By Alvin S. Hornstein
If you take many prescription drugs regularly, and subscribe to Medicare Prescription Part D, you are probably approaching or already in the dreaded “doughnut hole.”
The “doughnut hole” is the period during which you pay full price for your medications. Suddenly, the drugs — for which you may have been paying between nothing and $40 monthly or quarterly — cost hundreds of dollars.
Under the Medicare Drug Law of 2004, when you pay the nominal cost of a prescription drug, it is only a co-pay; your insurance plan is absorbing the rest. However, when these costs, together, total $2,400, you must pay full price until out-of-pocket costs total $3,850, when Medicare Part D resumes paying some 95 percent of the costs.
In most cases, this total may not be reached until at least fall, perhaps not at all. Regardless of which Part D plan you have, these figures are the same.
Several pharmaceutical companies and Centers for Medicare and Medicaid Services (CMS) offer some advice on putting off entering the doughnut hole:
• Ask your physician if you can take less expensivegeneric drugs instead of brand names.
• Depending on your condition(s), ask about over-the-counter (OTC) medications you might substitute for the brand-name drug. These are often inexpensive and, because paid out of pocket, do not count towards your allocated dollar amount.
If you are among the lower-income seniors who qualify for the state’s PACE or PACEnet programs, the “doughnut hole” problem does not threaten you.
CMS (www.medicare.gov/bridging-the-gap.asp) offers a direct link to Medicare’s Prescription Drug Plan Finder section, which includes suggestions for savings costs by using mail-order pharmacies, some neighborhood discount pharmacies or less-expensive brand-name drugs. Some drug companies offer assistance plans for the needy.
If you need help, try these resources:
• PCA’s APPRISE Program, at www.pcacares.org/pca_ss_APPRISE.
aspx
• APPRISE Program Hotlines — Mayor’s Commission on Services to the Aging, 215-686-8462; Einstein Premier Years, 215-456-7600;
CARIE, 215-545-5728.
• Senior Educators Medicare Rx Education Network: www.senior
educators.org or 800-505-8515
• Pa. Dept. of Aging’s APPRISE
program: www.aging.state.pa.us
• National Council on Aging, www.mymedicarematters.org
• U.S. Dept. of Health & Human Services, at www.medicare.gov or 800-MEDICARE
• Medicare Rights Center: www.medicarerights.org or
1-800-333-4114, ext. 1.
NewCourtland Elder Services has launched “Living Well, Learning Well,” a community outreach program targeting adults over 62, their families and caregivers.
Designed to equip seniors to live longer, stronger and more independently, the program has begun with a series of workshops that address holistic care, nutrition and caregiver support, topics identified of interest to older adults in a survey conducted in collaboration with Center in the Park, a senior center in Northwest Philadelphia.
“We’ve been informed by older adults of the need for more resources, options and choices with regard to healthcare and information,” said Lynn Fields Harris, executive director of Center in the Park. “We’ve made it our mission to listen to the voices of our members and foster community connections to help us achieve it. That is why we are thrilled to collaborate with NewCourtland Elder Services in this community education outreach.”
To kick off the initiative, NewCourtland recently hosted “A Holistic Approach to a Whole New You,” the first of several events. Presentations were made by NewCourtland’s chief nursing officer, Kathie Brogan, and Gwen Foster of the Mayor’s Office of Health & Fitness. NBC 10 News Reporter Edie Huggins was facilitator.
A lecture/workshop, “Keeping the CARE in Caregiver” was held last month. Next will be “What’s Eating You,” nutrition tips to combat disease among seniors, 10 a.m. to 1:30 p.m. on Wednesday, June 27.
For information: NewCourtland at www.newcourtland.org or 215-965-1915; or Center in the Park, at 215-848-7722 or www.centerinthepark.org.
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For those considering retirement, before or after 65, there are a number of important healthcare considerations.
What happens with your employer health benefits when you retire? If you retire early, will you have health insurance to cover you until 65 when Medicare takes over? Will you need Medicare supplement insurance to cover any gaps in Medicare coverage after 65? What healthcare needs might not be covered?
A publication from the MetLife Mature Market Institute, Retirement Planning: Healthcare Considerations, seeks to answer these questions and more. It also points readers to resources for further investigation.
The booklet is available free from 203-221-6580 or www.maturemarket institute.com under ‘What’s New.’
Hospice care is not “giving up,” Dr. Stephen R. Connor insists. “It is choosing to live life fully to the end.”
Connor, of the Arlington, Va.-based National Hospice and Palliative Care Organization, told Reuters Health News Service that in many cases, hospice care actually seems to prolong life.
He and a team of colleagues analyzed the cases of 4,493 terminally-ill patients, and found that after being diagnosed as terminal, the 2,095 hospice patients among them lived an average of 29 days longer than the others.
The Alzheimer’s Association has launched an advertising campaign to educate the public about the disease, which a spokesman says “will overwhelm Medicare in less than 25 years unless scientists find a way to cure and prevent it.”
It includes $8 million in magazine and online advertising, a new website (www.actionalz.org) and initiatives by local chapters.
It’s designed to build public support for taking the steps necessary to fund research for a cure and treatment.
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