Could advances in medicine and technology allow us to live longer — a lot longer? Decades, perhaps centuries? Eve Herold, former director of the Office of Communications and Public Affairs at the American Psychiatric Association, investigates the medical technologies that could extend the human lifespan for hundreds of years in Beyond Human: How Cutting Edge Science is Extending Our Lives. She also looks at the practical and ethical issues which could arise when this technology becomes available.

Photo by Flickr user Rosie O’Beirne.

Low-income Californians who are elderly and disabled were less likely to go to the emergency room or be hospitalized after their in-home caregivers participated in an intensive training program, according to a report.

Under a pilot program, nearly 6,000 aides in Los Angeles, San Bernardino and Contra Costa counties were trained in CPR and first aid, as well infection control, medications, chronic diseases and other areas. All were workers of the In-Home Supportive Services program, who are paid by the state to care for low-income seniors and people with disabilities, many of them relatives.

Researchers at the University of California, San Francisco based their analysis on the results in Contra Costa County, which they said produced the most complete and reliable data.

UCSF professor emeritus Bob Newcomer said they compared insurance claims on 136 at-risk elderly and disabled residents whose caregivers were trained with the claims from more than 2,000 similar residents whose caregivers did not receive the training. Though the sample was small, Newcomer said he was encouraged by the findings.

“Training shows a lot of promise,” he said.

The rate of repeated emergency room visits declined by 24 percent, on average, in the first year after caregivers were trained and 41 percent in the second year, according to the UCSF analysis.

The  demand for in-home caregivers is rising nationwide as the population ages and people develop dementia or live longer with chronic diseases. Caregivers typically help elderly and disabled people with bathing, dressing, eating and getting to medical appointments. The work is largely unpaid and done by family members, but some states pay caregivers for eligible low-income residents through their Medicaid programs.

There are currently no federal training requirements for in-home caregivers, even if they are paid with taxpayer dollars. Around the country, however, training programs have been developed and tested, according to the Paraprofessional Healthcare Institute, an advocacy group that also provides training. Among the states that have tried different types of instruction are Massachusetts, North Carolina and Michigan.

California’s In-Home Supportive Services program pays caregivers to help about half a million elderly and disabled people stay in their homes rather than be placed in institutions. To qualify for the care, seniors must be eligible for Medi-Cal, be 65 or older, and be blind or disabled.

The caregivers in all three counties, 44 percent of whom did not have a high school education, voluntarily attended about 60 hours of classes and completed 13 hours of related work at home. The people they cared for also took part in some of the classes, which were conducted in several languages.

Caregivers who were trained told researchers they felt better equipped to do their jobs and communicate with clients and their doctors, according to the report.

One of the caregivers, Andrew O’Bryan, said he was especially happy to learn CPR in case his mother has an emergency. For more than eight years, he has been paid by IHSS to care for his 67-year-old mom, Anabelle O’Bryan, who he said has diabetes, congestive heart failure, arthritis and high blood pressure.

O’Bryan, who lives in Oakley, a city in Contra Costa County, said he also learned what to ask when he accompanies her to the doctor and how to decide if she needs to go to the hospital.

“Now I am more equipped to spot things” before they get worse, he said.

For example, O’Bryan said he knows to elevate her feet when they get swollen rather than immediately take her to the ER.

Annabelle O’Bryan said she is more confident in her son’s abilities after he took the class, and she knows that he is helping her stay healthier.

“He is really on top of me not eating the sugar,” she said. “He is really careful about that.”

Newcomer of UCSF said that because the caregivers are in the patients’ homes for hours, they can be the “eyes and the ears” for physicians and other medical providers. They can tell the doctors “if the person is more confused, or is refusing to eat, or that the status is changing,” he said.

The results of the study show that caregivers play a pivotal role in helping keep people out of the hospital, said Corinne Eldridge, executive director of the California Long-Term Care Education Center. The nonprofit center was founded in 2000 by members of the Service Employees International Union, which represents many IHSS workers.

During the training sessions, Eldridge said, the caregivers learned skills such as how to read medication labels or provide the best diet for a diabetic patient. Like Andrew O’Bryan, they also became more confident about handling worrisome situations, such as deciding when to call a doctor or dial 911.

Eldridge said the center is now hoping to gain support from Medi-Cal health plans to help pay for the training as a way to reduce health care costs.

“We really see training as part of the solution in order to provide better care … and frankly as a way to invest in the workforce,” she said.

Blue Shield of California Foundation helps fund Kaiser Health News coverage in California. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. You can view the original report on its website.

The post Teaching in-home caregivers seems to pay off, report says appeared first on PBS NewsHour.

Phil Moeller answers your questions on aging and retirement. Photo by Getty Images

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need in “Ask Phil.” Send your questions to Phil.

Check out his new Recommended Reading section with links to notable stories and reports at the end of today’s post.

Anna – Ill.: If the powers that be are looking at health outcomes when they spend Medicare dollars, why did Congress decide in 2008 that a cut in therapy benefits was a smart thing to do? In 2008, I was not yet 65, so I didn’t notice this change. But now that I am past 65 and having balance “issues,” the 2008 cut in therapy benefits does affect me. One of the leading causes of sending seniors into assisted care facilities is balance issues (falls), and many seniors soon run out of funds and have to rely upon Medicaid to pay for housing them in these facilities. Is it not more fiscally responsible to spend a few thousand dollars on balance therapy now rather than tens of thousands of dollars each month to “house” seniors in such facilities?

Phil Moeller: Caps on Medicare therapy services have been a contested topic for years. For 2016, the caps are $1,960 for physical therapy and speech-language pathology services combined, according to the Centers for Medicare & Medicaid Services. There’s another limit of $1,960 for occupational therapy services. However, there is an exceptions process that permits people to seek coverage when their total incurred therapy expenses exceed $3,700 during a calendar year. This exceptions process was in place in 2008 and has been extended every year since then. The American Physical Therapy Association has an extensive legislative history of therapy caps that provides the details. So, on this score, it’s not clear to me what cuts your referring to. Having said that, you and many other reasonable people could argue that the caps themselves are too low and need to be raised.

Diane – Md.: I am 65 and enrolled in Medicare. After this enrollment, I took a position with a 1,500-person firm and now have Blue Cross as my primary health insurance with Medicare as my second. I would like to use the health savings account option with Blue Cross, but have been told that I can’t have an HSA and Medicare. Is this true even if Medicare is the secondary provider?

Phil Moeller: Yes, according to the Medicare Rights Center. Having Medicare in any capacity makes it illegal for you to participate in an HSA or continue participating if you had one when you enrolled in Medicare. Further, as I’ve written before, signing up for Social Security requires you to have Part A of Medicare, which also nixes HSA participation.

READ MORE: Why health savings accounts and Medicare don’t mix

However, the fact that you went back to work and now have employer insurance provides you the right to drop Medicare without facing penalties later on when you leave work and need to re-enroll. If there are benefits having Medicare as a secondary payer, you should compare them with the tax benefits of having an HSA plan and decide which path is better for you.

If you do decide to drop Medicare, Social Security rules require a personal interview before approving your request. You also must complete form CMS-1763— Request for Termination of Premium Hospital and/or Supplementary Medical Insurance. Be warned: Supplementary Medical Insurance is Medicare’s term for Part B; don’t confuse it with Medicare Advantage.

Connie – Ontario: I’m a 68-year-old U.S. citizen with dual U.S.-Canadian citizenship, and I reside in Canada. When I turned 65, both my Canadian husband (non-U.S. citizen resident) and I qualified for and received Medicare cards (Medicare A only). If we were in an accident or serious illness while in the U.S. that required hospitalization, what would and would not be covered?

Phil Moeller: You certainly would be able to use your Part A insurance for hospital expenses and related institutional medical care, according to counselors at the State Health Insurance Assistance Program. If your husband’s Part A was valid, so would he, although it’s not clear to me why he would qualify for Part A unless he had spent substantial time working in the U.S. Part A only covers hospital expenses. If you needed to pay for doctors, outpatient costs, medical equipment or drugs, these would not be covered unless you had additional Medicare coverages for which you would need to pay premiums. In that event, you might face stiff late-enrollment penalties for not signing up for Parts B or D of Medicare when you first turned 65 and enrolled in Part A.

If either of you have Canadian health coverage, which I assume you do, you should explore whether it helps at all with medical needs that occur in the U.S.

READ MORE: When to consider Obamacare instead of Medicare

Linda Jo – Mich.: My mother is 93 years old and has been living abroad for several years. Until recently, her Medicare Part B premium was deducted from her monthly Social Security benefit payment. She asked to change this and stop paying Medicare Part B premiums. She was told by a person in a U.S. embassy Social Security office that she could reclaim from 12 to 18 months of payment of the Medicare Part B that had been deducted from her monthly benefit. Is this correct?

Phil Moeller: I don’t think so, but the Social Security spokeswoman I contacted was not able to give a definitive answer without more specifics about your mother’s situation. By law, Part B premiums must be deducted from Social Security payments for anyone participating in both programs. So the only way to stop these premiums from being deducted is to disenroll from Part B. I assume this is what your mother wanted to do and further assume it’s because Medicare doesn’t cover her outside the U.S., and she doesn’t travel back here enough to want the coverage when she is in the states.

If she does leave Part B, she normally would not be entitled to any premium refunds. See pages 30 and 31 of this document for details.

The only wild card here I can think of is whether she may be able to make a case that her effective Part B termination date should have been 12 to 18 months earlier, thereby entitling her to refunds tied to that earlier termination date. Your note makes no mention of this, so my best judgment is that the person in the embassy office was incorrect.

FOLLOW UP

Many readers had questions about a recent Ask Phil piece on high-income surcharges for Medicare premiums dealt with how selling a home can affect your premiums.

Steve – Wyo.: I just read your response to the woman who wondered about the potential effect of selling her home, with a capital gains realization, on her Medicare benefits. Your response clarified the issue with regard to triggering “surcharges” above the $85,000 threshold. What if that capital gain is immediately reinvested in another home? Would it count as income as such?

Charles – La.: Is this after the $250,000 to $500,000 home sale exclusion (primary home)? Do you understand that gains on the sale of a second home are taxable?

Sharon – Calif.: If I sell my principal residence and get $500,000 profit, I am qualified for the $500,000 tax exemption for couples so my profit will be zero in my tax return. In my case, I don’t have to worry about IRMAA, do I? [IRMAA stands for the Income-Related Monthly Adjustment Amount, which is the mouthful of words used to describe these surcharges.]

John – Calif.: In 2018, I will be hit with a very substantial MAGI [modified adjusted gross income] surcharge due to a one-time event, the sale of my business in 2016. My annual MAGI after the sale of my business will, once again, be less than $170,000. Is there a way to get my MAGI surcharge removed? I am married and retired in 2016.

Smilie – Maine: The sale of a primary residence owned and used as such for two out of five years would, under the facts of your recent post, be excluded from capital gain recognition ($250,000 exclusion per spouse), and I believe the instructions to Form 1040 provide that such sales should not be reported. See Internal Revenue Code section 121.

READ MORE: How selling a home may affect what you pay for Medicare

Phil Moeller: Thanks to all. It seems to me the key variable here is whether the income event (sale of a home or business for these readers) is included in MAGI. This is the definition of income that is used to calculate IRMAA surcharges. In the case of the sale of a primary residence, only amounts above the exclusion thresholds would be included in MAGI. The sale of a business would be a different matter, as would the sale of a second vacation home (which was the case in the Ask Phil column). Any bump in MAGI that triggers IRMAA surcharges should go away as soon as MAGI declines, keeping in mind that there is a two-year lag between the year the income is taxed and when Medicare premiums are determined. So, as John notes above, his 2018 IRMAA will be determined by his 2016 tax return.

RECOMMENDED READING

New Medicare Law to Notify Patients of Loophole in Nursing Home Coverage

Hospitals have the right to accept patients for what are called observational stays as opposed to formally admitting them. Medicare has different insurance rules for these situations and may charge people more for observational stays than formal admissions, even if the care is identical. In addition, Medicare will not cover subsequent care in a skilled nursing facility if a patient’s hospital stay was only observational. This is a bad policy, as described last year in an Ask Phil column. Under terms of a new law, hospitals will have to at least tell patients their admission status, which might help some people save money or appeal the hospital’s decision while there is still time to do something about it. Better still would be to revise the rules altogether and change the underlying rules. (Source: The New York Times.)

Closed Social Security offices, furloughed staff under GOP cuts, agency warns

Social Security Administration officials warn that the latest appropriations bill supported by congressional Republicans would further harm the agency’s already compromised ability to serve growing consumer demand for help. (Source: The Washington Post.)

CMS’ new star ratings are unfair to teaching and safety net hospitals

The Centers for Medicare & Medicaid Services recently issued a single star rating on the nation’s hospitals. Its stated goal was to give people a single, easy-to-understand summary of the quality of the nation’s hospitals. Reducing the many complexities of hospital operations and quality to a single indicator has provoked considerable opposition. (Source: Modern Healthcare.)

CMS also recently added new quality measures to its nursing home star ratings system. As with nearly everything CMS does, these changes also generated concern.

The post Why doesn’t Medicare cover more for physical therapy? appeared first on PBS NewsHour.

On today's show:

• David Wallace-Wells, Features Director at New York Magazine, recounts his frightening experience at Kennedy Airport last week, when reports of an active shooter - though there wasn't one - caused total chaos for travelers.
• Rachel Abrams, New York Times reporter, and Tina Sigurdson, general counsel for the Environmental Working Group, talk about the proposed legislation to require the FDA to regulate cosmetics.
• Reverend William Barber, president of the North Carolina chapter of the NAACP and pastor at Greenleaf Christian Church, talks about his new initiative and his DNC speech.
• Richard Bribiescas, professor of anthropology and ecology and evolutionary biology at Yale University, discusse how natural selection affected the way men grow old and how that affects human society.
• Have you dropped a person off at college recently? How did his/her packing list differ from yours? Listeners call in about the changing nature of what one brings to college.

Richard Bribiescas, professor of anthropology and ecology and evolutionary biology at Yale University, deputy provost for faculty development and diversity and the author of How Men Age: What Evolution Reveals about Male Health and Mortality (Princeton University Press, 2016), studies the way men age, not the medical story, but how natural selection affected the way men grow old and how that affects human society.

If you knew you were going to live to 100, how would it affect the way you live your life? Photo by Paul Bradbury/Getty Images

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need in “Ask Phil.” Send your questions to Phil.

Check out his new Recommended Reading section with links to notable stories and reports at the end of today’s post.

If you knew you were going to live to 100, how would it affect the way you live your life? Today, very few people have such certitude. But according to a provocative new book, “The 100-Year Life,” more and more will, as sustained longevity gains continue adding years to our lives.

More significantly, British academics Lynda Gratton and Andrew Scott argue, the prospect of such long lives will become part of younger people’s life view. It’s one thing if an 85-year-old concludes she will live to 100. But if a 25-year-old is convinced she still has 75 years of life in front of her, the implications are likely far more substantial.

We already are seeing a sustained deferral of marriage and childbearing decisions until later ages. The movement of people into full-time careers in their 20s likewise seems more and more to be delayed until their 30s. More research needs to be done about the extent to which people are changing behaviors because they believe they will live longer.

For example, it is easy to chalk up some trends to economic upheaval and related pressures. People with attractive career paths, especially women, are swayed by the logic of spending additional years cementing their professional futures before having families. Those without such appealing paths — of which there are far too many these days — may be forced to bunk in  at their parents’ homes.

As a result, a snapshot of people in their mid-30s today can look a lot like a picture taken 30 years ago of people in their mid-20s. There is, of course, no single image that can capture the diversity of ways people choose or are forced to live their lives. And who would want to travel along such a narrow proscribed path anyway?

The point here, and the point of the book, is that such changes have occurred and will more and more become the new normal. Yes, technology and shifting economic realities certainly play a role here. But, Gratton and Scott argue, so does the inexorable conclusion that longer and longer lives are in store for us.

I have some quibbles with this book, which has been shortlisted by the Financial Times as a candidate for the best business book of the year. Trying to suss out the ways that longevity will change our lives requires a better crystal ball than they (or, certainly, I) possess.

It’s also very hard to separate the effects of longevity from the impact of technological change. In an email exchange, Stone agreed with this, but said longevity gains deserve more of a marquee placement than they’ve received.

“Every generation tends to benefit from better technology and longer longevity. However, the technological change seems disruptive and discrete and so is much discussed, whereas the longevity is slow and constant and tends not to be of much focus.”

Quibbles aside, I have no argument with the growing likelihood that living to 100 someday will be a ho-hum milestone or that people and institutions should be spending more time thinking about how they need to prepare for these added years.

I also think the authors are on sound ground when they argue that the basic units of modern life must change. These units, which they describe as a “three-stage life,” include education, work and retirement. I think you could toss childhood into that first stage if you like and look at it as a period of development and preparation that younger people must complete before they’re ready to be on their own.

Likewise, there are broader models available in the second and third stages. For many people, the work stage of their lives also includes raising families — hardly an inconsequential afterthought. The broader point is that people spend their first 20 years or so in stage one, their next 40-plus years in stage two and the rest of their lives in stage three.

In a 100-year life, however, retiring at 65 is not feasible for most people. They simply do not have the financial resources to afford retirements lasting 35 years. They also may not have the patience to spend so many years on the sidelines of a life where they had long been active. We’ve already begun seeing responses to these pressures.

More people in their late 60s and 70s have remained in the workforce. Investment and job losses caused by the Great Recession are often cited as a powerful driver of this change. But looked at through the lens of “The 100-Year Life,” the possibilities of longer retirements also emerge as a factor.

The three-stage life increasingly will not be a workable model for people who must anticipate longer lives. Instead, the authors argue, people will be developing multi-stage lives. They will feel increasingly comfortable, but also practically driven to break their careers into more pieces, moving in and out of the workforce and going back to school to maintain and sharpen job skills. Parents will adopt patterns of shifting domestic duties among partners to spend more time with their younger children.

As people approach their mid-60s and 70s, they too will need to develop additional stages of life. We’re already seeing this in today’s “encore careers” movements. It will need to expand further in a world of longer life spans. Here, the risk-taking and entrepreneurial mindsets now associated with younger people could be adopted by people in their 70s and 80s.

“Imagine you will have two or three different careers,” the authors write, “one perhaps when you maximize your finances and work long hours and long weeks; at another stage you balance work with family, or want to position your life around jobs that make a strong social contribution. The gift of living for longer means you don’t have to be forced into either/or choices.”

This liberating longer-life view is, of course, much more feasible for highly educated and better-compensated people. For those on the lower rungs, choice is not so much the word that comes to mind. Without economic resources and options, the prospect of living to 100 is not so much fun. Worries about running out of money or of illness-plagued decades can predominate. Touting multi-stage lives to such folks can be a cruel form of humor.

“The danger is that the gift of a long life will only be open to those with the income and education to construct the changes and transitions required,” the book notes. “It is therefore crucial that governments begin now to construct a package of measures to support those less fortunate.… It is unacceptable that a good long life should only be an option for a privileged minority.”

In practice, of course, that seems exactly what will happen in the near term. If government does step up, such actions are not likely to occur until long after that better-enabled minority has been playing and winning the longevity game for some time.

RECOMMENDED READING

“Why Forcing People to Text to Log Onto Their Social Security Account Was a Mistake”

Social Security changed its mind last week and withdrew a hastily launched requirement that people needed to use their smartphones to access their online Social Security accounts. The Social Security Administration seems to have a tin ear when it comes to evaluating public needs and preferences and certainly did so here. Millions of people were unable to comply with the new rules nor fathom why it was needed. The agency’s motives were commendable. Increasing the security of personal wage and benefits information is important. But this effort was not well conceived. (Source: Mark Miller for Reuters via Money.)

“Private Equity Pursues Profits in Keeping the Elderly at Home”

Can the profit motive succeed where good intentions have fallen short? A potentially marvelous Medicaid program to help frail and mostly older people stay in their homes is about to find out. It’s called the PACE program, an acronym that stands for Program of All-Inclusive Care for the Elderly. Medicare does not pay for nonmedical long-term care services, but Medicaid does. However, the government’s tab for nursing-home care can be very steep. Rather than putting people into nursing homes, PACE provides them with at-home support services and provides transportation for them to a PACE center, where they can receive medical care, counseling and a daytime program of activities. All of these services, it turns out, can be provided for less money than a nursing home would cost. Not only does the government save money, but the quality of life enjoyed by PACE participants can be superior. Historically, PACE programs have been run by nonprofits, and not many people are enrolled in them. Recent regulatory changes have allowed for-profit companies to create PACE programs. Now, attention will be focused on how these companies balance the prospect of making money off of PACE participants with the quality of services they provide. (Source: Sarah Varney for The New York Times in collaboration with Kaiser Health News.)

“Are insurance policies saving patients money, or keeping them from the treatment they need?”

In an effort to save money, Medicare and other health insurers have the right to require doctors and patients to try less expensive drugs and procedures. If these efforts do not produce good results, people are then free to try progressively more expensive therapies until they find one that works for them. In a world of costlier medicine, these “step therapy” programs are likely to become more widespread. So, too, will be concerns that patient welfare is being sacrificed in the interest of corporate profits. (Source: Bob Tedeschi for STAT.)

The post Column: Will increasing longevity change the way you live? appeared first on PBS NewsHour.

Aging and retirement expert Phil Moeller answers your questions. Photo by Joe Raedle/Getty Images

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need in “Ask Phil.” Send your questions to Phil.

Check out his new Recommended Reading section with links to notable stories and reports at the end of today’s post.

Michael – N.J.: I have Medicare Parts A and B and a Medigap plan. I am 66, and I’m about to start getting Social Security in October. I was diagnosed with multiple myeloma early this year, and found out (too late of course) that Medicare will not cover the stem cell transplant I need from my identical twin brother.

I’m researching adding private coverage, but it doesn’t look promising. I have been reading that private insurers cannot legally write policies if they know you have Medicare. So I am considering dropping Medicare and getting a private plan that would cover this.

However, this looks even less palatable. I understand that to give up Part A means I forfeit future and past Social Security payouts. Also, if I give up Part B and later do re-enroll, my Medigap plan is no longer guaranteed issue.

Am I understanding this correctly? Am I missing any promising loopholes?

Phil Moeller: A spokeswoman for the Centers for Medicare & Medicaid Services confirmed that Medicare generally does not cover these tests. However, as with much of Medicare, there may be an exception for some Medicare beneficiaries with multiple myeloma who require allogeneic hematopoietic stem cell transplantation. The qualifications seem narrow, but you should check them out and follow up if it looks promising.

As for getting private coverage, I doubt you will find any takers. Even if you dropped Medicare and Social Security — which I do not recommend — I know of no private insurer who would take you on with this pre-existing condition. And if you did find one, the premiums likely would be higher than you could afford.

I wish I had better news. I hope you can find the help you seek.

Janet – Fla.: I am a 55-year-old woman. I have been receiving Medicare since 2005 when I became a disability claimant. I work part time from home, but between doctor’s payments and way over-the-top prescription drug prices, I need help. For example, a monthly prescription I used to pay $10 for is now $275 a month! I have prescription and medical insurance with Humana. Am I financially better off to just use my Medicare and not use private insurance? Supplemental insurance seems expensive.

Phil Moeller: Janet, I am so sorry that you are getting hammered by such outlandish price increases for your medications. Unfortunately, you are in the same boat as millions of other Americans. Tell me what drug you’re taking, and maybe we can embarrass the manufacturer like the maker of EpiPens was embarrassed. That manufacturer consequently agreed to make its product more affordable. And its price gouging, by the way, was only 500 to 600 percent. Yours is 2,750 percent!

READ MORE: Did outcry on social media lead to Mylan’s generic EpiPen?

Depending on your income, you may qualify for Medicare savings programs, including its Extra Help program for prescription drugs. Call a Medicare counselor in your state who works for the free State Health Insurance Assistance Program, see if you qualify and get help applying for benefits. In the meantime, you should look at Medicare’s Plan Finder online tool and see if Humana’s price for this medication is what other drug plan insurers also charge where you live. If you can find this medication at lower cost in another plan, you should consider switching to that plan for 2017 during this year’s annual Medicare open enrollment period, which runs from Oct. 15 through Dec. 7.

Another possibility you could consider is shopping for your health insurance on the Florida state insurance exchange created by the Affordable Care Act. While you are eligible for Medicare because of your disability, you do not have to enroll in Medicare until you are 65. The exchange plan may be cheaper than Medicare. The State Health Insurance Assistance Program might be able to help you find out. As for supplemental insurance, it’s not only costly, but it doesn’t even cover drugs.

READ MORE: Is there any relief for astronomical drug costs?

Lisa – Ga.: I am a Social Security Disability Income recipient and hope to move out of the country to Germany or someplace similar in Europe. I am currently 46. I know some countries it is acceptable to relocate on SSDI. I wish to be independent, but the chaos of politics and living where the buses don’t run and in a society that demonizes disability (especially cognitive) is tiresome. I speak conversational German, which I learned after a traumatic brain injury, but before subsequent brain injuries 12 years ago.  If I am receiving SSDI and can speak the language well enough to get by, what happens with my medical coverage? Can I live overseas? Please advise. I was a paralegal as well. I earned that degree in 1999 after my injury in 1996. I understand the law.

Phil Moeller: Lisa, you are already overcoming more obstacles than people without disabilities ever confront. I applaud your desire to be independent. I’m also sorry you’ve had such negative experiences in the U.S. The first part of your question is easy. If you get SSDI, these payments will continue to be sent to you if you relocate outside the U.S. to Germany. Social Security payments are not sent to people in all countries, but they are provided to people in Germany. The agency has an online screening tool that discloses the rules in different countries. However, you must become a legal resident of Germany (see page 6 of this document) for your Social Security payments to continue.

READ MORE: Why doesn’t Medicare cover more for physical therapy?

Even if you can jump through these hoops, getting medical insurance is not such an easy matter. I assume you are now on Medicare. It does not cover medical care outside the U.S. You would most likely need to get health insurance in your new country of residence. This could be a challenge, especially if you do not have a job and would be living only on your SSDI income. I would begin by joining some online discussion groups of ex-pats living in different European countries. There may be a lot of relocation issues you’d face beyond health insurance, and you should take the time to learn about them and plan your move. Next, I’d find a few insurance brokers who specialize in German health insurance. I say “a few,” because you will want to speak to several people to make sure you’re getting the best deal. I wish you the best of luck. Please let me know if I can be of further help.

Christopher – Mexico: I turned 65 in March, and I retired in Mexico about 100 miles south of the border. I began collecting retirement benefits at 62, and when I turned 65, my online account information was updated to say I was automatically enrolled in Medicare Part A. This is fine with me. In a pinch, I figured I could take a bus or taxi to the border for medical treatment if need be. Here’s my problem: I have never received a Medicare ID card. I used the online service every month to request one to no avail, and I called and spoke with the kind folks at the office in the states and they said they initiated a card replacement. The online service was recently changed to require a cell phone text message so now I can’t even check it out online.

Phil Moeller: Your Medicare card is supposed to be mailed to the address that is connected with your Social Security account. Assuming this address is in Mexico, that’s where the card should go. I’d call or email Social Security again and keep asking them to send you the card. Also, the agency’s requirement that people use a text message as part of its online security process was very short-lived. Many seniors do not have smartphones and do not text. They spoke up, along with advocacy groups, and the agency quickly reversed itself and abandoned the policy. So at least you will be able to access your online account once again.

READ MORE: I can get my Social Security abroad, so why not my Medicare?

Having said this, I don’t know that having a Part A card is going to do you much good. Part A charges no premiums to people who qualify for Social Security payments. That makes it a nice benefit. But it covers only hospital costs. If you really want to have medical treatment when you return to the U.S., you’d also need Part B of Medicare to cover doctors and outpatient clinics. And you’d need Part D to have your prescription drugs covered. Parts B and D both carry monthly premiums. You might get both of these rolled into a low-cost Medicare Advantage plan, but you’d need a U.S. address to document that you’re in the plan’s service area. I’d call some insurance brokers specializing in ex-pat coverage for folks living in Mexico and see what they suggest.

Carol – Ga.: My husband is on disability and will automatically be registered for Medicare next year. Should I still cover him on my insurance at work? Do I need to register him for Parts B and D?

Phil Moeller: It normally takes about 30 months between the date someone is approved for Social Security disability payments and when they can begin participating in Medicare. This is a wonderful safeguard for people with disabilities, providing them guaranteed access to insurance even at very young ages. However, in your situation there is no requirement that he has to take Medicare. Now, I don’t know exactly why you think your husband will automatically be registered for Medicare next year. Perhaps it’s because he’s turning 65 or simply that it will have been 30 months since he was approved for disability. Whatever the reason, he does not have to sign up for more than Part A of Medicare (which he automatically received upon commencing disability payments) as long as he is covered by your employer insurance plan and your employer has at least 20 people on the payroll (there are different Medicare rules for smaller employers). If he receives a Part B Medicare card from Social Security, he should call them and say he rejects the coverage and wants to return the card. Best of luck!

Sherry – Ariz.: I signed up for Medicare when I turned 65 in May of this year. I work full time and I had much better insurance through Walmart. Can I go back on the Walmart insurance during open enrollment this coming fall?

READ MORE: Should you stay on your employer health insurance or get Medicare?

Phil Moeller: As I just told Carol, you do not have to get Medicare when you turn 65 (or 75 or even 85) so long as you have health insurance from your employer and it employs more than 20 people. Walmart, of course, employs a lot more than 20 people! So I don’t know why you signed up for Medicare. Whatever the reason, if you have left the Walmart insurance plan, you may have trouble getting back into it. Before you drop Medicare, talk to someone at Walmart in the employee benefits department and understand exactly what your options are for resuming employer insurance.

Jonathan: In regards to taking Social Security benefits and then being unable to contribute to an health savings account, what’s the policy if a person claims a spousal benefit from Social Security, delays their own retirement benefit until 70 and continues to work?  Can they still contribute to their HSA under this claiming strategy?

READ MORE: Why health savings accounts and Medicare don’t mix

Phil Moeller: No, they can’t. Claiming any benefit, even a spousal benefit, will trigger the mandatory enrollment in Part A of Medicare. This enrollment qualifies as being on Medicare and thus disallows continue contributions to an HSA. Sorry!

Debbie – Wash.: My husband is turning 65 in January 2017, but has been medically retired since 2003. He has had Medicare since then. Since 1991, I have had very good private health insurance that covers both of us. I’m writing because whenever we make appointments or go to the hospital, he is always referred to as a Medicare patient. Sometimes we are told that a physician is not seeing any more “Medicare” patients, even though we have secondary private insurance and Tricare for Life. Is there a way not to have Medicare without penalty and have our private insurance the primary payer? It seems that being a “Medicare patient” only makes things worse.

Phil Moeller: Are you paying any premiums to Medicare for your husband’s insurance? I hope not and that the only kind of Medicare he’s had is premium-free Part A. As I’ve told other readers in today’s column, he does not have to have Medicare so long as he is covered on your employer’s plan. Now, I can’t tell for sure if you are still actively employed or whether your “very good private health insurance” is actually a retiree insurance plan. These plans nearly always require a person to have Medicare when they turn 65, because the plans become the secondary payer of health claims, and Medicare becomes the primary payer. That’s certainly the case with Tricare for Life. And if you have a secondary private insurance plan, then Tricare for Life would move to third place and wouldn’t pay claims until your primary and secondary carriers had paid their share of covered expenses.

RECOMMENDED READING

Audits Of Some Medicare Advantage Plans Reveal Pervasive Overcharging

Fred Schulte continues his compelling coverage of how some Medicare Advantage insurers have been gaming the system to get the government to pay them more money than is needed to provide insurance to some of their Medicare policyholders. Medicare Advantage is the private insurance product that is required to provide at least the same coverage as Original Medicare (Parts A and B) and usually includes a Part D prescription drug plan as well. Insurers receive per-beneficiary payments from the government that are based on the health of the beneficiary. By overstating how sick a person is, an insurer can get a higher fixed payment to cover that person. (Source: Fred Schulte for The Center for Public Integrity via NPR.)

How to include your digital assets in your estate plan

It’s hard enough to get your final wishes properly expressed in your will. Now, you have to worry about your digital afterlife as well! However, what used to be an oddity is moving mainstream. Here’s a helpful “how to” piece about making sure your Facebook page has a final resting place as nice as yours. (Source: Andrea Coombs for MarketWatch.)

Tax Credits for Ramps, Grab Bars to Help Seniors Stay at Home

Here’s another practical piece on efforts in some states to permit tax reductions for “age friendly” home improvements that help older and disabled people to continue living in their homes. (Source: Jenni Bergal for Stateline from The Pew Charitable Trusts.)

The post Medicare won’t cover a procedure I need. Can I get private insurance? appeared first on PBS NewsHour.

When you hear a singer like the late Whitney Houston belt out a song like “I Will Always Love You,” you’re listening to a marvel of vocal skill. But there’s no anatomical difference between her vocal system and yours.

Great singers “don’t have bigger lungs,” says voice rehabilitation specialist Linda Carroll. Neither do they have bigger vocal muscles. According to Dr. Steven Zeitels, director of the Voice Center at Massachusetts General Hospital, “I can place all your vocal muscles into one corner of one facial muscle.” Those vocal muscles move the vocal folds, ligaments that vibrate to make the sounds of speech and singing.

So without bigger lungs or muscles, how do singers do it? It’s all about the way the sound resonates in their body, according to the opera soprano Renée Fleming. “If you take any kind of instrument — whether it’s a violin or a piano — the strings sort of represent what the vocal folds do." Singing, she says, is like plucking a string. “If you do that with a rubber band, it just makes a ‘twang’ sound, but if you put that string on a box, then it resonates and creates a beautiful sound.” It’s the same for the voice, she says. “You’re putting air through the folds, they vibrate and the resonating chambers, which are your mouth, your throat, your sinuses, create the color.”

Singers of all ages come into Dr. Zeitels’ medical practice with trauma caused by breathing dried-out air in planes or singing in towns or buildings that have unfamiliar allergens. Renée Fleming says trauma can also come from the type of singing you do. “It’s pop and musical theater singing — particularly with girls — and rock singing for men that’s very hard on the voice,” she says. 

Aerosmith’s lead singer, Steven Tyler, is nearly 70 and has been torturing his vocal folds since he was a teenager. Tyler is one of Dr. Zeitels’ patients. One night, right in the middle of that famous high note in “Dream On,” Tyler ruptured a blood vessel in his vocal fold. His voice cut out completely. Dr. Zeitels performed surgery with a laser to seal the blood vessels, and today, Tyler can sing “Dream On” as loudly as when he was 25 years old. 

David Fahrenthold, a political reporter with The Washington Post discusses his investigation into Donald Trump's charitable donations. Filmmakers Ken Burns and Artemis Joukowsky discuss their new film, "Defying the Nazis: The Sharp's War." Affinity Konar on her novel, Mischling, about a set of twins who arrive at Auschwitz and become part of Josef Mengele’s experiments. Champion open-water swimmer Lynne Cox on her new book Swimming in the Sink: An Episode of the Heart. Journalist and author Ian Brown on his memoir Sixty: The Beginning of the End, Or the End of the Beginning?

Journalist and author Ian Brown talks about his memoir Sixty: The Beginning of the End, Or the End of the Beginning? He candidly confronts aging, and asks whether turning 60 means that he’s “soon to be elderly" and at "the age when the body begins to dominate the mind, or vice versa, when time begins to disappear and loom, but never in a good way, when you have no choice but to admit that people have stopped looking your way, and that in fact they stopped twenty years ago."

 Event: On Tuesday, September 20th 12 p.m., Ian Brown will be at the 92nd Street Y (Lexington Avenue at 92nd St) to discuss his memoir. Tickets are available on their website.

Hisham Uadadeh enrolls in a health insurance plan under the Affordable Care Act at Leading Insurance Agency in Miami, Florida. Photo by Joe Raedle/Getty Images

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need in “Ask Phil.” Send your questions to Phil.

Check out his new Recommended Reading section with links to notable stories and reports at the end of today’s post.

Stuart – Texas: I am unable to work and have been receiving disability since 2006. I am not yet 60 years old. When the Affordable Care Act began in 2014, I enrolled in an individual plan through the marketplace and was granted a subsidy because of my income. When I re-enrolled in 2015, the folks at Healthcare.gov refused to give me the subsidy, because I was technically on the Medicare roll (Part A only because of my disability). Now, in 2016, Social Security has added me to Part B, costing me even more. I now am paying a full individual premium through the marketplace plus the Medicare payment of $158 per month. I am not benefiting whatsoever from the Medicare plan. What options do I have?

Phil Moeller: Readers dying to know about the interactions of Medicare and the Affordable Care Act have struck gold today. Of course, I grant you that this might not be an enormous group, but I shall press on nonetheless. Unfortunately, the facts aren’t so favorable for Stuart. I have been in touch with both Medicare and Social Security about this. I have not shared Stuart’s name, so their responses are necessarily general. But I think the situation is clear, especially where it concerns Medicare.

By design, state health exchanges and Medicare are not supposed to work together. Most people signing up for health insurance on a state exchange qualify for subsidies that are often substantial. Given this federal support, providing such subsidies to Medicare beneficiaries would amount to a double subsidy. While Part A of Medicare, which covers hospital expenses, is fully funded by worker payroll taxes, the other parts of Medicare are not fully covered. In fact, taxpayers foot the bill for about 75 percent of Part B expenses and a hefty share of Part D drug expenses and Medicare Advantage plans as well. While Medicare premiums can be expensive for many older and disabled Americans, they would be unaffordable for most of us if we had to pay the full cost of the programs.

A person on Medicare is not entitled to also receive subsidies when they buy an ACA policy on a state exchange. And a person age 65 or older is not even permitted to buy an ACA policy in most situations. The exception is for older persons who do not qualify for premium-free Part A coverage. To qualify, they need to have worked at least 40 quarters (10 years) at jobs where they paid Social Security payroll taxes. Or they need to be married or have been married to someone who worked that many quarters. If not, they will have to pay steep Part A premiums that can exceed $400 a month. This small group of people may continue to purchase ACA policies.

However, ACA subsidies are not available to Medicare beneficiaries who qualify for premium-free Part A coverage. This includes Stuart. Now, I do not know whether Stuart was covered by Medicare at any period from the time of his disability until he signed up on a state exchange in 2015. But he was still on Medicare. How can this be? Because anyone receiving Social Security benefits must, by law, also receive Part A. And anyone receiving Part A is considered to be a Medicare beneficiary. This fact alone — which I grant may appear unfair in some circumstances — is a disqualifying factor when it comes to ACA subsidies, according to Medicare. Someone having either Part A or Part C of Medicare (Part C is the formal name of Medicare Advantage plans) is deemed by the agency to have what’s called Minimum Essential Coverage, or MEC, and having MEC disallows them from receiving any ACA financial support.

My guess is that while Stuart thinks he is getting a bad deal by losing his subsidy this year, the fact is that he never should have been entitled to a subsidy in 2015. The fact that he was is a not uncommon oversight; its one that Medicare has been working to correct. Here’s a statement to that effect from the agency:

CMS is reaching out to the small number of consumers enrolled in both Medicare and Health Insurance Marketplace coverage with financial assistance. We are doing this to make sure they take action to end their Marketplace coverage with advance payments of the premium tax credit because they are receiving Minimum Essential Coverage (MEC) Medicare, and thus are not eligible for this financial assistance. It’s important that such consumers do this in a timely manner, to help reduce the amount of advance payments of the premium tax credit the tax filer(s) may have to pay back when they file their federal income tax return. We’re committed to helping consumers with Marketplace coverage and will continue to work with them to understand their options.

So Stuart is 0-for-1 so far. In terms of being signed up by Social Security for Part B of Medicare, it seems to me he is correct that this is inappropriate. However, as I’ll explain, it could be that he winds up needing Part B.

A Social Security spokeswoman said she knows of no reason why Stuart would have been enrolled in Part B. Going back to 2006, when he qualified for disability payments, it’s quite possible that Social Security automatically signed him up for Part B when he became eligible for Medicare. This normally takes at least two years after disability payments have begun. And being entitled to Medicare at any age because of a disability is normally a helpful benefit.

However, Stuart did not have to accept Part B, and it appears he did not. He may have had other private health insurance himself or been insured on his spouse’s health policy. I don’t know. But it’s pretty clear he did not have Part B until Social Security enrolled him in it earlier this year.

“Based on the facts presented in this case,” the Social Security spokeswoman said, “I can’t think of any reason Social Security would have automatically enrolled this disability beneficiary into Medicare Part B 10 years after entitlement to disability benefits.”

If Stuart wants to pursue this matter and avoid paying Part B premiums, I’d suggest he call a local office of the State Health Insurance Assistance Program (SHIP) and ask a Medicare counselor to help him. SHIP deals more with Medicare than Social Security, so he may have to contact Social Security directly, which is what the agency suggested.

However, having lost his ACA income subsidy, there’s a good chance that Stuart’s best insurance deal would actually be to drop his ACA policy, purchase Part B and move onto Medicare. He can do this during the Medicare open enrollment period that begins Oct. 15 and extends through Dec. 7, and his new coverage would take effect next January. This decision means some more homework for Stuart to determine the mix of Medicare policies that make the most sense for him and to then shop for the best available policies. Future installments of Ask Phil will be dealing with open enrollment and can help guide Stuart and others in deciding whether what Medicare coverage they should have in 2017.

David – Calif.: Are there Medicare Advantage plans with a “Passport” feature that provide coverage benefits in two different states? I spend about seven months in California and five months in Washington state each year. Can I just enroll in a new Medicare Advantage plan when I move back and forth?

Phil Moeller: Passport is a trade name used by UnitedHealthcare and describes the portability feature offered by some of its Medicare Advantage plans. While UnitedHealthcare does offer the Passport feature on some Washington plans, a spokeswoman says, it is not available in California. So you are out of luck regarding this particular feature. I have not heard if other insurers offer similar Medicare Advantage plans, but perhaps some readers have. If so, please let me know, and I’ll pass the information on to David.

The idea of enrolling in a new Medicare Advantage plan every time you move back to one of these states is possible in theory, but challenging in practice. According to UnitedHealthcare, you would need to change your legal address every time you move, and make sure the new address has been registered with the Social Security Administration. It is the official arbiter of Medicare enrollments. Even if you do this, enrolling in a new plan every five or seven months would play havoc with your plan deductibles, which would need to be reset every time you switch to a new plan.

If a Medicare Advantage plan does not seem feasible given these constraints, you also could use the upcoming Medicare annual open enrollment period to switch to original Medicare (Parts A and B) plus a stand-alone Part D drug plan. You also should explore whether you can get a Medigap plan to close any coverage gaps in original Medicare. If you’re interested in Medigap, you should use Medicare’s Medigap tool to identify the best policies for you available at your current legal address. Then contact the insurers to see if they will sell to you and what their terms would be. Newcomers to Medicare have guaranteed access rights to Medigap policies on favorable terms. But people already on Medicare may not have these right, so you should check first. Open enrollment runs from Oct. 15 through Dec. 7. Good luck!

RECOMMENDED READING

Snapshot of Where Hillary Clinton and Donald Trump Stand on Seven Health Care Issues

Older and disabled Americans have a lot at stake in the upcoming Presidential election. Trying to get an impartial assessment of the issues is hard. The Kaiser Family Foundation certainly is biased to the extent it generally supports more health benefits for people. But its arguments are fact-based and very useful. (Source: Kaiser Family Foundation.)

Social Security Should Give Seniors Better Advice About When to Start Benefits

When Larry Kotlikoff, Paul Solman and I wrote our Social Security book last year, we often felt we had walked out onto a very long pier. Readers kept telling us about all the problems and mistakes they were encountering in their efforts to get the Social Security benefits to which they were entitled. But the Social Security Administration kept saying that it was doing a wonderful job, that its websites were winning awards for transparency and effective consumer communications and that its approval ratings were off the charts. Now, according to a recent report from the Government Accountability Office, it turns out that we have a whole lot of company on that pier. The Social Security Administration and its employees are not doing a particularly good job of helping people or of telling them about their benefit choices, the Government Accountability Office found. (Source: Mark Miller for Reuters.)

The Doctor Is In. In Your House, That Is.

Rising numbers of older Americans are “aging in place” — staying in their homes well into their later years. People always have preferred to stay in their homes as they age, and advances in “telehealth” and related technologies promise to deliver good and cost-effective care in the home. The trend is also being supported by the rise of age-friendly home design and retrofits, such as safer bathrooms and wheelchair accessible homes and rooms. Now, the push is on for Medicare to ease its restrictions and expand its coverage of in-home care. (Source: John Wasik for The New York Times.)

The post How do the Affordable Care Act and Medicare interact? appeared first on PBS NewsHour.

105-year-old Japanese Hidekichi Miyazaki poses like Jamaica’s Usain Bolt in front of an electric board showing his 100-metre record time of 42.22 seconds at an athletic field in Kyoto, Japan, in this photo taken September 23, 2015. Japanese centenarian Hidekichi Miyazaki set a record as the world’s oldest competitive sprinter a day after turning 105. Photo by Kyodo/REUTERS

Humans have squeezed almost as much they can out of their natural lifespans and are approaching the biological limit of how long they can extend their years.

So suggests a paper published Wednesday in Nature that argues that the human lifespan appears to be fixed. By analyzing demographic data, the authors write that the number of years any one human can live has a natural cap and is restricted by all the biological time bombs that can take us down.

Even if scientists are able to slow some aspects of aging, they say, there are plenty more that can kill us.

“There’s no doubt that these intrinsic aging processes, they limit our lifespan,” said Jan Vijg, an author of the paper and a genetics and aging researcher at Albert Einstein College of Medicine in New York. “There are so many genetic variants that could have a bad effect on you when you’re old. What are you going to do? Develop a drug for all of them?”

The record for longest known lifespan went to a Frenchwoman named Jeanne Calment, who died in 1997 at 122. Based on the analysis, the authors found that the global population would need to be 10,000 times bigger for someone to have a chance of reaching 126 years old in a given year.

The paper will likely fuel the debate over the value of aging research and whether limited funding should be devoted to trying to study something as nebulous as longevity.

“There are some people interested and excited about longevity research, and there are a lot of people who think it’s something we shouldn’t be doing,” said Coleen Murphy, an aging researcher at Princeton who was not involved in the new paper. She said she hoped the takeaway from the paper wouldn’t be the latter.

The hope that we can extend our lifespans comes in part from studies showing it is possible to extend the lifespans of some species. In 1993, for example, researchers discovered a mutation that doubled the lifespan of a worm. Other longevity genes have been found in groups of people who are more likely to live longer than others.

Even though Vijg doubts longevity research will help people live to 130, he said it could uncover treatments for conditions that afflict people in their 60s. He said such work could help more people live better and longer lives generally — a point echoed by aging researchers in defense of their work.

Jeanne Calment, who died in 1997 at 122, lived longer than any person in recorded history. Jean-Paul Pelisser/REUTERS/

Inspired by the buzz around longevity research, a number of companies seeking to delay aging have sprung up in recent years, including Calico (launched by Google) and Craig Venter’s Human Longevity. Major pharmaceutical companies including Novartis and GlaxoSmithKline have also pursued antiaging treatments.

For their analysis, Vijg and his coauthors — Xiao Dong and Brandon Milholland, also of Einstein — looked at data from about 40 countries in the Human Mortality Database, a joint project of the University of California, Berkeley, and the Max Planck Institute for Demographic Research in Rostock, Germany.

They found that while life expectancy — how long people can anticipate living — surged over the past century in developed countries, the rate of change drops after people hit old age. This, the authors write, “points towards diminishing gains in reduction of late-life mortality and a possible limit to human lifespan.”

Looking at the same data, the researchers found that year-to-year survival improvements — the idea being that if you were born in 1960, you could expect to live longer than someone born in 1959 — hit a plateau around 1980 and have remained fairly flat since then. Someone born in 2000 might not expect to live longer than someone born in 1999.

READ MORE: Can a worm’s lifespan hold the secrets to human aging?

The authors also examined the maximum age of death each year of people in Japan, France, the United Kingdom, and the United States — the countries with the most supercentenarians (people who live to 110). Although the researchers acknowledge they had only limited data, they found the maximum age rose until the mid-1990s and has since declined slightly.

In a separate editorial published in Nature Wednesday, another researcher echoed the findings of the paper, saying that biological underpinnings of aging set different species’ average lifespans. If that’s the case, he said, then “why would anyone think that people could live for much longer than we do now?”

“The crucial question is how much more survival time can be gained through medical technology,” wrote Jay Olshansky of the University of Illinois at Chicago. “With fixed life-history traits, it would seem that we are running up against a formidable barrier.”

Other researchers not involved with the paper said the analysis relied on the best available data, but that it underestimates the potential of scientific discovery.

Murphy said she agreed that there were natural limits to lifespans, but that unnatural limits could exist as well. “It’s not like we’ve tested every drug,” she said.

READ MORE: Can we ‘cure’ aging? Scientists disagree

In a way, researchers say, it can be hard to imagine an area that exists beyond a supposed limit until someone discovers the way to push past it. Before the discovery of antibiotics, many people would have found it impossible to believe people could live as long and as healthily as we do now.

“We don’t know yet what the impact will be of new pharmaceuticals, new technologies,” said David Sinclair, an aging researcher at Harvard Medical School. “The past doesn’t predict the future when it comes to technology.”

Sinclair — who helped start the longevity company CohBar, among other companies — said that discovering the body’s natural repair pathways and rejuvenating them to work like they did when they were younger could change not only how long people live, but how well they live.

“The goal of this research is not to keep people in the nursing home for longer,” he said. “It’s to keep them out of nursing homes for longer.”

Vijg said he doubts that scientists will discover some sort of master regulator that can affect all the age-related processes and diseases that he says constrain our lifespan. But, he said: “Maybe what I now think is impossible may be possible.”

This article is reproduced with permission from STAT. It was first published on Oct. 6, 2016. Find the original story here.

The post Even with medical advances, humans may not live past 130, study says appeared first on PBS NewsHour.

Sônia Braga stars in “Aquarius,” directed by Kleber Mendonca Filho. Braga plays Clara, a 65-year-old widow and retired music critic, who is the last resident of the Aquarius, one of the few old buildings standing in a rapidly changing seaside Recife neighborhood in Brazil. Clara vows to live in the building until her death, but must fend off developers to preserve her home and her memories.

"Aquarius" opens Friday, October 14th at the Angelika Film Center (18 West Houston Street, b/w Broadway & Mercer).

Social Security announced last week that its annual cost of living adjustment would be a paltry three-tenths of 1 percent in 2017. This small increase is not only unfair to Social Security recipients, but will also trigger an absolute mess with Part B Medicare premiums for the second straight year, writes Making Sen$e columnist Phil Moeller. Photo by Allen J. Schaben/Los Angeles Times via Getty Images

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need in “Ask Phil.” Phil is the author of the new book, “Get What’s Yours for Medicare,” and co-author of “Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security.” Send your questions to Phil.

Social Security announced last week that its annual cost of living adjustment, or COLA, for 2017 would be a paltry three-tenths of 1 percent. That’ s 0.003 percent for readers who are more numerically literate than me. As I explained then, this small increase is unfair to Social Security recipients and will also trigger an absolute mess with Part B Medicare premiums for the second straight year.

READ MORE: Average senior’s Social Security check to increase a measly $4 in 2017

Melinda, from California, wrote me a heartfelt rant and lament about this situation. Because it channels what I think many older Americans are thinking, I want to share it with you and ask you to share it with others, including the you-know-whos in Washington. Melinda asks me in her note about my views of what should be done about this situation. My cup of vitriol certainly does runneth over here. But I’d rather hear from you first about what you think should be done. So please fire up you emails and let me know!

Hi, Mr. Moeller. I read your article, and this is why I am bloody mad.

This same thing happened last year. Now I have to worry about this year. I am past full retirement age, but am stalling to collect my Social Security, because it is the only “savings” that is paying 8 percent a year, or so they tell me.

The longer I wait, the bigger the amount of my monthly payment. Since I am facing so many inflationary expenses (property taxes, homeowner’s dues/condo assessments, etc.), I thought I should try to hold out.

The problem is that this darn Medicare Part B is rising, and it’s NOT RIGHT — especially for only 30 percent of the beneficiaries (I’m one of them) STUCK paying for everyone else with ridiculous out-of-control increases. THIS CANNOT STAND and must be fixed, not only for 2017, BUT ENTIRELY.

Last year, I called everyone in WASHINGTON who I thought would get on this right away, and of course, there was NO RESPONSE, other than congresspeople telling me don’t worry, eventually they’ll get to it. That is outrageous. Unacceptable. Things have to change.

What is your opinion on my waiting to collect Social Security (which I was planning on doing 12 to 15 months from now? (I would get about $1,500 to $1,600 extra a year). Right now, I have NO income. I am only living off of some savings that are at almost 0 percent interest.

This whole situation is KILLING SENIORS. I can’t believe that no one in the government is doing anything to help seniors other than make their lives miserable and actually try to kill them off. It’s disgraceful.

I would love your thoughts on this situation and anything you can tell me about it. Why do they take so long to decide until the last day of the year, making it impossible for people to plan their lives, budgets and financial plans?

Please let me know how you feel about Melinda’s take on the COLA and how it is affecting Medicare premiums.

As long as we’re in the neighborhood of dubious government rules, I’ve got another one to share. This doozy is about Medicare and involves an ill-named program called “seamless conversion.” Under this program, the government has the option of empowering private Medicare Advantage insurers to automatically enroll you in one of their plans, possibly without your knowledge and certainly without your approval. Fortunately, this program does not appear to be heavily used these days. But a bad idea is still a bad idea, and I wrote words to this effect last June.

READ MORE: Beware of being automatically enrolled in a Medicare plan you don’t want

Well, Medicare rarely comes right out and says it goofed. But late last Friday — the preferred time for organizations to issue unfavorable, embarrassing news — Medicare said it would temporarily suspend allowing any new insurers to use the program. Further, in a belated transparency move, it released information identifying the 29 Medicare Advantage insurers and their 59 different insurance plans that have been approved to engage in such conversions. Please review this list if you believe you’ve been subjected to this tactic.

“CMS is reviewing its policies for the optional seamless enrollment mechanism in light of recent inquiries regarding the mechanism, its use by [Medicare Advantage] organizations, and the beneficiary protections currently in place,” the agency said in its public announcement. It also noted that it doesn’t know how many such conversations have actually occurred! Lacking this information, the decision to suspend new participants reflects at least some ugly optics surrounding the program if not outright consumer abuses.

And now, what would an Ask Phil be like without some actual Ask Phil items?

Susan: My husband (age 73) has Humana Advantage coverage in the U.S. We will be residing in Hong Kong for a number of months, and he will need to have follow-up testing to monitor for kidney function (kidney recently removed) and cancer screening. Hopefully, these are only tests (not treatment). Please advise if there is a Medicare plan that will work for him as it is now time to reevaluate his options.

Phil Moeller: Medicare generally does not cover medical care outside the U.S. There are some Medigap policies that cover foreign care outside the U.S., but they cover only emergency treatment and not the kind of medical testing you mention in your note.

READ MORE: Are you prepared for Medicare open enrollment?

I am not sure how expensive these tests will be or what other health expenses both of you might incur. If it were me, I’d explore getting in-country health coverage and just continue to pay the Humana premiums while I was away.

I realize this is hardly a low-cost solution, and I’ve railed against Medicare’s non-coverage of care outside the U.S. In many cases, people can get superior and cheaper medical care outside the U.S., and doing so would save money for the Medicare program. As you can imagine, however, U.S. health care providers and insurers are hardly big fans of this!

Julie: I just finished the Medicare book. It is an excellent resource just like “Get What’s Yours” for Social Security. Thank you! My parents are both on Medicare Advantage plans (Kaiser Senior Advantage). It is my understanding that they cannot purchase Medigap policies to help defray additional out-of-pocket costs. If that is the case, what options do they have to help defray additional costs? They won’t qualify for long-term care insurance policies due to preexisting conditions. Any advice you can provide would be greatly appreciated.

Phil Moeller: Thanks for reading our books and for your kind words.

Yes, it is against the law for someone to have both a Medicare Advantage plan and a Medigap plan. Normally, Medigap plans do a better job of protecting a person from out-of-pocket costs than does Medicare Advantage. But it depends on the specific policies involved. Generally, each of them has out-of-pocket safeguards.

READ MORE: What Clinton and Trump propose for Social Security and Medicare

However, neither policy insures against long-term care expenses. Until and unless Congress tackles this problem, the only protection is for your folks to sock away more money in savings against the day when one or both of them will need long-term care. As you may know, if they run out of money, they can go onto Medicaid, which does cover long-term care. However, this is not an outcome anyone should look forward to.

In terms of defraying additional costs, I don’t have any easy fixes. They could explore group living arrangements to lower their current housing costs and also benefit from a broader support structure. They could move in with you (or vice versa) to lower expenses and also provide on-site help. These choices boil down to some form of downsizing that reduces current living expenses and builds up savings. Best of luck.

George: I read your article in the paper on Part A. I will turn 65 in February 2017 and will continue to work for a very large employer with whom I have health coverage. I will not collect Social Security. Am I allowed to sign up for Medicare Part A? Would it be considered supplemental? My wife will turn 68 in January 2017 and is covered under my work plan and does not collect Social Security. Is she allowed to sign up for Part A? Would it be supplemental?

Phil Moeller: You can elect to receive Part A when you turn 65. Because you qualify for Social Security, you don’t need to pay a premium for Part A.

I am not sure what you mean by Part A being supplemental. It can be what’s called “secondary” coverage, helping to pay covered hospital expenses that are not fully paid by your employer insurance. In this case, you would most likely need to pay any of your private insurance deductibles before Part A coverage is available.

Getting Part A makes sense to me unless you have a high deductible health plan with a health savings account. Tax-free contributions to HSAs are not allowed if you are on Medicare, and having Part A is considered being on Medicare.

Lastly, as your spouse, your wife is also eligible for premium-free Part A even if she has not worked enough to qualify for her own retirement benefits from Social Security.

Julie – Minn.: I’m 64 with a high deductible health insurance plan ($3,500 out of pocket plus $600 premiums — plus employer contribution — annually) through my employer and will begin Social Security at age 66 (my full retirement age). Is there a Medicare plan(s) that can mirror my existing coverage for the same amount of money? I’m going to live on a fixed income in retirement and planning for medical costs is a primary concern. Thanks for your help!

Phil Moeller: Great question!

Other than paying $4,100, I don’t really know how your insurance policy pays after that for covered expenses. Does it pay all of them or have a co-pay? Do you have a hard cap on your annual out-of-pocket expenses?

Looking only at the $4,100, I’d think you can find comparable Medicare coverage (but I’d stress again that it depends on details of your current coverage).

READ MORE: Signing up for Medicare? Read this cautionary tale first

The premiums for basic Medicare are $0 for Part A and, for most people, $104.90 a month now for Part B. Your Part B will be more expensive – at least $121.80 a month and possibly as high as $149. Each also has its own annual deductibles and, for Part B, copay requirements. Average premiums for Part D drug plans will be about $42, but that may require a $400 annual deductible and several thousand in potential out-of-pocket costs depending on the drugs you take. You then could get a Medigap plan to plug holes in basic Medicare. These policies easily can cost $200 or more a month, depending on the type of plan you get.

Alternatively, you could get a Medicare Advantage plan that includes basic Medicare, Part D coverage and out-of-pocket protection that can be comparable to a Medigap plan. Again, it will depend on the specifics of the policies. You normally have to pay the Part B premium in addition to a Medicare Advantage premium. Still, these plans usually are less expensive than having basic Medicare, Part D and Medigap.

There can be downsides to Medicare Advantage. These plans usually require enrollees to use doctors and hospitals in the plan’s provider network. These limitations can make it hard to get care from preferred docs and hospitals, especially if you have a serious health condition where seeing specialists becomes a priority.

The best advice I can provide is to read past Ask Phil Medicare columns that explain these matters in more detail. You can also find these answers in my new book, “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs.”

The post Column: Questionable Social Security and Medicare policies put seniors in a bind appeared first on PBS NewsHour.

The annual Medicare open enrollment period is underway, having begun on Oct. 15 and extending through Dec. 7. For 2017 plans, active shopping may yield the greatest benefits in Medicare Part D prescription drug plans, writes Phil Moeller. Photo by Heidi de Marco/KHN

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need in “Ask Phil.” Phil is the author of the new book, “Get What’s Yours for Medicare,” and co-author of “Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security.” Send your questions to Phil.

The annual Medicare open enrollment period is underway, having begun on Oct. 15 and extending through Dec. 7. During this period, you can shop for new Medicare policies and even switch from Original Medicare (Parts A and B) to a Medicare Advantage plan or vice versa. Most people don’t change plans, despite studies that repeatedly find they could save money and improve their coverage by doing so. Doing nothing here means you actually are doing something — automatically re-enrolling in your current plan.

For 2017 plans, active shopping may yield the greatest benefits in Medicare Part D prescription drug plans. Every day seems to bring another horror story of some pharmaceutical company cynically jacking up prices, not because of underlying business conditions, but simply because they can. Medicare officials, who are legally barred from negotiating drug prices, can do little here but continue approving claims for what often are outrageously overpriced drugs.

Part D premiums will be 9 percent higher in 2017 than in 2016, the Kaiser Family Foundation reported, and will average more than $42 a month. This is on top of the 13 percent jump in average premiums this year. These figures are for stand-alone Part D plans, which are the choice of about 60 percent of roughly 41 million Part D enrollees. The other 40 percent have Part D plans as part of their Medicare Advantage plans. I’ll be covering those plans in a couple of weeks.

(Geek alert: Kaiser’s averages and those in other Part D analyses are weighted to reflect the numbers of enrollees in different plans. So a plan with 2 million people has double the weight as one with 1 million participants.)

READ MORE: Signing up for Medicare? Read this cautionary tale first

There also will be fewer plans than in past years, continuing a consolidation trend that I think is healthy. There simply have been too many plans for consumers to feel at all capable of making informed decisions. CMS is encouraging plans to consolidate or even leave the market and is trying to focus attention on quality plans that receive the agency’s highest star ratings.

Even with fewer plans, most consumers will continue to have plenty of plans to choose from.  While there are lots of plans, there are not lots of insurers. Kaiser says four insurers control 80 percent of this market: Humana and United Healthcare, 24 percent each; Aetna, 22 percent; and WellCare, 10 percent.

Many Part D beneficiaries qualify for low-income subsidy benchmark plans that charge zero monthly premiums. The numbers of such plans offered by insurers is also decreasing. This means that millions of Plan D enrollees will need to find new plans for 2017.

There are great variations within this $42 average premium, so it’s essential to look at actual premiums for plans available in the ZIP code where you live. Beyond premiums, of course, you will also need to understand other key costs in Part D plans.

Rising prices have caused Medicare to raise the maximum allowable deductible for Part D plans to $400 from $360 this year (and $320 last year). This is the amount of money you must pay before you get any insurance coverage at all. In past years, lots of plans charged annual deductibles that were lower than the allowed maximum. Fewer and fewer are doing so now.

Once you have paid your drug plan’s annual deductible, Part D rules will cover you until you and your plan have spent $3,700 on covered drugs in 2017. Then, a so-called coverage gap kicks in and strips you of all insurance until total out-of-pocket spending hits $4,950. While in the gap, also known as the donut hole, you will pay 40 percent of the cost of brand-name drugs and 51 percent of the cost of generic drugs. However, 95 percent of the costs of brand name drugs will apply to the total spending in determining when you reach the end of the gap. For generics, it’s only the 51 percent of the cost that you paid.

READ MORE: Column: Questionable Social Security and Medicare policies put seniors in a bind

Under terms of the Affordable Care Act, the donut hole will disappear by the year 2020, at which time your copay for all drugs — branded and generics — will never be more than 25 percent. However, don’t assume this means you will be paying 25 percent as your share for each and every drug you take. This figure is what’s called, in Medicare-speak, an actuarial average. Some plans may charge you 40 or even 50 percent of the cost of a drug. However, they must also provide a commensurate offering of drugs with little or no co-pays. They can do this so long as their actuarial average is about 25 percent.

When total costs have reached $4,950, you will enter the catastrophic phase of plan coverage and will pay only a few dollars for each prescription or 5 percent of the cost, whichever is greater.

How to shop for a Part D plan

As I said in an earlier column, you should already have received annual documents from your Medicare drug insurer explaining any important changes in your plan for 2017. Here’s what to look for:

How will your overall costs change next year?

Go online to Medicare’s Plan Finder, put in your ZIP code and see what drug plans are offered where you live. Many of these plans will be included in Medicare Advantage plans. For now, just look at the drug part of those Medicare Advantage plans.

READ MORE: Get ready for big changes in Medicare drug pricing

You can get a rough idea of comparative plan costs for next year by looking at Plan Finder summaries for each drug plan. However, these summaries do not reflect your specific prescription drug needs and costs. Enter your drugs in the Plan Finder formulary section. This will take a little time, and most likely you will need to round up your prescription bottles and refer to them. The good news is that once you have completed your personal formulary, you don’t need to do it again. It will be stored at Plan Finder and accessible via a password, allowing you to easily compare different plans.

Doing this detailed comparison should give you a good idea of your annual out-of-pocket costs for different plans. This is the number you need to know to really compare plans. Just looking at monthly premiums is not enough and could lead you to make the wrong decision.

Are all your prescription drugs still included in your plan formulary (the list of prescription medicines covered by the plan)?

It’s essential to find out if your drugs are still in your current plan’s formulary in 2017. Insurers and pharmacy benefit managers are permitted to negotiate with drug companies on prices, so a drug may not have the same cost to you in different plans. Another way to combat high prices is to simply drop an expensive drug. This is also more likely to happen in 2017 plans. Medicare rules require plans to offer therapeutically equivalent drugs in key categories, so plans may argue that they can drop your drug and move you to a cheaper equivalent. Your prescribing physician has a strong voice here, so make sure your doctors accept any such changes. If not, you may be able to continue to get your preferred medication.

If you take any expensive medications, how will they be treated?

This information should be included in plan formularies as well. Look to see whether the plan is charging you significantly more for these drugs in 2017 than 2016 — either through direct increases or by moving the drug from one plan pricing group, or tier, into a more expensive one. Most plans have five tiers — preferred and other generics, preferred and other brand drugs and specialty medications (aka the ones that break your bank if not your financial back).

READ MORE: Are you prepared for Medicare open enrollment?

Even if you see an out-of-pocket total for a drug plan, this is probably not your worst-case financial hit. Under Part D rules, as explained above, you are still on the hook for up to 5 percent of the cost of a drug in the so-called catastrophic section of plan coverage rules. With some drugs costing $100,000 a year or even more, 5 percent can still be a lot of money.

Can you still get your prescriptions filled at your local pharmacy, and at what price?

Nearly all Part D plans now have preferred pharmacy networks. Filling your prescriptions with your plan’s preferred pharmacy provider will save you money, especially on mail-order prescriptions. Even if you can fill a prescription at a non-preferred pharmacy, you may end up paying a higher price. While the plans do publish enormous pharmacy directories, the easiest thing for you to do is call your preferred pharmacy and make sure it is still in the preferred network of your current plan for whichever plans you might be considering switching to during open enrollment.

Are your prescriptions written by a Medicare-enrolled provider?

A new Medicare rule took effect this year that denies Part D coverage for prescriptions that are not written by a provider who is enrolled in Medicare (most are) or has a formal exception from the agency. While this is not likely to trip you up with a physician’s prescription, dentists and other professionals can write prescriptions, and they also need to be enrolled. This is a preventable surprise you don’t want to get!

READ MORE: Lower drug prices: Does any candidate have an Rx?

Is your income low enough to qualify for Medicare’s Extra Help program?

Millions of Medicare beneficiaries receive financial assistance from Medicare to pay for their Part D drugs and even their insurance premiums. The Extra Help program can be complicated, so I recommend you get free help by calling a counselor in your state with the State Health Insurance Assistance Program.

Finally, here’s a look at 2017 premium changes in the nation’s most popular stand-alone prescription drug programs (PDP), courtesy of Kaiser. These 10 plans enroll more than 80 percent of all Medicare buyers of stand-alone plans:

*Cigna is banned from selling Part D and Medicare Advantage policies to new customers in 2017 because of Medicare rules violations. Existing customers can renew their Cigna policies.

Lastly, remember that these are averages and that the premiums offered by these plans where you live may differ a lot.

READ MORE: Is there any relief for astronomical drug costs?

Kaiser also has a very useful table in a recent report showing how much money major insurers charge enrollees for drugs in the five tiers of the their plans. You will find it on page 10.

I’ll be shifting to other aspects of open enrollment next week, as well as getting back to answering your questions. Send your questions to me here.

The post Here’s how to find the Medicare Part D drug plan right for you appeared first on PBS NewsHour.

Tens of millions of adults are chronically lonely, which has deleterious impacts on aging. Photo by brunella fratini/via Adobe

A new national campaign rolling out on Wednesday aims to raise awareness of a hidden but devastating complication of aging: loneliness.

Tens of millions of adults are chronically lonely. And a growing body of research has linked that isolation to disability, cognitive decline, and early death.

The first-of-its kind campaign, organized by the AARP Foundation and the National Association of Area Agencies on Aging, aims to help seniors assess their social connectedness and suggest practical ways they can forge bonds with other people.

“This is a public health issue of growing concern,” said Lisa Marsh Ryerson, president of the AARP Foundation.

Addressing stigma will be a priority. “Who wants to admit that, ‘I’m isolated and I’m lonely?’” said Dallas Jamison, a spokeswoman for the National Association of Area Agencies on Aging. “It’s a source of shame and embarrassment.”

Her organization represents 622 agencies across the country that provide meals, transportation, in-home help, and other support to seniors. They’ll take the lead in identifying older adults who are isolated and linking them to resources, in part through the federal government’s Eldercare Locator. The campaign will also encourage families to talk about these issues during the holidays.

READ MORE: Paging Miss Lonelyhearts: Social isolation boosts risk of cardiac disease

These efforts come as research highlights the physical and emotional toll of isolation in later life.

A seminal study of more than 1,600 seniors age 60 and older found that lonely people were far more likely have difficulties with walking, bathing, dressing, and climbing stairs than those who were not. They were also 45 percent more likely to die during the six years that researchers tracked them, from 2002 to 2008.

Some 43 percent of seniors interviewed for that study said they were lonely — a subjective feeling of not being meaningfully connected to other people. Based on a separate analysis, AARP estimates that 42.6 million adults age 45 and older are chronically lonely.

That feeling of isolation sounds an “I’m not safe; all is not well” alarm in seniors, raising blood pressure, sparking inflammation, inspiring stress, and interfering with the immune system’s response.

“If you’re lonely, you feel there aren’t adequate people around to support you and that means you have to surveil your environment continuously for every kind of threat,” said Linda Waite, director of the National Social Life, Health, and Aging Project and a professor of sociology at the University of Chicago.

“This consumes cognitive, physical, and psychological resources,” Waite said, “and makes it harder for you to do other things that might be beneficial to your health.”

READ MORE: How old is too old? A debate on toying with the human life span

Social isolation may mean that you rarely get out of the house and lack a support system of people who will notice when you’re feeling sick, bring over chicken soup, go out and get a decongestant, or take you to the doctor. About one in five seniors reports being isolated, Jamison said.

Still another line of research suggests that loneliness and isolation doubles the risk of Alzheimer’s disease in older adults by inducing changes in the brain that are not yet well understood.

“Humans evolved to live in social groups, and we’re most comfortable when we feel part of a group — more relaxed, happier, with lower blood pressure and cortisol levels,” Waite said.

Along with the coming campaign, the AARP Foundation plans an initiative called Connect2Affect that will highlight research on loneliness and innovative attempts to address the issue.

This article is reproduced with permission from STAT. It was first published on Nov. 16, 2016. Find the original story here.

The post Loneliness harms aging health. This new campaign aims to curb isolation appeared first on PBS NewsHour.

This is a rebroadcast of an interview that originally aired on April 13th, 2016.

Before journalist Lesley Stahl joined 60 Minutes, she became the first woman to serve as CBS News' White House Correspondent. Her coverage of news, political leaders and stories has taken her around the globe. Her latest investigation looks into the science of grandparenting. In Becoming Grandma: The Joys and the Science of the New Grandparenting Stahl reflects on her own experiences as a grandmother, and interviews friends and experts to understand how grandmotherhood affects women. 

Journalist Philip Moeller shares tips from his latest book, Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs. "Sporkful" podcast host Dan Pashman gets an inside look at the economics and shady dealings of the truffle business. "Gilmore Girls" star Lauren Graham on her new collection of personal essays, Talking as Fast as I Can: From Gilmore Girls to Gilmore Girls (and Everything in Between). How "Office Christmas Party" directors Josh Gordon and Will Speck mange their dual careers in advertising and filmmaking.

Philip Moeller, who writes the "Making Sen$e" Medicare column for the PBS NewsHour website and reports on aging, health and retirement for Money magazine, shares advice from his latest book, Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs, part of his “Get What’s Yours” series.  Moeller explains how to select the right Medicare plan and offers retirees ways to maximize their health coverage and save money in the process.

Photo by MoMo Productions via Getty Images

Aging is generally associated with improvements in our quality of life: We become more proficient in our work, learn how to manage our finances better and our bonds with loved ones deepen. With time and practice, most of the core domains of our lives improve as we develop skills and strategies to manage our lives with more mastery. An exception to this pattern is the quality of our sex lives, which has consistently been reported to deteriorate with age.

While this fits with the messages we receive from popular culture, which tell us that sex is a young person’s domain, it is somewhat at odds with the fact that older adults continue to explore and enjoy sexuality well into old age. The majority of men and women over 60 in the U.S. are sexually active, most at least two to three times per month (more often than many younger adults). They also rate sex as an important part of life.

So, if there is no epidemic of age-related frigidity, why would sexual quality of life take a nosedive in later life? A common answer to this question cites declining physical health and sexual functioning with age. Another answer might be: The quality of our sex lives doesn’t decline with age.

Studying sex and aging

There is a key element missing from nearly all studies of sex and aging: studying change over time. If we ask a group of people how satisfied they are with their sex life, and the younger people are more satisfied than the older people, does that mean that aging is responsible for this difference? What if instead the apparent age difference is because people born in the 1930s have different attitudes toward sex than people who grew up after the sexual revolution of the ‘60’s and ‘70’s?

To get to the bottom of how aging affects sexual quality of life, we analyzed patterns in longitudinal data collected from over 6,000 individuals followed over a period of 18 years, spanning ages 20-93. In 1995, 2004 and 2013, the representative sample of English-speaking Americans completed extensive self-administered survey questionnaires in private and returned them by mail.

A key question for our study was: How would you rate the sexual aspects of your life these days, from the worst possible situation (0) to the best possible situation (10)?

The basic trends in the data suggested that – without taking any other factors into account – sexual quality of life declines with age. But as people in the study aged, they placed more emphasis on the quality – not quantity – of sexual encounters. For example, frequency of sex became less important with age, and the amount of thought and effort invested in sex became more important.

These changing priorities were key predictors of sexual quality of life for older adults, and appeared to buffer its decline. When we matched older and younger adults on key characteristics of their sex lives – along with sociodemographic characteristics, and mental and physical health – older adults actually had better sexual quality of life.

For example, if we compared a 40-year-old man and a 50-year-old man with the same levels of perceived control over their sex life, who invest the same amount of thought and effort in their sex life, have sex with the same frequency and had the same number of sexual partners in the past year, we would expect the 50-year-old to report better sexual quality of life.

This is consistent with the improvement we see in other life domains with age, and highlights the benefits of life experience for sexuality as people learn more about their sexual preferences and their partners’ likes and dislikes. The positive relationship between sexual quality of life and aging was strongest in the context of good-quality romantic relationships, where sexual exploration and a focus on partners’ pleasure is more likely to take place.

Life experience related to a better sex life

Together these findings suggest that as we age, our sexual priorities change and we develop knowledge, skills and preferences that protect against aging-related declines in sexual quality of life. Since wisdom is “the quality of having experience, knowledge and good judgment,” our study suggests that life experience is fostering sexual wisdom.

This is great news, as a satisfying sex life has been found to be important for health and well-being, regardless of age. For older adults in particular, being sexually active predicts a longer and healthier life.

We now know that age-related declines in sexual quality of life are largely related to modifiable factors, so we can target sexual skills, beliefs and attitudes in clinical interventions. Given that our life expectancy continues to grow, this research highlights the opportunity to facilitate positive sexual experiences across the lifespan.

Miri Forbes, Postdoctoral Research Fellow in Psychiatry and Psychology, University of Minnesota; Nicholas Eaton, Assistant Professor, Clinical Psychology, Stony Brook University (The State University of New York), and Robert Krueger, Professor of Psychology, University of Minnesota

This article was originally published on The Conversation. Read the original article.

The post Column: Why age doesn’t get in the way of good sex appeared first on PBS NewsHour.