Nebraska Department of Insurance
THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM
MARCH 2001 NICA NEWS
ISSUES
Study Shows Differences Widen Between Medicare Beneficiaries With and Without Drug Coverage
Medicare beneficiaries who had prescription drug coverage in 1998 filled more prescriptions and paid considerably more for them than in 1997, according to a study by the Health Care Financing Administration (HCFA), which administers the Medicare program. Out-of-pocket expenses for prescription drugs for beneficiaries with coverage were lower than for beneficiaries without coverage.The authors of a survey found that Medicare beneficiaries without drug coverage filled 2.4% fewer prescriptions in 1998 than in 1997, but paid out-of-pocket costs of about $550 both years. Those with coverage got 9% more drugs than the year before, paid 18% more for them, yet they paid $453 less in total out-of-pocket costs in 1998 than the non-covered group. On average, beneficiaries without coverage spent $33 per prescription while beneficiaries with coverage spent $13.
The rate of beneficiaries who had prescription drug coverage at any point during the year was 73%, the same as in 1997, the first year since 1992 that the coverage rate did not increase. But the difference in the number of prescriptions filled by beneficiaries with drug coverage, compared to those without, grew from 5 prescriptions to 8 prescriptions, or an average of 24.4 prescriptions for beneficiaries with coverage compared to 16.7 prescriptions for beneficiaries without coverage.
Since Medicare does not directly provide an outpatient drug benefit, most enrollees get prescription drug coverage from a private supplemental insurance plan, such as a Medigap policy, an employer-sponsored retirement plan or Medicare+Choice organization. Some beneficiaries are covered under a publicly funded plan, like Medicaid or a plan funded by the Department of Veterans Affairs. The authors found that from 1997 to 1998, out-of-pocket spending grew faster than third party payments for beneficiaries with drug coverage and those beneficiaries are paying a higher percentage of their total drug cost, rising from 31% to 33%.
Preventing Heat Illness
The Dog Days of summer are here. Your body is working overtime to keep you cool, but stay alert for signs of heat illness. Here are ways to avoid three types of "hot flashes:"- Heat cramps: When you sweat a lot, you lose electrolytes, which leads to cramping. These muscle spasms usually hit the arms, legs, or stomach a few hours after running around in hot, sticky weather.
Tips:
- Drink lots of water, but also replace electrolytes by grabbing a replenishing drink like Gatorade.
- Limit salt intake, since salt exacerbates dehydration.
- Get rest.
- Heat exhaustion: As your body works to cool you down, the surface blood vessels that enlarge to try to cool the blood may collapse from a lack of body fluid and lost minerals. You can start to feel weak, anxious, or dizzy. You lose coordination and sweat a lot, and you may lose consciousness.
Tips:
- Move to a cool, shaded area, lie down and elevate your feet. This helps restore normal blood volumes.
- Make sure your clothes are loose enough so your body can "breathe," place a wet cloth on your forehead, and fan yourself.
- Down more electrolyte-replacing liquids.
- Heat stroke: The most serious of heat illnesses, heat strokes occur when the body's supply of fluids and salt is depleted and the body temp rises to a deadly level. Symptoms include a 103-degree or higher body temperature; a lack of sweat; hot, red, dry skin; a rapid pulse; difficulty breathing, and constricted pupils.
Treatment:
- Call 911.
- You must cool down as quickly as possible. Wrap a potential heat stroke victim in wet blankets or clothes, immerse him in cool water, or pour water over his body. Use ice.
Getting a Second Opinion Before Surgery
What is a second opinion?A doctor may tell you that you need surgery for a health problem that is not an emergency. This means that the surgery does not have to be done right away. That means you have time to talk with your doctor and decide what is best for you. Deciding what is best for you could be getting a second opinion from another doctor. A second opinion is when another doctor gives his or her view about your health problem and how it should be treated.
Doctors do not always agree on when surgery is the best choice of treatment. You have the right to
- Know what your choices are.
- Have another doctor look at those choices with you.
- Have your wishes considered before choosing surgery.
When should I get a second opinion?
Do not wait for a second opinion for emergency surgery. Some types of emergencies that may require surgery right away include:
- Acute appendicitis
- Blood clot or aneurysm
- Accidental injuries
It is up to you to decide when and if you will have non-emergency surgery. Getting a second opinion can help you make a more informed decision. For example, the following procedures are not always emergencies:
- Tonsillectomies
- Gall bladder procedures
- Hysterectomies
- Hernia repairs
- Cataract operations
You may also get a second opinion if your doctor tells you that you should have certain kinds of major non-surgical diagnostic or therapeutic tests.
How do I get a second opinion?
When you decide you want a second opinion, ask your doctor's office to send your medical records to the doctor giving the second opinion. That way, you may not have to repeat medical tests.
Before you visit the second doctor, call that office and make sure they have your records. During the visit, be sure that the doctor knows what tests you have had and what surgery you want to discuss.
If the second doctor does not agree with the first, you may feel confused about what to do. In that case, you may want to:
- Talk about your condition more with your first doctor.
- Talk to a third doctor.
What do I need to know before I get a second opinion?
When surgery is not an emergency, you may want to ask the doctor questions about your health problem and the surgery. It may help to write down a list of questions. Take the list of questions with you to the doctor. To help you with making your list of questions, you may want to call 1-800-MEDICARE (1-800-633-4227), and ask for the publication Choosing Treatments.
How do I find a doctor to give me a second opinion?
- Ask your doctor for the name of another doctor to see. Do not hesitate to ask; most doctors want you to get a second opinion. If you do not want to ask the doctor who recommends the surgery, ask another doctor you trust for the name of a doctor to see for a second opinion.
- Ask the local medical societies for the names of doctors who treat your illness or injury. Your local library can help you identify these societies.
- Call the Medicare carrier who handles your Medicare Part B bills. Your carrier can give you the names of doctors in your area who accept assignment (accept the Medicare approved amount as payment in full). This could save you money. For additional information on "assignment," refer to the Medicare pamphlet: Does your doctor or supplier accept "assignment?"
The Medicare Part B carrier for Nebraska is Blue Cross/Blue Shield of Kansas, 1-800-633-1113.
How does Medicare pay for a second opinion?
Medicare Part B helps pay for a second opinion just as it helps pay for other doctors' services that are medically necessary.
If you have Medicare Part B and are in the Original Medicare Plan:
- Medicare pays 80% of the approved amount for a second opinion. Your share is usually 20% of the Medicare approved amount, after you have paid your $100 annual Part B deductible.
- If the second opinion does not agree with the first, Medicare pays 80% of the approved amount for a third opinion.
If you are in a Medicare managed care plan (such as an HMO), you have the right to get a second opinion. But some plans will only pay for a second opinion if you first get a referral from your primary care doctor. (A referral is a written OK). You must get the second opinion from the doctor named in the referral. If you want to get a second opinion from a doctor who does not belong to your plan, talk to your plan first. Some plans will pay if you do this, but most will not.
If you are in a Private Fee-for Service plan a second opinion for your health problem is covered by Medicare.