Paul Barrett Insurance Services Blog
Atrial Fibrillation- an irregular condition
Atrial fibrillation(Afib) is an irregular heartbeat that is a risk factor for stroke, heart failure, and lack of blood flow to other organs.
There is a lack of coordination between the two upper chambers(atria) of the heart and the two lower chambers(ventricles). Common symptoms include palpitations felt in the chest, shortness of breath, and lightheadedness.
Afib can come and go or start suddenly and never go away. It is a condition that demands immediate medical attention.
Complications include blood clots forming in the poorly beating atria that can break off and travel to other parts of the body causing ischemia(lack of blood flow).
Interestingly, some people do not even know they have Afib until it is detected during routine physical. Other people will experience weakness, dizziness, confusion, shortness of breath and chest pain.
There are multiple types of Afib. One type is occasional(paroxysmal)- this means that the irregular beat comes and goes and can last a few minutes to a few hours and then goes back to normal without any treatment. Persistent Afib starts and does not end on its own. It can require medications or a mild electric shock(cardioversion) to return to normal. Permanent Afib means the condition does not respond to any treatment. The plan here is to use medication to slow the number of rapid beats sent down to the lower chambers(ventricles).
This allows patients to feel better and improve blood flow to the body.
Possible causes of Afib are hypertension, heart attack, coronary artery disease, certain heart defects you are born with(congenital), overactive thyroid gland, certains medications, caffeine, tobacco, and alcohol. The heart has its own natural pacemaker that can that can fail and cause Afib. A pacemaker can be helpful here. Other causes are lung disease, previous heart surgery, infections, and sleep apnea.
Complications include stroke, which occurs when a blood clot breaks off from the poorly beating atrium and travels to the brain. The clot forms because blood pools in the atrium and coagulates(clots).Risk of stroke increases if you have others medical conditions together with Afib. These include hypertension, diabetes, history of congestive heart failure, or previous stroke. The use of blood thinners greatly reduces the risk of stroke or damage to other organs due to lack of blood flow caused by the clot. Afib can also cause heart failure by not allowing the heart to beat effectively.
Tests used to diagnose Afib include a chest X-ray, blood tests, an exercise stress test, Holter monitoring( a 24 hr EKG recorded with you connected to a monitor the size of an iPod), and an echocardiogram, which is a form of ultrasound that shows the structures of the heart in motion and can detect abnormalities.
Treatment goals are to return the heartbeat to normal, or at least control how fast the heart is beating. The other goals are to prevent blood clots and decrease the risk of stroke. Treating and correcting an overactive thyroid gland can cause the Afib to return to normal heartbeat.
As mentioned, other forms of treatment include oral medications, a brief electric shock (with a sedative),or other more complicated electrical procedures.Blood thinners may or may not be used based on an informed discussion with your doctor.
Afib is a condition not to be ignored if you do not have symptoms.Stroke can be devastating to a person and their family. I urge anyone who reads this to learn how to take your pulse and check it once a day- it could save your life
Keith M. Oshan, M.D.
Diabetes is a group of diseases that affects how the body uses sugar(glucose).Glucose is an important source of fuel for muscles and is the main fuel for the brain.
Diabetes is simply too much sugar in the blood, which can lead to serious health problems. Types of diabetes consist of type 1, type 2, and gestational. Type 1 usually appears in childhood or adolescence and presents with a quicker onset of symptoms and more severe presentation.
When those of us of a certain age awaken each morning lots of body parts ache to varying degrees and according to the weather. The term arthritis means inflammation of the joints. As we age the pain and stiffness worsens. The most common types are osteoarthritis and rheumatoid arthritis.
Osteoarthritis, which is the most common type, has as its cause the wearing away of the cartilage that lines the surfaces of bones that form a joint.Hips and knees are the most commonly affected joints, but the spinal column, hands, feet and even the jaw (TMJ) can all be involved.
Rheumatoid arthritis is an autoimmune condition that targets the lining of the joint known as synovial tissue. An autoimmune condition is one in which the body attacks its own tissues as if they were invaders. Science has not yet figured out why this happens. Other autoimmune conditions include lupus, psoriasis, and ulcerative colitis.
Risk factors for all forms of arthritis include family history (genetic), age, sex, previous injury, and obesity.
We will discuss symptoms, causes, diagnosis, and treatment, touching on the most common points.
The most common symptoms include pain, stiffness,swelling, redness, and a decreased range of motion.The causes of the symptoms depends on which type of arthritis a person may have. Osteoarthritis, caused by the constant wearing away of the cartilage, allows bone to rub on bone which causes pain and stiffness. Joint injury or infection can speed up this process.
In rheumatoid arthritis the body attacks the synovial tissue lining the joint capsule.The synovium becomes inflamed and swollen.This can eventually cause destruction of cartilage and bone.
Diagnosis begins with blood and urine testing, and if the joint is swollen, removal and examination of the fluid. Diagnostic imaging begins with X-rays and may progress to CT, MRI, and ultrasound exam of the affected joint.
The goal of treatment is to relieve symptoms and increase joint function. Therapy usually begins with moist heat, physical therapy , and the judicious use of non-steroidal anti-inflammatory drugs (NSAIDS). Common drugs are Advil and Aleve. These medicines are meant for short term use only as they have significant side effects if used chronically. These include cardiovascular complications and irritation of the stomach that could result in bleeding. If stronger pain control is needed, there are prescription strength NSAIDS( meloxicam) and also opiate medication. Opiates are narcotics and carry their own risks and side effects. Decisions about which form of therapy are made only after the patient and prescriber are in agreement as to which is the correct form of initial therapy. Sometimes these therapies are not good enough to control the pain and decreased function and it is necessary to go to the next level of medications. Drugs such as methotrexate and plaquenil slow the body’s immune system response, which reduces symptoms of pain and swelling. Newer drugs such as Enbrel and Remicade block proteins made by the body that are part of the immune system attack on the joint. All of the medications can have very serious complications and a thorough discussion and understanding is mandatory.
The last form of medical therapy are steroids. These were the first drugs the were successful in halting the body’s immune system on the joint. Unfortunately, although highly effective, their long term side effects were not acceptable to many people.
Physical therapy and low impact exercise (walking) can strengthen muscles around the joints and increase the range of motion. Even though getting out bed is associated with all those aches and pains, the more you move, the better you will feel. If you rest you rust!
Other treatment options include joint repair and replacement, and fusion of certain joints. These are rather complicated and will be discussed in a later article.
Keith M. Oshan, M.D.
Welcome to our new insurance agency blog!
The Premium Penalty - The High Cost of WaitingIf time is money, then "Procrastination" also has a price. It now seems that even doing nothing may have a high cost when it comes to the Medicare Part D program.
The first Medicare Part D Open Enrollment period began November 15, 2005 and ended May 15, 2006. For those missing the May 15 deadline, the total increase for 2006 was an automatic 7% (representing the delay from May to December 2006). This percentage is then multiplied by the average premium cost for Medicare Part D plans (in 2006, this value is around $32.50). Some have called this cost increase a "life-time premium penalty" because anyone who incurs the premium penalty must pay the penalty each month for a long as they are enrolled in a Medicare Part D plan.
How does the work? Well, if this year's average monthly premium for a Medicare Part D plans is $32.50 per month, a person who waited 7 months to enroll in a Medicare Part D plan would add an extra $2.25 per month to their monthly premium (calculated - 1.07 * $32.20 = $34.45 or an additional $27.00 per year). The premium "penalty" will stay in effect for the life of the Beneficiary's Medicare Part D plan and may even increase over time (although in 2007 the average value of a plan will be reduced to $27.35).
Please note, that these penalties or additional costs may not apply if you currently have drug coverage through a former employer or union considered by the Centers for Medicare and Medicaid Services (CMS) as "creditable coverage". Also, anyone who qualifies for the "Extra Help" program will not be charged a Late Enrollment Penalty.Commonly known as Medicare Advantage, Medicare Part C more closely resembles traditional medical insurance. Beneficiaries choose from a variety of plans, offered by a number of insurance companies. Each plan must provide, at minimum, the same coverage offered by Medicare Parts A and B, with one exception. Medicare Advantage (MA) plans do not have to cover hospice care (although some do include this coverage). Many MA plans offer additional benefits, such as dental, vision, and prescription drug coverage.
What Is Medicare Advantage?Many private insurance companies offer Medicare Advantage plans, with the most common being health maintenance organizations (HMOs) and preferred provider organizations (PPOs). These plans provide the same hospital and medical coverage found in traditional Medicare, but many people prefer MA, as these plans typically require lower out-of-pocket costs along with improved benefits. For example, many MA plans include prescription drug coverage, saving beneficiaries the added confusion of choosing a Medicare Part D plan.
HMO plans include a network of providers, from doctors to clinics to hospitals. Members must visit in-network providers to ensure coverage. PPO plans also have a network of preferred providers, but members willing to pay a higher co-pay may choose to go out of network.
Medicare Advantage does not allow beneficiaries to purchase a Medigap policy to help defray their out-of-pocket costs. However, the plans place a limit on these costs.
Plans may change from year to year. These changes may include premiums, covered services, and provider network. Beneficiaries are encouraged to review their MA options every year.
The Benefits of Medicare Advantage PlansOne of the main reasons Medicare beneficiaries choose MA is to lower their healthcare costs. You still have to pay the premium for Medicare Part B, but even then, MA premiums are often lower, especially when you combine the Medigap policy premium with your cost for Parts A and B. Another potential savings is the out-of-pocket max, which varies from plan to plan. Once you reach that total, you have no further expenses for that calendar year. Traditional Medicare does not offer this benefit.
Members also appreciate the cohesiveness of an MA plan, which typically includes a single card, as well as a solitary system to navigate. This is especially true for new members coming off a standard employer-provided insurance plan. Most Medicare Advantage plans closely resemble this type of coverage, and that familiarity makes them popular with many recent retirees.
Of course, after worries about costs, it all comes down to benefits. While MA plans must include coverage included in traditional Medicare, most offer benefits that are more robust. Dental, vision, and hearing are not included in Parts A and B, but many MA plans offer this coverage. In addition, many include prescription drug coverage.
Finally, many beneficiaries like the coordinated care aspect of Medicare Advantage, especially if they choose an HMO plan. On these plans, members choose a primary care physician (PCP) from their provider network. Your PCP coordinates all aspects of your healthcare, an especially helpful feature for members with complex health issues.
Choosing Your Medicare Advantage PlanLook carefully at your plan options, as these vary from provider to provider, and consider your medical needs carefully. Review the details, including any fine print, to discover exactly what the plan covers and what it expects you to pay as far as co-pays and premiums. Look also at any restrictions listed, to ensure your plan meets your needs.
Do not ignore the provider network. If you have a preexisting condition and have long-standing history with a doctor or other provider, make sure the plan’s network includes your preferred provider. Remember, these networks include physicians, labs, hospitals, clinics, and more.
If you take any prescription medications (statistics say that you do), review the plan’s drug coverage. Not every Medicare Advantage plan includes prescription coverage. What’s more, drug formularies (the list of prescription drugs covered by the plan) vary by provider and plan type. Look closely at coverage, the formulary, and co-pays for your prescriptions.
It’s also important to predict what you may need over the course of the plan year. How do you determine future needs? Consider advice from your last yearly wellness exam. Did your doctor warn you about high blood pressure, pre-diabetes, or similar chronic conditions? Most treatment plans for chronic conditions include prescriptions.
The Bottom LineIf your goal is a comprehensive plan that covers medical, hospital, and drug coverage, a Medicare Advantage plan may be your best option. These plans typically carry lower out-of-pocket costs with broader benefits. However, they require beneficiaries to do a bit of homework to choose the best plan that meets their needs. In addition, although they help manage costs for the insurer, preferred provider networks limit flexibility for plan members. As in all things healthcare-related, do your research and compare your options before making a choice.