’t in their program. Medicare Advantage Plans contract with Medicare to provide Medicare Parts A and B services as well as coverage for your medicines. If you choose to enroll in a Medicare Advantage Plan you do not need to purchase Medicare Supplemental Insurance. These plans are not available everywhere, so it’s important to check what is available in the region or area in which you live. You can check online using the plan finder at www.medicare.gov or use our tools to find a local office to assist you in your search.

Here are a few questions to consider when determining what is right for you:

  • Does my current doctor or other care provider participate in the Medicare Advantage Plan?
  • If not, am I willing to change doctors/providers?
  • Are the care providers and other facilities in Medicare Advantage Plans convenient to me?
  • Are my medicines covered?

One last thing: Medicare provides a rating of 1 to 5 stars for Medicare prescription stand-alone plans and Medicare Advantage Plans. These ratings are based on both Medicare quality standards and beneficiary experience. For a full explanation of the star rating system, go to www.medicare.gov and don’t forget to look for and consider the rating as you select a plan.

Remember that a Medicare is open 24/7 at 1-800-633-4227.



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Thanksgiving Plans???

Thanksgiving weekend has been a traditional time for discussion and consideration of Medicare Part D plans. This year, as families gather, both Medicare beneficiaries and younger family members may be considering their various healthcare coverage options. It’s a great thing to do because plans and coverage needs can and do change from year to year!

The tools Medicare has provided on its website, www.medicare.gov, have become even more streamlined and user friendly over the years, and surveys consistently show that those of us who use them appreciate that convenience as well as the coverage we receive.

Happy Thanksgiving!

So, if you haven’t already done so, take a break from that post-turkey-dinner nap, non-stop football, or Black Friday shopping and go over your Part D coverage!   Don’t forget to also check out all of the resources that are available at www.SeniorsSpeakOut.org!  They will get you prepared for the tasks at hand.

Remember, www.medicare.gov is ready and waiting all the time, and though Medicare’s call center is closed of Thanksgiving Day, you call them bright and early Friday morning or any other time including the weekend at 1-800-633-4227.

Have a safe and wonderful Thanksgiving!



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Shopping for Plans In-Person or Via the Phone

Earlier this week on the blog, we laid out the simple steps you can take to compare plans and shop for coverage using the online tools, such as the Plan Finder, available at www.medicare.gov. Of course, there are people of all ages who are not comfortable putting all their information into a computer – or at least trying to do it without help. Fortunately, Medicare understands this. If you would rather have an in-person discussion or talk to a specialist on the phone, those resources are available as well.

The initial steps to shopping for coverage are the same whether with a representative or online. Begin by making a list of the medicines you take and the dosage. Next, decide whether you want to get most of your medicines, especially the ones you take regularly, by mail or at a local pharmacy. You’ll also need your Medicare card available which will have key information like your Medicare number and the date you became enrolled in Medicare.

If you don’t use a computer or have one available, you can call your local Area Agency on Aging and make an appointment to meet with the SHIIP Counselor who can help you compare available plans. You can find information on local agencies using our online mapping tool. When you go, remember to bring your medication information and your Medicare card with you when you go.

Additionally, you can speak to a Medicare counselor over the phone any day of the week by calling 1-800-MEDICARE or 1-800-633-4227. A live person will walk you through any questions or concerns you have along the way. They are available 7 days a week excluding federal holidays.

How long will this process take? Probably about an hour or so.  Not long, but enough time to maybe save you money or at least confirm that you are getting the best coverage you can for the medicines you take.

Finally, you can always get information directly from the plan you are interested in. To do this, go to the Plan Finder on the Medicare website, follow the directions, and you will get a list of plans in your area. Click on the name of the plan in order to obtain the contact information. You can also call a local SHIIP Counselor to get plan contact information.

Have you gone through the paper enrollment process? Any guidance you would share with fellow seniors? We’d love for you to sound off in the comment section or through our Facebook page to let us know about your personal experience.



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Online Tools to Shop for Part D Coverage

It is interesting to hear younger people talk about how hard it is to choose health insurance plans. They’re right. Evaluating all the intricacies of multiple plans can at times be a significant challenge. That’s why Medicare beneficiaries are incredibly fortunate. We have easy-to-use tools and real people to help us compare choices and select the Part D plan that’s right for us.

A quick visit to the Medicare Plan Finder website is all you need to get started using the tools that are available to compare plans. So, if you are thinking about reviewing your Medicare Part D plan options now that it is open season – and you really should be thinking about it – here are some easy steps to follow.

Begin by making a list of the medicines you take and the dosage. Next, decide whether you want to get most of your medicines, especially the ones you take regularly, by mail or at a local pharmacy. With that information, a laptop or tablet computer, a phone, and your Medicare card, you are ready to go.

Once on the Medicare Plan Finder website, you will be asked if you want to look broadly at all of the plans available in your area or do a more personalized search which requires providing your name, Zip Code, Medicare Number, date of birth, and the year your Medicare coverage became effective. All of that information can be found on your Medicare card. If you or someone searching for you has never put in your information before, you should use the General Search option.

Continuing with the General Search, you next have to provide some information about yourself and your income and Medicare status as well as the list medicines you take and their dosage. All of this is necessary to help narrow down the list to plans that are right for you.

If you have searched for coverage before, it’s even easier. Simply choose the Personalized Search option and it will automatically reflect the information you provided the last time you compared plans. It will also give you the chance to update the information with any changes or additions.

From that point on, just follow the directions on the screen until you have a number of choices that you are comfortable working with, or in some cases, a single choice that best meets your needs. You can always go back and change the search data to get more or fewer choices.

But the best news is that if you need help or have questions, — day or night, weekday or weekends — you can call 1-800-MEDICARE or 1-800-633-4227 and speak to a live person. They’re available anytime except federal holidays.

Watch the blog for more information this week about the resources available to you if you’d rather not search for a plan online. In the meantime, let me know what your experience has been like with the online tools – both good and bad.



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Small Increase in Social Security Benefits Announced, Good Thing We Have Part D

Bob Blancato-webThe Social Security Administration (SSA) recently announced that Social Security benefits will only rise by 1.7 percent in 2015, or an average of $20 per beneficiary. This low cost of living adjustment, or COLA, for 2015 marks the third year in a row that Social Security beneficiaries will receive an increase of less than two percent. By law, the increases are based on inflation, and this year has seen low inflation rates.

However, many older Americans face hefty price increases not measured by the government’s inflation index—health care costs. Older adults are more likely to spend more of their income on medical care. And, some retirement health insurance programs will be hit with increased costs; federal retirees will see their premiums rise by 3.8 percent next year, more than twice the percentage increase in COLA for Social Security.

There is one notable program that will not be facing substantial increases next year: Medicare Part D. Average Part D premiums are projected to increase by only $1 for a basic plan next year to up to $32. Eighty-five percent of seniors say that Part D has an affordable monthly premium, and nearly nine out of 10 seniors are satisfied with the program. Part D, a crucial part of our health care system, is vital to continuing to provide millions of older Americans with the affordable health care they need at a quality level they deserve. Though we may not like the low COLA increase for Social Security beneficiaries, we can be pleased that Part D premiums are one place that seniors aren’t having their wallets hit.

When new issues like this pop up that impact our health and wellness, make sure to check back in with the Seniors Speak Out blog. I encourage you to explore the rest of the site as well to learn about your options during open enrollment and please share any hurdles you face in accessing health care. I look forward to hearing your thoughts.



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The Benefits of Part D Coverage for America’s Veterans

This week, we celebrate Veteran’s Day, a time of thanks and appreciation for the sacrifices and service given to all of us by the men and women who are or have been in our armed forces. Providing the highest quality healthcare to our veterans is a national priority, so we wanted to review some important considerations for veterans who are eligible for Medicare.

There is a common but mistaken assumption that all veterans and their families receive health care services through The Department of Veterans Affairs (VA) or The Department of Defense. In fact, though millions of veterans use the VA system, not all veterans receive care that way. Moreover, except in very limited circumstances, spouses of veterans are not eligible to receive care through the VA system at all. Actually, millions of veterans are enrolled both in Medicare and in the VA Health system and thus receive different but very essential health benefits from each one.

VA encourages veterans who are eligible for Medicare to opt to enroll in Medicare Parts A and B so that they have coverage for medical services received outside the VA system. That is because VA only pays for services provided at a VA facility or a pre-approved non-VA provider. It’s easy then to see then why Medicare coverage may be particularly important, for example, if a beneficiary doesn’t live near a VA facility.

Another fact to keep in mind is that by enrolling in Medicare Part B when a veteran is first eligible, there is protection should VA benefits ever be lost or if any gaps in coverage occur. (More specifics on this are available at www.medicare.gov and www.va.gov.)

Medicare Part D is optional as well, but many veterans choose to supplement their VA coverage with a Medicare Part D plan.  Here are some reasons why:

  1. VA will not fill prescriptions written by providers outside the VA system. If a veteran enrolled in the VA Health System also takes medicine prescribed by a private clinician, Part D provides coverage for the medicine but VA will not. This situation can also arise if a veteran enters a non-VA nursing home or care facility and needs to use their pharmacy; VA will not cover this but Part D will.
  2. Only the veteran (except for CHAMPVA beneficiaries) can use the VA Health system pharmacy, so spouses definitely need to have coverage through Part D or another creditable plan. Creditable coverage means that the plan has been evaluated and found to provide coverage equal to or better than the basic Part D benefit plan.
  3. VA coverage only applies to VA pharmacies and mail order services. If a veteran lives far from a VA facility and needs new medicines suddenly and/or quickly, a local pharmacy would be an important option. Medicare Part D would cover the medicines but VA would not.
  4. Finally, for low income persons, Medicare provides financial help for Medicare Part D beneficiaries through its low-income subsidy (LIS) program. Some veterans who are eligible for this program may find that enrollment in Part D will reduce their drug costs even more.

If you have questions about VA benefits and coverage, contact the VA Health Administration Center at 1-877-222-8387.  If you have questions about Medicare, contact them at 1-800- 633-4227.



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Things to Consider When Choosing Your Medicare Plan This Open Enrollment

Open Enrollment is here again. We have the opportunity to review our Medicare Part D coverage to make sure it is right for us. From time to time, I have heard people complain that this yearly process is annoying and unnecessary, but I beg to differ. In the course of a year, many things can change – from where we live to the medicines we take. The open enrollment period is an opportunity to ensure we have a plan that best meets our current needs.

 

Plans themselves can also change from year to year. For example, this year, my plan will no longer have a preferred relationship with my pharmacy. If I stay with my current plan and keep the same pharmacy, my medicines may cost more, and I will be taking that into account as I make my decision about what plan will give me the most value.

 

Other possible plan changes may have an even bigger impact on your purse. Be sure to compare the list of medicines you take with the list of medicines your plan will cover because the list may be different than last year. Also, double-check that all or at least most of your medicines are listed. Don’t just pick a plan because the premium is low. If the medicines you need aren’t covered, you could end up paying more.

 

You should also consider the amount your plan will pay toward the cost of your medicines. Most of us are familiar with co-payments – the fixed amount you pay when you visit a doctor, get a health service or, in this case, pick up your medicines – but beware, some plans have co-insurance rather than co-payments for some medicines. Co-insurance requires that you pay a percentage of the cost of a particular medicine rather than a fixed amount like the co-payment. From year to year, plans may change their formulary (the list of drugs they cover) and cost-sharing levels so that a drug which last year only required a co-payment may now require co-insurance. Because this will change the amount of money you will need to pay, it is really important to review your plan to see what coverage is provided.

 

When Medicare Part D was created, many patient groups and consumer advocates worked hard with CMS (the agency that runs Medicare) to make sure that Medicare beneficiaries would be able to get the medicines they need. The Open Enrollment process is one of the most important safeguards of this program because it guarantees that every year we can decide which plan works best for us.

 

So, PLEASE review your plan and make an informed decision during Open Enrollment. Visit the Medicare website (www.medicare.gov) and use the plan comparison tool to see what options you have or go to the Medicare
SHIIP Counselor at your local Area Agency On Aging. You can also call Medicare all day, any day except Federal holidays at 1-800-633-4227.

 

Tell us what you found when you reviewed your plan. Did you decide to make a change? Did you get advice from anyone? What advice do you have for others reviewing their plans?

 

Remember– Open Enrollment ends December 7.