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  • 24Nov

     

     

     

     

     

     

     

     

     

     

    Have you heard of #GivingTuesday? It’s a global day of giving back, and it falls on the Tuesday after Thanksgiving, Black Friday and Cyber Monday. This year’s #GivingTuesday is Tuesday, December 2, 2014, and we at California Health Advocates join charities, families, businesses, community centers, and students around the world in coming together for one common purpose: to celebrate generosity and to give.

    Where does #GivingTuesday come from, you may ask? The retail industry has long benefited from seasonal shopping that symbolically kicks off with “Black Friday”– a day that has since inspired “Small Business Saturday” and “Cyber Monday.” #GivingTuesday, then, serves as a celebratory, fully connected day to kick off the giving season, when many make their holiday and end-of year charitable gifts.

    #GivingTuesday brings together diverse networks of people, large corporations, small businesses and nonprofits across an ever-expanding range of new media platforms to encourage and amplify small acts of kindness in the service of changing our world for the better.

    #GivingTuesday is not a new giving platform, but a call to action to celebrate giving and encourage purposeful giving during the Holiday Season. It’s an organizing principle to encourage the creativity and energy of people all over the world to work for good.

    Please consider donating to CHA as a way to support our continual giving and service to our millions of California Medicare beneficiaries, their families and professionals advocating on behalf of the health care rights of elders.
    Thank you! And may you enjoy a wonderful season of giving and gratitude!
  • 18Nov

    Did you know it’s illegal for Medicare beneficiaries to use coupons for their Part D drugs? Most people don’t….but it is. Coupons are a way that drug companies can entice beneficiaries to use drugs whose copayment, let alone the full cost of the drugs, would otherwise be too expensive. This means Medicare is then footing the bill for these more expensive brand name drugs that without coupons beneficiaries wouldn’t use. They would instead use lower cost generics. Drug companies are supposed to use safeguards to ensure beneficiaries don’t use coupons to get these high cost drugs, but such efforts are lacking, according to a recent Office of Inspector General report (PDF). The OIG found that up to 7% of beneficiaries use coupons to purchase their drugs, which amounts to about 2 million people buying more expensive drugs than they would otherwise and hence racking up Medicare’s Part D drug tab.

    While beneficiaries are just doing what seems like a smart and legit way to get the drugs they require at a price they can afford, this coupon use is illegal and drug companies are most likely letting it go unchecked to protect and sustain their own profit margins.

    For more information, see:

    The OIG report, Manufacturer Safeguards May Not Prevent Copayment Coupon Use for Part D Drugs (PDF)

    The Wall Street Journal article, Did Someone say Kickbacks? HHS Warns About Medicare Part D Coupons

  • 12Nov

    Medicare’s annual open enrollment period, officially referred to as the Annual Election Period (AEP), is in full swing. It started Oct 15 and runs through December 7. During the AEP, Medicare beneficiaries can review their health coverage options for 2015 and make a change. If you are in a Medicare Advantage Prescription Drug (MA-PD) plan, you can either switch plans or return to Original Medicare and enroll in a stand-alone prescription drug plan and vice versa. All the 2015 data on MA and PDP plans are on the Medicare Plan Finder tool. You can search by zip code, and for Part D drug plans, you can also search by the best coverage for the drugs you take. See our webpage on the Annual Election Period for coverage tips, resources and common questions and answers.

    Medicare’s AEP from Oct 15 – Dec 7 is not to be confused with Covered California’s annual open enrollment period, which is from Nov 15, 2014 through Feb 15, 2015. Covered California is the name of the health insurance marketplace in California. If you have Medicare, you do not need coverage through Covered California. See the Covered California website for information on how to apply and FAQs.

    If you currently have a health plan through Covered California and will become eligible for Medicare in 2015, see our recently updated Frequently Asked Questions about Medicare and Covered California. It reviews what to do once Medicare eligible and important points to consider when reviewing your coverage options.

  • 05Nov

    Low Performing Plans (LPP) get one more year. LPPs, which are Medicare Advantage plans or prescription drug plans with overall ratings of fewer than 3 stars for 3 consecutive years, were supposed to be terminated as of Dec 31, 2014, but the Centers for Medicare and Medicaid Services (CMS) has decided to give them one more year.

    About 165,000 beneficiaries throughout the U.S. and Puerto Rico are in consistently low-performing plans and will receive a notice from CMS reminding them that they can switch to a higher performing plan during the Annual Election Period (AEP) between Oct 15 – Dec 7. If they miss the AEP opportunity, they still have a Special Election Period (SEP) to change to a plan with 3 or more starts in 2015. To use this SEP, beneficiaries must call 1-800-MEDICARE.

    Note that:

    • This is a one-time SEP for individuals enrolled in a plan indicated with the Low Performance Icon in the Medicare Plan Finder.
    • The SEP can only be effectuated by CMS.
    • All enrollments under this SEP are prospective (no retro-active enrollments).
    • Individuals may use the SEP to disenroll from Medicare Advantage (MA) into Original Medicare.
    • A Part D coordinated SEP exists for individuals to enroll in Part D if they select an MA Private-Fee-for-Service plan as long as they make that enrollment at the same time.

    Beneficiaries with questions about their plan choices can call their local Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222. HICAP provides free, individual and unbiased counseling on Medicare questions and ways to supplement Medicare.

  • 28Oct

    You get a letter in the mail, telling you about the new law that requires you to get a new health care card. Maybe you get a call offering you big discounts on a new health insurance plan. Or maybe someone comes to your house and says they’re from Medicare, and they need your Medicare number to issue you a new card.

    Scammers follow the headlines. It’s Medicare open enrollment time. That means if you have Medicare, you get new choices. It also means you have to keep an eye out for people trying to rip you off. That might be crooks trying to get your Medicare number, financial information or health insurance number. Their goal? To steal your identity or trick you into buying something you don’t need. Or it could be “bad apple” insurance agents trying to sell you a Medicare plan that makes them money and cheats you out of benefits you really need.

    Don’t let anyone trick you into making a bad decision. Take the time every year for a “check-up” on your Medicare choices during Open Enrollment. Make sure you talk with your Indian health care provider before making changes.

    About Medicare “Open Enrollment”

    Medicare offers “open enrollment” every year from October 15 to December 7. People with Medicare can make changes to Medicare Prescription Drug plans (Part D) or Medicare Advantage plans during open enrollment. (See our page on Open Enrollment, also referred to as the Annual Election Period, on our website.)

    Your situation may have changed after you signed up for Medicare. Maybe you take different medications. Maybe your doctor told you that you now have diabetes—or another new health problem. Maybe you moved to be closer to your family. Whatever the reason, the plan you signed up for last year may not be the best plan for you now.

    Or, maybe you didn’t sign up for a Part D prescription drug plan when you first could. You can switch plans during open enrollment each year or sign up for a new Part D drug plan or Medicare Advantage plan.

    For Native American beneficiaries, if you get your medicine from an Indian Health Service (IHS) or tribal pharmacy, chances are you have “creditable coverage.”  That means your prescription drug coverage is as good as Medicare requires. Yet, even if you get your medicine from your Indian health care pharmacy you might still need a Medicare prescription drug plan. The plan may help pay for medicine your Indian health care pharmacy cannot.

    If you didn’t sign up for a Part D plan when you were first eligible, you may have to pay a penalty to sign up now. But, if you’re Native American and had “creditable coverage” by your IHS or tribal pharmacy, that penalty may be waived.

    Part A & B Changes Come Later

    Medicare offers another enrollment period between January 1 – March 31 for Part A (hospital) and Part B (outpatient). So, if you didn’t sign up for Part A or Part B when you were first eligible there is still another chance. You might have to pay an extra fee for enrolling late. Some people might qualify for special exceptions.

    Things to Consider When Choosing a Plan

    1. The type of coverage you need. Does the plan let you see the doctors you want and go to the hospital you want? Does the drug plan cover the medicines you now take?

    2. The cost of the plan. Prices are different. Compare costs. Find out if you can get help paying for the plan if you have a low income through the Part D Extra Help program, or if you’re a Native American elder, from your tribe.

    3. The location. Can you go to the pharmacy you like? For Native American elders, if you plan to use providers outside of the Indian Health System, are they close to your home?

    You are not alone. Get help from family, Indian health care providers, from the Medicare website or from your local Health Insurance Counseling and Advocacy Program (HICAP).

    How to Protect Yourself during Open Season

    Take a minute to stop and think: Do you really have to get a new health care card? Is that cheap insurance a good deal? Is that “government official” really from the government? The answer to all three is almost always: No.

    Don’t let someone push you to make a decision right away. Take your time. Before you share your information, ask people you trust for help. Talk to your friends and family, check with your Indian health benefits coordinator if you’re a Native American elder, and do some research.

    Medicare Matters to Elders & Our Communities

    Medicare is health insurance for elders that offers peace of mind and protection. It saves you.

    For Native American elders,signing up for Medicare doesn’t take away your right to get care from your Indian health care provider. You can still use your IHS or Tribal provider or go to a non-Indian health care provider who takes Medicare. They will all bill Medicare for you.

    When you have Medicare and go to your Indian hospital or clinic, Medicare insurance helps pay. You help your Indian health provider and your tribe save money. That money can be used for the health needs of your family and friends.

    We need you to help preserve and protect this precious resource. We need you to help protect our communities and your neighbors.

    If you think someone is trying to scam you, report it. Then pass it on. Tell your friends and people in your community.

    Report scams, or bad agents to your California Senior Medicare Patrol. Call us at: 855-613-7080. SMPs help protect elders and communities and prevent Medicare fraud.

    This article was supported in part by grant No. 90SM0012 from the Administration on Aging (AoA), Administration for Community Living (ACL), U.S. Department of Health and Human Services (DHHS).

  • 14Oct

    Clinics scheduled in Stockton, Tracy, Lodi, Berkeley, San Jose, San Francisco, and Oakland

    One of our California Health Advocates board members, Rajul Patel and his pharmacy students at University of the Pacific’s Thomas J. Long School of Pharmacy & Health Sciences will be offering health clinics in 7 cities throughout Northern California this fall to help Medicare beneficiaries save on their prescription drug costs and better understand their medications. The clinics will also offer a variety of health care screenings and services.

    Now in its 8th year, Rajul and his students participating in Pacific’s Mobile Medicare Clinics have served a total of 2,911 Medicare enrollees and saved seniors and other beneficiaries more than $2.2 million on their out-of-pocket Medicare Part D prescription drug costs, for an average savings of $769 per person per year.

    This year’s clinics will be offered during the annual Medicare Open Enrollment period, Oct. 15th through Dec. 7, in 4 Bay Area cities – Berkeley, San Jose, San Francisco and Oakland – as well as 3 Central Californian cities – Lodi, Stockton and Tracy. (Dates and locations are listed below.)

    Trained pharmacy students will assist beneficiaries with Part D plan review and enrollment, determine if they qualify for additional government assistance to help lower their out-of-pocket medication costs, and explore other cost-savings opportunities.

    Attendees will also receive a comprehensive review of all of their medications and have all of their medication-related questions answered. Since the program’s inception, Pacific student pharmacists have identified 137 potentially severe medication-related issues among clinic attendees, including severe drug-drug interactions and sub-optimal drug therapy that warranted physician follow-up.

    Under the supervision of licensed pharmacists, the student pharmacists will also offer vaccinations, including the flu and pneumococcal vaccines; diabetes screening; and blood pressure, cholesterol and bone-density testing.

    All told, pharmacy students have held 73 clinics in 16 California cities since the program first began, volunteering a combined 9,072 hours of time.

    If you would like to have your Part D plan reviewed and/or have a comprehensive evaluation of your medication, please call for an appointment. Phone numbers for each clinic site are listed below.

    IMPORTANT: Beneficiaries attending the clinic should bring the following:
    • Their red, white, and blue Medicare card
    • All of their medications

    Bay Area clinics

    San Jose
    Oct. 26, Sunday, 10 a.m. – 5 p.m.
    Seven Trees Community Center, 3590 Cas Dr., San Jose
    Call for an appointment: (209) 946-7728

    Oakland
    Nov. 1, Saturday, 10 a.m. – 6 p.m.
    Allen Temple, 8501 International Blvd., Oakland
    Call for an appointment: (510) 343-2473

    San Francisco
    Nov. 9, Sunday, 10 a.m. – 6 p.m.
    Jewish Community Center of San Francisco, 3200 California St., San Francisco
    Call for an appointment: (415) 292-1200

    Berkeley
    Nov. 22, Saturday, 10 a.m. – 6 p.m.
    Ed Roberts Campus, 3075 Adeline St., Berkeley
    Call for an appointment: (510) 841-4776 ext. 3112

    Central Valley Area clinics

    Lodi
    Oct. 23, Thursday, 1 p.m. – 6 p.m.
    LOEL Center and Gardens, 105 S. Washington St., Lodi
    Call for an appointment: (209) 369-1591

    Nov. 11, Thursday, 1 p.m. – 7 p.m.
    Hutchins Street Square (Room: Kirst Hall), 125 S. Hutchins St., Lodi
    Call for an appointment: (209) 369-6921

    Stockton
    Oct. 17, Friday, 1 p.m. – 5 p.m.
    Franco Center, 144 Mun Kwok Lane, Stockton
    Call for an appointment: (209) 466-4697

    Oct. 18, Saturday, 10 a.m. – 6 p.m.
    University of the Pacific, 751 Brookside Road, Stockton
    Call for an appointment: (209) 946-7658

    Oct. 25, Saturday, 10 a.m. – 6 p.m.
    Harvest House, 1609 N. Wilson Way, Stockton
    Call for an appointment: (209) 477-0378

    Nov. 2, Sunday, 10 a.m. – 6 p.m.
    O’Connor Woods, 3400 Wagner Heights Rd., Stockton
    Call for an appointment: (209) 956-3400

    Nov. 14, Friday, 1 p.m. – 6 p.m.
    First Congregational Church, 3409 Brookside Rd., Stockton
    Call for an appointment: (209) 951-8545

    Nov. 20, Thursday, 1 p.m. – 6 p.m.
    Northeast Community Center, 2885 E. Harding Way, Stockton
    Call for an appointment: (209) 468-3918

    Tracy
    Oct. 28, Tuesday, 1 p.m. – 6 p.m.
    Tracy Community Center, 950 East Street, Tracy
    Call for an appointment: (209) 831-4230

    For general information about the program, visit go.pacific.edu/medicare or contact them at (209) 932-2958. See the pdf of the 2014 outreach schedule for a printable copy.

    This article is edited from a Sept 29, 2014 University of the Pacific press release.

  • 07Oct

    Fall Open Enrollment starts on Oct 15th and is the time of year when you can switch your Medicare health and drug coverage. Below are 3 points to guide you in reviewing your Medicare coverage and options AND tips to protect yourself from fraud. These points are taken from the Medicare Minutes program.

    Point 1: Understand your current coverage and how it may change to help protect yourself against Medicare fraud.

    If you choose not to act, membership in your Medicare plan—whether Original Medicare or a Medicare Advantage plan—automatically renews each year (unless you’re in a non-renewing MA plan — see our website section When Medicare Advantage Plans Terminate Coverage). Understanding your current coverage will enable you to make an informed decision about your coverage for 2015 and help you detect Medicare fraud. At the end of September, you should have received mail from your current plan about its 2015 coverage. This should have included information about changes to your plan’s list of covered drugs (formulary), health benefits, and/or premium costs. Plans are allowed to change their cost and coverage rules each year, so it’s important for you to read mail from your plan to see if there are any changes that affect you. If you did not receive this information, call your plan to request it. Keep the mail you receive from your plan and reference it throughout the year. It is a form of Medicare fraud if a plan promises coverage for services, items or drugs that it does not intend to cover – so review and keep your mail to protect yourself.

    Point 2: Match your needs with the appropriate health or drug choice.

    Fall Open Enrollment lasts from October 15 to December 7. For most people, it’s the only time of year to switch your Medicare coverage. Any changes you make during this time will take effect on January 1, 2015. Plans can change their cost and coverage rules annually, so the plan that worked best for you in 2014 may not be the plan that will work best for you in 2015. Even if you are satisfied with your current coverage, you should look at other Medicare options in your area to see whether you can meet your current health care needs at a lower cost. Comparing plans during Open Enrollment and understanding your options will enable you to better detect Medicare fraud when you hear or see something against the rules.

    Before comparing your options, make a list of health care providers you see, prescription drugs you take, and pharmacies you use. When comparing plans, look first at whether the plan covers all the drugs you take and/or has all of your doctors in its network. Then look at the plan costs (premiums, deductible, and copays) and check the plan’s star rating. Keep in mind that a plan that works well for your friend or relative may not work well for you.

    Point 3: Watch out for Medicare fraud.

    One of the most important ways to protect yourself from fraud is never giving out your personal information – including your Medicare or Social Security number – to anyone other than a trusted health care professional. If you do, someone may use it fraudulently. Fraudulent use of a Medicare or Social Security number includes enrolling you in a plan you don’t want during Fall Open Enrollment.

    During Fall Open Enrollment, you should also watch out for Medicare marketing fraud. All plans are allowed to send you mail. However, plans are not allowed to call you without your permission, unless the call is from an insurance company you currently use. All plans (including your current plan) are never allowed to e-mail or visit you in person without your permission. Giving out your number and address to a plan at a presentation or health fair gives the plan permission to follow up with you. However, a plan cannot enroll you in its product without your permission. If you suspect fraud – whether it is marketing or another form – you should call our California Senior Medicare Patrol (SMP) hotline at 855-613-7080.

    Remember to Take Action: Only provide your phone number or address if you want a plan to follow up with more information. If you do not want a plan to contact you for marketing reasons, do not give them permission to do so. Report any suspected fraud to our SMP at 855-613-7080.

  • 30Sep

    As humans, one of our most powerful ways of learning is through stories. It’s also one way to break down cultural bias’ and prejudices…by hearing other people’s stories and realizing our common humanness. One of our Social Security Public Affairs Specialists for Northern California, Deogracias Santos shares an article below on the “faces and facts” of people living with a disability, and some educational videos and resources available on the Social Security website.

    FACES AND FACTS TELL THE STORY OF DISABILITY

    By Deogracias Santos

    Social Security Public Affairs Specialist in the Northern Area

    November is Family Stories Month. Every family has stories—stories are a great way to carry on family legacies, pass lessons on to future generations, and share what is important to your family with the rest of the world. Your family stories may include ones about the birth of a child, serving in war, helping people in need, or the deaths of loved ones.

    We’d like to share some stories about what it means to receive disability benefits from Social Security. And we have a website that does just that: The Faces and Facts of Disability.

    Learning the facts and hearing people’s stories about disability allows for a fuller understanding of what is perhaps the most misunderstood Social Security program. The Social Security Act sets a very strict definition of disability. To receive disability benefits, a person must have an impairment expected to last at least a year or result in death. The impairment must be so severe that it renders the person unable to perform not only his or her previous work, but also any other substantial work in the national job market. Social Security does not provide temporary or partial disability benefits.

    Because the eligibility requirements are so strict, Social Security disability beneficiaries are among the most severely impaired people in the country and tend to have high death rates. In addition, Social Security conducts a periodic review of people who receive disability benefits to ensure they remain eligible for disability. Social Security aggressively works to prevent, detect, and prosecute fraud. Social Security often investigates suspicious disability claims before making a decision to award benefits—proactively stopping fraud before it happens. These steps help ensure only those eligible have access to disability benefits.

    If you want to learn more about what happens behind the scenes when someone applies for disability benefits, watch our seven-part video series on the process.

    Please read and watch some of the stories about real cases of people who have benefited from Social Security by visiting the Faces and Facts of Disability website.

    Family and personal stories are great ways to discover important truths.

  • 23Sep

    Did you know that although the U.S. comprises 5% of the world’s population, it holds 50% of pharmaceutical company profits? On a per capita basis, Americans spend about $1,000 per person each year on drugs. That’s approximately 40% more than the next highest spending country, which is Canada.

    There are a number of reasons why this spending imbalance is occurring and some of these are discussed in the PBS articles linked to below. Americans use more drugs and have more access to the newest drugs on the market. They also pay more for them. U.S. prices for brand-name drugs are 50% to 60% higher than in France and twice as high as what citizens of the United Kingdom or Australia pay. That’s because in many countries, government agencies essentially regulate the prices of medicines and limit the amount they will reimburse. There is also a technique called “pay for delay,” in which brand-name manufacturers pay generic manufacturers settlements to keep their competition from producing identical drugs. Another option drug manufacturers use is called “evergreening.” This strategy is to redirect the customer from the drug they are taking to another brand drug the same company is making in an effort to keep them from purchasing the generic alternative

    See the PBS Newshour articles below for more information on why Americans spend so much more on pharmaceuticals than citizens in other democratic countries.

  • 10Sep

    In light of Women’s Equality Day on August 26th, one of our Northern California Social Security Public Affairs Specialists, Deogracias Santos published a short and informative article on some things women should know about Social Security and how to make the most of their entitled benefits. Enjoy and read below!

    WOMEN AND SOCIAL SECURITY

    By Deogracias Santos,

    Social Security Public Affairs Specialist in the Northern Area of California

    Women’s Equality Day is August 26, and this is the perfect time to remind you how much Social Security values and appreciates women. Even though men and women with identical earnings histories receive the same benefits, there are things women in particular should know about Social Security. There are trends and differences in lifestyle and patterns of earnings that can affect benefits.

    For example, some women may be caregivers for many people: spouses, children, and parents. Taking time away from the workplace to care for a newborn child, ailing spouse, or aging parent can have an impact on your future Social Security benefits.

    Also, despite significant strides through the years, women are more likely to earn less over a lifetime than men. In addition, women are less likely than men to be covered by private retirement plans, so they are more dependent on Social Security in their retirement years.

    Did you know that women tend to live on average about five years longer than men? This means more years depending on Social Security and whatever other retirement income or savings they accumulate.

    If a woman’s spouse earns significantly more than she does, it is very possible she will qualify for a larger benefit amount on the spouse’s record than on her own. To learn more, visit our Women’s page at www.socialsecurity.gov/women and read, print, or listen to our publication, What Every Woman Should Know.

    You may also be interested in listening to Carolyn Colvin, Acting Commissioner of Social Security, on National Public Radio as she talks about women and money. Just visit www.npr.org/2014/04/15/301782870/social-security-chief-women-live-longer-so-they-should-save-early.

    To celebrate Women’s Equality Day, learn how Social Security treats men and women equally by visiting www.socialsecurity.gov/women.

     

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