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With the end of Daylight Savings Time, the days are shorter and often darker. For some people, this can trigger a type of depression known as Seasonal Affective Disorder (SAD). People with SAD can experience exhaustion, lethargy, and may struggle to carry out their daily routines. SAD affects up to 5 percent of the population, and is connected to a reduction in natural light exposure due to shortened days. This can cause a brain chemical imbalance. To reduce your risk for Seasonal Affective Disorder and to promote general health during the fall and wintertime, take the following steps:
These tips can help with Seasonal Affective Disorder, and can help to increase energy levels during the winter. If you find that you are experiencing these symptoms over a period of time, seek help from a mental health professional. Click here to read more about Seasonal Affective Disorder from HealthDay News. |
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Medicare Answers from Marci !
Dear Marci,
My doctor told me that Medicare Part B will pay for me to get certain vaccines as preventive care, and that I would not have to pay for these vaccines. I’m especially concerned about the flu vaccine, since it is now flu season. Can you explain how Medicare covers these preventive services vaccines?
– Victor (San Antonio, TX)
Dear Victor,
Medicare Part B covers three vaccines as part ofpreventive care services: the flu vaccine, the pneumonia vaccine, and the hepatitis B vaccine. These vaccines are covered by in full, whether you have Original Medicare—the traditional program administered directly by the federal government—or a Medicare Advantage plan. Preventive care vaccines are an important part of staying healthy, and it is important to discuss these vaccines with your doctor.
The flu vaccine is covered once per flu season. The flu season typically runs from October through April. Therefore, Medicare may cover a flu shot twice in one calendar year. For example, if you get a flu shot in February 2014 for the 2013-2014 flu season, you can get another flu shot in November 2014 for the 2014-2015 flu season. Original Medicare will pay for the flu shot anywhere you receive it, as long as you get it from a Medicare provider. If you have a Medicare Advantage plan, your plan cannot require that you get a referral for the vaccine, but you may be required to use providers in the plan’s network.
The pneumonia vaccine is covered in full by Medicare once in your lifetime. However, in rare cases, Medicare will cover this shot more than once in a lifetime. If you are at high risk for pneumonia, meaning that you have an immunodeficiency, Medicare may cover this shot in full once every five years. Speak with your doctor if you think you are considered high risk for pneumonia. Medicare Part B covers the pneumococcal vaccine for pneumonia.
Medicare will also cover the entire cost of the hepatitis B vaccine if you are considered at medium to high risk for the disease. Some examples of individuals who are at medium to high risk for hepatitis B are people with End-Stage Renal Disease (ESRD), hemophiliacs, and those healthcare professionals who have contact with bodily fluids during their work. Speak with your doctor if you think you are at risk for hepatitis B. If you are at low risk for the disease, you can still get the hepatitis B vaccine, but it will be covered by your Part D plan, and you will likely have to pay a copay.
If you have Original Medicare, the best way to avoid additional charges is to see a health care provider whoaccepts Medicare assignment when receiving these vaccines. To avoid additional charges if you have a Medicare Advantage plan, check with your plan to make sure you follow their rules about receiving vaccines.
-Marci
Medicare Reminder !
Between October 15 and December 7, beneficiaries can make changes to their Medicare prescription drug plan coverage. Medicare’s drug benefit (Part D) is outpatient prescription drug coverage for anyone with Medicare. It is available only through private companies.
If you want to get this coverage, you have to choose and enroll in a private prescription drug plan. Enrollment is optional and only allowed during certain enrollment periods, includingbetween October 15 and December 7. Whether you should sign up for a Medicare private drug plan depends on your circumstances. Some people already enrolled in certain low-income assistance programs may be automatically enrolled in a Medicare drug plan and get financial assistance with premiums and cost-sharing.
Kaiser Family Foundation Report Compares Quality of Medicare Advantage with Traditional Medicare
Last week the Kaiser Family Foundation (KFF) released a comprehensive review of research literature comparing health care access and quality in Medicare Advantage with the traditional Medicare program. Today, 30 percent of all people with Medicare are currently enrolled in a Medicare Advantage (MA) plan, private plans that contract with the federal government to provide Medicare benefits. The literature review analyzes 45 studies that compare MA and traditional Medicare, published between 2000 and 2014.
The report reviews studies that examine a variety of topics, including beneficiary reports on quality and access, potentially avoidable hospital admissions, readmission rates, health outcomes, resource utilization and more. While highlighting some methodological criticisms of the studies, the report finds that the cumulative evidence shows that MA plans tend to perform better than traditional Medicare in providing preventive services and conserving their resources, at least through 2009. At the same time, according to the report, people with Medicare consistently rate traditional Medicare as being better than MA in terms of quality and access, though one study suggests that this gap may be closing for some groups of beneficiaries. Across studies, sicker beneficiaries overwhelmingly favor traditional Medicare.
Ultimately, the report expresses disappointment in the lack of information comparing MA with traditional Medicare. KFF calls for more study of the differences between MA and the traditional Medicare program, particularly in light of increasing MA enrollment.
Dear Marci,
Dear Marci,
I got a pamphletfrom my doctor’s office reminding me to get all necessary vaccines. I want to talk to my doctor about getting these vaccines, but I’m not sure how Medicare will cover them. How does Medicare cover vaccines?- Eddie (Denver, CO)
Dear Eddie,
Medicare covers vaccines differently depending on which vaccine you need. Most vaccines are covered under Part D, but some are covered under Part B. Different costs apply to vaccines depending on how they are covered.
Medicare Part B covers vaccines if you have been exposed to a dangerous disease. For example, if you step on a rusty nail, Medicare will cover a tetanus shot. Additionally, Medicare Part B covers the influenza, pneumonia, and Hepatitis B vaccines as preventive services. These vaccines are covered by Part B if you have Original Medicare or a Medicare Advantage plan.
If you receive a Part B-covered vaccine after exposure to a dangerous disease, you will pay the normal cost sharing for Part B services. If you have Original Medicare, Medicare will cover 80 percent of the cost, and you or your supplemental insurance will be responsible for 20 percent once you have met your Part B deductible. If you have a Medicare Advantage plan, you will typically pay a copay for this service. Contact your Medicare Advantage plan directly to ask about specific vaccine costs. If you receive one of the three preventive vaccines covered under Part B, Original Medicare will cover the costs with no coinsurance or deductible, as long as you see a provider that accepts Medicare assignment. A Medicare Advantage plan will cover the costs with no coinsurance, copays or deductibles as long as you see an in-network provider.
All other vaccines are covered by Medicare Part D. Both Medicare Advantage prescription drug plans and stand-alone Part D plans must include all commercially available vaccines on their drug formularies, including the vaccine for shingles (herpes zoster). However, for these vaccines covered by Part D, you may pay different amounts depending on where you get vaccinated. Check directly with your plan for coverage rules and costs.
In general, you will pay the least for a Part D-covered vaccine if you receive the shot at a pharmacy that is in your plan’s network, or at a doctor’s office that will bill your Part D plan directly for the cost of the vaccination process. When you are at your doctor’s office, ask your doctor to call your Part D plan first to find out if there is a way that your doctor can bill your plan for the vaccine. There may be a way for the doctor to submit the bill so that you will not have to pay the whole cost up front.
If your doctor cannot submit the bill for the vaccine to your Part D plan through a partnering pharmacy, or cannot directly bill the plan for the drug, you may need to pay more for your vaccination. If this happens, your doctor will bill you for the entire cost of the vaccine, and you will have to pay the cost up front. Then you will have to follow your Part D plan’s rules to get a refund. Know that your doctor has no limit in how much they can change you for the vaccine, but your Part D plan will only pay its approved amount for payment. You will be responsible for the difference between the doctor’s charge and the plan’s approved payment amount.
If you have Extra Help, the federal benefit that helps people with low incomes pay for their prescription drugs, you can go to any doctor or in-network pharmacy for a vaccine. You will be covered for the vaccination and will only be responsible for the Extra Help copay.
-Marci