Your guide to Medicare open enrollment: How to shop, switch, and compare plansPublished: Oct. 12, 2020 at 5:02 a.m. ET
Part A, part B, part D…You just want a health plan. Here’s help navigating the Medicare maze
As with most health care plans, Medicare plans have an annual open enrollment period. During this time, current Medicare users get a chance to evaluate their coverage and potentially make changes.
Medicare has one main open enrollment window from Oct. 15 to Dec. 7 each year. However, there’s also a Medicare Advantage open enrollment period annually from Jan. 1 to March 31.
What is Medicare open enrollment?Open enrollment is the health care user’s chance to evaluate the plan they have, take a look at what’s on the market and update their coverage for the coming year. Open enrollment is for consumers who already have Original Medicare or Medicare Advantage.
See: What are Medicare Advantage plans, and are they worth the risk?
During the main open enrollment period, from Oct. 15 to Dec. 7, any changes you make will take effect on Jan. 1. During the Medicare Advantage open enrollment period, any changes you make will take effect on the first of the month after the plan receives your request.
What you can changeThere are several things you can alter during open enrollment. From Oct. 15 to Dec. 7, you can do the following things:
Also see: The Medicare enrollment process is failing seniors and needs to be modernized
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Comparing Original Medicare and Medicare AdvantageIf you have an Original Medicare plan — you’re enrolled in Medicare Part A and Medicare Part B — open enrollment is the time when you might consider switching to a Medicare Advantage Plan. For some people, purchasing a Medicare Advantage Plan feels simpler.
“Some people prefer the sense of a one-stop shop,” says Deborah Gordon, author of “The Health Care Consumer’s Manifesto: How to Get the Most for Your Money.” “Like, ‘I cannot deal with A, B, D, I just want a health plan.’”
Here’s what you should know:
There are five different types of Medicare Advantage Plans:
Health Maintenance Organization, or HMO, plans: This kind of plan requires you to see an in-network provider unless it’s an emergency situation. Most require you to get a referral to see a specialist.
Preferred Provider Organization, or PPO, plans: This kind of plan allows you to see both in-network and out-of-network health care providers, although it typically is more expensive to go out of network.
Private Fee-for-Service, or PFFS, plans: This kind of plan allows you to see any Medicare-approved health care provider as long as they accept the plan’s payment terms and agree to see you, and you may also have access to a network of providers. You can see doctors that don’t accept the plan’s payment terms, but you might pay more.
Special Needs Plans, or SNPs: This kind of plan provides benefits to people with certain diseases, such as cancer, or health care needs, such as living in a nursing home. It also provides benefits to people with a limited income.
Medical Savings Account, or MSA, plans: These combine a high-deductible insurance plan with a medical savings account that can be used for health care costs.
Choosing between Medicare Advantage Plans will require you to understand your health care needs and think about what each type of plan offers. If you have a chronic health condition and you love your doctors, you’ll want health coverage that they accept. If you take prescription drugs, some plans may result in lower out-of-pocket costs than others.
Read: The COLA increase for next year doesn’t look good
Here are some questions to ask:
Do you have to get a referral? Some plans require you to get a referral from your primary care physician to see a specialist. If that’s not your preference, you’ll want to choose a plan with more freedom.
What benefits do they include? Do you need vision and dental coverage? Look for a plan that offers the benefits you want.
How much will your drugs cost? If you’re taking regular prescription drugs, compare costs within each plan to make sure you understand what you’ll be paying.
Are your doctors covered? If you like your providers, find out whether they’re included in the networks of the plans you’re considering.
What’s their rating? Each Medicare Advantage Plan comes with a star rating that ranges from one star to five stars. “I talked to a consumer in Massachusetts who essentially [won’t consider] any plan below a four-star plan,” Gordon says.
For additional help, try the Medicare Plan Finder on Medicare’s website.
How to switch Medicare Advantage PlansIf you’re already in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan during either open enrollment period: Oct. 15 to Dec. 7, or Jan. 1 to March 31. After you join a new plan, you’ll be automatically unenrolled from your old plan once your new one starts.
If you have questions about Medicare coverage, you can find lots of information at Medicare.gov, or you can call 1-800-MEDICARE (1-800-633-4227).
More Medicare basics from NerdWallet:
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Open enrollment is your annual opportunity to review your employer-provided benefit options and make elections for the upcoming plan year. You can get the most out of what your employer offers and possibly save some money by taking the time to read through your open enrollment information before making any benefit decisions. Every employer has its own open enrollment period (typically in the fall) and the information is usually available online through your employer.
What are your health plan options? Even if you're satisfied with your current health plan, it's a good idea to compare your existing coverage to other plans being offered next year. Premiums, out-of-pocket costs, and benefits often change from one year to the next and vary among plans. You may decide to keep the plan you already have, but it doesn't hurt to consider your options.
Should you contribute to a flexible spending account? You can help offset your health-care costs by contributing pre-tax dollars to a health flexible spending account (FSA), or reduce your child-care expenses by contributing to a dependent-care FSA. The money you contribute is not subject to federal income and Social Security taxes (nor generally to state and local income taxes), and you can use these tax-free dollars to pay for health-care costs not covered by insurance or for dependent-care expenses. Typically, FSAs are subject to the use-it-or-lose-it rule, which requires you to spend everything in your FSA account within a calendar year or risk losing the money. Some employers allow certain amounts to be carried over to the following plan year or offer a grace period that allows you to spend the money during the first few months of the following plan year.
Tip: As a result of unanticipated changes in the need for medical and dependent care due to the coronavirus pandemic, the IRS announced it will allow employers to amend their employer-sponsored health coverage, health FSAs, and dependent-care assistance programs and allow employees to make certain mid-year changes for 2020. The carryover limit for unused 2020 FSA dollars is now $550 instead of $500. For more information, visit irs.gov.
What other benefits and incentives are available? Many employers offer other voluntary benefits such as dental care, vision coverage, disability insurance, life insurance, and long-term care insurance. Even if your employer doesn't contribute toward the premium cost, you may be able to pay premiums conveniently via payroll deduction. To help avoid missing out on savings opportunities, find out whether your employer offers other discounts or incentives. Common options are discounts on health-related products and services such as gym equipment and eyeglasses, or wellness incentives such as a monetary reward for completing a health assessment.
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Join us for our online Seminar that we will be hosting in partnership with the Chesapeake Parks, Recreation & Tourism "55 & Better" Programs. All live viewers will have the opportunity to pick up an informational packet after the Seminar and will also have the chance to WIN AN IPAD.
Note: We will also be offering FREE Zoom instructional sessions prior to the Seminar for those who are not familiar with the online Zoom platform.
9:30 - 9:35AM - Welcome from Senior Advocate
9:35 - 9:40AM - Welcome from Karen Christy, Recreation Coordinator, Chesapeake Parks, Recreation and Tourism "55 & Better” Programs
9:40 – 10:00AM - “Managing Stress and Its Effects on Your Health” presented by Dr. Frank Lombardozzi, Kempsville Chiropractic
10:00 – 10:15AM - “Life As a Resident” presented by Kathy Parks, Director of Resident Services and Ann Dillman, Resident, Atlantic Shores
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11:00 - 11:15AM - “Veterans Benefits” presented by Jamar Blyther, Dept. of Veterans Affairs
11:15 – 11:30AM - “Fraud and COVID-19” presented by Shawn Smith, Director, Virginia Senior Medicare Patrol
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RSVP HERE by September 23 or call 757-724-7001 for more information.
Center for Medicare Advocacy Toolkit: How to Obtain an Additional 100 Days of Medicare Coverage in a Skilled Nursing Facility During the COVID Public Health Emergency
SEPTEMBER 3, 2020
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As the Public Health Emergency (PHE) continues and the number of Medicare beneficiaries impacted by the PHE grows, the Center for Medicare Advocacy (the Center) has received an increasing number of requests for guidance on expanded Medicare coverage in skilled nursing facilities (SNFs).
The following are a compilation of self-help materials that include articles written by the Center (citing CMS guidance), detailed CMS instructions to obtain the waiver, and an interpretation of the additional 100 day waiver as adjudicated by a Medicare Administrative Law Judge (ALJ):
Our July 2020 CMA Alert discussing the Centers for Medicare and Medicaid Services (CMS) detailed guidance about how to obtain up to an additional 100 days of SNF coverage. https://medicareadvocacy.org/cms-clarifies-covid-waivers/
A June 2020 CMA Alert discussing a case study of the 100 day waiver and a full explanation of when the additional coverage would apply, and when it would not. Here is a link to the article: https://medicareadvocacy.org/covid-19s-impact-on-beneficiary-rights-a-case-study-examining-medicare-coverage-exceeding-100-days-in-a-skilled-nursing-facility/
Traditional Medicare Cases: CMS has issued a Medicare Learning Network (MLN) article that explains exactly how to bill for the 100 days, including necessary coding and language required to be included in the remarks section (COVID100). Without working through the specific billing requirements, CMS states that the claim will not be processed. https://www.cms.gov/files/document/se20011.pdf
Medicare Advantage Plan Cases: A Medicare ALJ decision shared with the Center by a beneficiary details the steps used by the ALJ to award an additional 100 days of coverage, overruling organization determinations and the independent review entity’s denial of the additional days. The redacted decision is at: https://medicareadvocacy.org/wp-content/uploads/2020/09/COVID-19-100-extra-days-in-SNF-OMHA-decision.pdf.
A note of caution about Medicare’s 1135 blanket waivers, providing flexibility under section 1812(f) of the Social Security Act: A PHE waiver that extends SNF benefits by up to 100 days does not appear to afford beneficiaries the same rights as the first 100 days of statutory coverage. In a letter written in response to a congressional inquiry about the issue, CMS noted that the benefit extension under the PHE is at the discretion of the facility. CMS stated, “Our goal with these waivers is to provide flexibility for the wide variety of challenges that SNFs face during the pandemic. In such circumstances, blanket waivers allow facilities to apply provisions without the need to request them from CMS, thereby allowing SNFs to address very local and very specific challenges. If the SNF would like to cite and document…The SNF may choose to exercise that provision of the 1135 blanket SNF waiver…” The redacted CMS letter is at: https://medicareadvocacy.org/wp-content/uploads/2020/09/CMS-redacted-letter-re_-congressional-inquiry-PHE-100-day-waiver.pdf
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Today’s older workers may see the first cuts to Social Security benefits
Published: Sept. 11, 2020 at 10:16 a.m. ET
By Alessandra Malito
The Congressional Budget Office released an updated budget outlook, including the pandemic’s impact on the economy
The Congressional Budget Office released a report detailing the potential impact of the pandemic on the country’s economy.
Many young Americans say they don’t expect to get Social Security when they retire, but it’s the older workers of today who may see the first cuts to their benefits.
The Congressional Budget Office released an updated budget outlook on Wednesday, originally published in July, to reflect the impact the pandemic has had on the economy. In the report, the agency said the budget deficit will reach a record $3.3 trillion this year — and $13 trillion over the next decade. The national debt, which is projected to be 98% of gross domestic product this year, is also expected to surpass the levels of World War II next year, when it’s expected to reach 104% in 2021.
Among the numerous adverse effects of the current crisis is the steep incline in the expected insolvency dates for Social Security and Medicare’s programs, which are expected to run out of money in 11 years compared with the previous projection of 15 years.
See: Social Security recipients may be in for a rude awakening later this year
The programs rely heavily on payroll taxes. The CBO expects reported receipts from payroll taxes to increase this year despite record levels of unemployment in recent months, but that will change in subsequent years, it said. Lower interest rates and price levels will also reduce the cost of Social Security and other related health care programs, according to the Committee for a Responsible Federal Budget, which did an analysis on CBO’s updated outlook.
Still, Social Security is in trouble. The two trust funds that support the program, which pays out retirement benefits as well as disability and survivorship benefits, are already at risk of running out of money within the next two decades. With the impact of the pandemic under review, the CBO estimates the insolvency date for Social Security Disability Insurance to be 2026, and the Social Security retirement program, known as Old-Age and Survivors Insurance, by 2031. Medicare Hospital Insurance faces insolvency by 2024 if nothing is done to rectify these projections.
“In other words, today’s youngest retirees will face a sharp 25% drop in their benefits when they turn 73,” the CRFB said in an analysis about the CBO’s report. The cut is attributed to less tax revenue, an aging population that will inevitably claim Social Security benefits and trust fund assets that grow at a lower interest rate.
Other research and policy organizations have even less conservative assessments — the Bipartisan Policy Center, for example, anticipates the two trust funds will be depleted around the time of the 2028 presidential election, according to an April 2020 analysis.
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About the Author
Alessandra Malito is a retirement reporter based in New York. You can follow her on Twitter @malito_ali.
HHS Plan to Improve Rural Health Focuses on Better Broadband, Telehealth Services
By Sarah Jane Tribble
SEPTEMBER 4, 2020
A barn stands past a road sign for a nearby hospital along a rural road outside Sandwich, Illinois. (Daniel Acker/Bloomberg via Getty Images)
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Knowing it may be met with some skepticism, the Trump administration Thursday announced a sweeping plan that officials say will transform health care in rural America.
Even before the coronavirus pandemic reached into the nation’s less-populated regions, rural Americans were sicker, poorer and older than the rest of the country. Hospitals are shuttering at record rates, and health care experts have long called for changes.
The new plan, released by Health and Human Services Secretary Alex Azar, acknowledges the gaps in health care and other problems facing rural America. It lists a litany of projects and directives, with many already underway or announced within federal agencies.
“We cannot just tinker around the edges of a rural healthcare system that has struggled for too long,” Azar said in a prepared statement.
Yet, that is exactly what experts say the administration continues to do.
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“They tinker around the edges,” said Tommy Barnhart, former president of the National Rural Health Association. And, he added, “there’s a lot of political hype” that has happened under President Donald Trump, as well as previous presidents.
In the past few months, rural health care has increasingly become a focus for Trump, whose polling numbers are souring as COVID-19 kills hundreds of Americans every day, drives down restaurant demand for some farm products and spreads through meatpacking plants. Rural states including Iowa and the Dakotas are reporting the latest surges in cases.
This announcement comes in response to Trump’s executive order last month calling for improved rural health and telehealth access. Earlier this week, three federal agencies also announced they would team up to address gaps in rural broadband service — a key need as large portions of the plan seek to expand telehealth.
The plan is more than 70 pages long and the word “telehealth” appears more than 90 times, with a focus on projects across HHS, including the Health Resources and Services Administration and the Centers for Medicare & Medicaid Services.
Barnhart said CMS has passed some public health emergency waivers since the beginning of the pandemic that helped rural facilities get more funding, including one that specifically was designed to provide additional money for telehealth services. However, those waivers are set to expire when the coronavirus emergency ends. Officials have not yet set a date for when the federal emergency will end.
Andrew Jay Schwartzman, senior counselor to the Benton Institute for Broadband & Society, a private foundation that works to ensure greater internet access, said there are multiple challenges with implementing telehealth across the nation. Many initiatives for robust telehealth programs need fast bandwidth, yet getting the money and setting up the necessary infrastructure is very difficult, he said.
“It will be a long time before this kind of technology will be readily available to much of the country,” he said.
Ge Bai, associate professor of accounting and health policy at Johns Hopkins University in Baltimore, noted that telehealth was short on funding in the HHS initiative. However, she said, the focus on telehealth, as well as a proposed shift in payment for small rural hospitals and changing workforce licensing requirements, had good potential.
“We are so close to the election that this is probably more of a messaging issue to cater to rural residents,” Bai said. “But it doesn’t matter who will be president. This report will give the next administration useful guidance.”
The American Hospital Association, representing 5,000 hospitals nationwide, sent a letter to Trump last week recommending a host of steps the administration could take. As of late Thursday, AHA was still reviewing the HHS plan but said it was “encouraged by the increased attention on rural health care.”
Buried within the HHS announcement are technical initiatives, such as a contract to help clinics and hospitals integrate care, and detailed efforts to address gaps in care, including a proposal to increase funding for school-based mental health programs in the president’s 2021 budget.
A senior HHS official said that while some actions have been taken in recent months to improve rural health — such as the $11 billion provided to rural hospitals through coronavirus relief funding — more is needed.
“We’re putting our stake in the ground that the time for talk is over,” he said. “We’re going to move forward.”
Program of Comprehensive Assistance for Family Caregivers to expandWill open up to eligible WWII, Korean and Vietnam Veterans
Posted onMonday, August 31, 2020 10:00 am Posted in Caregivers, Health, Top Stories by VAntage Point Contributor
VA recognizes the critical role family caregivers play in enabling Veterans to stay in their homes, surrounded by their loved ones.
That’s why VA has announced the expansion of the Program of Comprehensive Assistance for Family Caregivers (PCAFC) this October.
The specific launch date will be announced in mid-SeptemberVA believes the PCAFC expansion will enhance the health and well-being of thousands of Veterans by supporting the caregivers who care for them. Two anticipated changes for the program are improved standardization and increased transparency.
Long DescriptionThe PCAFC expansion will enhance the health and well-being of thousands of Veterans.
PCAFC expansion will open up the program to eligible WWII, Korean and Vietnam Veterans. In addition, eligibility will change to eligible Veterans who have a single or combined VA service-connected disability rating of 70% or higher. This applies regardless of whether the disability is the result of an injury, illness or disease.
With this expansion, Primary Family Caregivers in PCAFC will also have access to financial planning and legal services.
Currently, PCAFC is only available to family caregivers of eligible Veterans seriously injured in the line of duty on or after September 11, 2001.
The program will expand in two phases
Many services are available via phone or online which is especially important during the coronavirus pandemic. All caregivers who provide personal care services to Veterans enrolled in VA healthcare have access to PGCSS.
Please consider contacting your local Caregiver Support Coordinator and asking about PGCSS.
Do not apply prior to the launch dateWWII, Korean and Vietnam Veterans will want to apply for PCAFC after the official launch date. VA will announce in mid-September.
Applications submitted from Veterans in these eras prior to the official launch date will be denied.
Check the Caregiver Support Program website at www.caregiver.va.gov for updates or subscribe to the Listserv to receive email updates.
A penny pinch: How America fell into a great coin shortageFor one more glimpse at these wild times, people might look in their car cup holders, wallets and piggy banks that are driving the nation’s great coin debacle
(Daniel Sulzberg for The Washington Post)
September 1, 2020 at 6:00 a.m. EDTWhen the nation’s coin shortage trickled down to Giant Wash Coin Laundry, chief executive Daryl Johnson plastered his stores with signs urging customers to bring in loose quarters and reprogrammed the change machines at his Minneapolis-area chain to take only smaller bills.
At one point, Johnson crossed state lines to head to Omaha on a critical mission to acquire $8,000 worth of quarters from another laundromat owner who had coins to spare.
“I was like, ‘I’ll take them!’ ” Johnson said. “It was about 10 hours round trip. I went and bought all of his quarters and wrote him a check.”
Americans don’t have to look far to see the damage wrought by the pandemic and recession. Car cup holders, sofa cushions, piggy banks and maybe even wallets laden with pocket change are fueling the nation’s great coin debacle.
ADIn yet another 2020 plot twist, coins aren’t making their way through the economy, with the repercussions rippling from the upper echelons of the federal government down to ice cream shops and bank teller windows. With more people staying home, buying less and shifting their spending online, the natural flow of pocket change through banks, restaurants and retail stores has dried up.
As permanent economic damage piles up, the Covid Crisis is looking more like the Great Recession
Coin issues can be a big deal. In the early 1960s, a shortage of silver helped usher in the passage of the Coinage Act of 1965, which removed silver from circulating coins. (Although, for those keeping score, the U.S. Mint says this is not a coin shortage or supply problem. The mint says it’s a circulation bottleneck that can only be cleared up with the public’s help.)
Whatever it’s called, this lack of coinage seems to be a challenge that ever-divided government, businesses and Americans can unite behind. There’s a new coin task force, complete with its own hashtag: #getcoinmoving. Businesses heavy in coins are helping businesses without. A Chick-fil-A in a South Carolina mall is inviting people to bring in their rolled coins in exchange for cash and a free sandwich. Casinos are trying to tempt would-be gamblers to empty jingling pockets in exchange for free slot play.
ADFor its part, the U.S. Mint is actually on track to produce more coins this year than it has in almost two decades, having ramped up production to fill the void. Like everything else about this pandemic, the coin shortfall is unprecedented, at least for modern times.
“There is no comparison to previous events,” said Michael White, spokesman for the U.S. Mint.
Simply making more coins won’t completely solve the problem — hence the U.S. Coin Task Force, established in July to pinpoint how to kick the supply chain back into gear.
At the table are exactly whom you’d expect: the mint, the Fed, bank and retail industry groups, plus representatives for the big armored carriers that drive the money around, coin aggregators and federal credit unions. Among the group’s preliminary recommendations: financial institutions could give out free coin-rolling kits, and parents could use this weird time in history as a “teachable moment” for young ones learning about money.
To narrow racial and economic disparities, Atlanta Fed chief Raphael Bostic is rethinking what the Fed’s mandate means
But when it comes to getting coins flowing through the economy once again, the solution will depend on swaying Americans to change new habits developed during the pandemic.
ADFor some businesses, getting enough coins in circulation is key to staying alive. Brian Wallace, president and chief executive of the Coin Laundry Association, said 56 percent of laundromats take quarters as their only form of payment. Back in June, Wallace said his association was getting calls from members saying they were limited in how many quarters they could get from banks and wondering if other businesses were in a similar spot.
“At the front end of the pandemic, we were deemed to be an essential business because we’re providing a basic public health service,” Wallace said. “And this was sort of a curveball. In some instances, it made it more challenging to deliver on that service. If we can’t make change, we can’t make money.”
In August, the U.S. Mint put out a public service announcement, with the head of the mint asking Americans to use exact change when making purchases and to turn coins in for cash at coin recycling kiosks. Treasury Secretary Steven Mnuchin tweeted out a call for people to “help get coins moving!” by spending any extra change they have at home or depositing coins at a bank.
ADIn a hearing on Capitol Hill this summer, Federal Reserve Chair Jerome H. Powell said the central bank was quick to realize that the flow of coins had more or less come to a stop. At the time, Powell said the expectation was that as the economy started to reopen, coins would be back on the move.
“It’s a significant issue. We’ve got a lot of resources on it,” Powell said at a July news conference.
Earlier in the pandemic, the mint scaled back the number of employees working shifts to allow for social distancing, White said. By mid-June, the mint had ramped back up to full production.
“This is not a coin supply problem,” White said. “It’s a circulation problem, and we need the public’s help to solve this. … Every little bit helps.”
The Fed, for its part, is allocating coins to depository institutions — such as credit unions, commercial banks and community banks — to ensure a fair distribution of lower-than-normal inventories. The Fed has been able to increase allotments of coins at different points this summer. But overall, Fed coin deposits are still much lower than their normal levels, according to the Federal Reserve.
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Earlier this summer, officials at First Citizens Bank in Iowa were initially worried they wouldn’t be able to get their full coin orders, said Tara Kruckenberg, vice president of teller management.
ADThat didn’t turn out to be much of an issue, but Kruckenberg said the bank still sought out anyone who could bring in idle coins to help the bank and its customers, such as restaurants, grocery stores, convenience stores and laundromats, that rely on coins for daily business.
“Internally, we asked co-workers if they had change,” Kruckenberg said. “It was also just word of mouth. For me, personally, we’ve had gatherings or we’re at ballgames this summer, and people would say, ‘What’s with this coin shortage?’ And we just say that we need coins and to bring it in.”
At Sundaes Restaurant and Tasty Freeze in Grand Gorge, N.Y., owner Andy Mumbulo hasn’t had issues getting the coins he needs from his bank. But he is taking precautions, just in case. The restaurant posted a sign asking customers to use exact change, if possible, and offering cash in exchange for coins.
ADMumbulo is thinking about tweaking the prices on his menu so that after taxes, his items would come out to whole dollar amounts. For example, he might raise the cost of a $2.50 soda (including free refills) to $2.78, so that the final bill is an even $3.
So far, the coin issues haven’t forced Mumbulo to alter his prices. So much depends on how long the pandemic lasts and whether the economic dominoes continue to fall.
“You have to go figure out, what if they want cheese or extra bacon?” he asked.
On the other end of the saga, this crisis is creating some coin heroes, too. When Johnson went on his 10-hour coin expedition, he met Peter Mayberry in Nebraska, who exchanged thousands of dollars in quarters he didn’t need.
Mayberry’s chain of Omaha-based laundromats runs on dollar coins. He’s put calls out in Facebook groups so people can set up their own swaps. And he recently dropped off $5,000 in quarters at his bank.
“Anybody that wants to buy quarters, I’ll sell them quarters,” Mayberry said. “I feel like some people are afraid to ask. Don’t be!”
NEWS RELEASE 3-AUG-2020Pandemic drives telehealth boom, but older adults can't connect
UNIVERSITY OF CALIFORNIA - SAN FRANCISCO
PRINT E-MAILThe COVID-19 pandemic has led to a significant increase in video visits between patients and their doctors, but for many older adults, the shift has cut them off from care, rather than connecting them.
A study by researchers at UC San Francisco has found that more than a third of adults over age 65 face potential difficulties seeing their doctor via telemedicine, with the greatest challenges experienced by older, low-income men in remote or rural areas, especially those with disabilities or poor health. The findings appear online Aug. 3, 2020, in JAMA Internal Medicine.
"Telemedicine is not inherently accessible, and mandating its use leaves many older adults without access to their medical care," said lead author Kenneth Lam, MD, a clinical fellow in geriatrics at UCSF. "We need further innovation in devices, services and policy to make sure older adults are not left behind during this migration."
Older adults account for a quarter of U.S. medical office visits and often suffer from multiple morbidities and disabilities. The U.S. Department of Health and Human Services and other organizations have promoted video visits to reach patients at home, but these visits require patients to have the knowledge and capacity to get online, operate and troubleshoot audiovisual equipment, and communicate without the cues available during a personal visit.
In the JAMA Internal Medicine study, Lam and his colleagues analyzed 2018 data on 4,525 patients from the National Health and Aging Trends Study of Medicare beneficiaries age 65 or older. They examined various scenarios that would pose difficulties with a video visit, including poor hearing or eyesight; problems speaking or making oneself understood; possible or probable dementia; owning no Internet-enabled devices or lack of awareness in how to use them; and no use of email, texting or Internet in the past month. The average patient was 79.6 years old, and 69 percent were white, 21 percent Black and 6 percent Hispanic.
Overall, for 2018, the researchers estimated that 38 percent of all older Americans - 13 million total - were not ready for video visits, and 72 percent of those 85 or older were not, primarily due to inexperience with technology, followed by physical disability. Even with third-party support, 32 percent (10.8 million) of older adults still were unready, and 20 percent (6.7 million) could not even handle a telephone visit due to dementia or difficulty hearing or communicating.
A lack of readiness was more prevalent in patients who were older, male, unmarried, Black or Hispanic, lived rurally, and had less education, lower income and poorer self-reported health, the researchers said.
"To build an accessible telemedicine system, we need actionable plans and contingencies to overcome the high prevalence of inexperience with technology and disability in the older population," Lam said. "This includes devices with better designed user interfaces to get connected, digital accommodations for hearing and visual impairments, services to train older adults in the use of devices and, for some clinicians, keeping their offices open during the pandemic."
Co-Authors: Senior author Kenneth Covinsky, MD, MPH; Amy Lu, MD; and Ying Shi, PhD, of UCSF.
Funding: Covinsky received National Institute on Aging grants during the study. The authors report no conflicts of interest.
About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF's primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. Learn more at ucsf.edu, or see our Fact Sheet.
Jeff Sodoma, MPA, Esq. is a lawyer based in Virginia Beach, Virginia
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