Unlike the experience of the general public who access state or federal health care exchanges to choose coverage, the choices offered to Members of Congress are dramatically different than those from many other parts of the nation. For 2017, Members had 57 plan options in "Gold" plans alone on the DC shop exchange. In many areas of the nation, particularly rural ones, Gold plans aren't even available. Unlike the Silver and Bronze level plans, Gold plans have lower deductibles, and cover 80% of costs with patients paying only 20%. Silver plans, for example, typically come with deductibles ranging from ,500 - ,000, and pay 70% of costs while patients pay the other 30%. And in some areas of the country, people are happy if they have a choice of more than six silver plans. Certain parts of the country have only one. .The drugs that would be affected by any Trump action are among the costliest taken by Americans. They include innovative therapies for cancer, immune disease and other disorders. The industry says that Part B pharmaceutical spending makes up just 3% of overall Medicare costs. .Low-income seniors and disabled adults who qualify for benefits under both Medicare and Medicaid frequently have multiple chronic health problems, and more than half have cognitive or mental impairments. More than half of dual eligibles also have annual incomes of less than ,000, and are more likely to receive nursing .But TSCL's polls, surveys, and stories on the COLA in the media have played a key role in helping to change that debate from one in which benefit cuts are inevitable, to one which explains why benefits should be made more adequate and payroll taxes should be increased. We could not have accomplished this without the hundreds of you who take time to send in your comments and stories, and who take our annual Senior Surveys. .Medicare's Fall Open Enrollment Period started on October 15th and will run through December 7th. For the past 14 years, I have volunteered to help neighbors and friends learn about changes in their current Part D prescription drug or Medicare Advantage coverage during this period. We compare options, track down the lowest costing plans and pharmacies, and often switch to a lower-costing plan when there's a better deal. .One is that vaccines for the flu and pneumonia may be protective because the two diseases they are designed to prevent are known to affect the brain. Another possibility involves evidence linking Alzheimer's to a general weakening in the immune system and to changes that allow more bacteria and viruses into the brain. .The Centers for Medicare and Medicaid Services (CMS) has estimated that it improperly paid .1 billion to Medicare Advantage plans in 2013 alone. Yet the plans are rarely forced to repay the money they have overcharged, or face closer government scrutiny after the audits, according to the Government Accountability Office (GAO). The GAO report said that CMS has failed to target health plans with "known improper payment risk", allowing the worst abusers to avoid scrutiny. ."If you want to save money on health and prescription drug plans, it's more important than ever to compare and switch now during the fall Medicare Open Enrollment period which ends December 7th," Cates says. Free, unbiased, one – on – one counseling is available through State Health Insurance Assistance Programs (SHIP), many of which operate through local agencies on aging. .Indeed, the Social Security Administration does not "promise" a specific amount of benefits, but they do not promise to replace a specific percentage of pre-retirement earnings either. Both benefit amounts and "replacement rates" can change at any time if Congress and the Social Security Administration deem it necessary. Prior to the 1977 changes, the replacement rate was not a stable percentage. For people who retired under the 1972-73 flawed formula (those born 1913 through 1916), replacement rates grew from 39% to a high of 54%. The new benefit formula led to a lower, more stable replacement rate of about 43%, as well as lower benefits.