Sunday, November 25, 2007

Can You Afford to Buy Prescription Medications?

Buying prescription medications on a fixed retirement income is a problem many retirees face when deciding on competing necessities like rent and food. Many patients opt to not buy medication, take a lesser dose than prescribed to make the medicine last, or resort to buying prescription drugs online. Even with Medicare Part D prescription drug plan, there are pitfalls not easily anticipated. This blog aims to clarify some of the confusion in prescription drug plans and to suggest ways to make prescription drugs more affordable.

Medicare Part D

Effective January 2006, persons with Medicare became eligible to purchase Medicare Part D Prescription Drug Coverage by: 1.) joining a Medicare Prescription Drug Plan by paying additional premium or by 2.) joining a Medicare Advantage Plan such as an HMO ( health maintenance organization) or a PPO (Preferred Provider) or a Medicare health plan that provides prescription insurance.

Things to consider when obtaining Medicare D coverage:

  • Coverage: Does the plan cover the medications on your list?

  • Cost: May include: a.) monthly premium b.) annual deductible and c.) coinsurance and copayments. Persons falling under certain income guidelines may qualify for "extra help" also known as low income subsidy. This helps pay for the monthly premium, annual deductible, coinsurance and copayments.

  • Convenience: Some plans allow for obtaining prescription through the mail.

  • Coverage gap: (Also known as the doughnut hole) This is a very important but poorly understood aspect of the Medicare Part D plan. Essentially, in any given year, when prescription drug cost reaches a certain amount, ( $2,510.00 in 2008), the patient is responsible for 100% of the cost of medications for the next $3,216.00. Once this total of $5,726.00 is reached, Medicare Part D catastrophic coverage kicks in and pays for 95% of drug cost. This doughnut hole was built in by Congress to limit taxpayer cost while at the same time ensuring that persons with extremely high drug cost can get assistance. Individuals who qualify for " extra help" do not have a coverage gap.

  • Note: The monthly Medicare D premium must be paid during the doughnut hole period.

Some Strategies for Negotiating the Doughnut Hole and High Drug Cost:

  • Obtain coverage gap insurance ( in addition to regular monthly premium.) Many of these plans pay only for generic drugs, so check what you are buying.

  • Go bare and self insure by setting aside savings equal to the coverage gap amount each year.

  • Talk to your health care provider about generic medications or class equivalent drugs.

  • Monitor prescription drug expenditure to avoid the doughnut hole.

  • Check with WalMart Pharmacy if your medication is in their generic medication $4.00/month supply list. Other pharmacies such as Target Pharmacy offer a price match. Costco Pharmacy also offers the lowest mark-up on many generic medications.

Understanding Prescription Drug Tiers:

Medicare requires that all drug coverage plans cover at least two drugs in each category of drugs except that they are not required to cover certain drugs such as sedatives ( barbiturates and benzodiazepines), weight loss or weight gain drugs, drugs for erectile dysfunction and over the counter medications. Some prescription drug plans may limit the quantity of medication per fill, require prior authorization for certain medications or request stepwise therapy where one must try a similar or less expensive drug before progressing to a more expensive drug. Prescription drug plans also classify medications in what is known as a tier system.

  • Tier 1 covers most generic medications and has the lowest copayment.

  • Tier 2 covers preferred brand name prescription medications ( usually brand name medications deemed to be equally effective but less expensive as similar drugs) and has medium copay.

  • Tier 3 covers non-preferred brand name medications and has a high copay amount.

  • Specialty tier covers very expensive unique medications and have the highest copay.

Generic medications must be bioequivalent to the brand name and has the same active ingredient, efficacy, and safety profile as the trade brand medication. They undergo the same oversight by the Food and Drug Administration as its brand name equivalent.

It is also helpful to discuss bioequivalent medications with your health care provider. Talk about the intended treatment outcome and whether or not a less expensive medication will do just as well. For example, will aspirin have the same therapeutic outcome as more expensive blood thinners? Will a less expensive ace-inhibitor work just as well as other brand name blood pressure medication.

Patient Assistance Programs

When brand name medication is essential, talk to your health care provider about patient assistance programs. Drug manufacturers have agreed to provide medically necessary medications to persons falling below certain income guideline ( different from drug company to drug company) and who do not have prescription insurance coverage. Persons who are in the doughnut hole may qualify for this program. This requires that your physician and you complete an application form. Proof of income is usually required but may differ with each patient assistance program.

Talk to your pharmacist about discount prescription drug plans. These plans do not require a premium and usually provide the patient with a discount card where medication cost is discounted.

And don't forget the incentives such as gift cards and rebates that some pharmacy chains give out for obtaining your business. Every little thing helps.

A Caution About Buying Prescription Drugs Online

There is no substitute for the services of a pharmacist that you can ask questions of and who can counsel you on your medications. Online drug stores do not have the regulatory oversight that brick and mortar pharmacies do. Be suspicious of medications purchased this way.

Wednesday, November 21, 2007

Baby Boomers

On October 15,2007, Kathleen Casey-Kirschling went online and applied for Social Security retirement benefits. This would have been a non-event for anyone else but Kathleen and her family had she not had the distinction of having been born on the first second of January 1, 1946 making her the first American baby boomer to transition from the workforce to retirement. This event was not lost to Social Security Commissioner Michael J. Astrue who witnessed the event. Kathleen leads an expected 80 million Americans who will reach retirement age over the next 20 years, an average of about 10,000 a day, a phenomenon referred to in some circles as the "silver tsunami."

Baby boomer is a term given to people born in the post World War II era between 1946 and 1964. A fairly lengthy period, it is sometimes divided into two epochs the first from 1946 to 1954 and the second from 1954 to 1964. This generation has had defining moments such as the Vietnam War and the beginning and end of the Cold War, political initiatives such as civil rights, feminism, gay rights, handicap rights and the end of the military draft, technological advances such as the internet and the conquest of space, and cultural changes in music, movies and arts. It boasts of influential persons, the likes of Bill Gates.

The White House Conference on Aging ( September 2006) calls for formulating a proactive plan for anticipating the impact of aging baby boomers on the nation.. The sheer numbers of retirees are staggering and the nation has not yet come up with a plan for managing the retirement, health care and living needs of this group. On the one hand, many boomers are expected to live healthier longer and be affluent both from their own achievements as well as from transfer of wealth from their parents. On the other hand, with many persons living longer, it is anticipated that a good number of the elderly will be women and minority individuals groups that typically fall within the poverty level. Since the social security system is not a true retirement plan, funding of retirement benefits fall on the backs of those currently working. Boomers retirement also poses problems on the work force. It is expected that boomer retirement will leave gaps in skilled and specialized areas unable to be filled by a decreasing number of the younger working generation.

Boomers are expected to wield great political clout and are the target of marketing strategies of consumer product advertising. The good news is that many retirees are expected to return to the work force for different reasons. Many will need to supplement retirement income to meet living needs. Many who continue to enjoy life will embark on new careers. And there are those who are simply retirement flunkies who find working to be a very fulfilling part of their lives. Retirees might return to work for an employer full-time or in creative variations of part-time work. Some might choose self employment and entrepreneurship. Some might work as permanent part-time or part-time intermittent employees. Still others might choose to work full time for a few months out of the year.

Clearly baby boomers will be influential in their old age as they have been in their younger years and will continue to contribute wisdom and experience.

Friday, November 16, 2007

Health Care and the Senior Citizen

I understand that if I live long enough, I am likely to come down with some illness at one time or another. This reality prompted me to pay attention to what is coming down in Medicare, the national health insurance plan for people age 65 and older, under 65 with certain disabilities, and any age with end stage renal disease ( kidney failure.) Understanding Medicare insurance can be a daunting task and this is it in a nutshell.

Working persons pay into Medicare through mandatory payroll deductions. It is government administered and consists of four parts.
  • Medicare Part A covers hospitalization, skilled nursing facility, hospice and home health care under certain conditions and is provided with no additional premium.

  • Medicare Part B covers 80% of Medicare allowed medically necessary services outpatient services, physician and other health care provider fees and certain preventive services to prevent some diseases from getting worse. This requires payment of a premium usually billed quarterly or deducted from retiree social security pension. Enrollment may be made during specified enrollment periods. Individuals falling within certain income guidelines are entitled to some premium assistance.

  • Medicare Part C also known as Medicare Advantage Plans represents a privitization of Medicare wherein individuals enroll with approved private health insurance companies. These insurance plans must cover medically necessary services and thus provide similar services despite some differing advertising claims. They may differ, however, in copayments, co-insurance or deductibles. Medicare C plans combine Medicare A, B and oftentimes, D benefits.

  • Medicare Part D is Medicare prescription drug coverage. Again it requires the payment of a premium and enrollment during certain open enrolment periods. Individuals within certain income guidelines are entitled to premium subsidies.

Since Medicare health insurance only pays for 80% of allowed charges, the patient is liable for the remaining 20% which he/she pays out of pocket or subcribes to private health care insurance companies for Medicare supplemental insurance plan ( also known as Medigap.) All of these insurance premiums could take a big chunk out of the senior citizen's retirement benefits. Small wonder that many seniors opt to go bare and just go with Medicare Part A.

It is important for seniors to research and compare offerings of private health insurance companies when choosing Medicare Part C, Medicare Part D, and Medigap. Companies such as AARP Medicare Insurance, Humana Medicare Insurance, and Blue Cross Blue Shield Medicare Insurance are among those commonly marketed to seniors. When choosing a Medicare D prescription plan, it might be necessary to check with your pharmacist to make sure that expensive maintenance medications are covered by the plan.

A Threat to Health Care Access

A White House Fact Sheet pledges, "Medicare is the binding commitment of a caring society to our most vulnerable citizens and a commitment that America must always keep." At the same time, the Center for Medicare and Medicaid (CMS) announced a 10% cut in Medicare allowed physician fees effective 2008. There is will continue for the next four years for a total of 40 % cut in reimbursement. A poll by the American Medical Association of its members, shows that 60% of physicians indicate they will have to cut down on accepting new Medicare patients should these cuts come to pass. Physicians faced with increasing overhead from quality improvement and best practice initiatives do not feel that afford further decreases in their revenue base. This places many senior citizens at risk for not having an identified primary care health care provider at a time in their lives when diseases move to chronicity and consistent medical follow-up becomes necessary.

A Call to Action

Senior citizens will soon comprise a voting majority. It is time to take our elected officials to task in honoring " the binding comittment of a caring society" to its vulnerable citizens in particular and to all citizens in general. It is imperative that we demand that candidate and party platforms have a viable health care plan for all which moves health care from an option to a right similar to education and safety. A country that can send men and women to the stars and spend billions in other nation building must commit to ensuring a healthy nation.

Monday, November 12, 2007

I Want an Aeron Chair

I don't usually think about growing old ,except for those ocassions which come more often now, when the hip and the low back start aching. One of these ocassions, prompted me to check out desk chairs. I spend a great deal of time sitting in front of a desk, talking to people and typing on a computer. I thought it was time to treat myself to a high end desk chair.

I first sat on an Aeron chair a few years ago, on one of those few ocassions I stayed in an expensive hotel suite. It was quite comfortable and I have wanted to upgrade to an Aeron desk chair since.

Introduced in 1994, Aeron chairs quickly became the rave in office furniture. Designed by Don Chadwick and Bill Stumpf for the Herman Miller Company, it was and many would argue, still is the desk chair to sit on. Aeron chairs combine the notion that form follows function with stylish design, making it at home in any office setting be it the boardroom or the home office.

There are executive chairs, side chairs and task chairs in this line। The tall wide back is designed to relieve stress on the lower vertebrae while the arm rest design helps minimize arm and hand fatigue from repetitive keyboard strokes. The seat front has a waterfall design to minimize numbness from circulation to the legs being cut off during prolonged seating. The mesh design of the chair back allows good aeration and ventilation thus keeping the back cool especially on warm weather. Adjustable tension allows modification for different body size and form. Durable materials including titanium alloy make these office chairs easy to clean, maintain and repair.

Designed for comfort, Aeron chairs quickly became popular with computer types tired of ill fitting desk chairs while hunched in front of their computer screens, with people with low back pain and with corporate and government offices। It soon was a symbol of opulence and alas, of fiscal mismanagement as well। When dotcom companies and huge corporations such as Enron went belly up, the large quantities of Aeron chairs in their inventory were taken as yet another evidence of fiscal irresponsibility.

There is no question Aeron chairs are pricey, an executive chair easily setting one back well over $1000।00 and task chairs over $500।00. Used Aeron chairs are not any less expensive and remain a favorite on Ebay and other auction houses. The best compliment, of course, is in the fact that Aeron chairs are being copied as knock offs or less expensive variations, much to the consternation of Herman Miller. The Herman Miller Company has approached this problem by offering incentives to knock off customers to trade in their copy for an authentic one and by a cease and desist legal action towards knock off manufacturers. Before buying a used Herman Miller Aeron chair, it would be wise to check with the company on the warranty. While Herman Miller honors warranty on original purchase, it might not honor waranties on previously owned chairs.

Customer reviews are mixed. Many consider the Herman Miller Aeron chair to be the chair to own while some find that the chair did not deliver as well as they expected or they did not get relief from back pain as they had hoped.

Price and reviews aside, the Aeron chair continues to be the office chair to have. I, for one, still covet it and look beyond water heater replacements, car repairs, and new carpeting to that time when I can finally own one.


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