Author Archives: Dianne Savastano

Managing Health in the “Nifty Fifties”

My cousin Caroline just turned 50. She has been reflecting on recent experiences with the healthcare system and suggested I write about healthcare consumers in her age category.

As a woman with a career, two children approaching their early teens, a husband, parents, and in-laws with recent issues requiring hospitalization, her first thought when she noticed some physical changes of her own was, “Who has time for this?”

Fortunately, she did not ignore her symptoms and sought care from a specialist physician with whom she has had a long-standing relationship.

Your Fifties Are Not Your Thirties

In the interest of preserving her privacy, I am not going to share the specifics of Caroline’s diagnosis, other than to say that it was serious and a bit of a wake-up call for her.

Further, and since both her parents and in-laws had developed conditions that required major life-style changes, she reflected on what might evolve in her own health when she reached their age. She shared that her natural inclination to not make time for exercise and healthy eating could make a significant difference down the line regarding the development of chronic medical conditions and disability. She knew it was time to make some changes in her family’s household!

She also realized that reaching out for help was not a source of weakness, but a strength. All of us in her family care so much for her that allowing us to know what was going on and assist in any way we could was not only helpful to her, but to us, too. We could demonstrate our love AND share our expertise, taking away our feelings of helplessness. She’s not sure she would have recognized this when she was younger.

Relationships and Communication

It is so important to establish and continuously cultivate relationships with our physicians. Identifying the most efficient way to communicate in-between appointments is critical, because you never know when you might need their help.

Caroline sent an email to her physician and received an immediate response. Her physician, knowing that Caroline does not always put herself first, recognized that her reaching out meant that she was concerned. That led to an urgent appointment.

Caroline learned, however, that email is not always the preferred method of communication with a physician. Unlike email, Patient Portals are secure, provide a permanent record of communication, and allow other members of the physician team to respond quickly and appropriately in providing care.

Questions to Ask Every Time

When Caroline first described her symptoms, her doctor was quite certain about her initial diagnosis. Fortunately, Caroline and I had talked about the work of Dr. Jerome Groopmanand how, when preparing an agenda for appointments, one should always plan to ask the following three questions:

#1. What else could it be? This combats search bias and leads the physician to consider a broader range of possibilities.

#2. Is there anything that doesn’t fit? This combats confirmation bias, leading the physician to think broadly.

#3. Is it possible I have more than one problem?Individuals can have multiple, simultaneous disorders that can cause confusing symptoms.

These questions led to recommendations for diagnostic testing. Sure enough, the initial diagnosis proved to be incorrect.

What and Whom to Listen To

Although she reached out to close friends and family, Caroline initially kept the circle small and made a conscious decision to consider her own opinion first regarding proposed treatment options.

As is true on so many topics, those with whom we share our concerns bring their own experiences and opinions to the discussion. Listening to too many points of view can be overwhelming, particularly when trying to assimilate new, and sometimes anxiety-provoking, information.

Caroline recognized this and made clear and concise decisions about what she was and was not willing to do. When she was younger, the opinions of others may have led to second-guessing.

What to Read

When educating herself and preparing for her appointments, Caroline sought out websites recommended by her physician, as well as some other sites I suggested (e.g., Up-to-Date).

She stayed away from those that include advertisements and focused instead on sites that provide clinical information derived from reputable research and that contribute to the development and continuous improvement of evidenced-based clinical decision support.

Overall, this helped her to outline her specific questions and led to meaningful conversations with her healthcare team. I loved seeing how she took charge!

In-Patient Experience

Overall, Caroline’s in-patent experience was positive. She was in awe at how streamlined the processes were, something she was particularly thankful for, since the pandemic meant she had to be alone.

But there were a few encounters that did not go so well. One involved feeling very rushed by a nurse to perform a bodily function that her body just wasn’t ready for. She knows now that she could have politely pushed back and asked for a greater explanation and more time.

Second, she unexpectedly had to go home, requiring her to perform a function that is usually done in a hospital by trained nurses. Here, the education and support were not the best and again, in hindsight, she realized she could have been more assertive.

Listening to Your Body

Lastly, Caroline acknowledged that her body is not as strong as it was when she was in her thirties; recovery would take longer. Even though slowing down was not something that came naturally to her, she listened to the advice of her physician and gave herself the time necessary to gradually improve, adding lots of stretching into her daily routine as well (and catching up on lots of Cobra Kaiepisodes along the way!).

Giving yourself time to heal is something I coach people about all the time — especially following a surgery that requires general anesthesia. It sounds so simple, but listening to our bodies is not easy for many of us (myself included).


I was so grateful that Caroline agreed to be interviewed for this newsletter. She shared that a conversation we had early on in her journey helped her tremendously, and she is now relaying it to others. Here is what she said.

“Acknowledge the anxiety you feel with a new medical diagnosis. Figure out what you can get answers to and work on getting those answers. Recognize that while there are unknowns, if you can learn five or six things out of ten, you have more control than you think. The rest of the answers will come in time.”

Recommended Reading: Remaining diligent


Please, please, remain diligent, even as you obtain your vaccinations for COVID-19. We still don’t know what the impact of the multitude of variants will be. Reading thisshould remind you that youth and good health do not always prevent severe illness and death.

Long-Covid is real and can have a devastating impact on younger individuals, as this article highlights.

Under the Affordable Care Act and as of 1/1/2021, women and girls over 13 can now be screened for anxiety as part of a routine checkup. Read more here.

“It legitimizes the fact that anxiety is a very serious condition that needs treatment and has huge consequences for people, and for women’s lives particularly. It’s not that it’s only in women. It’s just that it’s twice as prevalent in women.”

Health Insurance in 2021

While working with clients who are newly enrolled in Medicare or accessing health insurance via the Open Market and/or from employers, we identified common themes in the advice we offer. I share those themes below, in the hope that it will get your new plan year off to a smooth start!

Paying Premiums

This may seem like common sense, but please be sure to pay your premiums! Just as every insurance product is different, so are the processes by which premiums can be paid.

For some, a monthly paper bill is received and must be paid by a certain date. For others, coupon books are sent, and it’s up to you to remember. For still others, some form of electronic payment is possible*.

[*If you sign up for a form of automatic payment — it will take time for bank deductions to begin. During this time, you may be required to continue making payments, so be sure to understand and follow the insurance company’s requirements.]

Whatever the specifics, make sure to create a plan for payment and follow it. See below for more detail on how payment works…


Unfortunately, there are several entities involved, each of which requires separate payment:

Medicare Part B premiums and Medicare IRMAAs (Income Related monthly Adjustment Amounts) for Part B and Part D

  • Premiums can be deducted from your Social Security benefit, if you are receiving one.
  • Premiums can be paid after receiving a paper bill. (These can be very confusing initially, as they are processed by different systems and do not arrive together.)
  • Premiums can be paid via your “My Medicare” portal.
  • Premiums can be deducted automatically from a checking or bank account via Medicare Easy Pay.

Regardless of which method you use, we highly recommend that everyone on Medicare enroll in a “My Medicare” account for viewing bills online and making quick electronic payments.

Medicare Part D Prescription Drug Plans or Medicare Advantage Plans

  • Premiums can be deducted from your Social Security benefit, if you are receiving one.
  • Premiums can be paid after receiving a paper bill or coupon book.
  • Premiums can be deducted automatically from a checking or bank account, or set up as a recurring payment from a credit card. (Note that electronic payment requires enrolling in the Part D plan’s member portal, which can be valuable in any case for reviewing claims and medication costs.)

Medicare Medigap/Supplement Plans

  • Premiums cannot be deducted from your Social Security benefit.
  • Premiums can be paid after receiving a paper bill or coupon book.
  • Premiums can be deducted automatically from a checking or bank account, or set up as a recurring payment from a credit card. (Note that electronic payment requires enrolling in the Medicare Medigap/Supplement plan’s member portal, which can be valuable in any case for reviewing claims and benefits.)

Open Market Plans

On most plans, you are not given much of a grace period before you may be disenrolled from the plan for non-payment. Reinstatement can be tedious, sometimes even impossible, which could leave you without insurance until January 1 of next year!

As we have mentioned in (many!) previous newsletters, setting up a member portal on your plan’s website is valuable for payment, for reviewing claims and benefits, and for asking questions.

Employer-Sponsored Health Insurance Plans

Typically, your contributions to premiums are made via payroll deduction. Even so, be sure the amounts deducted are accurate and reflect the choices you made during Open Enrollment season.

Coordination of Benefits


If you are newly enrolled in Medicare and all of its associated products, you should contact the Medicare Coordination of Benefits (855-798-2627) the week Medicare and the associated products become effective/primary for you. You want to make certain the Medicare system shows Medicare as your primary insurance and your Medicare Supplement as secondary.

Follow the prompts and provide the information requested. The system will then provide a response — the response you want to hear is “Medicare is primary” for Part A and Part B. If you hear anything else, follow the directions to get to a live person and explain that Medicare should be primary as of a specific date.

If you do not take this extra step, in addition to notifying your healthcare providers that Medicare has become primary for you, bills could be inadvertently sent to your previous insurer, be denied, and cause administrative hassles that you will need to troubleshoot later on.

If You Made a Change to Your Health Insurance

Three things:

First, be sure that your previous insurance company is notified that your plan was discontinued as of midnight the day before your new coverage begins.

Second, be sure you receive your new plan’s identification card and share it with your healthcare providers and pharmacy, so they know to bill the appropriate health insurance company.

Third, remember to put copies of your new insurance cards in your Grab-n-Go Kit!

Understanding Benefit Levels

Every January, we receive lots of calls from clients who are surprised by how large the out-of-pocket costs are for their prescription refills. Most often, it’s because the deductible — which resets to zero on January 1 — has not yet been met. Many generic medications are not subject to a deductible, but for those that are, the out-of-pocket costs can be significant.

Make sure as well to pay special attention to plans that require staying within a network of providers and/or require prior authorization, have quantity limits, or employ step-therapy protocols for prescription drugs. Understanding how these requirements work can prevent confusion and aggravation as you begin to use your plan.

In Summary

I understand, it’s a lot to manage. But as we write often, it’s important to stay informed and be proactive about your health insurance benefits. Doing so will ensure that your year is off to a strong start, providing you with the coverage you need and with limited surprises!

Recommended Reading / Watching

Every Sunday morning, my phone displays a report of my screen time for the previous week. I am often astonished at how high the number is!

Yes, I read three newspapers online, which certainly adds to the total. But the truth is, I also spend countless minutes doing mindless things such as scrolling on Facebook and Twitter.

After watching this documentary and reading this article (admittedly, both on a screen), I was frightened on many levels, especially knowing how much more time my grandchildren spend on their phones during the pandemic. I think you will find these eye-opening too.