Five Things to Know about the Health Insurance Marketplace Why the Affordable Care Act Matters to African Americans Tips for Traveling with Diabetes
Living Well Through Awareness By Cathy Nedd Chief Operating Officer Michigan Chronicle
Welcome to Living Well. Recognized as the most credible source of fitness, health and nutrition information for African Americans, each edition is crafted to provide insight into health disparities impacting African Americans and methods of prevention and treatment. There is a growing need for health awareness in our community. The mission of Living Well is to provide our readers with a wealth of information that enables them to live healthier and happier lives. On these pages you will find content on health issues, healthy lifestyles and relatable personal stories from people in our community. November 1 marks the beginning of open enrollment for healthcare in the Health Insurance Marketplace. It is important to make sure you and your family have health coverage. This month’s Living Well includes resources and information on essential health benefits, qualifying coverage, fees, exemptions and local help. Living Well isn’t just words on a page, it’s a lifestyle and the Michigan Chronicle takes pride in helping lead the way. Be healthy and live well.
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Four Easy Steps to Applying for Coverage in the Health Insurance Marketplace
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Apply for health coverage, compare options, and enroll in a plan in one streamlined application through the Health Insurance Marketplace. When open enrollment begins November 1, 2015 you can fill out your application and view the health coverage options available to you. 1. Create an account First, provide some basic information. Then choose a user name, password, and security questions for added protection. 2. Apply for Marketplace coverage Enter information about you and your family, including your income, household size, and more. 3. Pick a plan Next you’ll see all the health insurance plans and programs you’re eligible for and compare them side-by-side. You’ll also find out if you can get lower costs on Marketplace coverage. 4. Enroll Choose a health insurance plan that meets your needs and enroll! Coverage starts as soon as January 1, 2016. If you need help with your Marketplace application, there are people trained and certified to help you understand your health coverage options and enroll in a plan in every state. And remember that you can contact us anytime by phone or live web chat for help with a Marketplace question. Courtesy of the Health Insurance Marketplace for more information please visit https://www.healthcare.gov/get-answers/
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Grocery Shopping with Diabetes Starts with These Tips Tips for Traveling with Diabetes
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4 Five Things to Know about the Health Insurance Marketplace Why the Affordable Care Act Matters to African Americans
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Definitions to the Health Insurance Marketplace Insurance premiums are calculated in varies ways. Understanding important terms can be the deciding factor when choosing the right health insurance policy. When shopping for insurance in the marketplace be sure to know and understand the following terms:
Coinsurance
Your share of the costs of a covered health care service, calculated as a percent (for example, 20 percent) of the allowed amount for the service. You pay coinsurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20 percent would be $20. The health insurance or plan pays the rest of the allowed amount.
Five things to know about the Health Insurance Marketplace 1. The Health Insurance Marketplace is for people who don’t have health coverage • If you don’t have health insurance through a job, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source that provides qualifying coverage, the Marketplace can help you get covered. • If you have job-based insurance, you can buy a plan through the Marketplace, but you’ll pay full price unless your employer’s insurance doesn’t meet certain standards. Most job-based plans do. A job-based health plan is considered “affordable” if the employee’s share of monthly premiums for the lowest-cost self-only coverage that meets the minimum value standard is less than 9.56 percent of their family’s income. • If you have Medicare, you can’t switch to Market place insurance, supplement your coverage with a Marketplace plan, or buy a Marketplace dental plan. 4 LivingWELL • October 2015
2. The amount you pay for insurance depends on your income Your savings depend on your estimate of your expected income for 2016, not last year’s income. Get a quick idea if your expected income is in the range to save at www.healthcare.gov/lower-cost/ Based on the income estimate provided on your application, the Health Insurance Marketplace will qualify you for one of the following: A health insurance plan with savings Most people who apply qualify for a premium tax credit that lowers their monthly insurance bill. Some also save on out-of-pocket costs like deductibles and copayments. You can choose any category of plan, but these out-of-pocket savings apply only if you enroll in a Silver plan. Plans are offered by private insurance companies with a range of prices and features. However, all plans cover: • Essential health benefits
Copayment 4. If you don’t have health insurance, you may have to pay a fee Most people must have qualifying health coverage or pay a fee with their 2016 federal taxes. If you don’t have coverage in 2016, you’ll pay a penalty of either 2.5 percent of your income, or $695 per adult ($347.50 per child) — whichever is higher. You can learn more about the fee at https://www.healthcare.gov/feesexemptions/fee-for-not-being-covered. In some cases, you might qualify for an exemption from the penalty. • Pre-existing conditions, including pregnancy • Preventive care You can add dental to a health plan, but you don’t have to. You can’t buy a dental plan unless you enroll in a health plan. Medicaid and the Children’s Health Insurance Program (CHIP) Medicaid and CHIP provide free or low-cost coverage to millions of people and families with limited income, disabilities, and some other situations. • Many states are expanding Medicaid to cover all households below certain incomes. • Your children may qualify for CHIP even if you don’t qualify for Medicaid. 3. You can apply for coverage four ways: • Online • By phone • With in-person help • With a paper application
5. Apply starting November 1. Get ready now. FYI Plans and prices for 2016 will be available by late October. • You can apply starting November 1, 2015. Coverage can start January 1, 2016. • After January 31, 2016, you can’t buy a health insurance plan for the rest of 2016 unless you have a life change — such as having
a baby, getting married, or losing other health coverage — that qualifies you for a Special Enrollment Period.
A fixed amount (for example, $15) you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service.
Deductible
Visit https://www.healthcare.gov/quickguide/dates-and-deadlines/ complete list of deadlines.
The amount you owe for covered health care services before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.
Courtesy of Healthcare.gov. Please visit https://www.healthcare.gov/quickguide/ for
Essential Benefits
more information.
Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace. Every health plan must cover the following services: • Ambulatory patient services (outpatient care you get without being admitted to a hospital) • Emergency services • Hospitalization (like surgery and overnight stays) • Pregnancy, maternity, and newborn care (both before and after birth • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy) • Prescription drugs • Birth control and breastfeeding benefit Find the complete list on https://www.healthcare.gov/coverage/what-marketplace-plans-cover/
Pre-Existing Condition
A health problem you had before the date that new health coverage starts.
Preventive Services
Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.
LivingWELL • October 2015 5
Why the Affordable Care Act Matters to African Americans By Sylvia Mathews Burwell and Valerie Jarrett A wife and mother of two young children, Muhammad, woke up on a spring morning in 2013 and knew something was wrong. A visit to the doctor in May revealed a mass growing on her brain. At the time she didn’t have health insurance and delayed treatment and surgery that, according to neurosurgeons, would mean the difference between life and death. Prior to the Affordable Care Act, insurance companies could have refused treatment for her pre-existing tumor, charge higher rates or denied her coverage altogether. But, after discovering the Health Insurance Marketplace, Muhammad was able to find quality affordable health insurance coverage. So this past summer, she had her tumor successfully removed and is now moving on with her life. And she is not alone. She attended the President’s State of the Union address as a representative of all those who have received insurance and care which has changed or saved their lives, or given them the peace of mind they need to rest more easily, without the worry that an unexpected health challenge could threaten their lives or livelihoods. During this African-American Community Week of Action, leaders, communities and families across the country are working together to ensure that all of their loved ones, neighbors and fellow Americans have the health insurance they need – and that those who are not covered visit HealthCare.gov to get covered right away. Since the start of Affordable Care Act’s first open enrollment period last year, the uninsured rate among non-elderly AfricanAmericans has declined by 30 percent. In just one year, 1.7 million uninsured AfricanAmericans gained health coverage, and that doesn’t include the 500,000 African-American young adults who now have coverage under their parents’ health insurance plans. And as more Americans take advantage of the current open enrollment period that ends Feb. 15,
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2015, those numbers will continue to grow. These strides are particularly important given the unique health challenges, and historic and structural barriers to care often faced in African-American communities. African-Americans have the highest cancer mortality rate of any ethnic group, a lower average life expectancy than white Americans, along with higher rates of infant mortality and chronic disease. The Affordable Care Act is helping to change the way many in African-American communities think about their health, the need for coverage, and for those who already had coverage – it has protected their investment. But the Affordable Care Act is breaking down many of the health barriers this community has faced. An estimated 7.8 million African-Americans now have access to expanded preventive services such as mammograms, well-child visits and flu shots with no out-of-pocket costs. And with the investment of $11 billion in community health centers nationwide, the law is dramatically expanding access to quality care facilities in many African-American neighborhoods. Still, for every story like Astrid’s, there remain countless more Americans in need of insurance, in need of quality care, and perhaps still unaware that the coverage they need is just a few clicks or a phone call away. So visit HealthCare.gov or call 1-800-318-2596 to find out more. This year’s Open Enrollment period ends on Feb. 15, so if you or someone you care about is in need of health insurance, do not wait. Get covered today. Sylvia Mathews Burwell is HHS secretary and Valerie Jarrett is senior advisor and assistant to the president for Intergovernmental Affairs and Public Engagement, the White House.
Living Well Through the Health Insurance Marketplace By Tatiana Wheeler The Affordable Care Act (ACA) is now five years old. The way Americans view healthcare has completely changed since its inception. President Barack Obama envisioned the Affordable Care Act as a way to provide everyday people with access to high quality care that could fit any budget. After several courtroom appearances, ACA has held it’s ground. African Americans are among those who have benefited, with 2.3 million gaining coverage in the past 3 years. Living Well spoke with Gwen Johnson who profited from the plans available in the Health Insurance Marketplace. Johnson, who is self-employed, paid her preferred health insurance plan directly out of pocket each month. “Once I went through the process, economically things were much better,” said Johnson. Once the Affordable Care Act opened the Marketplace, Johnson was able to shop and compare insurance plans and choose one that best fit her needs. “It was actually user friendly, but I can see how
it can be intimidating,” she said, explaining that although she completed her application online, there are inquiries that may be requested by the Health Insurance Marketplace and require immediate attention. The Health Insurance Marketplace is not as intimidating as it sounds. Yes, it is mandatory, if you don’t have coverage in 2016, you’ll pay a penalty of either 2.5 percent of your income, or $695 per adult ($347.50 per child) — whichever is higher. However, the supplements, savings and the piece of mind far outweigh the illusion of the hassle. “I went from paying $175 a month to $75 a month for healthcare and dental,” said Johnson. Supplements are credits based on the estimated income for the following year. The credits are then applied to the insurance plan’s bottom line amount per month. In addition, the marketplace offers plans for dental coverage and the same incentives apply. Open enrollment begins November 1. During the open enrollment period, individuals may shop around for the best coverage. Visit https://www. healthcare.gov/ for more information.
Local help to enroll in Affordable Healthcare Finding a source for unbiased Affordable Care Act information is easy and convenient. By visiting localhelp.healthcare.gov and typing in the desired zip code, a list of places and contacts will populate. This list contain “assisters” who are trained and certified to can help individuals and families apply for coverage and enroll in a health plan. Assisters are able to enroll individuals and families in a health plan with savings based on income or in Medicaid or Children’s Health Insurance Program (CHIP). They are required to provide information that is fair, impartial and accurate. This is a free service. For your convenience, following is a list of agencies to contact with questions or concerns regarding enrollment for health coverage. Detroit Health Care For The Homeless dba Advantage Health Centers Phone: (313) 835-5990 Email: administration@advantagehealthcenters.org Web: http://ahcdetroit.org Address: 79 West Alexandrine, Third Floor Detroit, MI 48201 Wayne State University Physician Group Phone: (248) 581-5840 Email: financialcounselors@wsupgdocs.org Web: http://www.wsupgdocs.org Address: 3990 John R Detroit, MI 48201
Wellness Plan Phone: (313) 875-4200 Email: cherrell@wellplan.com Web: http://wellplan.com Address: 4909 East Outer Drive Detroit MI 48234 Harper University Hospital / Hutzel Women’s Hospital Phone: (313) 745- 8040 Email: tbrooks@dmc.org Address: 3993 John R Detroit, MI 48201 Covenant Community Care, Inc. Phone: (313) 554- 0485 Email: jpettway@convenantcommunitycare.org Web: http://www.convenantcommunitycare.org Address: 559 West Grand Boulevard Detroit MI 48216 Small businesses and their employees can get help from the toll-free SHOP Marketplace call center Phone: 1-800-706-7893 or for TTY, call 711. More agencies can be found at localhelp.healthcare.gov. LivingWELL • October 2015 7
Grocery Shopping With Diabetes Starts With These Tips
By American Association of Diabetes Educators/Blackdoctor.org Grocery shopping usually isn’t at the top of anyone’s list of fun activities. For people with diabetes it can seem especially overwhelming – The carbohydrates! The sugar! Making healthy choices! But with a little planning, grocery shopping can be a very effective tool in meeting goals, from managing blood sugar levels to losing weight. “Planning ahead and shopping carefully are two great ways to take control, because you can get more out of your time and efforts,” said Melissa Joy Dobbins, MS, RDN, CDE, a Chicago-area diabetes educator and spokesperson for the American Association of Diabetes Educators (AADE). “It keeps you focused so you’ll buy more foods that are healthy and fewer that have little or no nutritional value. That way you don’t have to rely on your willpower when you’re back home to eat less of certain foods and more of others.” Successful grocery shopping is about focusing on what’s healthy, nutritious and tasty, so you’ll actually enjoy eating it. Diabetes educators can help people with diabetes make informed choices by explaining how different types of foods affect your diabetes, and sharing strategies about how to approach grocery shopping so it can help you meet your goals. They recommend starting with these tips: Make a List – Create a list of items you need at the grocery store before you go. Think of the meals you’ll make, the staples you’re running low on and perhaps a new, healthy recipe or food item you’d like to try. Organize the list by food group to speed up the process and keep you on track. If nothing is written under the vegetable category, 8 LivingWELL • October 2015
that’s a red flag; think about what vegetables you want to eat, and consider searching for a new recipe that you can get excited about. Make copies of a standard list you can update every time you go, or try a smart phone-shopping app. Eat Before You Go – It’s never a good idea to go shopping when you’re hungry; that’s when you’re more likely to make poor choices. Eat a healthy meal or snack. Think Inside the Box, or Bag or Can – Fresh fruits and vegetables are great, but they aren’t your only option. Dried, canned and frozen fruits and vegetables offer nutrients too, and can be healthy, easy and affordable additions to your diet. Look for fruits that are packed in juice rather than heavy syrup. Look for “low-sodium” or “no salt added” canned vegetables. Be aware that starchy vegetables such as peas, corn and potatoes contain more carbohydrates than other vegetables. Read Labels – Look past the “sugar free” or “low fat” claims. Read the nutrition label for specific information (from fat to carbohydrates to vitamins), noting the amounts that one serving of that food provides. Specifically: Consider the Carbohydrates – Looking at sugar content is fine, but it’s more important to consider the amount of “total carbohydrates,” which affect your blood sugar. Work with a diabetes educator to learn how many grams of carbohydrates are appropriate for you to eat per snack, meal and day. Focus on Fiber – Choose whole grain bread, rice, pasta and cereal. Then look for those that are a good source of fiber (2.5 grams or more per serving) or high in fiber (5 grams or more per serving). A healthy diet includes 25 to 30 grams of fiber from foods a day. Other good sources of fiber are beans, vegetables and fruits.
Hunt for Healthy Fats – Fats are an important part of every diet, but it’s important to lean towards those that are heart-healthy, such as olive and canola oil, avocado and nuts, limiting them if you are watching your weight. Grocery shopping can be a useful tool for diabetes management, if you do it wisely. Find a diabetes educator near you who can provide you with helpful information.
Grandmother in her Eighties Manages Diabetes By Keesha J. Atkins In 1977, when Naomi Jackson started to experience unquenchable thirst and double vision, she suspected that she had diabetes. Her doctor was skeptical at first, but blood and urine tests confirmed that she indeed had type 2 diabetes. For Jackson, an African American woman with a family history of diabetes and high blood pressure, this diagnosis is not uncommon. According to the American Diabetes Association, African Americans are 1.7 times more likely to have diabetes than non-Hispanic whites and an alarming 13.2 percent of all African Americans over the age of 20 have the disease. “The beginning was pretty scary with all those symptoms,” Jackson said. People facing the onset of diabetes can experience a myriad of symptoms including extreme fatigue, increased urination, slow-healing cuts and tingly or pain in hands and feet. Jackson’s primary care physician prescribed insulin shots, exercise and a low-calorie/reduced-sugar diet. “I was told to cut out the bad food and lose weight. Even today, I notice that when my weight is down my sugar is much better,” she said. Ironically, her first doctor later died of complications from diabetes. To stay
healthy and educate herself, she was able to observe those in her daily life. “I worked at a nursing home and learned a lot from watching the patients who also had it,” she said. Now 84 years old, Jackson has managed the disease for 38 years with the help of a team of doctors. A primary care physician, podiatrist and home health aide coordinate their efforts to ensure that she has the best care. All of these services are covered by Medicare. Though Jackson has minor trouble with her eyes and kidneys, she is lucky to have good vision and is grateful that she doesn’t need dialysis. She is able to enjoy her five grandchildren and five great-greatgrandchildren and cooks for them when she can. Other diabetics don’t fare as well. A few of the common complication associated with diabetes include stroke, high blood pressure, neuropathy and lower-limb amputations. “I think I’ve done real well. Sometimes I might get the urge for some cake, but I know it doesn’t help to eat it,” she said.
The Cost of Diabetes • $245 billion, the total economic burden in 2012 in the U.S. of the cost of diagnosed diabetes, including • $176 billion in direct costs and $69 billion in indirect costs (disability, work loss, premature mortality) • $322 billion, the total economic burden in 2012 in the U.S. of the cost of diagnosed diabetes, undiagnosed diabetes, prediabetes, and gestational diabetes • People with diagnosed diabetes have health care costs 2.3 times higher than what expenditures would be in the absence of diabetes • 1 in 10 health care dollars is spent treating diabetes and its complications • 1 in 5 health care dollars is spent caring for people with diabetes *Statistics from the American Diabetes Association, http://professional.diabetes.org/
LivingWELL • October 2015 9
can be tricky when changing time zones, so make a plan to adjust your schedule for injecting. Favor your feet – Wear comfortable well-fitting shoes and socks at all times. Never go barefoot. Check your feet frequently, especially after a hike or long walk. Feet and ankles often swell during flights so consider wearing light knee-high compression stockings (20-30 mm Hg) or bring thinner socks to change into if your feet swell. Wear a shoe that can be loosened if that occurs. Pointing and flexing your ankles during a flight can improve blood flow in your calf muscles and decrease swelling as well as lower the risk of blood clots. Prepare for a health emergency – If you need medical treatment, ask your hotel to recommend a local doctor who treats diabetes. Prior to an overseas trip, get a list of local English-speaking doctors through the International Association for Medical Assistance to Travelers. The secret to any successful trip is to take plenty of time and plan far in advance of your departure – and that goes double when you have diabetes. For more information about how a diabetes educator can help you plan your next trip, visit www.diabeteseducator.org/. Sources: Centers for Disease Control and Prevention (CDC), American Diabetes Association and Joslin Diabetes Clinic
Tips for Traveling Healthy with Diabetes By Jennifer N. Clements PharmD, BCPS, CDE, BCACP Just because diabetes is your constant companion doesn’t mean you can’t enjoy traveling, whether road tripping across America or flying to the far reaches of the globe. Ensuring you stay healthy and keep your glucose levels on an even keel does require a little bit of organization and planning ahead, though. The American Association of Diabetes Educators suggests a plan for ensuring your next travel adventure is safe and successful. Overpack your medications – Gone for a week? Pack two weeks’ worth of your diabetes medications in case of travel delays or misplaced supplies (insulin, syringes, testing strips, extra batteries for your pump, a first-aid kit, glucagon emergency kit, etc.). If you use a pump, ask the company if you can bring a backup in case yours fails. Have a prescription from your doctor for insulin or oral medication in case of an emergency. 10 LivingWELL • October 2015
Protect your supplies – Keep your medications and supplies close at hand and don’t put them in checked luggage or in the trunk where they can be exposed to harmful extreme temperatures (too hot or too cold). If you’re flying, keep them in the original packaging (so no one questions they’re yours) in a bag separate from your toiletries, as requested by the Transportation Security Administration (TSA), which manages airport security. Don’t worry, the TSA allows you to go over the 3.4 liquid-ounce carry-on limit for diabetes medications and supplies. Identify yourself – Wear your medical bracelet or necklace that notes you have diabetes and take insulin (if you do). Bring a doctor’s note that explains you have diabetes and lists your medications, as well as a prescription in case you need more. Carry a health card that includes your emergency contact and doctor’s name and phone number. Learn how to say “I have diabetes,” “sugar,” and “orange juice, please” in the language of the country you are visiting.
Carry snacks and low blood sugar treatment – Low blood sugar (hypoglycemia) can strike at any time and food access during travel is unpredictable, so be sure to bring plenty of snacks such as peanut butter crackers, granola bars and trail mix as well as glucose tablets or gel. Simplify flying – Tell the TSA folks that you have diabetes (they’re used to accommodating people with health issues). Visit http://www.tsa.gov/travelerinformation/passengers-diabetes before your trip to learn about current screening policies. If you plan to inject insulin while flying, be forewarned that the pressurized air can make it more challenging to draw up your insulin, if using a vial and syringe, so be extra careful not to inject air into the bottle. Test often – New foods, increased activity and different time zones can throw your glucose levels out of whack, so be sure to test frequently, including before and after meals. If you take insulin, keeping your levels steady
Avoid These Three Mistakes When Taking Medication for Diabetes By Tatiana Wheeler While there’s no magic formula for living well with diabetes, developing healthy eating habits, exercising regularly, taking the proper medications and communicating with your doctor will minimize its effects. Practicing these four things regularly should keep your diabetes under control. Try avoiding these three mistakes to stay on track with prescribed medications. 1. Forgetting doses This happens to almost everyone, especially in a world where multitasking is encouraged and it’s possible to be pulled in many different directions. “Forgetting or skipping doses would likely cause your diabetes to be out of control,” says Dr. Bola Oyeyipo, family physician in San Antonio, Texas. “Many patients go as far as lie to their doctor to cover up their mistakes. “Their uncontrolled blood sugar would often lead to the doctor increasing the medication dose when all that’s needed is better compliance with the prescribed medications.” To help keep track of which medications to take and when to take them, set a friendly reminder on your phone or leave a sticky note on your dresser or wherever it’s most beneficial. Open and honest communication with your doctor is very important. Make sure to discuss with him or her what to do if you
accidentally skip a dose. 2. Quitting medications after experiencing negative side effects No one wants to deal with nausea or vomiting after taking a prescription. However, if experiencing unpleasant side effects, it does not mean you stop taking the medication. “Diabetics shouldn’t be too quick to discontinue their diabetic medications when they experience side effects,” Dr. Oyeyipo says. “Discuss your symptoms with your doctor first as some diabetic medications, especially metformin, have side effects that taper off with continue use.” Inform your doctor right away of side effects. He or she will either lower your dosage or suggest a different medication altogether. 3. Not realizing when you’ve become immune to your medication “Over time, a good number of diabetics would need more than one diabetic medication or insulin to control their blood glucose levels regardless of good compliance,” Dr. Oyeyipo explains. “This is a result of the progression of the disease and no fault of the diabetic patient.” If you start to notice that your medication isn’t as effective as it once was, schedule an appointment with your doctor to determine whether it’s time to add or switch medication or increase the dosage.
LivingWELL • October 2015 11
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