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We are dedicated to making Medicare's program work well for all beneficiaries. Your feedback from your own or your client's concerns and experiences with Medicare, will guide our Medicare advocacy efforts with key policy and decision-makers in both California and nationally with the Centers for Medicare and Medicaid Services (CMS) and Congress.

  • 26Apr

    Knowing about and using Medicare’s covered preventive care and screening services can protect your health and save you money. Below is a review from the Medicare Minute program.

    Point 1: Know which preventive and screening services Medicare covers.

    For those new to Medicare, Medicare covers a one-time Welcome to Medicare visit within the first 12 months you have Part B. You are also eligible for an Annual Wellness Visit to manage your health care. Medicare’s more specific preventive services that help detect potentially serious conditions include exams, shots (such as flu shots), lab tests, and screenings (such as HIV screenings). To help you take care of your own health, it also covers programs for health counseling (such as nutrition and smoking cessation counseling), and education (such as diabetes self-management training).

    Some preventive care services are covered once every few years, while others may be covered more frequently if they are needed to diagnose an illness or condition. Speak to your provider about scheduling times to receive preventive services. It is important to know that Medicare covers preventive care services only if they are truly preventive in nature. If your doctor identifies a health issue during your preventive care visit and needs to provide care to address it, you may be responsible for certain costs, such as the Part B deductible and coinsurance. For more information on Medicare’s preventive care services, contact your State Health Insurance Assistance Program (SHIP).You can also call 1-800-MEDICARE (1-800-633-4227), or visit www.medicare.gov to find out if Medicare covers your test, service, or item.

    Point 2: Know how to prepare for your Welcome to Medicare and Annual Wellness Visits.

    Medicare covers a one-time, initial examination (also known as the Welcome to Medicare preventive visit) within the first 12 months you enroll in Part B. All people new to Medicare qualify for this visit. After you’ve had Part B for longer than 12 months, you can begin receiving Annual Wellness Visits. During each visit your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment.” Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. Note that you cannot receive your Annual Wellness Visit within the first year you are enrolled in Medicare or within the same year you have your Welcome to Medicare exam.

    Before your visit, make a list of illnesses that run in your family, surgeries, medical problems, treatments, injuries, allergies, and vaccines you’ve had, especially if you’re seeing a new provider. You should also make a list of all the medicines, vitamins, and supplements you use, including the doses and how often you take them. Remember to bring your lists with you and discuss them with your provider during your visit. Speaking with your provider is one of the best ways to make sure you receive the preventive and screening services you need.

    Point 3: Know the type of providers you should see.

    Original Medicare, you should receive preventive care services from providers who accept assignment. Assignment is an agreement by your provider to accept the payment amount Medicare approves for your health service or item, and not to bill you for any more than the Medicare- approved deductible and coinsurance. Part B now pays for most covered preventive and screening services at 100 percent of Medicare’s approved amount, so if you receive these services from a provider who accepts assignment, you will have no out-of-pocket costs. If you are in a Medicare Advantage Plan, your plan should not charge you for preventive care services that are free for people with Original Medicare, as long as you see in-network providers. In-network providers accept your Medicare Advantage Plan as insurance. If you do not see a Medicare-participating provider who accepts assignment or an in-network provider, charges will typically apply to your preventive care service.

    Note: You play a vital role in protecting the integrity of Medicare and can help detect fraud by carefully reviewing your summary of claims from Medicare or your plan. Always call your provider’s office to ensure they did not make a billing mistake. If your call is unsuccessful or if your provider is uncooperative, call our California Senior Medicare Patrol (SMP) at 1-855-613-7080.

     

  • 21Apr

    Did you know that our senior population is the fastest growing population group in America? And that worldwide the age group of 80+ is expected to more than triple between 2015 and 2050, growing from 126.5 million to 446.6 million?! By the year 2017, the world — for the first time — will have more people 65 and older than children younger than 5. With so many people coming into “elderhood”, celebrating and honoring our older adults and empowering them to contribute and live rich, quality lives in their golden years will benefit all of society.

    Established in 1963, Older Americans Month (OAM) provides one way to do this, as it historically has been a time to acknowledge the contributions of past and current older persons in our country, in particular those who defended our country. Every President since Kennedy has issued a formal proclamation during or before the month of May asking that the entire nation pay tribute in some way to older persons in their communities. Older Americans Month is celebrated across the country through ceremonies, events, fairs, and other such activities.

    How will you celebrate this month? We encourage you to connect with the elders in your life — your grandparents, teachers, mentors, seniors in your community and find out what events are happening in your area. You can also host an event or gathering yourself. :-)

    The Administration for Community Living has a number of outreach materials. This year’s OAM theme is Blaze a Trail. We all blaze our own path in life and as an elder, what is the legacy you’ll be leaving? ACL has some tip sheets on blazing trails in the areas of civic engagement, finances, reinvention and wellness. Listed below are some past Older Americans Month themes.

    Here’s to all the elders in our country and the many contributions they have brought forth throughout their lives and the wisdom they shine in their golden years.

    For more information on OAM, see ACL’s news announcement.

    Past Older Americans Month Themes

    • 2015—Get into the Act
    • 2014—Safe Today. Healthy Tomorrow.
    • 2013—Unleash the Power of Age
    • 2012—Never Too Old to Play
    • 2011—Older Americans: Connecting the Community
    • 2010—Age Strong! Live Long!
    • 2009—Living Today for a Better Tomorrow
    • 2008—Working Together for Strong, Healthy and Supportive Communities
    • 2007—Making Choices for a Healthier Future
    • 2006—Choices For Independence
    • 2005—Celebrate Long-term Living
    • 2004—Aging Well, Living Well
    • 2003—What We Do Makes A Difference.
    • 2002—America: “A Community for all Ages”
    • 2001—The Many Faces of Aging
    • 2000—In the New Century … The Future is Aging
    • 1999—Honor the Past, Imagine the Future: Towards a Society for All Ages
    • 1998—Living Longer, Growing Stronger in America
    • 1997—Caregiving: Compassion in Action
    • 1996—Aging: A Lifetime Opportunity
    • 1995—Aging: Generations of Experience
    • 1994—Aging: An Experience of a Lifetime
    • 1993—No theme selected (proclamation signed on May 25, 1993)
    • 1992—Community Action Begins with You: Help Older Americans Help Themselves
    • 1986—Plan on Living the Rest of Your Life
    • 1985—Help Yourself to Independence
    • 1984—Health: Make it Last a Lifetime
    • 1978—Older Americans and the Family
  • 12Apr

    The world’s older population continues to grow at an unprecedented rate. Today, 8.5% of people worldwide (617 million) are aged 65 and over. According to a new report by the National Institute on Aging (NIA) and produced by the U.S. Census Bureau, “An Aging World: 2015,”  this percentage is projected to jump to nearly 17% of the world’s population by 2050 (1.6 billion). The report examines the demographic, health and socioeconomic trends accompanying the growth of the aging population.

    “An Aging World: 2015” contains detailed information about life expectancy, gender balance, health, mortality, disability, health care systems, labor force participation and retirement, pensions and poverty among older people around the world. Below are a few highlights.

    • America’s 65-and-over population is projected to nearly double over the next three decades, from 48 million to 88 million by 2050.
    • By 2050, global life expectancy at birth is projected to increase by almost eight years, climbing from 68.6 years in 2015 to 76.2 years in 2050.
    • The global population of the “oldest old” — people aged 80 and older — is expected to more than triple between 2015 and 2050, growing from 126.5 million to 446.6 million. The oldest old population in some Asian and Latin American countries is predicted to quadruple by 2050.
    • Among the older population worldwide, noncommunicable diseases are the main health concern. In low-income countries, many in Africa, the older population faces a considerable burden from both noncommunicable and communicable diseases.
    • Risk factors — such as tobacco and alcohol use, insufficient consumption of vegetables and fruit, and low levels of physical activity — directly or indirectly contribute to the global burden of disease. Changes in risk factors have been observed, such as a decline in tobacco use in some high-income countries, with the majority of smokers worldwide now living in low- and middle-income countries.

    See the full report and news release at http://www.nih.gov/news-events/news-releases/worlds-older-population-grows-dramatically.

    For more information on NIA, the government entity charged with conducting and supporting research on aging and the health and well-being of older people, see www.nia.nih.gov.

  • 05Apr

    Are you in a Medicare Advantage plan? Wondering what doctor(s) to use? You can review the Office of the Patient Advocate’s new Medicare report card for medical groups that are contracted with Medicare Advantage plans. This is a new resource can help you make your choice.  Let us know how it works for you! http://reportcard.opa.ca.gov/rc/MedicareMGCounty.aspx

  • 30Mar

    Nobody likes penalties, especially when it means paying more money. When it comes to Medicare, most people can avoid penalties by enrolling in Parts A, B and D when first eligible, during their Initial Enrollment Period. Those who don’t enroll during this time, may have a penalty. The IEP is different for different parts of Medicare. This article reviews the Part D late enrollment penalty (LEP) and exceptions.

    Unlike Part A and B late enrollment penalties that don’t start until someone has delayed enrollment for 12 or more months, the Part D LEP begins accruing 63 days after one’s initial enrollment period has ended. The penalty amount varies depending on how long one delays enrolling in Part D after becoming eligible. To calculate the cost, Medicare multiplies 1% of the national average Part D premium ($34.10 in 2016) by the number of months without coverage. And this penalty is paid for eternity….well, not exactly, but the point is the penalty stays and one will pay it as long as s/he has Part D coverage.

    Are there exceptions?

    Yes, there are a couple of exceptions. The LEP is waived if you had “creditable drug coverage” during the months of delayed enrollment. To be considered creditable, the coverage must be at least as good as Medicare’s standard drug coverage. This could be coverage from an employer, union, TRICARE, Veterans Affairs, Indian Health Services or a Medicare Advantage plan with drug coverage. Each year you should receive a letter from your health plan stating that your coverage is creditable. Hold onto this letter. You may need it if you sign up for Part D at a later time.

    Another exception is for people who qualify for the Part D low-income subsidy, known as Extra Help that covers most premium and deductible costs. Those who qualify do not have to pay a penalty, regardless of how long they didn’t have drug coverage.

    See Prescription Drugs for more information on Medicare Part D, and our section on late enrollment penalties for more info on Part A and B LEPs.

  • 17Mar

    Do you have long-term care insurance? Concerned about premium increases? If so, you’re not alone. This is a conundrum elders and policy makers face nationwide. With 1 year of nursing home care costing at least $90,000, who can afford such care? In the 1970s, policy makers hoped long-term care (LTC) insurance would be their answer. Yet this industry has been nothing short of disastrous, as most companies greatly underestimated how long people would live, how much nursing home care they would require, how few people would drop their policies, and how little interest they would actually gain from banked premiums. As a result, most LTC insurance companies have left the market and policyholders are grappling with steep premium increases from each year from the remaining companies. Even California’s CalPERS (California Public Employee Retirement System), the state workers’ retirement plan, has raised their premiums 85% in the last 2 years.

    Many policyholders were told to plan ahead and buy a policy early on to secure a good price, as the rates would just increase if one waited to buy a policy later in life. Well this early purchase has not paid off for many policyholders, such as one women featured in a recent Money Magazine article. Currently 69, she bought her policy 20 years ago and has had her premium quadrupled in the last 2 years. She’s facing 3 unattractive options: she can pay the higher cost; reduce the price by reducing the benefits in her policy; or cancel her policy. With so many people facing these undesirable options, California Health Advocates, along with several advocate groups, pushed for more consumer protections, including one that allows those who lapse in their policies to at least use an amount of benefits that equals the amount of premiums already paid out.

    With one of the fastest growing population groups being people who are 80 and older, our nation has a long-term care crisis on its hands. Currently Medicaid (Medi-Cal in California), the federal public health insurance program for people with low-incomes and/or disability, covers about ½ of the nation’s long-term care costs and the price tag will continue to rise as baby boomers reach their 80s and 90s in growing numbers. Many people mistakenly assume Medicare, the federal health program for people 65 and older and those younger with disabilities will pay for long term care. While Medicare does pay for short nursing home stays after at least 3 days of inpatient hospital care, it does not pay for personal, or formally referred to as “custodial care” such as eating, bathing, cleaning, cooking, walking, dressing, etc. (See our Medicare Basics section for more info on Medicare coverage.) And, as highlighted, long-term care insurance has priced itself out of the middle class market, especially for women whose premiums are generally 40% higher than men’s.

    So where we go from here is something California Health Advocates and several other policy groups are working on. See our website for more information on long-term care and ways of financing LTC.

  • 08Mar

    Yes, and a big one. Over 26% of people in a recent poll said that health care costs posed a significant financial burden on them and/or their family. Forty-two percent of the people said they have paid all or nearly all of their savings on medical costs, and 27% said they were unable to pay for basic necessities such as food, heating, or housing. Seven percent have also declared bankruptcy because of health care costs. This is an unnecessary burden that faces both the younger population on Obamacare and the older population and people with disabilities on Medicare. In fact, a recent National Public Radio article notes that while 89% of Americans now have health insurance through Obamacare and Medcare, simply having insurance is no longer enough. The consumer costs keep rising.

    According to a Kaiser Family Foundation study done last year, more and more companies are also shifting rising health care costs to their employees. For example, the workers’ share of health insurance premiums for their families rose 83% from 2005 to 2015. The amount employees had to pay for deductibles for individual insurance also increased 255% from 2006 to 2015. These increases are much higher than growth in workers’ wages. And this example demonstrates what’s happening in all areas of health care coverage, with the sickest people being hurt the most.

    For more information on the poll, see NPR’s recent article, Medical Bills Still Take a Big Toll, Even with Insurance.

  • 04Mar

    Did you know that drug costs rose 12.2% in 2014 alone which is 5 times as fast as the year before? And that the price of the 50 top most-used generic drugs has soared over 373% between 2010-2014? What’s happening and how can we as consumers save money and be savvy about our prescriptions? One thing that’s happening is company mergers, currently leaving 3 companies in control of 40% of the generic drug market. Also, some of the newest drugs are prohibitively expensive, such as the new Hepatitis C treatment Sovaldi which is $1,000 a pill for an 84-pill treatment.

    With prices and rising costs like these, it’s no wonder that insurance companies look for ways to shift more costs to consumers and make it harder to receive the higher costs drugs. For example, many drug plans have increased the number of drug tiers in their formulary (covered drugs) from just 2 tiers (one for generics, one for brand name drugs) to 3, 4 and even 5 tiers – with each tier corresponding to higher costs. This makes it confusing for consumers to know what exactly their drug costs will be when comparing plan formularies. Drug plans have also increased the number of drugs requiring step therapy or prior authorization. Such strategies shift rising drug costs to consumers and put up a barrier to receiving the higher cost medicines.

    So what are some ways to save money? Money Magazine’s March 2016 edition details some good cost-saving strategies, several of which are summarized below.

    • Change your medication. If you’re taking a brand name drug, ask your doctor for its generic equivalent. Also, if you’re taking multiple medications, see if there’s one medication that can be used for multiple conditions. That option does exist in some circumstances.
    • Use mail-order to fill and refill your prescriptions. You can get a 90-day supply and will generally have a lower copay than if you get a 90-day supply at a retail store.
    • Watch out for online pharmacy scams. According to a 2013 Government Accountability Report, many of the online “Canadian pharmacies” are illegitimate. Some have been found selling drugs with lethal contaminants such as lead or rat poison. If you do use an online pharmacy, make sure the website URL ends in “.pharmacy”. This means the site meets certain regulation requirements and has been approved by the National Association of Boards of Pharmacy.
    • Use your Medicare Part D plan’s coverage determination and exceptions processes to get affordable coverage for the drug(s) you need.
    • Change your insurance. One of the most effective ways to reduce drug costs is to change your drug plan. Medicare Part D drug plans change their coverage every year, and just because one plan meets your drug needs and is affordable one year, does not guarantee it will be the same the next year. During Medicare’s Open Enrollment period (Oct 15 – Dec 7) each year, you have the option to switch plans. Review your plan’s coverage for the coming year and shop around. California’s Health Insurance Counseling and Advocacy Program (HICAP) literally helped clients save millions of dollars this year by helping them find a plan that meets their mediation needs. You can use Medicare’s Plan Finder tool at Medicare.gov. This tools allows you to easily search for compatible plans by entering your medication, dosage, frequency, and preferred pharmacies. The plan finder will then give you a list of plans with your estimated out-of-pocket costs.

    See our website for more information on Medicare Part D prescription drug coverage.

  • 18Feb

    A new Medicare rule requires prior authorization for certain covered durable medical equipment and it starts the end of this month. The Centers for Medicare and Medicaid Services (CMS) published this final rule on Dec 29, and, as with other efforts, like the Competitive Bidding Program, CMS is trying to find that happy medium of reducing fraud, on the one hand, and ensuring beneficiary access, on the other. We, among our our partner advocates are concerned the new prior authorization requirements may limit or delay beneficiaries’ access to DME. An outside group AdvaMed will monitor CMS’ implementation of the new rule and its affect on beneficiary access.

    Below are links to a CMS fact sheet and two articles for more information.

  • 03Feb

    Ready to be inspired?! This short video by Lifetime Arts organization shows how we can all turn “fearful aging” into “artful aging”…and revise our cultural beliefs and attitudes about age and aging to be a time of life, giving, blossoming and creativity! Please share!

    Learn more about Lifetime Arts, an organization that offers a positive, modern, artistic and social lens through which to serve, inspire and engage America’s growing population of older adults.

    The Wall with Credits from Spoke on Vimeo.

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