Blogs

Three Things You Didn’t Know About Rental Assistance

by The Gov on July 9, 2021

If you’re a landlord and the income you get from tenants paying rent payments is the way you pay your own mortgage, taxes, insurance, and other costs, then when the rent comes in short—or not at all—you might find yourself struggling to make ends meet. Help is available. State and local governments are distributing billions of dollars in federal emergency rental assistance, and you may have a right to apply for it. Rental assistance isn’t just for tenants. Rental assistance can help you recoup lost rent. If you’re a landlord, you may think of rental assistance as help for renters. But at the moment, most programs require landlords to apply for assistance first. Payments are usually made to you directly. State and local programs are delivering money straight to landlords, utility companies, and other providers. You have a role to play. You may be able to apply for your tenants. Where tenants can apply, they may need your help to complete the application process. They usually Talso need your information in order to pay you. Learn more about rental assistance and help for landlords, and share this information with your tenants and professional networks. About the Bureau The Consumer Financial Protection Bureau is a 21st century agency that helps consumer finance markets work by making rules more effective, by consistently and fairly enforcing those rules, and by empowering consumers to take more control over their economic lives. Learn more at consumerfinance.gov.

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Travel

How—and Where—to Get a Second Passport Without Having to Buy or Inherit It

by Travel Professor on January 16, 2021

By Jeff D. Opdyke If you're looking to get your hands on a second passport without having to buy or inherit it, then consider this less-costly, more-organic, nearly assured path: Move somewhere and gain citizenship—and a passport—via the naturalization process. That's not as difficult as it might sound. While lots of countries require that you live within their borders for a decade or longer before you can apply for citizenship, several impose a much-shorter timeline of between two and five years. And as a U.S. expat who's lived in Prague now for nearly two years, I can tell you those years fly by quickly. So, if you've ever given consideration to securing citizenship and a second passport, here are several countries where the process of citizenship-by-naturalization is relatively quick. Source: https://internationalliving.com/a-second-passport-without-having-to-buy-or-inherit-it-trl/ For more International Living content, click HERE

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Banking

Retail

Cosigning a Loan: How can I protect myself if I cosign someone else’s loan?

by Banking Professor on November 17, 2022

Think carefully before agreeing to cosign someone’s loan. You will be responsible for repaying the loan if the borrower does not. The loan will likely appear on your credit reports, as well as the borrower's credit reports. If you: Understand the risks of cosigning a loan, and Still decide to cosign someone else’s loan then there are two things you can do to help protect yourself: Get notified. Ask the lender to let you know if the borrower misses a payment or the terms of the loan change. The lender is not required to notify you of these events, so you need to ask. Get the lender's agreement to notify you in writing, before you cosign. The notifications will give you time to deal with the problem or make payments without having to repay the entire amount immediately. Get copies. Double-check to be sure that you get copies of all important papers concerning the loan, such as the loan contract and the Truth in Lending Disclosure. These documents may be useful if there’s a dispute. For more information, read this article from the Federal Trade Commission (ftc.gov).

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Healthcare

100 Million People in America Are Saddled With Health Care Debt

by HealthCare Professor on June 17, 2022

<h1>100 Million People in America Are Saddled With Health Care Debt</h1> <div> Noam N. Levey <time class="posted-on" datetime="2022-06-16T05:00:00-04:00"> June 16, 2022 </time> </div> Elizabeth Woodruff drained her retirement account and took on three jobs after she and her husband were sued for nearly $10,000 by the New York hospital where his infected leg was amputated.Ariane Buck, a young father in Arizona who sells health insurance, couldn’t make an appointment with his doctor for a dangerous intestinal infection because the office said he had outstanding bills. Allyson Ward and her husband loaded up credit cards, borrowed from relatives, and delayed repaying student loans after the premature birth of their twins left them with $80,000 in debt. Ward, a nurse practitioner, took on extra nursing shifts, working days and nights.“I wanted to be a mom,” she said. “But we had to have the money.”The three are among more than 100 million people in America ― including 41% of adults ― beset by a health care system that is systematically pushing patients into debt on a mass scale, an investigation by KHN and NPR shows.The investigation reveals a problem that, despite new attention from the White House and Congress, is far more pervasive than previously reported. That is because much of the debt that patients accrue is hidden as credit card balances, loans from family, or payment plans to hospitals and other medical providers.To calculate the true extent and burden of this debt, the KHN-NPR investigation draws on <a href="https://www.kff.org/health-costs/report/kff-health-care-debt-survey/">a nationwide poll conducted by KFF</a> for this project. The poll was designed to capture not just bills patients couldn’t afford, but other borrowing used to pay for health care as well. New analyses of credit bureau, hospital billing, and credit card data by the Urban Institute and other research partners also inform the project. And KHN and NPR reporters conducted hundreds of interviews with patients, physicians, health industry leaders, consumer advocates, and researchers.The picture is bleak.In the past five years, more than half of U.S. adults report they’ve gone into debt because of medical or dental bills, the KFF poll found.A quarter of adults with health care debt owe more than $5,000. And about 1 in 5 with any amount of debt said they don’t expect to ever pay it off.“Debt is no longer just a bug in our system. It is one of the main products,” said Dr. Rishi Manchanda, who has worked with low-income patients in California for more than a decade and served on the board of the nonprofit RIP Medical Debt. “We have a health care system almost perfectly designed to create debt.”The burden is forcing families to cut spending on food and other essentials. Millions are being driven from their homes or into bankruptcy, the poll found. Loading…Medical debt is piling additional hardships on people with cancer and other chronic illnesses. Debt levels in U.S. counties with the highest rates of disease can be three or four times what they are in the healthiest counties, according to <a href="https://www.urban.org/research/publication/which-county-characteristics-predict-medical-debt">an Urban Institute analysis</a>.The debt is also deepening racial disparities.And it is preventing Americans from saving for retirement, investing in their children’s educations, or laying the traditional building blocks for a secure future, such as borrowing for college or buying a home. Debt from health care is nearly twice as common for adults under 30 as for those 65 and older, the KFF poll found.Perhaps most perversely, medical debt is blocking patients from care.About 1 in 7 people with debt said they’ve been denied access to a hospital, doctor, or other provider because of unpaid bills, according to the poll. An even greater share ― about two-thirds ― have put off care they or a family member need because of cost.“It’s barbaric,” said Dr. Miriam Atkins, a Georgia oncologist who, like many physicians, said she’s had patients give up treatment for fear of debt.Patient debt is piling up despite the landmark 2010 Affordable Care Act.The law expanded insurance coverage to tens of millions of Americans. Yet it also ushered in years of robust profits for the medical industry, which has steadily raised prices over the past decade. Hospitals recorded their most profitable year on record in 2019, notching an aggregate profit margin of 7.6%, according to the <a href="https://www.medpac.gov/document/http-medpac-gov-docs-default-source-data-book-july2021_medpac_databook_sec-pdf/">federal Medicare Payment Advisory Committee</a>. Many hospitals thrived even through the pandemic.But for many Americans, the law failed to live up to its promise of more affordable care. Instead, they’ve faced thousands of dollars in bills as health insurers shifted costs onto patients through higher deductibles.Now, a highly lucrative industry is capitalizing on patients’ inability to pay. Hospitals and other medical providers are pushing millions into credit cards and other loans. These stick patients with high interest rates while generating profits for the lenders that top 29%, according to <a href="https://www.ibisworld.com/united-states/market-research-reports/medical-patient-financing-industry/">research firm IBISWorld</a>.Patient debt is also sustaining a shadowy collections business fed by hospitals ― including public university systems and nonprofits granted tax breaks to serve their communities ― that sell debt in private deals to collections companies that, in turn, pursue patients.“People are getting harassed at all hours of the day. Many come to us with no idea where the debt came from,” said Eric Zell, a supervising attorney at the Legal Aid Society of Cleveland. “It seems to be an epidemic.”In Debt to Hospitals, Credit Cards, and RelativesAmerica’s debt crisis is driven by a simple reality: Half of U.S. adults don’t have the cash to cover an unexpected $500 health care bill, according to the KFF poll.As a result, many simply don’t pay. The flood of unpaid bills has made medical debt the most common form of debt on consumer credit records. As of last year, 58% of debts recorded in collections were for a medical bill, <a href="https://files.consumerfinance.gov/f/documents/cfpb_medical-debt-burden-in-the-united-states_report_2022-03.pdf">according to the Consumer Financial Protection Bureau</a>. That’s nearly four times as many debts attributable to telecom bills, the next most common form of debt on credit records.But the medical debt on credit reports represents only a fraction of the money that Americans owe for health care, the KHN-NPR investigation shows.<ul><li>About 50 million adults ― roughly 1 in 5 ― are paying off bills for their own care or a family member’s through an installment plan with a hospital or other provider, the KFF poll found. Such debt arrangements don’t appear on credit reports unless a patient stops paying.</li><li>One in 10 owe money to a friend or family member who covered their medical or dental bills, another form of borrowing not customarily measured.</li><li>Still more debt ends up on credit cards, as patients charge their bills and run up balances, piling high interest rates on top of what they owe for care. About 1 in 6 adults are paying off a medical or dental bill they put on a card.</li></ul>How much medical debt Americans have in total is hard to know because so much isn’t recorded. But an earlier <a href="https://www.kff.org/health-costs/issue-brief/the-burden-of-medical-debt-in-the-united-states/">KFF analysis</a> of <a href="https://www.census.gov/programs-surveys/sipp.html">federal data</a> estimated that collective medical debt totaled at least $195 billion in 2019, larger than the economy of Greece. Loading…The credit card balances, which also aren’t recorded as medical debt, can be substantial, according to an <a href="https://www.jpmorganchase.com/institute/research/healthcare/spending-during-the-pandemic">analysis of credit card records</a> by the JPMorgan Chase Institute. The financial research group found that the typical cardholder’s monthly balance jumped 34% after a major medical expense.Monthly balances then declined as people paid down their bills. But for a year, they remained about 10% above where they had been before the medical expense. Balances for a comparable group of cardholders without a major medical expense stayed relatively flat.It’s unclear how much of the higher balances ended up as debt, as the institute’s data doesn’t distinguish between cardholders who pay off their balance every month from those who don’t. But about half of cardholders nationwide carry a balance on their cards, which usually adds interest and fees. Loading…Debts Large and SmallFor many Americans, debt from medical or dental care may be relatively low. About a third owe less than $1,000, the KFF poll found.Even small debts can take a toll.Edy Adams, a 31-year-old medical student in Texas, was pursued by debt collectors for years for a medical exam she received after she was sexually assaulted.Adams had recently graduated from college and was living in Chicago.Police never found the perpetrator. But two years after the attack, Adams started getting calls from collectors saying she owed $130.68.Illinois law prohibits billing victims for such tests. But no matter how many times Adams explained the error, the calls kept coming, each forcing her, she said, to relive the worst day of her life.Sometimes when the collectors called, Adams would break down in tears on the phone. “I was frantic,” she recalled. “I was being haunted by this zombie bill. I couldn’t make it stop.”Health care debt can also be catastrophic.Sherrie Foy, 63, and her husband, Michael, saw their carefully planned retirement upended when Foy’s colon had to be removed.After Michael retired from Consolidated Edison in New York, the couple moved to rural southwestern Virginia. Sherrie had the space to care for rescued horses.The couple had diligently saved. And they had retiree health insurance through Con Edison. But Sherrie’s surgery led to numerous complications, months in the hospital, and medical bills that passed the $1 million cap on the couple’s health plan.When Foy couldn’t pay more than $775,000 she owed the University of Virginia Health System, the medical center sued, <a href="https://khn.org/news/tag/uva-lawsuits/">a once common practice </a>that the university said it has reined in. The couple declared bankruptcy. The Foys cashed in a life insurance policy to pay a bankruptcy lawyer and liquidated savings accounts the couple had set up for their grandchildren.“They took everything we had,” Foy said. “Now we have nothing.”About 1 in 8 medically indebted Americans owe $10,000 or more, according to the KFF poll.Although most expect to repay their debt, 23% said it will take at least three years; 18% said they don’t expect to ever pay it off.Medical Debt’s Wide ReachDebt has long lurked in the shadows of American health care.In the 19th century, male patients at New York’s Bellevue Hospital had to ferry passengers on the East River and new mothers had to scrub floors to pay their debts, according to a <a href="https://www.press.jhu.edu/books/title/2520/care-strangers">history</a><a href="https://www.press.jhu.edu/books/title/2520/care-strangers"> of American hospitals</a> by Charles Rosenberg.The arrangements were mostly informal, however. More often, physicians simply wrote off bills patients couldn’t afford, historian Jonathan Engel said. “There was no notion of being in medical arrears.”Today, debt from medical and dental bills touches nearly every corner of American society, burdening even those with insurance coverage through work or government programs such as Medicare. Loading…Nearly half of Americans in households making more than $90,000 a year have incurred health care debt in the past five years, the KFF poll found.Women are more likely than men to be in debt. And parents more commonly have health care debt than people without children.But the crisis has landed hardest on the poorest and uninsured.Debt is most widespread in the South, an analysis of credit records by the Urban Institute shows. Insurance protections there are weaker, many of the states haven’t expanded Medicaid, and chronic illness is more widespread. Loading…Nationwide, according to the poll, Black adults are 50% more likely and Hispanic adults 35% more likely than whites to owe money for care. (Hispanics can be of any race or combination of races.)In some places, such as the nation’s capital, disparities are even larger, Urban Institute data shows: Medical debt in Washington, D.C.’s predominantly minority neighborhoods is nearly four times as common as in white neighborhoods.In minority communities already struggling with fewer educational and economic opportunities, the debt can be crippling, said Joseph Leitmann-Santa Cruz, chief executive of Capital Area Asset Builders, a nonprofit that provides financial counseling to low-income Washington residents. “It’s like having another arm tied behind their backs,” he said.Medical debt can also keep young people from building savings, finishing their education, or getting a job. One analysis of credit data found that debt from health care peaks for typical Americans in their late 20s and early 30s, then declines as they get older.Cheyenne Dantona’s medical debt derailed her career before it began.Dantona, 31, was diagnosed with blood cancer while in college. The cancer went into remission, but when Dantona changed health plans, she was hit with thousands of dollars of medical bills because one of her primary providers was out of network.She enrolled in a medical credit card, only to get stuck paying even more in interest. Other bills went to collections, dragging down her credit score. Dantona still dreams of working with injured and orphaned wild animals, but she’s been forced to move back in with her mother outside Minneapolis.“She’s been trapped,” said Dantona’s sister, Desiree. “Her life is on pause.” Loading…Barriers to CareDesiree Dantona said the debt has also made her sister hesitant to seek care to ensure her cancer remains in remission.Medical providers say this is one of the most pernicious effects of America’s debt crisis, keeping the sick away from care and piling toxic stress on patients when they are most vulnerable.The financial strain can slow patients’ recovery and even increase their chances of death, cancer researchers have found.Yet the link between sickness and debt is a defining feature of American health care, according to the Urban Institute, which analyzed credit records and other demographic data on poverty, race, and health status.U.S. counties with the highest share of residents with multiple chronic conditions, such as diabetes and heart disease, also tend to have the most medical debt. That makes illness a stronger predictor of medical debt than either poverty or insurance.In the 100 U.S. counties with the highest levels of chronic disease, nearly a quarter of adults have medical debt on their credit records, compared with fewer than 1 in 10 in the healthiest counties. Loading…The problem is so pervasive that even many physicians and business leaders concede debt has become a black mark on American health care.“There is no reason in this country that people should have medical debt that destroys them,” said George Halvorson, former chief executive of Kaiser Permanente, the nation’s largest integrated medical system and health plan. KP has a relatively generous financial assistance policy but does sometimes sue patients. (The health system is not affiliated with KHN.)Halvorson cited the growth of high-deductible health insurance as a key driver of the debt crisis. “People are getting bankrupted when they get care,” he said, “even if they have insurance.” Washington’s RoleThe Affordable Care Act bolstered financial protections for millions of Americans, not only increasing health coverage but also setting insurance standards that were supposed to limit how much patients must pay out of their own pockets.By some measures, the law worked, <a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.0369">research shows</a>. In California, there was an 11% decline in the monthly use of payday loans after the state expanded coverage through the law.But the law’s caps on out-of-pocket costs have proven too high for most Americans. Federal regulations allow out-of-pocket maximums on individual plans up to $8,700. Loading…Additionally, the law did not stop the growth of high-deductible plans, which have become standard over the past decade. That has forced many Americans to pay thousands of dollars out of their own pockets before their coverage kicks in.Last year the average annual deductible for a single worker with job-based coverage topped $1,400, almost four times what it was in 2006, according to an <a href="https://www.kff.org/health-costs/report/2021-employer-health-benefits-survey/">annual employer survey</a> by KFF. Family deductibles can top $10,000.While health plans are requiring patients to pay more, hospitals, drugmakers, and other medical providers are raising prices.From 2012 to 2016, prices for medical care surged 16%, almost four times the rate of overall inflation, <a href="https://healthcostinstitute.org/hcci-research/hmi-2018-prive-level-v-growth?highlight=WyJwcmljZSIsImluZmxhdGlvbiJd">a report</a> by the nonprofit Health Care Cost Institute found.For many Americans, the combination of high prices and high out-of-pocket costs almost inevitably means debt. The KFF poll found that 6 in 10 working-age adults with coverage have gone into debt getting care in the past five years, a rate only slightly lower than the uninsured.Even Medicare coverage can leave patients on the hook for thousands of dollars in charges for drugs and treatment, <a href="https://www.kff.org/medicare/issue-brief/medicare-part-b-drugs-cost-implications-for-beneficiaries-in-traditional-medicare-and-medicare-advantage/">studies show</a>.About a third of seniors have owed money for care, the poll found. And 37% of these said they or someone in their household have been forced to cut spending on food, clothing, or other essentials because of what they owe; 12% said they’ve taken on extra work.The widespread burden of medical debt has sparked new interest from elected officials, regulators, and industry leaders.In March, following warnings from the Consumer Financial Protection Bureau, the major <a href="https://www.washingtonpost.com/business/2022/03/18/medical-debt-removed-from-credit-reports/">credit reporting companies said</a> they would remove medical debts under $500 and those that had been repaid from consumer credit reports.In April, the <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/04/11/fact-sheet-the-biden-administration-announces-new-actions-to-lessen-the-burden-of-medical-debt-and-increase-consumer-protection/">Biden administration announced</a> a new CFPB crackdown on debt collectors and an initiative by the Department of Health and Human Services to gather more information on how hospitals provide financial aid.The actions were applauded by patient advocates. However, the changes likely won’t address the root causes of this national crisis.“The No. 1 reason, and the No. 2, 3, and 4 reasons, that people go into medical debt is they don’t have the money,” said Alan Cohen, a co-founder of insurer Centivo who has worked in health benefits for more than 30 years. “It’s not complicated.”Buck, the father in Arizona who was denied care, has seen this firsthand while selling Medicare plans to seniors. “I’ve had old people crying on the phone with me,” he said. “It’s horrifying.”Now 30, Buck faces his own struggles. He recovered from the intestinal infection, but after being forced to go to a hospital emergency room, he was hit with thousands of dollars in medical bills.More piled on when Buck’s wife landed in an emergency room for ovarian cysts.Today the Bucks, who have three children, estimate they owe more than $50,000, including medical bills they put on credit cards that they can’t pay off.“We’ve all had to cut back on everything,” Buck said. The kids wear hand-me-downs. They scrimp on school supplies and rely on family for Christmas gifts. A dinner out for chili is an extravagance.“It pains me when my kids ask to go somewhere, and I can’t,” Buck said. “I feel as if I’ve failed as a parent.”The couple is preparing to file for bankruptcy.<h4>About This Project</h4>“Diagnosis: Debt” is a reporting partnership between KHN and NPR exploring the scale, impact, and causes of medical debt in America.The series draws on the “<a href="https://www.kff.org/health-costs/report/kff-health-care-debt-survey/">KFF Health Care Debt Survey</a>,” a poll designed and analyzed by public opinion researchers at KFF in collaboration with KHN journalists and editors. The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.Additional research was <a href="https://www.urban.org/research/publication/which-county-characteristics-predict-medical-debt">conducted by the Urban Institute</a>, which analyzed credit bureau and other demographic data on poverty, race, and health status to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.The JPMorgan Chase Institute <a href="https://www.jpmorganchase.com/institute/research/healthcare/spending-during-the-pandemic">analyzed records</a> from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses.Reporters from KHN and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.<a href="https://www.khn.org/about-us">KHN</a> (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at <a href="https://www.kff.org/about-us">KFF</a> (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.<a href="https://khn.org/morning-briefing/">Subscribe</a> to KHN's free Morning Briefing.<img src="https://ssl.google-analytics.com/collect?v=1&t=event&ec=Republish&tid=UA-53070700-2&z=1655472248871&cid=db6197ea-b9e7-4f43-bdd4-a7a87e7f6d60&ea=https%3A%2F%2Fkhn.org%2Fnews%2Farticle%2Fdiagnosis-debt-investigation-100-million-americans-hidden-medical-debt%2F&el=100%20Million%20People%20in%20America%20Are%20Saddled%20With%20Health%20Care%20Debt"/>

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Investing

Alternative

Precious Metals

2023 Gold Price Predictions, Trends, & 5-Year Forecast

by Investing Professor on January 12, 2023

Most price forecasts aren’t worth more than an umbrella in a hurricane. There are so many factors, so many ever-changing variables, that even the experts usually miss the mark. But there is value in considering predictions. It can solidify why one has invested, point to factors that may have been overlooked, or compel one to revise their expectations. So while we take predictions with a grain of salt, let’s look at what might be ahead for gold in 2023, as well as the next five years. I’ll start with a survey of analysts, then examine the individual factors that are likely to have the biggest impact on gold, and then conclude with the prices I see based on those factors, including some long-term projections. This will be fun, so let’s jump in! Gold Price Prediction Chart Gold ended 2022 at $1,825 per ounce, so let’s see where some analysts forecast it goes this year. These are predictions I gathered from analysts both inside and outside of the gold industry. Billionaires Agree: Own This Asset To Protect Your Portfolio The world’s wealthiest investors are buying the one asset class that historically outperforms everything else during high inflation. Learn how easy it is for everyday folks to invest alongside billionaires and protect portfolios of any size today with this free guide. You’ll see how one simple allocation change can preserve your savings for decades to come. Learn More There were some interesting comments that accompanied these forecasts. ● Ole Hansen: “In general we are looking for a price friendly 2023, supported by recession and stock market valuation risks — an eventual peak in central bank rates combined with the prospect of a weaker dollar and inflation not returning to the expected sub-3% level by year-end — all adding support. The gold price will be higher once markets realize global inflation will remain hot despite monetary tightening.” ● Juerg Kiener wrote that many economies could face “a little bit of a recession” in the first quarter, which would lead to many central banks slowing their pace of interest rate hikes and make gold instantly more attractive. He added, “Gold is also the only asset which every central bank owns.” ● In the bank and institutional investor survey, we’ll note the group is notoriously bearish. That said, Bank of America wrote “gold could top $2,000 an ounce next year.” Citigroup analysts said, “elevated risks of a global recession could boost inflows into gold funds, with prices potentially breaking out by mid-2023 to average more than $1,900.” ● JC Parets’ prediction is interesting because he’s known as a long-time gold bear. “There is a good chance the gold market sees a major move, it’s not going to be just 10% or 20%, but a move that will really make new highs… the fact that bullion prices haven’t sunk means there are buyers who are helping keep the price robust… from less than $425 in 2004 to $1,900 in 2011, gold gained around 350%. A similar move would see prices above $8,000.” ● Frank Holmes wrote, “Since the year 2000, gold has been up 80% of the time.” ● Eric Strand: “It is our opinion that central banks will pivot on their rate hikes and become dovish during 2023, which will ignite an explosive move for gold for years to come. We therefore believe gold will end 2023 at least 20% higher.” ● George Milling-Stanley: “Gold has nothing to fear from interest-rate hikes. It’s the impact of rate increases on the dollar that is important. If the dollar has peaked, I expect to see gold above $2,000 again this year… history suggests that when gold is in a sustainable long-term uptrend, which has been in place since the price last touched $250 in 2001, prices tend to move up stepwise, consolidating at every stage in the upward march.” There were some bearish predictions too, of course, the most common reason cited was the belief that interest rates will continue to rise and inflation will fall, each of which they believe will soften demand. Gold Price Predictions for Next 5 Years Let’s examine the factors that are most likely to impact gold in 2023 and the next few years and see if we can come up with a reasonable expectation. We’ll start with the big three—inflation, recession, and interest rates… Inflation. One big question is how far inflation might fall. The CPI peaked at 9.1% last June, the highest rate in almost 40 years, and ended the year at 7.1%. This chart shows the CPI reading for the last 18 months. As a reminder, the Fed and government economists said inflation would be “transitory” in April 2021—which was obviously wrong. Further complicating the inflation question is the Fed’s insistence that it will lower the CPI to 2%. But… This begs us to ask… can we trust their forecasts? How effective will the Fed’s aggressive rate hikes be? And what if inflation remains above their 2% target for—gulp—years? Recession. The odds of a recession are high; the most reliable indicator of an upcoming recession is a negative yield curve (10-Year Treasury minus 2-year), and it went negative in Q3 last year. How does gold perform during recessions? Gold has historically risen during recessions. In some cases the gains were substantial, and the only two declines were single digits. Interest Rates. How much more can the Fed realistically raise rates? It’s a fair question, because between the aggressive rate hikes and surging debt levels, payments on federal debt are now at record highs. This is the steepest rise in history. It’s a path that is clearly unsustainable. Further, will the Fed continue to hike rates if the public and investors begin to grumble if we enter a recession and stock markets continue to fall? And here’s something you may find surprising… since the 1950s, the average time from the last rate hike to the first rate cut is just five months! This suggests that if the Fed ends rate hikes in 2023, it is entirely plausible it could begin cutting them before the year is over. This would be very bullish for gold. U.S. Dollar. One of the factors that kept gold from rising in 2022 was the soaring U.S. dollar, since gold and the dollar are typically inversely correlated. Does the dollar cool off in 2023? It wouldn’t be surprising to see a pullback, given the extent of the gain last year. If so, one of gold’s biggest barriers will be removed. Vulnerable Stock Markets. The S&P 500 fell 19.4% in 2022, while the Nasdaq crashed 33.1%. After that shellacking, one could easily be convinced that stocks will bounce. But if inflation persists, rate hikes continue, and a recession materializes, equities will face several strong headwinds. This table shows gold’s performance during the 10 biggest crashes in the S&P 500. Green means gold rose during the crash, red means it fell more than stocks, yellow means it fell but less than stocks. Gold is historically inversely correlated to stocks, an ideal hedge to weak markets. If we see further stock market weakness or a crash in 2023, gold is likely to rise. Resumption of QE? The Financial Times says the cycle of global liquidity is bottoming out. “Quantitative easing programmes by central banks to support markets are impossible to reverse quickly because the financial sector has become so dependent on easy liquidity.” It’s a fair point, since… ● The very act of quantitative tightening creates systemic risks that demand more QE. A resumption of QE is exactly what money manager Marc Faber said he expects in 2023. Meanwhile, President Biden signed a $1.66 trillion bill funding the U.S. government for fiscal year 2023. The budget remains deep in deficit. Central Banks. Central bank buying lends support to the price. This may explain why gold didn’t fall in 2022. As a group, central banks bought more gold through Q3 last year than any year since 1967, ironically when the U.S. was on a gold exchange standard. According to the World Gold Council, demand was “primarily driven by a flight towards safer assets.” China, for the first time in three years, bought more gold for its official Reserves. It purchased 32 tonnes in November, its total now at 1,980 tonnes. Cleary, the world’s central banks see something that compels them to make an overweight allocation to gold at this time. Gold’s Technical Picture. A number of chartists have pointed out that gold has a strong technical setup. Here’s what Silver Chartist says in their chart below: “Last month gold staged a clean breakout above the 2022 red downtrend line, suggesting a major trend reversal is underway. Of course, nothing moves in a straight line, but higher highs and higher lows are expected and gold’s prospects for 2023 look bright.” While the precise timing of an up-move is hard to pinpoint, it suggests a surge is coming in 2023. Add It All Up. This combination of factors shows there are multiple catalysts that could propel gold higher in both the short-term (one-year) and long-term (two to five years), even if one or more doesn’t play out. And that’s a big advantage of gold ownership: it isn’t about one factor or another, it’s about any factor that increases uncertainty on the part of investors. And there are a lot of risks surrounding us at this point that could drive investors into gold. Due to all these factors, my most confident prediction is that over the next few years, possibly longer, the gold price will be trading at much higher prices than where it is now, regardless of what it may do this year. 2023 Gold Price Prediction My forecast for the gold price in 2023 is based on the likely trajectory of inflation, recession, interest rates, stock markets, U.S. dollar, central bank demand, QE, and technical indicators. As a result, I expect the gold price to be higher in 2023. Here are my predictions. The most important message from this analysis is that even if I’m wrong, it has rarely been more important to own gold. That means dips in price should be bought, especially if they don’t hold a meaningful amount relative to your net worth. Either way, remember to… ● Make sure you own actual gold, that is actually yours. We hope you have enjoyed this article. If you agree that now is a good time to own precious metals, log in to your Hard Assets Alliance account, check your exposure, and consider adding to your physical metal positions today. Log in to Buy Gold and Silver Don't have an account? Signing up is easy. It only takes 5 minutes to set up and start precious metals investing. With Hard Assets Alliance you get: • Trusted Platform with $3B+ in assets and more than 100,000 investors. • Liquidity when you need it – buy or sell 24/7 – just like trading stocks • Secure storage with global vault options and on-demand home delivery • Automatic investing with MetalStream, as low as $25/month • Amazing potential tax benefits with precious metals IRAs • Real help via phone, email, or chat from our U.S.-based team Open Your Account Need assistance? Call us at 1-877-727-7387 (we're open 9am to 6pm ET) or reply to this email.

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Growth

How to Get a Third More Value out of Every Ounce of Gold

by Hard Assets Alliance on December 19, 2020

People invest in gold because, in times of inflation and extraordinary amounts of money printing, gold and silver have a tendency to rise. But do they? Astute investors see what precious metals are really doing… and that is maintaining purchasing power. Gold doesn’t go up in value, the dollar drops when priced in gold. Unfortunately, Uncle Sam doesn’t think that way... The way the IRS sees it, the dollar is not worth less – gold went up. And, if you want to realize that relative gain, you must pay taxes on it. And here’s the rub: real physical gold and silver get the short end of the stick on taxes... When you’ve held gold for a long time either in anticipation of a financial crisis or simply to preserve wealth… All looks good until you file your taxes and find out that – unlike equities and other capital gains, which get a favorable tax treatment – gold held for more than one year is taxed as collectibles, not investments. That means precious metals are taxed as high as 28%, much higher than long term capital gains. That’s a sizable bite out of your gains – just at the time you probably want to use that money for another investment. Thankfully, there is a simple way, open to every American, to change that. You just have to make one simple move... If you invest in gold inside a retirement account you could greatly reduce, or even eliminate, your tax bill on that investment. You are probably already aware: investments inside a qualified retirement account in the US grow tax deferred, and in some cases they can even be withdrawn tax free. But did you realize this has a bigger impact on precious metals than on say stocks or bonds? That’s because if you sell your gold or silver for a profit inside an IRA, you don’t get hit with that large collectible tax bill. You can control when and how you are taxed. For example, because that cash stays in your retirement account – tax-deferred until you need to take it out – it can be reinvested in full, with no need to hold anything back for the tax man. If you post $100,000 in gains, for example, instead of paying taxes and then reinvesting the $75k or so left over into stocks, bonds, oil, or whatever is next for you… you get to invest the full lot, compounding the speed at which your investments grow. If you need to withdraw the money to live in retirement, there are still benefits. For example, because retirement gains are taxed as income when withdrawn, then taking your earnings out in smaller chunks over a few years can help keep your tax bracket down and minimize what you pay. And those examples are just if you are using a “traditional” or pre-tax retirement savings account – the run of the mill IRA or funds you rolled over from an old 401(k). If you are eligible for and savvy enough to have invested some dollars in a “Roth” account, then any of the gains you make on your gold will be tax free when you withdraw them, too. Same benefit to compounding growth and no taxes to worry about on the far end. The point is, investing in gold through an IRA gives you options... You get the flexibility and liquidity of a brokerage account with your choice of tax advantages for holding what many people view as the ultimate safe haven asset: physical precious metals. And ultimately, if the value of your gold rises and you want to rebalance when other assets are relatively cheaper, you get more hedge for your dollar. Perhaps no asset is more suited to an IRA than gold. That’s why Hard Assets Alliance has launched a new, easy and secure way to open a gold IRA and start enjoying all its benefits right away. Open a Gold IRA in 5 Minutes • Invest in physical gold or silver for retirement • Ability to enjoy tax benefits including income deductions and tax-deferred or tax-free distributions • Easily rollover from a 401k, or transfer from an existing IRA • With help from our expert custodian partners at Equity Trust available every step of the way • Get more hedge for your dollar invested by combining gold with an IRA For more postings by Hard Asset Alliance, click HERE Website: https://www.hardassetsalliance.com/?aff=TWC WealthCare Connect may receive a referral fee from Hard Asset Alliance for purchases make through these links.

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Legal

Win Without Going to Trial

by How to Win in Court on January 4, 2021

Do you know how to win before trial? Lawyers drag out cases so they can bill for more time. You don't have to wait for trial to win! You aren't billing for your time! Many pro se litigants fail to do things "the right way" as JurisDictionary® explains. Then they get trapped into going through a full-blown trial where time constraints and nervous pressure makes winning difficult. If you have a winnable case, my course shows you how to win before trial. Do you have the winning facts and law on your side? Then learn how to win before trial! 1. There is no evidence you cannot get in before trial. 2. There are no witnesses you cannot question under oath before trial. 3. There are no documents or things you cannot get in before trial. 4. There are no legal arguments you cannot make before trial. 5. There is nothing going to happen at trial that cannot be made to happen before trial. The "trying" of your case with the first pleading and continues with discovery and motions before trial. Common reasons cases go to trial are: 1. Lazy lawyer didn't do the pre-trial work he could have done. 2. Stupid lawyer didn't know how to do the pre-trial work he could have done. 3. Greedy lawyer didn't want to do the pre-trial work he could have done. 4. No lawyer had no idea how to do the pre-trial work that could have been done ... pri-trial work you will learn in this case-winning tactics course.. Don't wait for trial! 1. Trial is uncertain, especially with unpredictable juries and crooked lawyers. 2. Trial is "think on your feet" with opponent trying to throw you off with objections. 3. Trial is a nasty battle against lawyers' willing to cheat if they can. 4. Trial is a last bite at the apple, with no take backs and no retreats. Win before trial ... and do it without a lawyer! It's easier than you may imagine! Learn How to Win in Court – For information on the “How to Win in Court” online course, click HERE For more JurisDictionary content, click HERE Website: https://www.howtowinincourt.com?refercode=SR0094 WealthCare Connect may receive a referral fee from Juris Dictionary for purchases make through these links.

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Healthcare

BILL OF THE MONTH: His-and-Hers Cataract Surgeries, But His Bill Was 20 Times as Much

by HealthCare Professor on July 7, 2022

<h1>His-and-Hers Cataract Surgeries, But His Bill Was 20 Times as Much</h1> <div> Angela Hart Photos by <a href="https://khn.org/news/author/heidi-de-marco/">Heidi de Marco</a> <time class="posted-on" datetime="2022-06-27T05:00:00-04:00"> June 27, 2022 </time> </div> Danilo Manimtim’s vision was cloudy and blurred — and it was growing worse. The 73-year-old retired orthopedic surgeon in Fresno, California, knew it was time for cataract surgery. “It’s like car tires wearing out because you drive on them so much,” he said.In December 2021, he went to the outpatient department of the local hospital to undergo the common procedure that usually replaces the natural eye lens with an artificial one and is designed to restore vision. The outpatient procedure went smoothly, and Manimtim healed over the next few weeks.Manimtim, who since retiring took a job evaluating disability claims for the state of California, knows the health care system and keeps tabs on his health benefits. He knew he already had met his health insurance deductible for the year, so he expected a manageable out-of-pocket expense for the surgery. He calculated his coinsurance would be about $750.Then the bills came.Patient: Danilo Manimtim, 73, of Fresno, California. He is insured through his employer by Anthem Blue Cross of California for outpatient care and is covered by <a href="https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medicare">Medicare for hospitalization</a>.Total Bill: Overall, the charges were $9,084 for surgery, anesthesia, medical supplies, pharmacy, and clinical laboratory services. Anthem paid $5,027 and initially billed Manimtim $4,057.Service Providers: <a href="https://www.trinity-health.org/our-impact/community-health-and-well-being/community-benefits/saint-agnes-medical-center-fresno/">Saint Agnes Medical Center</a>. It is part of Trinity Health, <a href="https://www.trinity-health.org/about-us/facts-and-figures-financial-strength">a nonprofit hospital system headquartered in Michigan</a> with 88 hospitals and 125 urgent care centers <a href="https://www.trinity-health.org/our-communities/">across the country</a>. The hospital system brought in nearly <a href="https://emma.msrb.org/P11532559-P11184577-.pdf">$20.2 billion</a> in revenue for the most <a href="https://www.beckershospitalreview.com/finance/trinity-health-s-annual-revenue-hits-20-2b.html#:~:text=Trinity%20Health%20reported%20higher%20revenue,1">recent fiscal year</a>.Medical Service: Cataract surgery as an outpatient, involving anesthesia.What Gives: Manimtim’s big bill stems from a simple decision that turned out to be a pitfall in the nation’s complicated health care system: He scheduled his surgery at a nearby hospital — a hospital that happened to charge about $7,000 more for the procedure than his insurer would pay.Manimtim has proof that it could have been different right under his own roof: Four months later, his wife, Marilou Manimtim, 66, got the exact same procedure at an outpatient eye care surgical center in Fresno called <a href="https://eyeqvc.com/eye-q/">EYE-Q</a>. It is a half-mile from Saint Agnes Medical Center but is not affiliated with the hospital.Both patients have the same insurance coverage through Anthem Blue Cross of California; they had identical cataract surgeries; and both providers were in Anthem’s coverage network. Marilou owed $204, while Danilo was on the hook for a staggering $4,057.“This is ridiculous, and it feels very unfair,” Danilo Manimtim said. “How can it be so much more expensive than the surgical center? It’s walking distance away, and if I would have gone there, I would have saved myself a lot of money.” Manimtim’s insurance plan, via his employer, the California Public Employees’ Retirement System, caps payment for outpatient cataract surgery at $2,000, according to Anthem. CalPERS instituted a <a href="https://www.healthaffairs.org/do/10.1377/forefront.20150707.049155/full/">“reference pricing” system in recent years</a>, in which it determines a reasonable price for a high-quality procedure of that type in California. It then reimburses only up to that amount, encouraging patients to shop for treatment priced under the bar. For the cataract surgery itself, patients in Manimtim’s plan are on the hook for any charges above $2,000.Even for hospital-based care, Saint Agnes’ overall charges are high for cataract surgery, said Dr. <a href="https://www.wellrithms.com/leadership-team-bios-iw">Ira Weintraub</a>, chief medical officer for <a href="https://www.wellrithms.com/">WellRithms</a>, which analyzes health care prices for employers. “The hospital charged three to four times the amount of what this surgery typically costs, which is around $3,000.”“Nobody gets $9,000 for cataract surgery,” he added.If Manimtim had opted for Medicare Part B, the part of the Medicare program that covers outpatient care, he likely would have been on the hook for only <a href="https://www.medicare.gov/procedure-price-lookup/cost/66982/">about $565</a>, a Medicare cost comparison tool shows. Medicare pays a set amount for procedures regardless of where they are performed.But like many older Americans who are still working, Manimtim chose not to sign up for that coverage, instead opting for his employer’s plan because his monthly premium would be significantly cheaper.Health care prices often have very little to do with the actual costs of providing the care and its quality — and patients often face the “double whammy” of high prices and complex benefits, said Anthony Wright, executive director of Health Access California, a nonprofit advocacy group. Too often, patients are on their own to figure out high prices and complex benefits, he said.“You wonder what is the rationale for any of the prices in our health care system,” Wright said.Resolution: After inquiries by KHN, Anthem contacted the hospital, Saint Agnes, seeking help for Manimtim. Although the doctor is responsible for requesting an exemption from CalPERS’ $2,000 limit on payments for cataract surgery under Manimtim’s plan, that didn’t happen before his surgery. Anthem asked the hospital and doctor to consider the request post-surgery, said Anthem spokesperson Michael Bowman.Saint Agnes spokesperson Kelley Sanchez told KHN that the hospital and provider later requested the exemption that would allow the insurer to pay more than the $2,000 limit and that it was ultimately approved by Anthem. That is expected to leave Manimtim with a much smaller coinsurance bill, around $750 — and get him off the hook for being taken to collections by the hospital. The hospital will receive a higher payment from Anthem, which will cover a large portion of the remaining $4,057 bill.And that high payment, like all high payments, contributes to rising health insurance payments for all.Sanchez said the hospital isn’t in the price-gouging business but noted that hospitals generally have higher costs and tend to charge more than outpatient facilities.“We never want to cause harm or create hardship for our patients, and that extends to our billing practices,” Sanchez said in a prepared statement.She noted that Saint Agnes has financial assistance programs available and encourages patients to ask questions and understand potential costs before seeking care. “Every patient’s insurance plan is unique so it is their responsibility to understand their plan benefits,” she wrote. “It’s still complicated and we recognize that, and will continue to work toward greater price transparency.”The Takeaway: The bottom line for patients, experts say, is to be sure to read the fine print of insurance coverage plans to understand all out-of-pocket responsibilities, including premiums, deductibles, copays, and coinsurance. Also, a small number of large employers that self-insure are <a href="https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/reference-based-pricing-lowers-health-plan-costs.aspx">using reference pricing</a>, putting caps on what they’ll pay for common procedures. Shop around, and ask about prices on the front end if possible.“People often focus on premiums because they are easy to compare, but premiums don’t tell the full story, and this example illustrates the trade-offs,” said Tricia Neuman, <a href="https://www.kff.org/person/tricia-neuman/">a Medicare expert at KFF</a>. <h4> Related Links </h4> <ul><li> <a href="https://khn.org/news/article/surprise-medical-bill-colonoscopy-screening-versus-diagnosis/"> Her First Colonoscopy Cost Her $0. Her Second Cost $2,185. Why? </a> </li> <li> <a href="https://khn.org/news/article/call-it-mexicare-fed-up-with-high-medical-bills-a-family-crosses-the-border-for-health-care/"> After Medical Bills Broke the Bank, This Family Headed to Mexico for Care </a> </li> <li> <a href="https://khn.org/news/article/the-case-of-the-489000-air-ambulance-ride/"> The Case of the $489,000 Air Ambulance Ride </a> </li> <li> <a href="https://khn.org/news/article/nicu-surprise-bill-loophole-no-surprises-act/"> An $80,000 Tab for Newborns Lays Out a Loophole in the New Law to Curb Surprise Bills </a> </li> </ul>Anthem spokesperson Bowman urged patients to use the online Anthem “<a href="https://www.anthem.com/find-care/">care finder</a>” to compare patient costs and find a cheaper option if one is available. Had Manimtim done that, he might have seen that getting his cataract surgery at an outpatient surgical center would have been much cheaper. But the details of provider cost and insurance coverage can be idiosyncratic and are often not displayed in a patient-friendly manner. Manimtim did try to explore his benefits before the procedure, he said, but did not get a clear answer from the insurer or hospital.Manimtim also had advice for consumers: If you receive a medical bill and don’t understand the charges, don’t pay right away. Instead, call your provider and insurer to ask about the charges and whether there are ways to lower your bill.“People need to be more informed by the insurance companies and hospitals about what options they have, to prevent overbilling,” Manimtim said. “A lot of people don’t know this could happen to them.”Stephanie O’Neill contributed the audio portrait with this story.Bill of the Month is a crowdsourced investigation by <a href="https://khn.org/news/tag/bill-of-the-month/">KHN</a> and <a href="https://www.npr.org/sections/health-shots/2018/02/16/585549568/share-your-medical-bill-with-us">NPR</a> that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? <a href="https://khn.org/send-us-your-medical-bills/">Tell us about it!</a>This story was produced by <a href="https://khn.org/">KHN</a>, which publishes <a href="http://www.californiahealthline.org/">California Healthline</a>, an editorially independent service of the <a href="http://www.chcf.org/">California Health Care Foundation</a>.<a href="https://www.khn.org/about-us">KHN</a> (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at <a href="https://www.kff.org/about-us">KFF</a> (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.<a href="https://khn.org/morning-briefing/">Subscribe</a> to KHN's free Morning Briefing.<img src="https://ssl.google-analytics.com/collect?v=1&t=event&ec=Republish&tid=UA-53070700-2&z=1657201777995&cid=38c876f6-4456-458a-ae45-51a33c595e3d&ea=https%3A%2F%2Fkhn.org%2Fnews%2Farticle%2Fhis-and-hers-cataract-surgeries-but-his-bill-was-20-times-as-much%2F&el=His-and-Hers%20Cataract%20Surgeries%2C%20But%20His%20Bill%20Was%2020%20Times%20as%20Much"/>

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Retirement

Social Security

Medicare

Tax

Which State Offers You The Best Tax Advantages for Your Retirement?

by WealthCare Blogs on August 29, 2022

Ah, retirement. Fun in the sun, golf and lemonade by the pool are the dream of every working person. While you’re welcome to retire anywhere you want, where you choose to retire can have a significant effect on your finances and retirement lifestyle. The right state for your retirement will depend on your level and sources of income. Different states have different tax laws that can really make a difference in the amount of money you'll have left over in your pocket at the end of each month. It’s financially smart to consider your financial situation and sources of retirement income before you choose. During retirement, determining your best taxation situation depends on more than just seeing if your state has a state income tax or not. For example, your favorite state might have a state income tax, but not tax pension income. So, if pension income is your main source of income, it might still benefit you financially to consider that state. Let's look at the 4 main taxes different states apply to varying degrees: Taxes on Pension Income. Currently, there are only three states that don’t tax pension income. Those states are Mississippi, Illinois, and Pennsylvania. If you have a military or government pension, there are several more tax-free options: New York, Michigan, Hawaii, Kansas, Louisiana, Massachusetts, and Alabama. Other states tax your pension income to varying degrees. Do your homework if you receive a pension as part of your retirement income. Sales Taxes. If you don't want to pay any sales tax, then Alaska, New Hampshire, Oregon, and Montana are your answer. Of course, sales tax rates vary from state to state. Also, some states exempt certain items like food and medical care / medical supplies. Take a look before you make the leap. The more you like to shop, the more sales tax will detract from your bottom line. Property Taxes. If you own an expensive home or multiple properties, property taxes can be significant. Property taxes are largely a function of property values, so you can limit your property taxes by living in an area with lower real estate prices. Keep in mind that city and local taxes can be a significant portion of property taxes. Find out what you can expect to pay in property taxes before you choose your retirement location. In certain areas, it might even make sense to rent instead of own property. Taxes on social security benefits. There are 36 states (and Washington D.C.) that do not tax social security benefits. The other states do tax to some degree, though most of these states have limits to the amount that can be taxed. Thankfully, there are a lot of ways you can avoid paying taxes on social security. The degree to which this tax impacts you will depend on your other sources of income. If your only income is from social security, this tax will matter more to you. This tax will be minimal for most folks, but be sure to find out how it may impact your situation in your desired locale. Now that you know the main taxation issues that can affect your retirement funds differently in each state, you may want to really dig into the information that's available online to make a wise choice. Visit the Department of Revenue website for each state that interests you as a possible retirement location. The information is easy to find and available to everyone. Everyone dreams of retiring to the perfect location, but some locations are more retirement friendly than others. If you'll do your homework before you move, it's a lot more likely that your move will be a happy one. Make an informed decision and enjoy your retirement! The information, views, and opinions provided or expressed by authors or publishers on WealthCare Blogs are for general education and entertainment purposes only. No advice or recommendations are provided. You should consult with an appropriately licensed wealthcare professional or do your own due diligence before making any wealthcare decisions.

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Retirement

Aging Parents, Isolation And The Painful Family Holiday Choices

by Aging Parents on December 15, 2020

This is the strangest holiday season of a lifetime, isn’t it? We get warnings about not visiting during holidays of all kinds and the rates of infection keep going up. Given that it’s inarguable now that the rates of infection by Covid-19, hospitalizations and ICU admissions are worse that ever, we have to consider the painful question before us: is it worse to visit our elders this season or is it worse to stay away? It’s individual, as situations vary. We see our aging parents, perhaps on Zoom, lonely and in need of company. We can talk on the phone with them, but there are many limitations. One 98 year old client of ours at AgingParents.com can speak on the phone but he’s quite hard of hearing. Calls tend to be brief. And he gets confused by Zoom. His company is his caregivers. At least they can come to his home and he can afford to pay for in-home care. Some seniors have little contact with others now in person. Technology is sometimes difficult enough for Boomers, and imagine how odd it feels for those Boomers’ parents, many of whom are in their 80s and 90s or older. For those with dementia, it is even worse. Difficulty learning new information is a characteristic of dementia and learning how to be on a video call is definitely new information for many. Yet, the emotions aging parents with dementia or other conditions feel are just as real as they are for anyone else. No one likes to be lonely and cut off from whatever fun they used to enjoy before the pandemic. Lonely aging parents need to be protected from exposure to Covid-19 When anyone asks me for advice about which is worse, possible exposure to Covid-19 from an asymptomatic person or serious depression and loneliness, I say possible exposure to disease. At least we have some ways we can address loneliness, as well as depression. We can make those phone calls to aging loved ones who are away from us, even if they’re very short because of hearing loss, confusion or anything else. We can try video calls when anyone in the house is capable of helping with logging on or using technology like FaceTime. We can coordinate with our aging parents’ physician, in the event that they are looking so depressed you are very worried about it. Medication does work for most depressed folks and Medicare pays for standard medications to treat depression. Adult children may need to be advocates for their loved ones about this. It’s unlikely that an aging person is going to tell their family they’re depressed and need medication to get by during isolation. Family can step up and ask for an evaluation of depression symptoms from the doctor. It makes sense to take the edge off painful feelings when we can, even temporarily, as current isolation finally has an end in sight. Pharmaceuticals for treating depression are readily available and they work with medical supervision for kind, dosage and eventually getting off the medications. What we know about Covid-19 now is what we knew early on when the disease ravaged nursing homes. Elders are by no means the only ones getting sick, but they have the worst mortality rate of any age group. Exposing them is not worth the risk of a holiday visit, painful as it is to forego it. They are just too vulnerable. For families who can’t bear the thought of not seeing Mom, Dad, or a grandparent during times when families always try to be together, consider that you could be saving lives if you refrain from the visit you want to have with them. I take comfort in knowing that apart from healthcare workers and those on the front lines of the fight against Covid-19, elders will be among the first to get the vaccine. That means that they have a better chance to get in front with protection and can avoid this life-threatening illness sooner than younger people can. The takeaway is that this holiday season is the time to grit your teeth and stay away from your aging parents unless you already live with them. It will not be long before we can use the first vaccines to save them from getting Covid-19. Meanwhile, do the best you can with the phone, gifts sent in the mail, flowers, cards, letters, and possibly video calls with them. Importantly, contact your aging loved one’s doctor and ask for an evaluation if what you see looks like serious depression. Appropriate medications can lift the spirits, help people function better, and help them feel more inclined to participate in whatever is offered to keep them engaged. And for all of us with elders in our lives, hang on a little longer. The vaccine will help us end this pandemic and enable us to look forward to a much better holiday season with aging parents next time around. You can feel good about staying away, as it is truly a responsible and loving act to protect those most vulnerable in our families. Carolyn L. Rosenblatt, R. N, Elder Law Attorney, co-founder of AgingParents.com and AgingInvestor.com

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Healthcare

Bill Of The Month: The Ambulance Chased One Patient Into Collections

by HealthCare Professor on August 4, 2022

The Ambulance Chased One Patient Into Collections Bram Sable-Smith July 27, 2022 In retrospect, Peggy Dula said, she shouldn’t have taken the ambulance. She was the least injured of the three siblings who were in a car when it was struck by a pickup truck last September. Her daughter had even offered to come to the crash site and pick her up. Jim Martens, 62, and Cynthia Martens, 63, Peggy’s brother and sister, were more seriously hurt and on their way to the hospital in separate ambulances. Peggy, 55, was told it would be a good idea for her to get checked out, too. So she accepted a ride with a third ambulance crew. When the wreck happened, the siblings were going to see the horses that Peggy’s daughter trains at a barn west of Peggy’s home in St. Charles, Illinois, about 45 miles outside Chicago. Peggy, who was driving on unfamiliar country roads, pulled into an intersection, mistakenly thinking it was a four-way stop. The truck slammed into the car’s side, spinning it into an electrical box. Cynthia, who wasn’t wearing a seat belt in the back seat, spent five days in the hospital with a brain bleed, a cracked rib, and a bruised lung. Jim also had fractured ribs, which he learned days later — only after he was back home in Tampa, Florida. Peggy was “a little stunned” but mostly unhurt as three ambulances descended on the crash site, alerted by 911. She was seen briefly in an emergency room and went home with just a bruised sternum, grateful she had dodged major injury. Then the bill came. The Patient: Peggy Dula, 55, who works in a fine jewelry store in Geneva, Illinois. Total Bill: $3,606 for ambulance services. Service Provider: Pingree Grove and Countryside Fire Protection District, a fire district serving more than 50 square miles near Elgin, Illinois. Medical Services: An ambulance ride to a nearby hospital and brief medical evaluation. What Gives: All three siblings were charged for the same service: “Advanced Life Support Emergency Level 1.” It’s code for transportation by a ground ambulance in response to a 911 call, and it can include medical services as simple as an assessment. All three were also charged a mileage fee. Jim and Cynthia were billed for 15 miles; Peggy was billed for 14 miles. But because they rode in separate ambulances, each from a different nearby fire protection district, they were billed three separate amounts: Cynthia was billed $1,250 — $1,100 for life support and $10 per mile — by Burlington Community Fire Protection District. Jim was billed $1,415 — $1,265 for life support and $10 per mile — by Hampshire Fire Protection District. Peggy was billed $3,606 — $3,186 for life support and $30 per mile — by Pingree Grove and Countryside Fire Protection District. And although private, for-profit ambulance companies have become notorious for pricey bills, Peggy and her siblings were being billed by taxpayer-funded fire departments. How could charges for the exact same services vary so widely? “The simple answer is that these bills are all made up,” said Dr. Karan Chhabra, a surgical resident at Brigham & Women’s Hospital in Boston and a former research fellow at the University of Michigan. In a 2020 paper published in the journal Health Affairs, Chhabra and his colleagues looked into surprise ambulance bills by analyzing a large national insurer’s claims data from 2013 to 2017. They found that 71% of ambulance rides were out of network, meaning the ambulance companies were not bound by a rate that was negotiated in advance with the insurer and could basically charge whatever they want. Even local fire departments can decline to join local insurance networks. “It often is the municipalities that are sending some of the most staggering bills and often pursuing them in really aggressive ways,” Chhabra said. The Pingree Grove and Countryside Fire Protection District’s chief, Kieran Stout, said their charges are in keeping with the federal Ground Emergency Medical Transportation program, which allows some public emergency services to receive supplemental payments for transporting patients on Medicaid, the state-federal health insurance program for people with low incomes. Ambulance services fill out a cost report, and if their average cost per ride is higher than the set rate Medicaid pays, they get paid the difference. Hampshire Fire Protection District uses the same program to determine the rates they bill, and the Burlington Community Fire Protection District recently began the cost report process as well. But ambulance services can get their full supplemental amount even if they charge non-Medicaid patients less than that average, said Jim Parker of the University of Illinois Office of Medicaid Innovation. The program is relatively new, though, and some services mistakenly think they need to raise their charges for every patient in order to participate, Parker said. So for Medicaid patients, the program will pay the difference between the ambulance company’s costs and the standard Medicaid payment. But for patients with private insurance, like Peggy, the fire protection district bills patients directly for the balance not covered by their insurance, Stout said, a practice known as balance billing. He added that the district only balance-bills patients who live outside the district. In the case of Peggy’s accident, all three siblings lived outside all three districts. (Jim and Cynthia both eventually received settlements from Peggy’s car insurance.) Congress took aim at balance billing with the No Surprises Act, which went into effect Jan. 1. The law limits the patient’s responsibility for most surprise bills, such as those from an out-of-network anesthesiologist who puts a patient to sleep for surgery at an in-network hospital or for a ride in an air ambulance, almost all of which are privately owned. But ground ambulances were, controversially, exempt from the law — even though ground ambulance rides are far more common. Of the 1,498,600 ambulance rides in Chhabra’s study, nearly 98% were by ground ambulances. Chhabra suspects ground ambulances got special treatment because federal lawmakers felt a need to “tread lightly” around their relationships with local governments. Many ambulance services are run by municipalities and may need to bring in enough revenue to pay their expenses. “This might be what they need to do in order to cover their own budget,” Chhabra said. Resolution: Peggy said her insurer, BlueCross BlueShield of Illinois, deemed the “reasonable and customary rate” for the services Peggy received to be $1,892. It applied $400.23 to her deductible and then paid $895.06 — 60%, according to the cost-sharing requirement of Peggy’s plan. Pingree Grove and Countryside then billed Peggy for the balance of their charge, $2,710.94. Peggy challenged the balance with Paramedic Billing Services, the company that handles the district’s billing, citing her siblings’ much lower charges. “Needless to say, I am speechless at the outrageously high bill I received,” Peggy wrote. “I am willing to pay $354.94, which (with my insurance payments) equals the amount my sister is being charged for the exact same ride.” Paramedic Billing Services Vice President Michael Tillman said patients must dispute charges directly with the ambulance service. Peggy said her subsequent calls to Pingree Grove and Countryside have gone unanswered. To demonstrate her good faith in the absence of an answer, Peggy said, she sent $20 to Paramedic Billing Services. She received a letter back with a coupon saying she needed to set up a payment plan for the full amount, so she sent another $20. In June, she received a letter from a collection agency saying she owed $2,670.94. “They really weren’t working with me, were they?” she said. In a statement, a spokesperson for Peggy’s insurer, John Simley, said the insurer pays for ambulance services according to the terms of a member’s plan. “Certain ambulance companies may charge amounts far in excess of the benefits” a member’s plan provides, Simley said. “This sometimes subjects members to pay the balance of ambulance services not covered by their benefit coverage.” The Takeaway: Getting into an ambulance involves financial risk. Your health may demand it. But your wallet may suffer. So understand your options. Obviously, if you’re seriously hurt in an accident, you have no way to figure out whether the ambulance that turns up is in your network. However, if you feel well — just a bit banged up or with a laceration from a car crash or a fall from a bike — remember this: You do not have to get in just because an ambulance rolls up. They arrive because they’ve been informed of an accident by police or because a bystander has called 911. Related Links His-and-Hers Cataract Surgeries, But His Bill Was 20 Times as Much Her First Colonoscopy Cost Her $0. Her Second Cost $2,185. Why? After Medical Bills Broke the Bank, This Family Headed to Mexico for Care The Case of the $489,000 Air Ambulance Ride Calling a friend or car service like Uber or Lyft to drive you to a doctor, urgent care, or a hospital emergency room could save you thousands of dollars. (And please do seek timely follow-up care on any possible head injury.) It’s also worth knowing whether your local fire department’s ambulance service is in your insurance network, information that might influence your decision. Of course, this all raises the larger question of whether ambulance operations should be revenue generators at all. “Or should it just be something that’s a public good that we pay for out of our taxes like the fire department or police department,” Chhabra said, “none of whom I’ve ever heard of anybody getting a bill from?” Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it! KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation. Subscribe to KHN's free Morning Briefing. WealthCare Blogs are for general educational and entertainment purposes only. No advice or recommendations are provided. Do your own due diligence and consult with a licensed wealthcare before making any wealthcare decisions.

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Social Security

Veterans and Active Duty Military Members: Social Security Has Your Back!

by Social Security Professor on November 11, 2021

Every year on Veterans Day, we honor the people who risk their lives to protect our country. Our disability program is part of our obligation to wounded warriors and their families. Social Security is an important resource for military members who return home with injuries. If you know a wounded veteran, please let them know about our Wounded Warriors webpage. Our Wounded Warriors webpage answers many questions commonly asked about Social Security and shares useful information about disability benefits. On this page, you can learn how Social Security benefits are different from benefits available through the Department of Veterans Affairs and require a separate application. We also explain how veterans can expedite the processing of their Social Security disability claims if they become disabled while on active military service on or after October 1, 2001, regardless of where the disability occurs. Active duty military service members who continue to receive pay while in a hospital or on medical leave should consider applying for disability benefits if they’re unable to work due to a disabling condition. Active-duty status and receipt of military pay doesn’t necessarily prevent payment of Social Security disability benefits. We honor veterans and active-duty members of the military every day by giving them the respect they deserve. Please let these heroes know they can count on us when they need us most. They’ve earned these benefits! Our webpages are easy to share on social media and by email with your friends and family. Please consider passing this information along to someone who may need it. By Dawn Bystry, Deputy Associate Commissioner, Office of Strategic and Digital Communications Source

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