June3 by RI ARA

RI ARA

Affiliated with the Rhode Island AFL-CIO “Fighting for the future of our members.” “NOW, more than ever!!!” Publication 2018 Issue 22 Published in house by the RI ARA

June 3, 2018 E-Newsletter

The Next Wave of Retirees Will Struggle Even More The increasing wage gap between the average worker and top earners will manifest in Robert Roach, Jr new ways when people reach retirement. A new study by the Center for Retirement Research at Boston College found that 56% and 54% of low- and middle-income families are unlikely to be able to maintain their pre-retirement standard of living once they reach retirement, the highest earners only face a 41% risk. There are many reasons for the shortfalls but the growing gap between the wealthiest

Americans and everyone else exacerbates the issues created by the increased use of defined contribution plans, such as 401(k)s, rather than defined benefit pension plans, which affects low income workers more. Income also tends to rise at a much slower rate for workers on the lower rungs of the economic ladder and employers who hire for lower wage jobs tend to not even offer a saving options.

The wage gap is part of a larger problem. While financial experts stress the importance of working longer and waiting to claim Social Security, but the incentives for low income workers are just not there. High earners have a longer life expectancy and the ability to work longer, allowing them to delay Social Security. In contrast, lower wage workers have a shorter life expectancy and tend to work labor intensive

jobs, giving them a reason to retire earlier and a much lower incentive to wait for their benefits. “This new study quantifies what we already knew, that the wage gap only gets harder for people once they hit retirement,” said Robert Roach Jr., President of the Alliance. “We need policies that allow everyone to have a secure retirement after a lifetime of hard work. We need to defend defined benefit pensions and ensure that they remain a key part of the retirement equation.”

TAKE ACTION Sign a Petition Grassroots lobbying is perhaps the most effective way to let YOUR Representative and Senators know your opinion. Whether you are calling into a local or Washington, D.C. office; sending a letter or e-mail; signing a petition; or making a personal visit, Members of Congress are the most receptive and open to suggestions from their constituents. Tell your leadership what is important to you - Sign a Petition  Petition to Congress: Put an End to Dramatic Increases in Prescription Drug Costs

 Petition to Congress: A Fair Cost of Living Adjustment(COLA) for Social Security Benefits  Petition to Congress: No Budget Deal that Sells Out America's Seniors  Petition to Congress Protesting Illegal Alien Amnesty and U.S. Social Security Totalization With Mexico  Petition to Congress in Support of Social Security Fairness  Petition to Congress in Support of a Social Security Guarantee  Petition to Congress in Support of Social Security Notch Reform Call Congress Any Toll Free call to Congress on the number 1-844-455-0045 will be paid for by The Senior Citizens League. Take a Survey Your answers to these surveys will help TSCL educate Members of Congress, the media and the public about the views, experiences, and challenges facing seniors as they relate to Medicare and Social Security. 2018 Senior Survey Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 riarajap@hotmail.com • http://www.facebook.com/groups/354516807278/

Medicare Part B premiums devouring many retirees' Social Security increase, survey shows For many of the 47 million older Americans on Social Security, getting a 2 per cent cost-of-living increase in their 2018 benefits has been a bust. More than 40 percent of the over-65 crowd say they have watched the extra amount get completely or mostly eaten up by the cost of Medicare Part B premiums, according to a recent survey by the Senior Citizens League. Specifically, 25 percent say that after the deduction for the premium, their check is unchanged. Another 18 percent say the increase has been less than $5. "They've had nothing left over to deal with other increased costs," said Mary Johnson, Social Security and Medicare policy analyst for the Senior Citizens League, which surveyed 1,116 retirees across the country earlier this year. The reason for the premiums devouring all or much of the extra Social Security amount is due largely to the so-called hold

harmless rule that's been triggered in recent years. For most retirees — about 70 percent of them — the rule prevents Medicare Part B premiums from rising more than their Social Security cost-ofliving adjustment, commonly called COLA. Higher earners, who pay extra for their premiums, are not protected by the hold harmless rule. (See chart for what higher earners pay.) Nor are certain others, including those who first sign up for Medicare right before an increase takes effect. For people affected by the provision, the rule means they won't see their Social Security check get lowered in any given year if paying more for Part B would reduce it. (The premiums are typically deducted from Social Security checks.) When the premium jumped to $134 in 2017 from $121.80 the

previous year, 70 percent of Medicare Part B enrollees instead paid an average of $109 due to already being held harmless in previous years with meager COLA increases. And although the Part B premium hasn't changed from last year's $134, the extra money generated from the 2 percent Social Security COLA for 2018 is going toward the difference between what most recipients were paying and the standard premium amount. Even for those whose checks are more than last year, just 7 percent said the boost is more than $25. "Social Security increases, even when they come, are not huge and don't really make any meaningful difference in quality of life," said Kathryn Hauer, a certified financial planner with Wilson David Investment Advisors.

The survey also showed that 7 percent of respondents said their check is lower. Johnson, of the Senior Citizens League, said those people have uncommon circumstances that led to a lower check, none of which are related to the hold harmless provision. Exactly whether retirees will be shelling out more from their Social Security checks next year for Part B depends both on whether those premiums rise and what the Social Security Administration determines the 2019 COLA will be. Last July the Medicare trustees report forecast that 2019 Part B monthly premiums will remain at about $134. After that, they are expected to rise about 5 percent each year through 2026. The Centers for Medicare and Medicaid typically announces the next year's premium amount in November. The 2019 Social Security COLA, meanwhile, is scheduled to be announced in October.

Shifting Drugs from Part B to Part D May Create Winners and Losers This week, Avalere Health, a Washington DC-based consulting firm that specializes in strategy, policy, and data analysis, released a study on the impact of moving the coverage of some drugs from Medicare Part B to Part D. While most drugs are covered under the Part D prescription drug program, Part B, the part of the Medicare program that covers outpatient medical services like office visits, covers a few. The drugs covered by Part B are usually ones that beneficiaries would not give to themselves. For example, if a provider administers the drug during an office visit, Part B instead of Part D, might cover that drug. Earlier this month, the Trump Administration announced it

would consider transitioning certain Part B drugs into Part D as part of a larger strategy to lower drug prices and out-ofpocket costs. This makes it essential to understand what effects the switch could have on people with Medicare. In their study, Avalere found that switching drugs from Part B to Part D could expose some beneficiaries to higher out-ofpocket costs, while reducing costs for others. Specifically, people with traditional Medicare who have supplemental “Medigap” coverage would likely pay more out-of-pocket, while beneficiaries without a Medigap policy could expect to pay less—especially if they are eligible for the Low Income Subsidy, often called “Extra

Help.” This means that some people with Medicare might benefit from the switch, while others might face increased costs. In addition, the switch might drive Part D premiums up, possibly while reducing Part B premiums in turn. Drug pricing and the costs people with Medicare face is a very complex interaction of personal factors such as income, health status, and the prescriptions an individual might buy. This makes determining who might win and who might lose from any given policy change very difficult. Avalere’s study takes an important step in our understanding of the impact this policy might have on Medicare beneficiaries. It is important to

note that the Avalere analysis does not attempt to quantify the effect of these changes on people enrolled in Medicare Advantage or people who are dually eligible for Medicare and Medicaid. Medicare Rights continues to study the Administration’s drug plan to understand the full impact proposed changes would have. Read the Avalere study report. Read more about the Trump Administration’s drug pricing strategy.

Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 riarajap@hotmail.com • http://www.facebook.com/groups/354516807278/

New Report Captures Medicare Part D in 2018, Identifies Long-Term Trends

A recent report from the Kaiser Family Foundation (KFF) examines Medicare Part D data from the Centers for Medicare & Medicaid Services (CMS). The resulting analysis presents findings on Part D enrollment, premiums, and cost sharing in 2018, as well as key trends over time. Here are some of the key trends: Part D enrollment continues to grow. The number of people enrolled in Part D has grown steadily since the program started in 2006. In 2018, 43 million of the 60 million people with Medicare have prescription drug coverage under a Medicare Part D plan. Of these enrollees, most (58%) are covered under a stand-alone prescription drug plan (PDP), but a growing share (42%) are in Medicare Advantage prescription drug plans (MA-PDs). Three Part D plans cover a majority of people with Medicare. In 2018, thr ee health insurance companies— UnitedHealth, Humana, and CVS Health—account for over half (55%) of all Part D (PDP

12 million low-income Part D enrollees (29%) receive subsidies that help them afford Part D coverage. In 2018, 1.2 million of these Low Income Subsidy (LIS) enrollees pay an average monthly premium of $26—or more than $300 per year—even though they may be able to obtain Part D coverage without any premium. The average premium LIS enrollees pay in 2018 is up 13% from 2017 and is nearly three times and MA-PD) enrollees, and two- enrollment while plans that the 2006 amount. thirds (67%) of all PDP decreased premiums saw higher This report’s analysis of enrollees. Notably, the proposed enrollment. Medicare’s current climate and mergers of CVS Health and Cost sharing varies greatly the program’s evolving Aetna, and Cigna and Express landscape will be helpful to for generic and brand name Scripts would result in further drugs. Most Part D enrollees Medicare Rights’ near- and consolidation of the Part D face modest cost-sharing long-term advocacy, education, marketplace. amounts for generic drugs, but and outreach efforts. In can face much higher cost particular, both the trends it Premiums continue to increase. PDP enr ollees ar e in sharing for brand name and non- identifies and the present-day plans with an average monthly preferred drugs, and a mix of snapshot it presents will be premium of $41 in 2018—a copayments and coinsurance for important as we continue to seek relatively modest 2% increase different formulary tiers. For opportunities to engage older over 2017, but an 11% increase example, for PDP enrollees, the adults and people with over 2015. Premiums for seven median cost sharing amount disabilities and inform future of the 10 most popular PDPs ranges from $1 for preferred policymaking. As always, our increased in 2018, and continue generics to $37 for preferred goal is to improve the program to vary widely—ranging brands, and a 40-50% and empower people with from $20 per month for Humana coinsurance rate for nonMedicare to evaluate and obtain Walmart Rx to $84 per month preferred drugs. the best, most affordable for AARP Medicare Rx coverage for their unique Many low-income Preferred. Of the top five PDPs, beneficiaries pay a monthly circumstances. plans with premium increases premium, even though they Read the KFF report. from 2017 to 2018 may be able to obtain coverage unsurprisingly saw a decrease in with no premium. More than

Medicare's stealth price hike Seniors are paying more for generics even though the drug prices haven't increased Here's a riddle about drug pricing to ask our healthcare administrators, including Health and Human Services Secretary Alex Azar: Since the prices of generic drugs haven't risen since 2011—in fact, in many cases have fallen—why have out-ofpocket costs for seniors on Medicare nearly doubled? What the insurers have been up to, according to Avalere, is moving many generic drugs into co-pay tiers that require patients

to pay larger portions of the drugs' cost. By shifting more costs onto patients this way, the insurers can keep Part D premiums stable. That's important to them, since they know that patients generally choose their Part D plans based on premiums. It's a classic baitand-switch, because only once they start filling prescriptions do the patients realize what their real costs are. The trend can deliver a real jolt to patients. Avalere says that total out-of-pocket costs for the same basket of generic drugs

increased by $6.2 billion, or 93%, from 2011 through 2015. In that period, average generics prices increased only 1%, and the volume of generics purchased rose by only 22%. The difference was almost entirely the result of higher copays charged per prescription by the insurers. If left unchecked, this practice will thwart any government initiative to hold drug prices down. One would hope regulators would be on top of this situation, because limiting the growth of generics prices is

a linchpin of the Trump administration's initiative on drug prices. The administration also says it's determined to hold down prices for Medicare beneficiaries. Yet in announcing the White House's drug pricing blueprint last week, HHS Secretary Azar soft-pedaled proposals for Medicare to take a firmer stand in negotiating with drug companies, and made no mention of co-pay policies in Part D….Read More

50 PERCENT OF RETIREES SAW LITTLE OR NO COLA INCREASE IN NET SOCIAL SECURITY BENEFITS THIS YEAR Despite receiving a2 percent cost-ofliving adjustment (COLA) in 2018 — about half of all people age 65 and over report that they received virtually no boost to their net Social Security benefit, after factoring in the deduction for steeply increased Medicare Part B premiums, according to a new survey by The Senior Citizens League. “Nearly 27 million Social Security recipients are going through a third consecutive year of no net increase in Social Security benefits,” says Mary Johnson, Social Security policy analyst for The Senior Citizen League. “Retirees aren’t just trying to live on a ‘fixed income,’ but a shrinking one,” Johnson says. The Senior Citizens League’s 2018 survey collected information from 1,116 retirees

Johnson notes. “After deducting for steeply rising Part B premiums, in 2018, that left little or nothing left over for other rising costs like home heating oil, food costs, especially for fresh fruits and vegetables, and out-of-pocket across the nation about the which has a relatively minimal medical costs,” Johnson impact of extremely low impact on Part B says. “This means retirees must COLAs, and the Social Security premiums. Since 2010, spend more from retirement “hold harmless” provision on however, the hold harmless savings, go into debt, or join benefit growth. The hold provision has been triggered on growing numbers who are harmless provision is triggered a nationwide basis an turning to safety net programs when the dollar amount of unprecedented four times. This or going without,” Johnson Medicare Part B premium occurred when inflation was so explains. increases more than the dollar low that no COLA was payable The Senior Citizens League amount of an individual’s in 2010, 2011, 2016, and a survey asked participants— COLA. The hold harmless COLA of just 0.3 percent was “Which of the following provision protects most (but not paid in 2017. amounts most closely resembles all) retirees’ net Social Security New research conducted by your monthly Social Security benefits from being reduced Johnson for The Senior Citizens benefit increase this year, when the dollar amount of an League found that, in 2018, the AFTER the Social Security individual’s annual COLA entire COLA was consumed by Administration’s deduction for increase is not sufficient to rising Part B premiums for the Medicare Part B premium cover the increase in the retirees with a Social Security increase?” See chart above for Medicare Part B premium. benefit of as high as $1,288 per the breakdown of how Normally, the provision month. “That’s just slightly participants answered ...Read affects only a tiny number of lower than the national More beneficiaries in any given year, ’average’ retiree benefit,”

 S. S. is LESS than I received in 2017  S. S. benefit is the SAME as I received in 2017  $0.10-$5.00  $5.10-$10.00  $10.10-$25.00  More than $25.00

7% 25% 18% 23% 20% 7%

Looking For Lower Medicare Drug Costs? Ask Your Pharmacist For The Cash Price. As part of President Donald Trump’s blueprint to bring down prescription costs, Medicare officials have warned insurers that “gag orders” keeping pharmacists from alerting seniors that they could save money by paying cash — rather than using their insurance — are “unacceptable and contrary” to the government’s effort to promote price transparency. But the agency stopped short of requiring insurers to lift such restrictions on pharmacists. That doesn’t mean people with Medicare drug coverage are destined to overpay for prescriptions. Under a littleknown Medicare rule, they can pay a lower cash price for prescriptions instead of using their insurance. But first, they

must ask the pharmacist about that option, said Julie Carter, federal policy associate at the Medicare Rights Center, a patient advocacy group. “If they bring it up, then we can inform them of those prices,” said Nick Newman, a pharmacist and the manager at Essentra Pharmacy in rural Marengo, Ohio. “It’s a moral dilemma for the pharmacist, knowing what would be best for the patient but not being able to help them and hoping they will ask you about the comparison.” A simple question could unlock some savings for millions of beneficiaries. But details may be hard to find: Medicare’s website and

annual handbook don’t mention it. “If you don’t know that there are a bunch of different prices that could be available at any given pharmacy, you don’t know what you don’t know,” said Leigh Purvis, the AARP Public Policy Institute’s director of health services research. Researchers analyzing 9.5 million Part D prescription claims reported in a letter in the Journal of the American Medical Association in March that a patient’s copayment was higher than the cash price for nearly 1 in 4 drugs purchased in 2013. For 12 of the 20 most commonly prescribed drugs, patients overpaid by more than 33

percent. Although the study found that the average overpayment for a single prescription was relatively small, Newman said he had seen consumers pay as much as $30 more than the cash price. And many beneficiaries may not know that if they pay a lower cash price for a covered drug at a pharmacy that participates in their insurance plan and then submit the proper documentation, insurers must count it toward their out-ofpocket expenses. The total of those expenses can trigger the drug coverage gap, commonly called the doughnut hole. (This year, the gap begins after the once the beneficiary has spent a total of $5,000.)...Read More

RI ARA HealthLink Wellness News

The First Warning Sign of Alzheimer's May Surprise You

This problem crops up long before any clinical diagnosis of the disease. We've all heard the stories of the grandma who got lost on her way home from the grocery store, or the great uncle who relies on GPS for the drive to his weekly doctor's appointment, but now there's research to back up

the anecdotal evidence that trouble finding your way around may indicate a much bigger problem. Problems navigating new surroundings crop up before memory loss, and long before any clinical diagnosis of the disease, according to a recent study published in the Journal of Alzheimer's Disease. Researchers at Washington University in St. Louis asked study participants to use patterns and landmarks to make their way through a maze on a computer,

the Huffington Post reports. The individuals were divided into three groups: early-stage Alzheimer's patients, undiagnosed people with early markers for Alzheimer's (considered "preclinical Alzheimer's"), and a control group of clinically normal people. The study showed that individuals with preclinical Alzheimer's had more difficulty learning the locations of objects. "These findings suggest that the wayfinding difficulties experienced by people with

preclinical Alzheimer's disease are in part related to trouble acquiring the environmental information," said senior author Denise Head, associate professor of psychological and brain sciences. While Head cautioned that the study has limitations, she explained that navigational tasks that assess cognitive mapping strategy "could represent a powerful tool for detecting the very earliest Alzheimer's disease-related changes in cognition."

Spotting Elder Abuse: Tips for Long-Distance Caregivers From a distance, it can be hard to assess the quality of your family member’s caregivers. Ideally, if there is a primary caregiver on the scene, he or she can keep tabs on how things are going. Perhaps you have already identified friends or neighbors who can stop in unannounced to be your eyes and ears. Sometimes, a geriatric care manager can help. You can stay in touch with your family member by phone and take note of any comments or mood changes that might indicate neglect or mistreatment. These can happen in any setting, at any socioeconomic level. Abuse can take many forms, including domestic violence, emotional abuse, financial abuse, theft, and neglect. Sometimes the abuser is a

disease, the older adult may become difficult to manage and physically aggressive, causing harm to the caregiver. This might cause a caregiver to respond angrily. But no matter who is the abuser or what is the cause, abuse and neglect are never acceptable responses. If you feel that your family member is in physical danger, contact the authorities right away. If you suspect abuse, but do not feel there is an immediate hired caregiver, but he or she continues a long-standing family risk, talk to someone who can can also be someone familiar. pattern. In others, the older act on your behalf: your parent’s Stress can take a toll when adult adult’s need for constant care doctor, for instance, or your children are caring for aging can cause a caregiver to lash out contact at a home health agency. parents, or when an older person verbally or physically. In some Suspected abuse must be is caring for an aging spouse or cases, especially in the middle to reported to adult protective sibling. In some families, abuse late stages of Alzheimer’s services. Signs of Self-Neglect Self-neglect describes situations in which older people put themselves at high risk. People who neglect themselves may have a disorder that impairs their judgment or memory. They may have a chronic disease. Knowing where to draw the line between a person’s right to independence and self-neglect can be hard. Here are some signs that may mean it’s time to intervene, although they can be hard to recognize during a short visit: • Hoarding • Failure to take essential medications or refusal to seek medical treatment for serious illness • Leaving a burning stove unattended • Poor hygiene • Not wearing suitable clothing for the weather • Confusion • Inability to attend to housekeeping • Dehydration

Shingles What Is Shingles? How Do You Get Shingles? Can You Catch Shingles? What Are the Symptoms of Shingles? How Long Does Shingles Last? Long-Term Pain and Other Lasting Problems Have a Rash? Go to the Doctor Should You Get the Shingles Vaccine? What Can You Do About Shingles? Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 riarajap@hotmail.com • http://www.facebook.com/groups/354516807278/

Dodging Dementia: More Of Us Get At Least A Dozen Good, Happy Years After 65 You’ve turned 65 and exited middle age. What are the chances you’ll develop cognitive impairment or dementia in the years ahead? New research about “cognitive life expectancy” — how long older adults live with good versus declining brain health — shows that after age 65 men and women spend more than a dozen years in good cognitive health, on average. And, over the past decade, that time span has been expanding. By contrast, cognitive challenges arise in a more compressed time frame in later life, with mild cognitive impairment (problems with

memory, decisionmaking or thinking skills) lasting about four years, on average, and dementia (Alzheimer’s disease or other related conditions) occurring over 1½ to two years. Even when these conditions surface, many seniors retain an overall sense of well-being, according to new research presented last month at the Population Association of America’s annual meeting. “The majority of cognitively impaired years are happy ones, not unhappy ones,” said Anthony Bardo, a co-author of that study and assistant

professor of sociology at the University of Kentucky-Lexington. Recent research finds that: Most seniors don’t have cognitive impairment or dementia. Of Americans 65 and older, about 20 to 25 percent have mild cognitive impairment while about 10 percent have dementia, according to Dr. Kenneth Langa, an expert in the demography of aging and a professor of medicine at the University of Michigan. Risks rise with advanced age, and the portion of the population affected is significantly higher for people over 85.

Langa’s research shows that the prevalence of dementia has fallen in the U.S. — a trend observed in developed countries across the globe. A new study from r esear cher s at the Rand Corp. and the National Bureau of Economic Research finds that 10.5 percent of U.S. adults age 65 and older had dementia in 2012, compared with 12 percent in 2000. Because the population of older adults is expanding, the number of people affected by dementia is increasing nonetheless: an estimated 4.5 million in 2012, compared with 4.1 million in 2000….Read More

Nonprofit Meal Delivery Groups: Not Just About Food Anymore THE CONCEPT IS SIMPLE: a healthy meal delivered to your door at little or no cost. It’s a lifesaver for about a million older adults in the U.S. who are unable to buy groceries and cook for themselves because they are homebound, sick or struggling financially. But meal delivery service, typically provided by nonprofit groups, is evolving to include far more than dinner. “We’re not just here to deliver food. We’re here to help people live longer,

healthier, more independent lives,” says Elaine Clark, CEO of Meals On Wheels Diablo Region in Walnut Creek, California. About the Providers Daily or weekly meal delivery usually comes from charity kitchens, senior centers or spiritual organizations. Some nonprofits receive federal funding through the Older Americans Act, as well as from state or local governments,

while others operate only on private donations. Some groups use the name Meals On Wheels, but they’re not all part of one national organization. Every senior nutrition or Meals on Wheels program across the country operate independently. “We don’t own the phrase ‘Meals on Wheels.’ It grew out of such a grassroots movement that our organization was actually established after many

of these community programs were already using it,” explains Jenny Bertolette Young, vice president of communications for Meals On Wheels America, which acts as a trade association for about a thousand organizations that choose to be members. Regardless of the name, there are about 5,000 communitybased senior meal programs in the U.S., according to Bertolette Young….Read More

Safe Use of Medicines for Older Adults Medicines help us live longer and healthier. But, taking them the wrong way or mixing certain drugs can be dangerous. You need to be careful to keep track of your medicines and use them safely. What Are Medicines? What Are Drugs? Medicines, often referred to as drugs, can be:  Prescriptions. What you can get only with a doctor’s order (for example, pills to lower your cholesterol or an asthma inhaler)  Over-the-counter pills,

liquids, or creams. What you buy without a prescription (for example, pills for headaches or chew tablets for heartburn)  Vitamins, eye drops, or dietary supplements. Questions to Ask Your Doctor About a New Medicine  What is the name of the medicine and why am I taking it?  What medical condition does this medicine treat?  How many times a day should

 

I take it? At what time (s)? If the bottle says take “4 times a day,” does that mean 4 times in 24 hours or 4 times during the daytime? How much medicine should I take? Should I take the medicine with food or not? Is there anything I should not eat or drink when taking this medicine? How long will it take this medicine to work? Will this medicine cause problems if I am taking other

medicines?

 Is it safe for me to drive while

taking this medication?  What does “as needed” mean?  When should I stop taking the

medicine?  If I forget to take my

medicine, what should I do?  What side effects can I

expect? What should I do if I have a problem?  Will I need a refill? How do I arrange that? Each time you visit your doctor, be sure to ask if you still need to be on all your medications….Read More