Volume 18, No. 1, Winter 2010
By Sonja Brewer
Since I’m new as director and to start off the new year and for any new folks, here’s a recap of who and what we are and how we work.
SHINE stands for Serving Health Information Needs of Elders. We are a state agency and we counsel and assist seniors—and the disabled—with their health insurance options. We counsel people in person and over the phone, make group presentations and provide information by mail and e-mail.
We were extremely busy across the Cape and Islands the last seven weeks of 2009 helping people navigate the myriad options that had become available.
So, now that the annual November 15-to-December 31 open enrollment period for Medicare Part D drug plans has ended, you may think that you are stuck with the choices you have already made. If you cannot afford your premiums or co-pays, if you can no longer see your favorite doctor or if necessary medications are no longer covered, are you just plain out of luck for the next 12 months?
The answer is “not necessarily.” Here are some opportunities to make changes:
Your choices will depend on your health, your need for certain physician services, your level of need for prescription drug coverage, your ability to pay certain plan costs including premiums and co-pays, your income eligibility for Prescription Advantage and your income and asset eligibility for MassHealth and/or Extra Help.
It’s important to customize your options to your personal situation so that you know exactly what is available to you. Contact your local Senior Center and ask to make an appointment with the SHINE representative or call the state SHINE directory at 1-800-243-4636 then press “3” for contact information.
(Ms. Brewer is the Cape & Islands Regional Director of SHINE, a division of the Massachusetts Executive Office of Elder Affairs.)
By G. Robert King II, CFP®, AIF®
Historically, retirees have relied on three different sources to meet their retirement income needs: Social Security; personal savings and pension plans.
Increasingly, however, Americans have had to rely upon personal savings to fund their retirement. That’s because many employers have discontinued their pension plans and increased life expectancy has contributed to an overburdened Social Security System.
Now the retirement savings game is about to change again.
Due to their favorable tax status and flexibility of investment choices, IRAs can be an effective investment vehicle for retirement savings. These accounts generally come in two flavors: Traditional and Roth.
Traditional IRAs allow you to pay taxes later; under Roth IRAs you pay taxes now.
With rules for Roth IRAs changing this year, it may be to your advantage to convert from a traditional vehicle.
Through 2009, only individuals with adjusted gross incomes less than $100,000 were able to convert qualified dollars to a Roth IRA. Beginning January 1, however, the $100,000 limit was eliminated, opening up the field considerably.
When you convert to a Roth, you pay income tax on the taxable dollars that are converted. One benefit of the new rules, however, is that amounts converted in 2010 will be eligible for a special tax option that enables you to spread out the income tax payment in equal installments over two years. Taxes due from conversions after 2010 will be due in full that same year.
There are many potential benefits of converting to a Roth IRA, but whether it makes sense depends on individual situations. Here you’ll probably need professional advice. Issues involved include handling tax-free withdrawals; will you need a hedge against rising income taxes; and how will this affect your estate planning strategy, assuming you have one.
Some questions to consider:
Your answers will help your professional advisor assist you in making the best decision.
(Mr. King is a Certified Financial Planner in Hyannis, 508-790-7100 or info@capitalportfolios.net.)
By Gary Sheehan
I’ve been impressed by reading the PricewaterhouseCoopers' Health Research Institute's annual listing of the “Top 10 Health Industry Issues in 2010”, which puts cost control at the head of the list as the overarching theme for the year ahead.
“Healthcare typically lags trends in the business cycle by a year or more. While flat may be the new growth for other sectors of the U.S. economy, the recession could hit healthcare in 2010,” they report. “The primary emphasis for all healthcare organizations in the year ahead will be on reducing costs and creating greater value in the system.”
Summarizing this year's top 10:
Intense effort to reduce costs—Hospitals, physicians, and other providers will look to squeeze every penny out of their operations and supply chains, renegotiating purchasing agreements and contracts with suppliers on everything from food services to medical devices and pharmaceuticals. Employers will seek to weed out employee dependents no longer eligible for coverage.
Aftermath of health reform—Healthcare organizations will be busy absorbing the first waves of regulatory changes. This will be a recurring process.
Government accelerates change through rewards and penalties—2010 will be a double-bonus year for physicians who act quickly to take advantage of government incentives to adopt electronic medical records and e-prescribing. Those who do not will face potential penalties later. This represents a shift in the government's role as a “passive payer” to an “active buyer” of healthcare.
Focus on fraud and mistakes—Healthcare organizations will need to tighten internal controls and raise the bar on compliance as the government goes after fraud and mistakes. They’re banking on as much as $1.6 billion in savings from fraud prevention and recovery the administration has boosted its fraud and abuse budget by 50 percent. Pharmaceutical executives now face jail time for off-label marketing violations.
Technology and telecommunications sectors become leading players—The convergence of healthcare with technology and telecommunications companies, as well as other new market participants, will change the regulatory rules, the basis for competition and the way health services are delivered.
Big pharma joins the delivery team—The role of pharmaceutical and life sciences companies will evolve from manufacturer/supplier to full partner on the healthcare delivery team as its focus shifts from lab-based outcomes to promoting prevention and patient outcomes.
Physician groups to rejoin health systems—The percent of hospitals employing physicians has nearly doubled since 1994, and the trend will continue in 2010 as physicians seek greater stability and electronic connectivity.
Alternative care delivery models to emerge—Traditional care delivery models will give way to alternative models of care outside of physicians' offices and hospitals such as work-site and retail health clinics, home health services and other technology-enabled delivery such as e-mail, telehealth and remote patient monitoring.
H1N1 elevates emphasis on readiness for public health outbreak–-Another wave of H1N1 flu in 2010 will put pressure on healthcare organizations, public health officials and employers to re-evaluate readiness for a major public health outbreak.
Community health becomes new social responsibility—A new social responsibility for community health will emerge among employers, healthcare leaders and community leaders, with a major boost in funding from the government. More states and municipalities are creating policies and forming alliances to promote sustainable healthy lifestyles in entire communities.
A full copy of the Top 10 Health Industry Issues in 2010,including implications for healthcare organizations,is available online at www.pwc.com/us/top10.
(Mr. Sheehan is President/CEO of Cape Medical Supply, gsheehan@capemedical.net.)
By Kevin Comick
Many people in good health assume that they will stay in their own homes until the end of their lives.
On the other hand, there are many reasons that encourage singles or couples 55 and older to investigate residential communities and the company of friends with whom they have a great deal in common.
To many, this companionship is more important than leaving behind the maintenance problems, yard work, or isolation of remaining in the home.
The apartment homes are maintenance-free and most have their own generators, so when a storm stops a town’s electrical service, these residents are not sitting in the dark, alone, with no water or heat.
And pets may be welcome in many of these residential communities.
Financially, it can make sense. In non-profit communities, there is a membership fee that secures a life lease on the apartment. This fee can range from $139,000 for a one-bedroom home to $450,000 for a customized two-bedroom residence. And up to 100 percent of this amount may be returned when the resident leaves the complex. Also payment can be adapted to the resident’s needs, such as deferring the fee until the sale of a primary residence.
Of course, the entrance charge is just that. After moving in, there is a monthly fee that covers round-the-clock staffing, transportation for medical appointments and groceries, activities both within and outside the community, housekeeping services, restaurant-style dining, fitness center, crafts and art room, library, lounges, salon, and access to rehabilitation and nursing services as needed. The fee also covers utilities and maintenance, including emergency apartment repairs.
Some financial advisors say it’s never better to wait to sell a primary residence. Clients are urged to balance the ongoing costs and other negatives of maintaining a private residence against the fees and positive aspects of community living to see what works for them.
(Mr. Comick is the new Executive Director at Seashore Point in Provincetown, 508-487-0771.)
It’s no secret that the economy is taking its toll on the budgets of the Cape’s nonprofits. With client services always the top priority, staff training often is put aside. But several local organizations are discovering that collaboration can create new training opportunities.
Out of a grassroots coalition of health, education, and human services organizations, HealthSpeak Cape Cod, is taking shape to present an in-depth program on strategic communication for professionals and volunteers in health-related fields. The event will take place from 8 a.m. to 4 p.m. April 9 on the campus of Cape Cod Community College. HealthSpeak will begin with a keynote address on communication and health, followed by a Greet the Press panel presentation on What Makes Health News. There also will be morning and afternoon workshops on such subjects as Frontline Skills Training in Human Services, Dialogue with Difficult People, Spreading the Word through Social Media, Public Relations in Healthcare, The Rules of Nonprofit Advocacy, Legal and Ethical Aspects of Advance Care and End-of-Life Conversations Grant Writing Update, and Careers in Health Communication.
A round-table luncheon, hands-on assistance on social media from representatives of Geek Girls, and a resource exposition from sponsors and friends will provide other avenues of collaboration, training, and assistance.
To stretch resources as far as possible, Suffolk University professors and their students in Event Planning and Promotion, Public Relations, and Advertising courses on Cape Cod will undertake all the logistics of planning, publicizing, and hosting the day-long conference. Cape Cod Community College will provide the venue.
Other program sponsors include Barnstable County Human Services, The Cape & Islands Community Health Network, Caregiver Homes, Community Connections, Duffy Health Center, Geek Girls, Hospice & Palliative Care of Cape Cod, Power in Aging, Suffolk University Cape Cod, Mass 2-1-1 and To Your Good Health, A Health Care Newsletter.
The HealthSpeak coalition welcomes additional participation from the Cape Cod community. To learn more about participating in the event as either a sponsor or attendee, see www.suffolkcapecod.org or call 508-375-4083