Helpful Tips on whether to Go to the ER or an Urgent Care Center for Care:

https://www.healthgrades.com/right-care/urgent-care/should-you-go-to-the-er-or-urgent-care-how-to-decide

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American Rescue Plan Act (ARPA)

COBRA Subsidies

The Act provides up to six months of free COBRA coverage for “Assistance Eligible Individuals,” a special COBRA enrollment/coverage period, and new notice obligations as described below.

The COBRA subsidy is equal to 100% of COBRA premiums for eligible coverage and is available from April 1, 2021 to September 30, 2021.

An Assistance Eligible Individual (AEI) is defined as someone who: a) lost medical coverage under a group health plan due to their/their family member’s involuntary termination of employment or a reduction of hours; and b) is already enrolled in COBRA coverage on April 1, 2021 or enrolls in COBRA coverage during the Special Enrollment Period.

The Act provides an AEI who is not enrolled in COBRA as of April 1, 2021 a second window of time to enroll in order to take advantage of the subsidy. This includes AEIs who never made a COBRA election or who made an election but later dropped COBRA. The Special Enrollment Period runs for 60 days after the individual receives notice. An AEI who enrolls in COBRA during the Special Enrollment Period will have coverage from April through September or through what would have been the end of their typical COBRA coverage period.

Employers are required to provide a notice describing the availability of the subsidy and the Special Enrollment Period to AEIs by May 31, 2021. The Dept. of Labor must develop a model notice template that can used for this purpose within the next 30 days. Additionally, a notice of subsidy expiration must be sent between 15-45 days before the end of the period. Again, the federal government is tasked with publishing a model notice sometime within the next six weeks.

The employer (self-insured plans) or carrier (fully-insured plans) will be reimbursed the total COBRA premium – including administrative fees – by claiming a credit against Medicare payroll taxes. It is anticipated that the IRS will provide additional guidance on exactly how to claim the credit in upcoming weeks.

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Getting MAGI Right: Do COVID-19 Stimulus Payments and Extra Unemployment Count toward Medicaid Eligibility?

The most popular blogs I’ve ever written were part of a 2015 series about Getting MAGI right. At the time, MAGI was a little understood acronym for Modified Adjusted Gross Income, which changed the way income and household size is counted for Medicaid and CHIP eligibility for children, pregnant women, parents and expansion adults. As part of the Affordable Care Act, MAGI was intended to align the way income and household size are calculated for Medicaid and CHIP with eligibility for financial assistance to purchase a qualified health plan in the ACA’s health insurance Marketplace. The purpose was to make sure no one slipped through the cracks, which could easily happen if Medicaid and CHIP used a different methodology for determining income and household size than Marketplace coverage.

Once again, MAGI-related questions are cropping up about the stimulus payments and extra unemployment compensation that families and workers will receive as part of Families First and CARES’ coronavirus response laws. Here’s the scoop:

• The stimulus payments ($1,200 for an individual, $2,400 for joint filers, and $500 per child) are “rebates against taxes imposed.” This means these payments are NOT taxable and will not be counted as income for Medicaid, CHIP or financial assistance in the Marketplace.
• The unemployment bump of $600 per week is a different story. For individuals qualifying for regular unemployment, the CARES act established an additional weekly payment of $600 until July 31, 2020. The act expressly excludes this additional payment – but not the base unemployment compensation – from counting toward income in Medicaid and CHIP. Unfortunately, this does not apply to eligibility for premium tax credits or cost-sharing subsidies in the Marketplace.

Given the fact that the ACA sought to align income eligibility, it’s a bit of a head scratcher as to why the CARES act exempted the extra payment from inclusion in Medicaid and CHIP but not Marketplace financial assistance. That said, the fact that it doesn’t count as income in determining eligibility for Medicaid or CHIP means that more people will qualify. However, if total family income without the bump is over the Medicaid limit, then individuals will get less financial assistance in the form of premium tax credits, as well as cost-sharing assistance, in purchasing a Marketplace qualified health plan.

There are differences in how household size and income are determined in Medicaid, particularly for individuals who do not file taxes and for children who are tax dependents of someone who is not their parent (i.e., a grandparent). But these and other differences regarding lump sum payments and using current monthly income rather than projected annual income, complicate coordination along the continuum of coverage across Medicaid, CHIP and the Marketplace. The unemployment compensation issue matters more for individuals applying through Healthcare.gov (or state-based Marketplaces), which has to calculate income differently when first screening for eligibility for Medicaid or CHIP. Let’s hope that this time Healthcare.gov gets it right!

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 Tricia Brooks

 TriciaBrooksCCF

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2020 Medicare Deductibles and Coinsurance Updates

Medicare premiums, deductibles, and co-payment amounts are adjusted each year in accordance with the Social Security Act.  Please see the figures below for the updated deductibles and coinsurance rates for 2020:

Social Security

Increase: 1.6%

2020 - Part A Deductible and Coinsurance

Inpatient Hospital Deductible:                     $1408.00

Daily Coinsurance Days 61-90:                    $  352.00

Daily Coinsurance - Lifetime Reserve:     $  704.00

Skilled Nursing Facility - Days 21-100:    $  176.00

2020 - Part B Premium and Annual Deductible

Standard Monthly Premium:                         $  144.60

Annual Deductible:                                              $  198.00

Please visit www.medicare.gov for more information on the 2020 Medicare Parts A and B premiums and deductibles.

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How Does My Other Insurance Work with Medicare?

When you have other insurance and Medicare, there are rules for whether Medicare or your other insurance pays first.

If you have retiree insurance (insurance from your or your spouse's former employment)...

MEDICARE PAYS FIRST.

If you're 65 or older, have group health plan coverage based on your or your spouse's current employment, and the employer has 20 or more employees...

YOUR GROUP HEALTH PLAN PAYS FIRST.

If you're 65 or older, have group health plan coverage based on your or your spouse's current employment, and the employer has fewer than 20 employees...

MEDICARE PAYS FIRST.

If you're under 65 and have a disability, have group health plan coverage based on your family member's current employment,  and the employer has 100 or more employees...

YOUR GROUP HEALTH PLAN PAYS FIRST.

If you're under 65 and have a disability, have group health plan coverage based on your or a family member's current employment, and the employer has fewer than 100 employees...

MEDICARE PAYS FIRST.

If you have Medicare because of End-Stage Renal Disease (ESRD)...

YOUR GROUP HEALTH PLAN WILL PAY FIRST FOR THE FIRST 30 MONTHS AFTER YOU BECOME ELIGIBLE TO ENROLL IN MEDICARE.  MEDICARE WILL PAY FIRST AFTER THIS 30-MONTH PERIOD.

Note: In some cases, your employer may join with other employers or unions to form or sponsor a multiple-employer plan.  If this happens, the size of the largest employer/union determines whether Medicare pays first or second.

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ACA Round-Up: New House Legislation, Litigation Over The Health Insurance Tax, And Guidance On AHPs

SEPTEMBER 18, 2018 10.1377/hblog20180917.813918

 The House of Representatives is considering legislation that would suspend the Affordable Care Act’s (ACA’s) employer mandate as well as some of the law’s other taxes. The proposal would increase the federal deficit by an estimated $58.5 billion over 10 years.

In other news, a district court judge ruled that the Internal Revenue Service (IRS) must repay six states for what they paid Medicaid managed care companies to account for the ACA’s health insurance tax. Although the amount is disputed, the states could be owed as much as $839 million. And the Department of Labor (DOL) issued new guidance on association health plans to help states and interested parties implement a recently finalized federal regulation.

New House Bill Takes Aim At Employer Mandate And ACA Taxes

The House of Representatives is, once again, considering a bill—the “Save American Workers Act of 2017”—to revise and suspend the ACA’s employer mandate, further delay the Cadillac tax, and fully repeal the tanning tax. The House continues to take aim at many of the ACA’s revenue-raising provisions, which were designed to help pay for the law’s expansion of coverage. In late July, the House passed two bills to repeal the ACA’s medical device tax, extend the moratorium on the health insurance tax to 2022, and expand access to “copper” plans.

On September 11, 2018, the Congressional Budget Office (CBO) released its score of the bill. CBO projects that the legislation would increase the federal deficit by $58.5 billion over 10 years. Much of the cost would be due to changes to the employer mandate (about $35.7 billion) followed by the delay in the Cadillac tax ($15.5 billion). In part because of the price tag, the Senate is not expected to take up the bill before the end of the year.

What The Bill Does

First, the bill would suspend the employer mandate from 2013 to 2019. The mandate was expected to go into effect beginning in 2014. However, due to a series of delays in enforcement (and despite numerous legal challenges), the mandate went into effect for employers with more than 50 employees beginning in 2016. In 2017, the IRS began sending assessment notices to employers who failed to comply with the mandate in 2015; some employers initially owed millions but many assessments have been disputed and ultimately lowered. The bill under consideration in the House would mean that no employer would be subject to the mandate through January 1, 2019 and would eliminate these penalties for employers.

Second, the bill would change the definition of “full-time employee” to refer those who work 40 hours/week (instead of 30 hours/week under current law). This has been a long-standing request from employers. This change would be retroactive to 2013 when the mandate went into effect.

Third, the bill would adjust reporting requirements for employers. Instead of requiring employers to provide information on minimum essential coverage to employees, employers would only have to provide this information when requested by an employee (and they would only have to provide it once). Nothing would prohibit an employer from providing this information automatically, but they would no longer be required to do so.

The bill would also delay the ACA’s Cadillac tax by an additional year, extending the moratorium from 2022 to 2023. The Cadillac tax is designed to disincentivize high-cost employer-sponsored coverage through a 40 percent excise tax on employer plans that exceed an estimated level of premiums. The Cadillac tax was suspended from 2020 until 2022 earlier this year.

As noted above, the House bill would also fully repeal the ACA’s “tanning tax” on indoor tanning services.

Litigation Continues Over Health Insurance Tax And Medicaid Managed Care Organizations

Litigation continues to heat up over the health insurance tax and its application to states and Medicaid managed care plans. Six states had challenged the health insurance tax, arguing that they were being impermissibly required to pay the tax through requirements laid out in regulations for Medicaid managed care plans. These six states are Texas, Indiana, Kansas, Louisiana, Nebraska, and Wisconsin.

In May, Judge Reed O’Connor of the Northern District of Texas (the same judge who is presiding over litigation over the individual mandate in Texas v. United States) upheld the ACA’s health insurance tax but invalidated parts of a regulation issued by the Department of Health and Human Services (HHS) with respect to Medicaid managed care plans. He held that the federal regulations impermissibly granted too much authority to the American Academy of Actuaries and the Actuarial Standards Board to determine how states should pay the health insurance tax. The decision was a partial win for the states and surprising because Judge O’Connor’s reasoning invoked federal nondelegation doctrine, which has rarely been used to strike down agency delegations to private entities (at least not since Carter Coal in 1936).

Following the May ruling, the states asked Judge O’Connor to reconsider their claim for a refund of the health insurance tax. In 2016, he had concluded that the states were not entitled to a refund because the tax did not directly apply to states and the states had not actually paid the tax on behalf of Medicaid managed care companies. Even though the states were indirectly required to pay the tax, they were not “taxpayers” under federal law and thus had no claim to a refund.

After a series of filings, Judge O’Connor partially granted the states’ motion for reconsideration on August 21. Although he denied their other arguments, he agreed that the states are entitled to “equitable disgorgement” of the health insurance tax. The HHS regulation unlawfully required the states to account for and pay the health insurance tax in their Medicaid managed care capitation rates. Because this accounting and payment was unlawful, the IRS has no right to retain the amount of the health insurance tax paid by the states and thus must “disgorge” these funds to the states. Although Judge O’Connor’s ruling did not provide an amount that must be returned, the states believe that they are owed an estimated $839 million.

This was not a final judgment, which typically means that the litigation would continue before Judge O’Connor (rather than on appeal to a higher court). However, following the ruling, the federal government asked the court to stay final judgment for 60 days. In that filing, it disputed the amount of disgorgement and raised the concern that determining this amount will “likely be complicated and burdensome.” To potentially avoid this time-consuming process, the federal government asked for additional time to consider filing an appeal on the court’s decisions thus far. The states argue that the calculation of the amount is simple but nonetheless do not oppose an appeal to the Fifth Circuit.

The states do, however, oppose a stay and asked Judge O’Connor for an expedited decision on whether they can amend their complaint to challenge the health insurance tax for 2018. The federal government opposed this request on September 12. This litigation is ongoing.

New Guidance On Association Health Plans

In August 2018, the DOL issued a new bulletin on how to comply with its recently finalized regulation on association health plans (AHPs). The bulletin summarizes the final regulation, clarifies which federal laws apply to AHPs, and includes a series of questions and answers on AHPs.

One of these questions focuses on state authority over AHPs. As it did in the rule, the DOL reaffirms that its new rule does not disturb a state’s ability to regulate AHPs. States can regulate self-insured AHPs so long as the regulation is not inconsistent with ERISA as well as insurers and the policies they sell to AHPs.

State authority over AHPs has been a topic of interest and concern for at least some state insurance regulators. Regulators in states such as Oregon and Pennsylvania have issued new guidance to insurers or outlined their approach in letters to the DOL. These states are among the 11 states and DC with Democratic state attorneys general who have challenged the final rule on AHPs and recently asked that the rule be vacated. Other states, such as Iowa, are moving in the opposite direction and have begun the process of fast-tracking new AHPs under the final rule.

Separately, the Internal Revenue Service (IRS) issued a new frequently asked question (#18) on whether the employer mandate applies to employers that offer coverage through an AHP if that employer has fewer than 50 full-time employees. (If an employer has fewer than 50 full-time employees, it would not otherwise be required to comply with the employer mandate.) The IRS confirms that whether the mandate applies (or not) is unrelated to the fact that the employer is offering coverage through an AHP. Put another way, a small employer does not have to comply with the employer mandate simply because they participate in an AHP.

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Medicare Part D premiums continue to decline in 2019

Today, the Centers for Medicare & Medicaid Services (CMS) announced that, for the second year in a row, the average basic premium for a Medicare Part D prescription drug plan in 2019 is projected to decline. At a time when health insurance premiums are rising across-the-board, basic Part D premiums are expected to fall from $33.59 this year to $32.50 next year.

“President Trump and Secretary Azar have made clear that prescription drug costs must come down. The actions that HHS and CMS are taking to increase competition in order to drive down costs for patients are working,” said CMS Administrator Seema Verma. “CMS will continue to strengthen the Part D program and bolster plans’ negotiating power so they can get the best deal for seniors from prescription drug manufacturers.”

In Medicare Part D, beneficiaries choose the prescription drug plan that best meets their needs, and plans have to improve quality and lower costs to attract beneficiaries. This competitive dynamic sets up clear incentives that drive towards value, as determined by beneficiaries. Earlier this year, CMS announced several changes in the Part D program aimed at further empowering Part D plans to drive a hard bargain with drug manufacturers and lower the cost of prescription drugs. Strengthening negotiations is a key pillar of the Administration’s Blueprint to reduce prescription drug costs. CMS has been working to ensure that Medicare Part D plans can leverage all of the tools that are available to commercial plans in negotiations.

Changes that CMS has made to date include:

Reducing the maximum amount that low-income beneficiaries pay for certain innovative medicines known as “biosimilars.” 

Allowing for certain generic drugs to be substituted onto plan formularies more quickly during the year, so beneficiaries immediately benefit and have lower cost sharing.

Increasing competition among plans by removing the requirement that certain Part D plans have to “meaningfully differ” from each other, making more plan options available.

Increasing competition among pharmacies by clarifying the “any willing provider” requirement, to increase the number of pharmacy options that beneficiaries have.

The upcoming annual Medicare open enrollment period for 2019 begins on October 15, 2018, and ends on December 7, 2018. During this time, Medicare beneficiaries can choose health and drug plans for 2019 by comparing their current coverage and plan quality ratings to other plan offerings, or they can choose to remain in traditional Medicare. The agency will be continuing to improve the website for Medicare plan selection, so beneficiaries can more easily compare options and choose the plan that best meets their needs. CMS anticipates releasing the premiums and costs for Medicare health and drug plans for the 2019 calendar year in mid-to-late September.

To view the 2019 Part D base beneficiary premium, the Part D national average monthly bid amount, the Part D regional low-income premium subsidy amounts, the de minimis amount, the Part D income-related monthly adjustment amounts, the Medicare Advantage employer group

waiver plan regional payment rates, and the Medicare Advantage regional PPO benchmarks, visit: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Ratebooks-and-Supporting-Data.html and select “2019.”

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Waiving Health Coverage: A Cheat Sheet for Companies and Teams

Waiving Health Coverage

Inside every waiver of coverage, you may find waves of confusion. Waiving, or opting out of a health insurance, sounds like someone is snubbing the idea of benefits altogether. But in reality, the waiver only allows someone to say “no thanks” to coverage specifically offered by their employer — not all health insurance options. When an individual waives coverage, there are a handful of rules both companies and teams need to follow to keep things flowing smoothly. In this article, we’ll explain how to waive coverage for yourself or your employee, all while keeping everyone’s uncertainty at bay.

Back up. Why do people decline work-sponsored health insurance?

There are a few good reasons to reject coverage. Some people are already under a family member’s plan, are receiving insurance from another employer, or prefer an individual health plan because it offers better benefits. In rare cases, employees may feel that another plan is more affordable than the one their company is offering, so they decide to press ahead with that one instead.

How do I waive coverage?

For employees

1. Know the basics

Whether it’s with your employer or not, you can’t get around having health insurance. Under the Affordable Care Act’s individual shared responsibility provision, you can either sign up for a health plan, get an exemption, or wind up with a fine from the IRS. It’s also important to note that when you opt out of insurance at work, it means your family won’t be eligible for that plan either.

2. Understand your timeline

You can only decline your employer-sponsored insurance during an open enrollment period, which you may be in the middle of if you just started at your company. If not, you’ll have to wait for the next enrollment period to come around, unless you have a qualifying life event, like a birth or marriage. Luckily, if you ever lose your other source of coverage, you’ll be able to jump back on your employer’s plan immediately. Keep in mind that this only happens if your coverage has expired or otherwise ended — not from you stopping payment or deciding you don’t want it anymore.

3. Assess your options

What kind of plan do you want? Ask for a copy of the summary of benefits and coverage from your employer so you can compare it with the one you’re interested in or already have in place through a partner, a parent if you’re under 26 (yay ACA!), the individual market, or another source. Keep in mind that if your company-sponsored option meets the ACA standards and you waive, you no longer qualify for any premium Marketplace subsidies. It may look like you are at first, but the IRS will see that your employer offered it and will take back any credit you received.

4. Sign your waiver of coverage

Now, ask your employer for a waiver of coverage form. You’ll have to fill out the following details:

Your name

Social Security number

Policy number and carrier information for your main plan

Waiver of coverage explanation

The waiver of coverage explanation typically contains language that says you understand that if you reject coverage, you won’t be able join the plan until the next open enrollment period, or if you experience a qualifying life event. It also lays out what those special periods entail.

5. That’s it!

You have successfully waived coverage the right way.

ACA checklist

For employers

1. Brush up on your responsibilities

As an employer, your goal is to make sure all full-time employees have the chance to sign up for health insurance during open enrollment. Everything rides on this. If someone wasn’t given an opportunity, they can sign up for a plan from HealthCare.gov and then claim a premium subsidy on their taxes. This can trigger an audit for any employer, but if you’re a company with 50 or more FTEs, it will unlock a penalty. Basically, it’s telling the IRS that you didn’t offer your employee adequate health insurance, even though you were supposed to.

2. Know your carrier’s participation requirements

Most insurance companies require a certain amount of employees to join a group plan. The number is usually around 75 percent, but it varies by carrier. Now, you may be thinking that it’s bad for your business when an employee waives coverage. Not quite. If an employee has a valid waiver of coverage, the carrier won’t apply that person toward your minimum. Employees with a valid waiver get taken out of the denominator for the participation calculation.

3. Educate, educate, educate

Before any decisions are made, make sure you’ve properly educated the team on what their choices are. Not only is this important for their well-being, but it can also have potential repercussions if you have more than 50 FTEs, and they enroll in another option and then claim a premium subsidy. If an employee buys a plan that doesn’t meet the minimum value standard, it’s not ideal, but everything won’t come crashing down. You have to comply with the ACA, but if one of your employees doesn’t, you’re not at fault in the eyes of the IRS.

4. Request a waiver of coverage

Now, ask your carrier for a waiver of coverage form, and hand it to your employee to complete (many services can help you do this directly online). The form acknowledges that your teammate was offered coverage but decided not to enroll. Here’s a sample form from Anthem to give you an idea of what you’ll be dealing with.

5. Learn how it plays into reporting

All you have to do is put any code besides 2C on line 16 of your 1095-C form, and that tells the IRS that your teammate waived coverage.

1095-C

6. You’re done!

Waving goodbye to coverage is just a fact of life for many folks. And by studying up on the best course of action, you’ll be able to get — or help someone get — the plan that works for all of life’s ebbs and flows.

About the Author Lauren Fifield

Lauren is a health tech veteran and a licensed producer of accident, health, and life insurance. She currently leads benefits advising and operations at Gusto.

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5 Reasons Why Your Business Should Offer Health Insurance

There are many benefits you can offer through your business, but there’s one winner that rules them all: Health insurance. That’s because it keeps your team healthy and happy, and it signals that you care about their well-being. In fact, many small business owners agree, even if they aren’t required to provide coverage by the Affordable Care Act. A little over one in four companies with fewer than 50 employees provides health insurance and a promising 22 percent plan to roll it out the next year.

Why do these small businesses cover their employees through group plans, even if they’re not legally required to? Because it’s good for their teams and good for them. If you’re on the fence yourself, here are the top five reasons to offer health insurance:

1. It’s easier than you think

First thing’s first: You don’t have to do this alone. A broker or health insurance advisor can guide you through the whole shebang. As your go-to agent, they’ll:

Help select a plan that’s right for you and your team, based on your industry and the coverage preferences of all the folks in your company

Set everything up and keep you compliant on an ongoing basis

Be the resident healthcare know-it-all for your employees, so you don’t have to answer difficult questions on all things health insurance

2. It makes your employees happy

According to a survey by Glassdoor, employees said health insurance is, by far, the most important benefit they receive from their employer. That’s why employers should offer health insurance as their first company benefit, then add on additional benefits over time.

The top three benefits that make employees the most satisfied, according to Glassdoor’s study, are:

Health insurance

Vacation and PTO

Pension plans, 401(k) & other retirement plans

If health benefits are a top priority for your employees, it should be a top priority for you. Offering it can help with recruiting and entice them to stay longer at your company.

3. It saves you money on taxes

This is a big one, so we wrote an entire post about it. In fact, employers and employees pay less for insurance when they purchase it as a group.

Savings for employees:

When employees buy health insurance on their own, they have to use post-tax dollars to buy it: They make money, the government taxes that money, and then they take the remaining amount to buy what they need. But when employees buy health insurance as a group, they pay for the insurance with pre-tax dollars which can save up to 30 to 45 percent on their health insurance plans.

Savings for employers:

Here are all the tax savings you get by offering group health insurance:

Employer contributions are tax-deductible

Employer payroll taxes are reduced by 7.65 percent of employee contributions

Employer workers compensation premiums are reduced

Paying for health benefits instead of higher salaries can also save you money because you don’t pay payroll taxes and workers compensation premiums on money used towards health benefits. Plus, your employees may prefer benefits over salary as well. According to that same Glassdoor study, nearly 80 percent of workers would prefer new or additional benefits to a pay increase.

4. It can give you access to more doctors and hospitals

Group insurance networks are often larger than individual networks. That means on an individual plan, you don’t have access to the same doctors and hospitals you would on a group plan. Doctors and hospitals that don’t accept individual plans often charge more for their services and are often more sought out by patients. The network differences vary by state, but in California, individual plans are typically two-thirds the size of group plans. So purchasing a group plan can increase your access to more, and often better, doctors and hospitals.

5. It helps boost employee productivity

A study from MetLife found that 60 percent of employers say offering health insurance has led to higher productivity levels. And according to the CDC, employees who prioritize preventive care — like regular checkups — get more accomplished at work.

As an employer, you want your employees to focus on being their best productive and successful selves at work. Worrying about health insurance drains their energy and time. As you know, health insurance can be a pain to set up. And if your employees are enrolled in individual plans, all of that burden of setting up and managing their plan shifts from you to them.

And there you have it. From building a healthier, happier team to actually saving money, there are many reasons to take the plunge and offer health insurance to your team. Offering health benefits signals that you care about your team, ultimately building a culture of trust.

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An artist’s VR work is being used by a New York hospital to help reduce patients’ need for opioids.

In spring of 2017, the Bronx-based Montefiore Medical Center envisioned a new kind of distraction for patients: a VR art experience. In order to make it happen, the hospital reached out to artist Tom Christopher.

Christopher is an artist trained in technical drawing for courtrooms and of cars for commercial clients, but he took a looser, more expressionist approach for his VR artwork. Using Google’s Tilt Brush––a virtual reality application used to draw three-dimensional forms––Christopher created immersive, gestural, and colorful depictions of nearby neighborhoods so that pediatric cancer patients could explore a picture similar to their own home, while staying inside the hospital.

Being able to wander through the virtual reality environment Christopher created has reportedly helped reroute the patients’ focus away from their pain. For some patients, the ability to redirect one’s attention also means a lesser need for opioid pain medicines. As Olivia Davis, the assistant curator at Montefiore tells Forbes contributor Charlie Fink:

“The Virtual Reality Fine Art Program at Montefiore seeks to diminish anxiety, pain and opioid addiction through stimulus-rich and curated artistic environments. These experiences will serve as ‘immersive analgesics’ allowing physicians to treat their patients more effectively by improving patient’s health and hospital experiences and reducing reliance on pain medication, especially opioids.” 

Dr. Brennan Spiegel of Los Angeles’s Cedars-Sinai Hospital explained that the VR’s ability to overcome a patient’s focus on pain isn’t universal but shows promise. “It doesn’t work on everybody, but when it works, it really, really works,” he said.

While Christopher is the first to create a VR experience for a very specific group of patients, VR content is also being put to use in other medical centers. A Los-Angeles based group, Applied VR, is treating patients with anxiety, chronic pain, memory loss, and more with VR experiences ranging from games to guided relaxation exercises. In London, Royal Trinity Hospice is using VR experiences in end of life care to help patients check items off their bucket lists.

Eli Hill

Jun 22, 2018 at 11:54 am, via 

Forbes

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Where do you want to live when you're retired — in your own home or in an assisted-living facility?

Although the answer might seem obvious, that question is one that everybody should ask themselves, their spouse and their parents.

Predictably, 90 percent of people plan to age in their homes, according to data from AARP. However, planning where to live as a retiree entails considering not just the actual location of where you'll hang your hat but also factoring in the financial, social and physical ramifications of your decision.

Wanting to age at home is a natural preference. Home feels comfortable, safe and easy, and many people probably assume it is the more affordable option. But is that still the case when you take into account some of the common by-products of aging?

With age comes the general weakening of bones and muscles and a natural decline in mobility and energy, which could make everyday chores dangerous or impossible. While there are resources for getting help around the house, including mobile apps and digital marketplaces for finding service professionals, hiring help introduces a new set of costs, whether at a monthly or hourly rate. For retirees who need more significant help, engaging a professional homemaker may be necessary, but keep in mind that the average monthly cost of a homemaker is $3,994 (assuming 44 hours of care per week), according to AARP research.

The toll that aging takes on the body may also necessitate changes to your home's design or layout. Basic home modifications — including installing grab bars, sturdy handrails along stairs, replacement rugs, better lighting and lever-handled doorknobs — can cost up to $10,000. Meanwhile, more extensive renovations — such as removing or reducing the height of steps, widening hallways, adding a ramp, lowering cabinets, installing no-step showers and installing a generator to protect against power loss — can cost up to $100,000.

While home may be where the heart is, living alone can also come with other age-related challenges. For example, if you need to adhere to a special diet, are you equipped to purchase and prepare the proper food? If you fall, do you have a way to get in touch with a family member or emergency services? If you no longer drive, will you suffer from cabin fever and loneliness? There are solutions to these problems (enrolling in a food-delivery program, installing a voice-activated device or using on-demand car services), but again, everything has a price tag.

While many people might shudder at the thought of leaving home for an assisted-living facility, it's worth weighing the pros and cons.

For retirees who suffer from declining health or mobility limitations and for whom lifestyle changes or the expense of home renovations are not feasible, assisted-living communities can offer a certain peace of mind. The buildings and restrooms are designed to meet the accessibility needs of their aging residents, and all maintenance and repairs are handled by a professional. Meal planning and nutrition are also taken care of, as tenants are served three meals a day that are tailored to any medically restricted diets.

An assisted-living community might also make sense for people who worry about feeling isolated in older age. Most facilities have common areas to encourage socialization and regularly plan activities and outings for the residents. Plus, there is something to be said for the camaraderie that develops among a group of people who are all in a similar situation.

Of course, a big reason many people might be hesitant to move into an assisted-living facility is the cost. The average monthly cost of assisted living is $3,750, while the average monthly cost of a private room in a nursing home runs around $8,121. On an annual basis a nursing home can cost $85,776 to $97,452.

Moving into an assisted-living facility might have its perks, but it, too, does not come cheap.

So where do you want to live when you're retired?

It turns out that is not a simple decision, and it's not a onetime, cut-and-dry conversation. Whether you choose to age in your own home or move into a senior community, there are benefits and challenges to both options.

Before you make a choice based on immediate preference or assumption, consider the financial, social and health implications of each scenario. Only then can you really answer what might be one of the most significant questions of your life.

— By Mike Lynch, vice president of Strategic Markets for Hartford Funds

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https://www.medicare.gov/Pubs/pdf/11037-Medicare-Coverage-Outside-United-Stat.pdf

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On Monday, March 5, the IRS reduced the family Health Savings Account (HSA) contribution limit for 2018 from $6900 to $6850. It happened because the federal government changed the way it calculates inflation adjustments to the limits. So, the limits are:

2017: Single Plan: $3400 Family Plan: $6750

2018: Single Plan: $3450 Family Plan: $6850