Medication Costs will Break the Budget of Retiree’s Nest Egg

This is a VERY IMPORTANT post!!!

We have all heard about how Drug Costs are increasingly becoming a burden on our pocket books and the Healthcare System as a whole. For those of you planning for retirement, you would be wise to factor in general healthcare as well as medication costs. A recent study conducted for MedCo a pharmaceutical benefit manager, indicates that one in three retirees claim they are spending far more on their healthcare and prescriptions than they expected. The research indicates that for one in four middle-income retirees, $1 out of every $10 of their monthly retirement income goes to pay for medications alone. The average 65-year-old couple retiring today will need $70,000 just to cover Prescription drug costs. Twenty four percent claim to use very few to none of the cost savings tools available to cut their medication expenses. Now, more than ever, retirees are nervous about outliving their ability to afford the escalating costs of living well.

Medco is making it their purpose to educate retirees about tools to unlock hidden savings that can be used to reduce their prescription drug expenditures. Here are a few more figures revealed in the study:

• Nearly half of retirees stated they infrequently or never discuss with their Doctor ways to save money on their medications, such a switch to generic medications rather than name brand.
• Few knew about Drug Optimization: taking fewer pills at a higher dose to reduce the number of pills you have to buy…always work this out with your MD and pharmacist.
• 40% of Seniors who have reviewed Medicare plans indicated that their primary factor in choosing a plan is premium price.
• One in five seniors over age 65 who are still working stated one of the reasons they continue to work is to receive employer-sponsored drug coverage.
  
  Medco then offered six (6) tools or strategies that can help reduce the out of pocket costs of medications. These tools are briefly described below. I will put the entire study as a page on my website with the link as shown below as well as my email address if you want to talk it through with me. I will assist as I can.
• Save money by using a mail-order pharmacy for all your maintenance medications. Average annual savings with Generic through mail order equal $396…..THAT IS SIGNIFICANT SAVINGS!!
• In choosing a Medicare Part D Plan, look at more than just the premium price. An excessively lower premium price may indicate higher out of pocket costs and plan restrictions. Other important factors you should consider when evaluating the value of Medicare Part D plans:
  -Out-of-pocket costs: what are the fixed co-pays and co-insurance.
• -Size of the formulary (how many drugs the plan covers)…are your drugs covered under the plan??
  -Coverage in the “donut hole”…Does it cover costs in the Coverage Gap between $2,510 and $4,050? There are tools on the internet that allow you to plug in your meds and estimate cost.

www.medicare.gov www.medicaredadvisor.net

• Ask your Doctor if there is a generic alternative for your drug. Most physicians will be more than willing to write for a generic med. However, if you do not ask, many times the physician writes for a name brand drug. In my opinion, the reason for this is 1) it is easier and 2) the pharmaceutical sales people are continuously marketing to physicians for the use of their name brand drug. They leave samples which also contribute to continuing on with the name brand. The total cost of a generic drug can be up to 80% less than its brand name counterpart.
• Ask your doctor if your medication dosage can be optimized. For instance, you take your blood pressure med 20mg twice daily…that causes you to buy 60 pills per month. If you can take twice the dose (40mg) one time daily, you would only need to purchase 30 pills. Another way to do this is to prescribe the larger dose but you break them in half to continue taking them twice daily. This can amount to over $500 per year. A word of caution: DO NOT do this without arranging it with your doctor!
• Learn the secrets to online savings. Probably the main disadvantage here is that many sites provide comparisons based on retail price…the price someone what is uninsured or are paying 100% for the bill. Otherwise, look for a plan that has an online comparison tool that compares prices based on your individual plan, not just retail prices. Many times the company web site will offer this tool…Use It!!! A recent study found people who switched to a lower-cost drug after using a prescription benefit provider’s cost-comparison tool saved $171 annually per medication.
• For those who see more than one doctor, including specialists are now taking many different medications. Each doctor may not know all the medications you are taking, how much and when. Here are two ways you can be wasting money (aside from the effects on your health) if you don’t tell your doctors about all your medications.
  o Medication Duplication – two doctors prescribe a medication that does essentially the same thing as others you are taking.
  o Medication Cancellation – Two doctors each prescribe a medication that cancels the other out.

Either way, you end up paying for medications that aren’t working the way they were intended. Since this is more than a cost saving measure, it could be a life-saving measure you must inform each of your doctors of all medications you are taking…this included over the counter meds and herbal supplements. The best way I have found to make sure you don’t leave anything out is to put them in writing and take the list with you when you present for any medical or mental health care. I will also provide a sample medication list on my site.

I think I have provided you with some pretty significant possibilities for major cost savings with your prescription plans. It is the time of year to be shopping for your 2008 plans. Be sure and consider the above suggestions to provide the most cost effective plan. If I can be of any assistance, my email address is

Email : ezhealthcare@sbcglobal.net

Web site: http://www.ezhealthcareonline.com

Health Insurance: To Buy or Not to Buy? That is the question

Hi everyone!
I am back to continue our discussions.
Many of us are fortunate enough to have employers who provide a significant portion of our health insurance coverage. Today I am very grateful for that but that has not always been the case. I need to tell a story. Being a nurse, my employment options have always been fairly solid, i.e. among other things my Health Insurance policy has always been provided with very little out of pocket expense. Not to long ago I was transitioning out of one job/employer with the intent to take a break and “find myself”. My little break meant I would be paying my own health insurance. I could not believe how much it cost! This was just for myself (but it was very good coverage)…I really couldn’t even guess what it might have cost if it was a family policy…Oh My Gosh! So, I am paying my way and there is no income…you can imagine this might not last very long. I also ran up some additional expenses. Suddenly I ran out of money and didn’t have another job lined up at the moment. I depleted my entire savings, had an excessive amount of revolving debt and had More Out-Go than In-Come. I was riding a very thin financial line.

All this story to say that at that point, if a large expense occurred I would have absolutely no resources to manage. I could easily see how the middle management, middle aged person can end up sleeping in a cardboard box down by the river. I was very fortunate to be able to secure another position (one that is right for me) that provided benefits. I managed to get my revolving (credit cards) debt down while I checked on other options. I could see the abyss and it was scary. I can now see how people could let themselves be without insurance. Similar decisions as to whether to take the dog in for her yearly vaccinations or pay the electric bill are somewhat common at my house these days.

Now, we can finally get to the question of can you go without insurance??? My opinion is a big fat NO!

What do you guys think about this topic? Let me hear from you. I will return later and continue...unless you guys give me something else to talk about.

Alice

Staph Infections (MRSA): What You Do to Prevent Them

Hi All!

I saw another article regarding this topic so I thought I might as well weigh in on it. There is a lot of talk about MRSA infections or antibiotic resistant staph infection. This is sometimes referred to as a Super Bug. There are only a couple of antibiotics that will kill it and those are pretty powerful drugs. So, how did it get to this point? You know that the bacteria Staphylococcus Aureus is present on our bodies and many times in our nose. In fact, one source says that the nose is the most common for it to hide and the place we really need to watch out for. It is a mutation of this Staph Aureus bacteria that becomes antibiotic resistant. Over the years, when we were sick, we would most likely be prescribed an antibiotic. The bug gradually became resistant to them. Additionally, as people have illnesses that lower the immune response (for example HIV, chemotherapy, etc.) the bugs spread and gradually became resistant.

Still, the hospital is the most common place this appears...close contact, multiple other illness, etc. I have always heard the phrase: "The hospital is no place for sick people". Meaning that there is a mixture of everything and someone with a lowered immune system predispose you to infection. If you do not NEED to be in the hospital, try to get your care at home. Now, I am not trying to say that hospitals are dirty or anything as such but there is too much of it floating around.

If you are in the hospital, there are a few things you can do to minimize your risk of infection:

• There should always be a dispenser of antibacterial solution, usually mounted on the wall. Any time you are up, to the bathroom or touching things, blow your nose, cough into your hand, etc. you should use the solution on your hands.
• Make sure that every care giver (nurses, physicians, therapists, transport, etc.) use the solution prior to touching you. Sometimes the physicians are not cleaning their hands, but if you think about it they go from room to room and could easily spread an infection.
• Also watch the instruments that care givers use...are blood pressure cuffs moved from room to room? Asked that it be cleaned prior to your use.

Becoming more and more common is the Community Acquired MRSA. Contributors are rampant use of antibiotics. This bug as said previously is in your nose, on your skin and in the dirt. Other common places are the gym, hot tub, crowded living areas, contact with other people such as in prisons, the gym. Poor hygiene contributes to the infection. Below are some steps you can take to help prevent contamination:

• Bathe regularly-the bacteria is on your skin, but can be washed away with good hygiene. Be sure to wash the areas that are usually warm and moist - under arms, groin area
• Wash your hands frequently
• Don't pick your nose! After blowing, always wash your hands.
• If you have a cut or scrape, cover it with a bandage until healed.
• If you are given antibiotics for anything, always take all that is prescribed. Being careless with antibiotics has led to several resistant strains of bacteria. More often now we are seeing a change in ordering antibiotics unless really needed. Infected cuts/scrapes are usually treated conservatively without antibiotics and if it starts getting worse then they will break out the drugs.
• Don't share towels, clean gym bag and don't put dirty clothes and towels in gym bag--the warm moist environment is a feeding ground for germs.

I hope this has helped give you some practical knowledge you can use anywhere. Stay clean and don't pick your nose, until next time.

Alice

Factors Influencing our Choice of Doctor or Hospital

I am back again to continue our discussion on pricing / cost and free choice in determining our Doctor or Hospital. Since we introduced the concept of how (sort of) prices are determined and we all know that they are too high, what about health insurance? Do we really need it? and this next question is a big one...is it or should it be our right to obtain health care rather than a choice...should the US Government make a national healthcare plan to provide care to everyone from cradle to grave? This will be a hot topic for the presidential election...Hillary is already talking about it!!!

Oh my! Where to start? Do we really need health insurance? Will we not receive the same care if we do not have insurance? The answer to that is very tricky. A hospital (if they receive any federal money) cannot turn away anyone with emergent illness based on the ability to pay...this is part of what are referred to as EMTALA laws. They were the product of the 1997 Social Security Act. which also yielded the privacy laws. But let me tell you, there are a lot of caveats. These laws are watched pretty closely...especially by competing hospitals in a community. For instance, a person presented to Hospital A with a cough. He was not admitted so he goes down the street to the emergency room where it is determined he has pneumonia and is admitted to the hospital. He does not have insurance and mentions to Hospital B staff that he was at Hospital A earlier. This could trigger Hospital B to either make a call to A and check it out or a call to the hospital police to be investigated. If a hospital is deemed that they broke the rule...they could actually lose their federal funding. Losing Federal Funding would for most facilities put them out of business. Federal Funding can sometimes account for more that 50% of their revenue.
In addition, most facilities have policies stating that you will not be turned away based on the ability to pay.

So, now! Do you really need health insurance anyway? Especially if the employer is not paying the premium cost.
You guys ponder that for awhile, and I will check back with you later. Bye for now.

Alice

our Right to Free Choice of Doctor or Hospital

Hi Everyone,

What did you think about the pricing discussion?

I think most people will agree that this is a big issue in healthcare. A big issue for providers as well as you and me. It seems like prices for healthcare services just keep going up. We cannot get a break. The worse part is that they have a captured audience when we seek healthcare. And some providers may take advantage of that by raising prices on services we need, then of all things...make us pay for it.

Anytime another rule or initiative that is aimed at enhancing quality of care comes about, you can bet the cost is going to go up. So, how do we manage to get the needed healthcare and pay for it also. You know, this is a free society and what something is worth is deemed by how much someone will pay for it. But of course, a business cannot price itself out of the market. If there are three hospitals in a community, they will vary somewhat in their services, outreach and prices. Rest assured that before they raise any price, they have surveyed the market to see what is reasonable and comparable.

So, I have just decribed the global view pricing...so if all the prices are comparable (physician and facilities) what differentiates one from another. How do you decide who or where to get your care...OR do you even have a choice? Ya'll think about that for a little while...I will be back later to finish this discussion---It is going to get good! I will spill more secrets in order to assist you.

Until Next Time, Alice

Health Care Cost: Hospital and Physician

Hi everyone!

Now, I want to go back to the thought that Healthcare is a multi-billion dollar business. You know, if you think of it as a business it sort of takes on another dimension. A service and materials are provided then a bill that includes parts and labor is sent to you. This is no different than any other business. It may first go through your health insurance company to pay a contracted amount. Finally, the balance is billed to you. Once again, your insurance company may have contracts with you that limit the portion of that remaining balance that you will ultimately need to pay. I know it always seems like a large bill........... because it is!!!
You know...the $2.00 aspirin. As someone who has aspirin in the cabinet where the entire bottle was two dollars it doesn't make sense! But if you think about it like a business, the cost of that aspirin is partially labor, pretty much all of it. It includes the pharmacist, a pharmacy tech, transport to the appropriate place and then Nurse who gives it to the patient...but WAIT!! There are two of them, so it will be $4.00. Items or services that are larger in scope and higher cost will be marked up maybe less than the "aspirin". Most providers I have had experience with have some sort of algorithm for the purpose of pricing.

Now------- Hospital / Doctor Pricing:

What do ya'll think about it? Post a comment to this blog.

Until next time, Alice

ps: Next time we will talk about Health Insurance options and"sould you have health insurance"?

Medicare Stops Paying for Errors: Your Opinion?

Well Hi everyone!

So what do you think about the previous post? Is this something that will reform the healthcare system? Or is it going to be an aggravator and not help at all? In the big scheme of things or at your personal level.

OK! What do you think? Let me know.

I think it is a mole hill that's just puffing smoke up our...nose. My guess is there will not be big savings from this measure. It will just create more paperwork and in general raise the cost to the rest of us--that's right--we will ultimately pay the bill. Providers (hospital or doctor) will need to compensate some how. To do this they raise the prices for those of us who will actually be paying a bill. Oops! That might have been a secret...oh well. But really...that is how business operates and we cannot forget that healthcare is a multibillion dollar business.

I will let you ponder this for a while, then I will be back.

Alice

Medicare Won't Pay for Mistakes??

The thing that you will learn about me is that I generally will have an opinion about something. That opinion is not always the most popular and or it may be somewhat twisted. Any and all statements are my opinion and not those of any other party. Throughout my blog, you will find tips and techniques that will help you access and maneuver the system easily. The nature of the healthcare system creates many obstacles or bumps that make it difficult to work through.

A short while ago, there was an article in our local newspaper about how Medicare will no longer pay for mistakes. The general message was that hospital payments will be reduced or retracted by Medicare if the hospital charges were caused by a preventable hospital error i.e. certain infections or bed sores. I can just imagine that hospitals are scrambling to adjust for this rule. How will it be determined what is normal condition of a patient or a potentially preventable condition. I suspect there will be a fine line, resulting in conflicts between the hospital and Medicare. Appeals to the decision will be made and probably so much red tape to wade through that the cost of care has already gone up.

What is Medicare? It is the government's pay system for the elderly and disabled. The proportion of the population that is of medicare age is somewhere in the neighborhood of 50%. As we have all been warned that figure is going to jump drastically as the first of us Boomers turns 65 years old. So, you can think of Medicare as your future insurance company.
Something is fundamentally wrong with this initiative as with many of Medicare iniatives. That is leaving out the physician in the picture. Yes, there will be impact on the physician but it will be done by the hospital. It does not appear to me that this initiative is any different. The physician reimbursement is not affected by these restrictions. When this happens, the hospital is forced with implementing new policies and trying to convince the physician to not only comply but be enthusiastic about it.

I know it sounds like I am taking sides with the hospital industry but really I am more in favor of including the physician reimbursement with these cuts. I have always thought that the physician payments should be ammended along with the hospital...how else are incentives ever going to be totally aligned for the good of the patient-you and me.