Take The Time To Evaluate Your Medicare Drug Benefits

Medicare Prescription plans are changing for 2009. Each company offering Part D plans have made changes to their plans for next year. Medicare has approved each change. The question to ask is, "With my existing 2008 plan, am I going to pay more in 2009 than I have to for Medicare Drug coverage?"

I have listed two ways to answer that question. Even if you have been satisfied with your benefits during 2008, take the time to evaluate your plan for 2009. Seniors are not required to change, but may find it financially beneficial to do so.

NOW IS THE TIME TO EVALUATE YOUR PLAN. Open Enrollment will end December 31, 2008.

Many plans have increased monthly premiums, increased certain medicine co-pays, and even changed the drug formulary (list) itself. Use this free tool to evaluate your current plan and see any changes it may have for 2009. If another will be less expensive in premiums or lower your co-pays, you can enroll by phone or online after the analysis.

HERE ARE TWO WAYS TO INDEPENDENTLY ANALYZE THE 2009 PLANS.

1) Call 1-866-955-2022. A knowledgeable and helpful attendent will assist you.

2) Click the web link below to enter your specific medicines and what different plans will cost.

http://plancompare.destinationrx.com/intermediate.aspx?aid=answers

New Marketing Rules for Medicare Plans

Medicare has enacted several new rules regarding marketing techniques during Medicare Open Enrollment. These rules further define the steps insurance agents are allowed to take to market and enroll beneficiaries. Important changes are as follows:

Absolutely No Cold Calling. All contacts with prospects must be pre-approved by the beneficiary. Don't allow anyone initiate contact without a senior asking for it.

Plans and agents can't provide full meals at seminars. Refreshments are permitted, but full meals were being used to "buy" contracts.

Prospect meetings are to be limited to one topic. Discussions of other topics, like annuities, during an Medicare Advantage appointment should not happen until another time at least 48 hours later.


While these rules are very limiting to the sales of Part D and MA plans, agents who are honest and customer-focused will continue to do well. Dishonest agents hopefully will leave the industry. Seniors will be better served.

Increased Growth In After-Hours Clinics

Competition, patient demand are fueling growth in after-hours clinics. Doctors are expanding hours to accommodate the demands of busy, informed patients—and combat competition from retail health clinics popping up in drugstores such as Walgreens and CVS. "Given the choice, most patients who have a regular physician would prefer to see them on extended hours than go elsewhere for treatment," said Doug Henley, CEO of the American Academy of Family Physicians. "It’s moving to a more patient-centric (business) model rather than a physician-centered model," Henley said. Read the full article from the Kansas City Star.

State Specific Report Shows Increasing Health Insurance Costs

Families USA has released a series of state-specific reports showing the rising cost of health insurance premiums compared with median family income. In Alabama, for example, annual premiums for employer-sponsored family coverage rose 79% between 2000 and 20007, while median worker earnings rose 17%. The reports’ findings are based on data from the U.S. Census Bureau and departments of Labor and Health and Human Services.

New Treatments Drive Up Spending On Diabetes

Annual U.S. spending on prescription drugs to treat diabetes rose 87% between 2001 and 2007. A study in the Oct. 27 Archives of Internal Medicine revealed total annual expenditures for diabetes medications rose from $6.7 billion in 2001 to $12.5 billion in 2007, while the average drug price per prescription rose from $56 to $76. Estimated patient visits to office-based physicians for type 2 diabetes grew from 37 million in 2000 to 45 million in 2007.

New Approach to Medical Costs

Americans spend more than $265 billion a year out of pocket on healthcare and pile up medical debt, struggle to pay it off and sometimes end up in financial ruin. Now Haddam, CT-based Criterion Ventures is creating a new approach to dealing with those costs. Criterion's idea is to weave together private and public sources of payment, negotiate discounts on hospital and doctor care, and load it all onto a hybrid debit-credit card. Criterion believes the project will help people avoid drowning in medical debt and could also reduce bill collection hassles for care providers. Read the full article from the Hartford Courant.

Are Alternative Medicare Plans Reducing Costs?

Private Medicare Advantage plans will be paid an average 12.4% more per enrollee in 2008 than the same enrollee would have cost in the traditional Medicare fee-for-service program, according to a new report from the Commonwealth Fund. I wanted to post this report to inform the public of the continued debate over the course of Medicare. In any study, one should question the calculations that are used to determine the results. I, personally, like the fact that seniors have a choice in receiving their healthcare insurance. The Medicare Modernization Act of 2003 has attempted to bring Medicare into today's behaviors and mindset. As the financial impact is calculated and debated, continue to be aware of these issues. Seniors can have a louder voice when informed about the issues. Take time to educate yourself or risk allowing others to make your decisions for you.

Study of Trends in Health Insurance

A new report from the Employee Benefit Research Institute examines trends in health insurance coverage and the factors that affect coverage, including the strength of the economy. "While the percentage of the non-elderly population with employment-based health benefits was unchanged between 2006 and 2007, and the percentage with public coverage increased, resulting in a decrease in the uninsured, this should not be viewed as an indicator of things to come in 2008," the authors note. "As compared with 2007, unemployment was higher in 2008, meaning fewer individuals will have access to health insurance through a job, and gas and food prices were higher, meaning more individuals will have to choose between health insurance coverage and basic necessities."

Reducing Insurance Options For Seniors

After the Independence Day recess, Congress will resume debate over cuts and changes to Medicare. Physicians and senior citizens stand to lose if cuts are passed. Many in Congress seem to want to limit the options that seniors now have to receive health insurance through Medicare Advantage plans. Allowing private insurance companies to administer benefits appears to threaten the "government should do it all" viewpoint.

I am probably the only insurance agent working with seniors who has sought out the opinions of hospital intake staff and physician billers regarding Medicare Advantage. Feedback from those who bill for medical services has been very positive. Access to doctors is, in my opinion, a non-issue. Sadly, my " insurance colleagues" have brought criticism on this program because of selfish sales practices. Medicare is right to monitor the industry for "abuses" Don't penalize seniors, however. I don't recommend this program for every senior, but I like being able to give people options as they make health insurance decisions. Please stay informed on HR 6331. Let your opinion be heard. www.house.gov www.senate.gov

Diabetes On The Rise

An estimated 24 million Americans had diabetes in 2007, an increase of more than 3 million in about two years, according to data released recently by the Centers for Disease Control and Prevention. Another 57 million people are estimated to have pre-diabetes, a condition that puts people at increased risk for diabetes. Among adults, diabetes increased in both men and women and in all age groups, but still affects the elderly most. Almost one-quarter of Americans 60 and older had diabetes in 2007. Creating a culture of wellness and prevention is key.

Anxiety and Elders

Most of the recent posts to this site have been reports of pertinent studies. All the recent postings detail trends in healthcare, not only for seniors, but also the population as a whole. However, this post is more personal. Working in the eldercare industry, I have seen plenty of anxiety among the senior population. However, in the last several weeks, I have witnessed a heightened level of anxiety in my parents and parents-in-law. When it is close to home, it is difficult to handle. However, the same strategies hold true no matter the person.

I hope this posting will begin a dialogue between those of us facing this anxiety issue among our loved ones. My advice when facing a situation of heightened anxiety among your parents is compassion. Inquire of the person what they are feeling and why they feel this way. Of course, ask these questions in a non-threatening or judgemental way.

One thing I know is that it can be frustrating to deal with a person you feel is worrying about nothing. Take each situation with patience and understand that much of this behavior is a result of some other variable. Be truthful. Be patient. Try to expand your vantage point to gain some perspective.

Please share your thoughts by clicking on the comment line on this entry. Lets get a dialogue started to help others.

Fewer Small Businesses Offering Group Health Insurance

More than 65% of businesses with 10 or fewer employees say high cost is the most significant barrier to their offering health insurance, according to a survey released by the National Association for the Self-Employed. Only 19% of businesses with 10 or fewer employees currently offer coverage for full-time employees, down from 46% in 2005. One in 10 respondents spent 25% or more of their gross revenue on health insurance, up from 10.1% in 2005. NASE called access to health care the single biggest barrier to people joining and remaining in the ranks of the self-employed. Read the press release.

New Rating System For Nursing Homes

Acting Administrator of the Center for Medicare/Medicaid Services Kerry Weems announced that CMS will add a nursing home ranking system to its Nursing Home Compare Web site in December. “The new ‘five-star’ rating system will provide a composite view of the quality and safety information currently on Nursing Home Compare to help beneficiaries, their families and caregivers compare nursing homes more easily,” said Weems. The agency said it plans to work with other health care providers and consumers to make similar rating systems available for hospitals. Read more with the CMS announcement.

Health Savings Accounts Increasingly Popular

More than 6.1 million Americans were covered by Health Savings Account-eligible insurance plans in January 2008, America’s Health Insurance Plans reported yesterday. That’s 1.6 million more people than in January 2007. The average annual deductible was $2,600 for single coverage and $4,846 for family coverage, while the average annual out-of-pocket limit was $3,661 for single coverage and $7,057 for family coverage. HSA products accounted for 31% of new coverage issued in the small-group market, and 27% of new purchases in the individual market, AHIP said.

Rate Of Growth For Family Coverage Premiums Eclipses Income

The amount employees pay for family coverage increased an average 30% between 2001 and 2005, according to study released today by the Robert Wood Johnson Foundation. That’s 10 times the average pay increase for family policyholders over the period, the study adds. “As costs continue to go up, fewer people can pay their portion of the premium, and fewer employers are able to offer insurance benefits,” said RWJF President and CEO Risa Lavizzo-Mourey, M.D. “This research shows that an ever-increasing number of people will join America’s uninsured unless our nation’s leaders act to reform our health care system.” The study was released in conjunction with Cover the Uninsured Week (April 27-May 3), an annual campaign led by RWJF to raise awareness about the 47 million Americans without health insurance. The AHA is a national partner in the campaign, which includes events to help those who are eligible enroll in low-cost or free health coverage programs.

Recent Congressional Actions On Medicare

As required by the 2003 Medicare Modernization Act, House and Senate leaders yesterday introduced legislation proposed by the administration to respond to a Medicare funding warning issued by the program’s trustees last April. According to the administration, the legislation (H.R. 5480/S. 2662) takes an approach to strengthening Medicare that includes limits on means testing for Part D premiums and medical liability costs; improved health information technology and electronic medical records; transparency in price and quality information; and incentives for providers to deliver and Medicare beneficiaries to choose high-quality, low-cost health care. At the same time, the president’s fiscal year 2009 budget proposes more than $182 billion in cuts to the Medicare program over five years, $137 billion of which would come from hospitals.

Good News About Cognitive Health

Rates of cognitive impairment among Americans over 70 are on the decline, according to a new study supported by the National Institutes of Health. Researchers tested memory and judgment among people age 70 and older and found cognitive impairment dropped from 12.2% in 1993 to 8.7% in 2002. They found higher levels of education were associated with better cognitive health, but said more research is needed to pinpoint the factors influencing the ability of older Americans to think, learn and remember. Read more by clicking on the study link.

More Seniors Living With Heart Failure Condition

The number of Medicare patients living with heart failure rose from about 140,000 in 1994 to 200,000 in 2003, according to a study in the Archives of Internal Medicine. “Identifying optimal strategies for the treatment and management of heart failure will become increasingly important as the size of the Medicare population grows,” the authors conclude. The proportion of beneficiaries with a heart failure diagnosis grew from 90 per 1,000 in 1994 to 120 per 1,000 in 2003. Although the mortality rate declined slightly over the period, more than 60% of patients die within five years of diagnosis, the report's authors said.

Diabetes Among Senior Population Is Increasing

The annual number of Americans aged 65 and over diagnosed with diabetes increased 23% between 1993-1994 and 2003-2004, according to a study in the Archives of Internal Medicine (2008;168:192-199). The study used Medicare claims and other data to examine trends in the rates of diabetes and its complications. One-quarter of Medicare beneficiaries 65 and over had diabetes in 2003, up from 15% in 1994. The death rate for patients diagnosed with diabetes declined 8.3% over the period when compared with those who were not diagnosed with the disease. Most patients with diabetes experienced at least one complication within six years of diagnosis; for example, almost half had congestive heart failure. “For Medicare, the message is that the increased burden of diabetes will contribute to increased budgetary pressures in the future,” the authors said.

Diabetes Association Estimates Diabetes Costs Nation $174 Billion Each Year

A new report from the American Diabetes Association estimates diabetes cost the nation $174 billion in 2007. The estimate includes $116 billion in excess medical expenditures and $58 billion in reduced national productivity, according to the report by the Lewin Group. Medical costs attributed to diabetes include $27 billion for care to directly treat diabetes, $58 billion to treat chronic complications attributed to diabetes, and $31 billion in excess general medical costs. Hospital inpatient care accounted for half of the estimated medical expenditures. On average, medical expenditures are more than twice as much for patients with diabetes, the study estimates. As of 2007, 17.5 million U.S. residents have been diagnosed with diabetes, the study estimates, up from 12.1 million in 2002. “The burden of diabetes is imposed on all sectors of society – higher insurance premiums paid by employees and employers, reduced earnings through productivity loss, and reduced overall quality of life for people with diabetes and their families and friends,” the report concludes

Retail Health Clinics On The Rise

Expect to see more "You're sick, we're quick" clinics coming your way. There are now nearly 1,000 U.S. retail clinics in the U.S., operating in 36 states, according to a study by Verispan. The fastest growing player in the sector is Minute Clinics, which are operated by CVS Caremark. You can read a news article about the study here. http://www.healthcarefinancenews.com/story.cms?id=7520

Medicare Spending Increases Due To Prescription Drugs

Medicare spending grew 18.7% to $401.3 billion in 2006, as prescription drug spending shifted to Medicare from Medicaid and private coverage, the Centers for Medicare & Medicaid Services reported today. That’s the largest annual increase in Medicare spending since 1981 and twice the growth seen in 2005. Total U.S. spending for hospital care grew 7.0% in 2006 to $648.2 billion, down from a 7.3% increase in 2005, as growth in the underlying cost of hospital services slowed to 4.1% from 4.3%, CMS said. Spending for physician and clinical services grew 5.9% in 2006 to $447.6 billion. That’s down from 7.4% in 2005, due in part to a freeze in Medicare payments. The report appears in the January/February issue of Health Affairs.

Disability Due To CHF

Congestive Heart Failure is leading to greater likelihood of disability among older adults. Medical breakthroughs in recent decades have allowed heart attack survivors and other heart-disease patients to live longer. But as their hearts decline into congestive heart failure, an increasing number will experience disability and the need for nursing-home care. A new study from the University of Michigan Health System and the VA Ann Arbor Healthcare System sheds light on the degree of disability among people with CHF, as well as the implications for the health care system, community care facilities, families and the patients themselves. Click link for full article.

http://www.chipsnetwork.com/newsstory.asp?article=6190&sid=877912