Peninsula Daily News Column 10-25-12 "Play the acronym game for Medicare"

            HEADS UP! If you’re planning on attending the 6^th annual “Building Your Caregiver Tool Box” conference on Saturday, November 3^rd (and I hope you are), you need to know that it’s been moved to the Dungeness Valley Lutheran Church at 923 N. Sequim Avenue in (you guessed it) Sequim! Everything else is the same: 8:30 to 3:30, free lunches and snacks (free everything!), a chance to learn some stuff that folks like us could stand to learn and a whole bunch of people who are doing the same thing – Taking care of somebody who needs to be taken care of.

            See you there. Now:

This is about Medicare – again.

            ‘Tis the time of the season for Medicare, because “open enrollment” for Part D and Advantage Plans began ten 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 you like who is, feel free to go immerse yourself f in some frivolous pursuit that might actually nudge you to the brink of mental health – 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 if I don’t, 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 $931 per month and your “assets” are at or below $6,940. “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 $1,261 per month, assets at or below $10,410.

            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 $1,117 per month, assets the same: $6,940; for a couple, income at $1,513 per month, assets the same at $10, 410.

            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 $1,257 per month, assets the same at $6,940, and for a couple, income = $1,702 per month, assets the same at $10,410.

            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.

            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…Mental health be damned.

           

Peninsula Daily News 10-18-12 "Caregiver panel to put the 'us' in useful"

            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 as a nation, 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. Health insurance does…other stuff.

            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. We’re very different from one another in a whole lot of ways, but there’s one way in which we are a whole lot alike: We have to remember to take care of us, which isn’t always as easy as it sounds.

            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 6^th annual “Building Your Caregiver Tool Box” conference will be held on Saturday, November 3rd, from 8:30 am to 3:30 pm, at Trinity United Methodist Church, 100 N. Blake Avenue, in Sequim, free.

            We like free.

            The theme this year is “Caregiving: How to Cope,” and if you’re somebody who is taking care of somebody, that phrase speaks to you – It speaks to me. After we get settled and get some morning munchies and say, Hi,” we’ll start the day with a panel discussion on how to recognize depression and treat it – Early! – By a panel who knows what they’re talking about. There will be breakout sessions on “Depression: What is it?” Cultural Values: Nurturing the Spirit in Our Diverse Cultures,” “Life Cycle-Life Review: Helping the Patient and the Caregiver Create a Personal History,” 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” and other stuff that I’m, undoubtedly, forgetting - 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. You will walk away from this, at the end of the day, with something very special: You’ll walk away with hope.

            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.

            Now, let me talk, for a moment, to the “newbies” – The folks who are relatively new to this “caregiving” thing, be it from choice, necessity, fate, love or what seems like a CRUEL Universe:

            Show up for this thing. I know you don’t have time, or maybe even the energy. And you’ll have to go through Lord-only-knows how much hassle to make sure your person is OK, while you’re away – I know. I get it. But here’s what you’ll find when you get there: A lot of laughter. I know that those topics that I rattled off above don’t sound “fun” – Or funny! – They aren’t. But what is funny (in more ways than one) is that caregivers laugh – A lot.

We could analyze the heck out of why that happens, but that would take a lot of the fun out of it. We laugh. And you’ll see very quickly the difference between laughing “at” and laughing “with.” And we don’t do a lot of “crowd control;” see, a big part of what makes these things work is caregivers talking to caregivers: laughing, commiserating, sharing discoveries and tricks and, sometimes, just being quiet – With other people who understand why, sometimes, just being quiet is good.

Don’t make a bigger deal out of this than it needs to be – Just figure out how to give yourself the gift of one lousy day, call the number above to register and just show up. If it turns out to be a waste of your time, you can take it out on me.

            And I am so sure of myself on this one that I’m willing to take that chance.

Peninsula Daily News Column 10-11-12 "Extra help at hand online, on Peninsula"

            Today is October 11^th, 2012. As noted last Thursday, which was October 4^th of 2012, “open enrollment” for Medicare Part D and Advantage Plans starts four days from today, which is October 15^th – Monday. If you’re NOT retired, it makes perfect sense that “open enrollment” would begin on a Monday. If you ARE retired, Monday is simply the day that keeps Sunday and Tuesday from bumping into one another; either way, Monday is (literally) “D-Day.”

            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! There is no practical way to make a quasi-intelligent decision about these Part D and Advantage Plans 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).

            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 Monday.

            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 2013. Whatever you do (or don’t do) will kick-in on January 1, 2013 – 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 2013 you will at least get a 52.5% 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 21% discount on generics covered by the Plan, courtesy of the Affordable Care Act.

            So, 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 $1,397 per month ($16,764 per year) AND your assets are less than $13,070, 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 $1,892 per month and your assets below $26, 120; 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 “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 (where you see a photo of Chubby Checker) and you want to do this RIGHT NOW! If you call, will you have a wait on the phone? Probably, so take the opportunity to cruise through your checkbook while you’re waiting, in order 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. So, beginning Monday:

• 3^rd Tuesday, Port Townsend Community Center, Lawrence & Tyler, 1:00-3:00 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 Monday and Friday, Port Angeles Senior Center, 328 E. 7^th in P.A., 9:00 am to 12:00 pm;
• Every Tuesday and Friday at the Sequim Senior Activity Center, 921 E. Hammond, 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, to put the “Thank you!” back into Thanksgiving!

Peninsula Daily News 10-4-12 "Preparation for Medicare, Advantage Plans"

            It appears to me that we’ve stalled as long as we can; in fact, the more intransigent among us are still looking at August on the wall calendar, simply to avoid looking at September, because September would have inexorably led us to October! – Alas, nonetheless, here we are.

Many of us would just as soon avoid October, because October means “open enrollment” for Medicare Part D and Medicare Advantage Plans, which means in all probability, a lot of work, hassle and migraines as we tiptoe through the minefields of health insurance. I’m sorry, and I can absolutely assure you that this was NOT my idea.

If you are not on Medicare, consider plowing through this with us so you could be of some service to people who are on Medicare and still think it’s September. If you are on Medicare, have your Part D or Medicare Advantage Plan in place, are just happy as can be with it and are absolutely convinced that nothing will change, then by all means, do nothing and, not surprisingly, nothing will change – The operative word there being “surprise.”

But maybe you like surprises! – Like changes in premiums or formularies or providers! OK, then, do nothing, continue looking the September calendar picture of the Petrified Forest, but the rest of us are moving on.

Ready? Take a breath? Holding hands? OK, here we go, because this year’s “open enrollment” happens from October 15^th (eleven days from today!) through December 7^th so consider flipping that calendar.

            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 (hospital, home health, hospice, etc), Part B (doctor, outpatient, durable medical equipment, tra la), 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 (“health maintenance organization” or, what many call somewhat derisively, “managed care”), 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 another 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 2013 numbers:

1.      Mrs. Jones joins the “White Rabbit Part D Plan” on 1/1/13, and doesn’t get “extra help” (we’ll come back to that), and pays the first $325 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 $2,970;

3.      Mrs. Jones now enters the legendary “donut hole” (aka, “coverage gap”) in which, basically, White Rabbit pays zero. The “good news” in 2013 is that Mrs. Jones will pay 47.5% of the cost of “covered” (meaning that they’re on the formulary) brand-name drugs and 79% of the cost of generics while she resides – Uncomfortably! – In the donut hole;

4.      If Mrs. Jones’ costs reach $6,734, she emerges from the donut hole and enters the appropriately named, stage 4 “catastrophic coverage,” in which White Rabbit pays 95%.

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 carpet 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 www.medicare.gov and clicking on “Find health & drug 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 11^th, which will be four 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, so go flip the calendar and continue holding hands.