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Four Generations Struggle With Aging in Cathleen Schine's New Novel

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86-year-old Joy Bergman is struggling to keep her life under control. She’s single-handedly caring for her husband who’s suffering from Alzheimer’s – plus she’s trying to hang onto her job as a museum conservator despite her bewilderment with modern technology – and, above all, she’s hiding the severity of her problems so that her adult children won’t worry about her – or worse – try to take control. Joy is the heroine of the 10th novel by Cathleen Schine, They May Not Mean To, But They Do

Event: Cathleen Schine will be giving a reading at the Barnes and Nobles, Upper West Side (82nd & Broadway) at 7:00 p.m. She will also be in conversation with Meg Wolitzer.


Why Aging is Crucial to Our Survival

Sobering IMF report on U.S. economy cites dwindling middle class, growing income equality

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Photo by Flickr user melfoody.

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JUDY WOODRUFF: The American middle class is shrinking and struggling. The six-year-long economic recovery is showing some signs of slowing. And the pronounced wealth divide in the U.S. may get worse without bigger steps.

That warning was part of a new report issued today about the U.S. economy by the International Monetary Fund.

I sat down with its managing director, Christine Lagarde, at IMF headquarters here in Washington earlier today to hear more of her concerns about what’s happening to the middle class and the poor, and what could be done about it.

Managing Director Christine Lagarde, thank you for talking with us.

CHRISTINE LAGARDE, Managing Director, International Monetary Fund: Pleasure.

JUDY WOODRUFF: So, this latest report from the IMF looks at the American economy, says it is in good shape overall, shows resiliency, but then it goes on to point out a number of factors that provide concern for the future.

And one of them has to do with the shrinkage of the American middle class. What do you and your colleagues see, and what concerns you?

CHRISTINE LAGARDE: We are seeing a shrinking of the middle class.

If you look at the size of the middle class in 1975, it was roughly 60 percent of total population. If you look at the middle class today, it is about 50 percent. So, that’s a significant decline of the middle class. And it is an economic issue, because the middle class has always been the consumption force of this nation.

The upper class doesn’t spend as much. The lower class doesn’t have as much to spend. So, the maximum impact in terms of consumption is generated by the middle class.

JUDY WOODRUFF: What’s happening here? You also write in the report your concern about the so-called labor force participation rate, the number of people who are actually working.

And we know that there is concern about the number of men and women who are able to find a job. What do you see there?

CHRISTINE LAGARDE: What we are seeing is something that affects us all, which is aging.

The U.S. population is aging, like in other economies of the world, and, as a result, the participation of active workers in the economy is declining. Now, we cannot stop the course of time, but what policies can do is encourage people who are not joining the workplace, the job market, to actually do so.

And I would point to a couple of policies. One is support given to women. And, by that, I mean maternity leave policy that would help them face the decision of, do I stay or do I go? Second, child care support, and not just child actually, but the kind of support that would help families look after a child or look after an elderly, because, with aging, we will have to support more parents or grandparents.

JUDY WOODRUFF: And you’re describing a real squeeze on the middle class in this country.

CHRISTINE LAGARDE: Yes, there is that squeeze. And that’s where you head in the directions of people feeling insecure, people not wanting to move from one job to the other, people not spending as much as they would otherwise do.

Those behaviors, those decisions have an economic impact on our growth.

JUDY WOODRUFF: Help us understand, what’s the connection with the overall economy?

CHRISTINE LAGARDE: Well, the major engine for growth in this country and in quite a few advanced economies as well is typically consumption.

When the U.S. consumer consumes, there is demand, more demand, and, therefore, the U.S. manufacturers must manufacture more. If they have to manufacture more, they have to create more jobs. It’s a fairly simple virtuous circle that is generally initiated by consumption.

JUDY WOODRUFF: A number of remedies you lay out would cost money. They would require action by the Congress at a time when this country is very politically polarized. How realistic do you think your recommendations are at a time like this?

CHRISTINE LAGARDE: I see one area where there is some agreement.

And that’s on the Earned Income Tax Credit, which, if combined with the minimum wage increase, would certainly bring people up and would boost consumption. So, on the Earned Income Tax Credit, there seems to be common ground.

I hope we can find many of those small-ticket items which will push the envelope further and increase growth in the U.S.

JUDY WOODRUFF: And if these remedies that you lay out are not enacted, what’s your concern for the future of the economy?

CHRISTINE LAGARDE: You know, if those issues such as low participation in the labor force, increased poverty, reduced productivity and polarization in terms of income are not addressed, then the U.S. economy will face what I have called this new mediocre, where potential growth is lower, there is growth, there is a degree of recovery, but not sufficiently to bring people out of those poverty levels that we talked about, not enough to increase the middle class, and not enough to address the unemployment of those who are still looking for jobs.

But those forces, poverty, participation, productivity, and polarization of income, are there to stay unless they are addressed.

JUDY WOODRUFF: Finally, a different question.

Voters go to the polls tomorrow in Great Britain to say one way or another whether their country should leave the European Union. You have been clear. You have made public statements about how you think this, if it happens, would be harmful to Great Britain, to other parts of the world.

How do you see the effect on the United States if there is a vote to leave, Brexit, to leave the European Union?

CHRISTINE LAGARDE: Well, if the U.K. decided to leave the European Union, there would be some effect on the U.S. economy. How big that effect would be, difficult to say.

There are two channels of communication of uncertainty and lack of demand. One is through trade, less trade between the U.S. and the U.K. most likely. But it’s not a huge volume. So that impact would be relatively low.

However, on the financial front, because of the role played by London as a financial center, because of the potential impact on volatility, on the anxiety of people who then sort of fly to — fly their money to safe havens, then there could be a significant impact on the U.S. economy.

JUDY WOODRUFF: So, Americans should be watching closely?

CHRISTINE LAGARDE: I think we should all be watching closely, yes. And I hope the right decision is made, but it’s for the U.K. people to decide.

JUDY WOODRUFF: Christine Lagarde, the managing director of the IMF, thank you very much.

CHRISTINE LAGARDE: Thank you, Judy.

The post Sobering IMF report on U.S. economy cites dwindling middle class, growing income equality appeared first on PBS NewsHour.

Is there any relief for astronomical drug costs?

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Credit: Flickr user ep_jhu

Medicare is prevented by law from negotiating with drug companies over their prices. In recent years, the price tag for people who must take expensive new drugs has risen at an alarming rate, writes aging expert Phil Moeller. Credit: Flickr user ep_jhu

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.


Marcy – Ill.: Is there anything I can do about prohibitively expensive medications I will need to take for the rest of my life?  I take three medicines with no generic alternative. My doctor told me that they were “covered” by Medicare. Now, I’ve come to find out that even on the most comprehensive and expensive drug plans, I will pay more than $1,000 a month just for the drugs, not for the premiums or any other Medicare expenses. I have some resources, but this will deplete them in a few years.  I am not poor enough to qualify for assistance, but soon will be. I know now I should have done more research on what my doctor told me and perhaps worked until I died or was fired, so I could stay on employer insurance, but that bridge is burned, and I surely will never get another job with benefits. Is there any relief for astronomical drug costs?

“I will pay more than $1,000 a month just for the drugs… I have some resources, but this will deplete them in a few years.”

Phil Moeller: Marcy, I’m so sorry to learn that you have been victim of another of Medicare’s major gotchas. Medicare is prevented by law from negotiating with drug companies over their prices. This was a pro-business feature of the 2003 law that created Medicare’s Part D prescription drug insurance program. We have been paying for it ever since, and the price tag has risen at an alarming rate in recent years for people who must take expensive new drugs. Miracles or not, they can devastate personal and family finances. Even the prices of some generics have soared.

READ MORE: Medicare’s catastrophic drug insurance can be a catastrophe for consumers

Having said this, I wonder if you’ve factored in the effect of Part D’s coverage of drugs in the so-called “catastrophic” tier of the program? Once you and your Medicare insurer have paid a total of $3,310 for drugs this year, you will enter the so-called donut hole and will need to shoulder a greater share of drug expenses until your out-of-pocket spending has hit $4,850. At this point, you will have entered the catastrophic tier of your coverage. In this tier, you need to pay only a few dollars for each prescription or 5 percent, whichever amount is greater. Now, 5 percent of a big number can still be a hefty amount. But I doubt that it will total $1,000 a month.

Medicare is prevented by law from negotiating with drug companies over their prices.

If you need help calculating your Part D costs, get in touch with the State Health Insurance Assistance Program or the Medicare Rights Center. Please let me know how things turn out. If your costs are still going to average $1,000 a month, there may be some other private prescription support programs available to you. Let me know, and I’ll provide information about them.


Mary – Ill.: I am turning 66 in August. Several months after I turned 65, I discovered I “had to” file for Medicare Part A at age 65. So I did about six months after I turned 65. But since I was still working and had no plans to retire until I was 66, I continued my health savings account contributions. Now, I find out what I did was illegal, and I am liable for tax fines on the HSA contributions. Our human resources manager never mentioned this conflict, which annoys me. Can I rescind this or fix it? I have since retired, two months prior to reaching my full retirement age of 66. But I have not filed for Social Security or any other part of Medicare. If I can’t rescind or fix this, can my penalty only be for the months after I filed and not retroactive to August 2015? I read you can withdraw from Part A, but also read that that could jeopardize my Medicare and benefits for life. HELP!

Phil Moeller: Mary, you have been ensnared in a nasty Medicare gotcha. First off, there was no requirement that you file for Part A when you turned 65. Whoever told you this was wrong. So long as you have active health insurance from your employer, you did not have to file for any part of Medicare at age 65 (or at any older age, for that matter). Now, I advise folks without an HSA that getting Part A at 65 is a good idea. Anyone with enough earnings to qualify for Social Security (either directly or as a spouse or even former spouse of a qualified person) can get Part A without paying any premium. Should they need hospital care, which is what Part A covers, some expenses their private health insurance does not fully cover can be picked up by Part A. It thus can help and should never cost the person more money than not having the coverage.

So long as you have active health insurance from your employer, you did not have to file for any part of Medicare at age 65.

However, as prior Ask Phil pieces have explained, having Part A is regarded as being on Medicare, and folks on Medicare are disqualified from participating in a tax-favored HSA plan. Continuing to make such contributions is, as you note, not only disallowed, but can also expose you to tax penalties. In fact, in a rule only a crystal ball seer could love, you must stop such contributions six months before your HSA eligibility expires!

In theory, you could rescind your Part A election and continue participating in the HSA. But since you have retired, I fear getting the timing right would be a nightmare. You would need to suspend Part A up to but no later than your effective Medicare coverage date. You have several months to enroll in Medicare following your retirement and the end of your employer health insurance. But timing this too closely risks having no health insurance at all for a short period, so I think people should enroll in Medicare as soon as they need to and not risk exposing themselves to an uninsured health event.

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

I’d call a Medicare counselor, at the State Health Insurance Assistance Program or the Medicare Rights Center. See if someone can help you. However, while I believe you have the right to avoid an IRS penalty here, I’m afraid that in the real world you might be better off just paying the penalty and moving on. I know. I’m never supposed to admit defeat and should always argue that consumers need to stand up for their rights. Sadly, you are dealing with Social Security, Medicare and the IRS here. Don Quixote’s task was simple by comparison. Good luck, and please let me know how you fare.


Anonymous – Fla.: I live on my Social Security retirement income and am now getting $555 a month. That’s the only income I have. My medical coverage now is through the city of Jacksonville, since I live below the poverty level. I get Medicare next year when I reach 65. Will I have to pay anything out of my Social Security payments to Medicare?

Phil Moeller: You should call a SHIP counselor in Florida and find out how Medicare’s lower-income support programs for your area compare with the help you now get from Jacksonville. My first take is that you should not have to pay for Medicare if your only income is that monthly $555 Social Security payment. But you are smart to plan ahead, and counselors should be able to help you.


Sue – Pa.: I am 64 and will be 65 in January. My husband carries medical insurance for us through his work. My husband is 62. Do I have to sign up for Medicare? Would it be advantageous to do so? How would I sign up if I had to? Thank you. This is all very confusing.  My home mailbox is always getting Medicare notices.

You might want to get premium-free Part A of Medicare if his health plan does not include a health savings account.

Phil Moeller: Yes, it certainly can be confusing. When a friend of mine was nearing his 65th birthday, his mail from Medicare insurers literally filed up a grocery bag! Look at my answer above to Mary’s question. You need not sign up for Medicare at 65 if you’re still covered by your husband’s health plan. But you might want to get premium-free Part A of Medicare if his health plan does not include a health savings account.


FOLLOWING UP

Nancy – N.J.: I am a New Jersey SHIP (State Health Insurance Assistance Program) counselor and have encountered basically the same problem as the person you wrote about in “Getting trapped in the regulatory morass of Social Security and Medicare.” Our client collected on her ex-husband’s Social Security record. She switched to her own retirement benefit at age 70 and encountered a changed Medicare number, just as in your earlier example. Usually, Medicare will see both numbers, and there will be no problem. But in this case, Social Security somehow cancelled her previous Medicare coverage. Her Medicare Advantage plan thus has been cancelled and this insurer is trying to recover earlier insured payments that it made to providers. She has been working to solve this mistake for nearly five months, including communications with her Medicare Advantage plan, Medicare, the Social Security Administration and her U.S. senator’s office. They say it will be a while longer before matters can be addressed. I am told only the Social Security Administration can fix this and not Medicare. As a SHIP counselor, I have no standing with the Social Security Administration. Your earlier column asked readers to stay tuned for the next chapter of this situation, so I am staying tuned and wonder if you have any solution or ideas?

READ MORE: Getting trapped in the regulatory morass of Social Security and Medicare

Phil Moeller: Nancy is among an understandably large percentage of the human race that does not read and memorize every word that I write. Imagine that! As it turns out, I did provide an update to this situation in a later column. While I do love to drive up my online traffic numbers, I will save Nancy the trouble of searching for this item, which is reproduced here:

I wrote about a financial adviser whose client and her husband had run afoul of both Social Security and Medicare. The government linked their Social Security numbers and the woman’s effort to file and suspend her Social Security somehow led to her losing her Medicare coverage! As the old Ripley’s “Believe It or Not” stories used to say, we can’t make this stuff up, folks.

Her adviser reports that the women’s situation is being straightened out, but that she is still exposed to nearly a month-long period when she will have no Medicare. Let’s pray she remains in good health until her insurance coverage resumes. In the meantime, a Social Security spokeswoman reports that it is not uncommon for two spouses’ Social Security numbers to become linked. Here is what she writes:

In your message, you state that her Medicare is now under her spouse’s Social Security number (SSN). I can confirm this change occurs when a Medicare only entitlement on a SSN converts to a monthly benefit entitlement on a different SSN. However, the start date of entitlement to the Medicare coverage on the old record does not change when it converts to the new SSN.

Additionally, a new health insurance card is issued when an individual status changes. For the card issuance policy and corroboration, see HI 00901.045: Health Insurance Card – Policy and HI 00901.065: Health Insurance Card Issuance.

I include this explanation in full, because A) Social Security has on occasion quibbled with how its comments are translated, and B) you need to see how clearly the agency explains its own rules.

Of course, this response may not help Nancy or her client. So, I will send this item to the Social Security Administration, along with Nancy’s email address, with a request to please expedite this matter. Nancy, if you hear back from these folks, please let me know how things went for your client.

AND YET ANOTHER REQUEST FOR INFORMED GOVERNANCE

How much healthier and financially better off would the nation be if consumers were more informed about Medicare and equipped with the tools to make better decisions about how to purchase and use it?

The aforementioned SHIP program appears to have once again dodged a wrongheaded effort to kill its $52 million in annual federal spending support. Perhaps SHIP was inadvertently caught in the fiscal crosshairs of conservative lawmakers after bigger game. Whatever its real or perceived sins, however, the program’s retention and even expansion is needed by those older and disabled Americans who must navigate Medicare and its endless gauntlet of complex if not unfathomable rules. SHIP’s funding supports a largely volunteer counseling program that millions of Medicare beneficiaries turn to, often as a last resort, for problems they cannot solve on their own. For now, the program’s annual appropriation appears secure.

I urge and implore congressional leaders to give serious thought to this question: How much healthier and financially better off would the nation be if consumers were more informed about Medicare and equipped with the tools to make better decisions about how to purchase and use it?

The post Is there any relief for astronomical drug costs? appeared first on PBS NewsHour.

How selling a home may affect what you pay for Medicare

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A 'for sale' is seen outside a single family house in Uniondale, New York, U.S., May 23, 2016. REUTERS/Shannon Stapleton - RTSFLBM

Photo by Shannon Stapleton/Reuters

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.


Lauren – Mass.: For the past three years my income has been $30,000. We have a small cottage that we want to sell. We bought it for $135,000, and we’re selling for $230,000 with a capital gain of $20,000. My husband is not on the deed. I will be 64 in October. What happens to my Medicare benefit?

Phil Moeller: Regardless of changes in your future taxable income, nothing would happen to your Medicare benefit. However, it could be another matter when it comes to how much you pay for that benefit. People who must pay Medicare’s premiums for Part B and Part D — and nearly everyone on Medicare does — face high-income surcharges under what’s called the program’s income-related monthly adjustment amount, also known as IRMAA. The surcharges begin kicking in when a couple’s modified adjusted gross income, or MAGI, exceeds $170,000 a year ($85,000 for a single person). There’s a two-year lag between when you earn the money and when it will affect IRMAA charges. Premiums in 2016, for example, are based on 2014 tax returns. If you file for Medicare when you turn 65 in late 2017, for example, your premiums would be based on your 2015 tax return. Now, it doesn’t appear that your home sale would boost your MAGI enough to trigger these surcharges. But if it did, it would not show up until your 2016 tax return, meaning it would not affect your Medicare premiums until 2018. But as I said, it doesn’t look like your taxable income would jump enough to trigger the surcharges for even a single year.


Jackie – S.C.: I have power of attorney for a person whose nursing home bill is $1,350 per month, with medicine costs of another $175. He only draws $1,338 per month in retirement income. He had additional savings that helped cover costs, but those funds are gone and now he faces eviction. Is there anything we can do to help cover his medicine costs?

Phil Moeller: Yes. I am assuming he is dually eligible for Medicaid and Medicare, because your note did not mention anything about Medicare premiums. Medicaid should help with these drug expenses. However, the income figure you provided may be net of his Medicare premiums. If so, Medicare’s Extra Help program might defray some or even all of the costs of his medications. Call a Medicare counselor with the State Health Insurance Assistance Program in South Carolina, and see what can be done.


Wayne – Wash.: I am age 69 and have Medicare Part A coverage. I thought I could cancel Medicare Part A and legally enroll in my employer’s health savings account program, but I found out I could not unenroll in Part A. The HSA started in 2016. My last contribution was in Apr 2016:

Year to date contribution is $6,696.09.

Year to date distribution is $5,294.33.

Current fair market value of the account is $1,402.29.

My question is how do I “zero” out the account? The HSA has suggested the following: I send them $5,294.33 to cover the distributions and do a withdrawal of $6,696.62 ($5,294.33 + $1,402.29). This will in effect set the account to $0.00 and “close” the account.

The other option I can envision is to withdraw the unspent amount of $1,402.29 (which will close the account) and then just pay the taxes and penalties on the contribution of $6,696.09.

Phil Moeller: I don’t know why you can’t unenroll from Part A. Unless you are already receiving Social Security payments, you can unenroll. However, I’ll assume your reasons are valid.

As for the HSA itself, I see no reason why you should repay all the money that’s been distributed from the plan. Most of these dollars came from you, didn’t they? In my view — and I am not claiming to be an expert here — the only dollars you would need to repay would be the ones the company contributed on your behalf. You would also need to pay back the amount of the tax benefits you claimed on the account. Your HSA should have this information.

While you could face an IRS penalty for improperly claiming the tax benefits in the first place, my experience is that if you take care of this within a tax year and have no improper tax deductions on your 2016 tax return, you will escape a penalty.

The unspent funds are supposed to be used for qualifying medical expenses. So simply withdrawing them yourself may be unwise. Odds are that repaying any company contributions and tax benefits would represent an amount close to or even greater than the balance of unspent funds. So, I’d ask the company if it would back out these amounts from your account balance. If there is a remaining balance of your own, post-tax funds, can the company switch these into whatever health plan you’re now using? Also, would it move some if not all of its HSA contributions into your new insurance plan?

Best of luck, and please let me know how all this turns out. If there are other readers who have faced similar problems, please chime in as well. These HSA “gotchas” have been a major problem for lots of folks.


Ellen – Kan.: I will turn 65 soon, but am still working full time, and because of my husband’s sudden death two years ago, I will still need to work for several years. I have good health insurance with my small consulting company employer. Do I have to file for Medicare?

Peter – Va.: I turned 65 in April, but I am still employed full time and have health coverage through my employer. Should I sign up now for Medicare Part A, or should I wait until I retire and/or I lose health converge?

Betty: I am turning 65 in August. I plan to continue working and keep my high-deductible insurance plan through my employer. I contacted my state’s Office on Aging, and the woman I spoke with (perhaps a volunteer) said that I don’t need to do anything until I retire and switch to Medicare. But I read elsewhere that it is necessary to fill out an application indicating “on the back” that I am declining Medicare at this time. I’ve only seen an online application option, so I don’t know whether or how I need to indicate that I don’t want Medicare this year. My concern is that I don’t want to be hit with a penalty later because of a requirement I wasn’t aware of.

Phil Moeller: So long as you have a valid group employer health plan, you do not have to file for Medicare when you turn 65.

However, if you do not have a high-deductible health plan, you might want to enroll in Part A of Medicare, which covers hospital care. Part A charges no premiums to people who have worked enough to qualify for Social Security benefits. It can come in handy to cover some hospital expenses that are not fully paid by your employer health plan. However, Part A invalidates the use of an HSA health plan.

Also, to Ellen, you are eligible for Social Security survivor benefits. I don’t know if you’ve claimed them, but if not, you might want to do so. If they are less than your own retirement benefits would be at age 70, you should file for them right away. If your husband made a lot of money and your survivor benefit will be larger than your own retirement benefit, I would advise you to wait to file for it until it reaches its maximum value when you turn 66.

Ellen’s follow-up: God bless you for getting back to me so quickly and putting my mind at ease. My husband made less than I do, and I was advised not to claim them when he died two years ago. So if I understand you correctly, I can file for them now and not jeopardize the benefits I get from my wages when I retire? Will the IRS take part of his Social Security benefits if I do opt to get them?

Phil’s follow-up: Yes. You can file for them without jeopardizing your own retirement benefits later. Make sure that the person at Social Security you deal with understands that you are electing to claim only your survivor benefit. Depending on your total income, a portion of your Social Security benefits may be taxed.

The post How selling a home may affect what you pay for Medicare appeared first on PBS NewsHour.

Tessa Hadley Reads “Dido's Lament”

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Tessa Hadley reads her story “Dido's Lament,” from the August 8 & 15, 2016, issue of the magazine. Hadley has published six novels and four story collections, including “Sunstroke and Other Stories” and “Married Love.” She won this year’s Windham Campbell Prize for Fiction. She has been publishing fiction in The New Yorker since 2002.

Extending the Human Lifespan Hundreds of Years

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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 LivesShe also looks at the practical and ethical issues which could arise when this technology becomes available.

Teaching in-home caregivers seems to pay off, report says

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Photo by Flickr user Rosie O'Beirne.

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.

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.
The goal of the pilot program was to determine whether educating IHSS caregivers and integrating them into the medical team would improve the health of their patients. The training was conducted by the California Long-Term Care Education Center under a three-year, $11.8 million grant from the federal Centers for Medicare & Medicaid Services. The center, which released the report on the results of the pilot program, worked in conjunction with UCSF.

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.


Why doesn’t Medicare cover more for physical therapy?

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African American woman helping Senior man use walker

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?

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.

Connecting Faith and Public Policy; Making Makeup Safe; Men's Aging and Evolution

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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.

Men's Aging and Evolution

Column: Will increasing longevity change the way you live?

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Senior couple hugging on porch Photo by Paul Bradbury/Getty Images

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.

If you knew you were going to live to 100, how would it affect the way you live your life?

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.

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.

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.

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.”

Without economic resources and options, the prospect of living to 100 is not so much fun.

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.

Medicare won’t cover a procedure I need. Can I get private insurance?

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MIAMI, FL - FEBRUARY 21: Dr. Martha Perez examines Maria Lebron in a room at the Community Health of South Florida, Doris Ison Health Center on February 21, 2013 in Miami, Florida. Florida Governor Rick Scott reversed himself on Wednesday and now is callling for an expansion of Medicaid to Florida residents under the federal Affordable Care Act. (Photo by Joe Raedle/Getty Images)

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.

The Science of Singing

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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. 

Fact-Checking Donald Trump's Philanthropy, Ken Burns on 'Defying the Nazis'

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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?


Life After 60: Confronting Aging with Grace and Humor

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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.

 

How do the Affordable Care Act and Medicare interact?

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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

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.

Even with medical advances, humans may not live past 130, study says

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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

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.

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/

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.

'Aquarius' Explores Brazilian Life in a Changing Neighborhood

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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).

 

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

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John and Mary Benbow, 67, and 68, respectively, of La Jolla, shown holding his finger over his social security number on his Medicare card, work hard to protect themselves from the scourge of identiy theft. They took their first names off their checks, they black out personal information and shred financial documents before putting them in the trash. There's just one area where they feel vulnerable and there's little that they can do about it. They must carry around their Medicare cards, which are emblazoned with their Social Security numbers, which experts say are a skeleton key to an individual's financial life. (Photo by Allen J. Schaben/Los Angeles Times via Getty Images)

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.

Here’s how to find the Medicare Part D drug plan right for you

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Jones can now afford to take antiretroviral drugs to suppress her HIV viral load. “You have to be a hustler for your own health,” she said. (Heidi de Marco/KHN)

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.

Most people don’t change plans, despite studies that repeatedly find they could save money and improve their coverage by doing so.

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.

For 2017 plans, active shopping may yield the greatest benefits in Medicare Part D prescription drug plans.

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:

 Name2016 Enrollment2016 Average Premium Monthly 2017 Average Premium Monthly Percent Change
SilverScript Choice [CVS Health]4.16 million$22.78$29.1228%
AARP MedicareRx Preferred [UnitedHealthcare]3.14 million$60.79$71.6618%
Humana Walmart Rx Plan1.98 million$18.40$16.81-9%
Humana Preferred Rx Plan1.81 million$28.36$27.32-4%
AARP MedicareRx Saver Plus [UnitedHealthcare]1.23 million$33.93$37.3410%
Aetna Medicare Rx Saver1.07 million$25.89$31.3521%
Humana Enhanced0.98 million$66.28$64.23-3%
WellCare Classic0.94 million$31.71$28.96-9%
First Health Part D Value Plus [Aetna]0.75 million$33.85$39.2716%
*Cigna-HealthSpring Rx Secure0.67 million$35.95$27.86-22%

*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.

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Loneliness harms aging health. This new campaign aims to curb isolation

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

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.

Still another line of research suggests that loneliness and isolation doubles the risk of Alzheimer’s disease

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.

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Lesley Stahl on Becoming a Grandmother, Reporting from the White House, and 60 Minutes

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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. 

 

Lauren Graham, Truffles, 'Office Christmas Party'

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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.

Getting the Most Out of Medicare During Turbulent Times

Column: Why age doesn’t get in the way of good sex

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Photo by MoMo Productions via Getty Images

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.

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Growing number of Americans are retiring outside the U.S.

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A foreign resident teaches local children how to draw at the Cultural Arts Center in Ajijic June 9, 2012. For decades, American and Canadian expats have flocked to the shores of Chapala, seeking refuge in the spring-like climate of Mexico's largest natural lake, where English author D.H. Lawrence once came for inspiration. But the calm of the clustered lakeside retreats was shattered in May 2012 when suspected drug-gang hitmen kidnapped a group of Mexican locals and dumped 18 decapitated bodies in two vehicles just miles (kilometres) from the lakeside tourist enclave of Ajijic. Picture taken June 9, 2012. REUTERS/Alejandro Acosta (MEXICO - Tags: CIVIL UNREST CRIME LAW DRUGS SOCIETY EDUCATION TRAVEL) - RTR33SO3

A foreign resident teaches local children how to draw at the Cultural Arts Center in Ajijic June 9, 2012. For decades, American and Canadian expats have flocked to the shores of Chapala, seeking refuge in the spring-like climate of Mexico’s largest natural lake, where English author D.H. Lawrence once came for inspiration. Photo by Alejandro Acosta/Reuters

Newly widowed, Kay McCowen quit her job, sold her house, applied for Social Security and retired to Mexico. It was a move she and her husband, Mel, had discussed before he passed away in 2012.

“I wanted to find a place where I could afford to live off my Social Security,” she said. “The weather here is so perfect, and it’s a beautiful place.”

“I wanted to find a place where I could afford to live off my Social Security.”

She is among a growing number of Americans who are retiring outside the United States. The number grew 17 percent between 2010 and 2015 and is expected to increase over the next 10 years as more baby boomers retire.

Just under 400,000 American retirees are now living abroad, according to the Social Security Administration. The countries they have chosen most often: Canada, Japan, Mexico, Germany and the United Kingdom.

Retirees most often cite the cost of living as the reason for moving elsewhere, said Olivia S. Mitchell, director of the Pension Research Council at the University of Pennsylvania’s Wharton School.

“I think that many people retire when they are in good health and they are interested in stretching their dollars and seeing the world,” Mitchell said.

McCowen’s rent in Ajijic, a community outside Guadalajara near Mexico’s Lake Chapala, is half of what she was paying in Texas. And since the weather is moderate, utility bills are inexpensive.

In some countries, Mitchell said, retirees also may find it less expensive to hire someone to do their laundry, clean, cook and even provide long-term care than in the United States.

McCowen has a community of other American retirees nearby and has adjusted well.

But for others there are hurdles to overcome to adjust to life in a different country.

Viviana Rojas, an associate professor at the University of Texas at San Antonio, says the biggest obstacle is not speaking the language or knowing the culture.

“Many of the people we interviewed said they spoke Spanish, but they actually spoke very little Spanish,” said Rojas, who is writing a book about retirees in Mexico. “They didn’t have the capacity of speaking enough Spanish to meet their basic needs like going to the doctor or to the store.”

Access to health care also can be a challenge. While retirees still can receive Social Security benefits, Medicare is not available to those living abroad, Mitchell said.

Joseph Roginski, 71, says that while the cost of living is higher in Japan, access to health care is not. “Things are very expensive here. It is impossible to live off Social Security alone,” said Roginski, who was stationed in Japan in 1968. “But health insurance is a major factor in staying here.”

The former military language and intelligence specialist said he pays $350 annually to be part of Japan’s national health insurance. His policy covers 70 percent of his costs. The rest is covered by a secondary insurance program for retired military personnel.

Japan experienced the biggest growth of American retirees — at 42 percent — and more than any other country between 2010 and 2014, according to data from the Social Security Administration. The large U.S. military presence in the country may be a factor.

There are more than 50,000 U.S. military servicemen and -women stationed in Japan. The presence is so large that in the island of Okinawa, the U.S. military occupies about 19 percent of the area, according to Ellis S. Krauss, professor emeritus of Japanese politics and policy-making at the University of California, San Diego.

Roginski, who volunteers for the Misawa Air Base Retiree Activities Office, said he helps connect more than 450 retirees and their families living in Northern Japan with resources. He said he would never move back to the United States.

“We have a real strong sense of security here,” he said. “I can leave my door unlocked and no one will take anything. When I go to another country I feel nervous, but when I come back I feel like I’m home.”

Mexico has become home for retired firefighter, Dan Williams, 72, and his wife, Donna, 68. The couple has been living near the same retirement community in Lake Chapala for 14 years.

“The climate and the medical services are very good,” Williams said.

Williams teaches painting to adults and children and puts together a monthly magazine for the local American Legion. He is also a member of the Lake Chapala Society, which offers daily activities for American retirees.

It was those same services that attracted McCowen to the region.

“Before moving, I found out how many widowed and divorced women lived here,” she said. “There is comfort in numbers.”

She says she loves being in a lively community.

“I see older people walking year round. I see them all over the place, even in their wheelchairs. If they were in the U.S., they would probably be in a nursing home,” she said. “I don’t think I could move back.”

___

EDITOR’S NOTE — Maria Ines Zamudio is studying aging and workforce issues as part of a 10-month fellowship at The Associated Press-NORC Center for Public Affairs Research, which joins NORC’s independent research and AP journalism. The fellowship is funded by the Alfred P. Sloan Foundation.

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Can Keeping Our Cells Healthy Lead to a Longer Life?

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Dr. Elizabeth Blackburn, who won the Nobel Prize in Physiology/Medicine in 2009, and Dr. Elissa Epel, a health psychologist who studies stress, aging, and obesity, discuss their book, The Telomere Effect: A Revolutionary Approach to Living Younger, Healthier, Longer. Blackburn discovered a biological indicator called telomerase, the enzyme that replenishes telomeres, which protects our genetic heritage. They explain how we age at a cellular level and how we can make simple changes to keep our chromosomes and cells healthy, allowing us to stay disease-free longer and live more vital lives.

Column: Social Security will reduce paper statements in 2017. Here’s why it shouldn’t

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Mature adult looking at Social Security documents Photo by Jim McGuire/Getty Images

Mature adult looking at Social Security documents Photo by Jim McGuire/Getty Images

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need. 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 Social Security Administration just announced it would curtail sending paper statements to many people in order to save money. This is as bad an idea now as it was the last time the agency did this several years ago. After that move, public pressure caused it to reverse course. Let’s hope something similar happens this time around. I would like to believe the agency is smarter than this, and I’m cynical enough to even wonder if it might have planned this action to draw attention to its continued funding shortfall.

And that certainly is the bigger story here. Congress has continued to refuse to properly fund the agency, causing it to cut back on its services at just the time when record numbers of baby boomers are aging into the program and badly need all the information they can get.

The Social Security Administration just announced it would curtail sending paper statements to many people in order to save money. This is as bad an idea now as it was the last time the agency did this several years ago.

The agency has far fewer employees to serve the public than it did a few years ago. And while online information services can be a great way to save money without compromising customer service, Social Security is too complex and too important to be trusted to a smartphone app.

Social Security statements are the primary status reports that consumers receive from the agency. They show a person’s official wage history, which is the basis for their retirement benefits. They also provide estimates of key Social Security benefits to which a person will be entitled at different claiming agencies. The Social Security Administration provides online versions of these statements, and these certainly are useful to many people. But the paper statement is better, and it’s relatively cheap to provide.

Here’s what the agency said earlier this week: “Paper statements will only be sent to people age 60 and over, who are not getting benefits and don’t have a my Social Security account. This will bring down the costs of processing and mailing paper statements by $11.3 million in FY 2017.”

This is not even a rounding error for an agency that forks over roughly $900 billion a year in benefits and covers more than 170 million workers in this country. Millions of those workers are not able to save nearly enough money to afford even barely adequate retirements. They will depend almost entirely on Social Security benefits for their retirement spending, and they need all the help they can get to understand these benefits and make informed decisions.

Before reading this week’s reader questions, please consider protesting this decision to your U.S. representative and senators.


Mark – Calif.: What was the rationale behind the Windfall Elimination Provision that reduces Social Security pension amounts if one is receiving other public pensions? I’m a school teacher, have worked for a railroad and have enough quarters for Social Security. I worked for all those pensions, yet my Social Security and the railroad pensions are being reduced. My teacher pension isn’t. The total of all these pensions amounts to about half of my full-time pay. I’m grateful I’m getting an income for retirement, yet I don’t believe I’m getting all the benefits that I have earned.

Phil Moeller: No one likes the Windfall Elimination Provision, or WEP. But there is a rationale for it. Here is an abbreviated explanation (a fuller take can be found in our Social Security book, “Get What’s Yours”).

Social Security is, in economic terms, a very progressive program. This means its benefits are skewed to be very generous to low-earning folks. They get a much higher percentage of their wages back in benefits than do people who make more money.

READ MORE: Column: What can we do to protect Medicare and Social Security?

This form of income redistribution is a fundamental part of Social Security. It is accomplished by splitting up a person’s earnings record into three tiers. People get 90 percent of the first tier in their Social Security payment and smaller percentages of the second and third tiers. People with low earnings often don’t even make enough to reach the second or third tier.

No one likes the Windfall Elimination Provision … But there is a rationale for it.

The thinking was that a person with a public pension who has paid some Social Security taxes could be quite well positioned for retirement, but would be seen as a low-wage earner in terms of Social Security’s records. When they applied for Social Security, therefore, they’d get 90 percent of their earnings back in the form of Social Security payments. A person whose entire lifetime wages had been subject to Social Security payroll taxes might also be entitled to a private pension, but their Social Security payments would be fair and fully supported by the payroll taxes they had put into the system.

To deal with this, the WEP takes that 90 percent first-tier benefit calculation and reduces it to 40 percent for people with public pensions that are not tied to Social Security payroll taxes. This penalty begins disappearing when a person has been paying payroll taxes for 30 years and totally disappears at 40 years.

Whether you think it’s fair or foul, that’s the rationale.


Helen – Tex.: I’m so worried about Medicare Part B going up and how I’m going to manage every month. I’m 70. All I have to live on is my Social Security of $862 and a part-time job that brings in less than $400 a month. I’m still paying a mortgage, my vehicle is 10 years old, and I’m just barely able to make it each month after utilities and food. If I start my retirement, which I’m required to do now, how will that affect my Social Security and Medicare? If I quit the part-time job would that keep me from losing any of my Social Security? I don’t know what to do. I lie awake at night worrying about all this.

Social Security and Medicare do protect seniors from poverty, but there often is not much extra to go around.

Phil Moeller: Millions of older Americans are struggling to get by just like you. I know this doesn’t make it any easier to pay the bills, but your problems help explain why these benefits are so important. Social Security and Medicare do protect seniors from poverty, but there often is not much extra to go around.

Medicare has programs to help lower-income people. You can get free Medicare counseling from the State Health Insurance Assistance Program. Call them, and see if they can help. They may ask you about your income and financial situation, so make sure you have those records with you when you call.

READ MORE: Column: Social Security needs to be reformed, not have its funding cut

At your age, your Social Security will not be reduced or, most likely, affected at all by whether you are still working and earning wage income.


Tammy – Calif.: Can Republicans cut Social Security and medical benefits for the disabled? I have a severe condition which doesn’t allow me to ever work again, and I’ve been very stressed and concerned thinking my benefits are going to be cut or privatized. I have been reading online articles that Republicans want to “gut” Social Security and “end Medicare as we know it.” How realistic are these claims?

“Can Republicans cut Social Security and medical benefits for the disabled?”

Phil Moeller: Yes, Congress can change these programs, and I have seen the same stories you have about Social Security, Medicare and Medicaid being on the cutting block, along with the Affordable Care Act.

I can’t tell you not to worry. I can tell you that proposals to change any of these programs will trigger a major congressional battle. The GOP majorities in the House and Senate have a lot of power, but Democrats have promised to resist changes to these programs, and enough Republican senators have voiced reservations to jeopardize the GOP’s 52-48 Senate majority. Further, it’s not yet clear where President-elect Trump actually will stand when rhetoric yields to action. So far, he has only said he supports Social Security and Medicare and doesn’t want to change the programs. He has, of course, promised to end Obamacare. And many of his key appointees support changes to these programs as well.

READ MORE: How plans to repeal the Affordable Care Act could affect Medicare

Once the new president, his appointees and the new Congress take office, we will see if these claims come to pass. I can understand that you are stressed, and you have every right to be. You also have the right to complain to your congressman and senators. People need to stand up and be heard on these matters.


GW – N.C.: I am a vet and have medical coverage, but pay for copays and medicine. Do I have to enroll in Medicare, or is there a different coverage for vets?

Phil Moeller: There is different coverage for vets, but you may still need to enroll in Medicare. I am not clear whether you’re still working or are already retired. You say you already have medical coverage. Do you know who is providing this coverage? If it’s from an employer, and you’re going to keep working, you probably don’t need to change coverage just because you’ve turned 65.

If you already are retired, the major coverage for retired military personnel is called Tricare For Life. And you may also be eligible for Veterans Affairs coverage at its facilities.

Once you’ve determined your eligibility for either or both of these programs, I suggest you speak with their representatives about what they cover and how they work with Medicare. Some vets find VA is fine, and some supplement it with Tricare, which includes a Medicare component. It depends on their health care needs and often on their financial situation.

After you’ve looked into this, please feel free to get back to me with detailed questions.


Kevin: I have read “cover to cover” “Get What’s Yours” and have browsed the internet and attended some seminars that offer cocktails, dinner or whatever to get you into a meeting with a financial adviser. We do have wealth managers helping with investments; they are good at the investing, but weak in knowledge of Social Security. I think we have formulated a plan using the “restricted application” filing. We originally wanted to use “file and suspend,” but that window was closed to us as of last May.

My birthdate is Jan. 27, 1951, and my wife was born April 6, 1952, so we meet the 1954 birthdate test. Our plan:

I will file and suspend Social Security in January 2017, allowing me to reach the maximum payout in January of 2021. My wife will wait until April 2018 and also file and suspend until she turns 69 in 2021 or 70 in 2022. We want her to claim spousal benefits during my wait for 2021. We believe they would total about half of what I would get at my full retirement age of 66. When I start taking my full benefit she can either take her age-69 benefit or wait another year to get the full benefit.

READ MORE: Column: Under a President Trump, Medicare reforms are a matter of when, not if

Does she need to wait until she is 66 to file for spousal benefits? She would still file and suspend at full retirement age. Could she get a spousal benefit when I file and suspend? Is this a solid plan? Do we understand correctly how this could work for us?

Phil Moeller: Your note correctly notes that “file and suspend” is no longer possible for you. But then you later say your plan includes both you and your wife filing and suspending. So I hope you can understand that I am confused about your plans!

The fact is that anyone who had not turned 66 before the end of last April can’t file and suspend.

Therefore, your options are limited. Both of you can wait until age 70 to each receive your respective maximum retirement benefits. Or, one of you can file before this time and thus make the other spouse eligible to file a spousal benefit. In that situation, the second spouse would be able to file a restricted application when they reach full retirement age at 66. They would receive only a spousal benefit and defer their own retirement benefit to age 70, earning four years of delayed retirement credits.

If a restricted filing made sense to you, it would normally be better for the lower-earning spouse to file for their retirement on or after reaching full retirement age. The higher-earning spouse then would file the restricted application, preserving their maximum benefit.

This can be especially important if the higher-earning spouse dies first. In this event, the lower-earning spouse would get a survivor benefit equal to the higher-earning spouse’s age-70 benefit.

Figuring out the best strategy often requires more computational power than I have. My co-author Larry Kotlikoff offers Maximize My Social Security software that will let you run all the scenarios and figure out your best option. You will need to know details of all relevant Social Security benefit projections to get the most from the software.


Jane – Mo.: Once you become eligible for Medicare, it covers 80 percent of the medical bill, and my existing employer plan drops to 20 percent coverage. Why wouldn’t they each pay half? This wouldn’t cost Medicare so much and would not let my private insurer off the hook for paying its fair share of claims. As a retired federal employee, my private insurer premiums didn’t go down when I retired, and now I have to pay Medicare premiums as well. Why are the insurance companies getting away with paying only 20 percent of covered claims?

Phil Moeller: I have heard complaints from other federal retirees who think their federal premium should decline when this insurance moves from being primary to secondary. There also are some federal insurance plans where the person does not have to get Medicare, but can stay fully on their federal plan. I assume this was not possible for your plan.

Part B of Medicare pays only 80 percent of covered expenses when it is the primary insurer. Because of this “hole” in coverage, many people get either a Medigap private insurance policy or a Medicare Advantage plan. These policies can plug that hole.

In cases such as yours, where Medicare becomes the primary insurer and the employer plan moves from being primary to secondary, it’s the employer plan that steps up to fill that 20 percent hole. I do not know if anyone at Medicare has ever considered or proposed a 50-50 split in such situations.


Christopher: Are Part B excess charges the same as balance billing charges, or are these separate phenomena?

Phil Moeller: These terms are related. They often are used interchangeably, but this can be misleading. According to Medicare experts at Aetna, balance billing refers to the amount by which charges by health care providers exceed Medicare-approved payment amounts.

Nearly all providers accept Medicare assignment, meaning they have agreed to accept Medicare-approved charges as payment in full. In this case, balance billing is prohibited by federal law.

However, health care providers who do not accept Medicare assignment but agree to treat Medicare enrollees may engage in balance billing. If they do, these amounts are called excess charges. Here is how Aetna describes them:

While non-participating providers are allowed to balance bill, there is a limit on how much they can balance bill. Federal law sets the limit (known as the ‘limiting charge’) on the amount that the provider may balance bill (some states prohibit or limit balance billing as well). The limiting charge is based upon a percentage of the Medicare approved charge. In most cases, non-participating providers may not charge or balance bill more than 115 percent of the Medicare approved charge.

These excess charges are not covered by basic Medicare, but are covered by two types of Medigap, or Medicare supplement plans: letter F or G plans.

I also have seen balance billing described as the practice of billing patients the difference between what an insurance company would pay for a health procedure and the “retail price” that an uninsured patient would pay for the procedure.

The post Column: Social Security will reduce paper statements in 2017. Here’s why it shouldn’t appeared first on PBS NewsHour.


Care provider directories wrong nearly half the time in Medicare Advantage plan lists

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John and Mary Benbow, 67, and 68, respectively, of La Jolla, shown holding his finger over his social security number on his Medicare card, work hard to protect themselves from the scourge of identiy theft. They took their first names off their checks, they black out personal information and shred financial documents before putting them in the trash. There's just one area where they feel vulnerable and there's little that they can do about it. They must carry around their Medicare cards, which are emblazoned with their Social Security numbers, which experts say are a skeleton key to an individual's financial life. (Photo by Allen J. Schaben/Los Angeles Times via Getty Images)

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. 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.


As Congress continues to move toward repealing part or even all of Obamacare, it’s not surprising that other health care news has fallen off our radar. Last week, however, the Centers for Medicare & Medicaid Services, the agency that oversees Medicare, released some very upsetting results of a study that reviewed the accuracy of the directories of health care providers in the networks used by Medicare Advantage plans.

These networks are a central component of Medicare Advantage plans, and the accuracy of network details clearly is significant for people who enroll in the plans. Most Medicare Advantage plans either prevent people from using providers not in their networks or charge them higher rates for out-of-network care. It’s thus very important that people review a plan’s network directory and make sure it meets their needs before enrolling in the plan. Are their doctors, hospitals and other providers in the network? If not, the plan might not be their best Medicare option.

There was at least one mistake in nearly 47 percent of the provider reviews and nearly that many among all locations.

There have been widespread reports of inaccuracies in these directories. But the study nevertheless comes as a shocker. It found that nearly half of directory entries were inaccurate in the plans it reviewed. The Centers for Medicare & Medicaid Services reviewed more than 5,800 health care providers offering care at more than 11,600 locations. The directories were provided by 54 Medicare Advantage Organizations that represented about a third of all Medicare Advantage providers. The study reviewed entries for four widely used doctors — cardiologists, oncologists, ophthalmologists and primary care physicians.

Each provider’s office was called to verify that their name and contact information was correct, they saw patients at the address contacted, accepted the Medicare Advantage plan that listed them in its directory and if the directory was accurate in describing whether the practice was now seeing new Medicare Advantage patients.

There was at least one mistake in nearly 47 percent of the provider reviews and nearly that many among all locations. They were widespread and not concentrated among a few providers. And they were not clerical errors.

The Centers for Medicare & Medicaid Services said 85 percent of the deficiencies it found “were of the highest weighted, most egregious errors” that were “most likely to affect access to care.” Here’s an extended comment about providers who were not located at the listed address or perhaps not even in a plan’s network at all:

We found that providers were not located at about 31 percent of the locations listed in the provider directory. This finding means that if a member were to look up a provider/location in an MAO directory, he/she would be unable to make an appointment with that provider because the provider did not work at that location. In about 1,162 of these cases, the provider associated with these locations did not work at any of the locations identified in the online directory. For example, if a provider were listed at three locations in the directory, CMS’s review found that the provider was not at any of the three locations identified. Given that the provider was not at any location listed in the directory, this finding raises concerns about whether these providers are even part of the network.

The report did not identify specific Medicare Advantage insurers, but the problems were so widespread that perhaps this doesn’t matter. Of the 54 Medicare Advantage Organizations whose networks were reviewed, the Centers for Medicare & Medicaid Services issued 31 notices of non-compliance, 18 warning letters and three warning letters that asked that the agency be provided with a business plan.

Medicare enrollees need to do their own due diligence here. Do not assume that a plan’s provider directory is accurate. Call the offices of your primary physician and any specialists you see. Make sure the hospitals they prefer are also in your plan’s directory.

And now, on to this week’s reader questions.


Debra – N.M.: I’ll turn 62 shortly and understand that I will not be eligible under the new Social Security law to file and suspend. I also know the severe downside of claiming before reaching my full retirement age. Therefore, I plan to wait until I’m 66 and two months to file, but I may not be able to wait that long, as I’m currently unemployed. I divorced over 10 years ago and do not have contact with my ex-spouse, who will turn 70 in July 2017. I believe he earned substantially more than me. My questions are: A) What is the most timely way for me to accurately determine when he dies? B) Without actually filing a claim for my benefit, will the Social Security Administration tell me when he filed? c) Will the Social Security Administration give me an accurate estimate of my spousal benefit (which I believe is 50 percent of his full retirement age benefit before his death and 100 percent after he’s deceased)?

Phil Moeller: This is a great question, and I only wish I had a great answer. Unfortunately, personal privacy considerations can make getting this information from Social Security very difficult. Without filing a claim, you really can’t demand this information from Social Security, although I think it would be nice if you could.

One approach I’d suggest is to call Social Security and tell them you’re thinking of filing a claim for your own retirement benefit. Tell them you understand that making this filing, even after you’ve reached your full retirement age, will also subject you to the new deeming rules enacted last year. Tell them you think your former husband has already filed for his retirement benefit, and you thus wonder whether deeming will provide you an excess spousal benefit in addition to your own retirement benefit. This will only happen if your ex-spousal benefit is higher than your own retirement benefit.

Make it clear that this is only an informational call and that you can’t make the decision about whether to actually file for benefits until you know if you’re entitled to an ex-spousal benefit and if they tell you how much that would be.

This information, of course, will also give you a clue as to what your ex-spousal survivor benefit would be. However, your ex-spousal survivor benefit is not 100 percent of his full retirement age benefit, but up to 100 percent of what he was actually collecting, or the amount he was entitled to collect at the time of his death. If he filed for retirement before his full retirement age, your survivor benefit will be reduced; likewise, if he deferred filing until after his full retirement age, your survivor benefit will be greater than his full retirement age entitlement.

Do not expect Social Security to let you know when a former spouse has died. If you’re collecting ex-spousal benefits off of his earnings record, they should alert you to his death and to the possibility of getting an additional survivor benefit. However, there may be a long lag time between his death and this communication. And if you’re not collecting a benefit based his earnings record, the agency would have no basis for even knowing that you used to be married and that his death thus might affect your own benefits.

I know this information can be confusing, and the process is difficult to navigate. You have learned a lot about how Social Security benefits work, and I urge you to keep working to get all the benefits to which you’re entitled.


Ed: I suspended my Social Security until I turned 70 last November. I was paying $121.80 in monthly Medicare premiums, since I was not on Social Security and was not held harmless. Now that I am, my Social Security statement says I will be paying $132 for 2017. I thought once I received Social I would be “held harmless” and drop back to the $109 for 2017 like my spouse, who has been receiving Social Security since she was 65. Am I wrong? Also, why is my monthly premium not $134, which is what Medicare says it should be?

Phil Moeller: My crystal ball for divining Social Security decisions has been cracked beyond repair by the nutty hold harmless rules for 2017.

While people are being held harmless for 2017, this does not mean their Part B premiums won’t increase. It just means they can’t increase by more than the measly 2017 COLA of 0.3 percent. So, for example, if your benefit was $2,000 a month, the cost of living adjustment, or COLA, would raise it by $6 a month, and this is the maximum amount that your Part B premium would rise in 2017.

It seems unlikely that this math would explain why your premium would rise from $121.80 to $132. That’s $11.20 more. Your monthly benefit would need to be nearly $4,000 a month to explain such an increase in terms of the 2017 COLA. And this would be larger than the current ceiling on benefits. So I assume something else is going on. Only I don’t know what!

Under Social Security rules, the fact that you had Part B deducted from your December Social Security payment means that you should be in the hold harmless group for 2017. If your income was higher enough to trigger the high-income premium surcharge, which you say was not the case, the surcharge would be much larger than the increase you are being charged.

So I would think your 2017 Part B premium should be $121.80 plus 0.3 percent of your expected 2017 monthly Social Security payment. I’d calculate this amount and then get in touch with Social Security to try and change the amount of your Part B deduction. And, as you note, if you were mistakenly not held harmless, your monthly Part B premium for 2017 should be $134.

Please let me know how things turn out. If there is a logical reason for the agency’s decision, I’d like to know what it is.


Catherine: I now receive a Social Security spousal benefit and applied for Medicare in December. This has permitted me to be held harmless and shielded from those big Part B premium increases. However, when I switch to my own retirement benefit at age 70, will I be considered a new applicant and thus no longer in the hold harmless group? One person at Social Security told me that I would be subject to a higher premium and would be considered a new applicant filing under my own Social Security number and not my husband’s number. Another representative said no, that the premium would just come out of my new Social Security claim. I tried to answer this question by calling Medicare, but they referred me back to Social Security.

Phil Moeller: Your “hold harmless” status is determined by your initial Social Security benefits claim. If you later file for another benefit, you should not be considered a new applicant. You will not be held harmless for 2017, however. It takes Social Security a month to begin withholding Part B premiums from your benefits. So, even though you may have filed for Part B last December, your first withholding payment shouldn’t have occurred until January, thus preventing you from being held harmless this year.


Roberto – Calif.: My wife started receiving Social Security when she turned 62 last October. I am 60 years old now. My problem is that the Social Security office told me that I need about four more quarterly work credits to be eligible to receive Social Security, and I don’t think I will be able to work enough to earn them. Can I apply for spousal benefits when I turn 62 in 2018? Her monthly Social Security is $954. Would I be eligible to receive half of that amount, or $477, when I turn 62 years old?

Phil Moeller: It’s unfortunate you won’t have enough credits to qualify for your own benefits. You can file for a spousal benefit based on your wife’s benefits, but it will be different than half of her age-62 benefit.

There are two sets of calculations you need to understand or at least ask Social Security about. The first involves the basis on which your spousal benefit is calculated. It’s not what your wife is actually receiving, but what she would have been entitled to receive if she filed for retirement benefits at the age of 66, which is called her full retirement age. There’s a reduction for filing before this age, so the good news for you is that this figure is as much as a third larger than what she is actually collecting. The precise difference depends on how old she was when she filed.

The maximum amount of your spousal benefit will be, as you noted, half of this figure. In order to collect this large of a benefit, however, you would have to wait to file for it until you reached your full retirement age. The full retirement age is getting later for anyone born after 1954, and this includes you. The crucial thing to note here is that if you file for a spousal benefit before reaching full retirement age, you will be hit with an early spousal reduction that could exceed 30 percent.

I understand that you might need the money right away. But the longer you can wait to file past the age of 62, the higher this benefit will be for the rest of your life.


Beth – Ga.: I have two questions about Medicare’s high-income surcharges. First, are these surcharges applied to Medicare Advantage plans, specifically a Medicare Advantage plan with drug coverage, or does this option exclude a surcharge? Second, if my employer offers a retirement package that includes a drug benefit equal to or better than a Part D drug plan, will there be a surcharge for the employer’s coverage?

Phil Moeller: If your Medicare Advantage plan includes Part D drug coverage, and most Medicare Advantage plans do, you would have to pay an IRMAA surcharge. You didn’t ask, but you’d also have to pay an IRMAA surcharge on Part B premiums. You have to have Part B to even sign up for a Medicare Advantage plan and must pay those premiums.

If your employer offers retiree drug coverage, and you pay for it separately and apart from any Medicare coverage or charges, you would not pay IRMAA surcharges on that drug plan.


Terry – British Columbia: I have Part A of Medicare, and I receive Social Security payments. I’ve lived permanently in Canada since 2003. My question is: When I am traveling in the U.S., am I covered by Medicare (Part A) for hospital care should it become necessary? I have been buying supplemental insurance to make up the difference in costs between the Canadian and U.S. systems (which is huge).

Phil Moeller: Welcome to my world! I get uninterpretable answers from Medicare all the time. And this is when they answer me at all. According to the Social Security Administration, which handles a lot of Medicare administrative work, your Part A will cover you for hospital expenses received in the United States. The last time I looked, however, it was impossible to be hospitalized without being treated by health care providers!

Unless you have Part B coverage, either directly or in a Medicare Advantage plan, the expenses of healthcare providers who treat you in the U.S. would not be covered. I am not sure what kind of supplemental insurance you have purchased, but unless it specifically addressed this situation, you would be exposed to big health care bills.

The post Care provider directories wrong nearly half the time in Medicare Advantage plan lists appeared first on PBS NewsHour.

Column: Why aren’t my chiropractic appointments covered by Medicare?

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Chiropractor treating shoulder joint problem of a female patient lying on table in the medical office. related words: chiropractic, physical therapy. Photo by Dean Mitchell/Getty Images

Phil Moeller is here to provide the answers you need on aging and retirement. Photo by Dean Mitchell/Getty Images

Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. 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.


Michael: We were stunned to learn from my chiropractor that upon retiring and moving from my workplace health insurance to Medicare, the monthly chiropractic adjustments that I’ve viewed as a “medical necessity” for keeping crippling sciatica at bay over the last decade will no longer be covered. My chiropractor’s office gave me details on why coverage was denied. But a friend tells me that his chiropractor deals with this issue by performing an “evaluation” at the beginning of each year (that my friend pays for), which results in a treatment plan for periodic, monthly visits (much like mine) that Medicare covers. What should I do?

READ MORE: Column: Social Security will reduce paper statements in 2017. Here’s why it shouldn’t

Phil Moeller: I wish I had a clear answer for you or could recommend a specific course of action.

Medicare pays for billions of dollars in uncovered medical services every year. Medicare also fails to pay for billions of dollars in covered medical services every year.

In theory, these things do not happen. But of course they do. “Medical necessity” is a governing concept of what Medicare will and won’t cover, but it hardly lends itself to a universally agreed-upon definition or application. And this concept can be especially difficult to apply consistently in therapeutic situations.

From reading the materials you provided, my takeaway is that your chiropractor’s office certainly appears to have based its position on a thorough review of relevant regulations. I do not know about the other chiropractor. However, even if that other office was wrong in its understanding, it’s quite possible that Medicare would honor your friend’s medical claim. If your chiropractor does not feel it’s appropriate to file such a claim, it seems to me you are stuck with either doing the workaround the office suggests, paying for these treatments yourself, perhaps reducing the frequency of care or finding another chiropractor willing to file this claim with Medicare.

“Medical necessity” is a governing concept of what Medicare will and won’t cover, but it hardly lends itself to a universally agreed-upon definition or application.

If you can convince your chiropractor to file a claim on your behalf and it is rejected, there is a well-established appeal process. However, the “win” rate for claimants is low, and the time frame for resolving appeals is measured in years, not months.

The American Physical Therapy Association may be able to help you with this matter. I often refer people to three consumer nonprofits that specialize in providing free assistance to people with Medicare problems: the State Health Insurance Assistance Program, the Medicare Rights Center and the Center for Medicare Advocacy.

Generally, the State Health Insurance Assistance Program is best at general consumer questions, while the Medicare Rights Center and Center for Medicare Advocacy are more appropriate for addressing the kind of complicated situation you face.


Laura: My husband was not collecting Social Security when he began getting Medicare, and his Part B premiums were $121.80 a month. I understand that this is the rate for people who are not collecting Social Security and having their premiums deducted from their Social Security payments. I’m told it has something to do with the agency’s “hold harmless” rule, which limits Medicare premium increases so that net Social Security payments don’t decline from one year to the next. I understand this. But when he began collecting Social Security last summer, didn’t he join the hold harmless group? I thought his Part B premiums should have dropped to $104.90 a month then.

READ MORE: Column: Why is my Medicare Part B premium more than my husband’s?

We got a letter from Medicare that his 2017 premiums would be $109 a month after this year’s 0.3 percent cost of living adjustment went into effect. This confirmed that my thinking was correct about the $104.90 rate. However, we later got a statement from Social Security that it will be deducting $132 a month for Part B! We next went to our local Social Security office in person where the rep shockingly hadn’t heard about the “hold harmless” rule and instead told us that the $132 was correct without being able to explain why. At this point, I don’t know who else to ask since we’ve already contacted both Medicare and Social Security and haven’t gotten consistent answers.

Phil Moeller: Your understandable confusion is a major reason why I think Medicare and Social Security need to get their heads together, scrap the hold harmless rule and come up with a better way for setting Medicare premiums. I applaud the notion of holding people harmless so that their Social Security payments don’t decline from one year to the next. But the hold harmless rule as it presently exists is simply not equipped to deal with a world of persistently low inflation rates.

First off, simply being held harmless does not mean your husband’s Medicare premiums should have declined to $104.90 a month. That was the hold harmless rate that most enrollees had to pay in 2016, due to there being a zero cost of living adjustment last year.

His hold harmless “set” point is not $104.90 but $121.80, which is what he was paying when he began Social Security. Assuming your income does not trigger high-income surcharges, he will be held harmless for 2017. You can find more gruesome details here.

But the hold harmless rule as it presently exists is simply not equipped to deal with a world of persistently low inflation rates.

This means that his Part B premium should be $121.80 plus the amount of his 2017 cost of living adjustment, or COLA. Because the COLA for this year is only 0.3 percent, this means his Part B premium should be no more than $121.80 plus 0.3 percent of his 2016 Social Security benefit. For this to equal $10.20 – the difference between $132 and $121.80, his monthly Social Security benefit in 2016 would need to have been $3,400 a month! This nearly equals the maximum possible Social Security benefit of someone who began claiming benefits last year.

The $109 figure included in your letter from Medicare described the 2017 Part B premium that would be typically paid by a person who was held harmless last year and had been paying $104.90 a month. Again, this group would not include your husband.

I have no idea how Social Security came up with the $132 figure in the statement it sent you. I am guessing this is the Part B premium in 2017 for people who are not held harmless this year. However, Medicare says the number should be $134.

Whatever you wind up paying this year, you are not due any refund for 2016 payments as a result of your husband’s enrollment in Social Security. Part B premiums are set for the entire year each January, and your husband’s premium was accurate as of January of last year.

By now, you may already have passed out on the floor through a combination of shock, confusion and possibly outrage. You have my sympathy. Maybe you can turn to the uninformed Social Security representative for your smelling salts. Good luck with that!


Ron – Wisc.: I turn 65 in April 2017 and have no health issues and take no medications. I plan to enroll in a local health maintenance organization (HMO) Medicare Advantage plan without taking the drug coverage option. My only cost will be the Part B premium required. In the future, would I be able to add the drug coverage option for this same Medicare Advantage plan during annual open enrollment for plan changes? What penalties or restrictions might apply if I choose to add the drug plan option?

Phil Moeller: Most Medicare Advantage HMO plans include bundled-in drug coverage, so you should use the Medicare Plan Finder to see if there is a plan available where you live that will let you add a stand-alone Part D drug plan at a later date. You might need to get a separate stand-alone plan at first, and then you can find an acceptable MAPD (shorthand for Medicare Advantage Prescription Drug) plan and switch to it during your first available Medicare open enrollment period.

There will be a late-enrollment premium penalty for the Part D plan that equals 1 percent a month for each month you are late. With Part D plans averaging about $40 a month, this penalty would cost you slightly less than $5 a month for each year you are late. These are lifetime penalties, so you should do some sample calculations to decide on your best strategy.


Carol – Mass.: My husband died in 1986 at age 34, leaving me with a 4-year-old son. I collected benefits for my son and continued working full time. My son died in 1998. I immediately notified Social Security, and this benefit stopped. Unfortunately, I did not know for quite some time that I had over-collected for my son, because I was making too much money. I had no idea my salary affected this, and it was never explained to me when I went to the Social Security office to begin benefits for him. When the agency told me I owed it several thousand dollars, I contested, and they refused to reconsider the matter — quite rudely I might add. When I turned 66, they began deducting this money from my Social Security payments and said they would last for 10 years. Is it better for me to continue these deductions or to pay what I owe them in full?

Phil Moeller: I am sorry to hear about the tough road you have had to travel.

READ MORE: Column: Social Security needs to be reformed, not have its funding cut

In terms of economic theory, I think most experts would say that it would be better to let Social Security continue deducting $72 a month from your benefit payment than to pay them back in full right now. Under the concept known as “present value,” a dollar is worth much more today than it would be in the future, because you could invest this dollar, and inflation will make it worth less in the future. Therefore, saving your current dollars would be the way to go.

Having said this, if for any reason your financial situation today is much better than it will be in the future, it could be better to pay the lump sum and then receive that $72 back every month when times might be leaner.


Melinda – Costa Rica: My husband and I live abroad and are residents of Costa Rica but are U.S. citizens. We receive health coverage through Costa Rica’s national insurance. My husband will be 65 in July 2017 and receives Social Security benefits now. We realize that we are not covered by Medicare while we live outside the U.S., but that he must purchase Part B coverage or face late enrollment penalties. Can my husband delay in applying for either Part A or B Medicare when he is eligible at 65 until, or if, he returns to the U.S. and avoid Part B penalties?

Phil Moeller: I assume your husband is retired. If so, the clock will start ticking on his Medicare enrollment obligations when he turns 65. His initial enrollment period will be seven months long, beginning three months before his 65th birthday month and ending three months after. That will be the longest he can delay getting Part B without incurring lifetime late-enrollment penalties.

If you plan to continue living outside the U.S. for several or more years, you should balance the savings of not paying Part B premiums against the cumulative expense of paying higher Part B premiums when you return to the U.S.

Having said this, if you plan to continue living outside the U.S. for several or more years, you should balance the savings of not paying Part B premiums against the cumulative expense of paying higher Part B premiums when you return to the U.S.

The late-enrollment penalty for Part B is 10 percent of your Part B premium for every complete year he is late in enrolling. The Part B premium this year for new enrollees is $134 month for most people, although higher-income enrollees will pay more.

To get a rough idea of the trade-off, let’s assume he gets Part B with a five-year penalty. This would add 50 percent to his Part B premiums. He would be saving five years of premiums by not enrolling, so it would take him 10 years back in the U.S. before the penalty exceeded his premium savings.

Should Congress raise the Medicare and Social Security retirement age? Phil explores that question in his latest piece.

The post Column: Why aren’t my chiropractic appointments covered by Medicare? appeared first on PBS NewsHour.

My employer health insurance is unaffordable. Should I get Medicare?

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Nearly 10 million people have signed up and paid for health insurance under the Obama Administration's healthcare law, the Associated Press reported Tuesday. That means the administration is on track for year-end goals. Credit: Ariel Skelley/Blend Images via Getty Images.

Journalist Philip Moeller answers your questions on aging and retirement. Photo by Ariel Skelley/Blend Images via Getty Images.

Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. 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.


Maria – Florida: I will be 70 in December, at which time I would like to retire. I am now covered by my employer’s health insurance, but it has a $1,500 deductible in network. I needed some physical therapy, but I first had to cover my deductible, and I couldn’t afford it. My sister has suggested that I drop my employer’s insurance and enroll in Medicare. A Medicare Advantage plan that my husband has is very good. Employer insurance is really getting very expensive!

While you do not have to get Medicare, because you’re covered by an employer plan, you always are free to drop your employer plan and get Medicare instead.

Phil Moeller: While you do not have to get Medicare, because you’re covered by an employer plan, you always are free to drop your employer plan and get Medicare instead.

In an ideal world, your employer would pay at least some of your Medicare premium, because leaving the employer plan would save money. In practice, this seldom happens. But, hey, I’d go ahead and ask your employee benefits office about it. From what you say, you might save money even if your employer provides no assistance for the move.

If you do leave the employer plan, be aware that you might not be able to rejoin it later if you changed your mind. This is also something you should check out ahead of time.

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

Also, I wonder why your husband has Medicare and is not covered on your health plan? If he’s eligible, you could save his Medicare premiums, and perhaps afford to pay your insurance plan’s deductible.


Richard – New York: I am moving my aging mother from New York state to Naples, Florida, so she can spend her last years in a warm climate. She was a school teacher for more than 38 years and she gets full health care coverage from a third party administrator for a low monthly premium. When I called her group plan administrator, I was informed that since my mother is leaving the state, her monthly cost would be seven times more than what she’s paying now. She can’t afford this. She is 79 and has Medicare Parts A and B coverage. Do I need to find a health maintenance organization to supplement her Medicare coverage in Florida, or is this not necessary? She’s very healthy and takes no medications.

Phil Moeller: Finding a low-cost HMO plan in Florida is the prudent way to go. In effect, you would be buying a catastrophic health plan that can cap out-of-pocket expenses should your mom have a medical emergency. And despite her current good health, a medical emergency is exactly what you need to plan for in her case.

Rather than buying a plan to complement her retiree package, you might consider helping her determine whether it would be better to junk that soon-to-be-costly coverage altogether. With the dollars she’d save, for example, she might be able to afford basic Medicare, a Part D drug plan and a Medigap supplemental insurance plan. I don’t know if her retiree plan also provides dental, vision or hearing coverage — things basic Medicare does not cover.

Focusing on a Medicare Advantage plan would be my first choice. Some of these plans do cover dental, vision and hearing needs. They provide out-of-pocket spending caps as well. Plus, Florida has plenty of low-cost Medicare Advantage plans. You can use the Medicare Plan Finder tool to find the best deals in the Florida ZIP code where she intends to live. Keep in mind that usually these plans would cover her only in the plan’s local coverage area and may not be of much help when she is outside the state.

READ MORE: Don’t make this Medicare mistake: COBRA is not like employer health insurance

Also, you should carefully review the plan’s directory of health care providers to make sure your mom can receive care from providers both of you like. HMOs usually deny coverage from non-network providers or charge you higher out-of-network rates. This is homework you need to do before getting a plan.

If she is going to travel a lot outside Florida, you should consider getting a Medigap plan to plug the coverage gaps in basic Medicare. Medigap plans, like basic Medicare, may be used at any provider in the U.S. who accepts Medicare and is seeing new patients. These policies will, however, cost you more than an HMO.

If her health worsens, you could help her switch into more comprehensive Medicare plans during the program’s annual open enrollment season, which runs from Oct. 15 through Dec. 7 every year. Be aware that finding a Medigap plan at her age might be expensive.


Jane – Oregon: I’m planning to move abroad because of the unaffordability of living costs in the U.S. Right now, my Medicare Part B premium is paid for by a low-income program. I also pay the full cost for a letter F Medigap policy. If I maintain a state mailing address, can I still receive the Part B premium benefit? Otherwise, that and Medigap would eat up a third of my Social Security benefit, which is my only source of income.

Phil Moeller: You do not need a U.S. mailing address to maintain Part B or, as far as I know, a low-income support benefit. These are federal programs, not state-related. The premiums will continue to be deducted from your Social Security payments, and you can be covered by Part B anywhere in the U.S. if you decide to return here for medical care.

However, if you are receiving a Medicaid benefit and thus are dually eligible for Medicare and Medicaid, you would need to check with your state’s Medicaid office about this. I wouldn’t want you to unintentionally lose a state Medicaid benefit.

READ MORE: Beware this Medicare gotcha when you file for Social Security

As for Part F, it strikes me you should do some “what if” analyses and decide if you should continue paying for this supplemental coverage or self-insure against gaps in Part B coverage. You also might want to check up on the availability of health insurance in the nation where you wish to relocate.


Scott – California: I recently got a letter saying that the state of California will no longer pay my Medicare Part B medical insurance premium. Is this a blanket statement for all Medicare beneficiaries in the state of California? I believe it was paid through Medi-Cal.

Phil Moeller: Experts at the State Health Insurance Assistance Program (SHIP) say that they think you have been in a Medicare Savings Program that is managed in California by Medi-Cal. Eligibility for these programs can be affected by changes in a person’s personal income and asset totals, as this is a means-tested program. There also is a periodic recertification process that can trip up people. The California arm of SHIP is called HICAP and can be reached at 800-434-0222. Someone there should be able to help you. There is no cost for this counseling.


Susan – Nova Scotia: I live in Nova Scotia and received a Medicare card at my address here when I turned 65. I travel to New York state and California every year to visit family.  If I required medical attention while I’m in the United States, would I qualify for anything from Medicare? I am a U.S. citizen but have lived in Nova Scotia for 17 years. I don’t take out extra medical insurance when I’m visiting the United States, as I assumed I would receive some coverage if anything did happen.

Phil Moeller: That Medicare card was most likely providing you Part A of Medicare, which covers hospital expenses. It charges no premiums if you have worked enough years in the U.S. at jobs where you paid Social Security payroll taxes.

If that card included Part B, you would have had to sign up for it, and you would be paying monthly premiums or having them deducted from your Social Security payments. Your note doesn’t say whether you’ve applied for Social Security, but I assume you qualify.

Part B covers doctors, medical equipment and other outpatient expenses. If you don’t have Part B, you would be exposed to big uncovered medical bills in the U.S. And even Part A has a hefty $1,316 deductible before your coverage begins paying.


Pete – Indiana: If I am on Social Security Disability Income, can I use the remaining balance in my health savings account?

Phil Moeller: Yes. Acceptance of Social Security benefits invalidates continued tax-exempt contributions to an HSA. But you are still free to use any existing balances in your HSA to pay for eligible health care expenses.


Julie: My husband and I are separated, and we’re both on disability. We’ve been separated for almost a year now, and my husband has been living off of his parents and borrowing money from credit cards. The divorce is finally going to go through. Are there any back-pay awards from Social Security for the year that we have been separated?

Phil Moeller: I’m sorry, but Social Security does not pay divorce benefits unless there is a legally binding divorce in place. Being separated is not a basis for paying benefits. Your note doesn’t say whether one or both of you have qualified for Social Security Disability Income payments. If you are, you both should be receiving payments each month. If so, getting a divorce would not boost your Social Security unless one of you earned a great deal less than the other. If this is the case and the lower-earning person qualifies for ex-spousal benefits, they could file once the divorce is final, and they should receive an added payment.


John – Massachusetts: I will turn 66 next month. My wife is four years older and collects Social Security. Can I, and should I, file for spousal benefits next month and defer my own benefits until age 70? When I do file for retirement, can my wife then file for a spousal benefit? Also, must I keep working and earning my current income to reap the higher benefit in four years?

Phil Moeller: Because you had turned 62 before the beginning of last year, you are grandfathered under the 2016 changes to Social Security laws. Because your wife has already filed for her retirement benefit, once you reach your full retirement age, you can file what’s called a restricted application for just your spousal benefit while deferring your own retirement benefit up to age 70, during which time it will receive delayed retirement credits that will increase your retirement benefit by 8 percent a year.

READ MORE: Column: Why is my Medicare Part B premium more than my husband’s?

Once you have filed for your own retirement benefit at age 70, your wife can file for a spousal benefit based on your earnings record. If this benefit is larger than the retirement benefit she is receiving, she would receive what’s called an excess spousal benefit that equals the amount by which her spousal benefit exceeds her retirement benefit.

You do not need to keep working after age 66 to receive delayed retirement credits.


Michael – Kansas: I am turning 65 in six months. I have health coverage from my employer, but we have less than 20 employees. Do I have to sign up for Medicare even though I am not going to draw Social Security until I am 66 or 70?

Whether you need to sign up for Medicare has nothing to do with Social Security. Under the Medicare rules, people with health insurance through what are called small-employer plans must sign up for Medicare at 65.

Phil Moeller: Whether you need to sign up for Medicare has nothing to do with Social Security. Under the Medicare rules, people with health insurance through what are called small-employer plans must sign up for Medicare at 65. At that age, their employer coverage automatically becomes their secondary insurance plan, and Medicare becomes the primary payer of covered insurance claims. Failure to get Medicare can thus expose someone to huge medical bills.

The threshold for a small employer plan is, as you indicated, 20 employees. Some companies with fewer than 20 employees can, however, skirt this rule by becoming part of a multi-employer health insurance plan. You should check with your employer to see if this is the case. If not, you will need Medicare.


D – Illinois: I have Medicare and am planning to get married to a same-sex partner. Would my partner be covered with my Medicare after we marry?

Phil Moeller: No, they wouldn’t. Medicare covers only the individual, not their spouse or family members. If your partner is 65, they would need to get their own Medicare coverage. If they are younger than 65, they would need commercial health insurance from a state Obamacare insurance exchange, a private insurance plan or, if they’re employed, their employer’s group insurance plan.

People approved as disabled by Social Security qualify for Medicare at any age, but enrollment in Medicare takes upwards of two and half years after Social Security Disability Insurance payments begin.


Barbara: I am 58. My husband died two years ago. I am told I can start collecting survivor benefits at age 60. Once I start collecting benefits at age 60, will those benefits be effective if I remarry after that?

Phil Moeller: You will not lose these survivor benefits should you remarry. While you can begin survivor benefits as early as age 60, they will be 30 percent less each month than if you wait until 66 to file. Of course, you would also forego these benefits entirely for six years, so if your own retirement benefits are going to larger when you file for them in the future, it might well be better to begin taking the survivor benefit as soon as possible.


Robert – Texas: I will start Medicare at 65 this July and understand that being on Medicare will mean that I will no longer be eligible to contribute to a health savings account. My wife won’t turn 65 for another 18 months. Our existing health insurance premiums have doubled to the point of being unaffordable. So we have decided to buy a very low-premium plan. My strategy is to put our premium savings into an HSA and then pay medical bills from this account. Can you point me to non-employer based HSA sources or references?

Phil Moeller: Unfortunately, HSAs are only available through an employer health plan. They don’t exist as stand-alone private accounts. Sorry!

The post My employer health insurance is unaffordable. Should I get Medicare? appeared first on PBS NewsHour.

Column: Need to unload family heirlooms? Prepare for disappointment

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British retiree Peter Harrison, 74, and his wife Anne, who have been living in Spain for 9 years, watch the television as they drink a cup of tea in their mobile home at Saydo Park in the outskirts of Mollina, southern Spain, May 18, 2016. REUTERS/Jon Nazca - RTX2EXEH

Richard Eisenberg of Next Avenue has advice for boomers desperate to unload family heirlooms. Photo by Jon Nazca/Reuters

Editor’s Note: Next Avenue columnist Richard Eisenberg has advice for boomers desperate to unload family heirlooms. You can read the original post here.


After my father died at 94 in September, leaving my sister and me to empty his one-bedroom, independent-living New Jersey apartment, we learned the hard truth that others in their 50s and 60s need to know: Nobody wants the prized possessions of your parents — not even you or your kids.

Admittedly, that’s an exaggeration. But it’s not far off, due to changing tastes and homes. I’ll explain why and what you can do as a result, shortly.

The stuff of nightmares

So please forgive the morbidity, but if you’re lucky enough to still have one or more parents or stepparents alive, it would be wise to start figuring out what you’ll do with their furniture, china, crystal, flatware, jewelry, artwork and tchotchkes when the mournful time comes. (I wish I had. My sister and I, forced to act quickly to avoid owing an extra months’ rent on our dad’s apartment, hired a hauler to cart away nearly everything we didn’t want or wouldn’t be donating, some of which he said he’d give to charity.)

Nobody wants the prized possessions of your parents — not even you or your kids.

Many boomers and Gen X’ers charged with disposing the family heirlooms, it seems, are unprepared for the reality and unwilling to face it.

“It’s the biggest challenge our members have and it’s getting worse,” says Mary Kay Buysse, executive director of the National Association of Senior Move Managers.

“At least a half dozen times a year, families come to me and say: ‘What do we do with all this stuff?’” says financial adviser Holly Kylen of Kylen Financials in Lititz, Pennslyvania. The answer: lots of luck.

Heirloom today, foregone tomorrow

Dining room tables and chairs, end tables and armoires (“brown” pieces) have become furniture non grata. Antiques are antiquated. “Old mahogany stuff from my great aunt’s house is basically worthless,” says Chris Fultz, co-owner of Nova Liquidation, in Luray, Virginia.

On PBS’s “Antiques Roadshow,” prices for certain types of period furniture have dropped so much that some episode reruns note current, lower estimated appraisals.

READ MORE: Column: Broke baby boomers, it’s time to face reality

And if you’re thinking your grown children will gladly accept your parents’ items, if only for sentimental reasons, you’re likely in for an unpleasant surprise.

“Young couples starting out don’t want the same things people used to have,” says Susan Devaney, president of National Association of Senior Move Managers and owner of The Mavins Group, a senior move manager in Westfield, New Jersey. “They’re not picking out formal china patterns anymore. I have three sons. They don’t want anything of mine. I totally get it.”

The Ikea generation

Buysse agrees. “This is an Ikea and Target generation. They live minimally, much more so than the boomers. They don’t have the emotional connection to things that earlier generations did,” she notes. “And they’re more mobile. So they don’t want a lot of heavy stuff dragging down a move across country for a new opportunity.”

“This is an Ikea and Target generation. They live minimally, much more so than the boomers.”

And you can pretty much forget about interesting your grown kids in the books that lined their grandparents’ shelves for decades. If you’re lucky, you might find buyers for some books by throwing a garage sale, or you could offer to donate them to your public library — if the books are in good condition.

Most antiques dealers (if you can even find one!) and auction houses have little appetite for your parents’ stuff either. That’s because their customers generally aren’t interested. Carol Eppel, an antique dealer and director of the Minnesota Antiques Dealers Association in Stillwater, Minnesota, says her customers are far more intrigued by Fisher Price toy people and Arby’s glasses with cartoon figures than sideboards and credenzas.

Even charities like Salvation Army and Goodwill frequently reject donations of home furnishings, I can sadly say from personal experience.

Midcentury, yes; Depression-era, no

A few kinds of home furnishings and possessions can still attract interest from buyers and collectors though. For instance, Midcentury Modern furniture — think Eames chairs and Knoll tables — is pretty trendy. And “very high-end pieces of furniture, good jewelry, good artwork and good Oriental rugs — I can generally help find a buyer for those,” says Eppel.

“The problem most of us have,” Eppel adds, “is our parents bought things that were mass-produced. They don’t hold value and are so out of style. I don’t think you’ll ever find a good place to liquidate them.”

Getting liquid with a liquidator

Unless, that is, you find a business like Nova Liquidation, which calls itself “the fastest way to cash in and clean out your estate” in the metropolitan areas of Washington, D.C., and Charlottesville and Richmond, Virginia. Rather than holding an estate sale, Nova performs a “buyout” — someone from the firm shows up, makes an assessment, writes a check and takes everything away (including the trash), generally within two days.

READ MORE: America’s boomers and undocumented immigrants need each other

If a client has a spectacular piece of art, Fultz says, his company brokers it through an auction house. Otherwise, Nova takes to its retail shop anything the company thinks it can sell and discounts the price continuously (perhaps down to 75 percent off) as needed. Nova also donates some items.

Another possibility: Hiring a senior move manager (even if the job isn’t exactly a “move”). In a Next Avenue article about these pros, Leah Ingram said most National Association of Senior Move Managers members charge an hourly rate ($40 to $100 an hour isn’t unusual) and a typical move costs between $2,500 and $3,000. Other senior move managers specializing in selling items at estate sales get paid through sales commissions of 35 percent or so.

“Most of the people in our business do a free consultation, so we can see what services are needed,” says Devaney.

8 tips for home unfurnishing

What else can you do to avoid finding yourself forlorn in your late parents’ home, broken up about the breakfront that’s going begging? Some suggestions:

  1. Start mobilizing while your parents are around.“Every single person, if their parents are still alive, needs to go back and collect the stories of their stuff,” says Kylen. “That will help sell the stuff.” Or it might help you decide to hold onto it. One of Kylen’s clients inherited a set of beautiful gold-trimmed teacups, saucers and plates. Her mother had told her she’d received them as a gift from the DuPonts because she had nursed for the legendary wealthy family. Turns out, the plates were made for the DuPonts. The client decided to keep them due to the fantastic story.
  2. Give yourself plenty of time to find takers, if you can.“We tell people: The longer you have to sell something, the more money you’re going to make,” says Fultz. Of course, this could mean cluttering up your basement, attic or living room with tables, lamps and the like until you finally locate interested parties.
  3. Do an online search to see whether there’s a market for your parents’ art, furniture, china or crystal. If there is, see if an auction house might be interested in trying to sell things for you on consignment. “It’s a little bit of a wing and a prayer,” says Buysse. That’s true. But you might get lucky. I did. My sister and I were pleasantly surprised — no, flabbergasted — when the auctioneer we hired sold our parents’ enormous, turn-of-the-20th-century portrait of an unknown woman by an obscure painter to a Florida art dealer for a tidy sum. (We expected to get a dim sum, if anything.) Apparently, the Newcomb-Macklin frame was part of the attraction. Go figure. Our parents’ tabletop marble bust went bust at the auction, however, and now sits in my den, owing to the kindness of my wife.
  1. Get the jewelry appraised. It’s possible that a necklace, ring or brooch has value and could be sold.
  2. Look for a nearby consignment shop that might take some items. Or, perhaps, a liquidation firm.
  3. See if someone locally could use what you inherited. “My dad had some tools that looked interesting. I live in Amish country and a farmer gave me $25 for them,” says Kylen. She also picked out five shelters and gave them a list of all the kitchen items she wound up with. “By the fifth one, everything was gone. That kind of thing makes your heart feel good,” Kylen says.
  4. Download the free “Rightsizing and Relocation Guide” from the National Association of Senior Move Managers. This helpful booklet is on the group’s site.
  5. But perhaps the best advice is: Prepare for disappointment. “For the first time in history of the world, two generations are downsizing simultaneously,” says Buysse, talking about the boomers’ parents (sometimes, the final downsizing) and the boomers themselves. “I have a 90-year-old parent who wants to give me stuff, or if she passes away, my siblings and I will have to clean up the house. And my siblings and I are 60 to 70, and we’re downsizing.”

This, it seems, is 21st century life — and death. “I don’t think there is a future” for the possessions of our parents’ generation, says Eppel. “It’s a different world.”

The post Column: Need to unload family heirlooms? Prepare for disappointment appeared first on PBS NewsHour.

Want to live past 100? These centenarians share their secrets

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100-year-old Marge Jetton lifts weights every morning.  "I'm for anything that has to do with health" Jetton says.  Photo by Getty.

100-year-old Marge Jetton lifts weights every morning. “I’m for anything that has to do with health” Jetton says. Photo by Getty.

Gertrude Siegel is 101 and hears it all the time. “Everyone says ‘I want to be just like you.’ I tell them to get in line,” she said.

John and Charlotte Henderson, 104 and 102, often field questions from wannabes eager to learn their secrets.

“Living in moderation,” he said. “We never overdo anything. Eat well. Sleep well. Don’t overdrink. Don’t overeat. And exercise regularly.”

Mac Miller, who is 102, has a standard reply.

“People ask me ‘What is the secret?’ The answer is simple. Choose the right grandparents. They were in their 80s. My mother was 89, and my father was 93,” he said.

John Henderson and his wife of 77 years, Charlotte, live in Austin in the independent living section of Longhorn Village, a community of more than 360 seniors. They were the first people to move into the retirement community when it opened. (Sharon Jayson for KHN)

John Henderson and his wife of 77 years, Charlotte, live in Austin in the independent living section of Longhorn Village, a community of more than 360 seniors. They were the first people to move into the retirement community when it opened. (Sharon Jayson for KHN)

Genetics and behaviors do play roles in determining why some people live to be 100 or older while others don’t, but they aren’t guarantees. And now, as increasing numbers are reaching triple digits, figuring out the mysteries of longevity has taken on new importance among researchers.

Although those 100 and older make up a tiny segment of America’s population, U.S. Census reports show that centenarian ranks are growing. Between 1980 and 2010, the numbers rose from 32,194 to 53,364, an increase of almost 66 percent. The latest population estimate, released in July 2015, reflects 76,974 centenarians.

“The number of centenarians in the U.S. and other countries has been doubling roughly every eight years,” said James Vaupel, founding director of the Max Planck Institute for Demographic Research in Rostock, Germany.

“When the baby boomers hit, there’s going to be acceleration, and it might be doubling every five or six years,” he said.

Henderson and his wife of 77 years live in Austin in the independent living section of Longhorn Village, a community of more than 360 seniors, many of whom have ties to the University of Texas at Austin. Henderson is UT’s oldest-living former football player, arriving in 1932 as a freshman. They’re the only centenarians in the complex and are a rare breed: married centenarians.

Charlotte Henderson said she believes being married may have helped them reach these 100-plus years.

“We had such a good time when John retired. We traveled a lot,” she said. “We just stay busy all the time, and I’m sure that helps.”

John Henderson’s secret to a long life? “Living in moderation,” he said. “We never overdo anything. Eat well. Sleep well. Don’t overdrink. Don’t overeat. And exercise regularly.” (Sharon Jayson for KHN)

Bernard Hirsh, 100, of Dallas agrees. His wife, Bee, is 102. They married in 1978 when both were in their early 60s and each had been widowed, she for the second time.

“I think it’s been such a wonderful marriage, and we’ve contributed to each other’s benefit,” he said.

Little research exists on the effects of marriage on longevity. One 2015 Belgian study of centenarians born between 1893 and 1903 did focus on their living arrangements during ages 60 and 100 and found “in very old age, living with a spouse is beneficial for men but not for women, for whom living alone is more advantageous than living with a spouse.” The study explained that “living with one’s spouse at the oldest ages does not provide the same level of protection as it does at younger ages. This may be explained by the decline of the caregiver’s own health as the needs of his or her spouse increase. Caregiving could also have negative consequences for the health and economic condition of the spouse who is the primary caregiver, especially for older women.”

“Especially if you’re quite old, it’s very helpful have a spouse. If you’re very old and don’t have a spouse, the chance of death is higher,” he said.

Siegel, who lives in a senior living community in Boca Raton, Fla., outlived two husbands. She never smoked and occasionally has a glass of dry, red wine.

“I am not a big eater. I don’t eat much meat,” said Siegel, who said she weighs 90 pounds and used to be 5 feet tall but is shrinking.

She stays active by walking inside the building about a half-hour each day, playing bridge twice a week and exercising.

“I feel that’s what really kept my body pretty good. It wasn’t sports. It was exercises,” she said of the routine she does daily twice a day for about 20 minutes.

Miller, of Pensacola, Fla., also outlived two wives.

He was a fighter pilot in the Marine Corps during World War II and spent eight years in active duty, which Miller said “was not so good for me because I sat in the cockpit of a plane for 5,000 hours.”

But, he was active as a youth — running track, playing football and spending hours surfing while living in Honolulu.

Charlotte and John Henderson, now 102 and 104 years old respectively, have been married for 77 years. Charlotte said she believes being married may have helped them reach these 100-plus years. (Courtesy of the Henderson family)

Miller is gluten-free because of allergies and doesn’t eat many carbohydrates. He also never smoked. And, he still enjoys a scotch in the evening.

The Hendersons usually have wine or a cocktail before dinner. She never smoked. He quit in 1950.

Hirsh, of Dallas, another non-smoker, attributes his long life to “good luck.”

“I was very active in my business and did a lot of walking during the day. I was not sedentary,” he said.

Now, exercise is limited to “some knee bends every morning to keep my legs stronger.”

“My father died of a heart attack in his early 50s, and my mother died in her early 60s of a stroke, so I don’t think my genes were very good,” Hirsh said.

There are certain commonalities among those who reach 100: few smoke, nearly all of the men are lean, and centenarians have high levels of the “good cholesterol.”

Geriatrician Thomas Perls, director of the New England Centenarian Study at Boston Medical Center, said research shows that behaviors have a greater influence on survival up until the late 80s, since he said most people have the right genes to get there as long as their behaviors aren’t harmful. But once people reach the 90s and beyond, genetics play a more significant role.

“To get to these very oldest ages, you really have to have the right genes in your corner,” he said.

As an international leader in the field, Perls’ focus is on finding the right mix of behavior, environment and genetics to produce long lives. His work includes a National Institute on Aging study called the Long Life Family Study.

“There are always questions about environment versus genes,” said endocrinologist Nir Barzilai, founding director of the Institute for Aging Research at the Albert Einstein College of Medicine in Bronx, N.Y. “We are with our genes in this environment. It’s really 50-50, no matter how you look at it.”

Barzilai’s studies include centenarians and their children, as well as efforts to slow the process of aging.

Among those who reach the 100-year-old milestone, Perls’ said his research and that of Barzilai and others has found certain commonalities: few smoke, nearly all of the men are lean, and centenarians have high levels of the “good cholesterol.” Studies show that whatever their stress level, they manage its well. And they’re related to other centenarians or have a parent or grandparent who lived past 80.

These lessons of long life are playing well with the public, who have made changes for the better in the 21st century, Vaupel said.

“We don’t smoke or drink so much, and we’re better at exercise. People are taking better care of themselves. People are better educated, and the more educated know when to go to the doctor and follow the doctor’s advice,” he said, adding that people now tend to have higher income and can spend more on health care and improved diet.

“The most important thing is we’re living longer and living longer healthy,” Vaupel said.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation and its coverage of aging and long-term care issues is supported by The SCAN Foundation.

The post Want to live past 100? These centenarians share their secrets appeared first on PBS NewsHour.

Many seniors who qualify for home-based care under Medicare aren’t receiving it. Why?

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A worrisome and growing number of Medicare enrollees have said that they have been denied home-based care even though they are qualified to receive it and it is covered by Medicare, Phil Moeller reports. Photo by Jim Young/Reuters

Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. 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.


One of the greatest gaps in Medicare coverage is that it does not help to pay for home-based care unless such care is requested by a physician as medically necessary. Medicaid will cover such long-term custodial care for people with little to no income or assets. But Medicaid covers fewer than one in five of the roughly 55 million people on Medicare, leaving the rest to fend for themselves or, for a small group of mostly better-off folks, purchase private long-term care insurance.

Now, it appears that even Medicare’s limited home-based coverage benefits for those with medical needs are also not possible for many people.

Now, it appears that even Medicare’s limited home-based coverage benefits for those with medical needs are also not possible for many people. The nonprofit Center for Medicare Advocacy says it been researching the availability of Medicare-covered home-based care in response to a worrisome and growing volume of complaints from Medicare enrollees that they are being denied home-based care even though they are qualified to receive it and it is covered by Medicare.

Like nearly everything about Medicare, this is a complex topic. But it appears that Medicare is not keen to encourage use of allowable home care benefits. Home care providers don’t much like this benefit either. They don’t make much money on it, and under new Medicare rules, they can actually lose money providing such care.

Let’s begin with the benefit itself. According to the Center for Medicare Advocacy, Medicare will pay for up to 35 hours a week of home-based care to people who are housebound and for whom such care is prescribed as medically necessary by their doctor or another authorized caregiver. This care can be for any one of three therapies — physical, occupational or speech-language — and for what Medicare classifies as “intermittent” and “part-time” skilled nursing care.

READ MORE: Does Medicare pay for a home health care provider?

According to Center for Medicare Advocacy, the benefit also includes the provision of home-based medical social services and for home health aides, who are allowed to perform certain personal services that stem from the patient’s underlying medical needs, but which are not the same as custodial care, which is not covered by Medicare.

These two coverage categories, while part of Medicare’s benefits, merit only a footnote on the Medicare website. And when Medicare updated its home health care brochure last March, it was full of errors about the nature of available coverage, according to Center for Medicare Advocacy associate director Kathleen Holt.

Holt says the allowable benefits are thus broader than people realize. However, she adds, it looks like it doesn’t matter what’s actually covered, because home health agencies routinely decline to provide even the skimpier services that Medicare publicizes to Medicare enrollees who request them.

Home health agencies routinely decline to provide even the skimpier services that Medicare publicizes to Medicare enrollees who request them.

Significantly, Medicare will only pay insurance claims to home health agencies who are registered and approved by Medicare. Ostensibly to help consumers, it has developed an extensive quality rating system, so consumers can find the most qualified agency. However, there apparently is no requirement that an agency actually provide home health services when Medicare enrollees request them.

The reasons why these agencies turn away business, Holt claims, stem partly from Medicare’s increasing emphasis on paying for health care that actually helps patients get better. This is an admirable goal, but what it means is that home health agencies are rewarded for treating patients who are likely to get better.

Supporting care that cures people, while understandable, is not a requirement Medicare insists on for covering most health care. Therapy that maintains a person’s ability to function, or even that slows the pace of decline, is a perfectly good goal for treatment and one that many older Americans and their families embrace.

However, Medicare and Congress have supported the shift from fee-for-service health care to fee-for-results care. In this situation, home health agencies face a carrot-and-stick financial incentive system based on measurable patient improvement. That’s all fine and dandy, but what this means is that agencies are effectively discouraged from treating people with long-term chronic conditions who may be qualified for services, but are unlikely to get better.

READ MORE: Does my mother qualify for home health care?

This latter group, of course, is filled with growing numbers of older Medicare beneficiaries. Overwhelmingly, such people would like to stay in their homes, and getting home-based care would help make this possible. It’s also well-established by research that home-based care is cheaper than being parked in a nursing home or other institutionalized care facility. On paper at least, Medicare’s home care benefit should be perfect for many of these folks.

While Medicare stresses that the benefit should be considered a short-term solution, Holt notes that it can be renewed for consecutive 60-day episodes of care. So long as a doctor prescribes continuation of such care, Medicare is supposed to cover it.

However, Medicare has been stepping up its surveillance of fraud in home health care services, Holt says, and this has added to home health agencies’ reluctance to accept such Medicare patients. Care lasting beyond 60 days has become a red flag that triggers a fraud investigation by the outside fraud contractors hired by Medicare, she says. Needless to say, home health agencies are not eager to have their Medicare licenses threatened by having a fraud bullseye painted on their backs.

The common response to all of these forces is for home health agencies to either physically or figuratively just not come to the phone when Medicare enrollees come calling looking for care. And this, the Center for Medicare Advocacy has found, is exactly what has happened. In a white paper published last October, the Center for Medicare Advocacy concluded:

Medicare and Medicare Advantage plans are stating that beneficiaries are able to receive up to 8 hours a day and 35 hours a week of home health coverage, however this is not occurring in practice at the home health agencies. Only 8.1% of the home health agencies telephoned were willing to offer, and stated Medicare would cover, [even] 20 hours a week of home health aide services. Although many home health agencies said the number of hours they would provide depended on their assessment of the individual, 52.1% offered 3 or less visits a week, despite contradicting doctor’s orders. Some home health agencies indicated staffing concerns to meet the requested home health aide hours, but many stated a lack of Medicare coverage was the reason for the limited amount of visits a week.

In one specific case in Oklahoma, the Center for Medicare Advocacy found, a person with ALS (Amyotrophic Lateral Sclerosis) theoretically could choose from among 48 Medicare-licensed home health agencies for care where they lived. A patient’s representative got through to 42 of the 48 agencies and was told that only three of the 42 would even consider evaluating the person for care. Further, none of the agencies would consider providing the person more than three hours of home health aide services a week, even though the person’s doctor had prescribed 20 to 28 hours of care a week as medically necessary.

I reached out to Medicare for comment on this situation. The agency’s public information office had not responded after several days.

READ MORE: How to hire in-home help when your aging parents don’t want to move

The post Many seniors who qualify for home-based care under Medicare aren’t receiving it. Why? appeared first on PBS NewsHour.

How older adults can recover from loneliness

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Photo by Jose Luis Pelaez Inc/Getty Images

It’s widely believed that older age is darkened by persistent loneliness. But a considerable body of research confirms this isn’t the case.

In fact, loneliness is the exception rather than the rule in later life. And when it occurs, it can be alleviated: It’s a mutable psychological state.

Only 30 percent of older adults feel lonely fairly frequently, according to data from the National Social Life, Health and Aging Project, the most definitive study of seniors’ social circumstances and their health in the U.S.

The remaining 70 percent have enough fulfilling interactions with other people to meet their fundamental social and emotional needs

“If anything, the intensity of loneliness decreases from young adulthood through middle age and doesn’t become intense again until the oldest old age,” said Louise Hawkley, an internationally recognized authority on the topic and senior research scientist at the National Opinion Research Center (NORC) at the University of Chicago.

Understanding the extent of loneliness is important, insofar as this condition has been linked to elevated stress, impaired immune system function, inflammation, high blood pressure, depression, cognitive dysfunction and an earlier-than-expected death in older adults.

A new study, co-authored by Hawkley, highlights another underappreciated feature of this affliction: Loneliness is often transient, not permanent.

That study examined more than 2,200 Americans ages 57 to 85 in 2005 and again in 2010. Of the group who reported being lonely in 2005 (just under one-third of the sample), 40 percent had recovered from that state five years later while 60 percent were still lonely.

What helped older adults who had been lonely recover? Two factors: spending time with other people and eliminating discord and disturbances in family relationships.

Hawkley explains the result by noting that loneliness is a signal that an essential need — a desire for belonging — isn’t being met. Like hunger or thirst, it motivates people to act, and it’s likely that seniors reached out to the people they were closest to more often.

Her study also looked at protective factors that kept seniors from becoming lonely. What made a difference? Lots of support from family members and fewer physical problems that interfere with an individual’s independence and ability to get out and about.

What helped older adults who had been lonely recover? Two factors: spending time with other people and eliminating discord and disturbances in family relationships.

To alleviate loneliness, one must first recognize the perceptions underlying the emotion, Hawkley and other experts said.

The fundamental perception is one of inadequacy. People who are lonely tend to feel that others aren’t meeting their expectations and that something essential is missing. And there’s usually a significant gap between the relationships these people want and those they actually have.

This isn’t the same as social isolation — a lack of contact with other people — although the two can be linked. People can be “lonely in a marriage” that’s characterized by conflict or “lonely in a crowd” when they’re surrounded by other people with whom they can’t connect.

Interventions to address loneliness have received heightened attention since 2011, when the Campaign to End Loneliness launched in Britain.

Here are two essential ways to mitigate this distressing sentiment:

Alter perceptions. Loneliness perpetuates itself through a gloomy feedback cycle. We think people don’t like us, so we convey negativity in their presence, which causes them to withdraw from us, which reinforces our perception that we’re not valued.

Changing the perceptions that underlie this cycle is the most effective way to relieve loneliness, according to a comprehensive evaluation of loneliness interventions published in 2011.

Heidi Grant, associate director of the Motivation Science Center at Columbia University, described this dynamic in an article published in 2010. “If co-worker Bob seems more quiet and distant than usual lately, a lonely person is likely to assume that he’s done something to offend Bob, or that Bob is intentionally giving him the cold shoulder,” she wrote.

With help, people can learn to examine the assumptions underlying their thoughts and ask questions such as “Am I sure Bob doesn’t like me? Could there be other, more likely reasons for his quiet, reserved behavior at work?”

This kind of “cognitive restructuring” is an essential component of LISTEN, a promising intervention to treat loneliness developed by Laurie Theeke, an associate professor in the school of nursing at West Virginia University. In five two-hour sessions, small groups of lonely people probe their expectations of relationships, their needs, their thought patterns and their behaviors while telling their stories and listening to others.

Joining a group can be effective if there’s an educational component and people are actively engaged, experts said.

Invest in relationships. With loneliness, it’s not the quantity of relationships that counts most. It’s the quality.

If you’re married, your relationship with your spouse is critically important in sustaining a feeling of belonging and preventing loneliness, Hawkley said.

If you haven’t been getting along, it’s time to try to turn things around. Remember when you felt most connected to your spouse? How did that feel? Can you emphasize the positive and minimize the negative? If you’re badly stuck, seek professional help.

Investing in relationships with family members and friends is similarly important. This is the time to move beyond old grievances.

Invest in relationships. With loneliness, it’s not the quantity of relationships that counts most. It’s the quality.

“If you want to recover from loneliness, try to deal with difficulties that are disrupting relationships,” Hawkley said.

Also, it’s a good idea to diversify your relationships so you’re not depending exclusively on a few people, according to Jenny de Jong Gierveld and Tineke Fokkema, loneliness researchers from the Netherlands.

Training in social skills can help lonely people deal with problems such as not knowing how to renew contact with an old friend or initiate conversation with a distant relative. And learning coping strategies can enlarge their arsenal of adaptive responses.

Both of these strategies are part of a six-week “friendship enrichment program” developed in the Netherlands. The goal is to help people become aware of their social needs, reflect on their expectations, analyze and improve the quality of existing relationships and develop new friendships.

One simple strategy can make a difference. “If you have good news, share it,” Hawkley said, “because that tends to bring people closer together.”

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

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 How older adults can recover from loneliness appeared first on PBS NewsHour.


If I’m healthy, do I really need a Medigap or Medicare Advantage plan?

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The Social Security Administration has no idea who’s in your family unless you tell them. That information can affect the benefits you collect. Photo by Siri Stafford/Getty Images.

Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. 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.


Christian – Virginia: Do I really need a Medicare supplement or Medicare Advantage plan if I’m very healthy and take no prescription medicines? There’s a chance I may someday need a hip replacement, but fortunately, I do have the capital to pay my coinsurance and copayments. I’m just wondering if staying “self insured” this way is better than paying monthly premium for a benefit I’ll likely not use much.

Phil Moeller: It’s all a matter of your own risk-reward calculation.

First off, there is no law that says you have to get any part of Medicare when you turn 65. You can totally self-insure.

While you are healthy now, Medicare is about insuring a “future” you who is not going to be nearly so healthy.

The downside to this is that if you later decide you do need Medicare, you will get socked with lifetime late-enrollment penalties for Part B and Part D. You also might have trouble even getting a Medicare supplement plan. And you undoubtedly will face a gap of up to six months or even more between when you want Medicare and when coverage becomes effective. So, if you wait until you get sick to apply, it might be too late to avoid really big bills.

And don’t kid yourself, health care is incredibly expensive. My wife went in last year for a one-day “outpatient” treatment and was in the hospital something like 30 hours. The bill from the hospital was nearly $110,000! I kid you not. Insurance covered all but $1,000.

Lastly, while you are healthy now, Medicare is about insuring a “future” you who is not going to be nearly so healthy. Even very healthy people face substantial medical bills in their later years.

Having said all this, it remains your choice.


Donna: I am 64 years old and have been divorced for eight and a half years after a 31-year marriage. I understand that I can’t get my full benefits until 66. Can you tell me what is the best thing to do, and how much do I get if I wait until 66? Also, can I collect on both of our benefits? For instance, if I get $1,000 for myself, will I be able to get an additional $500 from him?

Phil Moeller: As you noted, you will need to wait until age 66 to get full divorce benefits. Their exact amount will depend on how much money in benefits your former husband would have been entitled to at age 66 (whether or not he had actually filed for them by then). This figure is determined by the record of wages on which he paid Social Security payroll taxes.

Whatever that amount is, it will be reduced by 7 to 8 percent for each year you claim it prior to age 66.

You cannot claim both your full retirement benefit and your full ex-spousal benefit at the same time. Social Security will look at the size of each benefit and pay you an amount that is roughly equal to the greater of the two.

You can find out your own benefit entitlement by opening an online account with Social Security. It will show you the agency’s records for your lifetime wage earnings and provide you a rough calculation of how much money you would get in retirement at different claiming ages.

Armed with this knowledge, you can then contact Social Security and ask them to calculate what your ex-spousal benefit would be. This can take a while, and you need to be patient. Unless you are friendly with your ex and he agrees to provide you access to his Social Security records, you are dependent on the agency to gather this information for you. If your local Social Security office is like most of them, it is understaffed and overworked, and the people you deal with may not even understand the rules as well as they should.

READ MORE: Can I work and still collect my late husband’s Social Security benefits?

Once you know the size of both benefits, you can begin to fashion a good claiming strategy.

If your ex-spousal benefit at age 66 is always going to be greater than your own retirement benefit, then you should just file for it and not worry about your own retirement benefit.

However, perhaps your retirement benefit already is the larger of the two, or maybe it would be if you delayed filing for it until age 70, when it reached its maximum amount. In this situation, you should consider taking advantage of another Social Security claiming rule.

Under the terms of a major change in Social Security laws enacted in 2015, anyone who turned 62 on or before the beginning of 2016 is allowed to file what’s called a “restricted” application. This applies to you. What it means is that at age 66 you can file a restricted application for just your ex-spousal benefit, while delaying the filing for your own retirement benefit.

If you did this, you could get the full value of your ex-spousal benefit for up to four years. Then, as late as age 70, you could file for your own retirement benefits. If you did this, you would get an additional payment roughly equal to the amount by which your retirement benefit exceeded your ex-spousal benefit.


Nancy – Virginia: I am currently 64 and am planning to quit my job on my birthday next year when I turn 65. Although I do not plan to collect Social Security until I am 66, I will file for Medicare before I turn 65 so that I am not penalized. My husband is five years younger than me. I was planning to drop my employer’s insurance when I resign at 65 and get added to my husband’s health insurance. Do you advise this move? To be added, it will cost approximately $100 a month.

Phil Moeller: If you like your husband’s coverage, I’d suggest you skip Medicare for now and simply have him add you to his plan. So long as you are covered by an employer plan — as the employee or the spouse — you can avoid late-enrollment penalties when you later enroll in Medicare.

If being added to your husband’s plan would cost only $100 more a month, I wonder if it makes sense to do this right away and not wait until you’re 65?


Lee: My wife filed before her full retirement age for her own benefit based on her work record. Since I have not applied for benefits, Social Security is saying that I must apply for benefits before they can make a determination on her application. Since I have not applied, do deeming rules apply in that she must apply for all the benefits she is “eligible” for, including spousal benefits? She may be eligible for spousal benefits, but since I didn’t apply, they are not available to her. I planned to apply for spousal benefits on her record and let mine benefit grow until I’m 70.

Phil Moeller: Your wife’s entitlement to her own retirement benefits is not dependent on you first filing for yours, so I am at a loss why Social Security would tell you this.

READ MORE: Should we raise the retirement age for Social Security and Medicare?

If you have not filed, she cannot be deemed, because she is only eligible for her own retirement benefit and not for her spousal benefit.

Assuming you turned 62 before the beginning of 2016, you are grandfathered under Social Security’s new rules and may file a restricted application for just a spousal benefit when you reach your full retirement age. This will permit you to delay your own retirement benefit until as late as age 70.

If you revisit this issue with Social Security, I would love to know the official source for their position that you must file before your wife can file.

Why does drawing Social Security benefits prevent seniors from making HSA contributions? Phil Moeller reports on the issue in his latest column.

The post If I’m healthy, do I really need a Medigap or Medicare Advantage plan? appeared first on PBS NewsHour.

What do you need to know about successful aging and retirement?

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Tens of millions of adults are chronically lonely, which has deleterious impacts on aging. Photo by brunella fratini/via Adobe. related words: seniors, retirement, health care, medicare

Tens of millions of adults are chronically lonely, which has deleterious impacts on aging. Photo by brunella fratini/via Adobe. related words: seniors, retirement, health care, medicare

Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. 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.


Medicare and Social Security are of critical importance in enabling older Americans to age in good physical and financial health. To support these broader goals, “Ask Phil” is expanding its mission.

If you have questions about other things that are shaping your own experiences with aging, please send them my way.

Where to start? I am so glad you asked! I have written what seems to be countless stories and received thousands of questions from readers about facets of what I call successful aging. I wish that success meant that we’d all live forever and avoid stormy weather during our journeys. Of course, it does not.

Successful aging means aging with as much physical well-being, financial security and dignity as possible. To this I would add the nebulous but critically important goal of living a life that is satisfying, or at least satisfying enough that the view from your death bed is not one of regret. I co-authored a book about this in 2012 called “How to Live to 100.” While I am not sure I would want to live that long, I am sure that the required elements of a long and successful life are very much worth paying attention to.

Here, then, is a laundry list of aging topics that I hope will help prime your “Ask Phil” pump and prompt questions that you would like addressed.

GOALS

Purposeful time: volunteering, education, giving back and worship
Leisure time: travel, entertainment and hobbies
Family and social relationships
Estate and legacy issues
What does your finish line look like?

ISSUES

Budget deficits and senior safety nets
Technology, self-driving cars and senior independence
Longevity, demographics and implications for aging
Alzheimer’s and dementia
Long-term care
Who will take care of us?

MONEY

Investments
Budgets and spending
Financial fraud and abuse
Taxes

WORK

Retirement, non-retirement and pre-retirement
Working forever
Encore careers
Workplace issues for older employees

HOME

Aging in place at home
Age-friendly homes and communities
Reverse mortgages, home equity and other housing issues
Downsizing
Retirement communities

This list is not meant to be complete or exclusive. If you have questions about other things that are shaping your own experiences with aging, please send them my way.

And now, here are this week’s reader questions.


Cynthia – Texas: Where can I get some help with Medicare questions? What is SHIP? I will be 65 in July and need some help. Also, my husband is 66 years old and has been receiving Social Security since he was 62. I am still working. Can I file under his Social Security to receive a spousal benefit?

Phil Moeller: SHIP is shorthand for the State Health Insurance Assistance Program. It provides free Medicare counseling and has local experts in your home state. President Trump’s current budget proposals would eliminate all of SHIP’s annual $52 million in funding, continuing recent Republican efforts to eliminate this source of free help to consumers. While Medicare’s own information services can be very helpful, they do not do a very good job of helping consumers navigate Medicare’s seemingly countless complexities. That $52 million, by the way, supports an enormous volunteer network of thousands of consumer counselors. Medicare would need to spend many times this amount to replace what SHIP does.

READ MORE: Column: Why we need to save Medicare counseling from the federal chopping block

As far as your Social Security question is concerned, you can file for a spousal benefit if you are at least 62. However, these benefits will increase every year until reaching their maximum amount when you reach your full retirement age of 66.

Also — and this is big deal — if you file for a spousal benefit before you turn 66, Social Security will deem you to be simultaneously filing for your own retirement benefit. You would be hit with early claiming reductions on both benefits. Worse, Social Security would not pay you each benefit, but only an amount roughly equal to the greater of the two.

Because you already had turned 62 as of the beginning of 2016, you are grandfathered in under new Social Security laws. Under this provision, if you waited to file for a spousal benefit until you were 66, you could file what’s called a restricted application for just your spousal benefit while deferring your own retirement benefit until as late as age 70, when it would reach its maximum amount.


Richard – Minnesota: I have a disability that forced me to stop working as a registered nurse. My former employer provided me a wonderful benefit to continue my health plan at the same payment rate until I turned 65. However, after I received Social Security disability benefits, I now find that I can no longer use this plan as my primary insurer if I sign up for Medicare. So I will have to go onto my wife’s employer health plan. In either case, the expense is raised by thousands of dollars each year. Why does the government find this a reasonable way to treat disabled persons?

Phil Moeller: I am sorry you are finding out in such a negative way that Medicare is not always reasonable. It is, however, usually logical. Your former employer’s plan apparently is designed so that it ceases to be the primary payer of health claims when you turn 65 or, at least in the plan’s eyes, are retired. Most retiree plans require Medicare to become the primary payer of claims, with the retiree plan becoming the secondary payer. This provision holds down employer expenses and is a major reason why they offer retiree plans at all.

If you get Medicare, even if you had not yet turned 65, this apparently triggers the provision that your former employer’s plan become a secondary payer. I can understand that you feel you have no choice but to be covered under your wife’s plan and that either Medicare or her plan will cost you a lot more money than you were paying.

READ MORE: Should we raise the retirement age for Social Security and Medicare?

In this case, I don’t think your disability is the cause of your problem. Rather, it’s that your former plan would view you as a retiree if you went onto Medicare. You would be treated this way whether or not you were disabled.

By the way, finding a health policy on Minnesota’s state Obamacare insurance exchange might be another option. While these rates have been increasing and Republicans would like to end Obamacare altogether, this could be a less expensive option for you than moving to your wife’s employer health plan.


Eugene: I am reading your Medicare book and think it should have mentioned the U.S. Family Health Plan. This plan works with Tricare and covers former military members in some parts of the country, allowing them to avoid needing to sign up for Medicare after they turn 65.

Phil Moeller: Thanks for mentioning the U.S. Family Health Plan. It’s always hard to know how much detail to go into for situations that are not widespread, and this is one of them.

According to Tricare, there are slightly more than 100,000 members in this health plan, which is the only one of its kind. This is a little more than 1 percent of about 9.4 million Tricare members.

Even though Medicare is not required for people in this plan, its limitation to only six regions of the country prompted Tricare to tell me, “We strongly encourage these beneficiaries to enroll in Part B when they first become eligible. If they disenroll from USFHP, or move to a non-USFHP area, they won’t be eligible for other TRICARE benefits if they don’t have Part B. And, if they don’t enroll in Part B when first eligible, they may be required to pay the Medicare Part B Late Enrollment Penalty.”


Dan – Texas: I have been trying to find home care (unskilled) for my 83-year-old mother. She has Medicare, but also has a Humana policy. It covers 35 hours a week, but every time I try to get assistance, I am denied. I don’t understand why we can’t get her the desperate help we need for her. My mother has Alzheimer’s and dementia and is the widow of a veteran.

Phil Moeller: Sadly, Medicare does not cover most unskilled home care. This is not Humana’s fault, but it is a Medicare rule.

If you don’t have a doctor’s recommendation, I am not surprised you are being rejected for coverage. Might your doctor prescribe such care as medically necessary? Even if he has, and she qualifies for Medicare’s home care benefit, the challenge is to find a home-health agency to provide it.

READ MORE: Many seniors who qualify for home-based care under Medicare aren’t receiving it. Why?

This has become an enormous problem. Even though this is a covered benefit, it seems that many home-health agencies simply do not want to provide these services. There are lots of reasons — other care is more profitable, they have staff shortages, etc. But the bottom line is that it is very, very hard to get this care.

Humana should have a list of recommended home-health agencies. Medicare also maintains an online list of registered agencies and has a rating system to grade their performance. Even so, it can be very hard to find an agency willing to take on a client such as your mother.

The post What do you need to know about successful aging and retirement? appeared first on PBS NewsHour.

Think you’re too old for a bucket list? These 90-somethings disagree

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Mildred “Milly” Reeves, right, flies a Cessna Model 172 with assistance from pilot Pete Lockner, left. (Screengrab of family video/YouTube)

Mildred “Milly” Reeves, right, flies a Cessna Model 172 with assistance from pilot Pete Lockner, left. (Screengrab of family video/YouTube)

It is one thing to have a bucket list at any age. It is something else entirely to have a bucket list that sends you to college for the first time at 92 — or that sends you on your maiden flight at the controls of a single-engine airplane at 97.

These are the bucket list accomplishments of Cecile Tegler (92) and Mildred “Milly” Reeves (97). And neither of them is done yet.

“I never even thought about having a bucket list,” said Reeves, a resident at Mount View Assisted Living in Lockport, N.Y., who became familiar with the insides of airplanes in her 20s, when she was a small-parts inspector for Bell Aircraft during World War II. After the war ended, she stayed home and had seven daughters — so the notion of ever flying a plane solo grew increasingly distant.

Nor had Tegler, her friend and fellow resident at Mount View, ever created a real bucket list. What she did have, however, was an urge to go to college, since her folks — who had to support their own parents — didn’t have the money to pay for college when she was in her late teens. Both of Tegler’s daughters graduated from college, but she never imagined that she could go to college, too.

Within the past year — because of unusual outreach efforts by staff at the assisted living community where they both live — Tegler attended a community college, where she finally learned how to use and operate a computer. And Reeves took the controls of an airplane and flew it, on her own, for about 15 minutes. Whether or not these are actual bucket list items, they are accomplishments that have spurred both women to set even more goals.

It stands to reason that bucket lists — specific life goals to accomplish before dying — are more popular as Americans live longer and find they have more time on their hands.

Such goals don’t have to be about flying airplanes or entering college in your 90s. Sometimes, bucket lists that focus on helping others can be the most effective. That, at least, was the plot line of the 2007 film “The Bucket List,” starring Jack Nicholson as an eccentric billionaire who finds himself sharing a hospital room with a car mechanic played by Morgan Freeman. Both men suffer terminal illnesses but opt to complete their lifetime bucket lists together — only to discover their new friendship tops the list.

“The best bucket lists aren’t usually about skydiving or climbing the Great Wall of China,” said Marc Agronin, a geriatric psychiatrist who is vice president for behavioral health and clinical research at Miami Jewish Health Systems in Miami. “Our bucket lists need to be in line with our core values.” He suggests that people simply look around and see the riches they have and the potential for adventure right in their own communities.

Cecile Tegler, right, stands in the lobby of Niagara County Community College with fellow Mount View Assisted Living residents Sandra Leaming, left, and Marge Reinard, center, before heading to a class on computer applications. (Courtesy of Mount View Assisted Living)

Cecile Tegler, right, stands in the lobby of Niagara County Community College with fellow Mount View Assisted Living residents Sandra Leaming, left, and Marge Reinard, center, before heading to a class on computer applications. (Courtesy of Mount View Assisted Living)

Reeves, whose grandson eagerly came along with her on her maiden flight to capture the moment on video, totally gets that. She said that she took as much — if not more — pleasure in her grandson coming along for the ride as she took in the moment when the captain of the plane handed her the controls. Reeves takes the greatest pride in her seven daughters, 12 grandchildren and 14 great-grandchildren.

Meanwhile, Tegler, who attended computer class three times weekly at Niagara County Community College in Niagara Falls, N.Y., learned how to use Microsoft Word and Excel software. She was among the first at Mount View to enroll at the college and has since inspired others to do the same. Among those now considering a return to college is her friend Reeves.

“The ultimate goal of this is to get them more involved in society and in the belief that they can still do things.”

“I’ve helped many people in my life,” said Tegler, who expressed no fear or hesitation about attending college with a bunch of 20-somethings. Many students in the class helped her learn how to use the computer. When Tegler was younger, she said, she often volunteered at homes for veterans because her husband, father and brothers all served in the Army.

Quietly helping Reeves, Tegler and 266 other residents of two assisted living homes in upstate New York accomplish their bucket list goals is David Tosetto, who owns both Mount View and Cobb’s Hill Manor in Rochester, N.Y. “Young people dream and old people remember,” said Tosetto. “The goal of the bucket list is to give them something to dream about.”

Mount View owner David Tosetto, left, stands with Mildred “Milly” Reeves, right, after her flight in a Cessna Model 172 at the Genesee County Airport. (Courtesy of Mount View Assisted Living)

Mount View owner David Tosetto, left, stands with Mildred “Milly” Reeves, right, after her flight in a Cessna Model 172 at the Genesee County Airport. (Courtesy of Mount View Assisted Living)

The way Tosetto figures it, happy residents make for longer-term residents and happier employees. So, he doesn’t charge them one penny extra for the bucket list outings. Besides the flying school and college opportunities, he’s also putting together a scuba diving class at a local pool and a kayaking adventure this summer.

“The ultimate goal of this is to get them more involved in society and in the belief that they can still do things,” said Tosetto. He puts the programs into motion by posting large “Bucket List” signs around the two assisted living facilities that announce the opportunities and encourage residents to sign up.

Tosetto won’t sponsor some activities, such as skydiving. “I just don’t know how they can land safely,” he explained. “Of course, if they choose to do it on their own, that’s up to them.”

In the end, said Agronin, author of the book “How We Age: A Doctor’s Journey Into the Heart of Growing Old,” your legacy isn’t about how many planes you’ve jumped out of or how many countries you’ve visited. “When the trip of a lifetime ends, you still have the rest of your life to live,” he said. Your real legacy is about the people you touch along the way. “The relationships you create and what you teach your children is how you build your legacy,” he said.

At 97, Reeves is still building hers.

Asked to name the lifetime accomplishment of which she’s most proud, it’s not the plane flight at all. “I’m still a Girl Scout,” she boasted, noting that she earned the Gold Award, scouting’s highest honor. “I still pay my dues.”

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

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 Think you’re too old for a bucket list? These 90-somethings disagree appeared first on PBS NewsHour.

What’s the best place to retire? Keep these factors in mind before settling down

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Two elderly people sit on a bench as they look at a parascending during a sunny summer day in Nice, southeastern France, July 28, 2014. REUTERS/Eric Gaillard (FRANCE - Tags: ENVIRONMENT TRAVEL SOCIETY) - RTR40E3K related words: medicare, aging, retirement, travel, retired

Photo by Eric Gaillard/Reuters

Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. 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.


I’ve always taken those “Best Places to Retire” lists with a very big grain of salt. Most people think the best place to retire is right where they are, usually staying in their own homes as long as possible. Family concerns are another driver, with people moving to be near grandchildren or perhaps other relatives, especially those who need looking after.

I have become convinced, however, that location will become a more significant variable in later-life decisions. Several factors are shaping this shift.

President Trump and the Republican Congress want to give states a much greater say in how they spend federal health care dollars, particularly in the Medicaid program. Medicare does not cover long-term care, and Medicaid is the primary payer of nursing home care for millions of lower-income, older Americans. Changes in Medicaid thus could produce big differences in the amount and quality of health care provided by different states.

Democrats vow to strongly resist these efforts, and it’s not at all clear that Republicans will be able to agree among themselves that they should even more forward with a version of the American Health Care Act that passed the House of Representatives.

But there is a lot of writing on the wall here that says states will not be able to look to Washington for the kind of funding support they’ve enjoyed.

Federal deficits have not been a widespread concern since the deep recession began roughly 10 years ago. Deficit spending was accepted by even many conservatives as a necessary antidote to a weak economy. With inflation remaining very low, our rising national debt has not produced painful consequences to date.

But the weak recovery has nonetheless been a recovery. The unemployment rate is now at a 16-year low of 4.3 percent. I grant that many people are badly underemployed, working in jobs they dislike for equally disappointing salaries. Millions of other unemployed people are not even counted in the work force.

READ MORE: Analysis: Today’s unemployment number fools us and President Trump, but for different reasons

Still, warts and all, we are approaching — if not already at — full employment. Historically, a steady supply of legal and illegal immigrants would have boosted the supply of labor. But with the immigration spigot turned tighter, rising pressure on wages and price levels would hardly be surprising. Any appreciable uptick in inflation would ratchet up interest costs on the national debt, bringing federal deficits back into the news.

Already, rising numbers of older Americans are driving higher federal government spending on Social Security, Medicare and Medicaid. If the rate of inflation picks up, these programs will become unsustainable even earlier than forecast. Even a sympathetic Washington, which we don’t have today, would have little choice but to reduce its support for senior safety nets. This, in turn, would give the states more effective say in shaping local safety-net supports.

At the same time, lack of consensus in Washington on just about everything has been the norm for several years. Many state governors and legislatures have responded to this federal vacuum by charting either modest or major changes in the courses that their states are taking.

Against this backdrop, three other trends deserve mention:

First, climate change appears to be having an unequal impact on different parts of the United States. As this reality becomes better understood and more pronounced, it can’t help but produce winners and losers among the states.

Second, the rising numbers of older citizens has boosted attention to the quality of life offered to seniors in different cities and states. So-called “age friendly” programs and policies have the potential to create significant differences in the desirability of living in different parts of the country. The Milken Institute, among others, has been assembling a compelling case for this in its annual “Best Cities for Successful Aging” reports.

Third, there already are significant differences in state tax policies. These have long influenced retirement location decisions of wealthier folks. As states wrestle with the consequences of more responsibility for their older citizens’ retirement and health needs, these differences could become even more pronounced.

Now, before you scatter to the retirement hills in whatever state beckons you, here are this week’s reader questions.


John – Massachusetts: My wife is 66 and has a health savings account. She recently was laid off and thus will need to sign up soon for Medicare. We know that doing so will render her ineligible to continue contributions to her HSA, but we are confused about the part of this rule that says the effective date of her signing up for Part A of Medicare could be retroactive to six months prior to her enrollment. If she signs up for Medicare soon, will this six-month retroactivity affect her HSA contributions for last year? Might she be better off waiting until July 1 to sign up? Or could I simply request an HSA distribution for November and December of last year and pay taxes on that amount?

READ MORE: The Social Security and Medicare gotcha that makes contributing to your HSA illegal

Phil Moeller: The six-month retroactivity “gotcha” for HSA eligibility stems from Social Security rules, and it certainly could affect 2016 contributions. But the biggest issue with your timing question is not about possible IRS penalties for making improper contribution. It is, or should be, making sure your wife does not find herself with no health insurance, even for one day. Thus, she should either get Medicare right away or get a COBRA continuation policy through her former employer, but for no more than a couple of months. Her Medicare enrollment period began as soon as her employer coverage ended. Having COBRA does not pause the clock on when she needs to have Medicare and avoid its late-enrollment penalties.

If she waited until July, you would eliminate the need to deal with the IRS on 2016 tax issues. But you will still have to adjust your 2017 tax returns to reverse the benefits of any pre-tax contributions to her HSA this year. Whether you will face IRS penalties is another matter, although it seems to me that making HSA adjustments during 2017 will remove any tax benefit you may have received and thus eliminate the cause for being penalized. However, I have learned never to predict what the IRS might or might not do.


David: My parents are Christian missionaries in Mexico. They have been doing this for more than 40 years. Needless to say, they have not made very much money throughout their life and have no serious post-retirement plans. My mother turns 65 this year and she has no clue what she is supposed to do (my father is a Mexican citizen). They have been getting wages though their sponsoring church, so I assume they have contributed to Social Security and Medicare. My parents plan to remain in Mexico. What would be their best course of action?

Phil Moeller: In terms of Social Security, they (or you) should use their Social Security numbers to open online accounts with the agency that will show them their benefits under some different claiming ages. Our Social Security book goes into all the gory details of how they can evaluate these options.

In terms of Medicare, they probably should do nothing, so long as they are confident they will not live in the U.S. later in their lives. I recently wrote an explanation of Medicare issues for ex-pats that might provide you a good overview.


Gary: Regarding Medigap rating approaches, it appears that community rating is superior to the issue-age or the attained-age rating. I reached this conclusion based on that fact that it is not age related, like the attained-age approach, and not individually health related, like I assume the issue-age rated approach to be. Am I correct here?

Phil Moeller: When a person first becomes eligible for Medicare, they normally have what’s called a guaranteed access period for Medigap. During this period, Medigap insurers are not allowed to discriminate against an applicant based on their health. Having said that, the prices of both issue age and attained age policies may be affected over time by the generally poorer health of pools of older policyholders.

Here are explanations of these approaches that were provided to me for research on my Medicare book. I found them helpful, and hope you do, too:

Attained age rating, when structured properly, reflects the underlying costs for each age. This rating type is used frequently since it is least expensive for younger insureds (e.g., age 65), even though it is most expensive for older insureds. While this structure may provide the lowest rates for someone first eligible for Medicare, rates increase over time for both aging (about 2% to 4% per year up to age 80 or 85) and inflation. At older ages, it may be challenging to pay the higher rates required. For those who want the lowest rates now and who may not expect to live long, attained age rating may provide the best value.

Issue age rating charges a rate that’s a little higher than the cost of benefits during the first few years and invests the excess in a reserve that grows with interest and survivorship. (Survivorship means that the reserve for people who die or terminate their coverage is shared among those who remain.) In later years when the issue age rate is not enough to cover the cost of benefits, the reserve is used to help fund the difference. This structure has a higher initial cost than attained age rating and is not used often except in states that require it (Florida, New Hampshire) or prohibit the use of attained age rating (several states including Idaho). Rates increase for inflation but do not increase due to age. With issue age rating, people enrolling at older ages pay higher rates than people enrolling at younger ages. Issue age rating helps members avoid the higher rate increases associated with attained age rating and can provide excellent value for those who expect to continue their insurance for many years.

With pure community rating, everyone in the community pays the same amount for their plan. (A state may have more than one community, defined by geographic region within the state.) Similar to issue age rating, younger insureds pay more than their average cost of benefits, while older insureds pay less than their average cost of benefits. Unlike issue age rating, there is no reserve build up since today’s younger insureds are subsidizing the extra costs for today’s older insureds. Community rating is required in seven states: Connecticut, Maine, Massachusetts, Minnesota, New York, Vermont and Washington. Pure community rating is not often used in states where it is not required, since community rates are higher for younger insureds than attained age rates and issue age rates. Modified community rating may include rates that vary within the community based on factors other than age. Rates under modified community rating can be competitive with attained age and issue age rates, and can provide excellent value for people of all ages.


Deanna: I know you are the guru on Social Security and Medicare, and I love reading your articles! I’m nearly 64 years old and still working. My husband passed away two years ago. Last year, I started collecting Social Security survivor benefits, but I only get six months’ worth a year, because I’m still working, and the earnings test reduces my benefits. My question concerns Medicare. I will be 65 next year in July 2018, and I’m not sure how long I’ll continue to work. Since I’m collecting Social Security, will I automatically be enrolled in Medicare Parts A and B? I have insurance coverage at work that includes health, vision and dental. It is less expensive than Medicare Part B. I know Medicare Part A will not charge me a premium. Should I enroll, or keep Part A if I’m automatically enrolled? Would my work insurance be my primary coverage even if I have Medicare Part A and/or Part B?  If I decline Medicare when I turn 65, will I be able to enroll once I decide to retire?

Phil Moeller: When you turn 65, you should be automatically enrolled in Part A of Medicare but not Part B. Mistakes do happen, of course, so if Social Security does enroll you in Part B, you need to quickly contact the agency and reject Part B until you retire and lose access to your employer health insurance.

Having Part A invalidates continued participation in a health savings account. But I’m guessing you don’t have an HSA, or you would already have encountered this rule. For people without HSAs, I recommend keeping Part A, which can come in handy as a secondary insurer for covered hospital expenses.

You don’t need to worry about getting Medicare until you lose your employer health coverage. At that time, you will have an enrollment period to get Medicare and will not face any issues for not having done so when you turn 65.

The post What’s the best place to retire? Keep these factors in mind before settling down appeared first on PBS NewsHour.

How the back pain industry is taking patients for an unhealthy ride

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Searching for solutions to back pain can lead sufferers into an expensive and sometimes dangerous maze of ineffectual treatments, procedures and pills, journalist and investigative reporter Cathryn Jakobson Ramin found. Illustration by leremy/via Adobe

Searching for solutions to back pain can lead sufferers into an expensive and sometimes dangerous maze of ineffectual treatments, procedures and pills, journalist and investigative reporter Cathryn Jakobson Ramin found. Illustration by leremy/via Adobe

For the majority of us, it’s not a question of whether we’ll someday experience back pain; it’s a question of when.

‘Study after study after study has shown that long-term visits to chiropractors don’t help patients. They don’t prevent back pain; they don’t solve back pain.’

But searching for solutions can lead sufferers into an expensive and sometimes dangerous maze of ineffectual treatments, procedures and pills, as journalist and investigative reporter Cathryn Jakobson Ramin found. For years, she searched for ways to alleviate her own intractable back pain. Then she began to investigate the entire back pain ecosystem: doctors, chiropractors, surgery centers, pharmaceutical companies, “posture mavens,” collusion between personal injury attorneys and doctors … you name it.

Her new book, “Crooked: Outwitting the Back Pain Industry and Getting On the Road to Recovery,” explores what she found, while also telling the story of how she overcame her chronic suffering. When it comes to people making money on — literally — the backs of other people, “A lot of things didn’t add up,” she says. “That generally means something is wrong.”

Ramin recently spoke about her investigation with Eric Westervelt on KQED’s Forum program. Here is some of what she said.

Beware the One Surgeon Who Says Yes

Ramin, who had ineffective minor surgery for her back pain, said the post-surgical woes of Tiger Woods and Golden State Warriors’ coach Steve Kerr serve as prime examples of what can go wrong with back surgery.

‘Minimally invasive surgery’ is a marketing term. ‘The damage beneath the skin will be exactly the same as it would be in traditional spine surgery.’
She said some athletes do have successful surgery for back pain, but that it’s unlikely their example would apply to the rest of us. “Those athletes are highly, highly trained and in excellent condition,” she says.

Ramin says the fee-for-service payment system in the U.S. incentivizes unnecessary and potentially damaging spine surgery, where in other countries, spine surgery is rare.

And beware the surgeon who agrees to operate on you after other reputable doctors have turned you down. She gave the example of author, physician and marathon runner Jerome Groopman, who, after five surgeons had told him there was nothing they could do for his back injury, found a sixth who claimed he could operate and get him up and running in six weeks.

“He spent the next 19 years in extraordinary pain,” Ramin says.

Beware the surgeon who agrees to operate on you after other reputable doctors have turned you down.

Ramin also warns against taking the description “minimally invasive spine surgery” literally, calling it a marketing term.

“These are sexy buzzwords,” she says. “Perhaps the incision is small — and it isn’t always. If in fact you do have a small incision, good for you, you might look better in a bathing suit. The damage beneath the skin will be exactly the same as it would be in regular, traditional, conventional spine surgery.”

These procedures are often done in outpatient surgery centers , she says. “If anything goes wrong afterward, you’re not in a hospital environment.”

Chiropractors: A Very Mixed Bag

Ramin says some chiropractors are completely ineffectual while some are treating patients the right way. Of the latter, “They have stopped seeking vertebral subluxations [partial dislocations] which don’t actually exist on any X-ray or any type of scan, and have moved onto the very excellent practice of rehabilitation. They may ultimately be a back patient’s best hope because they have studied exercise science and they have worked hard on it.”

Neck adjustments, Ramin said, “are to be avoided at all costs. There is no reason to let a chiropractor anywhere near your neck.” Photo by Microgen/via Adobe

Neck adjustments, Ramin said, “are to be avoided at all costs. There is no reason to let a chiropractor anywhere near your neck.” Photo by Microgen/via Adobe

However, “If you see a chiropractor more than one or two sessions, you are wasting your time if you are being cracked, adjusted or walked over. Study after study after study has shown that long-term visits to chiropractors don’t help patients. They don’t prevent back pain; they don’t solve back pain.”

She said the World Health Organization has come up with a long list of all the diagnoses for which chiropractic is contra-indicated.( See page 20 here.) “And it’s probably anything that would take you to a chiropractor.”

Neck adjustments, she said, “are to be avoided at all costs. There is no reason to let a chiropractor anywhere near your neck.”

Pharmaceutical Companies: Painkilling Pill Pushers

In the 1990s, Ramin says, pharmaecutical companies embarked on a well-funded campaign to get primary care doctors to ask all their patients if they were experiencing any pain.

‘There is no reason to let a chiropractor anywhere near your neck.’
Oftentimes they were experiencing some back pain, “because it is a human condition,” she says. “The answer to that from the primary care doctor’s perspective, because of the active marketing from pharmaceutical companies, was to say ‘Well, we can take care of that pain.’ ”

Doctors often started out with short-acting pain killers, such as Vicodin, a potent and addictive narcotic. This was often followed by longer-acting, extended-release painkillers, such as the opioid-based Oxycodone — which has led thousands into heroin addiction.

But, Ramin says, opioid painkillers don’t work well for people with back pain.

“They cause those patients to become very unmotivated and very sleepy,” she says.

Plus, a condition called opioid-induced hyperalgesia can arise, in which the brain generates pain independent of the original injury.

Expensive Chairs and Standing Desks

What Ramin calls “posture mavens” rely on “ergonomic smoke and mirrors” to fix back pain, Ramin says.

For instance, many back sufferers will try new office chairs.

“I had a stable of office chairs,” she says. “One after another, expensive office chairs parading through my office, and I found most of them to be not very good.”

These chairs are “often built for 250-pound men,” she says.

Some tremendous benefits can be gained from doing yoga, Ramin says, but there is potential harm, as well.

“I realized you could have a chair from Costco for $25 that could keep you in the right position.”

The standard, erect typing position, she says, is actually a relic from when you had to press hard on typewriter keys to get them to work.

Regarding the use of standing desks, Ramin says those come with their own problems. “It’s a nice variation from sitting. But remember, if you are standing, you are putting tremendous pressure on possibly a different set of ligaments,” she says. “But still you’re asking your ligaments to hold you up for a really extended period of time. We’re seeing all kinds of problems related to standing desks, now. They tend to be knee and hip problems, but those will lead to back problems.”

If you have a standing desk, you still need to move around every so often, she counsels.

The Yoga Trap

Some tremendous benefits can be gained from doing yoga, Ramin says, but there is potential harm, as well.

“One of the risk factors is finding yourself in a very competitive Northern California yoga class where you are pushed to do what you really cannot do. Most of us who are even remotely competitive will experience that.”

She says if you have back pain, there are limitations to what you should do in class, and you need an instructor who can give you variations on postures to suit your condition.

Moving is the key. Our bodies are not built to sit or stand in one place for hours at a time.

“Be very careful about finding yourself in a flow yoga class where things are moving very fast and there’s no way the teacher can keep a close eye on you.”

Two type of yoga she recommends for back sufferers: Iyengar yoga and Viniyoga.

“Both of them have a very powerful orthopedic focus,” Ramin says.

So What Does Work?

Two things: Exercise and changing the way you think about back pain.

“Understanding that hurt does not mean harm,” Ramin says. “You can continue to live an active life. The most dangerous thing you can do for yourself is take to the couch or take to your bed or take to pain management. But of course that is what most people do.“

Ramin recommends finding a “back whisperer”–someone who understands the musculoskeletal system and is able to help people build strength, balance their gaits and move effectively.

Moving is the key. Our bodies are not built to sit or stand in one place for hours at a time, she says. “The best posture is your next posture.”

This report was produced by KQED’s Future of You. You can view the original report on its website.

The post How the back pain industry is taking patients for an unhealthy ride appeared first on PBS NewsHour.

Help! I lost my job and just turned 65. What do I do about health insurance?

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A job seeker walks past a sign at a veterans' job fair in Burbank, Los Angeles, California March 19, 2015. The number of Americans filing new claims for unemployment benefits rose marginally last week, indicating the labor market remained on solid footing despite slowing economic growth. REUTERS/Lucy Nicholson - RTR4U3N5

Phil Moeller answers your aging and retirement questions in his weekly column, “Ask Phil.” Photo by Lucy Nicholson/Reuters

Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. 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.


Anonymous — Florida: Help! I am turning 65 next week and was shocked to be let go from my job last week! My company had paid my medical and dental, and I paid these benefits for my husband, who is 17 months younger than me. My company gave me forms to go on COBRA and said it will make my COBRA payments for a year and continue to deduct from my severance what I pay for my husband. What should we do?

Phil Moeller: I’m so sorry that you lost your job. However, in the haze that can accompany such surprises, I urge you not to simply take COBRA and assume you’re done with health insurance concerns for the time being. You’re not done yet.

COBRA does not qualify as employer group insurance for Medicare eligibility. So when you turn 65 next week, you need to sign up for Medicare as soon as possible. There are two adverse consequences if you don’t: You might face late-enrollment penalties from Medicare, and what’s worse, your COBRA coverage might not pay your covered health claims.

You should check with your COBRA insurer, but it’s common for COBRA insurers to not be the primary payer of covered insurance claims for people who are eligible for Medicare.

For the same reason, you need to look into supplemental coverage now as well. I lay out all these choices in my Medicare book, and I hope reading it can take at least some of the deer-in-the-headlights panic out of this process.

As for your husband, he will need to get individual coverage on your state Obamacare exchange. This will be a hassle, but it should not be any more expensive than COBRA and possibly less expensive.

There are some Medicare Advantage policies that include a modest dental benefit. But all dental policies are relatively modest, so you might be better off just buying a separate policy from a private insurer. In any event, I would not let dental concerns be the determining factor in what types of supplemental Medicare coverage is best for you.

Best of luck, and again, I’m so sorry you lost your job and you have to go through this health care stress as well.


Patsy – Pennsylvania: When dying in a nursing home, an oncology unit in a hospital or in a hospice center, why isn’t a patient allowed hydration or food and medicated to the point of being barely conscious? Can a patient who does not want to be starved to death choose to be given minimal medication — just enough to take the edge off, but remain conscious?

Phil Moeller: Either the patient or their legal decision maker should be able to request whatever drugs and nutrition are needed for the patient to be comfortable in their final days. The primary purpose of hospice is to provide palliative care, which by definition, is to be provided with the patient’s comfort as the primary goal.

I can only assume you were involved with treatment of a loved one or friend that failed to meet these objectives. I am so sorry this happened.

There can be many reasonable differences about the kind of care a patient should receive at the end of their life. This is something the patient or their caregiver should learn about ahead of time, including having discussions with their doctors and caregivers at the facility where the patient will receive end-of-life care.

I hope that others reading about your experiences will be prompted to take charge of their own end-of-life care. Advance planning is essential here.

Having said this, I know that real-life situations can be hectic and often do not unfold as planned.


Sal – New Jersey: In your opinion, how much would future Social Security cost of living adjustment (COLA) increases need to be for all Medicare B premiums to be the same for everyone except the higher earners? Charging people different Medicare premiums is not fair and needs to stop.

Phil Moeller: What a great question! I don’t have a precise answer. The impact of the hold-harmless rule, which is what your question concerns, depends not only on future rates of consumer price inflation but also on future Medicare Part B premium increases. These, in turn, will be keyed to future rates of health care inflation that are not known today.

I think I’m on safe ground, however, in saying that it would take several years of at least moderate inflation before Part B premiums would be equalized. While consumer prices have ticked up as of late, it’s not clear to me that we will see even moderate COLAs during the next few years.

If I were running the zoo — one of my not-so-fond names for our national government — I would change the rules to get rid of this situation. This is easier said than done.

For example, ending the hold harmless rule would allow the same Medicare premiums to be paid by everyone except for wealthy enrollees. But it would expose Social Security recipients to declines in benefits if Medicare expenses outstrip the pace of inflation.

If you do not find this exposure acceptable, then we’d need to devise a mechanism that works like the hold harmless rule, but does not produce different payment levels for Medicare enrollees. To do this, we’d need rules that protected Social Security benefits from being eroded by either inflation or higher Medicare premiums and that prevented Medicare health inflation from triggering differential premium impacts.

One solution would be for the government to step up and pay any annual amounts by which Medicare Part B premiums exceeded the annual COLA. This has occurred, at least in part, on an emergency basis the past two years. Making it permanent would require Washington to further subsidize Medicare premiums. I wouldn’t hold my breath for this happening while Republicans control the White House and Congress.

The fiscal conservative in me is also obligated speak up. Such a solution might be “fair” and certainly attractive to Social Security and Medicare recipients. But it wouldn’t be so good for the national debt!


John: If a participant in a high-deductible health plan is reaching 65 shortly, what would happen if he elected to take a Social Security spousal benefit on his wife’s earnings while deferring his own Social Security retirement benefit? Could he still contribute to a health savings account?

Phil Moeller: No. Any type of Social Security benefit, even one taken on a spouse’s earnings record, will automatically enroll a beneficiary in Part A of Medicare. This invalidates continued tax-advantaged contributions to an HSA. The only way to avoid Part A in this situation is to forego Social Security benefits entirely.


Paul: My wife started collecting Social Security in November 2015 and soon will turn 65. I started collecting in February 2017, when I turned 66. We are being told she must start collecting spousal benefits now, because I started collecting. I thought she could wait until she turned 66 and get more out of the spousal benefit.

Phil Moeller: No, she can’t wait. Because she is already collecting her retirement benefit, she is automatically deemed to also be claiming her spousal benefit as soon as she became eligible for it. This eligibility was triggered when you filed for your own benefit.

The ability to avoid deeming was largely eliminated in major changes to Social Security laws enacted in 2015 by Congress. There is a limited exemption from deeming for people who were at least 62 as of the beginning of 2016. When they reach their full retirement age, they can file a restricted application for only one benefit. But because your wife had already filed for her retirement benefit, this option is no longer open to her. Sorry!

The post Help! I lost my job and just turned 65. What do I do about health insurance? appeared first on PBS NewsHour.

Bill Nye Lets Out His Inner Nerd, How To Grow Old Without Getting Old, 'A Life of Adventure and Delight'

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Bill Nye joins us to discuss his new book Everything All at Once: How to Unleash Your Inner Nerd, Tap into Radical Curiosity and Solve Any Problem. Malachy McCourt on his latest book Death Need Not Be Fatal, a collection of personal stories and reflections on how to grow old without acting old, and how to die without regret. Akhil Sharma joins us to discuss his new collection of short stories A Life of Adventure and Delight, eight stories that focus on Indian protagonists at home and abroad. Jim St. Germain talks about his memoir A Stone of Hope, his story of immigrating to the U.S. from Haiti, involvement in gangs and drug dealing, and how he turned his life around.


#100 Is 100 That Exciting?

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In honor of our 100th episode, producer Abigail Keel talks to some centenarians about the good and the bad of 100. To join the conversation, go to www.longestshortesttime.com! This episode is brought to you by Thirdlove, Uniqlo, Olive & Cocoa and Crane & Canopy.

Older people dying on job at higher rate than all workers

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old Hand women on bed patient

Poor women are four times more likely to be jobless by the end of treatment than their better-off peers, according to a study published Monday in Health Affairs. Photo by srisakorn/via Adobe

Older people are dying on the job at a higher rate than workers overall, even as the rate of workplace fatalities decreases, according to an Associated Press analysis of federal statistics.

It’s a trend that’s particularly alarming as baby boomers reject the traditional retirement age of 65 and keep working. The U.S. government estimates that by 2024, older workers will account for 25 percent of the labor market.

Getting old — and the physical changes associated with it — “could potentially make a workplace injury into a much more serious injury or a potentially fatal injury,” said Ken Scott, an epidemiologist with the Denver Public Health Department.

Gerontologists say those changes include gradually worsening vision and hearing impairment, reduced response time, balance issues and chronic medical or muscle or bone problems such as arthritis.

In 2015, about 35 percent of the fatal workplace accidents involved a worker 55 and older — or 1,681 of the 4,836 fatalities reported nationally.

William White, 56, was one of them. White fell 25 feet while working at Testa Produce Inc. on Chicago’s South Side. He later died of his injuries.

“I thought it wouldn’t happen to him,” his son, William White Jr., said in an interview. “Accidents happen. He just made the wrong move.”

READ NEXT: I was successful and recognized. Now, at 64, I can’t get an interview.

The AP analysis showed that the workplace fatality rate for all workers — and for those 55 and older — decreased by 22 percent between 2006 and 2015. But the rate of fatal accidents among older workers during that time period was 50 percent to 65 percent higher than for all workers, depending on the year.

The number of deaths among all workers dropped from 5,480 in 2005 to 4,836 in 2015. By contrast, on-the-job fatalities among older workers increased slightly, from 1,562 to 1,681, the analysis shows.

During that time period, the number of older people in the workplace increased by 37 percent. That compares with a 6 percent rise in the population of workers overall.

The workplace fatality rate for all workers — and for those 55 and older — decreased by 22 percent between 2006 and 2015. But the rate of fatal accidents among older workers during that time period was 50 percent to 65 percent higher than for all workers.

Ruth Finkelstein, co-director of Columbia University’s Aging Center, cautions against stereotyping. She said older people have a range of physical and mental abilities and that it’s dangerous to lump all people in an age group together because it could lead to discrimination.

She said she’s not sure that older workers need much more protection than younger workers, but agreed there is a need for all workers to have more protection. “We are not paying enough attention to occupational safety in this country,” she said.

The AP analysis is based on data from the Bureau of Labor Statistics’ Census for Fatal Occupational Injuries and from one-year estimates from the American Community Survey, which looks at the working population. It excludes cases where the cause of death was from a “natural cause,” including a heart attack or stroke.

AP also examined the number and types of accidents in which older workers died between 2011, when the bureau changed the way it categorized accidents, to 2015:

— Fall-related fatalities rose 20 percent.

— Contact with objects and equipment increased 17 percent.

— Transportation accidents increased 15 percent.

— Fires and explosions decreased by 8 percent.

“We expect that there will be more older workers increasing each year and they will represent a greater share (of the fatalities) over the last couple of decades,” said Scott, the Denver epidemiologist. “This issue of elevated risk is something we should be paying close attention to.”

An Associated Press-NORC Center for Public Affairs Research poll found in 2013 that 44 percent of older Americans said their job required physical effort most or almost all of the time, and 36 percent said it was more difficult to complete the physical requirements of their jobs than it was when they were younger.

William White Jr. said his father had been working in the same Chicago-based warehouse for over a decade and was a manager when he fell to his death on Sept. 24, 2015.

“My dad was the best at what he did. He’s the one who taught me everything I know,” the 26-year-old Chicago resident said. “He went up to get an item for the delivery driver and the next thing you know he made a wrong move and fell. The job is fast-pace and everybody is rushing.”

Thomas Stiede, principal officer for Teamsters Local 703, said White knew the safety procedures and he can’t understand why White didn’t wear a safety harness. “He was a very conscientious employee,” he said, his voice cracking with emotion.

Testa Inc. was fined $12,600 by the U.S. Occupational Safety and Health Administration for failing to provide safety training. The company declined to comment for this story.

The same year White died, the fatal accident rate in Illinois for older workers was 4.5 per 100,000 workers, 60 percent higher than the comparable rate for all workers.

In most states, the fatal accident rates for older workers were consistently higher than comparable rates for all workers.

Nevada, New Jersey and Washington had the greatest percent increase in fatal accident rates for older workers between 2006 and 2015.

The three states with the biggest percent decrease were Hawaii, Oregon and Vermont.

Eight states saw their overall workplace fatality rate drop, even as the rate for older workers increased: Massachusetts, Michigan, Montana, Nevada, New York, Texas, Utah and Washington.

In two states — North Dakota and Wisconsin — the trend was reversed; older worker accident rates decreased while the accident rate overall increased.

In metropolitan areas, Las Vegas ran counter to the national trend.

In 2006, the fatal accident rate among older workers in the Las Vegas metropolitan area was lower than the rate among all workers. But by 2015, the rate of deaths among older workers more than doubled even as the rate among all workers declined.

Transportation accidents account for a large portion of fatal workplace incidents among both older workers and workers in general.

In one such incident, Ruan Qiang Hua, 58, died last Nov. 21 from injuries suffered in a forklift accident at Good View Roofing and Building Supply warehouse, according to the California Occupational Safety and Health Administration. After a bag of mortar fell from the pallet, Qiang backed up and rolled off a ramp. The forklift tipped over and Qian was crushed when he jumped off.

The agency fined the San Francisco-based company $62,320, saying it had failed to ensure that forklift operators were competent and wore seat belts.

The company is appealing the penalties, according to OSHA.

Records show that Hua was not properly trained or certified as a forklift operator. Video of the incident showed he was not wearing his seatbelt. Other video from the worksite showed that other forklift operators also had not used their seat belts and that the employer failed to install a curb along the sides of the ramp to prevent the lifts from running off the ramp. The company declined to comment.

In California, the 2015 rate of fatal accidents was 3.4 per 100,000 workers for older workers, 60 percent higher than the rate for all workers.

The AP analysis showed that older workers were involved in about 1 in 4 fatal workplace accidents related to fires and explosions from 2011 to 2015.

In April 2014, Earle Robinson, 60, and other employees were doing maintenance work at Bryan Texas Utilities Power Plant, about 100 miles north of Houston, when there was a loud explosion. Workers called 911 and pleaded for help.

“He’s in bad shape. He’s got a lot of facial burns,” according to a transcript of the 911 calls. “He’s got some pretty bad burns.”

Robinson was taken to a hospital in Houston and died days later. The company declined to comment for this story.

The year Robinson died, the fatality rate among older workers in Texas was 6.1 per 100,000 workers — 43 percent higher than the accident rate for all workers.

The National Center for Productive Aging and Work is pushing for changes in the workplace to make it safer for older workers. The year-old center is part of the National Institute for Occupational Safety and Health.

“We advocate to make workplaces as age-friendly as possible,” said co-director James Grosch. For example, increased lighting helps older workers whose eyesight has weakened with age.

He said the center is emphasizing productive aging, looking at “how people can be more productive, how their wisdom can be leveraged in a workplace.”

Maria Ines Zamudio is studying aging and workforce issues as part of a 10-month fellowship at The Associated Press-NORC Center for Public Affairs Research, which joins NORC’s independent research and AP journalism. The fellowship is funded by the Alfred P. Sloan Foundation

The post Older people dying on job at higher rate than all workers appeared first on PBS NewsHour.

Age Shaming of the Aging

Standard Medigap plans are learning some new tricks

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Husband and wife playing hula hoop in the park

Photo by David Jakle/Getty Images

Medigap supplement policies have begun to change, moving away from being the plain-vanilla member of the Medicare family. Increasingly, these private insurance policies are likely to cover health-club memberships and perhaps also set up health care provider networks to save money for themselves and their policyholders.

In doing so, the plans are emulating the moves of private Medicare Advantage (MA) plans. Such plans legally must cover everything provided by basic Medicare but usually feature additional benefits. Given that the same insurers dominate MA and Medigap markets, this development is not surprising.

First, some background. More than 12 million people had Medigap policies in 2015, representing 22 percent of the more than 55 million Medicare enrollees, according to the American Association for Medicare Supplement Insurance.

However, a much higher percentage of people using traditional Medicare have Medigap plans. That’s because about a third of Medicare enrollees have MA plans, which provide their own supplemental coverage and whose enrollees aren’t permitted to buy Medigap plans. Also, nearly 10 million low-income Medicare enrollees also qualify for Medicaid, and are not able to afford Medigap premiums. By my rough calculations, this means that 40 to 50 percent of basic Medicare enrollees purchase Medigap plans to help cover things that basic Medicare does not fully pay.

READ MORE: How do I get the Medicare coverage I want with the lowest out-of-pocket cost?

If you need a primer of what these are, check out page 11 of Medicare’s annual Medigap guide, which also includes other helpful background. In brief, these plans offer different levels of protection and carry individual letter designations – Plan A, B, C, D, regular F, high-deductible F, G, K, L, M, and N. Two-thirds of all outstanding Medigap plans are Plan F, according to the Medicare supplement trade association, followed by N (12 percent). D and G (each 9 percent), and C (4 percent). For reasons I’ve explained before, Plan G sales are booming, while the appeal of Plan F is declining.

The uniformity of Medigap plans is changing, meaning that not all same-letter plans offer the same features.

Although benefits differ among these letter plans, every Plan A sold by private insurers must cover the same set of proscribed minimum benefits. As must every Plan B, every Plan C, and so forth. Insurers are free to charge different premiums for their plans, and wide cost variations exist. Because benefits have been identical within the same-lettered plans, price shopping is the major and usually only factor that should guide consumer selection.

However, this uniformity is changing, meaning that not all same-letter plans offer the same features. For example, I am now the happy owner of a Medigap plan that includes a steep price discount on health-club memberships offered by clubs that participate in the popular Silver Sneakers program. I was surprised that this feature was available, and so was an experienced Medigap broker who helps keep me up to date on Medigap developments. But more than one Medigap insurer confirmed to me that they now offer these plans in some of their letter plans.

So, if you are considering a certain Medigap letter plan, don’t assume that all such plans will offer the same features.

In another development, an unnamed Medigap insurer has just received a Medicare ruling that could lead to it offering policies that include a proprietary network of participating hospitals. These hospitals would agree to waive Medicare’s Part A deductible to plan members using the hospital. This deductible is $1,316 this year, and is fully covered by all popular Medigap plans.

Consumers with popular Medigap plans are already protected from paying the hospital deductible, so they wouldn’t see these savings directly. It’s the insurer who would benefit. In turn, it would provide members using such hospitals a $100 reduction in future premiums. The broader savings could, however, be considered by state regulators in setting future premiums for the insurer’s Medigap plans. (Medigap plans are regulated by the states, not Medicare.)

Providing discounted services is something that can run afoul of Medicare’s anti-kickback laws, which frown upon unfairly tilting the use of medical services to providers offering price breaks to health insurers. The insurer sought and received an assurance from Medicare that its plan would not trigger such sanctions.

Medicare’s thinking is that Medigap policyholders receive no direct price breaks because they don’t pay the Part A deductible. The insurer, whose identity was redacted in the Medicare advisory opinion, set up the system so that consumers are free to use any hospital. If they use a non-network hospital, the insurer will pay the full amount of the Part A deductible. Likewise, the insurer said its network was open to any hospital accepting Medicare. This avoided charges that the insurer was unfairly driving business only to hospitals in its network.

Saving money through the use of health provider networks is an enormously important trend for Medicare enrollees, and a key element of the movement toward managed care that is appearing in all types of health care. How much of those savings flows to consumers as opposed to health insurers is a big wild card. So is the quality of care available in a controlled network that might not offer consumers the choice they’d prefer in medical providers.

Having received this ruling, there is no guarantee about whether or when the insurer will begin offering such plans. For now, my message to Medigap policyholders is much less cosmic: ask what your plan covers and how its features differ from other similar plans.


This week’s questions and answers

Jon – Ind.: I have been disabled for several years and on Medicare, and recently had to repair my wheelchair. I have gone to almost every durable medical equipment (DMW) outlet in Indianapolis. None of them will even help me order parts or cover. When I ask them if Medicare would cover a new wheelchair, all I get is a huge NO. This is the only chair that has worked for me. Just because I’m disabled doesn’t mean I do not want to be as active as possible.

Phil Moeller: I’m sorry you’ve had such a hard time. I don’t pretend to understand all the details of wheelchair standards, Medicare rules, and the craziness of DME suppliers. But I agree that the system often seems to deny the best long-term solution in the interest of saving a few bucks today.

I don’t know what kind of Medicare you have. If it’s only Parts A and B, then your claims are not handled by an insurance company but by the Medicare administrative contractor (MAC) who oversees the part of the country where you live. These businesses are hired by Medicare to handle claims, with their approval and denial process based on Medicare coverage rules.

READ MORE: Medicare’s lack of dental, hearing and vision coverage can put seniors in a bind

The A-B MAC for Indiana is the Wisconsin Physicians Service Insurance Corporation. There also is a MAC for durable medical equipment. In Indiana, that MAC is CGS Administrators, LLC,.

In my experience, the actual DME suppliers are not really the decision makers here, but are only following what they’re told by the MACs. The MACs, in turn, usually point to the Centers for Medicare & Medicaid Services (CMS) in Washington as the final decision-maker. This often appears to be an effort to pass the buck, as neither the MACs or CMS can be easily held accountable by consumers.

I don’t know if you’ve been turned down for this coverage by the MAC where you live. I also don’t know if your physician(s) have prescribed this particular wheelchair as medically necessary. If you have committed doctors on your side, they can make a big difference in reversing Medicare coverage denials.

There are two Medicare nonprofits I deal with that might be willing to help you with your claim. I should warn you that they are overwhelmed with consumer demand, but perhaps they have encountered your type of problem before and can give you good advice. They are the Medicare Rights Center and the Center for Medicare Advocacy.

Please let me know how things go. I wish you the best of luck, and admire your efforts to overcome the challenges caused by your disability.


Vickie – Ore.: I am worried about Social Security running out of money. Even though it might be best to collect at full retirement age or, ideally, 70, do you think a person should consider collecting at 62 to make sure they receive least some benefits? Where can I get honest advice on what to do?

Phil Moeller: I certainly am concerned about Social Security’s financial viability. But I see no upside to filing early for fear that future benefits might disappear.

I certainly am concerned about Social Security’s financial viability. But I see no upside to filing early for fear that future benefits might disappear.

First, I have seen no proposals to change the rules that would reward early filing. Second, even if Congress does nothing, benefits can be paid in full until the year 2034. After that, they would still be paid at the rate of 77 cents to the dollar, and I’d much prefer to get 77 percent of a larger number by waiting to file.

On the advice front, my co-author Larry Kotlikoff and I continue to write about Social Security, so I would immodestly suggest you can follow our articles.

The National Committee to Protect Social Security and Medicare is a good place to track threats to future benefits. Many of these threats will never become legislation, let alone be enacted. But this group is a good “canary in the coal mine” about attacks on Social Security.

READ MORE: Social Security trust fund will be depleted in 17 years, according to trustees report

From a financial perspective, the Committee for a Responsible Federal Budget serves a similar “alarm” function about the need to rein in federal deficits. From this perspective, you will see a lot of content about how Social Security deficits need to be reduced, often by reducing benefits.

The truth, of course, lies somewhere in the middle. Good luck finding it!


Kathy – Utah: I turn 65 next year, but will be working full time and not collecting Social Security until I turn 66 in 2019. My health insurance at work has now gone to a $4,000 annual deductible. What do you think about the idea of me dropping my employer plan and signing up for Medicare instead?

Phil Moeller: It is certainly worthwhile to run the comparative numbers and see. I used to routinely advise people to keep their employer plans when they became eligible for Medicare. But the rise in high deductible plans has changed my thinking.

If you do leave your employer plan, you should be aware that the plan may not have to take you back if you later change your mind.

Beyond getting Part B of Medicare and a Part D drug plan, Medigap supplemental policies can be expensive for someone with modest health expenses. But all it takes is one medical emergency to generate hundreds of thousands of dollars in medical expenses. Among other things, Medigap covers the 20 percent of Part B expenses that Medicare does not pay.

You also should look at available Medicare Advantage policies. These plans must cover everything that basic Medicare covers, and also usually include a Part D drug plan. Lastly, they also have protection against catastrophic out-of-pocket health costs, and thus do not require a Medigap plan. These plans usually require you to use only the doctors and hospitals in the plan’s provider network, so you need to make sure you can live with such restrictions.

While you are healthy now, I advise people to keep in mind that they are buying insurance for their “future” self and not their present self. You clearly are a planner. Congratulations on being part of a club that is much too small. As a planner, I suggest you use Medicare’s Plan Finder to compare different Medicare plans, including Medigap plans.


Alice: I am signing up for Medicare Part D for the first time. Presently, I only take a low-cost blood pressure medication. While I am in relatively good health, I have heard horror stories about how friends have found out that they have cancer and, during open enrollment, were denied coverage in a better part D plan that would cover more of their medications. Is it better to buy the best plan that I can afford, or go with the plan that is low cost and no deductible?

The difference in premiums between a bare-bones and deluxe Part D plan is not that great. Were it me, I’d opt for the better plan and sleep well at night.

Phil Moeller: I don’t know exactly what happened in the horror stories you’ve heard, but they don’t sound accurate to me. A person has the right during open enrollment – which begins every year on Oct. 15 and extends through Dec. 7 — to switch to a different Part D plan. They cannot be denied coverage due to a pre-existing condition.

For this reason, your worst-case Part D situation would be if you needed expensive drugs early in the calendar year, and had to wait to shift plans until the first of the next year, which would be the effective date of any new plan you’d find during open enrollment in the fall. You thus would be exposed to your plan’s maximum out-of-pocket spending rules, plus you’d be on the hook for 5 percent of your drug costs even after reaching the so-called catastrophic level of the plan’s coverage zones.

The difference in premiums between a bare-bones and deluxe Part D plan is not that great. Were it me, I’d opt for the better plan, shell out a few hundred “extra” dollars in annual premiums, and sleep well at night.


Deanna: I’m 64 and currently receiving Social Security survivor benefits. Social Security is holding back approximately half of my benefits because I am working full time. Will I ever get back the money that they’re holding back? I’ve read somewhere that my benefit will increase when I turn 66.

Phil Moeller: If you continue receiving survivor benefits after you retire, you should see your current benefit reductions repaid to you in the form of higher monthly benefits. However, were you to switch to another type of benefit, say your own retirement benefit, this adjustment would disappear. Presumably, your retirement benefit would be larger than your survivor benefit, or else you’d have no reason to switch to it. But you should be aware of this limitation to repayment of benefits affected by Social Security’s earnings test.


Michele: I took early Social Security at age 62 as a divorcee on my own record. My ex continues to work and he is now 84; neither of us have remarried. When he dies (none of us can get out of this life alive, you know!), and if I survive him, can I collect benefits on his then-current record and his then-current rate? Or, will that benefit be reduced due to the fact that I took early retirement?

Phil Moeller: You will receive the full amount of what your ex-spouse was receiving at the time of his death. It will not be reduced because you took early retirement.

In addition, if your former husband filed early for his own retirement benefits, there is a chance your survivor benefit would be higher than what he received. In this situation, you would get the higher of either what your ex was receiving or 82.5 percent of the benefit he would have received at his full retirement age. If you have access to his Social Security earnings records, you can get a good idea of whether this rule might apply to you.

The post Standard Medigap plans are learning some new tricks appeared first on PBS NewsHour.

I Can't Grow Old Gracefully

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Surprise! We've got one last Pull Quote episode for you. When we remembered this tape, we couldn't help but share it with you. Musician Robert Earl Keen talks about aging in a way that feels so true and so honest, but also so rare, especially from a man. And who hasn't spent a moment thinking about the passage of time as we begin this new year?

If you'd like to hear my whole conversation with Robert Earl Keen, find it here. Hannis Brown composed the music for our Pull Quote series.

 

Opportunity Costs: I Never Felt Inferior

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I first talked to Ernie Major a few years ago, for our episode about living alone. When we put out our call for class stories, Ernie got in touch again. "I’m retired now, by myself in a single wide trailer," he wrote us, "but I still don’t feel inferior to other people of higher class. In fact, sometimes I feel kind of sorry for them, trapped their web of expectations."

Ernie is 73, and over the course of his life he's been in a lot of different class brackets. He grew up "dirt poor" as a homesteader, but he had relatives who were quite well off. After serving in Vietnam, he went to college on the G.I. Bill, and worked as a photojournalist before starting a new career in his fifties at an oil refinery. And now, he's on long term disability after a motorcycle accident last year. Those experiences exposed him to a lot of class diversity, but he says as an adult, he's identified as "socially lower middle class, economically a bit better than that," without aspirations to move up. "I look down on people who invest a lot of time and energy into status symbols that can just go away in a second."

Yet Ernie also recognizes that being white has allowed him a level of class fluidity--which has fueled some of that emotional detachment from where he fits in the class hierarchy. "I understood early on that [being white] gave you a a a step up even though we were dirt poor," he told me. "And I had my mom’s [upper-middle class] family, so I had a connection with people who were not definitely not the same as us." 

Anna took this picture of Ernie after their conversation, with his new Death, Sex & Money "should-less day" mug. Afterward, when we asked Ernie to send us a picture of something that represents his class status, he sent along a picture of his Royal Enfield motorcycle on a wheelchair ramp next to the trailer where he lives. He wrote, "My friends made this ramp after I crushed my foot in an accident. It's the kind of thing that people would do when I was a kid and we lived on a homestead." 


 

This episode is part of our collaborative series with BuzzFeed called Opportunity Costs: Money and Class in America. To hear more, go to deathsexmoney.org/class.

Who Will Care For Our Parents and Grandparents?

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As the population ages and more people would like to grow old in their homes, E Tammy Kim, freelance writer and fellow at The Investigative Fund at the Nation Institute, reports for Bloomberg Businessweek on the challenges in our home-care infrastructure, from paying for it to the working conditions for caregivers.






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