Opuscula Selecting the right Medicare plan for you

 

First things first: FINDING PLANS IN YOUR AREA.

The best source of approved Medicare plans in your geographic area is the Medicare.gov web site: https://www.medicare.gov/

Now, ASKING THE IMPORTANT QUESTIONS

Q1: Do you have a specific physician - primary care or specialists - that you feel you must have?

If YES, then compare only those plans that include that physician.

The easiest way to find out is to call the plan's toll-free number and ask: "Is Dr. (insert name) on the providers' list?"

Lesson learned the hard way Ask if the primary care physician (PCP) is capitated. That means while a doctor you want to see may be on the plan's Provider List (more on that later), the PCP may be limited to only a few of the practitioners on the list; if the doctor you want is not on the particular PCP's list, you cannot be referred to that doctor; referrals are allowed only to those practitioners on the PCP's personal list.

Q2. Do you have any specific medications that have no substitutes?

Check with a PHARMACIST - not a doctor or nurse - about alternatives for the medication you are taking. Pharmacists usually know better than doctors, nurses, pharmacy reps, and your Great Aunt Tillie when it comes to medicines.

If YES, check with the plans you like to assure the plan's FORMULARY (drug list) includes the drug(s) you are taking. Also check the drug's LEVEL (typically 1 through 4; each level being more expensive) and what your co-pay will be for a 30-day and 90-day supply.

The easiest way to find out is to call the plan's toll-free number and ask: "Is drug (insert name) on the formulary?"

Q3. What are hospital in-patient costs? Some plans have $0 co-pays for the first "n" days with $100 or greater co-pays for the next "n" number of days; other plans charge (relatively) high co-pays of $250 or more for the "n" initial days then $0 for the remaining days.

Since I've been on Medicare I have been hospitalized three (3) times (for surgeries). My maximum time-in-hospital was 5 days. My plan has the first five days free (no co-pay); my co-pay bill for all three surgeries combined was $0.00.

The easiest way to find out is to call the plan's toll-free number and ask: "What are the in-patient co-pays?"

SOME providers provide easy access to this information from their Web site. Others force prospective clients to call a toll-free number and hope the information received is accurate. Get hard copy documentation to be safe and sure.

Keep in mind that you and the plan are "stuck" with each other for the full plan year. You normally can change PCPs every month, but you normally cannot change to a different plan.

THE DOCUMENTS

There are three (3) documents you want to see, preferably BEFORE you make a decision:

1. EVIDENCE OF COVERAGE: The evidence of Coverage follows Medicare's list of benefits and adds the plan provider's additional benefits. This is the "bible" of the plan; it is approved by Medicare and cannot be modified during the plan year. It is subject to change ONLY for the coming plan year. (If you sign up for a 2016 plan, it won't be subject to change until 2017.)

2. PROVIDERS' LIST: This is a list of physicians, hospitals, clinics, therapists, etc. that have contracts with the plan. This list IS "subject to change," but for the most part whoever/whatever is on the list when it initially was published remains on the list through the plan year.

3. FORMULARY: This lists all the prescription medications the plan covers. Like the PROVIDERS' LIST, it is "subject to change," but change rarely occurs in mid-year.

NOTE There are several plan types in two plan categories.

The categories are Advantage plans and Supplement plans. Many excellent Advantage plans cost no more than what the Medicare recipient pays already. Medicare Supplement plans typically charge an additional fee. Supplement plans often have no restrictions on providers or locations and may be a better option for travelers. (Some Advantage plans have "worldwide" coverage, but there are conditions.)

The two sub-options are "with drugs" and "sans drugs." There also are "drugs only" (Part D) plans.

What plan is best suited to each individual is determined only by that individual.

Lack of policy Perventable, Tragic Mistake

 

The official Palm Beach Gardens Police Statement reads, in part,

It was an easily preventable death.

While there are many qquestions that may never been asnwered - if they even are asked - this death never should have happened, especially at the hands of a supposedly experienced police officer.

Florida drivers, as are drivers elsewhere, are told that when they are being followed by even a marked vehicle to continue to a lighted area before pulling over.

The cops know this; they are the ones who tell us.

Because there have been too many "incidents" when cops or people pretending to be cops have taken advantage of a marked car, a uniform, a blue light, cops HAVE to know approaching a vehicle is dangerous.

In this case, Jones' vehicle apparenly broke down and Jones was sitting in the vehicle. Had he called someone to come to his aid? A relative? A towing company? The local or county cops? (Would 9-1-1 have taken the call and forwarded it to an appropriate agency?)

Hind sight is wonderful. I wonder if I would have made a call.

Enter Raja.

In an unmarked car - his or a department vehicle. Unknown.

Out of uniform - in a plain clothes role or on his way home. Unknown.

Apparently Raja got out of his vehicle and, again, "apparently" was heading toward Jones.

Jones, seeing someone approaching - and by all accounts NOT knowing Raja was a cop, got out of his broken down vehicleo with his gun in hand. It was a legally purchased and owned firearm. Jones allegedly bought the firearm for protection in his job as a Delray Beach Housing Authority employee .

What SHOULD have happened

If Raja was in a police vehicle, he should have called for a marked vehicle with a unifomed officer to join him BEFORE approaching Jones' vehicle.

This would make sense in any event since Jones' vehicle was on/near the traveled roadway; it needed to be protected from other cars and towed to a safe location.

If Raja was in his provate vehicle - sans police radio - he should have used his cell phone - are there any cops who lack a cell phone? - to contact the Palm Beach Gardens PD dispatcher to send a marked vehicle with a uniformed officer to the scene.

According to all accounts available today, Jones did not exit his vehicle until Raja exited his vehicle. Jones might have been nervous and he may have had his weapon in hand, but as long as Raja was in his vehicle, Jones was safe.

While Raja should have been calling for backup, Jones should have called 9-1-1 and reported a strange vehicle parked behind him and that he feared for his safety. All but the most obtuse 9-1-1 dispatcher would have immediately acted on Jones' call - how much 9-1-1 activity was there at 3 a.m.?

Appearently neither of those things happened.

IN ORDER TO PREVENT a recurrance of this tragedy, police departments need to put procedures into place so that an officer in a similar situation WILL contact the department dispatcher - either by radio or phone - and ask for a marked vehicle with uniformed occupants to join the officer at the scene. The plain clothes officer in the unmarked vehicle will remain in the vehicle until backup arrives.

CAVEAT:

My #1 Son is a cop and I worry for him. He did NOT vet this blog entry.

Like Jones, I also have a legal firearm and I probably would have acted the same way Jones acted, except I doubt I would gotten out of my car. In truth, I probably would not remain in a broken down vehicle while waiting for help; there is too great a risk of another vehicle colliding with mine.

Wasted: a young man's life and an officer's career.

Medicare Plans Getting plan info Is not an easy task

 

IT'S THAT TIME OF YEAR when geezers, I proudly include myself in that group, look at Medicare plans - Medicare Advantage and Medicare Supplement plans from sundry providers.

Such plans are profitable for the providers - health insureance companies; if you don't believe me, look at the numbere of companies advertising their wares for the $100-plus dollars geezers pay into Medicare each month.

But it isn't the "dues" the companies want; it’s the additional revenue from D.C. they are after - substantial additional revenue.

Over the years I've signed up with two different providers; I'm currently back with my original provider.

But my original provider changed the fees for some of my medications; the co-pay went from $21 for a 90-day supply to $105 for the same amount. That was enough to send me in search of "options."

What I want to see - and some providers make it easy - are three documents:

1. Evidence of Coverage
2. Providers' List
3. Formulary

Evidence of Coverage The EOC tells me what the plan covers and what it pays. All plans seem to cover everything Basic Medicare covers, but usually offer additional coverage and lower co-pays.

For example, Medicare covers in-patient hospital care at $0.00 for the first 60 days (https://www.medicare.gov/coverage/hospital-care-inpatient.html), but there is a nasty $1,260 deductable for each benefit period. My current provider gives me Days 1 through 5 at $0, but my co-pay for Days 6 through 20 is $80/day, dropping back to $0 co-pay for the rest of my stay. My deductable: $0.

Many plans charge $100-$200-a-day for the first days and then drop the co-pay to $0.

Over the last few years I have been a hospital "guest" twice; the first time for 5 days (=$0) and the second time one day (again, $0). When I initially signed up, the sales person told me "most hospital stays are 5 days or less." So far he's been proven correct.

Providers This lists all the physicians, hospitals, pharmacies, and other health care people and organizations with contracts with the plan.

Back when I had a really great PCP, I would first check to see that he was on the list. Then he and my current provider failed to reach an agreement and he was dropped from the plan's proivider list. (In a fit of pique I went with another plan only to fiind out that while it had lots of providers, my access to them was limited by my PCPs' personal list. I went through 5 PCPs in a year with that plan. When enrollment time arrived, I was back with my original plan and yet another PCP who seems to be at least "OK.")

Since I've learned to live with other than my preferred PCP - his office operation was, and remains, a total disaster - I now assure that my vascular surgeon is a plan provider; that he's "on the list." Because he is associated with the hospital where my surgeries are performed, the hospital automatically also is on the list.

Two medical professionals are important to my well-being; the vascular surgeon and the anesthesiologist - I have the scars to prove it.

Formulary The Formulary is a list of medications the plan is willing to provide; some for $0 co-pay and some for co-pays ranging upward from $35 for a 30-day supply.

The cost of medications links back to the Evidence of Coverage. The EoC shows how much the plan provider will pay toward medications. When that limit is reached - it seems to vary between $2750 and $3500 depending on plan - the plan member - the geezer - falls into the "Donut Hole" and has to pay "45 percent of the negotiated price and a portion of the dispensing fee for brand name drugs. You pay no more than 58 percent for generic drugs and the plan pays the rest." The "Donut Hole's" official name is "Coverage Gap Stage."

The Gap comes into play when the plan and the member together have paid the plan's limit - e.g., $3000 - for perscription medications and continues until the member (geezer) has paid a total of $4850 from the member's pocket. Most plans will estimate the total cost of medications - based on the geezer's medications list - before asking for a signature on the virtual dotted line.

UNFORTUNATELY some providers, even some "Big Name" providers, hide the information from prospective clients. Rather than make it easy for geezers to review their plans they hide the information. On-line chat is no help for some. Calling likewise is a waste of time. (I encounted both earlier today.)

My recommendation: If you have a physician that you consider critical to your well being, GO to that practitoner and as what Medicare policies he or she accepts, then, if necessary, contact the providers' local offices and demand to see the three critical documents. Medicare - read taxpayers - pay the providers to prepare and distribute those documents for current and potential plan members.

On the other hand, any plan management too stupid to make the documents available on-line in PDF format probably isn't a plan worth having.

Opuscula Let's hear it For the judge

 

MY LIBERAL FRIENDS (and yes, I DO have liberal friends) are declaring how nasty Seminole County FL judge Jerri Collins had the chutzpah (gall, nerve) to sentence a battered bride to jail for failing to appear when she was supposed to.

From MEDIAite " Jeanne Gold, CEO of the SafeHouse organization, told WTFV that Judge Collins’ actions were “appalling” and “horrible.” She also expressed her worry that the judge’s shaming of the victim in court could possibly discourage her from ever calling the police again."

But let us consider the whole picture.

First of all, none of the on-line reports I saw mentioned the victim's name.

According to the Orlando Sentinel (a paper for which I once worked), Gold said that,"I can't blame the state for wanting to get a bad guy, but you cannot lean on a victim of domestic violence to solve the societal issues in our world, It's so unfair, and it just shows that there is a lot more education needed."

Time after time, victims of domestic abuse - both men and women - call the cops who come and separate the combatants and one or the other of the battlers makes a formal complaint.

Domestic calls are one of the most dangerous for responding officers; most departments require at least two officers to respond. I know this because I once covered the police beat for several newspapers in several states, and because my First Born is a cop.

I think the judge was correct in her actions, particularly in light of the victim's reason for ignoring the order to appear.

From the Sentinel: "Prosecutors in Phil Archer's State Attorney's Office said it is rare for domestic-violence victims to be jailed for contempt of court, but it happens for different reasons.

"Archer defended his office's actions saying the woman's reluctance to testify against her attacker was a "decision to thwart the court process by refusing to cooperate" by testifying against a man who has a prior domestic-violence conviction.

"When she filed a police report in April, the woman said she wanted to press charges after her assailant choked her, pressed his thumbs against her eyes and came at her with a knife, according to an arrest report."

MEDIAite reported that the abuser "allegedly choked her and threatened her with a kitchen knife. He was charged with simple battery and spent 16 days in jail, but when his trial date arrived, the victim was nowhere to be found. Hence the contempt of court hearing."

"But a month before the trial, she expressed reservations about testifying against her assailant, the notes show. And the week before jury selection, she said she wanted nothing to do with the case."

The victim told the judge that that she wanted to separate from her attacker; spending three days in jail certainly would accomplish that.

There are several things to consider.

1. Is it possible or probable that her attacker threatened her with more harm if she testified? Unless he was incarcerated - unlikely since there had yet to be a trial - that's possible.
2. Was she concerned her complaint would fail to withstand a defense attorney's challenges? The district attorney apparently thought that - based on the woman's testimony - the state could make a winning case.
3. Many, many victims "bail out" at the last minute because they know the law will pity them and ignore the fact that an abuser remains on the loose, to terrorize the victim - and perhaps others - again and again.

The assailant, without the victim's testimony, was sentenced to only 16 days in county jail. Sixteen days, despite a history of recidivism.

According to Gold, "She (the victim) never will call again. Look what happened to her. She could be lying, broken in a ditch somewhere, and she would probably not call police because of what happened to her in this place.”

I have to partially agree with Gold; since her abuser was put away for only two weeks and two days the woman must relocate to avoid retaliation, even though she elected not to testify. She won't call the police because the police now know that even if they rescue her again, she won't help get the abuser off the streets. She knows it. The cops know it. The DA's office knows it. Worse, the abuser knows it.

Perhaps if victims understand they must follow up and assist the prosecution or face a brief period behind bars, they will do what is necessary to get abusers off the streets.

Putting the victim behind bars protected her from the abuser's friends where lesser punishments would leave her at the mercy of friends of the abuser.

In Gold's opinion, “To put her in jail was ridiculous,” she added. “Even if they were so angry... why not give her community service hours [at a local shelter]? She could be with women here who are going through the same thing she is.”

The victim, who said she is penniless and trying to raise a one-year-old on her own, still has the option of going to a shelter after leaving the county jail.

 

Found on the WWW

Judge Jails Domestic Violence Victim For Failing To Testify (Huffington Post)

Florida judge berates domestic abuse victim, sentences sobbing woman to jail: ‘You haven't even seen anxiety’ (NY Daily News)

Meet the Judge Who Jailed a Domestic Abuse Victim For Not Testifying Against Her Abuser (Mediaite)

Opuscula Left hand Right hand

 

I'm scheduled for relatively minor surgery on Wednesday.

Standard Operating Procedure (SOP) is for the hospital to tell the patient - me - what I must do/have done before admitting the patient.

Several weeks ago, the hospital sent a "secure" electronic message with a questionnaire attachment. I filled out the hospitals 20-plus questions, updating one or two answers from previous stays at this hospital.

Late Friday afternoon - just "before they shut down the computers" the caller explained - I had to play 20-questions over the phone; same questions, same answers.

ONE DIFFERENT QUESTION was "Do you have clearance from your primary care physician (PCP)?"

Oops. No one told me I had to get my PCP's approval. I see him every quarter and I have kept him up-to-date with reports from my vascular surgeon. Unfortunately for me, my PCP uses Macintosh computers; the hospital's physician information exchange software apparently is not "Mac friendly." I assume my surgeon is sending his updates to the PCP, but because the surgeon is a strong supporter of the hospital's physician information exchange software I am beginning to have my doubts.

ANYWAY, at 4:40 p.m. Friday I call my PCP's office and find out its closed for the long Columbus Day weekend. (And why is it that the Italians get a bank holiday and the Irish don't? Doesn't seem fair.)

No way I can get my PCP's clearance until Tuesday - the day before surgery.

Meanwhile, I am to present myself Tuesday morning - Columbus Day was booked solid - for a series of tests that could have been more conveniently performed in my PCP's office.

One test that hospitals usually insist on doing in-house is a blood type and cross match, a T&C. I have been a Type O Positive since birth; I was a Type O Positive at both my surgeries at this hospital. Even "Dr. Oz" writes that, without outside influences, e.g., marrow transplants, blood types don't change, not alphabetically or positive/negative.

The hospital has a fat electronic file on me that lists my blood type and includes the answers to the questions asked a few weeks ago . . . and then again last Friday.

I can understand the EKG requirement; my PCP gives me an annual EKG close to the start of the calendar year . . . 10 months ago. Likewise an x-ray to assure my lungs are clear.

In addition to the tests, I am to meet with an anesthesiologist. Before I "consented" to Wednesday's surgery, I insisted that the anesthesiologist be the lady who put me under for a major surgery at this hospital. I know and trust her and she knows me and my "big mouth." I had the chutzpah to tell the surgeon, with whom I have a history, that if "my" anesthesiologist is not at the head of the (operating) table, no surgery. Fortunately, we three share similar senses of humor - or lack thereof.

IT IS DISCONCERTING that the hospital administration seems to be a bed of confusion,with the right hand not knowing what the left hand is doing - or has done. If I thought the surgical side of the house was that inept I'd look for a different hospital.

The fact that my Mac-loving PCP cannot (perhaps will not?) connect to the hospital's physician information exchange software likewise is cause for concern. Concern, not panic, since when the hospital posts results of tests ordered by the surgeon, I save the results as a PDF and forward it to the PCP in hopes that his office staff will include them in my folder at the PCP's office.

Specialists are supposed to coordiinate with the PCP - my Medicare Advantage plan demands it - but given that I didn't know I needed a PCP clearance, I have my doubts this is being done.

I have confidence in the surgeon and the anesthesiologist. I've got a pretty high level of confidence in the crews working the cardiac/vascular floor.

But the front office? Not so much.

Opuscula Strongman rule Putin vs. Obama And "Arab Spring"

 

Obama's Arab Spring tried to depose all Arab tyrants that Obama didn't like; in particular in Libya and Syria. The result of his meddling in Arab affairs is civil war in Libya and Syria.

It is interesting to note Obama's Arab Spring did not include Saudi Arabia or the Gulf states. .

Russia's Putin, being a political strongman himself, knows the value of powerful leadership. He had put Russia in bed with both the ayatollahs of Iran and Syrian president Bashar al-Assad.

WHILE PUTIN IS doing everything he can to "show the world" that Russia is a power with which to contend, Obama is rapidly destroying any vestiges of respect for the U.S. left from his first term as U.S. president.

Unlike Sarah Palin, who could at least SEE Russian territory from the state she governed, Alaska, Obama had zero international experience, which the voters conveniently overlooked in both elections.

Obama exudes weakness, indecisiveness, and like the Bushes before him, a lack of planning that reaches a position that advances America's interests - or at least causes no damage. Even "Tricky" Nixon had a plan to extract us from Vietnam - a legacy from JFK & LBJ* - and to open diplomatic relations with China, a move that may in the end be the worst thing Nixon ever did.

Putin is, as he proved in the Ukraine, a bully, but there seems to be no one who can reign him in except perhaps the Islamists. In that case, the "cure" is worse that the "disease." Putin would like to see the former USSR restored and Soviet influence once more dominate much of Europe and Asia. Obama shakes his finger and figuratively says "naughty, naughty" and Putin laughs at the impotent U.S. president.

 

* I am aware that Dwight Eisenhower sent in limited personnel Military Advisory Groups before JFK sent in a division-size units at a time until it was decimated, then he sent in another division; LBJ tried to end the war by inundating Vietnam with thousands of troops. Nixon, having learned the lesson of the French - who earlier has been chased out of Vietnam with their tails between their legs, ended the war. Not proudly, but at least with an end to U.S. deaths and injuries. Interestingly, Johnson, who actually tried to win the war - was the target of the leftists - not JFK - who talked of LBJ's "Youth In Asia (euthanasia) program." Maybe they still were angry for LBJ lifting a beagle off its front paws by its ears.

Opuscula Fire her!

 

Kim Davis, County Clerk of Rowan County, KY, unless Kentucky is different that any other state in which I have lived, took an oath of office that included adhering to the Constitution.

By refusing to issue marriage licenses to same-sex couples, she is failing to follow the Constitution as interpreted by the U.S. Supreme Court.

It might be argued that The Supremes should not be mucking around with the U.S. Constitution, but the justices have been making the laws for many years and the laws are generally accepted by the citizens.

When an official, who has sworn to uphold the Constitution fails the oath, that official - at least where I have lived - is removed from office by the state's governor; the official is impeached. I've seen it happen to District Attorneys, mayors and council/commission members, and both city and country elected officials.

So why hasn't Kentucky Gov. Steven Lynn "Steve" Beshear removed Ms. Davis from office?

BOTH GOV. BASHEAR AND MS. DAVIS are Democrats and that might have some clue. Most removals from office I have witnessed were by governors of Party A removing elected officials from Party B (who were replaced by appointees from the governor's party).

Perhaps Kentucky has decided to ignore the U.S. Constitution, but given all the other issues the state has implemented, probably Kentucky follows, perhaps grudgingly, the U.S. Constitution as do the other 49 states.

So why is Ms. Davis still in office?

She was jailed for contempt of court on the order of U.S. District Judge David Bunning. (Why only Ms. Davis? She is just one of three Kentucky county clerks who refuse to comply with their oath of office; Casey Davis of Casey County and Kay Schwartz of Whitley County, were, as of September 3, also still refusing to perform same-sex marriages.) Judge Bunning noted that "I myself have genuinely held religious beliefs but I took an oath."

Gov. Beshear emphasizes that clerks do not have to agree with the Supreme Court ruling, but reminds clerks that they took an oath to uphold the U.S. Constitution.

"Our county clerks took an oath, as elected officials, to uphold the Constitution of the United States and the Constitution of Kentucky. This oath does not dictate what our clerks must believe, but it certainly prescribes how they must act in carrying out their duties as elected officials," the governor wrote.

MS. DAVIS AND THE POPE

Ms. Davis issued a statement following Pope Francis' visit to the U.S. that she had a meeting with the pontiff and that he supported her stand.

The Vatican admitted Ms. Davis was received by the pope and had about 15 minutes with the visitor - as part of a large group who met with the pope at the same time - in other words, it was NOT a private tête-à-tête according to a Sylvia Poggioli-NPR report from Rome on Oct. 2 2015.

The U.S. Constitution prohibits a "state religion," and this has repeatedly been construed to mean that government agencies and employees - elected or appointed - will NOT let their personal beliefs interfere with the duties of the office - Ms. Davis' personal beliefs must be set aside during her hours as a government official. Let her, if she wishes, protest the Supreme's ruling on her own time while following the law - however personally repugnant to the government official - during "office hours."

If Ms. Davis cannot separate her personal views from her Constitutional; obligations - obligations she swore to perform with her oath of office - then she should resign, or the governor should remove her. There are no other options.

MEANWHILE, there are several deputy clerks in Ms. Davis' office that told Judge Bunning that they would - albeit reluctantly - issue marriage licenses to same-sex couples.

My opinion: grant sesame-sex couples all the rights and privileges of a heterosexual couple - just don't call it "marriage" - call it "civil union" or some other term, just not "marriage." Save that for a union between a man and a woman.

 

Sources

Kim Davis, Kentucky Clerk, Held in Contempt and Ordered to Jail
Pope Francis Met With Kim Davis, Kentucky County Clerk, in Washington
Vatican Details Pope's Meeting With Kentucky Clerk Kim Davis