Share this post:

Medicare – What Can We Expect Under the Biden Administration

While it’s a new year with a renewed hope for a return to normalcy, we also have a new President with new power, given that the Democrats hold the majority in both the House and the Senate. The big question is, what impact will this administration and control of both Houses of Congress have on Medicare?

As you might remember, one of the big discussion issues among the Democratic Presidential hopefuls had to do with healthcare. Some of the more progressive candidates pushed for a single payer, government-controlled healthcare system. The more moderate candidates, President Biden being one of them, campaigned for an expansion of Affordable Care Act (sometimes called Obamacare) and some cuts to some parts of Medicare and an expansion of benefits to others.

One of the changes to Medicare that President Biden has talked about is adding a public health insurance option to the healthcare choices for those under 65. It would be administered by the traditional Medicare program. It is opposed by hospitals and many doctors because it would likely fix many of the prices of healthcare at or below the already low Medicare prices. This would especially impact rural hospitals since many are already teetering on insolvency. With the small majorities in both houses this approach will be one of the harder ones to get passed.

The President has also proposed that the Medicare age be lowered to 60. This is just another way to open the way for more people to rely on the government for their healthcare; some say it is merely a steppingstone to a single payer system. It just doesn’t seem logical to lower the Medicare age, putting more pressure on an already financially strapped program, when people are staying healthier longer. This will also be difficult to get done.

Drug prices is another area that President Biden has promised change. This is one area where he and former President Trump were most alike. He also wants to use methods like using foreign prices to set our drug prices and allowing the unregulated importation of drugs. I’ve discussed in further detail these and other approaches in earlier blogs, here and here. There is one place where President Biden differs from the former President on drug pricing. President Biden wants to allow the government to negotiate the drug prices in Medicare Part D. Now this sounds like something that every free-market advocate would embrace, but what it really means is the government would merely be setting the prices and would not save much money according to the government’s own non-partisan accounting office, the Congressional Budget Office.

One area that might get some renewed attention is a change that could help older Americans immensely. That change would put a cap on a Medicare beneficiaries yearly out-of-pocket prescription drug costs. This change would help those who are the sickest amongst us and who are often in no position to afford huge drug costs. I hope that a new bipartisan effort to consider this needed change will be one of the positive things that this administration champions. 

It will be interesting to see if President Biden uses the Executive Order route favored by President Obama and President Trump or the legislative route to enact his administration’s policies. I have said many times that our Representatives on Capitol Hill need to be involved in issues that have such a profound effect on our lives. Whatever happens, we will help you stay informed on any proposed changes to your healthcare and continue to be a conduit for your voices to those on Capitol Hill.

A reminder, tomorrow we will hold another virtual town hall. We will be focusing on our country’s COVID-19 vaccination effort. The information below will discuss the town hall in more detail and how you can register for the event.

Best, Thair

Medicare Today Town Hall
Wednesday, February 17
2:00 p.m. ET

Guest Speakers
Thair Phillips
former President and CEO of RetireSafe
Janet McUlsky

COVID-19 Vaccine Education and Equity Project
They will discuss:

  • The latest information on COVID-19 vaccines
  • The impact of vaccination uptake
  • Efforts to ensure equitable access to authorized
    and approved vaccines

Register Here

After registering, you will receive a confirmation
email containing information on joining the Town Hall.

Share this post:

National Heart Month – A Chance to Take Control of Our Health

Some of you may remember the infamous photograph in 1964 of President Johnson lifting his pet beagle, Him, by his ear. It caused an outpouring of concern from dog lovers everywhere and caused the President much embarrassment. I was only 16 years old at the time but still remember the debacle. It’s unfortunate that I remember that fact about President Johnson but had no idea that also in 1964 he started a great tradition that has had much more impact on people’s lives than the unfortunate dog incident. He issued the first proclamation that February would be National Heart Month and every President since then has continued that tradition. It has helped America focus on important steps we can take to keep our hearts healthy.

This month may be the most important National Heart Month since 1964. The COVID-19 pandemic has been a huge negative impact on America’s heart health. For instance, many people, especially the more vulnerable older population, have:

  • Postponed or cancelled important doctor appointments.
  • Developed or reverted back to unhealthy eating.
  • Stopped or reduced exercise routines.
  • Become more anxious about the threat this virus has become to our health and our very lives, a threat that we have had little control over.

This month, National Heart Month, is a great time to come out of the darkness of the last 11 months and see the light of hope and renewed effort to keep our hearts healthy. While we still have a long way to go to rid ourselves of this terrible virus, we need to remember that we have highly effective vaccines that have already been administered to many healthcare workers and older Americans (I get my second shot in two days). This vaccine will free us to not be afraid to go to the doctor, get off the couch and get outside and get back together with our vaccinated friends. We can even start planning a trip for later this year. We still need to listen to what are scientists are saying, there could be setbacks, but I’m convinced we have every reason to be hopeful that we’re on the way back.

Our heart is our bodies’ most important organ and National Heart Month gives us an opportunity to focus on the things that can help us stay heart healthy. According to the American Heart Association (AHA) heart disease is still the greatest health threat to Americans and is the leading cause of death worldwide. The sad thing is there are many things we can do to avoid this deadly disease. According to the AHA, in most cases, heart disease is preventable when people adopt a healthy lifestyle, which includes not smoking, maintaining a healthy weight, controlling blood sugar and cholesterol, treating high blood pressure, getting at least 150 minutes of moderate-intensity physical activity a week and getting regular checkups. This year the pandemic has prompted the AHA to create “Don’t Die of Doubt,” a national awareness campaign that reminds people that hospitals are the safest place to go when you have symptoms. High blood pressure is the enemy of our heart health. The Centers for Disease Control and Prevention (CDC) has some great tools that help us identify and control our blood pressure. There are many places that we can get the information we need to get and stay healthy.

It’s time for us to get back control of our lives and our health. Unfortunately, I think this pandemic has caused us to sometimes think we have lost control of our lives, that we are slaves to the restrictive rules and regulations that are needed to keep us safe. We need to decide that we are the masters of ourselves and we can decide to be healthy, pandemic or no pandemic. We now have the hope of highly effective vaccines. Let’s use National Heart Month as the launching point to better health.

Best, Thair

Share this post:

Why I Got Vaccinated

People all across the United States, and the world, are getting vaccinated, not as fast as we had hoped, but the momentum is building. In America, each state is given a quota of vaccine doses depending on the number and makeup of their population, but it is up to each state to determine how and to whom the vaccine is given. Some of the problems with getting people vaccinated has been that the states’ overworked and understaffed public healthcare workers were given this added responsibility. It has also been reported that some people are still reluctant to get vaccinated. I thought it might be helpful to explain why I made the decision to get vaccinated and the somewhat convoluted path I took to get my first vaccination.

I have written here before about all the logical and scientific reasons everyone should get vaccinated. You can click here to read that blog. There are other reasons that made me even more motivated to get vaccinated. I’ve been very careful for almost a year, I’ve worn a mask, stayed away from my kids and grandkids, and stayed home. I was getting sick and tired of all of it. I’m sure there are a lot of you that feel the same way. Getting vaccinated has been a glimmer of hope that has kept me from saying to heck with all of it and letting down my guard. When I finally got scheduled for my first shot (more about that later) my mind set was . . . keep staying safe, you don’t want to blow it now. I think looking forward to getting vaccinated may help us to continue to do the things that keep us safe.

The other thing that has motivated me was my take on how getting vaccinated was going to change my life. Now, this is my opinion, I’m not a scientist, I’m just a guy who believes in science, and I think the government and the media have been overly cautious and undersold the fact that getting vaccinated will, both in the short and the long term, change our lives.

After getting the second shot and waiting the appropriate amount of time so I get the full protection of the vaccine, I’m going to go to a restaurant and sit down and enjoy a meal with my wife and another couple who have also been vaccinated. I’ll enjoy a meal that isn’t cold from delivery or eaten while battling with the steering wheel of my car (a car that has witnessed so many meals in the last months that I could survive for a week on just the food that has dropped down between the seats.) We’ll then go back to our house and sit down and enjoy each other’s company without masks and social distancing, we might even play cards. I’ll go to a movie, go see a play, go to a concert, travel, and stay in a hotel. When I’m doing these things, I will wear a mask, as instructed by health officials, when I could come in contact with people who may not have been vaccinated. I think there is a small chance that someone who has been vaccinated can pass the virus. I do hope that the scientists are looking at the data and doing whatever they need to do to ascertain if a vaccinated person can infect someone. The sooner we know the answer, the better off we’ll be.

We need to somehow get better at getting people vaccinated. I know we wanted to get the most vulnerable people vaccinated first, but we should also be getting as many needles in arms as possible. The war will be ultimately won when the virus can’t infect anymore people . . . herd immunity. My sense is that there has been very little overall organization in getting people vaccinated. Take my experience for instance. I happened to be in southern Utah away from my home in northern Utah when our Governor said that people 70 and older would now be eligible to be vaccinated. I quickly signed onto the southwest Utah health department site only to find that all the appointments for weeks ahead were already taken and I had to try again next week. The next day, my friend texted me that a friend of hers had seen on a Facebook page that the local hospital had obtained a few thousand doses and there was a link to get scheduled. I clicked the link and there was a sign-up calendar on a well-known scheduling software with some available times. I was able to get appointments for my wife and me for the next day. My point here is that a friend of a friend had found a link and I got scheduled. My older friends in northern Utah will get their first shot two or three weeks after me. This example was certainly not the most equitable or efficient way to vaccinate the older people in Utah. Somehow, we need to get better at this, put emphasis on getting the most people vaccinated as quickly as possible. Establish a single place for vaccination information and make it accessible by computer and by phone and broadcast it to everyone.

An article came out today from the New York Times that focuses on the good news about vaccines. This is exactly the kind of article that puts things in the correct perspective.

I do want to tell you that I walked away after getting my shot with a real deep feeling of relief, a feeling of hope that I was finally on the road to normalcy and the only side affect was a slightly sore arm for a day. Our government and the media need to tell some of those stories, they need to tell us that getting vaccinated can give us relief and hope. We need to tell our friends to trust the science and recognize how getting vaccinated will change our lives. I’m due for my second vaccination on February 10th and I’m making a reservation at a nice restaurant on the 24th. For me that will be a huge change in my life.

Get vaccinated so that all our lives will change, and we can all hug our loved ones again!

Best, Thair

Share this post:

Looking back, Looking forward

George Santayana, in 1905 said, “Those who cannot remember the past are condemned to repeat it.” This is a good reason for us to look back since many of the proposed changes to healthcare going forward will resemble those of the past, but with some new twists. While the new Administration will probably take some different paths, they will still be focusing on healthcare costs, especially prescription drug prices, and Medicare and Medicaid costs and benefits. They will also be looking to revitalize the Affordable Care Act (often called Obamacare) along with increased transparency in the healthcare supply chain. Some of these changes could be good and some could be bad; it will be my goal in 2021 to parse out the details of each change, explain the impact of each change in plain and simple terms and then identify the best ways we can speak out to encourage the enactment of the good changes and what we can do to stop the bad changes. As always, my focus will be on how these changes affect older Americans.

One of the first things I would like the new Administration to do is to quit using Executive Orders (EOs) to make policy changes. The use of the EO has thrust itself into prominence as a way to change our healthcare. It has been overused and I feel it’s a threat to some of our basic rights. With a sweep of the pen, past presidents have instituted changes that have changed some of the basic tenets of laws that have been passed or have circumvented the rightful legislative process. The elimination of checks and balances is never a good path. When former President Trump issued the Most Favored Nation EO (you can click here and here to read more about this in some earlier blogs) he ventured into a legal gray area that has been stopped by injunction in the courts. It shows another weakness of using EOs.

The misuse of a positive aspect of the Affordable Care Act is another example of a way that past Administrations have bypassed the acceptable path for change. I discussed this in a blog last year. You can click here for more detail. This process, enacted through the Center for Medicare and Medicaid Innovation (CMMI), was meant to test new ways to improve healthcare by developing small, short term, test projects. Past Administrations have tried, and sometimes succeeded, in enacting huge changes by pushing through projects that were nationwide, long term and mandated provider participation. This program misuse needs to stop. We need our elected representatives, our voices in Washington, to be part of any changes that have such a huge effect on our lives.

Drug prices have become the scapegoat for healthcare costs. It has been easy to focus on “rich” drug companies and the list price increases that have resulted from the convoluted business model that supplies our prescription drugs. Past proposals have tried to use foreign prices to force drug prices down. Allowing the importation of unregulated prescription drugs or basing our drug prices based on the drug costs in foreign countries were both ideas that have yet to be implemented. The real solution is simplifying the prescription drug supply line and allowing new ways to price new drugs, like pricing based on the medicine’s success or what savings the medicine produced in the whole healthcare system.

One past change involved setting the price of some Medicare Part B drugs. These expensive drugs are often infused by a doctor in a doctor’s office for sicknesses like cancer and autoimmune deficiencies. Again, this is a sledge hammer approach that will impact many local clinics but will most likely not result in savings for the patient. I think the cost of medicines in Medicare Part B will be a target going forward.

One change that we hope is considered going forward is a yearly cap on a patient’s out-of-pocket-costs for Medicare Part D. This change will eliminate a huge variable that has troubled people as they plan for retirement. It will also help reduce the impact of drug costs on the very sickest among us.

While one party holds the Presidency and the majority in both Houses, the path to legislative changes will be tenuous given the slim majorities in both the House and the Senate. We need to return to the process of having sub-committees and committees debate issues, hold hearings, and have active floor discussions of legislation. It will require some give and take by both sides to pass legislation – that’s the way it should be. We should be able to have our say, have the chance to tell our Representative and Senators how we feel about an issue. We shouldn’t allow changes that use the gray areas of the law, gray areas that can be challenged by injunctions, like the Most Favored Nation Executive Order.

As we look forward to 2021, I hope it will be with a new sense of civility, a return to an open discussion of the merits or faults of an issue. The battle to overcome the COVID-19 pandemic will consume a lot of time and effort, but the battle to ensure that we have access to life improving and lifesaving healthcare will continue. It will be up to each of us to get involved in the process and make our voices heard.

Best, Thair

Share this post:

Glaucoma – The Secret Sight-Stealing Disease

As a fan of the Eagles in my younger days I knew all the words to their hit song, Hotel California. I can relate to one line, “my head grew heavy and my sight grew dim,” much more now that I am older. I do get tired more easily and old age has dimmed my sight somewhat. Glaucoma is much more serious than the incremental sight dimming of old age; it is an insidious disease that can steal our sight without much warning.  

January is National Glaucoma Awareness Month, a time for us all to spread the word about this sinister disease that affects many of us. Here are some facts about glaucoma:

  • Glaucoma is a group of diseases that damage the eye’s optic nerve and can result in vision loss and even blindness.
  • About 3 million Americans have glaucoma. It is the second leading cause of blindness worldwide.
  • Open-angle glaucoma, the most common form, results in increased eye pressure. There are often no early symptoms, which is why 50% of people with glaucoma don’t know they have the disease.
  • There is no cure (yet) for glaucoma, but if it’s caught early, you can preserve your vision and prevent vision loss. Taking action to preserve your vision health is key.

Anyone can get glaucoma, but certain groups are at higher risk. These groups include African Americans over age 40, all people over age 60, people with a family history of glaucoma, and people who have diabetes. African Americans are 6 to 8 times more likely to get glaucoma than whites. People with diabetes are 2 times more likely to get glaucoma than people without diabetes.

One big reason that this year may be especially important to think about our eyes is the COVID pandemic. Almost all of us have postponed some type of healthcare appointment due to the pandemic. Sometimes, it has even been our healthcare provider that has cancelled or postponed an appointment. I suspect that a yearly eye examine is a prime candidate as an appointment that might have been postponed. This isn’t good since the best way to detect glaucoma is through an optometrist-administered comprehensive dilated eye exam. This is especially important of those who fall into any of the high-risk categories.

This pandemic has forced us to all make some hard, often heart wrenching choices. Everyone has been telling us to not touch our faces so venturing out to a doctor’s office to have someone touch our eyes and face doesn’t sound like a wise move. Here are a few things to consider: everyone in healthcare wears masks and masks have been shown to be a big deterrent to COVID-19; and the transmission by surface infection has shown to be much less of a risk. There are other things we can do to reduce the risk as we visit the doctor. This link gives us some excellent guidance about visiting the optometrist during the pandemic.

One other thing to consider, some of you may have already been vaccinated. I am scheduled to receive the first of the required two vaccinations later today. Two weeks after receiving your second COVID-19 vaccination your chances of catching COVID is greatly, and I mean GREATLY, reduced. After receiving your first vaccination think about making an appointment with your optometrist. You can calculate when your body will be protected, for the Pfizer-BioNTech it is three weeks between vaccinations, add two weeks for your body to get fully protected and you can make your appointment five weeks after receiving the first vaccination. For the Moderna vaccine it will be six weeks after the first vaccination. Your eyesight is worth it!

As we grow older our head might grow heavy and our eyesight my seem a little dimmer but there are some things we can do to guard against glaucoma stealing our sight. Spread the word during National Glaucoma Awareness Month that now is the time to look ourselves, and our friends and families, in the eye (pun intended) and get checked for glaucoma.

Best, Thair

Share this post:

Who Do You Trust?

A long, long time ago there was a TV show called “Who Do You Trust.” The basic premise was whether the contestant thought he or she knew the right answer to the question the game show host asked (which happened to be Johnny Carson for most of the show’s run) or trusted that their partner had the correct answer. It was up to the contestant to analyze what they knew about their partner to guide them on whether they should trust that their partner knew the correct answer. I think the question on everybody’s mind these days centers around the fact that we are not sure who we can trust to answer today’s critically important questions?

How we overcome this pandemic is probably the biggest question we needed answers to. The COVID-19 pandemic was a big unknown in the beginning; no one knew how it came to be, how it spread, what the symptoms were or how sick it was going to make us. Our elected officials often contradicted the advice given by government scientists. The vaccine approval process was rumored to be influenced by political motives. We really didn’t know who to trust.

As we begin the rollout of the two vaccines that gained emergency use authorization to date, there are many that still don’t know if they can trust the vaccine to be safe. Here are some points that have helped me decide that the vaccine is safe.

  • The breakthrough science that is the backbone of this new vaccine has been actively studied for over 5 years.
  • This new approach does NOT use a weakened portion of the virus to induce the body to produce antibodies.
  • The vaccine was approved in Europe weeks before it was approved here and people in Europe have been vaccinated with minimal adverse effects.
  • Over 40,000 people participated in the phase three study.
  • I have attended many, and testified in some, of the FDA’s advisory committee meetings to evaluate prescription drugs. I have found them to be thorough and unbiased.
  • While it sells papers (or these days gets clicks) to highlight any adverse reactions, the fact of the matter is that any prescription drug or vaccine will have some adverse reactions. So far, any risk of adverse reactions has been far outweighed by the benefits.

The only real chance we have to return to normal is for enough people to be vaccinated that the virus has nowhere to spread. I hope that we can trust the facts and use our own deductive powers to see that the vaccine is safe and effective.

Best, Thair

Share this post:

Speaking Out in 2021 is Critical

Happy new year. I hope we all can, as the old song says, “accentuate the positive and eliminate the negative” as we go forward into 2021.

I think it will be critical for you to make your voices heard in 2021 as we support the positive changes to healthcare and fight against the negative changes that will hurt older Americans.

No matter what happens tomorrow in the Senate races in Georgia there will be slim majorities in both the House and the Senate. Legislation may pass or fail by just a few key votes. Your informed voices could have a huge impact on the outcome of legislation, regulation and executive orders that come out of Congress and the new administration.

I cannot overemphasize the impact of a constituent’s opinion on each of your senators and representative. The politics of many states and congressional districts are changing and that fact just magnifies the importance of a well-informed constituent. At Seniors Speak Out we will work hard to wade through the rhetoric and “Washington speak” to give you the facts on how proposed changes will affect older Americans. The pandemic has accelerated many changes to how our healthcare is administered. Seniors Speak Out will work hard to keep you informed and amplify your voices as we face the proposed changes that are sure to come.

Best, Thair

Share this post:

It Just Makes Me Mad!

I know I was supposed to take the holidays off and start fresh in January, but this Most Favored Nation (MFN) thing that is supposed to go into effect in January has been simmering in the back of my mind and finally just boiled over. As you might remember, “this MFN thing” was an Executive Order signed by President Trump shortly after the election. Some feel it was in retaliation for the timing of the release of the Phase 3 vaccine results, but whatever the reason, it finalized a concept that has been kicked around for over a year. It is an attempt at lowering drug prices by basing the price we pay for a particular drug on the average price a group of foreign “MFNs” pays for that drug. You can click here to read more about this approach in one of my earlier blogs.

While there are many details of this executive order that are complicated and convoluted, it’s the overall approach that really bothers me. Rather than exporting our successful innovation methods that makes us the world leader in discovering medicines that save and improve our lives, we are choosing to import the rationing and price control methods of countries that don’t share the same level of concern for the patient that we do. It just seems crazy that we have suddenly decided that looking to other countries is a solution to our healthcare costs.

I know the comparison might not be the same, but I can’t help but think of the oil cartel that has a big influence on oil prices. The Organization of the Petroleum Exporting Countries (OPEC) was formed by five founding countries: Iran, Iraq, Kuwait, Saudi Arabia, and Venezuela. Their goal was, and continues to be, the control of the price of oil to their advantage by controlling their production, much to the disadvantage of the United States and other countries. OPEC has a level of control over the price of oil and it has an impact on what we pay for gas. Why would we allow this same type of control to creep into our healthcare system? Why would we turn over the control of the prices of some of our prescription drugs to a group of foreign countries? Why does this seem to be a logical solution?

Is it fair that foreign countries should pay less for certain medicines than we do? No, but the solution certainly isn’t the capitulation of our responsibilities to foreign countries. This surrendering of control makes me mad. There are problems with how we receive and pay for our healthcare. There are changes that need to be made, but we need to look inward and correct the inefficiencies, streamline the processes, base cost on results, reward preventative care, and encourage innovation . . . rather than depend on knee-jerk reactions and superficial solutions.

Thanks for listening to my tirade. I’ll try to calm down and get back into the holiday spirit. Let’s hope for some well thought out solutions in 2021. Have a happy new year.

Best, Thair

Share this post:

20/20 Hindsight

You’ll probably read a lot of year end missives talking about how bad 2020 was, probably because it was really, really bad. Think of the babies born in 2020 who will forever be asked about the year they were born as if they could remember their first year on earth. It will be remembered as a year of challenges and heartache and hopefully a year of solutions. I’m not going to dwell on all the bad things that happened in 2020; I want to look forward, using our perfect 20/20 hindsight to guide us as we venture into 2021.

We found out in 2020 that there really are things that can happen that will bring the whole world to its knees. Hopefully, going forward, we will put more effort into studying these viruses so we can be better prepared.

We found out that trusting our scientists makes sense. As Aaron Burr says in the musical Hamilton, we should “talk less, smile more.” Talking less would have helped us listen to what our scientists were saying, and smiling more would have helped everyone’s attitude as we made our way through the pandemic. Keeping our scientists free from political influence should be a priority going forward. The trust in our institutions that exist to keep us safe has been compromised, we need to rebuild that trust and independence.

We reaffirmed the power of our country’s innovation machine. America has built an environment that enables innovation by limiting government regulations while maintaining government oversight. This balance enabled the creation of a COVID-19 vaccine in less than a year, a feat that was deemed impossible in February. I don’t think it was a coincidence that the first vaccine to gain emergency use authorization was created by a partnership of companies that didn’t accept any funds from the government. They feared at the outset that any government interference would slow their progress, and it looks like they were right. As we look to 2021, our government should realize how powerful America’s innovation machine is and find ways to further encourage innovation . . . finding cures saves lives and saves money.

And finally, in 2020 we found how divisiveness stagnates us — how it hinders progress. I hope that the new Administration, coupled with narrow majorities in the House and the Senate will require Washington to cooperate. We might even find that less rhetoric and more discussion will produce progress.

I hope that our perfect 20/20 hindsight gives us a clearer vision of how we can move forward in 2021. I look forward to continuing to speak out for seniors. Have a safe holiday and I’ll see you in January.

Best, Thair

Share this post:

How Did Your Medicare Open Season Go?

Well, open season for changing Medicare insurance is over (although you can still change your prescription drug insurance, Medicare Part D, until tomorrow). How did it go? Did you keep the insurance you had? If you did you would be in good company, historically over 80% of us don’t change our insurance. Did you take the opportunity to really evaluate your options or did you just take a cursory review, or did you let the opportunity go by and just keep the insurance you had continue for another year? Many people I have talked with didn’t take the time to review their insurance, a dangerous approach given the changes that are going on, to say nothing of the changes to your health that might occur. I warned, cajoled, even begged everyone in earlier blogs to take the time to review their coverage. I hope some of you listened. Let me tell you what steps I went through as I reviewed my insurance and how I made my final decision.

I moved last year and, for the first time, chose a Medicare Advantage (MA) plan. Generally, a MA plan offers more benefits, usually some discounts or free memberships to health clubs, often some hearing benefits, maybe even dental and eye benefits. Surprisingly, these often come with no premiums. For me this was a big change from the premiums I was paying with my old supplementary insurance. As you might imagine these benefits and low or no premiums are offset by some stipulations and rules that need to be considered. Often their network of doctors and hospitals is more restricted, and your copays and other out-of-pocket costs are larger. Many MA plans include prescription drugs, but their formulary may be more tightly controlled. Since MA plans get paid a fixed cost for each member of their plan, they are incentivized to keep you healthy, hence the focus on fitness, healthy living, and preventive care. They are also focused on keeping costs down. Those are the tradeoffs I looked at going into the open season.

I first read my insurance company’s Annual Notice of Changes. I was pleased to find that my copayment for a specialist dropped 20% and for hospital specialists and treatment dropped $110 dollars or 25%. That was big for me since I had paid both of these copays for some tests that I had. The tests turned out fine, but it was pleasing to see that I will pay less in 2021 if I need that sort of healthcare. My drug plan stayed the same except for a big reduction in the cost of insulin in 2021 which was capped due to legislation and rules instigated by Washington. This will have a big impact on many diabetics. Given the healthcare needs of my wife and myself we found that staying with are current MA plan continued to save us money and fit our situation.

I hope that increased competition gave you more choices and more opportunity to save money in 2021. I will be really interested to see what next year’s open season brings. With the hope of vaccines allowing us to return to normal by the second half of 2021, we could see many changes in how healthcare is administered. Telehealth, in-home tests, more sophisticated medical devices to monitor our health, may all lead to changes to how we receive and pay for healthcare.

The new administration will certainly be pressured to control healthcare costs. I hope they see how competition is the quickest and best way to balance access with cost. I’m convinced that the reason my MA plan dropped their copays was not because they had a banner year — many doctors and hospitals saw a big drop in revenue due to the pandemic. What these plans do see in 2021 is a big increase in healthcare demand due to our country’s return to normal as we emerge from the pandemic and an increase in competition to satisfy that demand. A system that is based on cost controls and limited access would not respond as quickly, or at all, to this increased demand.

Keep track of your costs and access to care in 2021. Document the changes in your health. Know where you stand with your prescription drug costs. These are all things that will help you make an informed choice when next year’s open season rolls around. It could have a big impact on your cost and level of care going forward.

Stay Healthy, Thair