Insurance For Over 65

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Greg Nicholaides

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Here’s How to Avoid Costly Medicare Mistakes When Retiring After Age 65

By Sarah O’Brien – PERSONAL FINANCE – July 19, 2019

If you’re among the growing contingent of Americans who plan to continue to work after age 65, be sure to review your Medicare options before you do eventually decide to finally say farewell to your coworkers.  While it’s common for people working past that age to stick with a company-sponsored health plan and delay enrolling in Medicare, impending retirement means you should be planning ahead to avoid a coverage gap or costly missed deadlines.

“It’s important to do everything you need to do before you set your retirement date,” said Elizabeth Gavino, founder of Lewin & Gavino in New York and an independent broker and general agent for Medicare plans. “I’d start planning at least a few months before then to make sure all your ducks are in a row.”

Most people sign up for Medicare when first eligible at age 65 either because they no longer are working or don’t have qualifying coverage through a job. For a small but growing number of older Americans who continue to work past that age, however, having workplace coverage means having options.

Regardless of when you sign up, Medicare Part A (hospital coverage) costs nothing as long as you have at least a 10-year work history. Part B, which covers outpatient care and medical equipment, has a standard monthly premium of $135.50 for 2019. Part D prescription coverage also comes with monthly premiums averaging $32.50. For both Parts B and D premiums, higher-income enrollees will pay more.

For those in the age-65-and-older crowd who work for a large company and get qualifying health-care coverage through their job (the rules are different for small firms), it can sometimes make sense to delay signing up for the Medicare parts that come with a cost.

“They tend to enroll in just Part A because it’s free and then delay Part B and Part D because they’d have to pay premiums,” said Danielle Roberts, co-founder of insurance firm Boomer Benefits in Fort Worth, Texas.

However, be aware that if you also have a health savings account through work, you cannot continue to make contributions once you enroll in Medicare, even if only Part A.

Once you’re planning to retire from your job and will lose workplace coverage, you need to be aware of various Medicare deadlines and rules to avoid shelling out more for premiums than necessary.  As long as your employer-sponsored health care is considered qualifying coverage (called “creditable”), you can avoid paying a penalty for having delayed Part B signup — although you must enroll within eight months of stopping work.

Ideally, however, you should coordinate the end of your work-sponsored coverage with your Medicare effective date so you don’t find yourself without insurance.  If you were to be subject to the late-enrollment penalty for Part B, it would be 10% per year that you should have been signed up but were not. The amount would be life-lasting and tacked on to your premium.

Be aware that when you retire, if for some reason you end up continuing your workplace health plan under COBRA — a law that allows you to continue the coverage for a set time if you pay the full premiums — Medicare does notconsider that coverage creditable. The same goes for insurance through your ex-employer after you retire.

For Part D prescription coverage, the late-enrollment penalty is 1% for every month that you could have been signed up. People with qualifying coverage through an employer plan don’t face that life-lasting penalty as long as they secure coverage within two months of their other plan ending.  However, once you do enroll, you’ll get a form from the insurance company that needs to be filled out and returned to confirm you were permitted to delay enrollment, Roberts said.  “If you miss that letter and fail to send it back, you’ll get charged the penalty,” Roberts said. “We’ve seen where someone misses it because they get so much mail and accidentally throw it out and it can take months to appeal that late penalty,” she said.

Meanwhile, if you want to sign up for a Medicare Advantage Plan, you also get two months from when your workplace coverage ends to do so without having to wait until the fall general enrollment period.  If you go this route, your Parts A and B coverage — and typically Part D — will be delivered through the insurer offering the plan. The cost of an Advantage Plan (on top of your Part B premium) depends on the level of coverage you choose and availability of options in your area.

For some Medicare recipients, however, an Advantage Plan isn’t a good fit. Those folks often pair a so-called Medigap policy with their Parts A, B and D coverage (you cannot have both Medigap and an Advantage Plan). Those policies provide help with things such as deductibles, copays and coinsurance.

If you plan to go this route: Once you sign up for Part B, you have six months to get a Medigap policy without the insurer being allowed to nose through your health history. After that window, you could face that underwriting process and possibly be charged more for coverage or rejected altogether.

At ‘Greg Says’ we’re ready to help those who have delayed their enrollment in Medicare Parts B and D adhere to the rules in order to avoid the penalties and possible coverage gaps.

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Where There’s Rarely a Doctor in the House: Assisted Living

The patient moved into a large assisted living facility in Raleigh, N.C., in 2003. She was younger than most residents, just 73, but her daughter thought it a safer option than remaining in her own home.

Dr. Rayomand Bengali takes the vital signs of Jean Morgan, 91, at her assisted living facility, Brookdale Chapel Hill, in North Carolina.

The woman had been falling so frequently that “she was ending up in the emergency room almost every month,” said Dr. Shohreh Taavoni, the internist who became her primary care physician. “She didn’t know why she was falling. She didn’t feel dizzy — she’d just find herself on the floor.” At least in a facility, her daughter told Dr. Taavoni, people would be around to help.

As the falls continued, two more in her first three months in assisted living, administrators followed the policy most such communities use: The staff called an ambulance to take the resident to the emergency room. There, “they would do a CT scan and some blood work,” Dr. Taavoni said. “Everything was O.K., so they’d send her back.”

Such ping-ponging occurs commonly in the nation’s nearly 30,000 assisted living facilities, a catchall category that includes everything from small family-operated homes to campuses owned by national chains. It’s an expensive, disruptive response to problems that often could be handled in the building, if health care professionals were more available to assess residents and provide treatment when needed.

But most assisted living facilities have no doctors on site or on call; only about half have nurses on staff or on call. Thus, many symptoms trigger a trip to an outside doctor or, in too many cases, an ambulance ride, perhaps followed by a hospital stay. Twenty years after the initial boom in assisted living — which now houses more than 800,000 people — that approach may be shifting.

Early on, assisted living companies planned to serve fairly healthy retirees, offering meals, social activities and freedom from home maintenance and housekeeping — the so-called hospitality model.  But from the start, the assisted living population was older and sicker than expected. Now, most residents are over age 85, according to government data. About two-thirds need help with bathing, half with dressing, 20 percent with eating.

Like most older Americans, they also generally contend with chronic illnesses and take long lists of prescription drugs — and more than 80 percent need help taking them correctly. Moreover, “these places became the primary residential setting for people with dementia,” said Sheryl Zimmerman, an expert on assisted living at the University of North Carolina at Chapel Hill. 

About 70 percent of residents have some degree of cognitive impairment, her studies have found. So residents can find it difficult to coordinate medical appointments and tests, and to travel to offices and labs, even when facilities provide a van.

“The assisted living industry has to recognize that the model of residents going out to see their own doctors hasn’t worked for a long time,” said Christopher Laxton, executive director of AMDA, a society that represents health care professionals in nursing homes and assisted living.

His recent editorial in McKnight’s Senior Living, an industry publication, was pointedly headlined: “It’s time we integrate medical care into assisted living.” AMDA is considering developing model agreements. “There has to be more attention to medical and mental health care in assisted living,” Dr. Zimmerman agreed. “Does everyone who falls really need to go to an emergency department?”

Lindsay Schwartz, an executive at the National Center for Assisted Living, a trade association, said in an email that “assisted living has certainly expanded its role in providing medical care over the years by adding nursing staff and partnering with other health care providers, among other ways.”

But persuading most operators to provide medical care likely won’t happen without a fight. They’ve built their marketing strategies on looking and feeling different from the dreaded nursing home, and they object to “medicalizing” their communities. “They don’t want the liability,” said Dr. Alan Kronhaus, an internist who, with Dr. Taavoni (they are married), started a practice called Doctors Making Housecalls in 2002. 

The facilities also “live in mortal fear of bringing down heavy-handed federal regulation,” he said. That can happen when Medicare and Medicaid, which cover most residents’ health care, get involved. Doctors Making Housecalls provides one example of how assisted living can offer medical care. The practice dispatches 120 clinicians — 60 doctors, plus nurse-practitioners, physician assistants and social workers — to about 400 assisted living facilities in North Carolina.

“We see patients often, at length and in detail, to keep them on an even keel,” Dr. Kronhaus said. By contracting with labs, imaging companies and pharmacies, the practice can provide most of the medical care for more than 8,000 residents, on site and around the clock.  Working with a local emergency medical service, he and his colleagues reported in a 2017 study that the practice could reduce emergency room transfers by two-thirds. The Lott Assisted Living Residence in Manhattan, on the other hand, relies on a single geriatrician, Dr. Alec Pruchnicki, to provide medical care for most of its 127 or so residents.

If they’re feeling sick, a family member calls or the resident just knocks on the door of “Dr. P’s” basement office. “Sometimes it’s just a cold — chicken soup,” Dr. Pruchnicki said. “But this winter we had a few cases of flu and pneumonia, things you need to treat.” Nearby Mount Sinai Hospital employs him and provides emergency services when needed. Often, they’re not. In 2005, Dr. Pruchnicki reported at medical conferences, he decreased hospitalizations by a third. “I can’t be in the only place in the country where this would work,” he said.

Spending time in emergency rooms and hospitals often takes a toll on residents, even if their ailments can be treated. They get exposed to infections and develop delirium; they lose strength from days spent in bed. Perhaps that contributes to short stays in assisted living. Adult children often see these facilities as their parents’ final homes, but residents stay just 27 months on average, after which many move on to nursing homes.

Adding doctors to assisted living could also cause problems, advocates acknowledge; in particular, it might increase the already high fees facilities charge. But something has clearly got to give. “There can be health care in assisted living without making it feel like a nursing home,” Dr. Zimmerman said.

Family members tell of frightened and confused residents arriving unaccompanied at emergency rooms, unable to give clear accounts of their problems. Dr. Kronhaus recalls a resident with dementia taken to the local E.R. by ambulance; discharged, she was sent home by taxi. The address she gave the driver was her former home, where neighbors spotted her and called the police.

By contrast, the North Carolina woman with a history of falls is doing well. Dr. Taavoni discovered that her hypertension medications were causing such low blood pressure that she fainted. Reducing the dose and discontinuing a diuretic, Dr. Taavoni also weaned the patient off an anti-anxiety drug she suspected was causing problems, substituting a low dose of an antidepressant instead. The falls and the related emergency room visits stopped. Doctors Making House calls is still caring for her, and for most of the neighbors in her assisted living facility.

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Are Vegetarians Less Likely to Develop Heart Disease?

Before we answer this question, let’s first ask another, more basic question: What exactly is a “vegetarian”? You might think the answer to this question is obvious, but not all vegetarians are created equal. Most people would agree that there are seven types of vegetarians, and they all differ from each other in some respects.

What are the Different Types of Vegetarians?

Vegans

Vegans consume no animal products or by-products. This means they consume no fish, fowl, or any type of meat. They also don’t consume any eggs or dairy. And when we say no animal products or by-products, that’s exactly what we mean. They typically don’t use honey, gelatin, beeswax, silk, wool, or leather either.

Lacto-Vegetarians

These vegetarians don’t eat any meat, fish, eggs, or fowl. However, they do consume dairy products such as cheese and milk, which is where they get the name “lacto-vegetarian.”

Ovo-Vegetarians

Just like lacto-vegetarians, these vegetarians don’t eat any meat, fish, or fowl. They are also the exact opposite as lacto-vegetarians because they eat eggs and no dairy products.

Lacto-Ovo Vegetarians

Lacto-ovo vegetarians are the most common form of vegetarians because they do not consume any meat, fish, eggs, or fowl, but they do eat both eggs and dairy products.

Pescatarians

Members of this group only eat fish and other seafood; they do not eat any land-based animals, meaning no red or white meat. These people are considered “semi-vegetarians.”

Pollotarians

Pollotarians only eat poultry or fowl, so they, like pescetarians, are considered to be more semi-vegetarians. These people do not eat red meat, fish, or seafood.

Flexetarians

These folks follow a mostly plant-based diet with an occasional meat item. They try to limit their meat consumption as much as possible, but needless to say, this is not considered a “true” vegetarian diet.

Are Vegetarians Less Likely to Develop Heart Disease?

There have been conflicting reports about the health benefits of vegetarian diets. Some studies claim meat and dairy are health hazards, while others attest that plant-based diets can do more harm than good. One study published in the American Journal of Clinical Nutrition, attempted to examine some of these contradicting claims. By analyzing data from different groups of vegetarians in California and Britain, researchers concluded that vegetarians seem to experience lower rates of coronary heart disease (CHD), hypertension, and diabetes, and also higher life expectancy rates.

Due to the lack of red meat in their diet, vegetarians have lower LDL cholesterol levels, which greatly influences CHD. Even though vegetarian diets are healthy and can decrease the risk for developing heart disease, the study also concluded that “different types of vegetarians may not experience the same effects on health.”

Some Plant-Based Diets are Healthier than Others

Although many studies have supported the efficacies of vegetarian diets against heart disease, some diets are healthier than others. In fact, some plant-based diets are associated with a higher CHD risk. A study in the Journal of the American College of Cardiology analyzed three different groups of people over a 20-year period to determine the correlation between diet and CHD. The groups were based on the type of plant-based diet:

  1. Diets that maximized plant-based nutrients, but did not exclude animal-based nutrients
  2. Plant-based diets that maximized intake of healthy plant foods (fruits, veggies, whole-grains)
  3. Plant-based diets consisting mostly of unhealthy plant-derived foods (sweetened beverages, potatoes, sweets, and refined grains)

“When we examined the associations of the three food categories with heart disease risk, we found that healthy plant foods were associated with lower risk, whereas less healthy plant foods and animal foods were associated with higher risk [of heart disease],” says Dr. Ambika Satija.

Choose the Right Diet for Your Lifestyle

Just because you’ve cut red meat and sugar out of your diet doesn’t mean it’s a healthy diet. Simultaneously, only following a plant-based diet doesn’t guarantee a disease-free life. The best thing you can do is develop a diet and exercise routine that works for you.

However, try to stay away from processed foods that contain added sugar and sodium even if they are derived from plants, fruits, or nuts. The most heart-healthy diet is a diet that maximizes your intake of healthy fruits, veggies, and whole-grains.

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What’s the Advantage to Medicare Advantage Plans?


Nearly 22 million Americans currently receive their health benefits through a Medicare Advantage plan. There’s much to like about these plans, which provide extra services and make coverage more affordable than traditional Medicare by capping out-of-pocket costs.

It’s no surprise that a 2018 poll found a whopping 90 percent of people with Medicare Advantage plans are satisfied with their coverage.

But do you understand the ins and outs of Medicare Advantage? Read on for answers to some frequently asked questions to help find the coverage that’s right for you.

What is Medicare Advantage?

Medicare Advantage plans (also known as Medicare Part C) are offered by private health insurance providers that have been approved by Medicare. These companies receive government funding to cover your Medicare benefits and keep you healthy.

With traditional Medicare, the federal government pays your providers directly.

What do Medicare Advantage plans cover?

If you join a Medicare Advantage plan, that plan will provide all of your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage. But that’s not all.

Medicare Advantage plans cover many things that traditional Medicare doesn’t cover. These extras can include vision, hearing and dental benefits, as well as wellness programs. Many Medicare Advantage plans give seniors access to affordable prescription drug plans, often at no additional cost.

And all Medicare Advantage plans limit the amount you must spend out of pocket for deductibles, copayments, and coinsurance each year for covered Medicare services.

Who is eligible to purchase a Medicare Advantage plan?

You must already be covered by Medicare Parts A and B to join a Medicare Advantage plan. You also must live in the Medicare Advantage plan’s service area.

Open Enrollment, which lasts from mid-October until early December, is when you can initially sign up, switch, or leave your Medicare Advantage plan. Beginning this year, you can also switch Medicare Advantage plans or from Medicare Advantage to traditional Medicare until March 31 if you change your mind.

Are all Medicare Advantage plans the same?

There are different options to meet different health and financial needs. Just as with individual or employer-sponsored insurance, several types of Medicare Advantage policies are available. The most common types of Medicare Advantage plans are:

  • Health Maintenance Organizations (HMOs)
  • Preferred Provider Organizations (PPOs)

You also may see Medicare Advantage plans called Private Fee-for-Service (PFFS) and Medical Savings Account (MSA) plans. If you are eligible for Medicaid, have a chronic condition, or live in a nursing home, you may also be able to sign up for another type of Medicare Advantage tailored to your specific needs called a Special Needs Plan (SNP).

While many Medicare Advantage plans are available at no additional cost, some charge premiums or have costs for optional services. Which providers are in the plan’s network also varies. That means it’s important to comparison-shop carefully, just as you do for other important expenditures. You’ll want to understand specific costs and benefits before you join.

Is a Medicare Advantage plan the same thing as a Medicare Supplement Insurance (Medigap) policy?

No. A Medigap policy is private insurance that helps supplement traditional Medicare. This means it helps pay some of the health care costs that traditional Medicare doesn’t cover (like copayments, coinsurance, and deductibles).

Greg Says encourages all Medicare eligible beneficiaries to consult with a licensed independent agent before making a decision about what Medicare plan is best for them. There are several variables to consider and there isn’t any one-size-fits all solution.

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About One-Fourth of Private Long-term Care Insurance Claims Begin and End in Assisted Living

March 26, 2019

By Lois A. Bowers– Mcknight’s Senior Living

Almost one-fourth (24.5%) of private long-term care insurance claims began in assisted living in 2018, and two percent more (26.5%) ended there, according to new data from the Los Angeles-based American Association for Long-Term Care Insurance.

The steadiness reflects trends across all settings where private long-term care insurance is used — most claims end where they first began, according to AALTCI Director Jesse Slome.

“For the most part, people with long-term care insurance begin care in a specific setting — typically their home — and that’s where the claims ends due to death, recovery or the exhaustion of policy benefits,” he said.

In 2018, 72.5% of all long-term care insurance claims ended because of death, 14% ended because of recovery and 13.5% of claims ended because benefits were exhausted, the AATLCI found in a January study, for which the association gathered data from seven national long-term care insurance companies.

“There are many misperceptions about long-term care insurance, and we conduct these studies to provide consumers with current and relevant insights,” Slome said. “For example, most consumers associate long-term care insurance with nursing home care. Less than one in four new LTC claims begin with someone receiving care in a nursing home.”

More than half (51.5%) of claims began in home settings in 2018, and 43% ended there, according to the association. By comparison, 23% began in nursing homes and 29.5% ended there. One percent of claims began and ended elsewhere.

Long-term care insurance companies paid out a record $10.3 billion in claims in 2018, according to the American Association for Long-Term Care Insurance.

“The industry passed the $10 billion mark for the first time,” American Association for Long Term Care Insurance Director Jesse Slome said.

Benefits were paid on more than 303,000 traditional, health-based long-term care insurance policies, which represent the majority of policies. “Traditional long-term care insurance pays when care is needed at home, in assisted living communities or in a skilled nursing home environment,” Slome said.

The 2018 totals compares with total claims amounting to $9.2 billion paid to approximately 295,000 people in 2017, according to the advocacy organization.

The AALTCI expects claimants paid in 2019 to exceed 303,000.

Greg Says believes there is a need for more education regarding long-term care insurance. There are now several approaches to this valuable coverage besides the traditional long-term care insurance policy which is cost-prohibitive for many people today.  One approach that’s gaining popularity is a life insurance policy that includes a living benefits rider.