JustCare

Tag: Vaccine

  • 2025: Government finalizes new Medicare Advantage policies

    2025: Government finalizes new Medicare Advantage policies

    Last Friday, the Centers for Medicare & Medicaid Services (CMS) issued a final rule regarding Medicare Advantage (MA) and Medicare Prescription Drug (Part D) policy. The rule will take effect in 2026. Of note, the final rule does not call for Medicare coverage of Ozempic or other anti-obesity drugs for people seeking to lose weight, as proposed, nor does it put guardrails on insurers’ use of artificial intelligence to deny care.

    CMS chose not to finalize provisions in the Biden Administration’s proposed rule related to promoting equity, ensuring equitable access to MA services, imposing guardrails for artificial intelligence (AI) or covering anti-obesity medicines.

    The rule does require MA plans to cover inpatient hospital admissions that they approved based through a prior authorization process. MA plans have too often decided post prior authorization approval to deny coverage for inpatient admissions that they deemed, after the fact, should have been treated as outpatient admissions. MA plans can only reopen a prior approval of an inpatient admission because of fraud or administrative error.

    CMS also finalized a rule ensuring that enrollees and providers can appeal an MA denial whether it comes before, during or after a procedure.

    CMS finalized a proposal that prohibits Medicare Part D plans from charging a deductible or copay for adult vaccines that the Advisory Committee on Immunization Practices recommends. The deductible also does not apply to insulin products; and, cost-sharing for these products cannot go above $35.

    In addition, Part D plans must allow enrollees to make monthly payments for their covered drugs over the course of the year, rather than in one lump sum at the pharmacy. Effective this year, these payments cannot exceed $2,000 over the course of the year.

    Here’s more from Just Care:

  • Don’t trust social media for wellness advice

    Don’t trust social media for wellness advice

    You likely see dozens of clips each day providing wellness advice. Unfortunately, a lot of what you see on social media and TV should not be trusted. What should you do? Jude Joffe Block reports for NPR on what’s happening on social media. Reed Abelson and Susanne Craig report for the New York Times on the misleading information that Dr. Oz promotes, while benefiting financially.

    Dr. Oz has promoted Medicare Advantage plans endlessly, without warning people that they could struggle getting the care they need in a Medicare Advantage plan. Insurers offering Medicare Advantage delay and deny care inappropriately and routinely, particularly costly care. They have a powerful financial incentive to do so. Every treatment they delay or deny helps maximize their profits. Like the insurers, Dr. Oz profits from promoting Medicare Advantage.

    Dr. Oz also has profited to the tune of tens of millions of dollars from selling supplements, even when there is little or no scientific evidence to show any benefits from the supplements he promotes and, in some cases, people can be harmed.

    Some people are trying to fight online misinformation from wellness influencers with accurate information. That’s tough. You want to be sure that whatever wellness advice you’re taking is based on science and not hokum. You can save money by not consuming products that are of no value or, worse still, harmful to your health.

    Whose wellness advice should you take? You probably should not listen to anyone who makes money from providing wellness advice. Anyone profiting from providing advice has a conflict of interest, including Robert F. Kennedy, Jr., the newly confirmed Secretary of Health and Human Services.

    For example, if you look at the scientific evidence, you should be getting a vaccines for Covid and a range of other conditions, even though RFK Jr. likely disagrees. Medicare covers a range of vaccines. And, for most, you have no out-of-pocket costs so long as you get them from a Medicare participating provider.

    Here’s more from Just Care:

  • Coronavirus: Beware of the latest Covid strain

    Coronavirus: Beware of the latest Covid strain

    If you’re careful and lucky, you have yet to fall prey to the latest strain of Covid hitting people in the US, JN.1. But, large numbers of Americans are coming down with it, reports Adriel Bettelheim for Axios, so beware. Fortunately, the symptoms tend to be mild, including dry coughs and fatigue.

    I recently caught Covid, for the first time, sitting next to someone who did not stop coughing and sneezing, on a plane trip to visit my 88-year old aunt. As soon as I saw that my seatmate was ill, I put on two masks, but it was too late. So, instead of caring for my aunt, she ended up having to take care of me!

    I had a very mild case of Covid and recovered in a few days, though I continued to test positive for a week. My worst symptom was exhaustion. I think I slept 12 hours for the first two nights, but I had no respiratory symptoms. I’d like to believe that all the Covid booster shots I’ve gotten helped minimize symptoms, but who knows.

    The experts at the Centers for Disease Control and Prevention (CDC) believe that this latest Covid strain is likely better at getting around our immune systems than other strains because so many people are catching it. Time will tell whether more people will be hospitalized as a result of catching it. As of now, there are relatively few hospitalizations.

    People in the Northeast have been most likely to be infected by the JN.1 Covid strain.

    According to the CDC, people who have had vaccines should be better off fighting the JN.1 strain. And, the World Health Organization believes it poses low risks to the public health. If you end up with respiratory symptoms, you should talk to your doctor.

    If you do catch Covid, you should be immune for at least a few months afterwards. Once your body has successfully fought off the virus, it is as if you have been vaccinated.

    Keep in mind that Covid symptoms tend to be similar to flu symptoms. And, there are a lot of people who are catching the flu this winter. To know whether you have Covid, take a Covid test.

    Here’s more from Just Care:

  • Coronavirus: Should you get the 2023 booster shot?

    Coronavirus: Should you get the 2023 booster shot?

    The next Covid-19 booster shot should now be available from your local pharmacy, health clinic or doctor’s office. Medicare pays for it in full, whether you are enrolled in Traditional Medicare or a Medicare Advantage plan. If you are in a Medicare Advantage plan, the booster shot should be covered in full from network pharmacies, but perhaps not if you go out of network for the booster. Should you get the booster shot?

    The Food and Drug Administration just approved the booster as safe and effective. The booster shot protects people from the current Covid 19 variants in the US. The Centers for Disease Control panel of advisors believes that everyone over six months old should get it. Some argue that if only older adults are vaccinated, it will mean 100,000 additional hospitalizations.

    Fewer than one in five Americans got the Covid-19 booster that was approved in 2022. But, the data show that people who got the booster had a much lower likelihood of getting very sick or dying.

    Many people are getting Covid-19 now and more people are being hospitalized for it than earlier in the summer. More still are expected to be hospitalized this fall and winter.

    The list price of the booster is $130. But Medicare pays for it under Part B. Medicaid also covers it. And, so does commercial insurance. If you are uninsured, the federal government’s Bridge Access Program covers the vaccine at Federally Qualified Health Centers and at Walgreens, CVS and some other pharmacies.

    While the booster shot might only keep people from getting Covid for a few months, it still reduces the likelihood of being hospitalized and dying for a much longer period of time.

    The booster was tested on monkeys and mice, not people. But, around the world, billions of people have gotten the booster safely.

    Should you get the booster shot? You probably should not get the booster shot if you’ve had Covid in the last two months. Otherwise, many recommend you get the booster shot soon. If you are planning to travel over the winter holidays, you might wait until early November to get the booster. You then increase the likelihood that the vaccine protects you from infection during your travels.

    Some doctors question the value of the booster for people who have had Covid-19 and have been vaccinated one or more times. They believe that this alone should keep them from getting seriously ill from Covid-19, even if they get Covid.

    Should you get the Covid booster, the RSV vaccine and the flu shot at the same time? It might be smart to space them out.

    Free Covid tests: The federal government is once again offering free Covid tests beginning September 25. Click here to get four free tests sent to your home.

    Here’s more from Just Care:

  • This Fall, talk to your doctor about getting an RSV vaccine

    This Fall, talk to your doctor about getting an RSV vaccine

    It’s just about that time of year again, when flu season hits. This year, there’s a new vaccine, covered in full under Medicare Part D, which helps prevent coughs and shortness of breath resulting from an RSV respiratory infection. But, the New York Times reports that some pharmacies are charging people with Medicare more than $300 for the vaccine.

    RSV or respiratory syncytial virus kills as many as 10,000 people in the US every year and leads to as many as 160,000 hospitalizations. Two new FDA-approved vaccines have a very high likelihood of preventing hospitalizations and death from respiratory tract disease. But some commercial insurers are not covering it.

    According to the CDC, RSV is a common respiratory virus. Symptoms tend to be mild and cold-like, a runny nose, coughing, sneezing, fever or wheezing. But, sometimes people become short of breath or face lower oxygen levels. You can catch RSV from other people, usually through coughs or sneezes coming in contact with your nose or mouth or eyes. You can also catch it from touching a surface that has the virus on it.

    The CDC recommends that adults 60 years and older get a single dose of RSV vaccine, if your primary care doctor agrees. Older adults and people with weakened immune systems are at the highest risk of hospitalization from RSV. Older adults living in nursing homes or long-term care facilities are also at high risk. You can get the vaccine at the same time that you get your flu shot or other vaccines.

    Blue Cross, Blue Shield won’t cover the vaccine because it is not yet on the centers for Disease Control’s vaccine schedule for older adults.

    Here’s more from Just Care:

  • Coronavirus: When public health emergency ends, so will some Covid coverage

    Coronavirus: When public health emergency ends, so will some Covid coverage

    The President has declared May 11 as the date for an end to the Covid-19 public health emergency. Rachel Cohrs reports for Stat that once the public health emergency ends, older adults and people with disabilities will be at greater risk of not getting needed care. The Centers for Medicare and Medicaid Services (CMS), which administers Medicare, says that people with Medicare will face higher costs for  Covid-19 tests and treatments.

    People with Medicare currently get free Covid-19 tests. They also get Paxlovid, a prescription drug which treats Covid-19, for free. Come May 11, Covid-19 tests will no longer be free. Paxlovid will remain free until supplies run out, most likely in the summer. But, people with Medicare could have out-of-pocket costs for other treatments.

    Comprehensive coverage of Covid-19 tests and treatment is critical for people with Medicare; older adults are more likely to die of Covid than working people or any other age group. Paula Span reports for the New York Times that in January alone, 10,600 people with Medicare died of Covid, which represented 90 percent of all Covid deaths last month. Overall, people with Medicare over 75 represent 75 percent of Covid deaths–8,500 deaths in January.

    People with Medicare are also five times more likely to be hospitalized because of Covid-19 than younger people. Hospitalizations and deaths are higher than they should be for people with Medicare because six in ten of them have not received the bivalent booster.

    What Covid-related services will Medicare cover after the Covid public health emergency ends? After the public health emergency ends, vaccines, lab tests, and antigen tests that a physician or other health care provider orders will remain free for people with Medicare. If there are monoclonal antibody treatments that are effective, they will also be covered through the end of 2023.

    Insurers covering working people have yet to determine how much their enrollees will pay for Covid-19 tests and treatments once the public health emergency ends.

    People with Medicaid will continue to get free vaccines once the public health emergency ends. But, they will not have protections against out-of-pocket costs for Covid testing and treatments beginning January 2025.

    People who are uninsured are most at risk at the end of the public health emergency. States will no longer have funding through Medicaid to cover their Covid-19 tests, vaccines and treatments.

    Here’s more from Just Care:

  • How to keep healthy this flu and Covid season

    How to keep healthy this flu and Covid season

    It’s getting colder outside and that means that you are more likely to get sick with a virus. The cold weather won’t make you sick. But, viruses spread more easily when it’s cold out. Hannah Seo reports for the New York Times on four ways to strengthen your immune system and reduce your risk of getting sick this flu and Covid season.

    1. Believe it or not, exercise and other activities that get you moving, such as walking and dancing, help ward off sickness. One study found that people who exercise at least five times a week got sick less often from an upper respiratory tract infection than people who exercised rarely. That said, overall, people who did a little exercise were less likely to get sick than people who did not exercise at all.
    2. Enough sleep and good quality sleep also give your body what it needs to ward off viruses. You should sleep more than seven hours a night.
    3. Eating healthy, particularly different colored fruits and vegetables, gives your body flavonoids, which fight inflammation and illness.
    4. Make sure you get this year’s flu shot and the Covid-19 bivalent booster. If you have Medicare, you should pay nothing for them.

    Why is exercise helpful in warding off sickness? It stimulates immune cells to wipe out cells infected with a virus.

    Why is proper sleep helpful? It regulates stress, lowering inflammation, strengthening your immune system and allowing your body to fight off infection.

    Why is a proper diet helpful? Processed foods, cigarette smoke, excessive alcohol intake can keep your immune system from working well. Supplements also are of no help, based on the evidence, and often contain ingredients that can be harmful to your health. It’s better to eat a good diet.

    Why are vaccines helpful? They give your body the antibodies needed to fight off flus and Covid-19 infections. And, even if you catch the flu or get Covid-19, if you’ve been vaccinated, you will increase your chances of having only a mild case.

    Here’s more from Just Care:

  • Coronavirus: Get your booster shot as soon as possible

    Coronavirus: Get your booster shot as soon as possible

    Fall is in the air and the new Covid-19 booster vaccine is ready to be administered. This new booster shot is designed to protect you against different strains of the coronavirus. Get your booster shot as soon as possible.

    Pfizer and Moderna both offer updated booster shots, which target omicron variants. The new booster vaccine gives you better protection against variants of the original virus. You should be able to get your shot from your doctor, at your local pharmacy or health clinic.

    Covid-19 vaccines have saved millions of lives already. The vaccines and boosters available to date have worked best on the original Covid-19 virus. But, they are not as good at fending off new strains of the virus. That’s why it is so important to get this new booster shot.

    How will the booster shot help? The booster will reduce your risk of hospitalization from Covid-19 as well as your risk of getting seriously ill from Covid-19. It also reduces your chances of getting long Covid.

    When should you get the booster? Right away, if you haven’t had Covid-19 recently. It’s excellent protection against what could be a new surge of the virus this fall or winter. If you have had Covid recently, talk to your doctor. You have antibodies in your system, so it might be ok for you to wait a couple of months before getting the booster.

    Are there safety concerns with the booster? The CDC says there are none.

    Are there side effects from this booster? Side effects are said to be similar to side effects from the original vaccine and boosters, pain, fatigue, headache, chills, nausea and fever.

    Can you get the booster at the same time as the flu shot? Yes. And, if you’re over 65, ask about getting the high-dose flu shot.

    Here’s more from Just Care:

  • Coronavirus: Older adults without booster shots are still at significant risk

    Coronavirus: Older adults without booster shots are still at significant risk

    The latest COVID-19 data reveal that vaccines are not enough to protect many older adults from serious illness if they have the virus. Fenit Nirappil and Dan Keating report for The Washington Post that a higher proportion of vaccinated older adults are dying. Apparently, over time, COVID-19 vaccines do not work as well as you might hope; to minimize risk, older adults need booster shots.

    In January and February, more than four in ten people who died of COVID-19 were vaccinated. Most of them had not received a booster shot. Last September, just 23 percent of people who died of COVID-19 were vaccinated.

    Researchers who analyzed the data found no meaningful difference between people who had had the Pfizer vaccine and people who had had the Moderna vaccine. For both, it appears that the vaccine’s full protection lasts for about three months after the second vaccine.  That said, one CDC expert said that Moderna appears to offer a somewhat more effective vaccine against hospitalization than Pfizer.

    For people over 65, Moderna is 87 percent effective against hospitalization versus Pfizer, which is 77 percent effective. And, the effectiveness of Johnson & Johnson’s vaccine appears to increase over time.

    Some people are mixing up the types of vaccines they receive. But, they do so at their own risk. There is no data on whether that is either safe or effective.

    Note: People who are unvaccinated are most likely to die from COVID-19.  In fact they have a 20 times greater likelihood of dying from a COVID-19 infection than people who are vaccinated and boosted. Still, two-thirds of deaths from the omicron variant of COVID-19 were people over 75. Most of those deaths, among the vaccinated, were people who had not gotten a booster shot.

    Here’s more from Just Care:

  • To improve your immune response after a vaccine, exercise!

    To improve your immune response after a vaccine, exercise!

    Sometimes, it seems as if exercise is a cure-all. Walking is important to speed your recovery in the hospital, among other reasons, and aerobic exercise has many other benefits. Gretchen Reynolds reports for The New York Times on a new study that finds exercise could improve the efficacy of a vaccine, be it a Covid-19 vaccine or a flu vaccine.

    All kinds of exercise could help improve your immunity after a vaccine. For example, walking, biking and jogging are all helpful for raising people’s antibodies after having a vaccine.

    The study measured people’s antibodies after engaging in a range of different aerobic activity for 90 minutes following a vaccine. People who exercised produced a higher degree of interferon alpha, which increases your antibodies. The researchers believe that these additional antibodies from exercising reduces people’s risk of getting really sick after a flu shot or Covid-19 vaccine. Notably, exercise did not appear to bring more side effects or reduce side effects.

    The study was conducted on 70 people and needs to be expanded to a much larger cohort to learn more. Still, it appears that physical fitness and daily exercise helps strengthen our bodies to ward off illness. Exercise transforms the way immune cells in our bodies operate, for the better.

    To date, data show that physical activity protects people against all sorts of mild respiratory infections. And, when people in good shape fall ill, being physically fit can reduce the seriousness of the illness.

    A recent study of nearly 50,000 people with Covid-19 in California determined that the Californians who were not physically fit and had not been exercising before getting Covid-19 were around twice as likely to be hospitalized as their counterparts who were fit and active.

    Don’t feel like exercising after getting a vaccine? Try moving your arm a lot before getting the shot. One recent study found that moving your arm before a vaccine also increased antibody levels and specialized immune cells.

    What’s the right amount of exercise? We don’t yet know.The researchers found that 45 minutes was not enough to boost antibodies to a statistically significant degree. But, 90 minutes of exercise was. They did not measure the effects of 60 minutes of exercise.

    However, it’s not clear that excessive exercise is beneficial. Some data suggest it could undermine immunity. But, we’re talking marathoners, so most of us have no need to worry about excess.

    How long will exercise help with antibody levels and stronger immune responses? More research is needed. This study only measured people’s responses after one month.

    Here’s more from Just Care: