Savvy Senior

What Health Care Reform Means for Seniors

By Jim Miller

Dear Savvy Senior,
How will the new healthcare bill affect seniors? My wife and I both receive Medicare benefits and would like to know what we can expect.
— Concerned Senior

Dear Concerned,
There are several ways the new healthcare reform law will affect seniors on Medicare and those planning for their retirement years.

Drug Benefit Boost
If you’re one of the 27 million U.S. seniors who has a Medicare (Part D) prescription drug plan, healthcare reform has just upgraded your coverage. Seniors that fall into the coverage gap known as the doughnut hole will get a $250 rebate to help pay for their medications this year, and a 50 percent discount on brand-name drugs next year. By 2020, the coverage gap will be eliminated. That means that seniors who now pay 100 percent of their drug costs once they’re in the doughnut hole will pay 25 percent.

Currently, seniors fall into the doughnut hole once they hit their $2,830 annual limit. Then they have to pay $3,610 out-of-pocket for drugs before prescription coverage picks up again at $6,440.

Free Screenings
In addition to the prescription drug plan improvements, Medicare’s preventive services will also be beefed-up under the new law. Currently, traditional Medicare covers a one-time “Welcome to Medicare” physical, but only to new beneficiaries within the first 12 months of enrollment. And, they pay 80 percent of most health screening costs with you footing the bill for the remaining 20 percent. But starting next year, Medicare beneficiaries can get annual wellness exams and preventive tests, like screenings for high blood pressure, diabetes and certain cancers, for free.

Dis-Advantaged
The news isn’t so good for seniors who have a Medicare Advantage plan. These are plans run by private insurers and are an alternative to Original Medicare (Part A and Part B). Many of these plans offer extra benefits that Original Medicare does not provide like free eyeglasses, hearing aids and even gym memberships. These extra benefits, however, come at an extra cost. Studies have shown that Medicare Advantage plans cost the government 14 percent more on average than Original Medicare. That’s why the new healthcare law will cut around $135 billion in subsidies over the next three to six years to the private insurers who offer these plans.

What all this means is that the 10 million seniors that have Medicare Advantage can expect their premiums or co-payments to increase, or their extra benefits to be reduced, or both, over the next few years.

Keep in mind that if you are enrolled in Medicare Advantage, you can switch to Original Medicare and join a prescription drug plan any time during the open enrollment period, which is between Jan. 1 through Feb. 15, every year. To help you compare your Medicare Advantage plan with other plans in your area or with Original Medicare, visit www.medicare.gov/mppf or call 800-633-4227. And to evaluate Part D prescription drug plans, see www.medicare.gov/mpdpf.

Long-Term Care
Another provision in the healthcare reform law that older workers approaching retirement should know about is the Community Living Assistance Services and Supports (CLASS) Act, which is a voluntary long-term care insurance program available through employers. Starting next year, workers can set aside money from their paychecks to pay for services and supports that many will need in their old age or if they become disabled.

This program is meant to help offset the high costs of home-based care, assisted-living facilities and nursing homes.

Those that pay into the program for at least five years will receive an average cash benefit of no less than $50 a day when they need it. The details of the program, including the eligibility, premiums and a mechanism that allows people to purchase insurance if they’re self-employed are being ironed out.

Savvy Tip: For more information visit healthreform.gov along with the Medicare Rights Center Web site at medicarerights.org.

Financial Help for Family Caregivers

Dear Savvy Senior,
I’ve been taking care of my elderly mother for nearly a year now and it’s wearing me out both physically and financially. Is there any way I could get paid to be her caregiver?
— Tapped Out

Dear Tapped,
To get paid as your mother’s caregiver, there are several possibilities you should check into, and a variety of support services that can help, too. Here’s what you should know.

Caregiving for Pay
If your mom is eligible for Medicaid, you may be able to get paid a small amount by the government. In 15 states, including Vermont, Medicaid offers a Cash and Counseling program (see cashandcounseling.org) that provides direct financial assistance to beneficiaries, and that money can be used to pay in-home caregivers. In Vermont, contact Merle Edwards-Orr at the Department of Aging and Independent Living
in Waterbury. Phone 802-241-4496; Email
merle.edwards-orr@ahs.state.vt.us

Other Options
If your mom has financial resources of her own, find out if she can afford to pay you herself. If she agrees, it may be a good idea for both of you to draft a short written contract detailing your work and payment arrangements. Or, if your mom has long-term care insurance that includes in-home care coverage, in some cases those benefits can be used to pay you.

Tax Breaks
The IRS may also be able to help you out if you can show that you pay at least half of your mother’s yearly expenses, and her annual income was below $3,650 in 2009 (not counting Social Security). If so, you can claim her as a dependent on your taxes, and reduce your taxable income by $3,650. Your mom doesn’t have to live with you to qualify as a dependent. IRS Publication 501 (see www.irs.gov/pub/irs-pdf/p501.pdf or call 800-829-3676 to get a copy mailed to you) has a worksheet that can help you.

If your mom’s income, however, is over $3,650, you can’t claim her as a dependent. But if you’re paying at least half her living expenses, you can still get a tax break if you’re helping pay her medical and long-term care costs and they exceed 7.5 percent of your adjusted gross income. You can include your own medical expenses in calculating the total. See the IRS publication 502 (www.irs.gov/pub/irs-pdf/p502.pdf) for details.

Support Services
If you don’t qualify for caregivers’ pay or a tax break, you can still get some financial relief through the National Family Caregiver Support Program (NFCSP). This is a federally funded program that provides aid for specific caregiver needs like respite care or adult daycare to give you a break, counseling and support groups, and supplemental services including the purchase of medical supplies, SOS emergency response systems and even home modifications. In addition to the NFCSP, you should also check into home delivered meal programs, volunteer companion programs, and even home and personal care services. To locate all the various programs and support services in northern and central Vermont, contact the Champlain Valley Agency on Aging at 802-865-0360 or visit www.cvaa.org.

Pill Splitting: When It’s Safe, and When It Isn’t

By Jim Miller

Dear Savvy Senior,
Is pill splitting safe? I have several friends who split their prescription pills to save money, and several who don’t because they don’t think it’s safe. What can you tell me?
­— Split Decision

Dear Decision,
Splitting your pills – literally cutting them in half – is a simple way to save money on your prescription drugs but be sure you talk to your doctor first, because not all pills can be split. Here’s what you should know.

Savings and Safety
The reason pill splitting is such a cost cutter is because of a quirk in the way drugs are manufactured and priced. A pill that’s twice as strong as another may not be twice the price. In fact, it’s usually about the same price. So, buying a double-strength dose and cutting it in half may allow you to get two months worth of medicine for the price of one. But is it safe? As long as your doctor agrees that splitting your pills is OK for you, you learn how to do it properly, and you split only pills that can be split, there’s really no danger.

What to Do
If you’re interested in pill splitting, the first step is to talk to your doctor or pharmacist to find out if any of the medicines you use can be safely split. It’s also important to find out whether splitting them will save you enough money to justify the hassle.

The pills that are easiest to split are those with a score down the middle. However, not every pill that’s scored is meant to be split. Pills that are most commonly split include:
•     Cholesterol lowering drugs, like Crestor, Lipitor, and Pravachol
•     Antidepressants, like Celexa, Paxil, and Zoloft
•     High blood pressure medicines like, Monopril, Prinivil, Univasc, Zestril, Avapro and Cozaar
•     Erectile dysfunction pills, like Viagra, Cialis and Levitra

Having the right equipment helps too. Don’t use a knife to cut your pills in half. It can cause you to split them unevenly resulting in two pieces with very different dosages, which can be dangerous. Purchase a proper pill cutter. They only cost around $5 to $10 and are available at most pharmacies and large discount stores.

For convenience, you might be tempted to split the whole bottle of pills at once. But check with your doctor first. It’s possible that exposing the interior of the pills to the air could reduce their effectiveness. It’s also important to know that pills are only safely split in half, and never into smaller portions such as into thirds or quarters.

Unsafe Splitting
Many medicines, because of their ingredients or design, cannot be split safely. Here’s a list of pills that should not be split:
•    Blood thinners (Coumadin, warfarin)
•     Chemotherapy drugs
•     Anti-seizure medicines
•     Birth control pills
•     Capsules of any kind that contain powders or gels
•     Pills with a hard outside coating
•     Extended-release pills that deliver medication over time in your body
•     Pills that are coated to protect your stomach
•     Pills that crumble easily, irritate your mouth, or taste bitter.

Again, your doctor or pharmacist will know which drugs can and cannot be split. If you’re taking a medicine that can be split, you’ll need to get a prescription from your doctor for twice the dosage you need. Then you can start splitting, and saving, safely.