Still Clickin

When you reach age 65, you find that traditional Medicare offers very extensive medical coverage . . . up to a point.  Medigap plans provide coverage for those times when you go beyond those points.

Medigap plans are supplements to the traditional Medicare Parts A & B.  These plans offer coverage of the medical charges that are not covered by Parts A & B.  Although the companies involved vary state by state, the coverage provided by plans themselves, listed A through N, are fixed by the federal government.  (Note: Plans E, H, I and J are no longer being sold, but they can be retained by those that already have them.)  Although different companies may charge different amounts for different plans, the coverage provided by the plans themselves is uniform throughout.  With the new changes coming in 2011, the specifics of these plans will undoubtedly by modified, but their overall thrust will likely remain unchanged.

During the past decade, Congress introduced Medicare Part C, aka Medicare Advantage, in an attempt to reduce costs.  These plans offered broader coverage but limited the choice of doctors and hospitals.  Ironically, Congress legislated higher payments for these plans in an effort to entice people to change to them.  On the flip side, the amounts paid to doctors with traditional Medicare patients were reduced.  When physicians stopped accepted new Medicare patients as a consequence, Congress relented and reversed the cuts to traditional Medicare.  Your doctor should welcome your new Medicare status.

Now, with the new health care legislation, Congress is eliminating the price advantage of Part C while adding coverage for many preventative care measures to the traditional plans.  As a consequence, you will be able to keep your own doctors, and Medigap will likely live on.

Of all the Medigap plans, Plan F has been the most popular.  But that does not mean that is the one you should choose.  The different plans are for different situations, and you have to spend the time to determine what is best for your lifestyle, health, and wallet.  For example, some plans offer coverage for medical expenses while traveling abroad.  If you are not a traveler, it makes no sense to pay for that feature.

Some sites to visit for further information are -

Guide by Medicare

AARP Medigap description of plans

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What kind of pet person are you? There are bird-lovers, dog-lovers, cat-lovers, and goldfish-lovers. Everyone has their own particular favorite that was usually established during their youth. People that have had pets can even be classified as such. For example, we have dog-people, cat-people, and bird-people. Are you a certain pet-person?

If you are, maybe you are currently pet-less and rethinking that decision. Obviously, there are a number of pros and cons to such a decision, but the choice of the type of pet has a lot to do with most of them. There are a wide variety of pets that seniors may choose.

Dogs -
Dogs need and give love. Many studies indicate that having a dog really can help a senior’s health and attitude. Not only do they offer companionship, but their needs serve as an ongoing encouragement for some good exercise as well. Also, they are probably the best security system available on the market today.

If you are particular about breeds, you can contact the American Kennel Club and get a list of local breeders. Be prepared to open your wallet, however, since many breeds now go for $1,500 or more.

Another approach is to take a visit to the local animal shelter. These pets often have that wonderful price of ‘free’, although small donations are very welcome. These pets can vary widely, so you must look carefully to find the right dog for you. The people in the shelters understand animals and can provide you with a wealth of information. Don’t be afraid to ask. Before you “take the plunge”, consider -

• Age - If a dog is older than 18 months, it will not only be housebroken, its teeth will have grown in and it will also be less inclined to eat your slippers. If a dog is older than six, you may find not only health problems but an inability to adapt to new surroundings.
• Size - Golden Retriever mixes and Labrador mixes are great, but if you are going to walk the dog, you may need a smaller dog (who won’t pull you over when it chases after a squirrel). However, if you aren’t used to having a small dog around, you probably shouldn’t get a dog weighing less than 25 pounds. You don’t want to trip over the little thing because you didn’t see it.
• Allergies - If you have avoided dogs because you are allergic, look for dogs that don’t shed. Many terriers and poodles have this trait.
• Temperament - Undoubtedly, the vast majority of dogs have better temperaments than many people. A few, however, may have experienced poor treatment and developed a nasty streak as a consequence. Pay attention to how the dog reacts to you, since initially you are a stranger.

Cats -
“For a balanced ego, a person that has a dog to adore him should have a cat to ignore him.” That old quote is harsh, but contains an element of truth. Cats are much more independent than dogs. As long as they are properly fed and stroked occasionally, cats require far less attention than dogs. They quickly learn how to use a litter box and can amuse themselves for hours with a favorite toy. This independence allows a cat to tolerate much longer absences from their owners than dogs.

If you are looking for a cat at a shelter, many of the same cautions for dogs apply to cats. Their sizes, however, are much smaller. They compensate for their small size by their pronounced ability to quickly leap out of the way.

Other Critters -
For the most part, other small animals kept as pets live in defined enclosures. This reality makes them far less intrusive than dogs or cats. They each offer their own special qualities that can both divert and delight. They still require care, however, and someone else must mind them if you take a trip.

If you do live alone, having another living creature around the mansion has distinct benefits for all involved. Yes, they do require you to expend extra effort and care, but that is a gift. Answering needs is what life is all about.

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Ever since the passage of the Health Care Reform Act on April 23rd, I’ve been looking for a good summary of its components. Of course, any legislation with that many pages will be difficult to summarize, but someone had to take a swing at it. I guess no one will be surprised that it was the AARP that took up the challenge.

At the link, AARP User’s Guide to Health Care Reform, you will find a summary that doesn’t take that long to read. It does, however, have a sufficient sweep and level of detail, that you can develop a sense of the legislation.

Three things to note -

1. Medicare will finally start to cover its most foolish lack, i.e. some preventative services. Catching conditions sooner rather than later should always reduce the cost of their care.
2. The Part-D Donut Hole will be phased out over the next decade.
3. The overpayments for Medicare Advantage Plans will be phased out.

Every senior should read this summary. Thanks AARP, you did a good job!

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Although some individuals are still covered by company and union health plans once they start Turning Age 65, fewer and fewer people have that opportunity. By far, Most US citizens discover that they have come under the Medicare umbrella. Whatever other insurance they may consider, it is all influenced by Medicare. Or, if your income level provides that alternative, Medicaid. (A few qualify for both.)

What do these choices mean?

Original Medicare Part-A provides hospitalization coverage for no charge. It doesn’t cover everything, but it does cover a lot. The key words for coverage are “medically necessary” procedures, i.e. those required to keep you alive and functioning. Once you get in to “elective” or “experimental” procedures, you are no longer covered. For example, it does not cover private rooms, private nurses, or even TV and phones in the room because they are not “medically necessary”. Basically, during each year it covers hospital stays for -

• days 1 - 60 after $1,068 deductible,
• days 61 - 90 at $267/day,
• days over 90 at $534/day, which are deducted from a 60-day pool of “lifetime reserve days”, and
• days beyond the pool of “lifetime reserve days” at full coverage.
• Charges for blood as well as home, hospice, of skilled nursing facility care are determined separately.

Original Medicare Part-B provides coverage for doctors, lab work and other medical services. There is a monthly charge for this coverage which amounts to $96.40 during 2010. The coverage is limited to the Medicare-approved amount for the Medicare-approved services. For example, a colonoscopy is limited to once every ten years, or two years for high-risk patients. Basically, after an annual deductible of $135, Part-B covers -

• 80% of doctors services and medical devices,
• 100% of clinical lab and home health services, and
• other “medically necessary” services after a co-pay or co-insurance deductible.

Original Medicare Supplement policies, Medigap fill in some of the gaps left by deductibles and co-pays. The coverage offered by these policies is strictly formulated by Medicare and specified by the letters A through N. (Plans E, H, I, and J are being phased out.) Until now, F has been the most popular. Although the coverage of each lettered plan is specific, the companies and charges vary by state.

Medicare Advantage, i.e. Part C plans, are privately run HMO alternatives to Original Medicare. Your care is generally restricted to the doctors and facilities that are members of that organization. Essentially, the government pays your Medicare allocation directly to these plans. The plans then set up their own internal rules for coverage as well as any additional charges that may apply. These plans vary on a state-by-state basis, and must be reviewed in that context.

Medicare Part-D Drug Plans, which also vary state-by-state, provide coverage for prescription drugs. Unless you have other drug insurance, you must sign up for one of these plans within four months of turning 65 to avoid being charged a late penalty.

Medicaid programs offer more extensive coverage to people with limited income and resources. This program is jointly funded by both federal and state governments, so it also varies state-by-state.

Go to the government’s Medicare Web Site for more information and for links to individual state programs.

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For most people turning 65, Medicare offers welcome relief. Pre-existing conditions are no longer an issue, and the vast majority of hospitals and doctors accept it. A very brief description of this program follows. Of course, this is the view from 2009, before any changes (hopefully for the better) that are currently being discussed in Congress.

Start at Age 65:
One of the confusions surrounding the Medicare program is that it is somehow linked to Social Security. It is not. It is a different program. Specifically -

• The start date for social security benefits is variable, depending upon your birth year, the start date for Medicare is fixed at age 65.
• Although most people should wait until their full retirement age (or beyond) before they start taking Social Security benefits, there is only one reason to delay Medicare, i.e. your retirement benefits from your employer includes private health insurance that covers more than Medicare. The reality is that there are not many of those plans left.

“Parts is parts”:
That quote from an old commercial referred to chicken, but it could also apply to Medicare since it also has parts. The different parts of the Medicare program cover different aspects of coverage - hospitalization, doctors, private Advantage plans, and drugs. Specifically -

• Part A - covers stays at facilities (hospitals, clinics, skilled nursing, etc.) You do not pay any additional fee to enroll in or benefit from this program.
• Part B - provides payments to doctors and other service providers such as physical therapists. You must pay an additional monthly fee to be part of this program. In 2009, the fee is $96.40/mo.
• Part C - usually called Medicare Advantage, these are private plans (HMO’s, PPO’s, or PFFS’s) that are subsidized by Medicare and replace the Medicare Part A and Part B programs. These plans vary by state. The coverage rules of these plans are determined by the individual plan operators, not Medicare. To enroll in these plans, you must first sign-up for Medicare. Once you enroll in these plans, you are excluded from Medicare A and B, and it is quite difficult to return.
• Part D - offers coverage for prescription and generic drugs. These are also private plans which vary by state and require a separate fee. They operate separately from the other parts of Medicare.

MediGap (Medicare Supplement) Plans:
Medicare doesn’t cover all medical expenses. For example, there are deductibles for hospital stays and co-pays for doctor visits. To address these shortfalls, many private insurance companies offer MediGap policies that cover the gaps. These plans vary by state. Although Medicare does specify the coverage rules of these plans, labeled “A” through “J”, they do not administer them.

Decisions to Make:
Among these various options, the decisions a person must make include -

1. Do I enroll in Medicare Part B? Most people choose this, but it does require the monthly payment of an additional fee.
2. If enrolled in Medicare A & B, should I abandon them and enroll in one of the private Advantage programs? Because you usually cannot reverse this decision once made, your coverage is no longer controlled by Medicare, and you can no longer choose your own doctors or hospitals for the less expensive plans, only about 15% of the people make this choice.
3. Do I enroll in Medicare Part D? Since you pay a penalty for enrolling after the initial six month grace period, most people do enroll despite the infamous “donut hole” in the coverage.
4. Is there any reason to wait until the changes being discussed in Congress occur? The short answer is NO.

To learn more about Medicare, go to the Medicare web site which is well put together and offers a wealth of information.

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Retirement comes with a mixed blessing . . . Time. All of a sudden, you gain a lot more control over your time and how you use it. Of course, there are legions of pundits at the ready to tell you just how you should use it, but I often wonder how many of these people have tried it themselves. This is especially true when it come to exercise, both physical and mental. We all know that we should do both, but which form is best?

One mental exercise that I have tried is the crossword puzzle in the New York Times. When I was still working, I sometimes tried it during the commute home when I didn’t have any task that was left over from work. Now, without the commute, I can do it any day I want.

My encounter with the NY Times Crossword began as a mild diversion that was completely mysterious at first. I didn’t even realize that there was a theme to the three or four long answers in each puzzle. Like most things, however, you soon develop a sense of its rhythm and discover that its level of difficulty increases throughout the week.

On Monday and Tuesday, both the clues and their answers are reasonably straightforward. The answers typically consist of one word. The clues usually have only one or two meanings. Sometimes, Monday can seem tougher than Tuesday, but usually it is the other way around. If you are new to crosswords, don’t try anything other than Monday or Tuesday, or you will quickly become discouraged.

On Wednesday, the clues start to become both more subtle and more diverse. For example, a question mark at the end of a clue indicates a fairly bizarre connection, e.g. the answer for the clue, ‘Homeland plot?’, could be ‘acre’. Also, the answers start to require multiple words, e.g. the answer for ‘Just for laughs’ could be ‘in fun’. Nonetheless, you are still working with one letter per box.

That can change on Thursday. On that day, a variety of tricks may start to appear. A box may require a symbol, or multiple letters, or an entire word. You begin to recognize this is happening when nothing seems to fit. Of course, that meaning has to work both directions, across and down. It is that double requirement that helps you uncover the secret. At this point, you recognize that the trickster that created this puzzle is really trying to fool you.

On Friday, you encounter the classic tough puzzle. All of the clues either have multiple meanings or are extremely obscure. Many of the answers require phrases rather than words. Whenever you finish a Friday puzzle, you start to feel that you are really are learning how to wrestle with this trickster, especially if you do it in ink.

Saturday’s puzzles are like Friday’s, but the answers are longer. Sunday’s puzzles are twice the size of the daily ones, but include elements of each day of the week.

Solving crosswords can not only be a diversion, it can also be a social, cooperative effort. My wife and I often share one, challenging each other with those difficult clues. It is not rocket science, but it is definitely an exercise for your brain cells. At our age, that can’t hurt!

You can find the crossword in any issue of the Times. I access it by just buying the paper. But you can also try a free puzzle online. You can also sign up for an annual online subscription if you get hooked.

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Every once in a while, you find yourself laughing so hard that your sides hurt. Last weekend, I encountered such a time. My wife had corralled me into an evening of square dancing, so I went along - naïve, nonchalant, and non-western. I probably would not have done well “out on the range”.

Our group entered a very clean, spacious facility which we had completely to ourselves . . . until some others showed up. It was obvious that these strangers took this western theme seriously. A lot of cowboy hats, vests, string ties, and even some boots. Many of the gals wore those flared skits that spread out like an upside-down funnel. A few sported badges that certified either their expertise or longevity at this activity, which they all took seriously, but with a smile. In all, they were an engaging group.

In the corner, the Caller set up his gear. It was all high tech, i.e. a PC and amp with speakers and a microphone. He made it very plain that he clearly liked his microphone. He explained that square dancing was a purely American dance that has now spread around the globe. He also revealed that the people assembled here were all volunteers that thoroughly enjoyed square dancing and were here to teach us in order to spread that joy. Then, he started the music.

These folks really started moving, following the changing directions of the Caller. One or two couples were in there 50’s, but most were older. I was surprised at how physically intense this activity was, for they hardly stopped moving. As the routines kept changing, even these ‘pros’ made a misstep every once in a while, but they handled it with humor and grace. In truth, theirs was a class act.

After a short break, each of the ‘pros’ grabbed one of us onlookers as their new partner. Some of us were ‘excess’, so we formed our own square without a pro to guide us.

It was fortuitous that I was in this excess square. All of my life, I have never been able to tell right from left. I now know that I am dyslexic, which means that I am not wired to reflexively respond to that direction. When told to take a right turn, my mind has to go through a logical process. It has to first think of which hand it is that I write with and then turn toward or away from the location of that hand. Since this process takes a bit of time, I can be a little slow on the uptake in an activity like the square dance.

The results were hilarious. Because of delaying or going the wrong way, I not only threw myself off, but the other dancers as well. A few times we were as perfect as the “pros’, but most of the time it was like riding bumper cars. With each bump, we laughed harder and harder, so that it was best there were no “pros’ in our group to embarrass.

Although it could never be my cup of tea, I was very impressed by the enthusiastic fun and healthy exercise everyone experienced. I became convinced that square dancing is a vigorous activity that every senior should seriously consider. It engages your mind, muscle, and sense of humor.

To start your search for groups in your neighborhood, this site contains links to a number of square dancing resources on the Internet. Enjoy your dosado!

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If you are turning 65 this year, and you haven’t yet joined the “Social Security Club”, then this is your year to enroll. The questions that you will encounter in this process are presented below with a few typical answers.

1. When do I qualify for full retirement benefits?
   People who turn 65 during 2009 will not qualify for full retirement benefits until they reach age 66. You can choose to start benefits earlier, but you will pay a hefty penalty for that choice. You can assess your retirement benefits using the BEST calculator for Social Security Benefits.
2. Why should I enroll this year if I don’t qualify for full retirement benefits until next year?
   Although those born 1944 do not qualify for full retirement benefits until they reach age 66 during 2010, Medicare benefits still begin at age 65.
3. Do I need to register for Medicare if I am still covered by my company’s health plan?
   You need to check with your company’s health plan. Their plan may revert to a Medicare supplement when you turn 65.
4. When, during this year, should I enroll with the Social Security Administration?
   Typically, you should sign up for Medicare about three months before you turn age 65. This allows time for your records to be fully activated prior to your birth date.
5. Medicare has different plans, A, B, C and D. What is the difference?
   These letters represent the different parts or plans in Medicare.
   • Part A is Hospital Insurance that the government pays.
   • Part B is Medical Insurance for visits to doctors that you must pay monthly to be enrolled.
   • Part C is the HMO/PPO type of non-government private plan, called “Medicare Advantage”, that you must pay for monthly.
   • Part D is the prescription drug insurance for which you must pay monthly.
6. What is the difference between traditional Medicare, the new Medicare Advantage Plans, and the Medigap plans?
   • The traditional Medicare plan is a government program whose benefit amounts are set by the government program. Physicians accepting Medicare patients are also agreeing to accept the Medicare benefit amounts as their payment. Seniors can choose their own doctors and hospitals with traditional Medicare.
   • Medicare Advantage works either like an HMO, where you use assigned doctors and hospitals, or a PPO, where you select from a list of pre-approved doctors and hospitals. Although subsidized by government payments, these are private plans that set their own rules.
   • Today, most seniors still select the traditional Medicare program. Some will supplement that with a private Medigap policy which provides coverage for the few things that Medicare doesn’t cover. The coverage provided by these policies is strictly formalized by Medicare, i.e. F-level coverage from two different companies must provide identical benefits.
7. What is this November 15th - December 31st enrollment period that I hear about?
   Each year, people enrolled in the Part D (Drug) program may change to another plan or provider without penalty. It is called the Free Enrollment Period.
8. If I do nothing, what happens?
   Obviously, you will receive no benefits. In addition, if you change your mind and decide to enroll later, you may be assessed some penalties. The website of the Social Security Administration offers a number of other answers about Medicare.

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“The weather outside is frightful!”

One of the assurances my children gave us when they encouraged our move to the northwest was - “It rarely snows. When it does, it’s gone within a couple of hours.” They lied! This very morning we even had THUNDERSNOW!

Last night, it started snowing once again. It wasn’t the 32″ we experienced our last winter in Rhode Island, but enough for ice to form under your feet. That ice will not go away within two hours because the thermometer is projected to stay below freezing for a number of days. I have to admit, I am very wary.

I fell twice on the ice during the week we moved out of Connecticut in 2003. I learned then that a ‘frozen shoulder’ has nothing to do with the cold. I landed more softly on my Rhode Island slips. However, I managed to find black ice during my first winter in Seattle and had to have my scalp stapled. That’s why I am wary.

I have since learned that simple falls become the greatest accident exposure for senior citizens. We need activity to keep our bodily systems engaged, and the simple act of falling can result in enough damage to curtail that activity for prolonged periods. The snow may be pretty, but the ice is dangerous.

To cope with the situation, I am -

• staying indoors as much as possible despite the fact that I can’t stand the cabin fever,
• wearing ugly high-traction boots whenever I must go out,
• driving only on tires with decent tread,
• carefully selecting parking places that are somewhat drier and closer to covered walkways,
• noticing some of my fellow seniors using ski poles while walking, and am considering adapting their style, and
• spreading kitty litter (my latest ‘wonder product’ discovery) on the walks around our house.

Love to hear any other ideas that would forestall a visit to the ER. Other than that, the snow is beautiful to see. I love to watch the kids rolling around in it.

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Last month, before I went “under the knife”, my surgeon asked if I had any questions. I know I mumbled a few things, but I really felt stupid. Everyone tells you that, in this day and age, you must become your own advocate. It is your obligation to learn about what is going on and become involved with and knowledgeable about the process.

I confess. I didn’t do any of that. I was raised in an era where you trusted your doctor to give you the best care and physical pain was something you absorbed stoically. That style is not PC today, but it seems to be how I always react after I turn over the Medicare card.

In hindsight, although I can’t abandon my “boys don’t cry” orientation, becoming informed doesn’t mean that I consider the doctor my adversary. It simply means that I can be a better patient. I need to be aware and provide proper feedback to help the medical professionals provide the quality of care that they want to deliver.

That said, where do you go to learn enough to ask intelligent questions? In today’s world, that means the Internet. The following sites I found after my surgery seem to offer a sufficiently broad range of information to help with the most common health questions.

• The Google Search Engine - This is an obvious place to start looking, but you need to enter your search criteria carefully, not logically. Start with the most important word first and place the following words in decreasing importance. E.g. surgery heart ventricle left, rather than heart surgery of left ventricle. Google led me to The British Medical Journal, which I never would have found on my own.

• WebMD - This is the granddaddy of Internet medical information sites and is quite comprehensive. However, it is broad, rather than deep, so you might want to use it to make sure you are using the correct terms before you dig deeper. It is a commercial site, so you will see a lot of ads.

• The Mayo Clinic - You have to bounce around this site to locate everything you are looking for, but the information goes much deeper. It would be helpful if the site offered more graphics.

• The Merck Manual of Medical Information - This is a well organized resource that has extensive information as well as helpful graphics. It is very easy to navigate through this site. Its inclusion of associated topics can help expand the scope of your search.

• RN Central List of 100 Health Sites - Leave it to the nurses to reach out and lend a hand. They have done just that with a list of 100 health and wellness sites for seniors. These sites not only deal with health, but with aging as well. The RN Central site is actually a place on the web for nurses, but they created this list specifically as a help for seniors.

• The National Health Information Center - A site oriented more toward living a healthy lifestyle than information on diseases. This is a US government service. It has no commercial aspect.

• Tips for Understanding Medical Information - This site contains some guidance from the University of Connecticut about how to deal with all of the medical information that we encounter in today’s world. It’s a dose of common sense.

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