Talking With Kerry Weems: Medicare Advice for Caregivers

The acting administrator talks about the agency's new efforts to help caregivers navigate the Medicare maze.

Tired of being on hold with 1-800-MEDICARE? Not sure if Medicare covers home health aides or nursing facilities? Overwhelmed just thinking about finding your parent a local doctor who accepts Medicare?

Kerry Weems says he feels your pain. The acting administrator of the Centers for Medicare and Medicaid Services (CMS) admits that sorting through the complexities of the program can be trying even for seasoned bureaucrats like him.

Appointed to lead CMS by President Bush in the fall of 2007 and scheduled to depart when a new administration takes over in January 2008, Weems is a fleeting presence on the Medicare scene. Many healthcare insiders speculated that the 24-year veteran of the Department of Health and Human Services was appointed more to cut Medicare costs than to improve access to its services. But in just over a year, Weems has initiated two projects aimed at caregivers that, he hopes, will be helping them long after his tenure with the agency ends.

In September, he launched Ask Medicare , a web page designed to provide caregivers with information on Medicare coverage and links to government and local community resources. This month, Ask Medicare will send out its first e-newsletter, aimed at answering caregiver questions and providing other information to make it easier to navigate the system.

Weems spoke to about caregiver identity, how today's caregivers can plan for their own long-term needs, and the likelihood of a Medicare overhaul.

What was your family's personal caregiving experience?

My wife's mother was an extraordinarily healthy individual, but she came down with Alzheimer's disease. My wife, Jean, and her sister and father helped their mother through a good deal of that experience. Finally she was institutionalized in a nursing home, and during that period, my wife's father died. Then her mother died about 18 months ago. Over about eight years, my wife had a very concentrated experience of her mother's decline to Alzheimer's disease and her father's death.

Do you think being a caregiver to someone with Alzheimer's hastened her father's death?

I think he probably survived longer because he was taking care of his wife. She was in a pretty good nursing home in their town, so he saw her daily. He still felt some of the companionship.

Was your wife's experience part of the inspiration for Ask Medicare?

Well, you know, when you're in a leadership position, you draw on a number of things. Obviously, this was on my mind. I had also found in my experience on this job and other jobs I've had in HHS that Medicare beneficiaries, and by extension the people who are caring for them, just don't understand the Medicare system.

Medicare can be an extraordinarily complex program. You pick up insights like this in the job that I have -- first of all, just by trying to understand the program yourself. But second, I was in one of our 1-800-MEDICARE call centers talking to some of the people who answer the telephone for us there, and I said, "If you could wave a magic wand, what would you change?"

There was a huge consensus among that group that they wished the people who called knew more -- knew the right question to ask. People who come on Medicare get a handbook, but it's a complex program and hard to navigate. Responses like that formed the inspiration for Ask Medicare.

You've said that if a person helping someone on Medicare doesn't relate to the term "caregiver," they miss a lot of resources. What do you mean by that?

Many people who are caregivers don't think of themselves that way. Their orientation is to their connection with the person -- they think, "I'm not a caregiver; I'm a son or brother or friend." They often don't take on that title, so in titling something "for caregivers," we might miss those folks.

So some of what we're trying to do is remind people that if you're helping somebody out by getting groceries for them and cooking dinner for them one night, you really need to think about yourself as a caregiver, and here's how we can help with some of those responsibilities.

How would Ask Medicare help the person who is bringing groceries and cooking dinner once a week?

It depends. For example, we have open enrollment coming up for the Prescription Drug Program. So when you're cooking dinner for the person on Medicare, and talking together, you might ask what prescription program they're in and make sure you get them in the right one.

Our own interest is to make sure people use their Medicare benefit to get the most out of it, so one of the things our website does is help connect caregivers to resources in their local area.

One problem we often hear is that people just don't understand how the various parts of Medicare work with each other and the relationship between Medicare and other insurance. Will the site help people understand that?

One of the basic questions the site addresses is: What does Medicare cover? For instance, a lot of people think that Medicare covers long-term care, but it doesn't. Other basic types of things we do cover are how to file a claim, how to enroll, how to appeal or file a grievance, how to report fraud.

Another thing we do is link to our "hospital compare" website. People need to understand that just because a hospital is the closest doesn't mean it's the best. There is variability among healthcare providers. We also link to our "nursing home compare" website.

What were the most difficult aspects of caregiving for your wife?

Being a long-distance caregiver, some of the big traumas for my wife were things like her mother falling and injuring herself. The biggest thing for the family was to make the decision about a nursing home.

I have to sort of channel my wife, but I'd say she mostly wishes she had known about the local resources available to support her father, and later her mother. She didn't know about them because she was long-distance. Also, there's a strong streak of self-reliance that sometimes keeps us from reaching beyond ourselves.

People say it's difficult to find a good doctor who will accept Medicare. Do you help direct them to one?

We don't yet rate doctors, but there is a link that will tell you what doctors in your area accept Medicare payments. We can point you to doctors and home health agencies that practice in the area, and we do compare hospitals and nursing homes.

In November, for the first time, we're also targeting a newsletter to this community -- the beneficiaries and their caregivers -- to start answering some of their questions and talk to them about the Medicare benefits.

So people will be able to ask questions and the answers will appear in the newsletter?

We'll sum up their questions and try to take the ones that are asked most. For instance, one of the things that would be very helpful is a quick primer on how to navigate Medicare's 1-800 system. So if you have a question about a hospital bill, it will tell you to ask for a Part A claims representative, and you'll get through the system a lot faster. Tricks and tips like that can turn a ten-minute phone call into a three-minute phone call, and those seven minutes mean a lot for a caregiver.

Caregivers often say they're stunned to find that Medicare doesn't cover things like home health or transportation. Will this site help people with those things?

That's where connecting them to local resources is important. We do answer questions about long-term care and alternatives for nursing homes and how to get in-home services under the home health benefit, but those in-home health services aren't the same as personal care services, which is not a covered benefit. They way people can get help with those is by connecting with the local resources that provide those kinds of services.

Overhauling Medicare to include some of those services is a big issue. Given the financial situation, do you think there's going to be any kind of overhaul in the near future?

It's going to be extraordinarily difficult to add something like a long-term care benefit. That's extremely costly and right now Medicare is running at a deficit, so it's difficult to see adding an extremely costly benefit on top of what’s already an unsustainable financial scheme.

It's very difficult for a person to get long-term insurance in their 70s or 80s. Do you have advice on how to prepare for long-term needs?

Sure, and how to plan for long-term care is one of the subjects that we cover. This is going to be important for people who are still in their 40s and 50s, who may be caregivers now, to read because they still can get long-term care insurance. You can also save your money and self-pay. The last alternative is to exhaust your resources, and then the state Medicaid programs provide long-term care.

But it's tough for a lot of people in their 40s and 50s to afford long-term care insurance when they're paying for their kids' college and their parents' care.

It probably is a difficult decision to make, but there are some creative and good things that are going on in the insurance market. For example, certain types of life insurance policies can be converted into long-term care policies. There are mixed products out there that people can take a look at, and they might be able to receive several benefits from a single investment.

There's a lot of discussion among caregivers as to what Medicare should cover. Some people believe that when you're elderly, you should have all medical services taken care of. Other people say the only way for that to happen is for all of us to pay more taxes. If you don't want to pay higher taxes, you can't expect these things. Do you think that's true?

If you look at the history of the Medicare benefit, it's a lot different than the Social Security benefit. With Social Security, people have a legit claim to say, "Look, I paid into the system all these years." That's only true of the Part A benefit, the hospital benefit, in Medicare.

Of the Part B benefit, which covers doctors' services, 75 percent is paid for out of general tax dollars and 25 percent is paid by beneficiary premiums. It isn't one of the earned entitlements, the way that Part A and Social Security are. So currently, much of the Medicare program is already being paid for through tax dollars and deficit spending and premiums and cost sharing from beneficiaries. And that's the way it is.

In her New Old Age blog, Jane Gross wrote that some Medicare dollars are spent on certain tests that don't seem that important, while other, more important screenings and procedures aren't covered. If we look at the way the Medicare money is spent and reform it, there might be more money for long-term care. Do you agree?

That's a very good way to think about it. Right now, the way the Medicare system works is that we essentially just buy it by the yard. We compensate poor-quality providers as well as good-quality providers; we pay for excessive and repeated tests.

In some parts of the country, costs are much higher than in any other parts. Those costs are driven by utilization -- doctors just doing more -- but there's not a difference in the health outcomes. Clearly, there is waste in the system from overprovision of services, and that could be redirected other ways.

Is that something that could be addressed in the near future?

Yes, and given the financing path of Medicare, it's clearly something that will have to be addressed.


over 6 years, said...

it seems to me that because you sacrify yourself, when you both work and try your best to put some of your pay toward a saving acct. and then you are penalize when you get older and because you put some money toward your retirement than you are not eligible for extra help as the medicaid program. I know of some people that have sold their homes and taken out their savings to be able to qualify for medicaid. That is what the rich people do when they hide their financies and take them to other countires and not pay taxes or count against them. I know the millionaires do not need assistance, but with medicare there should be some way that would still qualify you for some kind of help and not punish you because you have some saving to help you for your other medical assistance. Maybe just give us some assistance, an indivisual to help maybe even 8 hrs per week with things we are not able to do such as picking upgroceries, taking us to the doctor, for unexpedted needs that might happen. Just wishing we would be able to get some kind of assistance. Another thing is we would appreciate if at least some there would be a way that we would get some help of someone that would help us out.