Omaha Insurance Solutions - January 2021

Omaha Insurance Solutions - January 2021

Club MED

January 2021

REMEMBERING THE DECADE THE WORLD ALMOST ENDED

I noticed Elvis Presley’s 86th birthday on Jan. 8, and it brought back a strong memory: Elvis’ death. Before Elvis (and before the Beatles), it was a very unusual thing to see women — or anyone — become intensely emotionally attached to musical superstars. Jazz was popular, but the fanfare around it was nothing compared to the number of screaming women at Elvis’ concerts. Even my dad complained about it from time to time! “What’s gotten into these women?” he’d wonder out loud. My mother was no exception to this. She adored popular music back in the ’50s and ’60s — it’s what she listened to growing up. So, when Elvis died on Aug. 16, 1977, I found her crying. It wasn’t profuse sobbing, but quiet tears that she tried to hide. I was amazed it was such an emotional day for her. “Wow,” I thought. “A lot was happening before I was born.” It made me wonder what her life was like before I came around. Her love for music itself didn’t necessarily shock me. When I was in second grade in ’67, I was in Cub Scouts, and she was the den mother. Mom helped at our troop meetings. At the end of the monthly meetings, each den was responsible for putting on a skit or show. Even as a kid, I was stunned by how talented and creative my mom was! Using cardboard, she created these cool guitars and a drum set. She gathered

wigs (which were a popular fashion) from her extensive wardrobe and other moms. She turned us into the Beatles, and we “played” our instruments and lipsynced “A Hard Day’s Night,” one of the hottest songs at the time. I didn’t even know who the Beatles were then. I just knew the fashion was long hair, which for men at the time just meant over your ears. Some may remember that there were also many riots in northern Omaha in ’67 and ’68. Although segregation was outlawed at this point, landlords could choose to whom they rented. As you might’ve guessed, landlords didn’t want to rent to Black people in white neighborhoods, so they kept them in north Omaha, effectively forcing Black people to live there. Back then, 24th Street used to be a massive place for Omaha businesses, but that all changed with the Omaha riots in ’67 and ’68. All the businesses were burned down and never rebuilt. As a kid, I didn’t know anything about it. My parents kept us safe and protected despite fears that the world was swirling around us. I was born in ’61, and John F. Kennedy was shot in ’63. Martin Luther King, Jr. and Robert F. Kennedy were shot in ’68. I didn’t realize it as a kid, but in the ’60s, protests, riots, wars, and nuclear threats were raging. Everyone thought the world was ending. For better or worse, though, it changed forever. A lot of good things have happened since then. No matter how bad 2020 might seem, I know we have plenty more amazing things to look forward to in the future. I can’t wait to see them together. Have a fantastic start to the new year! I didn’t realize it as a kid, but in the ’60s, protests, riots, wars, and nuclear threats were raging on. Everyone thought the world was ending.

–Christopher J. Grimmond

Medicare Insurance Made Easy

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Essential Stretches Everyone Must Do!

inpatient hospital care and following DRG billing codes. In 1987, there were 700 DRG codes. By 2011, that number increased to 14,000, and by 2015, there were over 100,000 and counting! This is why, unfortunately, your first step to finding out your treatment costs isn’t actually contacting your insurance company or Medicare’s customer service. You will need the DRG code before you get any precise dollar amounts. To locate the DRG code for your treatment, contact your hospital or doctors’ billing office. Then, contact your insurance company to discover what costs are associated with the code. We hope this series has been helpful to you so far! We’ll have one more in the future that clients often ask us about: what the newer Medicare Part C program does and how it got here. Back Stretches Your spine carries you all day long. Give it the proper foundation to avoid pain throughout the day. Here are two exercises to get you started. • Cat/Cow: Start on your hands and knees. Inhale and arch your back upward (cat) and as you exhale, lower your spine below neutral and look upward (cow). Repeat as necessary. • Child’s Pose: After cat/cow, lower down onto your forearms and keep your neck neutral, staring down at the floor. Sit your butt down onto your ankles and breathe deeply for a few moments. As with any form of exercise or stretching, always consult with a professional before you begin. In fact, a physical therapist can help you develop a routine that targets your troublesome areas!

Exercise and diet are the foundation of any healthy routine, but there’s often a vital component to wellness many of us forget: stretching! Start your day off right with these essential stretches. Neck Stretches Neck pain or tightness can lead to chronic headaches and even difficulty concentrating, but in just two moves, you can loosen the muscles in your neck. • Neck Pull: Start by raising your right hand above your head. While looking forward, bend your arm down toward your head and place it near your left ear. Then pull your head toward your right shoulder, placing minimal force on your head. Repeat as needed on both sides. • Neck Push: Sit cross-legged on the floor. Place one hand flat on the ground, as if you were pushing the ground away. While looking forward, tilt your head in the

opposite direction of that arm. Hold the position for 20 seconds and switch sides, repeating as needed. Leg and Hip Stretches A tight torso can be painful, no matter what your daily activities are. Taking a few moments each morning to loosen your muscles after waking up can combat chronic pain and stiffness. • Hamstring Hang to Downward Dog: Start with your feet shoulder-width apart and bend forward until you’re folded in half. Grab your elbows and lightly swing side to side. After a few moments, lay your hands on the floor and walk your hands forward until your body is in a triangular shape. Stay there for a few seconds and pedal your feet for a deeper stretch. To end, either lower your knees down or walk your hands back to your feet and stand up.

The Transformation of Medicare, Part III HOW MUCH DOES MY PROCEDURE COST? The most common reason

claims. Before, millions of paper bills flooded in from hospitals and doctors. Now payments

clients call our office is to find out the cost of a particular procedure. We can only speak generally on that, based upon the information Medicare and the insurance

are based on “reasonable cost,” which has formed the Medicare prospective payment system.

“Reasonable cost” is defined by Medicare as “both direct and indirect costs of providers of services, including normal standby costs.” Reasonable cost is the case so long as treatment is “in accordance with regulations establishing the method or methods to be used and the items to be included.” Of course, the “reasonable cost” for each treatment and case varies, which means their program requires a lot of regulation. The Medicare prospective payment system was based upon a system of diagnosis-related groups (DRGs) for

companies put out. To get actual numbers, we refer clients to customer service at their insurance company or Medicare, but first to their health care provider’s office. Why is that? Because of billing codes and regulations. Hundreds of thousands of them. In past editions, we covered how Medicare evolved to do business with private companies. After that occurred in 1983, Medicare revised how it paid

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A Month’s Insulin for $35 or Less How President Trump’s Executive Order Changed Medicare Insulin Costs When I meet with prospective clients and clients on insulin or diabetic-related drugs, the conversation always takes a severe turn. I feel the worry over the “donut hole” and how to pay for everything because the cost of medications is so high. It has been a frustration for years. There have been few times that executive orders have affected health insurance and medication/treatment costs. However, on July 24, 2020, President Trump released an executive order to decrease prescription drug prices and make a historical impact on insulin prices. Known as the Part D Senior Savings Model, pharmaceutical manufacturers and plans will provide many Medicare beneficiaries access to a broad set of insulins at a maximum $35 copay for a month’s prescription. Over 1.3 million seniors who rely on Medicare Part D plans and use insulin will save an average of $446 (66%) a year on insulin costs. For a life-changing and life-enhancing drug that was initially $1, this is immensely more affordable than $100–$300 a vial, its price not so long ago. How did the pricing get out of hand, anyway? One problem was that, at one point, Medicare Part D plans changed from a copay to a coinsurance model where subscribers paid 25% of the medication fee. This coverage gap may not seem so bad, but it was for those with medications that cost hundreds of dollars. Manufacturers lost the incentive to keep their prices low, leaving the plans and seniors to make up the difference. To test a fix, the Centers for Medicare & Medicare Services (CMS) allows enhanced Part D plans to lower out-of- pocket costs for insulin throughout the Part D benefit while maintaining the manufacturers’ full coverage gap contribution to the drug’s costs. Essentially, there’s more room for robust negotiation between manufacturers and plans — eager to attract patients in a competitive environment.

Testimonial

“Chris took care of a friend of mine. He did a great job, so my friend sent me to Chris.” –Rodney K.

Easy One-Pot Lentil Soup

This delicious plant-based soup is loaded with vegetables, so it’s a healthy way to stay warm on a winter night! This recipe makes four servings, and you can freeze the leftovers for up to a month.

Ingredients

• 2 tbsp coconut oil • 2 cloves garlic, minced • 2 shallots, diced • 4 large carrots, sliced thin • 4 stalks celery, sliced thin • Sea salt, to taste • Black pepper, to taste • 3 cups red potatoes, cubed

• 4 cups vegetable broth • 2–3 sprigs fresh rosemary or thyme, chopped • 1 cup uncooked green lentils, rinsed and drained • 2 cups chopped kale

Directions

1. In a large pot, heat oil over medium heat and sauté garlic, shallots, carrots, and celery for 4–5 minutes, adding salt and pepper to taste. 2. Add potatoes to pot, along with more salt and pepper. Sauté for 2 minutes. 3. Add vegetable broth and herbs, then bring soup to a simmer. 4. Add lentils, stirring until soup returns to a simmer. Then, turn the heat to low and cook soup uncovered for 15–20 minutes. 5. Finally, add kale and additional salt and pepper as needed. Cook for 3–4 minutes, thin soup with additional vegetable broth as needed, and serve!

In many cases, out-of-pocket costs have been reduced well below the model’s $35 maximum, which resulted in new and creative benefit designs surrounding premiums, copays, and formulary offerings. We’ve been thrilled to see this order work so well for millions of seniors, and if you need advice on how to make the most of your plan to take advantage of this opportunity, give us a call!

Inspired by MinimalistBaker.com

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INSIDE This Issue

1

Remembering the Decade the World Almost Ended

2

Essential Stretches to Start Your Day

How Much Does My Procedure Cost?

3

Get a Month’s Insulin for $35 or Less With Medicare Part D

3

Easy One-Pot Lentil Soup

4

The First Dog to Win a Nobel Peace Prize

FOXTROT’S HEROICS WITH THE WORLD FOOD PROGRAMME The First Dog to Win a Nobel Peace Prize

Just this past October, the Nobel Peace Prize was awarded to what can only be described as one the world’s goodest boys — a dog named Foxtrot, known also to his Instagram followers (of which there are nearly 7,000) as humanitarian_pup. While Foxtrot wasn’t responsible for improvements to auction theory (like Paul Milgrom and Robert Wilson, who won the Nobel Prize for economics) or for a standout career in writing poetry (like Louise Glück, who won the Nobel Prize for literature), this incredible canine shared the Nobel Peace Prize with the World Food Programme (WFP), for their work in combating world hunger. As the organization’s official mascot, Foxtrot shared in the win with the thousands of other WFP workers worldwide.

Foxtrot lives in Bangladesh (one of the most densely populated countries in the world) at a WFP outpost that works to supply one of the world’s largest refugee camps. According to an NPR article that spotlighted Foxtrot and the efforts made by his WFP humans, they worked not only to get food to refugees but also to flatten hillsides to make room for shelters for Rohingya refugees fleeing Myanmar.

efforts to end hunger in Bangladesh. This usually includes accompanying his humans while they work, wearing an adorable custom-made WFP cape, and taking to Instagram to raise awareness about how anyone can join in the WFP’s mission. After learning that he and his humans had won the Nobel Peace Prize, Foxtrot didn’t waste the opportunity to share his excitement with his followers. “Woweee,” the pup

Foxtrot himself became part of the effort to

said. “I … think it would be even more amazing if we didn’t need any peace prizes because peace was the status quo in our world.”

combat world hunger during a WFP beach cleanup in his home country. Workers found him as a 4-week-old pup, and

after failing to locate his owners, took him in as one of their own. For the past two years, Foxtrot has helped however he can to further the WFP’s

If Foxtrot and his humans keep up the good work that won them the Nobel Peace Prize, it seems like that status quo could be within reach.

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