Medigap, Nutrition and PBMs

Good Morning Readers and Happy National Watch Day! Just like a precision-engineered timepiece, we’ll dive into the world of Medicare Supplemental Plans (Medigap). In this issue, we unravel Medigap plans. Beyond healthcare, we discover nutrition tips to keep you ticking smoothly, insights into Pharmacy Benefit Managers (PBMs), and a mouthwatering recipe.. Join us as we explore these topics together, ensuring you're well-informed and prepared for what's ahead!
-The Editors

🏥Medicare Insights:

Medicare Supplemental Plans (Medigap): Understanding Your Options and Making the Best Choice
After exploring the great Medicare debate and breaking down the basics of Medicare, today we’re diving into another crucial aspect of Medicare: Medigap plans. These supplemental insurance plans can be a lifesaver when it comes to covering out-of-pocket costs that Original Medicare doesn’t. Let’s take a closer look at what Medigap plans offer and how to choose the right one for you.

What is Medigap?
Medigap, also known as Medicare Supplement Insurance, helps fill the gaps in Original Medicare (Parts A and B). These plans are sold by private insurance companies and can help pay for costs like copayments, coinsurance, and deductibles. Note: This is not a Medicare Advantage plan. Well dive deeper into this in the coming weeks!

The Standardized Plans:
Medigap plans are standardized and labeled Plan A through Plan N, (different than the traditional Medicare Part A through Part D!) each offering a different set of benefits. 

The Rundown:
Plan A: Basic benefits, covering Part A coinsurance and hospital costs, Part B coinsurance, and three pints of blood each year.
Plan B: Includes everything in Plan A plus the Part A deductible.
Plan C and F: Comprehensive coverage including foreign travel emergency care (note: Plan F is only available to those eligible before January 1, 2020).
Plan G: Similar to Plan F but doesn’t cover the Part B deductible.
Plan K and L: Lower premiums with higher out-of-pocket costs, but include an out-of-pocket maximum.
Plan M and N: Lower premiums with cost-sharing features for certain benefits.

Choosing the Right Medigap Plan:
When selecting a Medigap plan, consider the following:

• Health Needs: Do you frequently visit doctors or need specialist care? Higher coverage plans like G or N might be beneficial.

• Budget: Compare premiums and out-of-pocket costs. Plans K and L might offer savings with higher out-of-pocket limits.

• Travel: If you travel abroad, consider plans that offer foreign travel emergency care.

• Enrollment Period: The best time to buy a Medigap policy is during your Medigap Open Enrollment Period, which starts the first month you have Part B and are 65 or older. During this time, you have a guaranteed right to buy any Medigap policy sold in your state regardless of health status.

Switching Medigap Plans:
You may want to switch plans if your needs change. However, switching might involve medical underwriting, which means they will take your health status into consideration and you could be denied coverage based on health conditions.

Medigap vs. Medicare Advantage:
Remember, you can’t have both a Medigap policy and a Medicare Advantage plan. Medigap works with Original Medicare, not with Medicare Advantage.

Extra Considerations:
Check State-Specific Rules: Some states have additional protections and rules regarding Medigap.

Review Annual Changes: Benefits and premiums can change, so review your plan annually.

🌟Retirement Tips:

Maintaining optimal health in your golden years begins with a balanced diet. As we age, dietary needs shift, making it crucial to focus on nutrient-dense foods that support overall well-being. From staying hydrated to choosing healthy fats and incorporating essential vitamins, these simple tips can help seniors maintain vitality and enjoy a fulfilling retirement. Whether you're gearing up for a day of grandkid-chasing or planning your next bridge game victory, these nutrition tips will help you stay sharp and full of energy. 

1. Colorful Plates, Happy Plates
Fill your plate with a variety of fruits and veggies. Think of it as nature's way of giving you a health boost and a tasty treat all in one. Prioritize whole grains, lean proteins, fruits, vegetables, and healthy fats. These provide essential nutrients without excess calories.

2. Stay Hydrated
Keep the drinks coming! Water is your best friend for staying alert and feeling your best. Drink plenty of water throughout the day. Dehydration can lead to confusion, urinary tract infections, and other health issues. Plus, it’s a simple way to keep everything running smoothly. Sip Sip Hooray! 

3. Protein Power (Not Powder)
Don't skip on protein! It’s like your secret weapon for maintaining muscle strength and keeping up with your favorite activities. Include sources like fish, poultry, beans, and legumes. Protein is essential for maintaining muscle mass and strength. Pro Tip: For plant based options include tofu, tempeh, and lentils. 

4. Healthy Fats, Happy Hearts
Choose heart-healthy fats like avocados, olive oil, and nuts. They’re delicious and good for you—talk about a win-win!

5. Fiber Friends
Keep things moving smoothly with fiber-rich foods like whole grains and fresh fruits. Your digestive system will thank you. Aim for at least 25-30 grams of fiber per day. Foods like oatmeal, berries, and leafy greens are excellent sources.

6. Essential Vitamins and Minerals
Make sure you’re getting enough calcium, vitamin D, and B12—they're like the MVPs of your nutrition team, keeping your bones strong and your energy levels up.

7. Portion Control
Enjoy your meals without overdoing it. Smaller portions throughout the day can help you maintain your energy and avoid that post-meal slump. Pay attention to hunger cues and avoid oversized portions to prevent weight gain and digestive issues.

8. Flavor without the Salt
Spice up your meals with herbs and spices instead of salt. It adds a burst of flavor without the extra sodium. Check for hidden sugars and sodium in processed foods. Aim to cook at home where you can control ingredients

9. Keep Moving
Stay active in whatever way feels good to you. Whether it’s a daily walk, gardening, or dancing in your living room, staying active keeps you feeling vibrant. Physical activity complements a healthy diet by maintaining muscle mass, supporting heart health, and boosting mood.

10. Personalize Your Plan
If you have specific health needs, work with a dietician or healthcare provider to tailor your diet. It’s all about feeling your best, and they can help you navigate any dietary challenges.

💰Money Matters:

Pharmacy Benefit Managers (PBMs): How They Rule the Price of Your Medications

In the world of healthcare costs, Pharmacy Benefit Managers (PBMs) are like the behind-the-scenes puppet masters who decide how much you pay for your prescriptions. They work between insurance companies, pharmacies, and drug makers to negotiate prices and manage which meds get covered. Let's peek behind the curtain to see how PBMs play a role in prescription prices and why they sometimes stir up trouble.

What PBMs Actually Do
PBMs are third-party administrators that manage prescription drug distribution on behalf of health insurance plans, employers, and government programs like Medicare and Medicaid. Their primary functions include:

• Negotiate Prices: PBMs negotiate with drug companies to secure favorable pricing for medications. These negotiated prices determine how much pharmacies are charging for a specific medication.

• Choose Which Meds Are Covered: They create lists of preferred drugs (called formularies) that insurers will pay for. If your drug isn't on the list, you might have to pay more.

• Process Your Prescription Claims: PBMs manage all the paperwork to make sure pharmacies get paid for filling your prescriptions. It’s like they’re the gatekeepers of your meds.

How PBMs Affect Your Wallet
PBMs try to save money, but sometimes their practices can have unintended consequences including rising the price of medications.

• Price Games: Some say PBMs’ negotiations actually make drug prices higher. Drug companies might jack up prices to cover the discounts they give to PBMs.

• Keep Some of the Money: PBMs get rebates from drug companies, but they don't always pass those savings on to you. It’s like finding out your potion was on sale, but the savings vanished into thin air.

• Limit Where You Can Buy: PBMs control which pharmacies can sell your meds at lower prices. This can limit where you go for prescriptions and might leave smaller pharmacies feeling left out.

Why PBMs Stir Up Trouble
The impact of PBMs have sparked controversies within the healthcare industry. PBMs’ pricing and rebate deals can be a bit murky. PBMs also own some mail-order or special pharmacies. People worry they might steer you to their shops over others, even if it costs you more dough.

Governments are looking into PBMs to make sure they play fair and are clear about how they do business. It’s like a showdown in the Wild West, but with paperwork.

What’s Next for PBMs?
With healthcare costs climbing, PBMs are under pressure to change their ways. Everyone wants clearer prices and more choices for where they get their medications. Finding a balance that works for everyone is the real trick.

Read up on how billionaire Mark Cuban is disrupting PBMs here.

🍽️Recipe of the month:

Sheet Pan Lemon-Dijon Chicken and Vegetables

Looking for a hassle-free dinner that's both wholesome and delicious? This sheet pan recipe combines tender chicken breasts with colorful vegetables, all coated in a zesty lemon-Dijon sauce. With minimal prep and a burst of flavors, it's the perfect solution for busy evenings without sacrificing taste or nutrition.

• 2 boneless, skinless chicken breasts (about 8 ounces each)

• 12 ounces baby Yukon Gold potatoes, halved lengthwise

• 8 ounces carrots, diagonally sliced into 1-inch pieces

• 3 tablespoons extra-virgin olive oil, divided

• 2 teaspoons ground coriander, divided

• ¾ teaspoon salt, divided

• ½ teaspoon ground pepper, divided

• 2 tablespoons lemon juice

• 2 tablespoons chopped shallot

• 1 tablespoon whole-grain Dijon mustard

• 2 teaspoons honey

• 1 pound fresh asparagus, trimmed

• 2 tablespoons chopped fresh flat-leaf parsley

• 1 tablespoon chopped fresh dill

• Lemon wedges, for serving

Instructions:

1. Preheat oven to 375°F. Place chicken breasts on a clean surface and pound to 1/2-inch thickness using a meat mallet.

2. Arrange chicken on one side of a large rimmed baking sheet. On the other side, place potatoes and carrots in a single layer.

3. Drizzle 1 tablespoon olive oil over chicken and vegetables. Sprinkle with 1 teaspoon coriander, 1/2 teaspoon salt, and 1/4 teaspoon pepper.

4. Bake for 15 minutes.

5. In a small bowl, whisk together lemon juice, shallot, mustard, honey, remaining 2 tablespoons olive oil, 1 teaspoon coriander, 1/4 teaspoon salt, and 1/4 teaspoon pepper.

6. Remove pan from oven and switch to broil. Stir potato-carrot mixture and place asparagus in the center of the pan.

7. Spoon lemon-Dijon mixture evenly over chicken and vegetables.

8. Broil until chicken and vegetables are lightly browned and asparagus is tender-crisp (about 10 minutes).

9. Remove from the oven and sprinkle with parsley and dill. Serve with lemon wedges.

10. Enjoy!

Let us know how it goes!

🎉Two Truths and a Lie, Uncover the Fib:

1. Sharks are immune to all diseases.

2. Water covers around 70% of the Earth's surface.

3. Goldfish have a three-second memory span.

Answer at the end of the newsletter

🤝Community Corner:
Q: We've lived in our current house for over 30 years, and now we're ready to simplify our lives and down size. What are some practical tips for downsizing our home and managing our possessions as we transition into retirement- One concern we have is accommodating visits from our children and grandchildren?
Mary, Age 71, Portland, Oregon

Over 64: Thanks for writing in! Downsizing your home while ensuring it remains welcoming for family visits requires thoughtful planning and organization. Here are some practical tips to help you manage your possessions and living space effectively:

• Create a Flexible Guest Space: Designate a multifunctional area in your downsized home that can serve as a guest bedroom or sleeping area when needed. Consider options like a sofa bed, Murphy bed, or daybed that can easily convert into a comfortable sleeping space for guests.

• Optimize Storage Solutions: Maximize storage space in your downsized home to store extra bedding, towels, and other essentials for guests. Use under-bed storage bins, closet organizers, or built-in shelving to keep these items accessible yet out of the way.

• Streamline Guest Essentials: Keep guest essentials such as spare toiletries, towels, and linens readily available and organized. Create a guest basket or drawer with these items so you can easily accommodate last-minute visits without scrambling to find what you need.

• Maintain Flexibility in Living Areas: Choose furniture and decor that can easily be rearranged or moved to create more space when hosting family gatherings. Opt for lightweight or foldable furniture that can be stored away when not in use to maximize your living space.

• Lastly- Communicate with Family: Discuss your downsizing plans with your children and grandchildren in advance. Share your intentions for creating a welcoming space for visits and invite their input on how to make them feel comfortable during their stays.

By incorporating these strategies into your downsizing plan, you can strike a balance between simplifying your lifestyle and maintaining a warm and inviting space for cherished family gatherings. Good luck!

Do you have a question you'd like one of our experts to answer?
Shoot us an email at [email protected]! Each week, we feature one question from our readers. We'd love to hear from you!

Answer: - 1. While sharks have remarkable immune systems and some species are more resistant to certain diseases, they are not immune to all diseases. Like all organisms, sharks can be affected by various pathogens and health issues.

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