surgical risks

What are Riskiest Surgeries for Seniors?

Are you considering the risk of surgery for yourself or an older family member as her healthcare agent? Consider this:  a team of researchers recently compiled a list of 277 risky procedures for older adults. They hope it’s useful in preparing for the potential of unwanted outcomes. The study was published in JAMA Surgery and was generated by using admissions data of patients 65 years and older.

Considerable’s recent article entitled “These 10 surgeries are considered “uniquely high risk” for older adults” says that scientists found 10 surgeries to be especially problematic for older patients.

  1. Adrenal Gland Removal (Adrenalectomy). This is the removal of one or both of the adrenal glands which produce hormones necessary in carrying out daily bodily functions. A tumor can form on the glands and causes increased hormone production. When this happens, the gland(s) needs to be removed. The typical recovery time after this surgery is two to six weeks. The risks include blood clots, infections and high blood pressure.
  2. Plaque Buildup Removal from the Carotid Arteries (Carotid Endarterectomy). This is a procedure that removes plaque buildup from inside a carotid artery in the neck. It is performed to restore blood flow to the brain when there are symptoms of reduced blood flow. A carotid endarterectomy is typically preventative of a stroke and removes blockages that might trigger one. The risks include clotting, stroke, or death, but taking anti-clotting medicines before and after can reduce these risks.
  3. Arm Blood-Vessel Replacement (Peripheral Vascular Bypass Surgery). Blood vessel replacement in the arm improves blood flow when one or more of the arteries become narrowed or blocked. A blood vessel from another part of the body or a synthetic blood vessel is used to replace the damaged blood vessel. Risks include irregular heartbeat, infection and death.
  4. Resection or Replacement of Abdominal Veins. When a blood vessel causes tissue injury in the abdomen, some of the tissue might need to be removed or replaced. Risks can include pulmonary embolism, infection and excess bleeding.
  5. Varicose Vein Removal. These veins form in the legs, when the valves in the veins aren’t functioning properly. This can cause pain, blood clots, or bleeding. A doctor might recommend varicose vein removal, which has risks that include nerve injury, heavy bleeding and infection.
  6. High Gastric Bypass. Weight loss surgery changes how the stomach and small intestine handle the food a person eats. There are several criteria that must be met to receive this procedure. High Gastric Bypass can pose major risks and complications, such as malnutrition, perforation of stomach or intestines and dumping syndrome (when food gets “dumped” directly from the stomach pouch into the small intestine without being digested).
  7. Proctopexy (Rectal Prolapse Surgery). This procedure is performed to correct stool leakage, inability to control bowel movements (fecal incontinence), or obstructed bowel movements. This procedure helps put the rectum back in place. The risks can include damage to nearby nerves and organs, narrowing (stricture) of the anal opening and development of new or worsened constipation.
  8. Bile Duct Excision. If a tumor is blocking the flow of bile to the bile ducts, a surgeon may remove them. Nausea, jaundice, or a high temperature (over 101) are potential risks.
  9. Urinary Reconstruction. Sometimes a person’s urinary bladder is removed because of cancer, a non-working bladder, or another medical reason. This procedure creates a new way for urine to exit the body when a bladder is not present. A risk of this procedure is urine backing up into the kidneys, causing infections, stone formation, or organ damage over time.
  10. Ureter Repair. When the ureter is injured (i.e., scar tissue forms after an accident or surgery), more surgery might be required to repair it. Complications include chest pain, blood clots and trouble urinating.

Before any planned procedures, be sure your Medical Directive and powers of attorney are up to date. Review any needed updates with an estate planning attorney.

A note on dental exams. Dental examinations should be considered before any surgery—but they’re especially important for certain heart surgeries, along with joint replacements that use implanted devices. With both joint replacement and cardiovascular valve replacement surgery, the risk of the bacteria from the mouth traveling systemically to the surgical site is very high. During a dental procedure, the gum tissue can be broken and that lets bacteria from the mouth to enter the bloodstream. The bacteria can go to any foreign material in the body and attach, frequently developing a biofilm. This makes it very difficult to treat with antibiotics alone. As a result, surgical removal may be required for complete eradication.

Reference: Considerable (Nov. 4, 2020) “These 10 surgeries are considered “uniquely high risk” for older adults”


Medical Advice by Teleconference

How Do I Tell Fact from Fiction with the Flu?

Flu season officially spans October to May. We’re just getting going. That makes now an opportune time to get the real facts about the virus that claims tens of thousands of lives — a majority of them older adults — every year. AARP’s recent article entitled “7 Flu Myths Debunked” sets the record straight on seven common flu myths to help you strengthen your defenses.

Myth No. 1: Cold weather is the cause of the flu. Wrong. Viruses cause flu, not cold weather. However, the influenza virus survives better in colder environments. In colder weather, individuals also tend to gather inside with less air circulating, causing a higher risk of flu spread. Lower temperatures may also negatively impact the immune response, which makes us more susceptible to flu.  It spreads via droplets as people around us talk, sneeze, or cough.

Myth No. 2: Flu is merely a bad cold. Not every respiratory ailment is the flu. Influenza and the common cold can have similar symptoms, but they are caused by different viruses and each has distinct symptoms. A cold may give you a runny or stuffy nose, but the flu typically doesn’t. A cold can make you feel crummy, but the flu can make you feel like you were hit by a Mack truck. Colds also rarely lead to dangerous complications. However, a bad case of flu can move to the lungs and cause serious infections.

Myth No. 3: Antibiotics will help treat flu. Not true. The flu is a viral infection, and antibiotics only treat bacterial infections. Sometimes complications from flu, like pneumonia, are treated with antibiotics, but flu itself is not. To treat influenza, in addition to over-the-counter drugs for cough and stuffy nose, there are approved antiviral drugs, such as Tamiflu (which should be taken early in the onset of flu symptoms to be effective).

Myth No. 4: You don’t need a flu vaccine if you don’t get sick. Influenza is very contagious. Even healthy people can get it. A flu shot is the very best intervention we have to prevent flu infections and, sometimes, the serious complications it can cause. Everyone should get a flu shot every year—and in the middle of the pandemic, it becomes even more important. The flu virus can also mutate from season to season. As a result, if a strain circulates that your immune system doesn’t have experience fighting, you can be more susceptible to getting sick. Getting a flu shot will help because the shot will build immunity to the specific strains circulating in a given season.

Myth No. 5: A flu shot can make you sick. There’s no active virus in the flu vaccine, so it can’t cause the flu. Your body may hurt because it’s building up immunity. According to the Centers for Disease Control and Prevention (CDC), the flu vaccine stopped about 4.4 million influenza illnesses in the especially severe 2018-2019 flu season. It stopped 2.3 million flu-related medical visits, 58,000 flu-related hospital stays and approximately 3,500 deaths.

Myth No. 6: You might get a “stomach flu.” The word “flu” is often used incorrectly for several unrelated viruses and other illnesses. Although the flu can cause gastrointestinal symptoms, a stomach bug that causes nausea, vomiting, or diarrhea isn’t the flu.

Myth No. 7: If you get a flu shot, you won’t get the flu. After you get the shot, it can take up to two weeks for immunity to be built up in the body, but it’s not 100% effective at preventing the flu. That said, the flu shot will make any symptoms you do get less severe and help your provider distinguish between common flu symtoms and the COVID-19 virus. It’s also especially important to help lessen the strain on the health care system during the COVID-19 pandemic.

Reference: AARP (Oct. 22, 2020) “7 Flu Myths Debunked”


estate planning

Scottish Actor Sean Connery May Have Had Dementia

The famous screen actor, Sean Connery, who was famous for portraying the original on-screen James Bond, passed away recently at his home in the Bahamas.

Yahoo News’s recent article entitled “Sean Connery widow reveals he had suffered from dementia” reported that Connery died peacefully in his sleep surrounded by family members, according to his widow Micheline Roquebrune.

“I was with him all the time and he just slipped away,” the 91-year-old told the London Daily Mail.

“He had dementia and it took its toll on him. He got his final wish to slip away without any fuss. It was no life for him. He was not able to express himself lately.”

Connery will be remembered at a private funeral ceremony, with a memorial event to be held later, according to a publicist. He was knighted in 2000 and won many awards during his decades-spanning career, including an Oscar, three Golden Globes and two Bafta awards.

However, it was his smooth, Scottish-accented portrayal of the suave licensed-to-kill spy 007 that earned him lasting worldwide fame and adoration. He was the first actor to say the unforgettable “Bond, James Bond.”

He made six official films as novelist Ian Fleming’s spy, giving what many still consider to be the definitive portrayal.

Former 007 actor Pierce Brosnan joined the flood of weekend tributes to the Scottish actor, who he said, “led the way for us all who followed in your iconic footsteps.”

“You were my greatest James Bond as a boy, and as a man who became James Bond himself, you cast a long shadow of cinematic splendor that will live on forever,” Brosnan added.

Connery was born in Edinburgh in 1930. He married French artist Roquebrune in 1974 after they met in Morocco in 1970.

They lived outside his native Britain for decades, previously owning a home in the Spanish resort of Marbella and then in the Bahamas.

“He was gorgeous, and we had a wonderful life together,” the Tunisian-born widow said. “He was a model of a man. It is going to be very hard without him. I know that. But it could not last forever and he went peacefully.”

Dementia can happen to anyone. For information on how families deal its onset and paying for care, visit and our past blogs. Or call for a time to call and review matters.

Reference: Yahoo News (Nov. 1, 2020) “Sean Connery widow reveals he had suffered from dementia”


elder law

Good Planning for Life Is Also Good Planning for a Pandemic

The fear of the unknown and a sense of loss of control is sending many people to estate planning attorney’s offices to have wills, advance directives and other documents prepared, reports the article “Legal lessons from a pandemic: What you can plan for” from The Press-Enterprise.

However, people are not just planning because they are worried about becoming incapacitated or dying because of COVID. High net-worth people are also planning because they are concerned about the changes the election may bring, changes to what are now historically advantageous estate tax laws and planning to take advantage of tax laws, as they stand pre-December 31, 2020.

Regardless of your income or assets, it is always good to take control of your future and protect yourself and your family, by having an up-to-date estate plan in place. Anyone who is over age 18 needs the following:

  • Health Care Directive
  • Power of Attorney
  • HIPPA Release Form
  • Last Will and Testament

Any assets without beneficiary designations should be considered for a trust, depending upon your overall estate. Trusts can be used to take assets out of a taxable estate, establish control over how the assets are distributed and to avoid probate. You don’t have to be wealthy to benefit from the use of trusts.

Preparing estate planning documents in a last-minute rush, is always a terrible idea.

If you have more free time during the pandemic, consider using some of your free time to have your estate plan implemented or updated. This should be a top priority. The state of the world right now has all of us thinking more about our mortality, our values and the legacy we want to leave behind. Most estate planning attorneys encourage clients to think about the next three to five years. What would be important to you, if something were to happen in that time frame?

Estate planning is about more than distributing assets upon death. It addresses incapacity—what would happen if you became too ill or injured to care for yourself? Who would make medical decisions for you, such as what kind of medical care would you want, who will your doctors be and where will you live in the short-term and long-term? Incapacity planning is a big part of an estate plan.

When naming people to care for you in the event of incapacity, provide your estate planning attorney with three names, in case your first or second choices are not able to act on your behalf. Most people name their spouse, but what if you were both in an accident and could not help each other?

In recent months, Advance Health Care Directives have received a lot of attention, but they are not just about ventilator use and intubation. An Advance Health Care Directive is used to state your preferences concerning life-sustaining treatment, pain relief and organ donation. The agent named in your health care directive is also the person who will carry out post-death wishes, so provide as many details as you can about your wishes for cremation, burial, religious services, etc.

Trusts are a way to preserve a family legacy. A living trust gives you the ability to decide who you want involved, in case of your death or incapacity. You decide on your beneficiaries, and if you want your assets going directly to those beneficiaries or if they should be held in trust until certain goals are met, like finishing college or reaching a certain age or life milestone.

Your estate planning attorney will help you clarify family legacy goals, whether they include a beneficiary with special needs, a supplement for children who go into public service careers, etc.

Reference: The Press-Enterprise (Oct. 18, 2020) “Legal lessons from a pandemic: What you can plan for”

Suggested Key Terms: Pandemic, Estate Planning, Advance Medical Directive, Living Trust, Legacy, Incapacity, Beneficiaries, Tax Laws, Health Care Directive, Power of Attorney, HIPPA Release Form, Last Will and Testament

long-term care planning

When Do We Need an Elder Law Attorney?

A recent Kiplinger’s article “When Elder Care Requires Legal Advice” explains that a lot of panicked calls are made to elder law attorneys when a person becomes disabled. These are attorneys who specialize in planning for the legal complications that can arise in old age. However, seldom do people think to consult one preemptively to avoid making that panicked phone call when incapacity strikes.

Many, but not all elder law attorneys are members of the National Academy of Elder Law Attorneys (NAELA).

Elder care attorneys work in the best interests of the older person, although how that is accomplished may differ. If the senior is competent and contacts the attorney, it can be fairly straightforward. However, if an adult family member or friend is an agent or has power of attorney for an elderly person—and asks for help, the attorney may represent the agent. In our office, we normally consider the disabled person the client, even if we are working through an agent or other client representative. In fact, for new estate planning clients, we get their permission in advance to advise the power of attorney agent or other personal representative in the event they become incapacitated in the future. In any event, a person who has power of attorney for another has a fiduciary responsibility to do what is best for the elderly person granting them that authority.

If a power of attorney isn’t in place and the elderly parent is incapable of giving it, the family is required to go to court to have someone appointed as a guardian, which can be a time-consuming option. If a parent is cognitively capable and doesn’t want help, there’s nothing an attorney can do about it.

Although state laws vary, elder law primarily concerns these topics:

  • The client’s wishes and health
  • Family dynamics; and
  • The client’s financial assets and income.

An elder care attorney will also make sure that all important documents are in place and up-to-date, according to state laws. This includes a will, a trust, a power of attorney and an advance directive that includes a health care proxy.

Elder law attorneys also help moderate tough decisions, like when family members can’t agree about how a loved one wanted to be buried.

In addition, elder care lawyers understand the complex laws for Medicaid and Veterans benefits. An elder care lawyer can speak to many other issues, ranging from long-term care insurance to capital gains taxes.

A key when meeting with an elder law attorney is that you feel comfortable, that you’re not rushed and that your questions are answered.

Reference: Kiplinger (Sep. 15, 2020) “When Elder Care Requires Legal Advice”


Signing estate plan documents

The Wrong Power of Attorney Could Lead to a Bad Outcome

There are two different types of advance medical directives, and they have very different purposes, as explained in the article that asks “Does your estate plan use the right type of Power of Attorney for you?” from Next Avenue. Fewer than a third of retirees have a financial power of attorney, according to a study done by the Transamerica Center for Retirement Studies. Most Americans don’t even understand what these documents do, which is critically important, especially during this Covid-19 pandemic.

Two types of Durable Power of Attorney for Finance. The power of attorney for finance can be “springing” or “immediate.” The Durable POA refers to the fact that this POA will endure after you have lost mental or physical capacity, whether the condition is permanent or temporary. It lists when the powers are to be granted to the person of your choosing and the power ends upon your death.

The “immediate” Durable POA is effective the moment you sign the document. The “springing” Durable POA does not become effective, unless two physicians examine you and both determine that you cannot manage independently anymore. In the case of the “springing” POA, the person you name cannot do anything on your behalf without two doctors providing letters saying you lack legal capacity.

You might prefer the springing document because you are concerned that the person you have named to be your agent might take advantage of you. They could legally go to your bank and add their name to your accounts without your permission or even awareness. Some people decide to name their spouse as their immediate agent, and if anything happens to the spouse, the successor agents are the ones who need to get doctors’ letters. If you need doctors’ letters before the person you name can help you, ask your estate planning attorney for guidance.

The type of impairment that requires the use of a POA for finance can happen unexpectedly. It could include you and your spouse at the same time. If you were both exposed to Covid-19 and became sick, or if you were both in a serious car accident, this kind of planning would be helpful for your family.

It’s also important to choose the right person to be your POA. Ask yourself this question: If you gave this person your checkbook and asked them to pay your bills on time for a few months, would you expect that they would be able to do the job without any issues? If you feel any sense of incompetence or even mistrust, you should consider another person to be your representative.

If you should recover from your incapacity, your POA is required to turn everything back to you when you ask. If you are concerned this person won’t do this, you need to consider another person.

Broad powers are granted by a Durable POA. They allow your representative to buy property on your behalf and sell your property, including your home, manage your debt and Social Security benefits, file tax returns and handle any assets not named in a trust, such as your retirement accounts.

Some lawyers — and some homemade powers of attorney — include old boilerplate which limits gifts to some arbitrary amount related to gift taxes which apply to few Americans today. This restriction could prevent your agent from making perfectly appropriate and permissible gifts before applying for Medicaid. The point is, we all need a durable power of attorney, but it needs to be the right power of attorney.

The executor of your will, your trustee, and Durable POA are often the same person. They have the responsibility to manage all of your assets, so they need to know where all of your important records can be found. They need to know that you have given them this role and you need to be sure they are prepared and willing to accept the responsibilities involved.

Your advance directive documents are only as good as the individuals you name to implement them. Family members or trusted friends who have no experience managing money or assets may not be the right choice. Your estate planning attorney will be able to guide you to make a good decision.

Reference: Market Watch (Oct. 5, 2020) “Does your estate plan use the right type of Power of Attorney for you?”


Social Security Cost-of-Living Adjustment

How Big Is the Social Security Cost-of-Living Adjustment?

“The 1.3 percent cost-of-living adjustment will begin with benefits payable to more than 64 million Social Security beneficiaries in January 2021. Increased payments to more than 8 million [Supplemental Security Income] beneficiaries will begin on December 31, 2020,” the Social Security Administration said in a news release. That’s a smaller increase for retirees once again.

As The Federal Times reports in its article, “Retiree cost of living adjustments sink for the second year in a row,” the Bureau of Labor Statistics calculates the cost-of-living adjustment — known as the COLA — each year based on the consumer price index for workers. It looks at the changing prices of common goods to which the average worker would be exposed.

However, the National Active and Retired Federal Employees Association has for many years had an issue with that type of calculation. That’s because it fails to take into account the differences in costs experienced by the elderly, who receive Social Security benefits, rather than the standard worker.

“This insufficient COLA fails to keep up with inflation experienced by seniors, further eroding their purchasing power. The cost of health care continues to rise faster than other goods. Seniors spend more on health care than any other segment of the population — just as the nation struggles to contain a virus that poses particular danger to older Americans. And federal retirees will almost certainly be further burdened by significantly higher Federal Employees Health Benefits program premiums, which have yet to be announced for 2021,” NARFE National President Ken Thomas said in a statement.

“This didn’t need to happen. For years, NARFE has urged Congress to address the inequity of COLAs that don’t keep up with rising health care costs by passing legislation requiring the BLS to calculate COLAs based on the consumer price index for the elderly instead of the consumer price index for workers.”

COLA adjustments have varied widely each year. For example, in 2015, there was no increase, and in 1980, the bump was 14.3%!

In the past 20 years, COLA increases have only twice been more than 4%. The good news is that military veterans will also see an increase to some of their benefits based on the COLA increase.

In September, Congress okayed plans to link a COLA in veterans benefits with the annual Social Security increase. Under current law, Congress must approve the veteran’s benefits increase each year, but Social Security beneficiaries get the boost automatically.

The benefits for vets include disability compensation, compensation for dependents, clothing allowances and dependency and indemnity compensation checks.

Those receiving Social Security benefits should be notified of their new benefit amount beginning in early December. Most recipients should also be able to see the notice in their online Social Security accounts.

Reference: The Federal Times  (Oct. 13, 2020) “Retiree cost of living adjustments sink for the second year in a row”

Suggested Key Terms: Social Security, Retirement Planning, VA Benefits, Veterans, Military, Legislation


What Does an Estate Planning Attorney Actually Do?

It’s critical to understand what will happen to your estate after your death. That’s where the help of an experienced estate planning attorney comes in, says VENTS Magazine’s recent article entitled “What Does an Estate Lawyer Do Exactly?”

(And this article is timely.  My wife asks me what estate planning lawyers do all day all the time; at least what this one does all day!)

An experienced estate planning attorney is a legal professional, upon whom you can rely to help protect your estate after your death or in the event that you become incapacitated.

He or she can make certain that your assets and property are handled correctly.

In addition to assisting you with your estate, an estate planning attorney can help handle any family members trying to get involved in your legal affairs.

It may be difficult to please everyone when creating your will. Having an estate planning attorney will help you make the best decisions, when it comes to distributing your wealth.

Estate planning is critical—especially if you’re older, experiencing chronic illness, or just want to be smart about protecting your assets.

As we grow older, we can accumulate a long list of stressful issues and responsibilities. You may worry that your estate will be gobbled up by creditors once you pass away, or that your children will fail to distribute your assets as you intended.

Much of this stress is eliminated with the guidance and counsel of an experienced estate planning attorney. Having an estate plan allows you to enjoy a better quality of life, once you’re older. You won’t have to live every day with worry or stress about the future after you’re gone.

An experienced estate planning attorney is a valuable resource for your family, in the event someone tries to contest the will after your death.

Estate planning attorneys also aid in distributing the wealth, protecting your property from creditors and lowering estate taxes.

Reference: VENTS Magazine (Sep. 28, 2020) “What Does an Estate Lawyer Do Exactly?”

Moving extends your life.

Little Things Add Years to Your Life

Get moving, says a 20-year study conducted with nearly 15,000 residents of the United Kingdom age 40 to 79. The study found that lifestyle changes could add years to your life.

And you are probably not surprised. We’ve seen the connection with lifestyle and reduced risk of Alzheimer’s before.

This new research was conducted by the MRC Epidemiology Unit at the University of Cambridge, and the results were published in The British Medical Journal.

Considerable’s recent article entitled “This small lifestyle change can add years to your life” explains that the subjects who kept or increased to a medium level of activity were 28% less likely to die than those who stayed at a low level of activity.

The researchers split the sample into three groups who engaged in low, medium, and high levels of activity. They monitored changes to their activity for about eight years. Then they looked at the health effects over the next 12½ years.

The researchers found that those who stayed or increased their level of activity from low to medium were 28% less likely to die during that second phase than those who kept a low level of activity.

Moreover, those subjects who’d been moderately active but raised their activity level achieved a significant 42% increase in survival, compared to the low-activity subjects.

This impact was present even for those respondents who ate an unhealthy diet or had experienced a health condition, like high blood pressure, high cholesterol, or obesity.

So, the big question is just how much activity is required?

The study defined the activity levels according to the following guidelines:

  • Low: Less than the guideline of 150 minutes per week of moderate intensity activity
  • Medium: achieving the guideline of 150 minutes of moderate-intensity activity per week; and
  • High: The guideline of 300 minutes of moderate-intensity weekly activity.

The high level also allowed for an equivalent, like 75 weekly minutes of high-intensity activity, or 60 minutes of high-intensity activity and 30 minutes of medium-intensity activity per week.

The researchers think that their study will motivate more people to take it up a notch, regardless of their age.

“These results are encouraging, not least for middle aged and older adults with existing cardiovascular disease and cancer, who can still gain substantial longevity benefits by becoming more active, lending further support to the broad public health benefits of physical activity,” the authors commented.

Reference: Considerable (Sep. 22, 2020) “This small lifestyle change can add years to your life”


Medicare Advantage Premiums

Are Medicare Advantage Premiums Going Down?

You’ve heard the cable TV ads this month. And as the celebrity spokespersons tell it, there’s a Medicare Advantage plan out there that will practically make your coffee in the morning. Maybe not, but change is coming and a lot of it sounds good this time. Choices are going up and premiums are coming down. “The Medicare Advantage average monthly premium will be the lowest in 14 years (since 2007) for the over 26 million Medicare beneficiaries projected to enroll in a Medicare Advantage plan for 2021,” The Centers for Medicare & Medicaid Services (“CMS”) said in a press release.

Health Payer Intelligence’s recent article entitled “Big Premium Drop, More Medicare Advantage Benefits Slated for 2021” explains that the high enrollment projections would represent a 44% enrollment increase since 2017. This includes a newly eligible population of end stage renal disease patients, which some say will up the costs for health plans. However, other patient populations and Medicare Advantage beneficiaries as a whole will have access to a wider range of benefits in 2020 and save money. There are numerous potential implications for elder law and estate planning.

Beneficiaries with diabetes are now able to select from more than 1,600 Medicare Advantage and Part D prescription drug plans—they all will have insulin for a copay of $35 per month in 2021. That’s because of the Part D Savings Model that CMS announced in March 2020, primarily in response to the coronavirus pandemic. Additional plans have joined this model, which has a fixed insulin copay rate for the coverage gap phase of Medicare coverage. CMS said that more than 1,750 Medicare Advantage and Medicare Part D plans would participate in the model.

In addition, roughly 500 Medicare Advantage plans will offer lower copayments or supplemental benefits to enrollees with specific chronic diseases and other conditions. About 900 plans will offer benefits that aren’t primarily health benefits (such as meal delivery) to help enrollees manage their chronic diseases.

Enrollees will also have added access to supplemental benefits. Approximately 730 plans are offering their three million enrollees benefits like in-home support, therapeutic massage and adult day health services. Just over 50 Medicare Advantage plans are also offering palliative care and integrated hospice care. A total of 94% of Medicare Advantage plans will provide extra telehealth benefits, a 36% increase from 2020.

The good news is that Medicare Advantage beneficiaries will pay less for these benefits this year than they have in the past. The average Medicare Advantage premium should go down about 11% to $21 in 2021. The decreases vary by states, and some will see up to a 50% decrease from their 2017 premiums.

In fact, premiums have been dropping since 2017, so beneficiaries have saved around $1.5 billion in premiums, CMS estimated. The number of Medicare Advantage plans is also going up. There will be 76.6% more Medicare Advantage plans available in 2021 than in 2017 (2,100 more health plans). The average number of plans per county will rise 78.5% since 2017 and from 39 plans in 2020 to 47 plans per county in the new year.

Medicare open enrollment began on Oct. 15, 2020 and ends Dec. 7, 2020.

Reference: Health Payer Intelligence (Sep. 29, 2020) “Big Premium Drop, More Medicare Advantage Benefits Slated for 2021”



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