Month: October 2018

This AEP is our third year of using PDPHelper. The following are some tips to help us do accurate searches for you on Medicare.gov.

Step 1

Please enter your name, phone, email address, your zip code, and your county of residence. Some zip codes span multiple counties, and that’s why we request your county of residence. This means where your residence sits.

For example, if you have a Post Office box in Three Forks, MT, that’s in Gallatin County. Let’s say you live off Highway 287 in Broadwater County. Please enter “Broadwater” in the field.

Next, please list your top pharmacy choices. Next, we ask you if you would use Walmart, Walgreens, or a mail order pharmacy if that will save you money.

Step 2

In this section only, enter in pills, capsules, or tablets. Liquids, gels, creams, insulin, eye drops, patches, etc. are in the next steps.

Enter the name of your prescription, the dose, the quantity you buy, and this is the quantity you buy per month, every two months, every three months, or every twelve months. If you take something as needed, estimate how many pills you buy and how often you buy it. For example: 30 pills every 3 months.

Example #1—Betty takes two, 500 mg metformin tablets every day. She buys 60 every month.

Name of Prescription: Enter metformin

Dosage: Enter 500 mg

Quantity: Enter 60

Frequency: Enter month

Example #2—John take hydrocodone/apap, 325/10 mg, as needed for back pain. Some days he takes none but other days he takes two or three. He estimates he takes around 45 per month

Name of Prescription: Enter hydrocodone/apap

Dosage: Enter 325/10 mg

Quantity: Enter 45

Frequency: Enter month

Step 3

The section is for Insulin, Inhalers and Nebulizers

Example #3—Alice uses insulin. She checks “yes”, and she enters her information as follows:

Name of insulin: Lantus solostar

Size: 3 mL

Quantity: 5 pack or just 5

Frequency: per 2 months

Example #4—Alice uses Advair. She checks “yes” for the category, “Do you use any inhalers or nebulizers?” She enters her information as follows:

Name of inhaler: Advair

Size: 250/50

Quantity: 1

Frequency: 1 month

Step 4

This final step is for Eye Drops. Gels, Creams, Lotions or Salves, and Other Prescriptions.

Example #5—Mary uses eye drops. She checks “yes” for this category and fills in the information. Please do NOT attempt to say “2 drops per eye each day.” We need to know the SIZE of the bottle, usually 2.5 mL, 5 mL, 10 mL or 15mL.

Name of eye drops: Latanoprost SOL 0.005%

Size: 2.5 mL

Quantity: 1

Frequency: 1 month

When finished, please hit the submit button.

Background: Chapter 5 and 6 are the final chapters of Part 2 which deals with reward, dopamine, and addiction. Lustig’s writing is fairly technical; I’ll do my best to summarize his explanations into layman’s language.

Lustig begins the chapter by explaining that there’s a price to be paid for reward. It used to be in terms of dollars, but now it’s measured in neurons. Substances, sugar for example, that trigger a dopamine response are now cheap. It’s not a special once-a-year treat. The dopamine receptors in our brains are fragile. Although they like to be “tickled,” these receptors don’t want to be bludgeoned to death.

If you open the dopamine floodgates repeatedly, these neurons have some fail-safe methods built-in to protect themselves.

The over-stimulation of these cells (neurons) leads to cell damage or death, termed excitotoxicity.

My Comments: Dr Russell Blaylock has written a book titled Excitotoxins: The Taste That Kills. You can guess the main theme of his book. Various forms of sugar as well as artificial sweeteners such as aspartame (Equal) and sucralose (Splenda) are toxic substances to critical parts of our brains.

The Firing Squad

Chronic stimulation of your neurons results in cell death, and that’s not good for you. Your brain would continue to get fried. However, nature has provided you some protection against this process, notice some protection.

Ligand (molecules that bind to receptors such as dopamine or cortisol) almost uniformly down regulate their own receptors all over the body.

Put another way, the receptors don’t work as well. The cells don’t respond as well. You need more to get less.

Lustig calls this tolerance. The receiving neuron is becoming tolerant to the excessive stimulus. He says that this occurrence is both good and bad. It’s good because your neurons aren’t dead. It’s bad because you are going to need more of the substance to get the same reward.

My comments: Instead of one doughnut, it’s two or three. Instead of one beer, it’s multiple cans or bottles.

Continuing: Lustig says that tolerance is when a chemical binds to a receptor. This is also true with pharmaceutical drugs. The problem comes in when the stimulations overstimulates the neurons.

Pickling Your Brain

He says that every substance and behavior that drives up your reward triggers will just as quickly drive down your reward receptors. He cites the alcoholic that seemingly can consume more booze than a non-alcoholic as his liver metabolizes the alcohol faster than the non-alcoholic. He explains that this is the reason why drug addicts can easily overdose. First, they are in a period of abstinence, maybe due to treatment or being in jail. Next, they resume with their previous dose, but they no longer have the same level of tolerance. Then they overdose, and for some, it’s fatal.

In essence, he’s saying that one is literally burning up his neurons, and that he’ll never reach the same level or reward as before. He just doesn’t have the machinery to do so, ever! Lusting describes the motto of those in recovery from illicit substances: Once a cucumber becomes a pickle, it never will be a cucumber again.

He cites another problem, and that is withdrawal. Changes in your neurons has occurred. The acute cessation of many of these substances leads to withdrawal. Lustig says that the withdrawal symptoms can be from caffeine, alcohol, narcotics, and tranquilizers. He describes various symptoms in detail.

There can also be emotional withdrawal from cocaine, marijuana, and ecstasy. These symptoms include anxiety, restlessness, irritability, insomnia, headaches, poor concentration, depression, and social isolation. Tolerance and withdrawal are the classic two-headed hydra of the definition of addiction.

Lustig discusses how want turns into need for the addict. The addict will turn to crime to get money to get his fix, and this often includes harming family members.

Are Addictive Behaviors Really Addictive?

Lustig then segues to discussing whether or not behaviors, such as gambling, are addictive. He cited the American Psychological Association (APA) which said that for decades behaviors were not addictive. The reason for their stance was that since the criteria for addiction was both tolerance and withdrawal, there was lack of withdrawal if the behavior ceased. The APA has since changed its position in saying that behaviors can be addictive in certain circumstances.

Addiction Transfer

What happens if a person can’t get his favorite fix? Lustig points out that if a person’s dopamine pump is primed, it’s waiting to be fired, for something, anything. He says that people abstaining from one substance will frequently become users of another substance. He describes smoke filled rooms of AA meetings.

The Real Thing

Lustig recounts the story of John Pemberton, an Atlanta pharmacist. By 1886 he invented a formula using carbonation, and this concoction later became known as Coca Cola. Pemberton placed his first ad for his new carbonated drink in the Atlanta Journal. People came to his pharmacy to imbibe. The pharmacy had special equipment to carbonize the beverage, and this became known as the soda fountain.

My comments: I can remember back in the 1950s visiting the soda fountain at the old Thrifty Drug Store in Burbank, California. There were the stools for the customers, and you could order burgers, fries, malts, and of course, soda pop. The new Thrifty built in the 1960s on an adjacent lot phased out the old soda fountain. I always wondered why a pharmacy had a “soda fountain.” Now I know. It was a carry-over from the late 1800s. Wasam’s Drug in Clarkston, Washington still has their soda fountain that caters to the morning coffee crowd.

Continuing: Pemberton had Civil War injuries which resulted in him becoming a morphine addict following the war. To wean himself off his morphine addiction, he developed a concoction which included cocaine, alcohol, caffeine, and sugar. As Lustig puts it, these were four weaker dopamine/reward drugs, to take the place of one very strong one. Pemberton mixed those four with carbonated water.

Due to the growing temperance movement in the South following the war, Pemberton removed the alcohol from his formula., Due to being sick and penniless, he sold his formula to an Atlanta businessman by the name of Asa Candler for a paltry $2,500. Candler later developed Pemberton’s concoction into the most famous brand in the world. Pemberton died that same year, sick, in pain, and still addicted to morphine. Lustig points out that none of the sordid story of John Pemberton is revealed at the Coca Cola museum in Atlanta.

The federal government required the removal of cocaine from Coca Cola in 1903 leaving just the sugar and caffeine. Did that scuttle Candler’s carbonated drink? No, the two remaining substances were still enough to maintain the hook! Lustig asks a rhetorical question: Why do you think Starbucks sells Frappuccinos?

My comment: No wonder Lustig mentioned Frappuccinos. Depending if they use regular cream or fat-free “cream”, this beverage has about 60 to 90% of its calories from sugar!

Continuing: Coca Cola is in every country in the world except for North Korea. Lustig says that Coca Cola is the most recognized brand on the globe and for good reason:

It’s a delivery vehicle that mainlines two addictive compounds straight to your nucleus accumbens. Sugar just happens to be the cheapest of our many substances of abuse. But all of those substances do essentially the same thing. By driving dopamine release, they all acutely drive reward, and in the process, they drive consumption. Yet, when taken to extreme, every stimulator of reward can result in addiction.

Cost of addictive substances:

• Heroin or cocaine: You need lots of cash
• Alcohol and nicotine: You need an I.D.
• Sugar: You need a quarter or a cookie from Grandma

Lustig describes sugar as the cheap thrill and the reward that everyone on the planet is exposed to and the reward that’s affordable.

Everyone’s an addict, all your relatives are pushers. And it’s only one of two addictive substances that are legal and generally available. (the other one being caffeine). That’s why soda is such a big seller; it’s two addictive substances in one.

My Comments: I can personally testify that sugar is addictive as I became addicted to it an adolescent. Oh yes, I’ve gone through the cravings of wanting something sweet. Fortunately, I abused my health when I was young, and hopefully there have been no long-lasting effects from my past carelessness. The deceptive thing is that many sugar addicts don’t realize they are addicted, or they are in denial. Saying that I have a “sweet tooth” is just hiding that fact that I have a sugar addiction.

Sadly, many seniors are addicted to sugar, and it plays havoc with their health. Gary Taubes in his YouTube video, The Case Against Sugar, speaks of obesity, type two diabetes, heart disease, strokes, cancer, etc. as all being a subset of insulin resistance.

If you recognize that you are addicted to sugar and want to do something about it, there are several excellent self-help videos on YouTube. Simply enter “Breaking a sugar addiction” into your YouTube search window. Here’s a terrific one for starters, 3 Ways To Stop Your Sugar Cravings That Are Keeping You Fat. Here’s another by Dr. Axe, How to Kill Your Sugar Addiction Naturally. It’s superb. Good luck! End

The Medical Savings Account (MSA) type of Medicare advantage plan has existed previously, but it will be new for many people. This plan is available in selected states including Montana, Utah, and Wyoming but not yet in Idaho, Oregon, or Washington. Before we delve into the mechanics of how the MSA plan works, let’s review the types of Medicare advantage (MA) plans.

Health Maintenance Organization (HMO): Members use a designated network of doctors. With some exceptions, it is not intended to be used out-of-network.

Preferred Provider Organization (PPO): Members have lower co-pays if they use in-network doctors, but they have the flexibility go out-of-network.

Private Fee for Service (PFFS): Members can use any doctor that accepts the terms and conditions of the plan. When MA plans ramped up in 2006, most plans were PFFS. As the years rolled on, the marketplace evolved in that most MA plans transitioned to either HMO or PPO plans. PFFS plans have virtually disappeared from the marketplace.

MA plans can be MA plans only, or they can be MAPD, which means that they have a prescription benefit incorporated into the plan.

There’s one more important distinction to make. If you have either an HMO or PPO Medicare advantage plan and also want prescription coverage, it must be built into your MA plan. That means that you have an MAPD plan.

If you have a PFFS MA plan without drug coverage, or an MSA plan, you have the option to add a separate, stand-alone Prescription Drug Plan (PDP). If you have an MAPD, whether is be of the PPO or HMO variety and decide to switch to an MSA plan, you will need to pick up a stand-alone PDP, as MSA plans do NOT have prescription plans built into them.

How does the MSA plan work?

The following description is generic, as the numbers I’m using for example purposes only. They are NOT specific to any given MSA plan, but rather they are to illustrate how an MSA plan works. The name of our fictitious company is Acme Health Plans or AHP for short.

Qualification: Your must be on Medicare Parts A and B and live in a county where the plan is offered.

Premium: The plans are typically zero premium.

Savings account amount: The plan deposits $2,400 into your medical savings account. Remember, this is NOT the actual amount of any given plan, but rather It is for illustrative purposes only.

Deductible: $7,400—Again, this is an illustrative number only and not the amount of any given MSA plan.

Let’s say you are starting your new plan January 1, 2019. AHP deposits $2,400 into your MSA debit card account. You can go to any doctor that accepts your plan. There are no networks. You can use your plan in-state or out-of-state.

Your doctor bills AHP, and that bill comes back to you, along with your explanation of benefits, and you pay it out of your debit card account. Let’s say Medicare approved $100 for your office visit. The $100 that you paid counts towards your deductible.

Let’s say that you have exhausted your $2,400 debit account. Now you are the hook for the next $5,000 out of your own pocket for medical expenses until you reach your $7,400 deductible. Once you have met your deductible, AHP pays 100% of your Medicare approved health care expenses for the remainder of the year. The cycle resets at the beginning of the year with a new deductible and a new deposit into your MSA debit card account.

Potential downside of the MSA plan: Yes, you could be out of pocket $5,000, and that will not be acceptable for many people. In summary, AHP fronts you $2,400. From $2,400 to $7,400 you are on you own.

Other important questions

Do I lose whatever remains in my debit account at the end of year? No. Any remaining balance accumulates on a year by year basis. It’s NOT a “use it or lose it” program.

If I leave the plan after two or three years, does AHP take back my debit account? No. The funds are yours. You can continue to use them for qualified medical expenses. (see below) There may be an administrative fee on your debit account after you have left the plan.

Can I use my funds for things that Medicare doesn’t cover such as dental or vision? Yes. You can use your funds for IRS qualified medical expenses (QMEs).

Examples of QMEs:

• Dental
• Vison
• Co-pays for your prescriptions
• Hearing aids
• Long term care expenses

Paying for your prescription plan premium from you debit account is not a QME.

Can I drop a Medicare supplement plan and sign up for an MSA plan? Yes. Make sure that you notify your Medicare supplement company that you are leaving their plan.

If I sign up for an MSA plan, can I choose a prescription plan of my choice? Yes. Remember, the MSA plan does not have a prescription benefit.

If I have another MA plan, can I switch to an MSA plan? Yes. Remember, if your MA plan is an MAPD, you will also need to pick up a stand-alone prescription plan to maintain your drug coverage.

Conclusion

Assuming you live in a state where the MSA plan is offered, you will have to determine if the plan is right for you. Consider the pros and cons. Please contact us for further information. End