The Trump administration is considering expanding Medicare's ability to negotiate the cost of drugs by giving private payers a role in setting the price of medicines administered in hospitals and doctors' offices, Health and Human Services Secretary Alex Azar said.

Azar's comments provided more details on the plan announced by President Donald Trump to lower prescription drug costs for Americans.

While Trump has vowed to tackle rising prices since running for office, his plan spared the pharmaceutical industry from direct government negotiations to control costs. Drugmaker shares rose as Wall Street analysts said the new policies should not hurt industry profits.

Medicare is the national health insurance plan run by the federal government for Americans over the age of 65.

Azar said that Trump views tougher negotiation as key to the plan, and that his agency will consider an alternative system for buying Medicare Part B drugs, which are administered by a healthcare provider and covered directly by the government.

Instead, the administration would seek to allow private sector payers to negotiate the price of those medicines, as they do in Medicare Part D, which covers drugs that patients pick up at the pharmacy.

"We believe there are more private sector entities equipped to negotiate these better deals in Part B, and we want to let them do it," Azar said in prepared remarks. "More broadly, the President has called for me to merge Medicare Part B into Part D, where negotiation has been so successful.
 

The Home Equity Conversion Mortgage (HECM) is FHA's reverse mortgage program, which enables you to withdraw some of the equity in your home.  The HECM is a safe plan that can give older Americans greater financial security. Many seniors use it to supplement Social Security, meet unexpected medical expenses, make home improvements and more.  You can receive additional free information about reverse mortgages in general by contacting the National Council on Aging at (800) 510-0301. It is smart to know more about reverse mortgages and decide if one is right for you!

1. What is a reverse mortgage?
A reverse mortgage is a special type of home loan that lets you convert a portion of the equity in your home into cash. The equity that you built up over years of making mortgage payments can be paid to you.  However, unlike a traditional home equity loan or second mortgage, HECM borrowers do not have to repay the HECM loan until the borrowers no longer use the home as their principal residence or fail to meet the obligations of the mortgage.  You can also use a HECM to purchase a primary residence if you are able to use cash on hand to pay the difference between the HECM proceeds and the sales price plus closing costs for the property you are purchasing.

2. Can I qualify for FHA's HECM reverse mortgage?
To be eligible for a FHA HECM, the FHA requires that you be a homeowner 62 years of age or older, own your home outright, or have a low mortgage balance that can be paid off at closing with proceeds from the reverse loan, have the financial resources to pay ongoing property charges including taxes and insurance, and you must live in the home. You are also required to receive consumer information free or at very low cost from a HECM counselor prior to obtaining the loan. You can find a HECM counselor online or by phoning (800) 569-4287.

3. Can I apply for a HECM even if I did not buy my present house with FHA mortgage insurance?
Yes.  You may apply for a HECM regardless of whether or not you purchased your home with an FHA-insured mortgage. 

4. What types of homes are eligible?
To be eligible for the FHA HECM, your home must be a single family home or a 2-4 unit home with one unit occupied by the borrower. HUD-approved condominiums and manufactured homes that meet FHA requirements are also eligible.

5. What are the differences between a reverse mortgage and a home equity loan?
With a second mortgage, or a home equity line of credit, borrowers must make monthly payments on the principal and interest.  A reverse mortgage is different, because it pays you – there are no monthly principal and interest payments.  With a reverse mortgage, you are required to pay real estate taxes, utilities, and hazard and flood insurance premiums.

6. Will we have an estate that we can leave to heirs?
When the home is sold or no longer used as a primary residence, the cash, interest, and other HECM finance charges must be repaid.  All proceeds beyond the amount owed belong to your spouse or estate. This means any remaining equity can be transferred to heirs.  No debt is passed along to the estate or heirs.

7. How much money can I get from my home?
The amount varies by borrower and depends on:

• Age of the youngest borrower or eligible non-borrowing spouse
• Current interest rate; and
• Lesser of appraised value or the HECM FHA mortgage limit of $679,650 or the sales price

If there is more than one borrower and no eligible non-borrowing spouse, the age of the youngest borrower is used to determine the amount you can borrow. 

8. Should I use an estate planning service to find a reverse mortgage lender?
FHA does NOT recommend using any service that charges a fee for referring a borrower to an FHA-approved lender.  You can locate a FHA-approved lender by searching online at www.hud.gov or by contacting a HECM counselor for a listing.   Services rendered by HECM counselors are free or at a low cost.  To locate a HECM counselor Search online or call (800) 569-4287 toll-free, for the name and location of a HUD-approved housing counseling agency near you.

9. How do I receive my payments?
For adjustable interest rate mortgages, you can select one of the following payment plans:

• Tenure- equal monthly payments as long as at least one borrower lives and continues to occupy the property as a principal residence.
• Term- equal monthly payments for a fixed period of months selected.
• Line of Credit- unscheduled payments or in installments, at times and in an amount of your choosing until the line of credit is exhausted.
• Modified Tenure- combination of line of credit and scheduled monthly payments for as long as you remain in the home.
• Modified Term- combination of line of credit plus monthly payments for a fixed period of months selected by the borrower.

For fixed interest rate mortgages, you will receive the Single Disbursement Lump Sum payment plan.

• Single Disbursement Lump Sum - a single lump sum disbursement at mortgage closing.

 10. What if I change my mind and no longer want the loan after I go to closing?  How do I do this?
By law, you have three calendar days to change your mind and cancel the loan.  This is called a three day right of rescission.  The process of canceling the loan should be explained at loan closing.  Be sure to ask the lender for instructions on this process.  Mortgage lenders differ in the process of canceling a loan.  You should ask for the names of the appropriate people, phone numbers, fax numbers, addresses, or written instructions on whatever process the company has in place.  In most cases, the right of rescission will not be applicable to HECM for purchase transactions.

With the possibilities of a hurricane coming to the Southeast, now is a good time to review your plans for helping older neighbors and relatives. Bear in mind that these special individuals may be reluctant to evacuate, choosing to just stay home and ride out the storm.

If you have a loved one in a mandatory evacuation zone, please either go pick up this person and bring them to a safe area or alert authorities in that area if you can't physically get there yourself. Considerations for the elderly who may evacuate include: taking any specialized medical equipment, such as oxygen; making sure an adequate supply of medication is available and packed, important papers are gathered (insurance, medical IDs, wills, etc.); as well as comfort items, such as bedding, clothing, snacks, etc.

If a senior has medically necessary equipment running that requires electricity, make sure that they know about the possibility of power outages during and after a storm. It may be much better to take the equipment and evacuate for a short time, instead of being without a needed or critical device in a crisis situation.

There are shelters set up for those with special needs. Check out the South Carolina Emergency Management Division's website by clicking here. They have important information regarding any emergency declarations, shelter locations, business and government closings and more.

When it comes to signing up for Medicare, there's plenty of confusion. Which part of the four-part program covers hospital stays? Do all parts help pay for prescription drugs? What's the difference between Original Medicare, Medicare Advantage and Medicare Supplement Insurance?

Medicare itself has four parts. Part A (hospital insurance) and Part B (health insurance) come standard in every Original Medicare Plan. Part C is called Medicare Advantage, and it's an alternative to a standard Medicare Plan that offers some additional benefits like prescription drug coverage. Stand-alone prescription drug plans, or Part D, cover prescription drugs for those who want to keep their Original Medicare plans. And then there is Medigap.

Medicare Supplement Insurance plans are private health insurance that can help you pay for the "gaps" in your traditional Medicare policy – such as copayments at a doctor's office, coinsurance at skilled nursing facilities and out-of-pocket hospital costs not covered by Medicare Part A. There are 10 different types of Medicare Supplement Insurance plans, each designated by a letter of the alphabet (you can find details about all 10 plans at Medicare.gov). In most states, the benefits are the same no matter what insurance company you purchase the plan from, though each plan covers different things. Premium prices for each of the 10 Medigap plans varies depending on the benefits offered, and the premiums are separate from your regular Medicare premiums.

To be eligible for a Medicare Supplement Insurance plan, you must already have Medicare parts A and B. The most comprehensive Medicare Supplement Insurance plan is Plan F, which covers all available benefits. Plan C, which covers everything except excess health insurance costs, and Plan F are the most popular plans. 
 
The advantage of a Medicare Supplement Insurance plan is that you will have a larger network of providers from which to choose. If you have a health condition, a Medicare Supplement Insurance plan may also provide better ways to pay for medical expenses. If you can afford to spend a bit more, a Medicare Supplement Insurance plan may be a wiser choice. It may save you a lot of money in the long run if you need extensive medical services or treatments.

Nearly half (47%) of adults in the 40s and 50s have a parent aged 65 or older and are either raising a young child or financially supporting a grown child, aged 18 or older.
 
What IS the sandwich generation? In a nutshell, it’s taking care of both elder care and childcare or supporting a grown child at the same time. You’re “sandwiched” in the middle of both circumstances.
 
Family members, predominantly female family members, have provided the majority of care to their aging loved ones. Today, there’s a generation of middle-aged adults known as the Sandwich Generation, who are caught in the middle of child rearing or support and providing care to aging parents for these reasons:

1. Delayed parenting – a new norm in society is couples starting families in their middle to late 30s instead of earlier in life.
2. Increased life span: people are living longer as a result of better healthcare and technology.
 
The sandwich generation can be further defined:
•Traditional: those sandwiched between aging parents who need care and/or help and their own children.
 
•Club sandwich: those in their 50s or 60s sandwiched between aging parents, adult children and grandchildren or those in their 30s and 40s with young children, aging parents and grandparents.
 
•Open faced sandwich: anyone else involved in elder care.
 
•Interesting fact: Most of the sandwich generation were baby boomers until 2005. As of 2014, boomers became grandparents and started transitioning into the aging population while their children took their places and moved into the sandwich generation.

Rehabilitation hospitals say a proposed change to how Medicare will reimburse them for care could lead to inaccurate payments as new system pulls patient data from a new source.

In the 2019 inpatient rehabilitation proposed pay rule, Medicare proposed to retire the current patient assessment tool that helps categorize the level of care needed by a patient. The current tool has been used since 2002 to help determine the amount of care reimbursement. But now the agency wants to switch to a new patient assessment tool that's similar to one in place for other post-acute care settings to create a more uniform evaluation for patients' care needs. The change will kick in on Oct. 1, 2019 if it's finalized.

Clinicians use the tool in question to rank the severity of the patients care needs and develop a treatment plan.

The new assessment tool was introduced last year and it's unclear if it tracks patient needs sensitively enough to determine reimbursement accurately. "The limited analysis CMS has made available to stakeholders is insufficient evidence as to the data's validity or reliability as a basis for payment purposes," Richard Kathrins, chair of American Medical Rehabilitation Providers Association's board of directors, said.

Providers are worried about whether the new tool asks the right questions and helps them evaluate patients as thoroughly as the assessment method they've been using for years. The tool is still too new to answer those questions, according to rehab providers.

"Too little is known about the accuracy, consistency and clinical efficacy of the new clinical data and information that CMS is proposing to utilize," Mark Tarr, president and CEO of Encompass Health, one of the largest providers of rehab hospital services in the nation said. "These clinical data and information have not been sufficiently studied, understood or validated to determine payment or patient care implications for rehabilitation hospital services."

The Kentucky Hospital Association suggested Medicare should study and evaluate the accuracy and reliability of the new data source as well as its implications before changing the reimbursement model.

  Is there a history of stroke in your family? As stroke is the third leading killer in the United States, there is a good chance someone in your family has suffered from a stroke. The likelihood of having a stroke is one and a quarter times greater for men than women, but the odds even out as people get older. The control of high blood pressure is the best thing you can do to help prevent a stroke from stealing your life.
  As someone who’s charged with the care of another, it’s important to know the warning signs of a stroke so you can take immediate action. The sooner a stroke victim receives medical attention, the better chance he has of recovery and survival.
  Use the mnemonic device “FAST” to remember the checklist:

• F: FACE – Ask your parent to smile. Does one side droop?
• A: ARMS – Ask him or her to raise both arms. Does one drift downward?
• S: SPEECH – Ask a simple question. Does he or she seem confused? Is the
  speech slurred or unusual?
• T: TIME – Don’t waste time! Call 911 right away if you observe any problems.

  If your parent complains of a sudden weakness or numbness, loses vision in one or both eyes, has a sudden and severe headache or loses his balance, follow the FAST outline and call 911.
  My father had a stroke. It was very near the end of his life and happened while he was already in the hospital for a medication adjustment. His dementia was becoming more severe and we decided to work on changing his medication while he was in an in-patient environment. My sister and I met with the doctor around lunchtime and reviewed the list of meds he was taking, and discussed what changes could possibly be made to help him have a better quality of life.
  We didn’t get to visit with him while we were there because he was sleeping. I remember thinking that his breathing didn’t sound quite right, but the hospital staff wasn’t concerned, so I didn’t say anything. Don’t ever repeat my reluctance to speak up – it can mean the difference between life and death. If you suspect something is wrong, seek assistance and be persistent until you are taken seriously.

  Caring for your parent with Parkinson Disease requires you to be on your toes, ready to deal with changing conditions. Your parent may be able to move perfectly and then suddenly require assistance with the same type of movement. Close observation is required virtually all the time.
  As caregivers, we know what an all-consuming time commitment it is to look after someone and knowing you should be observant every minute of every day is difficult, if not impossible. All anyone can do is try your best. And if you need help, ask for it.
  Thousands of people are affected by Parkinson Disease each year. Ask your parent’s doctor about new research and drug trials in which your parent might participate. Researchers are searching for ways to identify Parkinson Disease sooner and delay the onset of symptoms. The Medical College of Georgia runs a Movement Disorders Program in Augusta, Georgia. This facility is a National Parkinson Foundation Center of Excellence. If you are interested in having your parent take part in the research trials, contact them at www.mcg.edu.
  You may be asking yourself, “what is Parkinson Disease?” It is a disease impacting the portion of the brain responsible for movement. A progressive disorder, PD occurs when neurons die or lose their function, failing to produce dopamine. The naturally occurring chemical dopamine allows us to move smoothly. When eighty percent of dopamine producing cells or neurons are impaired, the symptoms of Parkinson Disease manifest.
  Many lay people refer to it as Parkinsons, but the correct reference is singular, as in Parkinson Disease, not Parkinson’s Disease. Early symptoms are mild and then progress to more significant symptoms over a period of time. Movements your parent once made with ease may become difficult or impossible.

  Things can change quickly with the health status of your parent. You may be forced to make quick decisions and critical choices that can have a significant impact on the life and well-being of your loved one. It is for this reason you need to establish your personal Caregiving Plan. By developing a strategy in advance, it will help guide you through times when you’re forced to act without much time to consider the consequences. Being prepared is vital.
  The elements of your caregiving plan should be:

1. Narrative of Current Situation.
2. General Needs Assessment of the Person for Whom You are Caring.
3. What To Do As Illness Progresses.
4. Friends and Family Who Can Help.

  As you create your Caregiver’s Plan, begin by writing a narrative of your overall situation. It doesn’t have to be a difficult exercise, simply briefly summarize the situation. Having a written description of your circumstances can be very useful in filling out requests for benefits or applications for services. You may need financial records (look for these documents now, as many programs and services require you to provide a complete and current financial picture) to create a comprehensive overview of your parent’s needs and situation. 
  When you stop to consider the factors involved in your parent’s care, you will gain insight from the process and be able to quickly articulate your needs to doctors, nurses and service providers.
  After you’ve written the narrative, conduct a general needs assessment of the family member or members involved. By looking at the tasks your loved one could use assistance with, you will start to get a better idea of what your present and future needs will be as a caregiver.
  An excellent publication to review is Prepare to Care: A Planning Guide for Families, produced by the AARP Foundation’s Benefits Outreach Program. This booklet is available to download at https://www.aarp.org/benefits-discounts/all/prepare-to-care/. It provides a step by step approach to developing your Caregiver’s Plan.
  Don’t let the idea of creating a Caregiver’s Plan overwhelm you. We all make plans every day for one thing or another; this plan is just an extension of an idea that you will be ready for whatever comes. It doesn’t have to be a formal document, an outline of what your action will be based on changes in circumstance is sufficient.
  Knowing in advance what your loved one wants as his or her condition progresses will give you comfort and peace that you are making the right decision. Take time to sit down and discuss the options. Research your parent’s illness or medical condition so you’ll have an idea of what to expect as time goes on; the primary care physician could offer valuable information in this area. I found a chart format easy to create and refer back to throughout the months. Regardless of the method you choose, being proactive instead of reactive will serve you well.

  There are several helper devices that are extremely useful in the home and on the go. The initial struggle of the day can be simply finding a way to get out of bed. Even in households where there are two people, in an elderly couple many times the healthier person is still unable to lift the other from the bed. A triangle pull can be positioned over the bed so it can be used to pull one’s self up to a sitting position. This device is very low tech, yet it fosters the development of upper body strength and helps maintain personal independence and dignity.
  Another option to help with the daily transition is to install a hospital-type bed, one that raises and lowers both the head and foot areas with the touch of a remote control. The idea of having a hospital bed at home can be an unpleasant thought, but it may mean the difference between being able to stay at home versus moving to an assisted living facility. Under the right circumstances, the motorized bed may be covered by Medicare as a medical expense if ordered by a physician.
  If you find your parent is spending a good deal of time in bed, check into a pressure sensitive mattress. The last thing you want is the development of pressure ulcers (sometimes called pressure sores), which occur when the skin breaks down in areas from constant pressure against a surface, even a soft surface such as a bed or chair.
  Pressure Guard® makes a series of specialized mattresses for preventing and managing pressure ulcers. Their Turn Select mattress slowly (very, very slowly) maneuvers your parent into different positions to minimize the effects of immobility on the skin.
  Surprisingly, extended periods of simply sitting in a chair may lead to pressure sores. As long as movement is possible, encourage your parent to move as much as practical, at an activity level that is comfortable for him or her. Make sure the skin is examined carefully on a regular basis so any sores may be treated as quickly as possible. Bath time may be a good choice, if you (or another caregiver assisting with the bathing) can inspect without causing embarrassment to your parent.
  Don’t rely on asking your parent if he is experiencing this type of condition; he may not even be aware of it due to reduced feeling in certain areas. Or, to avoid an uncomfortable examination, he may deny anything is wrong.
  Pressure ulcers are a serious health complication that can cause pain and result in a slower recovery from other issues.