Posts tagged 'seniors'
There is a lot of controversy these days about what should go and what should stay in the huge U.S. budget which affects each state's and county's budget. Somewhere in that mirage of confusion, site Medicaid.
Though many of the proposed Medicare cuts and the ones already in progress are frightening and difficult, at best, to deal with, the thought of more Medicaid cuts puts more pressure on the people that need the program most.
Seniors and individuals with very low income often depend on Medicaid to get basic medical care. Nothing fancy or frilly. A few doctor's visits, maybe some tests and some medication. Medicaid is what is supposed to help these individuals who can't afford Medicare Supplements and who need to have regular medical care - even minimal care - to stay reasonably healthy.
When hearing what people on Medicaid have to say, they say it is a lifesaver - literally - in many cases. They say that without it they would be in a hospital somewhere very sick or dying at the state's expense. The unfortunate situation is that as budgets get leaner, criteria for people to qualify for programs gets tighter and more people who need this help are left out.
The problem is that rather than helping keep the benefits for people, once someone has lost them, the state and county end up paying untold thousands of dollars for emergency room visits that take the place of doctor visits. Keeping people on Medicaid and allowing new ones to get on it save the state and county money, short term and long term.
There is a lady who is 59 years old and lives with her children. Her only income is assistance since she is too young for Medicare and she has a disability that will probably continue the rest of her life. She has applied for Medicaid which she said was an escapade of jumping through hoops, and after she turned in every single paper (about 1/2 inch worth) she was denied. The woman can hardly walk. Her blood pressure is out of control, she has been in and out of the emergency room because her blood pressure has been so high they are worried about her having a stroke, and instead of accepting her to Medicaid to get the care she needs, she was turned away. So at age 59 she goes to sleep, fearful that she won't wake up, and there's nothing she can do unless things get so bad she goes back to the emergency room.
There are seniors that are worse off, who choose between groceries and medicine and use less of both, keeping them hungry, undernourished and undermedicated, while their condition gets worse.
In these times, it is understandable for cutbacks to happen. It is simply a matter that some of them don't make sense. In the richest country in the world we are letting seniors and others starve and suffer just to save a few dollars - and then it cost thousands more to care for the individuals anyway.
It is important for everyone to have a chance to feel as good as possible and get good care. Hopefully as budget cuts continue, the president and lawmakers will remember that there are people living on much less than $250,000 or even $25,000 per year through no fault of their own. It is important to think about their dignity and well being when putting programs on the chopping block.
Reports have surfaced showing that many states have underestimated and under-funded the cost of long term care. Medicare has done so as well. This has left many seniors understandably worried.
The estimates for the costs of long term care seem to be nearly $4.5 billion dollars below actual costs of providing quality care. The main states affected are California, Florida, Wisconsin, Massachusetts, New York, Illinois, Ohio, Pennsylvania, New Jersey and Texas.
Because of the fact that the gap between what quality care costs and what Medicaid actually pays is substantial, states are looking for a solution to eliminate at least part of the shortfall. Extreme budget pressures have states in a quandary as to what to do. They are looking for extra dollars, because if they cannot make up at least part of the difference between cost of care and payment for care, some seniors may not be able to get long term care services.
The American Healthcare Association (AHCA) President and CEO, Bruce Yarwood, feels that “a post-election stimulus package must include state Medicaid relief to help prevent problems with accessing this essential care in 2009.” The long term care industry hopes this will happen. One bright sign is that the head of the Federal Reserve recently indicated that in order to bolster the country’s economy, federal dollars need to be injected into state budgets to help provide essential services.
According to the National Governors’ Association, combined state shortfalls total $50 billion for the fiscal year from July 2008 to July 2009. Without federal help this will be an insurmountable amount. In addition, Medicaid is being “propped up” by Medicare, according to Yarwood, who feels that this leaves Medicaid in a very vulnerable and precarious position.
For now, all that seniors can do is to protect themselves the best they can with the coverage they can get and wait to see what lawmakers will do when working out the federal budget. Hopefully they will see the value in helping states stabilize programs such as Medicaid to ensure long term care for the nation’s senior population.
It’s not something your accountant would advise you to do if you are a physician or health care practitioner or professional. In fact, your account, financial advisor, closest friends and others would most likely strongly –very strongly – advise against making such a move.
But all business decisions are not simply made for profit only. Some are made because there is a serious need to be filled and there are people that are willing to go the extra mile to fill it.
The news is filled with stories every day regarding senior citizens who need health care and can’t afford it. Many of them receive Medicare benefits, but can’t find a doctor willing to be paid at Medicare’s lower than normal rates and even slower than normal payment pace.
A group of doctors in Amarillo, Texas decided to go the extra mile and help seniors in the area by opening a clinic that provides health care only to seniors with Medicare benefits, Medicare Supplements or enrolled in Physician’s Health Choice, which is a physician owned health plan which provides seniors with more coverage than Medicare.
The clinic, which recently opened, is designed to provide medical care to seniors, but that is not its only purpose. Doctors feel that if seniors had access to more information and accurate information regarding prevention and maintenance of health issues, they could maintain better health, therefore having to visit the doctor’s office for treatment less often.
The Amarillo Senior Care Clinic was established to address the fact that seniors face obstacles in receiving care because fewer doctors are willing to take Medicare for payment, and many will no longer accept new Medicare patients. As a result, seniors have less access to quality care, often exacerbating conditions that, if cared for regularly and properly could be controlled by medication and other interventions with less office visits, keeping more seniors out of emergency rooms, hospitals, long term care and nursing homes, because their conditions would be managed and not get to the point where they were out of control.
Many physicians say that this is a losing proposition financially; however the Amarillo Senior Care Clinic, though cautious, is not worrying. They feel that by stressing prevention and providing education, their patients will feel better and their health will stay more stable.
This is an innovative and exciting idea, and it would be great for physicians throughout the country to keep an eye on the Amarillo Senior Care Clinic and see how well it works. There are seniors in every county in every state who need this type of help to live longer, healthier lives.
Medicare is a system that is supposed to help seniors deal with medical issues by providing coverage for healthcare costs. As an individual works month after month and year after year, they pay into the Medicare system and the payments are taken out of each of their paychecks. The idea is that when they are at the point of retirement, the coverage that they have been paying for all those years that they worked will be there to take care of their health needs.
In theory, this works well, and until recently, Medicare has taken care of millions of seniors. Currently, there are about 44 million people enrolled in Medicare. Most of them have the coverage they need, however, during the past decade or so, Medicare has run into various financial issues, creating a situation in which seniors must pay for some of their coverage.
In addition, though the Medicare system has been overhauled to work better with regard to claims and paperwork, it become more sluggish regarding approvals and claim processing, and it has made it difficult for seniors to get good care and for physicians to give good care. The main reason for this is that many physicians have to wait extremely long periods of time to get paid by Medicare for the patients that they treat.
In fact, some physicians have had to stop treating patients covered only by Medicare or they have at least had to stop taking any new patients covered by Medicare. It is simply too long to wait for payment, and many physicians are experiencing financial trouble as a result.
One such provider is an ophthalmologist in Santa Cruz, California. Dr. Joshua Babad treats many patients covered by Medicare. He cares for his patients and knows they need his help. After all, Santa Cruz is not a large town, and even in large towns, there are not a lot of providers – especially eye doctors – who accept Medicare.
Dr. Babad has tried to do his best for his patients, and in doing so, has ended up over $50,000 in debt. He has had to use retirement money to pay expenses while waiting for Medicare to pay him for legitimate services rendered. In addition, his wife has a brain tumor, so he is struggling with serious family medical and financial issues on top of his long wait for payment. He wonders if Medicare is trying to discourage doctors from treating the elderly or disabled who depend on Medicare for their medical needs.
Dr. Babad has practiced in the same location for over 30 years. He has contacted Medicare, as well as his state representatives to try to deal with the situation. He has stated that if he had to depend on only Medicare, he would have gone bankrupt a long time ago. There are other providers in the general area who are experiencing similar issues with Medicare. Medicare’s response to recent contact is that they have communicated with Dr. Babad and his situation will be corrected soon.
In the meantime, many seniors and their providers continue to struggle with delays and hope that they can continue working together toward good health care while Medicare gets its act together.
For years we have heard about the plight of seniors on very meager incomes who have to rely on Medicare and Social Security to survive and who have had to buy second-rate food – or even dog/cat food – so they can eat.
Medicare has been designed to help seniors with their medical expenses, especially prescriptions. The prescription drug coverage, a supplement to Medicare, is essential to seniors, as much of their ongoing healthcare is dependent on their medication.
This part of the Medicare coverage available should actually be the easiest to deal with. No doctor, no hospitals, no tests, just medicine. However, with the changes to Medicare, especially with Medicare Advantage on the scene, things have gotten somewhat dicey in the area of seniors and prescriptions.
On the surface, Medicare Advantage is a good idea, but once you look into it, there re dangers lurking just a little below the surface. These dangers can leave seniors extremely vulnerable, because once seniors have reached a particular amount of coverage/paid claims for prescriptions, the bottom drops out.
What happens is that if a senior has a Medicare Advantage plan that pays up to $2500 in prescriptions, once they hit that amount, they must pay for further prescriptions out of their pocket – often to the tune of thousands of dollars. Once they reach the next plateau, coverage kicks in again.
The problem with this situation is that if a senior on Medicare Advantage has spent the initial allotment of coverage for prescriptions in the month of August, they will be paying for medication out of pocket possibly for the rest of the year. Many times, the cost of medication is more than their entire Social Security check or entire income that month.
Because of this, too many seniors are simply going without medicine. Imagine being on insulin or heart medication. How long could a senior with diabetes or a history of heart disease go without their medication before there are serious complications, or even fatal ones?
Lawmakers are trying to fix Medicare. This is one area where they have to pay close attention. In the meantime, physicians can try to work with their patients on Medicare to prescribe generics – especially those that are $4 on many pharmacy plans – so that seniors don’t have to risk their health and their lives by going without.
The idea of health fairs is not new. There are heath fairs in cities across the U.S. that provide everything from information about gentle dentistry to on the spot blood pressure and bone density tests, and everything in between.
The middle Alabama Area Agency on Aging (M4A) is sponsoring a health fair for seniors this Friday. This will be the first ever, and it will be entitled “A Walk in the Park” because it will be held in the local park. The event will honor Older Adults Month.
Part of the purpose of the event is to raise awareness about the M4A organization, its purpose, its services and how/who it can help. The event will have several types of screening available for seniors including blood pressure checks, blood sugar testing, and cholesterol checks.
Various health care organizations will be available to answer questions, including home health care organizations. There will also be information available about M4A including information they provide and assist seniors with, such as their nutrition program called Homebound Meals (similar to Meals on Wheels), assistance with prescriptions called Senior RX; and assistance with the Senior State Health Insurance Assistance Program (SHIP). SHIP helps with Medicaid, Medicare, Medicare Supplements and SSI, health insurance and long term care.
M4A has an ombudsman who checks into complaints and works to help solve problems. They have a great many friends and contacts in the community, so if there is a problem they can’t solve or a question they can’t answer, chances are they can connect you with someone who can answer those questions and walk you through, working with you to fix the problem if at all possible.
There have been more and more programs such as M4A in communities throughout the country. To find out if there will be any presentations or a senior health fair in your community, contact your local senior centers, chamber of commerce and your doctor or local hospital. The information at these health fairs is usually free and you can surely benefit from the information you will receive.
Medicaid has taken a giant and important leap recently. Because of this move forward, it is now possible that thousands of people will be able to get home-based care rather than being institutionalized. This new provision allows people to get care in their homes or in the community instead of an institutional setting.
The Deficit Reduction Act (DRA) allows states to provide people who qualify for Medicaid benefits to receive this care without having to apply for a demonstration waver to prove their eligibility. Having the option as to how an individual will receive long-term support is an historic step in leveling the playing field.
Individuals will now be able to receive person-centered care and have a part in the development and decision making about that care. Some of the services that states will be able to provide under this new provision will be case management, homemaker, home health aide, personal care, adult day health and respite care. In addition, individuals with chronic mental illness can receive day treatment, partial hospitalization, psychosocial rehabilitation and clinic services.
This new provision is an essential step in helping individuals with disabilities have the choice to be part of and participate in the community, stay in their own comfortable surroundings, make choices regarding services and have the support of a program that will offer them these options and more.
Many people have questions about Medicare and Medicaid including the question of what the differences are between the programs. There are some major differences between the two.
Medicare is funded by the federal government as an entitlement program, which mainly focuses on the older population. It is a social insurance program for individuals age 65 and over and it covers many individuals with disabilities. Medicare also covers individuals of all ages with end stage renal disease.
There are several parts to Medicare. Part A covers hospital bills, Part B covers medical insurance and Part D covers prescriptions.
Medicaid is different from Medicare in several ways. It is also an entitlement program, however, Medicaid is not funded only by federal government, there is a state component as well, and in some states, counties pay part of the cost.
Medicaid is based on need and social welfare, with eligibility based on income. If a person has limited income and/or financial resources, Medicaid covers a broader spectrum of services than Medicare does. It usually covers children, pregnant women, parents of eligible children, seniors and individuals with disabilities. Though poverty is used to determine eligibility, a person must fall into one of the coverage groups in addition to being determined eligible due to being in poverty. Medicaid benefits are paid directly to the provider of services. In addition to covering individuals who meet financial requirements, in some states Medicaid covers individuals who cannot otherwise afford insurance.
Some individuals qualify for coverage by both programs.
