Author Archives: Dianne Savastano

Recommended Reading: Working Beyond Age 65

Although there are general rules surrounding Medicare enrollment, if you and/or your spouse remain working beyond the age of 65, the timing for enrollment in Medicare Parts A and B has some nuance to it. In addition, if you remain working and contribute to a Health Savings Account (HSA), there may be tax implications.

As always, a customized assessment of your unique situation and that of your spouse is critical to making the right decisions at the right time.

This article discusses some of the issues.

This article provides insight on speaking with your employer if you are over the age of 65 and remain working.

Finally, I’m often asked if I recommend HMO plans through the ACA marketplace or through Medicare Advantage Plans for Medicare recipients. My standard answer is, “It depends on individual circumstances.”

Overall, my goal for individuals choosing these plans is for them to fully appreciate the guidelines and restrictions involved. This allows them to work within them and to anticipate and budget for out-of-pocket costs that will occur as care is accessed.

More on this topic, here.

Creating the “Perfect Patient Experience”

Recently, I attended a program at Simmons titled, “Is Bigger Better in Health Care? As mergers increase, how should we respond?” A panel of three economists discussed topics such as horizontal and vertical integration, the role of competition, anti-trust issues and value-based contracting. It was a great discussion, but one that approached healthcare solely from a macro perspective.

I, on the other hand, tend to look at the industry from the ground up. That’s why, as I was listening, I couldn’t help but think: “But how does this impact us, as healthcare consumers, who are finding our way through an incredibly complex system, so we can get good quality healthcare, when we need it, without going bankrupt?”

Eventually, I got to thinking of my dad and his terrific experience this past summer, when he had a knee replacement.

Before, during and after surgery

When it became clear my dad had a problem with his knee, we went back to the same orthopedic surgeon who did a fabulous job three years ago when dad needed a hip replacement. The surgeon is well educated, very experienced, and was wonderfully communicative about both the procedure itself, as well as what my dad needed to do before and after surgery to have a positive outcome.

My dad was going back to the same hospital where he had great inpatient experiences and outcomes previously (good news!).

On the day of surgery, everything went like clockwork:

Mom, dad and I arrived at 6:15 AM; he was in the operating room by 9:00 AM; he was in his room by 12:30 PM; he was up in the chair by 1:30 PM having some fluids for lunch. (See photo).

By 1:30 PM the next day, he was back home and comfortable.

All in all, it was a “perfect patient experience.” But, as you might imagine, these things don’t happen by accident. Let’s look at why dad’s experience went so well.

The Perfect Patient Experience

On the “Quality, Performance and Safety” link of the hospital’s website, it states that, “Every day, we strive to provide a perfect patient experience. When we find areas where we can improve, we have mechanisms in place to make improvements.” It goes on to describe The Albright Read Institute for Healthcare Improvement Science and Medical Research (ARI) that advances the hospital’s commitment to process improvement.

This Institute is one example of many quality improvement efforts underway in healthcare settings. You may have read about The Institute for Quality Improvement (IHI) or the Hoshin Planning Process and Lean Management, all quality improvement efforts implemented in healthcare settings around the world.

In the hospital my dad was in, and while serving on the Patient Family Advisory Council previously, I had the privilege of participating in a major quality improvement effort. This institution had a culture of excellence and improvement, and we felt it.

Here are some of the things that contributed to our satisfaction with my dad’s experience:

  • Excellent pre-surgery communication about where to go and what to do to prepare, including detailed instructions about pre-medications and skin preparation.
  • Pleasant and informative staff members who greeted us on arrival and told us what to expect, every step of the way.
  • Inclusion of me and my mom in the pre-op meetings with the surgeon and anesthesiologist.
  • Warm blankets – not only for my dad, but for my mom as well, who was cold from the air conditioning.
  • On-time surgery.
  • An electronic communication board in the waiting room that allowed us to “follow” where my father was – from the OR, to the recovery room, and to his room – so we didn’t have to wonder.
  • A post-op visit from the surgeon, in a private space, to review my dad’s experience and to outline what to expect next.
  • A welcome by the primary nurse responsible for his post-operative care, resulting in us feeling like she was taking care of all three of us, and not just my dad.
  • Helpful staff on my dad’s unit, all of whom welcomed my check-in calls at midnight and 5:00 AM the next morning.
  • Inviting my mom and me to arrive early the next morning to participate in his physical therapy evaluation and the discharge decision.
  • Excellent discharge instructions, covering pain control, plans for homecare services, and when to see the doctor for a follow-up appointment.
  • No more than a five-minute wait for the wheelchair transporter to take us downstairs and help us into the car. (This one really hit home for me. Many times, I have waited up to an hour with patients awaiting discharge.)

As I said, a perfect patient experience!

Evaluating your healthcare options

The Agency for Healthcare Research and Quality (AHRQ), an agency of the U.S. Department of Health and Human Services (HHS), defines quality in health care as:

  • Providing the best care
  • Providing the most appropriate care
  • Achieving the best outcomes for all patients

When obtaining care from a physician practice or from a hospital, look for a commitment to quality by asking about quality initiatives. Expect transparency about them.

Specifically, ask about…

…how (if it’s a physician practice) change efforts surrounding preventive care and management of common chronic diseases such as high-blood-pressure or diabetes are measured and initiated. Just as important, ask how patients experience care.

…electronic medical record systems and how information gets communicated during transitions of care.

…how quality is measured and what impact it has on the way insurance companies pay.

…Patient Family Advisory Councils and how patients participate in quality improvement efforts.

…how feedback is shared with physicians and staff.

…how the organization compares to national and state benchmarks of quality.


Yes, our healthcare system is complicated! But we, as consumers, need to be assertive, do our homework and assess the quality of care we plan to access, thus making informed decisions.

The culture of an organization and how it resonates with you and your needs is important. That organization may not always be around the corner, but as my dad’s wonderful recovery can attest to, the extra effort is worth it!

Recommended Reading: Medicare Costs

As we assist clients who are enrolling in Medicare for the first time, we consider many things. The articles below discuss some of those considerations.

Health Savings Accounts (HSAs) and Medicare

If you have an HSA and will soon be eligible for Medicare, it is important to understand how enrolling in Medicare will affect your HSA.


When some of our clients retire before they turn 65, they often ask about COBRA coverage in comparison to obtaining their own insurance through the Individual/Family market. There are many nuances to COBRA, and these require careful investigation as people are making choices.

Here is some general information about COBRA.

Medicare Advantage Plans

Changing the way we pay for healthcare by aligning incentives is critical to reducing cost.

This article describes some examples of the way physician groups are attempting to keep their members healthy and reduce costs for Medicare recipients.

Medicare: What’s Changing in 2019

By Camille Barron

The other day, my husband Jim and I were having dinner with friends when the topic of how we met came up. We shared the story of how we were introduced at a local restaurant while attending a social function. Things moved steadily from there and one year later — to the day — we were married in that exact same location!

Not only that, coincidentally, our 13th wedding anniversary — October 15th — was coming the very next day, something our friends were quick to point out. Jim and I, on the other hand, had both completely forgotten!

Jim doesn’t have a good excuse for forgetting, but I do: Ever since I’ve been in the Insurance and Medicare business, what I most associate with October 15th is the start of Open Enrollment for Medicare Advantage and Medicare Prescription Drug Coverage.

Open Enrollment runs from October 15 through December 7, 2018, something you may have noticed with all the TV commercials and piles of mail that have been arriving. As always, there are changes this year compared to last. Let’s look at some of the most significant and explore why they matter to you.


1) Medicare Part B — Standard Premium

Medicare Part B covers your doctors’ fees and outpatient medical expenses (things like labs, imaging, physical therapy, etc.). The standard monthly premium will be $135.50 for 2019, an increase of $1.50 from $134.00 in 2018.

Note that approximately 3.5% of Medicare beneficiaries (an estimated 2 million individuals) will pay less than the full Part B standard monthly premium amount in 2019 due to the statutory “hold harmless provision,” which limits certain beneficiaries’ increase in their Part B premium to be no greater than the increase in their Social Security benefits.


2) Medicare Part D — Prescription Drug Insurance

One component of Medicare that began in 2006 is Part D prescription drug coverage. To obtain this, you select a prescription drug plan (PDP) from the many (4-26) available in your specific county/zip code. The best choice for you will depend on the specific drugs you take and the prescribed dosages. This year, the number of Medicare Part D plans has increased significantly — from 782 in 2018 to 901 in 2019.

That means more choice, of course, but it also means that simply doing what you did last year may not be your best option. For one thing, your prescriptions may have changed from year to year, meaning that last year’s plan is no longer the most cost-effective.

Even without any modification to your medications, as plans change and new ones emerge, it’s important to do an annual review of Part D to make sure you’re getting the most appropriate and cost-effective coverage.

One last thing regarding Part D: The “Donut Hole” — a component of the original legislation that included participants paying a higher share once the total cost of their prescription drugs exceeded a stated threshold — is continuing to close as a result of the Affordable Care Act (ACA). Over the next two years, through 2020, you’ll see a decrease in the amount you pay for both brand name and generic drugs whenever you are within the Donut Hole. Good news!


3) Income Adjustment Amounts (IRMAAs) for Medicare Parts B and D

Medicare Part B covers your doctors’ fees and outpatient medical expenses. Part D is coverage for prescription drugs.

In both cases, higher income beneficiaries are also required to pay a surcharge, something known as the Income Related Monthly Adjustment Amount (IRMAA) and it’s based on their Modified Adjusted Gross Income (MAGI) from two years earlier.

The most significant change for 2019 is the introduction of a new tier for Medicare beneficiaries with the highest incomes. Please see the table below for the income thresholds and for the IRMAA amounts for Medicare Part B and Part D premiums.



4) Medicare Advantage Plan Changes

Medicare Advantage Plans (also known as Medicare Part C) are plans offered by private insurance companies that contract with Medicare and can be chosen in lieu of traditional Medicare Parts A, B and D. They come with a broad range of options and types, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and Private Fee-for-Service (FFS) Plans. It’s worth noting some changes for 2019 in these plans:

First, beginning next year, Medicare Advantage Plans will have the option to cover meals delivered to the home, transportation to doctors’ offices and in-home safety improvements, such as wheelchair ramps and bathroom grab bars. (These benefits must be recommended by the individual’s medical provider and may not be available in some plans.)

Second, Medicare Advantage plans may elect to pay for in-home assistance from home health aides who help individuals with daily activities such as dressing, eating and personal care. Previously, these plans only covered services that were primarily health-related.

Third, Medicare Advantage Plans will have the option of applying “step therapy” for certain drugs. Step therapy is a type of prior authorization that requires a patient needing medication to use condition-based “preferred” medications before using more expensive drugs, and progress to other treatments only if necessary. There’s debate as to the benefits of this approach. Some argue it will lower prescription drug costs up to 20%. Others are concerned that it may cause delays in dispensing prescriptions.


As always, sorting through the options and finding the coverage that’s best for you and/or your loved one can be time-consuming and tedious. So, make plans to spend time reviewing the options (choices made during Open Enrollment will remain in effect through all of 2019) and don’t hesitate to get in touch if we can help!