Dana Lyons Commentary – Thu 2 Jul, 2020

With such few sectors outperforming now is the time to stick to the leaders – This includes gold stocks

Dana Lyons kicks off the editorials today by sharing his investing strategy for these highly selective markets. Only a handful of sectors are actually up for the year but these are up a lot. The main sector leaders include tech, bio-tech, healthcare, and gold stocks.

Also click here for his subscriber site where you get more specific trading advice.

Click here to follow Dana on Twitter

Dana Lyons Commentary – Fri 15 May, 2020

Can just a handful of stocks support the overall markets?

Dana Lyons kicks off today by focusing on the overall markets and outlining the few sectors that are holding the broad averages up. A couple key questions are the following… Can these few sectors hold up the overall markets? And is there still upside in the few standout sectors?

Dana is also running a spring sale over at The Lyons Share. Click here to get 25% off his service.

Before You Pay Your Hospital Bill, Read This

This post Before You Pay Your Hospital Bill, Read This appeared first on Daily Reckoning.

Have you run up a huge hospital bill that you’re having difficulty paying?

The stress can be overwhelming, especially while you’re recovering from a complicated procedure and feeling like you’ve been hit by a truck. 

But you’re not alone…

The Consumer Financial Protection Bureau (CFPB) found that 43 million Americans have overdue medical debt on their credit reports.

You may have already pleaded with your insurance company and battled with debt collectors. But you still can’t get a break.

One resource you might consider is…

Hospital Financial Assistance

As part of the Affordable Care Act (Obamacare), all nonprofit hospitals must offer hospital financial assistance, also known as charity care. It’s optional at for-profit facilities.

The programs offer free or reduced-rates for certain patients. Yet the federal government doesn’t have any clear rules on how much assistance should be provided and who qualifies.

So that gives hospitals a lot of flexibility on what they offer and to whom.

Many base assistance on federal poverty guidelines (FPG). This is a measure of income and family size used by Washington to determine who is eligible for some federal programs. 

Others might have a sliding scale, which eliminates hospital debt for lower-income folks. Or there could simply be a standard amount of forgiveness.

Many hospitals post specifics about their financial assistance program on their website.

For instance, Jupiter Medical Center in Florida gives patients a 100% discount if their income is less than or equal to 200% of the FPG. If income is over 200% but not more than 400% of FPG, they’ll get an 80% discount.

The University of Pittsburgh Medical Center has a sliding scale. If patients have income below 251% of FPG, they’re eligible for 100% assistance. An income between 251% and 400% will get them partial debt forgiveness.

Here in California, USC hospitals grant a 100% discount for patients whose income is less than 200% of FPG. Those with family income between 201% and 350% will be eligible for a sliding scale discount.

Loyola University Medical Center is one of the more generous. The Chicago hospital has discounts for patients with family income as high as 600% of the FPG.

Other Criteria

Besides financial need, eligibility can depend on why you were in the hospital since some procedures, such as cosmetic and dental, might not be covered in your hospital’s program.

Also before requesting hospital financial assistance, you must have used all of any insurance benefits you were entitled to. That includes: insurance from your employer, auto insurance, and workers comp.

Patients with sufficient assets to pay for care are ineligible for financial assistance.

How to Apply

Hospitals have application forms online that you can download, print, and submit. You’ll likely have to include proof of income with pay stubs and tax returns as well as a list of assets, liabilities, and family members.

You have up to 240 days after the initial billing to file your application for assistance.

Call the facility’s billing office if you have questions on the application process.

And if You Don’t Qualify…

There are still steps you can take to get this monkey off your back.

The most important: don’t ignore it.

Because once a debt like that goes to collections, it can hurt your FICO credit report for up to seven years. And even land you in court.

So before your bill is sold to a collection agency, request an itemized statement from the hospital and ask that they put a hold on your account for 30 days. That gives you time to look for errors, such as double-billing and unexpected fees.

If you have medical insurance, they should have sent you or posted online an explanation of benefits (EOB) form. Compare it to the hospital’s itemized bill.

Is there something that you think the company should have paid but didn’t?

There could be a coding error, which may be why it was not paid…

For example, removing stitches from a gash on your arm, applying antiseptic cream, and covering it with a bandage at a walk-in clinic could have been coded as a much-more expensive emergency room visit.

Or tests done by technicians could’ve been coded as being done by doctors.

Or is there a large unpaid amount on the EOB form that you have no idea where it came from?

Get on the phone with your insurer and request to speak with a representative.

You can also delve deeper by comparing your bill to your medical records to see if the services invoiced were actually performed.

Extreme? Perhaps. But doing this legwork could save you thousands.

One study found errors in 99% of bills analyzed for 2017. Double-billing for services and procedures were among the most common.

Finally, if you’re uninsured or haven’t hit your deductible yet, remember that almost everything is negotiable, even hospital bills.

Not sure how much to offer? The Healthcare Bluebook lists the fair price for procedures in your area.

You might also see if the hospital will let you repay the bill on a low-or no-interest installment plan.

And in case you end up in the hospital again, you may want to reapply for financial assistance. Your family circumstances might change, and the FPG adjusts annually.

To a richer life,

Nilus Mattive

— Nilus Mattive
Editor, The Rich Life Roadmap

The post Before You Pay Your Hospital Bill, Read This appeared first on Daily Reckoning.

The Last Resort for Healthcare: What You Need to Know

This post The Last Resort for Healthcare: What You Need to Know appeared first on Daily Reckoning.

Long-term care for a semi-price room in a nursing home averages $6,844 per month according to the U.S. Department of Health and Human Services.

Many Americans can’t afford such costs, so they often look to the option of last resort: Medicaid. 

Medicaid is a program that provides health care to some middle-income families, even though it’s frequently thought to only be for the poor. Coverage includes custodial nursing home care in all states and home care services in a few.

It’s meant to pay for specific expenses after a patient’s resources are gone. The federal government pays a portion of the tab, while states operate and fund the balance.

Qualifying for it isn’t always easy, especially for elderly folks with a moderate income and who have accumulated a modest net worth over their working lifetimes.

Programs and qualifications among states can vary slightly depending on the needs and goals of that state.

That aside, there are basically two financial criteria that must be met. 

First, Is the Income Eligibility Criteria…

The Federal guideline for 2019 is that an individual, age 65 or older, cannot have a monthly income greater than $2,313. If married and both spouses are applying for Medicaid, each can have a $2,313 income for a combined $4,626.

When only one spouse is applying, the non-applicant is allowed some of the applicant’s income to help cover the living-at-home expenses while their spouse is receiving care. In most states, that maximum is $3,160.50 per month.

If your elderly loved one’s income exceeds the threshold, she could spend some of her income on health care and medical-related costs to get her income below that threshold.

Examples of Medicaid income spend down include:

  • Eyeglasses
  • Hearing aids
  • Transportation to receive medical care
  • Past medical and hospital bills

She should track every dollar spent on health care. Save every receipt. Missing one from the pharmacy, for example, could mean qualifying for Medicaid or not.

Second, Is the Asset Eligibility Criteria…

States will not grant Medicaid nursing home coverage if applicants have more than a certain amount of assets.

In most states, a single applicant, age 65 or older, is allowed to have $2,000. You can find your state’s requirements here.

If married and both spouses are applying for Medicaid, the typical limit is $3,000.

And if married with only one spouse applying, the non-applicant spouse can have as much as $126,420 in most states.

But not everything that people own is countable.

Countable assets are generally assets that can be converted to cash and used to pay for long-term care.

Examples include:

  • CDs
  • stocks
  • bonds
  • savings accounts
  • money market funds
  • a second home
  • IRAs, 401(k)s

Non-countable assets, that is those that are exempt from the state’s maximum, include:

  • furniture
  • clothing
  • personal belongings   
  • a car
  • irrevocable funeral and burial trusts
  • the primary residence — assuming the non-applicant spouse will continue to live there and the equity is not more than $585,000

Medicare Spend Down

Suppose your elderly loved one is not in good health. And you know that that she may need long-term care in the near future. The problem is that her resources exceed the state’s Medicaid allowance.

That means she’ll have to spend down her assets.

She could begin by converting countable assets into non-countable assets. For instance:

  • Making home improvements — a handicap bathroom, a chairlift, a wheelchair ramp
  • Paying off mortgages, auto loans, credit cards
  • Prepaying funeral and burial expenses

She could also set up a life care agreement…

This is a legal contract with a caregiver, can be a family member or friend, to provide a specified level of care for the duration of the elderly person’s life. Tasks could include housecleaning, preparing meals, and serving as an advocate if she goes to a nursing home.

The pay cannot be deemed as gifts, and a fair-market wage must be established.

You may be thinking… why bother with all that. Why not just give enough assets to friends and family members to get her countable assets down to the Medicaid limit, or sell them at a steep discount?

Clever idea. But states are onto that one with the…

Look-Back Period

This is a period of time when assets that could have been used to pay for long-term care were transferred. In most states it is 60 months. Here in California it’s 30.

The rules are complex and vary state to state. Basically though, authorities look closely for assets transferred within the look-back period.

And if they find that an applicant violated that rule, your loved one may not get the financial assistance she was seeking. Instead, she could with a penalty period — a period of Medicaid ineligibility when she would have to pay out of pocket for her own nursing home care.   

Medicaid Estate Recovery Program (MERP)

To make all of this even more complicated, states are required to seek recovery from an individual’s estate for Medicaid payments made. They have been known to get pretty aggressive, for example immediately going after life insurance proceeds that were intended to benefit a surviving spouse.

They can even put a lien on a patient’s home if she is permanently institutionalized, unless her spouse is living there.   

Bottom Line

Before implementing any Medicaid planning strategies, I suggest meeting with an attorney. Not the one who handled your home closing or divorce.

You want an elder care attorney who knows the ins and outs of the Medicaid rules for your state and can re-structure your loved one’s finances to help them become eligible. The National Academy of Elder Law Attorneys is a good place to begin your search.

To a richer life,

Nilus Mattive

— Nilus Mattive
Editor, The Rich Life Roadmap

The post The Last Resort for Healthcare: What You Need to Know appeared first on Daily Reckoning.

The Surprising Way to Save on Your Next Medical Procedure

This post The Surprising Way to Save on Your Next Medical Procedure appeared first on Daily Reckoning.

Americans seek health care in other countries for numerous reasons. Some are immigrants who prefer providers from a similar culture. Others might want a procedure that is not available in the U.S.

However, the biggest factor motivating them is cost.

In the U.S. we have the most expensive health care system in the world. It’s not difficult to find countries that offer procedures at 30%-65% of the cost in the U.S.

For example a knee replacement that would run $35,000 to $60,000 in the U.S. costs less than $23,000 in Costa Rica or India, including airfare and lodging for the patient and a companion.

Facilities offshore can charge less because of lower pay to doctors and other health care workers. Plus there’s less overhead since patients pay cash, and providers may not have to carry the same level of malpractice insurance as here in the states.

Common procedures include orthopedic surgery, cosmetic surgery, cardiac surgery, oncologic care, and dentistry.

So it’s no surprise that medical tourism is booming. Patients are combining medical procedures while vacationing abroad.

In 2017, more than 1.4 million Americans sought health care in a variety of countries, up from 750,000 in 2007. The number is expected to increase by 25% per year.

The Amount of Money Involved is Impressive…

Worldwide, patients spend $3,800-$6,000 per visit. And the total value of the entire medical tourist business per year is around $439 billion, which has made it one of the fastest growing markets in the healthcare sector.

Countries around the world are tapping into this niche…

For instance, nearly 1 million people went to Turkey in 2018 for health tourism.

Mummy makeovers have become popular in Thailand. Beginning at $10,000 new moms can undergo extensive procedures, such as breast lifts and laser peels, to regain their pre-baby appearance.

And companies offering vacation packages that include cosmetic surgery and dental procedures are popping up like mushrooms. The offers generally include private hospital services, “highly trained” and “credentialed” medical staff, and recovery time in an exotic setting.

The top destinations are Thailand, Mexico, Singapore, India, Malaysia, Cuba, Brazil, Argentina, and Costa Rica.

And they offer everything from “safari and surgery” to “tropical, scenic tour” vacation packages.

You’ll likely have to pay for your care at the time of service and use a private company or medical concierge to identify foreign health care facilities.

Unfortunately, these companies might not require accreditation of foreign providers, track patient results, or maintain medical record security policies.

The Risks

The quality of care in hospitals and clinics outside the U.S. is the primary concern. And there are no U.S. laws that will protect you or require medical personnel have specific training or qualifications. 

Countries differ in their standards for infection control and safety. Using fresh gloves, sterile instruments, and safe water are not always the norm. Without these precautions, you could be infected with hard-to-treat bacteria not commonly seen in the U.S.

For example, the Centers for Disease Control and Prevention (CDC) reported that some U.S. residents who had weight-loss surgery in Tijuana, Mexico, were diagnosed with infections caused by an antibiotic-resistant form of Pseudomonas aeruginosa bacteria.

And the CDC issued warnings about procedures in the Dominican Republic. That was after dozens of women reported coming down with potentially fatal infections post-surgery.

There are other issues too, such as:

  • Language barriers can increase the chance that misunderstanding will arise about your care 
  • Culture shock
  • Counterfeit medications or blood that hasn’t been properly screened
  • Long flights after surgery can increase the chance of blood clots
  • If there’s a problem after you return home, who will treat you? 

Precautions You Can Take

To reduce the chances of something going wrong: 

  • Consult with a travel medicine specialist in the U.S. at least a month before your trip.
  • Ask your doctor if you are healthy enough to travel abroad for the procedure.
  • Request a written agreement from the facility or group arranging the trip, defining the treatments, supplies, care that’s covered.
  • Arrange follow-up care with your local doctor before you leave.
  • Take a list of all the meds you use, including their brand and generic names, manufacturers, and dosages.
  • Before combining vacation activities with your trip, see if those activities are allowable after surgery.
  • Plan on staying in the area where the surgery was done for at least one week. Traveling too soon increases the risk of pulmonary embolism and blood clots.
  • Keep all outer packaging and package inserts from meds you receive or purchase abroad. They could be useful if you have complications.
  • Maintain records of all care you received overseas. And don’t be reluctant to share that information with your primary care provider.
  • Avoid black market private clinics, which are often operated by non-physicians who have little or no medical training.

Although there are many skilled and qualified physicians practicing all over the world, it may be difficult to access their training and credentials outside of the U.S.

Yet there are sources you should check.

For instance, are the facilities internationally accredited?

Joint Commission International, DNV International Accreditation for Hospitals, and the International Society for Quality in Health Care have lists of standards that members must meet.

Also, the American Board of Medical Specialties, the American Society of Plastic Surgeons, and the International Society of Aesthetic Plastic Surgery all accredit overseas physicians.

The decision to visit another country for medical care should go beyond simply comparing prices…

Do your homework. Research the procedure, the benefits, and the risks. Understand potential side effects and recovery time.

Finally… be informed. Use social media to find others who have had similar procedures done by the same provider so you have a better idea on what to expect.

To a richer life,

Nilus Mattive

— Nilus Mattive
Editor, The Rich Life Roadmap

The post The Surprising Way to Save on Your Next Medical Procedure appeared first on Daily Reckoning.

5 Ways to Haggle with Hospitals

This post 5 Ways to Haggle with Hospitals appeared first on Daily Reckoning.

I recently told you about my weekend hospital visit that totaled $30,124 from a surfing accident I had back in December.  

Fortunately, my insurance erased more than 90% of that bill and the total cost for the stay ended up being just a couple grand. But what if I didn’t have insurance or what if my visit wasn’t covered? 

I’ve been thinking more about what people do when they’re stuck with high hospital bills. What are your options? How much can you negotiate? 

It’s estimated that hospitals in the U.S. overcharge their patients by about $10 billion total every year. Patients are paying markups of 100-1000% annually without even realizing it. This is a huge problem in our country. 

Before you panic, know that most hospitals are willing to cut you a deal. As long as you know who to talk to and what to look for you can almost always slash a few decimals off your hospital bill. Here are some tips on how to do it.

1. Be Proactive

If you have a procedure that’s not an emergency, ask for a discount ahead of time. Explain your circumstances upfront to your doctor if you’re living on a fixed or low income. A lot of facilities have programs in place to help those who are financially strapped, but they don’t necessarily advertise unless you ask. 

And when you’re negotiating, try to do it through email. It’s best to have a paper trail if you successfully negotiate a discount in case you need to remind the billing department of your agreement. Another tip is keep notes during your hospital stay. 

Have a family member or friend help you out. You want to log all the procedures and services you receive so you can compare when your bill arrives. 

2. Pay in Cash 

Talk to your doctor or the billing manager and ask if they’re willing to give you a discount if you pay in cash. Cash will save the office credit card fees and staff time processing paperwork. 

Make sure you point these out when you make the offer, and if you have the means offer to pay the full amount upfront if they lower the bill even more. 

3. Check for Billing Errors

Eighty percent of medical bills have at least one error. Always ask for an itemized bill so you can determine whether you’ve been overcharged for a service. Medical bills are notoriously hard to decipher and it’ll look like a bunch of numbers next to your costs. 

If you’re unsure of what a code means, track it down online so you can see what you’re being billed for and whether or not you actually received that treatment. Codes might be mismatched, which means they don’t line up with your diagnosis. 

If the codes don’t match, your insurer will most likely decline to pay any portion of this claim. 

Watch out for duplicate billing and unbundling, when services that should have been billed under one umbrella diagnosis or code are broken out, sometimes adding up to additional costs. If you suspect your bill has an error, call your doctor, the hospital or your insurance provider to let them know and ask for a new, accurate bill.

4. Do Your Research on Insurance Rates

Look up the fair market price for the care you received. This is the amount providers regularly accept from insurance companies as payment in full, and it’s the amount you should aim for in your negotiations. 

You can find this information in the Healthcare Bluebook. After you know what you should be paying, contact the billing department and explain the situation. 

Ask to lower your bill to be in-line with the market price. Be polite and keep your composure, no one likes helping someone rude. 

5. Negotiate Payment Terms

Sometimes you’ll run into service providers that won’t budge on price — don’t cave. Ask if there are any payment plans that could meet your needs instead. 

Tell the billing representative exactly how much you can pay and when. If they ask for larger payments — and they will — explain that you can’t afford to do more. Make it crystal clear your ability to make payments. If you’re really having a tough time, drop the word “bankruptcy.” Most providers would rather receive some payment than nothing at all. 

Most of the time if you pay small amounts over an extended period of months, the provider won’t turn you over to collections. They’ll accept your money each month and send you a new bill the next month, unless you miss a payment. 

So don’t commit to more than you can afford, because as soon as you’re late on a payment, you lose all negotiating power. 

6. Hire a Billing Advocate 

If all else fails, consider hiring a medical billing advocate. The downside is most billing advocates cost money, though you typically don’t pay unless they’re successful negotiating you a lower bill.

Lastly, whatever you negotiate, make sure you follow through on your end of the deal. If you said you’d send in regular monthly payments, make sure they’re being sent on time every month. 

Failing to keep up your end of the bargain could lead to the provider rescinding any discount you negotiated and land you in the collections department. 

I hope you don’t find yourself in a situation where you need to use any of these tips. But if you do, know there are ways to reduce the costs.

To a richer life,

Nilus Mattive

— Nilus Mattive
Editor, The Rich Life Roadmap

The post 5 Ways to Haggle with Hospitals appeared first on Daily Reckoning.