23975375121Since Trump’s election last November, there has been a lot of speculation over how the President-elect will overhaul and revamp America’s healthcare industry.

With his recent appointments of Seema Verma to serve as the Administrator of the Centers for Medicare and Medicaid Services, and Georgia Representative Tom Price as head of the U.S. Department of Health and Human Services, there is more clarity on Trump’s vision; and, despite the hysteria, many within the health industry are encouraged by what could be in store.

Throughout the election, Donald Trump declared he would “repeal and replace” the Affordable Care Act. Now that he’s elected, it seems highly likely that Trump will deliver on his promise. Although many predicted this would be a nightmare scenario, it seems that hospitals and health insurers are pleasantly surprised with the President-elect’s first steps.

Trump’s appointments of Rep. Price and Verma, along with his recent softening on some aspects of the Affordable Care Act, is a signal to some insiders that instead of chaos, he is preparing an orderly transition to replace Obama’s health program with a plan that healthcare companies may want.

Rep. Price is an orthopedic surgeon who has drafted legislation to replace the ACA. Meanwhile, Verma has close ties to Vice President-elect Mike Pence and helped design his ACA Medicaid expansion model, Healthy Indiana Plan 2.0. She has also advised several states on how to add elements such as health savings accounts and employment requirements to their programs. If both are confirmed, experts predict more power will be granted to states in crafting individual insurance plans and Medicaid programs.

“Pence and Trump have made a big deal about giving the states more flexibility and autonomy in managing their Medicaid programs and [Verma] would appear to be the perfect person, given her expertise, to manage that rollout of more state flexibility,” said Robert Laszewski, president of Health Policy and Strategy Associates.

Of course, some have been critical of Trump’s choices and his declaration to repeal and replace the ACA. There is a fear that millions of Americans will instantly lose health insurance and there will be even more uncertainty surrounding Medicare and Medicaid. However, lawmakers, including House Majority Leader Kevin McCarthy, have indicated that although they will work to repeal the ACA immediately, there will be a two-year transition period to phase out the law and citizens currently insured by the program won’t be left without a safety net.

One plan, proposed by House Speaker Paul Ryan, will offer individual insurance with a form of Federal subsidies, provide block grant funding for Medicaid, create vouchers for Medicare coverage, and the eliminate the advance paid premium subsidies for individual insurance. Many believe Ryan’s plan will serve as the foundation of the eventual replacement plan. In the meantime, members in Congress have been already asking healthcare companies for input and advice on functional alternatives for the ACA.

While the future of healthcare under the Trump administration is still uncertain, the President-elect’s recent appointments and proposals have excited many healthcare professionals, including Kathleen Harrington, chair of Policy of Government Relations for the Mayo Clinic. Harrington is pleased with what she has heard so far from the administration over the past few weeks. She notes, “We are very encouraged with the approach we’re hearing so far from President-elect Trump in terms of having a focused review and removing certain parts of it.”

To learn more about Donald Trump’s recent appointments and his plans to reform America’s healthcare system, visit mymedicareplanner.com and contact Tom Chamouris. Tom and his staff are committed to protecting senior citizens and helping them navigate through the “Medicare maze”—at no additional cost. See our ad on page 1 of Boomer magazine.

 

Anthem bought Cigna for $54 billion last week. Aetna bought Humana for $37 billion this month. What does that mean for consumers?

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This image is from ModernHealthcare.com.

 

In the last month, four of the five biggest health insurance companies have entered major mergers. The “Big 5” are UnitedHealth, Anthem, Cigna, Aetna and Humana; all but UnitedHealth (the largest) are involved in the deals. If the mergers are approved, the “Big 5” would become the “Big 3”, who would hold over half (52%) of the Medicare Advantage market. The companies insure approximately half of the entire insurance market.
Some speculate that prices will go up.
If there are fewer companies to compete with, rates could rise. Historically, mergers of big insurers have caused the price of premiums to increase.Some suggest that prices will go down.
Insurance companies say the deals would substantially reduce their own costs, allowing them to charge consumers less for their plans.

Some say the future of the deals is uncertain.
The mergers will be reviewed by the federal government, with special attention paid to anti-trust laws. Some believe they won’t go through at all. If the deals are upheld, they won’t go into effect until 2016.

Insurers aren’t the only ones joining forces. 

  • CVS, the largest drugstore company in the US, bought Target Pharmacy for $2 billion in June. The 1,660 Target Pharmacies nationwide will eventually be CVS pharmacies.
  • Centene, a Medicare and Medicaid health plan provider, bought Health Net, a health plan provider in the same industry, for $7 billion in early July.
  • The biggest generic drug producer in the world, Teva, bought Allergan, a manufacturer of generic drugs best known for making Botox, over the weekend for $40.5 billion.
Why is everyone merging?
  • Insurers are merging because they want to cover more of the market. With the influx of customers from the Affordable Care Act, and the revenue from Medicare and Medicaid, they are buying companies with these strengths.
  • When one subset of the industry begins merging and combining market power, the companies on the other side want to do the same. To maintain power in negotiations and stay afloat in the changing industry, companies see merging as the answer.

tom

Tom says:
“Generally speaking, when an industry like the insurance industry begins to see mergers of the largest companies, it portends less competition and more price control between the remaining behemoths. Such mergers will be examined closely by the government for anti-trust violation. I will leave you with these quotes.”

“In an environment where the scales are already tipped, we are extremely concerned about the market imbalance this creates for medical practices and patients,” said Dr. Halee Fisher-Wright [of the MGMA]… “This will do nothing more than inflate healthcare premiums and decrease payments to physicians in favor of insurance companies and shareholders’ profits.” – Forbes

“One of the main goals of the Affordable Care Act was to restore competition in the health insurance sector,” said David Balto, a former policy director at the Federal Trade Commission who is now in private practice in Washington. “This consolidation will reverse these gains of the Affordable Care Act.” – Forbes

Will the Anthem-Cigna deal cost you money?

To find out what other changes could come with the health insurance mergers, click here.

Medicare will reimburse doctors
who talk with patients about
end-of-life care

Yesterday, Medicare announced that it plans to pay for the end-of-life conversations between doctors and patients. The plan answers questions surrounding “Death Panels,” which have been debated since the passage of the Affordable Care Act.
Coverage for end-of-life counseling was not included in the Affordable Care Act, but some insurance companies have begun to offer coverage. More companies are expected to when Medicare finalizes the plan.
The proposal will be decided on November 1st.If this has been helpful, please feel free to forward this email to family and friends. Please contact us at [email protected] to be added to our email list.
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Medicare Proposes paying for end-of-life counseling in sweeping physician payment rule

Modern Healthcare
In a draft of Medicare’s first physician payment rule since Congress scrapped the sustainable growth-rate formula, the CMS proposes paying for end-of-life counseling and revises several quality-incentive programs that will be rolled into a new comprehensive program in 2019.

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Medicare Plans to Pay Doctors for Counseling on End of life

The New York Times
Medicare, the federal program that insures 55 million older and disabled Americans, announced plans on Wednesday to reimburse doctors for conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves.

Allergy“Achoo !” , “Achoo ! “,God Bless You! It’s allergy season, and the grass, air pollution, dust, and pollen  have got you sneezing. Well, hold on to your tissues…helpful allergy tips are on the way. Allergies aren’t just for Springtime, over 67 million Americans suffer from allergies every day. The most common  allergen is Pollen. Pollen is an airborne allergen transferred by the wind. Various trees, grasses, and weeds create pollen; which is the culprit that irritates your sinus passages, eyes, and skin.There are also Seasonal Allergies, which include grass, pollen and mold. These allergies have triggers which are tied to particular seasons.
Seasonal Triggers
Winter  –  Smoke

Spring & Summer – Insect bites and stings

chlorine from indoor / outdoor swimming pools

Holidays – peanuts, other nuts, or chocolate

Thanksgiving & Christmas – Pine trees and wreaths

For allergy sufferers it is recommended that you work with your doctor or allergist to treat your symptoms, and find a way to avoid triggers.

Tips To Avoid Allergy Triggers
Monitor mold and pollen counts

Keep windows closed during allergy season

Go out early morning to do errands when pollen count is low

Wash hair, clothes and take a shower after being outdoors working, or playing

Use the air conditioner in your home and car

Use a humidifier

Get Allergy Healthy by seeing your doctor  or Allergist today!

 

Since today is National Walking Day, today’s newsletter focuses on small, but significant, changes that can improve your health- like walking! Time Magazine recently did an in-depth review of aging and longevity, citing many studies with some surprising results. In summary, a little bit goes a long way. Here are some of Time‘s findings on how you can improve aging, disease and general health.

  • Diet

It’s common knowledge that cutting calories is good for your waistline, but one study, published last year, shed light on another benefit. Participants’ calories were cut by one-fourth, which brought a huge health change: blood pressure and cholesterol were slightly better, and their risk of heart disease decreased by 47% (almost half!).

Another diet study that cut calories, from as little as one-third to over one-half of participants’ normal diets, found that their risks were lowered in areas of “aging, diabetes, heart disease and cancer, including lower blood sugar,” and lower levels of a growth hormone that speeds aging.

  • Exercise

Walking isn’t the only activity that can lead to a healthier future- simply doing chores around the house is a way to stay active. One study tracked over a thousand seniors in their 70s and 80s who had limitations on their physical activity. The results? Those who exercised the least had the greatest chance of a heart event within the next decade. But even small activities, like household chores, lowered the risk.

A different study involved 1,600 seniors between ages 70-89. One group took a health education course and one group did activities like walking. After three years, the walking group could walk over an hour and a half more per week than the other group. Their rates for major mobile disabilities were “significantly less.”

  • Mindfulness

Thinking positive makes a big difference. Results of a study showed that men and women who had negative attitudes toward aging in their 40s, had greater brain loss in the region associated with Alzheimer’s. They had the same level of brain loss in three years than those with positive outlooks had in nine years.

Other studies have found that those with negative views on aging have a greater risk of heart problems in the next 40 years than those with positive views. People with “mindful dispositions” have less body fat and better heart health, according to a study by Brown University.

 

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For more than 24 years, The Medicare State Health Insurance Assistance Program (SHIP) has advised, educated, and empowered individuals to navigate their state-specific Medicare choices. In addition, SHIP helps beneficiaries resolve fraud and abuse issues, billing problems, appeals, and enrollment in low-income health assistance programs. In 2015, SHIP provided assistance to more than seven million individuals with Medicare.

The Medicare State Health Insurance Assistance Program (SHIP) network is a critical resource for the elderly, disabled and families needing help to make informed decisions about their Medicare coverage options and enrollment decisions. Today’s Medicare beneficiary must choose among more than 20 prescription drug plans, 19 Medicare Advantage plans, and various supplemental insurance policies, all with different premiums, cost sharing, provider networks, and coverage rules.

Last week the Senate Appropriations Committee targeted two critical programs for significant cuts, and/or elimination for Fiscal Year 2017. The two programs targeted are The Medicare State Health Insurance Programs,(SHIP)  which is slated to lose all of its $ 52.1 million in funding. The second critical program is The Senior Community Service Employment Program. (SCSEP)

Eliminating SHIPs would leave millions of older Americans, people with disabilities, and families who need help applying for benefits, comparing coverage options, filing appeals, and navigating a complex program stranded without assistance.  Max Richtman, President and CEO of The National Committee to Preserve Social Security and Medicare stated “Senate appropriators have turned their backs on a growing number of people who will need SHIP services to navigate the complexities of Medicare coverage by proposing to eliminate program funding.”

The Senior Community Service Employment Program, (SCSEP) which is funded by the Older Americans Act provides subsidized, service based training for low income persons aged 55 and older who are unemployed, and have poor employment prospects. Cutting this program could result in fewer seniors receiving services, and less income due to deceased working hours. It would be devastating to the seniors who work and depend on this program.

Final decisions to cut the programs have not been made. The full Senate is expected to vote on the budget bill in the fall. If this is important to you, please take action by contacting your congressman to reject the imposed cuts, and to take steps to secure The State Health insurance Assistance Programs and  The Senior Community Service Employment Programs are funded.

For more information on our featured article visit http://khn.org/topics/medicare/

What happens if you take your Social Security benefits before your full retirement age? This is the question many seniors are pondering.

According to a recent Associated Press Center for Public Affairs Research poll found that 44 percent reported that income from Social Security will be their biggest income source during their retirement years., and that Americans 50 and older have access to multiple sources of income, but Social Security is the most common source.

According to the Social Security Administration, if full benefits begin at 65 or 66 and you were born between 1943 and 1954; you can begin collecting social security at 62, but at a reduced benefit rate by up to 30 percent. The average age that most people expect to start or have started collecting Social security is 64.   If you could wait in this case past 66 years of age and even to 70 to claim your benefits, your benefits would rise around 8 percent more.

There are advantages and disadvantages to taking your Social Security early. One advantage is that you collect your benefits for a longer period of time. The downside to that option is your benefits are reduced.

Your circumstances are just like your fingerprints, no two are alike.
The average retirement age for men is 64, and for women 62. There is no set answer as to when it is best for you to take out Social Security, in that it varies across all ethnic groups.

Click here for further statistics and information regarding what your full retirement age would be, and important factors you should consider regarding your social security benefits and retirement.

June is Men’s Health Month.  The Purpose of Men’s Health Month is to heighten awareness of preventable  health problems, and to encourage treatment and early detection of diseases among men and boys.

There is a health crisis in America in Men’s health. The crisis references the management of medical diseases such as diabetes, hypertension, heart disease and high cholesterol. These common and treatable health issues are causing men to die prematurely in the prime of their life.

According to a recent poll by  the centers for Disease Control and Prevention. Men are 80 percent less likely  than women to use a regular  source of health care. Most men go to the doctor only when they feel sick  or have a medical emergency and that’s not nearly as often as they should.

Let’s focus on tips and ways for men to stay healthy at any age in celebration of Men’s Health Month. It’s never too late to take care of your health.  Six things that will help you maintain good health are : Getting 7- 9 hours of sleep,quit smoking, more physical activity, eating more fruits and vegetables, avoiding drugs and alcohol, taming stress by taking care of yourself , and connecting socially with family and friends on a regular basis.

For National Men’s Health Month, here are six recommended health screenings, most of which  can  be done in your local doctors office, that men should add to their list to ensure better health.

                                          
 Recommended Health Screenings for Men

Blood Pressure Test
Cholesterol Test
Prostate Cancer Screening
Colon Cancer Screening
Skin Cancer Check
Diabetes Check

National Men’s Health Month has a primary goal of educating and encouraging men and boys to feel better about taking steps to stay healthy. Not all men avoid there screenings or doctors appointments , but the disparity between  men seeking health care , and women has a large enough gap for a men’s health crisis to be declared. Take charge of your health today.
Check out https://www.men’shealthmonth.org for further information on details for screening and further statistics on men’s health.

This month is Better Hearing and Speech Month. According to the National institute on Deafness and Communication Disorders, an estimated 26 million Americans have hearing loss in some capacity, due to noise.
The good news is that noise induced hearing loss is preventable. Hearing loss due to noise is not exclusive to the senior population, it affects  seniors, children and young adults, and the good news is that it is preventable.

Our Hearing and speech are essential to being productive in our daily lives, and we must take proper care to assure that we are functioning at our highest and healthiest capacity.
How We Hear
Being one of our five senses, hearing is a process of picking up sound, and attaching meaning to the sound. The ear is divided into three parts leading up to the brain. The outer ear, middle ear and  inner ear. How we hear is a pretty complex process. I will summarize the three major parts and their functions.
Outer ear – The ear canal and eardrum – sound travels down the ear canal, to the ear drum causing vibrations.
Middle ear – Three small bones connected in a cluster behind the eardrum at one end and to the inner ear at the other vibrate and creates movement of the fluid in our inner ear.
Inner ear –movement of the tiny hair cells sends electric signals from the inner ear to our auditory/hearing nerve to the brain, which causes what we know as sound.

Listed are a few steps to prevent hearing loss:

  • Turn down your stereo volume
  • Limit your exposure to unsafe sound levels.
  • Wear earplugs

Speech

Speech is crucial to our daily existence. Being able to communicate and express ourselves is crucial.  Approximately 40 million Americans experience speech communication disorders. Seniors  may also experience voice disorders often as a result of medical conditions such as cancer, stroke, Parkinson’s or traumatic brain injury. You may also be subject to voice disorders that have existed since childhood, such as stuttering.
If you are diagnosed , or through sudden illness you develop a speech disorder, you should seek treatment from a  Certified speech–language Pathologist .

 

After a successful program at YMCAs nationwide, Medicare will cover programs that help prevent diabetes among those with prediabetes.

What is Prediabetes?
Prediabetes is the condition when blood sugar levels are higher than usual, but not high enough to be considered diabetes. One in three adults has prediabetes in the United States, and 90% don’t know they have it. Without action, about 15-30% of those with prediabetes will develop Type 2 diabetes within 5 years.

What will Medicare cover?
If approved, Medicare will pay for certain “lifestyle change programs,” where a trained counselor leads a class focused on preventing Type 2 diabetes with eating habits and exercise. These programs were implemented in YMCAs across the country with a federal grant with a CDC-approved curriculum.

The YMCA programs saved Medicare $2,650 per person enrolled in the program over 15 months. Participants lost about 5% of their body weight, which significantly lessened the likelihood of diabetes.

Need convincing? Here are more results:
In one of the first studies on healthy eating habits and exercise on diabetes, the results were so strong that the study was ended early. About 3,000 participants between ages 25-75 were randomly sorted into three groups. Group 1 was treated with a healthy diet and exercise. Group 2 was treated with metformin, and Group 3 was given a placebo medication.

Groups 2 and 3, with medication, reduced their risk of diabetes by 31%. Group 1, with diet and exercise, reduced their risk by 58% and the patients lost at least 7% of their body weight. Those age 60 or older, reduced their risk by 71%. These rates of reduction have been seen in studies since.

The program will likely be covered by Medicare soon, as it doesn’t require congressional approval.

prediabetes-inforgraphicThis infographic is f CDC.gov.

You can take the CDC’s quick test online
to see your risk of prediabetes here.

For more on the YMCA prediabetes program,
see this New York Times article.

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