Peninsula Daily News column, 10-27-11 "It's time to fill caregivers' toolbox"

            It’s easy to be sarcastic about healthcare in America - It’s even easier to be sarcastic about health insurance! – In fact, it’s so easy that, sometimes, we can confuse those two things, so let’s start there:

            Health insurance is NOT healthcare. Healthcare keeps us going, and as healthy as we can, or are willing, to be, and we’re actually pretty darned good at it! We’re so good at it that a lot of us are living a whole lot longer than would have been imagined even a generation or two ago.

            So, the “good news” is that a lot of us are living a whole lot longer! The “bad news” is that, in the course of living longer, a number of us require “care” – You know, somebody (or somebodies) to help us get through the day. We call those folks, which most of us are, have been or will be, “caregivers,” but since “caregivers” almost never call themselves “caregivers,” here’s my standard definition: A “caregiver” is somebody who is taking care of somebody who needs to be taken care of, whether they like it or not.

            Does that sound at all like you to you? Then, WELCOME! – Because you’re “us.”

            And, yeah, there are a LOT of us.

            And if we don’t take care of us, what do you suppose happens to the folks that we’re taking care of? Right: Nothing good; so here’s our annual opportunity to take care of us.

            The 5^th annual “Building Your Caregiver Tool Box” will be held on Saturday, November 5^th, from 8:30 am to 3:00 pm, at the Peninsula College PUB (Pirate Union Building, and don’t panic: Costumes are NOT required!), 1502 East Lauridsen Blvd. in Port Angeles, free.

            We like free.

            The theme this year is “The Tsunami of Caregiving,” with the keynote address by Jamye Wisecup, the coordinator of the Clallam County Sheriff’s Emergency Management Division. There will be breakout sessions on “Map Your Neighborhood,” “Outages,” “Preparing for the ‘Little Emergencies’,” etc. as well as some other, more personal, options.

            There will also be a free lunch, snacks, beverages, vendor and informational tables, a lot of us “professional-types lurking about and a comedy (Yes, COMEDY! – If we don’t laugh at this stuff now and then, it’ll kill us!) presentation in the afternoon! – But here’s the best part: There will be a room full of people who are doing the same thing (more or less) that we’re doing, which means a room full of very smart, experienced and creative people.

            That’s what puts the “us” into the us.

            What do you do? Call 360-452-3221 (1-800-801-0070) to register, and do it RIGHT NOW! These conferences fill up fast, which ought to tell you something. Can you bring your “person” with you? No, and here’s why: If you bring your person, then you’ll be doing what you do all the time, which is giving care, which means that you’ll be all about them, and not about you, and this is about you.

            Us.

            Do this. Care enough about your person to care about you, and to remember that you aren’t alone.

            Us. See ya there.

            Now, change channels, OK? – Click. A number of the more loyal among you have heard me go on (and on!) about “Living Well with Chronic Conditions.” I know this to be true because a lot of you with chronic conditions have been through this 6-week, 2.5 hours/week workshop and have told me that it changed your life – For the BETTER! It works, and it’s free. We like free.

            So, now: What if I gave you a chance to become a facilitator for “Living Well with Chronic Conditions?” Really! To get trained in how to conduct these workshops that change lives, for free! Well, here’s your chance.

            The training will run November 8, 9, 15 and 16 at the Port Angeles Senior Center (328 E. 7^th, but you probably knew that). You’d run these workshops in teams of two, so bringing a friend would be fun, and you don’t have to have any teaching experience.

            All you have to commit to is showing up for all four days of the training and facilitating a minimum of two, 6-week workshops per year. Do you know how much you’ll learn from this? Not to mention the karma!!! And if you don’t have a lot of fun doing it, you’re doing it wrong.

            What do you do? Call 1-866-582-1487 and sign-up, then show up.

            So, what was the theme of today’s column? Right: Good and decent people being good and decent people – Together – One person at a time, in spite of everything you hear in the news.

Peninsula Daily News column, 10-20-11 "On acronyms, open enrollment, Medicare"

            This is about Medicare – again.

            ‘Tis the time of the season for Medicare, because “open enrollment” for Part D and Advantage Plans began five days ago (October 15^th) and will run through December 7^th (a day that will probably live in infamy); regardless, here we are.

            So (again), if you’re not on Medicare, about to be and don’t know anyone who is, feel free to go check out what’s on tap for “live music” on the Peninsula – The rest of us have work to do and today that “work” might save a number of us a considerable amount of money.

            As threatened last week, today we’re going to venture into a land of acronyms generally referred to as “Medicare Savings Programs.” I’ll quote the acronyms and tell you what they stand for, because some of you will feel sufficiently neglected to warrant e-mailing me, demanding to know what they stand for; however, it is NOT important that you remember said acronyms, nor is it important that you remember what they stand for – It IS important that you pay enough attention to the numbers to see if they will do you or yours some good.

            Acronym #1 is QMB (pronounced “Quimby”), that stands for “Qualified Medicare Beneficiary.” If you qualify for it, it will pay for your Part A premium (if you have one), your Part B premium (I’m pretty sure that you have one of those) AND your Part A or B deductibles, copays or coinsurances. If you have an Advantage Plan, QMB will pay copays and coinsurances for medical and hospital care.

            Did you follow that? Did you see the part about it paying your Part B premium? So, without even trying, we’ve just saved you real close to $1,200! – Indeed, Quimby is our friend.

            You qualify for QMB if your income as a single person is at or below $908 per month and your “assets” are at or below $6,680. “Assets” means cash, bank accounts, stocks, bonds, real estate contracts, blah blah – Pretty much what you’d think it means. It does NOT mean your house, one car or your stuff; also, if you have up to $1,500 set aside in a specific account for burial costs, that isn’t counted, either.

            If you’re a couple, income at or below $1,226 per month, assets at or below $10,020.

            FYI, if you qualify for QMB, you AUTOMATICALLY qualify for the Part D “extra help” (“L.I.S./Low Income Subsidy” – I went on about this last week), so you’d have very low to $0 premium, $0 deductibles and very low copays and, probably, no donut hole.

            See? Quimby is our friend.

            Acronym #2 is SLMB (pronounced “Slimby”), that stands for “Specified Low-Income Medicare Beneficiary” (feel smarter?). If you qualify for this, it’ll pay your Part B premium only (again, do the math in your head – Real close to $1,200/year, right? Right!)  To get in the game, for a single person, income at $1,090 per month, assets the same: $6,680; for a couple, income at $1,471 per month, assets the same at $10, 020.

            Acronym # 3 is QI-1 (pronounced “QI-1”), which stands for “Qualified Individual” (I know, but I don’t make them up). QI-1 will pay for your Part B premium only. Income for a single person at or below $1,226 per month, assets the same at $6,680, and for a couple, income = $1,655 per month, assets the same at $10,020.

            I know what you’re thinking, and No: You did NOT misread something – YES, I just referenced two acronyms that both pay your Part B premium, with different income levels, so you’re thinking, “WHY???”

            Answer: I don’t know. I probably knew once, but I don’t know now; more importantly, I don’t care. I DO care that people without a lot of money get the help.

            Now, a handful of you are, for lack of a more pejorative term, “policy wonks,” so you’re thinking, “You can’t fool me, Harvey! ‘Medicare Savings Programs’ are a form of Medicaid, which means that ‘they’ will come after my estate!”

            First, I’m not in the business of “fooling” you – If I were, we’d call this “Fool Line,” and we don’t.

            Second, you’re right about these being a form of Medicaid; however, Medicare Savings Programs are NOT “recoverable” under Medicaid, so you have nothing to lose (Score one for my side!).

            So, what do you actually do? Well, you can come to any of the SHIBA clinics that I listed last week or you can call any of the numbers at the end of this column for help.

            You can go online to http://www.dshs.wa.gov/onlinecso/findservice.shtml or you can truck on down to the nearest DSHS office (You want the “CSO,” which stands for “Community Services Office”). FYI, it really isn’t all that tough to get signed-up, so just keep repeating to yourself, “$1,200, $1,200, $1,200…” but do it silently, so people don’t look at you oddly.

            And, Yes, Virginia, you should insert this in your “Boomer Primer.”

I know this stuff can glaze you over – Me, too; but the fact is that they can save us serious money in a time when pretty much any money is “serious,” so read this two or three times, then DO IT, because waiting or “thinking about it” won’t help you or anybody else.

$1,200, $1,200, $1,200…

           

Peninsula Daily News column, 10-13-11 "On open enrollment for Medicare plans"

            Today is October 13^th, 2011. As noted last Thursday, which was October 6^th of 2011, “open enrollment” for Medicare Part D and Advantage Plans starts two days from today (October 15^th – I don’t know why such a life-changing experience would start on a Saturday, other than the possible conjecture that the “Ides of October” seems…symbolic); anyway, here we go, and I’m not going to repeat everything we covered on October 6^th, 2011, as a nod to the resilience of our short-term memories.

            This column is going to be all about the intricacies of this process. If Part D is not part of your life and you couldn’t care less, bail out now and go shopping for Halloween candy, and remember who loves you…

            OK, October 15^th through December 7^th! The short version is that there are 30 Part D plans to choose from. It appears that no Advantage Plans are leaving Clallam County, nor are any new ones coming in, while Jefferson County has a couple of new Advantage Plan choices to consider; clearly, there is no practical way to make a quasi-intelligent decision about these without using Medicare’s “Plan Finder,” which you can find at www.medicare.gov/find-a-plan or just go to www.medicare.gov and it will be obvious. You could also call 1-800-MEDICARE (1-800-633-4227) 24/7 for help (TTY = 1-877-486-2048) OR (if all else fails) you could actually read the “Medicare & You 2012 Handbook,” which likely showed up last month.

            And there is free, local, face-to-face help available – Stay tuned.

            All the Plans are now in the “Plan Finder,” so you could go into it, enter your drugs and what-not and get some extra time to think, but remember that you can’t actually enroll/change Plans until Saturday,

            If you have a Part D plan now that you’re just as happy-as-a-happy-clam with, and you’re totally confident that you’ll be clam-happy with it again next year (without even looking at premiums or formularies or whatever), then feel free to do absolutely nothing, and your current plan will continue, unabated and unperturbed, into 2012. Whatever you do (or don’t do) will kick-in on January 1, 2012 – Happy New Year!

            Last week I referenced the “donut hole” (i.e. “coverage gap”), in which the Part D plan pays nothing and we pay everything, assuming that you have a plan that has a “donut hole” – That’s true; however, if you hit the donut hole in 2012 you will at least get a 50% discount on all brand-name drugs covered by the Plan (which will still count toward getting you OUT of the donut hole) and/or a 14& discount on generics covered by the Plan (I know, but at least it’s something).

            Let’s talk about money. You may have heard “extra help” or “L.I.S.,” both of which refer to the Part D “Low Income Subsidy,” for which many of us qualify and don’t know it. If you’re single and your income is at or below $1,362 per month ($16,335 per year) AND your assets are less than $12,640, you qualify. “Assets” means, for most of us, money in the bank (plus stocks, bonds, contracts, etc) – It does NOT mean your house, your car or your stuff. For a couple, your income has to be at or below $1,839 per month and your assets below $25, 260; FYI, these numbers will probably increase in April of next year.

            If you do qualify, you’ll be able to enroll in one of the 9 “benchmark” Part D plans with little or no monthly premium, drastically reduced deductibles and NO “donut hole!” If this sounds even vaguely like you to you, you can apply by calling Social Security at 1-800-772-1213 (TTY = 1-800-325-0778) or going online to www.socialsecurity.gov/prescriptionhelp and you want to do this RIGHT NOW! Will you have a wait on the phone? Probably, so take the opportunity to cruise through your checkbook while you’re waiting to remember why you’re waiting.

            Now, I told you that there was free, local, face-to-face help available – There is. These folks know what they’re doing and will not try to sell you anything because they don’t have anything to sell – I know this to be true because they’re “us” – I also know them to be good and decent people. Here we go:

• 3^rd Tuesday, Port Townsend Community Center, Lawrence & Tyler, 3:00-5:00 pm;
• 2^nd and 4^th Tuesdays, Tri-Area Community Center, 10 W. Valley Road in Chimacum, 9:00 am to 12:00 pm;
• Every Wednesday and Friday, Port Angeles Senior Center, 328 E. 7^th in P.A., 9:00 am to 12:00 pm;
• Mondays, at the Sequim Senior Activity Center, 921 E. Hammond, 3:00-5:00 pm and Tuesdays, same place, 9:00 am to 12:00 pm;
• 4^th Wednesday, Quilcene Community Center, 294952 Highway 101, 10:00 am to 1:00 pm;
• In Forks, at our “Information & Assistance” office (481 5^th Avenue), the 1^st Wednesday, 9:00 to 11:00 am, or call 374-9496 for other appointments.

If you have any questions about any of that, call 452-3221 (1-800-801-0070).

Bring your Medicare card or Medicare number, any/all insurance cards/prescription drug cards/benefit booklets, any letters you’ve gotten from your insurance company on the subject, an estimate of your monthly/annual income and assets, a list of your medications, dosages and what you’re paying for them now and anything else that you think might be a good idea or that you have questions about.

These are first come, first served affairs, so remember to be as cheerful and patient as possible, because everybody else is doing the same thing that you’re doing and are equally thrilled at the prospect.

Last one today: Remember that part above about “extra help?” Well, if you’d like to see if you’re eligible and (if you are) actually apply online AS WELL AS finding out if you might be eligible for any number of other programs, go to www.benefitscheckup.org and work through it. It goes surprisingly quickly, is very straightforward and you might be amazed by what you discover.

I’d hoped to get into Medicare Savings Programs today, but I suspect that this is MORE than enough for now, so let’s call it “good;” remember, you have until December 7^th to pull this off; personally, I’m shooting for having it done before November 24^th, putting the “Thank you!” back into Thanksgiving!

Peninsula Daily News, 10-6-11 "More to-do for Medicare"

            The underlying premise of this whole “Boomer Primer” thing was to proceed in a, more or less, orderly fashion – First, think about this; then, think about that, then…You get it.

            The problem with a plan like that is that the Universe has absolutely no respect for our little plans because it has a much bigger plan of its own, and the Universe (as usual) wins. In this particular instance, the “Universe” takes the form of Medicare, which is about to super-impose “open enrollment” for Part D and Advantage Plans upon us, so – Ready or not! – Here it comes! And here we go (…well, what-the-heck, we would’ve had to go here eventually, anyway, so…).

            AND, as casually mentioned last week, this year’s “open enrollment” happens from October 15^th (nine days from today!) through December 7^th – So much for “casual,” so here’s the short version:

            Medicare Part D: “D,” as in “drug.” Drug coverage – Insurance. It isn’t run by the Feds, like Parts A or B – These are plans, run by private companies, that are approved by the Feds. There are two ways to go:

1. What many of us do is have “traditional Medicare,” which means Part A, Part B, a “MediGap” plan, to pick up the 20% that Medicare “approves” (but doesn’t pay for) AND a Part D plan – Yes, it is confusing;
2. What others do is have a Medicare “Advantage Plan,” which works (more or less) like a HMO, which provides all Part A and Part B coverage (usually, around here, through a “network” of providers) and (usually) Part D coverage – Yes, it is confusing.

As of this writing, we don’t know which (if any) Advantage Plans will be available in our corner of the Universe, nor do we know which Part D plans will be available; more will be revealed, which is the way of the Universe.

If you are “new to Medicare,” you get to sign up for these during the 7-month period that begins 3 months before the month you turn 65, the month you do turn 65 and ends 3 months after the month you turn 65. If you’ve been in the game for a while, you know that “open enrollment” means a specific period of time when you can change plans – “…and,” the newbie asks, “WHY would you do that?”

Well, because plans come and go, premiums change and formularies (the list of prescription drugs that a plan actually covers) change – Oops! So, the plan that was your best-friend-forever this year, may not be so great next year, get it?

If you don’t sign up for a Part D plan when you’re first eligible, you will incur a “penalty,” which is 1% of the “national base beneficiary premium” times the number of months that you dithered about, and that amount will be added to your premium (if you ever decide to sign-up for a plan) AND it will never go away. IF you have prescription drug insurance from other source (e.g. retiree insurance) and IF it is deemed equivalent to Medicare Part D coverage, you then have “creditable coverage,” which exempts you from the dreaded penalty. If this is the case, your insurance will send you a letter telling you so – KEEP THE LETTER!

The “skeleton” of Part D, which we can imagine to be in four “sections,” looks like this, using my BFF (Mrs. Jones), as an example, using 2011 numbers:

1.     Mrs. Jones joins the “White Rabbit Part D Plan” on 1/1/11, and doesn’t get “extra help” (we’ll come back to that), and pays the first $310 of her drug costs out-of-pocket, plus “White Rabbit’s” monthly premium – White Rabbit pays zero;

2.     Mrs. Jones pays a copayment and White Rabbit pays a bunch, until their combined amount (plus the deductible from #1 above) equals $2,840;

3.     Mrs. Jones now enters the legendary “donut hole” (aka, “coverage gap”) in which, basically, White Rabbit pays zero. The tongue-in-cheek “good news” in 2011 is that Mrs. Jones got a 50% discount on “covered” (meaning that they’re on the formulary) brand-name drugs while she resides – Uncomfortably! – In the donut hole;

4.     Once Mrs. Jones has shelled out $4,550, she emerges from the donut hole and enters “catastrophic coverage,” in which White Rabbit pays almost everything.

Now remember, that was the “skeleton” – Different plans look different, e.g. some plans don’t have a “coverage gap” – Will they be more expensive? Of course! And the premium has to be affordable and the formulary has to cover the drugs you take and what about this pharmacy vs. that pharmacy, and…

Right: Assuming that you don’t have the time, patience or endurance to cover the backyard with the policies of umpteen Part D plans for in-depth review, the only practical way to do this is to utilize Medicare’s “Plan Finder.” You can do this by going to http://www.medicare.gov/ and clicking on “Compare Drug and Health Plans.” It will ask you to enter the drugs you take, dosages, how much you pay, where you want to get them, blah blah, then will spit out a few of what appear to be the best plans for you, beginning October 15^th.

Local lore notwithstanding, the “Plan Finder” actually works pretty well for most people, most of the time, and you don’t have to be Bill Gates to navigate it, but if you’re not comfortable with computer stuff or don’t have one or your situation is “complicated” or or or, there is now (and will be) free help available, and I’ll give you those specifics next Thursday. If you need help TODAY, call any of the numbers at the end of the column and decent people will help you – For free – Without trying to sell you anything, because they don’t have anything to sell. I promise.

We’ll venture into specifics, like “extra help,” etc. next week, which will be October 13^th, which will be two days away from “D Day,” so stay calm and get this “open enrollment” thing on your “To-Do List” right now!

Look, this “Universe” is going to unfold, whether we like it or not, right? Sound a lot like “life?” Right, so we need to figure it out, deal with it and move on. Pretending it isn’t there only works with white rabbits.