Thursday, April 23, 2015

Don't Let Your Hospital Bill Cause a Heart Attack

Even if you’ve managed to avoid hospitals for most of your life, as you age chances increase that you’ll require a hospital stay. But there may never be a better time to have surgery, because hospitals are working to be more responsive to patients.

Just when you’re starting to recover from your hospital stay, you get the bill, and those chest pains start to come back. But you don’t have to feel like you have no control over your health care expenses. You can take steps—both before and after a hospital stay—to ensure the best possible financial outcome.

Admitted vs. Observed

One good way to make sure you’re not paying unnecessary costs is to pay attention when you first enter the hospital. Is the hospital classifying you as an admitted patient or just for observation? The difference can mean that you end up paying for your rehabilitative care.

Because Medicare considers hospital observation an outpatient service, it won’t pay for rehabilitation. Current Medicare law requires a patient to be in the hospital, admitted as an inpatient, for three days in order to receive coverage for rehabilitation in a skilled nursing facility. After that, Medicare pays for the first 20 days of rehab or other care. Conversely, if a patient has been under observation—for all or part of that time—he is responsible for the entire cost of rehab.

Because hospitals provide observation care on an outpatient basis, patients must usually pay co-payments for their doctors’ fees and each hospital service. In addition, patients must pay out of pocket for any medications the hospital provides for pre-existing health problems. Medicare drug plans are not required to reimburse patients for these drug costs because Medicare covers outpatient costs under Part B rather than Part A. This can mean paying more out of pocket for prescription drugs.

How to Avoid “Observation” Status
To prevent having to pay for skilled nursing rehabilitation after your hospital stay, AARP and Kaiser Health News recommend taking proactive steps:

  • Ask about your status each day you are in the hospital, as it can be changed (from inpatient to observation, or vice versa) at any time.

  • Ask your doctor whether observation status is justified. If not, ask her to call the hospital to explain the medical reasons why you should be admitted as an inpatient. However, even if the doctor agrees, the hospital may be able to overrule that decision, or Medicare can change it later when reviewing the claim.

  • After discharge, if you learn that Medicare won't cover your stay in a skilled nursing facility, ask your doctor whether you qualify for similar care at home through Medicare's home health care benefit or for Medicare-covered care in a rehabilitation hospital.

  • If you have to pay for services at a skilled nursing facility, but you believe those services should have been billed as inpatient, you can try formally appealing Medicare's decision. When you receive your quarterly Medicare Summary, follow the instructions to challenge the charges from the hospital listed under Part B of the notice. If this is denied, you can go to a higher level of appeal, following instructions on the denial letter. Also challenge any charges from the nursing home for outpatient services such as physical therapy.

  • If you are billed for care in the nursing home, ask the nursing home to submit a “demand bill” to Medicare. When it is rejected, you can appeal. The Center for Medicare Advocacy’s online "self-help packet" offers more details about how to challenge observation status.

    Source: “Medicare: Inpatient or Outpatient?” AARP; and “FAQ: Hospital Observation Care Can Be Costly For Medicare Patients,” June 18, 2014, Kaiser Health News.

Because Medicare has strict criteria for hospital admissions and usually won’t pay anything for admitted patients who should have been observation patients, hospitals in recent years have increased their share of observation patients. Yet, a government investigation found that observation patients often have the same health problems as those who are admitted (Kaiser Health News).

Growing Trend

More Medicare beneficiaries are entering hospitals as observation patients every year. The number rose 88 percent over the past six years, to 1.8 million nationally in 2012, according to the Medicare Payment Advisory Commission, which helps guide Congress on Medicare issues (Kaiser Health News). At the same time, Medicare hospital admissions stayed about the same.

The Center for Medicare Advocacy filed a class action lawsuit against the federal government in an attempt to abolish the observation status—or at least for patients to be notified and given the opportunity to make a swift appeal against the decision. However, a federal court judge in Hartford, Conn., dismissed the lawsuit, which was filed on behalf of 14 Medicare beneficiaries who were denied nursing home coverage.

The trouble is that hospitals don’t necessarily tell you how you are classified when you first come to the hospital (and Medicare doesn’t require this). So you need to be proactive to make sure you are admitted rather than observed. (See sidebar, “How to Avoid ‘Observation’ Status” for actions to take.) To counteract the overuse of observation status, in August 2013 Medicare introduced a new regulation that will require physicians to admit patients whom they expect to be in the hospital for longer than two midnights. However, the so-called “Pumpkin Rule” has gotten so much resistance from hospitals that its implementation has been delayed.

Steps to Control your Hospital Bill

In addition to inquiring about your status when you enter the hospital, you can take steps to lower health costs before and after going to the hospital.

Plan ahead. If you have the luxury of planning a procedure or surgery (that is, it’s not an emergency or you’re not restricted to certain hospitals), you can find out which hospital is the least expensive for your procedure (and is within your insurance network). Surprisingly, some of the higher-rated facilities offer the least expensive procedures. Using the billing code (available from your doctor) known as CPT (current procedural terminology), you can check Internet sites, includingFAIR Health, Healthcare Blue Book and New Choice Health for rates local hospitals charge for your procedure.

Also, when planning ahead, you may need pre-authorization, so be sure to check with your insurance company.

A freestanding ambulatory surgery facility, which is less costly than the hospital, can do some elective procedures. Check with your doctor and insurer. If you need an anesthesiologist, find out if they are in the network, because they bill separately. However, if unknown, most plans will bill at the in-network rate.

Stay on top of bills. After the surgery and once you start getting bills from the hospital, make sure you stay organized. For example, you could have bills coming from the hospital, various doctors, the lab and the ambulance. Some won’t come from the hospital itself, but from the provider who performed a service.

Check all the bills for errors. For example, if the hospital discharged you in the morning, protest if the hospital is charging a full daily-room rate for the date you left. Similarly, make sure there are no charges for medications you brought to the hospital. Also, the hospital daily-room charge should include fees for routine supplies, such as gowns, gloves and sheets, and not be extra.

Negotiate bills. If you think your bill is out of line, you can check other hospitals’ rates for the same procedure and use that data to try to convince the hospital to lower your fees. You can also use Medicare rates as a guide. Even though the government program typically has the lowest reimbursement rate for hospitals and medical providers, the Medicare fees indicate the government value of that hospital service and provide a good starting point for negotiating.

Also, many hospitals are willing to work with you if you can’t pay the bill, either giving you extra time or lowering their fees. Most hospitals have generous financial-assistance programs to help trim large bills even if your household income is above the poverty line. If the hospital can’t help, public, private and nonprofit programs are available to help. The federal government’s website and the nonprofit offer information on patient assistance programs.

Get professional help. If you think you were overcharged, and you’re unable to make any headway with the hospital, you can get assistance from a medical or patient advocate. These often experienced medical billing professionals can step in and look for errors and overcharges in your bill and ultimately negotiate a lower rate. Typically, there is no upfront cost. The advocates charge anywhere from 15-50 percent of the money they save you, and some put a cap on their fees.

Some state governments, including Connecticut, Rhode Island and California, provide medical advocates. There are also nonprofit groups, like the Patient Advocate Foundation, that will negotiate on your behalf for free or a small fee. You can also find patient and medical billing advocates through theNational Association of Healthcare Advocacy Consultants or the Alliance of Claims Assistance Professionals.

Don't Let Your Hospital Bill Cause a Heart Attack was featured in the April 2015 Senior Spirit newsletter.

Blog posting provided by Society of Certified Senior Advisors


Monday, April 20, 2015

ACA: A 2014 Update

As the ACA continues to evolve, it’s wise to stay abreast of any changes that
affect Medicare spending.

The Affordable Care Act has a number of provisions that affect both Medicare and older adults. Those provisions are designed to achieve four major goals:
  • Make preventive health care more accessible and affordable.
  • Eliminate the Medicare Part D prescription drug benefit coverage gap, also known as the “donut hole.”
  • Reduce overall Medicare spending and extend Medicare’s financial solvency.
  • Increase efficiency and reduce Medicare waste, fraud, and abuse.
Most of the provisions in the ACA designed to achieve these goals are ongoing or have already been implemented. It’s worth noting that the law and its provisions cannot reduce traditional Medicare benefits, change eligibility, ration care, or increase premiums,
co-pays, deductibles, and co-insurance. 

People on Medicare have the opportunity to receive a free annual wellness visit that includes nine services, an annual health plan, and a five to ten-year schedule for preventive health screenings. In addition, Medicare will cover seventeen preventive services without any out-of-pocket costs. These preventive services have been available since 2011.

Medicare Part D Donut Hole
The donut hole—the coverage gap in Medicare Part D prescription drug benefit—will be closed by 2020. The closure began after the passage of the law in 2010 and is on track to shrink according to the schedule in the chart below:

Funding to close the donut hole is provided, at least in part, through Medicare spending reductions achieved through the Affordable Care Act.

Medicare Spending
Prior to the passage of the ACA, the Medicare Part A Trustees Board projected that Medicare would become insolvent in 2016. This means that the program would spend more money than it would receive in revenue. For a program with over forty-nine million beneficiaries, insolvency would have significant implications that could eventually impact both benefits and delivery of services.

As a result, a major focus of the ACA was to extend Medicare’s solvency. And to a large degree, that effort has been successful. The latest projection from the Trustees Board extends Medicare’s solvency through 2030. While this solvency extension is not entirely the result of the ACA, the law’s spending reductions do play a major role.

In 2012, the non-partisan Congressional Budget Office (CBO) estimated that the ACA will reduce projected growth in Medicare spending by more than $700 billion between 2013 and 2022. In other words, Medicare spending will still continue to grow every year, but that spending growth will be lower because of the ACA. In 2010, the Centers for Medicare and Medicaid Services (CMS) estimated that Medicare spending without the ACA was projected to increase at an average annual rate of 6.8 percent. With the ACA, spending would grow at 5.3 percent.

It’s also important to understand where these spending reductions are targeted as well as the reasons behind them. In 2012, the same year as the CBO estimate, about 32 percent of all Medicare benefit payments went to hospitals, 23 percent was spent on reimbursements to Medicare Advantage (MA) insurance companies, and 19 percent went to physician payments. That means payments to hospitals and Medicare Advantage plans represented almost 60 percent of all Medicare benefit spending.

Based on those numbers, it’s not surprising that almost 70 percent of the ACA’s Medicare spending reductions focus on reimbursements to hospitals and Medicare Advantage plans.
Hospital reimbursements. Medicare’s largest spending reductions affect hospitals.

According to the Congressional Budget Office, Medicare hospital reimbursements will be reduced by about $260 billion between 2013 and 2022.

It is hoped that reduced hospital reimbursement rates will promote greater efficiency and reduce administrative waste without affecting service quality. But whether cuts will negatively affect long-term service quality remains to be seen. However, the most significant impact may be on the financial security of some hospitals. In 2011, CMS projected that 15 percent of hospitals could become unprofitable within a decade.

Another significant part of the law’s spending reductions includes reducing unnecessary hospital readmissions and Medicare waste, fraud, and abuse. Under the ACA, hospitals receive reduced reimbursement payments for “unnecessary” readmissions. Between January 2012 and August 2013, unnecessary readmissions were reduced by 130,000. CMS estimates that these provisions will lower Medicare spending by $8.2 billion between 2010 and 2020. Since 2010, efforts inspired by the ACA to reduce Medicare waste, fraud, and abuse have recovered about $19.2 billion from parties seeking fraudulent payments.

Medicare Advantage reimbursements. The second-largest spending reduction affects Medicare Advantage. Federal reimbursements to private insurance companies offering Medicare Advantage coverage became a focus of ACA spending reductions, not only because of their contribution to overall spending, but also what was viewed as systemic overpayment. Prior to the ACA, MA plans were being reimbursed 14 percent more on average than traditional Medicare fee-for-service plans. That translated into an extra $1,280 per MA enrollee, or $14 billion in higher aggregate payments.

As a result, the ACA reduced MA payments while providing marketing and other incentives for quality improvements. According to the CBO, MA reimbursements will be lowered by an estimated $156 billion between 2013 and 2022. Those spending cuts began in 2012 and are scheduled to end in 2017. MA payments have been reduced, on average, from 114 percent of Medicare fee-for-service in 2009 to 106 percent in 2014.

In reality, that estimate will likely be lower than projected, since planned reimbursement cuts were not made in 2014 and won’t be made in 2015. Instead of a 2.2 percent cut for 2014, MA reimbursements were actually increased by 3.3 percent. For 2015, a scheduled 1.9 percent cut will be changed to a 0.4 percent spending increase. Those changes were based upon lower Medicare spending trends over the next several years.

With one exception, the impact of these provisions on Medicare Advantage coverage has been pretty minimal. According to the Federal Department of Health and Human Services, since passage of the ACA:

  • MA enrollment has increased by more than 30 percent. Average MA beneficiary premiums have decreased by 10 percent. Total revenues for MA insurers have increased by 29 percent.
  • Plan quality has improved, with more than half of all MA policyholders enrolled in plans with four or more “quality stars.”
  • More than one-third of all MA contracts have four or more quality stars in 2014, compared to only 14 percent in 2011.

The downside for MA policyholders may be the potential impact on provider networks. The biggest overhead cost for insurance companies is the direct cost of health care, and they frequently adjust or reduce their provider networks to better manage costs and profits. UnitedHealth Group, a leading MA plan provider, has reduced its national provider networks by some 30,000 physicians over the last two years. The company’s stated goal is to reduce its networks by 10 to 15 percent over last year.

The Sequester and the latest spending trends. Medicare spending has also been significantly reduced by another law that has nothing to do with the Affordable Care Act. The so-called sequester (mandatory, across-the board spending cuts) created by the Budget Control Act of 2011, implemented a maximum 2 percent cut on all Medicare physician claims submitted after April 1, 2013. The CBO estimates that these sequester-based cuts will reduce Medicare spending by $123 billion between 2013 and 2021.

As it turns out, all of these spending reductions, as well as other factors (such as the enrollment of younger and healthier baby boomers into Medicare’s risk pool), have helped to create the lowest growth rate in Medicare spending in many years. This trend has been so significant that the CBO has lowered its projections for Medicare spending each year since 2010. Medicare spending was expected to be $1,200 lower per beneficiary in 2014 than was projected in 2010 and more than $2,400 lower in 2019. 

For the first time in recent history, Medicare spending is growing much slower than the rate of growth in the U.S. economy. Medicare hospital spending has been growing at an average rate of about 0.8 percent per year since 2009, compared to the overall economy, which has been growing at a rate of about 3 percent. 

However, this spending trend is not going to last. With the ever-growing aging population in the United States, Medicare spending is sure to increase. At some point in the not too distant future, Medicare will be facing insolvency issues again. At best, the ACA is helping in the short run.

The IPAB and the Elder Justice Act 
One of the more controversial provisions of the ACA is the creation of the Independent Payment Advisory Board, (IPAB) a board of experts nominated by the President and approved by the Senate. If Medicare spending growth increased more than a half of a percent above the economy, the board would make recommendations to bring that spending in line. Congress could implement those recommendations or reject and replace them. However, Congress would still have to reduce spending by the targeted amount.
Due to political concerns and the downward trend in overall Medicare spending, the board has not been appointed; it could not convene until spending thresholds have been reached. In the current political climate, it is unlikely that any appointee to the IPAB would be confirmed. As a result, the IPAB has had no impact on Medicare.

Another provision of the law is the Elder Justice Act. The act was designed to reduce elder abuse through funding of adult-protective services at the state level, as well as the development of legal guidelines, national databases, and forensic centers to address elder abuse and neglect. Unfortunately, the act was not funded in the law’s original appropriation and very few of these provisions have received meaningful funding since 2010.

Impact of the Midterm Elections
Since this article was written in November 2014, it’s not entirely clear how the midterm elections will impact the Affordable Care Act. There will be at least one more attempt by the House of Representatives to repeal the entire law, but that is not likely to pass the Senate, since the Democratic minority will likely filibuster the effort. Even if the repeal could pass in the Senate, it would certainly be vetoed by the President. As a result, the law is likely to remain in place through 2016.

Attempts will be made to repeal the medical-device tax, the individual mandate, and provisions of the employer mandate. There will also be attempts to defund specific parts of the ACA and its implementation.

A number of federal court cases and lawsuits may impact the ACA as a whole, but most of these do not specifically affect the provisions of the law that directly apply to Medicare.
In terms of specific legislation, incoming Senate Majority Leader Mitch McConnell and House Speaker John Boehner are clear that the new Congress will attempt to repeal the Independent Payment Advisory Board. Inasmuch as it was never implemented, that repeal would have no immediate impact on Medicare.

The real issue is whether the IPAB will be repealed without being replaced with another alternative. Given the aging baby boom population and higher Medicare utilization in the future, there is no doubt that Medicare spending will significantly increase over time. Even with current spending trends, Medicare is still projected to become insolvent in sixteen years. Clearly, some mechanism to manage Medicare spending will need to be introduced long before then. If the IPAB is simply repealed without some other major Medicare reform or restructuring, we will be forced to confront the problem with an important tool missing from the toolbox. •CSA

Bob Semro is a policy analyst for the Bell Policy Center, a non-partisan, nonprofit research and advocacy organization in Denver, Colorado. He currently serves on the Health Plan Advisory Workgroup for the Colorado Health Benefits Exchange. Contact him at 303-297-0456, ext. 225, or

ACA: A 2014 Update was recently published in the Winter 2015 edition of the CSA Journal.

Blog posting provided by Society of Certified Senior Advisors

Friday, April 17, 2015

Throw Out the Telephone and Start Skyping

For those of us who grew up in the age of communicating by telephone, supplemented by letters, a technology like Skype can seem amazing, because you’re able to see the person you’re talking to, even if he or she is on the other side of the country or world. It’s especially a boon for older adults whose families don’t live nearby, so you can see your grandchildren’s rapid growth spurts, or the drawing they did in class, or their piano recital. You can make contact with old friends who have moved away, and view their new homes and environment.

Although there are several video chat services, Skype has become the dominant one, even entering our language, as in “I just Skyped with my daughter.” Facetime is the other main video chat source but is more limited as it can be run only on Apple products. Skype, however, can be run on PC or Mac desktop or laptop computers, using the latest version of its operating system: Windows, Linux or Mac OS. Both Skype and Facetime can also be accessed on your cell phone. Unlike Facetime, Skype also offers audio calls, instant messaging, screen sharing, file sharing, games and video conferencing (think about getting the whole family together or your college friends for one big chat).

The beauty of both Skype and Facetime is that calls from computer to computer are free; you pay a fee only if you are using a landline or cell phone. Skype, which is owned by Microsoft, offers additional services for a fee, including teleconferences.

For Mac users, the advantage of Facetime is that it is already built into your device, so you don’t have to add anything else on.

Getting Started

If you just want to make voice calls with Skype, you can use the computer’s microphone or buy one; for better quality voice, use a headset. For video calls, you’ll need a webcam if your computer doesn’t have one. A general rule of thumb is that the more expensive the webcam, the better quality you’ll get for voice and visuals.

Make sure your computer meets Skype’s system requirements: one GHz processor at the least. If you're running Windows or Linux, you need 256 GB of RAM; for Macs, it's 1 GB. You'll also need the most recent update of DirectX (PC) or QuickTime (Mac).

Next, download Skype from its website, choosing your operating system (Windows, etc.) and select whether you want the free version or Skype Premium, which includes video conferencing and phone calls to landlines. After creating a Skype name, password and basic information about yourself, you can decide whether your information will be visible to the public (searchable by anybody using Skype), private or visible only to your friends. You’re also given the option of adding a profile picture.

At some point, you’re offered the option of adding "echo/sound test service" to your contacts, which is a good way to make sure your account is set up correctly. Once you've added this as your first contact, click on it and choose "call." This audio-only call plays a recording that allows you to record and play back your own voice. If you can hear both recordings, then you're ready to start Skyping.

Source: "How to Use Skype," How Stuff Works

Throw Out the Telephone and Start Skyping was featured in the March 2015 Senior Spirit Newsletter. 

Blog posting provided by Society of Certified Senior Advisors

Wednesday, April 15, 2015

E-cigarettes: A Safe Alternative to Smoking?

When e-cigarettes first became available in 2006 they were heralded as a smokeless and therefore safer way to inhale nicotine, as well as a method to quit smoking. But, almost a decade later, although they have become more popular, no studies have conclusively proven their safety and their effectiveness for smoking cessation.

When e-cigarettes first became available in 2006, they were heralded as a smokeless and therefore safer way to inhale nicotine, as well as a means to quit smoking. But, almost a decade later, although they have become more popular, no studies have conclusively proven their safety and their effectiveness for smoking cessation.

In fact, several smaller studies have shown harmful effects, and many jurisdictions are starting to take action to have e-cigarettes—also known as vapor cigarettes—regulated in the same way as traditional cigarettes. Canada prohibits the sale, advertising or import of e-cigarettes containing nicotine. In the United States, Wisconsin and New York are considering treating e-cigarettes the same as traditional cigarettes; and in San Francisco, a bill to regulate them would bar their use at work, schools, on public transportation and in restaurants and bars—just like cigarettes.

Health Risks of Traditional Smoking
While studies on the risks and benefits of e-smoking are not conclusive, those of traditional cigarettes have been well-researched:
  • An estimated 438,000 Americans die each year from diseases caused by smoking. Smoking is responsible for more than one in five U.S. deaths.
  • Smoking is directly responsible for more than 90 percent of chronic obstructive pulmonary disease (COPD) deaths and approximately 80 to 90 percent of lung cancer deaths in women and men, respectively. COPD prevalence rates are highest among those 65 years of age and older, and the disease consistently ranks among the top ten most common chronic health conditions and sources of daily activity limitation.
  • Men 65 or older who smoke are twice as likely to die from a stroke, and women smokers are about one and a half times as likely to die from a stroke than their nonsmoking counterparts.
  • Cigarette smokers have a far greater chance of developing dementia of any kind including Alzheimer's disease compared to nonsmokers. Smoking reduces one's normal life expectancy by an average of 13 to 15 years, thereby eliminating retirement years for most smokers.
Source: “Smoking and Older Adults,” American Lung Association

Teenagers comprise the bulk of e-cigarette users, although the general population is increasingly “vaping” as well. Nearly 1.8 million children and teens in the United States had tried e-cigarettes by 2012 (from HealthDay News). Last year, the number of American adults using e-cigarettes topped 40 million, an increase of 620 percent from 2010. 

While no figures exist for how many older adults use e-cigarettes, anecdotal evidence indicates many seniors have taken up the habit. If so, switching from traditional cigarettes to e-cigarettes makes sense for seniors. Older smokers are at greater risk because they have smoked a longer amount of time (an average of 40 years). They also tend to be heavier smokers and are more likely to suffer from smoking-related illnesses than the general population, according to the American Lung Association (ALA). They are also significantly less likely than younger smokers to believe that smoking harms their health.

After all, the older generation was weaned on the image of smoking as glamorous and cool: Just think of James Dean, Bette Davis, Humphrey Bogart and Lauren Bacall, to name a few movie stars, with cigarettes dangling from their mouths or coolly held between fingers. In fact, the ALA says that today's seniors had smoking rates among the highest of any U.S. generation. In the mid-1960s, about 54 percent of adult males were current smokers, and another 21 percent were former smokers; in 2008, about 23 percent of adult males were smokers and another 24 percent were former smokers. In 2008, 9 percent of Americans over 65 years of age smoked.

Despite our growing knowledge that smoking is harmful, more than 40 million Americans are cigarette smokers. Smoking cigarettes is known to cause damage to every organ in your body, and smoking-related illnesses are responsible for one out of every five deaths in the United States, according to the Centers for Disease Control. (See sidebar, “Health Risks of Traditional Smoking.”)

Nearly 70 percent of smokers report they want to quit, and a little more than 42 percent say they've tried to quit during the past year, which may be one reason that some smokers are using e-cigarettes to ease off their habits. Another possible reason for their use among older adults is that some senior-living facilities permit e-cigarettes but not traditional smoking, although this is an evolving area, and no hard figures exist about how many facilities are making this distinction. While Brookdale Senior Living, the largest senior-living provider in the country, does not allow either type of smoking in common areas, some facilities may allow e-smoking in a resident’s own apartment.

What Are E-cigarettes?

Electronic cigarettes are battery-operated devices that resemble traditional cigarettes. However, instead of burning tobacco, they generally contain cartridges filled with nicotine and other chemicals. An atomizer heats a liquid containing nicotine, turning it into a vapor that can be inhaled, or “vaped,” and creating a vapor cloud that resembles cigarette smoke. They can come in a variety of “flavors,” such as menthol, fruit, coffee and chocolate. Some e-cigarettes have a cigarette-like LED tip that glows red (or another color, depending on the product you're using).

Unlike traditional cigarettes, the federal government does not regulate e-cigarettes. In April 2014, the Food and Drug Administration (FDA) proposed rules that would regulate them in the same way as it does traditional cigarettes. Once the proposed rule becomes final, FDA will have the authority to ban the sale of e-cigarettes to minors, if it deems them to be unhealthy, and would be able to initiate comprehensive scientific review of them.

Because e-cigarettes have not been fully studied, the FDA states, consumers currently don’t know:

  • the potential risks of e-cigarettes when used as intended;
  • how much nicotine or other potentially harmful chemicals are being inhaled during use; and
  • whether there are any benefits associated with using these products.

When the FDA conducted limited laboratory studies of certain samples, it found that quality-control processes used to manufacture these products are substandard or nonexistent. For example, cartridges labeled as containing no nicotine in fact contained nicotine, and three different electronic cigarette cartridges with the same label emitted a markedly different amount of nicotine with each puff. The e-cigarette industry has criticized these studies as limited to only two makers of e-cigarettes.

Dangers of E-cigarettes

Although the FDA does not have the authority to monitor e-cigarette use, it receives voluntary reports of adverse events from consumers and health professionals, which have included hospitalization for illnesses such as pneumonia, congestive heart failure, disorientation, seizure, hypotension and other health problems.

In the absence of large-scale studies about the consequences of smoking e-cigarettes, several smaller ones have found harmful effects. One recent study found that vapor from electronic cigarettes may increase young people's risk of respiratory infections, whether or not the cigarettes contain nicotine (reported in HealthDay News). The vapor triggered a strong immune response in the cells that line the inside of the lung and protect the organ from harm, said lead author Dr. Qun Wu, a lung-disease researcher at National Jewish Health in Denver. Once exposed to e-cigarette vapor, these cells also became more susceptible to infection by rhinovirus, the virus responsible for the common cold, researchers found.

Another study (reported in HealthDay News) said that e-cigarettes operated at high voltages produce vapor with large amounts of formaldehyde-containing chemical compounds, according to research co-author James Pankow, a professor of chemistry and civil and environmental engineering at Portland State University in Oregon. Although the cancer-causing chemical was not found at lower voltages, newer versions of e-cigarettes can operate at very high temperatures, and that heat dramatically increases formaldehyde-containing compounds, the study found.

Other studies, including those trying to determine if e-cigarettes help smokers to quit, show positive results for e-cigarettes. A Cochrane Review showed that e-cigarettes double the likelihood of quitting smoking compared with a placebo, and that they increase the likelihood of reducing smoking levels by more than 30 percent (as reported in Medscape ). However, the investigators caution that few studies exist on the effectiveness of e-cigarettes, and that the quality of the available evidence is low.

The issue, health experts agree, is that e-cigarettes need to be studied further. Because the potential health hazards of e-cigarettes remain unclear, both the American Association for Cancer Research and the American Society of Clinical Oncology have called for regulating e-cigarettes like traditional cigarettes.


“The Research Behind Electronic Cigarettes,” Ecig Advanced

“E-Cigarettes: Questions and Answers,” FDA

“Smoking and Older Adults,” American Lung Association

“Health Risks of E-cigarettes, Smokeless Tobacco, and Waterpipes,”

“Quit smoking,” Mayo Clinic

“E-Cigarettes Under Fire,” WebMd

“10 Little-known Facts About E-cigarettes,” How Stuff Works

“E-cigarettes: Slippery slope to tobacco addiction?” Editorial, CMAJ Medical Journal

“E-Cigarette Use May Be Rising Among Teens,” Dec. 15, 2014, HealthDay News

“High Levels of Cancer-Linked Chemical in E-Cigarette Vapor, Study Finds,” Jan. 21, 2015, HealthDay News

“E-Cigarettes for Smoking Cessation: Jury Still Out,” Dec. 17, 2014, Medscape

E-cigarettes: A Safe Alternative to Smoking? 
 was featured in the March 2015 Senior Spirit Newsletter. 

Blog posting provided by Society of Certified Senior Advisors

Monday, April 6, 2015

The growing long term care funding crisis requires understanding private pay alternatives

Statistics show that the majority of people do not understand the various forms of long term care, the different means to pay for it, and most do not plan for long term care until they are hit by a health care crisis.  Today, Social Security, Medicare and Medicaid are all in the red and creating havoc for government budgets at the federal and state levels.   State budgets have been impacted particularly hard by shrinking tax dollars and growing Medicaid enrollment brought on by an aging population.  Over 10 million Americans now require long term care annually, and Medicaid is the primary source of coverage. 

Seniors and their families are already struggling with the costs of everyday living, if you add the costs of long term care to the picture it is a back breaking scenario for most Americans.  The simple fact is more responsibility is going to be placed back on the individual and their families to find the resources necessary to handle the costs of long term care.  Understanding the growing array of alternative private pay solutions is a critical part of long term care planning for any senior care advisor and provider.

The Solution

Twenty years ago the only real alternative to Medicare and Medicaid was long term care insurance.  Today, a variety of private pay options exist in the market that can help a person remain financially independent, preserve assets, maintain more control of the type and location of care they access, and will go a long way towards preserving dignity for an individual and their family when confronting the need for care. 

Among the options that a senior care advisor and provider should have familiarity with, are:

  • Veterans’ Aide & Attendance Benefit: A monthly benefit for low income veterans (and their spouses) who served at least one day during a wartime period.
  • Converting life insurance into a Long Term Care Benefit Plan: A Long Term Care Benefit Plan is the conversion of an in-force life insurance policy into an irrevocable, FDIC-insured Benefit Account that is professionally administered with tax-free payments made monthly on behalf of the individual receiving care.
  • Reverse Mortgages: A reverse mortgage is a loan that enables senior homeowners, age 62 and older, to convert part of their home equity (primary residence only) into tax-free income without having to sell their home, give up title to it, or make monthly mortgage payments.
  • Viatical/Life Settlements: A life or viatical settlement is the sale of an existing life insurance policy to a third party for more than its cash surrender value, but less than its net death benefit.
  •  Senior Living Loans: Senior Care Bridge Loans are designed to help seniors and their families with the cost of assisted living, home care or skilled nursing on a short term basis.  The loan is unsecured with up to 6 co-signers permitted instead of collateral and the loan payments are made directly from the loan account to the care provider.
  •  Single Premium Immediate Annuities (SPIA): An immediate annuity is a contract with an insurance company under which the consumer pays a certain amount of money to the company and the company sends the consumer a monthly check for the rest of his or her life. In most states the purchase of an annuity is not considered to be a transfer for purposes of eligibility for Medicaid, but is instead the purchase of an investment.
  •  Long Term Care Insurance: Long-term care insurance is designed to cover a wide range of long-term care services. Most long-term care services are NOT covered by any other kind of insurance, including health insurance, long-term disability insurance, Medicare, or Medicare supplemental coverage.

When it comes to private pay financial solutions for long term care it is not about selling a product; rather, it is about providing information and access to resources that will allow for effective long term care financial planning.  Advisors should be focused on understanding the crisis situation we are dealing with as a country and the variety of resources that can help people both plan for the future and react to an immediate situation.  The seven private pay funding solutions presented in this article are all viable alternatives to going onto Medicare and/or Medicaid. It is the responsibility of every advisor to be familiar with how they can benefit a family confronting the realities of long term care.

  • Watch the recent webinar, Private Pay Options for Long Term Care, presented by Chris Orestis, CEO of Life Care Funding. 

  • Read the expanded article by Chris Orestis covering Private Pay Options for Long Term Care in-depth in the spring edition of the CSA Journal.
 About the Author

Chris Orestis, CEO of Life Care Funding, is an 18-year veteran of both the insurance and long-term care industries.  A former Washington DC lobbyist, he is a nationally known senior care advocate and author of the Amazon best-seller book “Help on the Way”, a legislative expert, featured speaker, columnist and contributor to a number of insurance and long term care industry publications.  Chris is a frequent guest about senior issues on national radio programs; and has also been featured in the Wall Street Journal, New York Times, USA Today, Fox Business News, and PBS.
Founded in 2007, Life Care Funding was the first to pioneer the concept of converting a life insurance policy into a Long Term Care Benefit Plan.  Since the company’s inception, they have built a national network of agents, attorneys, and advisors as well as over 5,000 Homecare, Assisted Living and Nursing Home companies that offer the Long Term Care Benefit policy conversion option to families directly across the United States. 
His blog on senior living issues can be found at He can be reached at 888-670-7773 x 6623 or

Blog posting provided by Society of Certified Senior Advisors

Tuesday, March 31, 2015

Meet CSA Spotlight, Angela McCants

Bessie's Hope
I was a teacher at Dealey Montessori school before launching my real estate career, so I can appreciate the power of education. After working with the families of many clients who were moving for the last time, and after watching my own parents downsize, I realized there was a need for extra sensitivity, knowledge, and instruction. The regular Realtor training just wouldn’t do.

In 2005, I investigated the Society of Certified Senior Advisors and decided this was the training that would benefit my clients the most. It was very intense and gave me a great overview of the needs this demographic and their families faced. It also led me to other caring professionals in areas outside of my expertise to whom I would feel comfortable referring clients if they needed other services.

Recently, I also earned the Certified Senior Housing Professional designation, which zeroes in on meeting seniors and their families’ needs specific to real estate. With specialized tools and coaching, I now offer seminars such as “Downsizing Made Easy” and “How to Avoid 5 Common Mistakes Made by Adult Children of Aging Parents.”

I wanted to equip as many families as possible with this valuable information. But I realized this was going to be quite an undertaking, given that the adult senior market has quadrupled in recent years due to the Baby Boomers reaching retirement age.

So I teamed up with another caring and experienced agent, Caroline “CC” Allen. As the Senior Lifestyle Specialists, we have put together a network of other Certified Senior Advisors and highly vetted organizations to service our clients. Too many families have been taken advantage of in these precious years, so we want to make sure we work with individuals who have the highest level of integrity and whom we would trust with our own parents.

CC and I offer a monthly community breakfast called Heart Café at the Park City Club that keeps us connected to our clients and community by offering speakers who enlighten, engage, and encourage families going through one transition or another. It has been a wonderful way to continue serving and connecting to families adjusting to new lifestyles.CC and I are both agents with Dave Perry-Miller Real Estate, a firm that markets distinctive homes in Dallas’ most-established neighborhoods. We were drawn to the firm because its culture strives for excellence in all aspects of serving clients. Its motto is “Properties of distinction. Agents for life.”

I take the motto to heart. Each home is distinct and special to the owner. I find it to be a great treat to bring out and highlight features that the owner loved and cherished. I’m not just an agent who helps clients buy and sell homes. I walk them through the entire journey, simplifying what may otherwise be an emotional, complicated, and overwhelming task. At the end of the day/transaction, my goal is to leave them feeling overjoyed!

Online resources

Angela McCants

Senior Lifestyles Specialists

Heart Café

Angela McCants was featured as the CSA Spotlight in the March Senior Spirit Newsletter.

Blog posting provided by Society of Certified Senior Advisors