Author Archives: Dianne Savastano

Medicare: What You Need To Do Now

By Camille Barron

Once again, Medicare Open Enrollment Season is here. If you’re 65 or over, you’ve probably had enough of the mail and endless TV commercials promoting this or that Medicare product. It’s tempting to toss it all aside and keep the status quo. After all, your insurance has been working for you, so why change it, right?

Unfortunately, that approach is a mistake.

Each year, between October 15th and December 7th, you have a chance to evaluate your current Medicare plans and decide whether to stay where you are or change coverage. It’s important that you not overlook this opportunity.

The specifics of your coverage might not be the same as before and there could be costly consequences if you simply let your insurance continue without further examination. And, since this is a once per year event, if you don’t like what you end up with, you’ll have to wait an entire year to make further adjustments.

As a quick review, Medicare consists of several components. Listed below are each of these and what they cover.

Part A

Inpatient care, such as hospitalization, skilled nursing facility or hospice

Part B

Outpatient care, including office visits, outpatient surgery, lab work and testing

Part D

Prescription drug coverage

Part C

Known as Medicare Advantage, this packages Parts A, B and typically D into a single policy

Medicare Supplement

Also known as Medigap, this supplements Parts A and B, which cover approximately 80% of medical costs.

Depending on your coverage, there are important elements to be aware of:

1) If you have Parts A and B (AKA, “Original Medicare”), and Part D, combined with a Medicare Supplement plan:

Pay particular attention to Part D, your Prescription Drug insurance.

If you simply let your Part D plan renew, you may find yourself with higher drug costs or without coverage altogether on a certain drug.

It is estimated that more than half of those insured will experience premium increases if they remain with their current plan next year. This is because prescription drug insurers make changes to their drug formularies and pricing every year, affecting coverage, premiums and out-of-pocket costs.

In addition, changes at the federal level will alter the Part D Coverage Gap, also called the “Donut Hole,” in 2020. People who take expensive brand name drugs will pay approximately 25% of the costs of their prescriptions between the time they meet their plan’s initial coverage limit of $4020 and when they spend a total of $6,350. These limits increased in 2020 from $3820 and $5100, respectively. Those insured will have to spend more before their out-of-pocket costs drop to 5% in the Catastrophic phase. On average, this will translate into a price increase of $400 for many people.

Whether you’re happy with your Medicare Prescription Drug plan or not, it’s important to revisit your Medicare Part D choices every year. (We offer a Part D review to all our Medicare clients during Open Enrollment. If you haven’t signed up, now is the time.)

2) If you have Parts A, B and D, but no Medicare Supplement plan:

Pay particular attention to your potential for high out-of-pocket costs.

If you rely on Medicare Parts A and B for your medical insurance and forego adding a supplement, Medicare pays approximately 80% of covered medical expenses.

Once Medicare has paid its share, you are responsible for the remaining 20%.

While this cost-sharing arrangement may save money by eliminating the monthly premiums associated with Medicare Supplement plans, it places a financial burden on people with serious health problems.

Medicare does not place an upper limit on one’s out-of-pocket costs under Parts A and B. This means some individuals without supplemental coverage could face a significant financial burden because their 20% share is unlimited.

There is an additional risk for people who don’t have Medicare Supplement coverage. In most states (other than Massachusetts), there is an initial window in which anyone applying for this coverage is guaranteed acceptance regardless of health history. Anyone who waits until after that to apply needs to answer health questions. Depending on their responses, they may not be able to obtain coverage or may be accepted at a higher rate.

3) If you have a Medicare Advantage (Part C) policy:

Pay particular attention to whether you will have access to your current providers.

Medicare Advantage Plans (also known as Medicare Part C) are package policies that combine Medicare Parts A and B with medical insurance and, typically, prescription drug coverage. If you have a Medicare Advantage policy, your premiums are likely lower than what you’d pay for a Medicare Supplement.

That’s the good news.

Unfortunately, what you don’t pay in premiums is made up in out-of-pocket costs such as deductibles, copays and coinsurance which you pay at the point of service.

As with other Medicare products, Medicare Advantage plans may make changes to their premiums and out-of-pocket costs each year. People who have been satisfied with their coverage may find themselves spending more than expected when their policies renew.

Perhaps the greater risk individuals face by not looking closely at their Medicare Advantage plans is that their providers may no longer be in their plan’s network. Those with PPO (Preferred Provider Organizations) policies may continue to see their doctors but will pay a higher amount for an out-of-network provider. HMO policyholders have no coverage for going outside their plan’s network. For people with HMOs who are happy with their doctors, it’s a difficult decision between changing to a new provider or not changing, but having to pay the entire cost of their doctor’s visits themselves.

If you currently have a Medicare Advantage policy, make sure to examine the premium, deductible and out-of-pocket costs for both healthcare and prescriptions, to see if any of these have changed. And be sure to check the provider network to make sure your doctors and preferred hospitals are still in-network.


It can be overwhelming and confusing to navigate the changes to Medicare. But it could be costly to keep the status quo.

We encourage you to spend the time revisiting your Medicare Choices for 2020, during the Annual Open Enrollment Period (October 15th through December 7th), to make sure you are getting the best value for your insurance dollar. If you need help, please contact us.

Recommended Reading: Long-term Caregiving

One challenge Jack encountered was that Bill was seeking care from multiple health systems; his medical records were not easily accessible in one place. Jack is considering the use of a tool called Backpack Health.

Backpack Health is a mobile and web tool that makes it easy for individuals to manage, own and share health information for themselves and their families.

App users can link their Backpack Health profiles to patient portals, making it easier to keep track of both clinical and personal health data.

The (Possibly) Forthcoming Elder-Care Revolution is a sobering article about the politics of long-term caregiving. An excerpt:

“Levitsky found that the lack of public outcry for long-term care didn’t reflect an absence of need. Instead, it was driven by a widely held belief that caregiving is a family responsibility, tied up with what it means to be a good son or daughter. And because it’s so time-intensive and takes place in the home, caregiving is often extremely isolating, making it hard to see it as a systemic issue.”

Read the full article, here.

Recommended Reading: Food as Medicine and others

This is a terrific example of the impact lifestyle changes can make on one’s health. Food as Medicine!

The identification and management of Urinary Tract Infections (UTIs) in older adults is something we manage all the time. It requires patience to adequately diagnose and treat. This article highlights some of the challenges with options for treatment.

Elder Abuse is a growing problem. This piece highlights the impact of the lack of resources to deal with the demand for services.

Managing the Stages of Cognitive Decline

During a visit to his parents’ home over the holidays, our client Jack noticed that his dad, Bill, seemed a bit more forgetful than previously. Jack observed a slight change in personality and a significant withdrawal from all the family events that his father would normally embrace. Jack wondered if his dad’s medications were being taken appropriately as he noticed some still in the pill box at the end of the week.

Bill lives in Arizona during the winter and in New England during the summer. After his dad’s return this past spring,

Jack contacted me about his concerns and we embarked on a plan.

Step One: Communication

Among the actions that need to be taken when cognitive issues arise, the first is always up front and honest communication. This doesn’t always result in a positive experience, but it is worth trying. I suggested that Jack raise his concerns with his parents, to see if they were at all aware of what he noticed. As it turned out, his dad had noticed that his memory was not as sharp, but did not see that as a problem. He dismissed it as simply the result of normal aging.

Jack’s mom, Linda, however, opened up about a series of additional things she had noticed. Having lived with Jack for over 50 years (!), she was well positioned to observe changes. Linda expressed relief at being able to talk about her concerns.

Step Two: Planning

Bill appreciated how concerned his loved ones were about him and agreed to attend a meeting with his primary care physician (Dr. Jay), Linda and Jack.

Prior to the appointment, Jack set up a time to speak by phone with Dr. Jay. He wanted to share his observations as well as those of his mom before the meeting, and asked that one agenda item of the meeting be to address his concerns.

Physicians appreciate this type of pre-communication. It allows them to develop a strategy, and to be efficient and comprehensive in crafting an agenda for an appointment.

Step Three: Assessment

Dr. Jay addressed several items that day, but a major topic was the observed cognitive change. She conducted a Mini Mental State Examination (MMSE) that allowed an objective and measurable assessment to occur. The scoring revealed some concerns that she carefully and sensitively discussed with all of them.

From there, she outlined a plan that included the following:

  • Blood work — to identify if there were any issues contributing to the problems. Testing included examining thyroid function and possible vitamin deficiencies.
  • A brain MRI — to identify if any changes or major issues were contributing.
  • An Overnight Sleep Study — to identify possible Sleep Apnea contributing to poor quality sleep, resulting in fatigue and cognitive changes.
  • A meeting with a neuropsychologist — to conduct more extensive neuropsychological testing that would provide much more detailed information about the function of different parts of the brain.

As of this writing, Jack and his parents are still in the process of evaluation. But they are approaching the point of having adequate information to work from.

Whatever the final outcome, I am confident that Jack has done all he can to provide the best care for his dad.

First, because he was pro-active rather than waiting for a crisis to respond. Not only did he step in when he noticed changes with Bill, he had taken steps a few years earlier to establish a relationship with Dr. Jay.

Second, because he recognized that within his family and among his siblings, he was the one who needed to take on the responsibility for assisting his parents with their healthcare.

Lastly, he understood that as an accountant, navigating the healthcare system and assisting a family member with the appropriate management of cognitive decline was not something he knew much about. He reached out and was open to receiving professional help.


If you have older loved ones in your family for whom you may be responsible, I highly recommend paying close attention to subtle changes in the lives and behavior of these adults.

It is always best to be proactive and tenacious in obtaining appropriate medical evaluations before a crisis ensues.

My List of Essential Health Care Resources

First, a bit of background…

When I launched Healthassist in November 2004, there were very few private practices dedicated to the delivery of private “Health Care Advocacy / Advisory” services (my terminology for the work we do).

I had the great fortune of some national press, some of which led me to a fellow advisor in California. She founded her practice a bit after ours and was starting a national association. Her goal was simple: To bring advocates together and to educate the public regarding our new profession.

I became a founding member of the National Association of Healthcare Advocacy and things took off quickly. I presented at the first conference (and all subsequent conferences) and served for five years as Treasurer on the Board of Directors. Along the way, we developed Standards & Best Practices as well as a Code of Ethics to benefit and protect consumers.

Fifteen years later, I remain a member of NAHAC’s advisory board. It’s been a wonderful experience and I value the relationships I’ve developed with fellow advisors.

Here then, are some of the best health care resources I find myself recommending again and again to clients, friends and loved ones.

Resources for Health Care Advocacy

National Association of Healthcare Advocacy

“My dad lives in Chicago, and I live in LA. He was recently hospitalized and has now been in and out of the hospital and rehab three times. My brother is there but is not familiar with the healthcare system and it seems no one is communicating. What can I do? Can you help?”

Sadly, this is a common scenario. When we receive a call like this about someone in New England, our team goes into overdrive, acting quickly to assess the situation, introduce ourselves to the relevant healthcare partners and begin to put an action plan in place. With complicated situations, in particular, “boots on the ground” matter. An advocate who can go to the hospital, rehab centers and physician appointments is required.

When we aren’t able to help, I recommend visiting the NAHAC web site and conducting a zip code search for local professionals. When possible, and because I know so many of my fellow advocates across the country, I make a direct, virtual introduction to a local resource.

Massachusetts Resources for Health Care Advocacy

Sometimes, fellow advocates are better positioned to serve a client’s needs. In those cases, I refer callers to the web site of the first regional group of NAHAC, one that I helped to found, known as Massachusetts Healthcare Advocates (MAHCA). We now have 18 members.


AdvoConnection is another national directory web site. In addition, it provides a wealth of information and tools for consumers, to help them make smart, informed decisions in choosing a professional advocate.

Patient Advocate Certification Board

A recent milestone within the profession of Health Care Advocacy was the development of certification to “credential” those who work in the field (I’m proud to have been awarded PACB certification this year).

The certification process is rigorous and knowing that your advocate has received this distinction gives you confidence in their level of competence and professionalism.

Resources for Transition to a New Living Environment

“My mom has been considering moving to a retirement community in her area and we’ve heard about many different models and levels of care. Can you help us find the best place for her?”

When I receive these calls, I first explore what is contributing to the decision to make a change. If it is an unstable health-related issue, I suggest first achieving medical stability before a move occurs. Otherwise, I refer these callers to one of my Aging Life Care Professional colleagues.

These professionals, previously known as Geriatric Care Mangers, are regionally based, know their local communities and resources, and are best suited to conduct an assessment on the environmental, safety and psychosocial needs of an older adult. They are fabulous at matching the older adult’s needs to the most appropriate living environment, taking into consideration financial constraints.

The Aging Life Care Association includes a zip code search capability for finding local professionals. Many are trained as Social Workers, while others are trained nurses or other Allied Health Professionals.

Resources for Legal Issues

“My parents don’t have their affairs in order, and I’m concerned. What can I suggest?”

In these circumstances, I ask if the caller is familiar with attorneys certified as Elder Law Attorneys. It’s a specialty that most people are not aware of, so I describe The National Elder Law Foundation (NELF), the national organization certifying practitioners of elder and special needs law.

The National Academy of Elder Law Attorneys is another, similar resource.

Both resources allow national searches on their sites.


As much as I would like to assist everyone who calls, it’s not always possible.

I have great confidence in the resources noted above and I’m thrilled to be able to share them with you to help keep you and your loved ones safe and well cared for.

Medication List Template — Follow-up from May newsletter

In last month’s newsletter , we recommended a “project management” approach to managing the healthcare of yourself or a loved one. We also shared a template titled Medical Conditions, Surgeries, Hospitalizations.

We recommend using a similar template for tracking medications. You can see and use it here.

The Medication List has multiple tabs to include the following:

  • Daily Medications
  • Herbal Medications and Nutritional Supplements
  • PRN/Occasional or As Needed Medications
  • Previously Taken Medications