SAVVY SENIOR
How to Protect Yourself from Osteoporosis Bone Fractures  

 

Feb. 24, 2015

Jim Miller


Dear Savvy Senior,

Can a person in their early 50’s have osteoporosis? When I fell and broke my wrist last winter the doctor that treated me told me I might have osteoporosis. What can you tell me?

Worried Ronda
 

Dear Ronda,

While osteoporosis is much more common in older seniors, it can strike at any age. In fact, the National Osteoporosis Foundation estimates that half of women and up to 25 percent of men in the U.S. over the age of 50 will break a bone due to osteoporosis. Here’s what you should know.

 

Who’s at Risk?

Osteoporosis is a disease that causes the bones to become brittle and weak and more susceptible to fractures. Around 10 million Americans already have osteoporosis (80 percent are women) while another 43 million have “pre-osteoporosis,” or osteopenia. But the good news is this disease is both preventable and treatable. 

Most people, by the time they reach their late 30’s, gradually start losing some of their bone mass, but for women, menopause is the time when this process really accelerates. Bone loss for men occurs much more slowly. However, by age 75, osteoporosis is as common in men as it is in women. 

Some of the key risk factors of developing osteoporosis include: being over age 50; being female; menopause; having a family history of the disease; being small and thin; having an eating disorder; not getting enough calcium and vitamin D; getting too much protein, sodium and caffeine; having an inactive lifestyle; smoking; drinking too much alcohol; taking certain medications (see nof.org/articles/6 for a list); and having certain medical conditions (see nof.org/articles/5).

To help you determine your risk of osteoporosis, the National Institutes of Health has a quick, online quiz you can take at bonecheckup.org.

 

Prevention and Treatment

A good first step in preventing and treating osteoporosis is to get screened. For women, that should start around menopause, especially if you’re not taking estrogen, or anyone who has broken a bone after age 50 or who has other risk factors.

All women over 65 and men over 70 should be tested every two years - Medicare covers it. Screening for osteoporosis is a simple, painless, bone density test, which takes about five minutes.

 

Here’s what else you can do to protect your bones.

Boost your calcium: The best way to get bone-building calcium is through your diet.  Dairy products (low-fat milk, cheeses and yogurt), dark green leafy vegetables (broccoli, kale, collards), sardines and salmon, cooked dried beans, soy foods, almonds and fortified cereals and juices are all good sources of calcium. Vitamin D is also important to help you body absorb calcium.

The National Osteoporosis Foundation recommends 1,000 mg of calcium daily for women under age 50 and for men under 70, and 1,200 mg for women 51 and older and for men over 71. Note: Recent studies have found that excess calcium could increase the risk of heart disease.

They also recommend all adults under age 50 get 400 to 800 IU of vitamin D, or 800 to 1,000 IU if you’re over 50. If you’re not getting enough vitamin D through sunlight or food, consider taking a supplement. Most daily multivitamins contain at least 400 IU. 

Exercise: Weight-bearing exercises like walking, and strength training with weights or resistant bands three or four times a week can also significantly improve your bone health.

Control these vices: Avoid smoking, limit alcohol to no more than two or three drinks per day, and limit caffeine (coffee, tea or caffeinated soda) to three cups a day.

Consider medications: The most widely prescribed for osteoporosis are bisphosphonates, a class of drugs designed to slow or stop bone loss. Talk to your doctor about these and other medication options, as well as potential side effects.

 

Do You Need To File A Tax Return in 2015?     
Feb. 18, 2015


Dear Savvy Senior,

What are the IRS income tax filing requirements for retirees this tax season? I didn't have to file last year, but I picked up a little income from a part-time job in 2014, and I'm wondering I need to file this year.

Part-Time Retiree
 

Dear Retiree,

Whether or not you are required to file a federal income tax return this year will depend on how much you earned (gross income) - and the source of that income - as well as your filing status and your age. Your gross income includes all the income you receive that is not exempt from tax, not counting your Social Security benefits, unless you are married and filing separately

Here's a rundown of the IRS filing requirements for this tax season. If your 2014 gross income was below the threshold for your age and filing status, you probably won't have to file. But if it's over, you will.

* Single: $10,150 ($11,700 if you're 65 or older by Jan. 1, 2015).

* Married filing jointly: $20,300 ($21,500 if you or your spouse is 65 or older; or $22,700 if you're both over 65).

* Married filing separately: $3,950 at any age.

* Head of household: $13,050 ($14,600 if age 65 or older).

* Qualifying widow(er) with dependent child: $16,350 ($17,550 if age 65 or older).

To get a detailed breakdown on federal filing requirements, along with information on taxable and nontaxable income, call the IRS at 800-829-3676 and ask them to mail you a free copy of the “Tax Guide for Seniors” (publication 554), or see irs.gov/pub/irs-pdf/p554.pdf.

 

Special Requirements

There are, however, some other financial situations that will require you to file a tax return, even if your gross income falls below the IRS filing requirement. For example, if you had earnings from self-employment in 2014 of $400 or more, or if you owe any special taxes to the IRS such as alternative minimum tax or IRA tax penalties, you'll probably need to file.

To figure this out, the IRS offers a tool on their website that asks a series of questions that will help you determine if you're required to file, or if you should file because you're due a refund.

You can access this page at irs.gov/filing - click on “Do you need to file a return?” Or, you can get assistance over the phone by calling the IRS helpline at 800-829-1040. You can also get face-to-face help at a Taxpayer Assistance Center. See irs.gov/localcontacts or call 800-829-1040 to locate a center near you.

 

Check Your State

Even if you're not required to file a federal tax return this year, don't assume that you're also excused from filing state income taxes. The rules for your state might be very different. Check with your state tax agency before concluding that you're entirely in the clear. For links to state and local tax agencies see taxadmin.org - click on “State Agencies/Links” on the menu bar.

 

Tax Prep Assistance

If you find that you do need to file a tax return this year, you can get help through the Tax Counseling for the Elderly (or TCE) program. Sponsored by the IRS, TEC provides free tax preparation and counseling to middle and low-income taxpayers, age 60 and older. Call 800-906-9887 or visit irs.treasury.gov/freetaxprep to locate a service near you.

Also check with AARP, a participant in the TCE program that provides free tax preparation at more than 5,000 sites nationwide. To locate an AARP Tax-Aide site call 888-227-7669 or visit aarp.org/findtaxhelp. You don't have to be an AARP member to use this service.



 

 

Who should buy long-term care insurance?     
Feb. 10, 2015


Q: Is there a good rule of thumb on who should buy a long-term care insurance policy? My wife and I have a few assets we’d like to protect but we hate the idea of paying expensive monthly premiums for a policy we may never use.

A: There are two key factors - your financial situation and health history - you need to mull over that can help you decide if buying a long-term care (LTC) insurance policy is a wise decision for you and/or your wife. Currently, only around 8 million Americans own a policy. Here’s what you should know.

 

LTC Insurance?

As the cost of LTC (which includes nursing home, assisted living and in-home care) continues to skyrocket, it’s important to know that most people pay for LTC either from personal savings or Medicaid when their savings is depleted, or through a LTC insurance policy. National median average costs for nursing home care today is over $87,000 per year, while assisted living averages $42,000/year.

While national statistics show that about 70 percent of Americans 65 and older will need some kind of LTC, most people do not need to purchase a LTC insurance policy.

In fact, according to a recent study at the Boston College Center for Retirement Research only 19 percent of men and 31 percent of women should actually get one.

The reasons stem from a range of factors, including the fact that relatively few people have enough wealth to protect to make purchasing a policy worthwhile. Seniors with limited financial resources who need LTC turn to Medicaid to pick up the tab after they run out of money.

Another important factor is that most seniors who need LTC only need it for a short period of time - for example, when they’re recovering from surgery. For those people, Medicare covers in-home health care and nursing home stays of 100 days or less following a hospital stay of more than 3 consecutive days.

 

So who should consider buying a policy?

LTC insurance policies make the most sense for people who can afford the monthly premiums, and who have assets of at least $150,000 or more that they want to protect - not counting their home and vehicles.

Another factor to weigh is your personal health and family health history. The two most common reasons seniors need extended long-term care is because of dementia and/or disability. And, almost half of all people who live in nursing homes are 85 years or older. So, what’s your family history for Alzheimer’s, stroke or some other disabling health condition, and do you have a family history of longevity? The U.S. Surgeon General offers a free tool at familyhistory.hhs.gov to help you collect, organize and evaluate your genetic risks.

You also need to factor in gender too. Because women live and average of 5 years longer than men, they are at greater risk of needing extended LTC.

 

LTC policy shopping

After evaluating your situation, if you’re leaning towards buying a LTC policy, be sure to do your homework. The cost of premiums can vary greatly (ranging anywhere between $1,200 and $8,000 per year for a couple) depending on your age, the insurer, and the policy’s provisions. To help you find a policy, get a long-term care insurance specialist who works with a variety of companies. See aaltci.org to locate one. Also shop insurers like Northwestern Mutual and New York Life, who work only with their own agents.

If you want to save money, find out if your state offers a LTC partnership program (see aaltci.org/partnership). Under these programs, if you buy a long-term care policy approved by your state Medicaid agency, you can protect an amount of assets from Medicaid equal to the benefits that your policy pays out.






How to make your bathroom safer   
  
Feb. 3, 2014


Q: What tips do you recommend for making a bathroom safer and more functional for seniors. My 79-year-old mother slipped and fell getting out of the shower last month, and I’d like to modify her bathroom a bit with some safety features that can help protect her.
 

A: Because more accidents and injuries happen in the bathroom than any other room in the house, this is a very important room to modify for aging in place. Depending on your mom’s needs, here are some tips for each part of the bathroom that can make it safer and easier to use.

Flooring: To avoid slipping, a simple fix is to get non-skid bath rugs for the floors. Or if you want to put in a new floor get slip-resistant tiles, rubber or vinyl flooring, or install wall-to-wall carpeting.

Lighting: Good lighting is also very important, so install the highest wattage bulbs allowed for your mom’s bathroom fixtures, and get a plug-in nightlight that automatically turns on when the room gets dark.

Bathtub/shower: To make bathing safer, purchase a rubber suction-grip mat, or put down adhesive nonskid tape on the tub/shower floor. And have a carpenter install grab bars in and around the tub/shower for support.

If your mom uses a shower curtain, install a screw or bolt-mounted curtain rod, versus a tension-mounted rod, so that if she loses her balance and grabs the shower curtain the rod won’t spring loose.

If your mom has mobility issues or balance problems, get her a shower or bathtub seat so she can bathe from a seated position. In addition, you may also want to get a handheld, adjustable-height showerhead installed that will make washing while sitting down easier.

Another, pricier option is to install a walk-in-bathtub or a prefabricated curbless shower. Walk-in tubs have a door in front that provides a much lower threshold to step over than a standard tub. They also typically have a built-in seat, handrails and a slip resistant bottom, and some have therapeutic spa features with whirlpool water jets and/or bubble massage air jets.

Curbless showers have no threshold to step over, and typically come with a built-in seat, grab bars, slip resistant floors and an adjustable handheld showerhead. Prefabricated curbless showers and walk-in-tubs typically cost anywhere between $2,500 and $10,000 installed.

Toilet: Most toilets are about 14 to 16 inches high which can be an issue for many people with arthritis, back, hip or knee problems. To raise the toilet height, which can make sitting down and getting back up a little easier, you can purchase a raised toilet seat that clamps to the toilet bowl, and/or purchase toilet safety rails that sit on each side of the seat for support. Or, you can install an ADA compliant toilet that ranges between 17 and 19 inches high.

Faucets: If your mom has twist handles on the sink, bathtub or shower faucets, replace them with lever handle faucets. They’re easier to operate, especially for seniors with arthritis or limited hand strength. Also note that it only takes 130-degree water to scald someone, so turn her hot water heater down to 120 degrees.

Entrance: If your mom needs a wider bathroom entrance to accommodate a walker or wheelchair, install some “swing clear” offset hinges on the door which will widen the doorway an additional two inches.

Emergency assistance: As a safety precaution, purchase a waterproof phone for the bathroom or get a medical alert device (SOS emergency call button) that your mom could wear in case she falls and needs to call for help.

You can find all of the products suggested in this column at either medical supply stores, pharmacies, big-box stores, home improvement stores, hardware and plumbing supply stores as well as online.

 

 

How to take care of your kidneys   
  
Jan. 27, 2015


Q: What can you tell me about kidney disease? My mother died from kidney failure a few years ago at age 76, and I’m curious what my risks are and what I can do to protect myself.

A: Anyone who has a family history of kidney disease, or who has high blood pressure or diabetes is at risk and needs to have their kidneys tested. Here’s what you should know and some tips to help you take care of your kidneys.

 

Kidney disease

More than 26 million Americans currently have chronic kidney disease (when the kidneys can’t properly do their job of cleaning toxins and wastes from the blood), and millions more are at risk of developing it, yet most people don’t realize it. That’s because kidney disease develops very slowly over many years before any symptoms arise. But left untreated, the disease can eventually require people to spend hours hooked up to a dialysis machine or get a kidney transplant. Even mild kidney problems can double a person’s risk of heart attack and stroke, as well as cause anemia and bone disease.

The reason kidney disease has become so widespread today is because of the rise of obesity, type-2 diabetes and high blood pressure which all strain the kidneys.

Another factor is the increasing number of people who take multiple medications, which can overtax the organs. People over age 60 are especially vulnerable both because they tend to take more drugs, and because kidney function normally declines somewhat with age.

To help you rate your risk of kidney disease, the National Kidney Foundation has a quick, online quiz you can take at kidney.org.

 

Get tested

Because kidney disease has no early symptoms, the only way to catch it before it advances is to have a simple blood and urine test by your doctor. So, if you have diabetes, high blood pressure or heart disease, a family history of kidney disease, or are age 60 or older you need to get tested. African, Hispanic, Asian and Indian Americans along with Pacific Islanders are also at increased risk.

If you’re diagnosed with kidney disease you need to know that there’s no cure, but there are steps you can take to help contain the damage, including: 

Control your blood pressure: If you have high blood pressure, get it under 130/80. If you need medication to do it, ACE inhibitors and ARBs are good choices because of their proven ability to protect the kidneys.

Control your diabetes: If you have diabetes, keep your blood sugar as close to normal as possible.

Change your diet: This usually means reducing the amount of protein and phosphorus you eat, and cutting back on sodium and possibly potassium. Your doctor can help you determine an appropriate eating plan, or you may want to talk to a dietitian. Also see myfoodcoach.kidney.org where you’ll find lots of kidney friendly recipes and nutrition tips.

Watch your meds: Dozens of commonly used drugs can damage the kidneys, especially when taken in high doses over long periods - most notably NSAIDs like ibuprofen (Advil, Motrin and generic) and naproxen (Aleve, Naprosyn and generic). Herbal supplements can also be very dangerous. Talk to your doctor about all the prescription, over-the-counter and herbal products you take to identify potential problems and find alternatives.

Exercise and lose weight: If you’re overweight and inactive, start an aerobic fitness routine (walk, swim, cycle, etc.) that gets your heart pumping. This will help lower your blood pressure, control diabetes and help you lose excess weight all of which will help your kidneys.

Quit smoking: If you smoke, quit. Heart disease becomes a much greater risk to the kidneys if your smoke. Smoking also doubles the rate of progression to end-stage renal failure.






Getting around when you no longer drive  
  
Jan. 20, 2015

Q: Where can I find out about alternative transportation options for my elderly mother? She needs to give up driving, but before she does, we need to figure out how she’ll get around. 

A: Alternative transportation services vary widely by community, so what’s available to your mom will depend on where she lives. Here’s what you should know.

 

Transportation options

For starters it’s important to know that while most urban areas offer seniors a variety of transportation services, the options may be few to none for those living in the suburbs, small towns and rural areas. Alternative transportation is an essential link in helping seniors who no longer drive get to their doctor’s appointments, stores, social activities and more.

Depending on where your mom lives, here’s a rundown of possible solutions that can help her get around, along with some resources to help you locate them.

Family and friends: This is by far the most often used and favorite option among seniors. So make a list of all possible candidates your mom can call on, along with their availability and contact information.

Local transportation programs: These are usually sponsored by nonprofit organizations that serve seniors. These services may charge a nominal fee or accept donations and often operate with the help of volunteer drivers.

Also check out the Independent Transportation Network (itnamerica.org), which is a national nonprofit that has 27 affiliate transportation programs in 23 states. With this program, seniors pay membership dues and fees based on mileage. And, most programs will let your mom donate her car in return for credits toward future rides.

Demand response services: Often referred to as “dial-a-ride” or “elderly and disabled transportation service,” these are typically government-funded programs that provide door-to-door transportation services by appointment and usually charge a small fee or donation on a per ride basis. Many use vans and offer accessible services for riders with special needs.

Taxi or car service: These private services offer flexible scheduling but can be expensive, however, they’re cheaper than owning a car. Some taxi/car services may be willing to set up accounts that allow other family members to pay for services and some may offer senior discounts. Be sure to ask.

Another option to look into is ride-sharing services, which connects people with cars, with people who need rides. Uber (uber.com), Lyft (lyft.com) and Sidecar (side.cr) are three of the largest companies offering services in dozens of cities across the U.S.

Private program services: Some hospitals, health clinics, senior centers, adult day centers, malls or other businesses may offer transportation for program participants or customers. And some nonmedical home-care agencies that bill themselves as providing companionship and running errands or doing chores may also provide transportation.

Mass transit: Public transportation (buses, trains, subways, etc.) where available, can also be an affordable option and may offer senior reduced rates.

Hire someone: If your mom lives in an area where there are limited or no transportation services available, another option to consider is to pay someone in the community to drive her. Consider hiring a neighbor, retiree, high school or college student that has a flexible schedule and wouldn’t mind making a few extra bucks.

 

Where to look

To find out what transportation services are available in your mom’s community, contact the Rides in Sight national toll-free call center at 855-607-4337 (or see www.ridesinsight.org), and the Eldercare Locator 800-677-1116, which will direct you to her area agency on aging for assistance.

Also contact local senior centers, places of worship and retirement communities for other possible options. And check with her state department of transportation at www.fhwa.dot.gov/webstate.htm, and the American Public Transportation Association at publictransportation.org.

 

 


How to claim the retirement saver’s tax credit      
Jan. 13, 2015


A coworker was recently telling me about a tax credit she got last year for simply contributing to our company’s 401(k) plan. What can you tell me about this, and who’s eligible?
 

A: It’s called the “retirement saver’s tax credit,” and it’s a frequently overlooked credit that’s available to low and moderate-income individuals and families who make saving for retirement a priority. Here’s how it works.

If your contribute to a traditional or Roth IRA, or an employer sponsored plan like a 401(k), 457, 403(b), SEP plan, SIMPLE IRA or other retirement-savings plan, the retirement saver’s tax credit will allow you to claim 10, 20 or 50 percent of your contribution, depending on your income, up to a maximum of $1,000 per person or $2,000 per couple.

To qualify, you must also be at least 18 years old and not a full-time student, and were not claimed as a dependent on someone else’s tax return. And your adjusted gross income in 2015 must be $61,000 or less as a married couple filing jointly, $45,750 or less if filing as head of household, or $30,500 or less if you’re a single filer. These income limits are adjusted annually to keep pace with inflation.

To get the 50 percent credit, you’ll need to have an income below $18,250 if you’re single, $27,375 if you’re filing as head of household, and $36,500 for couples in 2015.

The 20 percent credit rate applies to individuals earning between $18,251 and $19,750; for head of household filers it’s $27,376 to $29,625; and for couples it’s $36,501 to $39,500.

And the 10 percent rate is for individuals with an adjusted gross income between $19,751 and $30,500; for head of household filers 29,626 to $45,750; and couples it’s between $39,501 and $60,100.

 

Double tax break

You also need to know that the retirement saver’s tax credit can be claimed in addition to the tax deduction you get for contributing to your employer’s retirement plan or a traditional IRA. Here’s an example of how this works.

Let’s say you’re married and have an income of $37,000, and your spouse is not working. If you contribute $1,000 to your company’s 401(k) plan, your adjusted gross income would be reduced to $36,000 on your tax return. You would also be able to claim a 50 percent retirement saver’s credit, which is worth $5,000, for your $1,000 401(k) contribution.

Keep in mind though that this is a tax credit, not a deduction, so it lowers your income tax dollar for dollar. It is, however, a nonrefundable tax credit, which means it cannot reduce the amount of tax owed to less than zero.

 

How to claim

To claim the credit, you will need to fill out Form 8880 (see irs.gov/pub/irs-pdf/f8880.pdf) and attach it to your 1040, 1040A or 1040NR when you file your tax return. Don’t use the 1040EZ Form.

If you think that you would have qualified for the credit in previous years but didn’t claim it, you can file an amended return as far back as 2011 and still get the credits. A 2011 amended return is due by April 15, 2015. See IRS Form 1040X (irs.gov/pub/irs-pdf/i1040x.pdf) for instructions on how to file an amended return.

And for more information on the retirement saver’s tax credit, see IRS Publication 590 “Individual Retirement Arrangements” (irs.gov/pub/irs-pdf/p590.pdf).

If you don’t have Internet access to see or download these forms, call the IRS at 800-829-3676 and ask them to mail them to you.

 

 

How to keep tabs on an elderly parent when you can’t be there     
Jan. 7, 2015


Q: Can you recommend any caregiving devices or technology products that help families keep an eye on an elderly parent that lives alone? Over the holidays, my sister and I noticed that my dad’s health has slipped, so we would like to find something that helps us keep closer tabs on him when we’re not around.

A: There are many different assistive technology products available today that can help families keep an eye on an elderly loved one when they can’t be there. Depending on your dad’s needs and how much you’re willing to spend, here are some good options to consider.

 

Personal emergency response systems

If you’re primarily worried about your dad falling and needing help, one of the most commonly used and affordable products for seniors living alone is a personal emergency response system (PERS) - also known as a medical alert device.

For about a dollar or two a day, these systems provide a wearable pendent button - typically in the form of a necklace pendent or wristband - and a base station that connects to the home phone line.

At the press of a button, your dad could call and talk to a trained operator through the system’s base station receiver, which works like a powerful speakerphone. The operator will find out what’s wrong, and will notify family members, a neighbor, friend or emergency services as needed.

Some PERS today even offer motion-sensitive pendants that can detect a fall and automatically call for help. And some offer GPS mobile-alert pendants that work anywhere. Some top companies that offer all levels of services include Philips Lifeline (www.lifelinesys.com, 800-380-3111), Medical Alert (www.medicalalert.com, 800-800-2537) and MobileHelp (www.mobilehelpnow.com, 800-992-0616).

 

Sensor monitoring

If you want to keep closer tabs on your dad than what a PERS offers, consider a sensor monitoring system. These systems use small wireless sensors (not cameras) placed in key areas of your dad’s home that can detect changes in his activity patterns, and will notify you via text message or email if something out of the ordinary is happening. For instance, if he went to the bathroom and didn’t leave, it could indicate a fall or other emergency.

You can also check up on his patterns anytime you want through the system’s website. And for additional protection, most services also offer PERS call buttons that can be placed around the house, or worn.

Some good companies that offer these services are GrandCare Systems (www.grandcare.com, 262-338-6147), which charges $300 for their activity sensors, plus a $50 monthly service fee. And BeClose (www.beclose.com, 866-574-1784), which runs $399 for three sensors, and a $69 monthly service fee if paid a year in advance.

If you’re interested in a more budget-friendly option, consider Lively (www.mylively.com, 888-757-0711), which costs only $50 with a $35 monthly service fee. Lively uses small motion sensors that you attach to movable objects like a pillbox, refrigerator door, front door, etc. These sensors will track your dad’s movement/activity and let you know of any abnormalities in his routines. For example, if he didn’t pick up his pillbox to get his medicine, or he didn’t open the front door to go out and retrieve his morning newspaper, you would be notified and can check on him. Lively also offers a PERS “safety watch” in case he falls or needs to call for help. 

Another affordable option to check out is Evermind (www.evermind.us, 855-677-7625), which lets you keep an eye on your dad by monitoring his frequently used electrical appliances through small plug-in sensors. So, for example, if your dad doesn’t turn on the coffee maker in the morning, or if he’s not watching his favorite television program before bedtime, you would be notified. Evermind costs $199 for the three sensors, plus a $29 monthly service fee.





How to appeal when Medicare won’t pay
Jan. 2, 2014


Q: How does one go about appealing Medicare when they won’t pay for something that has been covered in the past?

A: If you disagree with a coverage or payment decision made by Medicare, you can appeal, and you’ll be happy to know that around half of all appeals are successful, so it’s definitely worth your time.

But before going that route, talk with the doctor, hospital and Medicare to see if you can spot the problem and resubmit the claim. Some denials are caused by simple billing code errors by the doctor’s office or hospital. If, however, that doesn’t fix the problem, here’s how you appeal.

 

Original Medicare appeals

If you have original Medicare, start with your quarterly Medicare Summary Notice. This statement will list all the services, supplies and equipment billed to Medicare for your medical treatment, and will tell you why a claim was denied.

There are five levels of appeals for original Medicare, although you can initiate a fast-track consideration for ongoing care, such as rehabilitation. Most people have to go through several levels to get a denial overturned.

You have 120 days after receiving the MSN to request a “redetermination” by a Medicare contractor, who reviews the claim. Circle the items you’re disputing on the MSN, provide an explanation of why you believe the denial should be reversed, and include any supporting documents like a letter from the doctor or hospital explaining why the charge should be covered. Then send it to the address on the form.

The contractor will usually decide within 60 days after receiving your request. If your request is denied, you can request for “reconsideration” from a different claims reviewer and submit additional evidence.

A denial at this level ends the matter, unless the charges in dispute are at least $140. In that case, you can request a hearing with an administrative law judge. The hearing is usually held by videoconference or teleconference.

If you have to go to the next level, you can submit the claim to the appeals council review. Then, for claims of at least $1,400, the final level of appeals is judicial review in U.S. district court.

 

Advantage and Part D appeals

If you’re enrolled in a Medicare Advantage or Part D prescription drug plan the appeals process is slightly different. One difference is that you have only 60 days from the date on the denial notice to file an appeal. And in both cases, you start by appealing directly to the plan, rather than to Medicare. Follow the plan’s instructions on its explanation of benefits.

Part D has a fast-track appeal of 72 hours if you haven’t received your medication and waiting would jeopardize your health. Otherwise, the plan must notify you of its decision within seven days.

For more information, along with step-by-step procedures on how to make an appeal, visit Medicare.gov and click on the “Claims & Appeals” tab at the top of the page, or call Medicare at 800-633-4227 and request a copy of publication #11525 “Medicare Appeals.” You can also read it online at medicare.gov/pubs/pdf/11525.pdf.

 

Get help

If you need some help, contact your State Health Insurance Assistance Program (SHIP), which has counselors that can help you understand the billing process and even file your appeal for you for free. To locate your local SHIP, visit shiptalk.org or call the Eldercare Locator at 800-677-1116. The Medicare Rights Center also offers free phone counseling at 800-333-4114.

 



 

Q: What can you tell me about lung cancer screenings? My husband was a long-time smoker, but quit many years ago, so I’m wondering if he should be checked out.
Dec. 15, 2014


A: According to recent recommendations from the U.S. Preventive Services Task Force - an independent panel of medical experts that advises the government on health policies - if your husband is between the ages of 55 and 80, is a current smoker or quit within the last 15 years, and has a smoking history of at least 30 pack-years, he’s at high risk for lung cancer and should talk to his doctor about getting screened.

Pack years are determined by multiplying the number of packs he smoked daily by the number of years he smoked.

You’ll also be happy to know that lung cancer screenings - which are recommended annually to those at risk - will be covered by all private health insurance plans starting in 2015, and Medicare is expected to begin coverage this February or March. The Medicare screening, however, will only cover high-risk beneficiaries through age 74.

Lung cancer kills around 160,000 Americans each year making it the most deadly of all possible cancers. In fact, more people die of lung cancer than of colon, breast and prostate cancers combined.

Lung cancer also occurs predominantly in older adults. About two out of every three people diagnosed with lung cancer are 65 or older, and the risk of lung cancer peaks at age 71.

 

Lung cancer screening

The goal of annual screenings is to detect cancer early before symptoms appear, so it can be cured. The five-year survival rate among people with lung cancer when it’s caught in its earliest stage is 77 percent, versus only 4 to 25 percent for people whose cancer has spread.

To get screened for lung cancer, your husband will need a low-dose computed tomography (CT) chest scan, which is a painless, noninvasive test that generates detailed three-dimensional images of his lungs.

For the screening, he will be asked to lie on a table that slides through the center of a large, doughnut shaped scanner that rotates around him to take images. Each scan takes just a few seconds, during which time he’ll be asked to hold his breath, because movement can produce blurred images. The entire procedure takes only a few minutes from start to finish.

You also need to be aware that a lung CT screening has its downsides. First, it exposes you to some radiation - about the same as a mammography but more that of a chest X-ray.

Lung CT screenings aren’t foolproof either. They can produce a high rate of false-positive results, which means they frequently detect small spots (abnormalities) on the lungs that are suggestive of cancer but aren’t cancerous. These false alarms lead to more testing and sometimes lung biopsies, as well as unnecessary worry and anxiety.

 

Prevention

Because smoking causes 80 to 90 percent of all lung cancer cases, the best way to avoid lung cancer is to not smoke, and if you do smoke, quit. Even if you’ve been a smoker for a long time, quitting now still decreases your risk. Other factors that can increase the risk of lung cancer include exposure to secondhand smoke, radon, asbestos and other toxic chemicals or fumes.

For more information on lung cancer screenings, call the American Lung Association at 800-586-4872, or use their online tool (LungCancerScreeningSavesLives.org), which will help you determine if your husband needs to be screened.

 


 

Convenient ways to get help with your Social Security questions
Dec. 9, 2014


Q: Can you recommend some easier ways that I can get help with my Social Security questions? When I call their toll-free help line I get put on hold forever, and the wait time at my local Social Security office is over two hours.

A: It’s unfortunate, but the past few years the Social Security Administration has made some major budget and staff cuts that have greatly increased their phone service and field office wait times for their customers. With that said, here’s an alternative option and some tips that can help make your access to Social Security a little faster and easier.

 

Online services

With the evolution of the Social Security website, the quickest and most convenient way to work with Social Security these days is to do it yourself online. Depending on what you need, most tasks can be done at SocialSecurity.gov like getting your Social Security statement, estimating your future benefits, applying for retirement or disability benefits, signing up for direct deposit, replacing a Medicare card and much more. See a complete list of what you can do online at ssa.gov/onlineservices

You can also get information and answers to most of your Social Security questions at faq.ssa.gov if you’re patient enough to read through the information yourself.

But, if you need more help than their website offers, you can always call Social Security’s toll-free service line at 800-772-1213 Monday through Friday between 7 a.m. and 7 p.m. and ask your question over the phone, or make a scheduled appointment with your local field office. To reduce your wait time, avoid calling during their rush hour times, which are the first week of the month, and daily from about 10 a.m. and 3 p.m.

 

Need advice?

If you’re seeking advice on when you should start taking your Social Security benefits, you need to know that while Social Security employees do provide information on how the system works under different circumstances, they aren’t allowed to give case-specific advice on when you should start drawing your benefits.

If you want help with this, you’ll need to turn to some of the free or fee-based Social Security tools that are available online through private financial service companies or AARP.

Depending on the service, these tools take into account the different rules and claiming strategies that can affect your benefits, and some of them can crunch hundreds of calculations to compare your benefits under various scenarios and different ages to help you figure out the best time to start claiming.

Some of the best free tools are AARP’s Social Security Calculator (aarp.org/socialsecuritybenefits); SSAnalyze which is offered by Bedrock Capital Management (bedrockcapital.com/ssanalyze); and Analyze Now (analyzenow.com - click on “Computer Programs”) which offers a “Free Strategic Social Security Planner” but requires Microsoft Excel to use it.

Or, if you don’t mind spending a little money, there are higher-level services you can use like Maximize My Social Security (maximizemysocialsecurity.com), which charges $40 for their report, and takes into account the thousands of different factors and combinations to help you maximize your benefits.

And Social Security Solutions (socialsecuritysolutions.com, 866-762-7526), which offers several levels of service (ranging between $20 and $250) including their $125 “Advised” plan that runs multiple calculations and comparisons, recommends a best course of action in a detailed report, and gives you a one-on-one session with a Social Security specialist over the phone to discuss the report and ask questions.

 

 

 

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