Causes of Medicare Supplement Premium Increases

by Lance D. Reedy

Note: This article has been updated from a previous one.

In our companion article, Have Your Medicare Supplements Rates Gone Up?, we discuss what you can do if your rates have gone up.  Here we explain about the two main causes of these increases.

Cause #1: This one is the attained-age pricing that most states allow for their Medsupp plans. Here’s how it works. Company X has a rate, let’s say of $100 per month for a Plan G at age 65. Their rate chart says “Attained -age.” Company X takes its first attained-age increase at age 66. From there it increases at the rate of 3.5% per year. Their rate chart would look like this:

Attained-age Plan G
Age 65: $105.00
Age 66: $108.68
Age 67: $112.48
Age 68: $116.43
Age 69: $120.49
Age 70: $124.71

In this case, your premium increases 3.5% beginning at age 66 and every year thereafter. Some companies end their attained-age increases at age 80, and others go to age 99.

There are some variances for attained-age pricing. Company Y takes its first attained-age increase at age 68, again with a rate increase of 3.5% per year. Their rate chart would look like this:

Age 65: $105.00
Age 66: $105.00
Age 67: $105.00
Age 68: $108.68
Age 69: $112.48
Age 70: $116.43

Everything else being equal, I would choose Company Y over Company X for someone signing up at 65.

Just because a state’s insurance department allows attained-age pricing, doesn’t necessarily mean that all companies use it. A company at its own prerogative may choose issue-age pricing instead. Issue-age pricing means that if you sign up for a Medsupp at 65, let’s say with Company Z, you are always in the 65 year-old rate category. Since you are issued at age 65, your premium does NOT increase just because you advance in age.

Company Z’s rate chart may look like this.

Issue-age Plan G
Age 65: $112.00
Age 66: $112.00
Age 67: $112.00
Age 68: $112.00
Age 69: $116.00
Age 70: $120.00

If you come in at age 69, for example, your premium will be $116.00 per month, and then you will always be in the 69 year-old group.

Here’s the breakdown of how attained age pricing (if allowed) works in the five states we work in.

Idaho: An Issue-age state. Does not allow attained-age priced policies. The premiums typically start around $20 per month higher compared to attained-age pricing.

Montana: An attained-age state. Virtually all companies use attained-age pricing. Many of you have a company that is the exception and uses issue-age pricing.

Oregon: An attained-age state. All companies that I know of use attained-age pricing. Male-female rates are allowed; males are higher.

Washington: A community rated or flat-rate state. Each Medsupp plan letter has its own flat rate. It doesn’t make any difference for smoker or non-smoker, your age, or male vs. female. The rate is flat, period. Plan G’s might run around $190 per month.

Wyoming: An attained-age state. All companies that I know of use attained-age pricing. Male-female rates are allowed; males are higher.

Here’s the bottom line. Many people in Montana (but not all), Oregon, and Wyoming will have attained-age rate increases. Idaho, Washington, and those in Montana with an issue-age policy do not. However, the trade-off is that premiums usually start a little higher.

Note: One company in ID, MT, OR, and WY has its own unique pricing structure, which functions similarly to attained-age pricing.

Cause #2: All Medsupps eventually increase in premium due to the claims experience that any given company incurs. Let’s say Company W offers Medsupp plans F, G, and N.

As far as claims and premiums go, the people on Plan F are in one bucket, the people on Plan G are in their own bucket, and the Plan N folks have their own bucket. Premiums are money going into the bucket, and claims experiences (losses) and administrative expenses are money going out of the bucket.

Let’s say that the policyholders in Company W’s Plan F bucket as a group, begin to have more medical procedures. Bob Goodfellow has an unexpected open-heart surgery and Shirley Masters starts a chemo therapy regimen after a mastectomy.

Those two cases will incur substantial claims for the company and cause more money to flow out of the bucket. Let’s say that other Company W policyholders that increase their medical utilization of their Medsupp plan. The losses mount.

Finally, it gets to the point where Company W goes to the State Insurance Department, documents their increased losses, and files for a rate increase. If it’s 6%, for example, then everyone in Company W’s Plan F bucket goes up 6%. It makes no differences whether a policyholder has huge bills and another has had no claims at all. If the premium increase is 6%, then everyone goes up 6%.

As the people in any company’s block of business begin to age, the claims experience inevitably increases. The older standardized plans purchased prior to June 1, 2010 are all closed blocks of business and have increasingly greater rates of claims experience. That has put more pressure on rates.

More claims experience = more losses = premium increases.

There is another factor that leads to increased. claims. When Medsupps were initially offered, beginning in 1966, most plans covered the Hospital Part A deductible, just as most plans do today. In 1966 the Medicare Part A deductible was only $40. It wasn’t too long ago that it crossed over $1,000. More recently it looks like this.

  • 2016: $1,284
  • 2017: $1,316
  • 2018: $1,340
  • 2019: $1,364

Each year, as a policyholder is hospitalized, Company W has to pay out more money in claims. Even if the rate of hospitalizations is the same on a per 1,000-policyholder basis, the insurance company continually has to pay out more money.

Other Medicare deductibles and co-insurances also increase. As the Medsupp company continues to pay its own share of the costs, it has to pay out more and more every year coinciding with the increased obligations from Medicare. In fact, the companies usually send their policyholders a notice in the fall stating that they will automatically cover Medicare’s increases.

To sum up: As the company’s block of business ages, you have increasing medical utilization as well as gradually increasing deductibles and co-insurances from Medicare. Both of these cause more losses for the insurance company, and unfortunately, this leads to claims experience rate increases.

Conclusion: Both attained-age increases (OR, MT, and WY) along with increased claims experience (losses) will cause your Medsupp premiums to go up. The increases in ID and WA are due to claims experience only. While that’s nice for those two states, keep in mind that their rates start higher from the get-go.

What can I do to find lower rates?

Please refer to my companion article, Have Your Medicare Supplements Rates Gone UP? In addition to shopping for lower rates in general, sometimes switching from a Plan F to Plan G or Plan G to Plan N can be a smart more. If you have an older plan that has had substantial rate hikes and your health is stable, the chances are excellent that we can qualify you for lower rates. Please contact us, and we’ll start shopping for you. End

The Hacking of the American Mind Report #7—Contentment and Serotonin

Robert Lustig opens this chapter with a rhetorical question, which prescription medication (PM) has had the greatest societal impact. Cholesterol-lowering drugs? No. Anti-malarial drugs? No. Drugs to fight AIDS? No. Anti-inflammatories such as ibuprofen? Narcotics used for anesthesia? Viagra? No, no, and no.

The answer is Prozac (fluoxetine). Lustig explains that 16 to 18 percent if the population will at some time experience a major depressive disorder (MDD) in their lives. At any given time, 6-8 percent of the population are affected.

How were modern anti-depressants discovered? People with tuberculosis (TB) have been and still are treated with the drug, isoniazid. TB patients back in the 1950s out of the blue experienced a lifting of their depression. This led to further research, and scientists discovered that serotonin was responsible, in part, for the feeling of happiness and contentment. The serendipity effect of the drug is that it helped boost serotonin.

Lustig explains that there are two types of depression, retarded depression and agitated depression. Those with retarded depression can’t get out of bed and would kill themselves if they could. They require hospitalization. Much more common is agitated depression. These people can be anxious, irritable, sleepless, and just plain miserable. Both types of depression can be associated with individuals either eating and sleeping too much or too little. When Prozac was introduced in 1986, it helped people with both types of depression.

Pharmaceutical companies rushed their own versions of anti-depressants to the market. The common ones are as follows:

  • Zoloft or sertraline
  • Celexa or citalopram
  • Paxil or paroxetine
  • Lexapro or escitalopram
  • and others

These PMs are also know as selective serotonin reuptake inhibitors or SSRIs and are now prescribed to alleviate a great many metal disorders. SSRIs and the third most prescribed class of drugs and are the most prescribed for people under 65. Shockingly, 11% of adolescents are taking an SSRI, not just for depression but for anxiety, anger management, premenstrual syndrome, and obsessive-compulsive disorder.

Serotonin differs from dopamine in many ways. First, about 90% of the serotonin is produced in your gut, where serotonin is involved in neural and hormonal response to feeding and how full you are. About 9% can be found in your blood platelets. That means that only 1% of your serotonin is produced in your brain. Doing a urine test for serotonin levels is more reflective of what’s going on in your gut than it is in your brain.

There’s no biomarker for depression, no blood test that your doctor can administer. To diagnose clinical depression, doctors use a questionnaire known as the Beck Depression Inventory…

Serotonin neurons fan out to many different parts of the brain. Happiness can have many different definitions, manifestations and inputs because different interactions between regions of the brains influences different phenomena—joy, elation, love, etc. Please read pages 101-103 for more details.

The Sublime Science of Serotonin

Serotonin physiology has the same points of regulation as does dopamine.

1) Synthesis: The primary building block is tryptophan. Your body does not produce tryptophan,;it must be obtained from your diet. It’s found in small quantities in eggs, fish, and poultry. Vegetable protein sources are notoriously low in tryptophan.

Most of the tryptophan consumed is going to be used to produce serotonin in your gut…tryptophan is in competition with at least two other amino acids, phenylalanine and tyrosine, which are the building blocks for dopamine.

Put another way, dopamine completes with serotonin.

My Comment: This issue with tryptophan is one of many problems associated with a vegan diet.

Continuing:

2) Action:

Similar to dopamine, serotonin is released from its nerve terminals and must traverse the synapse to meet up with its receptor. Serotonin nerve terminals are all over the brain in order to bind to different receptors to exert different effects…

One receptor in particular, the serotonin-la receptor seems to be uniquely involved in decreasing anxiety and mitigating depression. It’s the binding to this receptor that is equated to well-being and contentment…Buspurone (Buspar) is a commonly used serotonin-la agonist in the treatment of severe anxiety.

3) Clearance:

After the packets of serotonin transmitters are released from the neuron, they need to traverse the synapse to get to the receptor. After they have bound to the receptor, they hang out in the synapse waiting to be recycled or deactivated.

This is the site of action of the newer SSRIs such as Prozac and the above-mentioned others. The intent of these drugs is to increase the amount of serotonin within the synapse to elevate mood. Having too much serotonin in the synapses can also be a problem.

For complete details of Lustig’s synthesis, action, and clearance discussion of serotonin, please read pages 104-106.

Always Look in the Bright Side of Life

Lustig explains that how well the serotonin mechanism in your brain depends on how happy you are.

Temperament goes a long way in explaining happiness, and differences in the serotonin transporter go a long way in explaining differences in temperament.

My comments: The four classic temperament types are sanguine, choleric, melancholic, and phlegmatic. There’s no question that people are born with these different and distinct temperaments. That there may be a serotonin connection is most intriguing.

Continuing: Lustig points out that blacks tend to exhibit less anxiety compared to whites and Hispanics. He suggests that perhaps one explanation is that the questionnaires used to derive this data are “culturally biased.” He also suggests that considering the history of slavery and discrimination, blacks might suffer from more anxiety.

Conversely, he mentions that blacks as a group have a higher percent of religious affiliation compared other racial groups. He suggests that this may provide then with a social basis for achieving happiness despite socioeconomic adversity.

Lustig also suggests that there may be a genetic difference or a biochemical reason as well. There is a known genetic difference in blacks which may slow down the clearance of serotonin. It’s like blacks have their built in SSRIs enabling them to become less depressed in adverse circumstances.

Too much serotonin can become a bad thing. Some of the side effects are irritability and suicidal thoughts and actions. There can also be negative levels of mood and impulsive aggression.

Serotonin syndrome, which results from too much serotonin activity because of SSRI overdose or interactions with other drugs, is characterized by changes in mental state and muscle tone, and autonomic nervous system problems. Going overboard on serotonin can take someone who’s morose and give them just enough brain activity and mental energy to make them suicidal, which is why people on anti-depressants shouldn’t dose themselves.

Lustig points out that there is no magic pill. A dose of Prozac for an 18 year-old may not work the same way for a 40 year-old. He mentions the use of anti-depressants for a woman suffering from post-partum depression. Her serotonin levels may return to normal after a year, but only 25% of those who take anti-depressants experience a full remission. Lustig ends the chapter with two rhetorical questions: Short of SSRIs, what hope do we have of achieving any meaningful happiness in life? Are we really a Prozac nation? Not quite. Read on.

How Different Antidepressants Work

I’ve taken some excerpts from WebMD explaining how antidepressants work. Please click here for the link if you care to read it in its entirety.

Note: Using WebMD as a source is not necessarily an endorsement of WebMD. While they have much good information, they also promote misinformation, especially when discussing diet and nutrition. Consider this:

Cut back on Fats and Oils: Eating too many fats can cause high cholesterol and heart disease. With DASH [Dietary Approaches to Stop Hypertension], you’ll limit fats and oils to two to three servings a day. A serving is 1 teaspoon of margarine or vegetable oil, 1 tablespoon of mayonnaise, or 2 tablespoons of low-fat salad dressing. When cooking, use vegetable oils like olive or canola instead of butter.

Soybean oil, canola oil, and cottonseed oil are the worst of the worst fats and should be avoided. For those that followed our reviews and digests of Dr. Stephen Sinatra’s The Great Cholesterol Myth, these already oxidized, seed-based* oils are high in Omega 6 fatty acids. Omega 6 oil are very unstable when heated *Calling them vegetable oils is a misnomer. You get oil from seeds, not vegetables.

Factory, high temperature processing causes these oils to become rancid or oxidized by the time you buy them. Because they are rancid, they throw off free radicals right and left.  When you consume them, this contributes to turning harmless, low-density lipo-proteins into bad cholesterol which in turn, leads to inflammation of your coronary arteries.

Yes, WebMD is still on the bandwagon of demonizing cholesterol. The fact that a supposed “health” website supports the use of margarine, a transfat, suggests that they have an agenda, one that does not have your health in mind.

WebMD has a bias that favors the use of pharmaceutical drugs and processed factory foods. Sites such as WebMD may also be the recipient of hidden corporate sponsorship. If a soybean oil processor, for example, is funding WebMD, that gives WebMD motive for demonizing butter and promoting seed [vegetable] oils and soy-based foods. Condoning the use of margarine, a transfat, is a dead giveaway.

For more revealing information about WebMD, please click here and here.

With these caveats in mind concerning WebMD, let’s learn about the pharmacology behind commonly prescribed antidepressants.

Reuptake Inhibitors: SSRIs, SNRIs, and NDRIs

…We really don’t know what causes depression or how it affects the brain. We don’t exactly know how antidepressants improve the symptoms.

That said, many researchers believe that the benefits of antidepressants stem from how they affect certain brain circuits and the chemicals (called neurotransmitters) that pass along signals from one nerve cell to another in the brain. These chemicals include serotonin, dopamine, and norepinephrine. In various ways, different antidepressants seem to affect how these neurotransmitters behave. Here’s a rundown of the main types of antidepressants…

Some of the most commonly prescribed antidepressants are called reuptake inhibitors. What’s reuptake? It’s the process in which neurotransmitters are naturally reabsorbed back into nerve cells in the brain after they are released to send messages between nerve cells. A reuptake inhibitor prevents this from happening. Instead of getting reabsorbed, the neurotransmitter stays — at least temporarily — in the gap between the nerves, called the synapse.

What’s the benefit? The basic theory goes like this: keeping levels of the neurotransmitters higher could improve communication between the nerve cells — and that can strengthen circuits in the brain which regulate mood.

My comment: simply put, an SSRI slows down the use or reuptake of your serotonin, causing it to last longer in your nerve synapses.

Continuing:

Different kinds of reuptake inhibitors target different neurotransmitters. There are three types:

Selective serotonin reuptake inhibitors (SSRIs) are some of the most commonly prescribed antidepressants available. They include Celexa, Lexapro, Luvox, Paxil, Prozac, and Zoloft. Another drug, Symbyax, is approved by the FDA specifically for treatment-resistant depression. It’s a combination of the SSRI antidepressant fluoxetine (Prozac) and another drug approved for bipolar disorder and schizophrenia called olanzapine (Zyprexa). Aripiprazole (Abilify), quetiapine (Seroquel), and brexpiprazole (Rexulti) have been FDA approved as add-on therapy to antidepressants for depression. Plus, doctors often use other drugs in combination for treatment-resistant depression. Also, the drugs  vilazodone (Viibryd) and vortioxetine (Trintellix – formelrly called Brintellix) are among the newest antidepressants that affect serotonin. Both drugs affect the serotonin transporter (like an SSRI) but also affect other serotonin receptors to relieve major depression.

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are among the newer types of antidepressant. As the name implies, they block the reuptake of both serotonin and norepinephrine. They include duloxetine (Cymbalta), venlafaxine (Effexor), desvenlafaxine ER (Khedezla), levomilnacipran (Fetzima), and desvenlafaxine (Pristiq).

Norepinephrine and dopamine reuptake inhibitors (NDRIs) are another class of reuptake inhibitors, but they’re represented by only one drug: bupropion (Wellbutrin). It affects the reuptake of norepinephrine and dopamine.

My comments: In doing Part D prescription plan searches for clients, I have frequently run across the classic SSRIs such as fluoxetine, sertraline, and citalopram. I found it helpful to understand that venlafaxine and duloxetine are SNRIs and that bupropion is an NDRI. Note: These are the generic names for brand name drugs.

Continuing:

Older Antidepressants: Tricyclics and MAOIs

These drugs were among the first to be used for depression. Although they’re effective, they can have serious side effects and can be especially dangerous in overdose. Nowadays, many doctors only turn to these drugs when newer — and better tolerated — medicines haven’t helped. Tricyclics and MAOIs might not be the best approach for someone who was just diagnosed. But they can sometimes be very helpful for people with treatment-resistant depression, or certain forms of depression (such as depression with anxiety).

Tricyclic antidepressants (TCAs) include amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil), and nortriptyline (Pamelor). Like reuptake inhibitors, tricyclics seem to block the reabsorption of serotonin and epinephrine back into nerve cells after these chemicals are released into a synapse. Because of the potential side effects, your doctor might periodically check your blood pressure, request an EKG, or recommend occasional blood tests to monitor the level of tricyclics in your system. These medicines might not be safe for people with certain heart rhythm problems.

My comments: I found it helpful to learn that amitriptyline and nortriptylineare in an older class of antidepressants. It was also interesting to note that these drugs are prescribed when the newer antidepressants haven’t worked. Using WebMD. Reading this section about antidepressants was the longest time that I have used this website. One criticism that a reviewer on Vox.com had of WebMD was the tediousness of reading the site for information because of the bombardment of advertisements and popups. I found the same to be true. Nevertheless, despite the shortcomings and conflicts of interest concerning WebMD, it is possible to ferret out some useful information. End

Disclaimer

The articles in Northwest Senior News are for your education and general health information only, and the opinions of various writers do not necessarily reflect those of Northwest Senior News. The ideas, opinions and suggestions contained in Northwest Senior News are NOT to be used as a substitute for medical advice, diagnosis or treatment from your doctor for any health condition or related issues. Readers of Northwest Senior News should not rely on information provided in these articles for their own healthcare. Any questions regarding your own healthcare should be addressed to your own physician. Please do NOT start or stop any medications or any other medical protocol without consulting your doctor or other licensed healthcare practitioners.

Common Anti-Depressants

In Dr. Robert Lustig’s book The Hacking of the American Mind, Chapter 7, Contentment and Serotonin, Dr Lustig references older and common Selective Serotonin Reuptake Inhibitors (SSRIs) anti-depressants. Let’s learn a little more about them.

Prozac (generic name-fluoxetine): It is available as a liquid, tablet, capsule, and as a delayed-release, long-acting capsule.

From WebMD: Fluoxetine is used to treat depression, panic attacks, obsessive compulsive disorder, a certain eating disorder (bulimia), and a severe form of premenstrual syndrome (premenstrual dysphoric disorder).

This medication may improve your mood, sleep, appetite, and energy level and may help restore your interest in daily living. It may decrease fear, anxiety, unwanted thoughts, and the number of panic attacks. It may also reduce the urge to perform repeated tasks (compulsions such as hand-washing, counting, and checking) that interfere with daily living. Fluoxetine may lessen premenstrual symptoms such as irritability, increased appetite, and depression. It may decrease binging and purging behaviors in bulimia.

Side Effects: Nausea, drowsiness, dizziness, anxiety, trouble sleeping, loss of appetite, tiredness, sweating, or yawning may occur. If any of these effects persist or worsen, tell your doctor promptly.

Precautions: Before taking fluoxetine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

From Wikipedia: Fluoxetine was discovered by Eli Lilly and Company in 1972 and entered medical use in 1986 It is on the World Health Organization’s List of Essential Medicines, the most effective and safe medicines needed in a health system. The wholesale cost in the developing world is between US$0.01 and US$0.04 per day as of 2014. In the United States, it costs about US$0.85 per day. In 2016 it was the 29th most prescribed medication in the United States with more than 23 million prescriptions.

Common side effects include trouble sleeping, sexual dysfunction, loss of appetite, dry mouth, rash and abnormal dreams. Serious side effects include serotonin syndrome, mania, seizures, an increased risk of suicidal behavior in people under 25 years old and an increased risk of bleeding. If stopped suddenly, a withdrawal syndrome may occur with anxiety, dizziness and changes in sensation.

From verywellmind.com: As an SSRI, Prozac works by preventing the brain from reabsorbing naturally occurring serotonin. Serotonin is involved in mood regulation. In this way, Prozac helps the brain to maintain enough serotonin so that you have a feeling of well-being, resulting from improved communication between brain cells.

Research also highlights how medications such as Prozac may help in combination with psychotherapy. In a 2008 study published in Science, it was shown that in mice, Prozac helped the brain to enter a more immature and plastic state, possibly making it easier for therapy to have an effect. We do know that combining medication such as Prozac with talk therapy is effective for anxiety, and this study indicates a potential reason why.

Zoloft: (generic name-sertraline):

From WebMD: Sertraline is used to treat depression, panic attacks, obsessive compulsive disorder, post-traumatic stress disorder, social anxiety disorder (social phobia), and a severe form of premenstrual syndrome (premenstrual dysphoric disorder).

This medication may improve your mood, sleep, appetite, and energy level and may help restore your interest in daily living. It may decrease fear, anxiety, unwanted thoughts, and the number of panic attacks. It may also reduce the urge to perform repeated tasks (compulsions such as hand-washing, counting, and checking) that interfere with daily living. Sertraline is known as a selective serotonin reuptake inhibitor (SSRI). It works by helping to restore the balance of a certain natural substance (serotonin) in the brain.

From Wkipedia: Sertraline was approved for medical use in the United States in 1991 and initially sold by Pfizer]] In 2016, it was the most prescribed psychiatric medication in the United States with over 37 million prescriptions.

From verywellmind.com: As with all medications, Zoloft may cause certain unwanted side effects. The most commonly experienced in those taking Zoloft include:

Diarrhea, Nausea, Indigestion, Decreased appetite, Fatigue, Sleepiness, Insomnia, Tremors, Agitation, Increased sweating, Sexual problems, including loss of libido and inability to ejaculate, Gastrointestinal problems can occur in as many as one in four people

There are some serious side effects associated with Zoloft use: Black or bloody stools, Chest pain, Fainting, Fast or irregular heartbeat, A severe or a persistent headache, Fever over 100 degrees F, Seizure, Suicidal thoughts, Stevens-Johnson syndrome (SJS), a rare but potentially fatal allergic reaction.

Celexa (generic name-citalopram):

From WebMD: Citalopram is used to treat depression. It may improve your energy level and feelings of well-being. Citalopram is known as a selective serotonin reuptake inhibitor (SSRI). This medication works by helping to restore the balance of a certain natural substance (serotonin) in the brain.

To reduce your risk of side effects, your doctor may direct you to start taking this drug at a low dose and gradually increase your dose. Follow your doctor’s instructions carefully. Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase. Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.

Side effects: Nausea, dry mouth, loss of appetite, tiredness, drowsiness, sweating, blurred vision, and yawning may occur.

From Wikipedia: Citalopram, sold under the brand name Celexa among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It is used to treat major depressive disorder, obsessive compulsive disorder, panic disorder, and social phobia. Benefits may take one to four weeks to occur. It is taken by mouth.

From Drugs.com: Celexa is made by Forest Laboratories, Inc.

From verywellmind.com: Celexa is an antidepressant medication that’s often prescribed to treat both mood and anxiety disorders. Celexa belongs to a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

How Celexa Works: Celexa balances your level of serotonin, a naturally occurring chemical substance or neurotransmitter in the brain. Serotonin is responsible for regulating sleep, mood, and other functions. Research has shown that imbalanced brain chemicals can contribute to mood and anxiety disorders, but the exact cause of panic disorder remains unknown. An SSRI like Celexa can assist in balancing serotonin by preventing the nerve cells in the brain from absorbing it. By reducing the rate at which serotonin is reabsorbed, Celexa changes your brain chemistry, improving mood and reducing feelings of anxiety. Celexa can assist in decreasing the severity of panic attacks and other panic disorder symptoms. Plus, Celexa can also reduce symptoms if you have a common co-occurring condition, such as depression.

Paxil (generic-paroxetine):

From verywellmind.com: Paxil is an antidepressant medication approved for the treatment of generalized anxiety disorder (GAD) and other anxiety disorders. It is in the same class as Prozac and Zoloft. Like other selective serotonin reuptake inhibitors (SSRIs), it was developed as a treatment for depression.

Paxil was approved for the treatment of generalized anxiety disorder (GAD) in 2001 and social anxiety disorder (SAD) in 1999. It is also a prescribed treatment for panic disorder, post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), and obsessive-compulsive disorder (OCD).

Nerve impulses are transmitted chemically between neurons in the nervous system. Neurotransmitters like serotonin are produced by one neuron. They travel between the cells and are deposited on the second neuron. It is theorized by some that keeping the serotonin around longer results in relief of depression.

People with GAD develop chronic and exaggerated worry and tension, even though nothing seems to provoke it. Those with this disorder are always anticipating disaster. They often worry excessively about health, money, family, or work. Just the thought of getting through the day may provoke anxiety.

Many people with GAD realize that their anxiety is more intense than the situation warrants. This knowledge does not reduce the anxiety. They may report being unable to relax and often have trouble falling or staying asleep.

Their worries are usually accompanied by physical symptoms, especially trembling, twitching, muscle tension, headaches, irritability, sweating, or hot flashes. They may feel lightheaded, out of breath, nauseated or have to go to the bathroom frequently. They might also feel as though they have a lump in the throat.

Generalized anxiety disorder is usually treated with psychotherapy, medication, or a combination of the two. It can take some time to figure out the best combination for you, so be patient and keep your doctor informed about what is and isn’t working for you.

Common side effects of Paxil are nervousness, sleep difficulties (either too much or too little), restlessness, fatigue, dry mouth, nausea, headache, sweating, diarrhea, and sexual problems. Typically, these side effects will go away within a couple weeks of taking the medication.

For a complete list of other anti-depressants, please refer to this Wikipedia link.

Disclaimer

The articles in Northwest Senior News are for your education and general health information only, and the opinions of various writers do not necessarily reflect those of Northwest Senior News. The ideas, opinions and suggestions contained in Northwest Senior News are NOT to be used as a substitute for medical advice, diagnosis or treatment from your doctor for any health condition or related issues. Readers of Northwest Senior News should not rely on information provided in these articles for their own healthcare. Any questions regarding your own healthcare should be addressed to your own physician. Please do NOT start or stop any medications or any other medical protocol without consulting your doctor or other licensed healthcare practitioners.

Are Medicare Supplement Plans C and F going Away? Not quite!

Note: I thank Ron Iverson, president of NAMSMAP* for assembling this data. This information comes from the National Association of Insurance Commissioners. *National Association of Medicare Supplement and Medicare Advantage Producers.

1)  Why is the standard model for Medicare supplement (Medigap) plans being revised?

A new federal law was passed on April 16, 2015. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) makes changes to Medigap policies that cover the Part B deductibles for “newly eligible” Medicare Beneficiaries on or after January 1, 2020.

2) What does MACRA require?

As of January 1, 2020, MACRA does the following:

2a) Prohibits first dollar Part B coverage on Medicare Supplement plans (Plans C and F) to “newly eligible” Medicare Beneficiaries, so Plans C and F cannot be sold to those “newly eligible” for Medicare. Those enrolled in Plans C and F prior to January 1, 2020 may keep their plan.

2b) Makes Plans D and G the guarantee issue plans for “newly eligible” Medicare Beneficiaries for the specified periods under current law that name C or F for current Medicare beneficiaries.

2c) Who is considered a “newly eligible” Medicare beneficiary under MACRA?

MACRA defines “newly eligible” as anyone who: (a) attains age 65 on or after January 1, 2020, or (b) who first becomes eligible for Medicare benefits due to age, disability or end-stage renal disease on or after January 1, 2020.

3) How much is the Medicare Part B deductible?

Medicare Part B deductible is $185 in 2019.

4) How does this relate to efforts to eliminate Medigap or Medicare supplement “first dollar coverage”?

This accomplishes the efforts to eliminate Medigap “first dollar coverage” (coverage of all claims without paying any out of pocket cost) by discontinuing sale of Plan C and Plan F only for “newly eligible” Medicare Beneficiaries

5) How are people eligible for Medicare on the basis of disability impacted by these changes?

Current beneficiaries are not impacted. The restrictions under MACRA apply to persons who qualify for Medicare as a result of a disability on or after January 1, 2020.

6) Why are plans “re-designated” for only “newly eligible” Medicare beneficiaries?

The Federal Government wanted to eliminate coverage for the Part B deductible making consumers responsible for that first dollar coverage. The only difference between Plans C and F and Plans D and G is the coverage of the Part B deductible under Plans C and F. All other benefits are exactly the same for D and G. Since Plans C and F will no longer be available for “newly eligible” beneficiaries, it was necessary to designate Plans C and F as Plans D and G for these individuals.

7) How are enrollees in current Plans C and F affected by these changes?

Current enrollees (those eligible for Medicare PRIOR to January 1, 2020) can continue with their Plan C or Plan F, including F High Deductible plan, and may continue to buy Plans C and F beyond January 1, 2020. Current enrollees will also be able to buy the new Plan G High Deductible plan on or after January 1, 2020.

8) What changes are made to High Deductible Plan options?

Since Plan F High Deductible cannot be sold to those “newly eligible” Medicare beneficiaries, a new Plan G High Deductible is created for those “newly eligible” Medicare beneficiaries as of January 1, 2020. The effective date of coverage for Plan G High Deductible must be on or after January 1, 2020. If you are not a “newly eligible” beneficiary and are enrolled in a Plan F High Deductible prior to January 1, 2020, you are able to continue this coverage beyond January 1, 2020 and to purchase this coverage on or after January 1, 2020.

9) When can the new High Deductible Plan G be sold and who can buy it?

Plan G High Deductible can be made available beginning on January 1, 2020; “newly eligible” Medicare beneficiaries and current beneficiaries would be able to buy the new Plan G High Deductible.

10) For high deductible plans, does payment of the Part B deductible count towards the plan deductible?

For Plan G High Deductible; while the Part B deductible is not covered (reimbursed), it does count towards the High Deductible plan’s deductible. If, in the rare circumstance the Plan G’s High Deductible is met with all Part A expenses and Part B Deductible expenses are then incurred, these expenses will not be covered expenses until the beneficiary meets the Medicare Part B deductible.

11) For the new High Deductible Plan G sold on or after January 1, 2020, what happens if a policyholder meets the high deductible amount with all Part A out of pocket expenses?

If, in the rare circumstance the Plan G’s High Deductible is met with all Part A expenses any Part B Deductible expenses incurred will not count towards meeting the High Deductible nor will they be covered expenses.

12) What changes are made to Guaranteed Issue requirements?

Since two of the current guaranteed issue plans, Plans C and F, will no longer be available for “newly eligible” Medicare Beneficiaries on or after January 1, 2020, Plans D and G will become two of the guaranteed issue plans for these individuals. Current enrollees can remain with or buy Plans C and F and individuals who do not fall within the definition of “newly eligible” Medicare beneficiary will still be able to purchase Plans C and F.

13) How does this change the way Plans C or F, and D or G, may be sold in the state?

Insurers can continue to sell Plans C or F to current Medicare beneficiaries. However, “newly eligible” Medicare beneficiaries cannot apply for or purchase Plan C or F. The “newly eligible” would be offered Plans D or G on a guaranteed issue basis instead. All other currently available plans may continue to be offered to all Medicare beneficiaries regardless of their date of eligibility for Medicare.

You are NOT considered “newly eligible” because you turned age 65 before January 1, 2020; and although you must enroll in Part B to purchase Medigap and that would occur after January 1, 2020, you could purchase C or F because you turned age 65 before January 1, 2020.  

Key Takeaways

1)  Plans C and F, and High Deductible F, will not be available to anyone who turns 65 (“newly eligible”) after January 1, 2020, including those eligible for Medicare by reason of disability.

2)  People currently with Plans C and F and High Deductible F will be able to keep them after the date.

3)  People who turn 65 and register for Medicare before the date, can still purchase Plans C and F because they are not considered “newly eligible.”

4)  And…even though a person who purchases Part B after January 1, 2020, they can still purchase Plans C or F because he/she turned 65 before the date.

5)  The current Plan C will become (be designated) the current Plan D after the date.

6)  The current Plan F will become (be designated) the Current Plan G after the date.

7)  All High Deductible Plan Fs will be available as they currently are after the date, and will become (be designated) High Deductible Plan G.  Available purchase will include people who turn 65 before the date, but again, not those “newly eligible.”

8) Guaranteed Issue (GI) Plans C and F will not be allowed to be sold to newly eligible, but GI plans D and G will.

9)  Plans K and L will remain the same, with the exception of the yearly raise of out-of-pocket expense.

10)  Plans M and N will not change.

11)  The rules also apply to “Medicare Select” plans.

Important Information—Please Read

The Annual Election Period (AEP), also known as Medicare Open Enrollment, ends December 7. Please return all applications ASAP. Every year we have the last-minute procrastinators contacting us at the eleventh hour on December 7th. Please do not be one of them.

Part D Prescription plans (PDPs)

Many of you contact us every fall to have us review your PDPs. This is a smart idea and a benefit for you because it helps you to enjoy having the lowest cost plan year after year.

One trend that we have seen through the years is this. Company X comes out with a very competitive PDP either with a low premium and/or low copays. As time goes by, their premium creeps upward. A few years ago, Company X was $15 per month in most states. Now it’s around $38 per month.

Company Y has had a very competitive PDP for about four years running. However, they increased their premium 25-30%, depending on which state you are in.

At the same time Company Z decides are come out with their new plan, undercutting the competition. Their premium is $15-16 in most states. We have already signed up dozens of you for this plan. This is saving people anywhere from $125 to $250 per year compared to staying with their current plan.

However, you still need to be mindful of the pattern. Company Z will almost assuredly suffer from premium creep in a few years. Most of the original plans from 2006 are gone. Many of the original Part D companies have pulled out, or most of the plans have been reinvented. However, Company A has a plan that was $13 per month in 2006. It’s now around $75 per month. That’s premium creep!

Here’s another trick some companies do. Most generics, but not all, are classified as tier one or tier two generics. This will be true of common prescriptions such as lisinopril, metformin, levothyroxine, simvastatin, omeprazole, and hundreds of others. So far so good.

Seroquel is a psychotropic drug used to treat depression or bi-polar. The generic is quetiapine fumarate. Through 2018 Company B lists quetiapine as a tier 3 drug. The cost is $9 in 2018. When I did a Medicare.gov drug search for one client, I discovered that the cost of quetiapine with Company B is rising to $39 per month in 2019. Tier 3, 4 and 5 drugs are subject to the $415 deductible. After that, tier 3 drugs have a $45 copay.

Isn’t that convenient of them! The $39 is still below the $45 copay for a tier 3 drug. Even if my client meets his deductible, he still pays $39 for quetiapine. The bottom line is that he got stuck with a $30 per month increase. Thirty dollars is $30, whether it be additional premium or a higher copay. He gets no help for this drug! Fortunately, we found another plan the has quetiapine as a tier 2 drug with a much lower copay. He elected to change plans. The above are examples of why we encourage you to shop your PDP every year.

Do you really like batting you head against the wall? Call your agent first!

Case #1

Note: I have changed the names of the actors and location for confidentiality.

Marvin and Betty Jones live in Snow City, Montana. Marvin is diabetic, and his doctor wanted him to get a blood glucose monitor. Betty initiated an inquiry to find out how it’s covered.

She first went to their pharmacist at Help You Get Well Pharmacy in Snow City. The pharmacist told Betty that her husband’s PDP covers the blood glucose monitor. Ouch! Upon hearing that, she called customer service at Marvin’s Part D company. Bad mistake! She was on hold for who knows how long and was passed from rep to another rep until the call finally dropped off. Par for the course!

Exasperated, she called Medicare. Now she’s on hold for who know how long, and when she finally spoke to a live person, said person had not a clue. You would think they would know better! Now she’s spent hours getting nowhere except for getting more frustrated.

In desperation she called me. Upon hearing her situation, I said, “Let’s check Medicare.gov and especially “What Medicare Covers.” I have a link for this on our website. Please click here. Look for the fourth bulleted item down.

In less than two minutes I had her answer. Quoting from Medicare.gov.

Blood sugar (glucose) monitors

…Medicare Part B covers blood sugar monitors as durable medical equipment (DME) that your doctor prescribes for use in your home.

Notice that it says Medicare Part B. Part B is medical, which means that Medicare will generally pay 80% of the cost of the blood glucose monitor and Marvin’s Medsupp plan will pay the other 20%.

Part D prescription plans pay for outpatient drugs. They do NOT pay for equipment or supplies such as diabetic test strips, meters, needles, catheters, blood glucose monitors, etc.

We’ll let the entry level employees at Marvin’s Part D company or Medicare off the hook. What about the pharmacist at Help You Get Well? A pharmacy degree requires something like six years of college. Furthermore, the pharmacist knows, or should know, that diabetic equipment is never billed to a prescription plan. You would hope that he’d also knew that a blood glucose monitor is also equipment and not a drug! His wrong answer sent Betty on a wild goose chase.

Now, if you enjoy being on hold, getting wrong answers, and getting you call dropped off, you’re welcome to do so. It’s your time.

If you want to save much grief, call your agent first!

Case #2

Joe and Betty Arlington live in Twin River, Idaho. (Again, all names are fictitious.) Joe was on his wife’s employer plan, which included prescriptions, for about five years, and last fall he went off her plan and signed up for a Part D prescription plan. We shopped for a new PDP for Joe this fall, and during the course of the conversation, Betty told me that she was paying about $25 per month extra for Joe’s Part D premium.

She called Joe’s PDP company, Company D, early in 2018. She asked the customer service rep why she was being billed a higher premium for Joe. The poor rep had not a clue. I might add that we should not expect these reps to know these answers. Their job is to verify your enrollment and answer general questions about the PDPs their company represents. They are not trouble shooters.

When Betty explained the situation to me, it didn’t take me long to figure out what was happening. Medicare doesn’t know that Joe was covered by an employer prescription plan for five years. Therefore, they are billing him for the late Enrollment penalty (LEP). The math works out that the extra premium that he’s paying is the LEP.

If Betty had called me first, that would have saved her a frustrating call to Company D. To resolve this issue, we will have to reach a supervisor in a 1-800 Medicare to fix the situation. Also, if she had called me sooner, we may have been able to have stopped the overcharge early on in the year. I’m doubtful that she’ll be able to get a refund.

Moral of the story: If you want to save heartburn and acid indigestion, CALL US FIRST concerning anything connected with any of your Medicare supplement, Medicare advantage, or Part D Prescription plans. We’ll do everything possible to save you the grief of having to call a company or 1-800-Medicare.

Changing Your Medicare Supplement Plan

There are two misconceptions concerning changing your Medicare supplement plan. Please see our companion article in this issue.

Misconception #1—People think that they can automatically change their Medsupp plan during the AEP. They hear “Open enrollment” on TV and think that that applies to a Medicare supplement plan. For most people, once you pass 65 ½, changing a Medsupp plan involves medical underwriting. This means having “No” answers to questions regarding your current health. Misconception #2—People think that a Medsupp plan can ONLY be changed during the AEP. You can change your Medsupp plan ANY MONTH of the year, subject to medical underwriting. Example: Max Bolivar is having a cataract procedure in March. Once his procedure is complete, he can change to another Medsupp as long as he can answer “No” to the health questions on the new company’s application.  End

The Hacking of the American Mind Report #6—The Purification of Addiction

The Hacking of the American Mind by Dr. Robert Lustig

Chapter 6

What does Lustig mean by titling Chapter 6, The Purification of Addiction?  Substances of addiction used to be scarce. Prior the 1700s addictive substances were expensive, and you had to go out of your way to get them. However, advances in technology dropped the cost of these substances making them much easier to obtain.

Addictive substances have been around for thousands of years, but addiction didn’t really become a societal problem until we started purifying these substances. Opium addiction in China goes back to 1000 A.D. Beer and wine production since the Romans could only get the alcohol content up to about 5%, and those products would still spoil. The alcohol content wasn’t high enough to cause addiction. Distilling alcohol was a game changer as the concentration of alcohol could be raised substantially beyond 5%. Alcoholism in Europe become a major problem in the 1700s once it became available and cheap.

Fast forward to the 20th century. Lustig suggests that is was not an accident that Prohibition was repealed in 1933, which was at the height of the depression. The federal government needed the tax revenues to help finance Franklin Roosevelt’s New Deal programs.

Lustig quotes some current statistics from the National institute for Drug Abuse: 9.5% of men and 3.3% of women are alcoholics. Add to that the binge drinkers. Total alcoholic beverage sales generate $212 billion in annual revenue for the alcohol industry.

He says that it’s not just binge drinking among our youth; it’s the other drug abuses.

Kids aren’t just bingeing on alcohol, they’re also popping uppers, downers, and everything in between. In adolescents over the last thirty-five years, the binge drinking rates, as well as use of virtually every other illicit substance, has continued to increase.

My comments: Why is this happening? Prior to the 1960s, major drug abuse among our youth was not a problem. Oh sure, there was drinking, but Lustig is referring to the degree of change that he has seen in his practice. What has changed? Why were our youth in prior generations not afflicted as so many are today? Lustig does a very good job at raising the issues, and that is the focus of his book. However, he does not get into the deeper causes of why these problems are occurring and how we can overcome them, at least not yet.

Continuing: Lustig says that alcohol is but one example of something that is refined and purified to suit the whims of societal addiction. Marijuana has been bred to be more potent. He also points that new pharmaceutical drugs have been used “off label,” ones that also become abused.

The Other White Powder

Lustig comments about the profit margins of the pharmaceutical industry, something like 20% or better for five large pharmaceutical companies. He continues by saying that that’s nothing compared to the processed food industry. That industry grosses $1.46 trillion annually, of which $657 billion is profits. The gross profit margin is a whopping 45%!

Lustig explains that in the traditional Jewish method of circumcision, the practitioner dipped the pacifier in wine. When the modern obstetrician performs the procedure in the hospital, he dips the pacifier in Sweet-Ease, a 24% super concentrated sugar solution. Doing so activates both dopamine and opioids in the brain, helping the infant to deal the pain.

My comments: Not too long ago I was in a client’s home writing business. The gentleman was also babysitting his whiny three-year old grandson. At one point he gave his grandson a snack of punch and Trix, a high sugar concoction called “cereal.” The little boy settled down and dutifully consumed his sugar-laced snack. It worked well, until the sugar effect eventually wore off.

Years ago, when my son was in the cub scouts, the horribly overweight den mother announced, “We’re having CAKE after the meeting.” It was like Pavlov’s dogs; just the sound of the word CAKE settled the kids down and got them salivating to their soon coming treat.

Lustig referenced the huge profits the processed food industry rakes in. The boxes of confections, erroneously called “breakfast cereal,” couldn’t be a better example. Those boxes that you pay $3, $4, or even $5 are a huge rip-off, especially the ones loaded with sugar. Oh, you will switch to “healthy” granolas? Better check the label. They, too, are loaded with sugar.

The key point Lustig makes in his circumcision example is that sugar is in effect, used as a drug. The grandparent above, also used sugar (likely unwittingly) as a calming agent for his fussy grandson.

Continuing: Lustig makes the point that virtually everyone loves sugar.

The world loves sugar. There’s not a race, ethnic group, or tribe on the planet that doesn’t understand the meaning of “sweet.”

He also explains that if a foodstuff was sweet, it was considered to be safe. He cites the Jamaican ackee fruit. When it’s immature and not sweet it contains a toxic compound that can cause vomiting and even death. When it’s mature, it’s sweet and safe.

Lustig reminds us that prior the World War II, sugar was mostly used as a condiment, drop a sugar cube in your coffee of tea. After the war is when the processed food industry ratcheted up the use of sugar. High fructose corn syrup, the even sweeter sugar, was in use by 1975.

My comments: How ironic it was that sugar was rationed during WW II so it could be packed off to our troops. Interestingly, diabetic rates dropped during WW I and WW II when sugar was less available for the civilian population.

Continuing: Adding to the increased use of sugar by the food industry was the anti-fat hysteria that also hit in the 1970s. If you reduce fat in a product such as ice cream, what do you put in its place? More sugar, of course!

Lustig cites research done with rats. You feed them sugar, and they want more and more. Those little rodents are sugar lovers.

He explains that white sugar, which is composed of glucose and fructose, is not necessary to have in our diet at all. Our liver, through the process of gluconeogenesis, will produce all the glucose, the energy of life, we need. He points out the when fructose is chronically consumed, it can be toxic, and many people become addicted to it. Lusting concludes this section be quoting studies that suggest that sugar is uniquely capable of driving the reward pathway and altering emotional responses.

Denying the Obvious

Lustig concedes that not everyone is on board with the “sugar is addictive” belief. However, he poses a rhetorical question: How can a food—like sugar that is necessary for survival also be addicting? His answer is that certain “foods” are not necessary for survival. He lists what is absolutely necessary for our survival. The four classes of essential nutrients are as follows;

  1. Essential amino acids
  2. Essential fatty acids such as omega-3 and linolenic acid
  3. Vitamins
  4. Other macro-nutrients such as minerals.

His key point is that none of the foods that contain these essential nutrients are even remotely addictive. He also explains that of the substances that contain calories, only alcohol and sugar have been shown to be addictive. Lustig also references caffeine, also addictive, that has been added to some “food” products.

Lustig lists some of the dangers from alcohol consumption and says that “alcohol is dangerous because it’s alcohol.” Those characteristics are remarkably similar to that of sugar, and it’s no wonder, as alcohol is a product of the fermentation of sugar.

He comments about sugar.

Sugar causes diabetes, heart disease, fatty liver disease, and tooth decay. Sugar’s not dangerous because of its calories or because it makes you fat. Sugar is dangerous because it’s sugar. It’s not nutrition. When consumed in excess, it’s toxic. And it’s addictive. Fructose directly increases consumption independent of energy need.

Lustig comments about the naysayers that say sugar is “natural” and has been with us for a thousand years. They maintain that sugar is FOOD, and since it’s food, how can it be toxic, and how can it be addictive? He says that their contention begs the question: What is food? He quotes Webster’s dictionary definition of food.

Food: A material consisting essentially of protein, carbohydrate, and fat used in the body of an organism to maintain growth, repair, and vital processes and to furnish energy.

Lustig quips that since sugar furnishes energy, it’s a food, at least according to some of the naysayers. He than discusses a European group called NeuroFAST. In essence, they claim that sugar is not addictive. For a complete discussion, please refer to pages 91-92.

Sugar is addictive for the same reasons and via the same mechanism as alcohol. Lustig explains that sugar is not a food; it’s a food additive. He continues to say that children are getting the same diseases as seen with those that consume excessive alcohol, type 2 diabetes and fatty liver disease.

When “Want” Becomes “Need”

Lustig asks the reader the following question: Can you honestly look yourself in the mirror and tell yourself that you have no addictions? He answers his rhetorical questions as follows: Ben & Jerry’s, eBay, Facebook, porn, video games, coffee?

He then asks: How long did the rush from the new iPhone or new car last? He says that as a society we’ve become tolerant by obtaining new stuff at a moment’s notice.

You might call dopamine the dark underbelly of our consumer culture. It’s the driver of desire, the purveyor of pleasure, the neurotransmitter of novelty, the lever that business pushes to keep our economy going, but at a clear, perceptible and increasing cost. We’ve purified our substances to concentrate their effects, and we are perpetually in need of the next new shiny object.

My Comments: Lustig points out that acquiring material things can also drive our dopamine receptors. I couldn’t agree with him more. I recently ordered and received my new Milwaukee M12 cordless impact driver and drill driver. It was like Christmas time when my shipment arrived and I opened the package and dug out my new” toys.” I loved the feeling. It was fun!

I asked myself if there was another M12 product that I “needed.” I went through the entire line of Milwaukee M12 products but couldn’t find one. Even though there was nothing I needed, I realized that it’s not too difficult to become hooked on buying another new “toy.”

For the guys, the dopamine inspired buying spree could be tools, guns, cars, and adult toys. For the gals it could be clothes, purses, shoes, or collectible items.

Is all pleasure bad? In an earlier chapter, Lustig explained that some stimulation or tickling of our dopamine receptors is actually healthy. We need to have some pleasure in life. We can enjoy the pleasurable rush of the new iPhone, car, or whatever. We can enjoy the occasional sweet treat. We can enjoy any of these things as long as we don’t become addicted to the substance or behavior or allow want to turn into need.

It’s important to keep in mind Lustig’s central them of his book: Too much pleasure leads to addiction, and not enough contentment or happiness leads to depression.  End

Tips for using PDPHelper

This AEP is our third year of using PDPHelper. The following are some tips to help us do accurate searches for you on Medicare.gov.

Step 1

Please enter your name, phone, email address, your zip code, and your county of residence. Some zip codes span multiple counties, and that’s why we request your county of residence. This means where your residence sits.

For example, if you have a Post Office box in Three Forks, MT, that’s in Gallatin County. Let’s say you live off Highway 287 in Broadwater County. Please enter “Broadwater” in the field.

Next, please list your top pharmacy choices. Next, we ask you if you would use Walmart, Walgreens, or a mail order pharmacy if that will save you money.

Step 2

In this section only, enter in pills, capsules, or tablets. Liquids, gels, creams, insulin, eye drops, patches, etc. are in the next steps.

Enter the name of your prescription, the dose, the quantity you buy, and this is the quantity you buy per month, every two months, every three months, or every twelve months. If you take something as needed, estimate how many pills you buy and how often you buy it. For example: 30 pills every 3 months.

Example #1—Betty takes two, 500 mg metformin tablets every day. She buys 60 every month.

Name of Prescription: Enter metformin

Dosage: Enter 500 mg

Quantity: Enter 60

Frequency: Enter month

Example #2—John take hydrocodone/apap, 325/10 mg, as needed for back pain. Some days he takes none but other days he takes two or three. He estimates he takes around 45 per month

Name of Prescription: Enter hydrocodone/apap

Dosage: Enter 325/10 mg

Quantity: Enter 45

Frequency: Enter month

Step 3

The section is for Insulin, Inhalers and Nebulizers

Example #3—Alice uses insulin. She checks “yes”, and she enters her information as follows:

Name of insulin: Lantus solostar

Size: 3 mL

Quantity: 5 pack or just 5

Frequency: per 2 months

Example #4—Alice uses Advair. She checks “yes” for the category, “Do you use any inhalers or nebulizers?” She enters her information as follows:

Name of inhaler: Advair

Size: 250/50

Quantity: 1

Frequency: 1 month

Step 4

This final step is for Eye Drops. Gels, Creams, Lotions or Salves, and Other Prescriptions.

Example #5—Mary uses eye drops. She checks “yes” for this category and fills in the information. Please do NOT attempt to say “2 drops per eye each day.” We need to know the SIZE of the bottle, usually 2.5 mL, 5 mL, 10 mL or 15mL.

Name of eye drops: Latanoprost SOL 0.005%

Size: 2.5 mL

Quantity: 1

Frequency: 1 month

When finished, please hit the submit button.

The Hacking of the American Mind Report #5—The Descent into Hades

Background: Chapter 5 and 6 are the final chapters of Part 2 which deals with reward, dopamine, and addiction. Lustig’s writing is fairly technical; I’ll do my best to summarize his explanations into layman’s language.

Lustig begins the chapter by explaining that there’s a price to be paid for reward. It used to be in terms of dollars, but now it’s measured in neurons. Substances, sugar for example, that trigger a dopamine response are now cheap. It’s not a special once-a-year treat. The dopamine receptors in our brains are fragile. Although they like to be “tickled,” these receptors don’t want to be bludgeoned to death.

If you open the dopamine floodgates repeatedly, these neurons have some fail-safe methods built-in to protect themselves.

The over-stimulation of these cells (neurons) leads to cell damage or death, termed excitotoxicity.

My Comments: Dr Russell Blaylock has written a book titled Excitotoxins: The Taste That Kills. You can guess the main theme of his book. Various forms of sugar as well as artificial sweeteners such as aspartame (Equal) and sucralose (Splenda) are toxic substances to critical parts of our brains.

The Firing Squad

Chronic stimulation of your neurons results in cell death, and that’s not good for you. Your brain would continue to get fried. However, nature has provided you some protection against this process, notice some protection.

Ligand (molecules that bind to receptors such as dopamine or cortisol) almost uniformly down regulate their own receptors all over the body.

Put another way, the receptors don’t work as well. The cells don’t respond as well. You need more to get less.

Lustig calls this tolerance. The receiving neuron is becoming tolerant to the excessive stimulus. He says that this occurrence is both good and bad. It’s good because your neurons aren’t dead. It’s bad because you are going to need more of the substance to get the same reward.

My comments: Instead of one doughnut, it’s two or three. Instead of one beer, it’s multiple cans or bottles.

Continuing: Lustig says that tolerance is when a chemical binds to a receptor. This is also true with pharmaceutical drugs. The problem comes in when the stimulations overstimulates the neurons.

Pickling Your Brain

He says that every substance and behavior that drives up your reward triggers will just as quickly drive down your reward receptors. He cites the alcoholic that seemingly can consume more booze than a non-alcoholic as his liver metabolizes the alcohol faster than the non-alcoholic. He explains that this is the reason why drug addicts can easily overdose. First, they are in a period of abstinence, maybe due to treatment or being in jail. Next, they resume with their previous dose, but they no longer have the same level of tolerance. Then they overdose, and for some, it’s fatal.

In essence, he’s saying that one is literally burning up his neurons, and that he’ll never reach the same level or reward as before. He just doesn’t have the machinery to do so, ever! Lusting describes the motto of those in recovery from illicit substances: Once a cucumber becomes a pickle, it never will be a cucumber again.

He cites another problem, and that is withdrawal. Changes in your neurons has occurred. The acute cessation of many of these substances leads to withdrawal. Lustig says that the withdrawal symptoms can be from caffeine, alcohol, narcotics, and tranquilizers. He describes various symptoms in detail.

There can also be emotional withdrawal from cocaine, marijuana, and ecstasy. These symptoms include anxiety, restlessness, irritability, insomnia, headaches, poor concentration, depression, and social isolation. Tolerance and withdrawal are the classic two-headed hydra of the definition of addiction.

Lustig discusses how want turns into need for the addict. The addict will turn to crime to get money to get his fix, and this often includes harming family members.

Are Addictive Behaviors Really Addictive?

Lustig then segues to discussing whether or not behaviors, such as gambling, are addictive. He cited the American Psychological Association (APA) which said that for decades behaviors were not addictive. The reason for their stance was that since the criteria for addiction was both tolerance and withdrawal, there was lack of withdrawal if the behavior ceased. The APA has since changed its position in saying that behaviors can be addictive in certain circumstances.

Addiction Transfer

What happens if a person can’t get his favorite fix? Lustig points out that if a person’s dopamine pump is primed, it’s waiting to be fired, for something, anything. He says that people abstaining from one substance will frequently become users of another substance. He describes smoke filled rooms of AA meetings.

The Real Thing

Lustig recounts the story of John Pemberton, an Atlanta pharmacist. By 1886 he invented a formula using carbonation, and this concoction later became known as Coca Cola. Pemberton placed his first ad for his new carbonated drink in the Atlanta Journal. People came to his pharmacy to imbibe. The pharmacy had special equipment to carbonize the beverage, and this became known as the soda fountain.

My comments: I can remember back in the 1950s visiting the soda fountain at the old Thrifty Drug Store in Burbank, California. There were the stools for the customers, and you could order burgers, fries, malts, and of course, soda pop. The new Thrifty built in the 1960s on an adjacent lot phased out the old soda fountain. I always wondered why a pharmacy had a “soda fountain.” Now I know. It was a carry-over from the late 1800s. Wasam’s Drug in Clarkston, Washington still has their soda fountain that caters to the morning coffee crowd.

Continuing: Pemberton had Civil War injuries which resulted in him becoming a morphine addict following the war. To wean himself off his morphine addiction, he developed a concoction which included cocaine, alcohol, caffeine, and sugar. As Lustig puts it, these were four weaker dopamine/reward drugs, to take the place of one very strong one. Pemberton mixed those four with carbonated water.

Due to the growing temperance movement in the South following the war, Pemberton removed the alcohol from his formula., Due to being sick and penniless, he sold his formula to an Atlanta businessman by the name of Asa Candler for a paltry $2,500. Candler later developed Pemberton’s concoction into the most famous brand in the world. Pemberton died that same year, sick, in pain, and still addicted to morphine. Lustig points out that none of the sordid story of John Pemberton is revealed at the Coca Cola museum in Atlanta.

The federal government required the removal of cocaine from Coca Cola in 1903 leaving just the sugar and caffeine. Did that scuttle Candler’s carbonated drink? No, the two remaining substances were still enough to maintain the hook! Lustig asks a rhetorical question: Why do you think Starbucks sells Frappuccinos?

My comment: No wonder Lustig mentioned Frappuccinos. Depending if they use regular cream or fat-free “cream”, this beverage has about 60 to 90% of its calories from sugar!

Continuing: Coca Cola is in every country in the world except for North Korea. Lustig says that Coca Cola is the most recognized brand on the globe and for good reason:

It’s a delivery vehicle that mainlines two addictive compounds straight to your nucleus accumbens. Sugar just happens to be the cheapest of our many substances of abuse. But all of those substances do essentially the same thing. By driving dopamine release, they all acutely drive reward, and in the process, they drive consumption. Yet, when taken to extreme, every stimulator of reward can result in addiction.

Cost of addictive substances:

  • Heroin or cocaine: You need lots of cash
  • Alcohol and nicotine: You need an I.D.
  • Sugar: You need a quarter or a cookie from Grandma

Lustig describes sugar as the cheap thrill and the reward that everyone on the planet is exposed to and the reward that’s affordable.

Everyone’s an addict, all your relatives are pushers. And it’s only one of two addictive substances that are legal and generally available. (the other one being caffeine). That’s why soda is such a big seller; it’s two addictive substances in one.

My Comments: I can personally testify that sugar is addictive as I became addicted to it an adolescent. Oh yes, I’ve gone through the cravings of wanting something sweet. Fortunately, I abused my health when I was young, and hopefully there have been no long-lasting effects from my past carelessness. The deceptive thing is that many sugar addicts don’t realize they are addicted, or they are in denial. Saying that I have a “sweet tooth” is just hiding that fact that I have a sugar addiction.

Sadly, many seniors are addicted to sugar, and it plays havoc with their health. Gary Taubes in his YouTube video, The Case Against Sugar, speaks of obesity, type two diabetes, heart disease, strokes, cancer, etc. as all being a subset of insulin resistance.

If you recognize that you are addicted to sugar and want to do something about it, there are several excellent self-help videos on YouTube. Simply enter “Breaking a sugar addiction” into your YouTube search window. Here’s a terrific one for starters, 3 Ways To Stop Your Sugar Cravings That Are Keeping You Fat. Here’s another by Dr. Axe, How to Kill Your Sugar Addiction Naturally. It’s superb. Good luck! End

Medical Savings Account: A ‘New’ Type of a Medicare Advantage Plan

The Medical Savings Account (MSA) type of Medicare advantage plan has existed previously, but it will be new for many people. This plan is available in selected states including Montana, Utah, and Wyoming but not yet in Idaho, Oregon, or Washington. Before we delve into the mechanics of how the MSA plan works, let’s review the types of Medicare advantage (MA) plans.

Health Maintenance Organization (HMO): Members use a designated network of doctors. With some exceptions, it is not intended to be used out-of-network.

Preferred Provider Organization (PPO): Members have lower co-pays if they use in-network doctors, but they have the flexibility go out-of-network.

Private Fee for Service (PFFS): Members can use any doctor that accepts the terms and conditions of the plan. When MA plans ramped up in 2006, most plans were PFFS. As the years rolled on, the marketplace evolved in that most MA plans transitioned to either HMO or PPO plans. PFFS plans have virtually disappeared from the marketplace.

MA plans can be MA plans only, or they can be MAPD, which means that they have a prescription benefit incorporated into the plan.

There’s one more important distinction to make. If you have either an HMO or PPO Medicare advantage plan and also want prescription coverage, it must be built into your MA plan. That means that you have an MAPD plan.

If you have a PFFS MA plan without drug coverage, or an MSA plan, you have the option to add a separate, stand-alone Prescription Drug Plan (PDP). If you have an MAPD, whether is be of the PPO or HMO variety and decide to switch to an MSA plan, you will need to pick up a stand-alone PDP, as MSA plans do NOT have prescription plans built into them.

How does the MSA plan work?

The following description is generic, as the numbers I’m using for example purposes only. They are NOT specific to any given MSA plan, but rather they are to illustrate how an MSA plan works. The name of our fictitious company is Acme Health Plans or AHP for short.

Qualification: Your must be on Medicare Parts A and B and live in a county where the plan is offered.

Premium: The plans are typically zero premium.

Savings account amount: The plan deposits $2,400 into your medical savings account. Remember, this is NOT the actual amount of any given plan, but rather It is for illustrative purposes only.

Deductible: $7,400—Again, this is an illustrative number only and not the amount of any given MSA plan.

Let’s say you are starting your new plan January 1, 2019. AHP deposits $2,400 into your MSA debit card account. You can go to any doctor that accepts your plan. There are no networks. You can use your plan in-state or out-of-state.

Your doctor bills AHP, and that bill comes back to you, along with your explanation of benefits, and you pay it out of your debit card account. Let’s say Medicare approved $100 for your office visit. The $100 that you paid counts towards your deductible.

Let’s say that you have exhausted your $2,400 debit account. Now you are the hook for the next $5,000 out of your own pocket for medical expenses until you reach your $7,400 deductible. Once you have met your deductible, AHP pays 100% of your Medicare approved health care expenses for the remainder of the year. The cycle resets at the beginning of the year with a new deductible and a new deposit into your MSA debit card account.

Potential downside of the MSA plan: Yes, you could be out of pocket $5,000, and that will not be acceptable for many people. In summary, AHP fronts you $2,400. From $2,400 to $7,400 you are on you own.

Other important questions

Do I lose whatever remains in my debit account at the end of year? No. Any remaining balance accumulates on a year by year basis. It’s NOT a “use it or lose it” program.

If I leave the plan after two or three years, does AHP take back my debit account? No. The funds are yours. You can continue to use them for qualified medical expenses. (see below) There may be an administrative fee on your debit account after you have left the plan.

Can I use my funds for things that Medicare doesn’t cover such as dental or vision? Yes. You can use your funds for IRS qualified medical expenses (QMEs).

Examples of QMEs:

  • Dental
  • Vison
  • Co-pays for your prescriptions
  • Hearing aids
  • Long term care expenses

Paying for your prescription plan premium from you debit account is not a QME.

Can I drop a Medicare supplement plan and sign up for an MSA plan? Yes. Make sure that you notify your Medicare supplement company that you are leaving their plan.

If I sign up for an MSA plan, can I choose a prescription plan of my choice? Yes. Remember, the MSA plan does not have a prescription benefit.

If I have another MA plan, can I switch to an MSA plan? Yes. Remember, if your MA plan is an MAPD, you will also need to pick up a stand-alone prescription plan to maintain your drug coverage.

Conclusion

Assuming you live in a state where the MSA plan is offered, you will have to determine if the plan is right for you. Consider the pros and cons. Please contact us for further information. End