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Medicare Coverage Gap; “Medicare Donut Hole”

Mark Hendel MSW — Thu, 26 Aug 2010 20:14:22 +0000

Medicare is the Federal Health Insurance Program that covers 45 million Americans.
More than 26 million Medicare beneficiaries are enrolled in Medicare drug plans, including 17.5 million in stand alone prescription drug plans and 9 million in Medicare Advantage drug plans.
The number of low income subsidy benchmark plans varied considerably across regions in 2009, ranging from a low of one prescription drug plan in Nevada and two prescription drug plans in Arizona to a high of 16 prescription drug plans in Wisconsin.
In 2009, three quarters of stand-alone prescription drugs programs and three-fifths of Medicare Advantage prescription drug plans offer little or no gap coverage. In 2009 the coverage gap begins after enrollees incur $2700.00 in total drug costs. Of the 17 prescription drug plan sponsors with plans available in every region in 2009, nine offer some type of gap coverage in at least one of their plan offering, down from 12 in 2008.
In 2009, 93 percent of prescription drug plan enrollees are enrolled in plans with no gap coverage.
Medicare Part D enrollees pay the full cost of their prescriptions when they reach the coverage gap. Between 2007 and 2009, the two prescription drug plans with the highest enrollment, AARP Medicare RX Preferred and Humana Standard Prescription Drug Plan, posted double-digit price increases for commonly used brand name drugs. Over the two year period, prices for the following brand-name drugs increased, on average, by about 19 percent in both the AARP and Humana Prescription Drug Plans: Actonel, Advair, Diskus, Aricpet, Diovan, Lexapro, Lipitor, Nexium, Plavix, and Prevacid.
Medicare Part D plans are an important source of prescription drug coverage for nearly 60 percent of the 45 million Medicare Beneficiaries in 2009.
The Size of the coverage gap increases each year (from $3,216 in 2008 to $3,454 in 2009) Among beneficiaries who reach the gap, one fifth either stop taking one of their drugs or switch to another alternative drug class.
A unique feature of the Medicare Part D drug benefit is the coverage gap, or so called “donut hole” – a gap in coverage in which Part D enrollees are required to pay 100 percent of the total drug costs until they reach the catastrophic coverage level.
An estimated 3.4 million Part D Enrollees (14 percent of all enrollees and 26 percent of those using prescription drugs and not eligible for low income subsidy) reached the coverage gap in 2007.
Seniors who fall into the donut beginning January 1, 2010, will receive a 50% discount on brand name drugs. Also the size of the gap will be cut by $500 under the revamped House Healthcare Reform Bill. The hole should be closed by 2019.
In June 2009, President Obama made an $80 billion deal with the pharmaceutical industry to cut prescription drug costs for the nation’s seniors. Under the new agreement, drug companies would pick up 50% of the tab for some of those patients falling into Medicare’s so-called donut hole.
The Kaiser Family Foundation reported that about 3.4 million Medicare beneficiaries hit the donut hole in 2007 and about 15 percent of them stopped taking their medications as a result.
For 2009, the gap begins after the cost of a Medicare Part D beneficiary’s prescription drugs, including the patients own deductibles and co-pays, has reached $2700.00. The individual then is responsible for directly paying the next $3453.75 until the total drug costs have reached $6153.75. At this point, catastrophic coverage sets in and Medicare again begins covering costs.
There are some factors that apply to your vulnerability to entering into the coverage gap
- Only drugs covered by your insurance plan count in the coverage formula
- Drug-related expenses that do not count include monthly insurance premiums and any drug purchased from other countries
- Each year the total amount of money you must pay out of pocket once you reach your annual coverage cap changes. Check to see what the new coverage is every fall.
- Annual caps are computed on a calendar year basis.
More than 3 million of the nearly 27 million older or disable American who receive the Medicare drug benefit are expected to reach the coverage gap this year and pay the full cost of their prescriptions, says the AARP Public Policy Institute
Beneficiaries hit the donut hole once their total drug expenses- both Medicare’s costs and their out-of-pocket costs- exceed $2700.00. Unless they qualify for a government subsidy or have bought extra insurance, they’re on their own for the next $3454 in prescriptions. At that point, after paying a total of $4350 out of pocket, beneficiaries become eligible for Medicare’s catastrophic coverage and are responsible for 5 % of their bills for the rest of the year. The process repeats itself each January 1.
Sixteen percent of beneficiaries who hit the gap reduce their medication or stop taking their drugs altogether, says the Kaiser Family Foundation.
About 10 million Medicare beneficiaries with the limited incomes and assets received extra help that pays almost all of their out-of-pocket drug costs. The subsidy essentially exempts them from the coverage gap.
Ways to Shrink the Donut Hole
- Ask your doctor if you can switch to generic, over the counter or other low cost drugs that would work as well.
- Look into drug makers assistance programs. Go to Medicare’s website, www.medicare.gov, and click on “Lower Your Costs During the Coverage Gap” to see if your drugs are included in any of the programs and how to apply.
- Ask your doctor for Free Samples
- Apply for extra help. If you have a limited income and resources, you may qualify for a government subsidy to reduce your out-of-pocket drug expenses. Check with Social Security by visiting www.socialsecurity.gov or call 1-800-772-1213
Catastrophic coverage- it assures that once you have paid $4350 (in 2009) out of pocket for drug costs in a calendar year, almost all of your drug costs above that amount are covered.
Medicare’s Tips for avoiding, delaying, or saving money in the coverage gap
- Consider switching to generic, over the counter, or other lower cost drugs. Switching to lower cost drugs may be enough to help you avoid the coverage gap and can save you hundreds or even thousands of dollars a year.
- Keep using your Medicare drug plan card, even while you’re in the coverage gap, to ensure that you’ll get the drug plan’s discounted rates and that the money you spend counts toward you catastrophic coverage.
- Explore National and Community Based Charitable Programs that might offer assistance (such as the National Patient Advocate Foundation or the National Organization for Rare Disorders). Comprehensive information on Federal, state, and private assistance programs in your area is available on the Benefits Check Up website, www.benefitscheckup.org
- Look into Pharmaceutical Assistance Programs (sometimes called Patient Assistance Programs) that may be offered by the manufacturers of the drugs you take. Many of the major drug manufacturers are offering assistance programs for people enrolled in a Medicare drug plan. You can find out whether a Pharmaceutical Assistance Program is offered by the manufacturers of the drugs you take by visiting www.medicare.gov and selecting “Lower Your Costs During The Coverage Gap”
- Look at State Pharmaceutical Assistance Programs (SPAP) for which you may qualify. Arizona does not qualify for this
- Apply for extra help. If you have Medicare and have limited income and resources, you may qualify for extra help paying for your prescription drugs. Contact Social Security by visiting www.socialsecurity.gov or calling 1-800-772-1213
- You can also contact the State Health Insurance Assistance Program (SHIP) at Toll Free: (800) 432-4040 Local: (602) 542-6595
- You can call Medicare at 1-800-MEDICARE, 1-800-633-4227 to get any phone numbers or answers.
- Some Pharmaceutical Companies offer assistance programs for the drugs they manufacture. The value of any assistance you receive from a Pharmaceutical Assistance Program for your drug(s) will not count toward your out-of-pocket costs or total spending under your part D benefit.

The “Donut Hole” information we have provided may not be up to date. The terms of this program continue to evolve. Please do not accept any of the aforementioned data as correct, but contact Medicare with any specific questions.

Sun City Links

Mark Hendel MSW — Mon, 16 Aug 2010 22:00:39 +0000

http://www.suncityaz.org/events%20calendar.htm

http://www.suncityaz.org/maps/map_of_sun_city_recreation_centers.htm

http://www.mowaa.org/

http://www.sunaz.com/index.html

Sun City West Links

Mark Hendel MSW — Mon, 16 Aug 2010 22:00:05 +0000

http://suncitywest.org/CommonlyAskedQuestions.pdf

http://suncitywest.org/Chartered%20Clubs.pdf

http://suncitywest.org/Recreation%20Centers%201-12-09.pdf

http://www.porascw.org/

http://www.rcscw.com/

http://scwaz.com/?cat=4

http://scwaz.com/?page_id=4911

General Guide to Guardianship and Conservatorship in Arizona

Mark Hendel MSW — Mon, 16 Aug 2010 21:58:09 +0000

A guardian is the person appointed by the court to make health care and lifestyle decisions for another person.
A conservator is the person appointed by the court to maintain the finances and make all financial decisions for another person.
The guardianship process can take up to 30 days. If it is contested it can take as long as 90 days.
If an emergency guardian or conservator is needed, this can normally be granted by the courts within 24-48 hours.
Temporary guardianship or conservatorship lasts 30 days, unless extended by the court for good cause. Temporary guardianship/Conservatorship can last no longer than 6 months
An emergency guardian may also have mental health placement powers.
You can find all the forms and guides for guardianship/ conservatorship online at www.superiorcourt.maricopa.gov under self-service center and under probate cases.
You have to pay the processing fees for filing the paperwork. Go to http://clerkofcourt.maricopa.gov/fees.asp to find the list of current fees.
You can apply for a payment plan or deferral if you can’t pay the fees at the time of filing.
If you don’t have a lawyer, you must call the court-appointed lawyer. Office of Court-Appointed Counsel 602-506-7228, between 8am & 5pm Monday thru Friday. You must have an attorney to apply for guardianship or Conservatorship.
Anyone deemed fit by the court can be the guardian or conservator and sometimes the same person fills both roles.
A guardian is not expected to handle the income or property of the “ward”
A conservator is an individual or corporation with trustee powers. The conservator does not make decision regarding the care or personal affairs of the ward.
Guardian has a ward and conservator has a protected person
A conservator has the powers and responsibilities of a fiduciary and is held to the standard of care applicable to a trustee.
The Probate and Trust Section of the State Bar of Arizona can provide basic information and answer questions, 602-252-4804
The guardian and conservator are required to file an annual report to the courts with an update on the ward or protected person.

The following information is NOT meant to be either definitive or accurate, but used as a general guide. The guardianship/ conservatorship process is very complex and subject to change without notice. We strongly suggest that you contact an attorney to get proper legal advice. If you need a list of private attorneys, please feel free to contact our office at 602-867-1270

Senior Centers

Mark Hendel MSW — Thu, 12 Aug 2010 17:42:26 +0000

A senior center is a facility found in the community that offers socialization, recreation, and classes for independent seniors. Senior centers tend to be multi-generational facilities and may have specialized programs for youth as well as seniors. Most senior centers have fitness programs that can offer swimming, tennis, golf and other sports. Generally, a membership is required.

Goelet A.C. Beuf Community Center

3435 W. Pinnacle Peak Rd.

Phoenix, AZ 85027

P: (602) 534-4754

Maryvale Community Center

4420 N. 51^st Ave

Phoenix, AZ 85031

P: (602) 262-5030

Pecos Community Center

17010 S. 48^th St

Phoenix, AZ 85048

P: (602) 495-5500

South Mountain Community Center

212 E. Alta Vista Dr.

Phoenix, AZ 85042

P: (602) 262-4874

Bret Tarver Learning Center

1516 N. 35^th Ave

Phoenix, AZ 85009

P: (602) 262-7127

Washington Activity Center

2240 W. Citrus Way

Phoenix, AZ 85015

P: (602) 262-6971

Pyle Adult Recreation Center

655 E. Southern Ave

Tempe, AZ 85282

P: (480) 350-5211

Rio Vista Recreation Center

8866 W. Thunderbird Rd.

Peoria, AZ 85381

P: (623) 773-8600

Palm Ridge Recreation Center

13800 W. Deer Valley Dr.

Sun City West, AZ 85375

P: (623) 544-6581

Kuentz Recreation Center

14401 W. R.H. Johnson Blvd.

Sun City West, AZ 85375

P: (623) 544-6561

Beardsley Recreation Center

12755 Beardsley Rd.

Sun City West, AZ 85375

P: (623) 544-6525

R.H. Johnson Recreation Center

19803 N. R.H. Johnson Blvd.

Sun City West, AZ 85375

P: (623) 544-6107

Marinette Recreation Center

9860 W. Union Hills Dr.

Sun City, AZ 85373

P: (623) 876-3054

Bell Recreation Center

16820 N. 99^th Ave

Sun City, AZ 85351

P: (623) 876-3040

Sundial Recreation Center

14801 N. 103^rd Ave

Sun City, AZ 85351

P: (623) 876-3048

Lakeview Recreation Center

10626 W. Thunderbird Blvd

Sun City, AZ 85351

P: (623) 561-6600

Oakmont Recreation Center

10725 W. Oakmont Ave.

Sun City, AZ 85351

P: (623) 876-6046

Fairview Recreation Center

10600 W. Peoria Ave

Sun City, AZ 85351

P: (623) 876-3044

Mountain View Recreation Center

9749 N. 107^th Ave

Sun City, AZ 85351

P: (623) 876-3042

Adult Day Health Centers

Mark Hendel MSW — Thu, 12 Aug 2010 17:39:55 +0000

An adult day health care center is a facility that can provide recreation and socialization during the days for those who require minor health monitoring. Each facility has a registered nurse on staff. Adult day health care centers charge an hourly fee and require all participants to undergo an assessment before being allowed to come to the center. Adult day health care centers are licensed by the Department of Health Services. Some adult day health care centers specialize in Dementia and Alzheimer’s Disease.

Benevilla, Mary’s Place Adult Day Program

14601 N. Del Webb Blvd.

Sun City, AZ 85351

P: (623) 815-1100

Benevilla Sun City Adult Day Program

15800 Del Webb Blvd.

Sun City, AZ 85351

P: (623) 977-8274

Benevilla Sun City West Adult Day Program

14495 RH Johnson Blvd.

Sun City West, AZ 85375

P: (623) 584-0040

Benevilla, Lucy Anne’s Place

16752 N. Greasewood St.

Surprise, AZ 85374

P: (623) 584-4999

Benevilla, Peoria Adult Day Program

8133 W. Cactus Rd.

Peoria, AZ 85381

P: (623) 979-7126

Glendale Adult Day Health Care

6010 W. Northern Ave

Glendale, AZ 85311

P: (623) 931-0983

Lincoln Adult Day Health Care

303 E. Eva St.

Phoenix, AZ 85020

P: (602) 870-6374

Phoenix Adult Day Services

3620 N. 4^th Ave

Phoenix, AZ 85013

P: (602) 297-1840

Santa Maria Adult Health Care Center

3801 E. Greenway Rd.

Phoenix, AZ 85032

P: (602) 285-1800

Sunflower Adult Day Care Center

2814 W. Bell Rd.

Phoenix, AZ 85053

P: (602) 843-8711

Arbor Rose Adult Day Club

6063 E. Arbor Ave

Mesa, AZ 85206

P: (480) 654-8200

East Valley Day Break

1525 N. Power Rd.

Mesa, AZ 85205

P: (480) 396-3795

Sirrine Adult Day Care of Mesa

7550 E. Adobe

Mesa, AZ 85207

P: (480) 464-1061

Sirrine Adult Day Health Care

247 N. MacDonald St.

Mesa, AZ 85201

P: (480) 464-1061

Tempe Adult Day Health Care Center

2234 E. Maryland Dr.

Tempe, AZ 85281

P: (480) 285-1800

Tempe Adult Day Health Care Center

2303 E. Maryland Dr.

Tempe, AZ 85281

P: (480) 446-3004

Daybreak Adult Health Care

1050 W. Supersition Blvd.

Apache Junction, AZ 85220

P: (480) 671-3086

Casa De Esperanza

780 South Park Centre Ave

Green Valley, AZ 85614

P: (520) 625-2273

The Center Adult Day Care

3407 N. Windsong Dr.

Prescott Valley, AZ 86314

P: (928) 775-3563

The Center

826 Sunset Ave

Prescott, AZ 86301

P: (928) 445-6384
Daybreak Adult Day Health Care

321 S. 15^th Ave

Yuma, AZ 85364

P: (928) 783-8316

Handmaker Jewish Services for the Aging

2221 N. Rosemont Blvd.

Tucson, AZ 85712

P: (520) 881-2323

Sedona Sunrise Center for Adults

110 Indian Cliffs Rd.

Sedona, AZ 86336

P: (928) 203-9476

Tolleson Adult Day Services

9555 W. Van Buren St.

Tolleson, AZ 85353

P: (602) 532-2979

Personal Belongings to bring to an Assisted Living Center or Home

Mark Hendel MSW — Fri, 06 Aug 2010 20:30:30 +0000

Clothing:

1. 7 tops & 7 bottoms

2. 10 pairs of undergarments

3. 10 pairs of socks

4. 2 pairs of outside shoes, ex: sneakers, sandals, etc.

5. Pair of house shoes

6. 3 night gowns or pajamas

7. Robe

8. Sweater and jacket

9. Accessories, ex: hats, wedding ring, scarves, sunglasses, etc.

10. We do not recommend bringing jewelry

Toiletries:

1. Make-up

2. Toothbrush

3. Razor for shaving

4. Deodorant

5. Face Cream/ Lotion

6. Perfume/ Cologne

7. Hair Brush

8. Blow Dryer, hair curlers, etc

9. Hair spray, gel, mousse

10. Personal washcloth/ Loofah

11. Glasses/ Contact lens

12. Shower Cap

Other:

1. Soap, body wash, shampoo, conditioner, baby powder, toothpaste

2. Linens or bedding; including pillows, extra blankets, etc.

3. Towels & washcloths

4. Room decorations including pictures, curtains, lamps, chairs

5. Hangers

Ombudsman

Mark Hendel MSW — Thu, 05 Aug 2010 20:46:56 +0000

Purpose: To hear and investigate complaints against long term care facilities by private citizens. The primary duty of an Ombudsman is to protect the rights of Arizona’s long term care residents.

Services:

Ombudsman services are free and confidential.
To address problems or any miscommunications between a resident or family member and the facility involved.
Advocate to resolve complaints and make referrals based on client needs.
To work worth with the staff to resolve any and all issues and complaints against them.
To educate residents, family, staff, and the community about : resident’s rights, the needs of long term care residents, long term care issues and services, and the development of resident and family councils.

Area Agency on Aging: Is contracted by the State of Arizona to oversee the Ombudsman Program. There are eight professional Ombudsmen and 18 volunteers that have been trained and certified to work with those in need. You will contact the Area Agency on Aging to schedule your appointment and ask to speak with the Long Term Care Ombudsman Program Coordinator.

Complaints: There are many issues that can be addressed by the Ombudsman, but the most common are issues of nutrition, care planning, financial issues or disputes, resident’s rights, privacy and confidentiality, visitation rights, or issues related to discharge or transfers.

www.aaphx.org

602-264-2255

Toll Free 888-264-2258

For the Hearing Impaired 602-241-6110

Foundation for Senior Living

Mark Hendel MSW — Thu, 05 Aug 2010 20:41:15 +0000

Purpose: The Foundation for Senior Living was created to help seniors, adults with disabilities, and their caregivers to maintain dignity, respect, personal choice, and independence.

Programs:

Adult Day Health Services- Centers for seniors and adults with disabilities that provide medical, recreational and social services.
Adult Foster Care- Training and recruiting of caregivers who are willing to open their homes to seniors and adult with disabilities.
Assisted Living Group- For adults with mental illness, the will help find a State-Licensed Behavioral facility.
Assisted Living Education- Professional training programs for managers and caregivers. They also offer classes for family members who are going to be caregivers to a loved one.
Care By Design- In home services offered on a free-for-service basis
Community Action Programs- Emergency services such as food, utilities, rent, and short term case management
Home Care- Housekeeping, chore, and personal services are offered to help an individual stay in there home as long as possible.
Home Health Care- A licensed, certified Medicare Home Health Agency will come into the home to provide services
Home Improvements- Home repairs for low-income individuals, seniors, and adult with disabilities
Housing- Help with finding affordable housing and apartments for low income clients
Pathways- Social workers helping seniors find community resources and services.
Senior Centers- Services for seniors that provides a place for social activities, home delivered meals, and education
The Caring Place- Support in the Northeast Valley with counseling, care management, personal services, and spiritual support.
The Catholic Outreach Program- Counseling, care management, and support in the Sun City.
The FSL Caregiver House- training center for caregivers or adults who manage their own care.
Young Adult Day Health Care- For ages 18-45, a person with a closed head injury or disability can go for restorative therapies and activities.

www.fsl.org

info@fsl.org

P: 602-285-1800

Toll Free: 866-375-9779

For The Hearing Impaired: 602-222-1063

Veteran’s Administration Special Benefits Program

Mark Hendel MSW — Thu, 05 Aug 2010 20:37:46 +0000

Eligibility: If you have had 90 days of active duty, one day beginning or ending during a period of war, during World War I, World War II, The Korean Conflict, The Vietnam Era, or inthe Gulf War, you may be entitled to receive a pension of up to $1645.00 per month. A surviving spouse can receive up to $1057.00 per month and a couple can receive up to $1950.00 per month. If you served before World War I, you need to contact the National Archives Trust Fund at inquire@nara.gov

Programs: There are three different programs you can apply for:

Special Pension
Basic Pension
Household Pension

All three are part of the Improved Pension Program. Your local VA office representative can help you determine which program is correct for you or your loved one.

Requirements: Before you apply, you will need a copy of:

DD-214, also known as separation or discharge papers
A copy of your marriage certificate
A death certificate if you are the surviving spouse
A current Social Security Award Letter
Your net worth information including all bank accounts, CDs, Trusts, Stocks, Bonds, Annuities, etc.
Proof of all income
Proof of insurance premiums
A Physician’s statement that includes current diagnosis, medical status, prognosis, name and address of Physician, ability to care for oneself, ability to travel unattended, etc.
Banking information for Direct Deposit of any VA payments
Employment history of you are 65 years or younger
A list of all doctors and hospitals you have visited in the last year.

Forms: Once you have gathered all the information needed, you will need to fill out VA Form 21-526, if you are the Veteran applying. If you are the surviving spouse or dependent, you will need to fill out VA Form 21-534. Remember to make a photocopy of all documents, certificates, and your application, in case the VA has any questions. Remember not to send them original copies of your papers or certificates.

Application Process: The process can take up to 4-6 months. Remember to be proactive during this process or you will encounter delays. Please keep records of all correspondence, applications, and records submitted through the filing process.

Help: You can contact the American Veterans Institute at www.vetassist.org. The AVI is run by Veterans and they understand how difficult this process can be. They are available if you need any assistance in filing for the Aid and Attendance Program.

www.veteranaid.org

1-800-827-1000

602-255-3373

1-800-829-4833 TDD Line for Hearing Impaired