Author Archives: Dianne Savastano

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!

Cancer Made Me Nice

My friend Karen was interviewed in Forbes Magazine in 2012 because she had a unique perspective: She had been diagnosed with breast cancer, and she was a cosmetic and reconstructive surgeon who performed breast reconstruction surgery for many women with the disease.

Karen wrote a blog throughout her treatment, all with the intent of informing women that, “although such a diagnosis is awful, it is not the end of the world.” Her premise was that you could take control of the situation, seek out valuable assistance and make decisions that were best for you.

Her nine recommendations are outlined below, along with my thoughts on their relevance for any difficult medical diagnosis.

Recommendation #1: Seek out the care of a specialist.

Karen wrote:

You can look for an accredited breast center in your area through the American College of Surgeons web site. At a minimum, you should meet with a breast surgeon or general surgeon who has significant experience with breast cancer treatment.

This piece of advice holds true for any number of diseases for which you may need a surgeon and/or a specialist. For example, Health assist clients who have Parkinson’s disease and who see a movement disorder specialist (rather than a general neurologist) receive a more comprehensive approach to treatment.

Recommendation #2: Encourage your providers to work as a team.

Karen wrote:

Your physicians are most effective when they work as a team. They should be able to offer you alternative options and to answer all of your questions. If you feel uncomfortable with any of your providers, it is time to get a second opinion.

This is one of the most critical aspects of comprehensive care and something we constantly reinforce and facilitate for our clients. Unfortunately, in places not as well organized as breast centers, this requires extra effort and time among physicians (who are already stretched for time).

In an ideal environment, we’ve been able to facilitate conference calls so specialists can consider findings together, relay their recommendations, receive feedback from their colleagues and come up with a mutually agreeable approach that is consistent with the client’s preferences and priorities.

Recommendation #3: Allow others to assist you.

Karen wrote:

Let the people in your life help you. Never be pushed into a quick choice. Waiting a few weeks to wrap your head around the decision-making process will not change your prognosis.

Often, our work involves identifying both the people around a client who can be supportive, as well as additional resources in the community that may be helpful. Examples include support groups organized through the American Cancer Society or other diagnosis-specific organizations, as well as healthcare providers themselves. These can often be accessed both in person or online.

Recommendation #4: Bring a “buddy” with you to your doctor appointments.

We call such individuals “Care Partners” and have written extensively about the value someone like this brings to the experience. We fulfill this role for many clients.

Recommendation #5: Make sure your questions get answered.

Karen wrote:

Meet with all your doctors, if you can, before you make your final decision. Your physicians should be able to speak to you in plain English and answer your questions. If one session isn’t enough, go back for a second session.

We coach our clients to use an agenda to outline the objectives they have for physician meetings. This always includes a list of specific questions they want to have answered. This tool helps you to take control of the meeting and meet your expectations.

And, as Karen suggests, even if you are satisfied when you leave the physician’s office, if more issues and questions arise, don’t hesitate to circle back.

Recommendation #6: Have a paper and pen nearby.

Karen wrote:

Keep a pad of paper and pen by your bed, that way, when you wake up in the middle of the night with a burning question, you can write it down before you forget.

This is fabulous advice when faced with any diagnosis. It’s so easy to have a quick thought and minutes later it’s gone. (Leaving yourself a voicemail message works well too!)

Recommendation #7: Identify your values and preferences

Karen wrote:

For some women, holding on to their own breast is the most important thing. If it is appropriate medically, they may be a candidate for lumpectomy and radiation. For other women, the anxiety of recurrence and monitoring the opposite breast may be enough to put a serious dent in their quality of life. For those patients, bilateral mastectomy and reconstruction may be the appropriate choice. In reconstructive surgery, patient satisfaction is most highly linked to being actively involved in the decision-making process and the relationship they have with their plastic surgeon.

This advice holds true for embarking on any health care intervention you are considering and is especially important as end-of-life decisions are being contemplated.

Recommendation #8: Take time to rest.

This is true not only for clients facing their own healthcare crisis, but for those who find themselves in the role of primary caregiver for others as well. Of course, this is not always realistic, in which case identifying additional resources can be helpful.

Recommendation #9: Live in the moment.

Karen wrote:

Take time to enjoy the people in your life. If you feel like you are doing nothing, remember that doing nothing is actively healing.

In practice, of course, this is easier said than done. Identifying resources such as support groups, counselors, and/or a meditation practice can be helpful.


Although incredibly saddened by the news that my friend Karen had passed on, I smile when I think of how pleased she would be to know that she continues to not only teach me, but that she impacts the lives of others with her written words.

Recommended Reading: Words Matter

Your loved one may be managing pain while in an acute care hospital or a skilled nursing facility. This discussion about the importance of using words to describe pain is very informative.

Managing communication and the sharing of accurate information when a loved one is hospitalized and then transitioned to a skilled nursing facility is fraught with opportunities for things to fall through the cracks. This discussion about the use of electronic medical records is encouraging.