CHA Blog

Medicare is the United States’ first universal health care system for people 65 and older and some people younger than 65 with a disability. Dr. John R. Burton, Professor at Johns Hopkins University, recently wrote an interesting piece on lessons Medicare can offer us in terms of national health care reform. 

Mr. Burton reflects that “Medicare eliminated the fragmented, episodic and often dehumanizing care that many retired seniors were forced to seek through emergency departments or charitable sources because they no longer had coverage from an employer.” Medicare’s implementation “increased the demand for primary care from physicians in private practice,” and as beneficiaries then had access to comprehensive primary care, ” overall health care quality went up, and average per-patient costs went down.”

Read Dr. Burton’s full article, “Medicare Offers Lessons on National Health Care Reform.”

See our section on Medicare Basics for information on the Medicare program.

Below is a summary of Medicare’s Part D prescription drug program costs for 2010.

See our Prescription Drugs section for more information on Medicare Part D.

For the ‘standard’ Part D plan:

• Annual Deductible: $310 (Beneficiaries who do not qualify for the low-income subsidy (LIS) must pay 100% of drug costs until they reach the deductible)
• Initial Coverage Period: drug costs between $310-$2,830 (Beneficiaries must pay 25% of their drug costs, which is $630, and their Part D plan pays the other 75%)
• Coverage Gap – Donut Hole: drug costs between $2,830 – $6,440 (Beneficiaries pay 100% of their drug costs, totaling $3,610)
• Catastrophic Coverage: drug costs >$6,440 (Beneficiaries pay the greater of either 5% of their drug costs or a copayment of $2.50 for generics and $6.30 for brand name drugs; their Part D plan pays the other 95%)

The total true out-of-pocket (TrOOP) costs before catastrophic coverage kicks in for 2010 is $4,550 ($310 + $630 + $3,610)

People who qualify for the full low-income subsidy (LIS) will have drug copayments of $1.10 and $3.30 for generics and brand name drugs respectively. People who qualify for the partial LIS will have copayments of $2.50 for generics and $6.30 for brand name drugs.

The national average premium for 2010 is $31.94.

The California benchmark plan premium is $28.99. Benchmark plans are Part D plans with monthly premiums below the California average. Beneficiaries who qualify and have the full LIS do not pay a premium or deductible if they enroll in a benchmark plan; they are, however, still responsible for paying their drug copayments. 

Beneficiaries with the LIS who enroll in a Part D plan with premiums higher than the benchmark must pay the difference between the subsidy ($28.99 in 2010) and the plan’s premium.

See our section on Prescription Drugs for more info.

While having health care insurance, such as Medicare, plays a major role in helping people successfully manage or recover from chronic illness or disease, having the support of family members also plays a valuable and crucial role. Family may be one’s spouse, or children or other relatives who many live nearby or far away in another state or country. Regardless, a variety of family intervention programs are available. The California HealthCare Foundation recently published a report that draws together a broad range of research findings, case studies, and resources to assist patients, their families, and health care providers to maximize the benefits of family involvement in chronic care support. 

The report highlights 3 examples of such family intervention programs: 

• A couple-oriented education and support program focused on setting goals for osteoarthritis self-help and care; 
• A program that covers communication techniques to support the autonomy of patients with heart failure; and 
• A technology-enabled program for people with heart failure that helps distant family members monitor their relative’s symptoms and test results. 

These programs are a sampling of strategies for handling challenges, improving communications, and maximizing the benefits of family involvement in chronic illness care. 

Click here to download the report (pdf).

California’s older adults and people with disabilities who qualify for state-funded adult day health care (ADHC) may be some of the hardest hit from the recent state budget cuts. Governor Schwarzenegger signed the budget revisions last week that reduces the amount of days covered for adult day health care from 5 to 3 days per week. In addition, the budget revision eliminates funding for Alzheimer’s disease programs.

These cuts pose a significant challenge for many families who may not be able to afford private caregivers. They also create a paradox, as the cuts may, in the long-term, end up costing the state much more money. Adult day health care services help many people continue living at home in their communities, versus living in an institutional setting like a nursing home. With a 40% cut in services, many beneficiaries have to move into an institutional setting, costing the state more than twice the amount of money per person for each day of care. For example, Medi-Cal, California’s Medicaid program pays $76.50 per day for ADHC services, compared with $170 to $200 per day for nursing home care. 

For updated information on the California budget, see:

• California Department of Finance
• California Disability Community Action Network
• Health Access

For information on Medi-Cal and long-term care, see:

• our section on Medi-Cal 
• our section on long-term care