Why Isn’t Dental Care Covered By Medicare?

A dentist is examining the teeth of a 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.

Prescription Drug Prices Up Again In 2020

A table with many different types of pills on it.


The increase in price of the brand name drugs most widely used by senior citizens was up 2.9% in 2020.  Although the increase is lower than the last couple of years, it’s still more than double the rate of inflation (currently at 1.3%) and some drugs remain exorbitantly and out of the range of affordability for many seniors.  USA Today recently ran a story on Lynn Carfuto, who has chronic lymphocytic leukemia, a disease which is treatable but with a drug that costs $14K per month.  The drug has seen an 82% price increase since its release in 2013.  She can only afford it due to receiving grants from non-profits.  It’s a very sad case when you have a disease which is treatable but the price is so far out of reach.

 

https://www.pressreader.com/usa/usa-today-us-edition/20210610/282153589220534

Biden Lays Out Plan To Cut Drug Prices

A building with the capitol in the background.


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 aids 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.

 

President Joe Biden’s Medicaid Plan Helps Family Caregivers : By Derek Baine

A man and woman cutting an apple on a board.


President Joe Biden has an ambitious plan to help seniors, including asking Congress to lower the age of Medicare eligibility to 60, and a $450 billion fund to help family caregivers over the next ten years.  The latter would include a $5,000 tax credit for caregivers, and should reduce waiting lists for in-home and community-based care.

Telehealth Booming During Pandemic

A person holding a stethoscope in front of a laptop.


Telehealth has expanded rapidly during the pandemic, and is likely here to stay.  Before the pandemic, Medicare was limited to beneficiaries living in rural areas only, with many restrictions on where you could receive services and by whom.  In early 2020, however, Congress and the Centers for Medicare & Medicaid Services (CMS) expanded coverage to make it easier to use Telehealth services.  Hopefully this will remain intact.  Under current rules, the expanded Telehealth coverage is set to expire once the pandemic is over.

https://www.kff.org/medicare/issue-brief/medicare-and-telehealth-coverage-and-use-during-the-covid-19-pandemic-and-options-for-the-future/?utm_campaign=KFF-2021-The-Latest&utm_medium=email&_hsmi=128256590&_hsenc=p2ANqtz–RXNnPjavKL184o0qKSG9L1m0wDM8ttcr5udBuLn5BgacMbgQX0oDKczuGvZJGgClVcbhGNBl_99-oxdqb74zYkr-vsg&utm_content=128256590&utm_source=hs_email

Costco Diving Deeper Into The Prescription Drug Market

A table with many different types of pills on it.


Amazon.com and Walmart Inc. have both jumped into the online pharmacy market and now Costco Wholesale Corp. is taking a different approach, with a focus on helping make prescription drug prices transparent for employers.  It has partnered with Navitus Health Solutions LLC, a small pharmacy benefit manager (PBM) which has a different business model than most PBMs.  Rather than taking a cut of rebates and discounts, they charge a flat free.  Costo recently purchased a minority stake in Navitus in a partnership which should benefit both employers and consumers.

https://www.bloomberg.com/news/articles/2021-04-22/costco-cost-health-care-approach-differs-from-amazon-amzn-walmart-wmt

Pacific Grove, CA In Home Dialysis Expands Under Medicare

A person holding a stethoscope in their hand.


Senior citizens with kidney problems will have an option of in-home dialysis care covered by Medicare.  About 1 in 3 Medicare patients that are struggling with end-stage renal disease will be enrolled in the new program.  In addition to being more convenient, it will reduce the risk of being exposed to people with COVID-19.  Medicare also announced that it will increase the amount it pays provider of home kidney treatments to help gain traction with the program.  About 92,000 Americans are currently on the kidney transplant list.  For more information, talk to one of our local dialysis centers in Monterey County which are listed here:

https://www.dialysisfinder.com/dialysis-centers/monterey/ca/100#.X9Kn79hKjcs

Monterey, CA Join The Alliance On Aging For A Zoom Meeting On Medicare Friday at 4:00


Join the Alliance on Aging this Friday for a zoom meeting on understanding the basics of Medicare.  Experts will discuss Part A, Part B, Part C Advantage Plans, Part D, Supplemental Plans, Penalties, Low Income Assistance Programs and more.  The meeting ID is 824 2926 4235 and the passcode is 739283, please see the link below.  If you don’t have access to a computer you can call in at 1-866-900-6833.  For more information, contact Moncerat Politron at 646-5049.

https://us02web.zoom.us/j/82429264235?pwd=UTJFdmJDQVBSQWUxWjNNSHpnQmJIdz09#success

California Sues Brookdale Nursing Home Chain

A woman looking out of the window at her home.


Salinas), claiming that they have manipulated the Medicare ratings system to make their nursing homes look more attractive than they actually are.  The lawsuit is among the first of its kind to accuse nursing homes of submitting false information to the U.S. Centers for Medicare & Medicaid Services, or CMS, which uses data on the amount of time spent with residents and pairs it with in-person examinations by state health inspectors.  The facility is then ranked based on stars, allowing consumers to choose which facility they want to put a loved one in.  The lawsuit accuses Brookdale of falsifying its payroll-based journal entries, effectively stating that they have more staff than they do.   Prosecutors also are accusing Brookdale of illegally evicting or transferring residents so the chain could replace them with clients that generate more revenue.  A former Brookdale nursing assistant said in a deposition that her supervisors told her to falsify medical records to make it look like patients received more care than they did.

https://www.nytimes.com/2021/03/15/business/california-lawsuit-brookdale-senior-living-nursing-homes.html?campaign_id=49&emc=edit_ca_20210316&instance_id=28107&nl=california-today&regi_id=52105769&segment_id=53505&te=1&user_id=7052b81671c57203c64c377c7522baa7

https://www.brookdale.com/en/communities/brookdale-salinas.html?cid=yext

Price Increase Is Higher Than Inflation For Many Drugs Covered By Medicare

A building with the capitol in the background.


President Joe Biden made a campaign promise to limit big pharma’s price increases on prescription drugs to no more than inflation—and now is the time to make good on that promise.  A new study found that half of all Part D-covered drugs had list price increases above inflation between 2018 and 2019, and the median list price was rose 6.4%, or 3.5x the rate of inflation.  List prices increased by 10% or more for 14% of all Part D-covered drugs during the same time period.  Another 36% had price increases above the price of inflation but below 10%.  Enough is enough!

https://www.kff.org/medicare/issue-brief/price-increases-continue-to-outpace-inflation-for-many-medicare-part-d-drugs/?utm_campaign=KFF-2021-The-Latest&utm_medium=email&_hsmi=109729367&_hsenc=p2ANqtz-_AXZh_W4n-D3VWBrKFXA_-0CRmkqxJKKUBlsKb-Niya4Pm8n01_t5IeraBLE3Zpsy3RsZYHP36wk4qheGXbVKI1qPPUQ&utm_content=109729367&utm_source=hs_email