A million low-income seniors have become eligible for a big assist on prescription drug expenses this year under a newly expanded federal program. The subsidy can defray thousands of dollars in costs, and in many cases eliminate prescription drug expenses entirely for participating seniors.

            The Extra Help program which is administered by the Social Security Administration subsidizes Medicare Part D prescription drug premiums for eligible seniors. While the program is not new, eligibility rules have been changed this year in a way that expands its availability dramatically.

            The government estimates the average annual benefit to Extra Help participants at $3,900. That should be welcome news for low-income seniors coping with soaring Part D premiums. Average monthly premiums jumped 11 percent for 2010, and they have risen 50 percent since 2006, according to the Kaiser Family Foundation.

            Seniors are eligible for Extra Help if their income is no greater than $16,245 a year for singles, and $21,855 for married couples living together. The value of stocks, bonds and bank accounts cant exceed $12,510 for singles and $25,010 for married couples. The income definition does not include the value of homes or automobiles.

            But there are two significant changes in eligibility rules this year. The cash value of life insurance policies is no longer counted as a resource, and assistance received from friends and relatives to pay for household expenses such as food or utilities also no longer are included. The Social Security Administration is urging anyone who did not meet the income standards in the past to re-apply.

            The assistance helps with monthly premiums, any annual deductibles, co-insurance and co-payments. The program even plugs the notorious doughnut hole the current coverage gap in Part D that starts when beneficiaries exceed $2,830 in total drug costs for the given year. At that point, the beneficiary pays 100 percent of costs up to $6,440, when so-called catastrophic coverage kicks in.

            Unlike standard Part D enrollment which occurs annually between Nov. 15 and Dec. 31, seniors can apply for Extra Help anytime during the year. But you will receive the maximum benefit if you are in a Part D plan with a monthly premium below a certain benchmark monthly premium set by Medicare for each region of the country.

            If you are already enrolled in a Part D plan and enter the Extra Help program, you will be informed whether your premium is entirely covered, or that you need to pay the difference between the premium and the benchmark amount. However, you also have the right to change to a different plan at any time.

            Low-income seniors who are not already enrolled in a Part D plan should apply for the Extra Help subsidy, and simultaneously enroll in a drug plan. If you are eligible, the benefit is retroactive to the first day of the month when you apply.

            If you are switching plans or enrolling in Part D for the first time, use the Medicare websites plan finder to select a plan that maximizes your Extra Help benefit. You will input data about your specific prescriptions and some other personal data; the tool will take into account the expected subsidy when it presents Part D plan options to you. You will be looking for the plan with the fewest restrictions on your specific prescriptions, and one that works with a pharmacy you want to use.

            You can also get free counseling and assistance in selecting a plan from your local State Health Insurance Assistance Program (SHIP), a government-sponsored counseling service for Medicare beneficiaries. To find the SHIP near you, visit http://www.hapnetwork.org/ship-locator/.

            To apply for Extra Help, visit this page Social Security Administration website, call Social Security at 1-800-772-1213 or visit your local Social Security office.

Most doctors don't talk about end-of-life issues with their cancer patients when those patients are feeling well, a new survey has found. Nor do they talk about them until treatments have been exhausted. Those delays mean patients might not be able to make truly informed choices early in their treatment.  The study, published online Jan. 11 in the journal Cancer, surveyed 4,188 physicians about how they would talk to a hypothetical cancer patient with four to six months to live. A majority of respondents (65%) said they would discuss prognosis, but only a minority said they would discuss do-not-resuscitate status (44%), hospice (26%) or preferred site of death (21%) at that time. Rather, they would wait until symptoms were present or until there were no more treatments to offer.   Current guidelines, from the National Comprehensive Cancer Network, a not-for-profit alliance of 21 of the world's leading cancer centers, say that such conversations should be initiated whenever a patient has been given less than a year to live, if not at diagnosis.  Doctors gave various reasons for not following the guidelines. Some didn't want to dash patients' hopes; some wanted to continue treating patients. In addition, said lead author Dr. Nancy Keating of Harvard Medical School: "There's at least some evidence to suggest that patients don't want to hear about these things."

Source: Los Angeles Times (January 25, 2010)
Full story:  http://www.latimes.com/features/health/la-he-closer25-2010jan25,0,5766082.story

In today’s age of the worldwide web, we engage in a great deal of Internet commerce.  We order office supplies, buy books, pay bills, transfer funds, check account balances, sell things, check email, and need a password to access a laptop or office computer.  We all have difficulty keeping track of our own passwords, let alone other people’s passwords.  Therefore, what would happen if you were to become incapacitated or were to die?  Who would have knowledge of your computer passwords?  We generally supply our loved ones with bank account information, safety deposit box key location, location of life insurance papers, wills, etc.  However, it is time that we know include passwords in otherwise confidential information.

My family personally experienced this situation upon the January 6, 2010 death of my father-in-law, Alan Feinberg, age 68.  Luckily, he had hand written his passwords on a peace of paper that was readily available.  However, were unable to access a few of his accounts and had to spend significant time determining the status of some accounts.

I urge you to have a system in place, as part of organizing your estate, for your loved ones to access your passwords in a time of crisis.  As more and more commerce is transacted electronically, this will take on increasing importance.                     

Despite continued studies that report the aging of Americans, the number of available nursing home beds continues to decline. Several states reported double digit declines in the number of available beds. A new report from the American Association for Long-Term Care Insurance (AALTCI) indicates the number of available beds at the beginning of 2009 was 1.67 million, a two percent decline from the prior year. Financial executives predict that if population and economic trends continue, the nation may face a two-class system of providing long-term care for millions of aging and disabled individuals. Those with savings or private insurance will have options including access to private facilities established for individuals who are not dependent on government programs, Medicare and Medicaid. Skilled nursing facilities that depend on government payments face a projected Medicaid shortfall in 2009 of $15.64 a day or almost $6,000 per-resident on an annual basis according to the AALTCI report. While experts report that the under-funding is not increasing sharply for 2009, it is expected to expand wider in 2010 as state budget shortfalls affect Medicaid shortfalls. States recently received $87 billion in increased federal medical assistant percentage (FMAP) funding as a result of the economic stimulus package. Many have not used the funds to increase Medicaid rates paid to facilities. Instead, they have used it to balance their budgets according to several experts who monitor the long-term care industry. Looking forward, a total of 48 states face budget shortfalls. The number of certified licensed nursing facility beds in the United States was 1.669 million as of December 2008. At the end of 2002, there were some 1.7 million nursing home beds. Texas had the largest number of nursing home beds (122,635), California had 121,950 followed by New York with 120,101. Alaska had the fewest beds with 725.

Source: EMax Health News (26 October 2009) Full story: http://www.emaxhealth.com/1/28/34234/long-term-care-insurance-association-reports-fewer-us-nursing-home-beds.html <http://www.emaxhealth.com/1/28/34234/long-term-care-insurance-association->