Lack of affordability tops older Americans’ list of health care worries

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Judith Graham | (TNS) KFF Health News

What weighs most heavily on older adults’ minds when it comes to health care?

The cost of services and therapies, and their ability to pay.

“It’s on our minds a whole lot because of our age and because everything keeps getting more expensive,” said Connie Colyer, 68, of Pleasureville, Kentucky. She’s a retired forklift operator who has lung disease and high blood pressure. Her husband, James, 70, drives a dump truck and has a potentially dangerous irregular heart rhythm.

Tens of millions of seniors are similarly anxious about being able to afford health care because of its expense and rising costs for housing, food, and other essentials.

A new wave of research highlights the reach of these anxieties. When the University of Michigan’s National Poll on Healthy Aging asked people 50 and older about 26 health-related issues, their top three areas of concern had to do with costs: of medical care in general, of long-term care, and of prescription drugs. More than half of 3,300 people surveyed in February and March reported being “very concerned” about these issues.

In fact, five of the top 10 issues identified as very concerning were cost-related. Beyond the top three, people cited the cost of health insurance and Medicare (52%), and the cost of dental care (45%). Financial scams and fraud came in fourth place (53% very concerned). Of much less concern were issues that receive considerable attention, including social isolation, obesity, and age discrimination.

In an election year, “our poll sends a very clear message that older adults are worried about the cost of health care and will be looking to candidates to discuss what they have done or plan to do to contain those costs,” said John Ayanian, director of the University of Michigan’s Institute for Healthcare Policy and Innovation.

Older adults have good reason to worry. One in 10 seniors (about 6 million people) have incomes below the federal poverty level. About 1 in 4 rely exclusively on Social Security payments, which average $1,913 a month per person.

Even though inflation has moderated since its 2022 peak, prices haven’t come down, putting a strain on seniors living on fixed incomes.

Meanwhile, traditional Medicare doesn’t cover several services that millions of older adults need, such as dental care, vision care, or help at home from aides. While private Medicare Advantage plans offer some coverage for these services, benefits are frequently limited.

All of this contributes to a health care affordability squeeze for older adults. Recently published research from the Commonwealth Fund’s 2023 Health Care Affordability Survey found that nearly a third of people 65 or older reported difficulty paying for health care expenses, including premiums for Medicare, medications, and expenses associated with receiving medical services.

One in 7 older adults reported spending a quarter or more of their average monthly budget on health care; 44% spent between 10% and 24%. Seventeen percent said they or a family member had forgone needed care in the past year for financial reasons.

The Colyers in Pleasureville are among them. Both need new dentures and eyeglasses, but they can’t afford to pay thousands of dollars out-of-pocket, Connie said.

“As the cost of living rises for basic necessities, it’s more difficult for lower-income and middle-income Medicare beneficiaries to afford the health care they need,” said Gretchen Jacobson, vice president of the Medicare program at the Commonwealth Fund. Similarly, “when health care costs rise, it’s more difficult to afford basic necessities.”

This is especially worrisome because older adults are more prone to illness and disability than younger adults, resulting in a greater need for care and higher expenses. In 2022, seniors on Medicare spent $7,000 on medical services, compared with $4,900 for people without Medicare.

Not included in this figure is the cost of assisted living or long-term stays in nursing homes, which Medicare also doesn’t cover. According to Genworth’s latest survey, the median annual cost of a semiprivate room in a nursing home was $104,000 in 2023, while assisted living came to $64,200, and a week’s worth of services from home-health aides averaged $75,500.

Many older adults simply can’t afford to pay for these long-term care options or other major medical expenses out-of-pocket.

“Seventeen million older adults have incomes below 200% of the federal poverty level,” said Tricia Neuman, executive director of the Program on Medicare Policy for KFF. (That’s $30,120 for a single-person household in 2024; $40,880 for a two-person household.) “For people living on that income, the risk of a major expense is very scary.”

How to deal with unanticipated expenses in the future is a question that haunts Connie Colyer. Her monthly premiums for Medicare Parts B and D, and a Medigap supplemental policy come to nearly $468, or 42% of her $1,121 monthly income from Social Security.

With a home mortgage of $523 a month, and more than $150 in monthly copayments for her inhalers and her husband’s heart medications, “we wouldn’t make it if my husband wasn’t still working,” she told me. (James’ monthly Social Security payment is $1,378. His premiums are similar to Connie’s and his income fluctuates based on the weather. In the first five months of this year, it approached $10,000, Connie told me.)

The couple makes too much to qualify for programs that help older adults afford Medicare out-of-pocket costs. As many as 6 million people are eligible but not enrolled in these Medicare Savings Programs. Those with very low incomes may also qualify for dual coverage by Medicaid and Medicare or other types of assistance with household costs, such as food stamps.

Older adults can check their eligibility for these and other programs by contacting their local Area Agency on AgencyState Health Insurance Assistance Program, or benefits enrollment center. Enter your ZIP code at the Eldercare Locator and these and other organizations helping seniors locally will come up.

Persuading older adults to step forward and ask for help often isn’t easy. Angela Zeek, health and government benefits manager at Legal Aid of the Bluegrass in Kentucky, said many seniors in her area don’t want to be considered poor or unable to pay their bills, a blow to their pride. “What we try to say is, ‘You’ve worked hard all your life, you’ve paid your taxes. You’ve given back to this government so there’s nothing wrong with the government helping you out a bit.’”

And the unfortunate truth is there’s very little, if any, help available for seniors who aren’t poor but have modest financial resources. While the need for new dental, vision, and long-term care benefits for older adults is widely acknowledged, “the question is always how to pay for it,” said Neuman of KFF.

This will become an even bigger issue in the coming years because of the burgeoning aging population.

There is some relief on the horizon, however: Assistance with Medicare drug costs is available through the 2022 Inflation Reduction Act, although many older adults don’t realize it yet. The act allows Medicare to negotiate the price of prescription drugs for the first time. This year, out-of-pocket costs for medications will be limited to a maximum $3,800 for most beneficiaries. Next year, a $2,000 cap on out-of-pocket drug costs will take effect.

“We’re already seeing people who’ve had very high drug costs in the past save thousands of dollars this year,” said Frederic Riccardi, president of the Medicare Rights Center. “And next year, it’s going to get even better.”

___

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

Beyond PMS: A poorly understood disorder means periods of despair for some women

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By Lauren Peace, Tampa Bay Times | KFF Health News (TNS)

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

____

For the most part, Cori Lint was happy.

She worked days as a software engineer and nights as a part-time cellist, filling her free hours with inline skating and gardening and long talks with friends. But a few days a month, Lint’s mood would tank. Panic attacks came on suddenly. Suicidal thoughts did, too.

She had been diagnosed with anxiety and depression, but Lint, 34, who splits her time between St. Petersburg, Florida, and Tulsa, Oklahoma, struggled to understand her experience, a rift so extreme she felt like two different people.

“When I felt better, it was like I was looking back at the experience of someone else, and that was incredibly confusing,” Lint said.

Then, in 2022, clarity pierced through. Her symptoms, she realized, were cyclical. Lint recognized a pattern in something her doctors hadn’t considered: her period.

For decades, a lack of investment in women’s health has created gaps in medicine. The problem is so prevalent that, this year, President Joe Biden signed an executive order to advance women’s health research and innovation.

Women are less likely than men to get early diagnoses for conditions from heart disease to cancer, studies have found, and they are more likely to have their medical concerns dismissed or misdiagnosed. Because disorders specifically affecting women have long been understudied, much remains unknown about causes and treatments.

That’s especially true when it comes to the effects of menstruation on mental health.

When Lint turned to the internet for answers, she learned about a debilitating condition at the intersection of mental and reproductive health.

Sounds like me, she thought.

What Is PMDD?

Premenstrual dysphoric disorder, or PMDD, is a negative reaction in the brain to natural hormonal changes in the week or two before a menstrual period. Symptoms are severe and can include irritability, anxiety, depression, and sudden mood swings. Others include fatigue, joint and muscle pain, and changes to appetite and sleep patterns, with symptoms improving once bleeding begins.

Unlike the mild discomfort of premenstrual syndrome, or PMS, the effects of premenstrual dysphoric disorder are life-altering. Those afflicted, according to one estimate, can endure almost four years of disability, cumulatively, over their lives.

Though researchers estimate that the dysphoric disorder affects around 5% of people who menstruate — about the same percentage of women with diabetes — the condition remains relatively unknown, even among health care providers.

In a 2022 survey of PMDD patients published in the Journal of Women’s Health, more than a third of participants said their family doctors had little knowledge of the premenstrual disorder or how to treat it. About 40% said the same was true of their mental health therapists.

Reproductive mental health has been sidelined as a specialty, said Jaclyn Ross, a clinical psychologist who researches premenstrual disorders as associate director of the CLEAR Lab at the University of Illinois-Chicago. Only some health care providers get training or even become aware of such disorders, Ross said.

“If you’re not considering the menstrual cycle, you’re at risk of misdiagnosing and missing what’s actually going on,” Ross said.

That was the case for Tampa, Florida, resident Jenna Tingum, 25, who had panic attacks and suicidal thoughts as a premed student at the University of Florida. It wasn’t until her college girlfriend read about PMDD online and noticed Tingum’s symptoms flared in the days leading up to her period that Tingum talked with her gynecologist.

“I don’t think I would have ever put the pieces together,” Tingum said.

Suicide Risk and Treatment

Because few researchers study the condition, the cause of PMDD is something of an enigma, and treatments remain limited.

It wasn’t until 2013 that the disorder was added to the Diagnostic and Statistical Manual, the handbook used by medical professionals in the U.S. to diagnose psychiatric conditions. PMDD was officially recognized by the World Health Organization in 2019, though references in medical literature date to the 1960s.

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Defining the disorder as a medical condition faced early pushback from some feminist groups wary of giving credibility to stereotypes about PMS and periods. But Ross said patients must be taken seriously.

In one study, 72% of respondents with the disorder said they’d had suicidal thoughts in their lifetime. And 34% said they had attempted suicide, compared with 3% of the general population.

Marybeth Bohn lost her daughter, Christina Bohn, to suicide in 2021. It was only in the months before her death at age 33 that Christina connected her extreme distress to her cycle — no doctors had asked, Bohn said. Now Bohn, who lives in Columbia, Missouri, works with medical and nursing schools around the country to change curricula and encourage doctors to ask people in mental health emergencies about their premenstrual symptoms and cycles.

“We need more research to understand how and why these reactions to hormones occur,” Ross said. “There’s so much work to be done.”

While doctors haven’t settled on a universal approach to address the symptoms, three main treatments have emerged, said Rachel Carpenter, medical director of reproductive psychiatry at the University of Florida–Jacksonville College of Medicine.

Selective serotonin reuptake inhibitors, the most common form of antidepressants, are a first line of attack, Carpenter said. Some patients take the medication regularly; others in just the week or two that symptoms occur.

For some patients, hormonal birth control can alleviate symptoms by controlling or preventing the release of certain hormones.

Finally, talk therapy and cycle awareness can help patients build mental resilience for difficult weeks.

Sandi MacDonald, who co-founded the International Association for Premenstrual Disorders, a leading resource for patients and clinicians, said peer support is available through the nonprofit, but funding for research and education remains elusive.

She hopes the new White House initiative on advancing women’s health research will open doors.

Let’s Talk About Periods

Both Lint and Tingum, who were diagnosed by medical professionals after learning about the disorder on their own, said a lack of conversation around periods contributed to their care being delayed.

Lint doesn’t remember talking much about periods in grade school; they were often the butt of a joke, used to dismiss women.

“For the longest time, I thought, ‘Well, this happens to everyone, right?’” Lint said of her symptoms. “Has a doctor ever asked me what my symptoms are like? No, absolutely not. But we’re talking about a quarter or more of my life.”

Brett Buchert, a former University of Florida athlete who took time away from campus because her symptoms were so severe, said that when doctors do ask questions, it can feel like boxes being checked: “The conversation ends there.”

Buchert, who graduated with a degree in psychology and now lives in Boulder, Colorado, said understanding what’s happening to her and being aware of her cycle has helped her manage her condition.

Lint and Tingum agreed.

Even as Lint struggles to find a medicine that brings relief, tracking her cycle has allowed her to plan around her symptoms, she said. She makes fewer commitments in the week before her period. She carves out more time for self-care.

She’s also found solace in reading stories of others living with the condition, she said.

“It’s helped me process the extremes,” Lint said. “There’s not something wrong with me as an individual. I’m not crazy; this is something that’s legitimately happening to me. It helps to know I’m not alone.”

This article was produced through a partnership between KFF Health News and the Tampa Bay Times.

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

How to use buy now, pay later like a pro

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By Melissa Lambarena | NerdWallet

“Buy now, pay later” plans have become a common option at checkout when shopping in store or online. Some plans, like the pay-in-four option, are appealing since they typically don’t charge interest or require a hard credit check that impacts credit scores.

These plans may seem like another payment method next to debit or credit, but they are installment loans that divide your purchase into several payments, with the first one typically due at checkout. The Consumer Financial Protection Bureau’s latest rule, as of May 2024, further clarifies that buy now, pay later lenders are credit card providers. They must provide some of the same legal protections and rights that apply to credit cards, such as the ability to get a refund after returning a product.

If you qualify for buy now, pay later, it can be easy to become overextended if you take on several plans, so using them frequently as a form of credit may be problematic.

Here’s how to use buy now, pay later the smart way.

Aim to use it strategically

A buy now, pay later plan can make sense to free up cash flow — if you know you’ll have the money to pay it off based on the terms. Review your budget to see whether a buy now, pay later purchase is truly affordable before accepting it. Given that they are loans, avoid reliance on these plans to cover basic necessities if possible. Frequent use of these plans to make ends meet could indicate that you need a financial strategy before an unexpected emergency or setback puts you in the red.

“They can look at their budget in general,” says Trent Graham, a program performance and quality assurance specialist at GreenPath, a nonprofit credit counseling agency. “What’s the cash coming in compared to the cash going out without use of credit? What are options or ideas on cutting back on expenses or increasing the income, one of the two, to balance that budget out?”

If possible, leave space in your budget for unforeseen expenses. Ideally, an emergency fund can cover unexpected costs that may arise to stay on track.

Avoid taking on too many plans at once

Buy now, pay later lenders may not report ongoing payments to major credit bureaus, so they might not have visibility into the number of plans you hold with different companies. As a result, it’s possible to become overextended.

If you do have several buy now, pay later plans open at the same time, keep on top of varying terms and due dates. Graham suggests staying organized with budgeting apps, a notebook, a calendar, or other ways to track and plan for these loans. Choose an option that works for you.

Pay on time

Buy now, pay later plans are a form of credit, but they don’t typically help build it. In some cases, in fact, they can harm your credit. Payment history usually isn’t reported to credit bureaus for buy now, pay later plans at this time, but missing a payment could have adverse ripple effects, depending on the lender.

Paying late can lead to fees or a frozen account that prevents purchases. Eventually, the debt can be charged off and may be turned over to a debt collector. These actions can be reported to credit bureaus and hurt your credit history. If you anticipate trouble paying on time, some lenders may allow changes to payment due dates.

Again, while it’s not recommended to juggle too many buy now, pay later plans at once, staying organized can keep them manageable. Among those who have opened credit cards, personal loans, auto loans, student loans or mortgages, customers who also have buy now, pay later plans were more than twice as likely to be delinquent on at least one of those products by 30 days or longer, according to a 2023 report by the CFPB.

Select your payment method thoughtfully

Some buy now, pay later lenders allow installments to be paid with a debit card, credit card or other options. Whether you’re required to sign up for automatic repayments or you select that option, choose the payment method thoughtfully based on your goals and the purchase amount.

Automatic payments with a debit card, for instance, could lead to overdraft or nonsufficient fund fees if there isn’t enough money to cover the payment. Paying with a credit card can avoid this issue, but if you carry a balance from buy now, pay later plans over several months, you could be paying interest charges. A large purchase could also impact your credit utilization ratio if it uses more than 30% of your available credit. It’s a key factor in credit scores.

Understand the terms

If you’re in a hurry to check out, It may be tempting to accept a buy now, pay later plan without reading the terms of the loan. But doing so could lead to unwanted surprises. The terms aren’t the same for all lenders, and they sometimes aren’t easy to find. Track them down on the lender’s website and read them carefully to know what to expect from the plan, including any potential fees.

Melissa Lambarena writes for NerdWallet. Email: mlambarena@nerdwallet.com. Twitter: @LissaLambarena.

Lakeville’s Tyler Wahl excited for opportunity with Timberwolves’ Summer League team

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Tyler Wahl’s previous runs at Mayo Clinic Square didn’t quite carry the same intensity as what he endured this week.

When Lakeville North played in the high school state tournament, the Panthers sometimes practiced at the Timberwolves and Lynx facility ahead of Target Center games.

This week, the Lakeville North alum was dueling it out with his new Summer League teammates in his first taste of pro basketball.

“It’s a little different, a little more physical. I felt all the big bodies,” Wahl told reporters this week. “But at the end of the day it’s always fun to get in here, compete, get better, and I’m ready to work towards something here.”

Essentially, what the 23-year-old is working toward is an opportunity. After five collegiate seasons at Wisconsin, Wahl went undrafted — which he expected — and quickly received an invitation to join the Timberwolves’ Summer League team, which also wasn’t a surprise.

“That was kind of the first call after the draft, and we jumped right on it,” Wahl said. “I feel like I had a pretty good (pre-draft) workout here. … (My agent and I) feel like we had somewhat of an idea of what was going to happen, but it’s really a dream come true to be here, be in the hometown, just 30 minutes from home. I really couldn’t ask for a better start.”

The Wolves kick off Summer League competition at 4 p.m. Central time Friday in Las Vegas with a game against the New Orleans Pelicans. How much Wahl plays in that game – or any Summer League game – remains to be seen. Minnesota’s Summer League roster is packed with draft picks that figure into the NBA team’s future plans. The team’s NBA roster spots are all spoken for, though two-way roster spots are fluid until the season begins.

Still, Wahl landed with the Timberwolves for a reason.

“He plays hard, man. He plays really hard,” Timberwolves Summer League head coach Chris Hines said. “I like the fact he has a nose for the ball, offensive rebounds, he’s a smart guy. We’ll definitely utilize him.”

Those were certainly Wahl’s primary traits with the Badgers — a gritty defender and rebounder who was willing to do the little things required to win. If he can show that in Las Vegas, whether that be in games or even just practice, he could land with the Wolves’ G-League team in Iowa.

Earlier this week, Wahl wasn’t overly consumed with his expected role over the coming week-plus of competition.

“At the end of the day, I think it’s just about getting better every single day,” he said. “I’m going to go out there, try to prove that I belong out here and get my best foot forward. Give that energy, be communicating with everybody and just be a positive impact on the team.

“I’m just happy to really be here and give all that I have.”

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