WASHINGTON — States around the country are clamping down on pharmaceutical companies, forcing them to disclose and justify price increases, but the drug manufacturers are fighting back, challenging the state laws as a violation of their constitutional rights.
Even more states are, for the first time, trying to regulate middlemen who play a crucial role by managing drug benefits for employers and insurers, while taking payments from drug companies in return for giving preferential treatment to their drugs.
The bipartisan efforts by states come as President Trump and his administration put pressure on drug companies to freeze prices and reduce out-of-pocket costs for consumers struggling to pay for drugs that often cost thousands of dollars a month.
Twenty-four states have passed 37 bills this year to curb rising prescription drug costs, according to Trish Riley, the executive director of the National Academy for State Health Policy, a nonpartisan forum of policymakers, and several state legislatures are still in session.
The burst of state activity on drug costs recalls the way states acted on their own to pass laws to expand health insurance coverage in the years before Congress passed the Affordable Care Act in 2010.
“In the absence of federal action, states are taking the lead in combating high drug prices,” said State Representative Sean Scanlon of Connecticut, a Democrat.
Under the Connecticut law, drug companies must justify price increases for certain drugs if the price rises by at least 20 percent in one year or 50 percent over three years. Insurers must identify their 25 highest-cost drugs and the 25 with the greatest cost increases when they file their annual rate requests with the state Insurance Department.
In addition, the middlemen, known as pharmacy benefit managers, must disclose the amount of rebates and other price concessions they receive from drug companies.
“As state legislators, we are responsible for the wise stewardship of taxpayers’ money,” said State Representative Norm Thurston of Utah, a Republican. “The state spends a lot of taxpayers’ money on prescription drugs, through Medicaid, corrections and jails, state employees, higher education employees and their dependents. We should be sure we’re getting the best deal.”
In response to a bill introduced by Mr. Thurston, the Utah Health Department is studying possible ways to import prescription drugs from Canada, and he is working with a Republican state senator on a bill to require the reporting of price information by drug companies.
California has adopted a law requiring drug companies to provide advance notice of price increases, together with a detailed statement of the reasons for the increases. In addition, insurers must file annual reports showing the percentage of premiums attributable to drug costs.
“Californians have a right to know why their medication costs are out of control, especially when pharmaceutical profits are soaring,” Gov. Jerry Brown said.
Drug companies have filed suit to block the California law, which they describe as “unprecedented and unconstitutional.”
The law “exports California’s policy choices” to the rest of the country and violates the First Amendment by compelling drug manufacturers to explain their price increases, said the lawsuit, filed by the Pharmaceutical Research and Manufacturers of America.
PhRMA, along with the Biotechnology Innovation Organization, also went to court to challenge a law signed by Gov. Brian Sandoval of Nevada, a Republican.
The Nevada law requires manufacturers of diabetes medicines, such as insulin, to report detailed information, including the production costs for each drug, the amount spent to market it, the profits earned on its sales and the amount of rebates paid to pharmacy benefit managers for sales of the drug in Nevada.
Drug companies dropped the lawsuit in June after Nevada agreed that certain information in the drug price reports could be kept confidential.
Reining in drug costs is a top priority for state officials who run Medicaid, the health program that serves more than 70 million low-income people.
Oklahoma will soon start paying for some prescription drugs based on how well they work. If a drug does not perform as promised, the manufacturer will refund the cost of the drug or another negotiated amount.
“If a drug claims to keep people out of the hospital and doesn’t, the manufacturer may be liable for the cost of the hospitalization,” said Nancy Nesser, the pharmacy director of the Oklahoma Medicaid program.
New York has imposed an annual cap on drug spending in its Medicaid program. If spending is projected to exceed the cap in any year, state officials must identify drugs responsible for the excess costs and try to negotiate additional rebates with drug manufacturers to keep spending under the cap. If a drug company balks, the state can restrict access to its drugs or impose controls on their use, based on advice from an independent panel that reviews the drugs’ costs and clinical benefits.
In the first year of the program, which ended in March, spending was on track to exceed the target, but state officials say they extracted $60 million in additional savings for the state through negotiations with companies that produce 30 particularly high-cost drugs.
In Ohio, Medicaid officials announced this past week that they had a new way to pay for prescription drugs. Pharmacy benefit managers will no longer be allowed to keep any of the payments they receive from drug manufacturers. The money must be passed on to Medicaid health plans and used for the benefit of Medicaid recipients, starting Jan. 1.
Ohio officials said they wanted to know whether the benefit managers had been overcharging the state, but were frustrated in trying to obtain drug pricing information.
“It’s shrouded in secrecy,” said Tom Betti, a spokesman for the Ohio Medicaid agency. “We intend to open up the black box.”
Maine adopted a law last month doing something that Congress has been trying, without success, to do for several years. The law requires manufacturers of brand-name drugs to make samples available to generic drug companies trying to develop inexpensive copies of those products. Generic drug developers need the samples to show that a low-cost generic copy is equivalent to the brand-name original.
The stated goal of the Maine law is to promote competition, so consumers do not have to pay “monopoly drug prices.”
A growing number of states have passed laws to ensure that pharmacists can inform customers of less expensive options. These laws ban “gag clauses,” which prevent pharmacists from telling consumers when they could save money on prescriptions by paying cash rather than using their health insurance.
Maryland tried a particularly bold approach.
After reports of huge increases in the prices of certain generic drugs, Maryland banned “price gouging,” defined as an unconscionable increase in the price of any “essential off-patent or generic drug.” A drug company that flouts the law could be fined $10,000 and be required to pay refunds to consumers.
Under the law, it said, Maryland would regulate prices in transactions that occur wholly outside its borders — prices charged by drug makers to wholesalers — regardless of whether any pills were ever shipped to Maryland.
In a lengthy dissent, Judge James A. Wynn Jr. said that Maryland should be able to protect the health and welfare of its citizens. The court, he said, was accepting the drug companies’ view that they were “constitutionally entitled to impose conscience-shocking price increases” on consumers.
This week, the Centers for Medicare & Medicaid Services (CMS) announced that next year, Medicare Advantage (MA) Plans will be able to limit options for people who get Part B-covered drugs by using many of the same tools plans currently use in Part D. The Trump administration argues that this will enable plans to negotiate better prices for the “preferred” medications – those that the plan will cover as a first-line treatment. Other drugs will only be covered if a person tries the preferred medication first and it doesn’t work or causes them harm, also known as step therapy.
Until now, MA plans were not permitted to place this type of restriction on medications covered under Part B. Part B drugs include drugs used in durable medical equipment, anti-rejection drugs for people who had Medicare when they got a transplant, and some chemotherapy agents, as well as drugs that are both supplied by and administered by a provider. Plans that have both MA and Part D coverage will be permitted to create combined step therapy requirements where a preferred Part B-covered medication must be tried before a non-preferred Part D-covered treatment.
These restrictions, which are common in Part D plans, can make comparing plans more difficult. While CMS requires plans to announce to enrollees that they intend to use this flexibility in the Annual Notice of Change, they do not require plans to send personalized or targeted notices to people currently taking, or who have a diagnosis that might require, the affected medications. Medicare Rights is concerned that it will be especially challenging to compare plans where Part B step therapy is used unless there are updates and improvements to the Medicare Plan Finder tool.
Medicare does cover chiropractic care, but does not cover acupuncture at this time. Here is a great article by Medicare FAQ that jumps into the topic with both feet.
Often times, in the weeks following an injury or when pain becomes too much to deal with, patients will seek the support of a chiropractor, or acupuncture specialist. Both acupuncture, and chiropractic care, were created to treat moderate to high level pain and discomfort.
However, one concern that always comes to mind is out-of-pocket expenses, which can definitely add up. So naturally, this has Medicare beneficiaries wondering just how much of these treatment costs are covered by their Medicare plan, if covered at all.
Chiropractic Care vs. Acupuncture
Like stated above, both of these methods of treatment were created to relieve pain or discomfort. Before looking into the cost difference between the two, you may consider what each form of treatment entails. It is best to look further into both before deciding on the best option for you.
Chiropractic care is a very hands-on process. For chiropractic treatments, the physician uses his or her hands to adjust the patients muscles and joints. This is done to generate better movement to tight muscles and gain better usage of affected joints.
Neck pain, back pain, headaches, or anything that may cause a disruption in the nervous system, are usually a common reason patients seek chiropractic care. Patients who receive this form of treatment typically feel results immediately after leaving the appointment.
However, chiropractic care does come with a few possible risks. Amongst them, are risks of having a stroke or unintentionally adding pressure to the injury. The risk is low with certified practitioners, but with constant shifting of muscles and joints, you could possibly end up being be more susceptible to injury.
Unlike chiropractic care, acupuncture is not as much of a hands-on method for reducing pain. Acupuncture is done by inserting needles into the surface of the skin. This is a practice that will stimulate certain parts of the body to alleviate pain, and can also help to treat several other medical health conditions.
In fact, several acupuncture patients have reported that this treatment has helped cure their depression, anxiety, and several other mental and physical issues. Again, like chiropractic care, acupuncture does come with some low risks. Acupuncture risks can include bleeding or bruising from the needles, infection, and in some cases can stimulate labor for pregnant women.
If you are considering acupuncture treatment, just be sure you choose a licensed practitioner.
It is important to note that, while both are proven effective and useful options, there are differences in what Medicare plans will cover.
Does Medicare Cover Chiropractic Care
Yes, Medicare covers chiropractic services, if they are medically necessary. Luckily, Medicare currently has no cap on how many times you can see a physician for necessary chiropractic appointments.
If you are enrolled in Medicare Part B, 80% of the cost for chiropractic care will be covered by Medicare. If you have the Original Medicare, and don’t have any other additional insurance, you are responsible for paying your Part B deductible, and a 20% coinsurance for your appointments.
You may also be required to pay for any additional tests that are ordered by your chiropractic physician. This can include, x-rays, any extra physical or massage therapy, and even, coincidentally, acupuncture. The specific amount of money owed will depend on several factors, including:
- Any other insurance you have.
- The facility that you seek care from.
- How much your individual doctor charges.
- Where you get your tests and services.
Do not go into this treatment with no knowledge of the average estimate of payment. Talk to your doctor, and get all of your questions answered before committing to a certain recommendation they’ve made.
Is Acupuncture Covered by Medicare
Unfortunately, no. At this time, acupuncture specifically is not covered by your Original Medicare plan. Medicare typically does not cover services that are not considered medically necessary. Medicare will cover other types of therapy, like physical, occupational, or speech therapy. However, acupuncture is not part of those types of therapy yet.
If you should decide to seek the help of a professional acupuncturist, it is important to be quoted on prices for the entire process. Patients typically get the initial first visit cost, and tend to forget any additional costs for follow up appointments or extra care.
Find out how many appointments you’ll need to attend. If there are any additional costs, and how often you’ll need to attend follow-up visits.
Acupuncture and Chiropractic Coverage with Medigap
What is Medigap? Medigap provides you with any additional coverage you may need when paying for your medical needs under Medicare. So are acupuncture and chiropractic care part of the additional coverage?
At this time, Medigap plans do not cover any costs that deal with acupuncture.
While acupuncture is not covered by Medigap, chiropractic care is covered by Medigap. In fact, Medigap Plan C and Plan F cover 100% of your Part B deductible, on top of your 20% coinsurance.
If you combine your Medicare and Medigap plans, any medically necessary chiropractic work will be completely covered, at no cost to you.
Does Medicare Advantage Cover Chiropractic and Acupuncture?
When it comes to Medicare Advantage plans, we hit a bit of a grey area with coverage for chiropractic care or acupuncture treatment. Each Medicare Advantage plan is different from the next. So one plan may offer high fees and less benefits, while another offers low fees and more benefits.
At this point, it may be tough finding a Medicare Advantage provider that covers acupuncture. It may be worth looking into though, if it is something you truly feel is a priority for your health.
The same answer goes for chiropractic services. Although it is usually much easier to come across, the prices and plans will vary.
The Center for Medicare Advocacy is pushing Medicare to include dental care in Medicare Part B. One of the big things Medicare has not covered in the past was dental. A diverse group of Medicare advocates have published a white paper that tackles the subject head on.
Contact: Matthew Shepard
July 19, 2018 – Washington, DC – The Center for Medicare Advocacy, along with a diverse group of partners, released a white paper, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care. This white paper is an interprofessional, collaborative effort written and published by leaders in the consumer, healthcare and dental fields, including the American Dental Association, Center for Medicare Advocacy, the DentaQuest Foundation, Families USA, Justice in Aging, Oral Health America and the Santa Fe Group.
With an expected 72.1 million seniors living in the United States by 2030, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care, examines the need for oral health care to be integrated with, and elevated to, the same importance as the rest of health care in Medicare. Says Center for Medicare Advocacy Senior Attorney Wey-Wey Kwok, “Medicare’s dental exclusion is misguided given the clear connection between oral health and overall health. The time has come to include an oral health benefit that covers preventive services, disease management, and necessary procedures for all Medicare beneficiaries.”
Medicare plays a key role in providing health and financial security for 59 million older people and younger people with disabilities. However, traditional Medicare does not include coverage for routine oral health care like checkups, cleanings and x-rays, or restorative procedures like fillings or bridges, tooth extractions and dentures. The Center for Medicare Advocacy is committed to working with our many dedicated partners to advance access to quality oral health care for Medicare beneficiaries by adding an oral health benefit into Part B, which will improve overall health and quality of life for millions of older adults and people with disabilities.
An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care looks at many aspects of adding an oral health benefit to Medicare, including medical necessity, costs and the need for legislative changes. Top findings include:
- 70 percent of all Medicare recipients lack or have limited dental insurance and fewer than half access dental care each year.
- Cost is the number one reason that older adults have not gone to the dentist in the past year.
- Integrating dental coverage in Medicare would close disparities in dental use and expense between the uninsured and insured and among older adults with few financial resources and limited oral health education.
- Surveys show that consumers widely support adding oral health coverage to Medicare and prioritize two categories of care: checkups and pain treatment.
- 71.2 percent of dentists agree that Medicare should include comprehensive dental benefits and a majority indicated they were willing to comply with typical Medicare practice requirements.
- The ADA recently commissioned a study that analyzed the cost structure for various dental benefit designs within Medicare. This study estimated that a comprehensive benefit without dollar value caps would cost the federal government between 31.4 billion dollars in 2016 dollars, $32.3 billion in 2018; the estimated base premium increase for a Part B benefit would be $14.50 per beneficiary per month. ADA input to this white paper does not constitute endorsement of inclusion of a dental benefit under Medicare at this time. The ADA is currently investigating a number of options to serve the dental care needs of a growing elder population.
An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care recommends the addition of a comprehensive oral health benefit to Medicare Part B as it covers outpatient services. Such a benefit would be amended to include dental services using the medically necessary and reasonable standard that applies to all Part B services. Advantages to the inclusion of Part B include:
- Ensures that everyone enrolled in Medicare will receive the oral health benefit.
- Provides the greatest number of beneficiaries access to a basic level of oral health care, encouraging equitable health solutions and provider participation.
- Simplifies a potentially confusing program and process for providers and beneficiaries.
- Uses established protections for both Medicare beneficiaries and providers, alleviating the need for a new system and bureaucracies.
To move an oral health benefit in Medicare Part B forward, Congress must pass legislation to remove the statutory exclusion in Section 1862(a)(12) of the Social Security Act. They must establish dental coverage in Part B, permit payment for preventive services prescribed in the dental benefit and define the dental services in the Medicare Statute.
“Research demonstrates that oral health disparities exist for many racial and ethnic groups, by socioeconomic status, gender, age and geographic location. This underscores the need to approach oral health disparities as a component of social justice,” says Center for Medicare Advocacy Policy Attorney Kata Kertesz.
The recommendations included in An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care stress the necessity of an oral health benefit for older adults. Read more about the medical necessity, costs, proposed structure and legislative changes needed at oralhealthamerica.org/medicaretoolkit.
Many people have big plans for what they will do once they retire. Baby boomers are taking advantage of their newfound freedom by traveling the world. Studies show that baby boomers are consistently finding ways to travel affordably, and a lot of them have a travel bucket list. This tendency to research their destinations means they are willing to plan ahead, and insurance coverage is something retirees should definitely be considering in their travel plans.
When you retire, you may have big dreams to see the world. Have you thought about what will happen if you get injured in a foreign country? What are baby boomers doing to make sure they have overseas travel coverage?
Foreign Travel and Medicare Overseas
It’s important when considering your options and retirement plans to know what Medicare Parts A and B will cover when you are traveling. As a general rule, traditional Medicare pays only for medical care in the United States. There are some unique circumstances where Medicare overseas will cover 80% of your emergency care outside of the US.
- Cruise ships no more than 6 hours from a US Port
- Direct driving routes between Alaska and the US
- Situations in which you are sick in the United States but the nearest hospital that can treat you is in another country
- If you live in the U.S., but the nearest hospital to your home is in another country
This means the chances of you getting medical coverage under Medicare when traveling in a foreign country are very slim. Fortunately, there are solutions to this dilemma.
Medicare Plan G
The best way to ensure that you are covered when traveling overseas is to pick up a Medigap plan. For example, Medicare Plan G provides coverage for foreign travel for baby boomers. Plans C, D, F, M, and N also provide some foreign travel coverage. Medicare Supplement Plan G is one of the most common plans for baby boomers.
This supplemental policy helps you cover out-of-pocket costs which are not covered by traditional Medicare. It also will help pay for part of your emergency medical expenses when you’re outside of the United States.
What Will be Covered?
Medicare supplement plans for foreign travelers cover a certain amount of services. Their foreign care coverage is designed to protect you in case of an emergency. It is not designed for routine care or testing.
Baby Boomers can expect that their supplement care foreign travel plan will cover emergencies that begin during the first 60 days of their trip. Baby Boomers who plan on traveling during retirement should invest in travel coverage via a Medigap plan at their first instance of eligibility. Although there is a small deductible, this can provide protection in many situations and will normally pay 80% of the fee for medically necessary emergency care.
What Kind of Travelling Do You Plan on Doing?
While you don’t need exact specifications, it’s good to know approximately how often and for how long you’ll be traveling in the years to come. This is because even Medigap plans have certain limitations when it comes to coverage in foreign countries. Do you think you’ll be out of the country for months at a time? Or will you be taking planned trips for shorter lengths of time?
If you plan on living overseas or plan on taking long extended trips to foreign countries, you may need to consider additional coverage such as travel insurance. If you are living overseas part of the year, you may be able to invest in a private insurance plan from the country that you are living in. However, this should be an addition to your Medigap coverage if the United States is your residence. This will ensure that you are covered in case of emergency during foreign travel and have the most protection possible.
Traveling is a great way to spend retirement. There is a big world out there to see, and you shouldn’t feel limited by fear of health expenses. With these options, you should be able to travel freely with minimal risk of out of pocket costs for emergency healthcare.
Telemedicine and Medicare Coverage: Telehealth
Telemedicine is becoming more and more popular. Here is a great article by MedicareFAQ that has some really good information.
Leaving your home when traveling to and from your medical visits can sometimes seem like an intimidating task. Especially if it’s difficult for you to travel.
With Telemedicine, also known as Telehealth, seniors will have the option to stay in the comfort of their own home to receive medical attention. Thus, avoiding the stress and trouble of attending appointments, routine check-ups, hospital stays, or any other aspect of medical health care.
What is Telemedicine
Telemedicine is essentially a way for patients to meet with doctors virtually, to be diagnosed and treated in remote locations. While this is a new service, Telemedicine is projected to lower some cost aspects of health treatments. As well as improve the way health is being monitored for seniors.
At this point in time, telemedicine is a well recognized service. It’s increasingly becoming the more chosen option when looking into health care services.
Benefits of Telemedicine
Aside from staying remote, when moving from place to place can be too physically demanding, telemedicine comes with five major benefits.
- Telemedicine technology provides you with the opportunity to seek health care at your convenience from any device that has a camera and microphone. Wherever you are, health care is available to you in the palm of your hands.
- Sitting in an office, anticipating your appointment, can be inconvenient and add stress to an already stressful situation. With telemedicine, you eliminate the waiting room process before your appointment. Not sitting in a waiting room also means there is less of a possibility to receive or spread sickness.
- Often times a patient may feel disconnected with their health care provider when attending in-person physician visits. Telemedicine provides you the opportunity to build a better relationship with your physician. Without meeting in person, communication about health care will be key, therefore strengthening the relationship between a doctor and patient.
- With telemedicine, you are presented a better opportunity to connect with more physicians and better doctors. For example, you may be sick, and needing a physician in a particular field, that could be located cities, or even states away. Traveling may be difficult for you, but you will have access to communicate with those people from a remote location.
- If the doctor is happy, the patient is happy! While the benefits for patients in telemedicine seem almost endless, it also benefits the physicians! When the doctor chooses to go the telemedicine route, they will have more time for necessary medical activities. If they have the ability to take care of their patients in a more efficient way, then they have more time to assist others in need and possibly even gain more knowledge in their own field!
Health Care Providers with Medicare in Telemedicine
Medicare typically limits the health care providers you can seek telemedicine services with. With Medicare, health providers that are eligible for telemedicine are:
- Nurse Midwives
- Dieticians/Nutrition Specialists
- Psychologists/Social Workers
Telemedicine and Medicare Coverage
Anyone who is a beneficiary of Medicare Part B qualifies for most telemedicine services. Just like in-person doctor visits and consultations with Medicare, you are responsible to pay for your portion of the cost for telemedicine services.
If you are enrolled Medicare Part B, you’ll typically pay 20% of the approved Medicare amount for telemedicine services, after meeting your Part B annual deductible.
If you are enrolled in a Medicare Advantage Plan, provided by a private insurance company who is contracted with Medicare, the cost for telemedicine health care would be the same as the cost for in-person health visits.
Telemedicine services covered by Medicare include, but are not limited to:
- Physician consultations
- Health check-ups
- Mental health counseling
Please note, it is important to contact your telemedicine physician first. This is to see if they participate in Medicare to ensure your coverage applies with their offered services.
If they do not currently take part in telemedicine technology, and it is something you are interested in participating in, we suggest looking for an office in your area that can accomodate your needs.
How will Telemedicine impact Medicare Beneficiaries
Telemedicine will provide a more comfortable and convenient medical health care experience. It’ll also save the patient travel expenses for routine check-ups and other charges that come from visiting a doctor in person.
While those are very noteworthy and valuable benefits, telemedicine technology is still new. It will continue to positively impact Medicare beneficiaries in the future.
In 2015, Medicare extended their beneficiary coverage to several new telehealth services, and they continue to research and grow.
The demand for telemedicine through Medicare is continuously increasing. While the telemedicine industry is still working out a number of challenges and sometimes even legal issues, it is a rapidly growing service.
In the upcoming years, as telemedicine becomes more popular with Medicare, Medicare beneficiaries can expect telehealth practices to reduce medical costs, improve the process of medical monitoring, and create a higher-quality health care administration for seniors.
Whether your new to Medicare, or are currently enrolled, give us a call to make sure you’re taking advantage of all the benefits you deserve. Get help with the out of pocket costs left up to the beneficiary to pay.
What is a Medicare Cost Plan?
Medicare cost plans are similar to Medicare advantage plans in some ways but have additional benefits that are not a typical of most Medicare advantage plans. Like a Medicare advantage plan, a Medicare cost plan may provide benefits that Original Medicare doesn’t, and like Original Medicare, it allows you access to out-of-network health care providers if you continue to have Medicare Part A and Part B. If you choose to go out of the plan’s service area, you may still be covered by Original Medicare. Your deductibles and coinsurance amounts may apply. Unlike Medicare advantage plans, you can typically enroll in a Medicare cost plan even if you’re only enrolled in Medicare Part B. You can sign up or drop the plan anytime, instead of having to wait for the Annual Enrollment Period. Medicare cost plans are offered by private insurance companies who contract with Medicare. In Many cases they are often sponsored by employer or union groups. The plan may or may not include coverage for prescription drugs, or other benefits not available under Original Medicare. One of the main benefits of a Medicare cost plan VS a traditional Medicare advantage plan is that you do not lose your Original Medicare benefits, and have the option to go out of network for health-care services without restriction. This may be an attractive option if you plan on doing any traveling in retirement.
Twelve States Are Loosing Their Medicare Cost Plans
There are disruptions in Medicare cost plans in 12 states and the District of Columbia this year. Cost plans won’t be renewed by CMS in counties that have at least two competing Medicare advantage plans that meet certain enrollment requirements. As a result, up to 535,000 current policy holders nationally could be impacted for the upcoming 2019 AEP. This change will trigger a special election period for people enrolled in these types of plans to go back to original Medicare. Which would then allow them to purchase a Medicare supplement plan with out having to qualify medically. They could also transition to a traditional Medicare advantage plan as well, but they more than likely will have those network restrictions, which was why they went with the Medicare cost plans to begin with. Below is an estimated break down of how many people will lose their plan at the end of the year, due to this change. If you live in one of these states and have received a letter from your current carrier informing you of this change. Please give MIC a call and we can help you sort out all your options. Toll-Free: 855-830-6099
|State||Number of Enrollees|
|Arizona, Florida, Nebraska, and New York||593|
Dentures are always a big concern for seniors, because Medicare does not cover dental. Not to mention most private individual dental plans pay very little towards dentures. In turn it, leaves seniors paying for the majority of the cost of dentures. Here is a great article by MedicareFAQ to help your dentures last.
Tips for Seniors on Avoiding Denture Problems
Improper dental care can lead to extensive tooth decay and gum disease, dentures can be used to replace teeth that have been removed. While dentures may fix the missing teeth problem, they can come with some issues of their own. Dentures can also require just as much, if not more care than natural teeth.
Dentures Can Become Necessary
When you don’t go to the dentist regularly you can develop tooth decay and gum disease. Dental insurance is something most seniors don’t have. “Does Medicare cover dentures?”, is a common question many seniors ask.
The simple answer is Medicare doesn’t typically pay for dental treatment or dentures. With certain medications or medical conditions that can cause oral health problems and accelerate tooth loss, you can see why this is a problem.
Dry mouth and other oral health problems can also make teeth and gums more prone to cavities and infections. Tooth decay and gum disease are among the top 5 dental issues for baby boomers. Seniors need affordable dental coverage to ensure a healthy mouth and a happy life.
Dentures That Don’t Fit
Dental adjustments can be made when dentures are not as comfortable as possible. If they are your first-time dentures or if you have had them for a long time, your dentist can refit the denture, so sores don’t occur.
If sores do occur see your dentist as soon as possible, they shouldn’t be ignored. Dentures that don’t fit are a common problem among denture wearers, and it can be a painful problem. Properly fit dentures should rest snugly against the gums and not slide around, pain shouldn’t be an issue. Ill-fitting dentures will constantly rub the gums and create what is called an epulis (callus) that requires oral surgery for removal.
If you have had your dentures for a while, then expect natural changes in the gums and jaw over time. Gums change and the bone underneath the gum can shrink, this change is slow, and seniors may not realize it. Seeing a dentist to be sure dentures fit properly and have any dental screenings needed preformed.
Fixing Dentures That Don’t Fit
Ill-fitting dentures can be fixed by your dentist no matter what the cause. An ill-fitting denture may cause lesions on mucosa and inflammatory overgrowth could appear; repairing, relining or rebasing the denture will solve the problem.
- Repairing: Dentures can fracture during use or they may drop on a hard surface. The key of repairing is the accurate reassembling and alignment of the broken parts in their original position. Dental laboratories can usually repair cracked teeth or tooth loss in a denture.
- Relining: Relining is the correction of denture adaptation to underlying tissues by the addition of a new resin material to its fitting surface without changing its occlusal relation. Additional material is added to the tissue side of a denture to improve its adaptation to the supporting mucosa. This can either be done in the office or in a lab.
- Rebasing: Rebasing is a process of re-adaptation of a denture to the underlying tissues by replacing the denture base material with a new one without changing its occlusal relation. Dentists will do rebasing when the existing denture base is unsatisfactory.
Tips for Seniors on Avoiding Denture Problems
Dentures require as much care as natural teeth. The following tips are recommended for denture wearers:
- Give your new dentures time, getting used to them may be uncomfortable at first. New dentures will usually require more adjusting from your dentist after the first fitting.
- Scheduling your adjustment is necessary if you begin to see sores on your gums or tongue. Dentures will need to be adjusted by your dentist. The dentist will place a soft, gum-like material in the denture to provide a cushion.
- Start a nutrition shake habit. Getting the nutrition needed can be hard when you are adjusting to your new dentures. Drinking a nutrition shake meal replacement will ensure you are getting the nutrients you need daily.
- Take your dentures out. You should remove your dentures for at least 4 hours a day. When you take your dentures out be sure to store them in a denture solution or water to help it hold its shape. Soaking your dentures at night is recommended; remove the dentures, clean them and soak them in denture cleanser overnight to preserve the quality of your dentures. Be sure to store dentures properly, away from children and pets. Dentures can break easily and will break if dropped even a few inches.
- Monitor your weight. Losing and gaining weight can impact how well your dentures fit. If you have a significant change in weight you should schedule an appointment with your dentist to check the fit and make any adjustments.
- A small amount of denture cream should be all you need. Denture creams used properly can work very well at sealing the denture. You should not rely on denture cream to force your dentures to fit. If your dentures are ill-fitting you need to see your dentist for an adjustment.
- Go to the dentist. Regular dental visits will allow your dentist to check your dentures and clean any remaining teeth that may hold your dentures in place. Even if you have no natural teeth you should still have your mouth examined annually for signs of gum disease and oral cancer.
- Good oral habits are needed daily. Brushing regularly can remove bacteria and food particles that lead to gum irritation and infection. You should brush your dentures every day and night just like natural teeth. Dentures can still build up plaque and tartar like natural teeth. Use a toothpaste and toothbrush designed for use with dentures. Regular toothbrushes are abrasive enough to scratch the dentures.
We know Medicare will not cover dentures; the next commonly asked question, “Does Medicare have any dental coverage?” The simple answer is that Medicare will not cover routine dental care. It is imperative that seniors obtain dental coverage.
Improper dental care will lead to extensive tooth decay and gum disease, dentures will be needed to replace lost teeth. Dental coverage can be affordable and is always necessary. Dental insurance providers can offer expansive coverage and may include all the routine dental services that you will need.
With dental coverage you will not need to worry about changing benefits and you typically don’t need to renew the plan each year. Dental plans will allow you to add family members who reside with you. Some plans will allow you to use any dentist, others will not. It is important that you choose a plan that fits your dental needs, you will use the coverage.
Elder Abuse is a serious issue in our society. It should not be tolerated at all! June 15th is Elder Abuse Awareness Day. Below is an article by the Administration For Community Living that has some pretty sobering numbers and links to some helpful resources.
Each year, an estimated 5 million older adults are abused, neglected, or exploited. Older Americans lose an estimated $2.6 billion or more annually due to elder financial abuse and exploitation, funds that could be used to pay for basic needs such as housing, food, and medical care. Unfortunately, it occurs in every demographic and can happen to anyone—a family member, a neighbor, even you. It is estimated that only one in five of these crimes are discovered.
World Elder Abuse Awareness Day (WEAAD) was launched on June 15, 2006 by the International Network for the Prevention of Elder Abuse and the World Health Organization at the United Nations (UN). WEAAD aims to provide an opportunity for communities around the world to promote a better understanding of abuse and neglect of older persons by raising awareness of the cultural, social, economic, and demographic processes affecting elder abuse and neglect. In addition, WEAAD is held in support of the UN International Plan of Action acknowledging the significance of elder abuse as a public health and human rights issue. This observance serves as a call-to-action for individuals, organizations, and communities to raise awareness about elder abuse, neglect, and exploitation.
Access the latest World Elder Abuse Awareness Day campaign materials available from the USC Center on Elder Mistreatment.
Please contact the National Center on Elder Abuse at 1-855-500-3537 or firstname.lastname@example.org with any questions.