It would be a good guess that many people turning 65 next year are not only busy with the holidays, but also busy wielding their way through the maze of insurance options associated with Medicare. Hubby and I were right there along with them, although we thought we'd successfully made it to the end when my Medicare coverage began in May. We thought we'd done our homework, had gone to several presentations, so we thought we knew what we were doing for the near term when we signed up with a carrier who steered us to MedAdvantage.

Several things that came up during the past several months made us ask questions over and over about whether we'd made a bad decision, so we started asking questions again, this time opting to go to as expert advisors as we were able to find. Really, the way Medicare coverage options are written, it doesn't matter how smart you are (or think you are). Even though you're assured over and over that if you aren't happy with the plan you choose, and that you can change anytime during the 6-week open enrollment period each November, I'm here to tell you that options you choose do matter more than you may realise. Be wary of anyone who works for the health coverage provider. It's not as "cut and dried" as you may think, and definitely better to get information from experts working outside of the provider.

Here's what happened to me. I was diagnosed with Rheumatoid Arthritis in the summer of 2005. Fortunately there are several medical treatments that, while they won't cure it, they do help slow the progression so that many of us diagnosed with it now can continue to live a pretty normal life. But they're expensive. Very expensive. And likely to stay that way. By December that same year, my Rheumatolist had determined my treatment and I've been giving myself weekly injections, combined with other drugs taken orally, ever since. My drug list is fairly long, and most though not all are available in generic form.

Last fall, as I was approaching my 65th birthday and eligibility for Medicare coverage, we began attending what we supposed were "ask and learn" sessions on Medicare options that we being funded by various Health providers. We outlined in detail the drugs I'm required to take each week for my RA, and the host brushed over the various questions on details, always steering us towards a Medicare Advantage Plan (MedAdvantage) with no monthly premium (beyond that automatically deducted from my Social Security). Under the "MedAdvantage" plan you're automatically covered for Supplement D drugs listed by that provider.

When we looked closely at what we did NOT have to pay, and added up the estimated co-pays for physicians, hospitals, and drugs for the year, it made sense to sign up for the Medadvantage plan. The money out of pocket for my coverage came out pretty closely the same under the Advantage plan as it would by signing up separately for a Part D Prescription drug plan. With all else being so close to equal, naturally we elected to go with the MedAdvantage plan, reasoning that it would eliminate the need to sign up for the Part B supplement separately at that time. Our assumption was that we would be able to switch to other options, if needed, at the end of the year.

Due to several "flareups" during this summer, our physician discussed the possibility of switching to in-clinic infusion therapy every two months rather than weekly self-injections. This treatment is covered by Medicare Part B and is reimbursible to the provider. However, under the MedAdvantage plan, it would have cost us 30% of the drug cost (about $500) out of pocket, plus office visit co-pay for each treatment just the same as if this treatment were not covered by Medicare Part B.

Can you see where this is going? When they sell the MedAdvantage plans these facts are never brought out and it is not very easy to find these answers even when you question the marketers. This is what we wish we had known: If I'd purchased a Part B Medicare Supplement plan, the in-clinic treatment would have been completely covered with no extra cost to me.

With the approach of the open-enrollment period (November 15 through December 31), we began in late October consulting other experts to get help about our best options. We started at the County Aging Services division and ended up in the office of an independent insurance agency specialising in Medicare enrollment. What we learned was an eye opener.

If I had decided to continue with the MedAdvantage plan for the next year, I would be stuck with it and would not be able to switch easily to other options such a separate Part B Supplement and Part D plans in the future, at least not without answering a series of medical questions plus listing all my medications and pre-existing conditions. Then the provider would have the option of rejecting my application. This could be potentially very expensive as Medicare pays only 80% of most of the covered expenses.

Those who sell you MedAdvantage plans will never mention that switching out of a MedAdvantage plan is not very simple after a year of enrollment. The insurance companies apparently make a lot of profit on the MedAdvantage plans since the benefits offered by the plan are not governed by the same rules as the Part B Supplement, and (and this is a big and) the insurance companies can set their own premiums and co-pay rates. That's such an important distinction, it bears repeating: The insurance companies can set their own premiums and co-pay rates. Because of this, there is a strong push from the insurance companies to steer their customers to the MedAdvantage plans rather than the Supplement Plans.

Luckily for us, we found this out in time. I'm still within the one-year enrollment period, and so the insurance company cannot deny my application for the Part B Supplement coverage. So, I am switching from MedAdvantage to the Part B Medicare Supplement and a separate Part D Prescription Drug plan. This is likely to be more expensive than the "zero premium" MedAdvantage plan for now, but when or if I decide to switch to Infusion treatment, the costs will be significantly less because I would not have to pay 30% of the drug cost on Medicare covered treatment. On a retirement income, that could be significant.

Our experience with the Medicare plans may not apply to everyone, but it shows that the rules are not all that clear, and you can't depend on insurance salespeople to give you the whole story. While MedAdvantage seems to make sense in the beginning, you have to think what might happen should you be stricken with other health problems a few years down the road which may make it difficult for you to switch to the Part B supplement. It's probably not a good idea to get stuck in MedAdvantage.

It's ironic that I am writing about fire safety when most of North America was frozen beneath a sheet of ice just recently. The topic came to my mind after reading about an unfortunate incident. Yesterday, my local newspaper reported that a 100 year old lady living alone in her home was killed by a kitchen fire. She was found at the back of her home and later succumbed to burns and smoke-inhalation in a hospital. Like her, many elders prefer to live independently and stay in their own homes. After living in place for a while, people will no doubt feel safe and confortable. After all, there is no place like home. However, the risk of fire is just a great regardless of your age and how many years you have lived in your home.

Injuries and fatalities caused by fire can be drastically reduced if the proper measures are taken. I used to see a lot of public messages in the media about fire safety many years ago. They served to remind us to check our fire alarms or be careful in our home. In recent years, I have noticed an obvious lack of these messages. It seems that fire safety is not a popular topic anymore. Either that, or our fire department is running low on advertising budget, which I think is a more likely case.

I am quite nit-picky when it comes to fire safety. For example, when I lived in a house a few years back, I insisted on having a large fire extinguisher convieniently located in all hazardous spots: one in the kitchen, one in the basement, and one in my bedroom. The preference for a fire extinguisher in the kitchen is obvious, as it's where we cook and handle hot items. I prefer to have one in the basement too because it's where our furnace is located. Besides, if I ever get trapped in the basement, such as by a fire at the stairs, I might be able to use the fire extinguisher to open a way out (in hindsight, I've probably watched too many movies to get this crazy idea). Lastly, I wanted one in my bedroom because if there's a fire when I'm asleep, I wouldn't have to go find a fire extinguisher when I needed it. Additionally, I prefer a large fire extinguisher because as big as they seem, even the big ones would last a few measly seconds. They are only good for putting out small fires.

When I think of fire safety, the experiences that comes to mind are the seemingly frequent fire drills at work and school. I have always enjoyed fire drills because they were like surprise recesses for me. Anything to get me off from work, even for a few minutes, was good by my book. However, the fire drill is arguably the best form of preparation for a building fire. Let's face it, if there is a serious fire in our home, we probably wouldn't (and shouldn't) be looking for a fire extinguisher and playing fire fighter. We should follow our instinct and head straight to a place of safety, whether it is escaping outside of our home or to a window for air if the exit route is dangerous or there is too much smoke.

One useful tidbit of information I learned over the years about fire safety is that most casualties from building fires are not caused by the fires themselves. It is the smoke that injures and kills people. That black smoke is much more dangerous and lethal because of the speed it can spread. To illustrate this point, here's a video of a living room being engulfed in smoke in less than 30 seconds. Let's say if there's a fire in a living room as in the video, a typical house can be completely flooded with smoke in just a minute or two. Not only is the smoke itself lethal to us, it will make the entire house appear to be pitch black. It would be very difficult to find your way out even in your own home. Thus it's a good idea to have regular fire drills or at least think about what you'll do if a fire does occur, even if you think your home is small. When it comes to emergencies, being prepared is one of the best actions we can take to help ourselves.

For a self-evaluation to see how prepared you are for fire safety, here is a list of suggested questions to ask yourself from the Public Health Agency of Canada.

1. Do you have a fire detector on every floor of your home?
2. Do you test your smoke alarm every six months?
3. Have you developed an escape route in case of fire and a fire safety plan?
4. Are you registered on your apartment building's fire safety plan?
5. Do you have a carbon monoxide alarm in your home?
6. Are flammable and hazardous materials clearly labelled and properly stored?
7. If you use a space heater, is it placed well away from flammable substances and materials?
8. Do you use appropriate power bars to prevent overloading electrical outlets?
9. If you live in an older home, have you or an electrician inspected your wiring, fuse box, electrical cords and appliances for safety?
10. Do you have a fire extinguisher and know how to use it?

As one of those fire safety commercial says, "accidents don't just happen. A few simple measures can save your life."

Sources:
Public Health Agency of Canada, "The Safe Living Guide: A guide to home safety for seniors," 2005.

Marshal's Public Fire Safety Council, "Older and Wiser-- Fire Safety Tips for Older Adults," 2006.

Center for Science in the Public Interest gave a grim report on the health quality of foods from Olive Garden and Romano's Macaroni Grill, two of the biggest American-Italian restaurant chain.

Who would have thought a dinner at a restaurant may be much worse than a visit to McDonald's?  click here to continue reading »

Eat well, exercise, and dispel your vice: the 3 commandments to healthy living. I disagree. People are different from other animals because of our minds and our place in society. We aren't just wandering bags of meat, so we shouldn't be treated as such. Being healthy does not mean qualifying for an USDA Prime rating for ourselves. Don't get me wrong; I do agree that maintaining a healthy body is a vital part of healthy living, but it shouldn't be the only item on our list of priorities for aging well.

In the middle of the last century, the World Health Organization redefined the meaning of health from a traditional biomedical model to a biopsychosocial model, wherein health is not just about the absence of disease and illness of the body, but the well-being of the overall individual in terms of the biomedical, psychological, and social aspects of the person.  click here to continue reading »

The risk of falling is a real threat to the independence of older adults. Even a simple fall can have serious consequences. Falls are among the most common accidents in our homes. In addition to increasing home safety in our bathrooms and stairs, a proven method to reduce the risk of falling is by improving your balance. This can be achieved by practising balance exercises.

Balance exercises include strength and control training of your lower body. The following are four simple exercises recommended by the National Institute on Aging. These exercises can be done almost anywhere without any special equipment.  click here to continue reading »