Four Medical Tests for Women Over 50; Four Medical Tests for Men Over 50

by LAS

Dr. Oz has been promoting the value of four basic medical tests for men and women age 50 and over to catch the most serious health problems early.

FOR MEN--

1- A PSA test. Recommended on an annual basis for men age 50 and over. You might get the test at age 50 just for a baseline reading, but Dr. Oz still feels that annual testing provides essential information for your healthcare provider.

2- Colonoscopy. Colon cancer is the third most common cancer in men.

3- Hearing test. Going to the audiologist is recommended especially for men, who more often work with power tools, jackhammers, or in noisy environments. Hearing loss affects about a third of adults over age 65, and almost half of all men over 75. Tinnitus (ringing in the ears) is also a reason to see your doctor.

4- Not a single medical test, but a head-to-toe skin check to catch changes in moles or other abnormalities that can signal skin cancer.

FOR WOMEN--

1- Bone Scan-- Osteoporosis can lead to bone fractures particularly in women past menopause. If you are identified as having a bone-thinning disease, you may elect to take bisphosphonates to curb further bone loss. Other approaches such as weight-bearing exercises or dietary changes can also fend off further bone loss.

2- Colonoscopy-- Colon Cancer kills more women than ovarian, uterine and cervical cancer combined. Testing can start at age 50, though you only need to take it once every decade.

3- Mammogram-- A baseline test is suggested at age 40, then annual tests after age 50. Your doctor may want annual tests earlier than that if you have had any family history of breast cancer.

4- Pap Smear Test-- Annual testing is suggested for most women of any age. You could elect to drop this test after age 65, though, since one's risk drops off greatly after that if you have had mostly clean screenings.

Smokers Cost Employers $12K More Per Year (each) than Non-smokers

by LAS

Studies show that each smoker costs a company an average of $12,000 a year more than non-smokers. Inspired by a California study that showed every dollar spent by the state on smoking-cessation programs saved $18 in health care costs – more employers are moving to start smoke-free policies or tobacco-cessation programs in the workplace.

Employers do have to skirt some smokers' rights laws in a few states to avoid discrimination lawsuits if they become too invasive.

In just 29 states, the employers are limited to prohibiting smoking in the workplace, and states may prohibit smoking in public places. They have what is called “lifestyle laws” that protect workers. Employers may not take smoking into account regarding promotions, hiring or firing.

These laws, one must admit, are pretty toothless. It is difficult to prove that an employer violated the law because they know enough to provide some other, innocuous reason for not hiring or promoting someone.

Some of the state laws are even weaker. The Virginia law apply only to state employees. Three states – Minnesota, Illinois, and Montana – protect smokers rights but allow employers to charge higher premiums for the smokers. Three states – Tennessee, Louisiana, and Colorado – apply their protection of smokers to future hires, not current employees (when the law was passed).

Smokers who try to quit generally have to make many attempts before it sticks. Statistically, it takes seven attempts for a smoker to quit smoking. So keeping trying, you never know what approach will finally help you reach your goal.

More Than Two-thirds of ER Visits Avoidable, Says Study

by LAS

A recent study by Truven Health Analytics found that 72 percent of emergency room visits were avoidable, and could have been safely treated by a primary care provider. Truven drew upon a database of 24 million patients.

Healthcare situations were broken down into four categories of urgency. Category One is Non-emergent; medical care was not required within 12 hours.

Category Two is Emergent – Primary-Care Treatable; medical care was required within 12 hours but could have safely been delivered in a primary care setting (that is, in a clinic office).

Category Three is Emergent, (preventable or avoidable); this means that the patient needed medical care within 12 hours, for could have been prevented with effective office visits. An example of the latter would be someone who had diabetes or high-blood pressure who was not taking their medication as advised, and suddenly had a sudden event such as a stroke.

Category Four is Emergent (not preventable or avoidable); these are the kinds of events that people normally associate with an ER visit – a child falls out of a tree, someone is a victim of a car accident or shooting, someone is hit by a softball in a game, a homeowner falls off the roof, etc.

Some events were split between two categories, such as “abdominal pain, unspecified site” since there is a 33 percent chance of it being a serious problem requiring emergency treatment and a 67 percent chance of being something that could be looked at in your doctor's office.

The good news that only 6 percent of patients had an event that could have been prevented with proper primary care. That suggests that people are taking existing conditions seriously, taking their medicine, and making sensible lifestyle decisions.

Almost half (42 percent) could have been acceptably treated by their primary care provider. No reason was floated for why patients did not go to their physicians. Possibly they felt they could not get into a treatment room in a timely fashion.

One quarter had serious conditions but did not require treatment within 12 hours. Presumably they could have gotten into their primary care provider within that time, or gone to an urgent care center.

When broken down by age, it was shocking to see that three-quarters of the visits by children age four and under were of a nature that should have been seen in a primary care setting. Whether the parents had health-care coverage for minors was not addressed in this report. But still, these health events should have been seen in a primary care setting by a pediatrician who was familiar with the child's background.

Steering patients to the proper non-ER setting would by itself create huge cost savings for not only insurers but the patients, who presumably would have come up with much larger copays for an ER visit. 

Gee, Does Medical Tourism Mean I Can Go To Appleton???

by LAS

I ran across a mention that a hip replacement costs only about $27,000 in Appleton, Wisconsin, while it can cost as much as $126,000 in a major metro area such as Houston, Texas. Why the disparity?

Obviously wide variations in income levels between major metro areas and smaller towns are a big factor. But also the fact that the hospital has to pay much higher property taxes and other expenses in a big city is another major factor. It may also have to buy another lot to build a parking structure on for patients and visitors, while the small town has free street parking.

The small town hospital might also sacrifice some frills, too. 

Joe Schmo and Mrs Schmo and the Inherited IRA

by LAS

Joe Schmo can leave his IRA to your surviving spouse (Mrs Schmo) or child (Johnny Schmo), no problem. But doing it right can avoid a big tax bite. This is according to Jane Bryant Quinn, so if your local finance advisor is at all confused over how to handle this, tell him that.

Mr Joe Schmo has a very fine IRA, but one day he kicked the bucket. Fortunately he designated Mrs Schmo as his beneficiary.

Mrs Schmo has to put this IRA in her name. This is called retitling. With a traditional IRA, she has to leave the money alone until she reaches age 70 and a half, when the law requires her to start making withdrawals. (NOTE: With a Roth IRA, you can keep money you do not need in the IRA for the next generation.)

Mrs Schmo is under 59 and a half, so this is how she should re-title this IRA: “Joe Schmo IRA (deceased MO-DAY-YR) for the benefit of Jane Schmo, beneficiary.”

When Mrs Schmo reaches 59 and a half, she ought to re-title it once more, this time in her own name. This has the advantage of allowing her to let the money accrue value until she need it, or rather when she is required to make withdrawals at age 70 and a half.

Now, let's say that a parent leaves the balance of an IRA to an adult child. The child also has to re-title the IRA. Joe Schmo leaves his IRA to his only child, Johnny Schmo, so Johnny has to re-title it like this: “Joe Schmo IRA (deceased MO-DAY-YR) for the benefit of Johnny Schmo, beneficiary.” (if there are several children, each one should re-title his or her share of the IRA)

Note that inherited 401(k)s can also be similarly retitled as an inherited IRA.

There is a book out there on this specific topic, “Retire Secure! Pay Taxes Later” by James Lange. 

“Payable-on-Death” or Power of Attorney to Avoid Inheritance Taxes?

by LAS

Bereaved parents who added an adult child to their bank accounts have found that the state can tax their own money as an inheritance, if the child dies an untimely death.

Laws in Pennsylvania, Indiana, and Nebraska tax inheritances. Also, Iowa, Kentucky, Maryland and New Jersey tax inheritances but exempt parents from being assessed this tax. (NOTE: When I lived in Wisconsin I had to pay inheritance tax to the state as well as the federal government; I have no idea why Wisconsin is not on this list.)

So keep this in mind if you live in those states and you wish to have an adult child handle bills for your funeral and other debts without waiting for probate to be settled. We have found that most banks will allow you to put the name of an adult child on your account under the terms of “payable on death” – which would have avoided the cases of parents paying taxes on their own money because of an untimely death of the designated child. 

One Nagging Question About Qualifying for PPACA Exchanges

by LAS

One of the nagging questions that keeps bothering me about the states insurance exchanges is whether the people who need it will be be able to get coverage.

The PPACA law was intended to expand Medicaid coverage to all low-income adults under age 65 beginning in 2014. This would have brought 16 million uninsured under the Medicaid umbrella – assuming income of up to $15,415 for an individual and $26,344 for a family of three.

However, the Supreme Court ruled that the states can decline (opt out) of the expansion of Medicaid. About a dozen governors have said they will not expand Medicaid in their states, or are leaning in that direction. Now, since the Supreme Court ruled on this matter, I hear that the federals are trying the ol' carrot-and-stick approach with the recalcitrant states in question.

While I am on the subject of PPACA, here is what goes into effect in 2014:

by LAS

Several provisions of the PPACA law, aka Obama-Care, will go into effect in 2014. Let's review them now.

First, we should mention that the “employer mandate” has been pushed back to 2015. No word on what happens then.

Second, rules regarding waiting periods will go into effect. The most important provision is that waiting periods for health care coverage can no longer extend past 90 days. This may be a bit tricky for employees who work seasonal or variable hours. In that case, it may be that these employees might not be covered at all in 2014 if the employer requires its employees to work a minimum number of hours to be covered.

Third, pre-existing conditions cannot be used as a grounds for denying a policy nor for denying treatment for that condition. Plans cannot discriminate against persons for any of a range of health factors. Plans cannot impose restrictions on eligibility or charge more for coverage based on health history, etc. Women cannot be charged more than men. Also a part of this clause is that all employees must be given comparable healthcare plans; that is, high-income employees cannot get gold-plated plans and everyone else gets a tin version.

Fourth, starting in July 2013, employers start paying one dollar per employee into a fund for the Patient-Centered Outcomes Research Institute, which will collect and publish data relating to effectiveness of medical treatments. The assessment goes up to $2 per employee for years 2 thru seven, when it is designed to terminate.

Fifth, rewards for meeting requirements under wellness programs will increase from 20 percent of cost of coverage to 30 percent. Wellness incentives for quitting smoking will increase up to 50 percent.

Sixth, the so-called “donut hole” in Medicare Part D prescription coverage will shrink until it is eliminated in the year 2020.

Seventh, the individual mandate may (or may not) also be pushed back, but there was never any provision for sending people to jail for not buying insurance. People may lose all or part of a tax refund, or pay an annual tax for 2014 of one percent of income or $95, whichever is greater.