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This week we have a new report from our Medicare expert regarding the changes which have been made to Medicare in 2019, and the expected changes in 2020 or later.  The expert who wrote this post is Danielle Kunkle Roberts, a recognized Medicare insurance expert and Forbes Finance Council member.  Some of you may have already read some of her other helpful guest posts which she has written for this blog over the past few years.  You will find contact information for Danielle Roberts in the sidebar of this blog, as well as at the bottom of the post.  She and the staff of her company are always willing to answer the questions of our readers, as well as help you find a Medicare Supplement or Advantage Plan to meet your healthcare needs and which is available in your state.
Updates to Medicare This Year and Ones to Look Out for Next Year
by Danielle Kunkle Roberts
Lately, Medicare has been announcing update after update. Some of these updates have been in the works for multiple years and are just now being pushed through. Updates to Medicare include things  such as plans being discontinued, new benefits, and more.

Exciting updates have been made to Medicare already in 2019, and we expect to see these updates progress in 2020. There are several updates which have been passed, but will not take effect until the start of 2020. Also, with the presidential election in 2020, we are bound to see more updates to Medicare within the next few years.
2019 Updates to Medicare
Medicare made a few changes to Medicare Advantage plans in 2019.  Between 2018 and 2019, there were about 400 new Medicare Advantage plans added to the mix. In addition to new plans, The Centers for Medicare and Medicaid Services (CMS) added new benefits to the list of benefits which Medicare Advantage plans are allowed to offer.

For years, Medicare Advantage plans have been able to offer benefits which Original Medicare (Part A and Part B) does not offer. Benefits such as drug, dental, vision, and hearing can be found in many Medicare Advantage plans. Now, in 2019, Medicare Advantage plans are allowed to also offer home health care and telehealth benefits.
New Benefits
Original Medicare does not cover home health care for those who only need help with activities of daily living (ADL). Therefore, Medicare beneficiaries who have wanted to stay at home in retirement but were unable to care for themselves have had to pay out-of-pocket for custodial care at home. 

However, now that Medicare Advantage plans offer some home health care services, these beneficiaries can enroll in a plan with these benefits during the Annual Election Period so they can continue to live at home. Home health care benefits which may be covered are adult daycare services, custodial care, transportation, home modifications, palliative care at home, and meal delivery.

Telehealth is a new benefit offered by some Medicare Advantage plans which allows their enrollees who live in rural areas to have better access to specialists who are not close enough for the patient to see in person. Now beneficiaries who have this benefit can have a video call visit with a specialist from their primary care doctor’s office.
Medicare Advantage Try Before You Buy
Another update involving Medicare Advantage plans is the new Medicare Advantage Open Enrollment Period (MA OEP). This period is from January 1st until March 31st. During this period, MA enrollees have the chance to change or drop their MA plan. 

This is a great update, because beneficiaries who choose the wrong MA plan during the Annual Election Period (AEP) can have a second chance to choose a better plan for their situation.
2020 Updates to Medicare
For the past couple of years, we have known about an update which would not be effective until January 1, 2020. This update is the Medicare Supplement (or Medigap) Plan C, Plan F, and High-Deductible Plan F discontinuation

Legislation has been passed which restricts Medigap plans from paying the Part B deductible for their enrollees. All three of the above plans currently cover the Part B deductible. Therefore, these plans will no longer be available to new Medicare beneficiaries as of 2020.

However, if you have one of these plans prior to 2020, you will be able to keep it for many years to come. Also, if you already have Part A prior to 2020, you will still be able to apply for any of these plans with a carrier who offers them.  You will likely have to answer health questions before being approved for one of these plan.
Possible Updates to Medicare in 2020
Since the presidential election will be held in 2020, we should all be on the lookout for important updates to Medicare. Each person running for President in 2020 is proposing changes to Medicare. 

There are proposals such as Medicare for All, Medicare at 50, and Medicare budget cuts. All of these would influence our current Medicare program in a big way. However, nothing is for certain as of right now.

Remember, Medicare always changes to some extent, each and every year. So, changes like ones mentioned in this article are not out of the ordinary. 
About Danielle Robert's company, Boomer Benefits:
"Founded in 2005 in Fort Worth, TX, Boomer Benefits is an award-winning insurance agency for national insurance carriers such as Blue Cross Blue Shield, Aetna, Cigna, Mutual of Omaha and many other A-rated carriers. We are licensed in 47 states. Over the years, we’ve learned just about everything there is to know about Medicare, and we’ve become known as the baby boomers insurance agency. We pass that knowledge on to you – absolutely free. There is never a charge for our services. Boomer Benefits Consulting is free."

Readers can contact Danielle Roberts and her wonderful staff at Boomer Benefits at:


If you are interested in learning more about Medicare, Social Security, financial planning, where to retire, common health issues as you age and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional helpful articles on a variety of retirement topics.

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When my husband was diagnosed with Chronic Kidney Disease ten years ago, we were alarmed to discover that the only way he could slow down the progression of the disease would be for him to carefully follow a restrictive diet. Eventually we realized this is true for many people with a wide variety of medical conditions. We have friends who have been diagnosed with heart disease, diabetes (or pre-diabetes), cancer or various intestinal disorders such as C. Difida, and in many cases they have also been told the best way to improve these conditions is to follow the appropriate diet.

While there are similarities among the different healthy diets, each one has specific foods which tend to be emphasized in order to provide the patient with the best results.  Because of this, whenever you or a loved one has been diagnosed with any serious disease, it is important to learn about the specific diet which will best control that condition and either help you heal your body or, at the very least, slow down the progression of your disease.

Learn How Food Can Help You Heal

You may want to start your treatment program by discussing dietary changes with your doctor.  However, most physicians did not study nutrition in medical school.  As a result, they may not have any more information than a brochure to get you started down the right path.

Most insurance companies, including Medicare, will cover the cost of a visit to a nutritionist who can talk to you about your current diet and explain how you can make appropriate changes in order to support your specific healthcare regimen.  In many cases, a good nutritionist may also be able to include some healthier versions of your favorite foods so you do not need to give up everything you love to eat.  They understand that you will not stick to a diet if the food does not taste good to you.

In addition, you may want to pick up a book to use whenever your diet confuses you and you are not sure what to eat.  A good choice is "Eat to Beat Disease: The New Science of How the Body Can Heal Itself."   

Dr. William Li, a heart expert and the author of the above book, has pulled together years of research to come up with specific doses of the best foods to help treat a variety of diseases. Regardless of your medical condition, it is worth reading.

Special Diets Can Benefit You

What are some of the special diets you can try following in order to help heal or slow down your disease progression?

If you have been diagnosed with Chronic Kidney Disease, you may want to use this Amazon link to  the book "Stopping Kidney Disease."

If you are concerned about memory loss, the MIND Diet has been proven to be helpful.  The Mediterranean Diet has been shown to improve heart health.  There are also special diets to help people who have been diagnosed with cancer and diabetes.  Reading about the correct medical-based diet for your condition can make it easier to find satisfying foods to eat. You can use this Amazon link to see a list of books for healthy diets and find the one which is most likely to meet your needs.

When I took the Brain Health Class with instructors from the MIND program at the University of California, they emphasized that there were no drugs which have been discovered which will either postpone or treat most cases of dementia, but they have observed that eating a diet rich in plants, in addition to getting regular exercise, did seem to make a difference for many people.

By following the right diet and making appropriate lifestyle changes, your medications will work better and you will help your doctors perform their job, rather than hinder them.

Does Diet Really Make Much of a Difference?

Despite all the research, many people remain skeptical that following the right diet can really make that much of a difference in treating their disease.  It is important that people understand that for some diseases, such as chronic kidney disease, the right diet is the ONLY thing which can slow down the disease and help you postpone dialysis.

Diet is also extremely important in dealing with diabetes, whether or not you are taking a medication.  In 2002, researchers compared the effectiveness of diet compared to taking the medication Metformin in preventing Type 2 diabetes in people who were considered at high risk. One group of people were assigned a diet which was low in sugar, salt and saturated fat. They were also told to eat lean protein, as well as to add more fresh fruits and vegetables to their meals.  The other group was told NOT to change their diets.  Instead, they were prescribed Metformin.  Those taking Metformin lowered their risk of of later developing diabetes by 31%.  The group who changed their diets and exercised regularly lowered their risk of diabetes by 58%.  The dietary and lifestyle changes were nearly twice as effective as taking the medication alone.*

In studies performed by heart expert Dr. Dean Ornish, it was discovered that people who followed his heart-healthy program were sometimes able to reverse their heart blockages and reduce their episodes of angina.

Eating the right diet for your disease is an effective way to deal with a serious illness.  When diet, lifestyle changes, medication and other treatments are combined, it can make a significance difference in the lives of most people.

Other Lifestyle Choices Can Help Fight Disease

Of course, food is not the only lifestyle change which might help your body fight off a dangerous disease.  It is also important to follow your doctor's orders regarding exercise, alcohol or sugar consumption, lowering your stress, and ending your addiction to cigarettes or other tobacco products.  No matter what disease you have, it is important to take a holistic or whole-body approach to the healing process.

If you are interested in learning more about common medical issues as you age, Medicare, Social Security, financial planning, where to retire, travel and more, use the tabs or pull-down menu at the top of the page to find links to hundreds of additional articles.

* Source:  http://www.diabetesincontrol.com/lifestyle-changes-superior-to-metformin-for-diabetes-prevention/

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It seems as though the older I get the more often I hear from a friend or neighbor who has been the victim of fraud.  The criminals who create these scams are ruthless.  They can seem friendly, charming and caring but, in reality, they do not hesitate to cheat their victims, even if their victim is a widow or someone living on a small fixed income.  Of course, one of the most famous cases of fraud was Bernie Madoff, who is thought to have committed the biggest financial fraud of all time.  Even though Bernie Madoff is now serving time in federal prison, cases of fraud still create financial hardship every day for ordinary people across the country.

The good news is that you do not have to resign yourself to being just one more hapless victim.  You can take action to make sure this never happens to you and, perhaps, help authorities shut down some of these scams so they do not harm other people.  Here are some of the things we all need to know.

Common Scams Targeting Senior Citizens

1.  Grandparent Scam - One of my closest friends fell victim to this scam. The way it works is that an imposter calls your home, pretending to be a grandchild in trouble. The "teen" is usually crying hysterically, so it is difficult to make out their voice.  They start the conversation by saying, "Grandma (or Grandpa)," after which many senior citizens will respond with the name of one of their grandchildren.  The scammer takes it from there, pretending to be that person.  In some cases, the scammer has already learned the name of your grandchildren and other details about your family from social media, before they ever call you, so they are even more convincing. In the case of my friend, she and her husband, a retired Sheriff's Deputy, wired $5,000 to another country to "rescue" one of their grandchildren.  In truth, her grandchild was here in the U.S., at work, not in any kind of trouble, and had never been in the country where they wired the money.  If my friend had taken just a few minutes to text their grandchild on his cell phone, or call his parents, they could have saved themselves from becoming victims.  However, like thousands of other victims, they were so distressed by the call, they rushed to "help" their grandchild as quickly as they could.  If this has happened to you, do not be ashamed.  These people are convincing.  If even a retired Sheriff's Deputy can become a victim of this type of crime, it is easy to see how anyone can fall for it.

2.  The IRS or Missed Jury Duty fines and Similar Scams - I have received these calls myself. The way they work is that a stranger calls and insists you owe money to the IRS, or you missed your assigned jury duty, or you failed to pay a utility bill, and you must pay a fine immediately or risk arrest or other penalties.  In real life, these agencies do not call people and threaten them.  If one of these agencies actually needs to contact you, they will first send you a letter.  On the rare occasions when one of these agencies or services does call, it is usually after they have already corresponded with you by mail or email.  Even if you do owe them money, they will never insist that you pay them within a few hours. They will never ask you to immediately wire them money or pay them in gift cards or other unusual ways. As a result, it is important that you never rush to send money to a stranger, no matter what government agency or private company they say they represent.  Call the agency or company at the direct number they list on your bill if you have a question and believe you may actually owe them money.

3.  Sweepstakes and Lottery Scams - Everyone hopes to win money, but what if someone claims you won a prize in a contest you don't even remember entering?  What if they say they will only send you the winnings if you first mail them a fee or payment of some kind?  Never give out personal information or credit card numbers over the phone or online to a stranger, even if they tell you they will send you a large prize in return.  Never rush to a store to buy gift cards or cashier's checks to pay for a prize.  In fact, never purchase gift cards to pay for any gift, prize or fee.  It almost always means they do not want to accept normal types of payments, which only happens when they are doing something dishonest.

4.  "Free Lunch" Investment Scams - If you live in a retirement community, you almost certainly have been sent countless offers of a free lunch at a local restaurant in return for listening to a sales pitch about annuities or other investment opportunities.  Often, this becomes a "hard sell" in which the presenter tells you that this is a "limited time" offer.  Never make major financial decisions in a hurry.  Always talk to a variety of legitimate investment advisors before investing your retirement savings with someone at one of these lunches, and check their references.  While many honest sales people do use these lunches in order to find new clients, it should be a red flag if they are too pushy and eager to force you to sign up and invest immediately with them.  Take your time.

5.  Romance Scams - One of the most heartbreaking types of scams are those in which a person pretends to care for you but, unfortunately, really just wants to trick you into giving them money.  This can happen in a variety of ways ... it could be people you already know, people you meet through a dating site, or someone who has reached out through other means of contact.  I have even seen people on sites like Twitter post that they are only there to "meet someone special."  The best advice is to never loan money to anyone, including family members, if you cannot afford to lose the money forever. If you cannot give it to them "for fun and for free," it is probably wise not to give it away at all.  In particular, do not loan money to people you do not know well, no matter how much they insist they love you, would never do anything to hurt you, etc.  Many older people, especially women, have lost thousands of dollars to unscrupulous people who claimed to be in love with them.  Often these scammers spend weeks or months gaining your confidence and then ask for a loan because of some "unexpected" problem, such as getting stranded in another country.  Do not be fooled.  These people are adept at playing the "long con", and they could be corresponding online with a dozen other people, or more, at the same time.  You do not want to be one more of their victims.

6.  Phony Charities - It is almost always best to limit your donations to organizations which you know. If you are unsure about them, there are online sites such as charitynavigator.org where you can verify which ones are legitimate.  In addition, you should know that it is unusual for most major charities to call your home and ask you to donate money to help orphans, police officers, firefighters or the sick, especially if you have never donated to that charity in the past.  If you are tempted to help one of these organizations, ask them to mail you an information packet. This will give you time to investigate the organization before making a final decision. Do not let a caller intimidate you into making a hasty decision over the phone. Anytime you feel pressured, hang up.

7.  Tech Department and Help Desk calls - No matter how often we have tried to stop it, my husband and I, as well as many of our friends, continue to get calls from strangers who say they are with with the tech department or help desk for Google, IBM, Dell, Apple or similar companies.  They always claim they are just calling to "help" us solve a problem we never knew we had.  Obviously, these callers must succeed in getting people to pay them for their non-existent "help" or they would not keep doing it.  Put a note next to all your phones: "Technology companies and computer companies will NOT call you unless you contacted them with a specific problem first."  The best thing you can do is just hang up on these people and block their phone numbers to make it harder for them to keep calling you.

8. Medicare Fraud - This can take many forms, including doctors who overcharge Medicare for treatments you did not receive, as well as people who steal your Medicare number and use it to obtain medical care in your name.  Both activities are illegal and, if you suspect someone has committed these crimes, it should be reported to the Social Security Administration and/or the Office of the Inspector General.

9. Identity Theft and Computer Hacking - A particularly frightening crime is that you could become the victim of identity theft or have your computer hacked and never realize it happened until it is too late.  These people can cheat you without ever personally contacting you.  Fortunately, there are ways to protect yourself from this type of crime, too.  The best way is to make your online identity as invisible as possible.  You can start by using this Amazon link to get a book such as:  "200+ Ways to Protect Your Privacy: Simple Ways to Prevent Hacks and Protect Your Privacy - On and Offline." Follow their suggestions and you will make it much more difficult for someone who is trying to secretly steal your information.

Common Scams Targeting Veterans

In addition to the scams mentioned above, veterans face their own unique types of scams.  These include: offers of cash now in exchange for turning over your future benefits to someone else; offers to help you change your investments in order to qualify for higher government benefits; phony charities which promise to help veterans; and ID theft by people who pretend to work for the VA and request your Social Security number or other personal information.  If you have a question about calls you have received, contact the Department of Veteran's Affairs directly to make sure anyone who contacts you is offering a legitimate service.

More Ways to Protect Yourself from Scams

Register your phones with the Do Not Call List:


If you receive a questionable phone call on your mobile phone, you can easily block the number so they cannot keep calling you from that number.  They may keep trying, using a different phone number each time they call, but eventually they will run out of numbers and the calls will stop. Contact your phone carrier for your land line to find out how to block these calls on your home phone.

Check out charities at:


Investigate financial advisors at:

https://brokercheck.finra.org or (800) 289-9999

Report Scams and Questionable Phone Calls to the Authorities

Whether you have become a victim of a scam or just believe someone was trying to cheat you, report these incidents to your local police or Sheriff's Department, as well as your state Attorney General's office and the Better Business Bureau.  In addition, depending on the incident, you may also want to report it to one of the following agencies:

Securities and Exchange Commission:  https://www.sec.gov

Mail Fraud: https://postalinspectors.uspis.gov/investigations/MailFraud/MailFraud.aspx
(626) 304-7164

Medicare Fraud:  Call (800) MEDICARE or (800) 633-4227

Federal Trade Commission: 

(877) FTC-HELP
(877) 382-4357

Do Not Be Embarrassed if you are the Victim of Fraud

The people who plan and implement these scams are very sophisticated.  They believe that if they try over and over again with enough people, they only need to defraud a few of them in order to make it financially worthwhile to them.  They practice their approach over and over again.  Because of their persistence, there is no shame in falling victim to these thieves.  They can be very charming and convincing.

In addition, the people who cheat you out of your money may actually be relatives or trusted friends.  Before you hand a friend a credit card or loan them money, ask yourself if you can afford to take a loss.  If not, make whatever excuse you need in order to avoid giving them access to your funds.  It may strain a relationship, but not as much as it would if they cheated you.

Do not be embarrassed to report what happened to you.  The money you lose is rarely recovered, especially if it is a phone scam that originated overseas, but if these people are allowed to keep up their behavior, they may repeatedly cheat you out of money or they may scam other people.  Reporting them to authorities is the best way to protect yourself and others.

If you are interested in learning more about financial planning, Social Security, Medicare, where to retire in the US and abroad, common medical problems and more, use the tabs or pull-down menu at the top of the page to find links to hundreds of additional helpful articles.

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As we reach the last few years of our life, our ideal medical reports should read: "healthy, healthy, healthy, healthy, dead."  This statement was made by the instructor of a brain health class I recently attended.  The point she wanted to make was that we all should strive to live lives which are as healthy as possible, right up to the time we die at a very old age.  If these are our goals, how can we increase our odds of making that happen?  What can we personally do to live as long and as healthy a life as possible?

See Your Doctor and Dentist

It may seem obvious, but too many people believe they are better off avoiding doctors. As a result, they are unaware of what is actually going on inside their bodies and may miss the opportunity to avoid easily treated ailments.  Everyone needs to make sure they are engaged in the medical system and do the following:

Maintain a healthy blood pressure
Monitor their A1C or their blood sugar level
Get a colonoscopy
Women should get regular mammograms
Get flu and pneumonia shots
Get professional teeth cleanings
Be checked for other health conditions such as Hepatitis C, skin cancer, prostate cancer, C-reactive protein, and any other tests your doctor recommends.

Practice Self Examinations

While seeing your doctor and dentist regularly is important, your medical providers will not be with you all the time.  Everyone should examine their own bodies regularly and be aware of any changes.  In particular, you will want to check for:

Yellow eyes, which indicate liver problems
Drooping eyelids, which could indicate Bell's palsy or a stroke
Changes in moles
Changes in the color of your urine or bowel movements
Any other changes to your skin, breasts, teeth or mouth.

Sleep a Reasonable Amount Each Night

Get a regular amount of sleep each night, but not too much.  Ideally, you should sleep between 7 and 9 hours a night.  If you have trouble getting a restful night's sleep, check with your doctor and participate in a sleep study, if possible.  Work with your doctor to determine what could be causing your sleep problems ... sleep apnea, too much caffeine, medications you are taking, etc.  Our bodies need sleep to stay healthy and there have also been studies indicating that restful sleep may help remove toxins from the brain and reduce our dementia risk.

Exercise in a Variety of Ways

Any exercise you get is better than nothing at all.  However, the more you move in a variety of ways, the healthier you are likely to be and the longer you will probably live.  Your exercise plans should ideally include:

Aerobics such as walking, swimming, bicycling and dancing
Strength training such as weight lifting or Pilates
Flexibility through stretching or yoga classes
Balance exercises
Back exercises, which could help prevent chronic back pain

Eat a Healthy Diet

Following the Mediterranean Diet, the MIND Diet or the DASH diet, which are all very similar, are great ways to eat whole, healthy food which you will enjoy, while also maintaining good health. Here is an Amazon link to "The MIND Diet Plan and Cookbook" which, along with the other suggestions in this article, is a great way to keep your brain functioning at optimal levels.  The same Amazon link will also enable you to view books on the DASH and Mediterranean diets.

Below are a few things to include in your healthy diet:

Fish and poultry
Nuts and beans
25 grams of fiber a day
8 to 10 servings of fruit and vegetables daily
Healthy oils like olive oil

Reduce your consumption of the following foods:

Sugar and artificial sweeteners
Refined flour
Fried foods
Red meat and butter

Avoid other Dangers to Your Health and Life

No matter how much you exercise or how well you eat, an accident or excess stress can undo all your good intentions.  As a result, there are a few more dangers which you should avoid or minimize in your life.  While some of the items on the list below may seem unrelated to living a long, healthy life, research has shown that these can be problem areas which many people, especially senior citizens, need to address.  

Quit smoking
Drink only small amounts of alcohol
Stay off stepladders and stools
Learn how to deal with stress in healthier ways
Get help with your financial problems
Don't use your phone while driving
Avoid left turns while driving
Cut back on night driving
Ride in the back third of airplanes
Wear a life jacket whenever you are in a boat
Wash your hands and avoid sick people, when possible
Be suspicious of unexpected phone calls, emails or visitors
Avoid dangerous situations by shopping during the day and parking near the entrance to businesses.  The elderly are frequently the victims of crimes, so it is wise to be cautious.

Enjoy Your Life

Finally, living a long happy life is not only about avoiding illness and dangers.  It also means finding a way for your life to include joy and meaning.  Here are some ways to make that happen:

Volunteer doing something which is meaningful to you
Socialize frequently and make new friends
Spend time with family and grandchildren
Get a hobby which engrosses you
Take classes which interest you and chat with the other students
Attend religious services

All of the above activities will bring meaning and happiness to your life and give you reasons to want to live a long life!

If you are interested in learning more about common medical problems, financial planning, Social Security, Medicare, where to retire in the US and abroad and more, use the tabs or pull-down menu at the top of the page to find links to hundreds of additional articles in this blog.

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As of 2019, it has been more than 15 years since any new medications have been developed to treat patients with dementia, including Alzheimer's Disease. According to experts, none of the drugs currently available can stop the development of dementia or slow it down.  None of the drugs can reverse dementia or prevent it.  In other words, as of today, there are no successful medical treatments for dementia, despite the "pseudo-scientific" reports you may have read in the newspaper or products you have seen advertised on TV.  Patients are often given medications to help them stay more alert, sleep better, or deal with depression, but these medications do not restore their memory.

These are just a few of the shocking facts reported by Dr. Joshua Grill from the University of California - Irvine MIND program, where their exclusive focus is on memory impairment and neurological disorders. UCI - MIND is one of thirty research centers around the United States which have been given the task of studying dementia and Alzheimer's Disease by the Centers for Disease Control.

How Big is the Problem of Dementia in the U.S.?

By early 2019, there were an estimated 5.8 million Americans living with Alzheimer's Disease, the most common form of dementia.  Nearly two-thirds of them are women.  This may be partly because Alzheimer's Disease and other forms of dementia are closely linked to aging, and women tend to live longer than men.  However, there are other factors which affect your risk, in addition to aging.  Hispanics are 1.5 times as likely as Caucasians  to develop Alzheimer's Disease.  African-Americans are twice as likely as Caucasians.  However, regardless of your background, no one can feel as though they are safe from dementia.

People of every race and demographic face the risk of developing dementia.  In California, where I live, 11 percent of senior citizens currently have Alzheimer's Disease and one out of eight people over the age of 55 will eventually develop it.  People who live to be 90 have about a 40% chance of being diagnosed with some type of dementia. People who live to be 85 have a 20% chance of having dementia. Even as early as age 80, there is a 10% chance you will be diagnosed with dementia. Unfortunately, the older you are, the greater your risk. 

What are Common Causes of Dementia?

As you see in the graphic from UCI - MIND at the top of this article, dementia is an umbrella term which covers a number of causes of memory loss and cognitive impairment.  In a few cases, such as when the dementia is accidentally caused by certain prescription medications, the brain function can sometimes be restored when the medications are adjusted.

In most cases of dementia, the underlying pathology is progressive and irreversible.  The most common cause of dementia is Alzheimer's Disease, and the word Alzheimer's is sometimes used almost interchangeably with the term dementia.  However, other common causes of dementia are just as debilitating.  They include Frontotemporal Lobar Degeneration (the most common cause of dementia in those under the age of 60), Parkinson's Disease related dementia, dementia with Lewy Bodies, vascular dementia (common in people with heart disease) and Creutzfeld Jacob Disease.

It is possible to have more than one type of dementia develop simultaneously.  For example, someone with Alzheimer's Disease or Parkinson's Disease could also develop vascular dementia because of their history of heart disease.  In addition, the patient's medications, a stroke, or a former brain injury could make the symptoms even worse.

Dementia is Financially Devastating for Families

In 2019, Alzheimer's Disease cost the U.S. $290 billion.  By 2050, it is estimated that Alzheimer's will cost the U.S. $1.1 trillion.  This does not include the value of the estimated $18.5 billion in unpaid care given by the family members of these patients.

Many families eventually have to either institutionalize the loved one or pay someone to come into their home and care for them.  This is because patients often reach the point where they need 24 hour a day care, and have to be protected from risky behaviors such as trying to cook, or wandering off.  The lifetime cost of dementia care can amount to an estimated $350,174 per individual living with dementia (in 2018 dollars).

One way to deal with the high cost of future memory care for you and your spouse is to purchase long-term care insurance, preferably while both of you are in your 50s or 60s and decades away from needing the care.  Although Medicare does not cover the cost of any type of long-term care, in some cases the cost may be covered by Medicaid.  It would be smart to explore the financial requirements necessary to qualify for Medicaid in your state.  Another option is to save enough money, if possible, to cover the cost of putting a loved one in a memory care facility. Even some types of life insurance could help defray the cost.  Having a plan can make the situation a little easier when the time comes.

What is it Like to Live with Someone who has Dementia?

It can be frustrating and exhausting to live with someone who is developing dementia.  Behavior changes are often noticeable even before the memory loss. They may have difficulty doing things which used to be easy for them, such as cooking, driving or handling money. They may experience mood swings, ranging from apathy to depression or anxiety.  They may virtually stop talking, or they could become hostile and argumentative, even violent in extreme cases.  They could become childlike and excessively dependent on you.  They may cry easily.  At times, they may behave inappropriately.  You may eventually be required to take care of their basic hygiene and do virtually everything for them. They may ask you the same questions over and over again.

No one is going to have all of the above-mentioned behavior changes, but regardless of what differences you observe, it will be obvious that what was once a loving relationship could eventually turned into a nurse-patient relationship.

The confusing aspect of these behavior changes is that they often build slowly and most people will not recognize them as early symptoms of dementia.  Your spouse may be able to perform routine tasks and engage in conversations with you for years after the behavior changes start, but they could have more difficulty getting along with the neighbors or relatives.  They might become a prime example of a "grumpy old man or woman."  They may become a bit more reclusive.  Their memory may seem fairly normal, other than annoying you by forgetting what you told them yesterday.  You may feel as though they have changed and are not as much fun as they once were, but it could be years before you recognize that these were the early stages of their developing dementia.

Real Life Examples of Dementia

A friend of mine, whose husband has dementia caused by Parkinson's Disease, initially took her husband to adult day care one day a week, so she could grocery shop and run other errands.  She is now taking him to adult day care three days a week.  The amount of care he requires continues to increase, and someday the community resources my friend relies on may not be enough.  Eventually, he may need around-the-clock care, if he reaches the point when she cannot care for him by herself during the hours when he is not in day care.  Around-the-clock care or a memory facility will put a severe financial strain on her.  His dementia developed fairly rapidly, over just a couple of years after his retirement.

My own mother died of Alzheimer's Disease, which was probably complicated by vascular dementia. My father cared for her for a decade after her initial diagnosis, since her dementia developed slowly.  He enrolled her in several trial drug studies, but they did not seem to help.  In the three years prior to her death, my mother was cared for in my sister's home, where she had the full attention of my father, my sister and my brother-in-law.  Even then, she managed to slip away a few times and it was only because of watchful neighbors that she was found before she wandered too far.  Once, when my sister and brother-in-law were at the store, my father went into the bathroom and could not find my mother when he came out.  She had slipped out of the house barefoot and wearing only a light nightgown in the middle of winter.  A neighbor who lived several houses away found my mother knocking at her door and the neighbor called my sister.  If my mother had been outside much longer, the results could have been fatal.

My mother also fell down the stairs a couple of times and had to be hospitalized for broken bones, even though my sister had a chair lift installed in her home.  However, my mother was not able to use it by herself and she would sometimes try to walk up and down the stairs when no one was watching.  These falls may have also had a subtle effect on her dementia progression.

You are Not Helpless - You can Reduce Your Risk of Dementia

This may seem like a lot of negative information, but there is also some some encouraging news.

First, a small amount of memory loss, diagnosed as mild cognitive decline, may never progress beyond that point.  Just because you forget what you had for breakfast this morning does not mean you are on your way to total dementia. Do not panic every time you misplace your keys.

In addition, researchers around the world are continuing to work on a wide variety of medications which they hope will slow down some of the various causes of dementia. Obviously, different approaches will be needed for the wide variety of health issues involved, but scientists are relentless in their research.

Meanwhile, even though there are currently no medications which can stop or cure dementia, there are a few personal actions you can take to lower your risk of getting it in the first place.  Below are two lists of the things you should be doing if you want to reduce your risk of dementia.  These lists are based on actual research by scientists at UCI - MIND and other memory research facilities.  Currently, these actions are more effective than any medication on the market!

Cut Your Risk Factors for Developing Dementia

Stop smoking - If you smoke, stop!

Moderate your alcohol consumption - Women should not consume more than one five-ounce drink of alcohol in a day; men should not drink more than two five-ounce drinks in a day.  You can lower your dementia risk even more if you only consume alcohol occasionally, not every day.

Avoid being overweight - Control your weight, particularly in middle age.  Maintaining a healthy weight is good for the brain.

Reduce your risk of cardiovascular disease and stroke - Control your blood pressure and cholesterol. Anything which is good for the heart is also good for the brain.

Avoid head trauma - People with a history of concussions may be especially vulnerable to memory loss. In addition, losing your balance and falling late in life can also cause dementia.  Make sure your home is safe and use a walker or cane if your doctor recommends one. Many senior citizens benefit by taking a balance class.

Improve your sleep quality - Take the time to get a good, solid seven to eight hours of regular sleep every night.  Your brain needs plenty of deep sleep in order to regenerate.  It is believed that some of the toxins which build up in the brain during the day are cleaned out during sleep.

More Actions Which Lower Your Dementia Risk

Eat a Healthy Diet - The Mediterranean diet, with its emphasis on fruits, vegetables, whole grains, and small amounts of fish and poultry is a good diet for the brain.  If you want to try an eating plan which is especially designed to benefit the brain the most, you may wish to use this Amazon link to purchase "The MIND Diet Plan and Cookbook."  Eating properly is one of the best steps you can take to protect your brain.

Daily exercise - Physical exercise causes fresh blood to flood through the brain, giving it the oxygen it needs to function well.  A brisk daily walk can help keep the blood moving.  Several walks a day will be even more effective. Avoid being sedentary. 

Take care of your overall health - Our brain is unlikely to do well as we age if we do not take care of the rest of our body.  See your doctor at least annually for a full physical. Follow their personalized instructions.  If you are taking several medications, make sure you are taking the correct dosage.  Go to the dentist, as well.  There is a definite connection between poor dental hygiene and both heart problems and memory problems.  Manage diabetes and any other chronic illnesses you may have.  Uncontrolled blood sugar can cause a variety of health problems.

Be a lifelong learner - Never, ever stop learning new things.  Take a class; learn a new language; take up a hobby; go back to school; read a book; become more proficient on the computer; play chess or bridge; work puzzles.  Continue to challenge your brain right up to the end of your life.

Manage your stress - Whether it means a walk in the woods, yoga, meditation, prayer, or simply spending time alone working on a hobby you love, anything you do to handle your stress will keep your brain relaxed, too.  When you are stressed, the blood vessels in your brain (and the rest of your body) constrict, and less blood and oxygen get where they are needed.  Relaxation helps our blood to flow better, and helps clear toxins from the brain.

Socialize - Although a little time alone is good for you, as with so many things, it can become unhealthy when taken to extremes.  It is very important to also spend time socializing with other people.  When you have a simple conversation, it keeps your brain in shape because you are constantly responding to what the other person is saying.  If you "zone out," you are not fully participating in the conversation.  You have to become engaged and interested in the conversation if you want to get the most out of it.  Practice having interesting conversations with people you enjoy.  Listen to what they say and respond appropriately.  This is great for your brain.  In addition, socializing with friends can help lower our stress levels.  Get out there and enjoy other people!

You Can Participate in a Dementia Study

If you are interested in joining a dementia study, there is a good chance that one is being conducted near you.  I have signed up to participate in the studies going on at UCI - Irvine, and will continue to report here on this blog about what I learn.  Several of my friends are participating, too.

To see which cities have a research center near you, check the attached map.

You can learn more about the trials going on at the various research centers throughout the nation and get more information, as well as their contact information, by checking out this website:


You may also want to sign up for the newsletters from one or more of the research centers.  This is a great way to stay current on cutting edge dementia research. 

To learn more about dementia, other common health problems as we age, Medicare, Social Security, financial planning, where to retire and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional helpful articles.

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Photo credit: Photos of UCI-MIND slides taken by author
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This week we have a very special guest post about New Zealand's Canterbury wine region, including information on the wineries you may wish to visit, as well as popular restaurants in the city of Christchurch.  The post was written especially for this blog by experienced kiwi tour guides at MoaTrek, a company which operates small group tours in New Zealand. 

The country of New Zealand is on the bucket list for many American retirees who have always dreamed of traveling south of the equator.  The New Zealand authors who wrote this post even provided several photos of tourists enjoying the food and wine in their unique part of the world, including the top photo with Lake Wanaka in the background.  

Since this blog has never had an article about this region, we are sure our readers will enjoy the article below.  Perhaps it will spur a few of you to explore New Zealand personally! Below is their post:


MoaTrek Wine Bucket List – Canterbury
If you love food, wine and unique travel experiences, New Zealand is probably already on your bucket list. You can get many big-name brands of New Zealand wine at your local restaurant or supermarket in a number of countries, but the most memorable experiences are created by visiting the remote but accessible corners of New Zealand’s wine regions, where you personally meet winemakers, drink the world's best wine, and eat meals to match. 
This New Zealand wineries guide for travelers has been written by experienced tour guides at MoaTrek, which has been running small group tours around New Zealand since the 1970s and, over that time, figured out where the best wines and wineries are. This article is a guide for overseas travelers planning a trip to New Zealand’s Canterbury wine regions, suggests the best wineries to visit, and recommends the best wines to try on your trip.

New Zealand is one of a group of ‘new world’ wine growing countries changing the global wine landscape - and while our viticulture history doesn’t go back as far as the traditional wine growing areas of Europe and the Middle East, it hasn’t taken long for New Zealand wines to gain a fantastic international reputation. As the youngest country on earth, our wine making history is relatively short; the first grapes were introduced by missionary Samuel Marsden in 1819, who remarked “New Zealand promises to be very favourable to the vine”.
The first larger scale wineries were established by Croatian immigrants around Auckland at the end of the 19th century, but it wasn’t until the 1970s and 1980s that the industry really started to develop. 
With warm summers, cold winters and good soil, Canterbury has a reputation for excellent and elegant Pinot Noirs, Chardonnays and aromatic wines, renowned for their rich flavour.  The Canterbury GI is very large, covering a 44,500 square kilometre (17,200 sq mi) region of New Zealand. (GI stands for the "Geographical Indications - Wine and Spirits - Registration Act" and
provides an international safeguard for New Zealand's geographic names in the wine sectors).
However, almost all of the region's vineyards are concentrated in a relatively small area around the city of Christchurch, prompting the establishment of two sub GIs within it, North Canterbury and the Waipara Valley. These are not the only wine producing areas you may wish to visit, with excellent wineries near Cheviot, Hanmer Springs and on the road to Akaroa producing well-regarded Pinot Noir; but the area around Christchurch is the area we will focus on in this article. 
The North Canterbury Wine Region is the top half of the larger Canterbury GI north of the Rakaia River in a small cluster of vineyards concentrated in 168 hectares (420 acres). The area plants Pinot Noir, Sauvignon Blanc, Riesling, Pinot Gris, and Chardonnay varieties.  Notable producers include French Peak (formerly French Farm), Melton Estate and Lone Goat, which is notable for producing well-reviewed Riesling from the vineyards originally owned by Giesen Estate and New Zealand's only Ehrenfelser wine. 
The main wine growing area of Canterbury is the Waipara Valley, north of Christchurch, and one of New Zealand’s newer wine regions, which began production in the late 1970s with Pegasus Bay.   The valley floor provides a warm micro-climate ideal for viticulture, with a rain shadow from the Southern Alps, low coastal limestone ridges and moderate, cool ocean winds to the east. 
Master of Wine Liam Stevenson has described Waipara as possibly the ‘most exciting place to grow Pinot Noir’, and it makes up the bulk of Canterbury's plantings (although there are also white wine varietals grown there).

Award winners from this region include Greystone Wines Pinot Noir, which has won the Decanter International Trophy and the Air New Zealand Trophy, and Black Estate, awarded the Trophy for Best Pinot Noir at the International Wine & Spirits Competition in 2010. 

Down-to-earth, warm and embracing, New Zealanders are known for their friendly hospitality... the perfect way to sample the top drops while relaxing in beautiful sunny settings and enjoying gourmet spreads.

How to Get to the Canterbury Wine Region of New Zealand

As the gateway to the South Island, many travelers will spend a night or two in Christchurch and take the opportunity to visit surrounding areas. Popular day tour destinations are Hanmer Springs, Kaikoura and Akaroa, which all have wineries on route to visit. You can drive yourself or take day tours from Christchurch. 

For real wine connoisseurs the Waipara Valley is on the way to both Kaikoura and Hanmer Springs. For those traveling South after crossing the Cook Strait by ferry, a stop-over in Kaikoura will be the perfect place to stay before visiting the Waipara Valley on the way South the following day. 

Canterbury wineries to visit:    
Pegasus Bay Winery, north of Christchurch
Terrace Edge Vineyard and Olive Grove in Waipara
Waiau River Estate in Hanmer Springs 

One Canterbury wine you have to try:
Mount Brown Estates North Canterbury Pinot Gris 2017

What to Eat in New Zealand

Being an island nation, New Zealand is big on fish and seafood. Our coastline is teeming with fish; local favourites include snapper, hapuka and the delicately-flavoured John Dory – best served lightly crumbed with lemon. One could say that fish and chips on the beach is a kiwi weekend institution! 

Scallops and mussels are restaurant staples, and delicious Bluff Oysters come into season during the New Zealand autumn. The rich waters off Kaikoura – an hour north of Christchurch – are famous for crayfish. In the Maori language, ‘kai’ means food and ‘koura’ means crayfish - and unsurprisingly, the local bounty you’ll find here is some of the best available in the world. (See the attached photo of koura, or crayfish.) One of the best ways to enjoy this delicacy is from one of the local ‘crayfish caravans’. These caravans are dotted along the coastline, selling freshly caught crayfish prepared with garlic butter and lemon. Devouring one of these beauties while sitting on the rocks looking out to sea has got to be one of the most quintessentially kiwi dining experiences you can have and certainly tops off a day of marine life encounters in this famous town.

Our Favourite Restaurants in Christchurch
Smack bang in the middle of the breadbasket of the nation and as the largest city in the South Island, Christchurch has always punched above its weight in the restaurant game. A lot of our guests finish their New Zealand trip in Christchurch, so a celebration dinner is called for!

Best overall - Cook'n with Gas - One of the most talked about restaurants in Christchurch. This award-winning bistro serves excellent modern New Zealand cuisine in a chilled out 1860s villa.

Best value - Shirley's Kitchen - Popular with university students, this Malaysian spot offers fantastic and affordable food. Try the Kampua, a mouthwatering dish that features noodles, BBQ pork and crispy onions.

Best takeaway - Burgerfuel - This iconic burger joint has locations all over New Zealand and the burgers are top quality - made with fresh, local ingredients such as 100% pure New Zealand grass fed beef and batch brewed tomato relish.

New Zealand has many other famous wine regions you may be interested in visiting like the Marlborough, Hawkes Bay and Central Otago. Check them all out here: 

* * * * * * *

THANK YOU to the kiwi tour guides from MoaTrek for this fun information about what to eat and drink during a tour of the Canterbury wine region in New Zealand.  I hope some of my Baby Boomer readers decide to plan an adventure there.

For more information, check out this Amazon link to "The Rough Guide to New Zealand."

If you are interested in reading more about what to do after you retire, where to retire, financial planning, Social Security, Medicare, common medical issues after retirement and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional helpful articles.

You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credits:  New Zealand kiwi tour guides from MoaTrek 
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If you are on Medicare and are rushed to the hospital, you may be told by emergency room staff that they are admitting you to the hospital as an outpatient, or for observation.  If you are sick enough to be kept overnight in the hospital, you probably are not paying full attention to what is going on.  Your only concern is being treated for your condition and feeling confident you are getting the best possible care.  However, whether or not you are admitted as an inpatient or an outpatient does make a difference for your future care and could have a significant financial impact on you.  Here are a few things you and your family need to know.

Why You Might Be an Outpatient Rather than an Inpatient

What if you are rushed to the hospital with chest pain, but the tests performed by the emergency room doctor do not indicate you have had a heart attack?  Rather than sending you home, they may decide to keep you overnight for observation.  You may stay in a special observation unit or you could be in a regular hospital room.  You will spend the night, or even several nights, in the hospital, and will probably need to sign some paperwork, but you are listed as an outpatient, under care for observation. Other than that, your treatment will be the same as if you had been admitted as an inpatient, but the decision could affect both you and your hospital in other ways.

Why Does the Hospital Admit Patients as Outpatients?

The simple reason why this happens is because Medicare has rules governing who can be admitted as an inpatient, and these rules have become stricter because outpatient care is cheaper for Medicare. 

In 2011, Medicare spent $690 million for outpatient care.  By 2016, that amount increased to $3.1 billion and has continued to rise since then.  Simultaneously, the cost of reimbursements for inpatient care has decreased.  Hospitals do not like these Medicare rules because they get paid about one-third less to care for an outpatient than they do an inpatient.  In most cases, the patients receive the same care, but the hospitals are paid less to provide that care.

Hospitals face stiff penalties from Medicare if they do not follow the strict guidelines for admission as an inpatient.  If the hospital is audited and Medicare determines they admitted people as inpatients when they should have been admitted as outpatients, the hospital has to return the full amount of the Medicare reimbursement they received.  In fact, in 2016, outside audits forced hospitals to return over $400 million to Medicare for incorrect Part A (hospitalization) charges.

More Procedures are Becoming Outpatient Procedures

Approximately twelve years ago, a neighbor of mine had knee replacement surgery. She spent three nights in the hospital and a week in a rehabilitation center.  Since she was an inpatient during the three night hospital stay, Medicare Part A covered her hospital expenses, as well as the additional week in the rehab center.  This was helpful to her recovery, since she lives alone and would not have been able to care for herself for the first week after her surgery.

In 2018, the rule changed.  Total knee replacements are now considered outpatient procedures.  Even though nothing has changed about the procedure or the required after-care, Medicare now reimburses hospitals less money and patients who cannot afford to pay out-of-pocket for a stay in a rehabilitation facility must find someone who will take care of them.

Even in situations when the hospital does have some discretion about whether the patient should be admitted as an inpatient or outpatient, many of them are hesitant to admit people as inpatients.  This is because Medicare penalizes hospitals when they admit someone as an inpatient and the patient is readmitted within 30 days.  If the patient is only in the hospital under observation, the penalties for re-admittance do not apply.

Hospital Admittance as an Outpatient can Hurt You Financially

At first, you may assume that it really does not make a difference to you whether you are admitted as an inpatient or an outpatient, as long as you receive the same care.  However, being an outpatient can hurt you financially. 

If you are admitted to a hospital as an inpatient, you are covered under Medicare Part A.  If you are admitted as an outpatient under observation, you are covered under Medicare Part B.  Under Part B, you may be liable for up to 20 percent of the cost of your hospital stay, unless your Medicare Supplement (Medigap) or your Medicare Advantage plan covers this extra cost.

After you are released from the hospital, the financial pain may continue. If you need to go to a skilled nursing facility or rehabilitation facility after your discharge from the hospital, Medicare will not pay for any of the cost of the rehab if you were in the hospital as an outpatient or if you were an inpatient for less than three days. 

On the other hand, if you were admitted to the hospital as an inpatient and spent at least three nights there, Medicare will pay fully for the first 20 days of skilled nursing care and partially for an additional 80 daysThe cost of skilled nursing can be substantial, so this is an important consideration for patients.

The rules regarding inpatient vs. outpatient hospital stays have saved Medicare millions of dollars in reimbursements to skilled nursing facilities.  In fact, it resulted in a decrease of 15 percent in skilled nursing days covered by Medicare between 2009 and 2016.  However, it also forced patients to either pay out-of-pocket for skilled nursing or do without it.

What Can Patients do to Protect Themselves?

Patients and their families need to understand the difference between an inpatient and outpatient hospital admittance.  If they believe they should be in the hospital as an inpatient, particularly if they expect to need skilled nursing care after they are released, they should appeal any decision to only list them as outpatients. Patients also need to set aside funds to cover the cost of skilled nursing whenever it is unlikely Medicare will pay for it.

In addition, you should ask in advance whether or not your Medicare Supplement or Medicare Advantage plan will cover any of the cost of skilled nursing care when you purchase your policy.  If not, you may want to set aside money for these types of events.

You may also want to check with Medicare.gov periodically, so you stay up-to-date on changes.

For more information on a variety of Medicare topics and issues, including ways the Medicare program could be strengthened, use the tabs or pull-down menu at the top of the page to find links to hundreds of additional helpful articles on Medicare, Social Security, where to retire in the US and overseas, financial planning, common medical problems and more.

You are reading from the blog:  http://www.baby-boomer-retirement.com
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The vast majority of Americans retire on a fixed income, which can get very tight over time.  As the years go by and the increases in their Social Security benefits turn out to be small or non-existent, it can become increasingly difficult to make ends meet.  This may cause stress and depression. While not all financial problems can be solved by continuing to tighten our belts, sometimes making a few changes can help stretch our dollars a little further.  As a result, I researched a number of sites for recommendations on how ordinary retirees can reduce their expenses.  Below are some of the ideas I discovered.

Money Saving Ideas after Retirement

1.  Cut out streaming services such as Netflix, Hulu and Amazon Prime.  If you are currently using all three, eliminating them can save you around $67 a month or $804 a year.  It will also protect you from the inevitable rate hikes.  If you must use a streaming service for your television entertainment, choose the least expensive one (which would be Amazon Prime in many cases) and prepay it each year to further reduce the cost.  In addition, with Amazon Prime you can get other amenities, such as free shipping on Amazon purchases, including the gifts you mail to your grandkids. Combined with using an antennae to watch local channels, you could find yourself with all the television options you want to watch. On the other hand, if antennas do not work in your area and the cheapest way for you to get your favorite TV shows is through Hulu rather than cable, then that could be your best option.  Just do your research, eliminate any unnecessary service, and make sure you are using the least expensive choice possible to enjoy TV.

2.  Do you really want to spend money on smartphone games?  Many people who use smartphones also spend an average of $7.25 a month on games.  Stick with free games and apps.  There are plenty of choices.  While you are at it, discuss your phone plan with your current carrier, as well as their competitors.  You may be able to save money by only paying for the amount of phone service you actually use!

3.  Eliminate subscriptions to newspapers and magazines. If you enjoy reading your news, download free news apps to your smartphone or follow your favorite news sources on Facebook and Twitter.  You can read all the major news stories through those sites and actually get the stories more quickly than waiting for tomorrow's newspaper.  This could save you $5 to $10 a month.

4.  Eliminate other subscription services, such as satellite radio.  Use free options like your local AM and FM stations or use Spotify and Pandora.

5.  Give up expensive coffee shops.  Our local Starbucks coffee shop is often full of retirees who enjoy meeting each other and chatting over a cup of coffee or a latte which could cost as much as $3 to $5 per beverage.  However, they could be going down the street to McDonald's and have the same conversations over a cup of $1 coffee.  Depending on how often they get together, saving a dollar or two a day could add up to a significant amount of money over the course of a year.

6.  Buy regular gas rather than premium, unless your car's owners manual specifically requires premium fuel.  The savings could add up over time.

7. Evaluate that annual membership at a warehouse store.  Do you really save enough to make the annual membership fee worthwhile?  How often do you use it?  Could you do just as well at your local grocery store by taking advantage of sales and coupons?  Spend a few weeks comparing prices and decide which is the best option for you.  If you discover that you use the warehouse store for more than just groceries, for example to fill your gas tank, replace your tires, purchase clothing, or for small appliances and gifts, you may decide to keep the membership.  Just make sure you are really using it.

8.  If you are retired and paying the full price for a gym membership, check with your Medicare policy.  Many of them offer free or extremely low cost gym memberships which could save you a substantial amount of money.  In many Medicare policies, these low-cost gym memberships are referred to as Silver Sneakers.  In addition, many local senior centers have exercise equipment and offer free or low-cost exercise classes.  Explore all your options and choose the one which costs the least and you are most likely to use.

9.  If you are still a smoker, give it up and reap the savings.  There are, of course, many other reasons to give up smoking.  However, if nothing else works, the fact that you could save as much as $200 a month, depending on how much you smoke, should be a good enough reason to give up this habit, especially if you are having trouble covering your expenses.

10.  Do you have other expensive habits or hobbies?  While no one wants to give up everything they love in order to survive during retirement, it could be worthwhile to explore less expensive options.  Are you taking guitar, piano, art or golf lessons?  Perhaps you could find free or low cost group classes rather than private ones.  Is your nearest golf course expensive?  Have you looked for a public course in your area?  Many cities offer free classes for senior citizens and have public pools, public tennis courses, public golf courses and other recreational facilities where seniors can participate for free or at a low cost.  Ask someone at your nearest senior center and see what they suggest.

11.  Reduce your debt payments.  Talk to your lender about refinancing your mortgage, if you have one.  If you believe your property tax assessment is higher than the actual value of your home, seek the help of a local Realtor and appeal it.  If you have a car payment, it is possible you may be able to refinance it through your bank or Savings and Loan.  If you are carrying a balance on your credit cards, see if you can transfer the balance to one with 0% interest for the first year, and try to pay off the balance within that time.  Check out every payment you make and see if there is a way to reduce it.

12.  Monitor your utilities carefully.   Lowering your thermostat a degree or two in the winter and raising it a couple of degrees in the summer could lower your gas and electric bills.  Reduce your water bill by taking shorter showers. You can make an even bigger difference by replacing some of your landscaping with drought resistant plants which require very little water.  Do you really need both a cell phone and a landline?  Eliminating the landline could save you $50 to $65 a month.  Making a few adjustments to your utility usage could reap large savings.

13.  Change your Medicare supplement to an HMO or try a Medicare Advantage plan.  Medicare beneficiaries have two choices in getting dealing with their Medicare benefits.  They can get basic Medicare plus buy a supplement OR they can get a Medicare Advantage plan.  In most cases, the Medicare Advantage plan is less expensive and often provides extra benefits, such as dental and vision insurance.  Talk to several insurance carriers in your area and compare the cost of their plans.  You also will need to compare your co-pays, deductibles and drug costs.  After making the comparison, decide which plan will give you the best coverage for the least amount of money.  In many cases, a Medicare Advantage plan can save you several hundred dollars a month.  If your income is low, you may also qualify for a combination Medicare/Medicaid plan. Be sure to ask about that, because the savings can be significant.

14. Evaluate the gifts you give your children and grandchildren.  Many senior citizens risk their own retirement because they are too generous with their adult children and grandchildren.  Even though you may want to help them, it doesn't benefit anyone if you end up becoming dependent on your children because you can no longer support yourself.  Keep that thought in mind when your children want to borrow money from you or ask for help with car purchases or college loans.  You can offer them guidance in finding other ways to finance the things they want, but you should not give them money that you cannot afford to lose. If you do, it will eventually only cause more problems for everyone.

15.  Don't forget to use AARP or AAA discounts.  Many restaurants, movie theaters and other organizations will give you a senior discount but, in most cases, you have to specifically ask for them.  Do not hesitate to ask!  If you belonged to a union during your working years, you may also qualify for various business discounts. For example, my union membership provides me with a 10 percent discount on my monthly cell phone bill.  Take advantage of every discount you can find.

16.  Go to a Food Bank.  Most food banks do not ask you to fill out any financial information.  They will give a bag of groceries to anyone who shows up.  If you are faced with the choice between food and your medical expenses, a food bank may be able to give you the essentials.  Then, talk to your medical provider about how you can lower the cost of what you are spending on co-pays or prescription drugs. This is a choice no retiree should have to make.  

If you are looking for more ideas to save you money, you may want to use this Amazon link to the book "Minimalist Budget: Everything You Need to Know about Saving Money."  It has even more great ways to save.  Use the above link to check it out.  

Look for Ways to Increase Your Income

If the above actions still leave you short of money, you may want to talk to your local Social Security office and the Department of Social Services.  They may be able to help you get a housing voucher to lower the cost of your rent, add you to the waiting list for low-cost senior housing, provide you with SNAP (food stamps), or put you on Supplemental Security Income (SSI).

If your current income is too high to qualify for any of those programs, you may want to talk to your local Senior Center or state employment office about how to find a part-time job to supplement your retirement income.

If you own a home, you may be able to rent out a room, or rent out storage space in your garage or basement.  Even small increases in your income can help bridge the gap between your fixed income and what you need in order to live comfortably.

Budgets are tight for many senior citizens.  You are not alone.  Reach out to your senior center and local government agencies to get the help you need to balance your budget before you get too deeply in debt.

If you are interested in learning more about retirement planning, Social Security, Medicare, affordable places to retire in the US and abroad, and common medical problems, use the tabs or pull-down menu at the top of the page to find links to hundreds of additional, helpful articles.

You are reading from the blog:  http://www.baby-boomer-retirement.com
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Baby Boomers are beginning to reach the age when they, their spouse, or their elderly parents may be nearing the end of their lives.  This new challenge brings with it a great deal of anxiety and uncertainty, as well as the possibility of pain and discomfort.  Although we would all prefer the end of our lives to be as easy and peaceful as possible, we are not sure how to bring this about.  One way to get the help you need is to call on hospice to provide assistance during the final months of life.

This week we have a special guest post by Lucille Rosetti from TheBereaved.org.  She has written a book called "Life After Death - A Wellness Guide for the Bereaved."  You can use the above link to her website to contact her for more information about her book.  In the thoughtful post below, she discusses common questions people have about hospice.
Three Questions to Ask When Considering Hospice Careby:  Lucille Rosetti
When people run out of options for curing or treating an illness, they and their families often have to make some difficult decisions. No one wants to see a family member in pain or discomfort, so hospice care is frequently one of the options on the table.

For most of our lives, medical decisions are fairly simple and easy — take this antibiotic, or eat more vegetables. However, for people facing the end of their lives, the decisions are rarely simple and never easy. You have a lot of questions, so here are a few basic answers to help make you and your loved one feel more comfortable about hospice care.

What can I expect from hospice care?  Comfort.

Hospice care is relatively diverse, so the nuances of what to expect vary greatly depending on your needs. In general, the goal of hospice care is to give someone the best possible life they can have in whatever time remains. Some people mistakenly think hospice care is only for those who are about to die. In reality, hospice care is about providing physical comfort to those whose terminal illness is no longer responding to treatment. There is a misconception that hospice care is a last resort, or that it only occurs shortly before death. While that is true in some cases, there are many people who live for several months or even longer in hospice care.

Who will be caring for my loved one?  Professionals.

Depending on your situation, you may have a variety of caregivers in your hospice team, from nurses to dieticians to personal care assistants to social workers. Taking the time to get to know the individuals on your hospice care team will reduce negative emotions, such as anxiety or awkwardness, and help everyone work together with more compassion and empathy. Building rapport with the team will help both you and your loved one have an easier time trusting the professionals and understanding medical decisions.

This is especially true for the hospice care social worker. Their job is to provide support and comfort to your loved one, making sure their wishes are understood. These are highly trained professionals, and they must have a master’s degree in social work, which often includes around 1,000 hours of hands-on practical experience. 

Some people may wish for their loved one to receive care from a licensed osteopath, who can provide a more holistic approach. However, while Medicare doesn’t offer coverage for holistic medicine, they do offer coverage from physicians who are licensed as osteopaths. If you would like expanded coverage for your loved one, consider looking into a Medicare Advantage plan, which offers a number of different options for you and your family to explore.  (Some Medicare Supplements may also offer you choices which will fit your needs.  You should always explore the best Medicare plan for your situation well in advance of needing hospice care or any other specialized treatments.)

How will I manage things when my loved one passes away? Day by Day.

There are a great many things to do and consider after a loved one passes away. Making sure you have a clear understanding of their end-of-life wishes can make this process exponentially easier. Hospice care workers help ease the burden of end-of-life care for family members and caregivers, but they won’t be involved in how to manage the burden after death.

To keep things running smoothly, be sure your loved one shares their important documents with you, such as their will, insurance information, living will, asset information, and financial records. Your hospice care team can help you know which documents you need and help you start difficult conversations with your loved one about end-of-life arrangements. Talk to them about how they want to be remembered: funeral or memorial, burial or cremation, flowers or donations. 

Moving into hospice care can be scary. To many, it signifies that your loved one has entered the final stages of life. The emotional turmoil can be draining for you and your family member entering hospice. You can find comfort in remembering that hospice care isn’t about dying. It is about prioritizing comfort, living life to the fullest, and celebrating a person surrounded by love.

Our thanks to guest poster:  Lucille Rosetti

If you are interested in more information about common medical issues as we age, Medicare, Social Security, where to retire, financial planning and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional helpful articles.  

You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credit:  provided by Lucille Rosetti - photo from Pexels
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Many Americans prefer to remain in their home state after they retire.  However, do you know how your state ranks compared to other states as a retirement destination?  Is it affordable and safe, with a comfortable climate and good healthcare?  Moneywise did the research for you and put together a list of the best states for retirement.  If your current state is on this list, you may be best off remaining where you are, or at least in a retirement community in your home state.  If your current state is not on this list, you may want to do a little research and decide if there is a nearby state where you may be able to live more affordably, comfortably, and safely.

Below is the list of states which Moneywise believes are the best places to retire, with the best states at the top of the list and the rating dropping from there.  All of these states are in the top twenty of those in the United States, according to the Moneywise research.

If your home state is not listed below, you may want to check the article "Worst States for Retirement" to see if it is listed there.  If it is not on either list, consider it a neutral state for retirement.  

Top Ten States for Retirement

New Hampshire - According to both Moneywise and U.S. News, this is the best state for retirement, although you will still have to deal with cold weather in the winter.  However, it has low taxes, including no sales tax or state income tax, beautiful scenery, and high quality healthcare.  In addition, housing prices are lower than that in other nearby states in the Northeastern U.S.   You should know that there is a 5 percent tax on dividends and interest.

South Dakota - If you are looking forward to spending time in the wild outdoors, hunting, fishing, camping and hiking, this could be the ideal state for you.  There is an abundance of affordable housing in both the small towns as well as the cities of Sioux Falls and Rapid City. The state does not tax Social Security or pensions, there is no inheritance tax, and the state sales tax is only 4 percent.

Colorado - Do you love the mountains?  Enjoy skiing or other winter sports? This state has a high quality of life, good healthcare, and high senior tax deductions.  Many of the small towns are quite affordable, although the major cities can be expensive.

Iowa - You may be starting to see a theme in this list of the best retirement states.  It seems that many of the states with plenty of outdoor activities are also great places to retire.  Housing in Iowa is affordable.  In fact, the cost-of-living in Iowa is approximately 12 percent below the national average.  Healthcare is also less expensive than in many other states.

Florida - Florida has long been considered a mecca for retirement, especially for people who lived along the East Coast during their working years.  On the Moneywise list, it is ranked as the 5th best state for retirement. There are miles of beaches and plenty of delicious seafood.  The photo of the sunset at the top of this article was taken in Florida.  Grandchildren will want to visit on their way to Disney World and the other theme parks in Orlando.  Homes are very affordable, whether you buy or lease.  There is no state income tax, estate tax or inheritance tax.  There is also no tax on Social Security or other retirement income. My parents retired to Florida and lived there for three decades until the last few years of their lives, when they returned to their home state to live with family.  They loved Florida and hated to leave.  Of course, if you retire there, you will need to deal with some of the less pleasant wildlife there, including mosquitoes and alligators!

Utah - This state has one of the fastest growing populations for people of all ages.  There are many reasons why people find this state appealing, including beautiful scenery, national parks, and other amenities.  The state is rated high for its healthcare system, Salt Lake City is affordable, and the city also has excellent public transportation.  Social Security and other types of income are taxable, but seniors get a tax credit of $450 per person and other taxes are low.

Virginia - This state has both mountains and beaches, with numerous small towns, yet parts of it are in close proximity to Washington, DC and other large cities.  Blacksburg, which is home to Virginia Tech University, was ranked by Forbes in 2014 as the best place in the nation to retire. My college roommate, who is now a retired English professor, lives there and loves it. Housing throughout most of the state, except for the area close to Washington DC, is quite affordable.  There are also special tax benefits for retirees.

Idaho - Another great state for those who love the outdoors is Idaho.  It is rated the 4th safest state in the nation and the overall cost-of-living is 5 percent lower than the average in the United States.  Social Security is not taxed and healthcare is also less expensive than in other states.

Arizona - This state has become popular for some people moving out of California but who want to stay close enough to easily visit friends and family in their home state.  There are a wide variety of activities in Arizona, including trips to the Grand Canyon.  Golf courses are plentiful and can be enjoyed the year around (although you will want to play early in the morning during the summer).  The state gets 250 days of sunshine every year.  You can choose from the desert areas around Phoenix or the mountain communities surrounding Flagstaff.  My sister-in-law and her husband moved from California to Flagstaff and love it there.  Housing is generally affordable and Social Security is not taxed.

Minnesota - Minnesota is well-named as the state of 10,000 lakes.  There are actually more lakes than that!  On the other hand, the winters can get extremely cold.  The state has a high quality of life, including its healthcare system.

Other States in the Top Twenty Best States for Retirement

The states listed below are also ranked in the top 20 for retirement.  You may want to explore a few of these, as well, before making your final decision about where to retire.

Washington State
North Carolina
North Dakota

If the state where you are currently living is one of those mentioned in this article, you may be best off staying right where you are.  If not, you may want to consider moving to one of the states on this list, especially if you are struggling financially or you do not feel safe or happy with the healthcare in your current location.  Do your research before making a major move, so you feel confident you will be happy with the change.

If your state is not on the list above, check out this article to see where it ranks on "The Worst Places for Retirement."

For more information on where to retire in the U.S. or overseas, financial planning, Social Security, Medicare, or common medical issues, use the tabs or pull-down menu at the top of the page to find links to hundreds of additional articles.

You are reading from the blog:  http://www.baby-boomer-retirement.com
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