Healthcare Savvy

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.
Read the rest of this entry →

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 →

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 →

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 →

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 →

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…

Read the rest of this entry →

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.