HEADLINES
Pat Sanders, Editor
Kirklin Clinic Head & Neck Cancer Support Group, Birmingham, AL
distributed by American Cancer Society
January, 2002

MEDICARE/MEDICAID BENEFITS
By Vicki Eorio VEorio@aol.com 

Many of us over 65 years of age assumed that we were well protected against high "out of pocket" expenses because of Medicare benefits and supplemental health coverage. But the reality is that many people over 65 are living near poverty levels. Below are the 2001 Health and Human Services poverty guidelines.

2001 HHS Poverty Guidelines

Size of
Family Unit

48 Contiguous
States and D.C.

Alaska

Hawaii

1

$ 8,590

$10,730

$ 9,890

2

11,610

14,510

13,360

3

14,630

18,290

16,830

4

17,650

22,070

20,300

5

20,670

25,850

23,770

6

23,690

29,630

27,240

7

26,710

33,410

30,710

8

29,730

37,190

34,180

For each additional
person, add

3,020

3,780

3,470

 

There is a little known program for seniors that allows those who qualify financially to obtain Medicare AND Medicaid benefits. The two agencies that can be of the most help in determining eligibility are the Social Security office in your area and the Agency for Aging which is usually a State agency that works with Social Security to coordinate benefits and to identify additional resources. When you go to either one of these agencies, you should know the "buzz" words and understand the concepts so that you can work more effectively with the agencies to obtain those benefits for which you qualify. There are several phrases that need definition.

DEFINITIONS:

Dual Eligible

Medicare has two basic coverages:

Part A pays for hospitalization costs and Part B pays for physician services, lab and x-ray services, durable medical equipment (also referred to as DME), and outpatient services. Dual eligibles are individuals who are entitled to Part A and/or Part B and are eligible for some form of Medicaid benefits.

Qualified Medicare Beneficiaries (QMBs) without other Medicaid

If you have Medicare Part A, have an income of 100% of the poverty level or less and yet are not qualified for full Medicaid coverage, you are considered to be a QMB. Under this definition Medicaid pays for Part A premiums (if any), Part B premiums and depending on the state in which you live, Medicare deductibles and coinsurance for Medicare services.

The list of other classifications include:

    • QMBs with Full Medicaid (QMB Plus)
    • Specified Low-Income Medicare Beneficiaries (SLMBs) without other Medicaid (SLMB Only)
    • SLMBs with full Medicaid (SLMB Plus)
    • Qualified Disabled and Working Individuals (QDWIs)
    • Qualifying Individuals (1) (QI-1s)
    • Qualifying Individuals (2) (Q1-2s)
    • Medicaid only Dual Eligibles.

Now before you go crazy and say, I can’t handle or understand all this government double talk, take a deep breath. The purpose of telling you about these classifications is for you to be armed with knowledge when you go to Social Security or Department of Aging. Once they know that you are aware of these classifications, it is up to THEM to explain and evaluate your individual situation to determine level of eligibility.

A National study, conducted at the request of the government, documented that participation rates are very, very, low due to lack of awareness on the part of older citizens. These moneys are sitting there, not being accessed by folks who are eligible but unaware and that needs to change. In some cases, the combination of Medicare and Medicaid benefits can result in coverage for prescription drugs and long-term care services. So the amount of effort it may take on your part to pursue eligibility provisions is well worth it. For low-income Medicare beneficiaries, obtaining financial protection against your "out of pocket" medical costs is possible.

Actions you can take:

  • Go to the website, http://www.hcfa.gov/,  look up Medicare and then look up "dual eligibles". Although there is a lot of government-ese language, I suggest you at least review the main points of the dual eligible programs.
  • Take the list of classifications provided here (and on the website) to your local Social Security agency. If they are not familiar with the programs, ask to speak to a supervisor and ask when knowledgeable employees will be available to work with you. DO NOT GIVE UP! Be persistent. Unfortunately, you must do this in person. You will find the 800 number puts you in a loop that lasts forever. In some areas, the Social Security Agency, while listed in the phone book, does not provide an address. Be prepared to furnish evidence of income, expenses, etc. You probably have been through that process before. It might help to start a notebook in which you have all financial information. The bureaucracy of the government can be a barrier but don’t let it be. If push comes to shove, don’t forget your local legislators. They can apply a lot of pressure because so much of the money is federal money that the State is entitled to in order to administer programs for its citizens.
  • Contact your state Department of Aging. If you don’t find a listing in your phone book, go again to the web. http://www.aoa.dhhs.gov/  (This agency is also funded by the same national department that administers Medicaid and Medicare, HHS.) Then click on the National Aging Information Center and then select the state information site. That will give you information about the programs available to you from your state agency, location, phone numbers, etc. I have found these people to be more knowledgeable about all aspects of available resources. They will also function as an advocate for you with other agencies such as Social Security.

And don’t forget our good friends, the AARP. They also will act as advocates for you in getting the benefits for which you qualify.

Good luck and don’t let the system get you down!

Recommendations for Chemo-Related Nausea

Environmental Nutrition suggests, in addition to what your doctor prescribes for nausea while undergoing chemotherapy, that you listen to your body and pay attention to what odors and tastes trigger your nausea. In general, they suggest that strong odors and fried, fatty or spicy foods might bother you more and that you should avoid mixing hot and cold foods. Room temperature foods might agree with you more.

Eat slowly and chew your food well through small frequent meals that preferably were prepared by someone else so they will be more appetizing. In between meals, sip clear soups and, if you tolerate them, "flat" soda, fruit juice and sports drinks.

Don't lie down immediately after eating and avoid sudden movements. Relaxation techniques, deep breathing and fresh air may help.

How can I get this thing to stick?
Some advice on gluing the Hands-Free housing
By Terry Duga TDuga@atg.state.in.us

If you haven't had the Hands-Free very long and you are concerned over problems getting a seal that lasts more than a few hours, patience is the key word. It takes time to find out what works for you. If I can remember that far back, it took me months to learn to get a good seal. Even today, there are days when the seal doesn’t want to work. And I just live with it. A clean stoma is a big key. If you use an adhesive remover, be sure that you get the remover off of the skin. Otherwise, it will dissolve the adhesive and defeat your seal.

Step by Step:

Wash around the stoma with soap and water.

Use alcohol to finish cleaning the area. I use alcohol on a tissue, but a wipe or gauze pad works.

Apply the Skin Shield or a similar product. Allow that to dry.

Apply the glue. I use the Skin Tac because it is easier on my skin. I think that the Blom-Singer Silicone adhesive holds better, but it is harder on my skin and must be cleaned with an adhesive remover (like Remove). Skin Tac cleans off with alcohol. Hold your breath while applying the skin shield and glue so the fumes don’t make you cough.

Allow the glue to dry. Then center your housing over the stoma and press the area. If using the True Seal, carefully press around the tape to get rid of the air bubbles. Allow the tape to sit on the skin for a while without the valve in place and the heat from your skin will help the tape hold. Don't talk as you allow the adhesive to set.

I use the standard housing. I like the True Seal, but find that with my reconstruction, the standard housing works better and gives me a better voice. But that is me. Everyone is different. At first, I used the foam disks to get a seal. Later, as I became more adept at placing the housing, I went back to the standard tape discs. There is a heavy duty tape disc that I bought once by mistake. It does hold better but if I need an extra tight seal, I will tape around the housing using micropore or similar tape. Cut the strips into ½ inch width and tape all around the housing. The tape will give extra hold to the housing. Dr. Blom suggests putting a layer of adhesive under the tape. This means you need to brush a layer of adhesive around the housing and skin and allow it to dry before applying the tape. I have not had an occasion where I have needed this much adhesion, but it is nice to know the trick.

You can use the tape to seal a blow-out or seal leak.

Air pressure is what causes the seal to break. I am fortunate in that I speak with very little pressure. Try not to strain when you talk. Also, it's a good idea to try to get the valve out before you cough since a cough weakens the seal.

Good luck. And remember, Patience is the key.