Important Information—Please Read

The Annual Election Period (AEP), also known as Medicare Open Enrollment, ends December 7. Please return all applications ASAP. Every year we have the last-minute procrastinators contacting us at the eleventh hour on December 7th. Please do not be one of them.

Part D Prescription plans (PDPs)

Many of you contact us every fall to have us review your PDPs. This is a smart idea and a benefit for you because it helps you to enjoy having the lowest cost plan year after year.

One trend that we have seen through the years is this. Company X comes out with a very competitive PDP either with a low premium and/or low copays. As time goes by, their premium creeps upward. A few years ago, Company X was $15 per month in most states. Now it’s around $38 per month.

Company Y has had a very competitive PDP for about four years running. However, they increased their premium 25-30%, depending on which state you are in.

At the same time Company Z decides are come out with their new plan, undercutting the competition. Their premium is $15-16 in most states. We have already signed up dozens of you for this plan. This is saving people anywhere from $125 to $250 per year compared to staying with their current plan.

However, you still need to be mindful of the pattern. Company Z will almost assuredly suffer from premium creep in a few years. Most of the original plans from 2006 are gone. Many of the original Part D companies have pulled out, or most of the plans have been reinvented. However, Company A has a plan that was $13 per month in 2006. It’s now around $75 per month. That’s premium creep!

Here’s another trick some companies do. Most generics, but not all, are classified as tier one or tier two generics. This will be true of common prescriptions such as lisinopril, metformin, levothyroxine, simvastatin, omeprazole, and hundreds of others. So far so good.

Seroquel is a psychotropic drug used to treat depression or bi-polar. The generic is quetiapine fumarate. Through 2018 Company B lists quetiapine as a tier 3 drug. The cost is $9 in 2018. When I did a drug search for one client, I discovered that the cost of quetiapine with Company B is rising to $39 per month in 2019. Tier 3, 4 and 5 drugs are subject to the $415 deductible. After that, tier 3 drugs have a $45 copay.

Isn’t that convenient of them! The $39 is still below the $45 copay for a tier 3 drug. Even if my client meets his deductible, he still pays $39 for quetiapine. The bottom line is that he got stuck with a $30 per month increase. Thirty dollars is $30, whether it be additional premium or a higher copay. He gets no help for this drug! Fortunately, we found another plan the has quetiapine as a tier 2 drug with a much lower copay. He elected to change plans. The above are examples of why we encourage you to shop your PDP every year.

Do you really like batting you head against the wall? Call your agent first!

Case #1

Note: I have changed the names of the actors and location for confidentiality.

Marvin and Betty Jones live in Snow City, Montana. Marvin is diabetic, and his doctor wanted him to get a blood glucose monitor. Betty initiated an inquiry to find out how it’s covered.

She first went to their pharmacist at Help You Get Well Pharmacy in Snow City. The pharmacist told Betty that her husband’s PDP covers the blood glucose monitor. Ouch! Upon hearing that, she called customer service at Marvin’s Part D company. Bad mistake! She was on hold for who knows how long and was passed from rep to another rep until the call finally dropped off. Par for the course!

Exasperated, she called Medicare. Now she’s on hold for who know how long, and when she finally spoke to a live person, said person had not a clue. You would think they would know better! Now she’s spent hours getting nowhere except for getting more frustrated.

In desperation she called me. Upon hearing her situation, I said, “Let’s check and especially “What Medicare Covers.” I have a link for this on our website. Please click here. Look for the fourth bulleted item down.

In less than two minutes I had her answer. Quoting from

Blood sugar (glucose) monitors

…Medicare Part B covers blood sugar monitors as durable medical equipment (DME) that your doctor prescribes for use in your home.

Notice that it says Medicare Part B. Part B is medical, which means that Medicare will generally pay 80% of the cost of the blood glucose monitor and Marvin’s Medsupp plan will pay the other 20%.

Part D prescription plans pay for outpatient drugs. They do NOT pay for equipment or supplies such as diabetic test strips, meters, needles, catheters, blood glucose monitors, etc.

We’ll let the entry level employees at Marvin’s Part D company or Medicare off the hook. What about the pharmacist at Help You Get Well? A pharmacy degree requires something like six years of college. Furthermore, the pharmacist knows, or should know, that diabetic equipment is never billed to a prescription plan. You would hope that he’d also knew that a blood glucose monitor is also equipment and not a drug! His wrong answer sent Betty on a wild goose chase.

Now, if you enjoy being on hold, getting wrong answers, and getting you call dropped off, you’re welcome to do so. It’s your time.

If you want to save much grief, call your agent first!

Case #2

Joe and Betty Arlington live in Twin River, Idaho. (Again, all names are fictitious.) Joe was on his wife’s employer plan, which included prescriptions, for about five years, and last fall he went off her plan and signed up for a Part D prescription plan. We shopped for a new PDP for Joe this fall, and during the course of the conversation, Betty told me that she was paying about $25 per month extra for Joe’s Part D premium.

She called Joe’s PDP company, Company D, early in 2018. She asked the customer service rep why she was being billed a higher premium for Joe. The poor rep had not a clue. I might add that we should not expect these reps to know these answers. Their job is to verify your enrollment and answer general questions about the PDPs their company represents. They are not trouble shooters.

When Betty explained the situation to me, it didn’t take me long to figure out what was happening. Medicare doesn’t know that Joe was covered by an employer prescription plan for five years. Therefore, they are billing him for the late Enrollment penalty (LEP). The math works out that the extra premium that he’s paying is the LEP.

If Betty had called me first, that would have saved her a frustrating call to Company D. To resolve this issue, we will have to reach a supervisor in a 1-800 Medicare to fix the situation. Also, if she had called me sooner, we may have been able to have stopped the overcharge early on in the year. I’m doubtful that she’ll be able to get a refund.

Moral of the story: If you want to save heartburn and acid indigestion, CALL US FIRST concerning anything connected with any of your Medicare supplement, Medicare advantage, or Part D Prescription plans. We’ll do everything possible to save you the grief of having to call a company or 1-800-Medicare.

Changing Your Medicare Supplement Plan

There are two misconceptions concerning changing your Medicare supplement plan. Please see our companion article in this issue.

Misconception #1—People think that they can automatically change their Medsupp plan during the AEP. They hear “Open enrollment” on TV and think that that applies to a Medicare supplement plan. For most people, once you pass 65 ½, changing a Medsupp plan involves medical underwriting. This means having “No” answers to questions regarding your current health. Misconception #2—People think that a Medsupp plan can ONLY be changed during the AEP. You can change your Medsupp plan ANY MONTH of the year, subject to medical underwriting. Example: Max Bolivar is having a cataract procedure in March. Once his procedure is complete, he can change to another Medsupp as long as he can answer “No” to the health questions on the new company’s application.  End

The Hacking of the American Mind Report #6—The Purification of Addiction

The Hacking of the American Mind by Dr. Robert Lustig

Chapter 6

What does Lustig mean by titling Chapter 6, The Purification of Addiction?  Substances of addiction used to be scarce. Prior the 1700s addictive substances were expensive, and you had to go out of your way to get them. However, advances in technology dropped the cost of these substances making them much easier to obtain.

Addictive substances have been around for thousands of years, but addiction didn’t really become a societal problem until we started purifying these substances. Opium addiction in China goes back to 1000 A.D. Beer and wine production since the Romans could only get the alcohol content up to about 5%, and those products would still spoil. The alcohol content wasn’t high enough to cause addiction. Distilling alcohol was a game changer as the concentration of alcohol could be raised substantially beyond 5%. Alcoholism in Europe become a major problem in the 1700s once it became available and cheap.

Fast forward to the 20th century. Lustig suggests that is was not an accident that Prohibition was repealed in 1933, which was at the height of the depression. The federal government needed the tax revenues to help finance Franklin Roosevelt’s New Deal programs.

Lustig quotes some current statistics from the National institute for Drug Abuse: 9.5% of men and 3.3% of women are alcoholics. Add to that the binge drinkers. Total alcoholic beverage sales generate $212 billion in annual revenue for the alcohol industry.

He says that it’s not just binge drinking among our youth; it’s the other drug abuses.

Kids aren’t just bingeing on alcohol, they’re also popping uppers, downers, and everything in between. In adolescents over the last thirty-five years, the binge drinking rates, as well as use of virtually every other illicit substance, has continued to increase.

My comments: Why is this happening? Prior to the 1960s, major drug abuse among our youth was not a problem. Oh sure, there was drinking, but Lustig is referring to the degree of change that he has seen in his practice. What has changed? Why were our youth in prior generations not afflicted as so many are today? Lustig does a very good job at raising the issues, and that is the focus of his book. However, he does not get into the deeper causes of why these problems are occurring and how we can overcome them, at least not yet.

Continuing: Lustig says that alcohol is but one example of something that is refined and purified to suit the whims of societal addiction. Marijuana has been bred to be more potent. He also points that new pharmaceutical drugs have been used “off label,” ones that also become abused.

The Other White Powder

Lustig comments about the profit margins of the pharmaceutical industry, something like 20% or better for five large pharmaceutical companies. He continues by saying that that’s nothing compared to the processed food industry. That industry grosses $1.46 trillion annually, of which $657 billion is profits. The gross profit margin is a whopping 45%!

Lustig explains that in the traditional Jewish method of circumcision, the practitioner dipped the pacifier in wine. When the modern obstetrician performs the procedure in the hospital, he dips the pacifier in Sweet-Ease, a 24% super concentrated sugar solution. Doing so activates both dopamine and opioids in the brain, helping the infant to deal the pain.

My comments: Not too long ago I was in a client’s home writing business. The gentleman was also babysitting his whiny three-year old grandson. At one point he gave his grandson a snack of punch and Trix, a high sugar concoction called “cereal.” The little boy settled down and dutifully consumed his sugar-laced snack. It worked well, until the sugar effect eventually wore off.

Years ago, when my son was in the cub scouts, the horribly overweight den mother announced, “We’re having CAKE after the meeting.” It was like Pavlov’s dogs; just the sound of the word CAKE settled the kids down and got them salivating to their soon coming treat.

Lustig referenced the huge profits the processed food industry rakes in. The boxes of confections, erroneously called “breakfast cereal,” couldn’t be a better example. Those boxes that you pay $3, $4, or even $5 are a huge rip-off, especially the ones loaded with sugar. Oh, you will switch to “healthy” granolas? Better check the label. They, too, are loaded with sugar.

The key point Lustig makes in his circumcision example is that sugar is in effect, used as a drug. The grandparent above, also used sugar (likely unwittingly) as a calming agent for his fussy grandson.

Continuing: Lustig makes the point that virtually everyone loves sugar.

The world loves sugar. There’s not a race, ethnic group, or tribe on the planet that doesn’t understand the meaning of “sweet.”

He also explains that if a foodstuff was sweet, it was considered to be safe. He cites the Jamaican ackee fruit. When it’s immature and not sweet it contains a toxic compound that can cause vomiting and even death. When it’s mature, it’s sweet and safe.

Lustig reminds us that prior the World War II, sugar was mostly used as a condiment, drop a sugar cube in your coffee of tea. After the war is when the processed food industry ratcheted up the use of sugar. High fructose corn syrup, the even sweeter sugar, was in use by 1975.

My comments: How ironic it was that sugar was rationed during WW II so it could be packed off to our troops. Interestingly, diabetic rates dropped during WW I and WW II when sugar was less available for the civilian population.

Continuing: Adding to the increased use of sugar by the food industry was the anti-fat hysteria that also hit in the 1970s. If you reduce fat in a product such as ice cream, what do you put in its place? More sugar, of course!

Lustig cites research done with rats. You feed them sugar, and they want more and more. Those little rodents are sugar lovers.

He explains that white sugar, which is composed of glucose and fructose, is not necessary to have in our diet at all. Our liver, through the process of gluconeogenesis, will produce all the glucose, the energy of life, we need. He points out the when fructose is chronically consumed, it can be toxic, and many people become addicted to it. Lusting concludes this section be quoting studies that suggest that sugar is uniquely capable of driving the reward pathway and altering emotional responses.

Denying the Obvious

Lustig concedes that not everyone is on board with the “sugar is addictive” belief. However, he poses a rhetorical question: How can a food—like sugar that is necessary for survival also be addicting? His answer is that certain “foods” are not necessary for survival. He lists what is absolutely necessary for our survival. The four classes of essential nutrients are as follows;

  1. Essential amino acids
  2. Essential fatty acids such as omega-3 and linolenic acid
  3. Vitamins
  4. Other macro-nutrients such as minerals.

His key point is that none of the foods that contain these essential nutrients are even remotely addictive. He also explains that of the substances that contain calories, only alcohol and sugar have been shown to be addictive. Lustig also references caffeine, also addictive, that has been added to some “food” products.

Lustig lists some of the dangers from alcohol consumption and says that “alcohol is dangerous because it’s alcohol.” Those characteristics are remarkably similar to that of sugar, and it’s no wonder, as alcohol is a product of the fermentation of sugar.

He comments about sugar.

Sugar causes diabetes, heart disease, fatty liver disease, and tooth decay. Sugar’s not dangerous because of its calories or because it makes you fat. Sugar is dangerous because it’s sugar. It’s not nutrition. When consumed in excess, it’s toxic. And it’s addictive. Fructose directly increases consumption independent of energy need.

Lustig comments about the naysayers that say sugar is “natural” and has been with us for a thousand years. They maintain that sugar is FOOD, and since it’s food, how can it be toxic, and how can it be addictive? He says that their contention begs the question: What is food? He quotes Webster’s dictionary definition of food.

Food: A material consisting essentially of protein, carbohydrate, and fat used in the body of an organism to maintain growth, repair, and vital processes and to furnish energy.

Lustig quips that since sugar furnishes energy, it’s a food, at least according to some of the naysayers. He than discusses a European group called NeuroFAST. In essence, they claim that sugar is not addictive. For a complete discussion, please refer to pages 91-92.

Sugar is addictive for the same reasons and via the same mechanism as alcohol. Lustig explains that sugar is not a food; it’s a food additive. He continues to say that children are getting the same diseases as seen with those that consume excessive alcohol, type 2 diabetes and fatty liver disease.

When “Want” Becomes “Need”

Lustig asks the reader the following question: Can you honestly look yourself in the mirror and tell yourself that you have no addictions? He answers his rhetorical questions as follows: Ben & Jerry’s, eBay, Facebook, porn, video games, coffee?

He then asks: How long did the rush from the new iPhone or new car last? He says that as a society we’ve become tolerant by obtaining new stuff at a moment’s notice.

You might call dopamine the dark underbelly of our consumer culture. It’s the driver of desire, the purveyor of pleasure, the neurotransmitter of novelty, the lever that business pushes to keep our economy going, but at a clear, perceptible and increasing cost. We’ve purified our substances to concentrate their effects, and we are perpetually in need of the next new shiny object.

My Comments: Lustig points out that acquiring material things can also drive our dopamine receptors. I couldn’t agree with him more. I recently ordered and received my new Milwaukee M12 cordless impact driver and drill driver. It was like Christmas time when my shipment arrived and I opened the package and dug out my new” toys.” I loved the feeling. It was fun!

I asked myself if there was another M12 product that I “needed.” I went through the entire line of Milwaukee M12 products but couldn’t find one. Even though there was nothing I needed, I realized that it’s not too difficult to become hooked on buying another new “toy.”

For the guys, the dopamine inspired buying spree could be tools, guns, cars, and adult toys. For the gals it could be clothes, purses, shoes, or collectible items.

Is all pleasure bad? In an earlier chapter, Lustig explained that some stimulation or tickling of our dopamine receptors is actually healthy. We need to have some pleasure in life. We can enjoy the pleasurable rush of the new iPhone, car, or whatever. We can enjoy the occasional sweet treat. We can enjoy any of these things as long as we don’t become addicted to the substance or behavior or allow want to turn into need.

It’s important to keep in mind Lustig’s central them of his book: Too much pleasure leads to addiction, and not enough contentment or happiness leads to depression.  End