health benefits

A Retirement Journey: Health Insurance Issues

Billie S. Dickenson July 30, 2022

Over the past two weeks, we’ve focused on the story of Bob, a recent retiree. We’ve gone over his pre-retirement experience and his journey through the processing of his retirement application. This week, we’ll look at his health insurance choices.

Bob has an ongoing dilemma when it comes to health insurance. He arguably doesn’t really need Federal Employees Health Benefits coverage or Medicare, because he is a veteran with a service-connected disability. That means all of his medical needs (service-connected and otherwise) are provided by the Veterans Health Administration, at no charge. VHA does bill private insurers (including those in FEHB) for the non-service connected care it provides.

Nevertheless, Bob enrolled in FEHB during his civilian service at the Federal Aviation Administration for a couple of reasons: in case he should need it for a future spouse, should he remarry, and in order to meet the requirement of being enrolled for the five years prior to retiring. Now that he’s retired, if he cancels his FEHB coverage, it’s a one-way ticket out. Bob isn’t eligible to suspend his FEHB, since having VA health benefits is not one of the reasons an enrollee can take this action. And he isn’t eligible for TRICARE because he isn’t retired from military service. 

Since Bob is over 65, he is enrolled in Medicare Part A. But he chose not to enroll in Part B (coverage for doctors and outpatient services). This won’t put him at great risk, because FEHB doesn’t require Medicare enrollment to maintain coverage. Bob has considered dropping FEHB, but he believes it’s possible Congress may not provide enough funding in future years for the VA to care for all veterans. Veterans who are in one of the lower priority groups could conceivably lose health care benefits in the future.

Bob could enroll in Part B later in a future general enrollment period. These are held each year from Jan. 1 to March 31, with coverage effective July 1. But he might be subject to  a late enrollment penalty for every 12-month period in which he could have been enrolled but chose not to. Currently, Bob has the opportunity to participate in a Part B special enrollment period,during which he can enroll without penalty. It will end eight months after his retirement last December. 

Here’s Bob on his insurance decisions: 

I enrolled in FEHB with the GEHA Standard Option FEHB plan when I onboarded in 2012, but switched to the GEHA High Deductible Health Plan about four years ago. My current premium is $136.95 per month. The HDHP includes a Health Reimbursement Arrangement, since I am not eligible to have a Health Savings Account. Having other health insurance, such as Medicare, disqualifies members from using the HSA, so GEHA establishes an HRA that does not earn interest and is not portable if I switch to another plan. But it does provide $900 annually to spend on co-pays for qualified medical expenses, as defined by the IRS.

The way I see it, having this extra $900 a year benefit effectively reduces my monthly premium. The way it works is when the VA sends the bill for my care to GEHA, GEHA pays the amount that would be covered by the plan. The remainder is covered by the VA, leaving me with $0 out of pocket expense for my care. I don’t have to worry about meeting the deductible or paying copayments since the VA covers my medical expenses.

Upon reaching my 65th birthday, I enrolled in Medicare Part A, since there is no premium for this coverage that helps cover the cost of in-patient hospitalization. Post-retirement, I am continuing my FEHB plan with GEHA but not Medicare Part B. Still, I question whether I really need it, when all of my medical care is free at the VHA. Veterans make up 30 percent of the federal workforce. And some of those veterans, like me, have service-connected disabilities and access to free medical care through the VHA. I also know retired veterans who thought that TRICARE for Life was free, until I told them that they had to enroll in Medicare Part B as well. With very few exceptions, all of my VHA visits are non-service-connected.

Bob’s Bottom Line

Bob’s top piece of retirement planning advice is not to be afraid to ask questions. He told me the people he spoke with at various federal agencies actually seemed to enjoy helping with whatever questions he had. Keep in mind that Bob communicates very clearly and takes his time. Customer service is a two-way street.

Of course, when it comes to retirement preparation, everyone needs to run the numbers. Make some rough financial projections, so you have a general idea of your income and expenses in retirement.

Bob has about half of his retirement income coming from his Social Security benefit, a little less than 20% from his federal retirement benefit, about 30% from a private sector pension that does not receive a cost of living adjustment, and roughly 3% coming from the VA. He doesn’t need to withdraw from his investments yet.

Overall, Bob is in very solid financial shape, due to his foresight, patience and planning.

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N.J. public workers face big increase in health insurance rates in coming year

Billie S. Dickenson July 25, 2022

Hundreds of thousands of public workers, early retireesm and school employees in New Jersey are facing potential rate increases of as much as 24% for health benefits under proposals being considered by the State Health Benefits Commission.

Rate increases being considered include a 24% increase for medical and a 3.7% increase for pharmacy benefits for active public workers, as well as a 15.6% increase in medical and a 26.1% increase in pharmacy benefits for public workers who retired before the age of 65, according to an email sent to county administrators from New Jersey Association of Counties Executive Director John Donnadio.

Donnadio said in the email that the figures, which haven’t been made public, were shared by an insurance and benefits broker.

StateTreasury spokeswoman Jennifer Sciortino acknowledged rate increases were being considered and added that rates for active members and early retirees would likely increase between 12-20% across the various plans for the upcoming year.

A vote to approve the rate increases was scheduled for Monday, but the state health benefits board and the Division of Pension and Benefits postponed the vote after acknowledging during a public meeting on July 13 that more time would be needed to address questions and concerns, Sciortino said.

“As has been the official process for many years now, the presentation materials provided to the State Health Benefits Program and School Employees Health Benefits Program Commissions last week are confidential until the rates are finalized,” Sciortino said.

The New Jersey League of Municipalities on Wednesday sent an email urging members to contact their representatives and the governor’s office, prompting a public outcry from state and local governments, as well as Democratic and Republican state lawmakers.

“This is a staggering increase that will saddle taxpayers, public sector workers and educators with higher costs at a time when we are all contending with inflationary pressures and a possible recession,” state Senate President Nicholas Scutari, D-Union; Senate Majority Leader Teresa Ruiz, D-Essex and Senate Budget Chairman Paul Sarlo, D-Bergen, said in a joint statement.

The Democratic state senators urged the board to reject the proposal and called on New Jersey Treasurer Elizabeth Muoio to use her authority to block the planned approval “and make sure a full accounting of the finances of the two health benefits’ plans is made public and fully discussed.”

Republican leadership in the state Legislature on Thursday called for the creation of a special legislative committee to investigate Democratic Gov. Phil Murphy’s administration for a “failure to control health care costs for public employees, retirees and taxpayers.”

“The 24% premium increase proposed for most active employees will take thousands more out of their paychecks annually and lead to huge costs for local governments that will translate into higher property tax bills for struggling families,” state Senate Republican Leader Steven Oroho, R-Sussex, said in a statement. “We must investigate the failures that led to these catastrophic premium increases to develop an effective plan going forward.”

The proposed rate increases shine a new spotlight on allegations that the Murphy administration squashed an attempt to recover $34 million the state paid to Horizon for a cost savings program that outside consultants found “yielded no apparent savings,” according to a report from Bloomberg.

Horizon administers health care plans for state and local government employees and retirees in New Jersey.

“It’s absolutely scandalous that high-level administration officials would intercede to prevent Horizon from being held accountable as premiums are set to skyrocket,” Senate Republican Budget Officer Declan O’Scanlon, R-Monmouth, said in a statement. “Employees, retirees, and taxpayers deserve to know why.”

Sciortino said several “extraordinary factors” are affecting rates for the coming year, including higher utilization of medical services during the COVID-19 pandemic and a return to normal services and procedures that had been previously postponed.

Those factors are being compounded by rising prices amid historic inflationary pressures that have increased health care costs nationwide.

“While there is significant volatility in health care trends, the rate increases for the State plans are in line with rate increases that our consultants’ other clients are experiencing and are also being reported nationwide,” Sciortino said. “We believe that these circumstances are an anomaly, rather than the norm, and we believe that it is more likely than not that utilization and costs will normalize.”

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Derek Hall may be reached at [email protected]. Follow him on Twitter @dereknhall.

The pros and cons of being a ‘weekend workout warrior’

Billie S. Dickenson July 19, 2022

A you a weekend workout warrior? Or do you prefer to spread your sessions out across the week?

Well, according to a new study it could be the type and total amount of exercise that counts, rather than the actual number of sessions, which is good news for people who struggle to find the time to exercise.

The research, published in JAMA Internal Medicine journal, involved 350,000 participants and did not find any significant difference in mortality rates between weekend sweaters compared to regularly active participants.

So what does that mean for your workout schedule?

READ MORE: Woman responds to job rejection with meme and lands an interview

The study is good news for the people who struggle to find time to exercise throughout the week. (Supplied)

Results indicated that adults who perform the recommended amount of physical activity per week may experience similar health benefits whether the sessions are spread throughout the week or concentrated in a weekend.

The current recommendations for adults aged 18-64 is a weekly total of two and a half to five hours of moderate activity, or one hour and 15 mins to two and a half hours of vigorous activity, or an equivalent combination of both.

"This large study suggests that, when it comes to exercise, it doesn't matter when you do it," cardiac nurse Joanne Whitmore told the BBC.

"The most important thing is that physical activity is undertaken in the first place."

Ben Lucas, Director of Flow Athletic, agrees, telling 9Honey: "It's true that some exercise is better than no exercise, especially in terms of health markers. If all you can fit in is a workout on the weekend, then absolutely, do what you can. Something is better than nothing."

Less might not always be more

Now this might be music to your ears if you consider yourself relatively time-poor. But while working out only on weekends might be enough to keep you fit, it might not be the ideal way to go for a variety of other reasons.

READ MORE: 12 health mistakes to avoid making this winter

There are more health benefits to spreading your sessions out throughout the week. (Getty)

READ MORE: How often do you have to hit the gym to build muscle?

According to the Department of Health, while there is a weekly target for physical activity, recommendations do state that ideally a person should "be active on most (preferably all) days".

"The con [of only working out on weekends] is that to make that exercise worthwhile you will need to train strenuously, for example HIIT training, heavy weight training, and you need to commit," Lucas tells us. "If you are only training two days a week, you need to stick to it and make sure it happens."

Lucas says spreading your sessions out is better for consistency and balance, and you could also put yourself at more risk of injury, if you are relatively sedentary for most of the week, before putting your body through extended sessions on just one or two days.

"The guidelines say that we should train for 150 minutes per week, that comes to 75 minutes per workout. That's a very long time to train for someone who isn't as fit and it can lead to injury to train at intensity for that long," he warns.

He recommends aiming for three or more workouts a week, or 30 minutes a day, even if it's a brisk walk.

"Especially if you are desk bound and if you are not doing much incidental exercise it is important to move for you overall health. It's good for your mood, mind, digestion, weight management and being consistent will give you better results than being more sporadic," he adds.

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Group Health Plans and Abortion: Implications of Supreme Court Decision | Baker Donelson

Billie S. Dickenson July 7, 2022

In the wake of the Supreme Court's ruling in Dobbs v. Jackson Women's Health, employers are questioning what impact, if any, this decision will have on their group health plans. In the Dobbs decision, the Supreme Court reversed 50 years of precedent by ruling that the Constitution does not provide for a right to abortion and therefore that states have the Constitutional right to legislate abortion. How, then, does this ruling impact employer-sponsored group health plans? In this alert we address four items of immediate concern and expect to supplement this analysis as this drastic change in the law develops.

1. Must a Group Health Plan Provide Coverage for Abortions?

There are no federal laws or regulations that require an employer-sponsored group health plan to provide coverage for elective abortions. The Patient Protection and Affordable Care Act of 2010, as amended (ACA), set forth standards that require coverage of "essential health benefits" for fully insured non-grandfathered plans. In addition, the ACA eliminated annual and lifetime dollar limits on such essential health benefits for all group health plans, including self-insured plans. At present, elective abortions would not be deemed essential health benefits. The determination of which medical expenses are and aren't "essential health benefits" is made by the U.S. Department of Health and Human Services, an administrative agency under the Executive Branch, and such guidance could change the definition to include elective abortion. In such event, the only employer-sponsored group health plans that would be subject to the change are those that are both non-grandfathered and fully insured.

2. May Group Health Plans Still Provide Coverage for Abortions, Even in States Where Banned?

Upon first impression, it appears that the broad preemptive provisions of the Employee Retirement Income Security Act of 1974, as amended (ERISA), should allow for group health plans to continue to provide coverage for abortions, whether elective or necessary, regardless of any state law prohibiting the procedure. ERISA is the federal statute that attempts to set uniform standards for the laws governing employer-sponsored benefit plans and applies to all employer-sponsored benefit plans, except those sponsored by non-electing churches and federal, state, and local governments. ERISA contains broad language that preempts "any and all state laws" that "relate to" an employee benefit plan, with the exception of the states' right to regulate insurance. Thus, if an employer group health plan provides coverage for abortion, then the plan should not be affected even though some states in which the employer has employees may ban abortion procedures.

3. Can Group Health Plans Provide Coverage for the Travel Expenses to a State Where Abortion is Legal?

To the extent that travel expenses are allowable under the Internal Revenue Code, then a group health plan (or health reimbursement account) should be able to provide this coverage. Many group health plans provide reimbursement for eligible travel expenses for participants who must obtain medical care outside their geographic home. However, the tax treatment of those benefits turns on whether the amounts are treated as exempt from tax under Section 213 of the Internal Revenue Code of 1986, as amended (Code).

Code Section 213(d) excludes from taxable income amounts reimbursed for expenses for medical care of an individual, the individual's spouse, or a dependent under a policy of insurance or group health plan. This exclusion defines "medical care" as amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body. 

Under current applicable law, a group health plan that reimburses or directly pays the "travel expenses" for "medical care" should be exempt from the taxpayer's taxable income and otherwise deductible by the employer (if self-insured). A fully insured health plan is subject to the terms and conditions of the insurance policy, so employers with this type of health plan could provide a self-insured rider or adopt a health reimbursement arrangement (HRA) to that policy to pay for travel expenses for women to obtain abortions if abortions are not available in their town of residence.

In general, to qualify as a medical expense:

i. The travel expenses must be essential to the medical care – presumably essential if no legal abortion is available in the taxpayer's geographic area, which is usually 35-50 miles for most IRS purposes; and

ii. Travel expenses must be limited to:

a. Transportation costs. The Code defines transportation expenses to include the cost of traveling by bus, air, taxi and/or train, as well as the cost of gas and oil if driving by car. Additionally, if a guardian, caretaker or medical provider is required to travel with the individual to obtain the medical care, those costs associated with the person accompanying the individual seeking medical care are also considered eligible expenses. Costs of car insurance, car maintenance and/or car repair expenses are not eligible medical expenses. The current mileage reimbursement rate is $0.18/mile (for 2022) for medical expenses. However, the taxpayer can use actual expenses (gas receipts); 

b. Lodging of up to $50/night; and

c. Meals only if provided by the medical provider.

4. Are Employers at Risk of Liability for Violation of a State's Aid and Abet Law that Creates Liability for Those That Assist a Woman in Obtaining an Abortion?

At this time, the answer to that question is unknown. This is an issue ripe for debate and litigation. While ERISA's preemption provisions are broad and theoretically should protect the plan and the employer from a state's attempt to impose liability on those who assist a woman in obtaining an abortion, there is no certainty on how such a dispute would be resolved in the courts. Further, there are concerns regarding a state's ability to obtain through subpoena information regarding those obtaining abortions out of state. While group health plans are "covered entities" for purposes of the Privacy Rule under the Health Insurance Portability and Accountability Act of 1996, as amended (HIPAA), employers are not covered entities. Thus, employers would be wise to make certain that they receive no individually identifiable health information about their employees so that they will not have knowledge of which participants are receiving abortion-related benefits under the group health plan.

Obviously, this is an issue that presents a great deal of political debate. Our alert is intended to advise employers on their legal options with respect to their group health plans. These issues will continue to develop for the foreseeable future, and Baker Donelson will provide updates and commentary as appropriate. 

Nutritional Facts About Artichokes

Billie S. Dickenson July 6, 2022

Artichokes contain a lot of instant nutritional perks as well as potential long-term health benefits. They’re also extremely versatile when it comes to cooking options.

Plenty of folks have never thought to eat an artichoke, mostly because it has kind of a strange look and an even stranger name. Fair.

Well, to ensure you’re not missing out, we’re intro’ing this little green goodie with everything you need to know about its nutritional value and how it translates to health boosts for your body.

You might’ve seen artichokes referred to as globe artichokes, French artichokes, or green artichokes. You might’ve also seen them being called vegetables, but they’re actually a type of thistle, which has been around for thousands of years.

An artichoke is a bulb made up of its thorny outer leaves, feathery choke, and fleshy heart. The heart is at the base of the bulb and this is what you’ll be wanting. The leaves are inedible, as is the choke unless you’re using a baby artichoke.

Eaten raw, artichokes taste slightly bitter, similar to asparagus or celeriac. When cooked (more on that later), the bitterness gives way to a milder taste that’s not unlike boiled potatoes.

They’re tasty and easy to find at the store, but are artichokes good for you? In short: yes! They pack a serious nutritional punch whether eaten raw or boiled up:

That’s a mighty little thistle, once we compare some of these values to your recommended daily intake (RDI) of certain nutrients. Artichokes contain:

  • 25% (raw) or 15% (boiled) of your Vitamin C DV
  • 24% (raw) or 22% (boiled) of Vitamin K DV
  • 22% (raw) or 27% (boiled) of folate DV
  • 19% (raw) or 13% (boiled) of magnesium DV
  • 12% (raw) or 9% (boiled) of phosphorus DV
  • 14% (raw) or 10% (boiled) of potassium DV

The healthy nutrient profile of an artichoke translates to a number of health benefits. For example…

Artichokes contain a boatload of antioxidants

Antioxidants protect against a huge range of health conditions by helping your body get rid of the toxic byproducts of processing oxygen. Artichokes are a potent source of antioxidants, meaning they could play an active role against:

  • Heart disease
  • Some cancers
  • Lung disease
  • Age-related eye disease

Artichokes can tell good cholesterol from bad

We’re reasonably sure that artichoke leaf extract plays a role in keeping cholesterol low – essential for your heart and your health in general. Better still, evidence suggests that the extract can balance the ‘good’ (HDL) cholesterol and the ‘bad’ (LDL) type.

Get used to artichoke leaf extract. This is what most studies use when they examine the health benefits of artichokes. It’s a concentrated version, usually sold in pill form. Very little formal research has been done on the plant itself, but we can reasonably assume its health effects will be similar to the extract.

You may be able to regulate your blood pressure with an artichoke

Studies on animals and test tube-bound cells suggest that artichokes might help keep your blood pressure steady. We know they’re a solid source of potassium, which regulates the blood. Some research also hints that leaf extract helps your body produce eNOS, an enzyme which keeps blood vessels wide enough to facilitate a healthy flow of the red stuff.

Your liver could get a boost from artichokes

Recent studies indicate that artichoke leaf extract might be good for helping your liver function. It helps repair damage done to the liver, speeding up the rate at which tissue grows back. It also increases the rate at which you produce bile, helping flush toxins out of the liver.

As with most of these benefits, we need more research before we can say for sure how they work. At our current best guess, it’s the antioxidants silymarin and cynarin that are to thank.

Artichokes might be great for digestion and IBS

Because they’re so rich in fiber, artichokes help keep things moving along nicely as far as your digestion is concerned. In particular, a type of fiber called inulin is present in artichokes. This is especially good for promoting healthy digestion.

If you have irritable bowel syndrome (IBS), inulin appears to be good for regulating gut bacteria and easing the spasms that sometimes come with the condition. Overall, the existing evidence is looking good for artichokes and your digestive system.

You can keep blood sugar low with an artichoke (maybe)

Studies have hinted that artichoke leaf extract might play a role in lowering your blood sugar levels. However, what little research in this area we have tends to mix the extract with other plants. Other studies have taken place on rats, but not humans.

The strongest evidence we have suggests that the specific enzyme which turns starch into glucose (called alpha-glucosidase) might be the key. However, we need to know more before we can say how artichokes interact with that enzyme.

Artichokes (might) fight cancer cells

The high antioxidant content packed into artichokes gives it a healthy start as a cancer-buster. More detailed studies have suggested that the leaf extract might slow the growth of cancer cells. Others indicate that the extract could have potential in other cancer therapies.

But, it’s still very early days for this research. Most studies have been done either on rats or cells contained in test tubes. We need to know more about how exactly the extract affects cancer cells in actual humans.

Artichokes are a very flexible food. You can get artichokes at pretty much any grocery store, but not all are created equal. To pick a nice ripe artichoke, look for:

  • Weight. A heavier artichoke means it’s still retaining plenty of moisture, meaning it’s closer to peak ripeness.
  • Sound. The leaves of a healthy artichoke should squeak against each other if you squeeze it. No squeak means dried-out leaves.
  • Form. A perfect artichoke’s leaves will be opened only slightly, without too much separation. If the leaves are opened up too much, it could be too old.

Finally, you might find an artichoke whose leaves are peeling a bit. These have been hit with a touch of frost, but they’re still perfectly fine to eat. In fact, some people insist that frost-kissed artichokes are even tastier.

Artichokes can be grilled, braised, or baked. Two of the most common (also quickest and easiest) ways to prepare an artichoke, however, are steaming and boiling. In either case, you’ll need to prepare it for cooking.

To do this:

  1. Use a sharp pair of scissors to snip the thorny tips off the outer leaves
  2. Cut off the tip of the artichoke (about an inch down) using a sharp knife
  3. Pull off the small, looser leaves around the base and stem
  4. Slice off any excess stem so you’ve only got about an inch sticking out of the artichoke’s base
  5. Rinse your artichoke, making sure the water gets in between the leaves

To steam your artichoke (one per person):

  1. Toss a clove of garlic (cut into two halves), a bay leaf and a slice of lemon into two inches of water
  2. Put a steaming basket on top of the pot and boil the water
  3. Place your artichokes into the steaming basket
  4. Steam for 25-35 minutes until the outer leaves can easily be pulled off

If you prefer to boil your artichokes, do so in lightly salted water for 20-30 minutes. As with steaming, you’ll know it’s time to eat when the leaves are easy to peel off.

Once the heart is cooked, you can use it in:

Artichoke allergies are extremely rare, most people are at no risk from eating a cooked or raw artichoke. You may be at higher risk if you’re also allergic to other plants of the aster family (like daisies, thistles, sunflowers and kiwis).

Artichoke extract is more concentrated. It’s recommended that pregnant or breastfeeding women avoid the extract, but we don’t have enough data yet to say whether or not it’s safe.

Because artichoke leaf extract helps increase bile movement, you should probably avoid it if you have bile duct obstruction or gallstones.

Folk have been eating artichokes since the days of old, but we still need more research to know exactly how these delicious thistles really benefit our bodies. That gives them an air of mystery, but don’t feel put off trying them.

Their versatility and unique flavor might just make them your new best culinary buddy!

Coconut milk: nutrition facts and health benefits

Billie S. Dickenson June 25, 2022

Due to its distinctive flavor and creamy texture, coconut milk can add a nice twist to coffees, protein shakes and desserts. Although it’s nowhere near as popular as other plant-based milk alternatives in the US, it retains a loyal fan base.But how nutritious is this drink? And can it bring about any tangible health benefits? 

Coconuts are well-known for their high saturated fat content. For decades, this nutrient has been linked to the obesity epidemic and a host of chronic diseases. However, recent years have seen a steep increase in studies (opens in new tab) challenging these findings, and even contradicting them. 

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