JustCare

Tag: Medicare Part D

  • One third of Social Security benefits spent on Medicare costs

    One third of Social Security benefits spent on Medicare costs

    An October 2017 Center for Retirement Research paper looks at the amount retirees spend on health care out of pocket as compared with income. It finds that Medicare out-of-pocket costs are so high that retirement income for many is inadequate, threatening people’s retirement security. Typically retirees spend one third of their Social Security benefits on Medicare out-of-pocket costs.

    Based on 2014 data, researchers found that, on average, retirees spend $4,274 a year out of pocket on medical and hospital care. Almost $3,000 is spent on premiums. Costs for long-term care are in addition to these costs. But, Michelle Andrews of Kaiser Health News reports that the researchers did not find a significant increase in average out-of-pocket spending when long-term care is factored in.

    Researchers further found that about 20 percent of a typical retiree’s income goes to Medicare out-of-pocket costs. And, almost one in five of retirees (18 percent) were left with less than half of their Social Security checks after paying for Medicare costs. Six percent of them were left with less than half of their total income, including Social Security benefits.

    That said, the researchers also found a $426 reduction in out-of-pocket spending in 2014 from 2004. In 2004, it averaged, $4,700. This drop is most likely attributable to the introduction of the Medicare Part D prescription drug benefit.

    In short, we need to expand Social Security if we want to ensure retirees can make ends meet and keep them from falling into poverty. Their situation could get even worse by 2020, when Medicare spending is projected to increase.

    If you want Congress to expand Social Security benefits, please sign this petition.

    Here’s more from Just Care:

  • Medicare Open Enrollment: Consider changing health plans

    Medicare Open Enrollment: Consider changing health plans

    Medicare Open Enrollment begins on October 15 and runs through December 7. During this time, it’s wise to take a hard look at your Medicare options for next year. Your health coverage may be changing and, you should consider changing Medicare health plans.

    If you’re enrolled in a Medicare Advantage plan or a Part D drug program, look at how your current plan is changing and your 2018 options. You may want to switch plans. Health plan costs and benefits often change significantly from one year to the next. Although it’s hard to know whether a health plan will meet your future health care needs, you may be able to save money by switching.

    You should know that after the open enrollment period ends, if you are enrolled in a Medicare Advantage Plan and would like to disenroll and switch to traditional Medicare, you can do so between January 1 and February 14. To learn more and get free advice, call your State Health Insurance Assistance Program at 800-677-1116.

    Before you make your choice, keep these facts in mind.

    • Traditional Medicare:
      • Traditional Medicare, the government health insurance option, is the Medicare health plan choice for seven out of ten people with Medicare.
      • Traditional Medicare offers coverage from almost all doctors and hospitals anywhere in the country.
      • Traditional Medicare charges a deductible—the amount you pay before coverage begins–and coinsurance for most of your care.
      • Supplemental insurance—Medicaid, retiree coverage from a job or a Medicare supplemental insurance plan you can buy–generally fills most or all coverage gaps. If you’re in traditional Medicare, be sure you have supplemental insurance, which protects you from catastrophic costs and allows you to budget for your health care.
    • Medicare Advantage plans:
      • Commercial health plans that contract with Medicare
      • Medicare Advantage plans generally limit coverage to a small group of doctors and hospitals in your community—the provider network–except in emergencies or urgent care situations. The provider network can change at any time with doctors and hospitals leaving and entering the network.
      • Medicare Advantage plans often charge an additional premium, a deductible (the amount you pay before coverage begins) and a copay or coinsurance, with each health care visit. These costs can change from one year to the next. You cannot buy insurance to fill these coverage gaps.
      • Medicare Advantage plans can be less costly than traditional Medicare if you see doctors in the network and do not have a complex condition requiring substantial health care services.
      • When people need costly services, Medicare Advantage plans may restrict access to the doctors and hospitals people want to use, and out-of-pocket costs can easily reach the $6,850 limit for in-network care. These costs can be even higher if people are hospitalized and are forced to use out-of-network doctors, a fairly common phenomenon, or if people want to use specialists out of network.

    If you’re in a Medicare Advantage plan now:

    • Check your health plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays. If those are good with you, also check to make sure your doctors and hospital are still in the network.
    • It’s also wise to look at your other health plan options, including traditional Medicare. One of those options may better meet your needs. You can call your State Health Insurance Program or SHIP for help sorting through your options. You can also call 1-800-633-4227 (1-800-Medicare) or use this Medicare tool to understand your options.
    • Before making a switch to another Medicare Advantage plan, call the plan to confirm your understanding of costs and network doctors and hospitals.
    • If you do want to switch to another Medicare Advantage plan, call 1-800-633-4227 (1-800-Medicare) to let Medicare know about your decision.
    • If you are unhappy with your Medicare Advantage plan choice, you have the right to disenroll any time between January 1 and February 14 and switch into traditional Medicare.

    If you have a Medicare Part D prescription drug plan:

    • Check your Part D drug plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays or coinsurance. If those seem good to you, check the costs for the drugs you’re taking.
    • It’s wise to look at other drug plan options. You might find a plan that covers your drugs at lower cost. Medicare offers a tool for comparing drug plans based on your drug needs.

    If you decide to switch plans, your new coverage will begin on January 1.

    Here’s more from just Care:

  • Senate bill would empower Medicare to reduce drug prices

    Senate bill would empower Medicare to reduce drug prices

    Today, Medicare covers prescription drug costs under Part B–drugs that are generally administered at a hospital or in a doctor’s office–and  Part D–drugs that are self-administered. And, Medicare pays whatever price pharmaceutical companies charge for their drugs because Congress forbids Medicare from negotiating drug prices. Now, Senator Amy Klobuchar has introduced a bill which would empower Medicare to reduce drug prices.

    The price of prescription drugs has been rising rapidly in large part because there is no free market for drugs. The FDA approves drugs based on select evidence, without knowledge of their price or clinical effectiveness as compared with other drugs already on the market. Drug companies effectively have monopoly power to set prices for their patented drugs for as long as they can keep them patented. Doctors are free to prescribe these drugs regardless of their clinical benefits or costs. And, Congress requires Medicare to cover them, even without evidence of their clinical benefits relative to less costly drugs on the market.

    Klobuchar’s bill is aimed at introducing some competition into the prescription drug marketplace through Medicare drug price negotiation. In early 2017, Klobuchar introduced legislation with John McCain to allow people to import drugs safely from Canada. She has also introduced bi-partisan legislation with Senator Charles Grassley that would keep Pharma from paying generic drug companies from delaying manufacture of their drugs as generics for lower cost, “pay for delay.” And, she has introduced bi-partisan legislation with Senator Mike Lee, Creating and Restoring Equal Access to Equivalent Samples (CREATES) to allow drug companies to sell drugs in the U.S. that they have sold abroad for at least 10 years when there is little or no competition for the drug in the U.S.

    Thirty-one senators are co-sponsoring Klobuchar’s Medicare drug price negotiation bill, including Chuck Schumer, Patty Murray and Tammy Baldwin.

    If you want Congress to rein in drug prices, please sign this petition.

    Here’s more from Just Care:

  • ACA repeal means higher costs for people with Medicare

    ACA repeal means higher costs for people with Medicare

    There has been a lot of focus on the implications for working people of the Republican leadership’s plan to repeal the ACA. Precious little has been written about the consequences for older adults and people with disabilities. According to the Kaiser Family Foundation, ACA repeal means higher costs for people with Medicare–higher premiums, deductibles and copays.

    While the ACA primarily is designed to provide affordable coverage to people not yet eligible for Medicare and without employer coverage, it also strengthens Medicare in a variety of ways, bringing down out-of-pocket costs for enrollees and extending the life of the Trust Fund:

    • It expands coverage under the Medicare Part D drug benefit. In 2017, the ACA ensures that the millions of people with high drug costs–with total drug costs of more than $3,700–are not responsible for the full $1,250 of their drug costs before the Medicare Part D catastrophic cap kicks in at $4,950 in drug costs. Instead, people are only required to pay 40 percent of the cost of their brand-name drugs and 51 percent of the cost of their generic drugs. And, if this ACA protection remains, the amount they pay in the coverage gap or “donut hole” will continue to shrink to 25 percent of their drug costs by 2020.
    • It requires that many Medicare preventive care services be covered in full, without a deductible.
    • It extends the life of the Medicare Trust Fund by 12 years to 2029.

    The Congressional Budget Office estimated in a June 2015 report that if the ACA were repealed, it would add $802 billion to Medicare’s costs over the ten-year period ending in 2025. The ACA reined in payment rates under both traditional Medicare and Medicare Advantage plans. Specifically, it reduced some provider payments in traditional Medicare. And, it reduced overpayments to Medicare Advantage plans so that they are no longer 14 percent higher than average per person costs under traditional Medicare, as they had been.

    Because enrollees are responsible for 25 percent of the Medicare Part B premium, if Medicare’s costs rise, so does the Part B premium.

    The ACA also imposes an extra payroll tax and tax on investment income for people with high incomes to help offset the cost of additional benefits. And, it imposes annual fees on health insurers. If those taxes were repealed, the program would lose $631 billion.

    If you want Congress to keep its hands off Medicare, sign this petition.

    Here’s more from Just Care:

  • Your Medicare costs in 2017

    Your Medicare costs in 2017

    Most people don’t realize that Medicare only covers about half of a typical person’s total health care costs. On average, people with Medicare spend about $5,000 a year on health care costs Medicare does not pay for. And, people needing long-term care services and supports can pay a lot more for their care each year. What are your Medicare costs in 2017?

    Your predictable Medicare costs–premiums and deductibles–depend upon your income, whether you enroll in traditional Medicare or a commercial Medicare health plan (click here to learn the difference), and the health care you need.

    Whether you’re enrolled in traditional Medicare or a commercial Part C Medicare health plan, you must have Medicare Part A and Part B to get hospital and medical coverage. You will have coverage for most preventive care services as well as virtually all medically reasonable and necessary services (except vision, hearing and dental services). Here’s what you’ll pay for them:

    • Most people who have worked at least 40 quarters or whose spouse has worked at least 40 quarters get Medicare Part A for free. If you need to purchase Part A, which covers inpatient care, you’ll pay up to $413 each month. 
    • Medicare Part B premium is $109 a month for about 70 percent of people, but some people with annual incomes under $85,000 pay $134.00. You will pay $134 a month if you’re not receiving Social Security benefits, enrolling in Part B for the first time in 2017 or have Medicaid as well as Medicare, in which case your state Medicaid agency will pay the premium. If your annual income is above $85,000, you also will pay more. To determine your premium, click here.

    With traditional Medicare, the government-administered option, and supplemental insurance to fill gaps in coverage–retiree coverage from a former employer, private supplemental insurance or Medicaid–you can see almost any doctor and use almost any hospital with few if any out-of-pocket costs for Medicare-covered services. Without supplemental coverage—which can cost a small amount each month up to about $250 a month depending upon where you live and what coverage you choose–your out-of-pocket costs can be substantial if you need a lot of costly care. Without supplemental coverage, you must pay:

    • $1,316 deductible for each inpatient hospital benefit period, up to 90 days (with 60 days outside the hospital or skilled nursing facility before a new benefit period begins).
      • $0 coinsurance for the first 60 days of each hospital benefit period.
      • $329 coinsurance a day for each benefit period beginning on day 61 through 90.
      • $658 coinsurance for each of your 60 “lifetime reserve days” of coverage after day 90.
      • All costs after your lifetime reserve days are used up.
    • No deductible for skilled nursing facility care but $164.50 a day for days 21-100.
    • No deductible or coinsurance for home health care or hospice care.
    • $183 deductible each year before Medicare covers medical services from doctors and other health care providers, plus:
      • coinsurance representing 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment, after you meet your deductible.
    • If you want prescription drug coverage, you also pay a premium and coinsurance for a Medicare Part D prescription drug plan.

    With a commercial Medicare Part C health plan, like Humana or United Healthcare, sometimes called “Medicare Advantage,” you still need Medicare Part A and Part B, and you may need to pay an additional Medicare Part C premium for your health plan and/or for drug coverage. Some Part C commercial plans require you to enroll in Part D for prescription drug coverage. You will have coverage for care from network doctors and hospitals provided you follow your health plan’s rules; you generally will need a referral to see a specialist. You cannot buy supplemental coverage to fill gaps. What you will pay out of pocket depends on the health plan you choose and the care you need.

    • You may have to pay a deductible before your coverage kicks in, which varies based on the health plan you choose; and,
    • You will have to pay a copay–a fixed amount–or coinsurance–a percentage of the cost–for each service you receive in the plan’s network, which also depends on the health plan you choose.
    • Your out-of-pocket costs depend on which health plan you choose, how much care you need and whether you use in-network doctors and hospitals, up to $6,850 out of pocket in 2016. (Medicare.gov does not list the out-0f-pocket limit for 2017.)
    •  If you use doctors and hospitals that are out of network (as about one in three people with Medicare need to do if they have a complex condition), you will generally need to pay the full cost of your care except in emergencies and urgent care situations; there is no out-of-pocket limit for out-of-network care.

    Keep in mind that no matter which option you choose, you generally need to pay out of pocket for health care costs that Medicare does not pay for. If you need to pay for long-term supports and services, such as custodial care in a nursing home or home care, you can easily spend between $20,000 and $80,000 a year out of pocket. Seven out of 10 people over 65 will need long-term care at some point in their lives. Medicaid will cover many of these costs if you qualify. In 2010, the 10 percent of the Medicare population with the highest costs, spent an average of nearly $20,000 a year for health care Medicare did not cover.

    And, you generally will need to pay out of pocket for dental care, hearing care and vision care. You also will need to pay out of pocket for care when you travel outside the United States. Here are some ways to keep these costs down.

    Here’s more from Just Care:

  • Older people’s annual drug costs average $26,000

    Older people’s annual drug costs average $26,000

    A new AARP Public Policy Institute report reveals that drug prices have been increasing significantly over the last 10 years, way higher than overall inflation. Indeed, double-digit retail price increases have been the norm, contributing to higher health insurance premiums, deductibles and copays. Today, older people’s annual drug costs average $26,000, most of which is covered by insurance. Will Trump honor his campaign pledge to rein in drug prices? In the meantime, how can you keep your out-of-pocket drug costs down?

    In 2015, the average increase in the price of 268 brand-name prescription drugs heavily used by people with Medicare was 15.5 percent as compared with the rate of inflation, which was 0.1 percent. What does this mean from a cost perspective?

    Older adults take 4.5 prescription drugs on average for their chronic conditions. In 2015, the average annual cost of one brand-name drug to treat a chronic condition was $5,800. This means that average annual drug costs for the typical older adult total $26,000–$1,850 more than the median yearly income for older people with Medicare. And, in 2014, 576,000 Americans had annual drug bills over $50,000.

    A majority of people with Medicare have prescription drug coverage that pays for most of the cost of the drugs they need. But, out-of-pocket costs in the form of premiums, deductibles and copays can still be high.

    To keep your costs down:

    House Speaker Ryan and the Republican leadership are looking to take the money the federal government currently spends on Medicare and use it to pay for tax cuts for the wealthy over the next ten years. If they succeed, people with Medicare will be forced to spend a lot more out of pocket for their drugs or go without them. If you believe the government should keep its hands off Medicare, please sign this petition.

    Here’s more from Just Care:

  • Drug prices likely to rise in Trump administration

    Drug prices likely to rise in Trump administration

    The price of drugs remains out of control, and President-elect Trump has vowed to address high drug prices. But, the Republican Congress is set to repeal the Affordable Care Act, which means that the drug companies will lose millions of customers with drug coverage who will no longer be able to afford their drugs. Because drug companies have the power to set drug prices and will want to make up for their lost revenue, drug prices are likely to rise in a Trump administration.

    Since passage of the ACA, the drug industry has seen enormous profits. Regardless, according to StatNews, Pharma is claiming that the ACA didn’t help drug companies as much as pharmaceutical executives expected. Drug makers had to pay billions in fees under the ACA. They also were required to give drug discounts and rebates to people with Medicare through the Part D drug benefit.

    Still, the ACA gave drug companies 22 million more customers with insurance to cover their drugs. And, the Republican Congress has no plans to replace the ACA with equally robust insurance. Consequently, drug companies should be prepared to lose substantial revenue after the ACA is repealed and Congress imposes fewer requirements on the coverage health insurers offer.

    Unfortunately, drugmakers can raise drug prices further to compensate for their loss of business. Indeed, they are likely to raise prices on many drugs significantly. And, notwithstanding Trump’s recent claim to Time Magazine that he is going to bring down drug prices, it is hard to imagine that the Republican Congress will do what it would take to change this likely scenario.

    Speaker Ryan and his Republican allies do not support legislation regulating drug prices. And, they have always supported laws that give drug companies monopoly power over prices for many drugs. The only reason drug companies would not raise drug prices significantly is fear that, if they do, Congress would take some extreme action against them. That seems unrealistic.

    Drug companies will also want to make up for the probable loss of sales stemming from the Republican leadership’s plan to deregulate the health insurance industry. Laws that require insurers to provide more generous drug benefits are not on Speaker Ryan’s or his Republican allies’ agendas. So, it seems inevitable that insurers will further restrict access to costly drugs.

    Health insurers would prefer to deter people with costly conditions who tend to use high-cost drugs from enrolling in their plans through a limited formulary or high cost-sharing. Indeed, they have many ways to cherry pick healthier enrollees. To keep premiums down and profits up, they will no doubt revert to using them as much as possible.

    So long as the Republican leadership opts not to privatize Medicare–a long shot–older adults and people with disabilities may be in slightly better shape than younger people with insurance. Some believe that even if the ACA is repealed, Congress will keep elements of the law that fill the gap in coverage under the Medicare Part D prescription drug benefit, known as the “donut hole.”  If drug costs continue to rise, however, it’s a good bet that Pharma will benefit far more than people with Medicare.

    If you want Congress to keep its hands off Medicare, please sign this petition. Yesterday, more than one million petitions were delivered to Congress, and Congressional Democrats vowed to fight Medicare cuts.

    Here’s more from Just Care:

  • Many older adults not taking blood pressure drugs as prescribed

    Many older adults not taking blood pressure drugs as prescribed

    A new CDC report reveals that some seven out of ten older adults have high blood pressure. And, half of them do not have their blood pressure under control. Five million older adults are not complying with their Medicare Part D blood pressure prescriptions. The risks of heart disease, stroke, kidney disease and early death are serious.

    Taking blood pressure drugs as directed is important to protect the heart, brain and kidneys. But, according to the CDC, one in four older adults with Medicare Part D prescription drug coverage are not doing so. Some are skipping doses. Others are not taking them at all. Underuse of drugs is associated with higher risk of death and health complications.

    There are many reasons people do not comply with their blood pressure treatment regimens, including high cost, failure to fill prescriptions, assumption that they don’t need to because they don’t experience symptoms, side effects, forgetfulness and complexity.

    The CDC found that four in ten older Native Americans did not take blood pressure drugs as prescribed, and almost as many African Americans (35 percent) and Hispanics (34 percent).

    The CDC is encouraging people to use blood pressure monitors at home to track their blood pressure. (Just Care offers these ten tips for taking your blood pressure at home.) The CDC also suggests people take their medications while doing other routine activities such as brushing their teeth, as a way to better ensure medication compliance. Weekly pill boxes and apps also can be used as reminders of when to take medicine.

    Here’s more from Just Care:

  • Why has AARP been supporting ALEC?

    Why has AARP been supporting ALEC?

    It appears that AARP has been supporting ALEC, the American Legislative Exchange Council at least since 2014.  ALEC is the Koch-based lobbying group that has been calling for the privatization of Medicare and Social Security, eliminating pensions for public employees, repeal of the Affordable Care Act, more protections for PhRMA, along with many other policies that threaten retirement security in America. So, why has AARP been supporting ALEC, and do AARP members know?

    AARP claims that it has supported ALEC to have a seat at the table with conservative policymakers. Really? AARP, a non-profit organization whose mission is to “advance the quality of life for all as we age” is providing financial support to an organization that works against the interest of retirees in order to talk to the policymakers who work against the interest of retirees.

    Under recent pressure from a number of organizations, AARP is now saying that it will not renew its membership in ALEC. “We would never work against the interests of older Americans and our engagement with ALEC was NOT an endorsement of the organization’s policies, but an opportunity to engage with state legislators and advance our members’ priorities.”

    The Center for Media and Democracy discovered AARP’s ALEC membership and exposed it in late June; it launched a petition to urge AARP to stop its funding of ALEC. Michael Hiltzik in a recent column for the L.A. Times asks why AARP would be allied with ALEC, given that ALEC’s support for repeal of the Affordable Care Act would mean that older adults would once again face a huge gap in prescription drug coverage under Medicare Part D.  ALEC is also opposed to Medicaid expansion. And, it would like to eliminate public pension plans that guarantee workers an annual retirement income in favor of a defined contribution pension plan, which could leave millions of retirees at risk, with retiree benefits subject to the whims of the stock market.

    What’s perhaps most confounding and disturbing about AARP’s ALEC membership is that even big companies like Amazon, Facebook, Google, Pepsi and Coca-Cola pulled their ALEC memberships a while back after the Center for Media and Democracy exposed them. If you’d like to keep pressure on AARP, sign this petition from Social Security Works.

    To stay on top of what’s happening in the Medicare, Social Security and health care world, subscribe to our Saturday newsfeed.