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What you Must Know About Atherosclerosis?

February 17, 2012 in Medicare

In atherosclerosis, the arteries grow narrower as a result of fatty deposits on the inner lining of arterial walls. These deposits are called “plaque” and are composed of fatty substances, cholesterol, cellular waste products, calcium, and a clotting material in the blood.

The cause of atherosclerosis

Atherosclerosis is thought to begin as a result of damage to the inner lining of arterial walls. In addition to hypertension, other factors that are associated with damage to the arterial walls include high level of fat and cholesterol in the blood and the cigarette smoking.
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Kaiser Family Website Has Brain Teaser Quiz on Medicare

February 2, 2012 in Health Insurance, Medicare

The Kaiser Family Foundation offers a multiple-choice “Medicare Quiz” on its web site because the subject is such a hot topic these days from a current affairs point of view. Unfortunately most of the quiz’s 10 questions really oversimplify a complex subject to the point that you could not answer the questions accurately without someone from Kaiser standing over your shoulder explaining them to you.

Here are the 10 questions with some background and my answers. I have no idea how recently the quiz was posted so my answers below may not agree with Kaiser’s. I used MedPAC  – the Centers of Medicare/Medicaid Services (CMS) in-house version of the Congressional Budget Office (CBO) — as my source. Its most recent report is dated March 2011 and Kaiser may well have access to more recent data.
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Beware of Rogue Web Sites about Medicare

January 23, 2012 in Health Insurance, Medicare

I suppose I could have ended the above sentence after “web sites,” but because I do a lot of research on Medicare, I tend to see many web sites apparently designed to fool senior citizens. Beware!

The web site medicare.gov is the official web site of the U.S.’s Centers for Medicare/Medicaid Services (CMS) specifically for Medicare information.  To make life simple I would suggest that you look at no other web site for information unless it is the site of an organization to which you belong such as AARP, a union, etc. (and remember even AARP is trying to sell you insurance)  Read the rest of this entry →

Will Your Doctor Leave Medicare January 1?

December 22, 2011 in Health Insurance, Hospital Bills, Insurance Bills, Medicare, Member Stories

All the recent publicity initiated by Democratic Congressman Hoyer and others, claiming that there is a risk of almost 50,000,000 Medicare patients losing their doctors — and therefore their health care — January 1, 2012 is great political theater.  No one’s watching this particular political theater of course because it’s Chanukah, Christmas, Kwanzaa, New Year’s Day in the Julian/Gregorian Calendar (whichever we use these days), Solstice,  etc.  and we all have better things to do.

But all the controversey is a reminder to Medicare beneficiaries to refresh themselves on the rules about doctors and Medicare. The following is probably not legally perfect but now that I am on Medicare I think there are three kinds of doctors: Read the rest of this entry →

Medicare Open Enrollment Ends… Medicare Special Enrollment Periods Begin

December 7, 2011 in Medicare

I bet you thought the barrage of Medicare enrollment literature and advertising would come to an end today, December 7, with the end of Medicare Parts C and D open enrollment. (If you’re Medicare age, it’s worse than any political campaign ever thought of being.) Think again. Read the rest of this entry →

Is Medicare Public or Private Insurance?

December 5, 2011 in Health Insurance, Medicare, News

Among seniors and those about to sign up for Medicare, some of the most confusing statements in the Medicare budget debate in Congress and on the “airwaves” involve the use of the terms “private” and “public option” to describe the various “Parts” of Medicare

But the easy answer to the headline question, if you are confused by the public vs. private statements, is “It’s a trick question.” (Or if you are an old Saturday Night Live fan, the answer is “It’s both floor wax and desert topping.”)

The words “private” and “public option” have no particular meaning to the Medicare beneficiary. In fact, all Parts of Medicare — A, B, C and D — are public in the sense that they are run by the United States government’s Centers of Medicare and Medicaid Services (CMS). And they are private in the sense that the CMS uses private insurance companies to run them. 

But if you want more detail on the private/public Medicare name game, read on. Read the rest of this entry →

What’s a Medicare Physical?

November 16, 2011 in Health Insurance, Medicare, Member Stories

Last week, I asked the question “What’s a Medicare Wellness Visit?”  Turns out — as is often the question when it comes to Medicare — I asked the wrong question.  I should have asked “What’s a Medicare physical?” Really! And after a week of trying I still can’t find the answer….

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What’s a Medicare Wellness Visit?

November 11, 2011 in Health Insurance, Medicare

One of the highly publicized benefits of the 2010 Patient Protection and Affordable Care Act (PPACA) for Medicare subscribers is the “annual wellness visit” feature that kicked in in 2011.

I know I made the mistake of assuming – and may have even written somewhere on this blog — that “wellness visit” was just a government bureaucrat’s name for a physical.  Then recently I talked to a Medicare subscriber who actually had a wellness visit.  Unfortunately a Medicare wellness visit is like a physical only in that you talk to a doctor or nurse for a while. You’re never asked to say “ahhh” and you’re never touched with a stethoscope.  For guys, you are never asked to “assume the position” or turn your head and cough. 

From the description I heard, a wellness visit sounded more like applying for insurance coverage than a physical. So I made a note to follow-up and set the record straight.  Then — senior moment — I never followed up.  But Betsy Cliff of the the Bend, Oregon Bulletin is all over the story.  Of course her article is written from an Oregon perspective but the facts she outlines agree with what I heard. I think we’ll begin to see a lot of national coverage on this issue, maybe even someone from the Herald, Telegram, Republican or Globe will pick up on it. (Or maybe Martha, although this story doesn’t fit her station’s age demographic.) Read the rest of this entry →

The “Medicare Price” of Enbrel Is Not Changing for 2012

November 3, 2011 in Health Insurance, Medicare

There is a very confusing story about the price of Enbrel — of Phil-Michelson-the-pro-golfer fame — running in the Boston Herald November 3rd. It’s one of those anecdotal heart-string-pulling/beat-up-insurance-company articles that journalists are so good at. But like I’ve said before, don’t believe everything you read in the newspapers.  I’ve identified six or seven statements that don’t make sense in terms of

  • timelines (e.g., Medicare has had standalone drug coverage for only six years so this situation could not have changed after 10 years, at least from a Medicare perspective, as implied in the article)
  • insurance plans (e.g, is the Herald talking about co-pays or annual costs changing over time?)
  • victim details (e.g., is/was the “Medicare victim” working or not and when?)

Whatever the answers to the above questions, Medicare stands falsely accused by the Herald of increasing its price for Enbrel because there is effectively no “Medicare price” of Enbrel.  There are variously priced Medicare Part D Standalone Prescription Drug Plans that cover Enbrel. The Medicare Plan Finder says a person could buy what it thinks is the strongest dose of Enbrel for half what the Herald says its “Medicare victim” would have to pay monthly. To reach the $600 a month level mentioned in the Herald article I had to quadruple what medicare.gov says is typically the strongest dosage.

(PATIENT BEWARE: I just punched the numbers in to try to agree with the Herald story; I have no idea if quadrupling the dosage from what medicare.gov says is the maxiumum is medically possible. Everyone’s situation is different and you cannot look at your healthcare insurance needs through the prism of another person’s prescription or other healthcare needs.)

In addition these prices did not change recently as implied by the Herald. The price of the lowest cost plans as they relate to Enbrel are about the same in 2011 as medicare.gov says they will be in 2012. Perhaps this was a change that affected the victim’s 2010 plan vs. 2011 plan but if that was the case, he could have chosen a different plan for 2011. Read the rest of this entry →

Is New Medicare MD Insurance Price below $100 a Month Good News?

October 31, 2011 in Health Insurance, Medicare, News

Well — like $3.49-a-gallon gas which is really $3.50 when you look closely at the sign while you’re pumping the gas –  Medicare MD insurance is only 10 cents below $100.

But that’s good news, right? The answer: Yes, No, and Maybe.

Here’s the background.  The Health and Human Services (HHS) department announced October 27 that the 2012 Medicare Part B premium will be $99.90.  As explained in an earier Healthcare Savvy post, Medicare Part B primarily covers doctors charges. As explained in another earlier Healthcare Savvy post, the Part B premium has been $96.40 for most Medicare subscribers since January 1, 2009. But it was $110 and change a month for those subscribers that signed up for Medicare Part B in 2010 and $115 and a few cents for those who signed up in 2011. 

Mostly that’s people who turned 65 in those years but it applied to all new 2010/2011 subscribers, including younger disabled people and older seniors that continued to work past 65 and received employer sponsored insurance until they signed up for B at whatever age. (Despite conventional wisdom, Medicare insurance is means tested and about 5% of subscribers nationwide — those with incomes over $85,000 — pay more than these amounts.  This blog post ignores the situation for these “poor” senior citizens.)

Now for the Yes, No and Maybe

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The Medicare Maze

October 28, 2011 in Medicare, Member Stories

If you’re 65 or older, or if you have a loved one who is, it’s now Medicare Open Enrollment. This year, the period has shifted earlier in the year, and will end on Dec 7 instead of Dec 31.

So, who does this affect? Anyone who is signing up for Medicare for the first time, or people who want to change their Medicare Part D (prescription drug) plans or Medicare Advantage (the privately run program that wraps up Medicare Parts A (hospital visits), B (doctor visits) and D (prescription drugs) into one plan).

On the Here & Now show, we spoke with a contributing editor from Kiplinger’s who told us that most people don’t end up switching plans, because they like what they have and they don’t bother to check whether things have changed. And boy, can they change.

The biggest issue tends to be for prescription drugs. During the course of the year, plans sometimes drop drugs, or increase the co-pays. So someone could go from paying $20/month for a drug to $40/month! Or lose drug coverage altogether.

The best thing to do is to review your plan. If you want more info, listen to our interview on Here & Now.

My mom’s coming to visit next week, and we have already scheduled time to sit down and review her plans!

New Medicare Premiums for 2012: Don’t Believe What You Read in the Newspaper!

October 17, 2011 in Health Insurance, Medicare

Did your father always tell you not to believe what you read in the newspaper? When it comes to Medicare, that’s good advice. Last week I posted about the start of Medicare 2012 Open Enrollment, which is in effect from now until December 7. 

So the obvious question is “How much does Medicare cost?” Well, like I said in August, it’s not simple. And the media confuses the issue even more.  The October 17 Boston Globe, reporting on open enrollment, says:

“Last month, the US Department of Health and Human Services announced that, on average, Medicare Advantage premiums will be 4 percent lower in 2012 than in 2011. Individuals, however, won’t know whether their own premiums will rise, fall, or remain the same until later this month.”

I think I know where the reporter was coming from with these two sentences but the wording could have been a lot clearer. Everything you need to know is available NOW. You do NOT have to — and shouldn’t — wait until later this month. For an explanation, read on… Read the rest of this entry →

2012 Medicare Open Enrollment Starts October 15

October 13, 2011 in Health Insurance, Medicare

If you’re over 65 with nothing else to do on a Saturday morning, this Saturday morning is the first day you can sign up for or change your Medicare choices for 2012.  In case you’d rather watch a grandson play soccer Saturday or — being politically correct — go to your granddaughter’s hockey game, you have from Saturday October 15 until December 7 to make those choices.

But whether you’re an early bird or the type that waits until the last minute, make sure you take a look and compare what you have now to the changes coming January 1.

  • Part C Medicare Advantage and Part D Standalone Prescription Drug Plans get dropped (and added) county by county.
  • Drugs get dropped from (and added to) existing plans’ formularies.
  • Medigap plans (also called Medicare Supplement plans and popularly known in Massachusetts as Medex, although that’s just Blue Cross’ brand name) can change too. However all Medigap plans have to provide the same benefits.

As I wrote back in August, it’s not simple.  But for 2012 medicare.gov makes it easy. Its Plan Finder involves only four steps. An explanation of how the Plan Finder works can be found if you click on…

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Head of Medicare Turns 65, Says He’ll Sign Up for It Himself

September 19, 2011 in Health Insurance, Medicare, Member Stories

The recent 65th birthday of Dr. Donald Berwick, head of the Centers of Medicare and Medicaid Services, provides a chance to better understand Medicare if you’re in the run-up to 65… or know someone who is.  

If you’re about to turn 65, your “full retirement age” according to Social Security is 66 or even a few months older.  The longer you wait (up to 70 if you want), the more you get (assuming you live many more years–sorry to be macarbe on Monday morning but that’s how Social Security works). Typically, if allowed, you would want to continue to stay on employer sponsored insurance even though eligible for Medicare because in general such insurance is much better than Medicare, which has high co-pays and deductibles, no vision or dental, geographic restrictions and lifetime limits (see more detail here). And typically employers have to allow you to stay on their plan or it would be considered discrimination. But every situation is different so check with your HR department, Medicare, and Social Security before making up your mind.

So how does it work for Dr. Berwick and might it work for you if your circumstances are the same as his: still working, working for an organization with more than 20 employees, not collecting Social Security yet, and/or plan to continue to get healthcare insurance from your employer?

First, as the NPR article in the first link explains, Berwick says he’s “in the process of signing up.” Huh?  Isn’t it automatic you say?  No, Medicare is not automatic when you turn 65 unless you are already on Social Security.  Medicare and Social Security ages were in synch when Medicare started in the 1960s but they became out of synch with the Social Security reform during the 1980s.

Second, if you plan to keep working after 65 and keep getting your health insurance through an employer (or a spouse gets coverage for you through his or her employer), the Medicare rules are different depending on whether the employer has 19 or fewer vs. 20 or more employees. Talk to the human-resources (HR) administrator where you work about the differences. 

Third, usually the best thing to do for everyone turning 65 is to at least sign up for Medicare Part A even if you plan to keep working just to get in the Medicare system. That’s what Dr. Berwick says he plans to do. And Medicare Part A, which primarily covers hospitalizations, is free (as long as you worked enough Social Security quarters). But the Medicare hotline told me there are situations where signing up for A while you’re still working could hurt your private, state/local-government, union or Social Security retirement benefits in the future.  Talk to Social Security about it before you turn 65 even if you do not intend to take Social Security benefits early.

And as the NPR story about Dr. Berwick explains, you also need to talk to Social Security if you decide to sign up for Part A and send them or bring them your birth certificate. Not surprisingly it is yet another life-change situation where you don’t have to show your Social Security card.   

Almost all you probably did not want to know about this subject can be found in this Medicare booklet.

More on Medicare Choice Confusion: Help Your Senior Friends, Relatives Get Some Help

September 12, 2011 in Health Insurance, Medicare, News

Back on August 18 I wrote about the study by Harvard professor Dr. Michael McWilliams and others concerning the complexity of choosing among Medicare Part C options.  Medicare Part C was once known as Medicare +Choice and is now known as Medicare Advantage. Over the Labor Day holiday I had a chance to read the entire report and Dr. McWilliams answered some follow-up questions.  

My takeaway from the research: Get some independent help to understand your Medicare Advantage options.  Even if you are not Medicare age yourself, if you know or are related to someone that is turning 65 or anyone that is already on Medicare, help them to get some help.  Senior centers can help you get that independent help.

The Harvard study finds that Part C complexity is especially a problem for a person with cognitive issues (which some would argue — only half jokingly — includes all of us over 65). Dr. McWilliams says: 

“…the most important finding of our study was that seniors with poorer cognition were less responsive to increases in benefit generosity in Medicare Advantage (MA) than seniors with higher cognitive functioning, who were more likely to switch into MA during the study period when benefits improved. (emphasis added by Byron)”

The report only covered the complexity of one type of Medicare. But Dr. McWilliams explained to me in an email that he thinks it is the most confusing type because — unlike with “Original Medicare” (formally called Parts A and B) and so-called Medigap plans — MA-plan benefits can vary from insurer to insurer. He is referring to the fact that some MA plans have high co-pays and deductibles (but never worse than Original Medicare); some have co-pays but not deductibles. Some cover prescriptions; some don’t. Some cover vision; some don’t. Some pay health club dues…  Etc.

The research found that the more MA plan choices there are in your county (particularly if more than 15), the less likely a person with poorer cognition is to choose the best plan for that person’s particular situation.

And as explained elsewhere on Healthcare Savvy (see Medicare is not simple) even a good decision one year is not the best plan for the next year because the details change every year. That’s why I put the emphasis on “when benefits improved” in Dr. McWilliams quote.  Or — of course — they could get worse.

That’s why seniors need to check their coverage every year. Do a senior you know a favor and at least remind them.

Prescription Retail Prices and the Medicare “Donut Hole”

September 8, 2011 in Health Insurance, Medicare

Recently I posted about the advantage of understanding prescription-drug reail prices — as opposed to just your own co-pays and deductibles — if you want to save a few bucks.  For seniors, this effort is even more important because of the infamous Medicare Prescription Drug Plan (PDP) “donut hole.”

Conicidentally, on September 7 the AP reported that fewer and fewer seniors were falling into the hole. (The link is to the Boston Globe version of the story.) This is good news but the following statement in the article confuses many seniors:

“This year (2011), for example, customers and their drug plans must spend $2,840 before they reach the coverage gap…”

The key words in that sentence are “and their drug plans.”  The phrasing makes $2840 sound like a lot but seniors on a Part D plan or a Part C plan with prescription drug coverage reach the donut hole a lot quicker than they think depending on the drugs they take. It happens when the drugs they buy have a retail value of $2840 (an amount that will likely be adjusted upward for 2012). The key amount is the retail value of the drugs, not the much lower amount that the seniors spend in co-pays, etc.

So, for example, if you have to take a fairly common brand name drug priced at $200 a month (for which you pay $15) instead of a generic, and you have one other generic drug on your list with a $50 a month retail value (even though you are only paying $5 for it), you’re in the hole. That might be OK if you figured it all out including the monthly PDP premium cost. But one unexpected additional prescription can run up your annual out of pocket costs dramatically and quickly.

Here’s the official Medicare document on the subject.  The basic message is that is not simple. So make your appointments now at your local senior center for updating your Part D choice (and Part C if you are on it) for 2012 because the open enrollment period has changed this year.  It now runs October 15 to December 7.

You’ll want to get into the senior center for a consultation before Thanksgiving if not sooner so you have a few weeks to think about your options. And a few weeks to ask around about retail drug prices.

More on Medicare’s Simplicity…. “Not” Says Harvard!!

August 18, 2011 in Health Insurance, Medicare, News

J. Michael McWilliams, assistant professor of health care policy and medicine at Harvard Medical School and a practicing general internist in the Division of General Medicine at Brigham and Women’s Hospital is out this morning with an academic view of the subject I blogged about here last week: getting on Medicare is not simple.

The Harvard research compared choosing a Part C Medicare plan (also known now as Medicare Advantage after originally being called Medicare Choice) vs. Original Medicare (Parts A and B). McWilliam’s view:

“Most other Americans choose from just a few health plans, but elderly Medicare beneficiaries often have to sift through dozens of options… The Medicare Modernization Act of 2003… dramatically increased the number of private plans participating in the (Part C) program and encouraged (Part C) plans to compete for enrollees by offering lower premiums and more generous benefits, such as prescription drug coverage.”

I couldn’t agree more, as I said last week. I’m trying to get the actual research document so I can opine more.  Although I agree with his finding as expressed in the press release, I actually think Part C is easier than choosing A & B and then having to pick a Gap plan and a D plan. 

Remember last week’s flow chart (the official flow chart from the Centers for Medicare and Medicaid Services). Medicare Advantage is actually the shorter branch of the decision tree, the one on the right hand side of the diagram.

But not every county has a good Part C option and/or your provider may not participate in it and/or it may change next year and/or… and so forth, and so forth…

Like I said I said, Medicare is not simple . Go to your senior center and ask for SHINE (SHIP outside Massachusetts).