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Back to Basics: Medicare Part D

Published by SSO

It’s summer already, and the year seems to be flying by! Before we know it, the fall open enrollment period will be here for the Medicare Part D prescription drug benefit as well as Medicare Part C, better known as Medicare Advantage. It’s important that beneficiaries know about the Medicare program and how we can utilize its resources, particularly access to prescription drug coverage that comes through Medicare Part D as well as most Medicare Advantage plans. A great way to get an easy refresher on the Medicare program overall is by watching this short clip here, which provides a brief overview of these important benefits. Arming yourself with the most comprehensive knowledge about Medicare is critical, especially for those of you who are turning 65 this year, or have friends or relatives that are becoming eligible.

Today, let’s go back to basics with an easy primer on one of the parts of Medicare—Medicare Part D!

Medicare Part D is the part of Medicare that covers prescription medications. One thing that differentiates Part D from other parts of Medicare is that the program is optional. Beneficiaries are automatically enrolled in parts A and B of Medicare when they reach age 65, however, beneficiaries must choose to opt-in to the Medicare Part D program and are not automatically enrolled.

Unlike other parts of Medicare, which are administered by the federal government, Medicare Part D coverage is provided through private insurers. Under the program drug manufacturers and private plans negotiate drug prices directly, allowing for a wider variety of treatment options and medication choices for beneficiaries.

This unique structure allows for and encourages increased competition among insurers, which aids beneficiaries by allowing individuals to shop around for the best-tailored plan for their unique health care needs. You can watch a quick video about how this competitive structure drives down the overall cost of Medicare Part D plans here.

There are a variety of Medicare Part D plans to choose from, each with different prescription drug formularies, coverage options, and costs. An easy way to find a plan that works for you is to use this interactive tool, which can help provide easy access to information about uniquely-tailored plans that could work for you.

Open enrollment will be here before we know it, and it is imperative that beneficiaries are equipped with the information we need to make smart decisions for our health. Opting in to Medicare Part D is an important part of maintaining a healthy lifestyle, so make sure you utilize these resources to keep up-to-speed on all things Part D!

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Have You Checked Your Plan Recently?

Published by SSO

We have recently discussed a number of different proposals that could alter seniors’ access to the medicines through the Medicare programs we rely on to stay healthy. It is critical that we, as seniors, are our own best advocates and that includes making sure we are up-to-speed on the provisions of our personal Medicare plans.

Health insurance can be complicated, which is why we are here to provide guidance for seniors so we can make the best decisions for our personalized needs. As we have discussed, Medicare Parts A and B, the parts that cover hospital and medical insurance, are included in your Medicare coverage as soon as you turn 65 years old. However, Medicare Part D, which is an optional add-on service, covers many of the prescription medications that we rely on every day.

Although Medicare Part D is optional, an overwhelming majority of seniors choose to add this important part of health coverage to their plans. In fact, out of the 60 million American Medicare beneficiaries, 43 million were also enrolled in Part D coverage as of May 2018—showing just how important this part of the program is to seniors’ overall quality of life.

It is critical that we keep on top of our Medicare plans to make sure they are working for us and our needs. The fall open enrollment season may seem far away now, but it is right around the corner! Make sure you are checking your coverage options, and stay informed, empowered, and independent!

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It’s Time for a Springtime Medicare Refresher!

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The lingering cold weather is slowly warming up, which can only mean one thing: Spring has sprung! Spring is a great time to reset physically and mentally, so we have prepared some easy explanatory Medicare materials for you to review to make sure you are informed throughout the rest of the year. Staying informed about your health is a year-round responsibility, and as we age it is important for us to educate ourselves on the programs and care options we can utilize.

As you may know, Medicare is a federal health insurance program that provides coverage for seniors aged 65 and older, as well as for certain individuals with disabilities. Medicare, through the years, has incorporated certain updates and changes to ensure that it is consistently working to promote the health of seniors as impactfully as possible, including the addition of different aspects, or “parts” to the program. Making sure you are knowledgeable about the Medicare program is important, as it can help you make decisions about which plan is right for you. Many people have heard about Medicare Parts A, B, C, and D, but don’t know what they necessarily mean. Medicare Today’s helpful infographic, provided below, highlights each fundamental aspect of the Medicare program and what each part of the program does.

Another helpful resource we want to highlight for seniors is a Medicare 101 informative video, which you can watch here, and see below. Take a minute to watch this short video, which gives a helpful snapshot of the Medicare program, what it does, and how it works. Warmer weather usually means busier schedules, and helpful explainer videos can be a great resource for getting the information you need quickly and efficiently. For more Medicare related video content click here.

Before we know it, the fall open enrollment period will be here, and it will be time to make changes or adjustments to our Medicare plans. Planning early and choosing the right plan for you based on your needs is very important, and brushing up on Medicare resources is a helpful way to prepare. You can enter the Spring season with an extra pep in your step knowing you are informed about the Medicare program!

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Do You Know About These Threats to Medicare?

Published by SSO

As seniors, we know just how important Medicare programs are to our health and wellbeing. Unfortunately, there are currently some government proposals that would affect Medicare’s ability to provide accessible, affordable care for seniors. We have outlined some of the major threats below, because the first step in making a difference is being informed!

First, there have been various proposals to repeal the non-interference (NI) clause of the Medicare Part D program. This clause prohibits the government from interfering in negotiations between manufacturers and insurers that result in rebates and discounts. The proposals seek to repeal that clause and allow the government to negotiate medicine prices under Medicare Part D, but studies have shown the only way the government could negotiated lower prices is if they severely restricted access to medicines. As seniors, it is vital that we support protecting Part D’s private marketplace structure that is in place to keep medications accessible and affordable. You can find an informative video about this issue here.

Another recent proposal that could threaten Medicare Part D relates to coverage of medicines within the six protected classes. Currently, Medicare Part D plans are required to cover “all or substantially all” medicines within these six classes—which include medicines that help those suffering with mental illnesses, HIV, cancer, and organ transplant rejection. The Centers for Medicare and Medicaid Services (CMS) has proposed making changes to these protections, which could harm some of America’s most vulnerable patients. Ensuring that seniors are able to receive the specific medications our doctors prescribe us is very important, and this proposal could threaten that ability.

Finally, another threat to Part D is the upcoming out-of-pocket cliff. This explainer video provides more information about this issue, as does this informative graphic from Medicare Today. If not addressed, the dollar value necessary to reach catastrophic coverage, which helps cover prescription medications for seniors once they have already spent a substantial amount out of pocket, is set to increase in 2020. It is vital that we advocate for seniors’ health by urging Congress to address this impending out-of-pocket cliff, and ultimately help patients save more money at the pharmacy counter.

In addition to Part D threats, the Administration has recently proposed some changes to Medicare Part B, the program within Medicare that covers outpatient physician-administered medicines, as well as outpatient services like doctor visits and ambulance services. The Department of Health and Human Services’ (HHS) International Pricing Index proposal could harm seniors and patients with chronic conditions by inserting middlemen into the doctor-patient relationship, which will create new administrative barriers that could hinder a doctor’s ability to provide care. The proposal would also open U.S. borders to price controls from socialized health care systems and could severely limit access to existing and new treatment options.

The American health care landscape is always changing, so it is critical that we keep informed about current proposals and challenges facing Medicare—a program that provides us with so many benefits and reliable, affordable access to care. The more we know as seniors, the better we can advocate for our friends, our families, and ourselves.

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October is Emotional Wellness Month!

Published by SSO

As the days get longer and the weather gets colder, it is tempting for many of us to stay inside and refrain from engaging in activities. For some people, however, this change in the time of year can lead to Seasonal Affective Disorder, or SAD. In fact, more than 10 million Americans are estimated to suffer from SAD per year, which may include depression-like symptoms such as loss of energy, changes in appetite or sleeping habits, irritability, and a loss of interest in socializing.

While Seasonal Affective Disorder may come and go with the time of year, other mental illnesses, including depression and anxiety can linger in many of us for years, or even for life. This October, as we celebrate Emotional Wellness Month, it is also important to highlight Mental Illness Week, which is October 7-13. Often, emotional wellness can be improved by activities like exercising, journaling, or spending time with family and friends. However, some living with a mental illness may need more significant treatment, including therapy or medication.

As society has become more open to discussing the challenges of mental illness, often, older Americans are not as willing to share their experiences and history of mental health. We also might not have as many facts about the importance of mental health as our younger counterparts, who are more likely to seek treatment if they are struggling. Fortunately, the National Institute of Mental Health has some great resources specifically geared toward educating older adults on mental health issues.

Additionally, individual and group therapy as well as a variety of medications used to treat mental illness are covered by Medicare. The UV light therapy needed to treat SAD is also covered. And, even if you do not need treatment for a mental disorder, Medicare provides resources to educate yourself further about keeping yourself healthy through emotional wellness and mental health care options.

As seniors, it is important that we support each other and lend a hand to family, friends, and neighbors struggling with mental health issues. We often focus on keeping our bodies healthy as we age, but ensuring that our minds are in top shape is just as important. Older Americans must be better about openly discussing these issues, and the pattern starts with all of you this October as we all celebrate Emotional Wellness Month.

How do you keep yourself emotionally well? Share tips or stories with us on our Facebook and Twitter pages, and let us know!

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Happy Birthday Medicare!

Published by SSO

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!

Published by SSO

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

Published by SSO

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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My New Year’s Resolution List for Congress

Published by SSO

Bob Blancato is the Executive Director of  National Association of Nutrition and Aging Services Programs (NANASP)

I believe New Year’s resolution lists can be extremely helpful. Making a list of resolutions allows you to set goals for the upcoming year to better yourself and those around you. It also gives us a sense of accomplishment when we’re able to check something off the list!

Likewise, it is important that Congress make a resolution list for 2018 to improve our nation and the lives of others. For those in government, we’ve already got a few ideas about what their goals should be in 2018. Check it out below!

  1. Repeal IPAB – IPAB was established by the Affordable Care Act to decrease Medicare spending if growth exceeds a certain target. If this happens, a board of 15 unelected officials are given a broad-range of authority to make decisions about cuts to Medicare spending. Such arbitrary cuts to Medicare are unacceptable, especially considering that these bureaucrats are unelected and in no way accountable to voters.

Medicare is extremely valuable to seniors like us who depend on the program for access to the medicine and health care services we need. But IPAB threatens to come between us and our doctors by making potentially drastic cuts to our Medicare. In fact, IPAB isn’t even required to maintain quality health care when making these cuts! In 2018, Congress should quickly repeal IPAB and ensure that seniors continue to have access to our doctors and coverage.

  1. Celebrate 15 years of Part D – This year marks the 15th anniversary of passage of this federal program which enjoys satisfaction ratings of nearly 90 percent by older adults, has come in under expected costs, maintained steady premiums, and improved the quality of life for seniors. Competition in the Part D marketplace has been one of the keys to its success, and this has allowed the program to provide access to affordable drug coverage while keeping costs low for older adults. The Part D program, which became law in 2003, needs to continue as it was adopted and Congress must protect it from changes that could undermine its structure and success.
  1. Protect U.S. consumers against counterfeit, substandard or unsafe medicines – Did you know in low- and middle-income countries 1 in 10 medical products is counterfeit? While it is important to ensure Americans have unfettered access to medications, it is equally as important to regulate the safety of them. Proposals to allow the importation of medicines, circumventing the robust safety standards we have in place here in the United States, could expose seniors to counterfeit or unsafe products. Though many argue importation of medicines could substantially reduce costs, the life-threatening consequences outweigh the benefits. In fact, the four former Food and Drug Administration commissioners sent a letter to members of Congress in opposition to drug importation proposals. Congress should oppose any proposals to allow drug importation.

What do you want to see on the government’s to-do list this year? Tell us in the comment section below.

 

 

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Assess Your Health This Holiday Season

Published by SSO
Image Courtesy of Wikipedia Commons

Image Courtesy of Wikipedia Commons

Medicare open enrollment has arrived and so has the holiday season! For those of us who are 65 and older, this means it’s time to examine our current coverage and determine if it still meets our individual needs.

Each year, Medicare users are given the opportunity to review and alter their Medicare Part D plan from October 15th to December 7th. Today, we’re sharing a few tips to make the process of assessing your coverage much easier. Feel free to use these tips over the Thanksgiving holiday period to discuss Medicare options with your family and loved ones. After all, Thanksgiving is National Family History Day.

Check Your Mail

You should have received an “annual notice of change” or “evidence of benefits” letter from your insurer. This letter is important to review, because it highlights the cost and benefit changes in store for 2018.

Know Your Medications

The medications you need may vary each year, so it’s essential to have a detailed list of all your current medications before you assess your Part D coverage. Be sure to check to make sure your current medications are covered, as well as any new medications you might now be prescribed.

Review All Costs

Be sure to calculate other costs associated with health care coverage besides monthly premiums, like out-of-pocket cost sharing such as copays or coinsurance. Study these factors to determine if they fit within your budget.

Check Approved Pharmacies

Make sure your preferred pharmacy is included in your Part D coverage by checking 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? This system shows how they are performing on specific features, such as customer service and patient safety. Don’t forget to check how your plan compares to others.

Look for Other Options

After you assess your plan, examine other options to see if there is a better fit for your individual needs. Use this Medicare Plan Finder to explore your options and compare plans here. Additionally, you can always call 1-800-Medicare 24/7, visit www.medicare.gov or call your Area Agency on Aging, which offers appointments with a Medicare information expert (SHIIP). If you need help finding contact information on your Area Agency, or if you need information on any service programs or resources, feel free to call the national Eldercare Information number at 800-677-1116.