If you are like many Americans and counting on Medicare to cover your medical expenses after you retire, then you need to take a more in-depth look at this program. This simplified overview will give you some of the benefits and some things that are not covered. Then, you can draw your conclusions about other types of coverage that you might want to consider.
Medicare covers a good number of things. The services it covers will prove useful as you grow older. It covers inpatient hospital care, stays in a skilled nursing facility, hospice services, lab tests, surgery, and some home health care. It also includes doctors' and other providers' fees within a set limit. Some durable medical supplies are covered along with some preventive services and screenings.
What It Doesn’t Cover
There are unfortunately many things that Medicare does not cover. You can only receive services in your home if your doctor deems them medically necessary. Even that is limited. Generally, Medicare does not cover 24 hour care in home. Most dental procedures, including dentures, are not paid for by Medicare. Additionally, prescription glasses and hearing aids are not covered in most circumstances. Many types of alternative health care, like acupuncture, are not included. Medicare will also not pay to have meals delivered to your home. Routine foot care is also not paid for by Medicare.
Medicare vs. Medicare Advantage Plans
You also need to be aware that there is a vast difference between Medicare and Medicare Advantage Plans. Under Medicare, you can go to almost any doctor that you choose. Under Medicare Advantage, you will be assigned a network of doctors. You may be limited to using doctors in the network or have to pay extra when you use an out-of-network doctor. You may have additional coverage under Medicare Advantage for vision and dental needs. If you want to see a therapist in your home, such as a physical, speech, or occupational therapist, then you are allowed many more visits under Medicare than Medicare Advantage plans.
This simple overview allows you to understand the basics of what Medicare will and will not pay for when you become eligible. It is your choice to obtain additional coverage if you find it wise. You may also want to decide if Medicare or a Medicare Advantage plan is the right choice for you. Taking a look at what is available before you retire helps you prepare for the future wisely.
You might also like this article: Common Retirement Expenses Every Senior Should Plan For
Age-related Macular Degeneration (AMD) is a leading cause of vision loss for people age 50 and older, and an estimated 16 million Americans are living with AMD. While an AMD diagnosis can be a scary thought, there are things people can do to help reduce the risk of progression of the disease. Here’s what you need to know.
(BPT) - The ability to see the people, places and things in front of you is one of life’s most precious gifts. Imagine a life without the ability to see these things clearly — what steps would you then take to protect your vision? Life with Age-related Macular Degeneration, or AMD, can potentially lead to vision loss or blindness. While an AMD diagnosis can be a scary thought, there are things people can do to help reduce the risk of progression of the disease. Here’s what you need to know.
What is AMD?
AMD is a leading cause of vision loss for people age 50 and older, and an estimated 16 million Americans are living with AMD. AMD affects the macula, the part of the eye that supports sharp, central vision needed for seeing objects clearly. The condition is progressive, which means that central vision can ultimately become impaired, which may cause difficulty keeping up with daily activities like driving, reading or recognizing the faces of loved ones. While there is no cure for AMD, there are steps patients can take to help reduce the risk of progression.
Tips for taking action
In addition, people diagnosed with AMD should talk to their doctor about taking a vitamin based on the AREDS2 study. PreserVision® AREDS 2 formula vitamins contain the exact nutrient formula recommended by the National Eye Institute to help reduce the risk of moderate to advanced AMD progression.
Get the facts and find support
Patients are often learning about AMD for the first time as they’re being diagnosed, which can be overwhelming. While the Internet is a great resource for patients, medical literature about AMD is often dense and difficult to follow. That’s why Bausch + Lomb developed SightMatters.com, an online resource to provide AMD patients with personalized tips and tools, along with a support system and network, to help each patient better navigate their life living with AMD no matter where they are on that journey.
SightMatters.com aims to help patients understand what AMD is, and how they can manage it. It also allows patients the opportunity to create a personalized action plan, which they can use to discuss with their doctor so they can start taking charge of their condition and continue to see what they love each day. Visit SightMatters.com to begin taking action today.
PreserVision is a trademark of Bausch & Lomb Incorporated or its affiliates.
AREDS2 is a registered trademark of the U.S. Department of Health and Human Services (HHS).
© 2020 Bausch & Lomb Incorporated or its affiliates.
A diagnosis like inflammatory bowel disease (IBD) means lifestyle changes throughout every aspect of life, including financially through direct costs of care as well as indirect costs like missed school or work. There are a number of resources like these that can help IBD patients manage the financial impact of the disease, many of which depend on the patient’s stage of life.
Managing the Cost of IBD
(Family Features) A diagnosis like inflammatory bowel disease (IBD) means lifestyle changes throughout every aspect of life, including financially. IBD has many direct costs of care, like clinic visits, radiology studies, procedures and costly medications. There are also indirect costs such as missed work or school.
There are a number of resources that can help IBD patients manage the financial impact of the disease, many of which depend on the patient’s stage of life. For example, young adults transitioning into the workforce and off their parents’ insurance may find their needs quite different from older adults who are approaching Medicare eligibility.
Evaluate your IBD needs and select an affordable insurance plan. When you turn 26, you age out of your parents’ health insurance plan. Your options may include enrolling in a plan sponsored by your employer or your spouse’s employer; purchasing a plan in the health insurance marketplace (you can enroll 60 days before you turn 26 and the timeframe ends 60 days after your birthday); purchasing insurance on the individual market; purchasing COBRA (a temporary health insurance plan that is extended under your parents’ plan for up to 18 months); or going on Medicaid, if you’re eligible.
To decide what’s right for your situation, start by listing your current health care providers and health services. Review the insurance plan you are considering and check whether your current providers, medications and hospital are covered in the plan, and whether they are considered in-network (more cost-efficient) or out-of-network (higher out-of-pocket costs).
You’ll want to weigh potential expenses, including the monthly premiums, deductibles, out-of-pocket maximums, copays and coinsurance, if applicable. Also be aware of the distinctions between medical and pharmacy coverage. This will give you a realistic picture of what you can expect to spend on a monthly and annual basis.
For assistance with your options, consider speaking with an insurance specialist or help center, such as the Crohn’s & Colitis Foundation’s IBD Help Center, which can help you review available plans and find one best suited for your needs.
Participate in a savings program. If you have the option of participating in a Health Savings or Flexible Spending Account, these personal savings programs can help pay your out-of-pocket costs. You contribute a certain amount of untaxed money to the account each year, which can be used toward expenses like prescriptions, deductibles, copayments and coinsurance.
Each program has distinct guidelines on factors, like payment and carrying over unused funds, so it’s important to do thorough research before selecting a plan.
Enroll in manufacturer assistance programs. Depending on your specific circumstances, you may be eligible for assistance from your prescription manufacturers or lab testing companies. In addition to drug copay discount programs and pharmaceutical financial assistance programs, you might be able to access help to offset the cost of certain procedures.
Your health care provider or pharmacist may have information on available programs, or you can visit manufacturer websites and other resources like crohnscolitisfoundation.org/managingcosts.
Investigate grants, foundations, and other assistance programs. Other types of financial assistance are also available. Pharmaceutical companies, the Patient Advocate Foundation, and several other foundations offer college scholarships to IBD patients.
Purchase coordinated or supplemental Medicare insurance. As you approach the age of 65, you enter an enrollment period (3 months prior and 3 months after your birthday) when you are eligible to apply for Medicare, a federal health insurance program. In addition to original Medicare, you have the option of purchasing additional insurance for added health care coverage and benefits, such as a Medicare Advantage Plan (Medicare Part C) or Medigap plan.
Enroll in federal and state savings programs. If you have or are eligible for Medicare Part A, and if you have limited income and resources, your state Medicaid program can help determine whether you qualify for one of the Medicare Savings Programs.
State Health Insurance Assistance Programs (sometimes referred to as SHIP programs) have different names in different states but all provide free one-on-one telephone counseling and advice services, personal face-to-face counseling sessions, public education programs and media presentations for assistance with Medicare programs (including Part D) and Medicaid.
If you have limited income and resources, you may qualify for help paying for prescription drugs. The Medicare Extra Help Program is for Medicare Part D recipients and recipients of both Medicare and Medicaid who have limited income and resources to help pay for prescription drugs.
Apply for financial aid through pharmaceutical companies. Another option, if you are eligible, is to enroll in financial assistance through the drug manufacturers. Funds are available from several manufacturers and non-profits to help patients cover copays and pay their out-of-pocket costs.
Pharmaceutical patient assistance programs are separate foundations set up by the drug manufacturers to provide financial assistance to people who cannot afford their medications. You need to demonstrate financial need when you apply for these programs.
While on private insurance, you may be able to use drug copay cards. The drug company will pay for a portion of the drug and the out-of-pocket cost to the patient is considerably lower. However, drug copay discount cards are generally no longer available to patients when they transition off private insurance onto Medicare.
Investigate grants, foundations and other assistance programs. Additional assistance may be available through other foundations. Find these and other resources to assist in planning your IBD medical expenses at crohnscolitisfoundation.org/managingcosts.
Lower Your Medical Costs
1. Compare prices and select in-network providers. Always ask if your labs and support team members (all providers, not just your gastroenterologist) are in network.
2. Not all pharmacies charge the same, so shop around. Online pharmacies can often be less expensive (for example, a 90-day supply can often be the same cost as a 30-day supply).
3. Check your bill. According to the Medical Billing Advocates of America, billing advocates and other health professionals estimate up to 80% of medical bills contain errors.
4. If insurance refuses to pay, talk to your healthcare provider about appealing the insurance company’s denial.
Photos courtesy of Getty ImagesSOURCE:
Crohn’s & Colitis Foundation
Every day nearly 200 people die from an overdose of drugs or from alcohol poisoning, with opioids responsible for the majority. Recognizing the signs and knowing how to respond to medical emergencies, including carrying and administering naloxone in cases of opioid overdose, can literally save lives. Here are tips from the American Society of Anesthesiologists (ASA) on what to do in case of a suspected overdose.
(BPT) - Every day nearly 200 people die from an overdose of drugs or from alcohol poisoning, with opioids responsible for the majority. Recognizing the signs and knowing how to respond to medical emergencies, including carrying and administering naloxone in cases of opioid overdose, can save lives, says the American Society of Anesthesiologists (ASA).
“The tragic increase in overdose deaths is an alarming and devastating issue that touches so many of us,” said ASA President Mary Dale Peterson, M.D., MSHCA, FACHE, FASA. “If you can identify an overdose or alcohol poisoning, you are more likely to react quickly, making the difference between life and death for a family member, friend or stranger.”
Physician anesthesiologists have a critical role in fighting against overdoses, starting with managing patients’ pain after surgery or chronic pain in responsible ways. During Physician Anesthesiologists Week, Jan. 26-Feb. 1, ASA is joining forces with U.S. Surgeon General VADM, Jerome Adams, M.D., M.P.H., to empower everyone to recognize the following signs of an overdose or alcohol poisoning:
Any one of these signs should prompt a call to 911 for emergency medical care. Never leave an unconscious person alone, as they may be at risk of dying, including by choking on his or her own vomit. If an opioid overdose is suspected, naloxone should be administered immediately, if available. Naloxone is administered by injection or nasal spray and access to it is expanding on a state-by-state basis. It can be prescribed by a physician and often is carried by police officers and emergency medical responders. Additionally, it’s increasingly available over the counter at some pharmacies.
“To stem the tide of the opioid overdose epidemic, we need everyone to consider themselves a first responder. We need to encourage everyone in our communities to carry naloxone and know how to use it,” said U.S. Surgeon General, VADM, Jerome M. Adams, M.D., M.P.H., a physician anesthesiologist who issued a Surgeon’s General’s advisory in 2018 calling for increased awareness and use of the medication. “When on hand, naloxone may mean the difference between life and death, and can be a first step to getting someone onto the pathway of recovery.”
Anyone who takes opioids to manage their pain may be at-risk for an overdose. In recent years, opioids were the go-to pain reliever for everything from backaches and injuries to post-surgical and chronic pain. In 2017, more than 190 million prescriptions were written for opioids. While they can be effective for short-term pain, chronic use can lead to abuse. Every day 130 people die from opioid overdoses, according to the Centers for Disease Control and Prevention.
“ASA strongly agrees with the Surgeon General and supports policies that promote access to naloxone and safe and effective pain management care,” said Dr. Peterson. “All of our members have a significant interest in reducing misuse, abuse and diversion of opioids that have led to unintended deaths.”
To learn more about the critical role physician anesthesiologists play before, during and after surgery, visit asahq.org/WhenSecondsCount. ASA also offers an opioid overdose resuscitation guide that provides guidance on symptoms of an overdose and how to help.
If you’re among the millions of people in the United States who suffer from a chronic illness, you may use “sharps” to manage your medical condition at home or on the go. Consider this information about sharps and steps for safe and proper disposal.
Understanding Medical Sharps and Safe Disposal Options
(Family Features) If you’re among the millions of people in the United States who suffer from a chronic illness, you may use “sharps” to manage your medical condition at home or on the go. For example, many people with diabetes self-inject at least two insulin shots every day, and conditions including allergies, arthritis, cancer, infertility, migraines and psoriasis, among others, may also require the use of a sharp to administer medication.
A medical term for devices with sharp points or edges that can puncture or cut skin, sharps may be used at home, at work and while traveling to manage medical conditions. Examples of sharps include:
However, disposing of those medical sharps safely may be a concern. In fact, in interviews conducted by SafeNeedleDisposal.org with sharps users, people who use needles and lancets to manage their medical conditions believe it is their responsibility to dispose of sharps safely, but lack clear, factual information on how to do so. Existing information does not always personalize disposal guidelines for people in every state or locality.
“SafeNeedleDisposal.org helps people in the United States make sense of safe sharps disposal options nearest to their home, work or wherever is convenient,” said Larry Ellingson, vice president of the National Diabetes Volunteer Leadership Council. “This resource is much needed for people who regularly use needles to manage health conditions like diabetes and want to do the right thing with their used sharps.”
According to the U.S. Food and Drug Administration, sharps not disposed of properly may cause injury. Consider these three steps for safe and proper sharps disposal:
For more information on safe disposal of sharps, visit SafeNeedleDisposal.org.
Photos courtesy of Getty ImagesSOURCE:
Although rare cancers don’t occur often, they can affect people of all ages and genders. Greater awareness of rare cancers may lead to earlier diagnosis and management, and potentially better survival rates. Consider these facts about soft tissue sarcomas, one type of rare cancer.
Understanding Rare Cancers
Four facts to know about one type of rare cancer, soft tissue sarcomas
(Family Features) Although rare cancers don’t occur often, they can affect people of all ages and genders.
A rare cancer is defined as fewer than 15 new diagnoses per 100,000 people per year, according to the National Cancer Institute (NCI). Additionally, as noted by the American Cancer Society (ACS), the 5-year survival rate is lower for people diagnosed with a rare cancer than for people living with more common cancers. Greater awareness of rare cancers may lead to earlier diagnosis and management, and potentially better survival rates.
If you have recently been diagnosed with STS, it’s important to ask your doctor for more information about the specific sub-type you have. For example, if you received a diagnosis of undifferentiated sarcoma, ask your doctor for an integrase interactor-1 (INI1) test to see if you have a rare STS called epithelioid sarcoma (ES). (See sidebar for more on ES.)
Learning More About Epithelioid Sarcoma
A rare type of STS, epithelioid sarcoma (ES) accounts for less than 1% of all STS, which themselves account for approximately 1% of all cancers, according to research published in “Archives of Pathology & Laboratory Medicine.” ES can present as a lump or sore on the skin.
Notably, more than 90% of ES tumors do not express the INI1 protein, which when present acts to suppress tumor growth. INI1 loss plays an important role in the diagnosis of ES, according to researchers with “The American Journal of Surgical Pathology.”
Data from the NCI indicates that approximately 150-200 people in the United States are diagnosed with ES each year. Research published in “The Journal of Clinical and Aesthetic Dermatology” found the disease often occurs in young adults in their 20s and 30s. Because most ES patients are adolescents and young adults, there is a gap in the unique psycho-social needs for this patient population, including resources for patients who miss school while undergoing treatments, as well as fertility considerations later in life.
If you or someone you love is living with ES, you can find resources, information and the real-life perspective of an ES survivor at ESsentialsforES.com.
Content courtesy of Epizyme, Inc.
Photo courtesy of Getty ImagesSOURCE:
Vaccine-preventable diseases, such as meningitis, continue to impact our communities, including schools and college campuses. Before your kids head back to school for the spring semester, schedule a wellness visit to talk to their doctor about the two different types of meningitis vaccines needed to help protect against the five vaccine-preventable groups of meningitis.
(BPT) - GSK spokesperson Patsy Schanbaum’s daughter, Jamie, was a college freshman when she contracted meningococcal disease, also known as meningitis.
“I got the call that every parent hopes they never get — their child has been hospitalized and it’s an emergency. By the time I got to the hospital that night, Jamie was in an induced coma, fighting for her life.”
Jamie was diagnosed with meningitis and, to help stop the spread of the disease, the doctors amputated both legs below the knee and her fingers.
“Giving the go-ahead to the doctors to amputate her limbs was probably the most difficult decision I’ve ever had to make as a mother, but it was the only way to help save her life,” Patsy said.
Early symptoms of meningitis may be similar to those of a cold or the flu. The disease can progress quickly and be fatal, sometimes within 24 hours.1 One in 10 of those who contract it will die, and one in five will suffer long-term consequences, such as loss of limbs, like Jamie.2
“My daughter was fortunate to survive meningitis, but others may not be so lucky, and it shouldn’t be because of a lack of education. As a mother, I feel it is important for parents to educate themselves about the disease and the vaccines available by speaking with their teen’s doctor about it.”
There are two different types of vaccines and both are needed to help protect against the five vaccine-preventable groups of meningitis – A, C, W, Y and B.7
Anyone can get meningitis, but adolescents and young adults are at an increased risk for meningitis due to behaviors like living in close quarters, sharing drinks or eating utensils, kissing or coughing.3,4,5,6 Serogroup B has been responsible for 100 percent of US college outbreaks of meningococcal disease from 2011 through March 2019, which involved 13 campuses, 50 cases and 2 deaths among an at-risk population of approximately 253,000 students.3
“I stayed by Jamie’s side for seven months while she recovered. Together we worked to physically and emotionally adapt to a new lifestyle. The journey to recovery was difficult, and at certain points I even felt helpless, but we made it through as a family.”
Jamie, also a GSK spokesperson, and Patsy founded The J.A.M.I.E. Group to help educate parents about the impact of meningitis and available vaccinations.
“I want to ensure no family ever has to go through what mine did.”
Today, Patsy feels empowered as a mother, advocate and spokesperson for GSK, sharing her family’s story to educate parents, teens and young adults about the potential dangers of meningitis and the types of vaccines available to help prevent it.
Vaccine-preventable diseases, such as meningitis, continue to impact our communities, including schools and college campuses. Before your kids head back to school for the spring semester, schedule a wellness visit to talk to their doctor about the two different types of meningitis vaccines needed to help protect against the five vaccine-preventable groups of meningitis – A, C, W, Y and B.7 Vaccination may not protect all recipients.
For more information, visit http://www.meningitisb.com.
Content sponsored by GSK.
 CDC. Meningococcal Disease: Signs and Symptoms: Available at: https://www.cdc.gov/meningococcal/about/symptoms.html
 CDC. Meningococcal Disease: Clinical Information. Available at: https://www.cdc.gov/meningococcal/clinical-info.html.
 Marshall GS, Dempsey AF, Srivastava, Isturiz RE. US college students are at increased risk for serogroup B meningococcal disease. JPIDS. 2019:1-4.
 CDC. Manual for the Surveillance of Vaccine-Preventable Diseases: Chapter 8: Meningococcal Disease. Available at: https://www.cdc.gov/vaccines/pubs/surv-manual/chpt08-mening.html.
 CDC. Meningococcal Disease: Causes and Spread to Others. Available at: https://www.cdc.gov/meningococcal/about/causes-transmission.html.
 Larimer County. Meningococcal Disease. Available at: larimer.org/health/communicable-disease/meningococcal-disease
 CDC. Meningococcal Vaccination: What Everyone Should Know. Available at: https://www.cdc.gov/vaccines/vpd/mening/public/index.html.
One in eight U.S. women will develop invasive breast cancer in their lifetime. The treatment of invasive breast cancer should be personalized because what is best for one woman may not be right for another. If you have breast cancer, it's important to take an active role in your health by learning about your available treatment options. An ongoing, collaborative discussion with your doctor is key in determining what treatment option best fits your individual needs.
(BPT) - As a commercial airline pilot with nearly 30 years of experience, Diane Sandoval, 50, is no stranger to making difficult decisions. However, she faced one of her toughest challenges not in the skies, but when she discovered a small lump in her left breast during a self-examination. Her worst fear was confirmed after a visit to her doctor when she was diagnosed with early-stage breast cancer.
Following an inconclusive mammogram and ultrasound, Sandoval learned she had several small tumors. She underwent a mastectomy to remove the tumors followed by breast reconstruction, putting her piloting career on pause.
The next big question was whether she should receive chemotherapy or not. Her physician recommended a genomic test — the Oncotype DX Breast Recurrence Score test. This tool has been proven to determine whether chemotherapy will be beneficial for individuals recently diagnosed with early-stage breast cancer. The test provides a personalized score based on the biology of the patient’s tumor that can help tailor treatment decisions for their individual cancer. Recent results from the largest breast cancer study ever conducted, called TAILORx, confirmed that the test clearly identified the 70 percent of women with early-stage breast cancer who receive no benefit from chemotherapy, as well as the remaining 30 percent of women for whom chemotherapy can be life-saving.
Sandoval is one of the nearly 1 million women who has put chemotherapy to the test with this genomic test. Her score confirmed that her risk of experiencing a breast cancer recurrence was low and she would not benefit from chemotherapy. As a result, she felt confident that she could forgo chemotherapy and its associated side effects. Subsequently, she was able to resume her career as a pilot and her active lifestyle.
She recently joined a campaign called “Put Chemo to the Test” to raise awareness of the Oncotype DX test and encourage women recently diagnosed with early-stage breast cancer to ask their doctor to order it before finalizing their treatment plan.
“I hope to help women with early-stage breast cancer better understand their treatment options by raising awareness of this test and how it can determine whether they are part of the majority of patients who may be spared chemotherapy and its well-known side effects or are among the important minority of patients who could receive life-saving benefit from chemotherapy,” said Sandoval.
One in eight U.S. women will develop invasive breast cancer in their lifetime. The treatment of invasive breast cancer should be personalized because what is best for one woman may not be right for another. If you have breast cancer, it's important to take an active role in your health by learning about your available treatment options. An ongoing, collaborative discussion with your doctor is key in determining what treatment option best fits your individual needs. Below are a few questions to ask your doctor:
Breast cancer patients and caregivers can visit ChemoYesorNo.org to download the full physician discussion guide and learn more about the test.
“I want women who were recently diagnosed with early-stage breast cancer to know that there is no one-size-fits-all treatment approach,” said Sandoval. “The test gave me the confidence I needed to forgo chemotherapy, which has allowed me to continue to enjoy my life with my husband. Ask your doctor to order this genomic test before finalizing your treatment plan.”
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