Medicare and the Part D Donut Hole

An ounce of prevention is worth a pound of cure?

This saying, made famous by Benjamin Franklin, is as true today as it was in the 1700's. Preventative care and early treatment can impact the outcome of most diseases.

Mammograms and prostate screening are effective tools against cancer
Sunscreens and limiting outdoor exposure to direct sunlight are effective methods to lower the risk for skin cancers

The proper use of medication can also prevent conditions from forming or stop existing conditions from worsening. A potential growing gap is forming between what the doctor orders and what the patient may or may not be taking. According to the Journal of the American Medical Association (JAMA) one third to more than one half of all hospital admissions are related to medications. These admissions account for many billions of dollars in healthcare costs each year. The reasons for why a person does not take a medicine ordered by the doctor may be as varied and the people themselves. If more than one doctor is writing prescriptions the chances for adverse drug interactions increases significantly.

The American Medical News placed the spotlight on one possible reason, the impact of medication costs. A conversation between a doctor and patient, which probably takes place too often, was highlighted by the article.

"Are you taking the medication?" The doctor asked his patient
"Not all the time," the woman sheepishly answered
"How often are you taking it?" he asked. "Once a week?" "Every other day?"
"Well, less than that," she said
"You're not really taking it at all," the doctor said
"Well, that's right," the woman answered
"Did you fill the prescription?"
"No," she said. "It was going to be $180 a month because it wasn't covered. And I can't afford that."

Some healthcare providers may not consider the cost of a drug when ordering it and the patient may be reluctant to bring up the subject. According to a report from a consulting firm IMS Health, Americans spent more than $307 billion for prescription medications last year.

Do drug costs create a barrier for people?
But what can be done about it?
Can healthcare providers help?
Are there programs to help pay for these expensive medicines?
How does Medicare help to pay for drugs?
What can patients do?

Healthcare professionals, click here [1] to find out how you can assist your patients to get the medicines they need

Click here [1] to learn more about Medicare drug coverage
Patients click here [1] for questions that you may want to ask your doctor
To learn more about drug assistance programs click here [1]

Medicare 101

Medicare Overview

Most Americans have heard of Medicare, approximately 45 million people were receiving Medicare benefits in 2008. The Centers for Medicare and Medicaid Services (CMS) has predicted that there will be 78 million people eligible for the program by the year 2030.

It might be expected that Medicare is very well understood, but the reality is that there are many pieces and parts that can be very confusing to the average person. A recent search on the internet for the term “Medicare” returned more than 16 million results in less than 1/10^th of a second. It would take a person a really long time to read through all of those references. We hope to remove some of the mystery surrounding Medicare.

The program was designed to be available to anyone who was born in the US, a permanent and legal resident for 5 years, or the spouse of an individual who paid Medicare taxes for at least 10 years. Additional eligibility criteria include:

Those under 65 who were disabled and receiving disability benefits for at least two years from Social Security or the Railroad Retirement board
People with end stage renal disease (ESRD) or those who needed a kidney transplant regardless of age (as long as they met the residency requirements)
The program also includes those afflicted with amyotrophic lateral scleroses (better known as Lou Gehrig’s disease) that are eligible for disability

In 2011 those with Medicare Part B will have an annual deductible of $162/year. This is generally considered an out of pocket cost but may be covered by special programs for those with low income or other special circumstances. When a person elects Medicare coverage they will receive a special red, white and blue Medicare card. This is their insurance card and it will show if they have parts A and/or B.

To order a free booklet from Medicare you can click here [2] or call 1-800-633-4227. Hearing impaired can call TTY 1-877-486-2048

Click here [3]to learn more about the different parts of Medicare

Click here [4]to learn about programs for low income people

To learn about Medicare/Medicaid coordination click here [5]

References

Medicare http://www.medicare.gov/ [3]

Social Security Administration Online http://www.ssa.gov/history/lbjsm.html [6]

SSA Medicare Booklet http://www.socialsecurity.gov/pubs/10043.html#part5 [2]

Medicare Premium Rules for Higher Income Beneficiaries: http://www.socialsecurity.gov/pubs/10536.html#rules [7]

Medicare Premium Information https://www.ssa.gov/pubs/EN-05-10003.pdf [8]

Medicare by the Letter

Part A

Medicare part A is designed to help cover expenses for institutional care. These mean hospitals, skilled nursing facilities after a hospital stay, hospice and home health care. For people who paid Medicare taxes (or their spouse did) while working this coverage does not cost any money. A person might also be able to buy this coverage if they are disabled and meet residency requirements.

People who are receiving disability from Social Security or the Railroad Retirement Board will automatically receive information near the time they will become eligible for Medicare. Those who are not receiving retirement benefits should contact Medicare 3 months before they turn 65. Even if a person does not retire at 65 they can still get Medicare coverage.
Besides the eligibility criteria mentioned above, there are a few other special circumstances that would make a person eligible for Medicare.
A disabled person between the ages for 50 to 65 who has not applied for disability because they are receiving money from another Social Security program.
Government employees who become disabled before they turn 65
A person that did not sign up or dropped their Medicare coverage they may be able to sign up again.
Permanent kidney failure at any age.

Part B

Part B is designed to cover healthcare services that are provided to people who live at home, often referred to as outpatient services. Part B pays for home health care, durable medical equipment, flu shots and doctor office visits. These are medical services that are not covered by Part A. Everyone who is eligible for free Part A can sign up for Part B, but there is a monthly premium for this coverage. The cost may be higher for those who have a very high income. If a person is not eligible for free Part A they may be able to purchase Part B alone if they are 65 or older and meet residency requirements.

When a person is turning 65 and becomes eligible for Medicare Part A they have a 7 month window to sign up for Part B. This window starts 3 months before a person turns 65 and runs through the birthday month and the 3 months after the birthday.

If a person is disabled or has permanent kidney damage their eligibility will depend on the date that the disability or treatment began.

The Centers for Medicare and Medicare created a chart showing when Part B coverage will start based on when you sign up for coverage.

If you enroll in this month of your Initial enrollment period:	Then your Part B Medicare coverage starts:
1 (3 months before your 65^th birthday)	The month you become eligible for Medicare
2 (2 months before your 65^th birthday)	The month you become eligible for Medicare
3 (1 month before your 65^th birthday)	The month you become eligible for Medicare
4 (your birthday month)	One month after enrollment
5 (1 month after)	Two months after enrollment
6	Three months after enrollment
7	Three months after enrollment

If a person does not sign up when they first become eligible they have another opportunity each year during general enrollment which runs January 1 through March 31. If they sign up during this period their coverage will not become effective until July of that year. The catch here is that for each year they wait to sign up, the premium goes up by 10%.

If a person is 65 or older and still covered by a group health plan either from their own or their spouse's current employment, they have a "special enrollment period". This means they may delay enrolling in Medicare Part B without having to wait for a general enrollment period and paying the 10% surcharge for late enrollment. This exception allows a person to enroll in Medicare Part B at any time while they are covered under a group plan based on current employment. Eligibility to sign up for Part B begins the month after employment ends or the 8 months after group coverage ends, whichever comes first. A person receiving disability payments but still covered by a group plan based on their own or their spouses employment, have a similar "special enrollment period".

Part C

Medicare Part C coverage is more commonly known as Medicare Advantage. These plans are available in many areas through different provider organizations. A person who has Part A and B can elect to receive their care through one of these organizations through Part C. There are different types of Medicare Advantage Plans which include:

Medicare managed care plans
Medicare preferred provider (PPO) plans
Medicare private fee for service plans
Medicare specialty plans

If a person chooses to join one of the Medicare Advantage plans you may have to pay a monthly premium for any extra benefits that might be offered. They will also receive a different type of health card. A person can choose to sign up for one of these plans when they first become eligible for Medicare or during the annual enrollment period from November 15 through December 31 each year. Special circumstances may allow for special enrollment periods.

Part D

Medicare Part D helps to cover prescription medicines. Anyone with Part A, B, or C is eligible for Part D. Joining Part D is optional and voluntary. There is an extra cost associated with this additional coverage. Again the cost is higher for those with very high incomes. If a person has different prescription coverage they may wait to sign up for Part D. In general, if this coverage is at least as good as Part D, there will be a penalty in cost for waiting. A person can sign up for Part D when they first sign up for Medic are or during the annual enrollment period from November 15 through December 31 each year. Special circumstances may allow for special enrollment periods.

Drugs that are not approved by the Food and Drug Administration (FDA)This is the newest part of Medicare; Part D was signed into law in 2003 and went into effect January 1, 2006. Just like most health plans Part D will not help to cover:

Those prescribed for off label use
Drugs not available in the United States
Drugs that would be covered under Medicare Part A or B
Drugs that are excluded by Medicaid

There is a gap in coverage that is referred to as "the donut hole". The gap begins when the total retail drug costs reach a certain amount. This gap remains in effect until a person's out of pocket costs reach another set amount. Once past this gap a person is responsible for set amount per month for generic medications and a higher amount per month for name brand medications.

Click here [9] to learn more about "the donut hole"

References

Medicare http://www.medicare.gov/ [3]

Social Security Administration Online http://www.ssa.gov/history/lbjsm.html [6]

SSA Medicare Booklet http://www.socialsecurity.gov/pubs/10043.html#part5 [2]

Medicare Premium Rules for Higher Income Beneficiaries: http://www.socialsecurity.gov/pubs/10536.html#rules [7]

Medicare Prescription Drug Coverage: http://www.medicare.gov/navigation/medicare-basics/medicare-benefits/part-d.aspx [10]

Medicare and ESRD

Medicare helps to pay for kidney dialysis as well as kidney transplants.

Eligibility

A person whose kidneys no longer work can get Medicare no matter what their age as long as they meet other criteria.
You have worked long enough to qualify for retirement benefits from Social Security, the Railroad Retirement Board, or as a government employee
You are already receiving retirement benefits
You are the spouse or child or a person who meets either of the above criteria

In order to receive full benefits you must apply for both Medicare Part A and B and wait the required amount of time. If you don't qualify for Medicare, you may be able to get help from your state to pay for your dialysis treatments.

A person with ESRD who is new to Medicare will most likely be covered under “original Medicare” rather than a Medicare Advantage Plan. A Medicare Part D plan may also be selected to help cover prescription costs. Some people may be able to enroll in a Medicare Special Needs Plan if there is one in their state.

Children and Medicare
A child with permanent kidney failure is eligible for Medicare as long as one with their parents has worked long enough to qualify for retirement benefits through Social Security, the Railroad Retirement Board, or as a government employee. A child can also be eligible if they are already receiving benefits from Social Security or Railroad Retirement.

When does Coverage Start?

When enrolling in Medicare because of ESRD and on dialysis, Medicare coverage usually starts the first day of the fourth month of dialysis treatments.

May	June	July	August
First month of dialysis treatments	Second month of dialysis treatments	Third month of dialysis treatments	Fourth month of dialysis treatments – Medicare coverage begins

If a person is covered by a group health plan related to employment, this plan will pay first for 30 months of dialysis treatments and Medicare pays second. If there is no group health plan there are other programs that can bridge the gap and help pay expenses not covered by Medicare.

This 30 month window is called the coordination period, and it starts whether or not a person has applied for Medicare coverage. When an approved Medicare home training program is completed or a transplant is done during the initial 3 month waiting period, the coordination period will start earlier.

If the group health plan has deductibles or co-insurance, Medicare A and B may help to pay for these expenses. Since Part B has a premium some people may find it better to wait to enroll until the 30 month coordination period is over to avoid paying premiums that may not be needed. If the group coverage ends before the coordination period has passed it will be important to sign up for Medicare Part A and B right away.

What happens after the coordination period?

At the end of the 30 month coordination period, Medicare begins to pay first for all covered services. Usually the group health plan coverage pays for services not covered by Medicare. Plans can vary so it is wise to check with the benefit coordinator for the group health plan to verify coverage.

Special Circumstances

There is a separate 30-month coordination period each time a person enrolls in Medicare because of permanent kidney failure. When a kidney transplant continues to work for 36 months, Medicare coverage ends unless a person is over 65 or disabled for another reason. If the transplant then fails a person will need to re-enroll in Medicare but coverage will begin right away, without the 3 month waiting period. There will be a new 30 month coordination period if there is a group health plan providing coverage.

Coverage Exceptions

Medicare can become effective sooner if a person meets both of these criteria
When a person takes part in a Medicare approved home dialysis training program
Your doctor expects the person to finish training and be able to do their own dialysis treatments at home

Medicare coverage can begin the month a person is admitted to a Medicare-approved hospital for a kidney transplant (or services that are needed before a transplant) as long as the transplant takes place in that same month or within the following 2 months.

Medicare does not pay for care that is needed in order to prepare for dialysis such as fistula placement unless the person has completed an approved home training program and starting regular dialysis all in the same month.

When does coverage end?

If eligibility for Medicare is only because of permanent kidney failure, coverage ends when:

It has been 12 months since dialysis was stopped
36 months after a kidney transplant

Medicare coverage may be extended if one of the following criteria is met:

Dialysis is restarted or a transplant is done within the 12 months after dialysis was stopped
If dialysis is restarted or another kidney transplant is performed within 36 months after the first transplant

References

Q1 Medicare.com: http://www.q1medicare.com/PartD-MoreOnTheDonutHolesOrCoverageGap.php [11]

Medicare website: https://secure.ssa.gov/apps6z/i1020/main.html [12]

Medicare Basics: https://www.medicare.gov/Pubs/pdf/10128-Medicare-Coverage-ESRD.pdf [13]

Dual Eligibility Medicare/Medicaid

Dual Eligibility refers to a person being eligible in some way for both Medicare and Medicaid. Medicare is a federal program while Medicaid is a state program that is available to those with low income and/or resources.

Medicare and Medicaid
Medicare covers acute care services and Medicaid covers Medicare premiums and cost sharing expenses. Medicaid may also cover expenses for long term care.

There are different types of eligibility and this link goes to a report with a table that outlines the differences

http://www.medpac.gov/publications%5Ccongressional_reports%5CJune04_ch3.pdf [14]

Medicare is considered the primary insurer and covers medically necessary acute care services, including physician, hospital, hospice, SNF, home health services as well as durable medical equipment (DME).

Medicaid is the secondary payer and covers services that are not covered by Medicare. Examples include transportation, dental and vision. There may be coverage for services not covered by Medicare as well as care after the Medicare benefit is exhausted or if certain Medicare criteria are not met. Types of services may include hospital, nursing home or home health care.

Medicare-Medicaid Coordination Office
The Federal Coordinated Health Care Office, also known as the Medicare-Medicaid Coordination Office, serves people who receive benefits from both Medicaid and Medicare. A person covered by both has dual eligibility. The goal for this office is to make sure that people with limited income and resources have full access to seamless, high quality health care while making the system as cost-effective as possible.

The Medicare-Medicaid Coordination Office works with each state’s Medicaid program and all federal agencies to help coordinate benefits between the two programs effectively and efficiently. Work is being done to create new care models and to improve the way those who are dual eligible receive health care.

The Medicare-Medicaid Coordination Office was created as part of the Affordable Care Act. The goals include the following for those who are dual eligible:

Assure full access to available benefits
Simplify processes to access items and services
Improve health care quality and services
Increase understanding of programs and improve satisfaction with coverage
Solve rule conflicts between state and federal programs
Improved continuity of care and safe care transitions among health care providers
Improved provider performance and care quality

Special Programs
The Program of All-Inclusive Care for the Elderly (PACE) serves frail elderly beneficiaries, age 55 and older, who meet states’ standards for nursing home placement and live in areas served by the PACE organizations.

State Demonstration Waivers have been created and operate under the Medicare demonstration authority. Typically these programs use a model based on a different type of fee schedule to improve coordination of services. Examples include the Minnesota Senior Health Options and the Wisconsin Partnership Program.

Evercare is a demonstration project that provides case management for those living in nursing homes. The goal is to reduce the need for hospital and emergency room care. Nurse practitioners work closely with primary care physicians and the project has shown that hospitalizations decreased when compared with control groups and that care is at least comparable to what is available to those not in the demonstration project. It currently operates in 11 states with 24,000 enrolled.

References
About the Medicare-Medicaid Coordination Office:
http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/index.html [15]

Understanding the Affordable Care Act http://www.healthcare.gov/law/introduction/index.html [16]
Dual Beneficiaries Overview: http://www.medpac.gov/publications%5Ccongressional_reports%5CJune04_ch3.pdf [14]

The Kaiser Foundation on Medicaid Facts:
http://www.kff.org/medicaid/upload/4091-04%20Final(v2).pdf [17]

Medicare and Part D Donut Hole

The Medicare "Donut Hole"

The Coverage Gap

The way Medicare Part D was designed there was a planned coverage gap, which has become known as "the donut hole". This gap has caused a great deal of confusion and higher than expected out of pocket costs for medications.

When do you reach the gap?

The gap begins when a person reaches a predetermined amount during the year based on average retail cost of drugs. In 2011, that amount is set at $2840. Since Medicare drug plans negotiate for a lower price the average retail cost is not what you actually paid out of pocket. Every drug plan can have a different negotiated amount so the same drug may cost different amounts from one plan to the next. This means that two different people with two different plans will reach the gap at different times.

A person reaches the other side of the gap when their out of pocket costs reach $4550 in a year. This excludes any amounts paid by you for premiums or any amounts paid by your insurance. This means that only actual costs out of a person's pocket will count.

Catastrophic Coverage

Once a person reaches the other side of the gap they are into what is called catastrophic coverage for the rest of that year. With this catastrophic coverage a person will pay up to 5% of the drug cost and the remainder will be covered by the drug plan.

Closing the Gap

A great deal of effort is being made to close this gap and in 2011 a special program was put in place that helps cover medication costs once the gap is entered. Once a person reaches the gap they received discounts to help cover costs. For covered brand name drugs a 50% discount is offered and a 7% discount for covered generic drugs. It is expected that the gap will be closed by 2020.

Programs to help ease the burden caused by the gap include a one-time $250 rebate check mailed to eligible beneficiaries beginning in June 2011. Those in the donut hole will also be eligible to receive a 50% discount on all brand name drugs and a 7% discount on generics.

By 2013 people in the gap will begin to pay less and less for brand name drugs and by 2020 their hole will be closed completely. Beneficiaries will only pay 25% of drug costs until they reach the annual spending limit.

Click here [18] for a gap calculator

The Affordable Care Act

In March of 2010 the Affordability Care Act was signed into law. It contains a number of provisions that create changes in American healthcare over the next 5 years. Provisions include:

New consumer protections

Placing easy to understand online tools that will allow people to compare medical coverage options
Prohibiting coverage denial for children with pre-existing conditions
Preventing health plans from canceling coverage because of illness
Eliminating lifetime coverage limits and regulating annual limits for essential services
Providing better access for people to appeal decisions and creates programs to help consumers navigate the system

Better quality and lower costs

Providing help for small employers to be able to offer insurance to employees
Coverage of preventive care at no cost
Efforts to cut down Medicare fraud
Creating programs to improve public health
Steps to close the Medicaid Part D donut hole

Increased access to affordable care

Provide a new insurance program for people who have been without coverage for 6 months due to a pre-existing condition
Allowing young adults to remain covered under their parents health insurance until age 26 in some circumstances
Creation of a program to expand coverage for early retirees
Expansion of the number of primary care doctors, nurses and physician assistants to make healthcare more available and increasing payments to providers in rural areas
Holding insurance companies responsible for unreasonable rate hikes
Allowing states to cover more people through Medicaid by providing matching funds
Providing increased funding to support and build more programs at community health centers

Extra Help for Low Income

People who meet certain low-income criteria may be eligible to receive additional financial assistance with premium and drug costs. The Extra Help Program is only available to those who are enrolled in a Part D plan. To get help enrolling or for additional financial help call 1-800-MEDICARE (TTY 1-877-486-2048) or go to the Medicare website www.medicare.gov. [3]

Medicare Savings Programs

Medicare Savings Programs (MSPs) are state programs for people with limited resources or low income to help to cover Medicare costs. This application can be done at the same time as the Extra Help application. The programs vary from state to state and can help cover premium costs and in some states may help with deductibles and co-insurance costs. This link can take you to the Medicare website and information for each state: http://www.medicare.gov/contacts/staticpages/msps.aspx [19]

References

Q1 Medicare.com: http://www.q1medicare.com/PartD-MoreOnTheDonutHolesOrCoverageGap.php [11]

Medicare website: https://secure.ssa.gov/apps6z/i1020/main.html [12]

Medicare Savings Programs: http://www.medicare.gov/contacts/staticpages/msps.aspx [19]

Kidney Patients and the Donut Hole

Can the Medicare "Donut Hole" Affect Kidney Patients?

The short answer to this question is "maybe". The longer answer reveals that the gap affects some Medicare recipients more than others. A closer look will help to explain the reason why these two answers are different and how your patient may be affected.

What is it?

The "donut hole" is a gap in prescription drug coverage under Medicare. This gap begins when a person reaches a predetermined amount during the year based on average retail cost of drugs. In 2011 the gap begins when a person spends $2840 in actual out of pocket drug costs in a year. They reach the other side when their costs hit $4550 in that same year. Steps are being taken to minimize the impact on seniors and the gap will be completely eliminated by 2020 through rebates and discounts for those who fall into this gap.

What does this mean for providers?

Many patients, especially those on fixed incomes, may have difficulty paying for their medications when their Medicare drug coverage stops. This can mean that patients take less of their drug to make it last longer or skip doses. Some stop taking their medication altogether. Obviously all of these can impact the health of the patient. The good news is that there are programs available to help bridge this gap for Medicare recipients.

What kind of help?

Those affected by the donut hole will receive a $250 rebate check. They will also receive a 50% discount off the price of brand name drugs and 7% off of generic drugs. This discount is being paid for by pharmaceutical companies. Patients will pay less over the next few years until they only pay for 25% of the cost until they reach an annual limit.

Independent co-pay foundations can cover out of pocket costs for drugs for Medicare recipients with standard part D coverage. Those with commercial or private health insurance may be eligible for discount programs through specific pharmaceutical companies.

Patients who are eligible for both Medicare and Medicaid, known as dual eligible, are usually not affected by this donut hole.

What can providers do?

Talk to patients about their prescriptions. Be alert to signs that they may not be taking them as ordered and be sensitive that cost may be a factor. Understanding the donut hole will help you to identify those patients who may be at risk due to the donut hole. Taking the time to talk to patients about these risks can help determine what kind of assistance they may need. Being familiar with available resources will help successfully connect your patients to the right programs.

Resources for Patients

It is critical to be an active and engaged participant in your own care. Reading this article will help you make sure you are getting the care you need. Any time new medicines or tests are ordered for you, it is important to ask questions. It can be intimidating to ask doctors or nurses these questions, but you are not able to make informed decisions without all of the facts. The Agency for Healthcare Research and Quality's (AHRQ), part of the part of the Department of Health and Human Services, was created to help with this process. The AHRQ has developed a patient guide of questions to help start the conversation with all of your health care providers.

When your doctor orders a new medicine

What is the name of the medicine?
How is it spelled?
Does it come in a generic?
If not, then it is expensive?
Are there programs to help me afford it?
What condition is it for?
How do I take it?
How often?
How long will I need to take it?
When will it start working?
When I feel better can I stop taking it?
How many refills can I get?
What kind of side effects are there?
Will they affect my ability to drive or work?
Do I keep taking my other medicines?
Will this interact with any of my other medicines?
What about vitamins and supplements?
Will I need to have lab tests done while I am taking this medicine?

When your doctor orders medical tests

What is the test for?
How is it done?
How long will it take?
Can I eat right before this test?
When will I get the results?
How will I know what the results mean?
Do I need to do anything to get ready for the test?
What will happen after this test?

When your doctor suggests a treatment for an illness or condition

Are there other choices?
What are the risks?
How will it help me?
Will it hurt?
If it will hurt how will you treat the pain?
Is this the treatment you recommend?
How much will this cost?
Will my insurance cover it?
Will it work?
How long will it take to work?
Are there side effects I should know about?
How soon do I need to decide?
What if I don't do anything?

Resources for Providers

When you order a new medicine

The name and spelling of the medicine
Whether or not the drug is available as a generic
Discuss the costs of medications and what programs help cover costs
Explain what condition the medicine is for
Review the dose and frequency with your patient
Be clear about how the medicine must be taken
Before eating
With or without food
During the meal
Let the patient know what to expect
How long they will take the medicine
When they should begin to notice improvement
What side effects they may experience
How it might affect driving or working
How many refills they will get
Let them know if they need to keep taking their other medicine or which ones to stop
Let your patient know about potential interactions with vitamins
Outline any needed lab tests done
Make sure the patient knows when you will see them again

When your order medical tests

Explain the test and what it is for
Talk about how the test it done and how long it will take
Be honest about whether or not it may hurt
Let the patient know of any special instructions such as fasting
When and how you will let them know about the results
Outline the plan of care, including next steps

When you suggest a treatment for an illness or condition

Talk about all of the available treatment options including success rates
Be clear about how the treatment may help and what risks there may be
Be honest about whether or not it may hurt
Talk about what can be done for pain
Be prepared for them to ask you what you would do
Know what the treatment may cost and whether it is covered by most insurance plans
Be honest about what may happen if they do nothing
Offer them time to consider their choices, set a reasonable time line for their decision

Choose Another Class

Congratulations on finishing the Medicare and the Part D Donut Hole Class! Please select another class from the listing below to continue your educational journey.