JustCare

Tag: Vision

  • Medicare Advantage dental, vision and hearing benefits offer little value

    Medicare Advantage dental, vision and hearing benefits offer little value

     

    Medicare Advantage plans advertise their “extra” benefits as a way to lure in new enrollees. But, new research published in JAMA Network finds that Medicare Advantage dental, vision and hearing benefits offer little value to enrollees. Enrollees have no better access to dental, vision and hearing benefits than people in traditional Medicare.

    The most recent MedPAC data show that the federal government is spending 22 percent more per Medicare Advantage enrollee than for enrollees in traditional Medicare. The data are increasingly also showing that, notwithstanding the estimated $83 billion more the insurers offering Medicare Advantage received from the federal government in 2024, Medicare Advantage enrollees get fewer benefits than people in traditional Medicare.

    For the most part, insurers offering Medicare Advantage only cover care for their enrollees from a restricted network of physicians and hospitals. In rural communities, people have to travel long distances to see a doctor or get treated at a hospital because their local providers are not in their Medicare Advantage plan network. And, the specialists qualified to treat certain conditions are also often not in-network.

    Moreover, Medicare Advantage insurers often inappropriately delay and deny care to their enrollees, particularly when they have complex and costly conditions. The insurers’ financial incentive is to withhold care because the government pays them upfront regardless of the amount of money they spend on care. The less care they cover the more money they get to keep.

    A team at Mass General Brigham looked at whether the “extra” benefits Medicare Advantage insurers offer add value. Insurers misleadingly claim that they give their enrollees more than traditional Medicare in the form of extra benefits. But, that is not true in fact.

    Insurers often deny Medicare Advantage enrollees coverage for treatments that traditional Medicare covers. And, while insurers technically offer enrollees additional benefits, too often, enrollees are not aware of these benefits or the out-of-pocket costs present a barrier to care. The researchers found that fewer than six in ten enrollees knew their Medicare Advantage plan covered these “extra” benefits.

    Between 2017 and 2021, people in traditional Medicare and Medicare Advantage spent about the same amount for dental, vision and hearing services, notwithstanding that Medicare Advantage plans claim to offer these benefits and traditional Medicare does not.  They also received about the same number of services. There is no reason to be paying Medicare Advantage insurers more per enrollee than the government spends in traditional Medicare.

    “Medicare Advantage plans receive more money per beneficiary than traditional Medicare plans, but our findings add to the evidence that this increased cost is not justified,” said first author Christopher L. Cai, MD. At best, people in Medicare Advantage are getting a discount of less than 10 percent on vision, hearing and dental treatment. Out-of-pocket costs are high, even with the benefits, and the panel of covered providers is narrow.

    “Supplemental benefits are a major draw to Medicare Advantage, but our findings show that people enrolled in Medicare Advantage have no better access to extra services than people in traditional Medicare, and that much of the cost comes out of their own pockets,” according to senior author Lisa Simon, MD, DMD, assistant professor in the Division of General and Internal Medicine at Brigham and Women’s Hospital. “Older adults and people with disabilities deserve better from Medicare.”

    Here’s more from Just Care:

  • Are lower income individuals enrolling in Medicare Advantage for the wrong reasons, at their peril?

    Are lower income individuals enrolling in Medicare Advantage for the wrong reasons, at their peril?

    Medicare Advantage enrollment is up, and people with low incomes and people of color are enrolling in Medicare Advantage at disproportionate rates. A new study published in JAMA by Avni Gupta, BDS, MPH, Diana Silver, PhD, David J. Meyers, PhD; et al. finds that lower income individuals are often drawn into Medicare Advantage because of ads promising vision and dental benefits. The authors consider whether this is a good reason for people to enroll in a particular plan or whether these people are more likely to end up in Medicare Advantage plans that threaten their access to care.

    Many people of color and low income individuals rely on misleading marketing to make their choices, which is highly problematic.

    The worst performing Medicare Advantage plans are largely responsible for tens of thousands of unnecessary deaths a year. But we don’t know which ones they are. The data is not available. People who enroll in a Medicare Advantage plan take a gamble that if they develop a serious condition they will get the care they need.

    The American Hospital Association (AHA) has urged the government to step in to protect people in Medicare Advantage. The AHA explains the harm to patients from prior authorization rules that lead to delays and denials of critical care. So does the HHS Office of the Inspector General. The Centers for Medicare and Medicaid Services, which oversees Medicare Advantage, does not have the resources to conduct adequate oversight and enforcement.

    In this study, the data show that Black Americans were more likely to sign up for MA plans with dental or vision benefits than White Americans. People with incomes no more than twice the federal poverty level also were more likely than higher income individuals to enroll in Medicare Advantage plans with dental benefits.

    It’s not clear from the study whether the MA plans with dental and vision benefits have better or worse health outcomes. As it is, they have on average 43 MA plans to choose from, all differing in ways that are impossible to assess, including with respect to premiums, deductibles and out-of-pocket caps, which are knowable, and with respect to typical out-of-pocket costs, denial and delay rates, and mortality rates, which are not knowable. What is clear is that people who enroll in a Medicare Advantage plan take a big gamble with their health and well-being that they will be able to get the care they need should they develop a complex and costly condition.

    Vision and dental benefits in MA plans tend to come with high out-of-pocket costs and to be restricted. While data is limited, it appears that most people do not end up using these benefits, either their dental and vision needs are not covered or they can’t find a provider to see them or their costs are unaffordable.

    What will happen to dental and vision benefits when the government addresses overpayments to MA plans? Based on prior research, changes to these benefits are likely to be minimal. One researcher found that with $1,000 less to spend, MA plans increased monthly premiums by $5. There is also a five percent risk that vision or hearing benefits would end.

    What will happen to Medicare if the government does not address overpayments to MA plans? It is not unlikely that Traditional Medicare will wither on the vine and that insurers will take over all of Medicare. Because they cost so much and often delay and deny care inappropriately, more people with Medicare are likely to be unable to afford or get the care they need, endangering their health and well-being.

    If you’re in a Medicare Advantage plan, take advantage of the Medicare Advantage Open Enrollment period, which runs through March 31. If you can, switch to Traditional Medicare if you want to ensure easy access to the care you need.

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  • How to protect your eyesight and a warning about some eyedrops

    How to protect your eyesight and a warning about some eyedrops

    As you age, your eyesight often deteriorates, particularly for seeing things up close and distinguishing colors. Unfortunately, Medicare does not cover most vision care. The National Institute on Aging offers practical advice on what you can do to protect your eyesight. And, the CDC issues a warning about some eyedrops that are causing severe eye problems.

    Warning: The Centers for Disease Control (CDC) recommends you stop using EzriCare Artificial Tears, Delsam Pharma’s Artificial Tears, and Delsam Pharma’s Artificial Ointment.  These eye drops, manufactured in India, might have been contaminated with rare drug-resistant bacteria. As a result, they might have caused three people  to die and dozens of others to get eye infections that caused vision loss .  Also, keep in mind that taking some prescription drugs can affect your eyesight.

    How to improve your vision: Usually, glasses, contact lenses and better lighting can help you see better as you age. But, you are also at risk of eye diseases. So, you want to continue to get eye exams to protect your vision to prevent vision loss.

    Eye care at the doctor’s office:  Be sure to get a dilated eye exam every year or two years, especially if you have diabetes or high blood pressure.A dilated eye exam allows the eye doctor to look inside your eyes.

    How to protect your eyes: Wear sunglasses that keep the ultraviolet rays out as well as a big hat, don’t smoke, be active, keep your blood pressure normal, and don’t spend too much time in front of a computer without a break.

    Eye problems that can cause you to go blind or lose your vision:

    • Age-related macular degeneration (AMD)
    • Diabetic retinopathy may occur if you have diabetes.
    • Cataracts cause blurred vision. Cataract surgery can improve your vision and is safe. Medicare covers this treatment.
    • Glaucoma can lead to vision loss if it goes untreated. It can be treated with surgery or prescription eyedrops.
    • Dry eye resulting from blocked tear glands. Your eyes could sting or burn. Home humidifiers or air purifiers as well as special eye drops or ointments can help.

    If you are looking for free and low-cost options for vision care, click here.

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  • What’s wrong with market innovations in health care?

    What’s wrong with market innovations in health care?

    Our government counts on market innovations in health care. It also allows companies to abandon these innovations as they please, with little concern for the harm it can cause Americans who depend on them. In an op-ed for Stat News, Claudia Jazwinska explains how the health care marketplace and our government can fail Americans who rely on health care innovations.

    Thousands of different implantable devices are in use around the globe, helping people. But, market pressures mean that these devices might not be reliable over the long-term. For example, hundreds of Americans rely on an implanted medical device in order to see. The Argus II is a retinal implant. But, its manufacturer, Second Sight, has stopped manufacturing it to avoid possible bankruptcy.

    When Second Sight discontinued the Argus II, people using it were left without vision and with an extremely expensive implant in their brain. They had no clue whether the device should be removed and, if so, who had the skills to remove it. They were left at serious risk because they had opted to use cutting edge technology, and the government did not step in to protect them.

    No one wants to inhibit meaningful innovation, which regulation can do. But, people who rely on medial innovations also need protections.

    The National Institutes of Health is continuing to support research from Second Sight even though it failed to continue the Argus II. The NIH is not supporting the patients who relied on its implantable device. It does not seem concerned about investing in companies that are not able to continue to service innovations that Americans rely upon them.

    Jazwinska asks why does our government allow companies to sell costly devices to Americans and then abandon them, especially when these devices are implanted into their bodies? At the very least, companies should be held accountable for doing so. Isn’t it negligence or malpractice to leave these people in the lurch?

    One solution would be to require these companies to make their proprietary devices open-source if they are discontinuing them. Other companies should be allowed to replicate them. Americans should not bear the burden of a company’s inability to continue a valuable technology.

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  • Prevent dementia: Take care of your eyes

    Prevent dementia: Take care of your eyes

    If you’re like me, you’re wondering what it’s going to take to stave off dementia as you grow older. While it might not be possible, there are things you can do. But, Paula Span reports for the New York Times on research finding that people who take care of their health, including their eyes, are more likely to forestall or prevent dementia.

    More people are being diagnosed with dementia. At the moment, there’s no drug to keep dementia at bay. Your genes play a big role in whether you will be diagnosed with dementia, and there’s little you can do about that. Some risk factors, however, are within your control, including high blood pressure, hearing loss and smoking.

    Simple behavior changes–which are not so easy to undertake in practice–such as stopping smoking, wearing a hearing aid and taking medications to bring blood pressure down, are all important. In addition, it’s important to keep a healthy weight, stay physically active, not drink too much alcohol and be socially engaged.

    Staving off dementia is also about keeping your neural system stimulated through sensory organs. People with healthy vision are less likely to suffer from dementia. So, get your eyes checked, wear glasses and get cataract surgery, if necessary. Without good hearing and vision, your neurons die. And, your brain function deteriorates.

    A paper in JAMA Neurology finds that these types of behavior changes could have prevented more than 60 percent of dementia cases today.

    Medicare does not cover most vision care, but there are ways to get free or low-cost treatment for your eyes. By doing so, almost everyone can avoid blindness or serious vision impairment. Medicare also does not cover hearing aids or most treatment for hearing loss. But, there are ways to get treatment for hearing loss as well.

    Medicare does cover treatment for glaucoma and macular degeneration as well as cataract surgery. People tend to think that Medicare Advantage plans will cover hearing aids. In fact, typically, coverage is extremely limited, just a few hundred dollars off a total cost that is usually several thousand dollars. So, out-of-pocket costs remain very high and a barrier to getting hearing aids.

    Here’s more from Just Care:

  • Will Biden expand Medicare benefits or strengthen the ACA?

    Will Biden expand Medicare benefits or strengthen the ACA?

    Jeff Stein reports for the Washington Post on health care reform proposals the Biden administration could include in the American Families Plan. House Speaker Nancy Pelosi is urging President Biden to invest in strengthening the Affordable Care Act. Senator Bernie Sanders wants him to add additional benefits to Medicare and make Medicare available to people 60 and older.

    Speaker Pelosi wants the next Congressional legislation to make greater subsidies to people under the Affordable Care Act permanent. In March, Congress expanded subsidies but they are  temporary. Her proposal would further entrench for-profit insurers in our health care system.

    Senator Sanders wants to shore up .the Medicare benefit package. He wants it to include dental, vision and hearing services. He also wants to lower the age of Medicare eligibility to 60 or 55. These benefits could bring down health care costs substantially for the 23 million people over 6o who are not eligible for Medicare today as well as for the 65 million people with Medicare.

    Biden, for his part, should recognize that pumping more money into our nation’s corporate health insurance system is going to drive up costs and keep us from having a sustainable universal health care system. Expanding public health insurance administered directly by the federal government is the only way to get a handle on health care costs and drive health care system improvements.

    The Biden administration is working on the American Families Plan. Right now, it appears it will cover child care, anti-poverty programs and health care. It could reduce prescription drug spending by $450 billion over ten years. Senator Sanders wants these savings, which are largely from Medicare, to benefit people with Medicare. Using the money on the ACA or any other health care initiative would take money out of Medicare.

    The savings on prescription drug costs should go to helping people with Medicare. The most up-to-date data show that older and disabled Americans suffer deeply as a result of not having comprehensive dental, vision and hearing benefits. Benefits available through Medicare Advantage plans appear to be theoretical and not meaningful. To the extent Medicare Advantage plans offer these benefits, they pay for only a fraction of the cost of treatment. Most people do not have the means to pay the substantial out-of-pocket costs.

    Consequently, nearly one in five people with Medicare over 70 have no teeth. An additional one in five of them suffer from tooth decay. Millions of people with Medicare also suffer from untreated severe or profound hearing loss. And millions suffer from lack of vision care. All of these services are prohibitively expensive. Lack of vision, dental and hearing care can lead to depression, increased risk of falls, social isolation, diabetes, cardiovascular disease and other co-morbidities.

    Whichever direction Biden goes, it will take enormous public pressure for Congress to pass the legislation. It will come after Congress passes an infrastructure package, which also will require a large public push.

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  • Medicare for all improves the lives of older adults

    Medicare for all improves the lives of older adults

    Letter to Chairman McGovern and members of the U.S. House of Representatives House Rules Committee in support of the Medicare for All Act of 2019, H.R. 1384, with a focus on its value for older adults:

    I want to share my thoughts on a very important and often overlooked aspect of the Medicare for All debate: How Medicare for All will greatly improve the lives of people with Medicare. Any discussion of this issue starts with the unacceptable state of the broader American health insurance system.

    Americans of all ages are increasingly being forced to make health care choices no one should have to make. Two in three[i] of us forego needed care in order to afford the rent, the heat, our dinner. In our commercial insurance marketplace, health care choice too often means gambling with our health. Not surprisingly, more than nine in ten Americans[ii] are asking Congress to address health care costs.

    Commercial health insurers charge Americans ever higher costs for their care. They have not succeeded at negotiating fair health care prices. Rather, prices are excessive and irrational. The same procedures[iii] cost tens of thousands of dollars more in one hospital than in another. On average, the US spends twice as much[iv] on health care as other wealthy countries; yet, the US ranks at or near bottom on most health outcomes, including infant mortality and life expectancy.

    Americans suffer or die needlessly for lack of health care. I recently spoke with one woman, Eve Meikle who was forced to “backburner” treatment for her ulcerative colitis in order to pay for diagnosis and treatment of her daughter’s gastritis. Eve and her family have insurance and an annual income just over $80,000. Still, it will take them years to free themselves of medical debt, and, left untreated, Eve’s condition may very well worsen and keep her from working.

    Medicare for All is the only policy proposal before you that controls costs and guarantees health care as a right[v] to everyone. Other proposals on the table– Medicare buy-ins, Medicaid expansion or state-based reforms–neither rein in costs nor make health care affordable for all Americans.

    Medicare for All guarantees health care for all. It promotes the public good. It provides greater security to older adults by filling Medicare coverage gaps, eliminating premiums, deductibles and coinsurance, and adding vision, hearing, dental and long-term services and support benefits. And, it does so while reducing national health care spending. It uses the leverage of all Americans to rationalize health care prices and eliminate administrative waste. Even by conservative estimates, it saves $2 trillion[vi] over 10 years. And, if we paid what other countries paid for their drugs, as President Trump and Senator Sanders have both proposed, it would save still more.

    Medicare for All builds on Medicare, which has a 50-year track record of providing health and financial security to older and disabled Americans. Medicare has helped significantly to reduce the poverty rate among older adults, which has fallen from 29 percent in 1965 to nine percent in 2016.[vii]

    Medicare works. I know firsthand. I am the founder and past president of the Medicare Rights Center, a national not-for-profit consumer service organization.

    Medicare works because it is designed to meet the needs of everyone, including people in poor health with costly conditions. It works because it gives people the freedom to travel or move in with an out-of-area family caregiver and see the doctors they want to see, wherever in the US they happen to be. Medicare works because it allows its enrollees, their children and grandchildren, to sleep at night knowing they can and will get the care they need. Still, three in four older adults say the government is not doing enough to address health care costs.[viii]

    Medicare for All would significantly improve the health and financial security of older Americans. Older adults are counting on you[ix] to expand Medicare benefits. Older adults, much like their kids, increasingly struggle to pay for health care that Medicare does not cover. One in four of them have less than $15,000 in savings.[x] Half live on annual incomes under $26,200.[xi] Social Security benefits are critical, but inadequate, to cover many basic needs. Private sector retiree benefits have eroded.

    Even with Medicare, Americans have thousands of dollars in out-of-pocket health care costs for hearing, dental, vision and long-term services and supports. They also need supplemental coverage to fill Medicare coverage gaps and protect themselves financially, which can be extremely costly. A Gallup poll[xii] released last week reveals that one in seven older adults, 7.5 million people, are unable to pay for the medicines their doctors prescribe. And, of those, eight in ten say that these medicines are for a somewhat or very serious condition.

    Traditional Medicare, without supplemental coverage, has high out-of-pocket costs and no catastrophic cap. For this reason, many older Americans have no choice but to sign up for commercial Medicare plans, known as Medicare Advantage plans, which have a catastrophic cap. The commercial Medicare Advantage system is a looming tragedy for older Americans that can only be addressed through Medicare for All.

    Commercial Medicare plans offer lower upfront costs than people with government-administered Medicare. Older and disabled Americans enroll in Medicare Advantage plans hoping to save money. But, there is compelling reason for serious concern that Medicare Advantage plans are keeping enrollees from getting needed care, jeopardizing their health, and overcharging the government and taxpayers. I want to highlight these three big issues.

    Wrongful Delays and Denials of Care

    Medicare Advantage plans routinely and improperly delay or deny coverage for needed care. The Office of the Inspector General[xiii] reports that audits by the Centers for Medicare and Medicaid Services (CMS) reveal “widespread and persistent [Medicare Advantage] performance problems related to denials of care and payment.” This should come as no surprise. The less care they deliver, the more Medicare Advantage plans profit.

    CMS has sanctioned dozens of commercial Medicare plans[xiv] for, among other things, “threatening the health and safety” of their members and “charging incorrect copayments to enrollees for medical services.”

    Poor Quality Care

    In addition, Medicare Advantage plans may prevent their enrollees from receiving good quality care. A recent study published in Health Affairs[xv] shows that Medicare Advantage plans send enrollees to lower quality nursing facilities than traditional Medicare. Research soon to be published shows that Medicare Advantage enrollees generally have less access to top hospitals than people in traditional Medicare. They also lack access to higher quality home care.

    A recent study in JAMA Internal Medicine[xvi] shows that people with significant health care needs are disenrolling from Medicare Advantage plans to traditional Medicare at far higher rates than people without significant health needs.

    In addition, Medicare Advantage enrollees cannot rely on continuity of care from their doctors. Kaiser Health News[xvii] reported earlier this month on a cancer patient in a Medicare Advantage plan who is losing the in-network doctors who have kept her alive over the last several years but are no longer in-network. She cannot afford to pay out-of-pocket for her doctors’ out-of-network services.

    No trustworthy public data is available as to which, if any, Medicare Advantage plans promote access to quality providers and good care. The current five-star rating system for Medicare Advantage plans is regarded as a farce. CMS policy[xviii] permits a Medicare Advantage plan to get a five-star rating even though CMS has sanctioned[xix] it for threatening the health and safety of its members and has “a longstanding history of noncompliance with CMS requirements.”

    Government Overcharges

    Of concern as well, government overpayments to Medicare Advantage plans appear significant. Congress entrusts commercial Medicare Advantage plans with covering the healthcare of our most vulnerable citizens at significant taxpayer expense. Yet we know from government audits that the Medicare Advantage plans bill taxpayers for tens of billions of dollars[xx] they are not due. They “upcode,” services, improperly claiming the health status of their enrollees is worse than it is in order to generate higher payments.

    The GAO[xxi] reports that the Centers for Medicare and Medicaid Services identified $14.1 billion in overpayments to Medicare Advantage plans in 2014 alone but that CMS is not recovering nearly as much in improper payments as it could with better oversight.

    A more recent study published in Health Services Research[xxii] estimates that “upcoding” by Medicare Advantage plans could account for as much as 13 percent of payments[xxiii] to Medicare Advantage plans and increase Medicare spending over ten years by $200 billion. And, it is not clear whether CMS can recoup this money.[xxiv]

    The litany of wrongful and harmful behaviors by Medicare Advantage plans is likely greater than we know. Critical Medicare Advantage data is unavailable for analysis. We know more about how restaurants, automobiles and televisions perform and rank against one another than we do about Medicare Advantage plans. Yet, the government paid them $210 billion in 2017[xxv] alone.

    With or without the data, we know that commercial health insurers are hard-pressed to meet the needs of people with Medicare or anyone else who develops a complex and costly condition. Imagine the best commercial health insurance company in the US. Let’s promise that it will always provide high value care for people with stroke, cancer and heart disease. This best health insurance company would be out of business before it opened its doors. Everyone in poor health would join, driving premiums up so high that no one could afford them. To make a profit, commercial health plans must compete to avoid high-cost enrollees.[xxvi]

    Instead of meeting our needs, commercial health insurers offer little health or financial security. They can and do change their network providers all the time, keep doctors from providing the care their patients need, shift costs onto their members who most need care and pull out of markets. They do whatever they need to do to promote their business interests.

    Medicare for All—an improved and expanded Medicare system—can do what commercial health insurance can never do: Protect Americans from the high cost of health care, while ensuring access to good quality care.

    To some, Medicare for All may seem too big a change too quickly. For Americans, the change could not come quickly enough.

    Thank you for your consideration.

    [i] Becker’s Hospital Review: https://www.beckershospitalreview.com/finance/64-of-americans-avoid-treatment-due-to-cost-of-medical-care-5-survey-insights.html

    [ii] Politico.com: https://www.politico.com/story/2019/01/07/politico-harvard-poll-medicare-for-all-1061791

    [iii] Modern Healthcare: https://www.modernhealthcare.com/article/20160427/NEWS/160429918/the-striking-variation-of-commercial-healthcare-prices

    [iv] Peterson Kaiser Health System Tracker: https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/

    [v] Political Economy Research Institute: https://www.peri.umass.edu/publication/item/1127-economic-analysis-of-medicare-for-all

    [vi] Blahous, Charles, The Costs of a National Single-Payer Health Care System: https://www.mercatus.org/system/files/blahous-costs-medicare-mercatus-working-paper-v1_1.pdf

    [vii] Joint Economic Committee, Democrats, Medicare: Protecting Seniors and Families: https://www.jec.senate.gov/public/_cache/files/5f4be5d9-b297-467a-948a-e7525d04f924/medicare-final.pdf

    [viii] Gallup: https://news.gallup.com/opinion/gallup/248741/seniors-pay-billions-yet-cannot-afford-healthcare.aspx

    [ix] Gallup: https://news.gallup.com/opinion/gallup/248741/seniors-pay-billions-yet-cannot-afford-healthcare.aspx

    [x] Kaiser Family Foundation: http://files.kff.org/attachment/Issue-Brief-Income-and-Assets-of-Medicare-Beneficiaries-2016-2035

    [xi] Kaiser Family Foundation: https://www.kff.org/medicare/issue-brief/how-many-seniors-live-in-poverty/

    [xii] Gallup: https://news.gallup.com/opinion/gallup/248741/seniors-pay-billions-yet-cannot-afford-healthcare.aspx

    [xiii] Office of the Inspector General: https://www.oig.hhs.gov/oei/reports/oei-09-16-00410.pdf

    [xiv] CMS Compliance and Audits: https://www.cms.gov/Medicare/Compliance-and-Audits/Part-C-and-Part-D-Compliance-and-Audits/PartCandPartDEnforcementActions-.html

    [xv] Meyers, David J. et al., Health Affairs: https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0714

    [xvi] JAMA Internal Medicine: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2725083

    [xvii] Kaiser Health News: https://khn.org/news/patients-caught-in-middle-of-fight-between-health-care-behemoths/

    [xviii] CMS policy memo: https://s3.amazonaws.com/assets.fiercemarkets.net/public/004-Healthcare/external/star_ratings_memo.pdf

    [xix] CMS policy memo: https://www.cms.gov/Medicare/Compliance-and-Audits/Part-C-and-Part-D-Compliance-and-Audits/Downloads/Cigna_Sanction_01_21_16.pdf

    [xx] GAO: https://www.gao.gov/products/GAO-16-76

    [xxi] Ibid.

    [xxii] Health Services Research: https://onlinelibrary.wiley.com/doi/full/10.1111/1475-6773.12977

    [xxiii] Van de Water, Paul, Center on Budget and Policy Priorities: https://www.cbpp.org/blog/medicare-advantage-upcoding-overpayments-require-attention

    [xxiv] UnitedHealthcare Insurance Company, et al. v. Alex M. Azar II, et al., Secretary of the Department of Health and Human Services: https://s3.amazonaws.com/assets.fiercemarkets.net/public/004-Healthcare/external_Q32018/UHvBurwell_overpayments.pdf

    [xxv] Cubanski, Juliette and Neuman, Tricia, Kaiser Family Foundation: https://www.kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/

    [xxvi] Archer, Diane and Marmor, Theodore, Health Affairs, Medicare and Commercial Health Insurance: The Fundamental Difference: https://www.healthaffairs.org/do/10.1377/hblog20120215.016980/full/

     

  • Need a crown or dental implant? Consider a trip to Mexico

    Need a crown or dental implant? Consider a trip to Mexico

    Because Medicare does not cover some basic health care needs, Just Care offers advice on a number of ways to get free or low cost dental, vision and hearing care in the US.  Nation of Change reports that millions of Americans cross our southern border to Mexico for a crown, a dental implant and other affordable health care.

    About 25 percent of Americans or 74 million people lack dental coverage.  And virtually no Americans have coverage for crowns, root canals and implants. These common procedures can cost several thousand dollars in the US.

    At one crossing point alone in Arizona, 6,000 Americans travel to Los Algodones primarily for low-cost dental care, vision care and prescription drugs. In Mexico, people typically can get a crown for less than $700 and sometimes as little as $400. Implants are commonly under $1,700 as compared to $5,000 in the US.

    These procedures cost so much less in Mexico because the cost of living is so much less there and dentists earn less money than they do in the US. They also pay less for dental school.

    Americans can spend little time as well as far less money than they would in the US for their dental care in Mexico. Los Algodones has many dental labs. So, you can have a crown, bridge or dentures made in a couple of days.

    One of the goals of Medicare for All is to fill the gaps in health insurance coverage, including providing coverage for vision, dental and hearing care. Medicare for All legislation in the Senate and the House would cover these services.

    For other free and low-cost resources, visit Just Care’s Get Help page.

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  • Get tested for glaucoma, save your vision

    Get tested for glaucoma, save your vision

    If you’re over 60, you should be getting a comprehensive dilated eye exam at least every two years. This test for glaucoma could help save your vision. Like many people, you’re likely wondering what is glaucoma, what are the symptoms, and who’s at most risk? I can explain.

    One thing our health care providers always check is our blood pressure. We know that if it’s too high for too long it can lead to heart disease and stroke. Well, high pressure can occur in our eyeballs too. Like high blood pressure, it can go on for years with no symptoms. Subtle decreases in peripheral (side) vision then occurs. If untreated, it can lead to blindness.

    The disease of high pressure in the eye is called glaucoma, and it’s the leading cause of preventable blindness. That’s why it’s important to go for regular eye exams, especially as you get older. And yes, those include the exams where they put in the drops to dilate your eyes and your vision is blurry and you’re sensitive to light for a while after your appointment.

    You are especially at risk for glaucoma if you’re African-American and over 40, of Mexican heritage and over 60, have a family history of the disease, or have poorly controlled blood pressure or diabetes.

    Most cases of glaucoma are treatable with eyedrops if diagnosed in time. And, although Medicare does not cover standard vision tests, it does cover the cost of glaucoma screenings.

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    This article originally appeared, January 19, 2017 and was updated in April 2018.

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  • Tips for driving safely

    Tips for driving safely

    As you get older, it can become increasingly challenging to drive. A variety of health conditions can affect your ability to drive. If you are concerned about whether you or someone you love is a safe driver, talk to your doctor. Don’t risk hurting yourself or others. Here are tips for driving safely from the National Institutes of Health.

    If your joint and muscles are stiff, you may have difficulty turning your head to see oncoming cars or responding to a situation where you need to turn the steering wheel or brake quickly. In these situations, you are likely better off driving an automatic car with power steering and brakes and big mirrors. And, you should exercise so that you are as strong and flexible as possible.

    If your vision is not what it used to be, you may have trouble seeing people and things in front of you as you drive. You also might struggle to see at night. Visit the eye doctor to ensure your vision is as good as possible. You also might consider stopping driving at night.

    If your hearing is failing, you may not hear horns and sirens and may not be warned when you need to get out of the way. Make sure to have your doctor check your hearing. Also, consider keeping the radio off while you are driving so that you are better able to hear outside noises.

    If you have mild dementia, you may continue to drive. But, you want to stop when your memory weakens and you are unable to remember where you need to go. You may not appreciate the challenges of driving.

    As your reflexes slow down, you may not be able to respond as quickly as needed while you are driving. Try to not to get too close to the car in front of you, brake sooner, and, if possible, stay out of rush-hour traffic. If you need to drive when the roads are busy, try to keep to the right lane.

    If you are taking medicines, be sure to note whether the warning label includes side effects like drowsiness or lightheadedness.  If so, driving can be unsafe, and you should not be driving. Be sure to check the warning labels on your medicines and discuss them with your doctor to see whether you should be driving while taking them.

    To be safe, try not to drive when the weather is bad and at night and avoid highways, if possible. Here are helpful tips on how to help someone you love decide when to stop driving.

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