Terms to Know

Here is a list of terms relating to Medicare prescription drug plans.

Co-insurance
This is an amount a person may be required to pay for services after paying any plan deductibles. In Original Medicare, this is a percentage (about 20%) of the Medicare-approved amount. A person has to pay this amount after paying the Part A and/or Part B deductible. In a Medicare Prescription Drug Plan, the co-insurance will vary depending on how much the person has spent. The quotes will also fluctuate depending on the current prescription drugs prices to ensure your get quoted accurately and fairly.

Co-payment
In some Medicare health and prescription drug plans, this is an amount a person pays for each medical service, like a doctor’s visit, or prescription. A co-payment is usually a set amount. For example, this could be $10 or $20 for a doctor’s visit or prescription. Co-payments are also used for some hospital outpatient services in Original Medicare.

Coverage Gap, Catastrophic Coverage
Most Medicare Prescription Drug Plans (Part D) have a temporary limit on what they cover for prescription drugs. This limit is called the “coverage gap” (also known as the “donut hole”). The coverage gap starts after you and your plan have spent a certain amount of money for covered drugs. All Medicare drug plans are different, so call your plan if you have questions about how the coverage gap will work for you.

You won’t need to pay out of pocket for all costs while you are in the coverage gap. Once you are in the coverage gap, your plan will cover a percentage of the cost of generic drugs. You will also get a percentage manufacturer-paid discount on covered brand-name drugs. Although you will only pay a percentage of the price for that brand-name drug, the entire price will count as out-of-pocket spending, which will help you get out of the coverage gap. There will be increasing savings for you in the coverage gap each year until 2020, when you will pay approximately 25% for both covered generic and brand-name drugs when in the gap.

If you have extremely high drug costs and pay the limit (or pay through the coverage gap), all Medicare drug plans provide “catastrophic” coverage. Catastrophic coverage means that once you pay a certain amount out-of-pocket for drug costs in a calendar year, the plan will cover almost all your drug costs above that amount.

( Watch the video for important information about avoiding Medicare Part D late enrollment penalties. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.)

Creditable Prescription Drug Coverage
This is prescription drug coverage (for example, from an employer or union) that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.

Deductible
This is the amount a person must pay for health care or prescriptions before Original Medicare, the person’s prescription drug plan, or other insurance begins to pay. For example, in Original Medicare, a person pays a new deductible for each benefit period for Part A and each year for Part B. These amounts can change every year.

Drug List
A list of drugs covered by a plan. This list is also called a formulary.

Extra Help
A program to help people with limited income and resources pay prescription drug costs. Also called the “low-income subsidy.”

Penalty
An amount added to a person’s monthly premium for Medicare Part B or a Medicare drug plan (Part D), if the person doesn’t join when first eligible. He or she pays this higher amount as long as they have Medicare. There are some exceptions.

Premium
This is the periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage.

Prior Authorization
Drug plans may have drugs that require prior authorization. Prior authorization means that the person and/or the doctor must contact the plan before certain prescriptions can be filled. The doctor may need to show that the drug is medically necessary for it to be covered. Plans do this to be sure these drugs are used correctly and only when medically necessary.

You’ve probably seen this warning on medicines you’ve taken. The danger is real. Mixing alcohol with certain medications can cause nausea and vomiting, headaches, drowsiness, fainting, or loss of coordination. It also can put you at risk for internal bleeding, heart problems, and difficulties in breathing. In addition to these dangers, alcohol can make a medication less effective or even useless, or it may make the medication harmful or toxic to your body.

Some medicines that you might never have suspected can react with alcohol, including many medications which can be purchased “over-the-counter”—that is, without a prescription. Even some herbal remedies can have harmful effects when combined with alcohol.

Medications typically are safe and effective when used appropriately. Your pharmacist or other health care provider can help you determine which medications interact harmfully with alcohol.

Some medications—including many popular painkillers and cough, cold, and allergy remedies—contain more than one ingredient that can react with alcohol. Read the label on the medication bottle to find out exactly what ingredients a medicine contains.

Certain medicines contain up to 10 percent alcohol. Cough syrup and laxatives may have some of the highest alcohol concentrations.

Women, in general, have a higher risk for problems than men. When a woman drinks, the alcohol in her bloodstream typically reaches a higher level than a man’s even if both are drinking the same amount. This is because women’s bodies generally have less water than men’s bodies. Because alcohol mixes with body water, a given amount of alcohol is more concentrated in a woman’s body than in a man’s. As a result, women are more susceptible to alcohol-related damage to organs such as the liver. Older people face greater risk

Older people are at particularly high risk for harmful alcohol–medication interactions. Aging slows the body’s ability to break down alcohol, so alcohol remains in a person’s system longer. Older people also are more likely to take a medication that interacts with alcohol—in fact, they often need to take more than one of these medications.

Timing is important

Livingston Memorial Visiting Nurse Association supports the total well-being of our community.  As part of their services, they host free monthly education classes throughout the county which include the following in Ventura: Classes are available in Ojai and Oxnard also.

Adult Bereavement Support Group Wednesdays, December 7, 14, 21 , and 28, from 6:30-8:00 pm at Livingston Memorial Visiting Nurse Association office, 1996 Eastman Ave., Suite 109.    These groups are open to individuals who have experienced loss and are free of charge. Call 642-0239 for more information or email [email protected].

Newly Bereaved Support Group:

Thursday, December 8th from 6-7:30 pm at Livingston Memorial Visiting Nurse Association office, 1996 Eastman Ave., Suite 109.  This monthly group is designed for adults who have recently experienced the loss of a loved one and is free. Call 642-0239 for more information or email [email protected].  These groups meet every 2nd Thursday of each month.

Diabetes Classes

Tuesday, December 6th from 1-2:30pm at Livingston Memorial Visiting Nurse Association, 1996 Eastman Ave, Suite 109.  These meetings are held on 1st Tuesday of each month.  General information is provided about Type 2 Diabetes including prediabetes, with emphasis on meal planning, medication, exercise, blood sugar monitoring, and new developments in diabetes.  Call 642-0239 for more information.

Joint Replacement Classes

Thursday, December 1st from 1:00-2:00pm at Livingston Memorial Visiting Nurse Association offices, in the Community Room at 1996 Eastman Avenue, Suite 109 in Ventura. You will learn what to expect before, during and after knee or hip replacement surgery and how to be an active participant in your care. These meetings are 1st Thursday of each month.  For information or to RSVP call Dinah Davis at (805) 642-0239 ext. 739.

Monday, December 12th for both English and Spanish speaking.  English 4:00-5:00 pm and Spanish 5:30-6:30 pm at Livingston Memorial Visiting Nurse Association offices, in the Community Room at 1996 Eastman Avenue, Suite 109 in Ventura. You will learn what to expect before, during and after knee or hip replacement surgery and how to be an active participant in your care.  For information or to RSVP call Dinah Davis at (805) 642-0239 ext. 739.

As of July 1, 2016, the Catholic Charities- OASIS Family Caregiver Resource Center has been open and helping bilingual family caregivers get the support they need to care for their loved one. We are funded through a grant from the Ventura County Area Agency on Aging.

The OASIS Family Caregiver Resource Center provides family caregivers with free resources, referrals, trainings, workshops and case management. They have a library and a computer station available to caregivers who would like to do some research on a certain topic or search the web for information related to their family caregiving needs.

The Center provides services for those caring for a family member (unpaid) aged 60 and older who are dependent upon two or more activities of daily living  or grandparents living with and caring for a grandchild informally due to parents being unable to care for their child.  Caregivers for families between the ages of 19 – 59 may qualify for services depending on the disability.

Catholic Charities’ OASIS (Older Adults Services and Intervention System) program was founded in 1986 to assist senior residents continue to remain safely in their own homes.  Throughout Ventura County, OASIS serves persons age sixty and above.  There are no fees or other qualifications to become a client.

OASIS offers individualized case management to seniors based on in-home assessments.  Following the in-home assessment, OASIS staff develops an appropriate care plan based on each client’s individual needs.

They also have a great volunteer program. Volunteers serve as “Friendly Visitors” or Volunteer Drivers who drive clients to their doctor appointments. They are actively recruiting for volunteers to serve throughout Ventura County.

Call  420-9608 for more information and to volunteer.

by Gail Field

Nestled among the hills overlooking Ventura sits a gem where compassionate caregivers minister to a small group of residents.  The place is Cottage Inn, a charming house with room for six clients needing physical and memory care.  Stepping into the facility immediately feels like home, from the charming pictures hanging in the living area to the aroma of delicious cooking coming from the kitchen.  Each resident has a room of their own, where cherished memorabilia, pictures and patterned fabrics set a restful and personal tone.

Adding to the warm atmosphere are the caregivers themselves.  Each is experienced in the care of the elderly and takes pride in their work.  “We love our residents, and treat them like family,” says Janet Espinoza, the Cottage Inn administrator.  “Our staffing model has one caregiver for every three residents, ensuring there is always someone to assist the residents when in need.”

Caregiver Michael Asuncion explains some of the activities that keep the residents engaged.  “We have exercising in the fresh air of our patio, playing card games, chatting over a family style dinner and singing along to familiar tunes.  They love Dean Martin and Frank Sinatra,” says Michael. “Those are the favorites.”

“I love cooking for the residents,” says Judith Gonzalez, a caregiver.  “One of their favorites is my banana bread, as well as the food my mother taught me to cook when I was a girl.”

Both Judith and Michel agree, “We work together as a team, and staff and residents all feel like family.”

“I feel our staff truly enjoys the gratifying work of caring for our senior population,” says Ezra Proctor, the facility owner.  “We promote an environment of dignity and support and do our best to engage not only the residents, but also the family members involved.  This can be an equally difficult time in the family’s life, seeing their parents or elders needing higher levels of care.”

One of the biggest champions of the Cottage Inn facility is Jean, a current resident.  “The staff is very responsive. I never have had to ask twice for what I need. I love it here.”

Janet Espinoza sums up the experience of Cottage Inn for residents and families.  “Families of our residents are always welcome.  We like them to come and have dinner with us and engage in conversation with the residents. Chatting over a delicious dinner is a good way to feel like we really are a family.”

The Cottage Inn is located at 191 Wayview Court, Ventura, CA  93001. Phone 650-7497.  Visit their website at http://www.cottageinnventura.com

by Lori Harasta

Women are at the epicenter of Alzheimer’s disease.  If you are a woman, you have twice the chance of developing Alzheimer’s disease as does a man. In addition, women comprise 65 % of the population that endure physical and mental stress caring for Alzheimer’s and dementia sufferers.

In 2014, the Alzheimer’s Association created the first-of-its-kind Women’s Alzheimer’s Research Initiative where 100% of the proceeds support women’s brain research. (http://thewomensalzheimerschallenge.org/)

To draw awareness for the initiative, California Central Chapter of the Alzheimer’s Association Member Sharon Bick, RN, owner of Meditech Health Services in Ventura, held a reception at her ocean-front home last month.

Central Chapter Board Member Teresa Valko shared about her experience with Alzheimer’s disease.  She has had more than her share of experience–100% of her mother’s family has had Alzheimer’s.  She has lost a brother and a sister to the disease.

Teresa learned from her uncle how to be patient and caring toward someone with Alzheimer’s when she visited with him and her grandmother one summer.  When Grandma asked, “Son, have you been traveling?”  He said, “Why yes, I was in St. Louis!” and told tales of his travels.  When she asked again a few moments later, he replied, “Why yes, I was in New Orleans!” and then he would tell all about that adventure.  And so on.  He demonstrated to Teresa how to let his mother’s reality be his, and to do so with grace.

Teresa is passionate about this initiative.  “I feel compelled to get active and support the Alzheimer’s Association.  The Alzheimer’s Association is the world leader in advancing research and care and I want to be part of that.  There will be an end to this disease and I’m going to do everything I can to make sure my children will not be burdened with my care and that they never know the personal experience of this disease.”

Recently, through the work of Ventura County Area Agency on Aging (VCAAA), Ventura County was recently certified as a “dementia friendly” county.  It is one of the first in the nation to do so.  Plans are being developed to educate the community on how to make “small changes” that will make huge differences in how we treat those among us who suffer from dementia.  A sneak preview can be seen on You Tube:  https://www.youtube.com/watch?v=Fz8ACEu7Lho 

According to Christine Voth, Manager of Business Strategy and Strategic Planning for VCAAA who attended the gathering at the Bicks’ home, “I see that the Women’s Initiative is a critical component of Dementia Friendly Ventura County, especially given that statistics are now being released that show older women are twice as likely to get Alzheimer’s disease than men.”

The gathering at the Bick home demonstrated Sharon’s commitment to the cause. “I believe we need to get people involved to change how we deal with Alzheimer’s in our community.”

by Cate Kortzeborn Medicare’s acting regional administrator for Arizona, California, Hawaii, Nevada, and the Pacific Territories.

Note: On Thursday, Nov.10 at 10am at Foster Library there will be a free

Medicare 101 Q & A with our local Medicare expert, Samuel Schwartz.The program will get you the answers you need to make an educated decision about Medicare. Bring any and all questions!

When someone with Medicare finds his or her way to my office phone, it’s often because of a complicated and snarly issue that’s going to take time to fix. Medicare can be a good way for potential patients to get help with their medical care since many can not afford the insurance needed to get the help they need. However, it also needs that some people will try their best to get past the restrictions in order to get the healthcare they require. To find out more about medicare waste and abuse, there is information online to learn about how to crack down on such fraud.

However, it’s sometimes a Medicare beneficiary who found my number somewhere and called for some basic help in understanding their coverage. I love those calls because I have a quick and easy answer for folks like that.

I refer them to the State Health Insurance Assistance Program, or SHIP. There’s a SHIP in every state in the country.

SHIPs are nonprofit organizations that help people with Medicare understand their benefits better. The counseling is personalized and it’s absolutely free. SHIPs aren’t connected to any insurance company or health plan, so they’re not trying to sell you any kind of product. If you’re eligible for Medicare, you’re eligible for assistance from your local SHIP.

The quality of the counseling is terrific. Many SHIP counselors have Medicare themselves and they’re well-trained to answer your questions. They know all the ins and outs of the program, whether you have Original Medicare (where you choose the doctor or hospital you want and the government pays your providers directly) or Medicare Advantage (in which private insurers offer health care services through a specific network of doctors, hospitals, and other providers). SHIPs also can help with Part D prescription drug insurance.

How do you get in touch with SHIP? Call 800-434-0222.

Of course, there are other ways besides SHIP to get information about Medicare. One excellent resource is the “Medicare & You” handbook, which is mailed to Medicare beneficiaries every fall.

“Medicare & You” is a gold mine of easy-to-understand information about how Medicare works, how to enroll, what services are covered, and many other topics. The handbook also lists all Medicare Advantage and Part D plans available in your area, their costs, and contact information for each one.

You can find the latest edition of “Medicare & You” online at: http://www.medicare.gov/Pubs/pdf/10050.pdf

Help is also available through the Medicare customer service center, at 1-800-MEDICARE (1-800-633-4227; TTY users call 1-877-486-2048). The call center is open 24 hours a day, including weekends.