Greg Nicholaides

by Robert King | FIERCE Healthcare

Oct 7, 2021

New data show that beneficiaries on Medicare Advantage (MA) have a 19% lower rate of hospitalizations for COVID-19 during the first nine months of the pandemic compared to traditional Medicare participants.

The data – released Oct. 7 by MA advocacy group Better Medicare Alliance – also show that fewer MA beneficiaries died of COVID-19 compared with those on traditional Medicare.

“COVID-19 illuminated opportunities for policymakers to lean in, learn and improve our healthcare system,” said Allison Rizer, principal and lead research of ATI Advisory, the consulting firm that conducted the study. “This analysis adds to that dialogue by showing that some of the most vulnerable individuals during the pandemic may have fared better in Medicare Advantage than those in Medicare [fee-for-service].”

Researchers looked at data from the fall 2020 Medicare Current Beneficiary Survey. The study discovered that there were 664 COVID-19 hospitalizations per 100,000 MA beneficiaries compared to 788 hospitalizations for those in traditional Medicare.

Fee-for-service Medicare also saw a 22% mortality rate of beneficiaries who were hospitalized with the virus, compared with 15% for those in MA. 

“Medicare Advantage beneficiaries comprised 40% of the Medicare population during the studied time frame and 36% of all Medicare beneficiaries hospitalized with COVID-19,” according to a release on the study. “By comparison, [fee-for-service] Medicare beneficiaries were 60% of the Medicare population and 64% of hospitalizations.”

The study also showed that access to care during the pandemic among dual-eligible beneficiaries was greater among those on MA than those on traditional Medicare.

For example, 78% of dual-eligible beneficiaries on Medicare and Medicaid in MA had access to diagnostics compared to 66% for traditional Medicare. Another 58% of duals were able to get a regular checkup compared with 43% in traditional Medicare.

MA dual-eligible beneficiaries also had a slight advantage (68%) for getting treatment for an ongoing condition compared to traditional Medicare (63%).

MA and traditional Medicare beneficiaries both had roughly the same access to telehealth services, with MA beneficiaries slightly above at 50% and traditional Medicare at 48%. Telehealth use burgeoned during the pandemic after the federal government loosened restrictions on reimbursement for providers.

MA has exploded in popularity among insurers as more payers are participating ahead of open enrollment that starts Oct.15.

If you suffer from seasonal allergies, you’re not alone. As many as 60 million Americans have allergy symptoms related to pollen, ragweed and other common allergy trigger. If you find yourself sneezing a lot or blowing your nose during certain times of the year, seasonal allergies may be the culprit.

Seasonal allergies develop when your immune system overreacts to a benign trigger in the environment. Although many people associate seasonal allergies exclusively with springtime, symptoms can often strike in autumn, too, because that’s when certain plants that can cause allergies pollinate.

Unfortunately, the triggers for seasonal allergies are not going away. In fact, pollen seasons have been lasting longer, and data has indicated rising pollen counts year over year.

This article will first focus on common allergy culprits to help you identify your triggers and then provide easy ways to help you prevent and manage symptoms.

Common fall allergy culprits

Ragweed is a prime culprit of fall allergies. If you find yourself feeling miserable with allergy symptoms at the end of summer, you could be allergic to ragweed. The plant releases pollen from August to November. Its lightweight pollen easily spreads through the air and can trigger nasal allergies and asthma symptoms for people at risk for asthma.

Ragweed is especially common on the East Coast and in the Midwest, but it can grow practically everywhere, including in fields and gardens and alongside roads. Ragweed pollen levels are at their highest in September, according to the American College of Allergy, Asthma and Immunology.

Other plants that can trigger fall allergies include:

• Burning bush
  • Cocklebur
  • Lamb’s-quarters
  • Pigweed
  • Sagebrush (or mugwort)
  • Tumbleweed (or Russian thistle)

Common spring allergy culprits

Every spring, nature blooms. That means there’s an influx of pesky springtime allergy culprits like pollen, grass and weeds. Airborne particles from these plants can cause the miserable symptoms associated with seasonal allergies for millions of people — even city dwellers.

And don’t think spring showers will save you from all that pollen. While rain does wash it away, the pollen count often returns with more intensity after a storm passes. This happens because raindrops can rupture pollen particles, breaking them into even smaller fragments that get into the air and enter the lungs.

In addition to pollen and grass, mold is another common springtime allergy trigger. Mold tends to grow quickly in heat and humidity, both of which can be plentiful in spring.

Across most of the United States, spring allergies start as early as February and run all the way through early summer.

How can seasonal allergies be managed?

Here’s the good news: You don’t have to suffer through all the miserable symptoms of spring or fall allergies. There is help!

Medicines and behavioral techniques are available to help prevent and manage seasonal allergies. However, if you already know you have seasonal allergies, don’t wait for symptoms to appear before you start treatment. Most allergists recommend a proactive approach and advise patients to begin taking allergy medication two weeks before symptoms appear. You want to identify your allergy trigger, so you know when its season starts.

Remaining indoors can help limit your exposure to an outdoor allergen, especially when it’s windy outside. If you’ve been outside, change your clothes when you come back inside. Wash the outdoor outfit and take a shower because pollen can cling to your clothes, body and hair. During allergy season, don’t hang your laundry outside to dry on a clothesline. That can act like a magnet for pollen.

In addition, keep your eye on the pollen count. You can receive a pollen count and allergy forecast for your area through some online weather sources. If the pollen count is high, it could trigger symptoms. Close doors and windows to prevent pollen from drifting inside.

Over-the-counter and at-home allergysupport products

Several types of nonprescription medications can help ease allergy symptoms. Oral antihistamines are available at your local pharmacy and can help relieve sneezing, itching, a runny nose and watery eyes.

Decongestants and some nasal sprays may help provide temporary relief for stuffiness. You might also want to use a neti pot or saline solution to flush out mucus and allergens that can accumulate in your nasal passages. Consult with a health care professional regarding which options might be right for you.

If these treatments are not helping, schedule a visit with your doctor. Allergists are doctors that specialize in treating allergy symptoms. They may order a skin test or blood test to help determine what is triggering your symptoms. With that information, your doctor can identify treatments that are likely to work best for you. The more you know about your allergy and what triggers it, the better equipped you may be to handle symptoms.

By Bob Carlson

Senior Contributor, Forbes Magazine

 Aug 30, 2021

The Covid-19 pandemic likely had a significant impact on long-term care insurance (LTCI), though most of the effects won’t be known for a while yet.

The pandemic appeared to increase interest in and purchases of LTCI. It’s too early for the data to be available, but anecdotal reports from insurers and agents indicates that the pandemic increased inquiries about and purchases of different types of LTCI.

The widespread effects of the pandemic made more people aware of the potential they might need LTC at some point. The pandemic also made more people realize that the need for LTC can arise suddenly and much earlier in life than they realized.

The increased interest in LTCI is consistent with reports that people became more concerned about estate planning during the pandemic.

The pandemic also taught insurers and agents to stress that LTCI is not “nursing home insurance.” A widespread misunderstanding about LTC in general and LTCI has been the assumption that the care primarily is delivered in a nursing home or an assisted living residence. In fact, the majority of LTCI claims paid by insurers now are for home care.

After reports that one-third of Covid-19 deaths were of nursing home residents and that long-term care facility residents were subject to forced isolation during the pandemic, many people emphasize that they want to receive any care they need in their homes for as long as possible. They want to create a financial structure that will help pay for LTC at home. Though LTCI has paid for home care for many years, many potential purchasers didn’t realize that until recently.

Most LTCI policies pay for LTC delivered in almost any location. The standard provision triggers benefits when the insured is diagnosed as having a cognitive impairment or needing assistance with at least two of the six activities of daily living. It doesn’t matter where the care is received. The ability to pay for care received at home makes LTCI attractive to more people.

A negative effect of the pandemic on LTCI is that it is more difficult to qualify for LTCI. Insurers reportedly are declining more applications for several reasons.

In-person medical exams are required for more applicants. Previously, in-person medical exams for LTCI applicants weren’t common. The underwriting process typically involved a review of a questionnaire and some medical records. A telephone interview also was common. Now, it’s more likely that an in-person medical exam will be required when the paperwork or telephone interview raise any questions.

More insurers are lowering the age limit at which they’ll issue policies. Also, the list of pre-existing conditions that will disqualify an applicant is lengthening at many insurers.

Insurers are more likely to be concerned about applicants who reside in areas of the country with high rates of Covid-19 infections or who have traveled to certain countries in the recent past. These applicants could be denied coverage, or the effective date of the coverage could be postponed until after a waiting period that makes the insurer comfortable.

Those interested in LTCI continue to move away from traditional LTCI and toward the hybrid policies. The hybrids are annuities or life insurance contracts with LTC benefits.

Traditional LTCI sales declined sharply after the financial crisis. Many issuers of LTCI policies left the market, and other insurers raised premiums substantially on existing policyholders. New policies have carried higher premiums and less coverage than policies issued before the financial crisis.

The hybrid policies guarantee no increase in premiums. Many are paid with one lump sum premium deposit. The hybrid policies also make it easier for the insured to recover most or all of the premium deposited with the insurer if the insured needs the money before needing LTC.

One of the more attractive features of the hybrid policies is they don’t have the use-it-or-lose-it characteristic of traditional LTCI. When the purchaser of traditional LTCI passes away after making few or no claims against the policy, the heirs of the policyholder receive nothing from the policy. The only benefit the insured received from the premiums paid was the comfort of knowing the coverage was there if needed.

The hybrid policies, on the other hand, provide something for beneficiaries when the insured didn’t exhaust the LTC coverage. The amount available to the beneficiaries will depend on the policy purchased but usually is at least full recovery of the premium deposit if no claims were made against the policy. The insured is guaranteed that the beneficiaries will receive some benefit from the policy if the insured doesn’t claim substantial LTC benefits.

These factors are why sales of hybrid LTCI increased substantially in recent years while sales of traditional LTCI continue to dwindle.

Did you know you can sell all or a portion of a life insurance policy, even term insurance?

Looking into selling a life insurance policy? Life settlements are an excellent choice for individuals who have a policy that they no longer want or need. But how much is a life settlement worth? How do companies calculate the worth of a policy? There are many factors that go into a life settlement offer, including the policy holder’s age, health, the policy type and size, premium cost, and the life insurance issuer. Let’s review these factors and more to see just how much a policyholder can receive from a life settlement. 

A policyholder could receive anywhere between 10% to 35% of the amount that would be paid when they die. On average, policyholders receive an upfront cash settlement that equals 20% of their life insurance policy death benefit. The larger the life insurance policy size, the larger the life settlement offer.

This means that an average life settlement offer on a $100,000 policy may be around $20,000 and an average offer on a $1,000,000 policy may be around $200,000.

There are a number of factors that affect the amount that a policyholder could be offered, including:

• Age of the Insured
• Health of the Insured
• Policy Type
• Policy Size
• Premium Costs
• The Life Insurance Issuer
• The Buyer’s Risk Profile

Here is a table that shows an example of how health status could affect the amount a policyholder could receive for their policy in a life settlement. The exception would be an insured in their early 80’s or older that is healthy, could still qualify to sell their policy.

Health Condition                       Type of Health Condition                        Value of Policy

Very Healthy                                No chronic conditions                                Not eligible for sale

Some Medical Issues                  Chronic but manageable conditions          10-25% of death benefit

                                                     such as hypertention

Serious Medical Conditions        Severe conditions such as cancer             25-35% of death benefit

Do I have to pay taxes if I sell my life insurance policy?

Possibly. Some of the money a policyholder could receive from a life settlement may be taxed as income or capital gains. Just like the sale of any other asset, a policyholder would likely have to pay taxes on the money they receive from a life settlement above their basis in the policy. The death benefit of a life insurance policy is tax-free to your beneficiaries.

How old do you have to be to sell your life insurance policy?

Although there is no set age range to sell your life insurance policy, you do have to qualify to sell a policy.  To be eligible to sell your life insurance policy, it is best to be over 65 years of age or have a serious medical condition. Most often the insured has a life expectancy of 15 years or less.

When would I get paid when selling a life insurance policy?

A policyholder would receive payment as soon as the necessary documents have been signed and the insurance company provides written confirmation that the owner and the beneficiary on the policy have been changed. It’s important to note that when selling a life insurance policy, the policyholder forfeits any money that would normally be paid when they die.

Life settlements may not work for everyone, but they’re a valuable option that many people don’t consider. If you have a life insurance policy that you’re planning to surrender, consider a life settlement. It might provide you with a valuable alternative.

By Rodney A. Brooks – Healthy Aging

July 12, 2021

More than 50 years ago, on July 30, 1965, President Lyndon Johnson signed Medicare into law, saying at the time, “I’ll spend the goddamn money,” he said. “I may cut back on tanks – but not on health.”

The story behind Medicare’s birth in Independence, Missouri, detailed here, reveals that LBJ called former President Harry Truman “The real daddy of Medicare.” (LBJ signed Medicare into law in Independence specifically to honor Truman’s effort to create national health insurance.) Truman became the first Medicare enrollee and Truman’s wife Bess got America’s second Medicare card – at the time, the monthly Part B premium was $3.

Quick facts about Medicare

• More than 50% of seniors had no health insurance prior to the establishment of Medicare, and 35% lived in poverty, according to the Center for Medicare Advocacy.
• Instant success – Medicare became effective in 1966, and more than 19 million people enrolled during its first year, increasing seniors’ access to physician and hospital care by a third.
• A model for universal healthcare – Medicare was initially conceived as a steppingstone to universal national healthcare. The Vietnam War put an end to that idea by syphoning off federal funds such an initiative would have required.
• A catalyst for desegregation – Medicare law required hospitals who wanted to accept Medicare patients to desegregate. More than one thousand integrated during the first four months.
• A plus for longevity – According to the New York Times, in the 30 years between 1970 and 2010, life expectancy at age 65 went up by five years, even though coverage was even more restricted than it is now. Analysts attribute the increase in part to Medicare enabling people to get early treatment.
• A boon for all – Ever been treated in the ER even though you lacked insurance? A 1985 ruling required emergency rooms at any hospital participating in Medicare to provide basic treatment to everyone, insured or not.

And now….

Growing, growing – What started as barebones insurance has grown into a robust program of coverage for seniors, with benefits added over the years: long-term disability insurance (1972), home health coverage (1980), hospice coverage (1982), prescription drug coverage (2006 – but initially only for those with private Medicare plans), expanded free wellness checkups and tests (2010, with the Affordable Care Act) and an end to the denial of coverage of skilled care for chronic diseases like Alzheimer’s based on a patient not improving (2012) and most recently, permanent repeal of Medicare’s annual physical therapy caps (2018).

 “I think there’s a significant potential that we will see a substantial expansion of home health care services,” says Social Security and Medicare expert Philip Moeller, author of Get What’s Yours from Medicare. “The Administration wants to provide something like $400 billion to expand the provision of home health care services.”

More than 52.6 million seniors are now covered by Medicare. Another 9 million disabled are also covered by Medicare. Enrollment is expected to reach 79 million by 2030, according to AARP.

Having previously introduced nursing home ratings, the Centers for Medicare and Medicaid is paying attention to the growing numbers of seniors who want to age in place and introduced a five-star ratings system for home health care on Medicare.gov. The ratings are based on patient surveys and let you search by zip code or name.

Medicare in its 56th year – what’s on the horizon?

The biggest change in Medicare has been the growth of Medicare Advantage Plans, says Moeller. Medicare Advantage Plans have grown to control 40 percent of the Medicare Market. That’s up from nearly 0 percent just 15 years ago. They are clearly the most popular choice of new enrollees to Medicare says Moeller. Enrollment is expected to reach 26 million in 2021.

People with end-stage renal disease are now eligible to join Medicare Advantage plans, the result of the 21^st Century Cures Act of 2021. Previously Medicare Advantage Plans were unavailable to them unless there was an ESRD Special Needs Plan available in their area.

High income brackets were introduced in 2007 for Part B and 2011 for Part D. For 2021, these thresholds have increased to $88,000 for a single person and $176,000 for a married couple. For 2021, the Part B premium for high-income beneficiaries ranges from $207.90/month to $504.90/month, depending on income.

Only 8% of Medicare beneficiaries switch plans in any given year. That number has not changed much in recent years. The Medicare Annual Election Period runs from Oct. 15 through Dec. 7, with coverage beginning Jan. 1. During this period you can change plans.

The standard Part B premium increased to $148.50 in 2021. The Part B deductible is $203 in 2021, up from $198 in 2020.

President Joe Biden had proposed cutting the age of Medicare eligibility to 60 and expanding Medicare to cover dental, hearing and vision during his campaign. But neither has been included in his legislative agenda so far. Medicare does not cover dental cleanings, root canals, eyeglasses, or hearing aids. Some progressive Democrats are pushing for expanding coverage for Medicare, but these would be expensive, and face Republican opposition.

Previously some politicians were pushing to raise the age of Medicare eligibility to 67. Medicare Part A is funded by the Medicare hospital trust fund. Since 2018 spending has exceeded revenue. The Kaiser Family Foundation (KFF.org) estimates that by the end of 2026 the fund will have a deficit of $31 billion.