Medicare Part D Special Enrollment Periods

According to the U.S. Centers for Medicare and Medicaid Services (CMS), in certain situations, people with Medicare may be eligible for a Special Enrollment Period (SEP) to join a plan that provides Medicare prescription drug coverage, or switch to a different plan.

A Special Enrollment Period is a period of time when an individual can enroll in or switch plans outside of the annual enrollment period (November 15th—December 31st). This chart from CMS describes the different situations in which an individual may be eligible for a Special Enrollment Period.

Expanded Medicare Coverage for Diabetes Screening in 2007

Medicare is committed to identifying and treating people with diabetes more effectively. 

In 2005, Medicare expanded coverage for preventive services to include diabetes screening.  Starting January 1, 2007, Medicare will begin providing more coverage for services that affect people with diabetes.  Medicare is increasing payments to doctors for some of the most frequently billed face-to-face doctor/patient services, as well as expanding access to rural and underserved areas.  Medicare is also updating a broad range of preventive services, including, adding a new abdominal aortic aneurysm screening to the “Welcome to Medicare” physical exam and excluding colorectal cancer screening procedures for the Part B deductible.

This tip sheet from CMS provides more details on these important new updates to Medicare’s diabetes-related covered services.

Social Security Inspector General Encourages Reporting of Potential E-mail Scam

Earlier this month, the Social Security Administration (SSA)issued a press release warning of a potential e-mail "phishing" scam aimed at current Social Security beneficiaries.

The fraudulent e-mail purports to be a message from the SSA advising beneficiaries about 2007 Cost of Living Adjustments (COLAS) and then goes on to ask the recipient to visit a bogus web site (designed to look like an official SSA web site) to "update their personal information." The message in question or any similar type message is unquestionably an attempt at fraud, according to an article in the National Senior Citizens Law Center Publication "Washington Weekly," because the SSA never requests personal information in this way.

Even though the timeframe for responding to the bogus web site suggested in the e-mail has passed, the SSA Inspector General would still like to hear from anyone who may have received the message, or anyone who receives a similar message in the future.

Contact the SSA IG's Office at 1-800-269-0271 (TTY1-866-501-2101).

Negotiating Drug Prices for Medicare Part D May Be Unnecessary Reports Washington Post

Since the inception of the Medicare Part D prescription drug benefit - and despite approval ratings hovering around 80% based on surveys of seniors actually enrolled in the program - a consistent criticism of Part D has been that the plan does not empower the government to negotiate directly with drug companies to set lower prices for drugs. The Democratic leadership that will take over control of Congress in January has said that changing the Part D rules to allow negotiated pricing will be a priority.

However, a November 26 article by Washington Post reporters Lori Montgomery and Christopher Lee questions whether that step is really necessary. In fact, some healthcare experts quoted in the story believe allowing price controls on drugs purchased for Medicare bebeficiaries could have the opposite effect.

From the article:

"This is going to be much more of a morass than people think," said Marilyn Moon, director of the health program at the American Institutes for Research and a former trustee of the Social Security and Medicare trust funds. Negotiating drug prices is "a feel-good kind of answer, but it's not one that is easy to imagine how you put into practice."

The Medicare drug benefit, one of the Bush administration's signature domestic programs, was created in 2003 and took effect in January. It has enrolled 22.5 million seniors, some of whom had no previous drug coverage.

Polls indicate that more than 80 percent of enrollees are satisfied, even though nearly half chose plans with no coverage in the doughnut hole, a gap that opens when a senior's drug costs reach $2,250 and closes when out-of-pocket expenses reach $3,600. By the latest estimates, 3 million to 4 million seniors will hit the doughnut hole this year and pay full price for drugs while also paying drug-plan premiums.

The cost of the program has been lower than expected, about $26 billion in 2006, according to the nonpartisan Congressional Budget Office. The cost was projected to rise to $45 billion next year, but Medicare has received new bids indicating that its average per-person subsidy could drop by 15 percent in 2007, to $79.90 a month.

Urban Institute President Robert D. Reischauer, a former director of the Congressional Budget Office, called that a remarkable record for a new federal program.

Initially, he said, people were worried no private plans would participate. "Then too many plans came forward," Reischauer said. "Then people said it's going to cost a fortune. And the price came in lower than anybody thought. Then people like me said they're low-balling the prices the first year and they'll jack up the rates down the line. And, lo and behold, the prices fell again. And the reaction was, 'We've got to have the government negotiate lower prices.' At some point you have to ask: What are we looking for here?"

Read the complete article.

Family Caregivers and Alzheimer's Awareness Take Centerstage During November

November is Family Caregivers Month, both nationally and in South Carolina, as well as being National Alzheimer's Disease Awareness Month, and according to a November 9 press release from the non-profit Family Caregiver Alliance, a new study into family caregiving estimates that the total dollar value of the caregiving services provided at greater than $306 billion a year in the United States, an increase of 19% over the last four years.

In South Carolina, the study estimates the total number of family caregivers at 416,214. Those caregivers provide an average of 446,000,000 hours of unpaid care in a year. Those same services would cost in excess of $4.4 billion dollars if they were purchased by private insurance or government programs.

Read the complete release on the website for the Family Caregiver Alliance's National Caregiving Center..

State-by-state data are available on the Family Caregiver Alliance website.

For more information, contact:

Bonnie Lawrence, Family Caregiver Alliance
(415) 434-3388, Ext. 312 or blawrence@caregiver.org

Deborah Halpern, National Family Caregivers Association
(773) 363-1587 or dhalpern@thefamilycaregiver.org

November is National Alzheimer’s Disease Awareness Month

Holidays Can Be a Stressful Time for Alzheimer's patients and their caregivers. The following article providing some helpful tips for supporting family members who are caring for a loved one with Alzheimer's was provided by Fran Brannon, Program Coordinator for the South Carolina Alzheimer's Resource Coordination Center in the Lt. Governor's Office on Aging:

This month our nation celebrates Thanksgiving. Many enjoy the food, the church services, family and football games that have become popular during this season. What if you couldn’t remember what you were celebrating, or didn’t understand why everyone else around you was celebrating? What if all you could do is remember this very moment, and you could not anticipate the joy and happiness of a holiday to come or remember those of the past?

Many of our parents, friends and relatives are experiencing this condition through a devastating disease called Alzheimer’s disease. Alzheimer’s disease is a major form of irreversible brain disease that usually begins later in life, but can strike people in their 50’s, 40’s, or even younger. It can last anywhere from 2 to 25 years from the time the first symptoms appear. A person can live in good physical condition for many years while requiring 24 hour assistance because of the damage to the part of the brain that controls thinking, judgment, and memory.

Most people with Alzheimer’s disease live with a spouse or family member for the duration of the disease. Although most family caregivers give care out of love, they are not immune to the stress, frustration and isolation that can occur with a disease that changes their lives so drastically. One thing caregivers find most difficult is asking for help. Why? They have the most to lose. If they ask, it is because they are desperate. If they are turned down, it strikes a double blow—one personally and one to their loved one. Don’t make them ask. Just help them!

Here are some suggestions:

• Give the caregiver a break. For example, watch TV with the person with Alzheimer’s while the caregiver takes a bath or a nap. Did you know that some caregivers cannot leave their loved one alone long enough to even take a bath?
  
• Go for a walk with the person with Alzheimer’s. Many people who have Alzheimer’s disease may wander. This way they can walk safely and the caregiver can take a break.
  
• Take a meal to their house and eat with them. Caregivers can become isolated and need companionship.
  
• Offer to stay with their loved one while the caregiver attends church. Spiritual needs and a sense of belonging to a group are often unmet at this time by both the caregiver and the person with Alzheimer’s disease.
  
• Take a friend with you if you are uncomfortable being with a person who has Alzheimer’s disease. There are lots of thing you can do that will be fun for all of you—toss a beach ball, play card games such as number matching or color matching, make candy or cookies, fold towels or washrags, look at photograph books or magazines, listen to music, dance, etc.

Just showing your love and support to those who are going through this journey with Alzheimer’s can be the greatest gift you give this holiday season—the gift of yourself.

Caring for Persons With Cognitive Impairment from the American Health Care Association

Residents in long term care facilities are particularly vulnerable to complications of influenza (the “flu”) due to their age and other concurrent medical conditions.

Employees would also be affected by a serious flu outbreak.
Maintaining operations in a long term care setting with the
expected staffing shortages during a pandemic, epidemic or
disaster would be very challenging. During this time, nonclinical
staff may be needed to assist with patient care. The American Health Care Association (AHCA) is distributing a 3-page basic guide for non-licensed staff and lay people who may become involved in direct patient care during a major disease outbreak or disaster. The guide is available on the AHCA web site.

The guide was developed with input from the following organizations:

• Alzheimer’s Association
• American Association of Homes and Services for the Aging
• American Health Care Association
• American Health Quality Association
• American Medical Directors Association
• National Association of Directors of Nursing Administration
• National Center for Assisted Living
  

New Nursing Home for S. C. Veterans to be Dedicated

From South Carolina Department of Mental Health Press Release:

Columbia, SC: South Carolina’s newest nursing home for veterans will be dedicated Saturday, November 11, 2006, at 11:30 a.m. in Walterboro, SC. The Veterans’ Victory House: Home of the Greatest Generations is a 220-bed state-of-the-art facility operated by Advantage Veterans Services of Walterboro for the South Carolina Department of Mental Health (SCDMH). SCDMH also oversees the Richard Michael Campbell Nursing Home, a 220 bed-facility for veterans in Anderson, SC, and operates the E. Roy Stone, Jr., Pavilion, a 90-bed facility for veterans in Columbia, SC, part of Tucker Nursing Care Center.

The ceremony, which will occur on the observance of Veterans’ Day, follows Walterboro’s first annual Veterans’ Day Parade. United States Senator Lindsey Graham of South Carolina will deliver the keynote address.

Read the complete release on the DMH Web site.