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Our Legislative Focus

As summer wanes and fall begins to come into focus, it’s time to look ahead to the healthcare legislative issues that could come into play. With campaigns heating up and the debates beginning, you can guarantee that promises will be made and accusations leveled concerning your healthcare. Some of the issues that will be brought up might have a small chance of actually being implemented, but this doesn’t mean that we shouldn’t pay attention. In the past, seemingly long shot proposals have become late night trading fodder when politicians make deals on far reaching legislation. Many of the issues I’ll talk about today were thought to be not-starters a few years ago and now they are political realities. What I will do is offer a simple explanation of each issue, give you an idea on how it could affect you and how likely I think it will be to be implemented. I’ve written an earlier blog about many of these issues. You can look through recent posts to get a more detailed explanation of some of the issues.

International Pricing Index/Favored Nation Pricing

Background – In an effort to lower drug costs some in Washington (most recently the President) have proposed that we fix the cost of a drug to the lowest price a “favored nation” paid. As I’ve explained before, price fixing has never been a long-term solution to any cost problem. There are better ways to have other nations share in the costly research and development that goes into discovering and manufacturing prescription drugs.

Impact – If this approach is implemented the supply line safety that we have enjoyed over the years will be jeopardized with no guarantee that any savings will make its way to you.

Chance of Implementation – While this idea has been around for at least a couple of years, its chances of becoming a reality have gone up. It would be difficult to implement and the chance of unintended consequences high. This makes its implementation politically unpopular but a great thing to talk about during debates.

Importation

Background – This issue has some of the same characteristics as the international pricing index. The goal is again to lower drug prices by allowing importation of these drugs from Canada. I talked about this proposal in my earlier blog explaining how it bypasses the safety net we now enjoy without any proof that the patient will see any savings while counting on Canada to implement a program that they have already said they can’t support.

Impact – While you or someone you know has gone across either our southern or northern boarders to purchase medicine at a lower price, this is not what this proposal is about. This importation proposal is at a much higher-level involving suppliers and transporters and large volumes. Some states have passed laws allowing importation but none of them have been implemented.

Chance of Implementation – This approach has been around for many years and no one yet has found a way to safely implement it. A pilot program of some sort may be started but it will take some real political will to make it happen.  Canadian officials have indicated they will not support it. However, the chances of it happening are much more likely than they were just a few years ago. This is one of those solutions that may gain some traction.

Changes to Medicare Part B

Background – The price of drugs administered and paid for under Medicare Part B have increased substantially. These are drugs that are often injected at a doctor’s office for serious diseases like cancer and many types of autoimmune diseases. A proposal to fix the cost of these medicines has been put forth. This approach would go against the market-based approach that is now in place. It would impact many of the doctors who perform these services and upend and regulate this vitally important portion of our healthcare. Again, fixing prices has never been and efficient, long range solution.

Impact – If implemented, this approach would change the economics of this vital service. Any savings to the patient has been hard to quantify but it would most certainly put pressure on already pressured neighborhood practices. Losing these close, more accessible, services would have serious consequences.

Chance of Implementation – Part B drug prices have become a focal point for people seeking solutions to increased costs. We need to correct the underlying parts of the system rather than using a sledgehammer to bludgeon one part of the business.

Part D Cap

Background – Almost all of us, either in private insurance or Medicare or Medicare supplemental insurance, have experienced caps on our healthcare out-of-pocket costs. It helped us budget our money, we even decided what type of insurance to buy based on the yearly cost caps. Medicare Part D has no such caps. Depending on what prescription drugs, we need we may have out-of-pocket costs that balloon to the tens of thousands a year.

Impact – While we have been against the other proposed changes, a Medicare Part D cap would have a huge impact on those of us who are already retired and everyone younger as they plan for their retirement. I’ve known people, maybe you have also, who were living comfortably until an illness struck and their drug costs forced them to tap into their retirement. The peace of mind that a cap on our drug costs would give all of us, whether planning for or already retired, would be immense. This a change that is worth fighting for.

Chance of Implementation – This change is gaining some traction. While it probably won’t be something that is done on its own, it is a change that could be incorporated in some larger legislation as a balance or concession to reach final approval on the bigger legislation. It would be a most welcome change.

It is guaranteed that there will be other changes to our healthcare put forth as we near election day. We will keep you up to date on each one, explaining in simple terms what the change is and its impact on you. There is one over all criteria that I would like you to consider. Making short term, knee jerk, politically popular, changes is not the answer. Trying to band aid or quick fix a broken process never ends well. We need to fix the underlying problem, simplify the process, and let the free market drive us to the most effective, cost efficient solution. I believe the reduction of administrative overhead and regulations is a big step toward this goal. Measure each change to see if it offers simplicity and transparency in its solution.

Let’s stay informed as we approach this critical election. Get involved, tell those in Washington how you feel. Also, get registered to vote and then vote! It’s one of the most powerful things we can do.

Thair



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Happy Birthday Medicare!

On July 30, 1965, President Lyndon B. Johnson signed the Social Security Amendments of 1965, officially creating what we now call Medicare. Now celebrating its 53rd birthday, Medicare has helped seniors across the nation to better afford the care and medications they need.

In honor of Medicare’s birthday, Seniors Speak Out wanted to provide a brief overview of Medicare’s four parts for those who may be unfamiliar with the program or may be preparing to sign up for Medicare for the first time this year. Below you’ll find a brief explanation of each part, as well as a handy graphic that you can keep on hand for reference. You can also learn more by clicking the links to Medicare.gov’s web pages on each of the four parts.

Medicare Part A: Part A was created as part of the original Medicare law and helps provide a variety of services, including hospital stays, hospice care, and nursing home care.

Medicare Part B: Part B was also created as part of the original Medicare law and covers outpatient services like doctor visits, ambulance services, and mental health services as well as preventative services like vaccines.

Medicare Part C: Also called “Medicare Advantage Plans,” Part C is coverage offered by Medicare-approved private companies. Advantage Plans cover all your original Medicare services, but can also extend to prescriptions, dental, vision, and other types of coverage.

Medicare Part D: Part D is the newest part of Medicare and covers prescription drug medications. To receive Part D coverage, you must opt in for a plan when you turn 65 by using one of these two options.

With each part covering such important aspects of care, it’s clear that Medicare is instrumental in helping seniors acquire the medical services they need without being overburdened by costs. As we celebrate another year of this important program, we’d love to hear how Medicare has helped you! Feel free to reach out to us over Facebook and Twitter to share your Medicare story!



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Call on Congress to Fix the Medicare Part D Cliff!

Attention seniors! In 2020, you may be faced with a significant spike in out-of-pocket spending under the Medicare Part D prescription drug benefit.

A measure included in the Affordable Care Act that slowed the growth rate of the “catastrophic threshold” is set to expire. This will cause the catastrophic threshold, or the amount of out-of-pocket spending needed to reach catastrophic coverage, to increase by an estimated $1,250 from 2019 to 2020.

Such a drastic increase could have terrible consequences for seniors on Part D. As you may know, once beneficiaries reach the catastrophic coverage phase, we are responsible for about 5 percent of our prescription drug costs. Unfortunately, this change will force many Medicare beneficiaries to spend substantially more out-of-pocket before reaching that phase, threatening our ability to afford the medications we need. The dramatic out-of-pocket cost increase many will experience could have especially disturbing consequences for patients with chronic conditions and mental illness, who might be forced off their medication entirely.

We need to let our Members of Congress know just how important Part D is to our health and wellbeing. Join us in calling for Congress to protect our access to medication NOW!

You can tell your members to stand up for a fix to this coverage cliff by signing on to the letter here: https://www.votervoice.net/SSO/campaigns/59358/respond 



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Seniors Speak Out About What Part D Means to Them

There are about 42 million Americans with Medicare Part D insurance for their medicines. We have different health conditions, take different medicines, live in different states and are covered by hundreds of plans. There is something we do share, however: our understanding of the importance and value of Part D coverage to our health and well-being.

Let me be the first to share my story about how and why Part D helps me personally. Before I reached 65, the insurance coverage I had available to me had very limited benefits for medicines, and one of my medicines wasn’t even covered at all. It was stressful and very costly. Now, I have a plan that works perfectly for me, and all my medicines are covered. When I moved three years ago, I was even able to choose a plan that worked with pharmacies in my new neighborhood and still get the same value I had been receiving before.

Here are some other stories from your friends and neighbors around the country:

Doug from Minnesota first made the change to Part D during open enrollment in the fall of 2016, and noticed that the change saved him $26 a month, on top of not having a co-pay for visits to the clinic. In his own words, for him “drug costs are minimal.” Even better, he is able to fill his prescriptions from his local pharmacy and support their business. As he says, “Being from a small town of 800 people it is critical to support the local pharmacy rather than the mail order system.”

Then there is Claudia from Alabama. Claudia has seen just how helpful Part D can be at a couple of different points in her life. The first came during her mother’s illness. Part D was instated while her mother was sick and she was able to see first-hand the “huge difference” that Part D made in her mother’s care. Now that she has it herself, she is happy to have access to it, as it “can really save you money.”

Robert from New Hampshire is a lung transplant recipient, which he noted “has drastically changed my views about Medicare Part D.” He and his wife used to get insurance through work, but a sudden change in employment meant they had to find a new plan. Everything they found meant increased drug prices and shorter prescriptions for the medication Robert needed, but his insurance agent eventually recommended Part D, which provided every medication he needed, and on 90-day prescriptions instead of the 30-day ones offered by other plans. By Robert’s own estimates, he now saves between $2,500 and $3,000 every year, in addition to fewer trips to the pharmacy due to the increased prescription length.

These are just a sampling of the outpouring of responses we received when we asked people to speak out about how Part D has helped them. These and other stories demonstrate how Part D remains an essential piece to our good health and quality of life.



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Tell Congress to Protect Our Medicare Today!

 

Attention seniors! Last week, an amendment was introduced that would dramatically alter our Medicare benefits. Should this amendment pass, costs for our prescriptions might rise and we could even be denied access to certain medicines prescribed by our doctors.

We know that 9 in 10 seniors nationwide are satisfied with their Part D coverage and that millions of seniors like us rely on Medicare for quality, affordable health care, so we must act NOW! Congress will consider this amendment this week. We need to speak out today to make sure our members of Congress know we won’t stand for this harmful proposal—our health is too important.

Make your voice heard and join me in telling the federal government to stop meddling in my Medicare! Sign the letter here: http://www.seniorsspeakout.org/speak-out/protect-seniors-access-to-medicare/
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Helping Hand: Tips for Open Enrollment

With Medicare open enrollment upon us, it’s important that those of us 65 and older take the time to look at our current coverage and determine if it still meets our individual needs. Assessing our health plan is especially essential when it comes to our Medicare coverage. Each year, Medicare users are given the opportunity to alter their Medicare Part D plan from October 15th to December 7th. This is the only time we can make changes to our Part D coverage for the upcoming year – given the fact that your medicines may change from year-to-year this is especially important. Use these tips to assess your current prescription drug coverage and determine if it meets your needs!

Know Your Current Medications

Medications change often, and it’s important to have a full list of all of your current medications before you assess your Part D coverage. Making sure your current medications are covered is a great place to start when determining if your plan meets your health care needs.

Review All Costs

Often times when we consider our health care costs, we only consider our monthly premiums. Don’t forget that there are other costs associated with health care coverage, such as out-of-pocket cost sharing like copays or coinsurance. Check these factors to determine if they fit within your budget.

Check Approved Pharmacies

Most of us have a favorite pharmacy—make sure it’s included in your Part D coverage. To do so, check if your pharmacy is preferred under your plan’s network. This can help lower out-of-pocket costs.

Assess Plan Ratings

Did you know Part D plans are assessed by a five-star rating system? You can see how they are performing on specific features, such as customer service and patient safety. Be sure to check how your plan stacks up.

Look for Other Options

After you assess your plan, look into other options to see if there is a better fit for your personal needs. Use this Medicare Plan Finder to explore your options and compare plans here.

If you have questions, visit your local Area Agency on Aging for assistance or visit our resource page. You’re not alone in your quest to get the best health care coverage!



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The Survey Says… Seniors are Satisfied with Medicare Part D Coverage

And the results are in…Our friends at Medicare Today have just released the annual Senior Satisfaction Survey and just as we expected to hear, we seniors are happy with our Medicare Part D coverage. Each year, Medicare Today conducts the Senior Satisfaction Survey, a national survey of nearly 2,000 seniors with prescription drug coverage. The results show seniors love Medicare with nearly 9 out of 10 seniors reporting that they are satisfied with their Medicare Part D coverage.

In case you didn’t know, Seniors Speak Out was started by Medicare Today, a coalition of national and local organizations representing seniors, patients, consumer groups, health care providers and employers. They are focused on providing beneficiaries with reliable information on the Medicare program and its benefits. Read more about their findings and the important work they do for seniors on their website and check out their blog post on the Senior Satisfaction Survey below.

New National Survey: Nearly 9 in 10 Seniors Satisfied with Medicare Part D

Policymakers Weighing Changes to Prescription Drug Program Must Keep in Mind Seniors’ Approval of Part D’s Choices, Value, Convenience, Medicare Today Chair Said

Ten years after its initial launch, the Medicare Part D prescription drug program remains overwhelmingly popular with American seniors, according to Medicare Today’s annualSenior Satisfaction Survey.  The nationwide survey of approximately 2,000 seniors conducted by Morning Consult found that 88 percent are satisfied with their Part D coverage and eight of every 10 believe their drug plan is a good value.

“The program continues to deliver on its promise of providing affordable access to prescription medications for seniors and individuals with disabilities,” said Mary R. Grealy, chair of Medicare Today and president of the Healthcare Leadership Council, a coalition of chief executives from all sectors of American health care. “As a result, once again beneficiaries are reporting high levels of satisfaction and demonstrating that Part D truly enriches the lives of those that rely on it.”

Key findings in the survey include:

  • 92 percent of seniors reported that their plan is convenient to use
  • 88 percent of seniors are satisfied with their prescription drug coverage
  • 86 percent said their plan works well and without hassle
  • 84 percent reported it was important to them to have a variety of plans to compare and choose from
  • 80 percent of seniors also reported their plan is a good value

 

Noting that some political figures have proposed significant changes to the Part D structure, Ms. Grealy stressed the importance of not disrupting a program of such high value to seniors.

“Now more than ever, it is critical that this program be safeguarded against unnecessary and potentially harmful changes that would undercut not only the longevity of the program but also the promise that we have made to our seniors,” said Ms. Grealy.

For more information and survey results, please visit Medicare Today’s recently updated and relaunched website: www.medicaretoday.org.



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Seniors Speak Out Has Resources to Help During Open Enrollment

Open enrollment for Medicare is underway until December 7th and with it comes the opportunity to enroll in benefits for the first time, or review your existing coverage to ensure its meeting your current needs. Medicare plans can change from year to year, and sometimes these changes can hit your wallet December 2015and subsequently your health. Open enrollment is the perfect time to do some additional research and make sure you’re getting the right coverage at the best price.

Comparing plans and navigating the process of enrolling in a new plan can seem a bit daunting at first, but it’s imperative to take the time to review them, since selecting the wrong plan might make the medications you require unaffordable or inaccessible. To help, we have updated our resources to give you specifics on plans in each state and tips to make the process as simple and efficient as possible.

If you’re enrolling in Part D for the first time, use these tips to identify the best plan for you. After you’ve familiarized yourself with the general program, Seniors Speak Out also offers state specific resources and information on our “Part D State by State” map. Each state will link you to the number of plans available, the number of beneficiaries enrolled, lowest available monthly premiums, and more. This information will allow you to compare your Part D plan to the others offered in your state and help you make an informed choice.

If you have any additional questions regarding open enrollment, contact your local Area Agency on Aging and schedule a time to talk to someone who’s been trained to help you make the most of your Medicare. Seniors Speak Out offers a map with each state’s contact information here.

Make sure to take advantage of the many benefits offered by Medicare during this open enrollment period so you can stay healthy and active for years to come.



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Giving Thanks for Good Health

 

Each year, the holiday season offers us time to reconnect with family, slow down and give thanks for all of the things we are grateful for in our lives. One thing I never take for granted as I get older is my health, and I know having access to affordable prescription drug coverage that keeps me healthy is key. That’s why this season I’m particularly grateful for my good health.

The comprehensive and affordable drug coverage provided by Medicare Part D is one way I am able to stay healthy, and that is something we can all be thankful for. Here are three things for you and your family to consider this Thanksgiving when it comes to your Part D plan.

  • Any time beginning three months before the month of your 65th birthday, you can apply for Part D prescription drug benefits without any penalty.
  • From now until December 7, you are able to join or renew your Medicare plan. If you’re looking for help in comparing options, Medicare.gov gives you the option to complete a general or personalized plan search.
  • For Veterans, Medicare Part D can be used as a supplement to your Veterans Affairs (VA) benefits. Whether it be for medication pick up or filling a prescription from a provider outside of the VA system, Part D can make up for the areas where other benefits may lack.

With all of the hassles the year has brought, don’t forget to give thanks for the things that are here to make life easier. Visit Medicare.gov for additional tips, advice and resources.



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Shopping for Medicare Part D

I recently saw a news feature about the growing number of people who complete their holiday shopping by Halloween. Wow! One shopper explained that shopping early gave her time to enjoy the holiday season with her family and avoid the frustration and exhaustion that comes with last minute shopping.

As impressive as this story is, shopping season can have an even bigger impact for those of us on Medicare — big savings on our medicines!

Every year we have the opportunity to keep or change the Part D plan that provides coverage for prescription drugs. Honestly, this may be the most important purchase of the year and far too few of us take time to shop around.

Does it matter?  ABSOLUTELY!  Here’s why:  Each year plans are allowed to make changes in the coverage they will offer for the next year. Additionally, you may have had changes or additions to the medicines you take. Why not take a few minutes to review the plan you have now and compare it to what else is available in your area?

Some key questions to ask: Are all your medicines still covered by your current plan?  What are your total costs, both premiums and cost-sharing?  Can another plan offer you a better deal? You may find that your current plan is still working well for you, or you may discover that you can save real money by making a change. Either way, checking your coverage is the best way to make sure you are getting the most from your Medicare Part D plan.

Medicare open enrollment is happening now and continues through December 7.  To compare Part D plans offered in your state, you can use the Medicare Plan Finder. If you have any questions, you can always visit your local Area Agency on Aging or call Medicare all day, any day (except federal holidays) at 1-800-633-4227.

Don’t miss out on this important shopping season!