Another twist to this month’s newsletter . . .

Foreign doctors becoming more prevalent

Will Medicare & Social Security survive? Both are currently solvent

SSA NOW REQUIRES LOGIN.GOV

Cigna Medicare plans gone . . .

Januvia dropped

Answers to questions you had not considered

Learning to get along

No, I did not have a brain aneurysm . . .

The April newsletter lead article “How I Survived a Brain Aneurysm” is from a Reader's Digest story with the same title.

When you clicked the link you discovered this was a “first person” story by and about Melody Wren, not me. I am touched by the well wishes and I apologize for the confusion.

I felt it was a very well written article that perhaps could help others.

Why Are There So Many Foreign Trained Doctors?

The percentage of doctors imported from abroad has skyrocketed from 9 percent in 1981 to 25 percent in 2024. U.S. medical schools have simply failed to keep up with the increased demand for medical services by not expanding the number of doctors they train. It was a policy choice to import significantly more foreign-educated doctors rather than train more in the United States. 

That policy choice was enforced by monopoly control over the accreditation of U.S. medical schools, which hindered new entrants and forced the U.S. healthcare system to look abroad for doctors. 

About a third of foreign-trained “medical residents” are U.S. citizens who were turned away from domestic medical schools and have been forced to go overseas.

Blame for the physician shortage that facilitated the dramatic rise in foreign-trained doctors in the U.S. falls squarely with the AAMC and AMA.

https://www.heritage.org/education/report/why-dont-us-medical-schools-produce-more-doctors

Are Medicare and Social Security Viable?

Because several of my clients are still asking about what will happen to Medicare & Social Security I am linking to a couple of well researched articles from trusted sources. This may not be relevant to some of you but there are enough folks concerned about this safety net that I feel compelled to provide assurances.

The Schwab article should be of particular interest . . .

Is Medicare Going Away

https://www.thestreet.com/retirement-daily/social-security-medicare/is-medicare-going-away-expert-dispels-myths-and-offers-reassurance

The Future of Medicare and Social Security

https://www.schwab.com/learn/story/future-social-security-and-medicare

CBO - Medicare Solvent Until 2052

Medicare’s trust fund (Part A) will collect more in taxes and pay out for fewer inpatient stays, CBO says

The Congressional Budget Office recently published its long-term predictions of the federal budget and buried a big surprise for people who follow the Medicare program. The government’s primary piggy bank that pays for Medicare benefits won’t be depleted until 2052 — 17 years later than what CBO analysts predicted last year.

This article is behind a paywall, but you can read it here

SSA REQUIRES LOGIN.GOV

If you created a Social Security username before September 18, 2021, you need to transition to a new Login.gov account or use an existing Login.gov or ID.me account to access our online services.

Starting March 29, 2025, when you sign in to your personal my Social Security account using your username and password, you will be required to transition to Login.gov to access our online services. If you prefer, you have the option to create or use an existing ID.me account to access your personal my Social Security account. Later this year, the “Sign in with Social Security Username” option will be removed, so it's important you act right away.

https://www.ssa.gov/myaccount/account-transition-faqs.html

Pay no attention to the reports claiming you will LOSE your Social Security benefits if you don’t have login.gov.

Januvia Dropped From Drug Formularies

In a move that should have been great news for patients, Merck significantly reduced the price of its blockbuster diabetes drug, Januvia (sitagliptin). However, instead of benefiting from the savings, many insured patients are discovering that their insurance plans no longer cover it.

The culprit? Pharmacy Benefit Managers (PBMs)—powerful intermediaries that negotiate drug prices on behalf of insurance companies—have removed Januvia from their formularies. Those same powerful intermediaries are the latest in the hot seat for their predatory behavior in the United States health system. PBMs have been found to make coverage decisions based on their financial incentives rather than patient access to affordable medication.

https://www.pharmacychecker.com/askpc/januvia-merck-pbms-formulary-drop

Let me know if you are searching for a lower cost for Januvia. I have several Canadian pharmacies that may provide savings plus offer generic versions.

Cigna Gone From the Medicare Market

Health Care Service Corporation on March 19 announced it has completed the previously announced acquisition of The Cigna Group Medicare Advantage, Medicare Supplemental Benefits, Medicare Part D and CareAllies businesses

https://www.insurance-forums.com/medicare/hcsc-completes-acquisition-of-the-cigna-groups-medicare-and-careallies-businesses/

The Downside to DIY Medicare Shopping

This rarely happens, usually less than half a dozen times per year, but the DIY approach to finding a Medicare plan has already happened 5x this year and we are just barely into April.

Most of my new clients are turning 65 and are also referrals from existing clients. Some have tried to figure out how Medicare works on their own. Most have talked with a handful of agents who did not listen to the question, refused to give answers (often because they don’t know the answer), and insisted on pushing a Medicare Advantage plan without explaining the differences in Advantage vs original Medicare and a supplement plan. 

All  of the folks who asked a LOT of questions and then ended up buying something else didn’t show the courtesy of letting me know they were choosing another agent,  or worse, no agent.

In every case they bought from a carrier I won’t use because of problems that keep repeating. That carrier uses a common renewal date for all of their policyholders without regard to the original effective date. Many will get a rate increase just a few months after buying their plan, rather than paying the initial premium rate for a full 12 months. 

Some who buy from that carrier will have TWO rate increases in the first 12 months. The carriers I recommend only have one rate adjustment per year.

They also require two household policyholders in order to qualify for a discount. Carriers I suggest only require that you live with someone age 60 or older.

The result is, one individual who chose to go his own way will be paying $200 per month for the same plan he could have had from Anthem with a discounted monthly premium of $162. 

A couple that bled me for information for 5 years will only pay their initial rate for a few months before being notified of a $50 per month rate increase followed by another increase 9 months later.

When you pay more, you don’t get more, you simply pay too much.

Finding Gems Among the Stones

I am constantly amazed at how I stumble across information that speaks to me . . . even when I didn’t think I was searching for an answer.

As we age life often deals us a hand we really didn’t expect or want. Over the last few years Rachel and I have been faced with friends and relatives who are dealing with illness and death. Sometimes it was expected, sometimes not.

About 20 years ago Rachel took on the role of caregiver when her mother, who lived with us, was diagnosed with a terminal illness. Granny moved in with us and seemed to be in good health. She loved the apartment we added on to the house so she could be near Rachel and her grandchildren.

After a few months her health changed dramatically, Rachel “moved in” with her, sleeping on the couch, and her mother just a few feet away in the next room. As we age, sometimes the roles are reversed and the child becomes the parent.

I recently came across an article written by a Christian lady who is a regular contributor to a conservative news feed. At this time she has penned 23 “chapters” in a series she titles “Caregiver’s Diary.”

Several articles are behind a paywall so I am providing an open link to the first chapter titled simply “The Pain”. Here is an excerpt.

Both of my parents are in their mid to late 70s. While they have some of the same health issues most senior citizens deal with when they get older, my dad in particular has been on dialysis for 10 years now. That has brought a heavy-duty amount of challenges primarily for him but also for the people who love and care for him.

At some point over the last 10 or so years, I became a part-time caregiver to them, though mom has shouldered the lion’s share of taking care of dad. As the years went on and dad’s health problems increasingly presented challenges, I took a more active role in helping her take care of him and their house responsibilities to the point where I’m now a full-time caregiver even though I don’t live with them.

Caregivers Diary - The Pain

I am always touched by adult children that are willing and able to take on the role of caregiver for someone they love. This is not an easy task and can be emotionally draining.

Alzheimer’s and dementia are the 7th leading cause of death in the U.S. and is most common among older adults. Some estimates say 6 million seniors have some form of dementia.

There are a number of books about caregiving for someone with alzheimer’s or dementia. The 36 Hour Day has sold over 3.5 million copies over the last 40 years and has had a number of updates.

The Elephant in the Room . . .

Every month my newsletters are  composed  based on a combination of things. I review articles including consumer questions and feedback then try to balance that data with questions and concerns of my clients. The March newsletter was received by some as a political “hit” piece which was not the intent. Many folks age 65 and over are concerned about possibly losing their Social Security benefit and/or their Medicare plan.

My advice, turn off your TV. So much of the legacy “news” sources no longer report the news, but rather editorialize the information. The tag line, “We report, you decide”, should be replaced with “Trust, but verify”.

No one is taking away your Social Security or Medicare benefits.

I invest over $1,000 per year in newsletters and periodicals with Medicare relevant topics. Most of my clients appreciate doing the research so they don’t have to.

One of my family friendly resources . . .

https://www.65nation.com/

For most of my adult life I have heard that SS is bankrupt and won’t be around when we turn 65. To a lesser extent, similar rumblings crop up regarding Medicare.

There are roughly 70 million covered by each program and most of them vote. The folks in DC that run government programs are not the brightest bulbs in the bunch but they are smart enough to know that eliminating social programs that benefit 70 million voters is the wrong path to take.

Some saw the March newsletter as intended . . . addressing the concerns of those who think the sky is falling as misinformation and gossip seems pervasive. 

Others felt the intent was to promote the agenda of one party against the other. 

Waste, fraud and abuse is not a political issue.

Everyone has a belly button and some think theirs is better than what others have. Truth is, I don’t care how you vote, who you sleep with or which sports team you support.

My goal is to answer questions, provide information that is helpful and do so without choosing sides or promoting an agenda.

Medicare and Social Security are not going away but both are in trouble unless changes are made. Perhaps the greatest threat is the pervasive revenue loss due to mismanagement of funds.

Almost every politician has promised to eliminate waste, fraud and abuse if you vote for them. So far, none have actually taken steps to fulfill that promise.

The GAO (Government Accountability Office) released a report just last year finding “No area of the federal government is immune to fraud. We estimated that the federal government could lose between $233 billion and $521 billion annually to fraud.”. That is a lot of money.

Debt created today that is not paid off will be a debt that is inherited by our children and grandchildren. Those who did not read the March newsletter to the bottom missed this non-political comment . . .

This is not a Republican or Democrat problem. Both parties are to blame.

If something is not done now, Social Security, Medicare and Medicaid may not be around for the next generation . . . but the bills will still come due.

https://www.youtube.com/watch?v=vxnpY0owPkA

In Closing

Finally  . . .  some chose to opt out of future newsletters. That is their choice. That reminded me of a man I knew that walked out of “On Golden Pond” because Henry Fonda used a swear word.

Too bad he missed out on a good movie.

A well known person was recently asked about folks who have differing views and how he handles it. His response . . . I suppose I’ll have to do what 99% of us do when confronted with someone who doesn’t share my views . . . just get over it . . .

Sounds like good advice to me.

Enjoy your summer!

Bob & Rachel