Savvy Senior Columns — June 2020

Savvy Senior – June Columns

  1. How to Find Health Insurance After a Job Loss
  2. How to Make the Most of Your Telehealth Appointment
  3. What to Know About Advance Care Planning in the Age of Coronavirus
  4. Why High Blood Pressure is Even More Dangerous in the COVID-19 Era

How to Find Health Insurance After a Job Loss

Dear Savvy Senior,
Because of the coronavirus pandemic, I just got laid off from my job of 22 years and need to find health insurance until I can get another job or enroll in Medicare at age 65. What are my options?
Scared to Death                                                                                   

Dear Scared,
I’m very sorry about your job loss. It’s estimated that as many as 45 million Americans could lose their health insurance as businesses continue to lay off workers due to repercussions of the coronavirus pandemic. Here’s where you can find health insurance coverage while you’re looking for new employment or waiting for Medicare.

The Affordable Care Act Marketplace
Your best option for getting affordable health insurance is through Affordable Care Act (ACA) Marketplaces, also known as Obamacare. Or, if your income is very low you may qualify for Medicaid.

Normally, enrollment in an ACA Marketplace is limited to the short window for Open Enrollment, which is between Nov. 1 and Dec. 15 each year. But there’s an exception for people who’ve lost their jobs, known as the Special Enrollment Period, which allows you to apply because your layoff meant a loss of health insurance. To do so, you must enroll within 60 days of when your coverage stopped and prove that you lost your health insurance.

There is no limited enrollment period for Medicaid.

Eleven of the states with their own health-insurance marketplaces (California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont and Washington), plus the District of Columbia, are also offering special enrollment periods, allowing anyone who is eligible under the ACA rules to sign up.

ACA health insurance is major medical insurance that covers essential health benefits with no annual or lifetime coverage maximums. And they can’t charge you more or deny you coverage because of a pre-existing health condition.

You also need to know that if your annual income will fall below the 400 percent poverty level, the ACA provides premium subsidies, which will reduce the amount you’ll have to pay for a policy.

To qualify for subsidies your household’s estimated income for 2020 must be under $49,960 for an individual, $67,640 for a couple, or $103,000 for a family of four. The lower your income is under these limits the higher your subsidy will be. Unemployment benefits count toward income.

To see how much subsidy you may qualify for, use Kaiser Family Foundation health insurance marketplace calculator at KFF.org/interactive/subsidy-calculator.  Or, if your income is very low – below the 138 percent poverty level – you may qualify for free, or low-cost health coverage through expanded Medicaid services, which is available in many states.

To apply for ACA Marketplace health plans or Medicaid, go to HealthCare.gov. Or, you can call their toll-free number at 800-318-2596 and get help over the phone.

COBRA
If you need health insurance coverage for less than 18 months, another option you may want to consider is COBRA, which allows you to remain on your former employer’s group health plan, but not every employer plan is COBRA-eligible. Contact your employer benefits administrator to find out if yours is.

In most cases COBRA is expensive, requiring you to pay the full monthly premium yourself. But, if you’ve already met or nearly met your employer plan’s deductible and/or out-of-pocket maximum for the year, and don’t want to start over with a new plan; or if you find your employer’s health plan to be better or more affordable than the marketplace options, it makes sense to keep your current coverage under COBRA.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of The Savvy Senior book.

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How to Make the Most of Your Telehealth Appointment

Dear Savvy Senior,
I manage a large doctor’s clinic that treats hundreds of seniors each month. We are moving to more telehealth visits to help keep our patients safe at home during the coronavirus pandemic, but this new way of seeing a doctor is befuddling to many of our elder patients. Can you write a column educating patients on how to prepare for a telehealth appointment?
Regular Reader

Dear Reader,
I’d be happy to help! To help keep patients safe and at home during the coronavirus crisis more and more doctors and other health care providers are turning to telehealth (a.k.a. telemedicine) appointments, which are remote e-visits using a digital communication device like a smartphone, tablet or computer.

Although telehealth has been around for a few years now, recent updates to regulations and a surge in demand has made it the easiest way to get many different types of medical care. Most telehealth appointments today tend to be primary care or follow-up visits that can assess symptoms or check on people who have had a medical procedure. Telehealth also works well for some specialties like dermatology or mental health care (counseling/therapy) services.

So, what can patients expect from a telehealth visit, and how should they prepare?

The first step is to call your doctor’s office to find out whether telemedicine visits are available and whether you will need to set up an account or install special software on your computer, phone or tablet.

Until recently, doctors were required to conduct telehealth visits through platforms such as Doxy, Thera-Link or MyChart that were compliant with the Health Insurance Portability and Accountability Act, or HIPAA. But some of those requirements have been relaxed in the current crisis, so many providers are using popular apps such as FaceTime, Skype and Zoom to conduct visits.

Once you know what technology you will be using, get familiar with it. You don’t want to spend the first 10 minutes of your visit trying to figure out how to unmute the audio.

For older patients that aren’t familiar or comfortable with technology, ask a relative or friend with a smartphone, tablet or laptop to assist you.

Take the time to clarify the purpose of the televisit before it begins. Prioritize a written list of three or four issues you want to discuss with your doctor and make a list of the medicines you’re taking, along with the dosages.  Also, have relevant medical devices or logs on hand, such as a penlight or smartphone flashlight for viewing a sore throat, a blood-pressure cuff and thermometer (or recent readings), blood-sugar logs if you’re diabetic or a food log if you have gastrointestinal problems.

If you’ve received medical care at different places, such as an urgent care facility or another doctor’s office, have your latest medical records with you during the telemedicine visit.

Wear loose clothing that will allow you to show your medical provider what is concerning you.

The length of the appointment may depend on the problem. A routine visit could be very quick, while others, such as a physical-therapy appointment, may last as long as a session at a clinic. Waiting rooms are sometimes replaced by virtual waiting rooms.

Before the visit ends, make sure you know the follow-up plan. Do you need to schedule an in-office visit, fill a prescription or get a referral to a specialist?

Right now, Medicare and Medicaid are covering the cost of telehealth visits (see medicare.gov/coverage/telehealth for details), and most private insurers are following suit.

If you don’t have a primary care physician or need urgent care, you can get help through virtual health care service like Doctor on Demand (doctorondemand.com) or TeleDoc (teladoc.com). These services currently do not accept original Medicare, but they may be covered by private insurers including some Medicare Advantage plans – be sure you check.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

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What to Know About Advance Care Planning in the Age of Coronavirus

Dear Savvy Senior,
All this horrible coronavirus carnage got me thinking about my own end-of-life decisions if I were to get sick. Can you recommend some good resources that can help me create a living will or advance directive, or other pertinent documents? I’ve put it off long enough.
Almost 70

Dear Almost,
Creating a living will (also known as an advance directive) is one of those things most people plan to do, but rarely get around to actually doing. Only about one-third of Americans currently have one. But the cold hard reality of the novel coronavirus may be changing that. Here’s what you should know along with some resources to help you create an advance directive.

Advance Directives
To adequately spell out your wishes regarding your end-of-life medical treatment are two key documents: A “living will” which tells your doctor what kind of care you want to receive if you become incapacitated, and a “health care power of attorney” (or health care proxy), which names a person you authorize to make medical decisions on your behalf if you become unable to.

These two documents are known as an “advance directive,” and will only be utilized if you are too ill to make medical decisions yourself. You can also change or update it whenever you please.

It isn’t necessary to hire a lawyer to prepare an advance directive. There are free or low-cost resources available today to help you create one, and it takes only a few minutes from start to finish.

One that I highly recommend that’s completely free to use is My Directives (MyDirectives.com). This is an online tool and mobile app that will help you create, store and share a detailed, customized digital advance directive. Their easy-to-use platform combines eight thoughtful questions to guide you through the process. If you’re not computer savvy, ask a family member or trusted friend to help you.

The advantage of having a digital advance directive versus a paper document is being able to access it quickly and easily via smartphone, which is crucial in emergency situations when they’re most often needed.

However, if you’d rather have a paper document, one of the best do-it-yourself options is the Five Wishes advance directive (they offer online forms too). Created by Aging with Dignity, a nonprofit advocacy organization, Five Wishes costs $5, and is available in many languages. To learn more or to receive a copy, visit FiveWishes.org or call 850-681-2010.

Another tool you should know about that will compliment your advance directive is the Physician Orders for Life-Sustaining Treatment, or POLST (sometimes called Medical Orders for Life-Sustaining Treatment, or MOLST). A POLST form translates your end-of-life wishes into medical orders to be honored by your doctors. To learn more about your state’s program or set one up, see POLST.org.

Readers should also know that if you’ve already prepared an advanced directive paper document, a POLST form or the VA advance directive form 10-0137, you can upload, store and share these documents too at MyDirectives.com.

And finally, to ensure your final wishes are followed, make sure to tell your family members, health care proxy and doctors. If you make a digital advance directive or have uploaded your existing forms, you can easily share them electronically to everyone involved. Or, if you make a paper advance directive that isn’t uploaded, you should provide everyone copies to help prevent stress and arguments later.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

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Why High Blood Pressure is Even More Dangerous in the COVID-19 Era

Dear Savvy Senior,
Are people with high blood pressure at increased risk of getting coronavirus?
Hypertensive Helen

Dear Helen,
If you have high blood pressure, you definitely need to take extra care to protect yourself during the coronavirus (COVID-19) pandemic. Research shows that people with hypertension are more susceptible to getting COVID-19, are more likely to develop severe symptoms if they do get sick, and are more likely to die from the infection, especially if they’re older.

High Risk Links
A weaker immune system is the key reason people with high blood pressure and other health problems are at higher risk for coronavirus. Long-term health conditions and aging weaken the immune system so it’s less able to fight off the virus. Nearly two-thirds of Americans over 60 have high blood pressure.

Another concern that has been circulating, but was put to rest last month, were theories that the medications that are commonly prescribed to treat high blood pressure – ACE inhibitors and angiotensin receptor blockers (ARBs) – could make patients more vulnerable to contracting COVID-19, and more susceptible to severe illness if they did become infected.

But new research published in The New England Journal of Medicine last month found no risk linked to these medications.

COVID Complications
While pneumonia is the most common complication of the virus, it can also damage the cardiovascular system. That’s why people with high blood pressure, heart disease, and heart failure are at risk.

High blood pressure damages arteries and reduces the flow of blood to your heart. That means your heart has to work harder to pump enough blood. Over time, this extra work can weaken your heart to the point where it can’t pump as much oxygen-rich blood to your body.

Coronavirus can also damage the heart directly, which can be especially risky if your heart is already weakened by the effects of high blood pressure. The virus may cause inflammation of the heart muscle, which makes it harder for the heart to pump.

If you also have plaque buildup in your arteries, the virus may make those plaques more likely to break apart and cause a heart attack. Studies have shown that people with heart disease who get a respiratory illness like the flu or earlier types of coronavirus are at higher risk for a heart attack.

What to Do?
While everyone needs to take precautions to prevent coronavirus, people with high blood pressure and other health conditions need to be extra careful.

The best way to avoid getting sick is to stay home as much as you can. If you have to go out, wear a mask and keep at least 6 feet away from other people. And every time you come home, wash your hands with warm water and soap for at least 20 seconds. Also, clean and disinfect all frequently touched surfaces like cell phones, countertops and doorknobs.

The CDC also recommends that you have enough medicine on hand to treat high blood pressure and other health conditions. And stock up on over-the-counter medicines to treat a fever and other symptoms if you get sick.

While a coronavirus vaccine isn’t available yet, you should stay up to date on your other important vaccines. The pneumococcal vaccines – Prevnar 13 and Pneumovax 23 – will prevent you from catching pneumonia on top of coronavirus. Also get a flu shot in September or early October. Its symptoms are easy to confuse with coronavirus, which could make it harder for doctors to diagnose you if you do get sick.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

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