Health Insurance Blog and Resources

Updated Septeber 10, 2021. Medicare Open Enrollment is a valuable opportunity to re-evaluate your Medicare plan, review Medicare options, and even find a better plan. The Annual Enrollment Period for coverage during 2022 runs October 15th through December 7th. Preparing for Annual Enrollment can help you take full advantage of this opportunity to make sure that your Medicare plans meet your needs. Here are three things you can do to be ready for this year’s Annual Enrollment Period: Analyze this year’s health costs Do your research Set an appointment with an agent Analyze this year’s health costs “People should prepare for Medicare Annual Enrollment by reviewing their health care utilization this past year and thinking about anticipated utilization and needs for the coming year,” advises Gayle Byck, PhD, Board Certified Patient Advocate, Certified Senior Advisor®, and founder of InTune Health Advocates, LLC. Understanding what you spent on health care this year can help you project costs for next year. As you think about how much your health plan costs, be sure to include the monthly premiums and all out-of-pocket expenses. Out-of-pocket expenses are the costs you paid for prescriptions, doctor visits, and treatment. While you’re evaluating this year’s costs, it’s important to consider how well your current plan met your coverage needs. While it can be less work to stay on the same plan, it’s not worth staying if there are cheaper options that offer better coverage. Byck recommends considering this question as you evaluate your current plan: Does your current plan (A, B, Supplement, and D, or Medicare Advantage) continue to meet your needs and make the most financial sense? As you evaluate the total cost of your plan and other health plans you are considering, include the monthly premiums and all out-of-pocket expenses. It’s important to do this in-depth analysis, especially if you’re considering switching between Original Medicare and a Medicare Advantage plan. While this kind of evaluation can be tedious and time-consuming, it’s worth it. If you’re living on retirement savings, you only have a certain amount that you can spend. It’s important to find the most cost-effective plan with the coverage you need to make your retirement savings last as long as possible. Do your research Medicare Advantage and Medicare Part D (Prescription Drug Plans) change every year. Additionally, companies offer new plans. There are a couple of important things to research about your current plan and for any new plan you consider: Changes New plans Coverage Cost saving resources Changes Make sure you know how your plans are changing by doing your own research. There are several great resources to help you understand how your current plans are changing, like Medicare.gov and Annual Notice of Change (ANOC) letters. Medicare.gov Troy Baccus, Medicare Life Group owner, suggests using Medicare.gov reports to check for changes in your Prescrption Drug Plan (PDP): “The best thing you can do to prepare for AEP is run a new prescription drug plan report on Medicare.gov. You'll want to wait until at least October 1 to run the report and make sure you are running the report for the year 2022 (it may default to the current 2021). Running a prescription drug plan report will help you confirm your current plan is still your best option for 2022. If not, you can usually enroll in the another plan directly from the Medicare.gov website.” Annual Notice Of Change Danielle K. Roberts, Boomer Benefits founder, suggests reading the Annual Notice of Change letter:“Review your Annual Notice of Change letter from your current Part D or Medicare Advantage carrier. You will receive this by mail in September. Look for what is changing that might affect you. Is the premium going up? Have your copays substantially increased? Are they dropping any of your important medications? If you find something you don’t like, then you have an opportunity to make a change during the upcoming OEP that begins on October 15th. Make a list of all your current medications, including dosage and frequency. You can enter these into the Plan Finder Tool on Medicare.gov website beginning in October. This will help you to search for plans that you know will cover your necessary medications.” New plans Because Medicare Advantage plans are privately operated by companies, companies can release new plans every year that can be a better option than your current plan. “New Medicare Advantage plans may be available in 2022 that provide superior coverage to your current plan. The easiest approach to review your Medicare Advantage plan is speaking with an independent agent. Just make sure they've got your best interest in mind and aren't looking to make a quick sale (we recommend checking out their Google reviews, if possible),” suggests Baccus. Coverage Coverage and access to your doctors are some of the most important things you need to double-check for your Medicare plans. To be clear, you can always see any doctor you like, but the cost-sharing available from your plan based on what plans your doctor accepts will affect how high your health care expenses are. “Reviewing your plan every AEP is important. Not only will you want to make sure your current plan will remain your best option for prescription coverage in 2022, but you'll also want to confirm your doctor will remain in network,” says Baccus. When checking your coverage, it’s a good idea to do your own research instead of relying on third-party information. “Please do not take a salesperson’s word for your network coverage, call your providers and ask – “will you be taking this specific plan next year?” Why specific? Because some companies have multiple plans, and your provider may not take them all. Going to medicare.gov is a safe recourse to get the facts,” recommends John Hill, President of Gateway Retirement. Cost saving resources Each state has federally funded programs to help people pay their Medicare premiums, typically for Original Medicare. If you qualify and apply, you may be eligible to participate in some of these Medicare Savings Programs. “During enrollment, be sure to look into the various savings programs available that can help pay for premiums, out-of-pocket costs, prescription costs and more. There are a number of services available and utilizing them can help you save money,” suggests Michael Stahl, HealthMarkets Executive Vice President and Chief Marketing Officer. Set an appointment with an agent If you’re new to Medicare or want help evaluating plans, meeting with an independent agent can be a smart move. “I always stress the importance of sitting down with a licensed, non-biased insurance agent who can provide information on Medicare, what is or is not covered, and pricing so you can be informed when it comes time to make decisions during enrollment and choosing your Medicare provider(s),” says Stahl. While experienced and knowledgeable agents can offer valuable insight and assistance with Medicare plans, it’s important to find a trustworthy one. “Seniors should find a solid broker with a consistent track record of providing value in the senior community and giving unbiased advice,” says Christopher Westfall, Sr, Senior Savings Network founder. Looking at client reviews and taking recommendations from friends can help you find a reliable agent. Beyond considering reviews, Medicare has rules regarding what insurance agents selling Medicare can and can't do when working with clients. Understanding these can help you identify good agents. Knowing that you’re getting good advice can be difficult to determine, especially if you’re not familiar with Medicare. If you want to be an informed decision-maker, it’s worthwhile to do your own research. “Do your own research rather than only relying on information from insurance agents. There are quality rating systems online and free resources from your state’s Senior Health Insurance Program,” advises Byck. Preparing for Medicare Annual Enrollment Understanding your health care expenses and coverage levels from this year will help you forecast costs for next year. It will also help you determine if it’s best to stick to your current plan or if another Medicare plan would be better. It’s also essential to be aware of any changes to current plans for next year. Knowing these changes will also help ensure that you enroll in the coverage you need in 2022. Working with a good agent can also help you understand your options and make an informed choice. Even working with an agent, do your own research so that you can ask these important questions and get the information you need to make the best choice for your health plan.

Guest Post by Danielle K. Roberts When your Medicare benefits begin, your Part B effective date kicks off a 6-month open enrollment window during which new Medicare beneficiaries can enroll in any Medigap plan with no health questions asked. However, once that window has passed, changing plans will require underwriting in most states. We often get asked about what this underwriting entails. Here’s what you need to know: It starts with your application Medigap applications come with a page of health questions which you must answer if you are not in your open enrollment period or a guaranteed issue period after rolling off employer insurance. In most instances, the insurance carrier wants you to be able to answer “no” to all the health questions. Some insurance companies won’t allow any “yes” answers at all and instruct the agent to automatically decline the application if the applicant answers yes to any questions. While chronic conditions like COPD or congestive heart failure will often cause an automatic decline, other things won’t necessarily be a problem. For instance, if you take a few routine medications, such as a blood pressure medication or a thyroid medication, these are often not a problem if they aren’t part of treating a larger health condition. On the flip side of that, just because you answer “no” to all of the health questions doesn’t mean you will be approved. This is just the first step that qualifies your entry into the underwriting process. Ultimately, the underwriter at the insurance company will decide whether to approve you after reviewing your application and medical records they can find. Medical questions vary by company, so if you can’t pass one carrier’s health questions, your agent may know of another carrier that has different questions. He or she may suggest that you apply there instead to give you the best chance of being approved. You can find some examples of underwriting questions here. Apply after any pending medical appointments When applying for a Medigap plan, you should do so after you have completed any pending medical procedures, surgeries, or follow-ups. Something as small as one last pending physical therapy session after a surgery that occurred months ago can cause a decline. If you have any kind of medical follow-up appointment on your calendar, get that done first and then apply for your Medigap plan afterward. Your prescriptions matter Underwriters have access to systems that will pull up records of any prescriptions that you have been prescribed over the last several years. For this reason, it is very important to be honest on your application and list all of the medications that you are taking or have taken recently (if the application asks for that). Medigap insurance companies also publish Underwriting Guidelines for agents that list all of the medications that will cause an automatic decline. Certain medications indicate that you have an underlying health condition, so if you take one of these medications, you are not eligible for coverage. Important tip: The underwriter can usually find records of any medication that has been prescribed to you even if you no longer take the medication. Often, we see problems occur when a client goes into their doctor about an issue, and the doctor prescribes a medication. The client thinks “I don’t need that,” and they never take the medication. Just because you choose not to fill the prescription doesn’t mean it’s not in your records. For example, if you mention feeling a bit foggy to your doctor and he prescribes Namenda for memory loss, you will run into a problem. This drug is associated with Alzheimer’s disease and dementia and will cause an automatic decline in most instances. If your doctor talks to you about a medication that you think you don’t need, tell the doctor NOT to prescribe it. This will help to prevent it from getting on your prescription history. Don’t overshare When the underwriter calls you to ask health questions, don’t share anything more than what they ask. Give yes or no answers whenever possible. When you volunteer information, that can sometimes lead you down a rabbit hole that you don’t want to go into. Sometimes applicants want to share that they have recently lost a bunch of weight or they were able to drop all their diabetes medications. While you may view this as positive, underwriters are sometimes wary of recent changes like this as they want you to have had enough time to stabilize on those medications. Going into any application knowing these things about the underwriting process should help both you and your agent to decide whether it makes sense to try applying with a new Medigap company. Danielle K. Roberts is a Medicare insurance expert and co-founder at Boomer Benefits where she and her team help thousands of beneficiaries navigate their Medicare decisions every year.

Health insurance is an important way to get the health care you need while protecting your finances from large medical costs. It's also important to find a health plan that fits into your budget from a trustworthy insurer. However, not all health plans are equally beneficial. So, how do you know if you have a good plan? There are four essential things to look at when evaluating your health insurance options: Coverage Health services costs Prescription costs Premiums Analyzing these four aspects will help you understand how good your health plan is and its overall affordability. Coverage The most essential part of your health plan is what it covers. If there are medical services or prescriptions that you know you will need, check to make sure that the health plans you’re looking at covers those. Health insurance plans on the Health Insurance Marketplace (on-exchange plans) cover the Essential Benefits outlined in the Affordable Care Act. Off-exchange plans offered by private insurers also meet these guidelines. Essential benefits include preventive care services like your annual physical, certain prescriptions and vaccinations, and care for pregnant women, children, and infants. Plans that are not compliant with the Affordable Care Act may not cover all of the essential health benefits. These include short term health plans and indemnity plans. It’s especially important to carefully review the coverage on these plans before choosing one. Some plans may also cover medical devices like crutches and blood sugar monitors. Coverage rules can vary by plan, so check your plan to learn more about what's covered.  Coverage also goes beyond covered services and medical devices. It includes the network of doctors and specialists included with your health plan. If you already have doctors that you like or prescriptions you require, it’s worth checking to make sure they would be covered under any new plan you’d choose. When it comes to networks, some plans only offer in-network coverage. Other plans offer in- and out-of-network coverage, though the cost-sharing rules may put a higher burden on policyholders for out-of-network services. Emergency services are always covered, regardless of where they were received. Keep in mind that health insurance companies have negotiated discounted rates with in-network providers, which makes visiting those providers cheaper for them. Since they do not have discounted rates from out-of-network providers, it's more expensive for the company when you receive out-of-network care. The company passes some of this expense on to you by charging higher rates in these cases. Questions to ask yourself What health services do my family and I need? Are there procedures or surgeries that my family and I will need in the next year? What medications, medical devices, and prescriptions do my family and I need? Know the answers to these questions before shopping for health insurance. This will help you quickly eliminate plans that won’t meet your health needs. Health services costs Many people assume that the monthly premiums reflect the full cost of the insurance plan. While premiums are the most frequently occurring cost for a health plan, the full cost also includes the cost-sharing burden on the policyholder. Each health insurance plan has its own cost-sharing rules, so be sure to look at how much the health insurance plan covers for different medical services. This will be listed in your plan’s Schedule of Benefits. Depending on your plan’s cost-sharing rules, you may be responsible for a portion of the cost of the medical services you receive. This is in addition to the monthly premiums. Fortunately, there are annual caps on how much you’ll have to pay for cost-sharing expenses. These are called the deductible and out-of-pocket limits. The deductible is the amount you must pay for your health expenses yourself before the insurance company will start paying some of the costs. Don’t worry — many health plans cover preventive services fully, at no cost to you. Health insurance also gives you access to discounted, negotiated rates from health care providers in your plan’s network. These discounted rates are advantageous, even when additional coverage and cost-sharing is delayed. The out-of-pocket maximum is the total amount you’d have to pay for health care costs for the year. Once it’s met, your insurance company will pay fully for covered services, other than your monthly premium. The deductible is often lower than the out-of-pocket max for this reason. Copays and coinsurance count towards your deductible and out-of-pocket maximum. Look at how high the deductible and out-of-pocket limits are for each health plan you consider. Compare the deductible and out-of-pocket limits across plans. It can also be useful to look at differences in copays and coinsurance. Copays are a set amount that you pay when you receive medical services. Coinsurance is a set percentage of the cost of services that the policyholder is responsible for. Coinsurance can be trickier to estimate because it depends on the negotiated price the insurance company has with the doctor. Questions to ask yourself What would the health services my family and I need cost under each health plan? (General information about these costs is available in each plan’s Schedule of Benefits. For specific pricing and cost information for your current providers, you can contact the insurance company directly.) Which plan has the best cost-sharing for specialist visits and urgent care clinics? Which plan has the best overall cost-sharing for the health services my family and I need? Prescription costs The cost sharing methods for prescriptions varies based on what tier the prescription falls under. Depending on the plan, you’ll either pay copays or coinsurance on prescriptions. Some health insurance plans may have different deductibles and out-of-pocket limits for medications than for other health services. Once these are met, the insurance kicks in at a higher level. Questions to ask yourself What tiers are my family’s and my prescriptions in? What would the regular prescriptions that my family and I need cost? (General information about these costs is also available in each plan’s Schedule of Benefits. For specific pricing and cost information for your current providers, you can contact the insurance company directly.) Premiums While the monthly premiums do not reflect the full cost of a health plan, they still contribute to the total cost of the plan and you need to make sure that they fit into your monthly budget. Look at a few health plans to get a better sense of what current premium rates are in your area. You can also check to see if you qualify for a government subsidy that can make premiums for an on-exchange plan more affordable for you. Questions to ask yourself What is the most I want to spend on health care next year? (Take the overall cost into account.) What is the most I can comfortably spend on premiums? What would I ideally spend on premiums? Answering these questions will help you narrow down your options further and choose the most affordable plan for your situation. Affordable health care Fully evaluating your health insurance plan before enrolling will help you make an informed decision. Understanding the details of each health plan will help you find one that covers the medical services you need. Looking at the deductible, out-of-pocket max, and cost-sharing amounts will give you a sense of what you’ll spend on medical care and medications in addition to the monthly premium. Working with the insurance company to get pricing on what different medical services and prescriptions would cost with a certain policy will help you understand the total cost of the plan in more detail. Analyzing your budget, premium rates, cost-sharing expenses, and coverage are key to finding affordable health care. Oscar Health Insurance and "GAUZE: Unraveling Global Healthcare" executive producer and director Suzanne Garber consulted on this article. Need more health insurance enrollment tips? 4 Ways to Prepare for Open Enrollment Pitfalls to Avoid During Open Enrollment 5 Questions to Ask About Special Enrollment Periods

Medicare is how many U.S. citizens over 65 receive health insurance. Because Medicare works differently from employer-sponsored insurance and private insurance, it can take some time to orient yourself. Medicare offers hospital insurance, medical care insurance, and prescription drug insurance in three plans. For additional coverage or assistance paying for Medicare copayments and deductibles, people can purchase Medicare supplement insurance. This supplemental insurance is often referred to as Medigap. Before enrolling in a Medigap plan, you should understand the cost and benefits of these plans. Here are five essential questions to ask about Medigap: What is Medigap? What does Medigap cover? What is the best Medigap plan? How much do Medigap plans cost? When should I enroll in Medigap? What is Medigap? Medigap offers additional cost-sharing for out-of-pocket expenses incurred by Original Medicare (Parts A, B, and D). This additional cost-sharing is helpful because Original Medicare cost-sharing places a larger burden on policyholders than other private health plans. “What many people don’t realize before enrolling in Medicare is that Medicare is not free and Original Medicare only covers 80 percent of medical expenses – leaving you responsible for the remaining 20 percent of expenses. This form of supplemental coverage is additional insurance to help alleviate the financial burden of covering remaining costs that Medicare won’t cover. For example, Medigap plans are extremely beneficial when it comes to covering costs of chemotherapy and dialysis,” says Danielle K. Roberts, Medicare Supplement Accredited Adviser and Boomer Benefits Cofounder. The additional cost-sharing assistance is also beneficial when people need extensive medical care. “Medigap insurance covers medical expenses Medicare doesn’t cover such as co-pays and deductibles, as well as foreign travel emergencies. The main thing is a major healthcare hospitalization, illness, or injury where the costs are so high that even if Medicare is covering a majority of the costs, the fees are overwhelming. These are “gaps” in Medicare coverage. Admittance into long-term facilities such as nursing homes or hospice can be very large costs,” says Ted Chan of CareDash.com. The health coverage offered by some Medigap plans also include coverage for health services in foreign countries and is great for people who plan on traveling or living abroad during retirement. Do you need Medigap if you have Medicare Advantage? For people with Medicare Advantage plans, Medigap is not available. Medicare Advantage plans work like employer group plans, so they vary company to company and can offer more comprehensive coverage. Expert insight Troy Baccus, Medicare Life Group Owner“The first decision with regard to Medigap is deciding between a Medigap plan and a Medicare Advantage plan. A Medicare Advantage plan will be similar to most employer plans, meaning it'll be an HMO or PPO with co-pays and deductibles. A Medigap plan, on the other hand, has no networks and will work at any hospital that accepts Medicare. For those who decide to go the Medigap route, we recommend choosing a Medigap plan after becoming familiar with the deductibles within each of the plans.” Kumar B. Goel, Lighted Road Insurance President and CEO“Traditional Medicare does not cover everything. For example, it does not cover outpatient prescription drugs or provide dental, vision or hearing benefits (exceptions apply). Medigap Plans do not cover these benefits either. If you are looking for a plan with additional benefits like these, Medicare Advantage may be a better choice for you instead of Medigap.” Back to Question List What does Medigap cover? Medigap currently has 10 plan options: Plan A, Plan B, Plan C, Plan D, Plan F, Plan G, Plan K, Plan L, Plan M, and Plan N. The plans are mostly consistent nationwide. “Except for Massachusetts, Minnesota, or Wisconsin which have their own versions or variations of the plans, the plans offered are the same across states. Whatever the state, you should review carefully to see what suits your needs,” says Chan. All Medigap plans cover the following: Coinsurance and hospital costs (Medicare Part A) up to 365 days once Medicare benefits are used up Coinsurance or copayment (Medicare Part B) First 3 pints of blood Hospice care coinsurance or copayment (Medicare Part A) These benefits are covered fully by Plans A, B, C, D, F, G, and M. Plan K offers 50 percent coverage for Part B coinsurance or copayment, first three pints of blood, and Part A hospice care coinsurance or copayment. Plan L offers 75 percent coverage for those same three benefits. Plan N offers full coverage for all benefits with the exception of copays up to $20 for some office visits and $50 copay for emergency room visits when you’re not admitted to the hospital. All Medigap plans except Plan A offer coverage for the Part A deductible. Plans K and M cover Part A’s deductible at 50 percent. Plan L offers 75 percent coverage for this benefit. The other plans (B, C, D, F, N) cover Part A’s deductible fully. Only Medigap Plans C, D, F, G, M, and N offer coverage for health care during foreign travel. Only Plans C and F offer coverage for Medicare Part B deductible. Since new Medicare enrollees are not able to receive this coverage, Plans C and F are not available to new enrollees. Plans C and F offer full coverage for the Part B deductible. Only Plans F and G offer full coverage for Part B excess charges. An excess charge occurs in cases when a medical provider is allowed to charge more than the Medicare-approved amount. “Some states have rules that override Medicare to the benefit of the consumer. For example, Pennsylvania, Connecticut, Massachusetts, Minnesota, New York, Ohio, Rhode Island and Vermont forbid or restrict Medicare Part B Excess Charges,” says Matthew Claassen, CMT, CEO and Independent Broker of MedigapSeminars.org. Keep your state’s Medicare rules in mind as you choose a Medigap plan. Plans K and L have annual deductibles. None of the other plans have deductibles. People interested in Plan F can choose a Plan F High Deductible Plan option (HDHP) option. Medicare enrollees who choose this option will have an annual deductible. Plan F and C are not available to people enrolling in Medicare for the first time after 2019. See Medicare.gov for further information. Back to Question List What is the best Medigap Plan? The best Medigap plan depends on your circumstances and the kind of coverage you need. Working with a licensed life insurance agent can help you consider all the factors necessary to make an informed decision. Expert tips Danielle K. Roberts, Medicare Supplement Accredited Advisor and Boomer Benefits Cofounder“When deciding which Medigap plan is best for you (A, B, C, D, F, G, K, L, M, or N) you should keep in mind the premium, how often you’ll use your plan, and what kind of coverage you want in case you get diagnosed with a severe illness. Plan F, G, and N are the most popular. When you decide on which plan you want, the only thing you need to look for now is the best premium and average rate increases from each carrier in your area. Since a Medigap plan’s coverage doesn’t change from carrier to carrier, you should just worry about finding the lowest premium with the best average rate increases.” Andrew Vasta, NJ Medicare Brokers LLC Owner“When choosing which Medigap plan, people should consider on average how many times they go to the doctors and the difference in the premium between the plans. Many people choose between Plan G and Plan N. Plan G has no out of pocket costs after the deductible while Plan N has a lower monthly fee but $20 copayment every visit to the doctor.” Matthew Claassen, CMT, CEO and Independent Broker of MedigapSeminars.org“Because a person can apply for a Medicare supplement plan up to six months before it starts coverage, most seniors will start to receive an abundance of cold calls and mailers starting about 7-months before the month they turn 65. This can be overwhelming. Some people turn off their phones or get spam blockers. This is a major issue to people turning 65. Most of these cold callers are from call centers that don’t even employ full time permanent agents. They just cold call and sell. This is not where you are going to get your best advice or even accurate advice. Buyer beware.” Troy Baccus, Medicare Life Group Owner“Make sure to work with an experienced agent who is seasoned in the Medicare insurance industry. A good agent will have complete knowledge about enrollment windows, be able to provide accurate quotes, and ultimately provide a smooth on-boarding process while enrolling in Medigap.” Back to Question List How much do Medigap Plans cost? Several expenses factor into a health plan’s cost: monthly premiums and copays or coinsurance, depending on the policy’s terms. It’s important to consider all of these factors when considering the cost of a Medigap plan. Premium cost Medigap premiums are priced one of three ways: Same rate for everyone, regardless of age Rate based on age when enrolled in plan and remains consistent Rate based on age, but increases with age It’s a good idea to ask how the insurance companies you’re considering determine their rates. It can help you compare premiums for plans across companies. Expert insight Ted Chan, CareDash.com“Typical costs are $200 to $600 depending on the tier of plan. Since the plans are standard (the only difference is cost), it is recommended you shop around, with a focus on reliable providers who you are confident will cleanly service your plan. Reputable insurers offer the plans, and you should recognize the plan being sold (e.g. Aetna, Blue Cross). Don't let a broker push a plan on you.” Andrew Vasta, NJ Medicare Brokers LLC“Medigap policies are standardized so a Plan N with one company is the same exact coverage as a Plan N with another company; however, the monthly premium can be drastically different. Any time someone gets a rate increased they should shop the market to see if they can lower their costs.” Travis Price, Licensed Medicare Supplement Agent ifixmedicare.com“Another great Medigap tip would be to talk to an Independent Medigap Agent. The truth is, insurance companies move in and out of the Medigap market constantly. Furthermore, some companies do not sell direct to consumer and are much less expensive than companies like AARP (United Healthcare) and Blue Cross Blue Shield.” Total cost The total cost of a health plan includes the amount you spend on copayments and coinsurance. These cost-sharing expenses can be harder to estimate and can come up suddenly. Know the total cost of your Medicare Part A and Part B plans, and compare those costs with the Medigap plan’s premium rates. Expert insight Kumar B. Goel, Lighted Road Insurance President and CEO“Medigap Plans typically have higher premiums with minimal cost-sharing compared to Medicare Advantage Plans. This is to be expected since they help pay for Medicare cost-sharing. If you are bothered by deductibles, copays, and coinsurance and would rather pay a consolidated monthly premium, Medigap may be for you. But do the math before deciding.” Back to Question List When should I enroll in Medigap? For guaranteed acceptance, it’s best to enroll at the same time you enroll in Medicare Part B. While there are other circumstances that permit guaranteed issue outside of the window when you enroll in Medicare Part B, it can be a good idea to enroll during your Medigap first open enrollment period. If you delay enrolling, you’ll have to go through an approval process for underwriting. Underwriting is the process insurance companies use to determine the risk of insuring the applicant. It often involves a health questionnaire and can involve a medical exam. In some cases, coverage may be denied because of health circumstances. If you opt for a Medicare Advantage plan instead of Original Medicare, you’ll still be eligible for a guaranteed-issue Medigap open enrollment period. “There are a few other situations where guaranteed issue is applicable. One is if you are on Medicaid Advantage and move, or the Advantage plan stops offering services,” says Chan. There are some exceptions that allow guaranteed acceptance outside of the open enrollment period. “Some states like Connecticut and New York have perpetual Open Enrollment periods. A person can enroll in a Medicare supplement or switch supplements at any time without ever being asked a medical question. Other states have rules that provide an Annual Special Enrollment to switch Medicare supplement plans without underwriting,” says Claassen. Learn more about Medigap guaranteed issue rights. Expert tips Adam Hyers, Hyers and Associates, Inc“For most consumers, the time to get a Medigap (Medicare Supplement) policy is when they first enroll in Medicare Part B. That can happen at age 65, but many people defer their Medicare Part B enrollment because they have qualifying group insurance at work (more than 20 people.) Still, others enroll in Part B before age 65 due to disability. These folks especially want to explore their Medigap options at that time as it may be difficult to get a plan later.” Danielle K. Roberts, Medicare Supplement Accredited Advisor and Boomer Benefits Cofounder“The best time to enroll in a Medigap plan is during your one-time Medigap open enrollment period. This period begins the day your Part B is effective and ends 6 months later. This is considered the best time to enroll in Medigap plans because during this time you don’t have to answer any health questions and therefore, don’t have to worry about getting turned down for coverage. If you miss this time, you will likely have to answer health questions, and can be denied coverage due to preexisting conditions.” Ted Chan, CareDash.com“As a patient advocate, I recommend it enrolling during the Medigap open enrollment period for anyone who has the means and could be overwhelmed by a large, unexpected medical bill. Otherwise, you should reconsider your circumstances and whether Medigap makes sense every open enrollment period. However, getting it right away protects you against developing a pre-existing condition and being denied coverage.” Back to Question List In sum Understanding your Medigap coverage options and your current health situation will help you find a plan that meets your coverage needs. It's also important to keep possible future health concerns in mind as you pick your plan. Keep your financial situation in mind as you evaluate premium costs and the overall costs of a Medigap plan each year. This will help you make smart budget decisions about choosing Medigap coverage. Working with an independent Medicare agent can help you evaluate your options and understand the enrollment rules for Medigap and Medicare. Understanding these rules will help you make informed decisions about Medigap enrollment.

Updated January, 2020. In general, people can only enroll in a health insurance plan during Open Enrollment. Medicare also has its own Annual Enrollment Period and its Initial Enrollment Period varies depending on your birth date. However there are some exceptions, including Medicaid, CHIP, and qualifying for a Special Enrollment Period (SEP). If you qualify for a Special Enrollment Period, you have a certain amount of time to make changes to your health insurance plan or enroll in a new one to ensure that you maintain the health insurance coverage you need. Here are some of the most common questions regarding Special Enrollment Periods (SEPs): What is a Special Enrollment Period? What qualifies as a Special Enrollment Period? What are my health insurance options? How do I apply for a Special Enrollment Period? What is a Special Enrollment Period for Medicare? What is a Special Enrollment Period? Special Enrollment Periods (SEPs) let you make adjustments to your health insurance coverage or enroll in a new plan outside of Open Enrollment under certain circumstances. These circumstances are referred to as a Qualifying Life Event. Having missed Open Enrollment does not make you eligible to apply for a Special Enrollment Period. Special Enrollment Periods typically last 30-60 days, which allows plenty of time for you to look at your health coverage options and make the necessary insurance coverage adjustments. “Don't forget about deadlines, and keep in mind that they're different for employer-sponsored plans versus individual market plans. For employer-sponsored plans, you'll generally have 30 days, whereas in the individual market, you'll have 60 days (some qualifying events trigger a special enrollment period both before and after the event, whereas others are only after it),” says Louise Norris, licensed agent and author of Insider’s Guide to Obamacare’s Special Enrollment. Whether you receive health insurance from your employer or purchase your own separately, you may qualify for a Special Enrollment Period as your life changes. If you purchase health insurance independently, you can work with an insurance agent or use online tools that make it easy to explore all your options before you make a change. “Never buy from an agent who only has one product. You need someone who can shop around effectively and give you options. Never call the health insurance marketplace on your own without guidance from an agent. The customer service reps are not agents, and you may not understand the rules and regulations they have,” Maria Townsend, Insurance Advisor, says. HealthCare.gov shows all of the group health insurance plans created by the Affordable Care Act. After you complete a questionnaire, it will include any subsidies you qualify for in the listed premium quotes. If you don’t want to buy a Marketplace plan, you can view covered benefits and costs (monthly premiums, deductibles, out-of-pocket expenses, etc.) offered by multiple companies by looking at a comparison website. A few health insurance comparison websites are HealthMarkets, HealthCare.com, and GoHealth.It’s a good idea to be careful when shopping online. Some websites are designed to generate leads for health insurance providers and sell customer information to multiple insurance companies, instead of just connecting the customer to the company and plan they requested. If you can’t see price estimates and plan details before providing contact information, it may not be the best resource.Townsend says, “I would stay away from the insurance sites that sell off your info for a price comparison, and later get 100 calls from different reps. Those sites never check your medications or doctor network to even know if it's a plan that meets your needs personally. I recommend sites like FreeInsuranceGuru.com, where you can chat, call, or even video chat with an agent licensed in your area and your information isn't sold.” Back to Menu What qualifies as a Special Enrollment Period? A Special Enrollment Period occurs when you experience a Qualifying Life Event. These events are life changes like Losing current health insurance Moving Getting married Having a baby or adopting Income changes Gaining Tribe membership Gaining U.S. citizenship Release from prison Starting or ending Americorps service You can also qualify for a Special Enrollment Period if the company you enrolled with made an error in the information they provided or breached their Marketplace contract. If you experience a qualifying event, you can make changes to your insurance coverage, like adding people to your current health plan. Keep in mind that even if you have a Qualifying Life Event, other rules still govern Special Enrollment Periods.Norris says, “In the individual market, keep in mind that most special enrollment periods now require that you had coverage prior to the qualifying event, so they serve as an option to change coverage rather than go from being uninsured to having coverage. So while getting married or moving to a new area used to allow a person to gain coverage after being uninsured, that's no longer the case (for marriage, at least one spouse must have had coverage prior to the marriage, although the other could have been uninsured). Some individual market rules limit enrollees' ability to use special enrollment periods to upgrade their coverage during the year. All of this is opposed to open enrollment in the fall, when anyone can sign up or change their coverage, regardless of their prior insurance status.” Back to Menu What are my health insurance options? For the most part, Special Enrollment Periods allow people to add a person to their current plan or enroll in a new plan. If you’re enrolling in a new plan, you can enroll in An employer-sponsored plan A Marketplace plan A private insurance plan Research to learn the health insurance plans available to you and what they cost. If you’re losing insurance coverage because you left a job and are starting a new one, it’s a good idea to enroll in some kind of health insurance plan. Most employers have a waiting period before new employees can enroll in health insurance.  To ensure that you have coverage during the waiting period, you can buy temporary health insurance, enroll in a Marketplace plan, be added to your spouse’s employer plan, or extend your employer’s health insurance coverage using COBRA.“Nobody needs a qualifying event to enroll in a short-term plan, as they're available year-round but with medical underwriting. However, it's also common to see short-term plans being marketed to people who are aging off their parents' health plan or losing access to an employer-sponsored plan when they quit their job. In both cases, the person is actually eligible for a SEP in the individual market (where there's no medical underwriting, pre-existing conditions are covered, and the plans include essential health benefits coverage), but people sometimes enroll in short-term plans because they aren't sure what other options they have,” Norris says.Short-term health insurance plans are an option that’s always available. They can be a good choice, but don’t offer the complete coverage that standard health insurance plans offer.If your spouse has insurance through their employer, you can also be added to their plan. “The qualifying event that triggers COBRA eligibility (and the SEP in the individual market) will also trigger a SEP that would allow the person to join their spouse on the spouse's employer-sponsored health plan (assuming the spouse has such coverage and the plan offers spousal coverage). But as noted above, that SEP only has to last 30 days, whereas it's 60 days in the individual market and there's a 60-day window for COBRA,” Norris says. What is COBRA Insurance? COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. It is the legislation that allows former employees to continue health insurance coverage from their former employer for a certain amount of time until they find new coverage up to 18 months.  Individuals who use COBRA coverage must pay the employer’s contribution and an administrative fee in addition to the monthly premiums. Norris says, “If you're being offered COBRA, take your time to compare individual market plans and COBRA — you don't want to jump into either option without understanding all the details, but you've got 60 days to make your decision.” When choosing between enrolling in a new plan or COBRA, research your options. Townsend suggests, “Reach out to an experienced insurance agent, who can provide you many options and speak to you intelligently about what options they have for you verses the COBRA route. Go online and shop if you enjoy shopping online!”Evaluating the costs and benefits of using COBRA versus another health insurance plan will help you make the best decision for your circumstances. The nice thing about using COBRA is that the coverage can be retroactive if you enroll later during your Special Enrollment Period.Norris offers a few scenarios in which COBRA may be ideal: “You're in the middle of a complicated course of treatment and don't want to have to worry about switching providers, dealing with a new drug formulary, etc. So a person going through cancer treatment, for example, might be better off with COBRA than with switching to the individual market. You've already met or nearly met your out-of-pocket maximum for the year. If you switch to a new plan in the individual market — even if it's from the same insurer that offers your group benefits — you'll have to start over with your out-of-pocket expenses. Your income is too high for premium subsidies and you're fairly certain you're going to have access to a new employer-sponsored plan soon. In that case, keeping COBRA will be less complicated than having to enroll in a new plan only to switch away from it again in the near future when you switch to the new employer-sponsored plan.” However, there are a few reasons why enrolling in a new plan might be better. “An individual market plan might be much less expensive, especially if you qualify for premium subsidies and/or pick a plan with higher out-of-pocket exposure than the one you had through your employer. Premium subsidies are available this year to a family of four with MAGI as high as $100,400, whereas there's no financial assistance available to offset the cost of COBRA. Depending on the specifics of the plan you had through your employer and the options that are available in the individual market in your area, you might find that you can pick an individual market plan that has a provider network and/or drug formulary that work better for you,” says Norris. If you’re eligible for COBRA and Medicare, you might want to enroll in both or opt for Medicare. “One serious mistake I see people make with COBRA is when they are also eligible for Medicare. They elect COBRA, but do not enroll in Medicare Part B. Medicare says you need to enroll in Part B even when electing COBRA and over age 65. Failing to do so can cause a lifetime Part B premium penalty because of a late enrollment fee,” advises Adam Hyers, owner of Hyers & Associates Insurance Agency. How do I sign up for COBRA? Employers are required to offer information on COBRA and enrolling in COBRA to their employees. Your employer’s human resources department can answer your questions and help you access coverage through COBRA. Back to Menu How do I apply for a Special Enrollment Period? For the most part, it’s not a matter of applying for a Special Enrollment Period, it’s a matter of enrolling in a health insurance plan or making adjustments to your coverage.If you have a qualifying life event, talk to your employer’s human resources department. The human resources team will help you through the process--whether you are enrolling in a different plan, making adjustments to add coverage, or using COBRA.If you don’t have insurance through your employer, contact your health insurance company. They will tell you what documentation they need and help you with the changes you need to make.If you’re choosing a new health insurance plan, research your options online. You can view your options by looking directly at company websites, looking at comparison websites, or looking at Marketplace plans on HealthCare.gov. Representatives from these websites can also help with the enrollment process.Getting advice from a licensed independent agent is always a good idea, especially if you’re working directly with a company. “I always stress the importance of sitting down with a licensed, non-biased insurance agent who can provide information on coverage and price on various policies from an array of carriers so you can find the policy that best meets your needs and budget. Whether you are enrolling in ACA or COBRA, understanding what is and is not covered and what the cost will be to you (and your family, if applicable) is very important,” says Chris Mason, Senior Vice President of Sales Distribution for HealthMarkets. If you are required to give documentation to show that you qualify for a Special Enrollment Period, do not send the originals. Make copies to send in and keep the originals for you records. Back to Menu What is a Special Enrollment Period for Medicare? Medicare Special Enrollment Periods are slightly different from regular Special Enrollment Periods, although the concept is the same. There are a few more situations that allow for a Special Enrollment Period. The length of the Special Enrollment Period also varied based on the circumstance that triggers it. Start dates also vary.Many of the Qualifying Life Events that trigger a Special Enrollment Period also trigger a Medicare Special Enrollment Period. However, some circumstances are distinct to Medicare.For example, you qualify for a Medicare Special Enrollment Period if you have an opportunity to purchase other non-Medicare coverage or if your current Medicare plan changes its Medicare contract. More information regarding Qualifying Life Events and corresponding Special Enrollment Period details, can be viewed on Medicare.gov.Understanding how Special Enrollment Periods work will help you be prepared, use the time offered to understand your options, and make sure that you have the coverage you need. For more information on Special Enrollment Periods, check out Health Insurance Marketplace’s Guide. Back to Menu

Updated February 2021. Most of the advice published about health insurance focuses on how to choose an insurance plan that meets your needs. This article focuses on choosing a health insurance company. Specific plans and costs discussed in this article may vary depending on your location, age, and other demographic information. If you’re considering plans from any of these three companies, this article will help you better understand what each health insurer offers and which insurance carrier may be best for you. We'll cover: Best Company user ratings and reviews Aetna vs. Cigna Kaiser Permanente vs. Aetna Kaiser Permanente vs. Cigna Best Company user ratings and reviews (Ratings as of February 3, 2021) Although each insurer has a fair number of 4- and 5-star reviews, each company also has a fair proportion of 1-star reviews. Aetna has 29 percent 1-star reviews. Cigna's is higher at 40 percent. Kaiser Permanente has 34 percent 1-star reviews. Negative reviews are common in the health insurance industry. For all health insurance reviews received by Best Company in 2020, 24 percent were 1 star. In 2019, 41 percent were 1 star. Since we considered reviews from all years for Aetna, Cigna, and Kaiser Permanente, it's hard to say exactly how these companies compare to annual industry findings. However, the proportions of 1-star reviews each insurer has don't stand out considering industry patterns. As you consider good and bad reviews about health insurance companies, keep in mind that insurers offer a wide variety of plans. Plans have different network structures, cost-sharing rules, and coverage restrictions. Health insurance plan offerings can also vary by location, so consider where the reviewer is from as you read reviews. Everyone's medical needs are also different, which can affect how plan members experience the insurance provider. If reviewers share details on why they had difficulty, that can help you know what questions to ask and decide whether or not to buy from an insurance company. Complaints about Aetna, Cigna, and Kaiser Permanente have similar themes. Reviews mention issues with claims, coverage denial, and difficulty resolving problems. These similarities show that the difficulties are common across these insurers. Choosing one over the other doesn't necessarily mean you'll avoid these problems. Aetna ratings and reviews As of February 3, 2021, Aetna had a 6.6/10 overall score and a 3.4/5 star rating based on 189 user reviews. Customer Review: Natalia Correa MDTribe from Miami, Florida "I had this insurance previously with one of my employments. I had a copay but I was able to go to the ER and outpatient. After my $40 copay, it covered everything else such as immunizations and routine lab work." 29 percent of Aetna reviews had a 1-star rating. Complaints include: Poor experiences with customer service Costs Claims denial Issues with filling prescriptions and the delivery process Pre-authorization delays Difficulty with the website Concerns with the network of providers Difficulty getting forms to fill-out 58 percent of Aetna reviews had a 4- or 5-star rating. Praise includes: Good communication around claims Satisfaction with customer service Satisfaction with coverage Quick claims process Satisfaction with the cost and value of plan Aetna Customer Reviews Learn more about Aetna's health insurance offerings and how it compares to other insurers by reading our expert review and customer reviews. Learn More Cigna ratings and reviews As of February 3, 2021, Cigna had an overall score of 7.7/10 and a 2.8/5 average star rating based on 204 user reviews. Customer Review: Melinda Olson from Goodyear, Arizona "Cigna has provided us with great insurance and to see the doctors we like. Customer service helped us figure out issues we had." 40 percent of Cigna reviews had a 1-star rating. Complaints include: Cost Coverage denial for treatment, tests, or prescriptions Customer service Approval process for pre-authorization Coverage restrictions Incorrect billing Poor organization Poor ability to resolve client issues Claims denial 44 percent of Cigna reviews had a 4- or 5-star rating. Praise includes: Good experiences with coverage and claims processing Satisfaction with provider networks Easy to use mobile app and website Satisfaction with customer service Cigna Customer Reviews Learn more about Cigna's health insurance offerings and how it compares to other insurers by reading our expert review and customer reviews. Learn More Kaiser Permanente ratings and reviews As of February 3, 2021, Kaiser Permanente has an overall score of 7.4/10 and a 3.2/5 average star rating based on 200 user reviews. Customer Review: Fay Falatea from Kaneohe, Hawaii "Me and my family have been insured by Kaiser Permanente for 13 years. The Drs I had were great and customer service from the receptionist was always pleasing. Was sad when I had to change to another insurance." 34 percent of Kaiser Permanente reviews had a 1-star rating. Complaints include: Poor customer service Difficulty resolving issues Dissatisfaction with Kaiser Permanente care providers and care facilities Coverage restrictions and denials Claims denials Scheduling difficulties Issues with prior authorization Cost 53 percent of Kaiser Permanente reviews had a 4- or 5-star rating. Praise includes: Convenience of all care providers in one facility Caring doctors and providers Network satisfaction Online portals Coordination between care providers Kaiser Permanente Customer Reviews Learn more about Kaiser Permanente's health insurance offerings and how it compares to other insurers by reading our expert review and customer reviews. Learn More Back to Menu Aetna vs. Cigna While Cigna has a higher overall score on Best Company, Aetna has a higher user star rating and a lower percentage of 1-star reviews. Remember that negative reviews across these companies hit on similar themes. Reading through each company's unique reviews can help you understand what to look out for with each company and make a better, informed decision for yourself. Since Aetna does not offer individual and family health plans, Cigna is the way to go if you're buying your own medical plan. Consumers seeking student health insurance coverage, Medicaid, or CHIP will find options from Aetna. Cigna and Aetna are also similar in their Medigap and Medicare plan offerings. The biggest difference is the inclusion of additional programs. Businesses of any size can find their needs met from either Aetna or Cigna. Both companieis also offer international health plans. Cigna has targeted offerings for NGOs. It's worth comparing cost specifics for domestic plans and cost specifics, coverages, and regions for international plans to find the best deal. Cigna Health Insurance Learn more about Cigna's offerings to see if it's a good fit for you. Learn More Back to Menu Kaiser Permanente vs. Aetna When it comes to Best Company user reviews, Aetna and Kaiser Permanente are fairly similar. However, Kaiser Permanente has a higher overall score. Aetna has a slightly lower percentage of 1-star reviews, which gives Aetna a slight advantage over Kaiser Permanete. Concerns reported in both companies' one-star reviews were similar, so read the most recent customer insight on their respective Best Company profiles. As Aetna does not offer individual and family health plans, Kaiser Permanente stands out. Remember that Kaiser Permanente only offers coverage for care received by the providers it employs, which is similar to a network-only health plan structure. Aetna stands out for its plan perks and offering of international insurance. While Kaiser Permanente stands out of its offering of Charitable Health Insurance. With Medicaid and CHIP, the biggest difference between the two is the states available. If both companies offer Medicaid and CHIP in your state, it's worth doing further research into what distinguishes the offerings of each company. Kaiser Permanente's and Aetna's Medicare plans are also similar. What makes Aetna stand out with its Medicare offerings are the perks and Medigap products. Employers seeking domestic health insurance for their employees can find good plans from both Aetna and Kaiser Permanente. However, if global health insurance is necessary, Aetna is a good option because Kaiser Permanente focuses on domestic health insurance. Kaiser Permanente Customer Reviews Learn more about Kaiser Permanente's offerings to see if it's a good fit for you. Learn More Back to Menu Kaiser Permanente vs. Cigna When it comes to ratings and reviews, Kaiser Permanente and Cigna are similarly rated on Best Company in the overall score and user ratings. If you're choosing between these companies and comparing similar plans, read the most recent reviews and complaints on their respective Best Company profile pages to make an informed choice. While Cigna could provide more general information about the plans it offers independent buyers, it also offers a nice variety of supplemental health insurance plans that are great for people seeking additional coverage for specific situations. Cigna is also a great choice for purchasing independent international health insurance. Kaiser Permanente stands out for its Medicaid, CHIP, and Charitable Health Insurance offerings. For consumers interested in this kind of health insurance, Kaiser Permanente is the clear choice. If you're considering Kaiser Permanente, keep in mind that their health plans only cover care received at its medical facilities by the care providers it employs. This is different from the distinct provider network structures that other companies like Cigna offer. If you're interested in a more traditional network structure, like a Preferred Provider Network (PPO) that offers both in- and out-of-network coverage, Cigna may be a better option. Both Cigna and Kaiser Permanente offer Medicare Advantage plans. The biggest differences between the two are the additional programs that are included with some plans. Cigna also offers Medigap insurance, which is great for consumers looking for additional cost-sharing help. Kaiser Permanente and Cigna both offer a nice selection of employer-provided health insurance plans. Employers who are choosing between the two should contact each company directly to compare pricing and coverage. Cigna also offers international insurance. Those seeking international insurance would need to work with Cigna when choosing between the two insurers. Kaiser Permanente Customer Reviews Learn more about Kaiser Permanente's offerings to see if it's a good fit for you. Learn More

Guest Post by Dr. Indra CidambiWith the spread of the drug epidemic from urban to suburban and even rural areas, addiction in the workplace is not uncommon anymore, and it is a serious issue. Not only is the loss of productivity from alcohol and drug abuse significant, it has negative implications for safety in the workplace, both of which raise business costs. Over 77 percent of illicit drug users are employed1 and business leaders need to know how to address substance abuse by their employees effectively.To get a handle on the scope of the issue, consider this: in 2013, roughly 25 million2 Americans, or 9.4 percent of the population, had used an illicit drug in the past month and 33 million3, or 12.7 percent of the population, were classified as suffering from alcohol use disorder. It also appears that no profession is immune: dependence on drugs and alcohol among nurses is roughly 10 percent4, in-line with the general population; as per a 2016 study, 1 in 5 lawyers5 reported that their use of alcohol or drugs was problematic sometime in their lives; in law enforcement, 1 out of 4 police officers6 on the street have a problem with drugs or alcohol; and, a survey7 of teachers discovered higher abuse rates of alcohol, amphetamines, and tranquilizers than the national average. Extrapolating the numbers above it is safe to say that at least 1 in 10 employees in the workplace is impacted by substance abuse. Drug and alcohol abuse negatively impacts productivity and safety in the workplace and drives up costs. Alcoholism alone is responsible for 500 million lost work days8 each year.Signs of substance abuse among employees, while not obvious, can be spotted with some informed observation. General signs (depending on the kind of work) include an unkempt appearance, inappropriate clothing (long sleeves in hot weather), frequent bathroom breaks, perennially sniffy or runny nose, mood swings, isolating from colleagues, volunteering for overnight or holiday work (especially among nurses), higher than normal absenteeism or tardiness, poor job performance and workplace theft.It is important to realize that addiction is a disease, not a moral failure, and treatment is needed. Although it took time, addiction is now largely recognized by the treatment community as a chronic disease and quitting requires more than good intentions and a strong will. Drugs change the brain in ways that make quitting hard and, therefore, treatment is needed. Fortunately, treatment options have widened to include ambulatory detoxification (for all substances of abuse) and medication assisted treatment (MAT) which have delivered better results. Nevertheless, it is not easy to have this conversation with an employee.The best approach would be to first document each instance where the employee’s behavior was unusual. If possible, include it in the employee performance records as well. Then approach a professional alcohol and drug counselor or a physician who specializes in addiction, not only to make sure you are on the right track, but also to get educated on treatment options. If you utilize the services of an Employment Assistance Program (EAP), you may want to hand over the documentation to them and let them address the issue with the employee and help him or her obtain treatment. If you have to do it yourself, approach the employee as a concerned colleague rather than as an overbearing boss. Detail the instances where you have noticed behavior that was off and delve into the causes of such behavior. Explain why such behavior is impacting workplace productivity, safety, or morale. Make the employee understand that you believe that addiction is a disease that needs treatment. Show that you want to work with the employee and offer support if he or she wants to address the issue through treatment. Educate the employee about the treatment options available and explain that it is possible to live sober. Hopefully, the employee will choose to leverage the support and seek treatment. Addiction is a chronic disease that usually does not spontaneously remit over time. Treatment interventions are needed. If the employee is not amenable to seeking treatment, the issue has to be dealt with under company policies and other disciplinary rules. Indra Cidambi, M.D., Medical Director, Center for Network Therapy, is recognized as a leading expert and pioneer in the field of Addiction Medicine. Under her leadership, the Center for Network Therapy started New Jersey’s first state licensed Ambulatory (Outpatient) Detoxification program for all substances nearly three years ago. Dr. Cidambi is Board Certified in General Psychiatry and double Board Certified in Addiction Medicine (ABAM, ABPN). Dr. Cidambi is the Vice President of the New Jersey Society of Addiction Medicine. Notes: National Household Survey on Drug Use National Institute on Drug Abuse (NIDA) JAMA Psychiatry National Council of State Boards of Nursing The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys; Krill, Patrick R. JD, LLM; Johnson, Ryan MA; Albert, Linda MSSW Police On-Duty Drug Use: A Theoretical and Descriptive Examination – Kraska, Kapeller;  On the Front Lines – Hepp. A 1990 study by the Journal of Drug Education, which surveyed 500 teachers in Texas U.S. Department of Labor

Guest Post by Dr. Bruce Pinker February is Women's Healthy Heart Month for a very good reason: According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death for females in the United States. According to the American Heart Association, nearly 80 percent of cardiac events can be prevented through education and lifestyle change. Genetics plays a role, but diet and exercise are major factors that have been proven to help reduce heart disease in women, as well as in men.As a board certified podiatrist and foot surgeon, I see many patients each day who suffer from foot pain that prevents them from running or walking. Without exercise, many run the risk of diminishing health. Regular exercise can promote cardiac health and overall wellness. Getting my patients back into pain-free activity is my number one goal. Plantar fasciitis One of the most common foot ailments is plantar fasciitis. An inflammatory condition affecting the bottom part of the foot, usually in the inferior heel region, it is often caused by overuse.  Due to excessive stress on the plantar fascia ligament, which spans from the heel to the toes, it stretches and snaps back, much like a rubber band. Regular stretching exercises can be performed to prevent it, coupled with the usage of supportive footwear, but this disorder sidelines millions of individuals every year. Whether or not you are very active is not necessarily a factor, as it affects people of all different ages and activity levels. Prolonged standing or walking can lead to plantar fasciitis. In many cases, a heel spur accompanies this painful foot condition.Various successful approaches can address plantar fasciitis, and most are conservative.  Physical therapy and orthopedic strappings are usually very beneficial, especially in cases diagnosed in early stages. Cortisone injections can be helpful, as well, and custom orthotics are usually instrumental in providing long-term relief. Custom orthotics can retrain the plantar fascia ligament, maintaining a proper arch that does not overstretch or contract. In the more challenging cases, high energy shockwave therapy (ESWT) or surgery can be performed.  Approximately 90 percent of all cases of plantar fasciitis can be successfully treated conservatively, based on my experience. Upon the onset of inferior heel pain, it is best to roll your foot over a frozen 20 ounce water bottle several times. If this attempt is not successful in reducing pain, it is important to see a podiatrist for proper evaluation. Bunion deformities and hammertoes Bunion deformities are also a common foot concern. A bunion deformity, referred to as hallux abducto valgus, is a structural foot condition, often caused by improper biomechanics. Some may be born with a bunion deformity, but most are acquired, often subject to the footwear that is worn; narrow or pointy-toed shoes and high heels are known to lead to bunion deformities if worn frequently. As the great toe points toward the second toe, and the first metatarsal points inward, excessive stress is placed upon the great toe joint. The stress leads to the growth of the typical "bump" right near the great toe as the ligaments stretch on the inside of the joint, and tighten on the outside. Tendons in the great toe region provide unbalanced forces that further the deformity.  As the "bump" enlarges, it presses against a nerve, leading to discomfort. While wearing shoes, the nerve can become sandwiched between the bones and the footwear, causing pain and difficulty walking. Some bunion deformities, if mild, can be addressed conservatively, with physical therapy, orthopedic strappings, and oral anti-inflammatories or Tylenol.  However, most bunions need to be surgically corrected for long term relief. Several bunion procedures are available, most requiring three to four weeks of healing, in my experience. They are performed as an outpatient procedure, and the correction lasts for many years. It is best to avoid footwear that puts the feet under unnecessary stress. However, rest assured, most bunions can be addressed successfully, either conservatively, or surgically. Most bunion surgeries are covered by health insurance plans.Often accompanying bunion deformities is the hammertoe. When a toe is contracted, it may point upwards at the first joint, and then downward at the second joint, thus illustrating a hammertoe. Improperly fitted footwear can cause hammertoe deformities. Pain usually develops on top of the toe, as it contacts the toe box of the shoe that is worn. The skin can thicken on top due to shoe irritation, and in some cases, can become a wound. The wound can get infected, leading to potential complications. The discomfort can be debilitating, so most hammertoes need to be corrected. Some can be treated conservatively with toe covers or spacers, but definitive correction through surgery is usually necessary, also performed as an outpatient procedure.  These procedures are typically covered by health insurance plans, and recovery time is usually just two to three weeks. Neuromas Neuromas are inflammatory conditions of the nerves in between the toes. Commonly brought on by tight or narrow footwear that is worn repetitively, neuromas can also be addressed conservatively and surgically. Most patients elect for cortisone injections to start, usually performed in a series. If unsuccessful in providing relief, custom orthotics can also be utilized.  Surgery is reserved for the more challenging cases, and usually results are long-lasting. Recovery from neuroma surgery is usually two to three weeks, performed as an outpatient procedure, and often covered by health insurance plans.                      Your feet need to last a lifetime, so taking good care of them is vital. Realizing that exercise is important for promoting cardiac health, it is essential to address foot pain when it occurs. Keeping your feet healthy can be pivotal for improving your overall wellness and heart health.  Don't let your feet break your heart! Dr. Pinker is a professional foot and ankle health and wellness speaker who delivers many original seminars annually, such as “Diabetes & Your Feet: The Winning Combination,” “Exercise Safe to Lose Weight,” and “Keep On Running.” He is a graduate of the New York College of Podiatric Medicine (NYCPM) in New York City. Dr. Pinker strongly believes the fusion of fashion and function is essential for footwear today, as the modern man and woman needs to look great and feel great. This is his motivation for his company: Dr. D-LuCS: Doctor Designed Luxury Custom Shoes. 

The new year often begins with motivation to make changes that will improve life. New Year's resolutions can be about education, finance, health, or more personal goals.According to a 2019 poll by Branded Research, 38 percent of U.S. consumers made a New Year's resolution in 2019.The age groups with the most people making resolutions are ages 18-24 (with 59 percent making resolutions), ages 25-34 (with 48 percent making resolutions), and ages 35-44 (with 45 percent making resolutions).The most common primary resolutions were health-related, with 28 percent overall with a primary fitness-related goal and 25 percent overall with a primary diet-related goal.Health goals were followed by finance-related goals, which 18 percent of U.S. consumers reported as being their primary goal.Of those who made a resolution, only 28 percent report that it is very likely that they will keep them. About 38 percent say somewhat likely, and 34 percent say not likely.If you've been struggling to keep your New Year's resolutions, you're in good company.We've compiled some expert tips on keeping your motivation going throughout the year so that you can stay excited about your goals and keep them. 1. Remember why If there are some resolutions that you're having difficulty keeping, it's a good idea to evaluate why you set that goal in the first place. Declan Edwards, founder of BUCoaching.org, says, “Revisit why the resolution matters in the first place. Human behaviour is driven by feeling. We rarely do what we logically know is good for us, we do what we feel like doing and one of the best ways to tap into feeling is to revisit our why.” There may be many reasons that you set a certain goal, and these reasons can be powerful motivators. John Gilmer, PhD, Vice President of Research and Development at Active Iron, says, “If you have something that you are passionate or firm about changing, decide why, because this, not the resolution, will drive you when you hit the wall and want to quit.” Whether or not you set a goal for the sake of having New Year’s resolutions, there may be additional reasons why you want to achieve that goal. Dannie De Novo, author, attorney, coach, entrepreneur, and podcast host, agrees. She says, “My best advice is to remind yourself often of why you made your decision. Take a piece of paper, write out your resolution in big letters at the top, and under your resolution list all the reasons why you are going to accomplish it. Make these statements positive. Then put that paper somewhere you will see it every morning, like your bathroom mirror. Make yourself read it and really reflect on the reasons why you started on this journey and why it is so important to you to continue.” 2. Evaluate barriers It’s now February, so you may have already encountered some obstacles along the way in your quest to keep your New Year’s resolutions. Instead of getting frustrated with yourself, focus on what you’ve learned about those obstacles and make a plan to overcome them. Gilmer says, “Eliminating obstacles is imperative, or you will constantly be tempted. Granted, this is easier done if you are cutting fat from your diet than if you are a smoker trying to quit, but no matter the gravity of the resolution, removing triggers is essential.” Some obstacles are harder to get rid of than others. In some cases, it may work better to make flexible plans. Eric and Ryan Johnson, founders of HOMAGE say, “When it comes to your training and nutrition, forecast ahead. By planning out your calendar at the beginning of the week, you won’t be caught off guard by any surprises. This will help you make the necessary adjustments to keep you on track.”  “For example, if you know you have a dinner scheduled for Thursday night, you can adjust your nutrition from Monday to Wednesday, so when Thursday comes around, you can enjoy yourself without any unnecessary guilt. The same goes for your training; if you have a particularly busy day scheduled, you can make it a rest day for training rather than stressing out how you’ll be able to fit it into your day,” they say. Other times, it can be just as effective to make small changes to your surroundings. Itamar Shatz, author of Solving Procrastination, says, “Making changes to your environment can help you pursue your goals. For example, if your goal is to drink more water instead of coffee, placing a glass of water next to your bed can help you make sure that that's the first thing that you drink in the morning when you wake up, which will make it easier to stick with your resolution. Similarly, you can also take a water bottle to work with you, and refill it throughout the day, in order to help make sure that you stay dedicated to your goal even when there are many temptations around.” 3. Make a plan Matt Edstrom, CMO of GoodLife Home Loans, says, “One of the best ways to make and stick with your New Year’s Resolutions is to create short term plans for your long term goals. Goals that you’ve planned to stick to for a full 52 weeks are going to seem incredibly daunting, especially if they have to do with something like food, something that we all interact with on a daily basis. Start new goals at the beginning of each month. Having new goals each month will help keep you motivated, hold you accountable, and keep you on track.” Chris Beavers, senior personal trainer at Ultimate Performance, agrees and recommends even shorter timeframes. He says, “Set bite-sized performance goals every week. Set a series of smaller and more achievable performance goals along the way to achieving your bigger goals. This is a great way to keep your training fun and challenging, and keeps you motivated as you achieve smaller wins on the way to your ultimate goal.” For some goals, you may need to break the steps down even further. Edwards says, “Success is driven by habits, not by giant leaps. If your resolution is to become healthier and fitter this year, your first step is not to go to the gym five times per week (especially if you weren't already doing that). Your first three steps would be to set the alarm in the morning, get out of bed when it goes off, and then get dressed in your gym gear. By the time you're out of bed and dressed, you're incredibly likely to follow through on the rest and show up to the gym. The decision to skip the workout is usually made while you're still in bed.” As you make your plans, it’s important to set achievable goals. Dan DeFigio, author of Beating Sugar Addiction for Dummies, says, “Be realistic so you don’t succumb to all-or-nothing thinking. If you make unrealistic promises or set unattainable intentions, you’ll most likely fail quickly, and end up right where you used to be. Instead, make yourself a more doable promise, such as “I will put exercise time in my calendar three days per week,” or “I will limit myself to one dessert each weekend.” 4. Set reminders There are many kinds of reminders — alarms, schedules, posters, lists, ect. You have to figure out what works best for you. Edstrom says, “A visual reminder can be a document where your goals are written down or a dream board or an item that reminds you of what you’re working towards. A visual reminder will help you stay motivated and remind you of the reasons why you set the goal in the first place. Don’t pick a visual reminder that’s going to point out what you don’t have yet in your life.” Hassan Alnassir, founder and owner of  Size Graf, agrees. He says, “If you want to stay motivated and retain the new year's resolutions, an effective trick is to always keep the end result in mind. Try to consistently imagine what difference it will make and how it will feel when you have finally achieved your health goal. Visualizing the outcome will help push you to keep going and take action toward accomplishing your desire.” For more specific reminders, Milana Perepyolkina, international best-selling author, says, “The best way to keep a resolution is to add it to your calendar. Treat it the same way you would treat an important appointment. Create one resolution per month and add it to every weekend (delete it after completion). Share your resolutions with social media; this will improve your accountability.” These reminders can be as frequent as you need them to be.  Eric J. Anderson, co-founder and Organizational Development Manager at ElMejorTrato.com, says, “Dedicate a special time to keep that resolution. Make it your time of day. For example, the first thing you do every day. If it is something very difficult to achieve, and you carry it out first, then the day is won. You have already beaten yourself.” There are also apps that can help remind you of your goals and keep track of your progress.  Lydia Noyes, health and wellness reporter for HighYa.com, uses HabitHub. She says, “This ultra-simple app lets you track the days that you complete predetermined goals, and multiple days in a row start to create visually appealing streaks. After a few days with this app, I started to get excited about how long I could make my streaks go, so sleeping in and skipping yoga started to have a higher mental and emotional cost than getting up and doing it. As simple as it sounds, this app truly changed my brain's approach to morning yoga and made me commit.” 5. Track progress and create rewards “Not seeing results from all your hard work in the gym often kills off that initial New Year motivation, and it's easy to just quit and fall back into bad habits. So, if you don't consistently track your progress, you won't be able to see the progress you're making,” says Beavers. Finding a way to track your progress will help you see the results of your efforts every day. It can be easy to focus the success of a goal based on results. However, that can lead to frustration and diminishing motivation. DeFigio says, “Two important tips for keeping resolutions: 1. Resolve ACTIONS, not OUTCOMES. For example, a common New Year’s resolution is to “lose weight”, or even more specifically “to lose 20 pounds.” These are worthy goals, but they are too diffuse because you are looking to an OUTCOME, not resolving to DO something. You have resolve to do the ACTIONS required to get the outcome. It’s better to resolve “not to eat after 7:00 pm”, or to promise yourself that you’ll bring healthy snacks to work, so you’re not at the mercy of whatever’s in the break room. These are ACTIONS that you can reliably perform that will get you where you want to go.”As you determine what to keep track of and how to measure progress, make it something that is in your control. You can keep track just for yourself or even share it with a friend. Gilmer says, “If you are accountable to someone, you will not only be more responsible, but more engaged as well. Studies show that accountability may be the single most important thing in goal setting and resolution. In addition, having some accountability will also ensure support, which is an equally important part of making important changes.” As you hit your smaller goals and make progress, plan ways to celebrate. Christian Koshaba, personal trainer and owner of Three60Fit, says, “People are so caught up with the end goal, they forget about the mile markers along the journey. This will make your wellness endeavor more of a lifestyle, rather than an end goal. Celebrate and be proud of your accomplishments, no matter how small. Find rewards to treat yourself with. A weekend vacation, a new outfit, trendy haircut, etc.” Celebrating even small successes also increases motivation.Maggie Schott, CEO of McKeating Solutions, says, “Our brains are engineered to reward us for accomplishments. When we achieve a goal or celebrate an accomplishment, our brains release those "good feeling" chemicals.  When we fail, not so much.  So our minds become patterned to seek out accomplishments.  When they're too few and far between, we can become discouraged.  Creating micro goals or mini wins, will help to give us this release and fuel us to keep working towards our overall goals.” 6. Deal with failure As you plan to celebrate your progress, it’s also a good idea to deal with failure in a constructive way. One way to do this is to practice self-compassion.Edwards says, “When you fall off the bandwagon with your resolutions, it’s all too easy to end up blaming yourself and calling yourself a failure. This just demotivates you from trying again. Try speaking to yourself more like you would speak to a close friend if they had fallen off the bandwagon with their resolution. Maybe January didn't go to plan, but don't throw out the remaining 11 months of the year just because one month didn't play out how you thought it would.”Another way to confront failure is to focus on the present and what you can do now.De Novo says, “Not dwelling in the future is as equally important as letting go of the past. Do yourself a favor and stop thinking three to six months down the road. Set your attention on today. What can you do in the present moment to help further your goal? What can you achieve today in the furtherance of your resolution?” Looking for more tips on keeping your New Year's Resolution? Check out: "New Year's Resolutions: Don't Give Up"

For many people, the holiday season means shopping, decorating, and wrapping gifts. These activities can cause foot and back pain, and in some cases may lead to injury. Below are a few suggestions from experts on avoiding foot and back pain this holiday season: Foot pain Dr. Bruce Pinker, DPM, AACFAS, FAPWCA, DABPM, a podiatrist and foot surgeon, says, “I see many patients with foot pain this time of year. One of the most common foot pain conditions is called plantar fasciitis. It is typically brought on by overuse — excessive walking or standing, or even running or jumping. Think of those waiting on line at airports or retail stores this time of year. With improper support in footwear, overuse worsens this condition. The pain can be so severe that it can prevent individuals from walking.” If you’re doing a lot of in-store shopping or participating in outdoor holiday activities, you’ll want to take especially good care of your feet. Fortunately, there are some simple ways to prevent this pain by being kind to your feet. Pinker says, “To prevent it, one should stretch the feet regularly. Rolling feet over a frozen 20 oz water bottle is helpful. One should also wear supportive footwear.”Neel Anand, MD, professor of orthopaedic surgery and director of spine trauma at Cedars-Sinai Spine Center, also recommends wearing good shoes.  “Make sure you’re wearing a comfortable pair of shoes with cushion and support for your feet when you shop because it will provide the same cushion and relief for your lower back,” he says. If your foot pain worsens despite these preventative measures, there are other ways to treat it.  “In most cases, plantar fasciitis can be treated conservatively by physical therapy, stretching, orthopedic strappings, cortisone injections, or anti-inflammatory meds. Many also benefit from custom made orthotics. Some, in the more challenging cases, require shockwave therapy (ESWT) or surgery,” Pinker says. Back pain Over the holidays, many people do a lot of bending and lifting as they shop, decorate, and wrap presents. Carrying shopping bags for long periods of time strains your back. “Getting in a good stretch before and after a shopping trip will loosen up your muscles and relieve some stress and stiffness, making you less prone to the post-shopping soreness that can lead to further injury,” Anand says. Another way to avoid shopping-induced back strain is to do all of your shopping online. Then, everything is delivered to your front door. Just be careful as you lift the boxes and take them inside. With decorating or any kind of bending and lifting activity, Anand says, “Be mindful not to bend at the waist when lifting those heavy boxes or string of lights. ALWAYS bend at the knees, and try to avoid twisting when you have your hands full.” Another common holiday activity that is hard on your back is wrapping gifts. Many people wrap gifts on the floor. However, doing so is not good for your back.  “Set yourself up at a table with a comfortable chair instead of sprawling out on the floor (this will prevent you from hunching) and wrap only a few gifts at a time allowing yourself plenty of breaks in between,” Anand says.