As of 2020, approximately 12.5 million people have both Medicare and Medicaid coverage. Medicare is a federal health insurance program for people over 65 and certain disabled individuals. Medicaid is a joint federal and state program that helps provide medical care for those with limited income and resources. Medicaid recipients include children, pregnant women, and individuals who are blind or have disabilities.

People with both types of coverage are called “dual eligible.” If you’re one of them, you have several options for coordinating your coverage and care. One option is to have Medicare with separate Medicaid coverage. A second option is enrolling in a Dual Eligible Special Needs Plan (D-SNP).

What Is a Dual Eligible Special Needs Plan?

It is helpful to understand what a Medicare Special Needs Plan (SNP) is to understand D-SNPs. An SNP is a type of Medicare Advantage plan that offers wider Medicare coverage for prescriptions, health and wellness, dental, and other services.

A D-SNP is an SNP for individuals who qualify for both Medicare and Medicaid. It combines these benefits into one managed care plan to simplify access to care for covered individuals.

Dual eligible persons often have complex medical situations and need assistance navigating both systems, and D-SNPs can assist with this process. D-SNPs must be approved by individual states to ensure they meet certain criteria before they can be offered to residents. As of 2022, D-SNPs are available in 46 states.

The type of D-SNP a person can enroll in depends on which Medicaid eligibility category they fall into, so it is critical to confirm with your state which plan you qualify for before signing up for one.

How Do I Qualify for a D-SNP?

Assuming your state offers D-SNPs, if you are eligible for both Medicare and Medicaid, you will most likely qualify for a D-SNP. However, you must meet certain baseline rules:

• You must be a U.S. citizen or permanent resident.
• You must qualify for Medicare Part A and Part B.
• You must meet income and asset requirements for your state’s Medicaid program.

How Can a D-SNP Help Me?

A D-SNP is designed with the goal of improving health care quality and efficiency for members on Medicare and Medicaid. It can help dual eligible individuals, especially those with complex medical needs. D-SNP enrollees can:

• Access more comprehensive health benefits including “extra” benefits beyond those offered through Medicare Parts A and B and Medicaid, such as dental, vision, hearing aids, fitness memberships, coverage of special dietary needs, meal delivery and over-the counter-products, assistance with transportation, and personal care benefits.
• More easily navigate benefits due to working with a health plan that understands the unique needs of dual eligible individuals and how Medicaid and Medicare health benefits intersect.
• Work with a care coordinator that can provide individualized guidance and service to members.

Costs of a D-SNP

Depending on the D-SNP and your particular situation, there may be minimal out-of-pocket costs (“cost-sharing”). How much you pay for cost sharing usually depends on your Medicaid eligibility category.

Generally, Medicare pays its portion of medical, dental, or other expenses covered by D-SNPs first, followed by Medicaid. You would then owe any remaining balance determined in accordance with your cost-sharing responsibility.

Enrolling in a D-SNP

To enroll in a D-SNP, you must be enrolled in Medicare. If you meet other D-SNP requirements, you have the following opportunities to enroll:

• During your initial enrollment period – Once you enroll in Medicare, you will be able to apply for a D-SNP. The initial enrollment period refers to the seven-month period starting three months before your 65th birthday. In addition, special rules that may allow access to a D-SNP sooner may apply to you if you are receiving Social Security or Railroad Retirement Board disability benefits.
• During the general enrollment period, which is January 1 to March 31 each year – In this time period, you can sign up for Medicare Parts A and B if you did not sign up when you were first eligible. You can then sign up for a D-SNP in April through June of that same year.
• During a special enrollment period if a qualifying event occurs – Qualifying events may include such scenarios as:
  • You are in a nursing home, moving into one, or leaving a nursing home. You can enroll in a D-SNP for the first time, switch plans, or leave a plan.
  • You become eligible for Medicaid – you can then enroll in a D-SNP.
  • You move outside the service area covered by your current SNP and want to switch to another plan.
  • Your D-SNP leaves Medicare – you can sign up for a different D-SNP.

D-SNPs are unique plans that can benefit members in many ways, expand their access to medical care, and often accomplish all of this at an affordable rate. If you have questions about whether a D-SNP is right for you, speak with an elder law attorney in your area.

You may be in need of a medical procedure, such an MRI, or are due to refill a certain prescription medication. And yet you may find yourself having to wait until your insurer approves coverage for it before you can move forward.

At a minimum, this process, known as prior authorization, can prove inconvenient. Worst case, many physicians say, prior authorizations can in fact put some patients’ health at risk. According to one 2023 survey of more than 600 medical practices, 97 percent of respondents reported that their patients were experiencing delays or denials for medically necessary care due to prior authorization requirements.

What Is a Prior Authorization?

Certain health insurance companies mandate that physicians secure approval from a patient’s health plan for medical procedures (or prescriptions for medications or devices) before the patient can pursue that particular course of treatment. The health care provider must first request approval, and then the patient needs to wait until the insurer issues its approval.

If you have a Medicare Advantage plan, you are likely familiar with these medical prior authorizations. According to one research brief, 99 percent of Medicare Advantage enrollees had to seek out approval for some services in 2021. Today, about 28 million people are Medicare Advantage enrollees, with that number growing steadily in recent years.

What to Do When Your Prior Authorization Is Denied

Your insurance company may deny you prior authorization, even if your doctor has requested a procedure or prescription that they feel you need.

As a result, you may have to pay out of your own pocket for the specific medical service or prescription that you need. Before you do, however, consider filing an appeal. Read more about what’s involved in the appeal process.

How to Speed Up Prior Authorization for Medication

If your health care provider is requesting pre-authorization for your prescription medication, verify that their office has all of your most up-to-date medical history, health insurance, and contact information on hand. The approval process can take a few days, or sometimes more.

If you know ahead of time that you’re going to need prior authorization for a particular prescription, you also may want to call your insurance provider directly.

Note that receiving pre-approval does not always guarantee that your health insurer will completely cover the cost. However, according to the Patient Advocate Foundation, it is “a good indication of your health plan’s intentions to pay for the service or medication.”

Lawmakers Pushing for Reform on Prior Authorizations

Health insurance companies say prior authorizations help patients save money, avoid needless medical treatments, and prevent overprescribing of medications. Yet recent research is highlighting the downsides of prior authorizations according to health care providers and patients alike.

The American Medical Association found that 25 percent of doctors report that delays in pre-authorization led to a patient being hospitalized. In another survey, practicing physicians cited the following problems with prior authorizations:

• Delays in patients’ medical care
• Higher costs for medical practices
• More time spent by medical groups working to meet prior authorization requirements
• Patients missing out on medical treatment altogether when they face denials

At the same time, polls show that many Americans also favor reform around the prior authorization process.

Through several different forms of legislation, a bipartisan group of federal and state lawmakers across the country have been advocating for change on this front.

In 2022, the Seniors’ Timely Access to Care Act secured approval in the House. This bill sought to streamline and modernize the prior authorization process for patients with Medicare Advantage plans. However, it never reached the Senate for a vote.

The Centers for Medicare and Medicaid Services subsequently issued a proposal focused on changes to improve the process. Almost 300 Congress members have rallied behind it. 

Then, in August 2023, State Rep. Mark Green (R-TN) reintroduced legislation focused on reforming prior authorizations. Green, who has his medical degree, is sponsoring the Reducing Medically Unnecessary Delays in Care Act.

“Prior authorization is a roadblock to care – equivalent to a bureaucrat in the waiting room,” said Green in a news release about the bill. “It’s time to put patients first. Pre-authorization doesn’t do that.”

According to the Health System Tracker, individuals in the United States have more than $195 billion in medical debt.

Medical credit accounts for a portion of this debt. From 2018, to 2020, people in the U.S. used medical credit cards or loans with deferred interest periods to pay for approximately $23 billion in health care expenses. This includes more than 17 million medical purchases from 2018 to 2020, including $1 billion in deferred interest.

What Is a Medical Credit Card?

A medical credit card is a type of credit card used only for medical expenses. Its initial purpose was to pay for procedures insurance does not cover, such as hearing exams, dental care, and cosmetic procedures. These cards have since evolved to cover additional health care charges, such as hospital treatment, per the Consumer Financial Protection Bureau.

Many companies offer medical credit cards, including Care Credit, Wells Fargo, and Simmons Visa.

Health Care Providers May Promote Medical Credit Cards

Some health care providers supply medical credit cards to their clients to finance medical payments. Once the patient signs up for one of these cards, the company pays the health care provider. The patient then becomes responsible for paying the credit card company back.

The Consumer Finance Protection Bureau warns that health care providers have incentives to encourage patients to take on medical credit.

• When a patient uses a medical credit card to pay for services, the provider receives the payment from the credit card company right away and in full.
• Since the patient has obtained credit to finance health care services, the patient may be more likely to agree to certain procedures without thoroughly researching alternatives.
• These cards reduce providers’ time and effort spent on debt collection.

In fact, several federal government agencies are teaming up to consider stricter regulations on these types of cards. The Consumer Financial Protection Bureau’s director, Rohit Chopra, is among those who expressed concern in a recent news release. “Financial firms are partnering with health care players to push products that can drive patients deep into debt,” he said.

Interest Rates

Most medical credit cards have a 0 percent interest period before the interest accrues. This deferred interest promotion period typically lasts between 12 and 18 months.

Compared to traditional credit cards, medical credit cards can have higher interest rates after the deferred period ends. Whereas traditional cards average 16 percent interest, medical cards average 26.99 percent. When cardholders make payments in installments, missing a single payment can trigger interest. Deferred interest promotions can seem attractive, but they can grow costly if you have yet to finish making payments when the promotional period ends, as the interest rates are typically higher for these cards.

Since you risk accumulating additional medical debt if you do not have the money to pay your credit card during the no-interest period, it is a good idea to consider alternatives to medical credit cards.

Alternatives for Covering Medical Bills

Before signing up for a medical credit card, review alternate options that may help you cover health care costs.

• Ask if you’re eligible for financial assistance. Under the Affordable Care Act, non-profit hospitals must provide free or discounted care.
• Some health care providers also offer payment plans. Patients can secure credit directly through lenders. These payment plans can help patients make deferred payments. However, they can also have higher interest rates that take effect after an initial no- or low-interest period.
• Most traditional credit cards can be used for medical expenses. With a standard credit card, you may earn rewards. Using a conventional credit card to pay for a health care expense could make sense if you have a low interest rate.

Consult With an Attorney

If you anticipate facing medical debt, consider working with a local, licensed attorney who can help you navigate the health care system affordably. An attorney can help you explore alternatives to taking on medical credit.

The National Council on Aging reports that more than 16.5 million adults 65 and older experience economic insecurity, with incomes below 200 percent of the federal poverty level. Rising housing and health care bills can burden seniors on fixed, limited incomes.

Life insurance is an asset that many older adults have. According to Vital Life, 57 percent of Americans aged 65 and older have life insurance policies. In 2019, life insurance companies paid beneficiaries $78.4 billion and supplied $88.1 billion in annuity benefits, per Forbes.

While the purpose of a life insurance policy is to provide for beneficiaries, some older adults may consider selling their life insurance policies, allowing them to use a portion of the policy’s value to cover their expenses.

How Life Settlements Work

When you sell your life insurance policy, you can receive a life settlement. This allows you to obtain money to cover your expenses. The payment will be less than the full amount of the cash benefit. The average life settlement ranges from 10 percent to 25 percent of the full benefit, according to Smart Asset.

In return for the payment, an individual or company becomes the new policy owner. The new owner is responsible for paying all premiums and receives the full payment upon your death. Once you sell your life insurance, you are no longer responsible for paying the premium, but any intended beneficiaries can no longer benefit from the policy.

Once you have entered into an agreement in exchange for a life settlement, you no longer own the policy, and your loved ones will not be able to obtain payment when you pass away.

Reasons People Sell Their Life Insurance for a Life Settlement

Obtaining a life settlement allows you to capitalize on your life insurance policy now, helping you pay for your expenses, such as medical bills and long-term care.

If you are at risk of lapsing on payments, selling the policy allows you to avoid forfeiting it entirely. When you receive a life settlement, you will get more than if your policy lapsed or you surrendered it. Keep in mind, however, that many policies have grace periods for lapses in payment. Before giving up your life insurance policy, check with the policyholder to find out how much time you have to pay your premium before losing coverage.

Life settlements can also be beneficial if you no longer need a life insurance policy. For instance, if your spouse was your intended beneficiary, but your spouse passed away before you, you may no longer feel you need the life insurance policy.

Considerations When Selling Your Life Insurance Policy

While selling your life insurance could help you cover your expenses, it may not be the best choice for everyone. Your age, health, and the terms of your policy can all affect how much you will receive from a life settlement. Consider the following before making a decision:

• Before agreeing to a life settlement, contact your insurer to learn about all of your options under your policy.
• Speak with a life settlement broker or life settlement provider. The broker can help you shop around and find the best settlement offer. Brokers typically charge 8 percent and must disclose their fees upfront. You may want to ensure that the broker has a license in your state.
• Consider alternatives to a life settlement, such as taking out a reverse mortgage on your home or using the cash value of your insurance policy as security for a loan.
• Take time to review your outstanding debts. Creditors may attempt to take your life settlement.
• Speak to a tax professional about the tax consequences of acquiring a life settlement. You will likely have to pay taxes on the amount you receive.
• Take into account how the life settlement could affect whether you are eligible for government benefits, such as Medicaid. The settlement could constitute an asset that disqualifies you.
• The individuals who would have otherwise benefited from your life insurance policy may need to sign off on your life settlement. This is a requirement of some life settlement providers.

Consult With an Attorney

If you are considering selling your life insurance policy, consulting with a local, qualified elder law attorney is essential. An attorney can help you determine whether a life settlement could benefit you. This can also assist you in identifying alternative strategies allowing you to maintain your policy and afford care.

For additional reading on life insurance, check out the following articles:

• What Types of Life Insurance Will Affect Your Ability to Qualify for Medicaid?
• Using Life Insurance as Part of Your Estate Plan

The 2023 Senior Report recently issued by America’s Health Rankings sheds light on the latest trends in the health and well-being of older Americans.

Highlighting the good news – and the bad – for aging adults in the U.S., the findings call attention to some of the greatest needs facing seniors in recent years.

For instance, while older adults’ mortality and drug-related death rates are on the rise, more elders now have improved access to the internet, home health care, and geriatricians than ever before. Perhaps most stark is the data revealing the particularly devastating effects of the COVID-19 pandemic and opioid crisis on aging Americans.

In addition to assessing the overall health and well-being of U.S. adults 65 and older, the report touches on related areas that have an impact on this population, including social and economic factors and clinical care. What follows is a glimpse into a selection of the research results.

Health and Well-Being: Concerning Trends

More Elders Died Early

While deaths among adults ages 65 to 75 had declined from 2011 to 2019, the early death rate rose by 4 percent from 2019 to 2021, reversing this trend. The coronavirus pandemic that began in 2020 may explain this increase. Per the Kaiser Family Foundation, those 65 and older experienced the most deaths from COVID-19.

Suicides Increased in Those Over Age 85

Suicides grew in prevalence among the oldest Americans. The suicide rate rose by 9 percent for adults 85 and older.

Opioid Deaths Among Older Adults Are Surging

Drug-related deaths, which have risen in the past two decades, continued to increase. In large part because of the opioid crisis, drug overdose deaths increased by a staggering 43 percent between 2016 and 2018, and 2019 and 2021.

The opioid epidemic has greatly impacted older adults, as they often receive opioids for chronic pain or surgery recovery. In fact, elders experienced a 175 percent increase in deaths due to synthetic opioids, such as fentanyl and tramadol, between 2016 and 2021.

Fewer Seniors Reported Cognitive Difficulties

While rising death rates present a concern, older adults did experience better cognitive outcomes from 2019 to 2021. The percentage of Americans ages 65 and older reporting physical, mental, or emotional problems or difficulty remembering, concentrating, or making decisions decreased by 6 percent.

More Older Adults Had Multiple Chronic Conditions

From 2020 to 2021, the portion of Medicare beneficiaries with three or more chronic conditions rose by 13 percent. Chronic conditions can affect daily functions and mobility. Since seniors with multiple chronic conditions need medication, monitoring, and specialized medical attention, they constitute one of the highest-need population groups.

Physical Activity Declined

Reports of physical inactivity in adults 65 and older in fair or good health rose by 6 percent. Inactivity increases a person’s risk for diseases such as heart disease, cancer, and diabetes.

According to the report’s findings, Utah stands out as the healthiest state for older adults, and seniors in Mississippi rank as the least healthy.

Social and Economic Factors: A Mixed Bag

Poverty Levels Rose

Poverty is related to worse health outcomes, mental decline, mortality, and homelessness among older adults. The percentage of older adults experiencing poverty increased by 10 percent between 2019 and 2021. Housing costs burdened 31.1 percent of elder households, consuming more than 30 percent of their income.

Notably, poverty is also associated with aging adults who reported that their physical health had not been good for two weeks or more in the past 30 days. Frequent physical distress was three times higher among older adults with household incomes less than $25,000 than those making $75,000 or more. Lower levels of education were also related to experiences with physical distress.

Elders’ Access to Food Is Improving

While poverty rates have increased, fewer older adults are experiencing food insecurity. There was a marked 79 percent growth in home-delivered meals between 2019 and 2021. As the pandemic made grocery shopping difficult for many older adults, home-delivered meals presented an alternative.

More Seniors Gained Access to the Internet

High-speed internet became available to 7 percent more of older adults from 2019 to 2021. Particularly during the pandemic, internet access helped individuals stay connected to loved ones and receive telehealth services.

Older Adults Are Facing Less Risk of Social Isolation

Several factors have contributed to a decline in social isolation among older Americans from 2011 to 2021.

• Independent living difficulty rates lowered by 12 percent.
• Disability decreased by 7 percent.
• Fewer older adults were divorced, separated, or widowed, and there was a 3 percent reduction in individuals living alone.

Seniors Are Not Volunteering as Much as They Had

Engaging in volunteer opportunities can provide older adults with positive social interactions and a sense of purpose, promoting better cognitive functioning. Yet volunteering among seniors decreased by 22 percent between 2019 and 2022.

Clinical Care: Some Bright Spots

Access to Care Changed – for the Better

Seniors’ access to home aides and geriatricians expanded. From 2016 to 2021, there was a 5 percent increase in personal care and home health aides. The number of health care practitioners specializing in geriatrics grew 8 percent between 2021 and 2022.

Meanwhile, however, fewer Medicare beneficiaries received hospice care. The percentage of Medicare beneficiaries who died in hospice went from 50.7 percent in 2018 to 46.7 percent in 2020.

Data included in the 2023 report came from 22 sources, including the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS).

Read the full report here.

According to the Social Security Administration (SSA), 69.1 million people benefit from Social Security programs, such as Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI).

Of the $1.1 trillion Social Security payments the SSA made in retirement, survivors, and disability benefits in 2021, about $1.8 billion, or 0.17 percent, constituted overpayments, AARP reports. An overpayment occurs when Social Security gives you more money in a month than you should have gotten.

Reasons for a Social Security Overpayment

Overpayments can happen when the SSA relies on incorrect or old information or makes errors.

• If you have experienced life transitions such as changes in your living situation, marital status, ability to work, or income, you may see your Social Security payments adjust. While you must update the SSA about any changes affecting your benefits, sometimes these updates face delays, and the information on file at the SSA needs correcting. This can lead to improper calculations for monthly benefits.
• In other cases, the SSA may make a processing or calculation error that causes the overpayment.

Can You Keep the Money?

When you receive an overpayment, the Social Security Administration will attempt to recover their loss. If you spend the surplus benefit, you risk not having enough money to pay back the SSA. Or, if the SSA reduces your monthly payment to compensate for the mistake, you may not have enough to cover your expenses.

Although the SSA may waive repayment, in most cases, it will seek recovery even when it bears responsibility for the overpayment. The Chicago Tribune reports that the SSA attempts to recoup significant overpayments even when the mistake persisted for years and the beneficiary spent the income.

Notice of Overpayment

The Social Security Administration will notify you if it determines that it overpaid you. According to the SSA, the notice will state the reason for the mistake and how you can pay the SSA back.

The notice will explain the steps you can take, including:

• Asking the SSA to reconsider the decision if you believe the payment was correct
• Requesting a waiver for the overpayment, allowing you to keep it
• Entering a payment agreement to pay back the amount at a different rate

Once you request reconsideration, a waiver, or a different payment rate, the SSA will pause recovery until it makes a decision.

Appealing an Overpayment Decision

If you disagree with the SSA’s claim that you received an overpayment, you may appeal the decision and ask that the SSA reconsider it. You may appeal by filing Form SSA-561, Request for Reconsideration, with your local Social Security office.

The form requires you to explain why you have not been overpaid. Should you agree you have been overpaid but disagree about the amount, you must also provide your reasoning.

Requesting a Waiver: Social Security Hardship Form

For those experiencing financial hardship, waivers are available. You may apply for a waiver if the mistake was not your fault and you cannot afford repayment. Once the SSA gives you a waiver, you can keep the money without repaying the SSA.

Use Form SSA-632, Request for Waiver of Overpayment Recovery, to seek a waiver. When you fill out the form, it asks for your income, the income of your spouse and dependents, and your family expenses, which the SSA uses to determine whether you can afford to pay.

Repaying the SSA Gradually

In the notice letter, the SSA gives a repayment rate, setting a timeline for the repayment. For those who need more time, gradual repayment is available. You’ll need to provide financial information, including how much money is in your accounts, as well as your income and expenses. Paying back the SSA over time can help you make ends meet.

Consult With an Attorney

Seek the counsel of an attorney if you receive an overpayment notice. A local, qualified attorney can help you understand what happened and guide you to the best course of action.

More Americans are living longer, with the number of people older than 65 projected to increase to more than 80 million by 2040. As this population reaches retirement age, the risk of social isolation substantially increases – along with its negative effects.

Keeping older adults socially engaged is an important part of their overall well-being. Older people are at high risk for social isolation as age, disease, and loss rob them of their social connections. In addition to a greater feeling of loneliness, diminishing social interactions can leave older adults vulnerable to developing diseases like dementia and other chronic illnesses.

For caregivers, deciding what is best for their senior loved ones can feel overwhelming. Given the benefits of fostering social interactions among seniors as they age, many caregivers might consider prioritizing opportunities to keep their aging loved ones socially active and connected.

Continue reading to learn more about the benefits of social connection, the risk of loneliness, and tips for keeping your family member connected as they age.

Tips to Keep Older Adults Socially Engaged

Keeping seniors engaged is critical to their quality of life. There are a host of benefits for seniors who remain socially connected, including increased physical activity, a stronger support system, decreased rates of depression, and relief from physical discomfort. Having regular social interactions can even extend an older adult’s quality of life. One study found that older adults who have strong community connections have a 50 percent greater chance of living five years longer than seniors who remained socially isolated.

Consider the following activities and changes if you are looking for a way to help your loved one create a stronger community:

• Hire home health services
• Adopt or foster a pet
• Make meals a social event
• Increase the use of social media platforms
• Get involved in local activities

It is important to keep the older adults in your life moving as well. Keeping physical activity fun can lead to increased motivation to remain physically active. Dancing is one great way to get seniors up and moving and getting great exercise.

Reach Out and Play

The Ageless Innovation and AARP have collaborated to create and advertise an initiative called Reach Out and Play. This series of events strives to encourage people from all age groups to connect with older adults and increase the number of meaningful interactions thereby increasing emotional and overall well-being. Reach Out and Play events will be happening from September through October of 2023. Find more information about events in your area.

Social Isolation May Influence the Development of Dementia in Seniors

There is a devastating connection between a lack of social interaction and an increased rate of older adults developing dementia. According to the Centers for Disease Control and Prevention, socially isolated seniors have a 50 percent increased risk of developing dementia.

According to a study published in the Journal of the American Geriatrics Society, chronic loneliness showed a 27 percent increase in the risk of developing dementia in adults who were studied over nine years.

Ensuring that seniors are not isolated is critically important. In addition to the risk of dementia, the CDC cites other health risks associated with long-term social isolation, including:

• A 57 percent increased risk of emergency room visits
• A 29 percent increased risk of heart disease
• A 68 percent increased risk of hospitalization
• A 32 percent increased risk of stroke
• Higher rates of anxiety, depression, and suicide
• An increased risk of premature death

Is Loneliness an Epidemic?

Chronic loneliness may be a bigger problem for Americans than most of us have considered. U.S. Surgeon General Dr. Vivek Murthy warns, “Our epidemic of loneliness and isolation has been an underappreciated public health crisis that has harmed individual and societal health. Our relationships are a source of healing and well-being hiding in plain sight – one that can help us live healthier, more fulfilled, and more productive lives.”

Now, as more of us are living longer, we must focus on taking steps to increase our quality of life as we age by increasing our connections.

According to AARP, people aged 60 and older owe upwards of $290 billion in student loan debt. Thankfully, many federal student loan borrowers have experienced payment reprieves for the past few years due to multiple payment pauses enacted during the pandemic by the CARES Act and other loan relief efforts.

These pauses on making payments for federal student loans are ending in August 2023, however. Interest will resume accruing on paused loans effective September 1, 2023, and student loan payments will be due in October 2023. To help borrowers get back on track with their payments, the Department of Education is implementing several programs.

Resuming Payments

One of the new initiatives is a yearlong “return-to-repayment” program designed to get borrowers back into active repayment status. Between October 2023 and September 2024, borrowers who miss payments will not be considered delinquent. Their loans will not be reported to credit bureaus as delinquent due to missed payments.

In addition, they won’t be considered to be in default. Although interest will still accrue, it will not be capitalized. The idea behind this program is to give borrowers time to contact their student loan servicers, explore their options, and hopefully enroll in an affordable repayment option.

Fresh Start Initiative

Additionally, the Department of Education is implementing a “Fresh Start” initiative. This program provides borrowers who were in default of their student loans before March 2020 with a way to get their loans out of default going forward. It allows them to request that their loans be removed from default and put back into repayment status via a simple request to their loan servicer.

This is significantly different from what borrowers previously had to do to get out of default, which often included a “trial” repayment effort before a loan was taken out of default.

The benefits of the Fresh Start program include allowing borrowers to:

• start paying their loans again regardless of prior missed payments,
• improve their credit scores,
• avoid administrative wage garnishment (AWG), and
• access income-driven repayment (IDR) options quickly. (IDR options often result in $0 monthly payments for low-income or fixed-income borrowers.)

Avoiding Administrative Wage Garnishment (AWG)

The ability to avoid AWG is significant. AWG can affect people at all stages of life, including seniors. AWG allows a federal agency to order a non-federal employer to withhold up to 15 percent of an employee’s wages to pay a debt owed to the agency, such as defaulted federal student loans. AWG can also mean receiving a lower tax refund or having a portion of one’s monthly Social Security benefits withheld.

However, if borrowers take advantage of the Fresh Start program prior to August 31, 2024, they can avoid a loan default that leads to AWG.

The SAVE Plan

In addition, the Department of Education is implementing a new IDR option in mid-2024 called the Saving on a Valuable Education (SAVE) Plan. The SAVE Plan amends and replaces the REPAYE Plan.

Typically, the amount a student loan borrower with an IDR plan must pay depends on their income and the size of their family. Effective July 1, 2024, the SAVE Plan will protect more of a borrower’s income from monthly payments. Compared with other IDR plans, the SAVE Plan will therefore lead to reduced monthly payments. For details, check out this fact sheet from the Department of Education.

Borrowers With Disabilities May More Easily Qualify for a TPD Discharge

Effective July 1, borrowers with disabilities will have an easier time qualifying for a total and permanent disability (TPD) discharge. New rules allow the Department of Education to offer TPD discharges (often automatically) to borrowers receiving SSDI or SSI who:

• have an onset of disability date five or more years ago and have been receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) based on this disability for at least five years;
• SSDI or SSI recipients who suffer from a condition on the Social Security Administration’s List of Compassionate Allowances;
• SSA beneficiaries receiving retirement benefits who met the requirements for a disability discharge before they retired;
• SSDI or SSI recipients receiving these benefits based on disability with a three-year disability review period; or
• SSDI or SSI recipients receiving these benefits based on disability with a five- to seven-year disability review period.

Disabled individuals who do not meet these criteria and wish to apply for a TPD discharge based on a doctor’s certification may now seek out certification from professionals beyond those holding an M.D. Nurse practitioners, physician assistants, and osteopathic doctors may now sign the certification verifying a borrower’s disability.

Borrowers who receive a TPD discharge in this manner will no longer be subject to a three-year income monitoring rule. However, if they apply for new federal loans within three years, they may lose their TPD discharge.

Forgiven Student Loan Debt Won’t Result in Taxable Income (For Now)

At the moment, student loan debt cancellation is not counted as taxable income to borrowers. This protection from additional taxes will remain in effect until December 31, 2025.

So, if you are considering applying for a TPD discharge or completing an IDR plan you previously started that would lead to loan forgiveness, now may be the time to act. However, note that this rule only applies to federal tax liability. Borrowers may still have liability under their state’s income tax rules.

For more information on how the recent developments in the federal student loan landscape may affect you, speak with a qualified attorney in your area.

According to the National Institutes of Health (NIH), hearing loss affects one-third of older adults. As difficulty hearing can lead to communication challenges and social withdrawal, it can also increase the risk of dementia. Dementia includes diseases affecting memory, thinking, and the ability to perform daily activities and affects 55 million people worldwide, per the World Health Organization.

Hearing loss accounts for 8 percent of the world’s dementia cases. The Alzheimer’s Association estimates that global dementia cases will triple by 2050.

Hearing Aids for Brain Health

Hearing aids could reduce the risk of cognitive decline in older adults experiencing hearing loss. A review of several studies also revealed that hearing aid use lowers the risk of dementia by 19 percent across two to 25 years. Using hearing aids for a short time was associated with a 3 percent advancement in cognitive test scores.

Access to hearing aids is essential for seniors at risk of cognitive problems. A study published in The Lancet found that giving audiological counseling and hearing aids to older adults at increased risk for cognitive decline lessened the development of cognitive impairments over a three-year period.

Over-the-Counter Hearing Aids

For older adults experiencing hearing difficulties, over-the-counter (OTC) hearing aids could improve quality of life, preserve social connectedness, and prevent cognitive decline. Following the Food and Drug Administration’s recent approval, devices for adults with mild to moderate hearing loss became available without a prescription in October 2022.

Where to Buy Over-the-Counter Hearing Aids

OTC hearing aids are available in drug stores such as Walgreens and CVS, as well as online pharmacies. Other sellers include Best Buy, Walmart, and Hy-Vee.

Who Could Benefit From Hearing Aids Over the Counter

If you or a loved one are older, experiencing cognitive difficulties, and facing barriers to accessing health care, an OTC hearing aid could help improve your daily life and reduce the risk of developing dementia. Since OTC hearing aids are available without a prescription, those who cannot afford a prescription hearing aid may obtain hearing aids for mild to moderate hearing loss directly from a store.

Those with significant hearing loss will need prescription aids from their otolaryngologist. Yet others who may have difficulty hearing in crowded areas or on the phone but do not have severe hearing impairments could benefit from an OTC hearing aid.

The average cost of a pair of OTC hearing aids is $1,600, about $3,000 less than prescription devices, according to the National Council on Aging’s recent report on the best OTC hearing aids. This makes OTC hearing aids a more affordable option for older adults with mild to moderate hearing loss.

How They Work

Hearing aids have microphones that receive sounds. An amplifier increases the sound’s strength in the wearer’s ear. By receiving and amplifying sounds, hearing aids allow individuals to detect sounds and maintain conversations.

Risks of Not Using a Hearing Aid

The NIH reports that fewer than a third of adults aged 70 and older who could benefit from hearing aids use them. Given the relationship between hearing loss and cognitive decline, forgoing a hearing aid could put you at greater risk of developing dementia

Without a hearing aid, some find engaging in social interactions with friends and family increasingly difficult and may not want to be around people as frequently. Johns Hopkins Medicine has identified social isolation as a factor contributing to cognitive deterioration. An OTC hearing aid could help you stay engaged in conversations with others, fostering a sense of social support and community that protects against cognitive decline.

For those who may have trouble accessing a prescription hearing aid, OTC hearing aids are an alternative that could prevent dementia. If you or a loved one experiences hearing loss, consider whether a hearing aid could help.

The No Surprises Act is a federal law enacted to protect patients from unexpected medical bills incurred on or after January 1, 2022. It aims to address the issue of surprise medical billing, which can occur when patients receive unexpected charges for their medical care. The Act applies to out-of-network emergency services, out-of-network air ambulance services, and certain out-of-network care received at in-network facilities.

Help for Seniors

The Act is important for all patients, but especially for seniors. Seniors are especially vulnerable to surprise medical billing because they often need more health care than other populations. They are more likely to be seen by out-of-network providers. The Act protects them from unexpected charges and provides a much-needed safeguard for their medical expenses.

Under the Act, patients are not responsible for surprise medical bills beyond their in-network cost-sharing amount. This means that patients will only be responsible for paying the same amount they would have paid if an in-network provider provided the care. The Act also prohibits balance billing, which is when providers bill patients for the difference between their charges and the amount paid by the patient’s insurance.

This can be relevant in a variety of settings seniors encounter, including emergency room visits, second opinions, surgical procedures, and even skilled nursing care where independent contractors provide services. Under the Act, providers must accept the Medicare-approved amount as payment in full. This prevents patients from being surprised with large balances and protects them from unexpected financial hardship.

Exceptions to the Act

There are some providers and services that are exempt from the Act’s billing protections (although your state may have a similar law that does not exempt them). These include:

• Ground ambulance services, which can charge you out-of-network rates
• Vision-only and dental-only insurances, which are not subject to balance billing protections
• Indemnity plans such as hospital indemnity insurance, which are exempt from the Act

If You Are Uninsured

For uninsured or self-paying patients, the No Surprises Act provides rules for a good faith estimate of how much a medical service will cost. You may request an estimate if you schedule a medical service at least three business days out or simply ask for one. If your final bill is $400 or more than the estimate, you may be able to dispute it. Having a good faith estimate allows patients to make informed decisions about their care.

Independent Dispute Resolution

To resolve payment disputes between providers and insurers, the Act establishes an independent dispute resolution (IDR) process. This process allows providers and insurers to submit their proposed payment amounts to an independent arbiter who makes the final decision. The IDR process aims to protect patients from being caught in payment disputes and ensures a fair resolution for all parties involved.

Pricing Transparency

In addition to protecting patients from surprise medical bills, the Act also includes provisions to increase health care pricing transparency. Health insurers must provide patients with clear and detailed information about their health care coverage. This includes a description of providers’ network status and estimated cost-sharing amounts. This increased transparency aims to empower patients to make informed health care decisions and avoid unexpected charges.

The No Surprises Act is a significant step toward addressing surprise medical billing and protecting patients from financial harm. By implementing clear rules and procedures, patients are not caught off guard by unexpected charges and have access to fair dispute resolution. With the Act in place, patients can have more confidence in seeking medical care, knowing they will not face unexpected financial burdens.