MENTAL HEALTH CHECK
And just like that: October. This has been an unusual year, to say the least. While everyone’s experiences through 2020 have been varied, I think it is safe to say that all of us are encountering some changes in the ways that we go about life. How are these changes impacting your health? What can you do to maintain your health in the midst of change? October is Mental Health Month, and an appropriate time to reflect on how you are feeling, and on whether it is time to access resources to support your mental health.
With change comes...opportunity? Growth? Challenges? Resistance? So many possibilities. Regardless of the outcomes, change often comes with stress. Some stress is good: it motivates us, particularly when changes are instituted as part of a personal goal, and under our control. We sometimes refer to this as eustress. Some stress is less positive, and can make us feel edgy, irritable, or even fearful or “distressed.” In the short term, our brains and bodies are typically able to respond to stress, combat its effects, and maintain balance. With longer-term or chronic stress, however, the balance becomes disrupted, and problems can develop.
Mental health can be affected by a variety of factors including: genetics, environment, physical health, medications, diet, socio-cultural influences. Some of us have underlying mental health conditions, and others may have episodic flares when conditions are just right...conditions like an increase in stress.
When patients come to me with concerns about depression or anxiety (or both), I often talk about these conditions as a response to stress. In the short-term, our bodies use various hormonal cascades and neurotransmitters to combat the effects of stress. They work by helping to slow the heart rate, lower the blood pressure, and combat inflammation. However, these are a finite resource - the well can run dry.
Therapy, or counseling, is the mainstay of treatment for issues with depression or anxiety. Often, this can be an opportunity to assess sources of stress that may be contributing to symptoms. This can also be a helpful way to explore techniques for managing stress. In some cases, medication can be a helpful adjunct, particularly when symptoms are interfering with day-to-day activities like sleep, personal interactions, and accomplishment of activities at home or at work.
If you feel that it is time for a mental health check up, please make an appointment to discuss with your provider. We can perform some basic assessments, discuss resources and basic treatment options, and help you to connect with mental health resources in the community.
How do you feel about your weight?
Are you concerned about your weight, or how your weight is impacting other aspects of your health?
In recent decades, the United States has seen significant increases in both adults and children who are overweight, with estimates that 2/3 of the population fall into the category of obesity. Obesity is typically described as a body mass index (BMI) of 30 or greater, and is further broken down into other categories as BMI increases. Body mass index is a measurement derived from an individual's mass (or weight) divided by the squared value of their measured height. You can calculate your own BMI fairly easily, and many calculators can be accessed for free online. One is available here: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm Normal BMI is a reading that falls between 18.5-24.9. Readings lower than this are considered underweight, and readings above this are considered overweight. While the BMI system does carry some bias, it still contributes information to a person's overall health or risk assessment.
There has been conflicting literature, and use of confusing terminology in recent decades including, "healthy fat," "fit fat," and "body positivity." While it is wonderful to witness some cultural shift regarding what we should expect from our bodies, and an embracing of our differences within our diverse population, there is still concern that overweight or obese individuals continue to carry higher risk for developing many health conditions.
Health conditions that can develop secondary to weight gain include high blood pressure, high cholesterol, both of which can lead to cardiovascular disease or stroke; musculoskeletal injuries may occur or be more difficult to heal, and elevated blood sugar may contribute to diabetes.
Unfortunately, maintaining or achieving a healthy weight can be difficult. Many social/cultural factors prime us to gain weight. With advances in technology, we are able to do many tasks without much physical effort or calorie expenditure. We also have a plethora of fast foods available to us in a variety of convenient ways. We live busy lives, with many people juggling multiple jobs, caring for family members, and managing tight budgets. Often diet and exercise are the first things to fall by the wayside when life gets chaotic. In times of stress, we may turn to food or alcohol. In some cases, metabolic issues, sleep apnea, family history, and other personal health issues may make weight loss even more challenging.
Given all of these factors, a journey toward healthy weight can seem daunting. There are many weight loss businesses that offer quick fixes and rapid weight loss. Unfortunately, many people find that these "quick fixes" are often followed by a rebound/regain and sometimes even wind up at a higher weight than they were previously.
Weight loss approaches that seem most effective are often gradual, and realistic goals may not be as extreme as one would expect. A reduction in 5% body weight over a 12 month period can have significant benefits for health, and is less likely to be associated with rebound weight gain. This can typically be achieved through gradual modifications to diet and exercise practices, in a step-wise fashion rather than an " all or nothing" approach.
If you are struggling with your weight, please make an appointment to discuss this with your health care provider. We can perform an evaluation to determine if existing health conditions are contributing to weight issues, and also discuss weight loss strategies and provide support/accountability and access to other weight loss resources.
Medicare at a glance
So, you’re on Medicare now? There’s a lot to learn about it and certainly a lot of industry lingo surrounding enrollment can be difficult to decode. It can be a lot to figure out on your own, and you may find the help of an Insurance Broker to be invaluable when deciding how to enroll.
Here’s a bit of information to get you started though!
Original Medicare- also known as Traditional Medicare.
This is the program that has the Red, White and Blue card and is funded through US Treasury Trust Funds. There are 4 parts to coverage with Medicare- Part A provides hospital coverage, Part B provides outpatient coverage, Part D provides prescription drug coverage and Part C which provides an alternate way for you to get benefits through private health plans- we’ll talk more about that later.
Original Medicare is a pretty straight-forward plan, there are no copays, you don’t need any referrals, you don’t have to designate a provider, but it has a deductible that has to be met each year before benefits are paid out. Medicare has an 80%/20% coinsurance sharing structure- meaning they pay 80% and you pay 20% of covered services. Many people add a Supplemental plan to help cover the cost of the deductible and/or 20% patient responsibility- we’ll talk more about those later. Part B(Outpatient) & D(Prescription) monthly premiums are based on your income tax filing and can be found on medicare.gov, most people do not pay a premium for Part A (Hospital). Additionally, there are lots of resources to get help in paying premiums, you can check those out on medicare.gov
Private Insurance Carriers- like Aetna, BCBS, Cigna, or United Healthcare, all have products that you can use as a Secondary Insurance to Original Medicare to help pay for your annual deductible and/or your coinsurance. The cost of these plans depends greatly on the amount of benefits you choose. There is no shortage of Medicare Supplemental Insurance carriers to choose from, in fact, you may already have Life Insurance coverage through one of them- carriers like Mutual of Omaha or Manhattan Life- It may be worth finding out if there is a discount for having multiple policies with a company like this to save you money.
The cost of Supplement Plans is no where near as cut-and-dry as looking it up on medicare.gov, The premiums will be based on how the carrier chooses to price their plans (examples: based on age, based on community) and the type of coverage you think is right for you. healthmarkets.com has a couple really handy charts to help visualize which plans cover what services. For example- you could get a Supplement Plan that covers your 20% coinsurance but does NOT cover your annual deductible- thus saving you some amount in premiums per month than a Plan that would cover both. If you are shopping for a Supplement to your Original Medicare, I would definitely recommend speaking with an experienced broker to help you compare the plans available.
Part C - also know as Medicare Replacement Plans
Also called Medicare Advantage, Medicare Complete, or Medicare Replacement. If you have Part C, that means that you have opted to replace your Original Medicare with a private carrier such as BCBS, Humana, Cigna etc… This is where a lot of people get confused. Many people enroll in one of these plans thinking that it is the Supplement plan to their Original Medicare, when in fact, it REPLACES their Original Medicare.
There are plenty of differences to be aware of, and maybe I’m a little biased, but one of the biggest differences to be aware of, is knowing who the doctor should send your claims to! With a replacement plan, the claims go to the private insurance carrier NOT Medicare. There are other differences that can have a big impact on your pocketbook (good or bad!) that you should take a look at. Premiums for replacement plans can be as low as $0/month, but also could have higher deductibles, or copays for pcp/specialist visits, they usually do require referrals and some even require you to choose a provider to go to. Comparing the Overall Cost of Original Medicare + Supplement with the Overall Cost of a Medicare Advantage plan is really important to think about, as one is not necessarily better than the other- it really comes down to your health conditions, needs, wants, and financial situation.
Part D - Prescription Coverage
Last, but certainly not least- Prescription Coverage!! Without getting too up-in-arms about the whole thing, Prescription Medications can be outrageously expensive. Now, if you choose to enroll in a Medicare Advantage plan- that likely would include Prescription Coverage- so make sure it’s a plan you can live with, ask for their formulary- to make sure any drugs you take are covered! If you choose to enroll in Original Medicare, you can utilize the Medicare Plan Finder search tool on medicare.gov to drill down and find the right Prescription Coverage for you.
These plans have varying monthly premiums depending on coverages chosen. Some have deductibles, copays, or coinsurance, some do not. When deciding how to enroll for Medicare-whether Original Medicare or Medicare Advantage- don’t forget to factor in Prescription coverage costs to the whole picture.
One last word of caution in choosing any plan- if you travel, make sure that whatever you choose will cover you across state lines, or even international borders.
It’s a lot to take in and learn, and that’s why I recommend finding a knowledgeable Insurance Broker who knows about Medicare Products specifically to help navigate it, there are also great resources online like www.caring.com/medicare/ where you can find helpful information. I can see why Medicare Replacement plans have gotten so popular, there are a lot of pieces to the puzzle with Original Medicare- and enrolling in a Replacement Plan does seem simpler, but don’t be intimidated - do your research, talk to a professional, and do what is best for your good health!
Here we are 10 days into September(!) - school is back in full-swing, the winter visitors are beginning to arrive (Welcome, if you are already here!), and the stores are stocking all things, Halloween, Thanksgiving, and yes, even Christmas. The end of the year will be upon us soon, a good reminder that it is an excellent time to take a look at your health before we round the corner into 2020! When is the last time that you saw your healthcare provider for a Wellness Visit?
What is a wellness visit?
This is an opportunity for you and your healthcare provider to review and discuss age-appropriate screening, diagnostic testing, and immunizations. Depending on your personal and family history, some screening tests may vary.
I feel fine. Why should I have a wellness visit if I’m healthy?
It is wonderful if you feel that you are in good health, and our goal is to keep you that way! Unfortunately, as we age, many health problems are silent, they creep up on us subtly, and often by the time symptoms are present, long-term damage may have already been done. Having a Wellness Visit on a yearly basis, keeping current on recommended screening tests, and getting recommended immunizations are a great way to maintain your health, and to detect and manage any developing health problems as early as possible.
Does my Insurance cover the visit?
Many health plans cover Wellness Visits at no additional cost, and some health plans or employers even offer incentives to participants who get their yearly Wellness Visits.
If your health plan is through Medicare, some information about what you may expect at an Annual Wellness Visit can be found here:
What is not covered in a wellness visit?
A Wellness Visit is different from a problem-based or “sick” visit where you see your healthcare provider regarding a new or ongoing health problem. Wellness Visits are scheduled in a manner that allows preventative/screening health items to be reviewed, but may not allow for additional concerns. If you arrive at a Wellness Visit, but determine that you have a more urgent health concern, your Wellness Visit may be postponed to allow for evaluation of such a concern. If, during your Wellness Visit, it is determined that a health problem needs further investigation, associated diagnostic care may be billed to your health plan.
If you haven’t had your wellness visit in the last year, give us a call and we will get you scheduled. If you aren’t sure if you have or not- it’s always a good idea to call your insurance carrier and double check with them (as they only cover one per rolling (or calendar) year.
As always, thank you for partnering with us for your good health!