With the cost of insulin nearly tripling over the past decade, many Americans with diabetes face difficult decisions when it comes to their health – whether to limit or stop taking their insulin because of the staggering cost. Seniors on fixed incomes may be even more vulnerable to the dire consequences of not being able to afford their medications.
In an effort to address the growing problem, the Centers for Medicare and Medicaid have implemented the Senior Savings Model for Part D Drug plans starting in January 2021. This new model limits copays in the deductible, initial and coverage gap phases for certain brands of insulin to a maximum of $35 per 30-day supply. The cost could even be less, depending on the medication. These rules apply to both stand-alone Part D drug plans and those imbedded in Advantage plans. Plans do not have to participate in the new model, and there are a limited number of plans that have opted into the new program.
In California, the stand-alone Part D plans that have agreed to participate are as follows: AARP Medicare Rx Preferred, Cigna Secure-Extra Rx, Express Scripts Medicare Choice, Express Scripts Medicare Saver, Humana Premier Rx, Mutual of Omaha Rx Premier, WellCare Medicare Rx Value Plus, WellCare Value Script, WellCare Wellness Rx. Advantage plans participating in the Senior Savings Model vary by county.
With domestic violence on the rise during the pandemic, Covered California has added a new Qualifying Life Event (QLE) for victims to get health coverage outside of open enrollment. Victims of domestic abuse or spousal abandonment may qualify for a special enrollment period at which time they may apply for coverage or remove themselves and/or dependents from existing coverage to enroll in a new health plan.
While a QLE is not needed to terminate coverage, if the consumer is the primary on the insurance or the spouse of the primary, he or she may remove the abuser and/or dependents from the plan. If not a spouse or registered domestic partner, the abused can remove only themselves from the plan but not dependents. Once removed from the plan, they may then apply for coverage under the single or head of household tax filing status. A CPA should be consulted about the tax ramifications reported on their returns once new coverage is selected.
Open Enrollment begins on November 1, 2020 and goes through January 31, 2021. (Not to be confused with Medicare’s Annual Enrollment Period which goes from October 15 to December 7.) During Open Enrollment, you may sign up for new coverage, change or renew current coverage or sign up for Medi-Cal (although you can apply for Medi-Cal at any time during the year).
If you have Medicare, you are considered among the high-risk groups for having complications should you get the COVID-19 virus, so knowing how you are going to be covered should you get sick is important. Utilizing the services you are entitled to can help keep you and your loved ones healthy and safe during these difficult times.
Medicare covers COVID-19 lab tests with no out-of-pocket costs, so if you feel ill, get tested. If you think that you have already had the virus, Medicare also covers the FDA-authorized antibody test. Once there is a COVID-19 vaccine, that will be covered as well.
Medically necessary hospitalizations are covered, but you will pay any deductibles, copays or coinsurance applicable to your stay. If you have a Medicare Supplemental or Advantage plan, the plan may pay all or some of these associated costs. Advantage plans may also pay for costs like meal delivery or medical transportation.
Under the 1135 Waiver implemented in March by the Coronavirus Preparedness and Response Supplemental Appropriations Act, the Centers for Medicare and Medicaid have expanded the availability and use of telehealth services to allow evaluation and management visits with your doctor, mental health counseling and preventative screenings. These “virtual check-ins” are brief communications with your health practitioner for an issue that wasn’t related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours or next available appointment. Verbal consent by you and documentation by your doctor is needed to initiate these services. Online patient portals can also be used with prior consent as well.
If you do go to the doctor, be ready for some changes many practices have implemented to minimize exposure to the virus. You might have to wait in your car prior to the start of your appointment, have your temperature taken, wear a face mask, and social distance.
With the House’s Democratic proposed Heroes Act stimulus package deemed “dead on arrival” by the Trump Administration, Americans are anticipating a new bill crafted by the Senate to address the economic hardships incurred by the COVID-19 pandemic.
The Heroes Act, passed by the House in mid-May, included a direct payment of $1,200 per adult and each child (up to 3 children) for those earning $75,000 or less (single adult) or $150,000 or less (for couples). It also extended the extra $600 weekly unemployment benefit through January 2021, established hazard pay to essential workers and provided nearly $100 billion in rental assistance.
Senate Majority Leader Mitch McConnell indicated that fewer people would likely receive a direct payment in the new stimulus package, suggesting an income limit of $40,000 instead of the $75,000 income limit provided in the Cares and Heroes Acts. Republicans are also reluctant to extend the federal unemployment benefit of $600 beyond July 31. Senator McConnell also wants a liability shield included in the new bill to protect businesses from being sued due to the coronavirus pandemic.
The Senate will return from its July 4th recess on July 20th, and if all goes well and the bill receives bipartisan support, a new stimulus package could be signed into law before the House begins their summer recess on August 3rd. Checks could go out in early September. If a bill isn’t passed, it will have to wait until the next session when both the House and Senate return from their respective recesses on September 8th. With several points of contention between the two parties, it could be late 2020 or early 2021 before Americans see any tangible relief.
Many states ordered hospitals to cancel elective procedures during the pandemic, but now that restrictions are being lifted, doctors are seeing people still afraid to seek treatment, even when they are facing life-threatening conditions like a heart attack or appendicitis.
The anxiety caused by fear of getting the virus, accompanied by the uncertainty of when there will be a vaccine or treatment widely available, can have a paralyzing effect on people, causing them to put off decisions that might seriously damage their health in the long-run. Couple that with the fact that they could be sequestered in a hospital room, unable to see friends and family if they were diagnosed with coronavirus, makes them even more apprehensive of going anywhere near a medical facility.
“People are saying, ‘So I’m having a heart attack. I’m going to stay home. I’m not going to die in that hospital,” said Dr. Marlene Millen, a University of California physician.
But safety measures have been put in place to deal with these issues, like testing of hospital workers, daily temperature checks of both staff and patients, wearing of masks and meticulous cleaning procedures.
So when should you go to the emergency room? Some of the symptoms you should seek immediate treatment for include trouble breathing, coughing up blood, dizziness, fainting, a sudden severe headache, slurred speech and drooping of one side of the body which could indicate a stroke. For a full list of symptoms that warrant a visit to the ER, go to Medline at: https://medlineplus.gov/ency/patientinstructions/000593.htm.