The Med Diva

An insider's guide to Medicare Part D and more

Archive for the category “Medicare”

Finding a Doctor Who Accepts Medicare | PBS NewsHour

Finding a Doctor Who Accepts Medicare | PBS NewsHour.


My gift is my song, and this one’s for Medicare

A symphony written for MedicareJust when I think I’ve heard and read it all about Medicare, a story comes along that grabs my attention and makes me want to share it with others:

A New Jersey resident is so thankful for Medicare, he’s written a song about it. Well, not really a song – more like a symphony in four movements for a full symphony orchestra. The name of the piece is, appropriately, Symphony No. 1, Medicare.

Speaking to the New Jersey press, N. H. Derwyn Holder, 74, said he wrote the piece to express his gratitude for the Medicare program and all the help it provided when he underwent numerous medical procedures.

“I’m filled with gratitude that the assistance that I’ve needed was made available for me through the Medicare program, from the AARP supplemental insurance, and by the fine medical people who have helped me to be here today,” Holder told the Hunterdon County Democrat. Describing the music, Holder says, “Through it I wish to ‘give back,’ not tell a story. The Medicare Symphony is the biggest thing I could do. It is intended to sound as beautiful as I could possibly make it.”

Holder is currently trying to arrange a first performance of his Medicare Symphony by enlisting the help of musical colleagues he has worked with during the years. I’ll keep you posted if I find and where and when it’s going to be performed.

In the meantime, I bet we’d be pressed to find someone who is willing to write a symphony for America’s health care system in general…


Granny, Get Your Gun — And No, Medicare Won’t Make You Tell Your Doctor!

Lately, there have been a lot of crazy rumors about Medicare spreading like wildfire on the Internet. Like the rumor that Medicare premiums are going to jump to $247 in 2014 thanks to the Affordable Care Act, or that Medicare is going to refuse procedures for seniors over 75 unless an ethics panel (aka, death panel) reviews them—again, thanks to Obamacare.

But this rumor that I came across today on the Huffington Post Politics blog isMedicare Does not Ask About Guns by far the most absurd falsehood I have heard yet: Apparently, a Vietnam Vet and/or retired police officer started spreading a rumor via e-mail that Medicare regulations require doctors to ask you if you own a gun. “Be forewarned and aware,” the e-mails state. “The Obama administration has gone on record as considering veterans and gun owners potential terrorists.”

There’s a long and convoluted story behind this rumor, which you can read for yourself on Snopes, but just know that this rumor is wrong and belongs way out in left field (or maybe that should be right field in this case). Although doctors (particularly pediatricians) in most states can ask patients if they own guns if the question is relevant to the person’s medical care or safety, this question is most definitely not required by Medicare. 

So as I stated in my last post, don’t believe everything you read or hear. If you want to sort through the rumors and get to the truth, do some searches on Google to find reputable sources, or check out these fact-finding sites: or or

Just the Facts, Ma’am: Don’t Believe Everything They Say About ACA and Medicare

ImageShortly after 10 a.m. last Thursday, I heard one of my coworkers shout out, “The individual mandate has been shot down. CNN reports that the Supreme Court has found it unconstitutional. Thank goodness!”

I hadn’t checked the news yet, but I got this feeling of dread. Oh no, I thought. How are we going to explain to all these Medicare beneficiaries that they may have just lost all the extra benefits they received under the Affordable Care Act? What a mess this is going to be!

Luckily, I didn’t take my coworkers’ announcement as set in stone and fret all day. Instead, I decided to do some due diligence and read the news for myself. I went to and read that the Supreme Court had upheld the Affordable Care Act in its entirety. I then read the same news on several other reputable news and healthcare sites. Finally, I did some checking and found out that both CNN and Fox had erred in their initial reporting.

Now, it is very rare that a major news outlet jumps the gun and gets it so wrong. In fact, New York Times reporter Charlie Savage called it a “Dewey defeats Truman” moment for this 21st century. However, the point I really want to make is then when it comes to important information that can affect you, it pays to play detective and do your own research to confirm the facts—or what passes as facts these days.

AARP survey: People are sick and tired of non-factual ‘attack’ ads

Speaking of “facts,” for the past few years—although it seems more like forever—there have been a lot of rumors going around about Medicare and Social Security. These rumors often rear their ugly head in political ads, and from what I’ve been seeing and reading, it’s only going to get worse as we get closer to the November elections.

A new voter survey of 1,001 registered voters by AARP of Washington shows that voters are “sick and tired of negative and misleading political ads, and most are misinformed or unaware of what’s behind the spin.” According to the survey, 79 percent of those polled agree that it is difficult to determine if claims made in TV ads are correct.  But only a third of the respondents said they know that it is NOT a violation of federal law for candidates to use deceptive or misleading statements in political advertising.

Other survey findings:
• 98% said Social Security is important to financial security
• 97% said Medicare is important to health
•  81% agree that politicians are “trying to make too many decisions behind closed doors regarding Social Security and Medicare”
• Only 8% think “most or all of political television ads” have given “objective, factual information about an issue or candidate”
• 13% understand that the contents of political advertising are not regulated by any government agency

Don’t be fooled by ads about Medicare and Social Security

Kathleen Hall Jamieson, a University of Pennsylvania political communications expert, tells AARP members to watch out for ads that play on fear, use emotional images or music, or in any way distract them from thinking critically about what it being said. “There is deception on both sides, and you might be deceived by your own side,” Jamieson tells the AARP.

Jamieson suggests three ways voters can inform themselves:
• Watch the candidate debates.
•  Read, watch and listen to news reports that cover all sides of issues.
• Check politicians’ claims by visiting nonpartisan fact-checking websites such as, and

Mission ola lāhui: Increasing awareness of preventive services covered by Medicare in Hawaii

Medicare beneficiaries in HawaiiThis morning I read in Kaiser Health News that only 1 percent of Medicare beneficiaries living in Hawaii have taken advantage of the free annual wellness visit they are entitled to, courtesy of healthcare reform. I immediately sent a tweet via Twitter to my friend Claire Santos, RN, who is a nurse and health communicator and educator in Hawaii. Claire, I tweeted, you now have a mission to increase awareness of preventive services covered by Medicare in your home state.

According to the Centers for Medicare & Medicaid Services, only 890 beneficiaries in the Aloha State have had a free wellness exam this year, which is the lowest percent of any state. Even worse, the state with the highest percentage of seniors who have taken advantage of the wellness visit is Rhode Island — coming in at just 8 percent. 

Nationally, only about 3.6 percent of beneficiaries, or 1.1 million seniors, have had a wellness visit since January.  Jim Firman, CEO of the National Council on Aging (NCOA), a nonprofit advocacy group, theorizes that many seniors simply do not know what additional Medicare benefits are provided in the Affordable Care Act. Speaking at a White House event highlighting benefits to seniors in the health law, Firman said of the annual wellness visit, “This is a really good benefit, but you have to use it to maximize the opportunity.”

What exactly is the annual Medicare wellness visit?

It’s important to understand that the wellness visit is not a physical exam. It’s actually just a great opportunity to talk to your doctor and develop or update a personalized prevention plan based on your current health and risk factors. Anyone who has had Medicare Part B for longer than 12 months is eligible for this annual visit, which includes: 
• A review of medical and family history
• A list of current providers and prescriptions
• Height, weight, blood pressure, and other routine measurements
• A screening schedule for appropriate preventive services
• A list of risk factors and treatment options for you

Other preventive services covered by Medicare

Thanks to the Affordable Care Act, numerous preventive services are now provided free under Medicare. These services include various exams, shots, lab tests, and screenings, plus counseling and education to help you take care of your own health. This year, only 43 percent of Medicare beneficiaries, or about 14 million people, have taken advantage of the free care this year.  CMS put out a great guide to Medicare’s preventive services, which I highly recommend you check out if you are among those eligible who have not yet taken advantage of these services – especially if you are among the 99 percent of beneficiaries in Hawaii who have not yet had your wellness visit.

By the way, if you’re wondering what “ola lāhui” means: According to online sources, it is defined as, “So that the people will live and thrive.” The term is often used with health care services or professionals — like my friend Claire — to show intent to improve the health and being of the Hawaiian people.

A question for Medicare: Why must a major Part D program depend on little ol’ me to save it from termination?

Medicare Part D worldIn my last two posts, I talked about how difficult it can be to convince Medicare beneficiaries to take advantage of the Medicare Medication Therapy Management program. One of the problems is that the Centers for Medicare & Medicaid Services (CMS) puts the responsibility on Part D sponsors to get members to opt into the free program. That means prescription drug plan employee peons like me have to write letters or make phone calls to persuade (in other words, beg) eligible plan members to participate in the program.

This week I am faced with a similar situation that involves convincing people to follow their doctors’ orders.  I must write a compelling letter to entice members who are not taking their medications properly to speak with a pharmacist. These members may be skipping pills, forgetting to take their medication, delaying their refills, or doing something else that is causing a gap in therapy (also called nonadherence). If members ignore this letter and don’t take their medication as directed, their Part D plan could be terminated.

Honestly, it sort of feels like the world is on my shoulders.

It’s all in the Medicare stars

To make a long story short, it all has to do with the Medicare star ratings.

CMS uses a star rating system as a guide to help beneficiaries compare the quality of private health plans in the Medicare Part D and Medicare Advantage (Part C) programs. These ratings measure everything from customer service issues such as call wait times to clinical issues such as adherence rates for members taking diabetes and hypertension medications. Based on these measurements, a plan’s overall star rating can range from 1 (poor) to 5 (excellent) stars.

Starting in 2015, CMS can cancel the contracts of Part D and Part C sponsors that fail to receive at least a 3-star (average) rating for 3 years in a row. Potential termination is a great “incentive” for Part C and Part D plans to deliver better care and value. The problem is that not all ratings are created equal: In 2012, clinical measures, such as adherence rates, were weighted three times heavier than other measures.

Many Part D plans received low star ratings in 2012 – even the plan I work for, which got a 5-star rating in 2011, dropped to 4 stars in 2012.  Many of the lower ratings were not due to poor customer service or low member satisfaction, but due to poor medication adherence rates. In other words, because many people are not following doctors’ orders and taking their medication the right way, Part D plans are getting lower star ratings. If these low medication adherence rates do not improve over the next two years, these Part D plans could be shut down by CMS.

CMS: Why is the burden on Part D plan sponsors?

Once again, I ask CMS why all the responsibility is placed on the shoulders of the Part D plan.

Although some plans do have very effective medication management tools in place—such as pharmacist outreach calls—it can be difficult and expensive for plans to ensure their members are following doctor’s orders and taking their drugs as prescribed. Plus, how do strangers at a Part D plan convince people who are not following their doctors’ orders to listen to them? If a doctor can’t make their patients take their medications as prescribed, what chance do I have?

CMS, I really hope you can give me an answer. Because right now, if I can’t convince a few thousand people to get back on track with their medications within the next few months, a large Part D program with a major health plan may soon be getting the boot from you. How wrong is that?

The Medicare MTM Program – Part II: Just What the Doctor Ordered

MTM: Just what the doctor orderedAs I mentioned in my last post, I’ve been writing a letter that invites my company’s Part D plan members to participate in Medicare’s Medication Therapy Management (MTM) program. The main feature of the Medicare MTM program is an annual comprehensive medication review, which includes a review of all medications, vitamins, and supplements with a pharmacist; a written summary and medication action plan to share with doctors; and a personal medication list. 

The letter has been written and approved, but I still have my doubts that it is going to convince people to take advantage of this free program. For some reason—well, many reasons—seniors who take a lot of medications just don’t think they need an annual medication review, even if their health and safety is at risk.

Aging and multiple medications increase your health risks

But here’s the hard truth, plain and simple: If you take multiple medications, your chances of ending up in the hospital because of dangerous side effects or a harmful drug interaction are pretty high. To make matters worse, aging increases your risk for medication side effects.

If you take multiple medications, you’re not alone

The average older American uses 4-5 prescription drugs and 2 over-the-counter medications.  The average nursing home resident uses at least 7-8 prescription drugs.  Here are a few other facts to consider:

• The more medications you take, the more chance there is for those drugs to interact negatively with each other — or with vitamins, supplements, and even certain foods.
• You may think the symptoms of such harmful interactions are normal, such as an upset stomach or feeling tired. Or you may not notice any symptoms at all. 
• If you are taking multiple drugs, there also is a greater risk of forgetting to take medications, taking them at the wrong time, or taking too much or too little.
• The more drugs you take, the more likely at least one of those drugs is not necessary.  

The MTM comprehensive medication review is just what the doctor ordered

Let’s face it. It’s not always easy to keep track of your drugs or know how to use them safely. That’s why the Institute of Medicine encourages people to participate actively in the healthcare process to prevent medication-related problems. One of the things that doctors suggest is a medication review with a healthcare provider at least once a year.

So what are you waiting for?

I hope I have encouraged at least a few seniors to participate in their Medicare prescription drug plan’s MTM program. And I hope you say “yes” if your plan invites you to have a comprehensive medication review with a pharmacist. Your health and safety depend on it.

Medicare Information for Non-Native English Speakers – AARP

Medicare Information for Non-Native English Speakers – AARP.

The Medicare MTM Program —Part I: Providers Say Yes, but Seniors Say No Thanks

Seniors say no to Medicare medication therapy managment

Most Medicare beneficiaries reject the free services provided by MTM programs.

Like all Medicare prescription drug plans, the Part D plan that I write for offers a special health benefit called a Medication Therapy Management (MTM) program. MTM programs are designed to help Medicare beneficiaries ensure their medications are working safely and effectively for the best possible clinical outcomes.

My assignment this week was to write a letter to all our plan members who are eligible for MTM this year. Not just any letter, but a compelling letter that encourages seniors to say “yes” to a free service that even many doctors recommend for patients who are taking multiple medications.

Easier said than done.

The MTM comprehensive medication review

The standard Medicare MTM program includes an annual comprehensive medication review for the beneficiary, which includes a review of all medications, vitamins, and supplements with a pharmacist; a written summary of the consultation and medication action plan to share with doctors; and a personal medication list.  All Medicare Part D sponsors are required to provide this service at no extra charge for members meeting the following MTM eligibility criteria:
• Have multiple chronic diseases
• Are taking multiple Part D covered drugs
• Are likely to spend more than a specific amount on Part D drugs during the year ($3,100 in 2012)

Although the people who concocted the Medicare Modernization Act of 2003 probably had good intentions when they set the guidelines for the MTM program, it appears that few seniors are actually taking advantage of the services the program provides.

Part of the reason why MTM participation is low is because the Centers for Medicare & Medicaid Services (CMS) places all the burden on the Part D sponsor: Plans must offer MTM services to all eligible beneficiaries each year, but participation is optional and must be sought out through letters or phone calls. Hence, my assignment to write a letter that makes members want to accept the free offer.

Low participation could also be due to neutral or even negative perceptions of the MTM program, and in particular, of comprehensive medication reviews (CMRs).  In a 2011 focus group study conducted by the University of Iowa College of Pharmacy, the majority of participants said they were not interested in the CMR, even though they are taking multiple medications and have a high medication risk rating.

Here are some responses they gave when asked why they did not want a CMR:
• Although I have multiple doctors and multiple medications, I consider myself at a low risk for a medication-related problem.
• The counseling I receive from my pharmacist is adequate so I don’t need a comprehensive review.
• This would be a waste of time for me because my pharmacist already talks to me whenever I have a new medication.
• My doctor should do this; not my pharmacist.
• I wasn’t aware that my Part D program offered this.

My recommendation to CMS: If you really want to help Medicare beneficiaries ensure all their medications are working together safely and effectively, don’t put the onus on Part D sponsors. Make the MTM program truly mandatory: Everyone who is eligible for the program must show proof of active participation in order to receive the prescription drug benefit. If that’s not possible — and it probably is not — than at least help sponsors out with outreach on your own CMS letterhead. Maybe a letter or phone call from CMS will work better — it’s worth a try.

Then maybe I won’t have to write a compelling letter that gets, at best, 5% of our eligible members to participate in MTM.

In Part II next week, I’ll talk about why CMRs are just what the doctor ordered.

Eliminating nonadherence to medications could help solve the Medicare insolvency crisis

Medication nonadherence costs US healthcare system over $317 billion

In 2001, medication nonadherence cost America more than $317 billion.

“Curing nonadherence could pay for the health care of 44.8 million Americans.” Express Scripts 2011 Drug Trend Report

According to the Express Scripts 2011 Drug Trend Report, 30 percent of adults with high cholesterol do not take their medications as prescribed. For those with high blood pressure or heart disease, 31 percent do not adhere to their therapy. An even greater number of patients with diabetes—43 percent–are nonadherent.

These are very disturbing numbers, especially when Medicare is allegedly on the verge of bankruptcy.

Nonadherence—not taking drugs as prescribed by the doctor—is our nation’s most costly health condition. According to Express Scripts, in 2011, medication nonadherence cost the U.S. health care system over $317 billion in treating medical complications that could have been avoided if patients had taken their medication. This amount is actually higher than the total cost of treating diabetes, congestive heart failure, and cancer combined.

Patients who are nonadherent and do not take their medications the right way are more likely to experience:
• Long-term complications
• More emergency room visits
• Unnecessary hospital admissions
• Additional physician visits and lab tests, and
• Other related medical expenses

What you can do if you are not taking your drugs correctly

Most people are nonadherent because of behavioral factors, such as forgetfulness, inattentiveness, or procrastination. For example, based on findings in the 2011 Drug Trend Report, 39 percent of nonadherent patients said they just forgot to take their medication while 30 percent said they didn’t renew or refill their prescription.

If you find yourself in one of the categories above, you may want to consider asking your Medicare prescription drug plan if it offers refill reminder alerts (by cell phone or email) or automatic prescription renewal programs with mail order.  If you have cut back or stopped taking certain medications because of high costs, ask your Part D plan about lower-cost medication alternatives or lower-cost pharmacy services such as home delivery. If you are eligible, you should also take advantage of your plan’s Medication Therapy Management (MTM) program, which I’ll talk more about next time.

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