Being your own Healthcare Advocate

10 Things You Should Bring to Every Doctor's Appointment

1. Medical History Card Ideally, your doctor will have your complete medical history on file, but this is not always the case, especially if you're seeing a new specialist, an emergency physician or someone covering for your usual doctor. So make sure you always bring along a record of your key information, including medical conditions, dates of past surgeries, current medications, doctors' names and contact information, next of kin and contact information, health insurance and any drug allergies. You can create a card on your computer or visit a website like MedIDs.com, which offers free templates that you can fill in and print out. Once you have a card, laminate it and keep it in your wallet or handbag so you'll have it with you wherever you go.

2. Changes to Your Medical Record If you've received any new test results since your last visit, bring them with you, even if you believe your doctor has already seen a report. Having this information on hand at your appointment ensures that you'll remember to discuss it with your physician. This is particularly important if you are seeing a new doctor or specialist. Current test results will help them get the most complete picture of your health, speed up diagnosis and reduce the need for additional or redundant testing that could carry unnecessary side effects.

3. Your Prescription Drugs Too often, patients tell doctors they don't remember the name or prescribed dosage of their medications. "I think I stopped taking the pink, tiny pill, but I'm still taking the white one and the blue one," is not as helpful as presenting the actual bottles with the labels on them. Before you leave home, gather all your medications and put them in a zip-lock bag. Tell your doctor if you've stopped taking any prescribed drugs or haven't followed dosage instructions. Be honest: If you mislead doctors about prescription compliance, they may assume your medications are not working and prescribe even more!

4. List of Alternative Therapies Doctors know that a majority of patients today may be employing some type of alternative therapy. It doesn't benefit either one of you to keep it a secret. Many physicians are not expert in alternative medicine, but it's useful for them to know what you're doing, especially if there may be potentially harmful interactions with other medications or treatments. Bring a list of any fish oil supplements, vitamins or herbal remedies you're using (or, preferably, the bottles themselves), as well as a record of visits to any chiropractors, naturopaths, acupuncturists or other practitioners.

5. Journal of Your Symptoms If your visit is related to a new concern, you should be keeping a journal that documents your discomfort and how it has affected your daily life in the days or weeks since it began. If your appointment is focused on a chronic condition, your doctor may have asked you to keep track of your response to new at-home treatments; to record objective measures, like your blood sugar; or to note subjective perceptions, like the intensity of a recurring headache. Whatever the information, bringing the journal to your appointment can help your doctor better understand what has been going on.

6. List of Questions You should expect your physicians to be responsive to your concerns, but you need to do your part as well. Always come to an appointment with a list of questions prepared in advance. Brainstorm your questions well before your visit, then jot down a concise list, arranged in order from most to least urgent. And don't leave your doctor's office without asking them.

7. Notebook and Pen This may seem obvious, but it's important to take notes throughout an office visit. If your doctor mentions an unfamiliar term, get him to spell it out. Don't hesitate to push for clarifications. At the end of every visit, request a verbal summary and write it down. Before you leave the exam room, review what you've written about your treatment plan; if there's anything you don't fully understand, ask again.
 

8. Friend or Family Member Having someone with you can provide crucial moral support. But it's also a valuable means of ensuring that your doctor addresses your most important questions. A friend or relative may not be able to sit in during the physical exam, but he or she should be welcome when you and your doctor discuss diagnosis, testing or treatment. That's when a companion can remind you of your primary questions and concerns, act as your advocate if you're not satisfied with the answers and take notes so they can help you follow through on the next necessary steps after an appointment.

9. Your Smartphone There is always some downtime during an office visit. Use it to look up more information about what your doctor has told you from trusted resources like the National Institutes of Health's Medline Plus. It's also useful to have your phone on hand if it carries your calendar so you can schedule follow-up visits and screenings. (And, of course, games, emails and websites can distract you from boredom if your wait is particularly long!)

10. Snacks Food options at a doctor's office or clinic are typically limited (or nonexistent), and you may end up being there for some time, perhaps missing lunch or dinner. Unless you've been told not to eat because of a scheduled test or screening, be sure to pack a healthy snack so you can maintain your energy and mood.

-Phil Smith, FirstLight Homecare

The importance of estate planning

ESTATE PLANNING: AN EXAMPLE

This article is intended to act as an example why someone should be concerned with their current status of their assets, it is intended to be read in conjunction with Estate Planning Parts One through Four (located here), and it is not intended to be read as the “one size fits all” plan. As parts one through four expressed, it is typically very important to avoid the probate system as much as possible. The probate system can add time, money, and emotional distress to your loved ones in the event that they have to come into contact with the probate system. For example . . .

Sally has one home and one car and does have a will leaving everything equally to her three children and naming her first-born, Mark, as executor. Her husband, James, died three years ago. Before James died, he changed the title to his car to have Sally listed as TOD (transferable on death), and the home was in a Joint Survivorship Deed leaving his entire interest to Sally. This is good for Sally because all she would have to do is file an affidavit and the death certificate with the local recorder’s office to transfer the home into her name alone. The death certificate would’ve been taken to the car title office and the transfer would be complete upon payment of a small fee. James was able to help Sally completely avoid the probate system. The transfers were quick and there wasn’t any contact with the court which would have saved Sally a lot of time, headache, and attorney fees.

However, let’s assume that after these two assets are transferred into Sally’s name, she does nothing. Sally has three children: Mark, Mary, and Michael. If Sally was to die, without updating the assets a number of things could happen. First, even though Mark is listed as executor, to be appointed as executor, he would have to take the will to the local probate court and pay court costs (probably exceeding $100.00) to open the estate. Next, the home and vehicle would have to be appraised which would require an appraiser to get a current-market accurate figure at least on the home. Next, the appraiser’s fee would have to be paid and then Mark would have to file the inventory. From the time of appointment to filing of the inventory, including estimate waiting periods for appointment of the executor and conducting the appraisal, you are probably looking at a three month period of time. All the while, real estate taxes and bills for the home and car would have to be paid, including insurance. At this point in time, the heirs would have the option of taking title to the home or selling the home. If they decide to sell, it could lead to additional time to clean out the home, list the property, and allow buyers to inspect and find financing. This period of time could take up to six months whereby additional bills would have to be paid. Finally, Mark would get to the final accounting, where he would have to list the proceeds of the sale, reimburse himself for bills paid, show the remaining balance and distribute the funds.

Nine months of bills, filings with the court, opening of accounts, and payments of fees, is the cost that would have to be paid in the above scenario. Instead, had Sally obtained a Transfer on Death Designation Affidavit for the home and filled out a TOD for the car, the entire process would be condensed. Mark could have completed the required paperwork in a day. The additional fees wouldn’t have been accruing. And, if the children decided to sell the property, they could have listed it the same day instead of waiting on court approval and paying all of the fees and taxes along the way. 

Breaking news on the reversal of Alzheimer's Memory Loss

I don't know about you, but when I hear that something can't be done, it makes me work harder on trying to find a solution. And, this is exactly what clinicians have been saying about "Reversing Memory Loss" for decades, that is, "It can't be done".

So, when I came across an article recently written in LifeExtension magazine summarizing the latest research on slowing and even reversing memory loss, I had to take pause.... What's more, is that the results aren't achieved from some revolutionary drug, they are achieved primarily through carefully choosing what we do or do not eat on a daily basis.

Now, before you run out and buy a subscription to LifeExtension magazine, consider this: The conditions for achieving success in the study by Rush University and other studies like it, are COMPLICATED and difficult to adhere to in their entirety.

Still, the author goes on to note that even where "middle of road compliance" to diet requirements were achieved, statistically valid reductions in memory loss rates of  > 40% can still be achieved.

So, before you say well..., I'm probably one of those "other" people that fell into the 60% majority, consider that over 90% of all test subjects saw a significant impact in their rate of memory loss suggesting some really strong science is at work here.

So here it is in a nutshell:

DO:
- Eliminate simple carbohydrates, gluten, and processed foods from your diet
- Meditate 2x per day and begin yoga to reduce stress
- Sleep 7-8 hours per night
- Take melatonin, methylcobalamin, Vitamin D3, fish oil, and coenzyme Q10 daily
- Optimize oral hygiene by flossing and using an electric toothbrush
- Reinstate hormone replacement therapy
- Fast a minimum of 12 hours between dinner and breakfast
- Exercise a minimum of 30 minutes, 4-6 days per week

DON'T:
- Eat pastries & sweets in excess of 5 servings per week
- Eat red meat in excess of 4 servings per week
- Eat cheese in excess of 1 serving per week
- Eat butter or margarine in excess of 1 tablespoon per day
- Eat fried or fast food in excess of 1 serving per week

Interestingly, all of these things have been suggested to us at some point or another to maintain good health, but never before has there been such compelling, statistical evidence that puts all of these relatively simple ideas together to cure a previously incurable disease!


For more information on this topic, reference LifeExtension magazine, April 2016, "How to Delay Brain Aging by 11 Years" complete with all of its 49 references!

-Phil Smith, First Light HomeCare

Where to turn for help when parents can no longer care for themselves

As I sit here writing this piece, I am reminded that another 10,000 seniors retired today and 10,000 more will retire every single day for the next nineteen years!

If you are a baby boomer, then I'm certainly referring to you.  But if you are not, you may have a loved one who is.  If you or someone you love has been fortunate enough to reach the milestone of retirement, there is no doubt that there are at least two things on your mind;

• "Do I have enough money to live the way I want to for as long as I want" 
• "Am I healthy enough  to enjoy my retirement with no help from others?"

Woody Allen once said "if you want to make God laugh, tell him all about your plans"

For the sake of conversation, let's just focus for a moment on some options for "aging in place" if your retirement aspirations don't go exactly to plan.  For instance, what if your health declines and you can no longer take care of yourself either short or long-term?  Who will you lean on and where will you turn?  Perhaps you feel like your family owes it to you to provide the care you need or maybe you feel like it's the State's responsibility and they will provide for you when the time comes.

At the end of the day, many family members do step in when necessary to help work through a crisis, but what if the challenges are longer lasting?  How much family support is reasonable and at what point will this begin to take its toll on your family's health and well being?

Certainly, it is not my intent to be all doom and gloom because there are so many happy endings to reflect on.  It is my intent, however, to educate you on the options available and provide some pros and cons of each.  Consider the list below:

1. Skilled nursing facility- Stay here for short-tern nursing and physical therapy (PT). Typically covered under Medicare and/or private insurance.
   
2. Skilled nursing agency- Can receive nursing and PT in the comfort of your home.  Typically covered by Medicare and/or private insurance
   
3. Long Term Care (Nursing Home)- Stay here for long term nursing needs where skilled care is needed 24/7.  Covered by insurance after spend down requirements are met for personal funds leading to Medicaid.
   
   
4. Assisted Living- Stay here for long term living when medically stable; still able to transfer and ambulate with minor assistance.  Not covered by insurance and costs can range from $2500-$8000/month
   
   
5. Private Duty Home Care- This provides non-medical support in the comfort of your own home with similar services to Assisted Living including meal prep, light housekeeping, bathing, transportation etc.  Not covered by traditional insurance and rates can range from $19-25/hr.

-Phil Smith, First Light HomeCare

Prescription Drug Plans- Medicare Part D

Medicare offers prescription drug coverage to everyone with Medicare Part A and/or Part B. If you currently use prescription drugs or think you may in the future you should consider joining a Medicare drug plan.  Part D coverage is not mandatory, it’s optional.   Keep in mind that should you decide not to join a prescription drug plan when you’re first eligible, you may have to pay a late enrollment fee.   If you qualify for Extra Help in paying for your prescription drugs or have creditable prescription drug coverage at least as good as Medicare you may not be assessed the late-enrollment penalty or LEP.

There are two ways to get Medicare prescription drug coverage:

       -A stand-alone PDP or Prescription Drug Plan.  You must have Part A or Part B to join.

2.       -A Medicare Advantage Plan or Part C that includes prescription drug coverage.  These plans require that you have Part A and Part B to join and are commonly called MAPD plans.

All plans must meet the same basic guidelines created by the federal government.  Each plan can vary in cost and in the specific drugs they cover on their formulary or drug list.  You want to make sure all your medications are covered on your prescription drug plan.  You also want to know your monthly estimated drug costs,  and if you are going to hit the donut hole during the year.   You must live in the service area of the Medicare drug plan you want to join, and generally you must stay enrolled for the calendar year. 

You can enroll in Part D coverage when you first become eligible for Medicare.  For most people this is three months before the month you turn 65, the month of your birthday, and three months after.   You can also join if you get Part B for the first time during the General Enrollment period, during open enrollment between October 15^th -December 7^th each year, and at any time if you qualify for Extra Help.  If you are on a limited income and you enroll in Part D, you may qualify for Extra Help in paying for your premiums, deductibles and co-payments.  Also, there are certain situations or Special Enrollment Periods when you may be able to join, switch, or drop Medicare drug plans.  An example is if you move out of the service area.  

Medicare Part D has four drug payment stages.

Stage 1 – The annual deductible stage.  The deductible varies from plan to plan.  If your plan has a deductible, you must pay the annual deductible before the plan will pay for your prescription drugs.  Once the deductible is met you move to the initial coverage stage.

Stage 2 – The initial coverage stage.  In this stage you pay a co-payment or coinsurance (percentage of the drug’s total cost), and the plan pays its share for each covered drug until the combined amount which includes the deductible reaches $3310 in 2016. 

Stage 3 – Coverage gap stage which is often called the donut hole begins once your total drug costs reach $3310 for 2016.  At this stage, you pay 45% of the cost of brand name drugs, and 58% of the cost of generic drugs.  What you pay and the discount paid by the drug company in the donut hole counts as out-of-pocket spending.   You continue in this stage until your total out-of-pocket costs reach $4850 for 2016.  Your total out-of-pocket costs are the amount you pay and what others pay on your behalf beginning January 2016. The total out-of-pocket does not include your monthly plan premium.

Stage 4 - Catastrophic Coverage – After your total out-of-pocket costs reach $4850 for 2016, your coverage gaps ends and you only pay a small co-payment or coinsurance amount for each covered drug until the end of the year.

-Jackie Greene, IEN Risk Management

Protecting your income past age 65

The Problem:

·         When protecting income, what usually comes to mind is protecting our loved one’s, in particular young families, through the purchase of life insurance.  This is typically the solution to protecting  income since final expenses, mortgage protection, college education, income replacement are all needs for spouses and dependent children. 

·         Many parents, wanting the best for their families, have also sought to provide their children the opportunity to go to college by helping their children financially.  Although this limits the college financial aid loan repayments awaiting the graduate, this strategy often succeeds at the expense of saving for their own retirement.

·         Income replacement for the 60 something’s is easily overlooked.   The death of an income earning spouse can still cause the household to suffer a real economic loss.

·         This working spouse provides income for current needs, contributions to retirement plans accounts, and provides other benefits such as healthcare, that may be lost with the death of the worker.

In order to make up for a reduced retirement savings, whether due to a lack of planning, or market declines, workers are now planning to retire at an older age.  The expected retirement age of many workers has gone up as has life expectancy. Please see the below table with information from the CDC.    

Exhibit 1: Historical Data for Remaining Life Expectancy at Age 65

	Male	Female
1950	12.8	15
1960	12.8	15.8
1970	13.1	17
1980	14.1	18.3
1990	15.1	18.9
2000	16	19
2010	17.7	20.3
SOURCE: Center for Disease Control
http://www.cdc.gov/nchs/data/hus/2011/022.pdf

The Solutions:

The life insurance industry has seen the evolving of their life insurance company product portfolio’s.  The longer life expectancy, and newfound needs for insurance protection have created some new products, with new applications for customers.  Term life insurance, generally associated with the needs of younger generations, is now commonly used as a solution to protecting the income needs of the 60 somethings.  

If insurable, purchasing a 10-15 year term life policy, can be a cost effective solution.  In many cases, a permanent (whole life or universal life) can be combined with a term policy to provide both short and longer term protection needs.

Although the best solution for a guaranteed death benefit will always be life insurance, some people cannot pass the underwriting requirements. This is where some unique annuity legacy strategies can provide the desired death benefit, and can be a positive addition to your planning.

With many annuities, a death benefit rider can be added at the time of application. Although there is usually an annual fee for this benefit, it can provide for the life of the policy, an annual growth rate that can be left to the beneficiaries. The fee is taken out of the accumulation value, and not the actual death benefit amount.

In addition to guaranteed death benefits, it is also possible to leave an income stream to your beneficiaries as part of your overall legacy plan. This benefit can provide an income to a surviving spouse for the rest of his or her life. 

-Ken Jones, IEN Risk Management

Annual Election Period Checklist

Checklist for AEP

1.        Confirm that you are eligible to enroll -  To join a Medicare Advantage Plan you need to be enrolled in Medicare Part A and Part B and live in the service area.  To enroll in a Prescription Drug Plan you must live in the service area and Medicare Part A and/or Part B.  Also, if you have end-stage renal disease you usually cannot join a Medicare Advantage Plan but here are a few exceptions.   

2.       Review any coverage changes and determine if your current coverage still meets your needs – If you are on a Medicare Advantage or Prescription Drug Plan, carefully review your ANOC or Annual Notice of Change.  Does your plan still meet your health needs and budget?  Does it still have you’re your doctors in network and are your prescriptions on their formulary list?  Do you want to add dental or vision?    

3.       Will making a change affect your other insurance –  You can only be in one Medicare Advantage or Prescription Drug Plan at a time.   A new Medicare Advantage or Prescription Drug Plan will automatically cancel the old one.    If you have retiree or VA benefits, check to see if that insurance covers services that Medicare does not cover.   Talk to your benefits administrator so you know how your insurance works with Medicare.

4.       Do some shopping – Review your health and prescription drug costs and shop around to compare prices.  Medicare plans can vary in what they pay for services and prescription medications.  Make certain your doctors and medications will be covered under your policy.   Be sure to check the Star Ratings of your Medicare Advantage and Prescription Drug plan.   These plans are rated on a scale from 1 to 5 for customer satisfaction and quality. 

Medicare doesn’t have to be confusing, and hopefully this checklist will serve as guide to steps you can take during AEP.   Just think of the Annual Election Period as your yearly Medicare check-up.   If you have any questions regarding AEP, I’m happy to help.

-Jackie Greene, IEN Risk Management