Monday, December 28, 2015

ABC Baby…You and Me!



"Health care is vital to all of us some of the time, but public health
is vital to all of us all of the time."
C. Everett Koop, U.S. Surgeon General 1981-1989

“Education is the most powerful weapon we can use to change the world.”
Nelson Mandela

One of the community services offered by our small pharmacy charity, “Sociably Secure-NGO,” is teaching seniors in rural Monroe County, Michigan about their rights and benefits as enrollees in the federal Medicare program.  We offer free quarterly seminars at library locations throughout the county, book individual appointments upon request, offer free one night classes through the county community education apparatus, and offer a free online webinar via our web page.  We also educate pharmacists and other health care providers about Medicare.

No matter the target live audience, every session starts out with the same simple query.  I ask for a show of hands from those in the room who know little or nothing about Medicare.  The response is usually unanimous.

In the popular movie, “Philadelphia,” a lawyer, (played by Denzel Washington), referring to the legal dilemma of a new client, (played by Tom Hanks), requests:  “Now, explain it to me like I'm a four-year-old.”  Most folks are thoroughly baffled by Medicare… and appreciate having it explained to them like they were four years old.

Pharmacists are uniquely positioned in most communities to act as educators and consultants about the Medicare program.  Medicare enrollees already depend upon us for providing immunizations, for offering Medication Therapy Management services, and for guiding them through the maze of picking a Medicare Part D prescription program.  General Medicare expertise and advocacy seems only a sensible professional services complement.

A role in your community as the Medicare guru can return the practical dividend of identifying prospective new patients in need of such services as immunizations and Medication Therapy Management.  Your assistance will be appreciated in kind.  Hakuna matata.

What follows is our equivalent of a “Reader’s Digest Condensed Version” of a program that introduces the rudimentary features of the federal Medicare program.  I hope that the information proves useful. 

Qualifying for Medicare

Medicare is available to each of the following individuals:

o       Americans sixty five years of age and older who qualify for Social Security benefits.
o       Americans sixty five years of age and older who do not qualify for Social Security benefits, but enroll at an additional expense.
o       Americans of any age who qualify for Social Security Disability Benefits.

A worker qualifies for Social Security benefits by contributing to the Social Security program for forty full quarters of work as a full time employee.  Spouses of qualified workers also qualify for special consideration as Social Security beneficiaries.  However, younger spouses of qualified workers do not themselves qualify for Medicare benefits until also reaching the age of sixty five.

Enrolling in Medicare

An eligible person who is sixty five years of age and who is drawing a Social Security benefit will automatically be enrolled in parts A and B of the Medicare program.

An eligible person who is sixty five years of age who is not yet drawing a Social Security benefit will be automatically enrolled in Part A of the Medicare program (with full waiver of monthly premium), but must separately enroll in Part B.
An eligible person who is sixty five years of age who is not eligible for a Social Security benefit must separately enroll in the Medicare program.

An eligible person, who is enrolled in Medicare Part A, or in Medicare Part A and Part B, must enroll separately in a Medicare Part D prescription program.

Premiums for both Medicare Part A and Part B, and for Medicare Part D may be deducted directly from a Social Security benefit check.  Premiums for Medicare Part A and Part B that are not set up for a Social Security deduction will be billed quarterly through the mail.  Premiums for Medicare Part D that are not set up for a Social Security deduction will be billed by the insurance company that sponsors the insurance.

Participation in the Medicare program is mandatory for all eligible individuals.  Failure to enroll in Medicare will result in the assessment of financial penalties.  You are excused from Medicare enrollment ONLY by demonstrating “other credible health insurance coverage.”

An eligible person who cannot afford to participate in the Medicare program due to economic hardship should qualify for assistance in paying for Medicare expenses through a state run State Health Insurance Program (SHIP) that administers the Medicare Special Needs Program (SNP).

Finding Answers to Medicare Questions

You can find answers to all of your important Medicare program questions in one of several different ways:
  
o       Visit the local Social Security Office.
o       Call the toll-free telephone number:  1-800-MEDICARE.
o       Visit the online website:  MEDICARE.gov

Questions about assistance in paying for Medicare expenses should be directed to the State Health Insurance Program (SHIP) in your state.  That contact information can be gotten by calling 1-800-MEDICARE.

The Medicare Program Alphabet

You can best understand the basic structure of the Medicare program by learning the meaning of the Medicare Alphabet; A-B-C-D:

Medicare Part A:  is a form of hospitalization insurance designed to cover the costs associated with a hospital stay.  Part A is administered directly by the federal Medicare system.

Medicare Part B:  is a form of major medical health insurance designed to cover health care costs incurred outside of the hospital.  Part B is an 80/20 health insurance program that assesses a twenty percent co-pay for all covered medical services.  Part B is administered directly by the federal Medicare system.

Medicare Part C:  is not a federal Medicare program at all.  Part C is a private insurance product designed to provide all of the same services provided by Medicare Part A and Part B.  Medicare Part C is also called Medicare Advantage; and is administered by a commercial insurance company under the strict supervision of the federal Medicare system.  Medicare Part C offers the ‘advantage’ of eliminating SOME insurance deductibles and co-pays, closing some coverage gaps associated with regular Medicare coverage, and putting a manageable cap on annual out-of-pocket medical expenses.

Medicare Part D:  is a Medicare prescription insurance program.  Part D is also a private insurance product that is administered by a commercial insurance company under the strict supervision of the federal Medicare system.

The Long Term Care Crisis

It is crucial to understand that the Medicare program offers very little insurance coverage to offset the cost of a lengthy stay in a nursing home.  Medicare does not offer traditional nursing home long-term care coverage.  Enrollees commonly assume that the Medicare program will cover nursing home costs.

The current cost of residing in a nursing home can exceed eighty thousand dollars per year.  It is estimated that seventy percent of all Medicare enrollees will spend at least two years of a lifetime in a nursing home.  A separate commercial insurance product that offers long-term care coverage is strongly recommended.

Medicare Part A:  Hospital Insurance

Medicare Part A is designed to cover the costs normally associated with a stay in the hospital, including:

The daily room rate often referred to as the “bed and Jell-O” charges.  The room rate covers the cost of staying in a hospital room, the housekeeping costs, and the cost of meals.

Inpatient medical insurance that covers the costs of medical treatment and medical testing incurred while in the hospital.

Limited convalescent care which covers the cost of a short-term stay in a nursing home only if required as a part of the recovery process for the condition that required hospitalization.  Long-term care in a nursing home is not covered.

Hospice care is fully covered for the duration of the period of time that any such treatment is deemed medically necessary.

Facts and Figures

Monthly Premium:  Medicare Part A carries a monthly premium of $407.00.  The premium is waived for all enrollees who are eligible for a Social Security benefit; whether or not they are yet drawing the federal retirement benefit.

Annual Deductible:  Medicare Part A carries no general annual insurance deductible.

Hospital Admission Deductible:  Medicare Part A carries a $1260.00 front-end deductible for each separate hospital admission.  You pay the first $1260.00 of admission costs, and this deductible can occur multiple times in a single year.


Hospital Admission Co-pay Schedule:  Medicare Part A carries a hospital admission co-pay schedule that works as follows:

o       Days 0-60 you pay $0.00 per day in co-pay
o       Days 61-90 you pay $315 per day in co-pay
o       Days 91-150 you pay $630 per day in co-pay
o       Days 151 and after you pay all costs.

Qualified Convalescent Care Co-Pay Schedule:  Medicare Part A carries a co-pay schedule for qualified convalescent care that works as follows:

o       Days 0-20 you pay $0.00 per day in co-pay
o       Days 21-100 you pay $157.50 per day in co-pay
o       Days 100 and after you pay all costs

Annual Cap on Out of Pocket Expenses:  Medicare Part A does not offer an annual cap on out of pocket medical expenses.  The sky is the limit!

Medicare Part B:  80/20 Major Medical Insurance

Medicare Part B is designed to cover costs for medical expenses incurred outside of the hospital.  The program generally covers eighty percent of eligible medical expenses, and requires the enrollee to pay the remaining twenty percent.  Covered medical services are comprehensive and include:
 
o       Physician office call charge
o       Outpatient diagnostics
o       Outpatient medical treatments
o       Durable medical equipment
o       Immunizations
o       Outpatient surgery including dental surgery and optical surgery
o       Outpatient chemotherapy
o       Outpatient intravenous drug therapy

Routine Dental services and routine Optical services are not covered benefits.  Prescription drugs are not covered.
                                                         
Facts and Figures

Monthly Premium:  Medicare Part B carries a monthly premium of $104.90.

Annual Deductible:  Medicare Part B carries an annual front-end deductible
of $147.00

Co-pay Schedule:  Medicare Part B assesses a co-pay of twenty percent on all eligible medical expenses.

Annual Cap on Out of Pocket Expenses:  Medicare Part B does not offer an annual cap on out of pocket medical expenses.  You are liable for a co-pay equaling twenty percent of infinity.

It is important to note that many costly outpatient medical treatments can generate bills totaling tens of thousands of dollars with cripplingly large co-pays.  Your co-pay responsibility amounts to $200.00 for every $1000.00 of medical expense.  Costly treatments can include, but are not limited to:

o       Outpatient physical therapy for an illness or injury
o       Outpatient chemotherapy or radio-therapy
o       Outpatient intravenous drug therapy
o       Outpatient general surgery, dental surgery, or optical surgery
o       Prosthetic devices
o       In-home skilled medical care

Medicare Part D:  Prescription Insurance

Medicare Part D is a commercial insurance product that is sold apart from the federal Medicare program that provides enrollees with a very affordable prescription drug insurance option.
  
                                                   Facts and Figures

Monthly Premium:  Medicare Part D monthly premiums vary depending upon the insurance product, but premiums average out to around $33.13

Annual Deductible:  Medicare Part D carries an annual front-end deductible
of $360.00.

Co-Pay Schedule:  Medicare Part D has a rather complex and convoluted co-pay schedule that runs as follows:

The enrollee pays contracted prescription insurance co-payment amounts, and the prescription insurance company pays all other unpaid prescription balance amounts; until combined payments from both parties reach an initial policy prescription benefit limit of $3310.00 in total purchased prescription prices, (cost of drug plus dispensing fee). The initial period enrollee co-payment amount is twenty-five percent; equivalent to roughly $827.50 in prescription co-payments for this portion of the policy.

A second annual participation deductible of $3662.50 kicks in when the $3310.00 initial policy benefit limit is reached. This second annual deductible is often referred to as the coverage gap or the “donut hole.” The “donut-hole” lasts until a total out-of-pocket cost amount of $4850.00 is reached.

When the second $3662.50 “donut hole” deductible obligation is met, the policy converts to a standard prescription drug coverage insurance policy with a five percent of prescription price co-payment requirement, (cost of drug plus dispensing fee). Minimum co-payment amounts for these policies are federally set at this point at approximately $3.00 for generic drug prescriptions, and $6.00 for brand name drug prescriptions; and these minimums vary from year to year.

The typical out-of-pocket burden required to reach the final stage of coverage is equal to the sum of: the $360.00 annual deductible, $827.50 in co-pays in the initial coverage period, and a $3662.50 deductible paid toward coverage while in the “donut-hole.” This total amount equals: $4850.00 before any “donut-hole” drug discounts from the American Affordable Care Act. Discounts currently cut the “donut-hole” nearly in half, and will reduce it by 75% by 2020; leaving the enrollee with a 25% co-pay.

Concurrent to the American Affordable Care Act, prescription drug manufacturers have voluntarily contracted to participate in a graduated drug cost discount program that applies to all prescriptions filled while an enrollee is paying a “donut hole” annual deductible. The applied discount value will increase annually between the years of 2014 and 2020, to reach a maximum drug cost component discount amount of 75% of all drug cost. The discounts are, in truth, a combination of contributions from both drug manufacturers, and the federal government. The enrollee will pay the dispensing fee plus 25% of all drug cost as a co-pay.

2016
Brand Co-Pay 45%   (Discount 55%)
Generic Co-Pay 58%   (Discount 42%)
2017
Brand Co-Pay 40%   (Discount 60%)
Generic Co-Pay 51%   (Discount 49%)
2018
Brand Co-Pay 35%   (Discount 65%)
Generic Co-Pay 44%   (Discount 56%)
2019
Brand Co-Pay 30%   (Discount 70%)
Generic Co-Pay 37%   (Discount 63%)
2020
Brand Co-Pay 25%   (Discount 75%)
Generic Co-Pay 25%   (Discount 75%)
These escalating discounts are applied by prescription insurers at the time that a prescription is filled to give enrollees their savings amounts in real time. The prescription insurers are reimbursed by drug manufacturers. However, the majority of the pre-discount prescription price is applied in order to meet the $3662.50 annual “donut hole” requirement.

Medicare Part C:  Commercial Medicare Advantage Programs

Medicare Part C, also called Medicare Advantage, is a commercial insurance product administered by an insurance company, under the strict supervision of the federal Medicare program.  A Medicare Part C enrollee actually leaves the care of Medicare Part A and Medicare Part B to become a client of the insurer that administers the Part C policy.

Medicare Part C offers all of the insurance coverage and benefits of Medicare Part A and Medicare Part B that we have discussed… in strict accordance to federal law.  However, these insurance policies often offer medical coverage in a fashion that reduces or minimizes the deductibles and co-pays associated with regular Medicare.  Medicare Part C policies usually have a Medicare Part D prescription program built right into them.

Medicare Part C also offers the huge advantage of placing a cap on annual out-of-pocket expenses… something that is so conspicuously missing from regular Medicare coverage.

Premiums, deductibles, hospital admission deductibles, and co-pays all vary widely depending upon the insurance product purchased.  Medicare mandates that these policies all offer a maximum annual out-of-pocket cap on medical expenses of $6800.00.  The cap is often much less depending upon the policy terms.

*Important Tip:  make sure that the Medicare Advantage plan that you choose does business with the local hospital and the local medical community as part of the service network!
  
Medigap:  Commercial Medicare Supplement Programs

Medigap, also called a Medicare Supplement Program, is also a commercial insurance product administered by an insurance company, under the strict supervision of the federal Medicare program.  Medicare supplement programs are designed to be added on to existing Medicare Part A and Medicare Part B coverage.  These products do not include Medicare Part D policies, which must be purchased separately.

These insurance products are designed to pay for all, or most of all, of the deductibles and co-pays that are normally left by Medicare coverage to be paid by the enrollee.  This includes all of the Medicare Part A deductibles, hospital admission deductibles, and co-pays; as well as all of the twenty percent co-pays associated with Medicare Part B.  All of theses expenses are covered benefits under a Medigap policy.

Monthly insurance premiums for these products vary according to the insurance product type; running as low as $50.00 per month to as high as $175.00 per month.  Out of pocket expenses, not including the monthly Medicare Part B premium which you must still pay... are reduced to as low as $0.00 per year to as high as $2100.00 per year.  Expenses can be limited to payment of only the monthly Medigap premium, plus the monthly Medicare Part B premium… with the best of these commercial insurance products.

Medicare Part A and Medicare Part B offer terrific insurance coverage.  The addition of a Medigap policy offers additional coverage for everything that Medicare misses… resulting in phenomenal insurance coverage!

*Important Tip:  buy your Medicare Supplement from an insurance broker who represents many companies that sell the plans.  Although the coverage for each plan from each company must be identical under federal law… prices from company to company will vary widely.  An insurance broker will offer a variety of prices from which to choose from an assortment of competing companies.

*Important Tip:  beware of Medicare Supplement policies that offer special lowered premiums for the first two policy years.  Premiums may skyrocket after the second year… and the enrollee would be required to health qualify to switch to a more affordable plan!  

The Importance of Medicare Annual Reviews

It is important to annually review your Medicare supplement insurance products.  The premiums on Medicare Advantage products, Medicare Supplement products, and Medicare Part D products can all go up over time.  An annual review will give you the perfect opportunity to examine the premiums that you are paying and to perhaps shop around for better values.
Federal law guarantees that you will qualify for any Medicare Supplement insurance product that you want for an enrollment period that starts ninety days before your enrollment in Medicare, and running for 90 days after enrollment.  You cannot be refused participation for reasons of bad health… enrollment is guaranteed.

After that one-time grace period you must demonstrate good health to qualify for the purchase of these insurance products…. this is called health qualifying  For as long as you remain in good health during the years after the initial purchase of a Medicare Supplement, you can shop around on an annual basis for the best premium values.  If you are lucky enough to stay healthy as you grow older… you have the right to save money on insurance premiums.

Only Medicare Supplement programs require you to health-qualify to switch products. Medicare Advantage programs and Medicare Part D plans have no health qualifications; and can be shopped around annually for the best deals.

A simpler way to make an important decision… is to ask simpler questions:  How much will my Medicare insurance program cost me to OWN each year?  How much will my Medicare insurance program cost me to USE each year?  Basic arithmetic becomes the compass… and savvy price shopping the lode star.

  The ABC’s of Medicare Enrollment
Tuesday  January 12, 2016   8:30pm
Monroe Public Schools Community Education & Recreation
Monroe Middle School    503 Washington St.    Monroe, Mi 48161
Program Information:  (734) 265-3170

Jonathan Shores is an independent educator not connected with the federal government, with CMS, or with the Medicare program.  This FREE program is designed solely for educational purposes

Sunday, December 20, 2015

Take Good Care of Yourself




“Button up your overcoat
When the wind is free
Oh, take good care of yourself
You belong to me.” 
 Frank Sinatra, ‘Button Up Your Overcoat

“Breath is the finest gift of nature. Be grateful for this wonderful gift.”
  Amit Ray

The new influenza season is officially upon us. Once again, thousands of Americans will die from flu related pneumonias over the next six to eight months… as surely as God made little green apples. The more is the pity, because the key to preventing many of these pending needless deaths is as elementary as… well, breathing.

Most of the unfortunates who shall die from influenza related pneumonias this season will be elderly, and most will not have been properly immunized against influenza and against pneumonia.

Seniors aged sixty five years and older historically immunize against influenza and pneumonia at dismally low rates as a group. Only one out of five seniors will voluntarily immunize themselves this year. From another perspective, four out of five seniors will be available to contract and carry influenza to share with vulnerable friends and family members; and with total strangers in numerous medical waiting rooms... and at local senior centers.

Vaccines against influenza and pneumonia are cost free to all seniors enrolled in Medicare, and for most seniors still covered by other credible insurance coverage. The availability of vaccines at a growing number of community pharmacies and community free clinics has made the immunization process in most states as trouble-free as scoring a Slurpee at the local 7-Eleven.

Cost and availability are in no way detractors preventing seniors from immunizing. The culprit variables might instead be as simple as unfounded fears about vaccinations, lack of education about vaccinations, or individual armchair- inertia. These mountains just won’t come to the immunizing pharmacists, so to speak... so we must go to them.

If pharmacists and other immunizers fail to actively reach out to these at-risk patients by mail, by telephone, via sneaker-net, or even by pleading-on-bended-knee… pathologically bad things will happen. Guaranteed.

Eight percent of this entire herd will eventually die from influenza related pneumonias. One out of ten visits to the emergency room for flu related pneumonias from this group will end in death. Two out of ten emergency room visits will result in multiple Medicare-readmissions-within-thirty-days… that will strain the finances of struggling hospitals. Escalating rates of bacterial resistance against antibiotics commonly used to treat pneumonias can only worsen this gloomy picture over time.

The following chart offers current federal recommendations for immunizing seniors against Influenza and Pneumonia:



The following general vaccine administration guidelines can be followed by immunizers when vaccinating at-risk elderly patients against influenza and pneumonia:

-Immunocompetent adults 19 to 64 years of age or older with diseases, habits, or living conditions that put them at high risk of pneumococcal disease: Heart disease (including heart failure or cardiomyopathy), Pulmonary disease (including COPD, emphysema, or asthma), Diabetes, Alcoholism, Cigarette smoking, Chronic liver disease, Long-term care facility residents:
   
 Annual Influenza Vaccine
 Single dose of Pneumococcal PolysaccharideVaccine                  (Pneumovax-23).

-Adults 65 years of age and older:

Annual Influenza Vaccine
Single dose of Pneumococcal Conjugate Vaccine (Prevnar 13) if not previously given, followed by Pneumococcal Polysaccharide Vaccine (Pneumovax 23) six to 12 months later.

• Wait until at least one year has passed since any previous Pneumococcal Polysaccharide Vaccine (Pneumovax 23) dose to give Pneumococcal Conjugate Vaccine (Prevnar 13).
• Those who received one or more doses of the Pneumococcal Polysaccharide Vaccine (Pneumovax-23) before age 65 for any indication should receive another dose at age 65 or older if five years have elapsed since their previous Pneumovax-23 dose.

Note that giving both vaccines to today’s seniors is estimated to prevent 230 cases of invasive pneumococcal disease and 12,000 cases of community-acquired pneumonia over their lifetime.  Referenced: “Pneumococcal Vaccination in Adults: Who Gets What and When?” Pharmacists Letter/Prescribers Letter, November 2014.

Immunizing pharmacists are uniquely positioned in most communities to perform the aggressive outreach necessary to educate at-risk seniors about, and to immunize vulnerable seniors against, influenza and pneumonia. The “main street” nature that is so integral to the practice of community pharmacy makes immunizing pharmacists a logical choice among health providers to lead a grassroots immunization campaign.

Absent such aggressive clinical actions, many of these patients will not live to see the start of another flu season. These older folks are our loved ones, our family, our friends, our neighbors, our patients. The best tune for seniors this flu season has a simple chorus to croon:  take good care of yourselves… you belong to us.

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Wednesday, December 9, 2015

A Light Sneeze



“Caught a light breeze, caught a light sneeze
caught a lightweight lightning seed.
Boys on my left side, boys on my right side
Boys in the middle and you’re not here.”
Tori Amos, Caught a Lite Sneeze
                 

I recently read an article that postulated that non-immunized taxi cab drivers in New York City are major culprits in the annual spread of influenza infections, (“Taxi Flu Epidemic:  Most Cabbies Are Not Vaccinated,” The New York Post, April 19, 2015).  The article wondered if a program that mandated the immunization against influenza of all licensed cab drivers in New York… would cut down on the transmission of disease.  

The question is a good one because it directs focus toward some larger and more important questions:  How do the flu do those things that flu do?  What role might Public Health better play in protecting public health?  Do workers who largely serve the public have a social obligation to protect the public against preventable communicable disease?
 
If the answer is yes for cabbies… then for whom else does it equally apply?  How about bus drivers, (et tu Ralph Kramden)?  How about any public servant who unknowingly places young infants and elderly unimmunized customers at increased risk of hospitalization and death... with something so simple as a cough, a light sneeze, or a friendly handshake?

People over the age of sixty five immunize against influenza and pneumonia at dismally low rates.  The herd immunity rate for the elderly is traditionally less than twenty percent.  They are at very high risk of catching influenza from others.  This same group is disproportionately sickened and killed by influenza and the pneumonias that are spawned by it.

Influenza related pneumonias cause six to eight percent of all deaths in persons aged over sixty five years.  Ten percent of all costly emergency room visits for pneumonia by this crowd end in death.  Fifteen percent of these same emergency room visits result in multiple costly Medicare-readmissions-within-thirty-days.

The mortality graph for influenza related pneumonias has a vertical axis that tracks numbers of deaths, and a horizontal axis that tracks victims ages.  The curve typically creates a letter U.  The base of the U curve anchors over the age of thirty five; and the two stem tips peak at the age of one year, and again at the age of seventy years.  The majority of deaths plotted are shared equally by infants and by the very old, over fifteen thousand of each annually… lending height and uniformity to the U curve.

The deadly influenza pandemic of the early nineteen hundreds created an atypical graph curve that looked like the letter W.  The middle peak of the W curve centered over the age of 35 years.  The majority of deaths were caused by secondary pneumonias… and mortality was shared across a spectrum of all ages of victims.  It is folly to assume that such an influenza pandemic could never again occur.

To illustrate the health risks posed, consider a day in the life of one favorite patient living in Monroe County, Michigan.  Her name has been changed for reasons of confidentiality.

Ann is seventy years old.  She foolishly does not immunize against influenza or pneumonia.  Ann was hospitalized with mild bronchitis ten years ago.  Ann lives alone in her own home and is economically home-bound.  She has Medicare insurance coverage, and receives a monthly social Security check, but does not qualify for additional economic assistance.  She uses the local transit system to complete all weekly errands.  One recent weekly itinerary with potential exposure to flu risk ran as follows:

  • Ann scheduled a series of errand stops with the local public bus transit system.  The transit system drivers are not required to get an influenza vaccine.

  • The first stop was at a local bank.  The bank tellers are not required to get an influenza vaccine.

  • The second stop was at the post office to check the post office box, and to mail some bills.  The postal employees are not required to get an influenza vaccine.

  • The third stop was at the local library to return some books and to pick up some new books.  Library employees are not required to get an influenza vaccine.

  • The final stop before returning home was at the local supermarket to do some light shopping.  The cashiers are not required to get an influenza vaccine.

There are several thousand home-bound seniors like Ann living in Monroe County.  If Ann dies of influenza related pneumonia at the local hospital later this flu season… to whom do we look? Who dealt the hand?

Some questions answer themselves.  People over the age of sixty five need to immunize against influenza and against pneumonias at much larger numbers.  A twenty percent herd immunization rate is unacceptable.  Medicare provides the vaccines cost free.  Immunizers need to get better at beating the bushes to get the elderly immunized.  Primary caregivers are simply not doing enough.

People who work directly in service of the public are morally and ethically obligated to immunize against influenza.  Workers who have health insurance are currently entitled to cost free immunizations as a benefit.

Employers with uninsured employees have a social obligation to provide workers with cost free vaccinations.  Cost free influenza vaccinations are available at any subsidized Public Health Department clinic.  Employers are obligated to require that all employees be properly immunized against influenza.

A single preventable death will always be too dear a price to pay.  Whose death is replaceable?  A senior who refuses to immunize, a service worker who refuses to immunize, an employer who refuses to demand immunization of all public service employees… could each directly contribute to a single preventable death this very year.  How many of the forty thousand deaths from influenza that happen this season will have been single preventable deaths?

Let the cab driver, the bank teller, the librarian, the cashier, the transit bus driver, and all others who work to serve the public take heed:  the senseless demise of someone that somebody else loves is at hand this year for the sake of a lightweight lightning seed… or of a light sneeze.

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Sunday, November 29, 2015

And Know They Love You




“And you, of the tender years can't know the fears that your elders grew by,
And so please help them with your youth, they seek the truth before they can die.”
Teach Your Children, Crosby Stills Nash & Young

“In a sane, civil, intelligent and moral society, you don’t blame poor
 people for being poor.” Andrew Young

Nearly twenty million senior citizens in America are economically vulnerable.  That is nearly half of all of the country’s elderly.  Furthermore, eight percent of all seniors are home-bound.  A large number of these folks are economically home-bound… too damned poor to go anywhere.

Income from the federal Social Security program, and health insurance benefits from the federal Medicare program, are godsends for economically disadvantaged seniors.  Even so, participation in the Medicare program carries some costs that many enrollees have difficulty meeting:  monthly premiums, co-insurances, and co-payments.

Federal aid programs currently exist to provide cost-sharing relief to eligible enrollees who are economically unable to meet the costs of participating in Medicare.  These programs are collectively known as Medicare Special Needs Programs.
 
The vast majority of the Medicare enrollees who qualify for federal cost-sharing relief do not know that these aid programs exist.  Medicare enrollees who are confined to their homes stand very little chance of EVER knowing that these programs exist.  And that’s just nuts.  This is where we come in… as the bearers of good news.

Eligibility for Medicare cost-sharing relief is predicated on two simple tests:  limits on net income, and on personal assets.  If enrollees pass the standards posed by both tests… they qualify for much needed financial assistance to help pay for Medicare costs.

The following is a summary of the available Medicare Special Needs Programs:

 Medicare Cost Sharing Special Needs
Programs SNP

Medicare Cost Sharing Special Needs Programs help cover some of the costs of services for individuals who enroll in Medicare.  Qualification is based upon both an asset limits test, and an income limits test based upon the current Federal Poverty Level Income.

Current Federal Poverty Level Income:

                1 person - $11,770
                2 people - $15,930

There are 3 different kinds of Medicare Cost Sharing Special Needs Programs.

Qualified Medicare Beneficiaries Program (QMB) pays Medicare Part B premiums and deductibles, the 20% copayment of Medicare approved amounts, and co-payments for Medicare-approved, skilled nursing home care.

How to Qualify:

Your Taxable Net Income (after deductions like a $20 income deduction and a portion of your earned income are taken out) must not be more than 100% of poverty.  The income of a spouse who is not eligible for QMB is counted.

                You must meet the income limits test:

                1 person - $11,770
                2 people - $15,930

                You must meet the asset limits test:

                1 person - $7,160
                2 people - $10,750

 Specified Low-Income Medicare Beneficiaries (SLMB) pays the Part B Medicare premium only.

How to Qualify:
                                                                                                             
Your Taxable Net Income (after deductions like a $20 income deduction and a portion of your earned income are taken out) must not be more than 120% of poverty.  The income of a spouse who is not eligible for SLMB is counted.

                You must meet the income limits test:

                1 person $14,124
                2 people $19,116

                You must meet the asset limits test:

                1 person - $7,160
                2 people - $10,750

Qualifying Individuals Program (QI-1) pays the Part B Medicare premium only.

How to Qualify:

Your Taxable Net Income (after deductions like a $20 income deduction and a portion of your earned income are taken out) must not be more than 135% of poverty.  The income of a spouse who is not eligible for QI-1 is counted.

                You must meet the income limits test:

                1 person - $15,890
                2 people - $ 21,506

                You must meet the asset limits test:

                1 person - $7,160
                2 people - $10,750

There are 2 different kinds of Medicare Cost Sharing Special Needs Programs to help with Medicare Part D prescription drug programs.

Poverty Income Part D Subsidy Program pays the annual deductible, and the monthly premium, and limits prescription co-pays:  generics $2.50 and brand name $6.30.

How to Qualify:

Your Taxable Net Income (after deductions like a $20 income deduction and a portion of your earned income are taken out) must not be more than 135% of poverty.  The income of a spouse who is not eligible is counted.

                You must meet the income limits test:

                1 person - $15,890
                2 people - $ 21,506

                You must meet the asset limits test:

                1 person - $8,100
                2 people - $12,910


Limited Income Part D Subsidy Program  reduces the annual deductible to $63, reduces the monthly premium on a sliding scale that goes no higher than the national averaged monthly premium, and reduces prescription co-pays to 15%... all the way through to the end of the donut hole.

How to Qualify:

Your Taxable Net Income (after deductions like a $20 income deduction and a portion of your earned income are taken out) must not be more than 150% of poverty.  The income of a spouse who is not eligible is counted.

                You must meet the income limits test:

                1 person - $17,655
                2 people - $ 23,895

                You must meet the asset limits test:

                1 person - $12,510
                2 people - $ 25,010

This new-found knowledge about Medicare cost-sharing assistance programs lends you the unique power to make a big difference in the lives of needy senior citizens in your own community.  Mother Teresa once counseled, “If you can’t feed a hundred people… then feed just one.”

Well, if you can’t help a hundred needy Medicare enrollees in your hometown, then seek out and educate just one.  Encourage your family, friends, and professional colleagues to do the same.

Teach your parents well.  Nourish them with knowledge, and feed them on your dreams…
and know they love you.

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