Medicare Insurance Plans Temporarily Suspend Marketing

The Centers for Medicare and Medicaid Services (CMS) announced June 15, 2007 that in response to concerns about marketing practices, seven health care sponsors have signed an agreement to suspend voluntarily the marketing of Private-Fee-For-Service (PFFS) plans. This suspension will be lifted only when CMS certifies that the plan has the systems and management controls in place to meet all of the conditions CMS has set forth. The companies include: United Healthcare, Humana, Wellcare, Universal American Financial Corporation (Pyramid), Coventry, Sterling, and Blue Cross/Blue Shield of Tennessee.
“While we note that most health insurance agents are helpful and responsible in describing and explaining choices to beneficiaries, there are a few bad actors that need to be removed from the system for good,” said Leslie V. Norwalk, Esq., Acting Administrator of CMS. “This voluntary agreement demonstrates that CMS and the plans are stepping up to ensure that deceptive marketing practices end immediately, and that beneficiaries understand what they are purchasing.”
“Through a variety of methods, including our ‘secret shopper’ program that uses trained individuals to attend marketing events and report back on the insurance agents’ activities, and the eyes and ears of our thousands of partners throughout the nation, CMS is proactive in protecting beneficiaries from rogue agents. Although the 2700 agent complaints we logged from December 2006 to April 2007 represent less than one half of one percent of the 1.3 million members enrolled in individual PFFS plans, we can always do better,” added Norwalk.

This is a case where the message is being adversely impacted by the actions of unethical messengers. I represent many of these private Medicare plans. I have helped many seniors save money while ensuring comprehensive healthcare coverage. One of my clients is saving $150 per month while benefiting from wellness services she previously did not have. Growth in these plans has been significant(currently 8.3 million members) , not because they are being oversold, but because it meets a need. Strict regulations will hopefully force many unethical agents from the business. These plans are here to stay, giving seniors many more options for health insurance coverage. This can only serve to benefit seniors over the course of time. Speculation is that these plans will be available again during open enrollment later this year, November 15, 2007. I will keep you posted.

Combating Alzheimer's Disease

Senator Barbara Mikulski (MD) introduced a bill in the U.S. Senate on March 15, 2007. If signed into law, the Alzheimer’s Family Assistance Act would combat the causes and impact of this terrible disease with the following goals:

1. Double the funding for Alzheimer’s research at NIH from $640 million to $1.3 billion.

2. Create a National Summit on Alzheimer’s so the best scientists in the country can come together to look at the current state of research, discuss the most promising breakthroughs, and chart the course for future research.

3. Offer family support because the family is always the first caregiver. The bill would provide a $3,000 tax credit for families caring for a loved one with a chronic condition like Alzheimer’s. It would help them pay for prescription drugs, home health care and specialized day care. It also includes a long-term care tax deduction to help make long-term care insurance more affordable for people and to help people help themselves as they plan for retirement and their future.

At the first hearing on the legislation Sen. Mikulski commented, “Alzheimer’s disease is an all-American disease that needs an all-American effort. Direct and indirect costs of Alzheimer’s and other dementias amount to more that $148 billion annually. In 2005, Medicare spent $91 billion on beneficiaries with Alzheimer’s and other dementias. That number is projected to nearly double to $189 billion by 2015." I will follow the course of this legislation and keep readers of this blog informed of its status.

Women and Strokes; Watch Your Waistline

Strokes are becoming more of a problem for women than men among the middle aged. More women than men appear to be having a stroke in middle age, according to a study published June 20, 2007, in the online edition of Neurology®, the medical journal of the American Academy of Neurology. Researchers say heart disease and increased waist size may be contributing to this apparent mid-life stroke surge among women. (Full Article). Strokes occuring to those in middle age create unique problems for families. Quite often additional financial burdens occur because minor children are likely still in the home. People underestimate the risk of disability. Income stops but expenses not only keep coming, but often increase. Families struggling to save for college costs have to divert funds to this new medical reality. Temporary or permanent disability can have long term emotional and financial impact. Share stories of overcoming strokes and or advice for women to better their heart health. by clicking on "comment" under this article.

Helping Seniors Beat the Summer Heat

As we here in Virginia face the sometimes blistering summer season, the ones most often at risk are our seniors. Often residing in older homes and on limited income, seniors have an increased need for cooling assistance. LIHEAP (Low Income Home Energy Assistance Program) has been a federal program since 1979. Administered through local Departments of Social Service(DSS), LIHEAP funds are used to purchase and/or upgrade air conditioners, ventilation systems or pay electric bills for those in need. Applicants must meet certain guidelines including financial and or health/age concerns. Filing schedules for these funds are between June 15 and August 15. Companies such as Dominion Virginia Power also provide corporate support for low income assistance through its Energy Share program. If you or someone you know faces the summer heat without the means for relief, please contact the local DSS office for further assistance. Applications for LIHEAP funds can be found at http://www.dss.virginia.gov/benefit/ea/cooling/forms/cgi

Medicaid Screening Process

I was speaking the other day to the Hanover County, VA Social Services Department. More specifically to the Long Term Care Social Worker. We agreed that many people are uneducated as to how to apply for Medicaid for an elderly relative. Moreover, many don't get this education until a crisis has occured and someone has entered the hospital and may need services upon discharge. As you know, many decisions under these circumstances can be very stressful. This entry is a very basic checklist of the Medicaid screening process. Some readers may need a quick guide to this process. This whole issue of Medicaid services is huge. I will devote considerable time and effort to inform this blog's readers on these topics. If there are specific questions or comments, please click the "comment" field under this entry.

Steps in Medicaid Screening Process

1. Contact the local Social Services Department for the county of residence of the senior.
Hanover County is 804-365-4100. check your local department.
2. Social Services and the Health Department nurse will coordinate a time for visit.
3. Health Department determines eligibility of applicant and what services would be necessary.
4. Eligibility is based on a person's ability to perform ADLs (activities of daily living)
5. Services will include Personal Care, Day Care, Assisted Living or Nursing Home.
6. Family selects provider of services (DSS can provide list).
7. Provider of services contacts DSS and Health Department for screening forms.

Be Careful What You Ask For

While many are finding favor with the concept of universal healthcare, imagining it to be a sweet solution to the sour healthcare situation, it might just leave a bad aftertaste in our mouths. Many politicians have proposed such fixes to the health crisis and an increasing number may see it as the answer. My advice: "Be careful." Yes, there is a problem with higher costs for and access to healthcare. However, I don't believe the answer is the federal government. With all its faults, I believe the United States still has the premier health system in the world. Let me ask one question. If you had a very important and irreplaceable package to send, would you entrust it to FedEx or the U.S. Postal Service? Just a thought. Can this carry over to vital issues like healthcare delivery? I would like to start a discussion amongst readers on this topic. I believe honest, open debate is always necessary on such an important issue. Please share your thoughts.

Cost of Healthcare Top Concern of U.S. Adults

The rising cost of U.S. healthcare is a pressing concern for 85 percent of U.S. adults, according to a recent survey sponsored by the American Society for Quality (ASQ) and conducted by Harris Interactive®. In fact, healthcare costs overtake U.S. adults' concern for other hot button issues including the war in Iraq (79 percent), the rising cost of fuel (80 percent) and the threat of global warming (61 percent).

The issue of universal healthcare coverage wins strong approval in the ASQ survey which found that 79 percent of adults believe universal coverage would improve healthcare quality. According to the ASQ survey, nearly nine in 10 (88 percent) adults think being able to go to any doctor would also improve the quality of their healthcare over the next five years. In other findings, 39 percent of adults said they would be concerned/very concerned about medical errors occurring if they were hospitalized; 29 percent of U.S. adults have not filled a prescription; and 28 percent have delayed a medical procedure due to expense (28 percent).
For more information on the study, go to http://www.asq.org/media-room/press-releases/2007/20070320-healthcare-war.html

More Seniors Are Selecting Private Medicare Advantage Plans

Enrollment in private Medicare health plans has grown sharply since enactment of the Medicare Modernization Act of 2003, which created a Medicare drug benefit and created incentives for new private plans to enter the Medicare market, according to four new reports from the Kaiser Family Foundation. Private plans called Medicare Advantage plans are now widely available and cover a record 8.3 million beneficiaries, up from 5.3 million in 2003, the reports indicate. Please click on report link above for further details.

Americans Doing More for Heart Health

More than 93% of U.S. adults engage in at least one of three recommended behaviors to prevent heart disease, according to a new report by the Agency for Healthcare Research and Quality. More than 56% of adults surveyed by the agency in 2004 got moderate to vigorous exercise three times a week, 78% did not smoke and 39% had a healthy body mass index or weight. However, only 18% practiced all three heart-healthy behaviors while 6% did not practice any, and 18% continued to smoke after their doctor found indicators of heart disease.

Wrong Choice of Words

I noticed something the other day. In reading an article about elderly persons, the word "invalid" was used. The context was to describe a person whose physical condition has been limited due to illness. I noticed that if you say the word differently, it becomes "invalid". This form of the word means lacking value or importance. In describing our elders, this cannot be further from the truth. Even folks with physical and or mental difficulties have tremendous value. I have never met a more rich and vibrant group of people as when I worked as the Admissions Director of Hanover Healthcare Center. I encourage you to visit folks others may label "invalid". You will be richly blessed! Please share your thoughts by posting comments on this blog.

Importance of a Good Doctor

Good care keeps certain elderly people out of the hospital. Elderly Medicare patients treated by experienced physicians are less likely to be hospitalized for bacterial pneumonia or chronic obstructive pulmonary disease, according to a study released recently by the Center for Studying Health System Change. Patients whose usual physician had less than 10 years experience or difficulty accessing ancillary services were at higher risk of hospitalization for both conditions. The findings are based on a 2000-01 survey of practicing physicians and Medicare claims data.