Medicare

An Annals of Internal Medicine paper reports that the money needed to treat dementia in a patient’s final five years is greater than for heart disease and cancer. Take a look at this New York Times article by Gina Kolata.
 
Three diseases, leading killers of Americans, often involve long periods of decline before death. Two of them — heart disease and cancer — usually require expensive drugs, surgeries and hospitalizations. The third, dementia, has no effective treatments to slow its course.

So when a group of researchers asked which of these diseases involved the greatest health care costs in the last five years of life, the answer they found might seem surprising. The most expensive, by far, was dementia.

The study looked at patients on Medicare. The average total cost of care for a person with dementia over those five years was $287,038. For a patient who died of heart disease it was $175,136. For a cancer patient it was $173,383. Medicare paid almost the same amount for patients with each of those diseases — close to $100,000 — but dementia patients had many more expenses that were not covered.

On average, the out-of-pocket cost for a patient with dementia was $61,522 — more than 80 percent higher than the cost for someone with heart disease or cancer. The reason is that dementia patients need caregivers to watch them, help with basic activities like eating, dressing and bathing, and provide constant supervision to make sure they do not wander off or harm themselves. None of those costs were covered by Medicare.

"Everything gets complicated when a person has dementia," noted Dr. Christine K. Cassel, a geriatrician and chief executive of the National Quality Forum.

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Read more of the NYT article here.

Many Medicare beneficiaries are being transferred to nursing homes only to find that because they were hospital outpatients all along, they must pick up the tab for the subsequent nursing home stay -- Medicare will pay none of it. 

The new law, the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, does not eliminate the practice of placing patients under “observation” for extended periods, but it does require hospitals to notify patients who are under observation for more than 24 hours of their outpatient status within 36 hours, or upon discharge if that occurs sooner. Read more.

This link to the Medicare website offers lots of useful information, http://www.medicare.gov/medicare-and-you/whats-new/whats-new.html.

In most cases, this open enrollment period may be the one chance you have to make a change to your health and prescription drug coverage for 2014.

Preferred-pharmacy plans that promise lower prices for people who agree to buy theirprescription drugs from certain stores may be costing the U.S. Medicare program more money to support, pharmacists said.

While Medicare patients get reduced co-payments in the plans, offered by companies including UnitedHealth Group Inc. (UNH)and Humana Inc. (HUM), the insurers are shifting the burden of those discounts onto the federal government, according to an analysis today by the National Community Pharmacists Association. The agency that runs Medicare told insurers in a Feb. 15 letter that it has begun to scrutinize the costs of preferred pharmacies.

Full story: http://www.bloomberg.com/news/2013-03-21/discount-drug-plans-for-may-not-be-saving-medicare-money.html

Medicare will revise the Medicare Benefit Policy Manual to correct suggestions that Medicare coverage is dependent on a beneficiary "improving." New policy provisions will state that skilled nursing and therapy services necessary to maintain a person's condition can be covered by Medicare.

For decades, Medicare beneficiaries – particularly those with long-term or debilitating conditions and those who need rehabilitation services – have been denied necessary care based on the "Improvement Standard".  

http://www.medicareadvocacy.org/hidden/highlight-improvment-standard/

Advice that may save hundreds of dollars can be found online, in person, in print or over the phone.

http://www.pressherald.com/news/medicare-confusion_-experts-offer-help_2010-11-27.html?searchterm=Medicare

http://online.wsj.com/article/SB10001424052748703374304575622480028578008.html?mod=WSJ_hp_LEFTWhatsNewsCollection

The Kaiser Family Foundation provides a fact sheet about the Medicare prescription drug benefit, Part D. The updated fact sheet for 2011 is available here, http://www.kff.org/medicare/upload/7044-11.pdf.

More than half of all Medicare beneficiaries (60 percent or 27.7 million) are enrolled in Medicare Part D plans as of February 2010, according to the fact sheet.