Greg Nicholaides

A stroke is the number five cause of death and disability in the U.S. A stroke can happen to anyone at any time, which means knowing how to spot a stroke early can prevent long term disability or even save a life. 

In honor of the fact that it was National Stroke Awareness Month in May, people are gathering together to discuss the latest advancements in brain health and to raise awareness for stroke warning signs and prevention tips. Here is what you need to know about strokes and how to spot them in time. 

What is a Stroke? 

A stroke occurs when the arteries in and around the brain either become blocked or rupture due to a clot. This blockage can prevent the brain from getting the blood and oxygen it needs, which causes brain cells to start to die. If treated quickly, doctors can help minimize the long-term effects created by the blockage. This means that stroke symptoms must be treated with a sense of urgency. 

Different Types of Stroke 

There are two types of strokes: Ischemic stroke and hemorrhagic stroke. While both forms of stroke are cause for medical attention, they require different types of treatment. 

Ischemic Stroke

An ischemic stroke is the most common form of stroke, accounting for 87 percent of all strokes. This type occurs when a clot causes a blockage in a brain vessel. Treatment for an ischemic stroke focuses on removing or breaking up the clot. 

Hemorrhagic Stroke

When a stroke is caused by a ruptured blood vessel in the brain, it is classified as a hemorrhagic stroke. This form of stroke is less common and is treated by stopping the bleeding.  

5 Signs of a Stroke 

It’s important to know the warning signs involved with a stroke, so you can seek medical attention for yourself or a loved one. Symptoms associated with a stroke are often times simply the side effect of a less serious issue, such as dehydration or a medication. However, if you experience the following signs altogether, it may in fact be a stroke.

1. Numbness: Sudden numbness, weakness or paralysis in the face, leg, or arm can occur. Typically, it will only be on one side of the body, and it can happen on the left or right. 
2. Vision Problems: If the stroke occurs on the right side of the brain, it may suddenly become difficult to see out of one or both eyes.
3. Language Confusion: If the stroke occurs on the left side of the brain, it can make it difficult to speak or understand others.
4. Severe Headache: Headaches can happen for many reasons, but if you experience a severe headache with no explainable cause, it could be a stroke.
5. Dizziness: Dizzy spells, a loss of balance, and trouble walking can all be signs of a stroke.

Are there Treatment Options for a Stroke? 

The long-term effects of a stroke can vary depending on where the clot is located in the brain along with the severity if the blockage. The treatment options vary depending on whether the stroke was ischemic or hemorrhagic. Unfortunately, after a person suffers a stroke, the risk of suffering a second one goes up dramatically. 

Greg Says agrees that strokes may be scary, but the good news is that 80 percent are preventable with the right treatment.

By Michelle Andrews

Kaiser Health News – March 20, 2019

When Beverly Dunn called her new primary care doctor’s office last November to schedule an annual checkup, she assumed her Medicare coverage would pick up most of the tab.

The appointment seemed like a routine physical, and she was pleased that the doctor spent a lot of time with her.

Until she got the bill: $400.

Dunn, 69, called the doctor’s office assuming there was a billing error. But it was no mistake, she was told. Medicare does not cover an annual physical exam.

Dunn, of Austin, Texas, was tripped up by Medicare’s confusing coverage rules. Federal law prohibits the health care program from paying for annual physicals, and patients who get them may be on the hook for the entire amount. But beneficiaries pay nothing for an “annual wellness visit,” which the program covers in full as a preventive service.

“It’s very important that someone, when they call to make an appointment, uses those magic words, ‘annual wellness visit,’” said Leslie Fried, senior director of the Center for Benefits Access at the National Council on Aging. Otherwise, “people think they are making an appointment for an annual wellness visit and it ends up they are having a complete physical.”

An annual physical typically involves an exam by a doctor along with bloodwork or other tests. The annual wellness visit generally doesn’t include a physical exam, except to check routine measurements such as height, weight and blood pressure.

The focus of the Medicare wellness visitis on preventing disease and disability by coming up with a “personalized prevention plan” for future medical issues based on the beneficiary’s health and risk factors.

At their first wellness visit, patients will often fill out a risk-assessment questionnaire and review their family and personal medical history with their doctor, a nurse practitioner or physician assistant. The clinician will typically create a schedule for the next decade of mammograms, colonoscopies and other screenings and evaluate people for cognitive problems and depression as well as their risk of falls and other safety issues.

They may also talk about advance care planning with beneficiaries to make decisions about what type of medical treatment they want in the future if they can’t make decisions for themselves.

At subsequent annual wellness visits, the doctor and patient will review these issues and check basic measurements. Beneficiaries can also receive other covered preventive services such as flu shots at those visits without charge.

When the Medicare program was established more than 50 years ago, its purpose was to cover the diagnosis and treatment of illness and injury in older people. Preventive services were generally not covered, and routine physical checkups were explicitly excluded, along with routine foot and dental care, eyeglasses and hearing aids.

Over the years, preventive services have gradually been added to the program, and the Affordable Care Act establishedcoverage of the annual wellness visit. Medicare beneficiaries pay nothing as long as their doctor accepts Medicare.

However, if a wellness visit veers beyond the bounds of the specific covered preventive services into diagnosis or treatment — whether at the urging of the doctor or the patient — Medicare beneficiaries will typically owe a copay or other charges. (This can be an issue when people in private plans get preventive care, too. And it can affect patients of all ages. The ACA requires insurers to provide coverage, without a copay, for a range of preventive services, including immunizations. But if a visit goes beyond prevention, the patient may encounter charges.)

And to add more confusion, Medicare beneficiaries can opt for a “Welcome to Medicare” preventive visit within the first year of joining Medicare Part B, which covers physician services.  Meanwhile, some Medicare Advantage plans cover annual physicals for their members free of charge.

Many patients want their doctor to evaluate or treat chronic conditions like diabetes or arthritis at the wellness visit, said Dr. Michael Munger, who chairs the board of the American Academy of Family Physicians. But Medicare generally won’t cover lab work, such as cholesterol screening, unless it’s tied to a specific medical condition.

At Munger’s practice in Overland Park, Kan., staffers routinely ask patients who come in for a wellness visit to sign an “advance beneficiary notice of non-coverage” acknowledging that they understand Medicare may not pay for some of the services they receive.

As long as beneficiaries understand the coverage rules, it’s not generally a problem, Munger said.  “They don’t want to come back for a separate visit, so they just understand that there may be extra charges,” he said.

Beneficiaries may not be the only ones who are unclear about what an annual wellness visit involves, said Munger. Providers may be put off if they think that it’s just another task that adds to their paperwork.

A recent study published in the journal Health Affairs found that in 2015 just over half of practices with eligible Medicare patients didn’t offer the annual wellness visit. That year, only 18.8 percent of eligible beneficiaries received an annual wellness visit, the analysis found.

Primary care physicians generally want to see their patients at least once a year, Munger said, but it needn’t be for a complete physical exam.  A wellness visit or even a visit for a sprained ankle could give doctors an opportunity to check in with patients and make sure they’re on track with preventive and other care, Munger said.

When Dunn called the doctor’s office about the $400 bill, she said, the staff told her she had signed papers agreeing to pay whatever Medicare didn’t cover.  Dunn doesn’t dispute that.  “There were lots of papers that I signed,” she said. “But nobody told me I would get a bill for $400. I would remember that.”

In the end, the clinic waived all but $100 of the charge, but warned her that next year she’ll have to pay $300 if she wants an annual physical with that doctor. If she comes in just for an annual wellness visit, she’ll be seen by a physician assistant.

Dunn is considering her options. She would like to stay with her new doctor, who came highly recommended, and she’s worried she might have trouble finding another one just as good who accepts Medicare. But $300 seems steep to her for a checkup.

Greg Says is trying to help the Medicare beneficiaries on its mailing list to be better informed about how to take full advantage of Medicare’s benefits and avoid unexpected costs.

And how we can (hopefully) prevent that from happening.

Written by: Michael Douglass at TMF Enterprise

Americans are worried about Social Security.

Whether it’s Transamerica’s annual retirement survey (44% of workers fear a reduction in or elimination of Social Security benefits), Gallup (67% of workers worry a “great deal” or “fair amount” about the Social Security system as of March 2019), or any of a variety of other surveys, the trend is clear. Americans fear that Social Security won’t be around (or at least won’t be as generous) in the future.

As the ratio of workers to retirees narrows — from between 3.2 and 3.4 between 1974 and 2008 down to a projected 2.2 in 2035 — the program will certainly be put under additional strain, and it is currently slated to run out of reserves in about 16 years.

Social Security’s Board of Trustees issues an annual report which reveals its exact prediction as to when Social Security will run out of money — and what happens next.

The deficits start shortly

According to the trustees’ report, the Old Age, Survivors and Disability Insurance (or OASDI) funds will start paying out more than they’re taking in next year. And by 2035, the combined funds of OASDI will be depleted.

(Technically speaking, OASI and DI are two separate programs — OASI is slated to deplete its reserves in 2034, with DI hanging on until 2052. But I digress.)

So, in short, Congress has about 16 years left to fix Social Security before it goes broke.

Here’s what happens if those efforts fail

If Social Security continues in its current arc and the trustees’ predictions are accurate, when the combined OASDI funds run out of money in 2035, Social Security will have to immediately reduce the benefits it pays out. OASDI will still be receiving money from payroll taxes, so the Social Security Administration will be able to pay out 80% of previously promised benefits.

Again, that differs between OASI and DI — OASI would be able to pay 77% of promised benefits when funds are depleted in 2034, and DI could pay 91% of benefits when its reserves empty in 2052. 

That’s certainly quite a bit better than “Social Security folds up shop and stops all benefits” (which was never a serious risk — though a persistent myth), but it’s still not great. Consider that Social Security represents at least half of income for 48% of married retirees and 69% of unmarried retirees. That’s a hefty cut to their retirement livelihood — at a time when it can be difficult to make up the deficit. (And given how expensive healthcare is in retirement, it’s not as if they necessarily have a lot of wiggle room.)

So what can be done?

To ensure 75 years of solvency going forward, the trustees recommend either immediately increasing taxes or reducing benefits (or both). To solve the issue using only additional tax revenue, they recommend increasing the payroll tax to 15.1% (from today’s 12.4%). Their benefit cut solution is to either reduce Social Security payouts by 17% for everyone (including current retirees), or by 20% to all new beneficiaries starting in 2019. Or, again, some combination of the above.

As you can imagine, neither of these solutions is terribly politically palatable. Nonetheless, there are plenty of historical precedents — the 1983 bill that stabilized Social Security increased both funding and the retirement age. (Increasing the retirement age functions as a benefit cut for future retirees, even if it isn’t explained that way.)

Of course, waiting longer makes it worse. The trustees predict that waiting until 2035 — when the combined funds net run dry — would necessitate a 3.65 percentage point increase in the payroll tax (to 16.05%) or a permanent 23% benefit reduction.

One way to ease the pain

An intriguing third option — albeit with some risk attached — involves investing a portion of Social Security funds in the stock market. Currently, Social Security’s roughly $2.9 trillion fund surplus is invested in U.S. Treasuries. While those are certainly safe securities, they don’t offer a lot of opportunity for growth.

Boston College’s Center for Retirement Research released a report back in 2017 that makes a compelling case for the Social Security funds taking on some investing risk in exchange for significantly better potential returns. The authors analyzed stock market returns and concluded that the Social Security funds would be in better shape today had they been invested in stocks starting in either 1997 or 1984 — despite the 2001 and 2008 stock market slumps. Their simulations also predict that “investing a portion (a maximum of 40%) of Social Security trust fund assets in equities would reduce the need for greater payroll tax contributions or benefit reductions.” (To be precise, 97% of their simulations found the trust fund strengthened, assuming stock investment began as of the study’s publication in 2017.)

What does this mean for you?

If you’re retired, I sincerely doubt you’ll face a benefit cut. It’s far more likely that the pain will fall on non-retired generations because most people understand how terrible it would be to force a massive benefit cut on current retirees.

If you’re still working, know that Social Security isn’t going to go belly-up and suddenly stop paying out benefits — even in the worst-case scenario. But you can’t necessarily depend on it as much as your parents’ generation did — so now’s the time to turbocharge your savings and build up your retirement income base. (And consider calling your Congressperson, if you have a strong opinion as to how the government should fix Social Security.)

CNBC – Sunday, June 2, 2019

Sharron Epperson and Jessica Dickler

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Why You Should Pay for Disability Insurance:

One in 4 adults will become disabled at some point before reaching retirement age, according to the Social Security Administration. Yet few people prepare for the possibility that any one ailment could cause them to miss work for an extended period of time.

A total of 20.1 million adults of employment age report a work related disability, according to research published by the National Institutes of Health.

Common causes include back or neck problems, depression, anxiety or other emotional issues as well as arthritis or rheumatism.

“Most disabilities you can’t even see,”said Leston Welsh, the head of disability and absence management at Prudential Group Insurance.

There are two basic kinds of insurance that can protect you financially if you are unable to work: Policies for short-term disability, which maternity leave is typically covered under, and which generally replace 60% to 70% of your base salary. Long-term disability, which ordinarily kicks in after three to six months and typically replaces 40% to 60% of your income.

“Understanding both short- and long-term disability coverage options is one of the most important ways individuals can protect themselves, their families and their finances,” said Bill Smith, the president of Cigna Group Insurance.

Most workers have no disability coverage

About three-quarters, or 78%, of employers offer short-term benefits to their employees, according to a survey by the International Foundation of Employee Benefit Plans. Sixty-three percent also offer long-term disability benefits to their workers. However, only 38% of all workers take advantage of short-term disability insurance and just 33% opt for long-term insurance.

Only five states have statutorily mandated disability benefit plans that include limited coverage similar to short-term disability.  Millions of Americans are only $400 away from hardship. As a result, more than half of people who experienced a disabling event took more than two years to recover financially, according to a separate disability study by Cigna.  “You are not only dealing with medical bills but lost wages and income,”Cigna’s Smith said.

Altogether, about 50 million working adults in the U.S. don’t have any disability insurance other than the basic coverage available through Social Security. But the average SSDI benefit is only about $1,200 a month, or $14,000 a year — barely above the poverty line.

Hard to qualify

In addition, the requirements to qualify for SSDI benefits are rigorous. Your condition must be so severe that it will keep you from working for 12 months or more. In addition, there is a significant lag time before the benefit kicks in – even up to two years – which means you must have other coverage or a well-padded emergency fund to bridge the gap.

For all of those reasons, “if your employer offers something, you should consider it,”said Mike Stein, a senior financial analyst at Allsup, a company that helps people file for and receive benefits. (Workers at or near retirement age may be offered short-term disability or long-term disability through an employer; however, long-term disability benefits could be limited.)

“Employer provider options tend to be far more reasonably priced,”he said. You may also want to consider a supplemental disability insurance policy from your workplace to get the most comprehensive coverage you can.

If there is no workplace plan option available, you can get individual disability insurance through any insurance provider, although it will be more expensive, he added.

Further, consider how disability benefits will be taxed. It depends on how they were paid. Benefits are taxed if the premiums were paid by employers or by pre-tax employee dollars, but not taxed if the premiums were paid by your after-tax dollars.

This all factors into a broader financial plan, and that’s where consulting with an independent insurance advisor is the prudent thing to do.