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They sound similar, but each serves different populations—though there can be some overlap.

Oct. 12, 2021 – By David Levine

Although they were born on the same day, Medicare and Medicaid are not identical twins. And even though they have been around for 55 years, many people still confuse these two government-backed health care programs.

On July 30, 1965, President Lyndon Johnson signed the laws that created Medicare and Medicaid as part of his Great Society programs to address poverty, inequality, hunger and education issues. Both Medicare and Medicaid offer health care support, but they do so in very different ways and mostly for different constituencies.

According to the Medicare Rights Center:

• Medicare is a federal program that provides health coverage to those age 65 and older, or to those under 65 who have a disability, with no regard to personal income.
• Medicaid is a combined state and federal program that provides health coverage to those who have a very low income, regardless of age.

Some people may be eligible for both Medicare and Medicaid, known as dually eligible, and can qualify for both programs. The two programs work together to provide health coverage and lower costs. And although Medicare and Medicaid are both health insurance programs administered by the government, there are differences in the services they cover and in the ways costs are shared.

Medicare Defined

Medicare is a federal health insurance program. According to the Department of Health and Human Services, the program pays medical bills from trust funds that working people have paid into during their employment. It offers essentially the same coverage and costs everywhere in the United States and is overseen by the Centers for Medicare & Medicaid Services, an agency of the federal government.

Medicare is designed primarily to serve people over 65, whatever their income, and younger disabled people and dialysis patients who are diagnosed with end-stage renal disease (permanent kidney failure requiring dialysis or transplant). Patients pay a portion of their medical costs through deductibles for hospital and other services. They also pay small monthly premiums for non-hospital coverage.

Medicare has two parts. Part A covers hospital care, and Part B covers other services like doctor’s appointments, outpatient treatment and other medical expenses. HHS says you are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:

• You receive retirement benefits or are eligible to receive benefits from Social Security or the Railroad Retirement Board.
• You or your spouse had Medicare-covered government employment.

If you are under age 65, you can get Part A without having to pay premiums if:

• You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months.
• You are a kidney dialysis or kidney transplant patient.

HHS says that most people do not have to pay a premium for Part A, but everyone must pay a premium for Part B. This is deducted monthly from your Social Security, railroad retirement or Civil Service retirement check; those who do not get any of these payments are billed for their Part B premium every three months.

Prescription drugs are covered under Medicare Part D. Everyone with Medicare, regardless of income, health status or prescription drug usage, can obtain prescription drug coverage for a monthly premium.

While the federal government administers what’s known as Original Medicare, it is also possible to purchase Medicare plans from some private insurance companies. These plans are known as Medicare Advantage. These include Part A and Part B coverage, but may or may not include prescription drug coverage.

Medicaid Defined

Medicaid is a government assistance program administered by both the federal government and state governments. As such, its rules of coverage and cost vary from one state to another.

It serves low-income people, families and children, pregnant women, the elderly and people with disabilities of every age. Income levels are generally based on the federal poverty level, but each state can determine who qualifies and who doesn’t.

According to HHS, patients usually pay none of the costs for covered medical expenses or a small co-payment. Some states cover all low-income adults below a certain income level. Since the enactment of the Affordable Care Act, states have been allowed to expand their Medicaid programs to cover all people with household incomes below a certain level. Some states have done so, while others have not.

Whether you qualify for Medicaid coverage depends partly on whether your state has expanded its program. HHS says that, in states that have expanded Medicaid coverage, you can qualify for Medicaid if your household income is below 133% of the federal poverty level. Some states use a different income limit, however.

The Fine Print

Being government programs, both Medicare and Medicaid can be complicated, confusing and challenging to navigate for some people.

Once you turn 65 years old, Medicare automatically becomes your primary insurance payer, says Diane Omdahl, president and founder of 65Incorporated, a Medicare consulting firm. If you also qualify for Medicaid, that becomes your secondary payer. “It works like a supplement plan, picking up the costs that Medicare Part A and B don’t cover,” she says. However, she recommends talking to a consultant or a representative of your state health insurance assistance program, known as SHIP, for guidance. “Talk to someone about what needs to be done, because you can’t rest assured that it will be done automatically,” she says.

When picking a Medicare or Medicare Advantage plan, the choices can be overwhelming. How flexible is the coverage offered? Are your doctors included in the plan? Does it cover your needs for, say eye care or mental health care?

Heart Conditions – CardioVascular Group – Sept.4, 2021

High blood pressure is a serious condition which can lead to heart disease and a stroke. Did you know there are several ways to improve your blood pressure without medication? We consider medication a last resort. 

The first option? Rethink your lifestyle. We don’t recommend you attempt to make these changes overnight; that’s not fair to you. Instead, try one at a time. Then add another. And another. That’s the smart path to lowering your blood pressure without medication.

Living a healthy lifestyle is crucial to improving blood pressure. CardioVascular Group cares about your health and suggests these lifestyle tips to lower your blood pressure without medication.

Exercise

Any form of aerobic exercise or moderate-intensity activity is proven to reduce blood pressure. As you start to exercise regularly, the pressure in your arteries decreases and your heart doesn’t have to work as hard. According to Dr. Randall Zusman, a cardiologist at Harvard Health, you should get 150-minutes of exercise per week. That means walking 30 minutes a day, five days a week, can reduce your blood pressure. So take the stairs at work. And park in the back of the parking lot. 

Change Your Diet

We all know adding fruits and vegetables to our diet is the healthy thing to do…but why? It reduces inflammation in the cardiovascular system, making blood flow more efficient. Eating processed and refined foods (i.e. junk food) damages the blood vessel walls, leading to high blood pressure and other severe conditions. Here are some tips that are essential in blood pressure health:

1. Increase potassium in diet – Potassium regulates blood pressure in the body. Foods high in potassium include:

Avocado
Banana
Nuts
Spinach

2. Decrease sodium (salt) intake – Where salt goes, water always follows. When you consume too much salt, your body retains water that could cause serious cardiovascular issues. A weakened heart causes fluid retention. To avoid this vicious cycle, reduce the amount of salt you consume by choosing low-sodium alternatives and avoiding processed foods.

3. Avoid sugar – Sugary foods cause weight gain, forcing your heart to work harder. Over time, this leads to high blood pressure. Ready to do something about it? Start incorporating whole foods in your diet. Also, avoid sodas. Both are great ways to start reducing sugar consumption.

4. Eat less dairy – According to Mark Hyman, MD, dairy contains unhealthy saturated fats and may be linked to heart disease – More: Dairy: 6 Reasons You Should Avoid It At All Costs…
Many healthcare professionals believe dairy products can be harmful to your health and suggest substituting almond or soy milk.

5. Relieve Stress – Although the effects of chronic stress on blood pressure are still unknown, studies show that reducing stress levels, paired with adequate exercise, can lower blood pressure. When you are stressed, the endocrine system produces an excess amount of hormones that trigger a fight-or-flight mode. The blood vessels constrict and force the heart to work overtime. Here are a few coping mechanisms you can try to reduce your stress levels:

6. Rest and relaxation – Take time each day to relax. The intention here is to get out of your head and into the now.

7. Meditation – Evidence shows that meditation may activate the parasympathetic nervous system, also known as the “Rest and Digest” system. Meditation relaxes the body by slowing the heart rate and lowering blood pressure.

8. Analyze your schedule – Avoid overworking and engaging in activities that cause stress—practice boundaries and learn how to say “No!”

9. Get plenty of sleep – Not getting enough sleep can throw your hormones off-balance and cause you to go into a frenzy quicker than usual. Make sure to get at least seven hours of sleep every night.

Stop Smoking

Smoking hardens the inner lining of the blood vessels and makes it harder for them to relax. In turn, the workload on the heart becomes more demanding, and blood pressure increases. Smoking is bad for your health in general and should be avoided at all costs.

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.