Wednesday, January 7, 2015

Test Your Flu IQ

The CDC is projecting a severe flu season and it is now widespread in Maryland and Virginia. Experts recommend getting a flu shot (It's still not too late.) and following these six steps to stop the spread of germs.
  1. Wash your hands often with soap and water or an alcohol-based hand rub.
  2. Avoid touching your eyes, nose, or mouth. Germs spread this way.
  3. Try to avoid close contact with sick people.
  4. Practice good health habits. Get plenty of sleep and exercise, manage your stress, drink plenty of fluids, and eat healthy food.
  5. Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  6. If you are sick with flu-like illness, stay home for at least 24 hours after your fever is gone without the use of fever-reducing medicine.
I also recommend taking a few minutes to complete the Well Flu Quiz from the New York Times. You can learn the answers to these questions, "What surface is the most friendly to the flu virus? Where’s the best place to stand when you’re talking to a sick person? And how are Australians curbing germs in schools?" and more....

* Precautions taken from Flu.gov



Tuesday, December 2, 2014

Help a First Responder Help You -- Set Up an Emergency Medical ID on Your Phone

A group of us spent yesterday afternoon running through disaster recovery scenarios at ASHA. This lead us to talking about emergency contact information and the new emergency Medical ID in iOS8's new health app. I'd never actually tapped "emergency" in the lower left corner of the passcode screen. (I was afraid it would dial 911.) It actually leads you to a screen with your Medical ID. 

Open the health app and tap Medical ID in the lower right corner to set it up. This apple insider article explains how to set it up if you need help. You can include medical conditions, allergies and reactions, blood type, organ donor status, and who you would like to have contacted in the event of an emergency. A first responder can see this information without unlocking your phone. 

If you don't have an iPhone or the current operating system, download an app called ICE and use it. I'm also a big fan of the low tech, Road ID

 

Monday, December 1, 2014

Can I Have a Health Savings Account if I'm Eligible for Medicare?

During our open enrollment period a lot of questions came up about Medicare. I reached out to our attorneys to confirm my understanding of some key issues. I'll share that information here, but first let's make sure we're on the same page in discussing the parts of Medicare. In the simplest terms: 
Image from www.scottinsurance.com

  • Medicare Part A covers hospitalization. It's free to those who enroll.
  • Medicare Part B covers physician care. Participants pay for it. 
  • Medicare Part D covers prescription drugs. Participants pay for it. 
Obviously, there are a lot more nuances to Medicare, but the above should suffice for this discussion. (You can read more about the different parts of Medicare on the Medicare.gov site.) 

It's a common misunderstanding that you have to apply for Medicare Part A when you turn 65. If you are an active employee and enrolled in health coverage, it's not necessary for you to enroll in Medicare Part A or Part B. It's enrollment in Medicare that precludes you from contributing to an Health Savings Account (HSA), not your age. So, you can contribute to an HSA if you have a high deductible health plan and you're Medicare eligible as long as you do not enroll in Medicare. If you start receiving social security benefits, you will be automatically enrolled in Medicare Part A. If you work for an employer with 20 or fewer employees, you may be required to enroll in Medicare when you become eligible. Check with your plan administrator.

Once you are no longer working, you must enroll in Medicare Part A and Medicare becomes primary. Most retiree health plans also require you to enroll in Part B by reducing the benefits as if Part B was elected. If you didn't enroll in Part B, you'd be left responsible for the part of the bills it would have paid. This is how ASHA's plan works. If you retire from ASHA and keep our retiree coverage, you should enroll in Part A and Part B. You should also not wait to enroll in Part B, once you are no longer working. If you wait to enroll in Part B, you may have to pay a penalty for late enrollment, which will last for as long as you are enrolled in Part B. 

Medicare Part D is different. It's completely voluntary and if you already have broad based prescription drug coverage (like what ASHA provides) you should not enroll in Part D. Many retiree plans state that if a person does enroll in Part D that the retiree coverage will terminate because the coordination of benefits provisions between Part D and a retiree plan are too cumbersome. ASHA provides a creditable coverage notice to our retirees each year. Because our coverage is creditable, our retirees can use ASHA's coverage and not pay a higher premium (a penalty) if they later decide to join a Medicare drug plan. 

Pretty straight forward so far, but now it gets tricky. I stumbled upon this warning at the end of this AARP Article
Warning for when you retire: You cannot contribute to an HSA in any month that you are enrolled in Medicare.  And there’s a pitfall inherent in that rule that you need to be aware of.  When you finally sign up for Social Security retirement benefits—probably when you’re on the point of retirement—and if you’re already at least six months beyond your full retirement age (currently 66)—Social Security will give you six months of “back pay” in retirement benefits.  It’s a generous gesture, but it means that your enrollment in Part A will also be backdated by six months.  Under IRS rules, that leaves you liable to pay six months’ of tax penalties on your HSA.  To avoid the penalties, you need to stop contributing to your account six months before you apply for Social Security retirement benefits.

When applying for social security, a person may be entitled to monthly benefits retroactively for up to six months for full retirement age claims. When social security benefits are paid retroactively, typically the Medicare Part A enrollment is also made retroactively to the same effective date. There is little information available about this. It may be possible to inform the social security administration that you had other coverage and you do not want to start Part A retroactively. If you were able to do this, there would be no problems contributing to an HSA while you're employed. Here's what we recommend: 
  1. Stop your HSA contributions six months prior to applying for social security benefits. When you do apply, ask the social security administration not to backdate your Part A enrollment. If they honor your request, you can make an additional contribution equal to what you would have contributed in the six months prior to applying for social security benefits. You'd make this contribution directly to the HSA trustee before December 31 or before you file your tax return for the relevant year. Then, you'd deduct the "missed" contribution from your income taxes. 
  2. If you do not stop your HSA contributions six months before applying for social security benefits and you are enrolled in Part A retroactively, contact the HSA trustee and request that your contributions during that time period be removed from your account and refunded to you. You should do this before December 31 of the year you became ineligible. (You may be able to do it up to the point when you file your tax return for that year, but that's more complicated.) If you do not have the ineligible contributions refunded, a special penalty tax applies to that contribution for the year and for each future year that the contribution is not withdrawn. 
So, the answer to the question posed in the title of this post is "Yes", but it can get complicated. We're hoping to have a Medicare expert come in and talk with ASHA staff next year. 

Monday, November 17, 2014

In the News: a new heart health calculator and a study on the value of cooking at home


Just a quick post to share two newsworthy items. First, the Harvard School for Public Health released a new online calculator to estimate your risk of cardiovascular disease. I like that it focuses on lifestyle choices and modifiable risks. It's easy to complete and you don't need to know your blood pressure or cholesterol to get your results. 


Despite being one of the leading causes of mortality and morbidity in the U.S. and worldwide, people seem to be less fearful of cardiovascular disease than cancer or Ebola. And, unlike some diseases almost all cardiovascular disease is preventable. The recommendations you receive after completing the survey include practical tips for improving your health. It's been so popular that the site sometimes gets overwhelmed (an encouraging sign), but keep trying. It's worth doing! 

Second, a new study from Johns Hopkins University Bloomberg School of Public Health revealed that:

"People who frequently cook meals at home eat healthier and consume fewer calories than those who cook less, according to new research. The findings also suggest that those who frequently cooked at home -- six-to-seven nights a week -- also consumed fewer calories on the occasions when they ate out."
Certainly, not surprising, but it does confirm again that we're on the right track in planning a series of cooking classes for ASHA staff.

Friday, November 14, 2014

Mediterranean Diet and Workplace Health -- The Evidence Behind the Recommendations

One final post about the the Mediterranean Diet and Workplace Health Conference at the Harvard School of Public Health. The conference organizers prepared the review paper below. It clearly indicates the health benefits of following a Mediterranean diet and the evidence that supports the recommendation. I particularly like this chart at the top of page three that provides clear instruction for following a Mediterranean diet. Please take a few minutes to peruse the paper.