Medicare’s Open Enrollment—It’s Almost Time!


Each year Medicare offers its beneficiaries a chance to make changes to their Medicare coverage. This year, the dates for Medicare’s Open Enrollment are October 15-December 7, 2019.  

During Open Enrollment you can change your Original Medicare A & B to a Medicare Advantage Plan, change from one Medicare Advantage Plan to another, add or change your prescription plan, or change your Medicare Advantage Plan back to Original Medicare. The changes you make will go into effect on January 1, 2020.

Medicare is not a set it and forget it plan.

Most folks do nothing, allowing their coverage to stay the same. This decision could cost them tremendously in both financial and care options.

Each drug plan and Medicare Advantage Plan can change each year.  These changes impact providers and patients alike. 

Premiums, copays, or other out of pocket costs may go up unexpectedly, coverage may not be as robust as in years past, healthcare provider networks may change, and terms for providers may change, limiting providers willing to work with certain insurance carriers at all.  Please remember that our Mindful Transitions team does not accept ANY of the Medicare Advantage plans-only Traditional Medicare.  

It is important for you to review your coverage, your needs, and your options every year.

Here are a few tips from The Medicare Rights Center to get you started:

  • If you are looking for a new Part D plan, you can use the Plan Finder tool from www.Medicare.gov to compare options in your area. Before you use Plan Finder, make a list of the medications you take, the amount that you currently pay for them, and which pharmacies you like to visit. You will be able to get a sense of which plans cover the medications you need with the lowest costs and fewest coverage restrictions.
  • If you are shopping for a new Medicare Advantage Plan, you can use the Plan Finder tool to compare options in your area. You can also call 1-800-MEDICARE and ask about plans in your area. Once you have a list of your available options, you can visit their websites to learn more.
  • After you have researched plans and found one that you are interested in, call that plan directly to confirm what you learned online. Ask about your doctors and hospitals to check that they are included in your plan’s network. Check also that the plan includes all the drugs you need on its formulary, and that your pharmacies are in the plan’s network. Write down everything about this conversation, including the date of the conversation, who you speak to, and the outcome of the call.
  • Call 1-800-MEDICARE if you decide to enroll in a new plan. This is the best way to protect yourself if there are any problems with enrollment. Write down everything about your call, including the date of the conversation, who you speak to, and any information the Medicare representative gives you during the call. Remember to confirm all the details about your new plan with the plan itself before calling Medicare.
  • Be wary of solicitations and advertisements stuffing your mailbox (both snail mail and email). Medicare Advantage Plans have started sending out information about their plans, but they must follow certain rules.

If you need additional help, please reach out to GA Cares at 1-866-552-4464 (option 4).

For more information please visit Medicare Rights Center.

All of the Clinical Social Workers are Medicare providers and accept assignment. We do not, however, accept any of the Medicare Advantage Plans.  If you want to learn more about our services, please visit our FAQ page, call us at (678) 637-7166, or email us at inquiry@23.21.76.49

Understanding Medicare’s Mental Health Benefits

Original Medicare offers mental health benefits to beneficiaries needing mental health services. Here is a quick overview of those benefits:

Outpatient Services

Medicare Part B will pay 80% (once the Part B deductible is met) for outpatient counseling services. The remaining 20% would be the co-insurance paid by the patient (or a MediGap plan, if the patient has a supplemental plan).

Medicare allows its beneficiaries the option of getting treatment through a variety of mental health professionals such as psychiatrists, psychologists, clinical social workers and clinical nurse specialists.  Most of our clients prefer to find a provider who accepts Medicare and takes assignment. If a provider doesn’t accept assignment then Medicare will not pay for the services or reimburse a beneficiary for amounts paid to non-participating providers. The Licensed Clinical Social Workers at Mindful Transitions are all certified Medicare providers and take assignment.

Mental Health Screenings

In addition to psychotherapy, Medicare covers yearly depression screenings that must be done in a primary care doctor’s office or primary care clinic. This can help with appropriate diagnosis, treatment and follow-up. There is no cost for this screening. If your doctor hasn’t talked to you about your mental health, you can always request a screening.

Inpatient Psychiatric Services

The benefits for inpatient psychiatric services are paid by Medicare the same way that general hospital services are paid. There is a $1,340 deductible for each benefit period, $0 coinsurance for the first 60 days, and $335 co-insurance for days 61-90. Medicare pays for 80% of all mental health services provided while the patient is in the hospital. Medicare limits the number of psychiatric hospital stays to 190 days per lifetime; after those days are used up, the patient must pay for inpatient psychiatric care privately.  

Partial Hospitalizations 

Partial hospitalization programs (PHPs) are structured programs provided as an alternative to inpatient psychiatric care. They are more intense than traditional therapy, are provided during the day, and  do not require an overnight stay. Medicare helps cover partial hospitalization services when they’re provided through a hospital outpatient department or community mental health center (assuming that the doctor and the partial hospitalization program accept assignment). 

Medications

Medicare usually covers medications used to treat mental health conditions under the Part D prescription drug benefit. The Part D formularies may limit which medications are covered and should be checked. Each Part D plan creates its own list of approved and covered drugs. The open enrollment period is a great time to review your plans’ formulary and to possibly switch to a new plan.

Medicare Advantage Plans

Medicare Advantage Plans also offer mental health services, but there are limits to their services. They have a narrow network of providers.  Each plan has to be explored individually to learn what they will provide.

Finding Providers

To locate a provider in your area that accepts Medicare assignment, use Medicare’s online tool at medicare.gov/physiciancompare. Type in your zip code, or city and state, then type in the type of profession you want locate, like “psychiatry” or “clinical social worker” in the “specialty” box.

The Licensed Clinical Social Workers at Mindful Transitions are Medicare providers and take assignment. In addition to providing psychotherapy, we also provide comprehensive clinical social work services to each of our clients, ensuring that they are connected to important services in the community and that their care is coordinated between all providers. Taking this holistic perspective that incorporates the whole system is important for the well-being and optimal functioning for each of our clients. We provide psychotherapy and so much more!

Finding Help with Psychiatric Medications: Atlanta’s Geriatric Psychiatrists

In our last newsletter, we discussed medication issues and the importance of medication reconciliation and regular medication reviews to make sure all of the right medications are being taken. Medication issues are no small matter for older adults. The financial and physical costs of taking too many medications can be quite high.

Our primary recommendation from that newsletter was to talk to your doctor regularly about all of your medications.  The goal of this is to:

1. Verify your medication list, making sure you both know what you are taking.
2. Make sure you are only taking what is needed.
3. Evaluate if all medications are necessary and are worth any potential side effects.

But what if your primary care doctor says that she cannot oversee or manage your psychiatric medications? What should an older adult do to get good advice on their medications?

Geriatric Psychiatrists

A geriatric psychiatrist is a doctor with special training in the diagnosis and treatment of mental disorders in older adults (e.g., depression, anxiety, substance use disorders, dementia, etc.).  A geriatric psychiatrist may be preferred over a psychiatrist that specializes in adults because older adults have special physical, emotional, and social needs that impact their mental health treatment plans.  Keeping this in mind, geriatric psychiatrists take a comprehensive approach that addresses co-existing medical illness and medications, family issues, social concerns and environment issues.

Establishing a relationship with a geriatric psychiatrist is usually recommended for our older adults dealing with mental health issues. We value their knowledge and approach and have witnessed the significant changes that usually follow their interventions.

Atlanta’s Geriatric Psychiatrists

Atlanta, like most communities, has a shortage of geriatric psychiatrists. We are lucky than most communities, but it can still be frustrating to find a geriatric psychiatrist and to get a timely appointment.  You can begin the process by asking your primary care physician for a referral. If she does not have a geriatric psychiatrist referral for you, please contact our office at (678) 637-7166 or inquiry@mindfultransitions.com.  We would be happy to help you navigate this issue.

Mental Health Crisis

If you are in a mental health crisis, it may be difficult to wait for a doctor’s appointment. Here is a list of the mental health emergency resources in Georgia:

Georgia Crisis and Access Line— A free 24/7 helpline providing mental health crisis assistance and access to mental health resources throughout the state of Georgia
1-800-715-4225
mygcal.com

9-1-1-For emergencies in which law enforcement may be called, ask for a Crisis Intervention Team (CIT) officer
Dial 9-1-1

If you are in the Metro Atlanta area, many of our psychiatric hospitals are available for walk-in assessments 24/7:

Ridgeview Institute,3995 S Cobb Dr, Smyrna, GA 30080
Peachford Hospital,2151 Peachford Rd, Atlanta, GA 30338

For questions about Mindful Transitions or to learn more about our team of Clinical Social Workers, please visit our FAQ page, call us at (678) 637-7166, or email us at inquiry@mindfultransitions.com .
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By Far the Best Christmas Gift Received by Our Clients!

We were pleasantly surprised to see that a number of our clients received an Apple Watch for Christmas! 2018’s Apple Watch came with features that made it the perfect gift for some of our clients. In case you missed it, Apple announced in September that they were adding a fall detection feature to its wearable technology, making it a no-brainer for many older adults.

Because falls are a real risk for many older adults, many could benefit from wearing a medical alert device, but many do not wear them because they are bulky, ugly, and stigmatizing. As a result, many who would benefit from wearing one, do not.

Enter the world of smartwatches to help older adults and their family members who worry about falls to find some peace of mind without having to use one of those “ugly” pendant buttons.

The families of some of our clients did their research and invested in the Series 4 Apple Watch. Not only does it look sleek, it has a number of great features that our clients will benefit from:

Fall Detection: The watch will monitor for hard falls and then ask the wearer to check in. If the wearer doesn’t respond, 911 is called.

Electrical Heart Sensor: Provides ongoing monitoring of the wearer’s heart rate and will send notification when there is a low or fast heart rate.

Wrist Calling: The wearer can make or receive calls from his/her wrist. The watch can be connected to the wearer’s iPhone and to WiFi to make calls without holding the phone. The wearer can even use Siri to make calls and never have to push a button.

Easy Emergency Calling: There is a button on the side of the Apple Watch that just has to be pressed to call 911.

Reminders/Alarms: The watch can be programmed to give regular reminders to take medications, get some physical activity, check in with a loved one, etc.

Location Capability: Others can find the wearer (if authorized) through GPS tracking, providing reassurance to those that worry about their loved ones potentially wandering.

Larger Screen and Louder Speaker: This latest version of the Apple Watch has a screen that is 30% larger and 50% louder.

Shower-Ready: The watch is resistant up to 50 meters so can be worn all the time, even in the shower. (The only exception is when it needs charging, which it needs for about 2 hours every 30 hours.)

Hard to Lose: Since the watch is attached to the wearer’s body, it is hard to lose.

Many older people don’t want to wear medical alert buttons because of the stigma associated with them, but they could benefit from their use nonetheless. The latest Apple Watch will help them to get this benefit while wearing something that looks more appealing and offers additional functioning.

We are so excited for our clients that have new Apple Watches. Do you know any older adults that have recently started wearing Apple Watches? What have you heard? Please share your thoughts and experiences by leaving a comment on our Facebook Page.

Understanding Psychosis in Older Adults

By 2030, there will be approximately 15 million older adults living with mental illness (up from about 6 million currently).* The average life spans of all adults, including those with mental illness, is growing, and since more and more people are living longer, the number of individuals who will develop a mental health disorder will also be growing.

This means that our community will likely start seeing more older adults living with psychotic disorders. Psychosis may present as delusions, hallucinations, incoherent speech, and/or extreme agitation, and the person exhibiting these behaviors will likely be unaware of his/her state or concerning behavior. Many older adults experiencing psychosis also are likely experiencing stigma, isolation, and poor treatment in primary, long term, and acute care centers. As this population grows, it is very important for us to understand more about psychosis in older adults.

Psychosis Has Many Causes

Older adults have an increased risk for developing psychotic symptoms. This increased risk is caused by a combination of physical illnesses, changes in the brain and neurochemistry, social isolation, sensory deficits (such as hearing loss), cognitive changes, and polypharmacy. Frequently, we see older adults experience psychosis alongside moderate-to-severe memory disorder, comorbid medical problems, a fragile support system, and a complicated medication regime.

The chronic and persistent presence of delusions, hallucinations, and other psychotic symptoms can be divided into two groups: primary psychotic disorders (e.g., schizophrenia, delusional disorder, mood disorder with psychotic features) or psychosis secondary to dementia, medications, substance use, or other general medical conditions.

Schizophrenia affects about 1% of the population. Older adults with schizophrenia often live alone, in assisted-care facilities, in
homeless shelters or on the street. Most older adults with schizophrenia were diagnosed before age 45 (only 10-15% of older adults with schizophrenia were diagnosed after age 45), and ideally have symptoms that have decreased in severity with age. Older adults, however, can experience a relapse of symptoms, causing an return of psychotic symptoms later in life.

The most common causes of new-onset psychosis in older adults are dementia, delirium, prescription/otc drugs, infections (e.g., pneumonia or urinary tract infections), and medical conditions (i.e., congestive heart failure, chronic obstructive pulmonary disease, renal insufficiency, and anemia) may lead to psychotic symptoms. Dementia and depression (and other mood disorders) can also cause psychotic symptoms.

Psychosis Does Not Equal Danger

Most people experiencing psychosis are not dangerous, and yet public perception does not match up with this fact. A violent history is the best predictor of future violent behavior, not psychotic symptoms. Someone experiencing psychosis may be a danger to themselves, as a faulty view of reality can lead to bad decision making.

Psychosis is Treatable

Treating psychosis begins with a thorough evaluation of the cause for the symptoms. If the psychosis is related to an infection, drug reaction, substance use, or medical issue, the underlying cause can be treated, making the psychotic symptoms disappear. If the psychotic symptoms are related to a mood disorder, or thought disorder, the treatment of psychosis usually involves a combination of antipsychotic medications and psychosocial therapy. For those living with dementia, an adjustment of the physical, environmental, and psychosocial triggers may help to ease symptoms.

The Clinical Social Workers at Mindful Transitions are trained to assess and help older adults experiencing psychosis to adapt their thoughts and behaviors through our ongoing assessment at every visit and through regular psychotherapy sessions. We also help guide our patients and care partners in how to obtain further evaluations of the cause of the psychosis and how to get appropriate medical treatment for those other causes. For more information on our services, please call us at (678) 637-7166 and visit our frequently asked questions.

 

*Jeste DV, Alexopoulos GS, Bartels SJ et al. (1999), Consensus statement on the upcoming crisis in geriatric mental health. Arch Gen Psychiatry 56(9):848-853.

How to Prevent a Suicide

We learned earlier this year that suicide rates have risen drastically since 1999.  In that time period, suicide rates increased 25% in the US.  Shockingly, there were more than twice as many suicides as homicides in 2016.  Currently, suicide is the tenth cause of death in the US.
Preventing SuicideFollowing up on this information, as well as the upsetting suicides of Kate Spade and Anthony Bourdain, the Chicago Tribune posted an article, “Are Suicides Really Preventable.”  In this article, Gracie Bonds Staples (interestingly enough, a contributor for the AJC) explained that according to her recent review of data, what we are doing to prevent suicide isn’t effective

This is discouraging news, to say the least. From the explanation of the data, it is almost impossible to predict (and therefore prevent) if a person will attempt suicide. Providing timely, effective interventions is what every mental health clinician and emergency resource strives for, but this seems not to be enough. One study found that over 75% of those who die by suicide , denied having any suicidal thoughts or intentions in their last communications.

How to Really Prevent Suicide

There are a variety of opinions and ongoing clinical research about what could help prevent future suicides. Clinicians have studied/are studying the ideas of changing public policy to reduce the availability of guns, reducing access to dangerous medications, and even erecting fences around certain areas.* Let us not be afraid to demand larger, community-wide, government-backed ways to prevent suicide. The work clinicians, friends, family members, church families, and others do to prevent suicide matters, but we need more.

And In The Meantime…

We will continue to do what we do.  The clinical social workers at Mindful Transitions are trained in suicide assessments and preventative strategies with our clients. We continue to help our clients build resiliency, to cope with stressors, and to create functioning social networks. We share our training with other elder care professionals, and we advocate for changes at the state and local levels.

If you are having thoughts of suicide, please reach out for help:

Call the National Suicide Prevention Lifeline: 1-800-273-8255
Chat at suicidepreventionlifeline.org
Text TALK to 741741 to text with a trained crisis counselor
Find more resources at: https://www.speakingofsuicide.com/resources/

*Miller M, Lippmann SJ, Azrael D, Hemenway D. Household firearm ownership and rates of suicide across the 50 United States. J Trauma. 2007 Apr; 62(4):1029-34; discussion 1034-5.
*Klieve H, Barnes M, De Leo D. Controlling firearms use in Australia: has the 1996 gun law reform produced the decrease in rates of suicide with this method?. Soc Psychiatry Psychiatr Epidemiol, 2009; 44: 285-292.
*Zalsman, G, Hawton, K, Wasserman, D, van Heeringen, K, Arensman, E, Sarchiapone, M, Carli, V, Höschl, C, Barzilay, R, Balazs, J, Purebl, G, Kahn, JP, Sáiz, P, Lipsicas, CB, Bobes, J, Cozman, D, Hegerl, U, Zohar, J. Suicide prevention strategies revisited: 10-year systematic review. The lancet. Psychiatry, ISSN: 2215-0374, Vol: 3, Issue: 7, Page: 646-59

Big Changes to Medicare?

Lately our clients have been asking about the new changes to Medicare heading our way.  The first change is the Medicare ID number. The second change is to the Medigap Plan F.  So, let’s talk about a bit more about these changes.

New Medicare Cards

New Medicare Numbers

In April of this year, Medicare started sending out new Medicare cards to all of 60 million of its beneficiaries. This new card will have a new ID number for everyone (a number that is not the beneficiary’s social security number) that will be made up of a series of 11 numbers and letters.  This process will cost about $242 million, and Georgians can expect to receive their cards sometime before April 2019.

To learn more, please visit https://www.cms.gov/medicare/new-medicare-card/nmc-home.html

Medigap Plan F

In addition to having Medicare Part A and B, many of clients have a Medigap plan. This is non-governmental secondary insurance plans that help cover what Medicare does not pay for. About 500,000 Medicare beneficiaries have a Medigap plan, and about 53% of them have a Medigap Plan F. Plan F is popular because it almost eliminates any extra out-of-pocket costs after the premiums are paid. Plan F pays the deductibles for Part A and B, all Part B excess charges, ​Part A hospital and coinsurance costs, Skilled Nursing Facility (SNF) coinsurance, and more. Unfortunately, this plan will no longer be sold as an option to Medicare beneficiaries who do not already have Plan F in place in 2020 as part of the Medicare Access and CHIP Reauthorization Act of 2015. 

So, what does this mean for our clients that currently have a Plan F? This change only affects new enrollees because the law states that as of January 1, 2020, Medigap plans that pay the Part B deductive will no longer be sold to newly eligible Medicare beneficiaries. Medicare beneficiaries that bought a Plan F before January 1, 2020 can keep their current Medigap coverage.
The rules for Medicare are always changing. It can be difficult to stay on top of the information or to understand the implications and details of every change. For further reading, please visit these sites:

Elder Abuse: Protecting Georgia’s Vulnerable Adults

Georgia Elder Abuse Reporting Card
Georgia Elder Abuse Reporting Card Provided by DAS

June is Elder Abuse Awareness Month. There is so much to say about the neglect, abuse, and exploitation of older adults in Georgia. Let’s start with the fact that 1 in 9 adults over the age of 60 are abused. According to the GBI, there were 2,082 criminal charges brought against elder abuse perpetrators in 2016. This was an increase from 366 in 2010.

As the number of older adults grows in our state, we have an increasing number of potentially vulnerable adults. Recent stats show that one in five Georgians are elderly or disabled. In addition to the growing number of potential victims, Georgia has been working hard to educate law enforcement, district attorneys, mandated reporters, and the community about this growing epidemic.

Despite the increase in elder abuse cases, it is still one of the most unreported and undetected crimes in the United States.

Continue reading “Elder Abuse: Protecting Georgia’s Vulnerable Adults”

The “Silent Epidemic” of Addiction in Older Adults

Substance use disorder (that is, alcohol and/or drug abuse) among those aged 65 and up is often underestimated and under-diagnosed.  The number of those suffering with these issues is on the rise (as evidenced by the stats on ER visits), but those accessing treatment for addiction is not increasing at the same rate.  This “silent epidemic” is dangerous. Addiction in late-life can be caused by a variety of factors, and it take many different forms. But drug or alcohol abuse among the elderly is particularly dangerous as compared with those in mid-life because senior citizens are more susceptible to the deteriorating effects of drugs and alcohol. Individuals over 65 have a decreased ability to metabolize these substances, and they have an increased brain sensitivity to the chemicals. This makes it dangerous for seniors to use drugs or alcohol at all, even if the person isn’t addicted. Along the same line, there are a high number of seniors using benzodiazepines to treat anxiety, pain, or insomnia. These are some of the most dangerous prescription drugs for seniors and are highly addictive. The rate of senior citizens addicted to benzos has increased every year.

The key to getting treatment is to first identify the problem and then to speak up. The following are signs of substance abuse in older adults:

  • Memory problems
  • Changes in sleeping habits
  • Unexplained bruises
  • Irritability, sadness, depression
  • Unexplained chronic pain
  • Changes in eating habits
  • Wanting to be alone often
  • Failing to bathe or keep clean
  • Losing touch with loved ones
  • Lack of interest in usual activities

Once an addiction is suspected, it is critical to seek treatment from programs and clincians that specializes in older adults and addiction. To learn more, please read our newsletter about this topic or visit the National Council on Seniors Drug & Alcohol Rehab.  And please contact us with any questions or to talk to us about counseling for yourself or a loved one.

Advance Care Planning: “It always seems too early, until it’s too late.”

Today is National Healthcare Decision Day (NHDD)! NHDD started in 2008 as a way to inspire, educate and empower the public and providers about advance care planning, and this year NHDD is whole week (starting today).  For Georgians this week is all about getting people to talk to their loved ones about their healthcare wishes and to complete a Georgia Advance Directive. So, let’s start talking!

First, what is the Georgia Advance Directive?
It is a statutory document that combines the healthcare power of attorney and living will into one document. It is the primary advance care planning tool in Georgia and has four main goals:

  1. Names someone to make healthcare decisions for you if you cannot or do not want to make your own  healthcare decisions.
  2. Communicates your treatment preferences if you are ever in a coma or diagnosed with a terminal illness and cannot speak for yourself.
  3. States your wishes for cremation or burial.
  4. Allows you to recommend a guardian if you ever need a guardian in the future.

Who Needs an Advance Directive?
Almost every Georgian over the age of 18 should have an Advance Directive in place. This is not a form just for the elderly or the disabled. Accidents, sudden illnesses and healthcare crises are equal opportunity events that can cause severe impairment in any of us at anytime. Completing an Advance Directive proactively (before it’s too late) will authorize an informed person to make your important healthcare decisions should you be unable to do so.

Where can I find the form?
This is a statutory form and can be found for free online. You can download a copy here. After you print it out, complete it with your loved ones, sign it, and then have two witnesses sign it. No notary or attorney is required.

What do I do with the form once completed?
You should give a copy of this completed form to people who might need it, such as your health care agent(s), your family, and your physician. Keep a copy of this completed form at home in a place where it can easily be found  if it is needed. Do not keep it in a safe or a safety deposit box. Review this completed form periodically to make sure it still reflects your wishes.

Completing a Georgia Advance Directive is an important step in planning ahead for future incapacity. It is never too early to talk to your loved ones about yours (and their heatlhcare wishes). We address this issue with each of our clients and their families, and we help them complete an advance directive when appropriate. Please let us know if you have any questions or concerns.