An analysis from the Kaiser Family Foundation quantifies, for the first time, the number of Medicare Part D plan enrollees in 2007 who reached a gap in their prescription drug coverage known as the “doughnut hole,” as well as the changes in beneficiaries’ use of medications and out-of-pocket spending after they reached that gap.

The study excludes beneficiaries who receive low-income subsidies (because they do not face a gap in coverage under their Medicare drug plan).

Approximately 3.4 million Part D enrollees, including many with serious medical conditions, reached the coverage gap in 2007, leading some to stop treatment, according to the analysis.

Beneficiaries taking drugs for serious chronic conditions had a substantially higher risk of a gap in coverage under their Medicare drug plan. For example, 64 percent of enrollees taking medications for Alzheimer’s disease reached the coverage gap in 2007, as did 51 percent of those taking oral anti-diabetic medications and 45 percent of patients on antidepressants.

Conducted by researchers at Georgetown University, National Opinion Research Center at the University of Chicago and Kaiser, the study found evidence of patients changing their use of prescription drugs when they are required to pay the full cost of medications in the coverage gap. Across eight classes of drugs examined—used to treat a variety of relatively common chronic conditions—15 percent of Part D enrollees who reached the gap stopped their drug therapy for that condition, 5 percent switched to another medication in the class, and 1 percent reduced the number of drugs they were taking in the class.

”The Medicare drug benefit has produced tangible relief for millions of people, despite the unusual coverage gap that was created to make the benefit fit within budget constraints,” Kaiser CEO and President Drew Altman said. “But if a new president and Congress consider changes to the drug benefit, it will be important to keep in mind that the coverage gap has consequences for some patients with serious health conditions.”

Beneficiaries who reached the coverage gap faced substantial increases in out-of-pocket spending. For example, among Part D enrollees who reached the coverage gap, but did not receive catastrophic coverage, average monthly out-of-pocket costs nearly doubled from $104 prior to the coverage gap, to $196 in the “doughnut hole.” The vast majority (84 percent) of the Part D enrollees who reached the coverage gap did not have sufficient additional drug spending during the year to receive catastrophic coverage, at which point their Part D plan would pay 95 percent of drug costs.

The study analyzes retail pharmacy claims data, based on 4.5 million Medicare beneficiaries in Part D plans in 2007, the first year that most people would be enrolled in a Part D plan for a full calendar year. The analysis is based on 2007 data from IMS Health’s Longitudinal Prescription Drug Database, which includes prescription drug information that represents half of all retail prescriptions filled in the U.S.

In 2008 the gap starts when a recipient has used $2,510 worth of medications; coverage does not resume until they have used a total of $5,726 in covered prescriptions, creating a coverage “gap” of $3,216.

The research team includes: Jack Hoadley of Georgetown University, Elizabeth Hargrave of NORC at the University of Chicago, and Juliette Cubanski and Tricia Neuman at the Kaiser Family Foundation.

— Lori Woehrle

The implosion of financial titans of Wall Street over the past week lays bare the ugly truth about privatizing Social Security: It’s a fundamentally bad idea.

I don’t know about you, but I’m neither a financial planner nor an investment strategist. And yet, since the mid-1980s when I began saving for retirement, I’ve been forced to play one at home with my 401K investments. Yes, I’m incredibly fortunate to have been saving that long. No question. But from the beginning, it’s been me, myself, and I directing where those precious retirement dollars are invested. (Talk about risk!)

Next month will be a scary one, and I’m not talking about Halloween. Around the first week of October, I should start receiving my 3rd quarter statements for my 401Ks. Given the market’s roller coaster response to the bailouts, closures and consolidation, I’m expecting the pages to jump from the envelopes with a resounding BOO.

Can you imagine all of the folks depending on Social Security suddenly coming up short because their Social Security investments went sour?

Social Security is the bedrock of retirement and must be protected.

Where from here?

Because I live in Washington, I want you to know where the presidential candidates stand on Social Security.

John McCain

[Note: I was unable to find statements on John McCain's official Web site regarding Social Security. Here's what CNN said about his positions.]

McCain advocates supplementing Social Security benefits with individual investment accounts. He prefers slowing the growth benefits to raising taxes. When asked about Social Security during a GOP debate, he stated: “Every man, woman and child in America needs to know it’s going broke, and we’ve got to do the hard things. We’ve got to fix it for the future generations of Americans… It’s got to be bipartisan. And you have to go to the American people and say we won’t raise your taxes. We need personal savings accounts, but we [have] to fix this system.”

Barack Obama [From his official Web site.]

“Obama is committed to ensuring Social Security is solvent and viable for the American people, now and in the future. Obama will be honest with the American people about the long-term solvency of Social Security and the ways we can address the shortfall. He will work with members of Congress from both parties to strengthen Social Security and prevent privatization while protecting middle class families from tax increases or benefit cuts. As part of a bipartisan plan that would be phased in over many years, he would ask those making over $250,000 to contribute a bit more to Social Security to keep it sound.”

I don’t know about you, but I don’t have 10+ houses or family wealth worth millions to fall back on when I retire. I’m depending on me and the few dollars I’ve been able to scrape together over the years to get me through. I need that bedrock of Social Security to be there and be square when the time comes.

—Lori Woehrle

Hurricane Ike just bore down on the Texas coast and the news of the aftermath reminds us of the importance of having a family plan in place to prepare for disaster.

If you have a chronically ill or an elderly family member in your home you need to take some special precautions. For example, those with chronic illnesses such as diabetes need to pay special attention to what they would do without their medicine or supplies.

The American Association of Clinical Endocrinologists and Olympic skier Kris Freeman who has Type 1 diabetes, offers tips on how people with diabetes can be prepared for an emergency by stressing the importance of having on-hand:

* An emergency kit that contains basics like a radio, flashlights, batteries, whistles,food, water and a list of emergency contacts

* At least one week of supplies in a central locations

* A few ice packs to keep insulin cool

* A kit of diabetes supplies, including blood testing supplies, health insurance cards, copies of your prescriptions, a glucagon kit and fast-acting carbohydrates.

Additionally, the American Red Cross has much more information about how to prepare a Disaster Supplies Kit.

Many seniors may also depend on in-home care for vital supplies and services such as oxygen or some types of dialysis and it’s important to confirm the emergency plan with the home heath agency.

Take a moment to plan what you would do to manage yours or a loved one’s condition in the event of a disaster. Also, be sure that any aging friends or relatives living away from you are prepared and their supplies are updated.

The deadline is approaching for seniors and others to file a 2007 tax return to receive their federal stimulus payment this year.

Some recipients of Social Security, certain veterans’ benefits and certain Railroad Retirement benefits may qualify for economic stimulus payments, even though they usually do not have to file a tax return.

To receive the payment—which for individuals typically ranges from $300-$600—people who might not otherwise be required to file a 2007 tax return will need to file. The return must show at least $3,000 in qualifying income.

Normally, certain Social Security, Railroad Retirement benefits and certain veterans’ payments are not subject to income tax. However, the economic stimulus law passed in February contains a special provision allowing Social Security recipients and recipients of certain veterans’ benefits and certain Railroad Retirement benefits to count those benefits toward the qualifying income requirement of $3,000 and thereby qualify for the stimulus payment.

Free tax help available

The Tax Counseling for the Elderly (TCE) Program provides free tax help to people age 60 and older. As part of the IRS-sponsored TCE Program, AARP offers the Tax-Aide counseling program at more than 7,000 sites nationwide during the filing season. To find an AARP Tax Aide site call 1-888-227-7669 or visit the AARP Web site.

The Internal Revenue Service estimated in late July that some 5.2 million Americans eligible for an economic stimulus check authorized by Congress have yet to file. Some estimates show nearly 70 percent of those who are eligible but have not filed are seniors.

— Lori Woehrle

Brain fitness games and puzzles such as Sudoku and the Brain Age game series from Nintendo are popular right now to improve memory, attention and communication abilities.

In fact, they are so popular that senior housing communities are offering these computerized tools in “brain fitness centers” as a part of community wellness initiatives.

The American Seniors Housing Association (ASHA) recently issued a 15-page report, entitled “Brain Fitness Centers in Senior Housing: A Field in the Making,” which provides an overview of the brain fitness field with four case studies that shed light on the use of such fitness centers in senior housing communities.

Additionally, these communities often offer “brain-healthy” (and heart-healthy, too) foods like salmon and walnuts, as well as those rich in Omega-3 fatty acids. Also on the menu of brain-boosting goodies: Exercise opportunities that improve circulation — believed to stave off memory loss or dementia.

Even if research is conflicted about the measurable cognitive benefits of these activities, brain fitness activities present healthy habits and provide seniors with a chance to socialize, learn about technology, and pursue goals. Additionally, anecdotal data from seniors concludes that many of them feel more alert, energized, and better able to concentrate, all results that improve quality of life.

With the growth of the industry of brain fitness programs, it’s important to know which products and services are proven and based on research results. If you’re interested in a brain health program, be sure to check out Sharpbrains.com for a checklist for consumers and professionals to help choose the right brain fitness program.

If we look back on our lives, the fondest memories are often associated with events that happen with our family and friends. Life’s fondest moments are cherished, and new memories are created when people who care about each other celebrate events.

Nearly one million seniors and individuals with disabilities in 38,000 assisted living residences nationwide are celebrating the 14th Annual National Assisted Living Week, which began on Grandparents’ Day, Sept. 7 and runs through Sept. 13.

Assisted living staff members and residents alike anticipate this event, and months in advance begin planning activities around a theme. This year’s theme is “Filling Life With Love” and spotlights the vital role assisted living plays in caring for our nation’s seniors and individuals with disabilities.

Moments between caregivers and residents, their relatives and friends, as well as individuals from the community, create many special moments that enrich residents’ lives and fill them with love.

Assisted living was founded on the principle of delivering care and services based on the individual resident’s needs and desires. These services also enhance the resident’s emotional, intellectual, physical, social, and spiritual well-being so they can live as independently as possible with the highest quality of life.

Through caregiving, staff members build close relationships with residents and often it’s as if the resident was their own parent, sibling, or close relative. Family members and friends are integral in caregiving and keeping residents engaged. Volunteers read to, play music, or listen to residents. Individuals from the community often deliver lectures on their expertise or lead residents in topical discussions about current events.

Is there something you can do to enrich someone’s life?

The “Filling Life With Love” theme celebrates and pays tribute to the exceptional involvement of all — providers, families, volunteers and individuals from the surrounding community.

Find out more about assisted living communities now.

Across the country, more and more nursing homes fighting to survive on diminishing reimbursements, evict or “involuntarily discharge” residents, often those who are long term patients, on Medicaid or other costly patients. This often results in frail, elderly patients being moved from their long term residences, often endangering their health.

Patients on Medicaid are especially at risk according to the Wall Street Journal article To Be Old, Frail And Evicted: Patients at Risk:

Those on Medicaid bring facilities as little as half what they can get from residents who pay out of pocket, with private health insurance or through Medicare, the federal-state health program for the elderly.

What are families to do if their loved one is faced with an involuntary eviction from a nursing home?

The Nursing Home Reform Law of 1987 requires a home give a resident at least 30 days notice before evicting him or her, and allows for only six possible reasons for eviction: they are healthy enough to return home; they require care not offered at the nursing home; they risk the health of other residents or staff; they endanger the safety of other residents or staff; they do not pay their bills; or the nursing home closes.

The Nursing Home Resident Protection Amendments of 1999 requires that nursing homes continue to provide care for Medicaid residents already living in the facility even if the nursing home chooses to cease participation in Medicaid.

If your loved one is facing an eviction from a nursing home or assisted living, each state has a Long Term Care Ombudsman. An Ombudsman advocates for residents of nursing homes, board and care homes, and assisted living. They can provide information about how to find a facility and what to do to get quality care and they are trained to resolve problems (A list of Ombudsmen by state).

If you are caring for an elderly or disabled relative who needs help managing their monthly Social Security or SSI benefits, you can apply to be representative payee. More than seven million people who get monthly benefits need help managing their money.

After a careful investigation, the Social Security Administration will appoint a relative, friend or other interested party to serve as the “representative payee.” This means that, if you agree to be a representative payee, the government will pay you the person’s benefits to use on his or her behalf.

In agreeing to serve as a representative payee, you are taking on an important responsibility (one that can make a positive difference in both the beneficiary’s life and your life).

With certain exceptions, a payee may not collect a fee for services provided to the beneficiary. Unless Social Security authorizes you to collect a fee for providing services, or you are the legal guardian who has been authorized by a court to charge a guardian fee, you may not collect a fee from the beneficiary.

Social Security will conduct a careful investigation to determine if you meet the requirements.

You must know what your relative’s needs are so you can decide how benefits can best be used for his or her personal care and well-being. First, you must make sure that food and shelter are provided.

After you have provided for the beneficiary’s basic needs, you may spend the money to improve the beneficiary’s daily living conditions or for better medical care. You may decide to use the beneficiary’s funds for major health-related expenses, if they are not covered by the beneficiary’s health insurance. Examples of these expenses are reconstructive dental care, a motorized wheelchair, rehabilitation expenses or insurance premiums.

You could use the money to arrange for the beneficiary to go to school or get special training.

You also could spend some of the money on the beneficiary’s recreational activities, such as movies, concerts or magazine subscriptions.

Special purchases

You may want to make some of the following special purchases for the beneficiary.

A home—You can use funds as a down payment, and you can use some of the money to make payments on a house owned by the beneficiary.
Home improvements—You can pay for renovations that make the beneficiary’s home safer and more accessible; for example, installing a wheelchair ramp or widening doorways to accommodate a wheelchair.
Furniture—You can buy furniture for the beneficiary’s personal use, as well as items that may be shared with other members of the household, such as a television.
A car—You can use funds as a down payment, and you can use some of the money to make monthly car payments as long as the car is used for and owned by the beneficiary.

For more information about the representative payee program, read A Guide For Representative Payees (Publication No. 05-10076), from the Social Security Administration.

— Lori Woehrle

Let me state right upfront: John McCain is not my candidate. Even with his Annie-Get-Your-Gun running mate from Alaska, this is one die-hard Hillary supporter who’ll be voting for Obama-Biden come November.

That said, while I have many reasons for not supporting McCain, his age is not one of them. Personally, I’m tired of hearing about how John McCain is too old to be president. That’s ridiculous. The man is in perfectly excellent health, and that’s all that matters when it comes to age. Is he healthy enough? Yes. Enough said.

Some of the complaints about Gov. Sarah Palin, the Republican vice presidential nominee, are that she is too inexperienced for that level of office. That may be. But what irked me in those conversations was all the talk about how she is too inexperienced to be a heartbeat away from the presidency—particularly given McCain’s age.

So, if she were on the ticket with someone younger, suddenly her scant two years as a governor would be enough?

No surprise here—I also wasn’t a fan of Ronald Reagan. And he was getting along in years when he served as president. But it wasn’t his age that was the problem. If anything, it was the now fairly well-established fact that he began suffering the early effects of Alzheimer’s disease while in office that bothered me.

If you’re reading this rant, and you haven’t read my colleague Elizabeth’s thoughtful look at the candidates’ positions on Social Security, you’re missing the point. Let’s keep the debate (and the candidates) focused on the issues that matter. Age—along with gender and race—is not one of them.

—Lori Woehrle

During one of my mother’s hospitalizations, it became apparent that she would be in no condition to go home, so my Dad and I were faced with deciding on a nursing home.

Unfortunately, we had to decide rather quickly as we got virtually no notice of her discharge.

We managed to visit nearly every nursing home in the area in a record amount of time, and the facilities we saw varied wildly.

One thing I did notice, however is that some of the nicer ones had more activities and amenities than I had access to at home. I was ready to move into a couple of them myself.

Apparently, these luxury hotel-like accommodations in senior living are a trend as seniors are ready to live the good life and be involved in the hustle and bustle of city life with support as their needs change:

Developments like the Bellettini and the Mirabella, which are open to those age 62 and older, are more like five-star hotels than traditional senior living complexes. They include such first class amenities as spas, swimming pools, gyms, personal trainers, room service, chauffeur service, brain fitness programs, travel services and concierge services. Residents who are the first to move in also have a say in the appliances, colors and decoration of their apartments.

People traditionally think of assisted living communities as staid, a bit depressing, and tucked away in the suburbs, but people are living longer and, while they may need assistance, they are still involved with society and enjoy being able to do the things they like to do.

For those that can afford it, these high-end facilities enable people to live the active lifestyles they are used to, with the help they need as they get older.

However, these luxury communities aren’t without criticism, as so many senior citizens live on Social Security alone and people are concerned about the current economy as well as being able to provide for their families after they are gone.

While they aren’t for everyone, people choosing these types of retirement communities are making their own decisions about how they live out their years and how they spend their money.

Read more about Lavish Retirement Living Options.