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Saturday, June 25, 2022

How to Reduce Your Medicare Bills

Seniors with original Medicare need to ask two questions before receiving healthcare that could save them a lot of money.  

Eight in 10 Americans are more worried about running out of money than dying, according to a recent study. Yet many older adults aren’t aware of two Medicare provisions that could have a big impact on how much they pay for healthcare. 

New Out-of-Network Bill Protection

In January, patients with individual or employer-sponsored health plans using an in-network emergency facility finally got federal protection from out-of-network billing. The No Surprises Act prevents out-of-network providers from billing patients for ancillary care, including care provided by an anesthesiologist or assistant surgeon. It also prevents surprise billing for air ambulance services, although ground ambulance service is exempt. 

“This new law will make sure that you won't get a bill that looks any different than the one you would have gotten if you were using an in-network provider,” says Jack Hoadley, research professor emeritus at Georgetown University’s McCourt School of Public Policy.
Now, even people who get routine care at in-network facilities cannot be billed out-of-network rates by providers who were involved in their care without their knowledge. For example, someone at an ambulatory surgical center cannot be billed more than the in-network rate by someone who put them to sleep or read their X-rays. If you suspect you are being billed incorrectly, read this article or call the No Surprises Helpdesk at 800-985-3059.

Paying Off Medical Debt

Hospital costs can add up in spite of our best efforts. If you get hit with a big bill, there are steps you can take to minimize the impact. First, check to make sure all the charges are accurate. Second, try to negotiate the bill with the hospital. See this article for more tips on reducing medical debt.

New Law Bars Medical Debt on Credit Score

Changes are coming that will soon lessen the impact of medical debt on credit scores. Two-thirds of such debts are the result of a one-time or short-term acute medical need. Together, the changes will wipe out more than $60 billion of medical collection debt from existing reports at Equifax, Experian and TransUnion, the three major credit reporting agencies.
  • As of July 1, 2022, all medical debt that has been paid will not be included in credit reports.
  • People will have 12 months, increased from six, to settle their medical bills before the unpaid debt will show up on credit reports.
  • As of the first half of 2023, medical collection debt less than $500 will not appear on credit reports.

Medicare Assignment

Once you have opted for original Medicare, you may think that all doctors who accept it are created equal as far as how much you will pay for their services. After all, only 3% of doctors don’t take Medicare at all. But you’d be mistaken. There are doctors who accept Medicare, and then there are doctors who accept Medicare assignment. What’s the difference?

A doctor who accepts Medicare assignment has agreed to take the government-approved amount as payment for covered services provided to his or her Medicare patients. This doctor sends the bill to Medicare, which then pays 80% of the cost that it has determined is appropriate. The patient is responsible for paying the remaining 20% or the patient’s Medicare supplement will cover the 20%.

A doctor who does not accept Medicare assignment but still accepts Medicare can charge the patient up to an additional 15% over the Medicare-approved amount for services provided. The patient owes the additional charge.

The lowdown: Ask every doctor if he or she accepts Medicare assignment, and only go to those who do for the lowest cost.

Outpatient (Under Observation) vs. Inpatient (Admitted)

You may be surprised to learn that you can spend the night in the hospital and yet be considered an outpatient. Of course it is not that simple. The types of procedures and tests you undergo can overlap between inpatient and outpatient status.

Outpatient status applies when you’re getting tests and services (even for urgent care) and the doctor has not written an order to admit you to the hospital. If you are “under observation” then you are an outpatient.

Inpatient status starts when your doctor writes a formal order to admit you to the hospital.

Why should you care which status you are? Money. 

As an inpatient, you are covered under Medicare Part A, where you pay a deductible of $1,556 in 2022 for the first 60 days of covered care.

As an outpatient, you are covered under Medicare Part B, where you will pay your annual deductible (if you haven’t already) plus a copayment or coinsurance for every covered service and 20% coinsurance for doctor services.

The difference can be substantial, especially if you go on to enter a skilled nursing facility (which includes rehab) within 30 days of discharge. If you have had a “qualifying stay” of at least three consecutive midnights, then Medicare will cover the cost. Your time as an outpatient, even if you were in the same hospital for the same problem, does not count. If you did not have a qualifying stay, nursing facility daily coinsurance through Medicare runs $194.50 per day in 2022.

The lowdown: Ask your doctor to which status you are assigned and consider how that will affect costs. Your doctor must formally request inpatient status. Head to for more information on how cost is affected between inpatient and outpatient status.


This article is not intended to be a substitute for professional financial advice from a qualified financial advisor. 

Blog posting provided by Society of Certified Senior Advisors

Tuesday, June 21, 2022

How to Choose an Electric Bike for Seniors

Older adults are increasingly picking an electric bicycle when they buy a new bike. The only question is: Which one?  

Electric bicycles, commonly known as ebikes, are the bikes of choice for many boomers and beyond. Although they all still rely on pedaling, the battery gives an extra power boost for getting up hills or just cruising along. Grandparents love them for keeping up with kids on regular bicycles, riding with a group, or just enjoying a longer ride. Older adults who had become intimidated by hilly country can tackle it again, and weaker riders can keep up with stronger cyclists. Bike shop owners say their ebike customers are usually already bike riders, not newbies, and there are plenty of older riders among them.


But even veteran riders need to learn a few ebike basics. For instance, there are three classes of ebikes. Class 1 bikes feature a motor that kicks in only when you pedal, and it stops assisting when you reach 20 mph. Class 2 has pedal-assist to 20 mph just like Class 1, but it adds a throttle-powered mode. Class 3 is pedal-assist only like Class 1, but it will keep assisting until you reach 28 mph. Most riders start with a Class 1 bike. They are not only the most economical, but they are allowed on city streets and most bike paths. 

Ebike Battery and Motor Basics

Bike batteries trade off performance for riding range. A stronger motor is going to give you more speed for keeping up and more torque to climb hills or haul cargo, be it your shopping bags or the grandkids. But keep in mind that a stronger motor will run down the battery faster and reduce your riding range. 

Comfort is Key

No matter what you want your ebike to do, comfort must be a key consideration. One factor you want to consider is whether you want a hybrid bike or a comfort bike. (We assume that road bike fanatics and mountain bikers are choosing their bike for performance). Your riding position is a little different on each.

So-called “comfort” bikes may induce back or knee pain after a ride on a rough trail. But the more forward position of a hybrid bike may cause lower back pain to flare. Be sure to try out both styles, consult your retailer, and read this evaluation of hybrid vs. comfort bikes

Battery capacity is listed in watt hours (Wh), or the number of hours a battery can put out a sustained watt of power before dying. So, a 250-watt motor paired with a 500 Wh battery (often found in Class 1 ebikes) drains power more slowly than a 500-watt motor paired with a 500 Wh battery (common in Class 3 setups).

Check out Bosch’s Ebike Range Assistant tool to see the interplay among an array of factors that affect riding range. REI’s Intro to Ebikes offers tips on how to extend your riding range.

Most bicycle batteries will charge in three to five hours, although you can buy quick chargers. Some ebikes come with two batteries you can use at the same time to allow for a longer ride. Batteries will either be integrated into the frame (allowing for a bottle cage) or mounted externally (making changes/replacements easier).

The motor is usually placed mid-drive where you pedal or in the hub of the rear wheel. Mid-drive motors lend a more natural feel to pedal assistance and give a balanced, stable ride with the motor centered and low on the bike. Hub-drive motors concentrate power on the rear wheel, making it feel as though someone is pushing the bike from behind. They can make it tricky to change a flat.

What Is Torque?

If you need to climb hills or want to carry loads with your new bike, then you need to pay attention to torque. It will help your bike power up inclines and haul heavy loads. Torque is measured in newton meters (N m). Check on the listed maximum range while understanding that actual torque will change depending on your pedal-assist settings. 

Ebike Cost

While an electric bicycle can extend your riding career for many years or decades, the machines don’t come cheap. Decent models start at about $1,500 and work their way up to $10,000 or more depending on the frame material, battery and motor, and component parts. 
As with most things in life, you get what you pay for. 

Throttle-operated bikes and bikes with a cadence sensor will set you back in the lower range of $1,500 and up. For $2,500 or more, you can get a model with a torque sensor. But buying a quality bike pays for itself in satisfaction dividends. 

Where To Go

Start out at a reliable local bike dealer who is enthusiastic about ebikes. How will you know? They will have many models to choose from, prominently displayed in the store. They will ask you lots of questions about what you want to use the bike for, where you like to ride, what features are the most important to you, if you have a favorite brand, etc. In other words, if you enter the shop and find there are two ebikes stored in the back and no one can answer your questions, turn around and walk out. 

You are not just looking for a reliable retailer for your electric bike purchase. You want someone who will be there for the next ten or fifteen years to service your bike, and someone who will take care to set up and tune your bike correctly. Find a local, independent dealer who has an interest in taking good care of you and your investment for many years to come.

How Long Will a New Ebike Last?

The life of your new bike is partly determined by its genetics: the way it was built, the materials it is within it, the quality of its construction. But the other part of this equation is the care it receives: cleaning and oiling, regular maintenance and service. A lithium-ion battery ought to last about 600 to 800 full charge cycles, so the timeline will vary depending on how often you use your bike.

Be smart and get a bike with a warranty. A two-year warranty on parts, motor, and battery (without any exclusions for normal wear and tear) is a reasonable expectation on ebikes costing $2,000 and up.

Know Your Priorities

There are as many electric bike styles out there as there are regular bikes, so knowing what you will be using it for is essential before you start shopping. If you are a long-distance rider (or will be with a power boost), then look for a battery with 400 watt-hours or more. If you just want comfort, make sure you get a step-through frame. If hill climbing will figure into a lot of your rides, then make sure you get a middle motor system or high torque hub motor. Your dealer should patiently help you through these decisions.

No matter what kind of bike you want, test ride several models. Love the first one you try? Test ride at least three more anyway. Electric bikes can handle differently depending on where the motor is placed and what it’s designed to do. You need to know the specs and research, but you also need to ask yourself if you love the bike when you ride it. If you do, double-check if it can do the job you need it for, if it fits you, and if it has the quality you’re looking for. Do not be swayed into an impulse purchase. Come back the next day and see if you love it every bit as much. 

Your bike should be a joy to ride. You ought to have high expectations of your new transportation. Not every ebike is made to stand the test of time or give you great performance. Ask your retailer if the brand has been around a long time and if they expect it to be around many more. And don’t hesitate to check reviews of the bike before you fall in love with it.

Wednesday, June 15, 2022

Is It Time for Home Solar Panels?

Federal and state subsidies, plus new products and utility incentives, make this an excellent time for seniors to consider getting solar panels installed on their home’s roof.  

The cost of home solar systems is going down year after year as the technology improves. The federal government offers tax credits for putting in a new system, and many states have their own programs to promote solar energy. Your utility company may buy back extra credit you produce, although the rate varies according to where you live. Finally, the largest American roofing company has just begun production on flexible solar shingles that nail onto your roof just like regular asphalt shingles.

Rooftop solar uses a technology called photovoltaics, or PV. These panels collect photons from sunlight to create an electric field. They are made to work in a wide variety of climates, but not every roof may be suitable. For example, trees may excessively shade a roof, or the roof may be angled too much to the north. Usually, solar panels are optimal on south-facing roofs with a 15 to 40 degree slope, but other configurations are often suitable, too.

Solar Shingles Are Here

Timberline Solar roofing systems are installed just like asphalt roofing tiles. The flexible shingles, less than a quarter of an inch thick, received a Best of Innovation Award for Smart Cities at CES 2022. 

“No one has ever specifically tried to make a solar product that a roofer can install,” says Martin DeBono, president of GAF Energy. “And we’ve done it, and our product goes on with just a nail gun. It goes on twice as fast as typical solar.”

Since installation is typically the greatest cost for residential solar, that is no small claim. GAF says that its new roof costs about half as much as the Tesla Solar Roof, and it has the added benefit of being offered by the company that makes one out of every four new roofs in the US, installed with the help of its national contractor network. Learn more about Timberline Solar shingles here.

According to a 2016 analysis, there are more than 8 million square meters of rooftop in the US where solar panels could be installed. To find out if your roof has potential for PV, and to check out the solar rooftop potential, check these three tools that estimate potential energy savings for any building’s rooftop.

Benefits of Solar

But why bother with solar energy in the first place? Apart from increasing your home’s value, solar has many environmental benefits. Using power from the sun instead of conventional energy forms cuts down on the amount of carbon and other pollutants that are released into the environment. This, in turn, contributes to cleaner air and water.

A recent study found that homeowner-owned solar panels are usually seen as upgrades, to the tune of about an additional $15,000 per home. Evidence also suggests that homes with solar panels sell faster than those without, a plus in a higher interest rate market. If you are buying or selling a home with a solar roof array, the PV Value® tool can help calculate the energy production value for the system.

Federal, State and Utility Subsidies for Solar

In alignment with federal goals for cleaner energy production, the US government offers a tax credit for new solar energy systems on residential homes. A tax credit reduces the amount of income tax you owe on a dollar-for-dollar basis. The credit is 26% for systems installed in 2022, and 22% for those installed in 2023. These credits expire in 2024 unless they are renewed by Congress. Even better, if your taxes owed are less than your credit, the credit can be carried forward. For a complete guide to the federal solar photovoltaics credit, go here.

Most states offer tax credits and/or rebates for installing solar. These credits will not reduce your federal tax credits for putting in a new system. Check out the Database of State Incentives for Renewables and Efficiency to check on your state’s program.

Finally, be sure to check with your local electrical utility to find out if it offers subsidies to install a solar PV system and/or payments for excess energy produced, and at what rate. While many state’s utilities pay for power at the same, or near the same, rate at which it is sold, others like Mississippi pay next to nothing. A total of 39 states, the District of Columbia, and four territories have mandatory net metering rules. Check your state’s net metering policy.

Add Solar When Replacing Your Roof

The optimal time to put a PV system in place is when you, like millions of other Americans annually, are putting on a new roof. The average cost to replace a roof runs about $10,000, and the average cost of a rooftop solar array is in the neighborhood of $19,000. But you can reduce this combined cost from nearly $30,000 to about $25,000 by saving on labor and doing them together. 

Solar panels last 25 to 30 years —the same number of years as an average roof. When you install them both at the same time, you will ensure they need replacing at the same time, saving money down the road. For more on saving money by installing solar when you get a new roof, go here.

Getting solar panels can be a quality investment in the environment and your home. With incentives like tax credits and rebates more plentiful than ever before, it makes sense to consider whether adding solar panels could be the right move for you. There is a plethora of statistics and information available to help you make the right decision. Make sure to use a reliable company after running the numbers. You may be one of many who can have the satisfaction of watching your electric meter run backward!

Tuesday, June 7, 2022

Social Security’s Trust Fund Woefully Underperforms

Every cent of your Social Security trust fund is invested in low-yielding government bonds. Is this fair?  

Back in 1935 when Social Security was enacted, America was in the throes of the Great Depression. The country had no appetite for stocks. Franklin Roosevelt was desperate to find a way out, and his New Deal needed financing. Killing two birds with one stone, policymakers voted to invest workers’ retirement funds exclusively in safe government securities. 

The program was financed on a pay-as-you-go system until 1977, when legislation called for the accumulation of large reserves. These reserves totaled $741 billion by the end of 1998 and continued to increase until recently. This massive sum was still bound by law to be invested entirely in low-yielding special Treasury issues. The fund pays out about 22% of current Social Security checks, and it is projected to run dry by around 2033. 

Investment Performance

How much are all those FICA (Federal Insurance Contributions Act) taxes you paid earning? In April, they were invested in notes that earned 2.5% interest. You might have heard that inflation is running a hot 8.5% this year, which means that all that money is losing 6% per year. In 2021, consumer prices rose 7%. How much interest did Social Security dollars earn that year? Get ready … 1.4%. It is not hard to see why the fund is in a meltdown.

Population Demographics Tip the Scales

America’s population is getting older. People 65 and over comprised 16.5% of the total in 2021, and that number is projected to grow. That means less youngsters paying into Social Security, and more folks relying on it for a check. Why is that changing?

Back when Social Security was created, families had more children than they do these days. Kids were considered assets who would help the family and take care of Mom and Dad in their old age, and modern birth control was not available. People are living longer now, too. In 1930, the average lifespan was 58 for men and 62 for women. In 2020, those numbers had zoomed up to 75.1 and 80.5, respectively. Retirement age has not changed much at all over those 90 years; the expected norm is still at age 65.

Immigrants and Social Security

Contrary to popular belief, undocumented immigrants cannot claim benefits under the Social Security program, even though they and their employers often pay taxes into the system. Documented immigrants must qualify for the program, either by having 40 US work credits just like any American citizen or by coming from a country that has a totalization agreement with the US. More than 25 nations have such agreements, allowing workers to combine credits earned in their home country with credits earned in the US. 
Does it have to be invested in Treasuries, you may wonder? Every other pension fund in America (and internationally, by the way) has diverse holdings. More than 6,000 state and local public pension funds manage $4.5 trillion, according to Boston College’s Center for Retirement Research. That makes them one-and-a-half times the size of the whole Social Security trust fund, and more than 80% of their money is working in assets other than bonds: stocks, private equity, real estate, commodities and more. 

Oh, and what was their average return last year? Take a guess … 29%. But 2021 was an exceptional year in the market, you might argue. How have they done on a longer basis? Over three decades, the average return of these funds was 8.8%, according to Boston College’s Center for Retirement Research. Social Security has not earned 8.8% once in those 30 years. The average return for Social Security funds from 2000 to 2021 was a measly 3.2%. Anyone who understands compounding will be horrified by those numbers. 

Possible Solutions

The gap between what Social Security is paying out and what it needs to remain solvent widened another $3 trillion last year alone. What can be done? 

  • Obviously, lawmakers could change the rules and invest Social Security funds in a broader assortment of assets that typically produce higher yields. 
  • Taxes for Social Security could go up on all workers and employers.
  • The tax cap for Social Security, set at $147,000 for 2022, could be pushed upward. This is the annual dollar amount of wages subject to taxation for FICA.

Only the first option is pain-free for workers, but it may be the least likely to become reality. Politicians enjoy having your money in the budget to spend. It is doubtful that anything at all will happen until we are faced with a budget cliff, because no one wants to be known as the person who voted for higher taxes. (Interestingly, when the Reagan administration wanted to tax Social Security earnings for the first time in 1983, he had bipartisan support and the amendment passed). 

While the solution may not be clear, it is a pressing matter for those of us who depend, or who will soon depend, on Social Security checks for part of our retirement income. It is worth discussing with your representatives to hear what they propose. Older Americans have a huge stake in the outcome.


Blog posting provided by Society of Certified Senior Advisors

Friday, June 3, 2022

Famous & 65

Look who's turning 65 this month

Find out which celebrities are turning 65 this month!

Image Source: Wikipedia

June 1 - Jeffrey Hawkins, PalmPilot inventor

Remember the PalmPilot? One of its inventors, Jeffrey Hawkins, founded Palm Inc. back in 1992. The device earned him enough respect from fellow engineers to get him elected into the National Academy of Engineering “for the creation of the hand-held computing paradigm and the creation of the first commercially successful example of a hand-held computing device.”

Hawkins has turned his considerable talents to neuroscience, and founded the Redwood Center for Theoretical Neuroscience in 2002, followed by Numenta in 2005. His efforts there include heading up a team to reverse-engineer the neocortex, something which has interested him since his days at the University of California, Berkeley, back in the late 80s where he was enrolled in the biophysics program. His current work aims to improve machine intelligence technology.

Hawkins is also an author, having written On Intelligence in 2004, and more recently A Thousand Brains in 2021. The latter book discusses intelligence and how the brain views the world. It proposes a theory of what is missing in artificial intelligence. Hawkins holds a degree in electrical engineering from Cornell University.


Image Source: Wikipedia

June 13 - Roy Cooper, governor of North Carolina

Taking the time-tested path from attorney to politician, Roy Cooper defeated Republican incumbent Pat McCrory in 2016, the first time a challenger beat a sitting governor in the history of North Carolina. However, the state legislature is dominated by Republicans, who passed bills to reduce the power of the governor before Cooper took office and have since overridden many of his legislative vetoes. All the same, Cooper was reelected in 2020.

Cooper’s family has deep roots in the state. His father farmed tobacco and worked in a family law firm while his mother taught school. Cooper worked in the same firm before being elected to the North Carolina House of Representatives, and then the State Senate, while still practicing law as a partner at Fields & Cooper.

However, it may be his work as attorney general that distinguished him with voters. Elected in 2000, he helped uncover several cases of corruption and ethics violations. He acted quickly after the 2007 Virginia Tech shooting, establishing a Campus Safety Task Force two days later to make policy recommendations, which he later used to create a bill that became law to require court clerks to record involuntary commitments in a national gun permit database.

Image Source: Wikipedia

June 23 - Frances McDormand, actress

With film and television credits galore, actress and producer Frances McDormand is one of only a handful of actors to win the famed “Triple Crown”: she has four Academy Awards, two Primetime Emmy Awards, and one Tony Award. She can also claim to be only the second woman to garner a Best Actress Academy Award three times, on one occasion winning Best Picture for producing a film, Nomadland, in which she also won the top acting award.

One of McDormand’s most iconic roles was as pregnant police chief Marge Gunderson in Fargo, for which she won not only an Academy Award but also the Screen Actors Guild Award for Outstanding Performance by a Female Actor in a Leading Role. Known for appearing in a plethora of independent films, catch her performances in such gems as Blood Simple, Raising Arizona, Burn After Reading, Mississippi Burning, Almost Famous, and North Country.

McDormand is one of three children adopted by her parents, who had no biological offspring. The actor attended both Bethany College and Yale University. She has been married to director Joel Coen, one of the famous Coen brothers, since 1984. They adopted a son from Paraguay in 1995 and have no other children.


Blog posting provided by Society of Certified Senior Advisors

Wednesday, May 25, 2022

Genetics Affect Drug Reactions in Older Adults

Increasingly, patients with Alzheimer’s, cancer, depression, chronic pain and cardiovascular disease are getting genetic testing to personalize and optimize their quality of care.  

Pharmacogenetics, also known as pharmacogenomics, is the study of how genes affect an individual’s response to drugs. Genetic testing searches for changes or variations in genes that may signal which medication might be the most effective or have fewer side effects for a particular patient.

Genomic Testing

For example, scientists have been working to understand why antidepressants help some people but don’t work for others. Humans use cytochrome P450 enzymes to process medications. These enzymes vary in different people due to inherited (genetic) traits, causing medications to affect each person differently. Your doctor can use a cytochrome P450 (CYP450) test to investigate how your body metabolizes a certain drug. The test can provide information about how you may process different medications.

Poor metabolizers have less active or inactive alleles, which are gene variations caused by chromosomal mutations. This places them at a higher risk of overdosing or experiencing an increase in toxicity with some drugs. On the other hand, ultra-rapid metabolizers can experience a lack of drug efficacy because medicine leaves their body too quickly, before they can work as intended. However, prodrugs such as clopidogrel and codeine can induce the opposite reaction after metabolization.

CYP450 2D6 Testing Available

It is possible to get a genotyping test via the internet. PUSH Health uses a licensed medical provider and Quest Diagnostics labs to collect information and samples. Results are delivered electronically in about four business days for a total of $154.51, which is typically paid privately. (Check first to see if your health insurance provider will cover the cost of any needed testing. Some do.)

The PUSH Health website states that the test checks for proteins that may play a role in “hormone, cholesterol and vitamin D metabolism,” and that the test can also “help with managing dosing for medications treating mood disorders.”

Genotyping tests like CYP450 are used in other areas of medicine too. A CYP2D6 test is valuable in determining which cancer drug, such as tamoxifen for breast cancer, is likely to be most effective for treatment. The CYP2C9 test can help doctors pinpoint the right dose of the common blood thinner warfarin to avert dangerous side effects. 

Drugs Often Ineffective, Dangerous

While 4 billion prescriptions are written every year in the US, only about half demonstrate the expected therapeutic efficacy. Adverse drug reactions (ADRs) are the fourth leading cause of death and cost an estimated $136 billion annually. According to research, genetic factors can impact up to 95% of a person’s drug response and are estimated to be a factor in up to 20% of total reported ADRs.

Furthermore, the COVID-19 pandemic forced growth in the field of personalized care and boosted demand for pharmacogenomics, as drugs were used before FDA approval, for compassionate use, or in clinical trials. In recent years, regulatory agencies worldwide, including the FDA, have approved the aggregation and dissemination of pharmacogenomic (PGx) information on hundreds of drug labels.

Use Still Infrequent

However, doctors are not always on board. In 2012, over 10,000 US physicians conducted a nationwide survey by US physicians revealing that although 97.6% of respondents agreed that genetic variations may influence drug response, only 10.3% felt adequately informed regarding pharmacogenomic testing. Additionally, only 12.9% of the doctors had ordered such a test in the last six months, while 26.4% anticipated doing so in the next six months. Only 29% of all respondents had received any education in the field. Those who had were more likely to incorporate testing in their practice. 

A 2019 study did not find much progress. Researchers noted that 

“in the last years, health authorities such as Health Canada and the FDA have set PGx biomarker information on labels of over 100 and 200 drugs, respectively. Despite these recommendations, the use of PGx testing in routine clinical care remains infrequent. Reasons that explain the slow uptake of PGx in clinics include unfamiliarity of health care providers with PGx, cost associated with testing, time constraints, absence of clear clinical guidelines, lack of easily accessible tests, and several ethical considerations."

Technological Advances Enable Genotyping

It is only recently that the field of pharmacogenetics was made possible by advances in genetic research and data gathering. Electronic medical records (EMRs) have provided a massive influx of statistical data that has barely begun to be mined, covering symptoms, diagnostics, biomarkers, therapy, and adverse effects. . In the future, artificial intelligence will enhance discovery and impact everything from medical devices to lifestyle management solutions. 

The role of PGx in therapy optimization is continuously evolving. Currently, some applications have proven very effective. One such application is dosing for the anticoagulant warfarin, in which 60% of individual variability in dosing can be explained by the analysis of three enzymes, combined with an individual’s age and weight.

In fact, a 2016 review of 80 studies found that 55% of those studies showed that PGx testing was cost-effective, 16% demonstrated that PGx was cost-saving, and 13% showed it was cost-dominant, defined as being both cost-saving and clinically beneficial. 

One challenge that remains is implementing PGx testing on a broader level so that patients could present the information to healthcare professionals as a matter of course. The goal would be to prescribe the right drug for the right patient more often. Additionally, it would generate an enormous sum of data to improve research outcomes and speed quality and cost-effectiveness. 

The quickest route to improved PGx testing is, in appropriate circumstances, for patients to request it, healthcare professionals to use it, and healthcare facilities to incorporate its use in care.

Tuesday, May 24, 2022

Asset Location: Which Assets Should Seniors Hold in What Accounts?

Want to pay less in taxes next year? Follow our advice on asset location, both before and in retirement, to avoid giving more money than necessary to Uncle Sam.  

"You can't control market returns, and you can't control tax law, but you can control how you use accounts that offer tax advantages — and good decisions about their use can add significantly to your bottom line," says Matthew Kenigsberg, Vice President of Investment and Tax Solutions at Fidelity Investments. 

Your biggest expense in retirement may not be home maintenance, travel, or even health care. Taxes may be your largest bill, according to government non-profit FINRA, which oversees US broker-dealers. Part of savvy financial planning is to minimize taxes by allocating different types of investment assets to different accounts.

Two Kinds of Investment Taxes

You may already be aware that there are two main types of taxes on investments: 

Ordinary tax is what you pay every year based on your income, and it can vary from year to year. You pay ordinary tax on interest and dividend income. Ordinary tax can vary from zero to 37%. (Check your rate here).

Who Benefits Most From Asset Location Strategies?

Four criteria determine how much you can benefit from asset location adjustments. Even if only one applies to you, it’s worth checking into. The more criteria that apply to you, the greater the potential benefit. 
  1. Your ordinary income tax rate is currently high.
  2. You think you’ll pay a lower marginal tax rate in the future.
  3. You have a lot of tax-inefficient investments in taxable accounts.
  4. You are investing for a long time horizon.
Capital gains tax works a little differently. When you sell an asset, such as a stock, the difference between the price you bought it for (the basis) and the price you sell it for is the capital gain (or loss). Currently, capital gains tax can be as low as nothing up to a high of 20% for assets that you have owned for at least a year and a day (known as long-term capital gains). The percentage you pay depends on your income. Assets that you have owned for a year or less before selling are taxed at your ordinary rate. 

Three Types of Investment Accounts 

Most investments fall into one of three main types of accounts:
  1. Taxable accounts include basics like your checking and savings accounts and money in a traditional brokerage account (not connected to a retirement account of any kind). You are taxed at your ordinary rate on dividends and interest, or at the capital gains rate for investments, such as stocks, that increase in value. 
  2. Tax-deferred accounts include retirement accounts such as traditional 401(k)s, 403(b)s, IRAs, and annuities. You don’t pay any taxes on these accounts, often for decades, until you withdraw from them, at which time the money you pull out is taxed as ordinary income. These accounts are subject to required minimum distributions determined by a government formula that start when the holder reaches age 72.
  3. Tax-exempt accounts like Roth IRAs, Roth 403(b)s and Roth 401(k)s hold assets, often for decades, that will not be taxed at all upon withdrawal, nor will it increase in value. Interest and dividends will not be taxed. Additionally, a Roth is not subject to required minimum distributions. You may be wondering why you shouldn’t just switch all your money to a tax-exempt account. Apart from having to pay ordinary tax on money you invest in a Roth, there are income and contribution limits. Health savings accounts (HSA)s are fully tax exempt in that you don’t pay tax on the contribution, and you don’t pay tax on qualified withdrawals. An HSA is only available if you have a high-deductible health plan.

What Accounts to Use for Different Assets

Because different assets are taxed differently, they should not be tossed willy-nilly into any old account. Here is a list of asset types and what they entail:

Taxable accounts are great for stocks and stock funds that you buy and hold. You will get taxed on the dividends every year, but capital gains won’t be due until you sell them. Stock index funds and index ETFs are also good choices since they trade infrequently. Municipal bonds, also known as “munis,” are perfect for taxable accounts since they generate tax-free income.

Tax-deferred accounts (such as traditional IRAs and 401(k)s) are ideal for bonds and taxable bond funds, which otherwise generate interest that gets taxed annually as ordinary income. Make sure you put any inflation-adjusted bond funds, also known as TIPS, here. The value of these funds goes up with inflation, which the IRS will treat as interest income if they are not sheltered. Another use of tax-deferred accounts is for actively traded stocks. Gains from these are treated as ordinary income and taxed annually unless they are sheltered.

Tax-exempt accounts should hold assets that are taxed at the highest rate, which is often your ordinary income tax rate. Assets that are good for your tax-deferred accounts will also be great here with the added benefit that you can withdraw from them without paying a dime of tax. Actively traded/managed stock mutual funds are widely held and can generate significant capital gains. Keep them here for tax-free growth. Note that some HSAs can be invested in stocks; if your HSA doesn’t offer this option, you may want to look for one that does. 

What about cryptocurrency? The government began taxing it for the 2021 tax year, so the decision to invest is an important consideration. If you just buy crypto (including Bitcoin and Ethereum, for example) with dollars and hold it, it’s not taxed. But when you use it to buy something or trade it, watch out. 

“Whenever you sell the investment, or exchange the investment for another investment, that is when a taxable transaction happens,” according to Daniel Johnson, founder of RE|Focus Financial Planning in Asheville, North Carolina. “You’ve got to be careful if you’re doing a lot of trading. If you’re going in and out of different types of cryptocurrency, every single time you place that trade, it is a taxable event.”

Asset location is an important part of tax-reduction strategy before and during retirement. Comb through your existing accounts to see if there are any allocations that should be switched over, and make sure to follow the guide when you make changes in the future. Knowing how to utilize the tax advantages you have at your disposal can help ensure your money lasts longer than you do.

Thursday, May 19, 2022

The “Affinity Communities” Trend is Set to Explode for Over-60s

Tapping into a common human desire to form friendships with people having similar interests, outlooks, or backgrounds, affinity senior communities attract like-minded older adults from across the country.  

It is not just golf courses that unite older adults within a housing community these days. The trend is taking off for dog lovers, LGBTQ people, travel buffs, and many more subsets. Some have been in operation for decades, but many are new to the concept and expanding the definition of what an “affinity community” can be. 

Many existing communities exemplify the trend, although they may not feature a formalized care component. Older Asian Americans can take advantage of the assisted living community at Aegis Gardens in Fremont, CA. Retired musicians, actors, writers, and artists (or those who wish they had been) can find an apartment at the Burbank Senior Arts Colony in Los Angeles. Summertown, TN offers cabins for nature enthusiasts at Rocinante. Retired letter carriers even have their own gathering place at Nalcrest in Central Florida. 

Finding Your Own Niche Community

You may be wondering how to go about finding your own affinity community. One way is to simply do an online search. There is a senior living provider that has trademarked “Affinity,” so be sure to double-check search results. 

Another avenue is the Private Communities Registry (PCR) website. You can input a state or country and filter amenities to find results. Looking for a community with a dog park in Georgia? Housing with fishing in Montana? PCR can match you up. Be aware that these are master-planned communities and may include all ages or lack assisted living facilities, etc. Still, this is a great place to start looking for an inclusive new home.

University Communities

Intellectual stimulation and cultural opportunities are available at university-based retirement communities (UBRCs). These are located on or near college campuses, allowing residents to audit courses or participate in research. There are more than 50, and can be found at universities like Penn State, Dartmouth, Stanford, Cornell, and Notre Dame. Most also offer skilled nursing care.

One UBRC is Kendal at Ithaca, near Ithaca College and Cornell University in upstate New York. Residents interact with college students on a variety of projects. When the three dining areas needed a redesign, students executing the project built full-size models and made videos so residents could provide input. Kendal at Ithaca is also a study center for aging and memory. 

"Cornell has realized that we're a living laboratory for studies in aging, so our residents get interviewed, and we're constantly fielding proposals from graduate students for research projects," says Betsy Schermerhorn, Director of Marketing and Admissions for Kendal at Ithaca.

"It's good for us because it helps residents keep up-to-date with the university," says resident and former Cornell administrator and professor Cindy Noble, "and it's good for Cornell because it keeps them in contact with former faculty and alums, many of whom are loyal donors.”
You don’t have to be affiliated with Ithaca or Cornell (or any college or university) to join Kendal at Ithaca, however. Many are attracted by the winding trails, creative arts studio, library, and dog play area. The winemaking group sets up tastings in Kendal’s wine cellar, and there’s a local theater.

Endless Options

About 200 to 300 residents are needed for a thriving retirement community. That’s a fairly low bar for entry, especially since these communities generally allow anyone access. That makes for more diverse options. Yes, there really is a community specifically for Jimmy Buffett enthusiasts at the Latitude Margaritaville in Hilton Head, FL. Go to Rainbow’s End in Livingston, TX to gather with other RV owners and find assisted living options as well as respite care. 

People born in another country may find comfort in one of the many communities geared toward specific ethnicities. Native American, Hispanic, and Greek American senior communities are some of the most popular around Chicago, while some in California cater to Japanese Americans and Chinese Americans. Residents can speak their native language, celebrate native holidays as well as those of their adopted country, and eat familiar foods together.

Affinity communities may be particularly attractive for groups that may otherwise feel marginalized. After moving to the LGBTQ community Rainbow Vision in Santa Fe, NM, resident Patrick Russell, a retired university administrator, finally felt understood and at home. 

"I'd never been at a place where I was in the majority," says Russell of Rainbow Vision. "It's become so matter-of-fact here that I forget that being a gay person is the least bit unusual.” There is a cabaret and lounge on the property that is open to the public, offering entertainment to go with the award-winning restaurant and fitness center. 

Various affinity community residents report that these communities seem to function well because friendships are more easily formed among people who share a mindset, vision, or even a hobby. As more and more baby boomers retire, this living trend will doubtless expand.

Monday, May 16, 2022

A Tech Concierge May Increase Your Business Catering to Over-60s

If you haven’t created a tech concierge position to help clients set up and maintain software and hardware, you may be missing out on creating brand loyalty and increased ROI.  

Seniors are increasingly reliant on technology to stay in touch with family and friends, keep up with finances, monitor their health, and access a host of everyday activities. A recent AARP survey found that most older adults have a more positive feeling about using technology compared to how they felt before the pandemic. However, it is still easy to get hung up when trying to video chat or install a new skill on Alexa, for example. 

The role of tech concierge has come to the forefront for senior living facilities in particular, although it could apply to many businesses serving older adults. Often, these are people who know the organization’s platforms and the devices it uses, and they are trained to help residents and staff utilize the technology.

Outsourcing a Tech Concierge

It is not always easy to fill positions in today’s hiring climate. You may choose to outsource a tech concierge. Sentrics can provide phone support or in-house services. Their phone line is available 24/7, and you will never get a recording or be rerouted. Another such service is Tech Concierge. Both of these companies will help your company’s staff, clients, or both.

“I would encourage everyone to jump in so that you can begin experimenting with this role and seeing how to position it for the future,” says Tammy Farris, Director of Strategic Innovation at Watermark senior living in Tucson. “Because I think it is going to change from what we even know of it today.”

Technology Use Is Growing Among Seniors

Around three years ago, Watermark began offering classes at its senior living facilities to teach residents how to use email, share photos, make video calls, and perform other tasks. This was helpful, but many residents needed more assistance with the tools or wanted to learn how to do other things. In a single community, staff was spending about 60 hours per week helping with tech questions. 

“We were surprised at the volume of requests, and so that’s when we started to talk about this concept of having a tech concierge,” says Farris. United Methodist Communities was on a similar path. They had a technician who traveled between their four retirement communities, beginning about four years ago. Although many of their clients were tech-averse, technology was playing an increasingly important role in their daily lives and providing a higher quality experience. 

“So we knew we had to meet that need, because it was certainly under met,” says Travis Gleinig, Director of IT at United Methodist Communities.

What a Tech Concierge Does

This may be a dedicated position, or it could fall to another staff member as part of their duties. Whichever the case, this person should be trained in how to work with older adults and have expansive knowledge of technology installation and use. On one day, they may be asked to install a voice assistant and set up capabilities, and on another, find and install a magnifier app on a smartphone.

“We’re definitely pulling out job descriptions and postings for multiple positions and emphasizing the ability to embrace technology,” says Farris. “You have to have patience…compassion, and you have to be a good teacher.”

Billing For a Tech Concierge

Many communities are beginning to consider rolling the cost of the position into their monthly charges. After all, it can be a selling point to let families know that a tech concierge is included in the fee.

“If you include from the get-go that technology interaction — ‘You have this, and here’s how you use it, and I’ll come by your apartment when you move in and I’ll get you onboarded’ — that’s a totally different experience,” says Gleinig. “And that’s way more valuable than the community down the road that says, ‘Here, we have XYZ, and good luck.’”

Others are choosing to bill for the time separately, usually in 15 or 30-minute increments. For example, Watermark charges $15 for 15 minutes. “I think it’s definitely going to end up in the direction where a community has a tech concierge as part of the cost of living here,” says Gleinig.

No matter how the position is implemented, it can only help residents and their families feel more confident and cared for. Even as new residents become more tech-savvy over the coming years, technology itself will become increasingly complicated. Having a tech concierge may be the difference between choosing one residence over another.