Great News For Medicare Recipients In New Senate Bill

Many had criticized Congress for working on a sweeping bill that, at the end of the day, did not include relief for consumers over the high cost of prescription drugs.  That has been quickly remedied.  A deal was reached today which adds to the $1.85 trillion social-policy and climate bill a provision which gives Medicare the power to negotiate the price of some drugs, penalize drug companies for raising prices faster than inflation, and cap out-of-pocket costs for seniors at $2,000 per year.  It also creates a $35 out-of-pocket monthly maximum for insulin.  “This deal will directly reduce out-of-pocket drug spending for millions of patients,” said Senate Majority Leader Chuck Schumer (D., N.Y.).

Medicare Insurers Took $9.2 Billion In Federal Payments In One Year Via Controversial Billing Practices : By Derek Baine

There seems to be no end to the tricks insurers will come up with in order to suck more money out of Medicare.  According to the findings of the Office of Inspector General of the Department of Health and Human Services, it analyzed 20 companies and investigators found that one received about 40% of the questionable payments, or $3.7 billion, while enrolling only 22% of Medicare Advantage customers.  It wouldn’t name the company, but BMO Capital Market looked at federal data and showed that the enrollment share closely matches UnitedHealth Group Inc. during the period the investors looked at.

https://www.wsj.com/articles/most-of-9-2-billion-in-questionable-medicare-payments-went-to-20-insurers-federal-investigators-say-11632303001

Pebble Beach, CA Telemedicine Is Here To Stay, Says Medicare

A doctor holding a stethoscope with his hand

More than three times as many Medicare beneficiaries had access to their doctors via a phone or video visit during the pandemic than before, a trend which is likely to continue with the new COVID-19 variant causing another surge in coronavirus cases.  The Kaiser Foundation, which recently conducted a study on this issue, said that expanded telehealth care is really good news for people of color, those with disabilities and low income families.   Those living in rural areas had difficulty getting to the doctor even before coronavirus.  Believe it or not, Monterey County is considered rural and indeed in South and North County populations are spread out over quite a large footprint. Thankfully, in early 2020, Medicare expanded coverage of such visits to enable all enrollees to keep up with their medical care while minimizing their r4isk of exposure to the coronavirus.  Although the rules only extend through the end of 2021, there are a number of bills in Congress which would make telehealth coverage permanent.

https://www.aarp.org/health/medicare-insurance/info-2021/telehealth-increase-covid-pandemic.html

Medicare Could Soon Cover Dental And Eye Care

A caregiver holding the woman's hand and speaking

As part of a large budget bill making its way through Congress, there is a provision to provide dental and eye care for Medicare recipients for the first time in our nation’s history.  Ironically, the bill is facing opposition from dentists, who fear that government reimbursement rates would be too low.  Back in 1965, the American Dental Association fought to keep dental from being a paid service for Medicare recipients.  Sadly, nearly half of all Americans over the age of 65 did not visit a dentist last year, and almost 20% have lost all of their teeth.  I know about the problem firsthand.  In addition to owning Family inHome Caregiving, I am president of the non-profit Hands to Help Seniors which provides emergency assistance to seniors in a financial pickle.  The vast majority of our donations go to providing dental care to low-income senior citizens, which is very expensive.

https://www.nytimes.com/2021/08/29/upshot/medicare-dental-care.html

Pacific Grove, CA Telemedicine Is Here To Stay, Says Medicare

A doctor holding a stethoscope with his hand

More than three times as many Medicare beneficiaries had access to their doctors via a phone or video visit during the pandemic than before, a trend which is likely to continue with the new COVID-19 variant causing another surge in coronavirus cases.  The Kaiser Foundation, which recently conducted a study on this issue, said that expanded telehealth care is really good news for people of color, those with disabilities and low income families.   Those living in rural areas had difficulty getting to the doctor e//ven before coronavirus.  Believe it or not, Monterey County is considered rural and indeed in South and North County populations are spread out over quite a large footprint. Thankfully, in early 2020, Medicare expanded coverage of such visits to enable all enrollees to keep up with their medical care while minimizing their r4isk of exposure to the coronavirus.  Although the rules only extend through the end of 2021, there are a number of bills in Congress which would make telehealth coverage permanent.

 

https://www.aarp.org/health/medicare-insurance/info-2021/telehealth-increase-covid-pandemic.html

TRUST Act Working Its Way Through Congress Could Cut Medicare And Social Security

A very unpopular bill called The Time to Rescue United States Trusts (TRUST) Act is now working its way through Congress.  If passed, it would set up groups of a dozen lawmakers with the power to recommend cuts to Social Security and Medicare.  This would hit the most vulnerable.  Half of those covered by Medicare have incomes of less than $27K.  Social Security is the main source of income for more than 34 million older households.  Under the new law, if seven of the twelve committee members approve of changes, they would be fast tracked in both the House of Representatives and the Senate, with no adequate debate among lawmakers and no amendments permitted on the floor of the House or the Senate.  To make sure that your senators and representative know you oppose the TRUST Act, please go to  https://action.aarp.org/trustact.

Biden Lays Out Plan To Cut Drug Prices

President Joe Biden recently signed an executive order that aims at lowering drug prices, and it actually has teeth.  One provision is that the government can now take legal action against companies that collude to try and keep generic drugs from coming to market.  Another allows states and Indian tribes to import drugs from Canada.  He also directed the FDA’s parent agency, the Department of Health and Human Services, to issue proposed rules within 120 days to allow hearing aides to be sold over the counter.  The four largest makers of hearing aides control 84% of the market.  Because they are so expensive, only 14% of the 48 million Americans suffering from hearing loss use the devices.  Still, some criticized the order because it doesn’t give Medicare the power to directly negotiate prices with drug companies.  “Negotiation of prices is the biggest and best solution,” to lowering drug prices, said Diana Zuckerman, president of the National Center for Health Research, a nonprofit based in Washington D.C.

Salinas, CA Retinal Implants To Restore Sight In Macular Degeneration Patients Shows Promise

A treatment where surgeons implant a tiny device in the retinas of patients which contain stem cells looks extremely promising for those with age-related macular degeneration (AMD).  Although it has only been done with 15 patients, many participants have passed the one-year mark with improving vision.  One woman who had the treatment said, “Shortly after the surgery, I turned to my husband while we were watching TV and said, ‘I can see all of their faces!’”  Doctors say FDA approval is about five years away.  To see local specialists in macular degeneration, see links below.

https://news.usc.edu/trojan-family/stem-cell-therapy-macular-degeneration-usc-clinical-trial/

https://www.montereyeye.com/our-services/retinal-care
https://www.peninsulaeyecarecenters.com/low-vision.html

http://vantageeye.com/services-macular.html

Why Isn’t Dental Care Covered By Medicare?

A dentist checking the tooth of the young patient

One of the great mysteries of the Medicare program is why they do not cover any dental work.  Many seniors forgo having dental work done because they can’t afford it, which can have a serious domino effect on their health.  The New York Times ran a story last month (June 13, page 8) about Ellen Phillips, who let a lot of teeth problems slide and eventually had to have all of her teeth extracted at a cost of $32,000.  The work was necessary because she needed heart surgery, and having dental infection or gum disease can allow bacteria to get into the bloodstream, causing serious surgical complications.  Some supplemental Medicare Advantage plans do offer a limited amount of dental coverage, but none would have covered the massive work that Ms. Phillips went through.  President Biden has proposed adding dental, vision and hearing coverage to Medicare.  I hope he is successful.  If you are in the Aptos or Santa Cruz Area, I recommend Dr. Delcore, in Santa Cruz try Stone Creek Dental.