JustCare

Category: Health conditions

  • Dental care is increasingly unaffordable

    Dental care is increasingly unaffordable

    The cost of dental care has become prohibitively expensive for the vast majority of Americans. In a new study by Synchrony, more than nine in ten Americans say that they would consider putting off getting dental care because of the cost, reports Pete Grieve for Money.

    Medicare does not cover dental care. And, people with Medicare should note that when Medicare Advantage plans offer dental benefits , the benefits tend to be extremely limited. As a result, many people in Medicare Advantage plans that claim to offer dental benefits are still not able to get dental care. In some cases, there are only a small number of in-network dental providers and it can be hard to see them. In other cases, the out-of-pocket costs for dental care are limited and unaffordable. Do not join a Medicare Advantage plan because of its dental benefits before checking closely to see what those benefits are.

    Note: Even though Traditional Medicare does not cover dental care, people in Traditional Medicare get dental care at the same rate as people in Medicare Advantage plans.

    The problem in getting dental care for most people is the cost; the price of dental care keeps rising, faster than inflation. Dental care costs are up 5.6 percent this year. The American Dental Association Health Policy Institute claims that costs are up because supplies and materials cost more, as do lab fees and labor.  It wold not be surprising if private equity firms buying up dental practices are driving up dental costs as well.

    The Synchrony researchers found that more than half (58 percent) of the 1,335 respondents surveyed said they could not afford dental care, even though many of them had dental insurance. Of course, when people do not have dental insurance,  it’s all the harder for them to afford critical dental care.Three in four people without dental coverage said they could not afford dental care.

    For the typical adult between 20 and 79 years old, dental insurance can cost as much as $51,000 during a lifetime. In addition, if people need dental implants or other complex dental care, dental procedures can cost tens of thousands of dollars.

    Consequently, 92 percent of adults studied said they were thinking about holding off getting dental care because of the cost. Even for emergency dental care, more than four in five adults (83 percent) were thinking about not getting care.

    The older you are, the harder it is to afford dental care. Two in three older people said that dental care was unaffordable as compared to 51 percent of young adults.

    Here’s more from Just Care:

  • Family caregiving: Costly, lonely and stressful work

    Family caregiving: Costly, lonely and stressful work

    Most Americans want to grow old in their homes, where they are most comfortable, not in a facility. But, because the US does not support paid caregiving, which is extremely costly, the job generally falls to family caregivers, which is challenging financially, emotionally and logistically. Michelle Cottle writes an opinion piece for The New York Times on the costly and too often lonely job of family caregiving.

    With little if any help, about 42 million Americans care for an aging person, 50 and older. That is challenging work emotionally and financially. Because the US is an aging nation, more Americans will find themselves as unpaid caregivers needing support.

    By AARP’s projections, unpaid family caregiving amounts to some $600 billion of free services in 2021. A lot of caregiving time can be spent commuting. The cost of not being able to work fulltime or at all drives some caregivers into bankruptcy. Caregivers forego a projected $522 billion a year in income.

    Typically, 25 percent of caregivers’ income goes to helping with expenses of the people they are caring for, such as home modifications, medical bills and housing.

    The stress too often causes declines in health, both mental and physical. Studies show that caregivers are more prone to suffer from depression and cancer and are more likely to die younger than people who are not caregivers.

    We have no system in place to train caregivers to undertake their myriad responsibilities. As the health care system evolves and creates additional burdens on individuals, caregivers often must assume responsibility for providing treatment to their loved ones, such as caring for wounds, administering injections and taking care of IV lines. They must also tackle the myriad health insurance obstacles to care and coverage, generally without assistance.

    Caregivers need to take a rest periodically. But, the cost of hiring caregivers can be extremely high. And, paid caregivers are few and far between in many communities.

    The Biden Administration planned to invest $400 billion in strengthening home care, providing training for caregivers and ensuring they are paid well enough to want to take on the responsibilities. But, Congress ended up cutting these provisions out of the Build Back Better bill in 2022. The President’s current budget proposal calls for $150 billion in Medicaid home care services, but Republicans are unlikely to support it.

    There are bills in Congress to support states in building a corps of trained caregivers. But, the cost of hiring caregivers is generally prohibitive. Medicare does not cover caregiver services except in very limited situations for short periods of time, under its home health benefit. It only covers care for people who are homebound and need skilled nursing or therapy services on an intermittent basis. And, even when it provides coverage, it is extremely limited, perhaps 12 hours a week.

    Medicaid sometimes does pay for caregiving services. But, to qualify, in most states, you can have no more than $2,000 in assets (the value of your home and car are excluded). Moreover, many people with Medicaid are on long waitlists to get caregiving services at home.

    Some states, such as Washington State, have their own long-term-care insurance program. Maine has a pilot program. About a quarter of the states have some paid family and medical leave or allow workers to use some of their sick time for caregiving.

    Here’s more from Just Care:

  • If you need long-term care services, how will you get them?

    If you need long-term care services, how will you get them?

    The majority of older adults will need long-term care services at some point. But, caregiving costs for older adults are super high, stemming from significant labor and facility costs, along with high demand. If you need long-term care services, how will you get them?

    More and more people are looking for adult day care, assisted living facility care and nursing home care. For many of them, relying on volunteer caregivers, such as friends and family, is not possible. But, the cost of paid care is prohibitive, swallowing up years of savings quicly. Caregiving costs increased more than 20 percent between 2012 and 2019 and continue to rise.

    Medicare does not pay for long-term care services. At best, Medicare will cover 100 days in a rehab facility or nursing home for people who need daily skilled nursing or therapy services. And, most Medicare Advantage plans inappropriately deny coverage for rehab and nursing care beyond a few days.

    But, a stay in a rehab or nursing facility can cost thousands of dollars if you have to pay out-of-pocket. The average cost of a nursing home stay is now more than $9,000 a month. The average cost of a stay in an assisted living facility is more than $4,500 a month.

    Caregiving costs are a lot higher in some states than others. In Massachusetts, average costs for a nursing home stay can be more than $15,000 a month. An assisted living facility stay can cost well over $8,000 a month.

    More than four in five households with someone over 65 need some type of care. Almost a quarter of them have significant care needs, including round the clock care. Almost two in five need help, though not round the clock. Only about one in five of them need minimal care, such as help getting groceries and cooking.

    Here’s more from Just Care:

  • Every American needs a primary care doctor

    Every American needs a primary care doctor

    The National Academies of Sciences, Engineering and Medicine (NAS) just released a report urging that the federal government invest heavily in primary care as part of its public health infrastructure. Every American should have a primary care doctor. Will the Biden administration act on the NAS’ advice?

    The NAS describes primary care as a “public good,” much like public education. Primary care practices generally include physicians, nurse practitioners and mental health providers.

    The report’s authors want every American to either choose a primary care provider or have them assigned one by their insurer or employer. At the same time, the authors recognize that primary care is withering in the US.  COVID-19 took a toll on the already weak primary care infrastructure in place in the US. Many primary care practices were forced to lay off staff or, worse still, close down.

    The report’s authors want major government investment in primary care and recommend that Medicare and Medicaid pay primary care providers more and specialists less. They believe that the US will not have a strong health care system without a strong primary care infrastructure. It is critical for improving population health, for saving money and for keeping people from dying prematurely.

    When you have good primary care, you are more likely to detect health issues early. You are more likely to have good care management and coordination. Having a primary care provider also promotes continuity of care. And, that in turn makes it easier for people to get needed care.

    Other wealthy and middle-income countries invest far more heavily in primary care than the US. In the US, primary care represents about $1 in every $20 in health care spending. Other wealthy nations invest nearly three times that in their primary care infrastructure.

    Here’s more from Just Care:

  • Plan ahead for a hospital visit: Talk to the people you love about these seven important items

    Plan ahead for a hospital visit: Talk to the people you love about these seven important items

    Few of us think about preparing in advance for a hospital visit, for someone we love, let alone ourselves. But, eventually, most of us will make a visit as a caregiver or a patient. Talking to the people you love about their needs while they are in relatively good health can ease the stress and reduce the costs of these hospital stays, particularly in emergencies. Here are seven important ways to prepare:

    1. Identify someone you trust to serve as your “health care proxy”–someone who can speak for you about your health care wishes if you are unable to speak for yourself. Make sure the person you choose as your proxy knows and talk to the person about the kind of care you want. Ideally, you should complete a an advance directive, which includes a health care proxy document (available for download for free here) and give a copy to your proxy or tell your proxy where to find it. You should give a copy to your doctor as well.  Here’s more information on the importance of a health care proxy.
    2. Ask a family member or someone else you trust to be your health care buddy and agree to accompany you to the hospital and stay with you if you are hospitalized. A second set of eyes and ears can be critical to your well-being.
    3. Make a list of your medications and your doctors. You should keep the list in your phone or your wallet and share the list with your health care proxy and family members.
    4. Decide which ambulance company will be called if needed. Make sure you have the phone number of a Medicare-approved ambulance company on hand or, if you are enrolled in a Medicare Advantage plan, the name and number of an in-network ambulance company. Here are two ways to make sure Medicare covers ambulance services.
    5. Decide which hospital you want to use. If you are not enrolled in traditional Medicare, make sure the hospital is in your network and that it gets a good rating for patient safety. Talk to your doctor about your choice. Here’s more information on choosing a hospital.
    6. Make sure you know what to bring with you to the hospital and what you should leave behind, such as valuables. Here’s a good checklist.
    7. Before you leave the hospital, make sure you have a written discharge plan, along with a phone contact at the hospital, schedule a follow-up appointment, and make a list of any new medications. Here’s a good checklist.

    Here’s more from Just Care:

  • Free local resources to help older adults

    Free local resources to help older adults

    If you’re looking for free local resources to help older adults, your local Area Agency on Aging is a great place to begin. Area Agencies on Aging (AAAs) develop, coordinate and deliver aging services throughout the country. They serve people over 60 at every income level. In fact, they help more than eight million people a year with long-term care choices, transportation options, benefits information and caregiver issues. You can find them in almost every community.

    Most Area Agencies on Aging are also Aging and Disability Resource Centers (ADRCs). ADRCs provide a hub for information on long-term services and supports to help older adults, their caregivers and families; they work to ensure that older adults are better able to live alone in their homes for as long as possible. They are government agencies that work to meet people’s long-term care needs.

    To contact your local Area Agency on Aging for free local resources for older adults or simply to understand available benefits, call the Eldercare Locator 800.677.1116. The Eldercare Locator is a program of the Administration on Community Living. You can also visit the website at www.eldercare.gov.

    LeadingAge, an association of 6,000 community-based non-profit organizations in the U.S., offers another great resource. It has developed on online tool to help you locate non-profit agencies, agencies that “put people before profits,” that provide services and living facilities for older adults.

    By entering a zip code or city, LeadingAge’s Aging Services Directory will let you know about non-profit resources in the community. You can choose from a list of 18 resources, including nursing, transportation, home-delivered meals and dementia care. You can also learn about retirement communities, assisted living, and subsidized housing.

    And, if you need help navigating Medicare, you should contact your State Health Insurance Assistance Program or SHIP.  For the number of the SHIP in your area, click here. Or, for free help, call the Medicare Rights Center national hotline at 800-333-4114.  For other free and low-cost services for older adults, check out Just Care’s Get Help page.

    Here’s more from Just Care:

  • Older adults are far more likely to die from the flu

    Older adults are far more likely to die from the flu

    A new CDC study provides yet another reason for older adults to get the flu vaccine. Specifically, it finds that the older you are the more you should be concerned about getting the flu. It also finds that the oldest Americans are far more likely to end up in hospital and die from the flu than younger Americans.

    The 46 million people over 65 experience about nine in ten flu-related deaths and at least half of flu-related hospitalizations. The likelihood of risk increases for people after 65, when they become frailer and less functional. Medicare covers the flu shot in full as part of its package of preventive care benefits to protect older adults from contracting the flu.

    Researchers looked at health outcomes for 19,760 people age 65 and older. They found that people 85 and older were at least twice as likely to be hospitalized and as much as six times more likely to be hospitalized as people between 65 and 74. The greatest likelihood of hospitalization came during the height of the flu season.

    The likelihood of flu-related death or transfer to hospice, end-of-life care, is greater for older people living in nursing homes and other congregate care facilities as well as for people with neurologic disorders, cardiovascular disease, renal disease, chronic lung disease, and immunosuppression. People with asthma, who got the flu shot, and who received antiviral therapy were less likely to die or be hospitalized.

    People over 85 were also far more likely to develop pneumonia and die or go into hospice care (8.7 percent) than people 65-74 (3.8 percent.) People over 85 were less likely to have fever and other flu symptoms, so testing is important.

    The high-dose and adjuvented influenza vaccines may be helpful in preventing flu for older adults.

    Here’s more from Just Care:

  • Could you pay more in Medicare Advantage than traditional Medicare?

    Could you pay more in Medicare Advantage than traditional Medicare?

    Many people with Medicare opt for a Medicare Advantage plan, a commercial insurance plan that contracts with Medicare to deliver Medicare benefits, because they believe it will save them money over traditional Medicare. But, you could pay more in a Medicare Advantage plan than traditional Medicare.

    These days, the Trump Administration makes the commercial Medicare Advantage plans look more enticing than ever. The message is “All the benefits of Medicare and more.” But, what does that really mean and what do you trade away?

    It’s not at all clear that you will spend less for your care in a Medicare Advantage plan. According to the Kaiser Family Foundation, average out-of-pocket costs for people with Medicare in 2013 were $5,503 (41% of the average individual’s Social Security annual income.) Kaiser’s analysis does not distinguish between people in traditional Medicare and people in Medicare Advantage plans. The Medicare Advantage plans don’t disclose this data.

    Why don’t the Medicare Advantage plans reveal this data? What are they hiding? Are people spending more out-of-pocket than their advertisements suggest? If people are spending as much or more in Medicare Advantage plans as in traditional Medicare, it is hard to believe many people would opt for a Medicare Advantage plan and restrict their access to doctors.

    If people are paying less out of pocket in a Medicare Advantage plan than in traditional Medicare, it may be because they are not getting the care they need, delaying or skipping care. They may choose to go without care to avoid paying the deductible and copays. Or, their Medicare Advantage plan may not authorize care they need. Since the data is not available, we don’t know whether the cost of getting care in a Medicare Advantage plan or the health plan’s refusals to cover care is affecting people’s health and well-being.

    The data do show that people who need costly services disenroll from Medicare Advantage plans when they can and switch to traditional Medicare at far higher rates than people in good health. Unfortunately, the cost of Medicare supplemental insurance or, in some cases, the lack of access to supplemental coverage, can be a barrier to enrollment in traditional Medicare. Congress needs to fix that as soon as possible.

    Here’s more from Just Care:

  • Commercial health insurance fails to protect people from financial ruin

    Commercial health insurance fails to protect people from financial ruin

    People not yet eligible for Medicare are generally expected to “pick the commercial health insurance that is right for them.” The clear implication is that they could easily pick commercial health insurance that is wrong for them. Given that most people have poor health plan choices, it is likely that they often do pick coverage that does not meet their needs. Margot Sanger-Katz reports for the New York Times on a new survey of nearly 1,500 Americans with costly health care needs, revealing that commercial health insurance too often fails to protect people from financial ruin.

    Commercial health insurance no longer offers financial security to most people needing costly health care. Even with insurance, it is easy to deplete one’s savings. More than one in three people surveyed who had costly health care needs spent the majority, if not all, of their savings on health care–deductibles, copays and uncovered services. To be clear, about 40 million Americans have complex conditions requiring significant amounts of health care.

    The unfortunate reality is that this inadequate coverage costs too much, and health care costs keep escalating. A new Kaiser Family Foundation report shows that the typical employer is paying about $14,100 on family health care coverage for each worker. This money would otherwise be going to workers’ wages. In addition, workers are paying a greater amount for their coverage, $5,550, on average, up 65 percent from ten years ago.

    Deductibles have increased as well. They are more than triple what they were in 2008. In 2008, they averaged $433, while today they average $1,350 a year.

    People without health insurance face even more dire financial predicaments than people with insurance. But, insurance does not provide the protection from financial risk that you might assume, especially for people who need a lot of care. And, because commercial insurers do not have to provide you with information about what they will pay for, the amount they will pay, and what you are responsible for, people cannot budget for their care.

    More than four in ten people surveyed faced large out-of-pocket costs for their hospital stays. And, more than one in four people reported that their insurer did not cover treatments their doctors recommended.

    A majority of people needing costly care are forced to stop working or to work less. Their decreased income only aggravates their financial well-being. Family and close friends may also suffer financially. Nearly one in four people surveyed, 23 percent, reported that friends and family experienced financial challenges as a result of caring for someone in poor health.

    In short, our health care system forces people to make choices no one should have to make–among health plans that are expensive and may not meet their needs and, when they get sick, between basic necessities, such as food and health care.

    Medicare for All, federally administered health care, an improved and expanded traditional Medicare, is the only realistic way to bring down health care costs and the best way to guarantee everyone in America good, affordable cradle to grave coverage. If you support Medicare for All, please sign this petition to Congress.

    Here’s more from Just Care:

  • For-profit nursing homes more likely to deny residents hospice care at the end of life

    For-profit nursing homes more likely to deny residents hospice care at the end of life

    A new study published in the Journal of American Medical Directors Association finds that for-profit nursing homes are increasingly offering their most vulnerable residents high-cost therapy at the end of life rather than hospice care. If someone you love is terminally ill in a nursing home, you may want to speak with the nursing home about different treatment options.

    Because hospice care provides comfort at the end of life and does not involve curative treatments, nursing homes make far less money on providing hospice care to their residents than other treatments such as physical therapy. Not surprisingly, researchers found that for-profit nursing homes in particular tend to steer away from delivering hospice care. Rather, these nursing homes provide a large number of therapy services—high volume at great intensity—to their dying residents, which generates more income.

    Over the last few years, a number of studies have found that for-profit nursing homes may not be providing as good care as non-profit nursing homes. A Kaiser Family Foundation report highlighted the many issues with chain nursing homes, which people should beware of. Another study found that Medicare Advantage plans were more likely to steer their patients to for-profit chain nursing homes. Yet another study revealed that Medicare’s nursing home ratings can be misleading and that you should not assume a five-star rating means good care.

    The JAMDA researchers studied care provided to nursing home residents in New York State in the 30 days before they died. There is every reason to believe that nursing homes in other states behave similarly to those in New York. The financial incentives are identical.

    Here’s more from Just Care: