Wednesday, June 20, 2018

Medicare, Substance Abuse, Addiction and Alcoholism

Our nation currently faces serious problems as the result of the large number of people who have become addicted to opioid painkillers.  Among those who are currently struggling with addiction problems are senior citizens, many of whom are on Medicare.  In addition to opioid addiction, the elderly may also struggle with other substance abuse problems, including alcoholism.  While it may be difficult to admit you have a problem with substance abuse, addiction or alcoholism, getting help for these issues can save your life.  

Many people worry about the financial hardship which could result from seeking help for their substance abuse problem.  Those who worry about the high cost of treatment may be relieved to know that Medicare does provide some coverage for these issues.  The amount of help you get can depend to some extent on the type of Medicare Supplement or Advantage plan you have.  As a result, this month I reached out to Medicare expert, Danielle K. Roberts with Boomer Benefits, to learn more about the insurance coverage which is available from Medicare for substance abuse problems.  You'll find her informative and helpful guest post below:

How Medicare Covers Substance Abuse

Today in America there is a growing struggle with opioid abuse among senior citizens. Opioid drugs are commonly prescribed to seniors for chronic pain and it is all too easy to get hooked because of the addictive nature of these medications.

Overcoming any drug addiction can be a lengthy process and a costly one as well. For many years, health insurance in general did not provide mental health coverage which was on par with other medical coverage. The passage of the Affordable Care Act in 2010 changed this for the better. 

Today it is mandated that treatment for mental health and substance abuse disorders be the same as any other form of medical treatment. This kind of parity for people under age 65 has been welcome news for both addicts and treatment providers alike. 

As people age into Medicare, they often have concerns about their upcoming coverage. Will they still be able to obtain good access to care for mental health and substance abuse once they enroll on Medicare?

Here’s a quick rundown on how Medicare provides benefits and treatment for substance abuse.

Medicare Benefits for Substance Abuse

Medicare is our nation’s healthcare program for people aged 65 and older. It also covers people under age 65 with certain disabilities or health conditions.
Medicare benefits are modeled after the old Blue Cross and Blue Shield style of coverage, with hospital and outpatient medical benefits falling into two separate parts.

Part A

Medicare Part A pays for your inpatient hospital coverage. If you have a stay in the hospital, it will provide you with a semi-private room and three meals per day. Part A also covers blood transfusions, care received in a short-term skilled nursing facility and hospice benefits for the terminally ill.

For individuals obtaining substance abuse care or mental healthcare, Part A provides a lifetime benefit of up to 190 days in a specialty psychiatric facility.  The patient or Medicare beneficiary is responsible to pay their own Part A deductible, which in 2018 is $1340 per benefit period.

When you enter a hospital, you start a benefit period with Day 1. When you leave the hospital, you must be out for 60 days to reset that. If you re-enter the hospital before 60 days are up, you continue with the original benefit period.

This provides the first 60 days of care in an inpatient facility. Thereafter, the patient begins paying a daily hospital copay which becomes larger over time.

If the beneficiary leaves inpatient care and remains outside of the hospital for 60 days or more, the benefit period closes. When the patient re-enters the hospital, a new benefit period will begin.

Every person has their own journey with substance abuse care. It is possible that some beneficiaries may need more care than the lifetime limit allows. In that scenario, Medicare may offer some additional coverage if those services are provided in a regular hospital.

Sometimes Medicare will cover treatment for substance abuse in a partial hospitalization program. This would occur if your physician certifies that you would benefit from 20 or more hours of therapeutic services each week. 

Your Medicare doctor must put together and submit an individualized care plan for you which will be under his supervision. He must also re-certify you for the program on a regular basis so that Medicare will keep paying for that care.

Part B

Medicare Part B provides outpatient medical care. This includes ordinary outpatient services like consultations with your doctor and lab-testing and preventive care, as well as more expensive procedures like surgeries.

However, it also provides for substance abuse counseling, psychotherapy in an outpatient clinic, screenings for drug or alcohol addiction and drugs like methadone which are administered in a clinical setting.

Part B will also cover Structured Assessment and Brief Intervention, if services are provided by a Medicare doctor or outpatient hospital. If a person shows signs of substance abuse, this treatment includes screening to determine the appropriate level of care, a brief intervention to encourage the patient to make changes, and a referral to access specialty care if necessary.

Just like Part A, Part B has cost-sharing which you are responsible for when you are using these services. You will owe an annual deductible upon your first Part B service of the year. After that, your benefits will pay for 80% of all Part B services, while you pay the other 20%. 

There is no cap on out-of-pocket maximum to this 20%, so you will continue to owe this for each service unless you have other supplemental coverage.

Part D

For over four decades, Medicare beneficiaries had no access to suitable outpatient drug coverage.  They would often be faced with paying full price for medications, and sometimes they would have to decide between food or medications. 

Fortunately, this problem was solved with the Medicare Modernization Act of 2003, which created the Medicare Part D program. In May of 2006, all current beneficiaries were given an opportunity to enroll, and now new beneficiaries are also given an initial enrollment period when they age into Medicare to sign up for drug coverage.
Medicare Part D is optional.  You are not required to enroll. Congress made the coverage voluntary because some people have access to drug coverage already.

For example, some veterans can get their medications at the VA clinic, so they may decide not to enroll in Part D.  However, if you do not have access to other creditable coverage for prescription drugs, it is important to enroll when you are first eligible or else you may be subject to a late enrollment penalty.

Plans are provided by private insurance carriers in each state, and this coverage is important in helping beneficiaries pay for medications which may help treat substance abuse disorders. 

All plans have minimum coverage rules. For example, drug formularies must include antidepressants and antipsychotic drugs, as well as drugs which are considered medically necessary to treat substance abuse. 

Beyond those minimum coverage rules, though, each carrier develops its own formulary of covered medications. Beneficiaries should carefully review a plan’s drug formulary before enrolling to confirm that their necessary medications are included.

Covering the Gaps in Medicare

While everyone would like it if Medicare covered 100% of medical expenses, it doesn’t work that way. In fact, Medicare is very similar to other health insurance in that it covers a share, and the member is also responsible for a share in their own medical costs. 

Beneficiaries must pay for their own deductibles, copays and coinsurance. To plan ahead for these expenses, beneficiaries can purchase supplemental coverage. There are traditional Medigap plans available in all 50 states and in most areas, there are also Medicare Advantage plan choices.
Medigap plans can be purchased from private insurance companies, and the plans' designs are standardized by the government. There are several standardized plans to choose from and these each cover a certain set of benefits.

Although 10 plans are outlined, a few plans have become more popular than others.  The most comprehensive plans are Medigap Plan F and Plan G.  These plans cover most of the gaps and leave very little for you to pay out-of-pocket. Some people prefer plans with lower premiums where they pay more of their own cost-sharing. Plan K and Plan N are popular choices for that.

Aside from Medigap plans, the other type of coverage available is Medicare Advantage. In this type of coverage, you choose to get your benefits from a private insurance company instead of from Original Medicare. In some areas, there are Medicare Advantage plans called Special Needs Plans which are created specifically for people with chronic diseases, and this may include mental health or substance abuse disorders.

When enrolling in a Medicare Advantage plan, you will agree to see the plan’s network of doctors for your care, so if you are seeing a psychologist or psychiatrist for substance abuse counseling, you will want to make sure that he or she is in the plan’s network. Premiums are usually lower with a Medicare Advantage plan than for a Medigap plan, but you will pay copays for your medical care as you go. 

All Medicare Advantage plans must cover the same services that Part A and B cover, so if you enroll in one, you will have access to substance abuse benefits through your plan. Just consult the plan’s Summary of Benefits to see what your cost-sharing is for counseling and other benefits.

About the author:  Danielle K Roberts is a Medicare insurance expert who helps baby boomers navigate Medicare. You can learn more about her and her team at 

(Note:  The numbers cited in this post are subject to change if the federal government makes changes to the Medicare program.  Check with your insurance carrier to confirm the specific benefits you are eligible to receive.)

If you are interested in learning more about common medical issues as you age, Medicare, Social Security, financial planning, where to retire and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional articles.

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Tuesday, June 12, 2018

Moving Money Overseas for Retirement

One issue which frequently concerns people who are considering an overseas move, whether it is for retirement or other reasons, is how they can access their money while living in another country. This week we have a guest blog from Jon Delacruz with, a fund transfer company which specializes in helping people move money from one country to another. 

Because of the interest many Americans have in retiring overseas, sometimes permanently and sometimes just for a few months or years, I felt this information would be extremely helpful for my readers.

A Guide to Moving Money Across Borders When Retiring Overseas

The U.S. Social Security Administration sends more than 500,000 payments every month to Americans who live outside of the country. This is a considerable rise from the 400,000 retiree payments that were sent overseas in 2016. There are around 247,000 British nationals over 65 years of age who live in European Union (EU) countries, and around 85,000 people in the same age bracket from the EU who live in the UK. These numbers show that a significant number of people from different countries retire overseas.

When you choose to retire in another country, planning your finances becomes crucial. After all, you do not want to end up in a foreign land with access to less money than you originally figured you would have. Fortunately, moving money across borders is no longer as time consuming, complicated, or expensive as it used to be until the turn of the last century.

Receiving State Pensions

Depending on the country where you have lived and worked throughout your life, you might be able to receive your state-sponsored pension payments in a foreign country. All you need to do to find out if you qualify is get in touch with the relevant authorities in your country.

More than half a million Americans reside out of the country and receive some kind of Social Security benefit, including disabled and retired workers, as well as spouses, children, widows, and widowers. The U.S. government considers you to be out of the country if you spend more than 30 days in a row in a foreign land, and you may receive your Social Security payments overseas, provided you are eligible.

Retirees who plan to move outside of the U.S. should inform Social Security about their travel dates to find out if their Supplemental Security Income (SSI) will be affected in any way. An online tool gives you easy means to determine if you may continue receiving your Social Security benefits outside of the country.

If you are a citizen of the UK, you stand to receive your state pension no matter which country you choose for your retirement. However, you will not receive increases if it is a country with which the UK does not have a social security agreement.

Areas where you will continue receiving increases include the European Economic Area (EEA), Switzerland, Gibraltar, Jersey, Isle of Man, Guernsey, the U.S., and most of the Caribbean. Some of the exceptions where retirees from the UK do not receive pension increases include Canada, Australia, New Zealand, South Africa, India, and Pakistan. The complete list is made available online.

Should You Receive Your Pension Payments Overseas?

If you plan to receive your pension payments from your country’s government directly into an overseas bank account, the cost of the transfer will depend on the service provider used to process the transfer. However, if you get your pension payment into a local bank account, there is no exchange of currencies involved.

In this scenario, you may then use an online overseas money transfer company to move your money from the bank account in your home country to a bank account in your new country of residence. However, you will need to consider the cost of maintaining a bank account in your home country.

Handling the Money You Have Saved

When time comes to relocate, do you plan to take your savings with you? If so, you will need to determine what you plan to do with the money in your bank as well as your investments in the form of stocks and bonds.

The maximum amount you may transfer depends on where you live. For instance, transferring major currencies such as U.S. dollars, British pounds, Australian dollars, euros, and Japanese yen come with little to no restrictions. However, you might have to worry about government regulations when it comes to regulated currencies such as the South African rand, Chinese yuan, and Korean won.

Limits may also apply depending on the service provider you select. For example, some banks and overseas money transfer companies have daily, weekly, monthly, and even annual transfer limits in place.

Banks or Overseas Money Transfer Companies

Turning to your bank to transfer money overseas may seem convenient, but it might not be your best bet. Most banks tend to add noticeable markups to existing mid-market exchange rates, and the rates they apply on the transfers they process are often less than desirable.

Specialist money transfer companies such as TransferWise, WorldFirst, WorldRemit, OFX, and Currencies Direct are able to provide bank-beating rates consistently by leveraging technology and keeping overhead costs to a minimum. While a small difference in exchange rates might not seem like much, it can have a considerable effect if you are transferring a large sum.

Banks are also known to charge steep transfer fees, whereas you end up paying little to no fees when working with a specialist money transfer company.

Factors to Consider

Given that there are a number of overseas money transfer companies from which to choose, it is important that you pay attention to different factors. Start by making a shortlist of companies that facilitate transfers between both of the countries in question, because lists of supported countries and currencies tend to vary from one service provider to the next. 

Cost effectiveness. The cost of moving money across borders depends on more than just the exchange rate  that applies on the transfer. Some companies are known to charge a percentage of the transfer amount as fees, whereas some others have fixed per-transfer fees in place. Some offer fee-free transfers, and some have fee-free threshold limits. The receiving bank may charge a currency conversion fee, and you may also incur additional fees when paying using a debit or credit card. 

Waiting for a better rate. If you feel that the exchange rate might swing in your favor in the near future, you might consider transferring your money using a market order. In this case, you set a target rate, and when it reaches the desired level, your transfer goes through automatically.
Lock in the rate. If you feel that the existing exchange rate is to your liking, you may use a forward contract to lock it in place for a transfer you wish to carry out in the future. Several money transfer companies let you lock in exchange rates for up to six months, and some even let you lock in rates for up to a year. 

Negotiate. Almost all money transfer companies add slight markups to prevailing mid-market rates. As a result, negotiating for a better rate is not out of place, especially if you plan to carry out a large value transfer.

Conclusion:   Moving money across borders when retiring overseas presents you with multiple alternatives. No matter whether you wish to receive state pension payments to take your own money with you, selecting the right method and a suitable service provider can result in noticeable savings.

Author Bio:

Jon Delacruz works as a researcher and mystery shopper with iCompareFX, a website that lets its users compare the world’s leading overseas money transfer companies. Outside of work, he likes to explore new sounds from different genres of music.

If you are interested in learning more about where to retire in the United States and overseas, financial planning, Social Security, Medicare, common health issues in retirement and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional helpful articles on this blog.

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Wednesday, June 6, 2018

Health Self-Exams and Disease Prevention

While all of us rely on occasional visits to our physician to get an official health evaluation, the truth is that the ultimate responsibility for our health is up to us.  We are the ones who need to pay attention to our bodies and watch for any symptoms which could indicate a problem.  We are the ones who need to practice good preventive measures to keep our bodies functioning as smoothly as possible.  We are the ones who need to be able to concisely report any suspected problems to our doctors during the 15 minute annual appointment they allow us.

However, most of us have no idea what we can actually do to evaluate our health.  How do we recognize suspicious changes to our body?  How can we keep our body operating smoothly?  Start by talking to your doctor about any special self-exams or preventive measures which would be specific to your medical conditions.  In addition, you may want to take the following actions.  The suggestions below came from my healthcare provider, Kaiser Permanente, or were recommended in the August/September 2017 issue of AARP Magazine or the September 2017 issue of the AARP Bulletin.  I've pulled them all together in one location here.

Health Self-Exams

Check for Breast Cancer - Breast cancer can occur in both men and women, although it is more common in women.  Both men and women should do monthly breast self-exams while in the shower, checking for lumps, discharges, rashes or unusual changes in the breast area.

Check for Skin Cancer - Even one bad sunburn as a child could make you more vulnerable to skin cancer as an adult.  Everyone should look for changes to their skin.  In addition, run your fingers over your skin to see if there are areas where it feels different.  Check for patches which feel rough, spots of shiny pink or brown bumps with raised borders, or moles which have changed shape or color.

Check your Eyes - Has your sight suddenly changed?  Do you have blurry spots in your vision? Has your peripheral vision decreased?  Does your lower eyelid droop?  Is their a bump on your eyelid with missing eyelashes?  All of these could indicate serious problems which should be reported to your eye doctor quickly.

Check your Hair - Are you losing more hair than normal?  Everyone loses some hair every day.  However, if the rate of hair loss suddenly increases, it could indicate anemia or thyroid disease.  Also, check your scalp for signs of skin cancer.

Check your Heart - There are several self-tests you should do periodically to make sure everything is OK.  Buy a blood pressure monitor and check your pressure regularly.  Unless your doctor gives you other instructions, strive for blood pressure under 130/80.  At the same time, check your resting heart rate.  Your blood pressure monitor may do it for you, or you can do it manually by feeling your pulse in your neck or wrist.  Ideally, you should have a heart rate between 60 and 100 beats per minute.  If you are very fit, your resting heart rate may be slightly under 60. Report high blood pressure, an extremely high or low heart rate, or an irregular heartbeat to your doctor.

Check your Motor Skills or Ability to Move - Can you walk one meter (or 4.37 yards) at your normal pace in four seconds or less?  If not, you may want to spend more time walking, with the goal of increasing your normal walking speed.  Faster walkers tend to live longer.  You may also want to test your ability to sit on the floor and get up again.  Your goal is to be able to do that with reasonable ease and without outside help, relying on just your own hands and knees.  Being able to do that comfortably is also linked to better health.

Disease Prevention

In addition to your health self-tests, you will want to make sure you take advantage of all the preventive measures possible. Most of them are covered by Medicare or private insurance, with little or no co-pays.  Below are some which are recommended:

Get an Annual Physical - At least once a year you should see a doctor and have your blood tested for cholesterol and any abnormalities which could indicate the early stages of a variety of diseases.  The earlier an abnormality is detected, the easier it is to treat.  It is amazing how many health issues can now be detected through a simple blood test, so make sure you have yours checked at least once a year. If you have been keeping up with your health self-exams, bring your results with you when you see your doctor.  Also, write down any questions you have for your doctor so you remember to ask them during your appointment.  Between the results of your self-tests, the questions you ask, and your blood work, the results of your annual physical will be much more meaningful.

Innoculations - According to the Centers for Disease Control and Prevention (the CDC), only 1/3 of people over the age of 65 have gotten the shingles shot; less than 2/3 have had a tetanus shot in the past 10 years; only 2/3 have had the pneumococcal vaccine; and only 2/3 of people between the ages of 65 and 74 received the flu vaccine last year.  These inoculations can save lives and also prevent misery.  Even if you had a shingles shot or pneumonia shot five or more years ago, you may want to ask your doctor whether or not you should get the updated, more protective versions. Most healthcare providers recommend these innoculations.  Check with yours to make sure you do not have a healthcare problem which would prevent you from getting one of these vaccines.

Get recommended screening tests - If your doctor recommends you get a mammogram, colonoscopy, or other screening test, be sure to follow their recommendation.  Colonoscopies can actually prevent many cases of colon cancer, since doctors remove precancerous polyps when they perform the procedure.  Screening tests can catch cancer and other diseases early and make them easier to treat.

Follow your heathcare providers' instructions for maintaining your health - This could mean losing weight, following a special diet, stopping smoking, cutting back on alcohol, getting more exercise or making other recommended lifestyle changes. Simple changes can improve both the quality and length of your life.

While taking the above steps cannot guarantee you will have perfect health for your entire life, they do increase your odds of leading a healthier and longer life.  They also make you an active participant in maintaining your health.  Ultimately, you are the person who knows your body best and you are the one responsible for seeing that it gets the best care possible.

If you are interested in learning more about common health issues affecting baby boomers, retirement planning, where to retire, Social Security, Medicare and more, use the tabs or pull-down menu at the top of the page to find links to hundreds of additional articles.

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