Can we make it about care again?

I thought about writing about the Diabetes Research Institute’s recent BioHub announcement, but there are already several excellent posts written on the subject. Instead, I’m going to put this piece up for you to consider. Sorry if it seems like I ramble a bit here… this is a multi-faceted subject, and it’s hard to concentrate on one part of it while ignoring everything else. At any rate, I hope this gives you something to think about, and I hope it gives you a little bit of a break from all of the DRI posts this week.

Over the weekend, I heard a rebroadcast of an interesting topic on Diane Rehm’s excellent radio show. It was about healthcare in the USA since the Affordable Care Act has been passed, what we can expect once a large slice of the law takes effect in 2014, and how the law itself doesn’t address the high cost of healthcare in my country, and why. Her guest was Steven Brill, who wrote a cover story for Time magazine on the subject. It’s a really good show and a great story, if you want to check it out:

Show: http://thedianerehmshow.org/shows/2013-03-03/us-health-care-costs-rebroadcast

Story: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

One of the points made by Mr. Brill on the show is that he believes that Medicare works pretty good for seniors (compared to the plans most of the rest of us deal with anyway), and most of all, it holds down costs. As a result, he thinks we might be better off if we just allowed everyone the opportunity to enroll in Medicare. I don’t know if this is a great idea or not, but it got me thinking.

Why do I care about this? To begin with, Medicare is where I’m headed in another 15 or 20 years. Also, it’s where you’re headed in the future, if you’re not there already.

So I thought I would look into it. I can’t say much with regard to whether Medicare’s costs are low or astronomical, but there is evidence that the rate of increase in costs for Medicare is nothing compared to the 97 percent increase in insurance premiums Americans have seen since 2002.

When it comes to what Medicare covers, and what it doesn’t cover, there’s a little more documentation. But surprisingly (my skepticism of government-run programs is legendary), there’s a fair amount in there for Seniors With Diabetes (SWD).

For instance… when you’re newly diagnosed, Medicare approves 10 hours of Diabetes self-management training in the first 12 months. Also, you get this training if you’ve already been diagnosed, but you’re going from oral medication to insulin therapy for the first time. I got about an hour’s worth of training back in 1991. What’s covered in the training? The basics about managing your BGs, your diet, and exercise. Also, these interesting bullet points: How to adjust emotionally to having diabetes, and the use of the healthcare system and community resources. By the time I’m eligible for Medicare, I hope this includes finding online support. In addition to the initial training, Medicare recipients are eligible to receive 2 hours of training per year after the initial training. Not sure what’s covered in that.

Now, let’s talk durable medical. On the one hand, Medicare will cover an insulin pump for you and cover 80 percent of the cost if your doctor prescribes it. On the other hand, if you’re on insulin therapy, Medicare will pay for up to 300 test strips every three months. That only allows you to test about 3 times per day. It’s even worse with non-insulin taking SWDs. If you’re like a lot of Type 2s and not on insulin, Medicare will approve up to only 100 test strips every three months. But there is this little caveat, from the online guide Medicare’s Coverage of Diabetes Supplies and Services:

“If your doctor says it’s medically necessary, Medicare will allow you to get additional test strips and lancets. “Medically necessary” means that services or supplies are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice. You may need to keep a record that shows how often you’re actually testing yourself.” So there is that.

On the bright side, your insulin is covered under Medicare part D if you’re on MDI (multiple daily injections). Part D is the prescription drug part of Medicare. If you’re using an insulin pump: Your insulin is still covered, but under the durable medical portion of Medicare part B. In case you’re wondering, they’ve gotten Medicare down to 4 parts:

Part A – Hospital coverage
Part B – Medical coverage, including durable medical supplies
Part D – Prescription drug coverage

Part C – Also known as Medicare Advantage. Offered by Medicare-approved private insurance companies, Medicare Advantage Plans are a way to get the benefits and services covered under Part A and Part B. Most Medicare Advantage Plans cover Medicare prescription drug coverage too. So if you have Part C coverage, you won’t need Part A or B, and you might not need Part D either. Confused yet?

And this is where I have to jump off of the information train for now. The more I read about Medicare, the more I worry about senior citizens in this country (including my parents). Keeping costs down is great, getting coverage for everyone at a time in their lives when they may be the most vulnerable is great, but confusing them with a lot of rules and websites and documents and other things is most definitely not great. Can we make it about caring for our seniors again?

I’m going to be a senior citizen in a couple of decades. I hope by then, coverage will be more universal (there… I said it). I hope we’ll have better access to care and drugs and therapies that will help us live great lives into our golden years. And I hope care for everyone, senior or not, will be determined by need and not by politics or the size of your estate.
 
 
Here are some great resources I found on Medicare and Diabetes…

From Diabetes Monitor:
http://www.diabetesmonitor.com/medicare

From the Centers for Medicare and Medicaid Services, Medicare’s Coverage of Diabetes Supplies and Services:
http://www.medicare.gov/Pubs/pdf/11022.pdf
 
 
 

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