The Donut Hole is Closed!

The year 2019 is here, and there is some good news to those who have had experience with the Medicare Part D “donut hole.” Since the passage of the Affordable Care Act in 2010, the “donut hole” has been on track to close by 2020. Due to the passing of the Bipartisan Budget Act of 2018, which stopped last year’s nine-hour shutdown of the federal government, the Part D “donut hole” has actually closed a year ahead of schedule.

Photo by Patrick Fore

Medicare, one of the publicly funded health insurance programs for people over 65 or people younger than 65 with a qualifying health condition, is divided into four parts. This can be confusing for those who are newly eligible trying to find what the differences are and what benefits they will end up having.

 

Medicare Part A is hospital insurance. This part of Medicare provides you a place to stay with meals while you receive medical services whether at a hospital, hospice, or skilled nursing facility.

Medicare Part B is for medically necessary outpatient procedures. This covers a portion of doctor office visits, lab testing, diagnostic imaging, preventive care, surgeries, ambulance rides, chemotherapy and radiation, and even extensive dialysis care for people with renal failure.

Medicare Part C, also known as Medicare Advantage, is private plans that can be purchased in place of Medicare. Patients can get their Part A, Part B, and sometimes also Part D all from one insurance carrier. Advantage plans usually has a network of providers from whom you will be able to seek your care. Part C plans can often have lower premiums, but patients pay more copays as you go along so they are not necessarily cheaper over the long term.

Medicare Part D covers prescription medications. Unlike Parts A and B, patients do not enroll for Part D through Social Security but instead select an optional plan that are offered through private insurance companies.

Basic Medicare Part D coverage works like this:

  • You pay out-of-pocket for monthly Part D premiums.
  • You pay 100% of your drug costs until you reach the $415 deductible amount.
  • After reaching the deductible, you pay 25% of the cost of your drugs, while the Part D plan pays the rest, until the total you and your plan spend on your drugs reaches $3820.
  • In the past, once you reach this limit you would hit the coverage gap or “donut hole.” You are now responsible for the full cost of your drugs until the total spent reaches the yearly out-of-pocket spending limit of $5100.
  • After this yearly spending limit, those covered by Part D are only responsible for a small amount of the cost, usually 5% of the cost of their drugs.

 

The gap in prescription drug coverage under Medicare Part D has been referred to as the “donut hole.” In 2019, once you reach $3820 in prescription drug costs (which include both your share of covered drugs and the amount paid by your insurance), you will be in the “donut hole” coverage gap.

Starting this year, the “donut hole” has closed so much that those covered will get the same 75% discount on brand-name drugs and a slightly lower 63% discount on generic prescription drugs while you are in the coverage gap. When your total out-of-pocket costs reach $5100, you qualify for “catastrophic” coverage. At that point, you are responsible for only 5% of your prescription drug costs for the remainder of the year.

 

The closure of the “donut hole” is a relief to those who have lived in the gap who were often unable to afford their medications. For those looking for more information about Medicare, each state in the U.S. has a State Health Insurance Program (SHIP) that provides free one-on-one telephone counseling and advice services, personal face-to-face counseling sessions, public education programs and media presentations. Most SHIP counselors are volunteers who have received extensive training and are well versed with all facets of the Medicare program, including Part D. NeedyMeds has a directory of all SHIP sites.

Making the Self-Care Commitment, One Step at a Time

There’s no better time than right now to invest in your health. Odds are you do it every day — even if you don’t know that’s what you’re doing.

From taking over-the-counter (OTC) medication for headaches, to setting weight loss goals or wearing a fitness tracker, most of us practice self-care every day without realizing it. New research from BeMedWise details just how common self-care is.

Among the report’s 2,000+ survey respondents:

  • 92% desire more control over their health
  • 89% say they know where to find answers to health questions or concerns
  • 80% feel the need to manage their health now more than ever before
  • 88% express confidence in making their own health decisions 

The full report, titled “Empowering Americans to Take Greater Responsibility for Their Health,” examines how self-care can improve an individual’s health while also reducing medical costs.

It comes at a time where 6 in 10 U.S. adults are living with a chronic disease. Chronic conditions like diabetes, heart disease, cancer, and depression together account for 90% of our $3.3 trillion healthcare budget.

However, the U.S. economy could save an estimated $6.6 billion if just 10% of those with a chronic disease adopted self-care practices.

Below, we’ll describe what self-care is and why it’s having a hard time catching on. Then we’ll send you off  with some of our favorite free self-care resources to help you start the new year off right!

What is self-care?

Self-care can include many different types of activities. At a general level, self-care refers to any deliberate decision or action to promote wellness in ourselves. More broadly, it’s our ideas about and attitudes toward taking care of health problems.

Specific self-care routines vary from person to person. Common forms of self-care include:

  • Finding answers to health questions on the internet or in pamphlets
  • Scheduling regular appointments with a medical professional
  • Eating fresh fruits and vegetables
  • Taking medication as prescribed
  • Maintaining social ties with loved ones
  • Getting a good night’s sleep
  • Avoiding tobacco, illicit drugs, and excessive alcohol use
  • Staying physically active
  • Washing your hands
  • Setting aside downtime every day 

Some self-care routines like washing your hands and brushing your teeth seem culturally ingrained here in the U.S. Unlike countries like Canada and Japan, however, the United States has yet to embrace self-care as an essential part of its healthcare system despite public and institutional support — a mistake that costs us billions every year.

So why isn’t self-care more of a national priority?

Barriers to self-care

In a 2013 paper, the Institute of Medicine included self-care as one of the four pillars of healthcare, where patients actively partner with healthcare professionals to make decisions about their health.

Despite its importance in a functioning healthcare system, BeMedWise’s report exposes our nation’s slow adoption of a self-care mindset. The report attributes that lag to several personal and institutional barriers including:

  • Inconsistent definitions of self-care
  • Low health literacy in medically underserved communities
  • Lack of public interest
  • Confusion about the right time to practice self-care
  • Widespread belief that healthcare professionals will prescribe more effective therapies
  • Concerns about wasting a healthcare professional’s time with questions 

These problems, while prevalent, are neither permanent nor impossible to fix. Below, we’ll look at the report’s conclusions on how to overcome self-care barriers.

6 ways to break down self-care barriers

Advancing our self-care culture requires a national commitment. Practically speaking, that means investing in public outreach, facilitating convenient ways to practice self-care, and supplying healthcare workers with the necessary resources to educate patients.

After consulting advisors from professional societies, health organizations, government agencies, and industry leaders, BeMedWise spells out six national priorities to ensure wider self-care adoption in the U.S.:

  1. Elevate self-care as an essential component of health care
  2. Agree on a common definition of self-care to unite the public health community
  3. Mount a sustained national awareness campaign that empowers Americans to make self-care decisions at different life stages
  4. Address the self-care information needs of Americans with low health literacy
  5. Create a supportive environment for health professionals to advance self-care
  6. Address roadblocks to greater self-care practices 

You can about learn more about each one by checking out the full report from BeMedWise.

Free self-care tools and resources

Ensuring a proper self-care culture requires buy-in at all levels; politicians, advocates, healthcare workers, and patients each have a role to play. But what does that mean for your daily routine? Where do YOU begin?

To help you answer that question, we’re providing some of the best free self-care apps, websites, and other resources to get you thinking about your own wellness.

 

Mobile Apps

  • NeedyMeds Storylines is a free self-care app that makes it easy for you to track and manage your health conditions. This customizable tool features a medication reminder, mood and symptom trackers, information on patient assistance programs, and can be integrated with your wearable fitness device.
  • MyFitnessPal is another mobile app that tracks your diet and exercise. Produced by Under Armour, it includes a database of more than 6 million foods, allows you to log workouts and meals, and even counts your steps.
  • Sleep Cycle is a sleep-management app that analyzes your unique sleep pattern, claiming to wake you when you’ll feel most rested.
  • Insight Timer, the Apple store’s top-rated free meditation app, includes more than 4,000 guided meditations along with other talks and podcasts.
  • SoberGrid is an addiction recovery app focused on community. Features include 24/7 live peer coaching, daily check-ins, progress tracking and sharing, and the ability to find local members near you.
  • SuperBetter is a play-based app designed to help users increase resilience by following through on personal goals and challenges.

Websites

More Resources

(With permission from the American Pharmacists Association, this blog was adapted from “In report, NCPIE seeks to advance U.S. self-care movement,” Pharmacy Today, May 2018, Volume 24, Issue 5, Page 20).

NeedyMeds does not endorse or recommend any commercial products, processes, or services. The views and opinions of authors expressed may not be used for advertising or product endorsement purposes.

State of Healthcare 2018

Healthcare in America and Americans’ access to healthcare have faced changes in 2018. There have been Medicaid eligibility changes, laws proposed and promises made to reduce drug costs, as well as public health concerns highlighted such as gun violence. People in the United States continue to count healthcare costs as a major concern.

We at NeedyMeds prefer to remain apolitical, but it is difficult to avoid the partisan nature of the changes in healthcare in America. The effort to undermine the Affordable Care Act (ACA; aka Obamacare) was continued with the expansion of short-term health insurance with lower premiums but high out-of-pocket costs and low benefit coverage, weakened benefit standards, cutting the ACA outreach advertising budget by 90%, and a federal court ruling the healthcare law unconstitutional after the Department of Justice declined to defend against the case. The changes have contributed to the rising uninsured rate and costs of care, the loss of benefits for those who need them, and fewer people participating in Open Enrollment. If the federal court’s decision were implemented, it would cause millions of people to lose health coverage and make coverage worse or less affordable for millions more. In the meantime, it is likely to result in confusion, uncertainty, and anxiety for people who depend on the ACA for access to health coverage and care. For now the healthcare law remains in place, pending appeals.

 

Other changes to U.S. healthcare this year have made it more difficult for people to access care and information. The Department of Health and Human Services (HHS) began approving work requirements for Medicaid requested by states. Arkansas, Indiana, Kentucky, New Hampshire, and Wisconsin have had their new requirements approved, and eleven more have their waivers pending. The changes in policy puts more bureaucratic barriers to cross for those who now have to prove they work, are looking for work, or are exempt from the work requirements. Nearly 17,000 people have lost Medicaid coverage in Arkansas alone due to the work requirement.

In January the HHS Office of Civil Rights changed course from its mission of protecting patients’ rights and formed the Conscience and Religious Freedom Division to protect healthcare workers who would use their religious beliefs as basis to discriminate against patients, jeopardizing the care of pregnant women and LGBTQ individuals as well as others who could be denied certain procedures. Government websites have also removed or altered pages with information regarding women’s health, environmental impacts on health, discrimination protections, and much more.

 

Some legislation has affected drug prices this year. One piece of good news is The Know the Lowest Price Act and the Patients’ Right to Know Drug Prices Act. Passed by Congress and signed into law this past October, this legislation bans the use of “gag clauses” that prohibit pharmacists from telling patients that lower prices for their prescription are available.

President Trump gave a speech in May with proposals to reduce prescription costs, such as pressuring pharmaceutical companies to include the price of medications in their advertising or publicly shaming companies that increase prices or keep costs high for patients. Market experts saw little potential that the proposals would have an impact on out-of-pocket costs for patients at the time. This week, 28 pharmaceutical companies announced plans to start raising prices on prescription drugs starting in January 2019.

 

As said, we at NeedyMeds prefer to remain apolitical—we work in a diverse office with people of varying backgrounds and views—but we believe in being informed and that those in need deserve care. It should be clear that NeedyMeds supports improved access to care as well as lower costs for medications and healthcare services for all.


NeedyMeds also encourages Americans to be active in the legislative process. The 116th Congress will be seated in the new year; if you have an opinion on the future of the health care or other important issues in the United States, call 202-224-3121 to reach the U.S. Capitol switchboard; from there you can be connected to your elected House Representative or Senator’s office.

NeedyMeds will continue to provide information as the need for assistance navigating the often expensive landscape of healthcare rises. The NeedyMeds website has databases of Patient Assistance Programs (PAPs), Diagnosis-Based Assistance (DBAs), and Free/Low-cost/Sliding-scale Clinics to help those in need. The NeedyMeds Drug Discount Card can save users up to 80% off the cash price of prescription medications for those without insurance or choose to use the card instead of insurance. In addition to the plastic card, the card is available in a printable form or the NeedyMeds Storylines smartphone app for Apple and Android devices. For more help finding information, call our toll-free helpline Monday-Friday 9am-5pm Eastern Time at 1-800-503-6897.

America’s Love Affair with the Car – and Medicines – Can Be Deadly  

First, some recent, eye-opening facts:

  • In the US there are over 276 million registered vehicles with 222 million drivers holding a valid license. Of this number, nearly 43 million are 65 or older. That’s roughly one in every five.
  • 40,100 people died in accidents involving motor vehicles in 2017 a 1 percent drop from the year before.
  • Almost a third of traffic fatalities involve drivers who were impaired by drugs or alcohol, according to data from the National Highway Traffic Safety Administration (NHTSA).
  • According to NHTSA there were 795 fatalities that were drowsy-driving-related in 2017.

 

Adding Medicines into the Mix

Often people use more than one medicine at a time. The combination of different medicines can cause problems for some people. This is especially true for older adults because they use more medicines than any other age group. Due to changes in the body as people age, older adults are more prone to medicine related problems. The more medicines you use, the greater your risk that your medicines will affect your ability to drive safely.

If someone has a couple of glasses of wine with dinner, he or she will probably feel impaired and know not to get behind the wheel. But many people could be unwittingly taking medications that may slow their coordination and responsiveness or increase fatigue—making it dangerous to drive. The following broad categories of medications can impair the ability to drive:

  • Anxiety and depression medications
  • Products containing codeine
  • Some cold remedies and allergy products, particularly those that help you sleep; decongestants and cough suppressants
  • Tranquilizers
  • Sleeping aids
  • Narcotic pain relievers
  • Diet aids
  • Stimulants

In particular, consumers need to be knowledgeable about the adverse effects of two frequently used medicines – sleeping aids and antihistamines.

It is well known that sleeping aids can cause problems when driving. Pharmacists recommend that patients using sleeping aids know to take most of these medications when they will be able to sleep for a full 7 to 8 hours. If it is a new prescription, it is recommended that it be taken on an evening when no driving is planned the next morning. FDA has even recommended that people don’t drive the day after taking sleep aids such as Ambien (zolpidem) and Lunesta (eszopiclone).

Consumers taking antihistamines should avoid using alcohol, sleeping aids, and tranquilizers if they plan to drive.

 

Tips about taking medications that may affect driving

Most people can drive safely if they are using medications. It depends on the effect those medicines – both prescription and over-the-counter – have on your driving. In some cases you may not be aware of the effects. But, in many instances, your doctor can help to minimize the negative impact of your medicines on your driving in several ways. Your doctor may be able to:

  • Adjust the dose;
  • Adjust the timing of doses or when you use the medicine;
  • Add an exercise or nutrition program to lessen the need for medicine; and
  • Change the medicine to one that causes less drowsiness.
  • Patients who have conditions such as high blood pressure, anxiety, Parkinson disease, or liver problems — particularly if taking more than one medication – should be aware of potential interactions that could inhibit their driving.
  • Take only the prescribed dosage of any medication that may cause drowsiness or impair driving. If the medication isn’t effective, check with the physician instead of adjusting it on their own.
  • Monitor reactions to new medications. Does it make you tired, affect your vision, or make you dizzy, faint, or inattentive? If so, how long does it take to “kick in”?
  • If a medication(s) are affecting you, talk to your physician, who can adjust the dosage, change the time when it is taken, or try another medication that doesn’t cause problematic symptoms.
  • Never combine medication, alcohol, and driving.

 

What You Can Do

To help avoid problems, it is important that at least once a year you talk to your doctor, nurse, or pharmacist about all the medicines – both prescription and over-the-counter – you are using. Also let your doctor know what herbal supplements, if any, you are using. Do this even if your medicines and supplements are not currently causing you a problem.

 

Check out how medications may affect safe driving

Eight out of ten older adult drivers age 65 and older take medications on a regular basis. And despite high prescription and over-the-counter medication use, almost half of older adult drivers using medications have never talked with their health care providers about how the drugs might affect their safe driving abilities. Roadwise Rx is a free online tool from the AAA designed to help drivers and their families understand common side effects of prescription drugs, over-the-counter medications and herbal supplements.  It also flags interactions between these medications that can impact safety behind the wheel. Print the free list and report, then discuss the confidential results with your doctor or pharmacist to learn how to mitigate possible crash risks.

 

(With permission from the American Pharmacists Association, this blog was adapted from Awake at the wheel: Certain scrips mean no trips, Pharmacy Today, July 1, 2014).

AIDS/HIV Awareness

World AIDS Day—which became the first ever global health day in 1988—recognized 30 years this past December 1st. Since HIV/AIDS became a public health concern in 1981, over 35 million people have died from AIDS-related complications worldwide. An estimated 940,000 people died from HIV-related causes in 2017 alone. At the beginning of 2018, approximately 36.9 million people were living with HIV, with 1.8 million newly diagnosed in the year prior. The World Health Organization (WHO) estimates that only 75% of people with HIV are aware of their status.

AIDS (Acquired Immune Deficiency Syndrome) is the advanced stage of HIV (Human Immunodeficiency Virus) which can be transmitted through the exchange of bodily fluids, most commonly through sexual contact or transfusing blood unsafely (i.e., intravenous drug use) with someone who is infected. A mother could also transmit the virus to their child during pregnancy, birth, or breastfeeding. The HIV infection attacks the immune system until an opportunistic infection such as certain kinds of pneumonia, toxoplasmosis, as well as rare cancers and brain illnesses are contracted, at which time the diagnosis has progressed to AIDS. There is no cure for HIV or AIDS, though there are life-extending treatments.

In the US, 1.1 million people were living with HIV in 2015 (the most recent year the information was available)—with over 15% of whom were unaware. In late 2017, President Trump fired the Presidential Advisory Council on HIV/AIDS (PACHA) which concerned advocates believe is part of an “effort to erase LGBTQ people.” The mass dismissal followed six members resigning the previous summer, citing the Trump administration’s apparent disinterest in helping the HIV/AIDS community. This year the Trump administration has proposed eliminating funding for AIDS Education and Training Centers (AETCs) and Special Projects of National Significance (SPNS), as well as cutting funds for the Housing Opportunities for Persons with AIDS (HOPWA) program, and domestic HIV/AIDS research and prevention efforts. AETCs and SPNS are essential for pioneering, evaluating, and implementing innovative HIV care models for vulnerable populations that are disproportionately affected by HIV including transgender women, gay men, and people of color; HOPWA gives grants to states, nonprofit organizations, and local communities to fund projects that help low-income people living with HIV find and maintain affordable housing.

World AIDS Day may be once a year, but you can still support people living with HIV all year. While others work towards an AIDS-free generation, NeedyMeds has information for those looking for help with a diagnosis. In a previous blog post we have outlined Ryan White HIV/AIDS Programs . The NeedyMeds website also has a Disease Information Page for HIV/AIDS with links to other resources . There we list the medications often prescribed, some of which offer drugs at low- or no cost through Prescription Assistance Programs. For those ineligible for a program’s unique guidelines, the NeedyMeds Drug Discount Card is available to help save patients money on their medication. We also link users to the Diagnosis-Based Assistance available for those in need and camps for those affected by the illness. For more help finding information, call our toll-free helpline at 1-800-503-6897 available Monday through Friday 9am to 5pm Eastern Time.