Drugs, Long term care, Medicare costs, Medigap

Buying Supplemental Insurance Can Be Hard For Younger Medicare Beneficiaries

By Susan Jaffe | February 3,  2016 | Kaiser Health News in collaboration with Money magazine

Danny Thompson’s kidneys have failed and he needs a transplant but in some ways, he’s lucky: Both of his sons want to give him one of theirs, and his Medicare coverage will take care of most his expenses.

Danny Thompson    (Heidi de Marco/KHN) 

Yet the 53-year-old Californian is facing another daunting obstacle: He doesn’t

have the money for his share of the medical bills and follow-up drugs, and he can’t buy supplemental insurance to help cover his costs.

“It’s frustrating to be in the shape I’m in,” said Thompson, who depends on dialysis instead of his kidneys to cleanse his blood. “My plan is to get a transplant so I can go back to work.”

Almost one in four Medicare beneficiaries has such a policy, known as Medigap, which is sold by private insurance companies. It can help pay for costs Medicare doesn’t cover, including the 20 percent coinsurance required for medical expenses, including certain drugs, plus deductibles and co-payments. Those expenses have no out-of-pocket limit for beneficiaries.

Money cover

This KHN story also ran on Money.

Federal law requires companies to sell Medigap plans to any Medicare beneficiary aged 65 or older within six months of signing up for Part B, which covers doctor visits and other outpatient services. If they sign up during this guaranteed open enrollment, they cannot be charged higher premiums due to their medical conditions.

But Congress left it to states to determine whether Medigap plans are sold to the more than 9 million people younger than 65 years old who qualify for Medicare because of a disability. [Continued in Kaiser Health News or Money magazine.]

Long term care, Medicare costs

Hospitals Step Up To Help Seniors Avoid Falls

By Susan Jaffe | Kaiser Health News | January 12, 2016     This KHN story also ran in washingtonpost SMALL logo

Falls are the leading cause of injuries for adults 65 and older, and 2.5 million of them end up in hospital emergency departments for treatment every year, according to the Centers for Disease Control and Prevention. The consequences can range from bruises, fractured hips and head injuries to irreversible calamities that can lead to death.

Despite these scary statistics, a dangerous fall does not have to be an inevitable part of aging.   Risk-reduction programs are offered around the country, including several at hospitals in the Washington area.  [Full article from Kaiser Health News  and The Washington Post]    [Watch video of  balance training class] 

Drugs, The Lancet

Some Congress members say a 1980 law may curb rising drug prices

Susan Jaffe | Washington Correspondent for The Lancet | 13th January 2016

No single federal agency reviews US drug prices, but 51 members of  the U. S. House of Representatives have discovered a 35-year-old law that allows the governmeThe Lancet USA blog logont to control huge hikes in drug costs.  And they want the Department of Health and Human Services and National Institutes of Health (HHS) to use it.  Earlier this week the group led by Texas Democrat Lloyd Doggett wrote to HHS Secretary Sylvia Matthews Burwell and NIH director Dr. Francis Collins to explain why. [Continued here]

FDA, NIH, The Lancet

Budget boon for biomedical research

Susan Jaffe | Washington Correspondent for The Lancet | 31st December 2015

budget 123115The US Congress has become famous for political gridlock  but sThe Lancet USA blog logohortly before going home for the holidays, members approved a 2,009-page budget for fiscal year 2016 with generous increases for some key health and science agencies, most notably the ailing National Institutes of Health. [Continued here.]

EPA, Global Health, The Lancet

Paris climate change agreement faces hurdles in the USA

Susan Jaffe | Washington Correspondent for The Lancet | 31st December 2015
Only a few hours after thousands of representatives from 195 countries approved the landmark Paris cliThe Lancet USA blog logomate change agreement, President Barack Obama stepped before the TV cameras at the White House to congratulate them. It Paris 2offers the best chance we have to save the one planet we have,” Obama said. “We’ve shown that the world has both the will and the ability to take on this challenge.”
But the international consensus to reduce global warming failed to move the Republican candidates competing for Obama’s job.  {Continued here.]
Drugs, FDA, Medicare costs, The Lancet

As drug prices go up, some point consumers up north

Susan Jaffe | Washington Correspondent for The Lancet | 8th December 2015
Pharmaceutical sticker shock has renewed American interest in drugs sold in other countries, particularly our northern neighbor.
Many Americans and even government health programs are feeling squeezed by rising drug costs, with federal officials reporting last week that US The Lancet USA blog logohealth care spending in 2014 rose at the fastest rate since 2002 “in part due to the introduction of new drug treatments for hepatitis C as well as of those used to treat cancer and multiple sclerosis.”120815
Treatments for hepatitis C, which affects around 3 million people in the USA, can cost more than $100,000, Health and Human Services Secretary Sylvia Matthews Burwell said at an unprecedented day-long conference on drug pricing HHS hosted last month.
“And that’s an issue for both patients and the organizations and governments that serve them. Since more than three out of four infected adults are baby boomers, this disease has become one of the main cost drivers for Medicare’s prescription program.  Impacts have also been significant in state Medicaid programs.”
…Prompted by the HHS conference and recent price hikes, two leading Senate Republicans, Charles Grassley of Iowa and John McCain of Arizona want Burwell to use a provision of a 2003 law to certify that drug importation is safe and would significantly reduce drug prices.  [Continued here.]
Drugs, Long term care, Medicare costs

Decline of Medicare subsidized drug plans leaves seniors with less choice

By Susan Jaffe, Kaiser Health News | November 21, 2015 | and also published in USA Today logo 2012
Even though health problems forced Denise Scott to retire several years ago, she feels “very blessed” because her medicine is still relatively inexpensive and a subsidy for low-income Medicare beneficiaries covers the full cost of her monthly drug plan premiums. But the subsidy is not going to stretch as far next year.

Denise-Scott-04

That’s because the premium for Scott’s current plan will cost more than her federal subsidy. The 64-year-old from Cleveland is among  the 2 million older or disabled Americans who will have to find new coverage that accepts the subsidy as full premium payment or else pay for the shortfall. As beneficiaries explore options during the current Medicare enrollment period, there are only 227 such plans from which they can choose next year, 20% fewer than this year, and the lowest number since the drug benefit was added to Medicare in 2006, according to the Centers for Medicare & Medicaid Services. [Continued in USA Today, Kaiser Health News and PBS NewsHour]
Drugs, FDA, Medicare costs, The Lancet

USA grapples with high drugs costs

 lancet cover 2Volume 386, Number  10009 
28 November 2015
WORLD REPORT   More Americans are getting health insurance, including coverage for prescription drugs, but high prices may make them inaccessible. Susan Jaffe, The Lancet’s Washington correspondent, reports.
 Patients in the USA pay more for prescription drugs than almost anywhere else in the world, forcing as many as one in four who can’t afford the high prices to go without their medicine last year, according to a Kaiser Family Foundation survey. So even though more Americans have health insurance, the new therapies and cures that can prevent more expensive health complications might be out of reach.
After several well-publicised, huge spikes in drug prices—including Turing Pharmaceutical’s increase for pyrimethamine (marketed as Daraprim) from US$13·50 to $750 a pill—the problem is drawing unprecedented attention from nearly every quarter: the Obama Administration, Congress, state officials, health insurance companies, drug makers, as well as the physicians and their patients who have clamoured for help for years. It also surfaced during this month’s Democratic presidential debate.
Heather Block, a patient advocate from Delaware who spoke at a day-long pharmaceutical forum hosted by the US Department of Health and Human Services (HHS) earlier this month, pays $9800 a month for the drugs she takes to treat breast cancer that has spread to her liver and lungs. Although she has Medicare coverage, she is still responsible for a share of her medical expenses. “Innovation is meaningless if nobody can afford it”, she said. “I still face financial insecurity and eventually bankruptcy—if I live that long.”     [Continued here ]
Medicare costs, The Lancet

Can you hear me now?

The President’s science advisors say innovative technology can provide low-cost alternatives to pricey hearing aids.
Susan Jaffe  |  Washington Correspondent for The Lancet  |  11th November 2015
Almost The Lancet USA blog logo30 million Americans over 60 years old have difficulty hearing, but less than a third can afford hearing aids, according to a report to President Barack Obama by his Council of Advisors on Science and Technology two weeks ago. Even though hearing loss is often part of the natural aging process, the council did not recommend that Medicare, pay for hearing aids, which can cost an average of $5,000 to $6,000 for a pair. [Continued here]
Drugs, Medicare Advantage, Medicare costs

Don’t Just Renew Your Medicare Plan. Shopping Around Can Save Money.

By Susan Jaffe | October 15, 2015 | Kaiser Health News in collaboration with Money magazine

Ten years after a prescription drug benefit was added to Medicare, 39 million older or disabled AmerMoney 4icans have coverage to help pay for their medicine, including most of the 17 million with private insurance policies known as Medicare Advantage, an alternative to traditional Medicare.
The annual enrollmentmedicare-shop-KHN 101515 period for these private drug and Advantage plans for 2016 starts Thursday and runs through Dec. 7.
It pays to shop around. The monthly cost is increasing an average 26 percent for UnitedHealthcare’s AARP MedicareRx Saver Plus while the First Health Value Plus plan
is dropping an average 13 percent, according to an analysis of the 10 most popular drug plans by Avalere Health, a research firm.
Some actual costs may be even more dramatic. In Albany, N.Y., the price of a Cigna-HealthSpring drug plan is going up 36 percent, according to the StateWide Senior Action Council, a New York consumer group. [More in Kaiser Health News or Money magazine]
Medicare Advantage, Medicare costs

Medicare Advantage Plans Need Tougher Oversight, GAO Says

By: | Connecticut Health Investigative Team Writer | October 5, 2015
Federal investigators have found that Medicare officials rarely enforce rules for private insurance plans intended to make sure beneficiaries will be able to see a doctor when they need care.
It’s a problem many Connecticut seniors know too well. In 2013, UnitedHealthcare, the nation’s largest health insurance company, dropped hundreds of health care providers from its C-HITConnecticut Medicare Advantage plan, including 1,200 doctors at the Yale Medical Group and Yale-New Haven Hospital. Medicare Advantage beneficiaries scrambled to find new insurance or new doctors while the Fairfield and Hartford counties medical associations went to court to try to stop the terminations.
The report by the Government Accountability Office, the investigative arm of Congress, said that Medicare did not check provider networks to ensure that doctors were available to beneficiaries and cited Connecticut as a “case study” in what can go wrong.
The GAO report shows that Medicare “was not verifying network adequacy. That’s their job and they abdicated that responsibility,” said U.S. Rep. Rosa DeLauro, D-New Haven, who requested the investigation along with other members of the Connecticut congressional delegation. MORE
Affordable Care Act, Long term care

To Sell Medical Students On Joys Of Geriatrics, Send In 90-Year-Olds

By Susan Jaffe  | Kaiser Health News | September 23, 2015 | This KHN story also ran in     nprlogo_138x46

When doctors told Robert Madison that his wife had dementia, they didn’t explain very much. His successful career as an architect hardly prepared him for what came next.

Belle Likover, a 95-year-old retired social worker, told Case Western Reserve medical students that growing old gracefully is all about being able to adapt to one’s changing life situation, including health challenges. Lynn Ischay/Kaiser Health News

     “A week before she passed away her behavior was different, and I was angry because I thought she was deliberately not doing things,” Madison, now 92, told a group of nearly 200 students at Case Western Reserve School of Medicine in Cleveland. “You are knowledgeable in treating patients, but I’m the patient, too, and if someone had said she can’t control anything, I would have been better able to understand what was taking place.”
     Belle Likover recounted for the students how she insisted when her husband was dying of lymphoma that doctors in the hospital not make decisions without involving his oncologist. “When someone is in the hospital, they need an advocate with them at all times,” said Likover, who turns 96 next month. “But to expect that from families when they are in crisis is expecting too much. The medical profession has to address that.”
     Madison and Likover were among six people all over the age of 90 invited to talk to second-year medical students this month. The annual panel discussion, called “Life Over 90,” is aimed at nudging students toward choosing geriatric medicine, the primary care field that focuses on the elderly. It is among the lowest-paid specialties, and geriatricians must contend with complex cases that are time consuming and are often not reimbursed well by Medicare or private insurance. And their patients can have diseases that can only be managed but never cured   [Continued  at Kaiser Health News  and at NPR]
Affordable Care Act, The Lancet

USA gears up for next round of enrolment under the ACA

lancet cover 224 October  2015

WORLD REPORT    As enrolment begins for the Affordable Care Act’s health insurance, officials cut estimates of how many Americans will get coverage.  Susan Jaffe, The Lancet’s Washington correspondent,  reports.
The past 2 years of President Barack Obama’s landmark health insurance programme haven’lancet 102415t been easy—surviving two Supreme Court challenges, nearly done-in by embarrassing technical glitches, and more than 50 congressional votes attempting to dismantle it. But its troubles are not yet over: enrolling new beneficiaries “is going to be tougher than last year”, warned Health and Human Services (HHS) Secretary Sylvia Mathews Burwell.
Burwell and other Obama Administration officials are damping down enrolment expectations just days before the 3-month sign-up period for 2016 coverage begins on Nov 1.  [Continued here ]
Drugs, NIH, The Lancet

End in sight for revision of US medical research rules

lancet cover 2Volume 386, Number  10000 
26 September 2015
WORLD REPORT   End in sight for revision of US medical research rules US health officials expect to update 25-year-old regulations on human participation in research by the end of next year.  Susan Jaffe, The Lancet’s Washington correspondent, reports.Lancet photo 092615
After proposing massive changes 4 years ago to rules first issued in 1991 protecting people participating  in research studies, federal health officials produced yet another revision earlier this month and say the effort to update the rules is on a fast track.
The revolution in science, technology, medicine, and public involvement that has transformed biomedical research over the past 25 years might be sufficient reason for the latest update, a daunting task that began in 2009, shortly after Barack Obama became president. But now there’s another factor driving the effort. [Continued  here]
Affordable Care Act, The Lancet

U.S. House of Representatives possibly “injured” by ACA spending, judge OKs lawsuit

 

The Lancet USA blog logo
 Susan Jaffe | Washington Correspondent for The Lancet | 15th September 2015      
                            lawsuit photo
A new threat to the Affordable Care Act emerged last week when a federal judge decided to allow an unusual lawsuit by Republicans in the U. S. House of Representatives against President Barack Obama, claiming that his Administration violated the U. S. Constitution by spending billions of dollars for the Affordable Care Act that Congress did not approve.  [Continued here]  House of Representatives 091515