Suzanne: And welcome back everyone to Answers for Elders Radio Network. And we are here with Kristine Grow, who is the spokesperson for the Coalition for Medicare Choices. And I got it right this time. Kristine, I’ve heard statements like dual eligibility. What is that type of a program?
Kristine Grow: People who are dual eligible qualify for both Medicare and Medicaid. And this can get confusing because a lot of Americans aren’t quite sure what’s the difference between that and Medicaid. Medicare, of course, is the program available for people aged 65 older or who have certain disabilities. Medicaid is available for low income Americans, especially for two million veterans, moms, their children. And those who are dually eligible for both programs represent some of the sickest and lowest income members of our communities. It’s about 12 million Americans. They have very serious health conditions, they need a lot of protection. So, they’re a very important population that has a lot of chronic conditions, greater levels of disability, and they’re more likely to need nursing home care as well.
Suzanne: When you look at a low income senior, they may have been neglecting their health a lot. How is that impacting their lives today, if they have the Medicare Advantage program?
Kristine Grow: If you have Medicare Advantage, the Medicare Advantage programs serve a lot of dual eligible through what are called SNP plans, or special needs plans. So there’s plans that are specifically designed to take care of people with these particular illnesses. There’s a lot of care coordination, there’s a lot of additional service for care. Things like diabetes, for example, is something that they really focus on. So these are very important plans for, for seniors in particular.
Suzanne: When you’re talking about diabetes, the cost of insulin is astronomical. How does Medicare Advantage help in that that area?
Kristine Grow: A lot of them have special programs specifically designed for people with diabetes, and it’s not just to cover their insulin. There are a lot of other illnesses and a lot of other conditions that come along with being a person who has diabetes, to manage your chronic condition. As your condition may get more serious, to take care of those illnesses as well, help you with healthier eating programs and a lot of other things to help get your blood sugars a little bit more stable and take care of you in the longer run. It also tends to to be accompanied by other chronic health conditions. So you may end up on a lot of different medicines. You have a lot of different doctors that you need to see. As you know, that can be very complicated, it can be very confusing and very overwhelming.
So having a representative from your plan that walks that journey with you and can help coordinate and bring all of that together to make sure that it’s all working it together. You’re getting healthier, you don’t have a medicine in one place that’s undermining the outcomes of the medicine in another area of your health, especially when you when you’re going to different doctors.
Suzanne: Those things can happen. Having this kind of a structure, what all happens? For me, it was interesting because because I was on a medication, that according to my area where I lived in, I had to get a different version of the medication in order for my Medicare Advantage to work to be covered. On the other hand, I have some that somebody that takes the same medication and there’s but they live in a different state. Why is that the case?
Kristine Grow: That’s because these Medicare Advantage plans are offered by health insurance providers. It’s a public/private partnership between the federal government and health insurance providers and the job of the health insurance provider is to negotiate lower costs for you, whether that’s through lower premiums, or through lower out of pocket costs. When you get the care that you need, various drug manufacturers are the ones that are setting the price for these medications. I think we can all agree that they need to lower these prices that they charge from a very high price. No matter how much you negotiate, you’re never going to get an affordable price for a lot of seniors who are on a limited income, but the health insurance providers do a great job of negotiating those lower prices. And they do that through tools that are available to them, such as a formulary which they may say, depending on other drugs that are available, if you have drugs that have the same efficacy, you can get a much cheaper price for it if you get this version of it, and it’s a way to get the drug makers to compete with one another. So, the drugs that are delivering the same kind of clinical outcome can be charged at a cheaper price. So it’s kind of like that negotiation between say, a brand name tissue or a generic tissue. You get the same value out of it, you just get a very good price for it as well. So there’s a lot of that negotiation that happens.
Suzanne: The cuts that are coming ahead, or that could potentially happen, how would that impact those that are on expensive prescriptions?
Kristine Grow: In the very short-hand, it could mean higher premiums or higher costs, especially when you look at some of the benefits. Now, the prescription drugs, I will say these Medicare Advantage plans are always going to be working to negotiate lower prices. But the premiums may go up as a result of some of this federal government investment in the program going away. So that’s gonna be very hard. Some of the programs that people rely on, that frankly may result in you taking fewer prescriptions or needing fewer prescriptions, those programs could go away. So you talked about some of the things like healthy fitness programs, or programs to get you in your community or healthy eating programs, those are some of the kinds of programs that could be at risk, which could unfortunately lead to a need for more prescriptions, more hospitalizations, interventions, which nobody wants that, nobody wants those sorts of outcomes.
Suzanne: And prevention costs a lot less than when you’re sick. So it’s in the best interest of the government to support these types of programs to keep people healthy. And I think that’s really one of the main lessons from today, wouldn’t you agree?
Kristine Grow: Absolutely. And I would say it, what’s unfortunate is about the cuts that they’ve proposed for next year, the people who are dually eligible for Medicare and Medicaid could be impacted most. In fact, one study showed that they could see cuts of 6.4% which is billions of dollars going to support these Americans.
Suzanne: Wow. Kristine, thank you so much for being on the show today. We so much appreciate you sharing what’s going on in the world of Medicare and to each and every one of you reach out to your Congresspeople, your president, et cetera to protect Medicare Advantage, and me Medicare advantage. And we’re really excited that you’re here. So thank you for joining us.
Kristine Grow: Thank you so much for having me.
Suzanne: I would like to thank each and every one of you for joining us today in this hour as we talked about Medicare. Thank you so much. And I am gonna end with the story today as I always do. You see, I was a daddy’s girl. I was born in 1956 and our home was what you’d call a traditional home. Dad worked, mom stayed home. And even though he didn’t have time for me often, let me tell you, I adored him. But my dad, he wasn’t a nurturing parent. Instead, he challenged me constantly. He often played a devil’s advocate and he would sometimes frustrate me. To him, I was never just accepted. Instead, he taught me that opinions mean nothing unless you can back them up. And he would say, unless you can be challenged and stand your ground on something, guess what? It’s just an idea, and not an opinion.
So as I got older, and so did he actually, challenging me never changed. He continuously made me think. And through his constant challenges, I learned to always ask myself, what can I do about it? Sometimes, I wish just to be accepted for who I was. But, you know, not with my dad. His questions were always, even in my adult life: how’s your job? What are you doing to improve your performance? How could you do it better? And even though I look forward to our weekly phone call, I wanted to share my victories and accomplishments. But he always said, how could you have done it better? So today, even though he’s passed away, 20 years ago, I can still hear his voice in my head. He always taught me to not limit myself to the things, and heights that I can soar to. And because of him, I believe that I can always do greater things.
Today, I think about what I would have become had I not had these experiences to be challenged by my father. Would I have given up on dreams when adversity hit? How many things would I not have done, if I didn’t have the belief that I could do more? And he contributed to me more than I ever realized. And now I’m grateful for the many ways that he challenged me, because today I wish I could have told him that.
I think about caregiving a senior parent. No doubt, if you have a parent you love who challenges you every single day, there are days that are more difficult than others. And when those days come around, think about the ways in which these challenges will make you stronger. Maybe a better person. How many things were hard then, bBut you can be grateful for today? What did you learn? Caregiving can be hard, but yet I believe similar challenges can fill you with more compassion, forgiveness, and grace, if you allow it to. There are silver linings in every experience. Caregiving is temporary, but the qualities you develop will last a lifetime.
And I end today, of course, on this Saint Patty’s Day weekend, may the Irish Hills caress you, may her lakes and rivers bless you, and may the luck of the Irish enfold you. May the blessings of Saint Patrick behold you. Until next week, everyone, be good to each other.
