Sep 5, 2017 | Articles Of Interest
Through its Ready Campaign, the Federal Emergency Management Agency educates and empowers Americans to take some simple steps to prepare for and respond to potential emergencies, including natural disasters and terrorist attacks. Ready asks individuals to do three key things: get an emergency supply kit, make a family emergency plan, and be informed about the different types of emergencies that could occur and their appropriate responses.
All Americans should have some basic supplies on hand in order to survive for at least three days if an emergency occurs. Following is a listing of some basic items that every emergency supply kit should include. However, it is important that individuals review this list and consider where they live and the unique needs of their family in order to create an emergency supply kit that will meet these needs. Individuals should also consider having at least two emergency supply kits, one full kit at home and smaller portable kits in their workplace, vehicle or other places they spend time.
Recommended Items to Include in a Basic Emergency Supply Kit:
- Water, one gallon of water per person per day for at least three days, for drinking and sanitation
- Food, at least a three-day supply of non-perishable food Battery-powered or hand crank radio and a NOAA Weather Radio with tone alert and extra batteries for both
- Flashlight and extra batteries
- First aid kit
- Whistle to signal for help
- Dust mask, to help filter contaminated air and plastic
- sheeting and duct tape to shelter-in-place
- Moist towelettes, garbage bags and plastic ties for personal sanitation Wrench or pliers to turn off utilities
- Can opener for food (if kit contains canned food)
- Local maps
Additional Items to Consider Adding to an Emergency Supply Kit:
- Prescription medications and glasses
- Infant formula and diapers
- Pet food and extra water for your pet
- Important family documents such as copies of insurance policies, identification and bank account records in a waterproof, portable container Cash or traveler’s checks and change
- Emergency reference material such as a first aid book or information from www.ready.gov
- Sleeping bag or warm blanket for each Consider additional bedding if you live in a cold-weather climate.
- Complete change of clothing including a long-sleeved shirt, long pants and sturdy Consider additional clothing if you live in a cold-weather climate.
- Householdchlorinebleachandmedicinedropper – When diluted nine parts water to one part bleach, bleach can be used as a disinfectant. Or in an emergency, you can use it to treat water by using 16 drops of regular household liquid bleach per gallon of water. Do not use scented, color safe or bleaches with added cleaners.
- Fire Extinguisher
- Matches in a waterproof container
- Feminine supplies and personal hygiene items
- Mess kits, paper cups, plates and plastic utensils, paper towels Paper and pencil
- Books, games, puzzles or other activities for children
Jun 26, 2017 | Articles Of Interest
By Jonathan Blum, Deputy Administrator and Director for the Center of Medicare at the Centers for Medicare and Medicaid Services
A number of visitors to www.HealthCare.gov have told us they’d like to know more about the Medicare “donut hole” in the Part D program.
If you aren’t familiar with Medicare, it is a health insurance program for people 65 or older, people under 65 with certain disabilities, and people with End-Stage Renal Disease (permanent kidney failure). People with Medicare have the option of paying a monthly premium for outpatient prescription drug coverage. This prescription drug coverage is called Medicare Part D.
In 2010, basic Medicare Part D coverage works like this:
- You pay out-of-pocket for monthly Part D premiums all year.
- You pay 100% of your drug costs until you reach the $310 deductible amount.
- After reaching the deductible, you pay 25% of the cost of your drugs, while the Part D plan pays the rest, until the total you and your plan spend on your drugs reaches $2,800.
- Once you reach this limit, you have hit the coverage gap referred to as the “donut hole,” and you are now responsible for the full cost of your drugs until the total you have spent for your drugs reaches the yearly out-of-pocket spending limit of $4,550.
- After this yearly spending limit, you are only responsible for a small amount of the cost, usually 5% of the cost of your drugs.
You may have read in the 2010 Medicare & You Handbook that there are some Medicare Part D plans that offer coverage in the donut hole—but these plans may charge a higher monthly premium. (There are also some Part D plans that are “enhanced” and offer fixed co-pays (for example $5, $10, and $20) for prescription drugs instead of the deductible and 25% cost-sharing that was described above. These plans also may charge a higher monthly premium.)
For those that qualify, there is also a program called Medicare Extra Help that helps you pay your premiums and have reduced or no out-of-pocket costs for your drugs.
Needless to say, for most people with Medicare Part D, the donut hole presents serious financial challenges. Some people have had to choose between their rent or groceries and their prescription drugs.
But, the recent health reform law – the Affordable Care Act – has some important changes that will help to relieve this burden for the people with Medicare that hit the donut hole each year (and are not already on a program called Medicare Extra Help,):
- This year, if you enter the Part D donut hole, you will receive a one-time, $250 rebate check. The mailing of these checks began in June. If you are eligible and do not receive your check, call your Part D plan first and then 1-800-Medicare.
- Starting in 2011, you will receive a 50% discount on brand-name drugs in the donut hole, and you will start to pay less and less for your generic Part D drugs in the donut hole.
- Starting in 2013, you will pay less and less for your brand-name Part D prescription drugs in the donut hole.
- By 2020, the coverage gap will be closed, meaning there will be no more “donut hole,” and you will only pay 25% of the costs of your drugs until you reach the yearly out-of-pocket spending limit.
Throughout this time, you will get continuous Medicare Part D coverage for your prescription drugs as long as you are on a prescription drug plan.
If you would like more information on the one-time rebate check, feel free to check out this brochure or call 1-800-MEDICARE. (Please note that you do not need to do anything to receive this rebate check and should not provide any personal information such as Medicare, Social Security or bank account numbers to anyone calling about the rebate.)
https://blog.medicare.gov/2010/08/09/what-is-the-donut%C2%A0hole/
Costs in the coverage gap
Most Medicare Prescription Drug Plans have a coverage gap (also called the “donut hole”). This means there’s a temporary limit on what the drug plan will cover for drugs.
Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. In 2016, once you and your plan have spent $3,310 on covered drugs, you’re in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.
Brand-name prescription drugs
Once you reach the coverage gap in 2016, you’ll pay no more than 45% of the plan’s cost for covered brand-name prescription drugs. You get these savings if you buy your prescriptions at a pharmacy or order them through the mail. Some plans may offer higher savings in the coverage gap. The discount will come off of the price that your plans has set with the pharmacy for that specific drug.
Although you’ll pay no more than 45% of the price for the brand-name drug in 2016, 95% of the price—what you pay plus the 50% manufacturer discount payment—will count as out-of-pocket costs which will help you get out of the coverage gap. What the drug plan pays toward the drug cost (5% of the price) and what the drug plan pays toward the dispensing fee (55% of the fee) aren’t counted toward your out-of-pocket spending.
Example
Mrs. Anderson reaches the coverage gap in her Medicare drug plan. She goes to her pharmacy to fill a prescription for a covered brand-name drug. The price for the drug is $60, and there’s a $2 dispensing fee that gets added to the cost. Mrs. Anderson pays 45% of the plan’s cost for the drug and dispensing fee ($62 x .45 = $27.90).
The amount Mrs. Anderson pays ($27.90) plus the manufacturer discount payment ($30.00) count as out-of-pocket spending. So, $57.90 counts as out-of-pocket spending and helps Mrs. Anderson get out of the coverage gap. The remaining $4.10, which is 5% of the drug cost and 55% of the dispensing fee paid by the drug plan, doesn’t count toward Mrs. Anderson’s out-of-pocket spending.
If you have a Medicare drug plan that already includes coverage in the gap, you may get a discount after your plan’s coverage has been applied to the price of the drug. The discount for brand-name drugs will apply to the remaining amount that you owe.
Generic drugs
In 2016, Medicare will pay 42% of the price for generic drugs during the coverage gap. You’ll pay the remaining 58% of the price. What you pay for generic drugs during the coverage gap will decrease each year until it reaches 25% in 2020. The coverage for generic drugs works differently from the discount for brand-name drugs. For generic drugs, only the amount you pay will count toward getting you out of the coverage gap.
Example
Mr. Evans reaches the coverage gap in his Medicare drug plan. He goes to his pharmacy to fill a prescription for a covered generic drug. The price for the drug is $20, and there’s a $2 dispensing fee that gets added to the cost. Mr. Evans will pay 58% of the plan’s cost for the drug and dispensing fee ($22 x .58 = $12.76). The $12.76 amount he pays will be counted as out-of-pocket spending to help him get out of the coverage gap.
If you have a Medicare drug plan that already includes coverage in the gap, you may get a discount after your plan’s coverage has been applied to the price of the drug.
Items that count towards the coverage gap
- Your yearly deductible, coinsurance, and copayments
- The discount you get on brand-name drugs in the coverage gap
- What you pay in the coverage gap
Items that don’t count towards the coverage gap
- The drug plan premium
- Pharmacy dispensing fee
- What you pay for drugs that aren’t covered
If you think you should get a discount
If you think you’ve reached the coverage gap and you don’t get a discount when you pay for your brand-name prescription, review your next “Explanation of Benefits” (EOB). If the discount doesn’t appear on the EOB, contact your drug plan to make sure that your prescription records are correct and up-to-date. Get your plan’s contact information from a Personalized Search (under General Search), or search by plan name. If your drug plan doesn’t agree that you’re owed a discount, you can file an appeal.
https://www.medicare.gov/part-d/costs/coverage-gap/part-d-coverage-gap.html
Jun 26, 2017 | Articles Of Interest
Example Medicare Drug Plan for 2017*
Your plan may vary depending on your deductible and copays
| COVERAGE STATUS
You/Medicare |
Your Actual Drug Cost |
Your Out-of-Pocket Cost |
| Deductible Period
You pay all/Medicare pays none |
$0-$400 |
$0-$400 |
| Coinsurance/Copayment Period
You pay 25%/Medicare pays 75% |
$400-$3,700 |
$400-$1,225 |
| Coverage Gap Period
You pay all/Medicare pays none |
$3,700-$7,425 |
$1,225-$4,950 |
| Catastrophic Period
You pay 5%/Medicare pays 95% |
over $7,425 |
over $4,950 |
*The example above shows 2017 calendar year costs for covered drugs in a plan that meets Medicare’s standards in 2017. Your costs may vary since each Medicare drug plan is structured differently.
YOUR YEARLY JOURNEY THROUGH THE DONUT HOLE:
Deductible Period-
You pay the first $400 of your actual drug cost before your Medicare coverage begins to pay.
Coinsurance/Copayment Period-
You pay your coinsurance or copayment amount until the actual cost of your drugs reaches $3,700. Notice: This does not mean your out-of-pocket will be $3,700. The actual drug cost of $3,700 is based on your out-of-pocket plus what Medicare pays.
Coverage Gap Period (Donut Hole)-
You pay the cost of your drugs until your total out-of-pocket reaches $4,950. This includes amounts you paid earlier during your deductible and coinsurance/copayment period. Based on the example above, the most you would pay during the coverage gap period would be $3,725. In 2017, you will receive a 60% discount on covered brand drugs and 49% discount on generics during the coverage gap. Check with your plan to see if your drugs are eligible for the discount.
Catastrophic Coverage Period-
You pay the reduced coinsurance or copayment amount set by your Medicare drug plan for the remainder of the year.
Note: People who have limited income and resources and qualify for full Extra Help or have additional coverage aren’t affected by the gap in coverage. They would continue to pay the same copayment amount for each prescription they get.
Jun 20, 2017 | Articles Of Interest
For anyone else who wasn’t aware Creon should not be administered via typical G-tube administration process:
- Mixing with thickened liquid (risk: tube occlusion; benefit: maintaining integrity of enteric coating which may preserve efficacy)
o Using a mildly thickened liquid as the vehicle is thought to reduce the risk of tube occlusion compared to using water or other thin liquid because a thin liquid allows the enteric-coated microspheres/beads to settle and clump together in the feeding tube.
o Adequate flushing of the feeding tube before and after administration is critical. If direct contact occurs between the acidic fruit juice and enteral feedings inside the tube, an interaction can occur that may clog the feeding tube.
o Some dietary experts have proposed the following technique, which can be used for tube sizes 10 Fr and above. However, if sizes 10 Fr or 12 Fr are in place, the use of low-dose enzyme capsules (3000—5000 units of lipase) are recommended because they contain the smallest sized microspheres/beads.
- Prepare 50—100 ml of mildly thickened fruit juice using a thickening agent (e.g., Nectar Thick).
- Open the pancrease capsule(s) into a small clean container.
- Add sufficient mildly thickened liquid to completely coat the microspheres/beads and stir gently to evenly suspend them in the liquid.
- If the patient is receiving continuous feedings, stop the tube feeds.
- Flush the feeding tube with an appropriate amount of water.
- Draw up the mixture with an enteral syringe of appropriate size for the volume and feeding tube size. Administer the mixture slowly through the feeding tube with slow, gentle pressure.
- Flush the feeding tube with water, and resume feeds.
