Category: Health Insurance

The Supreme Court’s Ruling on Health Care Reform: Is it All Good or All Bad?

On the last day before summer recess, the United States Supreme Court handed down its ruling in the much anticipated “ObamaCare” case. Despite being difficult to follow without the assistance of a roadmap, the result of the nearly 200-page ruling is that health care reform will proceed largely as planned. In the aftermath, many are left wondering, what now?

Ordinarily there is little disruption when the Supreme Court upholds a law because the status quo has been preserved. This is far from the case with the Patient Protection and Affordable Care Act (Act). The political excitement and division surrounding the Act left many unsure about whether looming changes to our health care system would ever become a reality.

Consequently, many are now desperately behind in terms of planning and preparing for the (apparently?) inevitable changes. In other words, it is crunch time for those who were expecting the Supreme Court to strike down ObamaCare.

To stay current, employers and individuals must become familiar with the changing landscape. Specifically, it is important to posses a minimum understanding of the current and future changes under the Act, such as:

  • the requirement that all individuals, with some exceptions, have health insurance;
  • the prohibition of lifetime benefits limits based on dollar amounts;
  • the prohibition of coverage rescissions or cancellations, except in cases of fraud or intentional misrepresentation;
  • the requirement that dependent insurance coverage continue up to the age of 26;
  • the prohibition of pre-existing condition exclusions for dependent children under the age of 19; and
  • the limitation on medical expense contributions to flexible spending accounts to $2,500 per year.

For individuals, many of the Act’s provisions require little or no preparation. The same cannot be said for employers, since various requirements under the Act require preparation, such as:

  • Mandatory Offer of Coverage: Employers with 50 or more employees may be assessed a $2,000 penalty (or tax, according to the Supreme Court) per full-time employee (in excess of 30 employees) if they do not offer coverage and if they have at least one employee who receives a premium credit through an exchange. Such employers offering coverage but having at least one employee receiving a premium credit through an exchange may face a $3,000 penalty for each full-time employee.
  • Automatic Enrollment: Employers with more than 200 employees are required to automatically enroll their employees into employer-offered health insurance plans; however, employees may be able to opt out of coverage.
  • Nondiscrimination Requirements: Under the Act, certain non-grandfathered group health plans (other than self-insured plans) cannot discriminate in favor of highly compensated employees in terms of benefits, eligibility or premium subsidies. Violations can result is severe penalties and taxes. (Note: Implementation of the nondiscrimination requirements has been delayed to allow for the issuance of additional guidance.)
  • Health Insurance Exchanges: Exchanges will provide marketplaces for individuals and small employers with up to 100 employees to directly compare available private health insurance options on the basis of price, quality, and other factors.
  • Tax Reporting Requirements: The Act requires employers to report the value of health care benefits on employee’s W-2 tax statements.

It is worth noting that not all of the Act’s provisions survived judicial scrutiny. For example, the Supreme Court limited the expansion of Medicaid by giving states some flexibility to not expand their Medicaid programs without paying the same financial penalties set forth in the Act.

Despite the Supreme Court’s landmark ruling, significant questions remain about how various provisions of the Act will be implemented, maintained and enforced. This makes it vitally important for businesses to maneuver through the developing law and stay ahead of the curve.

Those continuing to hold out hope for some kind of legislative or judicial relief from the Act should not delay their preparations any further. The time is now. Those needing to adapt their practices to comply with the Act should begin doing so immediately; otherwise, they may soon find themselves drowning in the coming sea of change.

At Setnor Byer Insurance & Risk, we are committed to guiding you through what is sure to be a bumpy ride. Check back with us periodically for future informational updates. If you have specific questions about the Act or if you are ready to take action and would like to see how Setnor Byer Insurance & Risk can help, contact us.

Healthcare Reform Prompts Many to Explore Alternatives to Health Benefit Programs

The passage and continued implementation of Healthcare Reform, as well as its uncertain political future, have placed employers in a precarious position with their health benefit programs. Nevertheless, employers continue to do their best to balance the need to attract smart and sophisticated employees by offering well-rounded health benefit programs with the costs of providing such programs.

It is important that employers succeed in their balancing act because health benefit programs remain pivotal in attracting and retaining top-notch employees. According to a study performed by MetLife, employees make the financial security and protection of their families a top priority, and many believe that this requires sound health benefit programs. According to the study, employees who are satisfied with their health benefit programs are more likely to remain satisfied with their jobs from year to year.

Research done by the Personal Group revealed that 40% of employers plan to review their health benefit programs, and that employers are beginning to explore the various options that will (or may) be available to their employees under Healthcare Reform. According to a Towers Watson’s 2012 HealthCare Trend Survey, in 2014, when healthcare exchanges are scheduled to become available, employers will begin to reconsider and redefine their role in providing healthcare benefit programs in light of the new options. Since healthcare exchanges will give employers an alternative to the traditional sponsoring of health benefit programs, many employees are beginning to view individual health care plans as a viable option.

At Setnor Byer Insurance & Risk, we have been successful in finding attractive solutions for those of our clients exploring new options. We would be pleased to have the opportunity to assist you in effectively navigating this transitional period, as well. Please visit our website at http://www.setnorbyer.com to view and compare our various health plan options.

Improving Patient Safety and Combating Abuse in Long-Term Care Facilities

In a move aimed at combating abuse and neglect in the nation’s long-term care facilities, the Centers for Medicare & Medicaid Services (CMS) awarded more than $13 million on October 6, 2010, to six states to design comprehensive applicant criminal background check programs for jobs involving direct patient care.

“Elder abuse and neglect is tragic and intolerable,” said HHS Secretary Kathleen Sebelius. “Workers with a history of abuse or neglect should be identified and prevented from ever working with residents of these facilities.

“The new health care law will help states identify the best, most effective ways to determine which applicants can be trusted with the health and safety of residents and which cannot,” said Donald M. Berwick, M.D., CMS administrator.

Created by the Affordable Care Act, the new National Background Check Program will help identify “best practices” for long-term care providers to determine whether a job seeker has any kind of criminal history or other disqualifying information that could make him or her unsuitable to work directly with residents.  

The first round of states to participate in the program are: Alaska, Connecticut, Delaware, Florida, Missouri, and Rhode Island.  They each will share a portion of $13.7 million.

An additional 11 states applied and may be funded beginning in October or November. CMS will also issue a second solicitation in October for those states that did not apply but may still do so.

The new law set aside $160 million for the program, which is to run through September 2012, an amount sufficient to enable all states to participate.

The national background check for each prospective direct patient care employee must include a criminal history search of both state and federal abuse and neglect registries and databases, such as the Nurse Aide Registry or FBI files.

Long-term care facilities or providers covered under the new program include nursing facilities, home health agencies, hospice providers, long-term care hospitals, and intermediate care facilities for persons with mental retardation, and other entities that provide long-term care services.

Questions about the National Background Check Program may be sent via e-mail to the Center for Medicare & Medicaid Services.

To learn more about conducting background investigations, click here.

Source: Department of Health & Human Services

Counting Employees for COBRA

If an employer has 13 full-time employees, each of whom works 40 hours per week, and 10 part-time employees, each of whom works 20 hours per week, can this employer qualify as a “small-employer plan” under the Consolidated Omnibus Budget Reconciliation Act (COBRA)?

Yes.  After a qualifying event, COBRA gives certain former employees the right to elect temporary continuation of health care coverage at the employer’s group rates. COBRA’s continuation of coverage requirement does not apply to a small-employer plan, which is a group health plan maintained by an employer who normally has employed fewer than 20 employees during the preceding calendar year.  Although all full-time and part-time employees are taken into account when determining whether an employer had fewer than 20 employees, each group of employees is counted differently. A full-time employee counts as one employee.  However, each part-time employee counts as a fraction of an employee, with the numerator (the top number) of the fraction equal to the number of hours worked by the part-time employee, and the denominator (the bottom number) equal to the number of hours that must be worked on a typical business day to be considered a full-time employee.

Though this formula may sound complicated, it’s fairly easy to apply. In the situation at hand, the employer’s 10 part-time employees work 20 hours per week out of the 40 hours per week ordinarily worked by full-time employees, thus producing a fraction of 20/40, or ½.  Therefore, each part-time employee is counted as ½ of an employee. Ten employees counted as “half” an employee equals 5 “whole” employees, which, when added to the number of full-time employees, 13, total 18 employees. Since this number is fewer than 20, this employer may qualify as a small-employer plan.

Family & Medical Leave Act – Armed Forces

In light of recent military-related amendments to the Family and Medical Leave Act (FMLA), should I update the FMLA notice currently posted in my employees’ break room?

Yes. The Family and Medical Leave Act (FMLA), which generally applies to employers with 50 or more employees, was enacted to balance the demands of the workplace with the needs of families by allowing covered employees to take reasonable leave for medical, health, or family reasons. On January 28, 2008, President Bush signed into law the National Defense Authorization Act (NDAA), which includes a provision that allows eligible employees to take up to 26 workweeks of leave during a 12-month period to provide needed care for a family member who suffers a serious illness or injury while on active duty in the Armed Forces. The NDAA also provides that eligible employees are entitled to a total of 12 workweeks of leave “because of any qualifying exigency (as the Secretary shall, by regulation, determine)” arising out of a family member’s active duty in the Armed Forces.

The regulations interpreting the FMLA, as originally enacted, require that every covered employer “post and keep posted on its premises, in conspicuous places where employees are employed…a notice explaining” the FMLA’s provisions and providing information concerning the procedures for filing complaints of violations of the FMLA. Even though the Department of Labor (DOL) has yet to address the NDAA in its regulations, the DOL did create the “FMLA Poster Insert for Military Leave Amendments,” which generally describes the recent military-related amendments to the FMLA. Until the DOL amends the general FMLA Poster to include the NDAA amendments, covered employers would be wise to post both the original poster and the insert in a conspicuous place on their premises.

Health Care Reform Installment – Making Sense of the Affordable Care Act

President Barack Obama signed into law on March 23 the most sweeping reform of the United States health care system in the last 50 years. Combined, the Patient Protection and Affordable Care Act and the Reconciliation Act of 2010, now referred to collectively as the Affordable Care Act, dedicates more than $900 billion in new federal funding over the next decade to provide as many as 32 million of the 46 million uninsured people with access to affordable health insurance. This 32 million comprises approximately 11% of our population of residents.

The Affordable Care Act made its way through Congress and to our President’s desk in order to deal with the uninsured who are: ineligible for public programs, and are unable to afford private insurance, do not qualify for private insurance
or those that are eligible for public programs but have not enrolled.

By 2019, the government reports that the Affordable Care Act will result in 94 percent of Americans being covered, up from the 85% percent today.

The Whitehouse suggests that the Affordable Care Act puts our budget and economy on a more stable path by reducing the deficit by more than $100 billion over the next ten years — and more than $1 trillion over the second decade, through cuts to government overspending and reining in waste, fraud and abuse. The deficit decrease in no way suggests that there won’t be considerable tax increases to all citizens who can afford to pay, including small businesses, who are on tap for a significant increase in their costs of doing business.

Today, our healthcare spending is estimated at 15% of Gross National Product, with projection for the percentage to reach 19% by 2018. These numbers are often used to alarm the public, suggesting that our healthcare dollars are being squandered. When one looks at Canada’s 10.1 or England’s 8.4 or Japan’s 7.9, one must realize that our numbers include the profits derived from a largely private system and increases in administrative costs due to a complex multiple payer system. In other words, the dollars we spend on direct care, are not the as alarming as reported. It should also be noted that the overhead associated with our healthcare distribution finds its way back into the system through spending in other sectors, thereby producing a greater GNP than our peer nations — a clear marker for economic health. The US economy is typically ranked in the top 3% for economic vibrancy.

This is all not to suggest that our current system is not flawed, which might explain, fully, the success of this legislation.
There are over 2000 pages of laws and documents that address 4 key areas:

  • Coverage access, along with coverage improvements
  • Financing of future healthcare
  • Mechanisms to reduce costs
  • Solutions for Long Term Care

The expansion of healthcare to some of the 32 million people, along with the mandated coverage improvements are already in place, with the Department of Health and Human Services ready to bind coverage for high-risk individuals as early as August 1st. The high-risk pool is available for individuals with pre-existing conditions who have not been insured by creditable coverage for the 6 month period preceding the application for coverage. To prevent the current insurance market from ‘dumping’ high-risk insureds into this new marketplace, there is a specific reference in the law for reimbursements from such insurers who take such action.

This high-risk pool is intended to remain in place until replaced by Insurance Exchanges in 2014, which will be an alternative marketplace for Qualified Health plans for the uninsured, self-employed, and small groups regardless of health status. These exchanges will subsidize those with incomes between 133 percent and 400 percent of poverty level. The Government has funded the high-risk pool, to subsidize premiums, with 5 billion dollars. Unfortunately, it is expected that this funding will have to increase to 15 billion by 2013. This pre-existing insurance plan (PCIP) will charge based on age, sex, and territory. Premiums in Florida can be as high as $675 a month for a 50 year male with medical conditions.

The Exchanges will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even if it’s to treat a preexisting condition. In addition to monthly premiums, you will pay other costs. You will pay a $2,500 deductible for covered benefits (except for preventive services) before the plan starts to pay. After you pay the deductible, you will pay a $25 copayment for doctor visits, $4 to $30 for most prescription drugs, and 20% of the costs of any other covered benefits you get. Your out-of-pocket costs cannot be more than $5,950 per year. These costs may be higher, if you go outside the plan’s network.
Some of the provisions within the Affordable Care Act apply to all plans, individual and group, while others apply exclusively to new plans, leaving so called grandfathered plans alone.

Grandfathered can be defined as plans that do not change substantially. The following plan changes will result in the “cessation of grandfather status:”

  1. The elimination of all or substantially all benefits to diagnose or treat a particular condition.
  2. Any increase, measured from March 23, 2010, in a percentage cost-sharing requirement (such as an individual’s coinsurance requirement).
  3.  Any increase in a fixed-amount cost-sharing requirement other than a co-payment (for example, a deductible or out-of-pocket limit), determined as of the effective date of the increase, that exceeds medical inflation plus 15%.
  4. Any increase in a fixed-amount co-payment that exceeds the greater of $5 (increased by medical inflation), or medical inflation plus 15%.
  5. A decrease in employer contribution rate by more than 5% or the addition of a new annual limit, when one didn’t previously exist, or a decrease in annual limits.

As of September 23rd, children under the age of 19 cannot be denied coverage for their pre-existing conditions; however, the law does not prohibit insurers from denying to insure the children, which is in the process of being remedied. It seems that the regulations were not drafted to require insurers to issue policies to these children.
As of September 23rd, insurers cannot rescind coverage on any health plan, new and grandfathered, except for fraud or intentional misrepresentation.
As of September 23rd, insurers cannot impose lifetime dollar limits on any, new and grandfathered, plan for essential benefits, like:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn Care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

It should be noted that regulations impose a good faith requirement with respect to the interpretation of the term, essential health benefits. Additionally all insurers, but for grandfathered individual insurers, must provide no less than specified annual limits defined by law for essential benefits as previously defined. In 2010, the maximum annual benefit is set at $750,000, increasing to a maximum of 2 million prior to 2014 when limits are removed completely.

As of September 23rd, all new plans, or existing plans that change substantially, not grandfathered plans, must cover, with absolutely no charge to the patient, certain preventive services such as children immunizations, tobacco counseling for pregnant women, mammograms, colonoscopies, hepatitis B screening, depression screening, HIV screening for high-risk adults and obesity screening and counseling for adults and children. The non-grandfathered plans must also provide patient protections such as access to OB-GYNs and pediatricians without a referral by a separate primary care provider; and greater freedom for patients to obtain certain emergency treatment without certain plan restrictions.

As of September 23rd, dependents under 26 are extended coverage on a parents plan. This applies to all plans.
In 2014, the law finally prohibits insurers from engaging in discriminatory practices that enable them to refuse to sell or renew policies or limit benefits due to health status, nor can health status be used in setting premiums.

While the Congressional Budget Office found that the law would have little impact on premiums for employer’ sponsored coverage, there remains debate as to the laws possible impact on the cost of health insurance premiums. The extension of preventive care alone, along with the elimination of annual and lifetime benefits as well as what will be pre-existing coverage for children under 19, the new taxes to health insurers and healthcare providers, additional cost-shifting due to changes in Medicare reimbursements, and the weaknesses in reform which still permit the healthy to remain uninsured, could raise premiums an average of 40% through 2013. Without these changes, premiums were expected to increase 26% through that same period, with the greatest impact hitting individuals and small groups.

For more information about financing the Affordable Care Act, as well as cost containment measures and Long Term Care provisions, contact the author.

The Health Care Reform Act: Unintended Consequences?

The health care reform act is officially upon us. On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act, and on March 30th the President signed the Health Care & Education Reconciliation Act. Together, these two bills make up the highly-publicized health care reform act.

At the outset, it is significant to note that the Act does not necessarily address the cost of health care by establishing guidelines or limits. Rather, the Act addresses access to health care. The Act generally operates to require all individuals not covered by Medicare or Medicaid to either obtain health insurance or pay a penalty.

The Act, which consists of over 2,500 pages of text and which is soon to be supplemented by thousands of pages of guidance and regulations, has been the subject of countless media discussions and debates. The fanfare, information, and disinformation have made it difficult for the average person to understand precisely how the Act will impact them. Unfortunately, much of how the Act will impact the health insurance landscape is yet to be determined. Nevertheless, here are some of the Act’s general provisions, some of which are effective immediately, with others having delayed effective dates:

  • Prohibition of lifetime benefits limits based on dollar amounts.
  • Prohibition of coverage rescissions or cancellations, except in cases of fraud or intentional misrepresentation.
  • Mandating that dependent insurance coverage up to the age of 26.
  • Prohibition of pre-existing condition exclusions for dependent children under the age of 19.
  • Requirement that employers report the value of health care benefits on employee’s W-2 tax statements.
  • Limitation on medical expense contributions to flexible spending accounts to $2,500 per year.
  • Establishment by each state of an insurance exchange where individuals who are not covered under their employer’s health insurance plan can shop for health insurance at competitive rates.

While many of the Act’s provisions appear straightforward, some of the provisions may bring about unintended consequences. For example, the Act provides that effective 2014, employers with more than 50 employees must provide health insurance or pay a fine of $2,000 per worker each year if any worker receives federal subsidies to purchase health insurance.

Clearly, the Act’s intent is to encourage such employers to provide health insurance to their workforce. However, employers focusing on the bottom line may discover that it is cheaper to pay the fine than it is to provide health insurance. In such cases, employees may be left without insurance coverage and employers may end up benefitting financially despite the fine.

Another possible avenue for manipulation involves the manner in which the Act deals with tax credits for small employers. Since the amount of the tax is dependent on the size of the employer and the average annual wage of its workforce, it is possible that some employers may let the tax credit dictate its hiring activities and the manner in which the employer determines the wages of its workforce. Since some of the tax credits are based in part on the average annual wage of an employer’s workforce, employers may choose to keep salaries within the range in order to preserve the tax credit. Moreover, employers may elect to use the services of independent contractors, rather than employees, in order to preserve the maximum tax credit.

Additionally, the Act includes an excise tax on employer sponsored health insurance plans that offer policies with generous levels of coverage. This so-called “Cadillac tax,” which becomes effective in 2018, imposes a 40% tax for any health insurance plan with an annual premium in excess of an inflation adjusted $10,200 for individuals and $27,500 for families. Unfortunately, the practical consequence of this tax may be the elimination of higher quality insurance for executive or key employees.

Regardless of one’s views of the Act’s provisions or the manner in which an employer may elect to operate in light of its terms, it is important for businesses to maneuver through the new law and stay ahead of any changes. By understanding the Act’s implications, it is possible to ensure future success under the new health insurance landscape.

At Setnor Byer Insurance & Risk, we are committed to helping our clients navigate the coming changes and to provide our clients with complimentary answers to their questions. If any of our clients have any questions regarding the Act, contact us.

Alternative Group Benefits: Another Option for Employers Coping with Rising Healthcare Costs

Every American is painfully aware of the impact of skyrocketing health insurance costs. Rising premiums, higher deductibles, larger co-pays, reduced benefits – both employers and employees are feeling the pinch as they look for plans that are affordable for everyone.

That’s why HRAs – Health Reimbursement Arrangements – are a welcome addition to the range of options that employers can offer their workforce. HRAs allow employers to give tax-free dollars to their employees, who then can use the money to purchase their own health insurance as well as pay for other eligible medical expenses. While HRA plans may not be the panacea for all the “ills” of the health insurance dilemma, they represent significant progress from the point where we were even just a few years ago when I first began to tackle this problem.

Then, in January 2002, fresh out of college, I was hired to administer a group health plan for my parents’ company. Though I knew little about health insurance, I learned quickly that the premiums we were paying were too expensive for both the company and our employees. After doing extensive research and reading numerous Internal Revenue Service (IRS) publications relating to health care, I uncovered one solution for the family business: a High Deductible Health Care (HDHC) plan. The high deductible encourages employees to make healthier lifestyle choices and spend their medical dollars more prudently while also allowing them to save for future medical expenses in their Health Savings Account (HSA), funds that they can take with them if they change jobs. The HDHC is good for employers also: Under the plan, our premiums were reduced by about half.

Not stopping there, we also began to offer HRAs as an alternative to our HDHC Group plan. Our hybrid benefits package gave employees a choice: Those who felt more comfortable remaining on the traditional HDHC group plan did so, while employees who wanted greater economy, portability, and freedom of choice opted for the HRA. We structured the packages so that employees choosing either plan received the same amount in benefits. The plans’ common denominator is that both increase employees’ awareness of how they spend their health dollars, thus encouraging them to live a healthier lifestyle because, quite simply, it saves them money to do so.

In 2007 The Wall Street Journal took note of our success and wrote a cover story on our creative benefits packages. Increasingly, employers asked me to assist them in designing an HRA or a hybrid plan for their businesses, even though I was not then an insurance agent. But after years of administering (and participating in) an HRA/Group Plan hybrid, I decided to change my career path and obtained a health insurance license, allowing me to use what I had learned to assist other small businesses.

However, finding an agency that provided both group and individual health insurance and that was sufficiently forward-thinking to consider these newer options was more difficult than I had anticipated. Surprisingly, I found that many agents in the mainstream insurance industry know little about HRAs, particularly those plans in which employees can access a broad range of products from different providers.

After pitching dozens of insurance agencies on employer-based hybrid health care plans, I finally found an agency willing and able to offer these cutting-edge health insurance solutions: Setnor Byer Insurance & Risk, which recognized the advantages of hybrid plans and was excited about offering their clients and prospects an even fuller range of cost-saving options.

Setnor Byer, with almost 30 years of experience in the insurance industry, can help employers expand their benefits offerings, promote wellness in their workforce, and reduce health insurance costs for both the company and its employees. With dozens of plan structures available, Setnor Byer’s insurance professionals will help you choose the right one so that your employees – and your business – remain healthy.

Here’s to wellness.

For more information about these and other types of healthcare insurance policies, contact the professionals at Setnor Byer Insurance & Risk or visit the Employee Benefits page.

Safety in Numbers: Monitoring Your Health

The numbers don’t lie: According to PricewaterhouseCoopers’ Health Research Institute, medical costs for 2009 will increase by almost 10 percent, significantly outpacing the current rate of inflation. In response to these skyrocketing costs, the Institute also reports on the increasing popularity of workplace wellness programs, which not only lower insurance costs but boost productivity and improve morale. Here is some vital information that you and your employees need to know about staying healthy and keeping healthcare expenses down.

More and more, we have come to accept the fact that good health is largely a matter of individual responsibility. An important step toward fulfilling that responsibility is to monitor those numbers that are essential for maintaining good health. With that in mind, do you know the significance of the following numbers to your health:

  • 120/80?
  • 30?
  • 2400?
  • 8?
  • 40 and 35?

Knowing what these figures mean and taking the necessary steps to get those numbers within a healthy range are essential for reducing the risk of cardiovascular disease, a leading cause of death.

Perhaps the most important numbers of all are those that make up the ratio 120/80; according to the American Heart Association, the optimal blood pressure for adults should be below 120/80. Blood pressure, the measure of the force of the blood through the artery walls when the heart is pumping and relaxing, may be thought of as a water balloon. The water in the balloon creates pressure inside the balloon walls. At a certain point, the water compromises the integrity of the wall, and the balloon bursts. Sustained high blood pressure, known as hypertension, is a known risk factor for heart attack and stroke. That’s why individuals should monitor their blood pressure and make sure it stays under the 120/80 limit.

“30” is the minimum number of minutes of daily exercise that experts recommend for maintaining cardiovascular health, with more recent studies suggesting that 60 minutes of brisk exercise on most days of the week is optimal. Remember, though, that some exercise is always better than no exercise, so don’t get discouraged if you find that you can’t reach the 60-minute threshold. And if you have difficulty squeezing in a 30-minute block of exercise into your busy schedule, get your exercise in 3 10-minute sessions, making sure to work at a brisk pace each time.

Because salt intake is a risk factor for high blood pressure, medical professionals recommend that an individual’s daily salt intake not exceed 2400 milligrams. “Salt” goes by many different names, so be sure to read carefully the lists of ingredients on the foods you eat (particularly processed foods) to check for salt’s many “aliases”: sodium chloride; sodium caseinate; halite; monosodium glutamate; trisodium phosphate; sodium ascorbate; sodium bicarbonate; sodium stearoyl lactylate; and other sodium-containing ingredients. Try to stay below that figure of 2400 milligrams per day.

Are you getting 8 hours of sleep every night, the number that has long been considered optimal for the body to sufficiently rest? The right amount of sleep each night allows the body to repair and rebuild muscle, including the body’s most important muscle – the heart. Tips for getting a good night’s sleep include the following:

  • Avoid caffeine three hours prior to bedtime.
  • Keep your room at a comfortable temperature.
  • Use room-darkening shades that keep out excess light.
  • Stick to a ritual of going to bed at the same time each night.
  • Avoid alcohol.
  • Keep a pencil and paper at your bedside to make lists of those “busy” items that can run through your head at night and keep you awake.
  • Choose healthy foods, such as milk, apples, and peanut butter, as bedtime snacks.

A simple tape measure is not just an essential tool for tailors and dressmakers; men and women should keep one handy to measure their waist lines. Recent studies suggest that the circumference of a man’s waist should be below 40 inches, a woman’s below 35 inches, to lower the risk of high blood pressure, diabetes, and heart disease. To accurately determine your waist size, place the tape measure directly over your belly button – and don’t pull it too tightly to get a lower number!

Keeping track of these numbers that are essential for good health should be on every individual’s “to do” list. To the extent that good choices can make a difference in improving health, doing what we can to keep our numbers within the normal range may increase the quality of our lives and spare us the physical, emotional, and financial costs of getting sick.

® 2008, Summit Health. Reprinted with permission.

Long Term Care: A Major Concern for Today’s Baby Boomers

As the large numbers of Baby Boomers start to turn 60, many of them assume incorrectly that Medicare, Medicaid, supplemental policies or standard health insurance policies will cover their long-term health care expenses and needs. Consequently, many people do not plan ahead financially to provide for their care in the event of infirmity or extended illness.

Costs of services provided by a nursing home in Florida (based on 2004 numbers) can exceed $60,000 annually, or more than $5,000 per month. Costs for residing in an assisted living facility or nursing home continue to rise every year. The cost of quality “in home health care” is already approaching that of a nursing home.

A New England Journal of Medicine study stated that 43% of all people age 65 would either have to enter a nursing home or require long term care in their home. Another study by the Health Insurance Association of America has shown that more than 50% of all Americans will need some form of long term care during their lives whether in their home, at a day care facility or in a nursing home.

Based on the above numbers, it is easy to see how a retirement nest egg can be depleted when one major illness strikes an individual, spouse or family. How to pay for this potential expense is, and should be, a major concern for our ageing society.

There are five basic options available on how to finance the cost of care:

Pay for the Cost out of Savings- This option is usually chosen by the extremely wealthy. If this is the option you are considering, you must ask yourself if you will have enough resources to pay this expense and continue to maintain your desired standard of living.

Depend on Medicare/Medicaid – Medicare pays a limited amount, and it only pays under certain circumstances. Medicaid is designed for only the poorest individuals.

Other Medical Insurance – Most medical insurance plans do not pay for long term care expenses.

Depend on Family – This type of care and expense is physically and emotionally demanding- is this what you want for your family?

Long-Term Care Insurance – This insurance is most likely your best choice. A quality Long Term Care Policy will help you pay for the expenses associated with long term care, while helping protect your family and your assets.

If after reviewing the five options above you decide that Long Term Care Insurance is the option you want to pursue, it is important to understand the following:

What is Long-Term Care Assistance?

Long term care is the everyday assistance needed when a person suffers from a cognitive impairment-such as Alzheimer’s disease- or can no longer perform activities of daily living due to age or illness.

Long-Term Care Insurance provides assistance for the following activities of daily living:

  • Bathing
  • Dressing
  • Eating
  • Toileting
  • Continence
  • Transferring

What options exist as to where this assistance can be provided?

Assistance can be provided:

  • In your home
  • In the community (Adult Day Care Facility)
  • In an Assisted Living Facility
  • In a nursing home

What factors need to be considered if applying for Long Term Care Insurance?

The cost of a Long Term Care Insurance Policy is determined by many factors: your age at the time of application, your general health, medications you are taking, your prior medical history and the benefit options you select. The two factors that have the greatest effect on your ability to obtain a Long Term Care Policy at a lower rate are based on your age and overall state of health. The younger and healthier you are when you apply, and ultimately purchase a Long Term Care Policy, will have the greatest effect on your final annual premium.

The number of insurance companies offering Long Term Care products has continually grown as the product demand has increased. Selecting the correct company is now as important as selecting the correct coverage. Many companies that came into the marketplace priced their product too low and are now increasing premiums on a regular basis.

When selecting a company, the following questions should be asked:

  • How long has the company been selling the Long Term Care product?
  • Have they ever had rate increases, and if so, how frequently?
  • Does the company guarantee that the policy can never be cancelled (except for non payment of premium)?
  • What is the insurance company’s rating by A.M. Best Company? (A.M. Best is recognized as the premier Insurance Rating Service Company. Other premier rating companies to look at are Fitch, Moody’s Standard & Poor’s and Weiss. The higher the rating, the more financially secure the company.)
  • What percentage of the Long Term Care market do they write? (The larger the number of policies they write, the more likely the company is to know the business.)

How To Get Started.

The best place to start is to contact your local insurance agent and have their Long Term Care Specialist contact you. You should try to locate an agent who deals with Long Term Care as his primary product. The Long Term Care market is very complex and dealing with an agent who has limited access to various markets or has limited knowledge of the product is not a path to take. Have the agent educate you on the Long Term Care product(s) he is recommending and options open to you regarding the various coverages, riders or options open to you.

After you have spent time with the agent discussing the various factors that affect Long Term Care Insurance Coverage, decide on the basic factors you want included in your policy.

The major items to be considered are: the amount of coverage (daily or monthly), duration of benefits, deductible periods and inflation protection. It is also important to remember that there are significant discounts offered by all companies if both a husband and wife apply for and purchase Long Term Care Insurance at the same time. Once these basic factors are determined, the agent will be able to present you with an initial quote.

Once a final program and company have been selected, the next step will be to complete the company application. The agent will complete the application with you. All companies require that a portion of the annual premium accompany the application. Depending on the applicant’s medical condition, the processing of the application can take up to six to eight weeks for approval. Many companies require that a company representative personally interview each applicant and detailed reports from the applicant’s doctors may also be required.

Once the application is approved, a policy will be issued. The premium originally quoted by the agent may be different than that on the final policy. The insurance company’s underwriters determine the final premium based on the applicant’s final health condition. The agent will deliver the policy directly to you and will be responsible for collecting any additional premium that is due. You will have thirty days to review the policy. If during that time you decide not to keep the policy, it should be returned to the agent and a full refund will be issued.