Tag Archives: medicare

August 14, 2022 · 2:40 pm

Prescription drug costs can be unexpected burden for elders

The legislation passed by Congress on Friday includes at least one initiative that has significant bipartisan support, especially among older Americans: Medicare will now be able to negotiate the prices of certain high-price drugs with drug companies.

In other countries, this is a common practice, but the pharmaceutical industry has lobbied hard against the measure over the years. AARP lobbied hard for elders and their families, and finally secured a victory.

I received an eye-opening education about the high price of medications when my father entered a memory care center during the last year of his life. He was put on several medications and Medicare only covered a portion of the costs. We had no say so on what medications he was placed on, and whether there was a generic, more affordable alternative. One medication was being used off label in a way that was not recommended in patients with dementia. We were left owing hundreds per month out of pocket, on top of the room rate of over $4,000 per month. We did not have the money to pay it off each month and after my father’s death, had accrued a bill of over $5,000 which we were able to negotiate down a bit and pay off out of my father’s estate.

The new legislation is limited in scope, but will still have a noticeable impact. In addition to negotiating drug prices, the legislation will:

Cap at $2,000 the annual out of pocket amount Part D prescription drug plan members would have to pay for their medications.

Levy a tax penalty on drugmakers that increase prices of their medications more than the rate of inflation.

Cap the cost of Medicare-covered insulin at $35 a month. (The insulin cost cap for private insurance did not survive a vote, so for now the cap only applies to Medicare members.)

Eliminate out-of-pocket costs for most vaccines under Medicare.

Photo by National Cancer Institute on Unsplash

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October 8, 2021 · 6:03 pm

Setting the record straight on Medicare

Expanding Medicare services is a hotly debated topic in Congress right now, as Democrats try to reach an agreement on what parts of President Biden’s Build Back Better agenda can garner enough votes to ensure passage. There is a lot of misinformation flying about that suggests many people, even legislators, don’t understand what Medicare covers. Nancy Pelosi complained in a closed door meeting that she didn’t see why she should receive $1,000 to “get her teeth fixed” and this editorial in The Washington Post bemoaned the idea that Bill Gates might be able to get a free pair of eyeglasses. There is a push by centrist and elitist Democrats to focus on childcare and maybe throw elders a bone by allowing Medicare to negotiate prescription drug prices.

These dubious examples do nothing to address the genuine, dire circumstances that many elders in the middle class and lower middle class experience on a daily basis. I know because my parents experienced it and in turn, my finances were damaged as well. Many people assume Medicare is like Medicaid for those over 65 and covers most medical services. What a rude awakening it can be for a family caregiver to discover that this is definitely not the case. The realization hits particular hard for those people who are deemed to be “too wealthy” for Medicaid, which covers much more. The amount of out-of-pocket expenses for middle-class Medicare recipients can have a crippling impact on a family’s budget.

I’ve discussed on this blog how those with dementia endure significant expenses that Medicare doesn’t cover, including memory care and home health care visits. Middle class families cannot afford to pay several thousand dollars a month for memory care or home health care for very long, especially if they are sandwich caregivers also raising children at the same time.

There is a lot of pushback from dentists about expanding Medicare to cover dental services. So far, I’ve not heard a single dentist discount the importance of dental care for the elder population. It all comes down to them making less money. Issues like gum disease increases the risk of serious health issues. Being able to properly chew food can assist with digestion that slows down as one ages and also supports proper nutrition. If your mouth hurts, you are unlikely to eat properly and eat healthier food like raw fruit and vegetables.

Vision services are more than a pair of glasses. Vision care includes glaucoma screenings and maintaining adequate vision is essential to keep elders from falling or being involved in car accidents which can lead to lengthy hospital stays. Hearing is another important health marker. Loss of hearing has been associated with a higher risk of dementia. These are not optional or cosmetic services but essential preventative care that will keep our elder population healthier at home.

My mother spent thousands of dollars out of pocket for dental care over the years she was on Medicare. This was on top of the several thousand dollars we paid for my father’s memory care. We also paid out of pocket for medical transport services, which is covered by Medicaid, but not Medicare. We burned through my father’s modest savings and then my mother’s savings. I ran up tens of thousands of dollars in credit card debt that I just finally paid off last month, thanks to my ability to refinance my home. I know my family was fortunate in many ways, and that many people have it much worse.

I will always advocate for essential preventative medical care to be covered for elders. Those who mock the importance of such care are out of touch with what middle class and lower middle class families face when trying to manage the health needs of their elder loved ones. The excuses about lack of funds and leaving future generations with debt don’t hold water because when push comes to shove, average Americans make great sacrifices to take care of their loved ones. We do it because it’s the right thing to do, even when it destroys our future financial health and our children’s opportunities. It’s long overdue for the government to have the same level of commitment to its citizens.

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Medicare and Respite Care – What Does it Cover? — The Imperfect Caregiver

Respite care is an issue I care about passionately, prompting me to launch Respite Care Share a few years ago. This guide offers an excellent overview about what respite care benefits Medicare covers. 

When it comes to our loved ones that may be living with health conditions that hinder their ability to perform everyday functions, we want to provide them with the best care. Statistics show that often, it is a family member that takes on this role as a full-time caregiver. Being a caregiver is one of […]

via Medicare and Respite Care – What Does it Cover? — The Imperfect Caregiver

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May 2, 2019 · 5:05 pm
September 16, 2017 · 1:56 pm

We are all members of the Caring Majority

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I spent part of this week in Minneapolis, attending Caring Across Generation’s Field Gathering. Family and paid caregivers, along with caregiver advocates from all over the country came together to discuss strategies on how to improve the lives of caregivers and the quality of care for those at every stage of life who needs assistance.

It was inspiring to be in a room full of people who are determined to fight for something so important that has been ignored by many government officials and society for too long. Whether it’s protecting Medicaid funding, pushing for paid family leave on a state and federal level or expanding quality care options and respite opportunities for family caregivers, there are a lot of issues to address.

Some states, like Hawaii, Maine, Minnesota and Washington, to name just a few, are making inroads at the local and state level. Hawaii passed the Kupuna Caregivers Act this summer, which pays family caregivers who work $70 per day to cover the cost of caregiving. Take Action Minnesota is working with cities on securing paid sick leave, and the Maine People’s Alliance is moving forward with its support of a Universal Family Care bill and Universal Home Care ballot initiative. The more programs that are established at the local and state level that are proven to be successful, the more we can move the needle to encourage other states to implement similar programs, and eventually, gain support at the federal level.

Long-term care is one of the core issues that Caring Across Generations is working to address. Many people don’t realize that it’s Medicaid, not Medicare, that picks up the costly expenses of long-term care for our elders once personal finances are exhausted. In addition to protecting this funding, we need to work on making it easier for people to age at home. This will help reduce the cost of care.

These issues should be bipartisan, but sadly, as Americans, we’ve made values like caring for our most vulnerable populations a point of contention. But the Caring Majority is growing. We are all part of it, even if some people don’t realize it yet. Once illness touches your family, you learn very quickly how important good care is, and that it is essential. Everyone alive right now was cared for as a baby, and will likely be cared for again as they grow older. We all have a responsibility to alleviate the financial, physical and emotional burdens of caregiving.

If you are interested in learning more about Caring Across Generations, check out their website or visit them on Facebook and Twitter. If you are interested in sharing your caregiving story or attending next year’s gathering, reach out to me in the comments section below.

 

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September 25, 2013 · 5:51 pm

Hospital visits for dementia patients often tied to insurance type

There is much talk here in the U.S. as the new health care exchanges that the Obama administration has developed to lower health insurance costs open on October 1st. But I found an article this week that has some surprising results in another part of the health insurance world that impacts dementia patients.

Presbyterian Hospital, the last place I saw Dad alive.

Presbyterian Hospital, the last place I saw Dad alive.

A study conducted by NYU researchers found that dementia patients with managed care insurance were sent to the hospital less often to treat end-of-life health issues that would not improve their quality of life. Managed care organizations receive a lump sum payment for each patient, so they have an incentive to keep costs low by not encouraging unnecessary medical care. However, those with traditional Medicare which pays a fee for each service rendered were sent to the hospital more often. The difference in hospitalizations by insurance type was significant: only 4 percent for those with managed care vs. 16 percent for those with Medicare.

Managed care incentives to keep costs low can backfire on patients, sometimes limiting coverage of services that are not medically necessary but would improve quality of life. But in this instance, the focus on the financial aspect of healthcare actually benefits advanced stage dementia patients. My father was in and out of hospitals the last year of his life because his inpatient stays were completely covered by Medicare. But they did not improve his quality of life; in fact the sudden change of environment may have left him more mentally confused. The elderly are also at high risk for serious, even deadly hospital-acquired infections every time they spend time in an inpatient facility.

It’s one of those rare examples where shrewd and calculating financial decisions actually translates to compassionate action.

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November 18, 2012 · 8:57 pm

Medicare broadens coverage of therapy for dementia patients

I was pleased to learn that Medicare is no longer requiring the “demonstrable improvements” mandate when it comes to covering the charges for a variety of therapy treatments for those with dementia. Most of us who have cared for a loved one with dementia know that physical therapy, speech therapy and occupational therapy can often improve quality of life. While this improvement was often not at the level Medicare required for reimbursement, it offered benefits that the indifferent eye of bureaucracy could not see.

While I have witnessed firsthand the challenges of successful rehab with a dementia patient, I think there are specific therapy programs that could brighten a dementia patient’s mood and help them better communicate their fears and frustrations. Dad somehow learned to walk again, despite being in the mid-stages of Alzheimer’s. I think it takes specially-trained therapists who know the best ways to reach dementia patients.

I hope more dementia patients can take advantage of therapy programs without their families having to worry about the financial consequences.

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May 23, 2012 · 2:20 pm

Dad’s fate decided by bureaucracy

Medicare and the rest of the government regulations that impact elderly care in this country didn’t give my father dementia, but they certainly played a major role in deciding how the end of his life played out. My Demented Mom posted a good blog entry about how U.S. senators are finally investigating the misuse of antipsychotics in the elderly that are in institutionalized care. It’s about time. I’ve written about the subject multiple times, about how Dad resembled a zombie and how indifferent the ER staff were about possible drug interactions. Sadly, most who have dealt with dementia in their families have these stories to tell.

I’m still reading this book I’ve written about before, a collection of end-of-life essays. I just finished one that really struck home hard, about a sweet lady named Margaret who had a stroke and went through rehab as approved by Medicare. Unfortunately, she just couldn’t make progress during the short rehabilitation period, though she did try. But after her rehab allotment time was up, Medicare forbid any further treatments, because she was not a good candidate for improvement. So she never was able to return home, and instead declined rapidly in the nursing home, despite her loving family trying to visit her as much as they could. (Like my family, they didn’t have the funds to hire 24-7 care for her at home.) What had once been a delightful, talented woman who loved to paint became the typical defeated nursing home patient, parked in a wheelchair with head drooping, alive in physical form only.

And one could argue that bureaucratic rules led to her early demise. Government regulations stole her dignity, and ultimately, her life.

I feel the same way about my father. He also had rehab a couple of times, for the allotted days that were covered by Medicare. But if he had been approved for a longer period of time, maybe he could have gained enough physical strength back to return home, where Mom could have set up home care. Instead, time was up, Dad couldn’t navigate stairs, and away he was whisked to a facility over an hour’s drive from my mom.

Now, I’m the practical sort and I know that programs have to have funding limits. I’m not a fan of tax increases. And yes, families shouldn’t be given false hope by their loved ones undergoing treatments that are futile. I don’t have the solutions, but at least the conversation is beginning.

But the elderly deserve to be treated better at the end of their lives. So many of them fought for freedom, worked hard to support their families, sacrificed in ways we will never know … we can’t continue to discard them like a broken-down car, a heap of junk pushed off to the side of the road that we try to avert our eyes from as we hurry on with our busy lives.

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