Month: October 2021

What are MSA plans and how to do they work?

An MSA is a high deductible health insurance plan combined with a savings account that you can use to pay for your health care costs. Since this is a type of Medicare plan, Medicare provides the funding.

Medicare.gov has a handy 10 step breakdown of how MSAs work.

1. Choose and join a high-deductible Medicare MSA Plan.
2. You set up an MSA with a bank the plan selects.
3. Medicare gives the plan an amount of money each year for your health care.
4. The plan deposits some money into your account.
5. You can use the money in your account to pay your health care costs, including health care costs that aren’t covered by Medicare. When you use account money for Medicare-covered Part A and Part B services, it counts towards your plan’s deductible.
6. If you use all of the money in your account and you have additional health care costs, you’ll have to pay for your Medicare-covered services out-of-pocket until you reach your plan’s deductible.
7. During the time you’re paying out-of-pocket for services before the deductible is met, doctors and other providers can’t charge you more than the Medicare-approved amount.
8. After you reach your deductible, your plan will cover your Medicare-covered services. Read information from the plan for details about out-of-pocket costs.
9. Money left in your account at the end of the year stays in the account and may be used for health care costs in future years.
10. If you use funds from your account, you must include this special form [PDF, 89.4 KB] with information on how you used your account money when you file taxes.

The available states in the West are now MT, WY, UT, AZ, NV, NM, and OR. Unfortunately, MSA plans are currently not available in WA, ID, CA, and CO.

How MSA plans work

When you see your medical provider, you present your MSA ID card to your provider’s billing office. The provider bills the MSA plan. The bill comes back to you, and you pay you provider from your debit card account. Meanwhile, the MSA plan applies that amount to your deductible. Never pay your provider prior to them billing the MSA plan.

MSA plans do not provide prescription drug coverage. Medicare beneficiaries who are enrolled in an MSA plan and who also wish to have drug coverage, will need to enroll in a stand-alone Part D prescription drug plan.

FAQ’s

Q: Where do MSA plans get the money to set up my debit card account?

A: Remember, Medicare advantage (MA) plans are privatized Medicare plans. Let’s say that an MA plan without Rx coverage receives around $800 per person per month from Medicare to provide your health coverage. Out of that, MSA plans can fund your debit card account.

Q: Let’s say I spend $500 on doctor bills for 2021, what happens to the $1,500 still remaining in my debit card account?

A: Your unused funds rollover and will be available for a future year. This is not a “use it or lose it” deal. If you don’t use it, it rolls over.

Q: What happens if I exhaust my debit card account and still have more medical bills?

A: Your responsibility is to cover your bills until you reach your deductible. Once you have met your deductible, your MSA plan pays 100% of your Medicare approved expenses for the remainder of the year.

Q: What about networks. Am I restricted to a doctor network?

A: There are no networks with MSA plans. Most any provider that works with Medicare should be willing to accept your MSA plan. That’s great news for snowbirds or those who travel to other states.

Q: What about preventative checkups? How are they covered?

A: Unlike other Medicare advantage plans, there are no, zero copay physicals or other preventative services. Your provider will bill the plan, and then you’ll pay your physician from your debit card account.

Q: Can I use my MSA funds to pay for vision or dental services?

A: Yes. In addition, you can also use your MSA account for hearing aids, hearing aid batteries, prescription copays, and long-term care expenses. Please note: Using money in your account to pay for health care costs that aren’t covered by Medicare will not count toward your MSA plan’s deductible.

Q: Who can enroll in an MSA plan?

A: Most people who are on Medicare Parts A and B and reside in a state where an MSA plan is offered are eligible to sign up. You will need to decide if the program is right for you. There are some people that are ineligible to enroll in the MSA program. These exceptions primarily are those receiving VA or Medicaid benefits.

The following are some of the reasons why Medicare beneficiaries have enrolled in an MSA program.

• Those that like the idea of a no premium plan.
• Those that live in a county where no other Medicare advantage (MA) plans are offered. Many of the sparsely populated counties of Montana, Wyoming, and Oregon have no other MA plans to choose from.
• Those that do little or infrequent doctoring.
• Those that like the idea of having funds available for dental or vision.
• Those that prefer to have their own standalone Part D Prescription (PDP) plan.
• Those who are looking for an alternative to their Medicare supplement plan and don’t want or can’t get a standard HMO or PPO Medicare Advantage plan.

Important Information for Existing MSA plan Members

If you are already a member of an MSA plan, your membership for 2022 will automatically renew. Be sure to read your annual notice of change to keep informed of any changes to your plan. The MSA company is also offering a second version of their plan with a larger debit deposit and a larger deductible. Please contact us for details.

Conclusion

Please contact us with questions about this MSA plan or your interest in any other Medicare advantage plan. There are some situations where a switch to the MSA plan may be a good fit for your situation. Here are some examples.

Case #1: Alice is in her 90s and is on an old Plan F with a premium of over $300 per month. She has a medical condition which makes it difficult for her to switch to another Medicare supplement plan. She lives in a sparsely populated county that has no other Medicare advantage plans. Her out-of-pocket will hundreds of dollars less than the annual $3,600 Medsupp premium.

Case #2: Martha has Medicare supplement Plan L. Since there is a fair amount of cost-sharing with Plan L, the maximum circuit breaker limit rises to $3,110 in 2021. By the time she adds in her annual premium for Plan L and her cost-sharing, she could be out hundreds more with Plan L compared to the MSA plan.

Case #3: Bill has Medicare supplement Plan K. In 2020 his circuit breaker limit is $6,220. That’s more than double of what him maximum out-of-pocket would be with the MSA plan.

Case # 4: Shirley’s Plan F has climbed to $200 monthly, and she would like to shop for a lower cost Medsupp. Unfortunately, she has a COPD diagnosis making it impossible for her to switch to a lower cost Medsupp. The MSA plan may be a good alternative for her. There is no medical underwriting.

Please contact us for complete details to see if the MSA plan is a good fit for you. End

The fall Annual Election Period (also know as Medicare open enrollment) is upon us. We have started discussing 2022 plans as of October 1^st. We can start taking applications October 15^th for the 2022 plan year. December 7 is the closing date of the AEP.

Ignore the Medicare-related TV Advertising the best you can.

Many of you have contacted us saying, “I heard on the TV that……”

Let’s take a quick look at the psychology of advertising. Most advertising is designed to create anxiety, apprehension and discontent. It’s purposely choreographed to upset your equilibrium and peace of mind. Please keep in mind that this is all done very subtly, and that’s the cleverness and deceptiveness of advertising.

Another element of advertising is to create fear. Misguided Medicare advantage advertising creates fear that you might be missing out on something really important. The bottom line is that the advertising by design is manipulative.

A more sinister aspect of advertising, especially television advertising, is to bombard your senses to the point where your ability to differentiate between truth and fiction is broken down. Your senses are dulled. The trickery is to push your feelings button rather than your intellect button. Please refer to our companion article, Scams, Scams, and More Scams.

Now the viewers’ defenses are worn down to the point where they are begging for relief from the anxiety caused by the TV ad. They end up being snookered after they’ve called the 800 number on the screen. They are no match for a slick-talking commission chaser in a boiler room.

If you do have questions after viewing a Medicare advantage TV ad, please call us first! In a future issue of Northwest Senior News, we’ll discuss some of the self-inflicted disasters people have caused for themselves as a result in dealing with the boiler-room sharks.

If you are happy with your plan and it’s working well for you, there is no need to change. Lastly, there are no pots of gold sitting at the end of the rainbow!

The types of changes you can make during the fall AEP

Abbreviations:

1. Medicare advantage plan = MA
2. Prescription Drug plan = PDP
3. Medical Savings Account = MSA

For those where a change is appropriate, the following list are changes you can make.

1. You can change from one PDP to another PDP.
2. You can add a new PDP if you never had one but need one now.
3. You can change from one MA plan to another MA plan. Most plans include prescription drugs but not all.
4. You can drop your Medicare supplement plan and switch to a MA if one is available in your county of residence.
5. You can drop your MA plan, go back to original Medicare and add a Medicare supplement plan. Medical underwriting applies in most situations.
6. You can drop your Medicare supplement or current MA plan and switch to the MSA plan, which is a type of MA plan.

Changing from one Medicare supplement plan to another

First, it’s important to note that you can change your Medicare supplement plan any month of the year. This change is not restricted to the fall October 15 through December 7 AEP, however, you must medically quality with the new company you are applying to. We usually seek a change in a quest for lower rates.

Part D Prescription Plan (PDP) News

We’re seeing mostly modest premium increases, although there are a couple of exceptions.

There’s a big shake-up with what we’ll call Company W. Company W bought three plans from Company A beginning the 2020 plan year. Medicare allowed Company W to run six PDPs for 2020-2021.

Starting in 2022, Company W is reducing their six plans down to three. If you currently have one of these plans, the Annual Notice of Change (ANOC) that you should have received in late September will inform you which of Company W’s three 2022 plans you will be moved to. They have Plan Low Premium, Plan High Premium, and Plan Xtra for those on Extra Help. Be sure to read you ANOC mailer to determine which of Company W’s three plans you will be moved to.

If it’s Plan Low, you likely will have a somewhat lower premium compared to 2021. If it’s Plan High, you will be shocked at how much higher your new premium will be. Call us, and we’ll shop a new plan on your behalf for 2022.

Lastly, we will be contacting as many of you with “Company W” as possible to determine the right plan for you for the 2022 year.

PDPHelper.com

A terrific way to submit a list of your prescriptions to us is to use our PDPHelper.com website.

Ways to contact us

Phone: 208-746-6283 or 888-746-6285
Fax: 888-819-0176
Email: lance@nwsimail.com
Website: nwseniorinsurance.com  Please click on the “Contact Us” tab.
PDPHelper.com: Submit a list of your prescriptions to us with this website.

Conclusion

As stated above, we strongly encourage you to use our PDPHelper.com website as a way of submitting of list of your current prescriptions to us. We thank you for your patronage and wish you the best for the upcoming 2022 season. End.

by Lance D Reedy

In this article I will discuss two scams that Medicare beneficiaries are being hit with. The first is the advertising that is hitting your mailboxes. The second is email and text scams.

What is a scam? Some definitions are as follows:

• A dishonest scheme: fraud
• A fraudulent or deceptive act or operation
• A confidence game or other fraudulent scheme, especially for making a quick profit, swindle
• An illegal trick, usually with the purpose of getting money from people or avoiding paying a tax
• An illegal plan for making money, especially one that involves tricking people

The objective of the scammer is to get money out of someone without a fair exchange of goods or services. Put another way, it’s taking money from someone that was not earned. It is done via artifice or trickery. Scammers are thieves.

I’m including “Bait and Switch” advertising in the scam box as such advertising is patently dishonest. The originators of such ads know what they are doing. They write the ad to bait people and then switch them to something else. It’s dishonest as the schemer does not reveal what is really being advertised.

Bait and Switch

Here is the language from a large post card that one of my clients received in the mail: I have added the numbers such as [1, 2, 3 and so on] in brackets.

Dear Jane Doe,

Our records indicate [1] that as a resident of [your] County, you may [2] quality for additional benefits that many on Medicare do not claim.

In addition to plans with more benefits, we will also check your eligibility for:

• Adding up to $144 back into your monthly Social Security check (adding back to your Part B premium payments) [3]
• Cost reduction savings from the Social Security Administration’s Extra Help program (worth $4,900 per year in extra savings) [4]

You may also quality for Medicare plans with benefits like $3,500 for routine dental work such as crowns, implants, and dentures. [5]

At SleazyHealth, we can check your eligibility to have up to $144 placed back into your monthly Social Security check. Please call (833) 555-xxxx (9TTY 7xx) today for your free, no obligation Medicare review. (Monday-Friday 8am-6pm CST)

[Disclosure at the bottom of the card in very fine print that you need a microscope to read:]

This is an advertisement for insurance. SleazyHealth is not connected or endorsed by any government entity. Eligibility for cost reduction savings is based on income verification. Not all benefits available in specific plans or regions. Visit ssa.gov and Medicare.gov for more information. [6]

*****

Let’s tear this piece of garbage apart.

[1] …..our records? They bought a list of names for people better than 65 in your county. In other words, they bought a mailing list! That’s their records.

[2] “May!” There is that pesky word “may.” Maybe you do, but probably you don’t. If you are one of the 15% of Medicare beneficiaries already on Medicaid, then Medicare may not charge said person for his/her Medicare Part B premium. Those 15% are already on one form of Medicaid or another. It’s all based on income. Put another way, this only applies to 15% of the Medicare population. That 15% already has this Medicaid benefit. This will NOT apply to virtually 100% of the people receiving this card.

[3} “Adding up to $144 back…” The $144 is a 2020 number. The 2021 number is $148.50. This outfit couldn’t even bother to update their numbers. If they are sloppy here, where else do you suppose they are sloppy?

[4] “(worth $4,900…in savings)” People on Extra Help or Low Income Subsidy have reduced premiums or no premium for their Part D plan. Their copays are also reduced. They just grabbed this number out of the sky because it looked impressive. If you are not on Extra Health but think you may quality, call 1-800- Medicare (1-800-633-4227) to inquire.

[5} There’s that pesky word “may” again. SleazyHealth is referring to people on Medicaid that quality for more dental benefits. It is true that many Medicare advantage plans have a dental benefit. Usually, the benefit is capped at $1,000 per year, although I have seen one plan that brags a $2,000 cap. Implants are generally excluded from this benefit.

[6] This discloser is sort of okay. “This is an advertisement for insurance…” This is their mea culpa for running a bait and switch scheme. These guys are nothing more than commission chasers. I could write another article about how these boiler room idiots have deceived people over and over.

The bottom line: SleazyHealth’s goal is to get you to ring their call center. From there, you will be connected to any number of commission chasers who will do everything possible to drive a wedge between you and your current Medicare plan.

TV Advertising

Medicare related TV advertising isn’t much, if any, better. They throw out “learn about Medicare benefits you may be missing” of “get the dental benefits you deserve”, etc. They are baiting you to call their 800 number.

The Refund Scam

There are different iterations of this scam. The basic theme is that the scammer pretends to overpay the victim and then requests the victim to reimburse him for the excess payment. One of my daughters unwittingly got caught in one of these schemes.

My daughter while at college posted an ad on Craigslist looking for a roommate to share her apartment rent. A scammer answered her ad and strung her along with nonsense questions about room color and décor, and finally after much ado, sent my daughter an initial rent check.

Just after my daughter received the scammer’s check, the scammer contacted her and said that she wrote the check for too much and asked my daughter to please deposit it and then send her a refund for the difference. Of course, the scammer put on a big sob story about how this mistake is going to cause some sort of cataclysmic event in her life.

My daughter, being raised to be an honest person, promptly deposited the scammer’s check and cut her a refund check and mailed it off.

In these scams, the money the scammer sends is always fake. In this case, it was a phony check that bounced. Fortunately for my daughter, she kept a low balance in her checking account and the “refund” check she sent to the scammer also bounced.

In our next issue I will discuss over-the-internet refund scams involving gift cards.

Meanwhile, to help you better understand how these scammers work and to have some fun while you’re at it, I encourage you to check out professional scam baiter, Kitboga. Kitboga strings the scammers along for hours, getting them to think that they have a fish on the line. Here’s one of many YouTube videos titled “The Angriest Scammer I’ve Ever Called.” And yes, this is a “classic” refund scam. End

Chapter 4, Part 4: Fructose and Galactose

Recap of Part 3: Advanced Glycation End-Products (AGEs)

Dr. Fife explains that sugar consumption accelerates the aging process. He explains that elevated blood glucose levels increase molecular entities known as advanced glycation end-products or AGEs for short. The sticky glucose in your bloodstream can stick to fats, but it’s especially attracted to proteins.

He points out that aging is the accumulation of damaged cells.

The more AGEs you have in your body, the “older” you become functionally regardless of how many years you’ve lived. AGEs adversely affect other molecules generating free radicals, oxidizing LDL cholesterol (thus creating the type of cholesterol that collects in arteries and promotes atherosclerosis, heart attacks, and strokes), degrading collagen (the major supporting structure in our organs and skin), damaging nerve tissue (including the brain), and wreaking havoc on just about every organ in the body. AGEs are known to play an important role in the chronic complications of [type 2] diabetes and in the development of Alzheimer’s, Parkinson’s, and other neurodegenerative diseases. [Ed: My emphasis]

Part 4 Begins: Fructose

Fructose (erroneously pronounced fruit-ose) has primarily found its way into our modern processed diet through an industrial process that churns out what is called high fructose corn (HFCS) syrup. Obviously, fructose is derived from corn.

Fructose has been hailed as the preferred sugar for diabetics because it doesn’t raise blood sugar as much as does sucrose or regular table sugar. Fife attributes this misinformation due to clever marketing tactics from the sugar industry.

He explains the invention of HFCS in 1957 and its subsequent development. A big myth is that fructose comes from fruit, due to the similarity in the spelling of their names.

He explains the HFCS has a higher content of fructose compared to regular table sugar and that fructose and glucose in HFCS is more rapidly absorbed.

Fructose has a much greater overall damaging effect on the body than glucose. We normally think of glucose when we talk about glycation, but fructose undergoes glycation about 10 times the rate of glucose and intensifies AGE generation and tissue degeneration.

Fife points out that vegetarians tend to eat more fruit and more honey which results in them having a higher intake of fructose. He explains another problem with the excessive consumption of fructose. In animal studies high fructose consumption coupled with a copper deficiency in growing animals interfered with collagen production. Collagen is what holds our tissues and organs together. People who eat a processed food diet are typically copper deficient.

Fructose is metabolized in the liver, which can cause non-alcoholic fatty liver disease. Fife points out that the detrimental effects are very similar to liver disease caused by alcohol consumption. It gets worse:

Fructose is far more fattening that other sugars or fat. Eating foods containing HFCS does not satisfy hunger but encourages overeating, which is another reason why food manufacturers prefer to use it in place of other sweeteners. Fructose tricks you into gaining weight by turning off your body’s appetite control system. Fructose does not appropriately stimulate insulin, which in turn, does not suppress ghrelin, the hormone that stimulates hunger, and not activate leptin, the hormone that suppresses hunger. This leads to overeating and weight gain.

My comments: Ouch! The bottom line is that the consumption of HFCS is even worse than sucrose or regular table sugar. Dr. Robert Lustig, a pediatric endocrinologist, has written and spoken extensively how the consumption of HFCS quashes the production of the hormone leptin, which tells your body that you have eaten enough.

Continuing: The fat from the HFCS weight gain tends to land in the abdominal area causing a pot belly. This is visceral fat which is stored inside of the abdominal cavity. It gets worse:

Visceral fat is not just excess fatty tissue, but it’s a metabolically active tissue that releases hormones and promotes inflammation and increases your risk of a number of health problems, including obesity, heart disease, diabetes, cancer, depression, arthritis, sexual dysfunction, sleep disorders, and dementia.

Rat studies have borne out the rats fed HFCS at lower levels than in soda pop get fat. They don’t get fat when fed a high fat diet! Long term rat studies lasting over six months show these rats being fed HFCS develop metabolic syndrome. Again, this is obesity, heart disease, diabetes, and many other degenerative conditions. Male rats suffered even more from metabolic syndrome.

High fructose corn syrup (HFCS) is found in hundreds of processed food and beverage products. Included are fruit juice, soda, cereal, bread, yogurt, ketchup, mayonnaise, salad dressing, and dozens of others.

Fife slams the myth that fructose doesn’t have an immediate effect on blood sugar compared to regular table sugar. Fructose has a more detrimental effect on insulin resistance.  He continues by stating that researchers understand this phenomenon so well that they routinely use fructose when they want to cause insulin resistance in laboratory animal studies.

Some physicians are now claiming that the increased use of fructose in all our foods is largely responsible for the skyrocketing incidences of diabetes we are experiencing today.

Fife reminds his readers that all sources of fructose have the same effect on the body. It doesn’t matter if the fructose is from HFCS, sucrose or a natural source such as agave syrup (a popular sweetener used in the health food industry). The effects are all the same.

He unmasks the agave scam. Agave is marketed to diabetics as being superior to table sugar or HFCS because it doesn’t spike your blood sugar as much as table sugar. Agave nectar is processed from starch from the agave root. It’s a process similar to the production of HFCS, and the fructose content ranges from 70 to 97% He concludes by stating:

Despite the misinformation from marketers, agave syrup or nectar is far worse for your health then any other form of sugar. ED: My emphasis

Galactose

Milk sugar or lactose consists of equal amounts of glucose and lactose, and lactose has similarities to fructose. Just like fructose, lactose is ten times more likely to form AGEs compared to glucose. Fife points out that when whole milk or cheese is consumed, there is not enough lactose to be concerned about. The problem occurs when the fat is removed as in non-fat milk, yogurt, and in other low-fat or non-fat iterations.

Dried non-fat milk is often added to low-fat or non-fat dairy products to add taste and texture. Fife explains that this is virtually doing the same things as adding HFCS.

All reduced-fat milk and milk powders are potential sources of excessive amounts of galactose…

My comments: I previously have not known what Dr. Fife just explained. I have used non-fat milk powder when camping as a way of having milk without refrigeration. Now I’ll have to rethink this.

Continuing: Fife explains that the galactose content of non-fat dry milk and skimmed milk powder is 49.5 to 52% galactose, which means that nonfat dry milk is predominantly sugar.

Like fructose, galactose is well known for promoting premature aging, inflammation, and excessive oxidative stress and vitamin deficiency due to the production of AGEs and free radicals. The consumption of high levels of galactose rapidly ages the body and the cardiovascular system, increasing the risk of heart attack and stroke.

Fife cites various studies concerning the consumption of diary products. Some people claim that the fat in whole milk is the culprit concerning heart disease. Fife makes it clear that the real issue is the high sugar content in low-fat or non-fat dairy products. The good news is that fermented milk and cheese have lower galactose levels, and they are not associated with oxidative stress or inflammation.

He references two groups of people that have thrived on whole milk. We can assume he is also referring to raw milk that has not been pasteurized or homogenized. One group is in Switzerland, and the other is the Masai in Kenya and northern Tanzania. Each Masai would consume several quarts of milk daily.

They were completely immune to cardiovascular disease, diabetes, cancer, and other degenerative diseases until more recent times, as they have adapted to agriculture and a diet much higher in carbohydrate-rich foods.

Fife reminds us that dairy consumption has always been considered to be healthy. The problem is with the increased galactose intake due to the consumption of non-fat milk and non-fat milk powders. The latter seems to wipe out the health benefits of high-fat, whole milk products.

Here are more examples of processed food products that contain these non-fat milk additives.

• Most low-fat dairy products; Cottage cheese, cheese, cheese spread, yogurt, chocolate milk, and ice cream
• Dessert and pudding mixes
• Chocolate milk mixes
• Gravy mixes
• Cookie dough
• Processed lunch meats
• Used in many dry goods including pancake and biscuit mixes, cake mix, cookies, crackers, bread, and other confectionary products

Fife throws one more dagger into the idea of consuming non-fat milk powder. Undamaged cholesterol is beneficial, but the processing of this product causes the cholesterol to become oxidized. Now, it’s harmful cholesterol. This is true for both dried non-fat milk and dried whole milk.

My Comments: This concludes our review and digest of Chapter 4, Sugar Isn’t Always Sweet. If you think Dr. Fide’s exposé of the destructive effects of sugar on your health in this chapter wasn’t damning enough, wait for his next chapter.

The 30-page chapter 5 is titled A Weapon of Mass Destruction. It’s not about chemical or biological weapons used for warfare, but rather he digs into the various processes of how the consumption of sugar thoroughly trashes our health. It ends up being chemical and biological warfare in your body.

Intellect Verses Feelings-Based Desires

Mexican restaurants typically serve a bowl of corn chips with hot sauce as an appetizer prior to your meal being served. My wife and I have avoided them for years due to the fact that they are baked with unhealthy oils.

Recently I was taken to a Mexican restaurant by some friends, and the server did the customary placing of the bowl of corn chips on our table. I was hungry, relented, and ate some of the chips. They tasted good. Unfortunately, I am very bad at stopping with just a few. In the next 24 to 48 hours, I could tell what I had eaten. My skin was more oily. I regretted my capitulation to what I know is not good for me.

Even more recently, a friend “Joe” and I were out for a hike. He mentioned to me that his wife sent some pie with him, and he asked if I would like some. I asked, “Does it have sugar in it?” Joe answered affirmatively. I passed up his offer. Later, we ate at a Mexican restaurant after our outing. Sure enough, the server dutifully placed a bowl of corn chips on our table. I didn’t touch them.

If you believe that these sugary foods and unhealthy seed oils are deleterious to your health, then your intellect will say, “No, I will not consume these products, no matter how good they may taste or how much pleasure I derive by consuming them. You leave your intellect in charge.

End