Download click here to view - Marilyn Bruno, Ph.D., JD

THE BOOMER'S GUIDE TO PLANET
RETIREMENT
DR. MARILYN BRUNO
WWW.GYNOSAPIENS.COM
VOLUME 7 ISSUE 10
OCTOBER 2014
IN THIS ISSUE: Page 1: Diabetes in the News – Turn White Fat to Brown Fat
Page 2: Potential Diabetes Drug Target
Page 3: Hormone Treatment for Diabetes
Page 3: The Brain in the News – Brain Atlas
Page 4: Anti-Aging Gene Enhances Cognition
Page 4: The Human Proteome
Page 5: Receptor involved in Brian Disorders
Page 5: Brain Injury
Page 6: Medical Technology
Page 9: Powering our Bionics
Page 9: Robot is Touchy-Feely
Page 10: Medicare Update: Coordinating Healthcare, Needymeds Update
Page 14: Save the Date – 11/12 – Comet Landing
QUOTE OF THE MONTH:
“What lies behind us and what lies before us are tiny matters compared to what lies within us.” Ralph Waldo Emerson
DIABETES IN THE NEWS
Turn White Fat to Brown Fat!
Who knew? We have several types of fat! I thought it was all blubber, but it turns out that white fat stores extra
energy. Too much white fat, a characteristic of obesity, increases the risk of type 2 diabetes and other diseases. Brown
fat, in contrast, burns chemical energy to create heat and help maintain body temperature. Researchers have previously
shown that, in response to cold, white fat cells in both animals and humans take on characteristics of brown fat cells. So
keeping cool will help stave off obesity!
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Here’s what researchers found at Virginia Commonwealth University and the Garvan Institute of Medical Research in
Australia. They explored the effects of ambient temperature on brown fat and metabolism. The researchers had 5
healthy men, average age 21 years, reside for 4 months in a clinical research unit in the NIH Clinical Center in Bethesda,
Maryland. The men engaged in regular activities during the day and then returned to their private room each evening.
The temperature of the room was set to 24 °C (75 °F) during the first month, 19 °C (66 °F) the second month, 24 °C again
for the third month, and 27 °C (81 °F) the remaining month.
The participants were exposed to the temperature for at least 10 hours each night. They wore standard hospital clothing
and had bed sheets only. All meals were provided, with calorie and nutrient content carefully controlled and all
consumption monitored. At the end of each month, the men underwent extensive evaluations, including energy
expenditure testing, muscle and fat biopsies, and PET/CT scanning of an area of the neck and upper back region to
measure brown fat volume and activity.
After a month of exposure to mild cold, the participants had a 42% increase in brown fat volume and a 10% increase in
fat metabolic activity. These alterations returned to near baseline during the following month of neutral temperature,
and then were completely reversed during the final month of warm exposure. All the changes occurred independently of
seasonal changes. The increase in brown fat following a month of cold exposure was accompanied by improved insulin
sensitivity after a meal during which volunteers were exposed to mild cold. Prolonged exposure to mild cold also
resulted in significant changes in metabolic hormones such as leptin and adiponectin. There were no changes in body
composition or calorie intake.
The findings suggest that humans may acclimate to cool temperature by increasing brown fat, which in turn may lead to
improvements in glucose metabolism. These changes can be dampened or reversed following exposure to warmer
temperatures. For more info: http://www.nih.gov/researchmatters/july2014/07282014fat.htm
Potential Diabetes Drug Target
Researchers have determined and analyzed the structure of the human glucagon receptor. The findings may aid in the
development of drugs for type 1 and type 2 diabetes and other metabolic disorders. When blood glucose levels rise,
such as after a meal, your pancreas releases the hormone insulin. This stimulates muscle, fat and liver cells to take up
glucose from your blood. Conversely, when blood glucose levels drop, such as after an overnight fast, the pancreas
releases the hormone glucagon, which stimulates liver and muscle cells to release glucose into the bloodstream. In
healthy people, blood glucose levels are maintained within a tight range through these and other mechanisms.
People with diabetes, though, have difficulty using glucose, and their blood glucose can rise to dangerous levels.
Medications such as insulin and glucagon can help maintain blood glucose in a safe range. Glucagon works by binding to
a G-protein coupled receptor (GPCR). GPCRs span cell membranes and relay signals from the outside in. Once activated
by the binding of a substance, the receptor triggers a cascade of responses inside the cell. These receptors help control
many essential cell functions and so are an important target for drugs.
GPCRs are subdivided into classes A, B and C. The structures of several class A receptors have already been uncovered.
However, the structures of class B receptors, including the glucagon receptor, have largely remained unsolved because
of technical difficulties. Now, an international team led by Scripps Research Institute set out to determine the structure
of the glucagon receptor. The scientists, who have extensive experience working with receptors, used a “fusion protein”
to painstakingly create crystals of the glucagon receptor so that the structure could be determined by X-ray
crystallography. In addition, they altered more than 100 different amino acids in the receptor protein to better
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understand what parts of the receptor help bind the hormone. They then built a structural model of the receptor with
glucagon bound to it in order to predict how the hormone and receptor interact.
Their work revealed that, typical of GPCRs, the receptor has 7 membrane-spanning sections. It differs from class A
GPCRs in that it has a wider and deeper pocket for glucagon to bind. It also has a “stalk” region that extends outward
from the cell membrane. The researchers believe this stalk helps the receptor capture the hormone and position it to fit
snugly into the receptor’s main binding pocket. The team is now working to determine the exact structure of the
receptor when glucagon is bound to it. For more info: Nature. 2013 Jul 25;499(7459):444-9. doi: 10.1038/nature12393.
Epub 2013 Jul 17. PMID: 23863937.
Hormone Treatment for Diabetes
A hormone called betatrophin prompts cells in the pancreas to multiply and produce more insulin. The finding, in mice,
may lead to new ways to prevent or slow the progression of diabetes. Previous studies found that, when insulin
signaling is blocked in tissues such as the liver, beta cells multiply and increase insulin secretion. Insulin-secreting beta
cells comprise just 1% of a normal pancreas and normally divide very slowly. Harvard researchers reasoned that, while
the causes for type 1 and type 2 diabetes differ, treatments that encourage beta cells to multiply could benefit patients
with both types of diabetes. The researchers therefore used a molecule that binds the insulin receptor to interfere with
insulin signaling.
The scientists confirmed that blocking the insulin receptor caused insulin resistance and stimulated beta cell
proliferation in mice. When they analyzed gene expression, they identified a gene that was up-regulated after the
treatment by about 4-fold in liver and 3-fold in white fat. The gene produces a protein that the scientists dubbed
betatrophin. The gene for an equivalent human protein is very similar. While betatrophin is expressed in the liver and
fat of mice, in people it’s primarily expressed in the liver. The hormone is secreted into the bloodstream to signal beta
cells in the pancreas to reproduce.
The researchers now aim to make betatrophin protein and test it directly by injection. They are working with 2 biotech
and pharmaceutical companies to move the newly discovered hormone toward the clinic. So, instead of taking insulin
injections 3 times a day, you might take an injection of this hormone once a week or once a month, or in the best case
maybe even once a year. For more info: http://www.nih.gov/researchmatters/september2008/09082008insulin.htm
THE BRAIN IN THE NEWS
Brain Atlas
A few months ago, scientists released the first comprehensive 3-D “Brain Scan Atlas” of gene expression in the
developing human brain. The resource is expected to help reveal the early roots of brain-based disorders such as autism
and schizophrenia – and hopefully Alzheimer’s for us Boomers.
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The structure and function of the human brain’s neocortex, the outermost brain region, allows for higher functions such
as action and thought. Its development is guided by gene expression patterns during prenatal development. Many
psychiatric disorders show altered gene activity in the cortex, suggesting harmful changes during development of this
region. However, our understanding of the transcriptome—when and where genes are turned on—in the developing
brain has been limited because extensive animal studies could not be done on the neocortex, which is smooth in rodents
but is elaborately folded in humans and non-human primates. The new Brain Scan Atlas provides a powerful map to pin
brain areas to genes tied to neurodevelopmental disorders and human-specific brain functions. For more info:
http://www.nih.gov/researchmatters/april2014/04072014brain.htm
Anti-aging gene enhances cognition
More good news. The gene KLOTHO is named for a Greek mythological goddess of Fate. A variant of the gene
KLOTHO is known for its anti-aging effects in people fortunate enough to carry one copy. Previous studies
found that increased levels of the KLOTHO protein can extend lifespan, whereas disruption of KLOTHO can
speed up aging. Now researchers also found benefits in brain function by increasing overall levels of KLOTHO
in the bloodstream and brain.
And, the improvements in learning and memory associated with KLOTHO elevation aren’t strictly tied to aging.
They also occur in young animal models (mice), according to a report published in Cell Reports on May 8th.
That means KLOTHO works to enhance brain power. Researchers from the Gladstone Institute and the
University of California, San Francisco examined over 700 people aged 58-72, divided in three separate groups
for aging studies of various kinds. Their analysis showed that people with one of the life-extending variants of
the KLOTHO gene scored better on cognitive tests. Researchers then turned to genetically engineered mice
that expressed higher-than-normal levels of the life-extending substance and found that KLOTHO doubled
their capacity for cognitive tests – such as remembering where a hidden platform was located in a water
maze. Elevating KLOTHO in mice also enhanced the formation and flexibility of neural connections, the cellular
basis for learning and memory.
In other words, KLOTHO appears to work in a manner independent of aging and may increase cognitive
reserve at different life stages. The researchers say that in healthy, aging humans the positive cognitive
effects of carrying one copy of the KLOTHO variant may even exceed the harmful effect of carrying the
notorious ε4 variant of the APOE gene, best known for its contributions to Alzheimer’s disease. For more info:
http://www.nih.gov/researchmatters/may2014/05192014brain.htm
The Human Proteome
In 2003, the Human Genome Project created a draft map of the human genome—all the genes in the human body.
Genomics has since driven many advances in medical science since genes control the most basic functions of the cell,
including what proteins to make and when.
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Now researchers have identified more than 20,000 protein-coding genes and found that the relationship between genes
and proteins isn’t a simple matter of one gene coding for one protein. Stretches of DNA can be read and translated into
proteins in different ways. Proteins are also more difficult to sequence than genes.
Researchers from Johns Hopkins U. and the Institute of Bioinformatics in Bangalore, India used an advanced form of
mass spectrometry to sequence proteins and create a draft map of the human proteome. The resulting draft human
proteome map includes proteins encoded by more than 17,000 genes—about 84% of the 2,350 total known proteincoding genes, including included histones, ribosomal proteins, metabolic enzymes, and cytoskeletal proteins.
This is an important first step because protein mess-ups play a big role in many human diseases. For more info:
http://www.nih.gov/researchmatters/june2014/06092014proteome.htm
Receptor Involved in Brain Disorders
Another breakthrough: scientists determined the structure of the intact NMDA receptor, a key protein structure that
creates a gate to open and close an ion channel involved in many brain-related illnesses including Alzheimer’s disease,
depression, schizophrenia, and autism. The finding may aid in the development of future therapies.
The NMDA receptor is a surprisingly massive multi-subunit complex that looks like a hot air balloon. The upper, balloonlike portion is found outside the cell and responds to chemical messengers. The lower portion, the basket of the hot air
balloon, is embedded in the cell membrane. This forms a gated channel, allowing ions—such as calcium—to enter the
nerve cell. The scientists further examined how the subunits fit together, and where molecules bind to trigger the
channel to open or close. They compared the structure to those of similar types of ion channel receptors to better
understand its function and regulation.
Activation of the NMDA receptor is thought to play a role in learning and memory. Too much or too little activation of
the NMDA receptor channel has also been linked to several neurological and psychiatric disorders. For more info:
http://www.nih.gov/researchmatters/june2014/06092014receptor.htm
Brain Injury
Nationwide, at least 1.7 million traumatic brain injuries occur each year, according to the U.S. Centers for Disease
Control and Prevention (CDC). About 75% of these are concussions or other mild forms of traumatic brain injury.
Concussions are seldom life-threatening, but they can have serious and lasting effects. The specific damage that occurs
in affected brain tissue is poorly understood. Researchers at NIH’s National Institute of Neurological Disorders and
Stroke (NINDS) examined the tissue and cellular responses in the brain after a concussion and initial CT scans didn’t
reveal physical damage to brain tissue. But, using a contrast agent and MRI, they observed fluid leaking into the
meninges, the outer covering of the brain, in 49% of 142 patients with concussion.
So, to more closely examine this type of injury, the researchers developed a new, closed-skull model of brain trauma in
mice. The model mirrors the effects seen in humans with mild traumatic brain injury. Laser scanning microscopy can
safely be used in the mice to visualize brain tissue just beneath the skull surface. The scientists initially saw cell death in
the meninges and at the glial limitans (a thin barrier at the surface of the brain) in the mice. Cell death in the underlying
brain tissue (the parenchyma) didn’t occur until 9-12 hours after injury. Within an hour of head injury, the researchers
observed parts of microglia (immune cells that act as first responders in the brain) extending toward the glial limitans
and forming a stable network resembling a honeycomb. Other microglia took forms resembling jellyfish and moved up
to the brain surface to repair damage. These reactions, which have never been seen before in living brains, help to
secure the brain’s protective barrier. Previous studies suggested that immune responses in the brain can lead to
damage. These findings show that they’re actually beneficial during the first 9-12 hours after a mild traumatic brain
injury.
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The researchers observed high levels of reactive oxygen species—a type of molecule that damages cells—at the trauma
site right after brain injury. To assess whether a local treatment could counteract these effects, the scientists first
determined whether the intact skull bone was porous enough to allow small molecules to pass through. They found
that it was, and then tested an antioxidant that reduces levels of a reactive oxygen species called Glutathione, which
reduced the amount of cell death by 67% when applied to the skull surface 15 minutes after brain injury and by 51%
when applied 3 hours after injury.
The bottom line is that there is a short window to treat brain injuries, and research is under way to administer
Glutathione effectively under the human skull. For more info:
http://www.nih.gov/researchmatters/december2013/12162013brain.htm
MEDICAL TECHNOLOGY
3-D Device Detoxifies Blood
I saw a similar 3-D printer in action at a recent technology event. This is a real Wow:
Researchers developed a liver-inspired 3-D device made of hydrogel and nanoparticles that can remove toxins from
blood. Designed for use outside the body, the device provides a proof-of-concept model for new detoxification
techniques. Toxins from animal bites and stings or from bacterial infections can damage cells, leading to pain and
illness. Conventional treatments, such as antisera, may not completely neutralize the toxins.
Scientists have previously developed nanoparticles that can bind certain types of toxins and neutralize them.
Nanoparticles, however, can’t be given directly to patients because the particles may accumulate in the liver, creating an
additional health risk. Researchers from the University of California, San Diego made nanoparticles that change color
when binding to toxins.
The group used 3-D printing to create a hexagonal pattern with a large surface area (mimicking the hexagonal
organization of a liver lobule) that could capture and remove blood melittin from a solution. To further test the ability of
the scaffold to remove toxins, the scientists mixed red blood cells with melittin treated with the detoxification device.
The device neutralized the toxin by capturing and separating it from the cells.
For more info: http://www.nih.gov/researchmatters/june2014/06022014nanoparticle.htm
iPod Diabetes Monitoring
Prominent U.S. hospitals are preparing to launch trials with diabetics and chronic disease patients using Apple
Inc's “HealthKit,” offering a glimpse of how the iPhone maker's ambitious take on healthcare will work in
practice.
HealthKit, which is still under development, is the center of a new healthcare system by Apple. Regulated
medical devices, such as glucose monitors with accompanying iPhone apps, can send information to HealthKit.
With a patient's consent, Apple's service gathers data from various health apps so that it can be viewed by
doctors in one place.
Stanford University Hospital doctors said they are working with Apple to let physicians track blood sugar levels
for children with diabetes. Duke University is developing a pilot to track blood pressure, weight and other
measurements for patients with cancer or heart disease.
The goal is to improve the accuracy and speed of reporting data, which often is done by phone and fax now.
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Potentially doctors would be able to warn patients of an impending problem. The pilot programs will be rolled
out in the coming weeks.
Apple last week mentioned the trials in a news release announcing the latest version of its operating system for
phones and tablets, iOS 8, but this is the first time any details have been made public. Apple aims eventually to
work with health care providers across the United States, including hospitals which are experimenting with
using technology to improve preventative care to lower healthcare cost and make patients healthier.
HealthKit makes a critical link between measuring devices, including those used at home by patients, and
medical information services relied on by doctors, such as Epic Systems Corp, a partner already announced by
Apple. Medical device makers are taking part in trials at Stanford and Duke.
DexCom Inc, which makes blood sugar monitoring equipment, is in talks with Apple, Stanford, and the U.S.
Food and Drug Administration about integrating with HealthKit. DexCom's device measures glucose levels
through a tiny sensor inserted under the skin of the abdomen. That data is transmitted every five minutes to a
hand-held receiver, which works with a blood glucose meter. The glucose measuring system then sends the
information to DexCom's mobile app, on an iPhone, for instance. Data can be uploaded from HealthKit into
Epic's "MyChart" application, where it can be viewed by clinicians in Epic's electronic health record.
PRIVACY ISSUES
We are being hacked right and left. While HealthKit promises to enhance the process of data-sharing between
physicians and those under their care, observers have noted the potential for sensitive data to be abused.
To ensure patient privacy, Apple is considering creating a "HealthKit Certification" for third party developers,
with conditions stipulating how data must be stored securely on devices and forbidding sale of data to
advertisers, according to people familiar with Apple's plans. Apple recently updated its developer guidelines
with data sharing rules for health apps.
The point is that this sort of technology is in all or our futures. Let’s keep on top of what downsides these
marvels can entail – and buy a premium subscription to LifeLock! For more info:
http://in.reuters.com/article/2014/09/15/apple-healthkit-idINKBN0HA0ZR20140915
Wearable cardiac monitor
Medtronic ($MDT) launched a wireless, adhesive heart monitor that it acquired when it bought startup Corventis in
June reportedly for more than $150 million. The Seeq Mobile Cardiac Telemetry System, its wearable sensor has a
depth of about 0.6 inches. It's water resistant and designed to be worn continuously while exercising, showering or
sleeping, and can be worn up to 30 days to detect and diagnose the cause of irregular heartbeats. But the device
remains a second-line tool behind the bulky Holter monitor.
In addition to the Seeq sensor, it includes a handheld transmitter that sends data to the Medtronic Monitoring
Center via Bluetooth technology, which is staffed around the clock by cardiographic technicians to analyze the data.
The system also includes a trigger button the patient can push to send data during a particular event.
Medtronic said the system is indicated for patients who have experienced symptoms that suggest an irregular
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heartbeat such as fainting, lightheadedness, vertigo, palpitations or shortness of breath and whose symptoms were
not detected by a 24-hour Holter monitor. A standard Holter monitor is much more burdensome for the patient, as
it is equipped with a variety of electrodes and monitors.
Earlier this year, Medtronic also launched its Linq Insertable Cardiac Monitoring System, which can continuously
monitor patients for up to three years. This implantable monitor is designed for patients with less frequent episodes
less likely to be detected by short-term monitoring. For more, here is the press release:
http://www.fiercemedicaldevices.com/press-releases/medtronic-launches-seeqtm-wearable-cardiac-monitoringsystem-united-states?utm_medium=nl&utm_source=internal
Intel wearable devices
Intel is introducing several new products and projects focused on wearables that we can all start using:
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Jarvis, a headset that can automatically integrate with a personal assistant app like Siri on a phone without
touching it.
A smartwatch with “geo-fencing” to monitor the person who’s wearing it. For example: in case of an emergency
and a person steps out of the geo-fence, the watch can send out an alert.
Wearable reference devices to accelerate wearable-device innovation, including smart earbuds that provide
biometric and fitness capabilities, and a smart wireless charging bowl.
Collaborations with Barneys New York, the Council of Fashion Designers of America and Opening Ceremony to
explore and bring to market new smart wearable technologies, and to increase dialogue and cooperation
between the fashion and technology industries.
Intel also introduced Intel Edison, a new Intel Quark technology-based computer housed in an SD card form factor with
built-in wireless capabilities and support for multiple operating systems. Intel says it will “enable rapid innovation and
product development by a range of inventors, entrepreneurs and consumer product designers when available this
summer.”
TECHNOLOGY FOR DOCTORS
Smart Glasses
Ouch! Ever had a nurse stick you several times, trying to locate a vein for drawing blood? This happens to my Auntie
Irma all the time. But help is on the way: the new Eyes-On “smart glasses” from Evena Medical now allow nurses to see
through a patient’s skin to the vasculature beneath.
The device adds multi-spectral 3D imaging to Epson Moverio glasses. Nurses can use Eyes-On to interface with hospital
electronic medical records systems share images remotely via Bluetooth, WiFi, and 3G wireless, using a belt-mounted
computer and battery pack. It can also record photos or videos of the imagery and save them on its onboard storage for
playback. Embedded speakers also allow for audio conferencing.
OK, Siri. Find a vein.
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Naturally, Google thinks that Google Glass is a better technology than a battery pack and computer, not to mention its
ability to perform other diagnostic tasks, such as AR overlay of patient records and remote videoconferencing via smart
phone.
POWERING OUR BIONICS
Investors – be aware of new breakthroughs!
Let your fingers do the charging! A simple tap from your finger may be enough to charge your portable device, thanks to
a discovery by Australian National University researchers, using “piezoelectric thin films.” The technology could allow for
an iPad that recharges every time you press the screen, or a pacemaker powered by your own blood pressure.
For more info: Madhu Bhaskaran, et al., Energy Materials: Nanoscale Characterization of Energy Generation from
Piezoelectric Thin Films, Advanced Functional Materials, first published online: June 16, 2011, [DOI:
10.1002/adfm.20119004112/2011]
ROBOT IS TOUCHY-FEELY
Researchers at the University of Southern California‘s Viterbi School of Engineering have developed a BioTac, a robot
appendage that can outperform humans in identifying a wide range of natural materials according to their textures,
paving the way for advancements in prostheses, personal assistive robots, and consumer product testing. BioTac sensor
is new type of tactile sensor built to mimic the human fingertip, using a newly designed algorithm to make decisions
about how to explore the outside world by imitating human strategies. Capable of other human sensations, the sensor
can also tell where and in which direction forces are applied to the fingertip and even the thermal properties of an
object being touched.
Like the human finger, the BioTac sensor has a soft, flexible skin over a liquid filling. The skin even has fingerprints on its
surface, greatly enhancing its sensitivity to vibration. As the finger slides over a textured surface, the skin vibrates in
characteristic ways. These vibrations are detected by a hydrophone inside the bone-like core of the finger. The human
finger uses similar vibrations to identify textures, but the robot finger is even more sensitive. The specialized robot was
trained on 117 common materials gathered from fabric, stationery and hardware stores. When confronted with one
material at random, the robot could correctly identify the material 95% of the time, after intelligently selecting and
making an average of five exploratory movements. It was only rarely confused by pairs of similar textures that human
subjects making their own exploratory movements could not distinguish at all.
The researchers say this robot touch technology could be used in human prostheses or to assist companies who employ
experts to assess the feel of consumer products and even human skin.
SynTouch LLC, which develops and manufactures tactile sensors for mechatronic systems that mimic the human hand,
was founded in 2008 by researchers from USC’s Medical Device Development Facility, the start-up is now selling their
BioTac sensors to other researchers and manufacturers of industrial robots and prosthetic hands. Original funding for
development of the sensor was provided by the Keck Futures Initiative of the National Academy of Sciences to develop a
better prosthetic hand for amputees. SynTouch also received a grant from the National Institutes of Health to integrate
BioTac sensors with such prostheses. The texture discrimination project was funded by the U.S. Defense Advanced
Research Projects Agency (DARPA) and the material hardness study by the National Science Foundation.
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For more info: http://www.kurzweilai.net/tactile-sensor-for-better-human-prostheses-personal-assistiverobots?utm_source=KurzweilAI+Weekly+Newsletter&utm_campaign=4241c89872-UA-946742-1&utm_medium=email
MEDICARE UPDATE
COORDINATING HEALTHCARE
Medicare doesn't automatically know if you have other insurance or coverage. Medicare uses your answers on
the "Initial Enrollment Questionnaire" (IEQ) to help set up your file and make sure your claims are paid
correctly. This questionnaire asks if you have group health plan coverage through your work or a family
member's work.
If your health insurance or coverage changes after you originally filled out the IEQ, call the Benefits
Coordination & Recovery Center (BCRC) at 1-855-798-2627. TTY users should call 1-855-797-2627. Tell your
doctor and other health care provider about changes in your insurance or coverage when you get care.
Keep the number of the BCRC handy in case you run into questions regarding the rules of coordinated
coverage. Here are some rules of thumb:
The group health plan pays first:
--If your coverage is based on your current employment (or the current employment of a spouse of any age),
and your employer has 20 or more employees. If the group health plan didn't pay all of your bill, the doctor or
health care provider should send the bill to Medicare for secondary payment. Medicare will look at what your
group health plan paid, and pay any additional costs up to the Medicare-approved amount. You'll have to pay
whatever costs Medicare or the group health plan doesn't cover. Generally, employers with 20 or more
employees must offer current employees 65 and older the same health benefits, under the same conditions,
that they offer younger employees. If the employer offers coverage to spouses, they must offer the same
coverage to spouses 65 and older that they offer to spouses under 65.
--If your or your spouse’s employer has at least 100 employees and you are part of their large group health
plan.
-- If you or your spouse’s employer has fewer than 100 employees but has joined with other employers to
form a multi-employer plan. If at least one employer in the multi-employer plan has 100 employees or more,
Medicare pays second.
--If a domestic partner is entitled to Medicare on the basis of disability and is covered by a large group health
plan on the basis of his/her own current employment status or the status of a family member (a domestic
partner is considered a family member).
--If a domestic partner is eligible for Medicare on the basis of End-Stage Renal Disease (ESRD) and is covered
by a group health plan on any basis, the plan covers first for a 30-month coordination period.
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--If a domestic partner is entitled to Medicare on the basis of age and has group health plan coverage on the
basis of his/her own current employment status.
--If you retire but your spouse is still working, and you're covered by your spouse’s group health plan coverage
(and your spouse’s employer has 20 or more employees), your spouse’s coverage pays first and Medicare pays
second.
--If you have COBRA continuation coverage and have Medicare based on End-Stage Renal Disease (ESRD),
COBRA pays first to the extent COBRA coverage overlaps the first 30 months of Medicare eligibility or
entitlement based on ESRD.
--If you have TRICARE and get services from a military hospital or any other federal health care provider,
TRICARE will pay the bills. Medicare usually doesn't pay for services you get from a federal health care
provider or other federal agency.
--If you have no-fault insurance or liability insurance, the insurance pays first. If the no-fault or liability
insurance denies the medical bill or is found not liable for payment, Medicare pays the same as it would if it
were the only payer. However, Medicare only pays for Medicare-covered services; you're responsible for your
share of the bill—for example, coinsurance, a copayment or a deductible—and for services Medicare doesn't
cover. If doctors or other providers are told you have a no-fault or liability insurance claim, they must try to
get payments from the insurance company before billing Medicare. However, if the insurance company
doesn't pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare.
Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary
payer should have made. If Medicare makes a conditional payment, and you get a settlement from an
insurance company later, it is your responsibility to repay the conditional payment from your settlement to go
to Medicare. If you have an insurance claim for your medical expenses, you or your attorney should notify
Medicare as soon as possible. If you have questions about a no-fault or liability insurance claim, call the
insurance company and Medicare’s Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627. TTY
users should call 1-855-797-2627. The BCRC will work on your case, using the information you or your
representative gives it to see that Medicare gets repaid for the conditional payments.
Medicare pays first:
--If you get your group health plan coverage through your former employer. If the group health plan didn't
pay all of your bill, the doctor or health care provider should send the bill to Medicare for secondary payment.
Medicare will look at what your group health plan paid, and pay any additional costs up to the Medicareapproved amount. You'll have to pay whatever costs Medicare or the group health plan doesn't cover.
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--If you're under 65 and have Medicare because of a disability.
--If your current employer has fewer than 100 employees.
--If you work for a small company (fewer than 20 employees) that has a group health plan, even if it has joined
with other employers or employee organizations (like unions) to sponsor a group health plan (called a multiemployer plan), as long as none of the other employers have 20 or more employees.
--If a domestic partner is entitled to Medicare on the basis of age and has group health plan coverage based
on his/her current employment status.
--If you don’t take group health plan coverage from your employer, unless you have coverage through an
employed spouse, and your spouse’s employer has at least 20 employees.
--If you or your spouse are retired and have COBRA continuation coverage, the same rules for groups apply.
--If you have TRICARE, Medicare pays first for Medicare-covered services. TRICARE will pay the Medicare
deductible and coinsurance amounts and for any service not covered by Medicare that TRICARE covers. You
pay the costs of services Medicare or TRICARE doesn't cover.
--If you are enrolled in the Federal Black Lung Program, Medicare will pay for all health care not related to
black lung disease. You should send your bills directly to Medicare. Medicare won't pay for doctor or hospital
services covered under the Federal Black Lung Program. Your doctor or other health care provider should
send all bills for the diagnosis or treatment of black lung disease to: Federal Black Lung Program, P.O. Box
8302, London, KY 40742-8302; 1-800-638-7072. If the Federal Black Lung Program won't pay your bill, ask
your doctor or other health care provider to send Medicare the bill. Ask them to include a copy of the letter
from the Federal Black Lung Program that says why it won’t pay your bill.
Neither may pay:
--If you go outside your employer plan's network or Medicare. Call your employer plan before you go outside
the network to find out if the service will be covered.
--If you don't take employer coverage when it's first offered to you, you might not get another chance to sign
up. If you take the coverage but drop it later, you may not be able to get it back. Also, you might be denied
coverage if your employer or your spouse's employer generally offers retiree coverage but you weren't
enrolled in the plan while you or your spouse was still working. Call your employer's benefits administrator for
more information.
--If you have Medicare and more than one other type of insurance, check your policy or coverage—it may
include the rules about who pays first.
--If you have or can get both Medicare and Veterans' benefits, you can get treatment under either program,
but you must choose which benefits to use each time you see a doctor or get health care. Medicare can't pay
for the same service that was covered by Veterans' benefits, and your Veterans' benefits can't pay for the
same service that was covered by Medicare. To get the VA to pay for services, you must go to a VA facility or
have the VA authorize services in a non-VA facility. Check with the Department of Veterans Affairs. If the VA
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authorizes services in a non-VA hospital, but doesn't pay for all of the services you get during your hospital
stay, then Medicare may pay for the Medicare-covered part of the services the VA doesn't pay for. Medicare
may also be able to pay all or part of your copayment if you're billed for VA-authorized care by a doctor or
hospital who isn't part of the VA.
Still confused? Who can blame you! Remember that you can always contact a certified Medicare counselor to
help you! Find one in your zip code by going to: https://shipnpr.shiptalk.org/findcounselor.aspx to find a
Medicare-certified State Health Insurance Program counselor near you. (S.H.I.P. is called SHINE in Florida;
ICAP in California.)
NEEDYMEDS
Needymeds is funded by Pharma companies. The new Generic Assistance Program (GAP) is designed to help
people unable to afford certain more expensive generic medications. In a collaboration with Rx Outreach, the
largest non-profit pharmacy in the country, NeedyMeds has launched this first-of-its-kind medication
assistance program to provide generic medication at no cost to those who qualify.
The program uses a voucher system and supplies medication for up to one year. Applicants must apply to
enroll in the program and reapply annually. Once accepted, coverage is guaranteed for the accepted
prescription for one year. GAP will offer nearly 20 generic medications at no cost to people who meet
program eligibility requirements. The guidelines are:

Must have no prescription coverage for needed medication

At or below 100% Federal Poverty Level (e.g., a single people whose income is at or under $11,670 per
year. For all rates, see: http://aspe.hhs.gov/poverty/14poverty.cfm)

Must be a U.S. citizen, legal entrant, or have a work visa
To apply:
http://www.needymeds.org/gap.htm?utm_source=September+2014+PAN&utm_campaign=Sept+2014+PAN&
utm_medium=email. Or, contact Needymeds at 800-503-6897
Save the Date – 11/12: COMET LANDING
I guess our taxpayers’ money is going for something that may save our planet some day! NASA is landing a probe
on a comet that is heading our way on November 12 – possibly to determine whether the comet is ice or rock, and
to get data as to whether it (or a comet like it) can be blown up before reaching our atmosphere. Below is a photo of
the landing site:
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https://pbs.twimg.com/media/ByfieW6CYAA0vdG.png:medium
Please let me know how topics you would like covered in our next
Newsletters! E-mail:[email protected].
All previous Newsletters are posted online on the homepage of
www.gynosapiens.com
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