The Med Diva

An insider's guide to Medicare Part D and more

Archive for the tag “seniors”

Yes, you can switch your pharmacy at any time with Medicare Part D

Walgreens survey about Medicare Part D

This infographic from Walgreens explains some of the findings from a recent survey regarding beliefs about Medicare Part D.

Today I had an “ah ha!” moment at work.

For years I have been telling the over 2 million Medicare beneficiaries in my company’s Part D prescription drug plans that they can often save money by using a different pharmacy. Using a mail-order pharmacy almost always yields savings, as does switching to a preferred retail pharmacy that offers lower co-pays or moving to a pharmacy that simply charges less money overall for prescription medications.

And for years I have been wondering why so few Part D plan members are taking my advice and using a more cost-effective pharmacy. Why aren’t seniors taking advantage of these savings opportunities?, I have often asked my coworkers and friends.

This morning I came across the results of an April 2013 Walgreens survey that answered my question — or at least, provided one explanation.   According to the survey, almost 30% of the 1,000 beneficiaries surveyed did not know that they can switch pharmacies at any time during the year. These 300 Medicare enrollees falsely believed that they could only switch to a new pharmacy during Medicare’s annual Open Enrollment Period.  In other words, they thought that if they were using XYZ Pharmacy when they first enrolled in a plan, they’d have to stick with XYZ until Open Enrollment (October 15 to December 7 of each year).

Although many Medicare beneficiaries shun mail-order pharmacies, even though using mail order is one of the best ways to save, retail pharmacies in a preferred pharmacy network are a great alternative for some people. Using a preferred pharmacy — if the Part D plan offers a preferred pharmacy network and there is a preferred pharmacy close to home — can potentially save beneficiaries hundreds of dollars each year on prescription drug co-pays.

However, it looks as though few people are taking advantage of preferred pharmacies. In fact, only 21 percent of respondents switched to a pharmacy within their plan’s preferred network as a way to save. One-fourth (24 percent) said they were unaware of whether their plan offers a preferred pharmacy option.

The survey  “underscores the need to educate Part D beneficiaries about how they can save on prescription and other health care costs,” said Dan Luce, director of pharmacy affairs, Walgreens. Many more Medicare Part D plans are starting to offer preferred pharmacy networks, so I guess I have my work cut out for me.


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

AARP tells seniors: “Don’t let Washington decide the future of Medicare & Social Security without you.”

Washington, Medicare and Social Security

Washington should not have the final say on the future of Medicare and Social Security

Recently, hundreds of seniors in several major cities attended an AARP town hall event to speak up in support of protecting Medicare and Social Security for current retirees and future generations. The participants recorded their opinions in video booths, completed questionnaires, and encouraged others to join the conversation through social media.

The AARP strongly believes that citizens who have paid into programs like Medicare and Social Security their entire working lives deserve to have a say in the debate about possible changes to these programs. That’s why the organization has launched a new campaign called “You’ve Earned a Say” in order to help make the voices of ordinary citizens heard.

Over the next several months, AARP will be listening to seniors at events in all 50 states and collecting responses to an online questionnaire. People can also share their ideas directly with members of Congress and presidential candidates through the You’ve Earned a Say page on the AARP website. If you’re active on Twitter, you can also show your support by using the hashtag #earnedasay. (Mom, I know you’re not on Twitter, so please don’t ask me to explain this!)

AARP Live broadcast invites you to speak out and ask questions

Each month beginning tomorrow night, April 19, the AARP Live one-hour call-in program will be broadcast on the RFD-TV cable network . This month the focus will be on You’ve Earned a Say, and viewers will be asked to share their thoughts on Medicare and Social Security. I’m going to tune in and report back on what seniors are saying about their benefits.

You can watch a live stream of the show here, on the ARP Live Facebook page, or on RFD-TV at 10 p.m., eastern standard time. The AARP invites you to join the conversation by calling 1-877-731-6733.

Health Care Professionals Should Focus on Visual Impairment and Health Literacy

I’m going to go off topic today and discuss an issue that affects not only seniors and other Medicare beneficiaries, but almost 90 percent of U.S. adults: Health literacy.

According to the National Library of Medicine, health literacy is “the degree to which people can obtain, process, and understand basic health information and services they need to make appropriate health decisions.”   A 2003 U.S. Dept. of Education literacy assessment of more than 19,000 Americans found that nearly 90 percent of adults lack some level of skills in reading, understanding, and acting on medical information.

Helen Osborne, a national health literacy consultant, likes to say that health literacy is about mutual communication. She recently told American Medical News that health literacy “is when patients or anyone on the receiving end of health communication and anyone on the giving end truly understand one another.”

Visual impairments also affect health literacy

I bring this topic up today because I recently experienced a lot of difficulty reading consent forms and other health information before and after having eye surgery. Even though the nurses knew I was having trouble seeing with both eyes, not one person offered to read the forms to me, or at the very least, provide a magnifier. Following my surgery, I was given some discharge instructions and a brochure about the procedure—I had to ask my 77-year-old mother to read them to me. For the first time, I experienced what it felt like to be in the shoes of someone who struggles to read and act on medical information.

Health literacy tips and patient advocacy suggestions for health care professionals

Although many health literacy studies focus on poor reading skills, including this latest study that suggests elderly patients with poor reading skills have an increased risk of death, visual impairments can also be a barrier to communications between providers and patients. Based on my recent experiences, I’d like to make some suggestions to health care providers, and in particular, eye doctors and retina specialists who have many senior patients with macular degeneration or other visual impairments:

• Use large print (at least 14-point type) on all written materials, especially consent forms, hospital discharge instructions, and brochures that provide information about health conditions or medical procedures.
• Provide visual aids, such as magnifiers or audiotapes, in waiting rooms, examination rooms, and recovery areas. Or, offer to read information aloud if you detect a patient is having difficulty.
• Provide additional lighting options in the waiting and recovery rooms. (The waiting room at my doctor’s office had two lamps in addition to the ceiling lights, but I could not turn either one on because they are on a timer.)
• Magazines and newspapers are always welcome in the waiting room, but they’re pretty useless if one can’t read the small print! Do your patients a favor and subscribe to a few large-print magazines — Reader’s Digest and The New York Times come in large print, as do many crossword puzzle books.

On her health literacy website, Helen shares additional strategies for healthcare providers to improve communications with patients who are blind or have visual problems. She also talks with Dr. Cynthia Stuen of Lighthouse International about age-related vision loss on this very informative podcast.

Although my suggestions and Helen’s strategies are geared toward health care providers, I encourage you to speak up and ask your own doctors to take whatever steps are necessary to help you read and understand health information. I’m going to get things started by printing this blog and bringing copies to my doctors’ offices and to the local libraries for Healthy Vision Month (May 1-31).

By the way, I have asked the people at WordPress to add a feature that allows bloggers to increase the type size on their posts, but so far there is no so option.


Why Romney’s pass on Medicare matters

Why Romney’s pass on Medicare matters.

To see or not to see: What type of vision care does Medicare cover?

Medicare Part B will cover eye exams that have specific medical reasons, such as AMD and Glaucoma screenings.

A week ago today, I was admitted to the hospital for emergency scleral buckle surgery. My retina in my left eye had become partially detached, and my doctor said the surgery was my best option. Click here for a short video of the surgery I had.

While sitting in the waiting room of my doctor’s office the next day following surgery, I noticed I was one of only two people in the room not eligible for Medicare (the other patient was a young male who appeared to have gotten into a fight). There were about 8 seniors in the waiting room, and as I engaged in conversations with each of them, I discovered that most of them had age-related macular degeneration (AMD). Several of these patients told me they were very fortunate that Medicare was covering their treatments.

 What type of vision care does Medicare cover?

Although original Medicare does not cover basic eye exams, it does cover basic eyeglass frames or lenses after cataract surgery as well as eye exams that have specific medical reasons. For example, if you have dry eye syndrome or blephartis (inflammation of the eyelash follicles), Medicare pays for treatment and doctor visits. Medicare also covers Glaucoma screenings for those most at risk, including:

  • People with diabetes
  • People with a family history of glaucoma
  • African-Americans over 50
  • Hispanics over 65

Does Medicare pay for the treatment of macular degeneration?

Macular degeneration (wet and dry), which can lead to the retina becoming detached and blindness, is most prevalent among those over the age of 50. Original Medicare (Part B) covers one treatment for AMD called ocular photodynamic therapy with verteporfin. For this treatment, Medicare covers 80 percent and you pay the remaining 20 percent after you have paid your Part B deductible. There are several treatment options for macular degeneration, so you will need to ask your doctor if photodynamic therapy is the best treatment for you.

Medicare Advantage and Medigap plan coverage

If you expect to need extra vision care or are prone to losing or breaking your glass, you may want to consider a Medicare Advantage plan (Medicare Part C) or a Medigap plan. These plans can offer additional coverage, which can include vision. Some plans may charge an extra fee for vision coverage, but the extra cost may be worth it if you have vision problems or are extremely nearsighted, like me.

Seniors are losing billions of dollars buried in unused benefits from Medicare and other agencies

Money doesn't grow on trees, but billions of dollars are buried in unused benefits.

According to a report released by the National Council on Aging (NCOA) and National Association of Area Agencies on Aging (n4a), millions of low-income older adults are missing out on over $20 billion in free and low-cost support that could help pay for health care, prescriptions, food, and utilities. The main reason why seniors are not taking advantage of these resources? They simply don’t know the money is there for them.

In response to this disconnect, the NCOA and n4a have launched a campaign, “You Gave, Now Save,” to help connect available funding to those who need it the most.

“It is no secret that millions and millions of Americans are struggling right now, but help is just a phone call away,” said Sandy Markwood, CEO of n4a, in a news release. “The aging network is coming together to do everything we can to communicate with older adults and caregivers who demand these services, and let them know that support is available. This campaign is about connecting those in need with the support that is right at their fingertips.”

Medicare Part D Extra Help counts for $6.8 billion in unused benefits

According to the NCOA, the $20 billion is based on estimates of the collective population eligible for benefits but not receiving them. One of these benefits is Part D Extra Help, which helps Medicare beneficiaries pay for their prescription drug costs. According to data from the Centers for Medicare & Medicaid Services (CMS), 1.7 million eligible people are not taking advantage of Extra Help, which has an annual average value of $4,000.

For more information about Extra Help, please see my October 8, 2011 post. You can also click here, contact your local Social Security office, or call Social Security at 1-800-772-1213. (TTY: 1-800-325-0778). 

You Gave, Now Save connects seniors with benefits

The You Gave, Now Save campaign directs seniors to two great resources that can help you connect with potential support:

• NCOA’s BenefitsCheckUp is a free online screening tool that has more than 2,000 public and private programs for low-income people with Medicare.

The Eldercare Locator (1-800-677-1116), a public service of the U.S. Administration on Aging, connects older adults and their families to local agencies and organizations that can assist them with applying for support from a variety of programs. Some of these programs include home heating and cooling assistance as well as free or discounted services from state and local governments and the private sector that provide tax breaks, legal assistance, and in-home assistance. You can go online or reach them at 1-800-677-1116, Monday through Friday, 9 a.m. to 8 p.m. EST.

Most Medicare beneficiaries are not getting recommended vaccinations covered under Part D

A study released yesterday by the U.S. Government Accountability Office (GOA) reports that most Medicare beneficiaries have not received routinely recommended vaccinations covered by the Medicare Part D prescription drug program.

According to the Centers for Disease Control and Prevention (CDC) national survey data for 2009, only 11 percent of beneficiaries age 65 and over had received a shingles vaccination and just 53 percent had a tetanus and diphtheria vaccination. In contrast, nearly two-thirds of those over 65 got flu vaccines in 2009 and more than 60 percent were vaccinated against pneumonia, both of which are covered under Medicare Part B.

The GOA reports that these data suggest that beneficiaries received vaccinations prior to enrolling in Medicare or, once enrolled, used other health insurance or paid out of pocket for these vaccinations. However, the agency also points out that a relatively low percentage of doctors and pharmacies stock the shingles vaccine due to factors such as purchasing costs, storage requirements, and challenges with obtaining reimbursement from Part D plans. Since doctors can’t add the vaccine charges to their bills under Part B, seniors have to pay out of pocket (the vaccine can cost around $200) and await reimbursement from their Part D plan or go to pharmacies that can administer the vaccine and bill Medicare directly.

Why is it important to get vaccinated against shingles?

Shingles is a painful, blistering skin rash that affects more than a million Americans each year. Also known as herpes zoster, shingles occurs when the virus that also causes chickenpox—and which can lay dormant in nerve cells for decades—reactivates to cause a painful skin rash. For some people, the intense pain can last for months after the rash clears, which is called postherpetic neuralgia. It can also attack the eyes and permanently damage vision. Even worse, once you get an outbreak, you can continue getting shingles over and over again.

Shingles vaccine reduces risk by more than half

The Food and Drug Administration approved the vaccine against shingles in 2006 after clinical trials on the vaccine revealed that it could, with few side effects, reduce the risk of developing shingles by more than half (and minimize the effects in those patients who do get it). In 2008, a national panel of experts on immunizations at the CDC recommended the vaccine to all adults age 60 and older.

Whether you are a Medicare beneficiary or senior caregiver, it’s important to understand the risks and effects of shingles and to ensure that you or your loved ones are vaccinated. Please help me spread the word that the vaccine is available and covered by Part D plans. And if you haven’t done so already, ask your doctor about getting vaccinated today.

Spread the Word: Only 2 Shopping Days Left for Medicare Part D Open Enrollment

There may still be 19 shopping days left until Christmas, but this year the shopping season for Medicare Part D ends on December 7. That means there are only 2 more days (after today) in which you can switch your prescription drug plan for 2012.

You can thank Healthcare Reform for the early deadline this year: The 2010 Patient Protection and Affordable Care Act mandated the earlier enrollment period to give you more time to weigh your plan options and the drug plans more time to complete paperwork and get membership cards and plan materials to beneficiaries by January 1, 2012. The intention was good, but unfortunately, the execution has been poor.

In fact, one recent survey shows that almost 20 percent of seniors are still unaware of the Wednesday deadline.

According to the survey conducted by Opinion Research Corporation and sponsored by PlanPrescriber, one in five seniors 65 years of age and older with Medicare prescription drug coverage were still aware that the Open Enrollment period ends December 7. The national phone survey was conducted between October 28 and October 31, 2011.

Please spread the word

Hopefully, this number has improved during the past month. Ideally, 100 percent of seniors are now aware of the early deadline. However, it’s more likely that a small percentage of beneficiaries are still in the dark about the deadline – which means we must still work hard to get the word out. That’s why I’m asking all of my readers, Facebook friends, and Twitter followers to talk to all the seniors in your lives and remind them that the last day to switch their Medicare Part D plan is Wednesday, December 7.  Thank you everyone!

When to enroll in a Medicare Part D prescription drug plan

Today I spent the day monitoring phone calls from my company’s Medicare Part D plan enrollment call center. Several seniors who called to enroll in our plan said they were very confused about the Open Enrollment deadline, especially those people who are eligible for both Medicare and Medicaid.

To help clear up some of this confusion, here is some basic information about when you can enroll in a Part D plan or switch Part D plans. In a nutshell:

• Most people can enroll in a Part D plan when they first become eligible for Medicare and then once a year after that during Open Enrollment if they want to switch plans.
• People who receive both Medicare and Medicaid can enroll when they first become eligible and then once a month after that if they want to switch plans.

Enrolling for the first time: Turning 65 or new to Medicare

If you are new to Medicare, it’s important to enroll in a Part D plan as soon as you become eligible (during your Initial Enrollment Period) to avoid paying any late-enrollment penalties. When first eligible for Medicare, you have a full 7 months to enroll in a Medicare Part D plan:
• Up to 3 months before you turn 65
• During the month of your 65th birthday
• Up to 3 months after you turn 65

If you join a prescription drug plan during the 3 months before you turn 65, your coverage will start on the first day of your birth month. If you join during or after your birth month, your coverage will begin on the first day of the next month.

Here are 3 examples to show you when your coverage will go into effect:
Let’s assume your 65th birthday is May 3, 2012. That means your Initial Enrollment Period is from February 1 – August 31, 2012 (3 months before to 3 months after your 65th birthday).

1. If you join a Part D plan before your birth month (February 1 – April 30, 2012)
Your coverage will begin the first day of your birth month: May 1, 2012

2. If you join a Part D plan during your birth month (May 1 – May 31, 2012)
Your coverage will begin: June 1, 2012

3. If you join a Part D plan after your birth month (for example, July 1 – July 31, 2012)
Your coverage will begin: August 1, 2012

When you can switch Part D plans

If you are already enrolled in a Part D plan, you can generally switch plans only once a year during Open Enrollment (also called the Annual Election Period). Open Enrollment runs from October 15 through December 7 for the 2012 plan year. Outside this time period, you may make other changes during the year only if you qualify for a Special Enrollment Period (SEP).

For example, you may qualify for an SEP for the following reasons:
• You lose creditable coverage (that is, coverage as good as or better than Medicare) through no fault of your own  (for example, your former employer or union stops providing coverage for retirees)
• You move to a new permanent address that is not in your current plan’s service area
• Your current plan no longer offers Part D coverage
• You receive Medicaid or get Extra Help with Part D costs
• You are enrolled in a State Pharmaceutical Assistance Program (SPAP)

Dual Eligibles can switch plans once a month

If you have both Medicare and Medicaid, you are considered a “dual eligible” individual. “Dual eligibles” may change plans once every thirty days. You can ignore the Open Enrollment dates and the December 7th deadline because they do not apply to you.

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