Medicare Open Enrollment

It is that time of year for Medicare Open Enrollment!  The Open Enrollment period goes from October 15th ending December 7th.  There are changes this year that you should be aware of when making decisions about your coverage.

The Medicare Advantage Disenrollment Period (January 1 – February 14 every year) will be replaced with a different arrangement. This will be effective starting in 2019, according to the Centers for Medicare & Medicaid Services (CMS).

The Medicare Advantage Disenrollment Period lets you drop your Medicare Advantage plan and return to Original Medicare (Part A and Part B). It also lets you sign up for a stand-alone Medicare Part D Prescription Drug Plan.

In 2019, a new Medicare Advantage Open Enrollment Period will run from January 1 – March 31 every year. If you’re enrolled in a Medicare Advantage plan, you’ll have a one-time opportunity to:

  • Switch to a different Medicare Advantage plan
  • Drop your Medicare Advantage plan and return to Original Medicare, Part A and Part B
  • Sign up for a stand-alone Medicare Part D Prescription Drug Plan (if you return to Original Medicare). Most Medicare Advantage plans include prescription drug coverage already. Usually you can’t enroll in a stand-alone Medicare Prescription Drug plan if you already have a Medicare Advantage plan, but there are some situations where you can. Call your Medicare Advantage plan if you have questions.
  • Drop your stand-alone Medicare Part D Prescription Drug Plan


Here are seven improvements to Medicare that that AARP has identified.  They will take effect in 2019. Some of the changes will affect all beneficiaries while others will apply just to individuals who select Medicare Advantage plans.

Donut hole 

An expensive element of the Medicare Part D prescription drug benefit requires enrollees with high prescription costs to pay more for their medicines after they reach a certain level of spending in one year. This creates a coverage gap – also called the “donut hole.” After a beneficiary’s out-of-pocket spending reaches a second threshold, they enter catastrophic coverage and pay substantially less. Under the Affordable Care Act (ACA), the donut hole was scheduled to close in 2020. But the spending bill Congress passed in March will close the donut hole for brand-name drugs in 2019. The gap will close for generic drugs in 2020.

Therapy cap gone

Beneficiaries of original Medicare won’t have to pay the full cost of outpatient physical, speech or occupational because Congress permanently repealed the cap that has historically limited coverage of those services.

Better information

Medicare is updating the handbook it sends to beneficiaries every fall. It will include checklists and flowcharts to make it easier to decide on coverage. The online Medicare Plan Finder tool will be easier to use and an improved “coverage wizard” will help enrollees compare out-of-pocket costs and coverage options between original Medicare and Medicare Advantage.

More telemedicine

Medicare is steadily broadening the availability of telehealth programs that let patients confer with a doctor or nurse via telephone or the internet. In 2019, it will begin covering telehealth services for people with end-stage renal disease or during treatment for a stroke.

Lifestyle support

Beginning in January, Medicare Advantage plans have the option to cover meals delivered to the home, transportation to the doctor’s office and even safety features in the home such as bathroom grab bars and wheelchair ramps. To be covered, a medical provider will have to recommend benefits such as home-safety improvements and prepared meals.

In-home help

Medicare Advantage plans also will have the option to pay for assistance from home health aides, who can help beneficiaries with their daily activities including dressing, eating and personal care. These benefits represent a revised and broader definition of the traditional requirement that Medicare services must be primarily health related.

Plan test drives

New regulations will let people try an Advantage plan for up to three months and, if they aren’t satisfied, they can switch to another Medicare Advantage plan or choose to enroll in original Medicare. Congress required this flexibility in the 21st Century Cures Act, designed to accelerate innovation in health care.


Domestic Violence among Older Adults

When I used to think of domestic violence I would picture a 20 or 30 something couple fighting over a myriad of marital woes.  I thought about spousal abuse and child abuse.  I did not think about older adults.  I was wrong!

Domestic violence (DV) is defined as an intentional infliction of harm to another family member, without regard for that person’s rights or safety (Flannery, 2003).  This includes physical or verbal harm related to sexual abuse, financial exploitation, neglect, intimidation or verbal abuse as well as physical aggression.

DV does not discriminate and crosses all ages, ethnicities, genders.  DV late in life is more common among women.  One study showed that 25% of the women with a lifelong partner experienced abuse.  39% of those women described severe sexual abuse and 70% reported severe non-physical abuse (Bonomi, 2007).

One factor that adds to abuse among older adults is dementia.  Stressed out caregivers are more likely to be abusive.  There are so many factors that add to this.  The caregiver may feel the frustration of watching a family member slowly slip away.  There may be a financial drain, a sense of isolation from other family members and friends, and a physical and emotional drain from the day to day requirements of caregiving.  Caregivers in need should reach out to their local Alzheimer’s Association.

If you suspect DV of an older adult is occurring call Adult Protective Services (APS) immediately.  Each county has an APS office to investigate abuse.

Older Adults: Emergency Preparedness for Natural Disasters

One month ago, this region underwent extensive rainfall and potential flooding. Yuba and Sutter counties experienced mandatory evacuations due to the potential that Oroville Dam would fail. 200,000 people were evacuated. Evacuations are scary and difficult. It is more of a challenge for older adults and caretakers to prepare for disasters and possible evacuation.

Many older adults live alone and may have special needs or limited physical mobility, which makes them more vulnerable than younger people when there is disaster. Therefore, it’s all the more important to take steps to prepare for an emergency by evaluating the specific challenges faced by older adults and making an emergency plan to fit their needs.

The following checklist is a helpful tool to help older adults (and those who love and care for them) prepare for a disaster:

Make a Medical Plan

-Medical facilities may not be available. Talk to your doctor about an emergency plan to access medication and other treatments, such as dialysis.

-Keep a current file of your medical history and medication. Make sure a family member or friend has a copy.

Prepare a Disaster Kit

-Have the supplies you need on hand in case you have to evacuate or manage on your own for a period after a disaster, including:

-Enough food, water, medication and other supplies for 72 hours.

-Important documents: health insurance cards, insurance policies, power of attorney.

-Cash to purchase emergency supplies.

Plan for an Evacuation

-Find out if you live in an evacuation zone.

-Locate nearby shelters. Research pet friendly shelters if you have pets

-If you are unable to drive, identify who can provide transportation.

-If you have physical limitations identify who can assist you in an evacuation.

-Create a network of support (neighbors, friends, co-workers, community members) what can help you in an emergency. Share your plan with them.

Above all, when the evacuation order is issued GET OUT! Do not stay behind!