Medicare and Medicaid are two separate, government-run programs. They are operated and funded by different parts of the government and primarily serve different groups.
The end of daylight saving time can mark the start of seasonal depression. Here’s how to head it off (hint: no sleeping late)
In Chicago, the sun rose on Nov. 1 to reveal icicles festooning garage gutters, trees lined with white and sunlight sparkling on snow-covered roofs. We barely had time to cozy up with hot cider and pumpkin baked goods, when suddenly … winter. It’s depressing, right?
In fact, yes it is.
Seasonal affective disorder, and the slightly less debilitating version, which psychologists call winter blues, are forms of depression that are tied to the winter season. An estimated 10 million Americans struggle with full-blown SAD, and another 10% to 20% are believed to suffer from less severe winter mood changes. Women are affected more often than men. The symptoms mirror those of any depression, but they show up year after year as the season shifts toward winter.
But will the first snowfall trigger the onset of those symptoms? Maybe, but another event that’s headed our way this weekend — the annual end of daylight saving time — could have a bigger impact. “Snowfall presents an interesting situation,” says Georgetown University professor of psychiatry Norman Rosenthal, “because it is sometimes accompanied by very cold weather, which keeps people indoors. But if people get out into the snow and walk about, you can get a dazzling amount of light reflecting off the snow. And the combination of light and exercise is a very good combination for people with SAD.”
Research strongly suggests that it is the light, not the cold, that is the key to seasonal depression. Light therapy has been prescribed for SAD patients for years, and a 2018 study from Brown University neuroscientists found evidence of a pathway in the brain linking photo-sensitive cells in the retina with areas of the brain that control mood. “People need to understand the key importance of a lack of light,” says Rosenthal, who has authored “Winter Blues” a guidebook for treating seasonal depression.
Winter’s shorter days already deprive the brain of light, but the end of daylight saving time can compound that effect for people already beginning to feel the onset of SAD, Rosenthal says. “When the clocks turn back, that’s supposed to give you an extra hour of light in the morning. But people with seasonal affective disorder typically have a hard time getting up in the morning. So light is being given back to them when they have the comforter over their heads, and then it gets dark in the afternoon, when people with SAD are most likely more active.”
That’s why experts like Kelly Rohan, a professor and researcher at the University of Vermont, have identified the end of daylight saving time as the moment for SAD patients to start implementing strategies to beat their depression.
Rohan’s research, which has focused on both light therapy and cognitive behavioral therapy approaches to treating SAD, has shown that a cognitive approach can be as effective as light therapy and may have longer-lasting benefits.
Cognitive behavioral therapy for SAD involves developing two sets of skills: pro-active behaviors to counteract the tendency to hibernate, and thinking skills to recognize and counteract depressed thought patterns. “Knowing about the illness and knowing about how to do things that make a difference can be very impactful,” says Rosenthal. “What Dr. Rohan has done is to systematize a way of telling people how to deal with winter depression.”
Part of the treatment, Rosenthal says, is planning ahead for winter. “Come up with a fun activity for every day,” he says. “People with SAD tend to be hibernators, they want to curl up, they don’t see people. That can become a negative spiral.” He suggests alerting friends and family to your tendency to hide during the winter, and ask that they help you by reaching out to make plans. “Get outside whenever you can,” he says. “Find a buddy, and make a pact to keep each other active.”
Getting outside helps provide the light your brain needs to regulate mood. But Rosenthal is also a believer in light therapy, if done correctly. “Just going out and walking in a bright, snowy morning is going to help you,” he says, but supplementing with a therapeutic light box is beneficial as well.
“There are a lot of light boxes available online,” he says, “and some of them are very beneficial. I think a nice, large light is better than a teeny-weeny one — I recommend light boxes be at least 1 foot square, maybe more.” He also recommends checking for brands that have been used in clinical research, as a measure of quality.
Some researchers have suggested that a DIY approach to light therapy can be hit or miss, in part because it’s hard to know exactly how much light you’re getting. Rosenthal says that trying light therapy on your own is fine, but he suggests reading up to make sure you understand how to use the light box to its greatest effect.
It’s important that the light be used in the morning, when it is most beneficial, and that it is used consistently. “If you skip a day, that’s probably OK,” he says. “But skip two days, and symptoms will start to come back. As you become aware that the light is helping you and making you more energetic, it becomes like brushing your teeth — you don’t skip a day brushing your teeth.”
Perhaps the most important step in fighting SAD, however, is the first one: just get started. “Intervene as soon as it’s having an impact on your quality of life or function,” Rosenthal says. “If you’re sluggish, finding it hard to get yourself going, often it’s a cognitive issue.”
Get in touch with friends, start making plans and get moving quickly to stop the symptoms before winter and depression take hold.
And, in spite of the temptation to “fall back” when daylight saving time ends, dig yourself out from under those covers and treat your retinas to some sunlight. “Sleeping in,” Rosenthal says, “is very bad for people with the winter blues.”
By one estimate, a 65-year-old couple who retire in 2019 may need about $300,000 in savings to pay their health-care expenses in retirement. This includes premiums for Medicare Parts B and D, supplemental (Medigap) insurance, and median out-of-pocket prescription drug expenses, but not other health expenses such as long-term care, dental care, and eye care.1
Health expenses are rising faster than inflation, and even insured workers are finding it harder to pay their portion from year to year (premiums, copays, coinsurance, and deductibles), much less plan for the future. The stakes are even higher for early retirees (younger than 65) and self-employed individuals who must purchase their own health insurance and bear the entire cost themselves.
A health savings account (HSA) is a tax-advantaged account linked with a high-deductible health plan (HDHP). They work together to help you cover your current health-care costs and also save for your future needs.
HSAs offer several tax benefits to help encourage diligent saving.
The maximum HSA contribution limit in 2020 is $3,550 for individual coverage or $7,100 for family coverage. This annual limit applies to all contributions, including those made by you, your family members, or your employer. You can contribute an additional $1,000 starting the year you turn 55. Once you sign up for Medicare, you can no longer contribute to an HSA.
Funds roll over from year to year and are portable, which means they are yours to keep. When HSA balances reach a certain threshold, you can steer the funds into a paired account with investment options similar to those offered in a 401(k). You can make 2019 contributions up to April 15, 2020.
Pros and Cons
HDHPs are designed to help control health costs. HSA owners are forced to pay attention to prices, so they may select lower-cost providers and be more likely to avoid unnecessary spending. On the other hand, some people with HDHPs might be reluctant to seek care when they need it, because they don’t want to spend the money in their account. A high deductible can make it difficult to pay for a costly medical procedure, especially if there hasn’t been much time to build up an HSA balance.
To be eligible to establish or contribute to an HSA, you must be enrolled in a qualifying high-deductible health plan — an HDHP with a deductible of at least $1,400 for individuals, $2,800 for families in 2020. Workers who are offered HDHPs (as a choice or their only option) or purchase their own insurance often face much higher deductibles. In 2019, the average deductible for employer-provided HDHPs was $2,486 for individual coverage and $4,779 for family coverage.2
Qualifying HDHPs also have out-of-pocket maximums, above which the insurer pays all costs. In 2020, the upper limit is $6,900 for individual coverage or $13,800 for family coverage, but plans may have lower caps. This feature could help you budget accordingly for a worst-case scenario.
Premiums are typically lower for HDHPs than traditional health plans. Until the deductible is satisfied, members usually pay more up-front for services such as physician visits, surgery, and prescriptions, but typically receive the insurer’s negotiated discounts.
Some preventive care, such as routine physicals and cancer screenings, may be covered without being subject to the deductible. Under new IRS guidance issued in July 2019, the list of preventive care benefits that HDHPs may provide was expanded to include certain medications and treatments for chronic illnesses such as asthma, diabetes, depression, heart disease, and kidney disease. Providing this coverage encourages patients to seek care before problems become more serious and costly.
Another HSA benefit is that account funds not needed for health expenses are available for any other purpose after you reach age 65. Although HSA funds cannot be used to pay regular health plan premiums, they can be used for Medicare premiums and qualified long-term care insurance premiums and services that you may need later in life.
If you can afford to fund your HSA generously while working, some of those dollars could be left untouched to accumulate for many years. You could even pay current medical expenses out of pocket and preserve your HSA assets for use during retirement. But save your receipts in case you have an unexpected cash crunch. You can reimburse yourself for eligible expenses at any time.
Open enrollment is the time of year when employers typically introduce changes to their benefit offerings. If you purchase your own health insurance, you might also be presented with new options for 2020. The bottom line is that choosing and using your health plan carefully could help you save money. If you choose an HDHP, make sure to contribute the premium dollars you are saving to your HSA, and more if you can.
Before you sign up for a specific plan, read the policy information and look closely for any coverage gaps or policy exclusions, consider the extent to which your prescription drugs are covered, estimate your potential out-of-pocket costs based on last year’s usage, and check to see whether your doctors are in the insurer’s network.
1) Employee Benefit Research Institute, 2019
2) Kaiser Family Foundation, 2019
This information is not intended as tax, legal, investment, or retirement advice or recommendations, and it may not be relied on for the purpose of avoiding any federal tax penalties. You are encouraged to seek advice from an independent professional advisor. The content is derived from sources believed to be accurate. Neither the information presented nor any opinion expressed constitutes a solicitation for the purchase or sale of any security. This material was written and prepared by Broadridge Advisor Solutions. © 2019 Broadridge Investor Communication Solutions, Inc.
Terence S. Phillips
is the founder of
79% of Americans agree they would benefit from having basic financial education and information.
Source: The 2018 Consumer Financial Literacy Survey, The National Foundation for Credit Counseling.
45% of American workers have saved less than $25,000 for retirement, and 26% have saved less than $1,000.
Source: Employee Benefit Research Institute, 2018
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