Credit: Kainaz Amaria/NPR

Part of the Family Matters series

May 1, 2012

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Few people want to turn over a loved one to institutional care. No matter how good the nursing home, it may seem cold and impersonal — and very expensive. But making the choice to provide care yourself is fraught with financial risks and personal sacrifices.

Those who become full-time caregivers often look back and wish they had taken the time to better understand the financial position they would be getting themselves into.

“I used to hear about people saying, ‘Oh you know, we’ve got to put our parents in a home; we can’t deal with it anymore,’ ” said Yolanda Hunter, 43, a Maryland resident who is struggling with her decision to drop out of the human resources field to become a full-time caregiver for her grandmother. “And I used to think: ‘Oh, how cruel are you?’

“You know, but now? I understand,” she said.

Hunter belongs to one of three families being profiled in NPR’s eight-week series, Family Matters: The Money Squeeze, which airs each Tuesday on Morning Edition. Each family is struggling with how to afford care for an older generation. The do-it-yourself approach is both common and costly.

Caregiver advocacy groups say Congress needs to be doing more with tax credits and Social Security benefits to help financially support those who choose to care for the elderly.

The Cost Of Elder Care

Adults have been providing an increasing percentage of financial assistance to their parents in recent years. Below are the national average annual costs and daily rates paid for various types of adult care.

Source: MetLife 2011 Market Survey of Long-Term Care Costs

The demands for such assistance may grow louder, given the demographic changes coming in our aging society.

Nearly 10 million people over the age of 50 are caring for their aging parents, according to a study conducted by the MetLife Mature Market Institute, in conjunction with the National Alliance for Caregiving and theNew YorkMedicalCollege. The number of caregivers has more than tripled over the past 15 years.

That increase reflects medical advances and the resulting increase in human longevity. As the average age of death has moved from 68 in 1950 to nearly 79 now, the ranks of the elderly have grown. Today, about 6 millionU.S.residents are over 85.

As a result, the personal cost of caring for the elderly at home is rising — in terms of lost wages and diminished pension and Social Security benefits, the MetLife study concluded.

Studies estimate that 2 out of 3 informal caregivers are women, many of whom are middle-aged mothers with children or adult children living in their households.

The cost of putting a parent into professional assisted-living care can be daunting. MetLife says that kind of care averages about $42,000 a year. A private room in a nursing home averages more than $87,000. But the cost of keeping a relative at home can be very high too.

The MetLife report said that for the typical woman, the lost wages due to dropping out of the labor force because of adult caregiving responsibilities averages nearly $143,000. That figure reflects the wages lost while not working — typically for about five years — as well as lower wages after returning to the workforce with rusty skills. When foregone pension and Social Security benefits are counted, the out-of-pocket losses roughly double.

“Family caregivers are themselves aging and yet are providing care at a time when they also need to plan and save for their own retirement,” MetLife said. The people who drop out of the workforce “can jeopardize their future financial security,” the study concluded.

Hunter has discovered just that. She quit her job to become an in-home helper for her 89-year-old grandmother, Ida Christian, who has Alzheimer’s disease. Christian lives with her daughter, Geneva Hunter, 66, who runs secretarial operations at aWashington,D.C., law firm. Yolanda Hunter has an apartment a few minutes away from her mother and grandmother.

Enlarge Kainaz Amaria/NPR

Ida Christian gets help from her granddaughter, Yolanda Hunter (left), in blowing out the candles on the cake celebrating her 89th birthday.

Kainaz Amaria/NPR

Ida Christian gets help from her granddaughter, Yolanda Hunter (left), in blowing out the candles on the cake celebrating her 89th birthday.

Like many other caregivers, Yolanda Hunter thought the “job” of watching over her grandmother would not last all that long. Her thoughts at the time she quit her job: “I can do this for a year, help settle things down, try and take the pressure off a little bit,” she said.

Her goal was to find a good home nursing aide to help her grandmother so that she could jump back into the workforce. But two-and-a-half years later, it “didn’t quite work out that way,” she says.

Although Christian’s savings are enough to provide a modest salary for her granddaughter, the amount is not great enough to allow Hunter to prepare for her own retirement.

So Hunter had to switch gears again and begin trying to re-enter the labor market at a time when nearly 13 million other people also were seeking work.

As this year began, she said she recognized that “I desperately want to get back to work, because I’m mentally tired and I feel — unless I win the lottery — I feel like I’m missing out on so much in terms of my future and making sure I have a stable future.”

But then again, “there’s that part of me that is very, very torn about leaving her, because no matter how compassionate the next person may be, they’re not going to do the extra things that you’re going to do,” she said.

Some women’s groups say Congress should expand tax credits available to people with dependent relatives and create “caregiving credits” to limit the Social Security penalty for time spent out of the labor force to provide family care.

Family Matters: The Money Squeeze

Family Matters: Meet The Families

The Caregiver Credit Campaign, an advocacy effort, says such help is warranted because without voluntary caregivers, “hundreds of billions of government dollars would be spent on alternatives like institutions.”

AnIndianaUniversityreport says “informal caregivers provide service that would otherwise cost the Medicare system $375 billion a year.”

Meryl Comer, president of the Geoffrey Beene Foundation Alzheimer’s Initiative, knows about the financial penalties of caregiving. At age 50, she was a journalist, living in aMarylandsuburb outside ofWashington,D.C.Then her husband, age 58 at the time, was stricken with early-onset Alzheimer’s.

She quit her job to become his at-home caregiver. Then her mother got Alzheimer’s too. Now, 18 years after quitting her outside-the-home job, she continues to care for her husband and elderly mother.

She argues that corporations should do more to help their employees handle adult-care needs while staying on the job.

“How do we do provide flex time for people who are taking care of their parents?” she asked. “The human resources policies [for caring for the elderly] need to mirror the child-care policies,” she said. “If corporations want women to be productive in the workforce, they have to make some accommodations,” such as allowing them more flexible schedules, family-leave time and telecommuting opportunities.

Comer said corporations have come a long way over the past 30 years in terms of responding to the needs of working mothers with young children. “Now they have to do the same for the other end of the age spectrum,” she said.

Do you have ideas for Elder Assistive Technologies?  Step up, reply, join TKP

How and when should one intervene in the personal financial dealings of one’s elders?  This is important as it can directly affect you.  Yet it can be a delicate situation getting involved with parents money matters.  There are no set rules or guidelines and each family has to direct itself.

TKP would like your opinion and any experiences you’ve had.  Someone reading this is going to find your advice very helpful.

Financial abuse of the elderly, including pushing them into reverse mortgages without their full understanding, has been perpetrated by mortgage professionals and victims’ family members.

February 19, 2012|By Lew Sichelman LA Times

Reporting From Washington — The recent conviction of aDelray Beach,Fla., loan officer for his participation in a scheme to persuade seniors to refinance their reverse mortgages should serve as a warning to the friends and relatives of elderly people about the surprising ease with which senior homeowners can be exploited.

That the loan officer and his co-conspirators, including a title agent, were creating false loan applications and pocketing the money casts a pall over the lending business. And with good reason, according to the National Council on Aging, which ranks homeowner/reverse mortgage scams as the eighth most prevalent scam specifically targeting seniors.

Yet rogue mortgage professionals aren’t the chief perpetrators of such elder abuse. Family members are.

About 60% of the financial abuse cases substantiated by adult protective services involve an adult child, according to MetLife’s Mature Market Institute. Sons are most likely to rip off their parents or grandparents, the study found, even more so than a paramour, bogus contractor, fly-by-night handyman or shady lender.

Still, while most lenders are lawful, some aren’t. If a senior citizen you know is considering a loan that taps into the home equity he or she has built up over the years, here are a few questions family members and friends can ask to help prevent exploitation:

• Does the applicant understand the loan? This is something that will be covered in a session with an independent housing counselor that is mandatory under the Federal Housing Administration’s Home Equity Conversion Mortgage program. But make sure your mom, dad, grandparent, aunt or uncle knows what he or she is getting into before getting that far into the process.

Of course, this implies that the applicant is willing to discuss his or her financial situation. Many keep that information to themselves for fear of losing their independence. But if you can get them to open up, you can discuss the pros and cons of reverse mortgages with them to be sure all of you understand the product.

If the senior doesn’t fully comprehend the nature of a reverse mortgage, that doesn’t mean it isn’t a good fit. It might just mean further education is needed, says Lori Delagrammatikas, who oversees the master’s program in adult protective services at the San Diego State University Research Foundation.

At the same time, the desire to take out a loan they don’t fully comprehend could be a sign that something else is going on in their lives.

Loneliness and isolation raise the risk of elder financial abuse, as does the high rate of dementia among seniors.

Who is going to benefit? Find out who the real beneficiary will be and why. If it’s not the senior, question it.

In one case a few years back, a 65-year-old woman was coaxed into taking out a $100,000 lump-sum reverse mortgage by her son, who proceeded to gamble away the money. The son was charged with criminal elder abuse and spent time in jail, but the money was never returned to his mother, who is now losing more than $3,000 of her equity every month.

AMontanawoman recently was convicted of bilking her elderly mother out of $120,000 from the proceeds of a reverse mortgage. The mother suffered from Alzheimer’s disease, and prosecutors argued she did not have the capacity to understand the loan. The daughter used the money to pay off her own credit cards, buy jewelry and stable her horses, among other things.

Is the senior being coerced? Determine if your senior is being pushed into the loan and, if so, by whom.

In another case, an elderly couple turned over the proceeds of their reverse mortgage to their grandson, who had threatened to commit suicide if they didn’t give him the money.

Be particularly aware of in-home helpers, including personal care attendants and meal service providers, who may have access to the senior’s financial papers and identifying information.

• Can the senior’s needs be satisfied in another way? There are several alternatives to reverse mortgages.

If you suspect a senior you know is being taken advantage of, contact the adult protective services agency in your state. APS programs are typically housed within local or state departments of social services or aging. Further information can be found on theNationalCenteron Elder Abuse’s website at http://www.ncea.aoa.gov.

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So – do you have any ideas, suggestions or questions?  Write to us at TKP.

Everyone should have a DNR or and Advance Medical Directive – see the Caregiving Chapters here at the TKP site for more info.

The end of life, if extended can become very expensive.  “So what?” you might ask if it keeps your aging parent or loved one alive for ________number of days or weeks.  How do you evaluate when the doctor comes to you with the question?

Here is a short article about how doctors decide for themselves.  You might find this helpful.

if you have experience or questions – please post to TKP – sharing information and suggestions is one of the best things we can do.

Doctors’ advance directives

Mercury Newsmercurynews.com

Posted:   02/18/2012 04:24:16 PM PST

February 19, 2012 12:26 AM GMT Updated:   02/18/2012 04:26:34 PM PST

Doctors have access to whatever care they want.

But experts in end-of-life care say they know its limits — and have specified, in their Advanced Directives, to go gently.

This is what two topAltaBatesSummitMedicalCenterphysicians have decided:

Glen Petersen, ICU doctor: “If I have a treatable reversible disease, then I would accept the care that is appropriate for that disease. But if it appeared that I was sick and not going to get better, or if meant there was undue burden to treatment, then I would not want supportive treatment. Very simple.”

Jeffrey Stoneberg, palliative care doctor: “I would want a reasonable chance to get better. If I would be unable to interact with the outside world, unable to communicate, unable to receive information That is not a life to be continued. If I cannot maintain an independent quality of life to be able to spend with friends and family, I would not want to continue.”

“Grandma, is it time for you to die?” Is this subject inevitable ? Yes.  Controversial?  It depends.  This is a topic for family to discuss.  However now with the new health care bill it seems that the government will be involved in these discussions.  This is a mixed bag.  Please weigh in with your thoughts on the subject.

Doctors see benefit in end-of-life controversy

Physicians say it’s brought needed attention to often overlooked service

 By Jessica Marcy

 KHN

 The paragraphs, buried deep in the 1,000-page House health reform bill, appear innocuous, but they have ignited a firestorm among critics predicting government-sponsored euthanasia.

The controversy, over proposed Medicare funding of end-of-life counseling, has come to epitomize some of people’s deepest fears about the government’s role in health care.

Yet physicians who work with patients on end-of-life planning say that while they are surprised and upset about criticism of the proposal, it has brought needed attention to what they view as a long under-funded and overlooked service. Jon Radulovic, vice president for communications at the National Hospice and Palliative Care Organization, says the debate dispute “is providing the end-of-life care community with an opportunity to talk about what good care is and the services that are available.”

Section 1233 of the House bill would reimburse physicians for advance care planning consultations with any Medicare beneficiary, but it does not mandate the completion of any advance care directive or living will. The provision, advocates say, would pay for doctors to have those conversations while a patient is healthy and communicative rather than in the middle of a health crisis.

‘Death panel’ rumors
Much of the furor has centered on claims that the provision would give rise to ‘death panels’ and euthanasia, which experts have dismissed. But critics also have raised concerns about the vagueness and complexity of the language in the bill, asserting that it could be open to a wide interpretation and encourage government to play an excessive role in end-of-life issues.

Sen. Chuck Grassley, R-Iowa, the top Republican on the Finance Committee, vowed the panel would not include such a provision in its much anticipated health care reform package. “I don’t have any problem with things like living wills,” he said. “But they ought to be done within the family. We should not have a government program that determines if you’re going to pull the plug on grandma.”

Dr. Ted Epperly, president of theAmericanAcademyof Family Physicians, often has advance end-of-life conversations in his work as a family physician and geriatrician inBoise,Idaho. He says the discussions can protect patients from having costly procedures done against their will.

He describes such conversations as sensitive and time-consuming since they delve into the “nitty gritty” details: whether patients want to use ventilators to breathe, defibrillation to restart their hearts or feeding tubes for nourishment. He says the discussions are best done with a trusted physician who has developed a relationship with the patients. Family members are also sometimes involved, he says.

Patients’ end-of-life wishes
To start such a conversation, Dr. Diane E. Meier, an internist and director of the Center to Advance Palliative Care in New York City, says she asks her patients what they would want if they were hit by truck and in a coma or a situation where they were not expected to recover sufficiently to be aware of their surroundings. Some say they would want everything possible done to prolong life, But roughly nine out of 10 of her patients say they would want care to be focused on their comfort — not sustaining life — if their brain was not functioning, according to Meier.

Dr. Gene Rudd, an ob-gyn and senior vice president of the Christian Medical & Dental Associations, said such conversations are part of good health care and should be encouraged. However, he worries that the provision could require that physicians use standardized language to counsel patients.

“It’s nothing novel here,” he said. “The novelty is the government then may be deciding that it can say what ought to be said in those sessions, not the fact that they ought to have these sessions and these discussions. It’s standard care.”

Still, health professionals say, these discussions are too rare. That’s largely because Medicare doesn’t explicitly pay for the service, discouraging doctors from taking the time to talk with patients about the issues. Private insurance companies often base their own payment policies on Medicare’s.

Currently, physicians generally classify the conversations under a funding code covering counseling and discussion of issues such as marital problems and depression associated with a job loss, Epperly says.

Medicare typically pays $92.33 for a 40 minute consultation, which Epperly says “drastically underpays for the complexity and the importance of this discussion,” adding that the creation of a new code — as called for in the House bill — would better value its importance.

‘Act of charity’
Under the current payment system, Epperly notes, doctors could see five patients or complete a more lucrative procedure in the time it would take them to have an in-depth end-of-life consultation.

Meier, who also works as a professor of geriatrics and internal medicine at Mount Sinai School of Medicine, agrees: “It’s time consuming, it takes skills and it is so poorly paid that it is basically an act of charity … Physicians who are in a fee-for service environment legitimately cannot really afford to have” such conversations.”

“In my view, (the House bill) is a small and mostly symbolic effort to redress that imbalance of which physician services get paid for and which don’t,” she says.

In addition to the payment issues, doctors often don’t have such conversations because of time constraints and the sensitive nature of such talks. The shortage of primary care doctors has also contributed to the problem, experts say.

According to Epperly, as a result, only one out of five patients who should have such a consultation actually does.

Both opponents and proponents of the legislation acknowledge that it could produce significant savings. Studies show that 25 percent of the Medicare budget is spent on people during their final year of life — with 40 percent of that spent in the final month.

Opponents worry that the cost savings might give doctors incentives to discourage treatment when they talk with their patients. The non-profit policy group Americans United for Life posted the following statement on its Web site: “The provisions that address end-of-life issues must be amended to leave no room for an interpretation that would pressure healthcare providers to make decisions based on cost rather than best medical care.”

Proponents say several studies show that having such conversations not only saves money but improves quality of care.

Researchers found patients with advanced cancer who had end-of-life care conversations with physicians had significantly lower health care costs in their final week of life while higher costs were associated with worse quality of care, according to a 2009 study published in the Archives of Internal Medicine.

In addition, hospice has been shown to improve quality of life and reduce costs during the end of life. Patients using hospice care save Medicare close to $2,400 per beneficiary, researchers fromDukeUniversityconcluded in a 2007 study. Meanwhile, research has found that hospice patients lived an average of 29 days longer than similar patients who did not enroll in hospice, according to a 2007 study in the Journal of Pain and Symptom Management.

Congress has waded into this issue before. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established the Hospice Education Consult, which provides Medicare coverage for a one-time hospice consultation that examines end-of-life care.

However, in order for that consultation to qualify for payment, the patient must be diagnosed with a terminal illness and have a prognosis of six months or less to live. Also, the act did not create a unique funding code.

High-tech beds to help the elderly and infirm

By Patrick May

pmay@mercurynews.com

Posted: 01/08/2012 04:38:00 PM PST

Updated: 01/09/2012 05:30:00 AM PST
First, we had the smartphone.

Then the smart meter.

Now, coming soon to an elder-care facility near you, it’s the “smart bed.”

Using gee-whiz software and a small but powerful sensor embedded in a thin pad beneath the mattress, the two Apple (AAPL) alums behind Campbell-based startup BAM Labs have created a device to monitor patients’ vital signs and movements without a single wire or electrode.

Launched in October, the Touch-free Life Care System (or TLC — get it?) is already being used in scores of beds in seven facilities, offering real-time remote monitoring of the bedridden. Its creators, who say they’ve exported their “Apple DNA” into the user-friendly product, claim that patient falls and bed sores have plummeted in the retirement homes where the smart beds are being used.

The ah-ha moment came in 2001.

“My wife gave birth to twins at 28 weeks,” said CEO Rich Rifredi, who worked as a product marketing manager at Apple alongside Steve Young, now BAM’s chief technology officer. “My son came home attached to a monitor by a bunch of wires. At 2 a.m., a wire came off and set off the alarm and we panicked. The monitor looked like it had been designed by cavemen. I told Steve: ‘We can do better.’ ”

Fast-forward to 2006, when the BAM team turned their focus from

babies to the residential-senior market. As Young put it, “10,000 people are turning 65 every day. Who’s going to take care of them? We are, using these sorts of tools.”

With Young’s Apple-tested code-writing talents in tow, the two men eventually came up with the smart-bed concept: Embedded into a thin air-filled pad slipped beneath the bed’s mattress, a rubber-wrapped biometric sensor the size of a saltine cracker “reads” the air movement and actually measures heart beat, respiration and other vital signs by monitoring a patient’s chest movements. A small “plug computer” attached to the sensor sends the data to BAM’s servers in the cloud, then wirelessly forward the readings to the caregivers’ PCs, iPod touches and other mobile devices they carry on their rounds.

“Instead of having patients hooked up to wires, and having alarms go off in the middle of the night or having nurses forget to turn the patient at the required times, the data is constantly streamed to the mobile device in the nurse’s hand,” said Young the other day, giving a demonstration of the technology. “The caregivers like it because they now have a tool with them at all times that helps keep them focused. And they no longer have to wake up the patient to check vital signs, either; the smart bed does it for them.”

At The Terraces, an upscale retirement center inLos Gatoswhere six of the smart beds were installed several months ago, director of nursing Agnes Toribio said the BAM device is a godsend for staff who must regularly turn incapacitated patients every few hours to avoid bed sores. And avoiding bed sores, which experts say can costs thousands of non-reimbursable dollars to treat, improves the lives of people living out their last years.

“We’ve never had anything like this to help us make sure the residents are turned as required,” said Toribio. “The staff knows what they’re supposed to do, but you have to account for human forgetfulness sometimes. As a result, I’ve actually seen my patients’ skin improve over time because they’re just not developing bed sores like before.”

BAM, which stands for “body and motion,” employs 12 people, a quarter of them Apple alumni. Its advisers include Silicon Valleytech executives as well as sleep experts and researchers from leading university hospitals around the country. BAM, which has also placed beds in elder-care facilities in Marin and Sacramento, has received angel funding from such valley luminaries as eBay (EBAY) founder Pierre Omidyar and the startup prides itself on “doing something good for the world,” said Young, adding that the smart bed is a “hospital-grade instrument at a consumer-electronics price.”

A company spokesman said the beds can be leased for under $2,000 a year, which includes access to the monitor, pad and application services.

“The magic,” said Young, “is in the software,” which BAM engineers continue to improve. Future applications may include a car-seat-sized mat. Young would not go into detail, other than mentioning that driving problems “like DUI and falling asleep at the wheel” might somehow be addressed by BAM’s technology.

Besides watching vital signs, the device protects patients’ dignity, say its creators, by eliminating the morale-busting need to tangle them up in a web of electrical wires. And the smart bed also helps caregivers know immediately when someone has moved in bed, possibly indicating a risky attempt to get up. That problem is especially acute for dementia patients.

“We’ve prevented many falls using the device,” said Toribio. “We have some patients who move a lot even though they’re too frail to do so safely.

“We told one patient about the smart bed,” she said. “She’s stopped trying to get out of bed because now she knows someone’s keeping an eye on her all the time.”

Marc Siegel

4 drugs cause most emergency room visits in elderly

By Anahad O’Connor

New York Times

Blood thinners and diabetes drugs cause most emergency hospital visits for drug reactions among people older than 65 in theUnited States, a new study shows.

Just four medications or medication groups — used alone or together — were responsible for two-thirds of emergency hospitalizations among older Americans, according to the report. At the top of the list was warfarin, also known as Coumadin, a blood thinner. It accounted for 33 percent of emergency hospital visits. Insulin injections were next on the list, accounting for 14 percent of emergency visits.

Aspirin, clopidogrel and other antiplatelet drugs that help prevent blood clotting were involved in 13 percent of emergency visits. And just below them were diabetes drugs taken by mouth, called oral hypoglycemic agents, which were implicated in 11 percent of hospitalizations.

All these drugs are commonly prescribed to older adults, and they can be hard to use correctly. One problem they share is a narrow therapeutic index, meaning the line between an effective dose and a hazardous one is thin. The sheer extent to which they are involved in hospitalizations among older people, though, was not expected, said Dr. Dan Budnitz, an author of the study and director of the Medication Safety Program at the Centers for Disease Control and Prevention.

“We weren’t so surprised at the particular drugs that were involved,” Budnitz said. “But we were surprised how many of the emergency hospitalizations were due to such a relatively small number of these drugs.”

Every year, about 100,000 people in theUnited Statesolder than 65 are taken to hospitals for adverse reactions to medications. About two-thirds end up there because of accidental overdoses, or because the amount of medication prescribed for them had a more powerful effect than intended.

As Americans live longer and take more medications — 40 percent of people older than 65 take five to nine medications — hospitalizations for accidental overdoses and adverse side effects are likely to increase, experts say.

In the latest study, published in The New England Journal of Medicine, Budnitz and his colleagues combed through data collected from 2007 to 2009 at 58 hospitals. The hospitals were all participating in a CDC surveillance project run looking at adverse drug events.

A common denominator among the drugs topping the list is that they can be difficult to use. Some require blood testing to adjust their doses, and a small dose can have a powerful effect. Blood sugar can be notoriously hard to control in people with diabetes, for example, and taking a slightly larger dose of insulin than needed can send a person into shock. Warfarin, meanwhile, is the classic example of a drug with a narrow margin between therapeutic and toxic doses, requiring regular blood monitoring, and it can interact with many other drugs and foods.

“These are medicines that are critical,” Budnitz said, “but because they cause so many of these harms, it’s important that they’re managed appropriately.”

One thing that stood out in the data, the researchers noted, was that none of the four drugs identified as frequent culprits are typically among the types of drugs labeled “high risk” for older adults by major health care groups. The medications that are usually designated high risk or “potentially inappropriate” are commonly used over-the-counter drugs like Benadryl, as well as Demerol and other powerful narcotic painkillers. Yet those drugs accounted for only about 8 percent of their emergency hospitalizations.

“I think the bottom line for patients is that they should tell all their doctors that they’re on these medications,” Budnitz said, “and they should work with their physicians and pharmacies to make sure they get appropriate testing and are taking the appropriate doses.”

Big Drug Hikes in Some 2012 Medicare Plans

By Philip Moeller | US News

Medicare beneficiaries have until only December 7 to make choices for their 2012 insurance plans. The good news for 2012 is that Medicare premiums will be lower for many people. The bad news is that some insurers have changed how they charge for certain prescription drugs. Even plans with lower premiums may not have lower out-of-pocket costs, depending on the specific prescription drugs needed by a plan participant.

On the premium front, Part B premiums for basic Medicare are rising by only $3.50 a month for many people already on Medicare. The resulting $99.90 monthly premium will represent an actual decrease for people who began receiving Medicare in the past two years. They’ve already been paying higher premiums.

Average premiums for Medicare Advantage plans and subscription drug plans (Part D of Medicare) will also be lower in 2012 than this year. And drug subsidies mandated by the health reform law are raising government payments for drugs that Medicare beneficiaries must buy when they are in the drug-plan coverage gap known as the “donut hole.” This insurance gap will be reached in 2012 when payments for covered drugs total $2,930 and will end when out-of-pocket costs exceed $4,700. (For details on the donut hole, see pages 88 and 89 of the 2012 Medicare & You handbook.)

Avalere Health, a Washington-based consulting firm, studied the 2012 drug plans of the largest Part D insurers. It found that most plans will be covering fewer drugs in 2012 than this year. Also, some plans are raising co-pays on their drugs. Many also are making more use of drug-pricing tiers in their plans, and have added drugs to higher-price tiers.

These changes make it difficult to generalize about 2012 drug costs for Medicare beneficiaries. But consumers should not assume that their current drug plan will continue to be their best choice, said Bonnie Washington, senior vice president at Avalere. “What our analysis has shown is that if you look at premium alone, the monthly premium has gone down,” she said, “but the cost-sharing for particular drugs may be going up.”

Fortunately, if you know the prescription drugs you will need to take in 2012, the government’s Medicare Plan Finder will calculate out-of-pocket costs for drug plans,Washington noted.

Washingtonwalked through the Plan Finder with U.S. News, using a hypothetical Medicare participant inChevy Chase,Md., who takes two prescription drugs: Cimzia for rheumatoid arthritis and Cozaar for high blood pressure. Cimzia is an expensive drug that is placed in the top pricing tier of many drug plans, she said. Cozaar has a generic equivalent, but the branded version was retained for this price comparison. Based on these two drugs alone, there was more than a $1,000 difference in projected 2012 out-of-pocket costs for the 10 cheapest plans out of more than 30 available in Chevy Chase. Plans with the lowest premiums did not always have the lowest out-of-pocket costs.

“There is more than $1,000-a-year difference in just these 10 cheapest plans,”Washingtonsaid, and urged consumers to use the Plan Finder to compare plan costs. “You can’t assume that your plan’s coverage is going to be the same next year as it was last year,” she said. To help make comparisons easier, the Plan Finder lets users click on a “2011″ cost option once it has calculated projected plan costs for 2012.

At least three large health plans have developed discount prescription pricing agreements with leading pharmacy chains. Humana has a deal with Wal-Mart,Aetnawith CVS Caremark, and Coventry Health Care with Wal-Mart, Target, and Walgreens. In reviewing drug plans from these insurers,Washingtonsaid, consumers should check to see if Plan Finder cost projections can be lowered by picking a partner pharmacy.

Lastly, she noted, the Plan Finder is only useful in projecting prices for the specific drugs already being prescribed. Many Medicare beneficiaries will wind up taking newly prescribed drugs in 2012.

Once a year there is an opportunity to change Medicare Plans.  The Open Enrollment dates are earlier this year October 15 – December 8, 2011.  Coverage begins January 1, 2012.

You or your elder parent can join, switch or drop a Medicare Advantage Plan any time IN CERTAIN situations, i.e., if you move out of your plan’s service area, or if you have Medicaid, you qualify for extra help or live in an institution

Keep current with the new “Blue Button” on www.mymedicare.gov to access Medicare claims and other personal health information