Category Archives: Senior Health

Alzheimer’s support model could save states millions


And younger man's hand holds an elderly man's handBy Lisa Gillespie

As states eye strategies to control the costs of caring for Alzheimer’s patients, a New York model is drawing interest, and findings from a study of Minnesota’s effort to replicate it shows it could lead to significant savings and improved services.  Continue reading


Women’s health — Week 29: Fecal incontinence


tacuin womenFrom the Office of Research on Women’s Health

Fecal incontinence, or loss of bowel control, can be devastating. People may feel the urge to have a bowel movement and not be able to hold it until they get to a toilet or stool may leak from the rectum unexpectedly, sometimes while passing gas. Continue reading


UCLA memory program offers ‘gym for your brain’


UCLA Memory 1

Vikki Helperin, 84, dances with her husband Sidney, 88, a retired anesthesiologist, at the Longevity Center at the University of California Los Angeles Medical Center. He was diagnosed with Alzheimer’s about four years ago, and the couple is hoping the memory sessions will slow the progression of the disease (Photo by Anna Gorman/KHN).


By Anna Gorman
KHN Staff Writer
MAR 15, 2014

This KHN story was produced in collaboration with wapo

Just as they had so many times during the past 60 years, Marianna and Albert Frankel stepped onto the dance floor. He took her hand in his, and smiling, waltzed her around the room.

“I remembered how it used to be and we could really do the waltz and he would whirl me around until I got dizzy,” said Marianna Frankel, 82, who is 10 years younger than her husband.

For just a few minutes as the music played, she didn’t think about her husband’s memory loss, the long days of silence or how much he had changed.

The Frankels and about 20 others had come to the University of California Los Angeles Medical Plaza on a breezy Tuesday afternoon to learn ways to boost the memory and help both patients and caregivers cope with what already had been lost.  Continue reading


One-in-three of skilled nursing patients harmed in treatment


A younger man holds an elderly man's handBy Marshall Allen
ProPublica, March 3, 2014

One-in-three patients in skilled nursing facilities suffered a medication error, infection or some other type of harm related to their treatment, according to a government report released today that underscores the widespread nature of the country’s patient harm problem.

Doctors who reviewed the patients’ records determined that 59 percent of the errors and injuries were preventable.

More than half of those harmed had to be readmitted to the hospital at an estimated cost of $208 million for the month studied — about 2 percent of Medicare’s total inpatient spending. 

Patient safety experts told ProPublica they were alarmed because the frequency of people harmed under skilled nursing care exceeds that of hospitals, where medical errors receive the most attention.  Continue reading


Men, minorities and the elderly not getting treated for depression


And younger man's hand holds an elderly man's handBy Milly Dawson
HBNS Contributing Writer

A leading cause of disability, depression rates are increasing in the U.S. and under-treatment is widespread, especially among certain groups including men, the poor, the elderly and ethnic minorities, finds a new study in General Hospital PsychiatryContinue reading


Health law helps states move elderly and disabled from nursing homes to home care


01_17_Chart_Health_Funding_thumbnailBy Christine Vestal
Stateline Staff Writer

In New Hampshire, Medicaid pays for in-home care for nearly all of its developmentally disabled residents. For frail elders, the opposite is true. Most wind up in nursing homes.

To remedy this imbalance, New Hampshire is taking advantage of Affordable Care Act funding for a program aimed at removing existing barriers to providing long-term care in people’s homes and communities.

Known as the Balancing Incentive Payments Program, it is one of several ACA provisions designed to keep as many people as possible out of costly institutions. Continue reading


Tips for staying safe in cold weather for older adults


Thermometer ThumbHypothermia and older adults

Tips for staying safe in cold weather from the National Institute on Aging

Frigid weather can pose special risks to older adults. The National Institute on Aging (NIA), part of the National Institutes of Health, has some advice for helping older people avoid hypothermia — when the body gets too cold — during cold weather.

Continue reading


Aging inmates push up prison healthcare costs


By Christine Vestal
Stateline Staff Writer

State spending on prisoner health care increased in 42 states between 2001 and 2008, with a median growth of 52 percent, according to a new report from The Pew Charitable Trusts. The primary driver of the cost spike is bigger and older prison populations.

“Health care is consuming a growing share of state budgets, and corrections departments are not immune to this trend,” said Maria Schiff, director of the State Health Care Spending Project, an initiative of Pew and the John D. and Catherine T. MacArthur Foundation.

Pew analyzed inflation-adjusted correctional health care expenditures collected by the U.S. Department of Justice from 44 states that participated. Overall, these states spent $6.5 billion on inmate health care in 2008, up from $4.2 billion in 2001. Average per-inmate spending also grew in 35 of the states during the same period at a median rate of 32 percent.


Of the states in the study, prisoner health care costs in Illinois and Texas decreased. Those not included in the study are Georgia, Kansas, Kentucky, New Mexico, Vermont, Wyoming and Washington, D.C.

Although sentencing changes have resulted in a recent decline in the prison population, the number of people held in state prisons ballooned over the last 30 years. During the study period, it grew by about 200,000, a 15 percent increase.

During the same period, the number of state and federal inmates age 55 and older grew from 40,200 to 77,800, a 94 percent increase. Since 2008, the number of elderly inmates has continued to grow to 121,800 in 2011. The aging of the prison population is the result of a large number of inmates living out longer sentences and an uptick in the number of older people who are sent to prison.

Like the the population on the outside, elderly prisoners are more likely to have chronic medical and mental conditions that require expensive treatments. The health care costs for inmates age 55 and older with a chronic illness is on average two to three times that of the cost for other inmates, according to the study.


Cutting Costs

States have developed a number of strategies to mitigate the rising cost of caring for prisoners, including increased use of telemedicine and the outsourcing of medical services to state universities and other providers, according to the report.

In addition, a small number of states have made limited use of Medicaid to help finance rising prison health care costs. The potential benefits of Medicaid financing will increase substantially in 2014 when the Affordable Care Act takes effect, but only in states that expand their programs.

Currently, most state Medicaid programs cover very few childless adults, who make up the bulk of the prison population. In most cases, only pregnant women and disabled inmates are eligible for Medicaid.

By expanding Medicaid to all adults with incomes up to 138 percent of the federal poverty line ($11,490 for an individual), virtually everyone who is incarcerated will qualify for the federal-state program. The federal government will pay 100 percent of costs for newly eligible adults from 2014 through 2016 and gradually decrease its share to 90 percent by 2020.

For inmates, Medicaid pays only for health care services provided outside of prison walls. But those charges – for inmates admitted for 24 hours or more to a hospital, nursing home or psychiatric center – are often substantial.

In Ohio, where Republican Gov. John Kasich recently circumvented the GOP-led legislature to approve the expansion, the state estimates it will save $273 million in prison health care costs in the first eight years. Michigan expects to save about $250 million on inmate health expenses in the first 10 years, and California expects to save nearly $70 million each year.

Stateline logo

Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.


Women’s Health – Week 9: Caregiving


tacuin womenFrom Office of Reseach on Women’s Health

Caring for a loved one, while immensely challenging, can also be a rewarding and positive experience. Caregivers provide many kinds of help, from grocery shopping to helping with daily tasks such as eating and dressing.

Women provide the majority of long-term care in this country. Caregivers act as health care providers,  friends,  companions,  decision-makers,  and advocates,  often while working and caring for their children at the same time.

To be able to take care of others, you must also take care of yourself. Eating right,  staying active, and making sure your own emotional and physical needs are being met are important places to start. Caregivers often have high levels of depression,  anxiety,  and other mental health issues.

You should talk to a counselor,  psychologist,  or other mental health professional right away if the stress affects your daily life or leads you to physically or emotionally harm the person you are caring for.

As a caregiver, you already know that it is important to track financial and medical records. Planning ahead in case of an emergency can make all the difference. The person who you are caring for should give consent in advance for their health care provider or lawyer to talk with you as needed if there are questions about medical care, a bill, or a health insurance claim. Without consent, the caregiver may not be able to get needed information.

Respite care
Respite care is the provision of short-term, temporary relief to you if you are caring for family members who might otherwise require permanent placement in a facility outside the home. It provides you with the break you need, and also ensures that your loved one still receives the attention that he or she needs. Respite care can vary in time from part of a day to several weeks. For more information about respite care:
for more information:

Think all caregivers are unhappy? They’re really not


A younger man holds an elderly man's handBy Nancy Shute, NPR News

This story comes from our partner ‘s Shots blog.

The stereotype of caring for a family member is that it’s so stressful it harms the caregiver’s health. But that’s not necessarily so.

Studies are conflicted, finding that caregiving can harm or help the caregiver. Here’s one on the plus side: A study finds that people who care for a family member live longer than similar people who aren’t caregiving.

The scientists didn’t ask the caregivers why they might be healthier and presumably happier than similar people who weren’t caring for someone. But the 3,503 people who participated represented a broad swath of the American public and may be a better representation of the caregiving experience overall.

Just 17 percent of the people surveyed said they had high levels of caregiving strain, and the majority put in fewer than 14 hours of care a week.

“The burden of caregiving certainly can be overwhelming and negative to health,” says David Roth, director of the Center on Aging and Health at Johns Hopkins University and lead author of the study, which was published in the American Journal of Epidemiology. “But those are not necessarily the typical experience.”

The study data was originally gathered for a big multiyear study on stroke risk, but the people being cared for in this study had a broad range of health problems. The caregivers themselves were age 64 on average, more likely to be female and either white or African-American.

Family caregivers were 18 percent less likely to die than non-caregivers over six years, the researchers found.

Something must have made life better for the caregivers. But what? To help find out, we called up Leah Eskinazi, director of operations for the Family Caregiver Alliance in San Francisco.

“There are people who find caregiving very rewarding,” Eskinazi told Shots. “They feel really good that they can give back to Mom, for example, because Mom was really there for them when they were growing up. Maybe they weren’t the best kid, but as they’ve aged they can have a more balanced healthier relationship and heal some of those wounds.”

Context is everything, Eskinazi says. Caring for someone with dementia can be more stressful and depressing because the person is facing a long inevitable decline. “You’re caring for someone who can’t voice their preferences,” she says. “You’re making decisions for another person and for yourself, and that can last for a long time. It’s tough.”

But only about 10 percent of family caregivers are tending someone with dementia, other studies have found.

Caring for someone after a stroke, by contrast, can be very positive. “There’s a lot of energy going into helping that person recover,” Eskinazi says.

And in many cases the person being cared for is in a position to be grateful. “To have someone stick by you, or a group of people stick by you, that’s pretty cool,” Eskinazi says. “It gives you an opportunity to say thank you.”

Spouses typically expect to be taking care of their mate in old age, but adult children don’t always prepare for that possibility — or try not to think about it.

People tend to avoid the Family Caregiver Alliance’s booth at health fairs, Eskinazi admits. “People don’t really want to think about it. It’s time, it’s emotion and it takes energy.”

But this latest study points out that caregiving isn’t all a big minus for the caregiver — something to prepare for, perhaps, but a normal, often rewarding part of life.

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

pill map

Huge differences by region in prescribing to elderly, study


by Charles Ornstein and Tracy Weber

Elderly Americans are prescribed medications in inexplicably different ways depending on where they live, according to a new report from Dartmouth researchers.The most depressed older patients or at least the ones being medicated — live in parts of Louisiana and Florida. There’s a cluster with dementia around Miami. And the seniors who have the most trouble sleeping? They live, perhaps unsurprisingly, in Manhattan.

The study by the Dartmouth Institute for Health Policy and Clinical Practice examined geographic variations in the drugs elderly Medicare patients received in 2010.

Pill map

Researchers mapped where patients got medications they clerly needed and where they got drugs deemed risky for the elderly. They also looked at differences in the use of so-called discretionary drugs, which they say are widely prescribed but of uncertain benefits.

The report’s findings underscore those of a ProPublica investigation in May, which found that some doctors who treat Medicare patients often prescribe drugs that are dangerous or inappropriate for certain patients.

ProPublica also found that the federal officials who run Medicare have done little to scrutinize prescribing patterns in their drug program, known as Part D, or question doctors whose practices differ from their peers. Officials from the Centers for Medicare and Medicaid Services could not be reached to answer questions about the study.

They have previously said that the primary responsibility for overseeing prescribing belongs to private insurers that administer the program. Still, they have acknowledged that Medicare should and will do more to track prescribing in Part D and follow up on unusual patterns.

The Dartmouth researchers did not look at the habits of individual doctors, as ProPublica did, but instead looked at the percent of patients in each region who received certain types of medications.

Regionals boundaries were based on where patients would be referred for hospital care. For example, 17 percent of elderly patients in Miami received a prescription for a dementia drug in 2010, while less than 4 percent of patients in Rochester, Minn., and Grand Junction, Colo., got one.

Nationally, the average was 7 percent, according to the report, titled the Dartmouth Atlas of Medicare Prescription Drug Use. There were similar differences by location for antidepressants.

In Miami, almost one-third of elderly Medicare enrollees received at least one prescription for such drugs and about one-quarter of those in a swath of Louisiana did. In Honolulu, just 7 percent got one.

The report does not address whether the patients had diagnoses that would warrant the use of these medications. It also does not include disabled patients under 65 who are also covered by Part D.

Researchers examined whether patients in different regions had been given widely accepted drug treatments following health emergencies, for instance a beta blocker after a heart attack or an osteoporosis drug after certain fractures.  And they calculated the percentage of seniors who were given drugs labeled risky by the American Geriatrics Society because they are known to affect their cognition and balance.

“We see that some clinicians are not achieving a level of effective medication use” compared to their peers, said Dr. Nancy Morden, a lead author of the report. “Conversely, some clinicians are putting their patients at much higher risk by using hazardous medications at a much higher rate than their peers.”

The report does not tackle two of the most fraught issues in prescribing today: the use of narcotic painkillers and anti-psychotics, especially to treat dementia in the elderly.

Morden said she was surprised to find that, in some regions, large percentages of patients were getting discretionary drugs that were moderately beneficial, like those for acid reflux — and not getting the ones that could save their lives, like the beta blockers or cholesterol-lowering drugs.

“What are we doing?” she said. “It’s surprising to me that we can use so much of our energy to pursue medications that give us far less in terms of health. I worry that it’s coming at the cost of getting the effective medications.”

People in some regions of the country are healthier than in others. But Morden said that does not explain the wide variations her group found in so many different categories of drugs.

That may be a signal that patients are not being adequately informed about the risks, benefits and costs of the drugs, she said. Doctors also may be unaware of how different their practices are from the peers in other parts of the country.

Overall, researchers found that the elderly in Miami fill more prescriptions than anywhere else. On average Miami area patients got nearly 63 per person, including refills, in 2010, compared to a national average of 49.Seniors in Miami also had the highest average spending on prescriptions that year, $4,738 compared to $2,670 nationally.

In the report, Morden and her co-authors encourage policymakers to seek ways of reducing geographic variation in the way medications are prescribed. They also urge patients to ask their doctors about whether a drug is truly needed for them.

The Dartmouth group has previously examined how costs and use of services in the Medicare program differ markedly across the country. They note that some of the highest-spending regions in terms of drug costs were also among the highest users of other types of medical services.

Want to know more? Follow ProPublica on Facebook and Twitter, and get ProPublica headlines delivered by e-mail every day.


Seniors cautioned to pay close attention to details as enrollment begins in Medicare plans


Magnifying GlassBy Susan Jaffe
This KHN story was produced in collaboration with 

The seven-week enrollment period for next year’s Medicare prescription drug and managed-care plans begins today, but seniors shouldn’t simply renew their policies and assume the current coverage will stay the same.

There’s a likely payoff for those who pay close attention to the details.

Among the top ten most popular drug policies, monthly premiums for 2014 are changing dramatically — up 55 percent for one AARP UnitedHealth plan and down 38 percent for another from Wellcare, according to a recent study by Avalere Health, a Washington, D.C., health research firm.

In addition, the second-most popular plan, SilverScript Basic, is now off  limits to new members until Medicare officials are satisfied that the plan’s nearly 2.9  million beneficiaries can fill prescriptions without encountering problems.

The company will not be able to resolve these issues before the end of this enrollment season, spokeswoman Christine Cramer, said in an e-mail. (Current members are allowed to stay if they wish.)

About 22.7 million people, or 43 percent of Medicare’s 52 million beneficiaries, are enrolled in these drug policies, also known as Part D plans.

The coverage gap, or “doughnut hole,” in Part D is growing smaller in 2014. The Affordable Care Act shrinks the gap every year until it is closed in 2020.

Next year, drug coverage stops when the insurer and member together have spent $2,850 and resumes when the member has spent $4,550. This year, coverage stopped at $2,970 in spending and resumed at $4,750.

Discounts on drugs seniors buy while in the gap have also improved, and next year’s deductible is $310 instead of $325.

This open season also will have 142 fewer Medicare Advantage plans, the private plans that are an alternative to traditional Medicare fee-for-service coverage, the Avalere study found. 

They offer medical and often drug coverage from a network of participating providers. That’s a 5.3 percent decrease, said Jennifer Rak, an Avalere senior manager.

Still, Medicare officials announced last month that they expect the enrollment in Medicare Advantage plans to continue to increase next year.  Roughly one in four Medicare beneficiaries have MA coverage. 

They also said that one-third of these plans would be awarded four or more stars in 2014, although these ratings have not yet been issued for 2014. Plans can earn ratings of up to five stars, based on the quality of service and customer satisfaction.

Officials expect average Medicare Advantage monthly premiums to increase by $1.64 to $32.60 next year while the average prescription drug plan premium will remain roughly the same, at about $31.

Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, a trade association, said Medicare Advantage continues to be popular despite the health law’s cuts in federal payments to those plans because insurers “are doing everything they can to preserve benefits and minimize disruption for seniors in the program.”

The Medicare open enrollment period, which ends Dec. 7, is for Medicare beneficiaries only. It is separate from enrollment in coverage obtained through the Affordable Care Act’s online marketplace, which began Oct. 1 and is geared mostly to people who have little or no insurance. Medicare Advantage and Medicare drug policies are not sold on the marketplace.

Because of the government shutdown, Medicare officials were not available for comment on details about the plans or enrollment. However, they said enrollment will start on time despite the shutdown.

Still, advocates for seniors noted that the government’s online plan finder has carried a warning for the past several days that plan details may not be up to date.

They recommend consumers should not decide on a plan until Medicare officials confirm that the plan finder provides accurate information.  In addition to the website, assistance is also available by calling 1-800-MEDICARE (800-633-4227).

Policies can change from year to year, so Medicare officials encourage seniors to review their current coverage to make sure their drugs are still covered and at the best price.

They should also check to see if they can get to the plan’s preferred pharmacies, which offer lower prescription prices than others in the plan’s network.

While the AARP MedicareRx  Saver Plus premium will go up 55 percent next year, it is still below the average national premium,  Sarah Bearce, a UnitedHealth Care spokeswoman said in an e-mail.

The combination of federal reimbursement cuts, the health law’s tax on insurers and the automatic cuts triggered by sequestration “required us to make changes to our plans,” she said, and added that this “financial pressure” is being felt across the health insurance industry.

Other changes in plan costs next year will be more subtle.  About 72 percent of drugs plans will direct members to the preferred pharmacies if they want to save money on prescriptions, according to a study by The Kaiser Family Foundation, released last week.  (Kaiser Health News is an editorially independent program of KFF.) Very few plans had these pharmacy arrangements when the drug benefit was introduced in 2006.

But price hikes, poor performance, and changes in covered drugs are often not enough to spur the vast majority of seniors to action. Only 13 percent changed policies in the four years since Congress added the drug benefit to Medicare in 2006, according toanother analysis released last week by KFF.

If most seniors continue not to pay attention to changes in their health coverage, insurers may get the impression that prices don’t matter, said Juliette Cubanski, associate director of the Kaiser Family Foundation’s Medicare program.

“Plans have less incentive to keep their costs down if they are not worried they’ll lose members to their cheaper competitors,” she said.

When considering coverage, it is important to look beyond premiums to consider drug co-pays and other costs. During last year’s fall enrollment period, Senior PharmAssist, a non-profit group in Durham, N.C., helped 387 seniors save an average of $676, said executive director Gina Upchurch.

“It’s easier not to switch,” said Dr. Richard Lees, a retired New York orthodontist who moved with his wife to Silver Spring, Md., to live closer to their two daughters and their families. But when he learned his premium is going up next year, “I was very disappointed,” he said.

He and his wife chose different plans because they take different drugs.  (Unlike employer-sponsored insurance, Medicare drug plans do not require spouses to be on the same plan.)

“Each year we have changed companies and improved our situation,” he said.

Contact Susan Jaffe at

This article was produced by Kaiser Health News with support from The SCAN Foundation.

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.


Medicare’s open enrollment starts Oct. 15 – Help is available in your community


From the Office of the Insurance Commissioner

Medicare’s open enrollment starts Oct. 15 – Help is available in your community

 Center for Medicare & Medicaid ServicesMedicare’s open enrollment period for prescription drug plans (Part D) and Medicare Advantage plans is Oct. 15 – Dec. 7. Local help is available in your community through the Washington state Insurance Commissioner’s Statewide Health Insurance Benefits Advisors (SHIBA).

”Many Medicare plans are changing this year,” said Insurance Commissioner Mike Kreidler.  “Now is this time to shop for the best plan that meets your needs. Our Statewide Health Insurance Benefits Advisors (SHIBA) program can help you understand your choices and your rights.

To enroll in a new Medicare plan or to change your coverage, you must contact Medicare. Washington’s new Health Benefit Exchange – – is only for people under age 65. It’s against the law for someone who knows you have Medicare to sell you an Exchange plan.

SHIBA offers free help to people with Medicare questions. “Our unbiased volunteers in your community can answer your questions and help you search for plans online,” said Kreidler.

Before you make your Medicare decision, consider the following tips:

  • Plan costs and coverage will likely change every year, so carefully review all letters and notices from your insurer.
  • Make a list of all current prescription drugs you take, the doses, and how often.  Then, use the Medicare Plan Finder to compare prescription drug (Part D) plans.
  • Review the 2014 Medicare & You handbook. You should receive it in the mail by mid-October.
  • If you have questions, call a SHIBA volunteer at 1-800-562-6900 or call 1-800-MEDICARE (1-800-633-4227) before you sign up.
  • If you have limited income and need help paying for prescription drugs, check out Medicare’s “Extra Help” program.  To see if you qualify, contact the Social Security Administration at 1-800-772-1213 or visit

“Whatever you do, don’t wait until the end of the enrollment period to get help,” added Kreidler. “Call our Insurance Consumer Hotline today at 1-800-562-6900 and ask to schedule an appointment with a SHIBA volunteer in your area.”


To attend a free Medicare workshop in your local area, go to: 

For help in other languages, call:

§  Spanish, Medicare, 1-800-633-4227

§  Spanish, National Alliance for Hispanic Health, 1-866-783-2645

§  Korean, National Asian Pacific Center on Aging, 1-800-582-4259

§  Chinese, National Asian Pacific Center on Aging, 1-800-582-4218

§  Vietnamese, National Asian Pacific Center on Aging, 1-800-582-4336

§  Or ask a trusted friend or relative for help.



Some good news about saving for retirement healthcare costs


Twenty-dollar bill in medicine bottleBy Ankita Rao

Saving for health care after retirement is less costly than it was just a few years ago thanks to the slowed growth of health care spending. But that’s just part of the picture.

new report from the Employee Benefit Research Institute found that Medicare beneficiaries, who are 65 years or older, would need to save six to 11 percent less in 2013 than they did in 2012.

Men hoping for a 50-percent chance of having enough money saved for retirement health costs would need an average of $65,000. For women, who have longer life expectancies and related costs, the savings goal would be about $86,000.

“These numbers are still uncertain, and they’re still high,” said Paul Fronstin, director of the institute’s research and education program, and author of the report. “But I don’t want to minimize the good news – they may be less shocking than they were.”

He pointed out that because of the Affordable Care Act, Medicare beneficiaries are also  paying less out of pocket for prescription drugs.

The health law reduces the size of Medicare’s “doughnut hole,” the gap in prescription drug coverage where beneficiaries cover all the costs.

Even so, saving for retirement won’t necessarily be easier in coming years. The report notes that its analysis doesn’t account for long-term care expenses like nursing home care, or for costs incurred by those who retire before they’re eligible for Medicare.

Some employers may also scale back their worker benefits, and pension program changes could mean less retirement savings, said Patricia Neuman, director of the Kaiser Family Foundation’s Program on Medicare Policy and its Project On Medicare’s Future.

She said that racial and ethnic disparities would also persist, and that black and Hispanic populations were projected to see fewer gains in income, assets and health care access.

“It’s always good news when medical costs go down,” she said. “But I guess the broader issue is that many seniors don’t have sufficient savings. And the Medicare population in 2030 won’t be much wealthier than the Medicare population today.”

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.


Seniors on Medicare don’t need to apply to the health law marketplaces – FAQ


ACA health reform logoBy Mary Agnes Carey
KHN Staff Writer

Nearly 50 million Americans are enrolled in Medicare, the federal health insurance program for the elderly and disabled. The 2010 health care law, known as the Affordable Care Act, will make some changes to the program. Here are some answers to frequently asked questions about Medicare and the health law.

Q: The health law creates something called a health insurance marketplace. What is that and can I apply for coverage on an exchange?

A: There is no need for you to enroll in the health law’s exchanges. It’s an online marketplace where individuals and small employers without group coverage will be able to shop for insurance coverage. Enrollment begins Oct. 1 for policies that will go into effect on Jan. 1.

Medicare is not part of the health insurance exchanges.   Seniors will still get health coverage through Medicare’s traditional fee-for-service program or Medicare Advantage plans, private health insurance plans that are approved by Medicare.

Those who are enrolled in Medicare Part A, which covers hospital care, or the Advantage plans will meet the health law’s mandate for individuals to have insurance.

Q: Does the health care law offer any new benefits for Medicare beneficiaries?

A: Beneficiaries receive more preventative care services – including a yearly “wellness” visit, mammograms, colorectal screening, and more savings on  prescription drug coverage.  By 2020, the law will close the Medicare gap in prescription drug coverage, known as the “doughnut hole.” Seniors will still be responsible for 25 percent of their prescription drug costs.

Q: Does the law cut spending on Medicare?

A: Medicare spending will continue to expand as increasing numbers of baby boomers reach 65. However, the law does cut the expected growth of Medicare spending by about $716 billion over the next decade.

Those cuts are made by lowering reimbursements to nursing homes, hospitals, home health agencies and other providers. It also cuts payments to Medicare Advantage plans to bring those payments closer to what Medicare pays for care for beneficiaries enrolled in the traditional fee-for-service plan. Medicare officials stress that the spending changes will not reduce Medicare benefits.

Some worry those cuts could lead to access problems, if providers drop out of the program. In the most recent Medicare Trustees report, Paul Spitalnic, then acting chief actuary for the Centers for Medicare and Medicaid Services, wrote that over the long term, some of the health law’s changes would cause Medicare payment rates for home health, hospital and other services to drop below those now paid by the Medicaid program, “which have already led to access problems for Medicaid enrollees.”

Q: Does the health law require higher-income Medicare beneficiaries to pay more for their Medicare prescription drug coverage?

A: It does. Currently, Medicare beneficiaries who earn more than $85,000 ($170,000 for a couple) pay more for their Medicare Part B premiums, which cover physician and outpatient services. The health law brought that same sliding-scale approach to beneficiaries’ prescription drug coverage in Medicare Part D for those with incomes of more than $85,000 ($170,000 for a couple). Those income thresholds will be frozen through 2019.

Q: I’ve heard a lot about something called the Medicare “doc fix.” What is that and does the health law fix it?

A: The “doc fix” refers to the sustainable growth rate, or SGR, which is the payment formula based on economic growth that Medicare has used to pay physicians since the late 1990s. Over the past decade, the formula would have cut Medicare physician payments but Congress has stopped the cuts. For example, it calls for a 25 percent drop next Jan. 1. Doctors warn that if the pay reductions were to take effect, fewer physicians will treat Medicare patients.

The health law does not change that formula, but there is bipartisan legislation pending on Capitol Hill that would. The House Energy and Commerce Committee passed a measure in July to repeal the SGR but the bill does not specify how to finance a fix.  The House Ways and Means Committee and the Senate Finance Committee are working on legislation as well.

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.