Protecting Our Future Health

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Portrait Of Female Owner Of Gift Store With Digital TabletAre you a ‘glass half full’ or a ‘glass half empty’ sort of person? Scientific research shows ‘you are how you feel’. And, depending on your attitude towards life, you could be helping or hurting your well being. 

Google “optimism” and find: “hopefulness and confidence about the future or the successful outcome of something.”

Google “pessimism” and find: “a tendency to see the worst aspect of things or believe that the worst will happen; a lack of hope or confidence in the future.”

Which one better describes how you feel now, and for the future? If you answered “pessimism”, here’s some data that may help change your mind.

Unhealthy Outcomes For Unhealthy Minds

From a Harvard Medical School article citing various scientific studies:

  • 309 middle-aged patients were to undergo coronary artery bypass surgery. Before the procedure, each patient took a psychological evaluation to measure optimism, depression, neuroticism, and self-esteem. Researchers tracked each patient for six months after surgery. At that point, the researchers discovered those who were more optimistic from the initial evaluation were only half as likely to end up back in the hospital compared to the pessimists.
  • 298 angioplasty patients were followed over a six-month period, post surgery. As it turned out, the pessimists ended up back in the hospital at a 3 times greater rate than the optimists. 

But pessimism does not affect only cardiovascular health.

  • In 2006, scientists conducted a “sneaky” test. They wanted to see how personality styles (positive or negative) impacted viral symptoms. After concluding personality tests on 193 healthy volunteers, the scientists gave each volunteer a common respiratory virus. The results? Those displaying a “positive” personality style had less viral symptoms than the “negative” personalities.

With all being equal, it appears that “pessimism” affects overall health. What’s more eye-opening is how it affects longevity, too.

  • In the mid-1960’s, 6,959 students at the University of North Carolina took a comprehensive personality test.  Over the next 40 years, 476 died.  Of the deceased, the most pessimistic [according to the 1960’s test] had a 42% higher death rate than the most optimistic. And this is not just an American phenomenon.
  • A Dutch study followed 941 men and women, age 65 to 85 years old.  Those who were more optimistic at the beginning of the study had a 45% lower risk of death over the nine year follow-up period.

The University of Rochester Medical Center concurs with these studies.  They cite how researchers reviewed over 80 studies to see how pessimism affected physical health.  The review’s findings [from the 80 studies] showed that those who were more positive in life had betteroverall longevity, survival from a disease, heart health, immunity, cancer outcomes, pregnancy outcomes, pain tolerance and other health topics.”

Pessimism clearly affects our physical health. More and more studies show the more pessimistic, the worse our physical state.  This holds true for people who are already suffering from health ailments as well.

What’s the explanation?

How can our mindset influence our health risks? Much if it has to do with the physiological impact that negativity places on the body.  In short, stress from the negativity can wreak havoc on our cells. And that stress produces the negative outcomes.

When we are stressed, our body must tolerate more inflammation. That’s because the stress hormone, cortisol, courses through our veins and can wear down cells through inflammation. This inflammation creates a chain reaction of negative events in the body. It affects heart, bones, liver, skin, joint and pretty much all other physical problems.    

The reverse is also true.  Women with a more positive outlook had lower levels of inflammation (measured through C-reactive protein and interleukin-6 levels). These two inflammation measures predict the likelihood of heart attack and stroke. 

Both men and women had lower cortisol levels when they showed more optimism in a 2008 standardized test.  These results also considered possible influential variables such as age, employment, income, ethnicity, obesity, smoking and depression. 

We can truly “think ourselves” into poor health even while making other lifestyle choices.

How can we be more optimistic? 

Saying there’s an easy way might be a stretch. It all depends upon the mindset and the sort of thoughts in which we are already predisposed.  Nonetheless, when trying tips to be more positive, we can see and feel the difference in our life:

  1. Be Conscious Of  Our Thoughts. It’s difficult to fix something if not knowing it’s an issue.  That’s why it’s important to stop now and then, and take stock of our reaction to certain events (particularly the ones that do not go our way). If there’s a tendency to have a negative reaction to these events, there’s the opportunity to be more optimistic going forward. This is the path to better health!
  2. Try Thinking PositiveWhile it could feel odd to start, it doesn’t hurt to try thinking more positive. If someone cancels an appointment, it provides the opportunity of freedom to finish or do something else. 
  3. Stop Making Comparisons.  It’s natural to have the emotions of jealousy or anger when comparing ourselves to others. We all have different stories, different strengths and different roles in this world. Though the feelings are natural, they are not productive and will not help. Appreciate what we have and let it be a reminder that things could be worse. 
  4. Surround Ourselves With PositivenessThere’s always at least one friend who’s fun, cheerful and positive to be around. If so, it’s a good idea to spend more time together. Their positiveness can be infectious and rub off more than is realized. They will either consciously or subconsciously radiate happiness. Plus, it’s good to laugh more, too!
  5. Practice GratitudeThis is a great exercise. Sit down with a pen and paper.  Write down three things of gratefulness. Doing this everyday can make us feel better and experience the positive affects in life. 




Medicare Advantage vs Original Medicare + Medigap

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medicare-advantage-choiceAs health insurers struggle with shifting government policies and considerable uncertainty, one market remains remarkably stable: Medicare Advantage plans. 

However, this may or may not be good news for seniors as they select coverage for the year ahead during Medicare’s annual open enrollment period, October 15 to December 7, 2017.

For 2018, 2,317 Medicare Advantage plans will be available across the country.

Medicare Advantage is an alternative to traditional Medicare. Administered by private insurance companies, the plans — mostly health maintenance organizations (HMOs) and preferred provider organizations (PPOs) — are expected to serve a record 20.4 million people next year, or slightly more than one-third of Medicare’s 59 million members.

Despite Medicare Advantage plans’ increasing popularity, several features — notably, the costs that older adults face in these plans and the extent to which members’ choice of doctors and hospitals is restricted — remain poorly understood.

Here are some essential facts to consider:

The Basics

Medicare Advantage plans must provide the same benefits offered through traditional Medicare (services from hospitals, physicians, home health care agencies, laboratories, medical equipment companies and rehabilitation facilities, among others). Nearly 90 percent of plans also supply drug coverage.

In general, HMOs require members to seek care from a specific network of hospitals and doctors while PPOs allow members to obtain care from providers outside the network, at a significantly higher cost.

Pros And Cons

Here’s a summarized list of the pros and cons for Medicare Advantage plans.

On the plus side, it cited they:

  • Put an emphasis on preventive care with in-network providers.
  • Provide benefits, such as vision care, dental care and hearing exams with, or sometimes without, an extra monthly premium.
  • Tout an all-in-one approach to coverage with in-network providers.
  • Have maximum annual out-of-pocket costs (HMO and PPO in-network $6,700) and (PPO out-of-network up to $10,000).

On the minus side, it cited they:

  • Have limited access to physicians and hospitals within plan networks.
  • Must get prior approval from a primary care physician before seeing a specialist.
  • Receive a set per-member monthly fee from the government and risk losing money if medical expenses exceed payments.
  • Have limits on care for members when traveling. Only emergency and urgent care is covered. 
  • Charge more than Original Medicare for short hospital stays, home health care or medical equipment.
  • Are locked in annually for a member with two exceptions: a special disenrollment period from January 1 to February 14 when a member can choose to return to Original Medicare; and an option to make changes during the annual enrollment period each year from October 15 to December 7.
  • Do not generally provide coverage for HMO out-of-network services.
  • Generally provide PPO out-of-network services with higher costs.
  • Portray the perception of costing less than Original Medicare. Actual costs depend on individual circumstances that are not easily calculated.
  • May not be effectively and consistently transparent [beyond zero or low premiums] in evaluating drug expenses, deductibles, co-insurance, hospitals, skilled nursing facilities and home health care.
  • Cannot easily determine which providers are in-network. Information is not on the Medicare website and directories are not accurate. Patients must call all their doctors about specific plans.

Notably, if someone enrolls in a Medicare Advantage plan when newly eligible for Medicare and stays with a plan past the Medicare Part B enrollment date, they may or may not health qualify for the other choice, a Medigap supplement plan.

Medigap policies cover charges such as deductibles, coinsurance and copayments that seniors with Original Medicare coverage are expected to pay out-of-pocket. 

Cost Perceptions

Seniors often first consider what they will pay in monthly premiums. In 2017, the average monthly premium for Medicare Advantage plans is $30. But nearly half of Medicare Advantage members are enrolled in plans that do not charge a monthly premium — so-called zero premium plans. 

To get a full picture of plan costs, which can vary annually and are in-network, seniors should look beyond premiums to drug expenses (including which drugs are covered by their plan, at what level and with what restrictions); deductibles (plans can charge deductibles for both medical services and drugs); what plans charge for hospital care (some have daily co-payments for the first week or so); and coinsurance rates for services such as home health care or skilled nursing care.

It’s really critical that people dig deep and find out about all possible costs they may incur in a Medicare Advantage plan before they sign. Part of the equation has to be what a person will have to pay [often more than expected] if they need extensive care.

Since 2011, Medicare Advantage plans have limited members’ annual out-of-pocket costs,  a form of financial protection. There is no similar limit in traditional Medicare. Yet, protection is not complete since out-of-pocket limits do not apply to drug costs, which can be considerable. 

Finding A Doctor

One way that Medicare Advantage plans try to control costs and coordinate care is by working with a limited group of physicians and hospitals. 

It’s not easy to determine who’s in-network for a Medicare Advantage plan. There’s no  streamlined way to search for information about provider networks across plans. Members must call all their doctors to ask if they are contracted in a plan [and refer to the plan number as well] because each insurance company may offer multiple plans in a market area.

Making matters even more difficult: Medicare Advantage plans can drop physicians or hospitals from their networks during the year, leaving members without access to trusted sources of care.

A new report discloses data about the size of Medicare Advantage plans’ physician networks for the first time. It finds that, on average, Medicare Advantage HMOs included 42 percent of physicians in a county in their networks while PPOs included 57 percent. Altogether, 35 percent of Medicare Advantage members are in plans with narrow physician networks, which tend to be the least expensive plans.


The Affordable Care Act?

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This year open enrollment for people who purchase their own private health insurance began Nov. 1st and ends Dec. 15th. 

That’s 45 days, six weeks shorter than last year — and only one of the big changes consumers need to consider. The Trump administration has cut back on marketing and funding for navigators to help people through the process.

Here are some important factors to keep in mind if a person plans to enroll for 2018 coverage under the Affordable Care Act: 

The health law has NOT been repealed.

Despite the efforts of President Donald Trump and the Republican-led Congress, the Affordable Care Act is still the law of the land.

This means if people do not have insurance with an employer or a government program, they can still get coverage for a set of comprehensive benefits regardless of any preexisting conditions. It also means that if a person meets income eligibility requirements, they will be able to get help from the federal government to afford the premiums, and, possibly, deductibles and other out-of-pocket costs.

The “cost-sharing reduction” subsidies help hold down out-of-pocket costs for people with incomes under 250 percent of poverty (a little more than $30,000 a year for an individual). They will be available despite Trump’s decision to stop the federal government from reimbursing insurers for the required discounts. Most insurers are making up the difference by raising premiums.

Meanwhile, if a person receives premium assistance in the form of tax credits, this  assistance for coverage is not likely to be much higher, either. That’s because as premiums go up, so do federal premium subsidies.

The requirement for most people to have insurance — and most employers to offer it — is also still in effect.

Under the law, most households that earn enough to owe federal income tax are required either to have health insurance or pay a fine due with their taxes. The fine for not having insurance in 2017 (and 2018) is the greater of $695 or 2.5 percent of the taxpayer’s income. A person can claim an exemption from the fine if demonstrating they cannot afford insurance offered in their area.

The IRS has stated it will start rejecting returns filed in 2018 that do not indicate if the taxpayer had health insurance in 2017.

Larger employers (those with 50 or more full-time employees) are also required to offer coverage to their employees or pay a penalty. The coverage must be comprehensive and affordable.

The best advice for people to follow is to shop around. 

While it’s always been important to compare options, this year it’s more crucial than ever.

For starters, people should shop and choose a plan themselves so that the marketplace does not automatically renew a person’s existing coverage for 2018.  That’s because the auto-renewal date this year is expected to be Dec. 16, the day after the open-enrollment period ends. So, if a person is assigned a plan they do not like, they won’t be able to change it until the 2019 open-enrollment season.

Shopping allows a person to compare plans, including which doctors and hospitals are in-network, as well as premiums and co-payments, which can vary.

Cost will be a factor.

This year, premiums are going up, in some areas by double digits, due in part to the Trump administration’s mid-October decision to cut off cost-sharing subsidies to insurers.

But the premium increases may not affect all plans and “metal levels” — which is why people should compare prices.

Some states, for example, instructed insurers to load those additional costs only onto the “silver-level” plans (mid-level plans that cover about 70 percent of an average person’s medical costs). The policyholder covers the remaining cost in deductibles and co-payments.

Even though as a result of the state’s pricing decisions, “gold-level” plans (highest level plans that cover an average of 80 percent of costs) might, in some cases, have lower premiums than silver plans.

Of course, if a person receives a cost-sharing reduction — meaning lower co-payments and deductibles — because their individual income is below $30,150, they will need to stay in a silver plan.

Another factor to consider, however, is that the increased prices for silver plans may drive up a different subsidy — the tax credits that help people pay premiums. Those remain in place for people earning up to 400 percent of the federal poverty level. They could rise because they are tied to the cost of a benchmark silver plan in each region.

In some cases, the tax credit increase could be enough to make a bronze or gold plan have a very low or even zero monthly premium, according to a Congressional Budget Office analysis done before the administration took action. But, of course, consumers not receiving either type of subsidy could be faced with higher costs. All the more reason to comparison-shop.

Some experts suggest looking beyond the official federal and state marketplaces — whether directly checking out an insurer’s website, working through a broker or consulting a private online website — because some states ordered insurers to load additional costs resulting from the Trump order only onto marketplace plans. Therefore, plans off the marketplace might cost less.

Buyers should also beware. 

Outside of the official marketplaces there may be more insurers selling lower-cost, “short-term policies.” These policies are only for specific periods of time and are subject to insurance underwriting (must health qualify). Also, a person may carry a short-term policy for up to three (3) months per year without an Affordable Care Act penalty.

Sabrina Corlette, who studies the marketplace for Georgetown University’s Health Policy Institute, said that such plans, while less expensive, may not cover all benefits and might exclude coverage of preexisting conditions.

These plans also do not meet Affordable Care Act requirements for “minimum essential coverage,” so policyholders would still be liable for paying a tax penalty. “There are  some people taking advantage of consumer confusion,” warned Corlette, adding that shoppers who buy outside of state or federal marketplaces “should consult a reputable broker.”