Nursing Home Costs Nationwide: Review Daily Costs of Nursing Homes

Senior care costs are an item that many of us do not plan ahead for - we just hope that it will never be a need.  However, the reality is that all of us should plan for needing senior care services for at least 2 years of our lives.  

Medicare, the health insurance program for all American seniors, does not pay for long-term care.  In the event a senior should "spend-down" all of their assets, they may qualify for Medicaid, a version of Medicare insurance for very low-income seniors with few assets.  Each state administers Medicaid benefits in conjunction with federal funding, which means the financial spend-down requirement varies in each state and you may view these financial requirements on Caregiverlist.

Medicaid financial qualification requirements in most states must be no more than $2,000 in assets for a single senior and $3,000 in assets for a couple.  There is an anti-spousal poverty provision that will allow one spouse to maintain more assets while the other spends down to qualify for Medicaid benefits.  This can especially be needed if one senior has memory loss or another age-related illness which requires years of caregiving services.

Nursing homes are often an extension of a hospital stay as Medicare will pay for rehabilitation services in a nursing home after a hospital stay.  However, Medicare does not pay for 100% of all the costs of a nursing home and only pays for the first 20 days of the daily fee (remember, some activities and hair care and other services cost extra) and then from days 21 to 148 the senior must pay $148 per day.  This means, in some instances, switching to one-on-one care in the home can be more cost effective.

Seniors should investigate nursing homes in their area before they need nursing home care, especially since there is a chance if a sudden medical condition such as a stroke or hip replacement, requires rehabilitation, the hospital may do a quick discharge to a nursing home in the area.  You may also receive information from licensed senior home care agencies.

Nursing home costs range from $100 to $400 or more per day.  You may review the daily costs of nursing homes nationwide in Caregiverlist's Nursing Home Directory to plan ahead for your senior care needs.



Seniors Saving Billions a Year on Prescription Drugs Thanks to Affordable Care Act

Doughnut holes are for pastry shops, right?  Wrong.  Not when it comes to our friendly Congress passing legislation that makes no sense.  A doughnut hole was actually included in the previous prescription drug benefit for seniors and recently corrected in the new healthcare law - it was a hole in payouts for benefits.  And when this type of legislation happens, it does spark the thought that lobbying can be very successful.  The prescription drug companies have spent millions lobbying Congress and as Open Secrets publishes, the drug company's lobbying dollars match when the legislation gets passed.

So this silly doughnut hole was labeled as such because as a senior you would have a benefit to pay for your prescription drug until you took a big enough bite and hit the "hole" and then there was no benefit paid until you got to the other side of the hole and then it would pay again.  Meanwhile, for whatever your health condition is, you need this medication so seniors were very stressed about how they would pay for it while in the "doughnut hole".

I was invited to serve on a research panel, which the government paid for just to make sure that seniors really were confused by their prescription drug plan and that everyone thought the doughnut hole was silly.  As I told them, what private paid healthcare plan would ever sell any such thing?  They wouldn't, because nobody would buy it.  

However, the good news is this:  
the new healthcare law - nicknamed "Obama Care", has saved seniors $6 billion dollars in prescription drug benefits because it eliminated this doughnut hole.  Here is the Health and Human Services news release on the announcement.


Health and Human Services Secretary Kathleen Sebelius announced this week that more than 6.3 million people with Medicare saved over $6.1 billion on prescription drugs because of the new health care law.

“By making prescription drugs more affordable, the Affordable Care Act is improving and promoting the best care for people with Medicare,” Secretary Sebelius said.

The Affordable Care Act makes Medicare prescription drug coverage (Part D) more affordable by gradually closing the gap in coverage where beneficiaries must pay the full cost of their prescriptions out of pocket. This gap is known as the donut hole.

People with Medicare in the doughnut hole now receive discounts when they purchase prescription drugs at a pharmacy or order them through the mail, until they reach the catastrophic coverage phase.  The Affordable Care Act gave those who reached the donut hole in 2010 a one-time $250 check, then began phasing in discounts and coverage for brand-name and generic prescription drugs beginning in 2011.  The law will provide additional savings each year until the coverage gap is closed in 2020.

In 2013, the health care law increases the discounts and savings to 52.5 percent of the cost of most brand name drugs and 21 percent of the cost of covered generic drugs.

Also under the Affordable Care Act, those who choose to enroll in Medicare Advantage and Part D now have access to a wider range of high-quality plan choices, with more four- and five-star plans than were previously available.  The Affordable Care Act continues to make Medicare more secure, with new tools and enhanced authority to crack down on criminals who cheat the program.

Learn more about how the Affordable Care Act closes the doughnut hole.

Review state-by-state information on savings in the doughnut hole.

Learn about senior care costs for long-term care and find nursing homes in your area as you plan for all your senior care needs.

Medicare Eligibility Age Removed from "Fiscal Cliff" Debate

Medicare health insurance is a national health insurance provided to seniors beginning at age 65.  Medicare pays for the basic health insurance needs of a senior and provides a sense of security as all seniors qualify for it (no rejections because of pre-existing conditions).  Seniors who have a very low income and nearly no assets can also transfer over to Medicaid, a program operated in conjunction with the federal and state governments.  Medicaid differs from Medicare in that it does pay for ongoing long-term care in a nursing home

Medicare was created when the life expectancy of an American was around age 72.  Today, a baby born in the U.S.A. can expect to live to be 100 years old.  The oldest senior, in fact, just passed away this month at age 116.  People are living longer and this means Medicare must pay for the health insurance for many more years than perhaps what was planned when the program was first developed.

As Congress debates the "fiscal cliff", one of the solutions was to delay the age until 67 for a senior to begin Medicare health insurance.

Today the Senate announced the White House was not in favor of moving the age requirement back for Medicare although the Republicans were holding on to this as a way to curb costs if they were going to finally give in to raising taxes on the very wealthy.

AARP, the association for American seniors, maintains a lobbying foot in Congress and keeps up on the latest developments as the debate continues.



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Medicare Recipients Saved $4.5 Billion on Prescriptions

Seniors on Medicare health insurance, which they receive at age 65, have saved more than $4.5 billion since the new provisions in the healthcare law took place in 2010, according to the Department of Health.

Previously, seniors with Medicare had experienced something called the "doughnut hole" where, just like the hole in a doughnut, there was a hole in reimbursements for medications during certain periods of their Medicare coverage, depending upon the type of medications and the dollar amount and their deductibles.  Yes our lawmakers had actually passed legislation that had such wacky reimbursements that it mirrored a doughnut - you were in the hole or out of the hole but it was very complicated to understand when you would be in the "hole' and not have prescription medications paid for by Medicare.

I participated in a focus group that was paid for by the Department of Health to find out if the prescription coverage with the donut hole was confusing - and everyone agreed it was extremely confusing.   Fortunately, the law was changed.  Drug companies do spend millions of dollars lobbying for Medicare coverage to go their way and that is what they even admitted happened to create the donut hole.

"We're seeing consistent, steady savings for seniors thanks to the health care law," said Jon Blum, director of the Center for Medicare. "In just 21/2 half years, seniors have seen billions in savings, and those savings will continue to grow as the doughnut hole is fully closed."

Drugmakers participating in Medicare agreed to give the government a 50% discount on premium drugs and 14% on generic drugs as part of the law, and the government passed those savings on to seniors.  In 2012, the coverage gap - or "doughnut hole" - is $2,930. The law eliminates that gap by 2020. So far, no research has shown that the drugmakers have passed costs from those discounts on to other consumers, as some opponents of the law had feared.

Clinical trials are another option for seniors, allowing those seniors who qualify based on their medical conditions, to participate in a drug study on new medications and to receive care and monitoring from the medical doctors who are administering the clinical trials.  Every medication on the market in the U.S.A. today was once part of a Clinical Trial study in order to be approved for sale by the FDA.

Check out Clinical Trials near you to see if you qualify for one of these drug studies for newer medications which may deliver positive results.


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Senior Care Costs: Medicare vs. Medicaid and Health Insurance for Caregivers

Senior care costs vary widely, based on which type of senior care health insurance a senior has received - Medicare or Medicaid.  As the presidential election gears into high speed, much talk and confusion is now filling the airwaves around Medicare and Medicaid insurance programs.

American seniors receive Medicare health insurance beginning at age 65, unless they qualify for Medicaid instead, as a very low-income senior.  You may review Medicaid financial qualifications in your state, as Medicaid is administered by each state in combination with federal money.  This is why Paul Ryan, the Republican Vice-Presidential candidate received health care and Social Security payments while he was a minor after the death of his father when he was age 16.  Paul Ryan also requested a grant for a community health center in Racine, Wisconsin, via the new healthcare law. 

This highlights the fact that candidates from both parties know that healthcare is a need for both those who are low-income as well as for seniors.  Moving past the political posturing, the facts are often somewhere in the middle.

Senior caregivers often do not have healthcare as a benefit - if they work part-time or as a direct-hire for a senior.  One benefit of the new healthcare law is the ability for everyone, including small business owners, to have access to affordable healthcare and the benefit of knowing that you will not be dropped from an insurance policy.

As unemployment remains high in the U.S.A., knowing you can both find and purchase individual health insurance and not be dropped from a plan just because you are not part of a group health insurance plan is a comfort to many Americans.  This also will be a comfort for senior caregivers who currently do not have health insurance.  A Caregiverlist survey found that more than 50% of all senior caregivers do not have health insurance.

Medicare's largest cost that can be easily trimmed is Medicare fraud which amounts to billions of dollars each year.  AARP supplies this report on questions to consider for candidates around Medicare.  Meanwhile, remember that senior caregivers often do not have access to health insurance right now.  One of the benefits of the new Affordable Care Act, called the O'bama Care law, is that everyone will have access to health insurance. 

Remember, too, that Medicare does NOT pay for long-term care while Medicaid DOES pay for long-term care in a nursing home.  Review nursing home costs nationwide to plan for your senior care needs.

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Mitt Romney Turns 65, Opts Out of Medicare, Social Security

Mitt Romney, GOP presidential hopeful, turned 65 on March 12 but has no plans to enroll in Medicare. Instead, the Republican front-runner will continue coverage through his private health-care plan.

Wealthier individuals, according to Mr. Romney’s campaign website, should pay more for government Medicare benefits, while lower-income seniors would receive more generous support. His plan would include a “premium support” contribution, allowing beneficiaries a choice between private plans and Medicare.

Social Security is another government benefit that the former Massachusetts is passing up. In response to Fox News host Neil Cavuto’s question if he was planning to sign up for Social Security on this, his eligible birthday, Mr. Romney emphatically declined. Citing the fact that retirement is far off, he stated, “I have no plans to retire at the current moment. I’m not going to be doing that anytime soon. I’m still very much in the work force, I hope.”

For both Medicare and Social Security eligibility, Mr. Romney proposes to “gradually raise the retirement age to reflect increases in longevity.” Beginning in 2022, the proposal would incrementally raise the eligibility age for both programs from 65 to 67 by one month per year.

How would the change affect beneficiaries today?

AARP Research & Strategic Analysis recently released Social Security State Quick Fact Sheets comprised of recently released 2010 data. In its findings, AARP shows that in 2009, more that one-third of the elderly population would be living in poverty if they did not receive Social Security benefits. Even in states where personal income is high, Social Security is the only income for a segment of the population.

How do you feel about delaying Social Security and Medicare benefits? While admirable from a personal (and political) standpoint, do you think Mr. Romney’s decisions and options are viable for the country at large? For information on your state’s services and resources, check your own individual Senior Services by State.

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Chicago Hospital CEO's Discuss New Healthcare Law

Chicago area hospital CEO's actually are welcoming the new healthcare law - - yes, it is not perfect, they admit, but it is a step in the right direction.  It is refreshing to hear the viewpoints straight from those who provide health care.

Crain's Chicago Business hosted the panel which included Pamela Davis, CEO of Edwards Hospital, Ramanathar Raju, CEO of Cook County Hospital, Sandra Bruce, CEO of Resurrection Health and Jim Skogsbergh, CEO of Advocate.

Some of the issues they all agreed upon:

Medicaid pays far less than the cost of care

Current Course is Unsustainable (people are living longer and Medicare not set-up to handle)

Social Issues and Obesity Impact Higher Care Costs

Unreimbursed Costs are Hindrance (Provena wrote off $124 million in unreimbursed costs last year)

Listen to this panel of hospital CEO's to learn more about the realities of the current healthcare system and why these CEO's are welcoming changes through the new healthcare law, with concerns that everyone may not be covered due to political wrangling.  They predict that hospitals of the future will be more accountable and efficient and integrative.  This means more integration of home care and physician care and accountability for outcomes.

Caregivers for seniors, many times, do not have health insurance under our current system and because many people never have healthcare until they retire and qualify for Medicare or Medicaid, health issues are allowed to escalaate.

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Doctors Soon Required to Report Payments from Drug Companies

Medical doctors often receive payments from drug companies for "consulting", speaking and conducting research.  Sometimes this is a good thing and sometimes, research has shown, this is not so good.  This then contributes to influencing treatment decisions and contributes to higher costs via more expensive drugs and medical devices.

For instance, blood pressure can be naturally lowered through diet and breathing exercises - naturally.  How many doctors prescribe daily relaxation breathing for their patients with high blood pressure?

Diabetics can also greatly influence their outcomes by proper diet and exercise - even up to 50% or more according to studies.

Now, the new health care law will require the medical doctors to disclose the payments they may receive from drug and medical device companies each year.  An analysis by the New York Times found that about a quarter of medical doctors take cash payments from drug and device makers and nearly two-thirds accept routine gifts of food, including fancy lunches and dinners for themselves and their staff.

And, doctors who accept these payment perks do prescribe more drugs than those who do not.

Under the new standards, if a company has just 1 product covered by Medicare or Medicaid, it will have to disclose all of its payments to doctors other than its own employees.  The federal governemtn will post the payment data on a website where it will be available for the public. This will hold everyone accountable.

Companies will be fined as much as $10,000 if they fail to report payments.  This should help curb Medicare and Medicaid fraud which has been as much as $6 billion in the past.

Senior caregivers should also report fraud when they see it, as they are the eyes for many seniors and their families.  Unneeded medical equipment and prescriptions have been popular ways for companies to tap into unnecessary Medicare and Medicaid reimbursements in the past.



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Health Care Reform Policy Debate Affects Seniors

Health care reform policy debate affects seniors
Summary: The health care policy options under debate could reduce costs and dramatically improve quality of long-term health care for seniors.
On Wednesday, Members of the Senate Finance Committee will debate health care policy options aimed at making the health care delivery system more effective and efficient. Many of the proposed options have a high potential to benefit the long-term care of seniors.
The policy options, released by Senate Finance Committee Chairman Max Baucaus (D-Mont.) and Ranking Member Chuck Grassley (R-Iowa), would create incentives for health care providers to focus on high quality care and to closely coordinate with a patient’s other doctors and providers. This is important for seniors who seek care from multiple doctors and risk doubling up on prescriptions that could have harmful interactions.
The proposed health care policy revisions, which will be debated in a closed-door hearing, also target changes in how private insurance companies bill Medicare patients, and are intended to reduce fraud, waste and abuse in the Medicare system.
The following details, as released by the Senate Finance Committee, reveal aspects of the health care policy options that would have a dramatic impact on seniors who receive continued care for chronic illness:
Promoting Quality Care: Medicare currently reimburses health care providers on the basis of the volume of care they provide. For every test, scan, or procedure conducted, providers
receive payment – regardless of whether the treatment contributes to helping a patient recover. Medicare must move to a system that reimburses health care providers based on the quality of care they provide. The policy options would shift Medicare from volumebased purchasing to valuebased purchasing. Under valuebased purchasing, Medicare would provide new payment incentives for care that contributes to positive patient outcomes. The policy options would establish a valuebased purchasing program for hospitals starting in fiscal 2012, direct CMS to develop plans to establish valuebased purchasing programs for home health and skilled nursing facility providers by 2012, strengthen and expand programs that will eventually lead to valuebased purchasing for doctors, reduce inappropriate ordering of imaging services like CT scans and MRIs, and start inpatient rehabilitation and longterm care hospital providers on a path toward valuebased purchasing program.
Promoting Primary Care: Primary care doctors are vital to reducing costs and improving quality in the health care system. Primary care doctors provide preventive care, help patients
make informed medical decisions, serve a critical care management role and help coordinate with other doctors. Despite their critical function, primary care doctors receive significantly
lower Medicare payments than other doctors, which has led to a shortage of primary care doctors. To encourage more primary care doctors to be part of the system, the policy options would provide primary care practitioners and targeted general surgeons with a Medicare payment bonus of at least five percent for five years, and provide Medicare payment to primary care practices that provide specific transitional care services for beneficiaries with high costs, chronic illnesses.
Fostering Care Coordination and Provider Collaboration: Today, many doctors want to spend more time working together, but report that current payment systems often discourage care coordination. When providers in different settings, like doctor’s offices, hospitals, nursing homes, and rehabilitation facilities work together, patients can get well sooner and costs in the
system are lower.
Chronic Care Management:To encourage chronic care management, the policy options will foster innovation by allowing broadscale Medicare pilot programs of patientcentered care
coordination models for the chronically ill that improve quality and reduce spending, and allow preliminary rapidcycle Medicare testing of evidencebased care management and coordination models across various settings to determine best models for success.
Provider Collaboration:To encourage hospitals and other health care providers to work together, the policy options will provide Medicare payment incentives to hospitals that reduce
preventable hospital readmissions, and provide a single bundled Medicare payment for acute and postacute episodes of care.
Payment for Accountable Care:To incentivize providers to improve patient care and reduce costs by offering patients access to care at a wide range of health care providers and settings, the policy options would address the impending cuts to physician reimbursement rates, allow highquality providers to share in savings they achieve to the Medicare program through increased collaboration, and expand Medicare participation in communitylevel health care delivery system reforms.
Quality Measure Development: The policy options will focus on quality measure development by requiring the Department of Health and Human Services to partner with stakeholders to
develop a national quality improvement plan and encouraging development of next generation quality measures that are aligned with delivery system reform goals like, for example, measuring
care coordination for chronically ill.
Health Care Workforce: Ensuring America’s health care system has a sufficient supply of health care professionals to meet the demands of a changing and aging population is essential to
maintaining focus on highquality, cost efficient care. To strengthen the health care workforce, the policy options would increase graduate medical education training positions for
primary care and implement other immediate modernizations to the Medicare GME program, and develop a proposal that requires Health and Human Services to work with external
stakeholders to develop and implement a national workforce strategy, in conjunction with the Senate Health, Education, Labor and Pensions Committee.
Medicare Advantage: Private insurers that participate in Medicare should bring value to the program and to beneficiaries. Health care reform should ensure payments to private insurers in the Medicare Advantage program bring high quality, efficient plans into the Medicare program. The policy options would use current measures to pay plans for quality improvement, change statutory benchmarks or set benchmarks based on competitive plan bids, provide a bonus payment to Medicare Advantage plans that use evidencebased programs to manage care of the chronically ill, and allow plans to continue to offer extra benefits, but reducing wide variation among plans.
Combating Fraud, Waste and Abuse: Reducing fraud, waste, and abuse in Medicare will reduce costs and improve quality throughout the system. The Medicare improper payment rate
for 2008 was 3.6 percent, or $10.4 billion, and the National Health Care AntiFraud Association estimates that fraud amounts to at least three percent of total health care spending, or more
than $60 billion per year. The policy options combat fraud, waste and abuse by enhancing the review of health care providers prior to granting billing privileges, leveraging technology to
better evaluate claims, educating providers to promote compliance with program requirements, monitoring programs more vigilantly, and penalizing fraudulent activity swiftly and sufficiently.
Caregiverlist provides a helpful breakdown for individuals trying to better understand what Medicare covers.
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