Things that are going on that you might want to know. 

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Headline: MEDICARE DRUG PLANS OFFER PREMIUMS OF $20 PER MONTH OR LESS
 LOWER DEDUCTIBLES, ENHANCED COVERAGE ALSO AVAILABLE

 Medicare beneficiaries all over the country will be able to choose
 prescription drug coverage that will cost less than originally expected,
 including plans with premiums of $20 per month or less. Options will also
 include plans offering zero deductibles or deductibles lower than $250
 annually, and plans that provide some coverage in addition to the
"standard"
 Medicare drug benefit.

 "Choice and competition among prescription drug plans is working to reduce
 premiums across the country making the drug benefit even more affordable
for
 seniors and other Medicare beneficiaries," HHS Secretary Mike Leavitt
said.
 "For just $20 or $30 per month, seniors will be able to get a
 Medicare-approved prescription drug plan that will provide real help and
 protect their life savings from ever being eroded by high prescription
drug
 costs."

 Earlier this month, the Centers for Medicare and Medicaid Services (CMS)
 estimated that the national average monthly premium for coverage
equivalent
 to the Medicare standard coverage would be $32.20. The reviews of the drug
 plans by CMS, which are nearing completion, show that Medicare
beneficiaries
 will be able to choose lower cost options and options with coverage in
 addition to Medicare's standard plan, including:

 * At least one prescription drug plan with
 premiums below $20 per month, and in some areas significantly below $20,
in
 every region of the country except Alaska. All regions have multiple plan
 options with premiums significantly below $30.
 * In every region, prescription drug plans
 that will have zero deductibles or deductibles lower than Medicare's
 standard $250 annual deductible.
 * Some prescription drug plans will offer
 coverage that exceeds Medicare's standard plan. This includes help for
 beneficiaries to pay for costs beyond $2,250 and before their
out-of-pocket
 costs hit $3,600 a year - the gap in Medicare's standard coverage. For
 example, some plans will cover generic drugs in the coverage gap.
 * In every region, beneficiaries with limited
 incomes (including those eligible for Medicaid and Medicare) will be able
to
 choose from plans with zero premiums offered by at least five
organizations.
 All of these plans will meet all of Medicare's standards for access to
 medications.

 "The robust response by prescription drug plans is translating into better
 benefits and lower costs for people with Medicare, however they prefer to
 get their Medicare coverage," said CMS Administrator Mark B. McClellan,
 M.D., Ph.D.  "All plans, including the lower cost options, must meet
 Medicare's standards for access to medically necessary drugs and
convenient
 neighborhood pharmacies."

 For the stand-alone prescription drug plans, regional figures and
 spreadsheets accompany this release and can be found at www.cms.hhs.gov.
 Between 11 and 23 organizations will offer stand-alone prescription drug
 plans in each region of the country.

 People with Medicare will also have access to lower-cost coverage and
 additional coverage in Medicare Advantage plans. Many of the Medicare
 Advantage prescription drug plans will have additional benefits beyond the
 standard Medicare coverage and have monthly premiums that are
significantly
 less than $20 and CMS figures show that beneficiaries in Medicare
Advantage
 plans are already saving about $100 a month on average in out-of-pocket
 health care costs, compared to traditional Medicare alone or with an
 individual Medigap plan.

 CMS is now completing the review of the stand-alone prescription drug
plans
 and the drug plans to be offered by Medicare Advantage organizations. The
 final review is evaluating important factors such as whether the plans
meet
 the Medicare law's standards for access to drugs at pharmacies convenient
to
 their homes.  Consequently, the plans available may change somewhat
between
 now and the completion of the plan reviews.

 "We will not approve any drug plans until we are convinced that they can
 meet Medicare's standards for serving our beneficiaries, which means some
 plans may not be approved," Dr. McClellan said. "While it is important for
 us to complete our review and work with plans to make any refinements, we
do
 not expect these further refinements to substantially affect the major
 features of the plan choices announced today."

 CMS will provide more comprehensive details on the premiums, benefits, and
 other features of the prescription drug plans and Medicare Advantage plans
 available in each region as the plan review is completed, ahead of plan
 marketing in October. All beneficiaries can begin to enroll in the plan of
 their choice beginning November 15.

 CMS will help beneficiaries get the information they need to choose a
plan.
 "This fall, Medicare will work with counselors, advocates, health
 professionals, and other

 partners to assist seniors, people with a disability, and their family
 members in making their choice about these important benefit options,"
said
 Dr. McClellan.

 CMS will mail the Medicare & You handbook to more than 41 million
households
 by mid-October.  Around that time, beneficiaries will be able to get
 personalized information on plans that reflect their own needs and
 preferences through www.medicare.gov <http://www.medicare.gov,
 1-800-MEDICARE, or CMS partner organizations. Medicare officials are
already
 working with a wide range of groups to help deliver this information,
 including health professionals, senior advocates and many other partners
at
 the state and local level. Information and assistance will also be
available
 all across the nation through the State Health Insurance Assistance
 Programs, local Area Agencies on Aging, and many churches, senior centers,
 pharmacies and other centers where seniors and people with disabilities
 work, live, play and pray.


 ###

38

 The Ramp Rethought -- and Refined

 By Jeff Turrentine

  Access is everything, so the saying goes. No one understands this better
than seniors or the mobility impaired, for whom even the smallest flight of
steps up to a front door can prove an insurmountable obstacle.

 Switchback-like ramps of treated lumber are one practical way of addressing
the issue. But rarely are they built to harmonize with existing architecture
or landscaping.

 "Clients don't want to advertise their disability," says Carol Lopez,
director of architecture for the Paralyzed Veterans of America. "And of
course they don't want to make their house less desirable visually, which is
what happens when you tack on something that was never meant to be there.
They just want access to their homes."

 The better solution, say Lopez and her colleagues in the field of
accessibility planning known as universal design, lies in a combination of
regrading, landscaping, hardscaping and establishing new points of entry.

 The typical ramp, according to architect John P. S. Salmen of Universal
Designers & Consultants Inc. in Takoma Park, is "an indication of a mistake
on the part of a designer" who hasn't bothered to make sure that the grade
in front of a house slopes up to meet the entrance. The problem, he says, is
best addressed by bringing grade and entrance together as smoothly and
gracefully as possible -- not by building an obtrusive contraption that only
draws more attention to the underlying problem.

 Salmen's own Takoma Park house is an example of a supremely elegant
corrective. Though he and his wife currently experience no problems climbing
the nine steps up to their porch from their front yard, Salmen wanted "to
create a place that we could live in for the next 50 years," he says. "Also,
as a specialist in universal design, I have many friends who are mobility
impaired, and we wanted them to be able to come over and enjoy the house."

 While replacing the crumbling foundation of his bungalow, Salmen took the
opportunity to lower his basement floor by two feet, which not only gave him
extra headroom but also significantly decreased the grade from the house to
the sidewalk. Behind the white latticework at the basement level he has
added a wheelchair-accessible entrance that opens to the brick-paved
driveway, which is "just a gently sloped walk up to the entrance of the
building." Connecting the floors of the house is a small elevator, which
cost Salmen $25,000. Tiers, defined by a pair of stone retaining walls,
soften the abruptness of the cutoff from the front lawn down to the
driveway, which cost about $5,000 to re-excavate and lay.

 For a client in an inaccessible residence on the Eastern Shore, architect
Tom Davies of Paralyzed Veterans of America designed a porch with a walled
concrete pathway on one end that runs from the entrance to a driveway made
of broken oyster shells.

 "On the Eastern Shore, you need to have a certain amount of permeable
surface in order to get a building permit," says Lopez. "A lot of people do
gravel driveways. But for wheelchair users, gravel is a very difficult
surface." Oyster shells meet this permeability standard, she says, but the
sharp pieces interlock with one another as they're crushed to make for a
surface that actually gets smoother the more it's used. Lopez estimates that
the walled pathway cost about $3,000.

 Louis Tenenbaum, a universal design consultant based in Potomac, gave a
house in Fairfax County with a step-up entrance a new flagstone sidewalk
from which a second sidewalk splits off and curves up to the front door.
(Another fork leads to the driveway.) In the small gap between the two
sidewalks, the lawn has been regraded to maintain proper drainage and to
ensure that wheelchairs and walkers don't slip off the edge of the path. The
project, which was completed a few years ago, would cost about $15,000 in
2005 dollars, says Tenenbaum.

 A well-designed entrance, he says, can mean the difference between
engagement and seclusion. "If you want to go to the movies, or if you need
to go to the doctor, and [your entrance] makes that difficult, it has an
impact on your decision. In terms of visitability, it has an impact on who
you can invite to your home. It's your connection point to the world."

 Resources for Ramps

 Universal Designers &amp; Consultants Inc.: http://www.universaldesign.com/
.

 Paralyzed Veterans of America: http://www.pva.org/ .

 Center for Universal Design: http://www.design.ncsu.edu/cud/ .



 

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