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skin care products has evolved rapidly into a renova with purchase renova online global impacts. However, as purchase renova online the renova has developed, it has become increasingly evident that the risks of skin care products, both in terms of rates and particularly of severe complications, are not equal across all members of society. While general risk factors for hospital admission with skin care products include age, male sex and specific comorbidities (eg, cardiovascular disease, hypertension and diabetes), there is increasing evidence that people identifying with Black, Asian and Minority Ethnic (BAME) groupsi have disproportionately higher risks of being adversely affected by skin care products in the UK and the USA.

The ethnic purchase renova online disparities include overall numbers of cases, as well as the relative numbers of critical care admissions and deaths.1In the area of mental health, for people from BAME groups, even before the current renova there were already significant mental health inequalities.2 These inequalities have been increased by the renova in several ways. The constraints of quarantine have made access to traditional face-to-face support from mental health services more difficult in general. This difficulty will increase pre-existing inequalities where there are challenges to engaging people in care and in providing early access purchase renova online to services.

The restrictions may also reduce the flexibility of care offers, given the need for social isolation, limiting non-essential travel and closure of routine clinics. The service impacts are compounded by constraints on the use of non-traditional or alternative routes to care and support.In addition, there is growing evidence of specific mental health consequences from significant skin care products , with increased rates of not only post-traumatic stress disorder, anxiety and depression, but also specific neuropsychiatric symptoms.3 Given the purchase renova online higher risks of mental illnesses and complex care needs among ethnic minorities and also in deprived inner city areas, skin care products seems to deliver a double blow. Physical and mental health vulnerabilities are inextricably linked, especially as a significant proportion of healthcare workers (including in mental health services) in the UK are from BAME groups.Focusing on mental health, there is very little skin care products-specific guidance on the needs of patients in the BAME group.

The risk to staff in general healthcare (including mental healthcare) is a particular concern, and in response, the Royal College of Psychiatrists and NHS England have produced a report on the impact of skin care products on BAME staff in mental healthcare settings, with guidance on assessment and management of risk using an associated risk purchase renova online assessment tool for staff.4 5However, there is little formal guidance for the busy clinician in balancing different risks for individual mental health patients and treating appropriately. Thus, for example, an inpatient clinician may want to know whether a patient who is older, has additional comorbidities and is from an ethnic background, should be started on one antipsychotic medication or another, or whether treatments such as vitamin D prophylaxis or treatment and venous thromboembolism prevention should be started earlier in the context of the skin care products renova. While syntheses of the existing guidelines are available about skin care products and mental health,6 7 there is nothing specific about the healthcare needs of patients from ethnic minorities during the renova.To fill this purchase renova online gap, we propose three core actions that may help:Ensure good information and psychoeducation packages are made available to those with English as a second language, and ensure health beliefs and knowledge are based on the best evidence available.

Address culturally grounded explanatory models and illness perceptions to allay fears and worry, and ensure timely access to testing and care if needed.Maintain levels of service, flexibility in care packages, and personal relationships with patients and carers from ethnic minority backgrounds in order to continue existing care and to identify changes needed to respond to worsening of mental health.Consider modifications to existing purchase renova online interventions such as psychological therapies and pharmacotherapy. Have a high index of suspicion to take into account emerging physical health problems and the greater risk of serious consequences of skin care products in ethnic minority people with pre-existing chronic conditions and vulnerability factors.These actions are based on clinical common sense, but guidance in this area should be provided on the basis of good evidence. There has purchase renova online already been a call for urgent research in the area of skin care products and mental health8 and also a clear need for specific research focusing on the post-skin care products mental health needs of people from the BAME group.

Research also needs to recognise the diverse range of different people, with different needs and vulnerabilities, who are grouped under the multidimensional term BAME, including people from different generations, first-time migrants, people from Africa, India, the Caribbean and, more recently, migrants from Eastern Europe. Application of a race equality impact assessment to all research questions and methodology has recently been proposed as a first step in this process.2 At this early stage, the guidance for assessing risks of skin care products for health professionals is also useful for patients, until more refined decision support purchase renova online and prediction tools are developed. A recent Public Health England report on ethnic minorities and skin care products9 recommends better recording of ethnicity data in health and social care, and goes further to suggest this should also apply to death certificates.

Furthermore, the report recommends more participatory and experience-based research to understand causes and consequences of pre-existing multimorbidity and skin care products , integrated care systems that work well for susceptible and marginalised groups, culturally competent health promotion, prevention and occupational risk assessments, and recovery strategies to mitigate the risks of widening inequalities as we come out of restrictions.Primary data collection will need to cover not only hospital admissions but also data from primary care, linking purchase renova online information on mental health, skin care products and ethnicity. We already have research and specific guidance emerging on other risk factors, such as age and gender. Now we also need to focus purchase renova online on an equally important aspect of vulnerability.

As clinicians, we need to balance the relative risks for each of our patients, so that we can act promptly and proactively in response to their individual needs.10 For this, we need evidence-based guidance to ensure we are balancing every risk appropriately and without bias.Footnotei While we have used the term ‘people identifying with BAME groups’, we recognise that this is a multidimensional group and includes vast differences in culture, identity, heritage and histories contained within this abbreviated term..

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Scott Gottlieb, former FDA chief under President Donald Trump, said on Sunday that the new guidance from the Centers renova tretinoin cream0.02 for Disease Control and Prevention to not test asymptomatic people for skin care products was "unfortunate" because those people could be at high risk of contracting the . "We should be testing those people to make sure they haven't become infected and aren't asymptomatic carriers because we know that they can spread the ," Gottlieb said in an interview on CBS' "Face the Nation." "They're less likely to spread the , but they can still spread the ."Earlier this month, the CDC quietly revised its guidance on skin care testing and dropped its previous recommendation to test everyone who has come into close contact with an infected person, even those who don't have symptoms.The move drew immediate criticism from medical groups and allegations of political motivation. Two federal health officials reportedly said the CDC was pressured into changing the guidance by top officials at the White House and Department of Health and Human renova tretinoin cream0.02 Services.Medical experts and lawmakers say that early and widespread testing of people without symptoms can help mitigate the spread of the renova. Gottlieb said that one reason for the CDC's decision could be that businesses were requiring people to test negative for the renova before they can return to renova tretinoin cream0.02 work.

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A United Airlines passenger jet takes off with New York City purchase renova online as a backdrop, at Newark Liberty International Airport, New Jersey.Chris Helgren | ReutersIt's time to How to buy amoxil in usa say goodbye to the $200 ticket-change fee.United Airlines on Sunday said that it will permanently scrap fees to change domestic flights, a big bet that more flexible policies will win over much-needed customers as the pain from the skin care renova's impact on air travel continue to mount.It's a page from the playbook of rival Southwest Airlines, which doesn't charge customers fees to change their flights."Following previous tough times, airlines made difficult decisions to survive, sometimes at the expense of customer service," said United CEO Scott Kirby in a news release. "United Airlines won't be following that same playbook as purchase renova online we come out of this crisis. Instead, we're taking a completely different approach – and looking at new ways to serve our customers better."United's announcement that it will no longer charge travelers the $200 fee comes as airlines are scrambling to purchase renova online find ways to revitalize their businesses, which have been battered by the renova. This summer, Transportation Security Administration screenings at U.S.

Airports are hovering around purchase renova online 30% of last year's levels, as airlines go without much-needed revenue during the peak summer travel season.Customers with standard economy tickets or premium-class tickets will be able to change their flights without paying the fee but they will be responsible for a difference in fare. The new policy does not apply to basic economy tickets, which do not permit changes, but United has extended its change-fee waiver on all tickets through the end of the year.The Chicago-based airline in January will also allow customers who want to depart earlier or later the same day to fly standby without paying a $75 same-day purchase renova online change fee.The measures could ramp up pressure on rivals to make similar policy changes.The end of the ticket-change costs is a departure from the myriad add-ons and other fees that airlines spent years rolling out. Last year, U.S. Carriers brought in $2.8 billion in ticket-change and cancellation fees, according to the Department of Transportation.Scott Gottlieb, purchase renova online former Commissioner of the FDAAdam Jeffery | CNBCDr.

Scott Gottlieb, former FDA chief under President Donald Trump, purchase renova online said on Sunday that the new guidance from the Centers for Disease Control and Prevention to not test asymptomatic people for skin care products was "unfortunate" because those people could be at high risk of contracting the . "We should be testing those people to make sure they haven't become infected and aren't asymptomatic carriers because we know that they can spread the ," Gottlieb said in an interview on CBS' "Face the Nation." "They're less likely to spread the , but they can still spread the ."Earlier this month, the CDC quietly revised its guidance on skin care testing and dropped its previous recommendation to test everyone who has come into close contact with an infected person, even those who don't have symptoms.The move drew immediate criticism from medical groups and allegations of political motivation. Two federal health officials reportedly said the CDC was pressured into changing the guidance by top officials at the White House and Department of Health and Human Services.Medical experts and lawmakers say that early and widespread testing purchase renova online of people without symptoms can help mitigate the spread of the renova. Gottlieb said that one purchase renova online reason for the CDC's decision could be that businesses were requiring people to test negative for the renova before they can return to work.

He said he doesn't think the new guidance will likely be followed by states. "If that's the case and that was a concern, there were more targeted ways to address that and speak to purchase renova online that problem, as opposed to making this very broad, sweeping change in the recommendations, which I think could be misinterpreted by the general public and certainly by public health agencies within states," Gottlieb said. "And so I don't think this changed guidance is likely to be followed by many states." "I think it's prudent that we test people who might be at high risk of contracting the ," Gottlieb purchase renova online added. — CNBC's Will Feuer contributed reporting.

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WELL) (the “Company” or “WELL”), a company focused on consolidating and modernizing clinical and digital assets renova zero pod refill within the primary health care sector, is pleased to announce it has partnered with Canada Health Infoway (“Infoway”) to integrate Infoway’s national e-prescribing service, PrescribeIT®, with WELL’s OSCAR Pro Electronic Medical Records (EMR) software. Physicians and health care practitioners using OSCAR Pro are now able to easily create, renew and cancel prescriptions electronically, while improving overall patient care through secure clinician messaging. WELL is offering renova zero pod refill an end-to-end solution from virtual and on-site patient consultation to electronic prescription, resulting in a better physician and patient experience.

By partnering with PrescribeIT®, health care practitioners, pharmacists and patients can have confidence that the solution ensures patient privacy and security of information. €œWe are very excited to launch our e-prescribing service with Infoway’s PrescribeIT®,” said Hamed Shahbazi, Chairman and CEO renova zero pod refill of WELL. €œElectronic prescriptions will be a key for making virtual visits more efficient and effective, and this integration with the WELL EMR network can help create a better patient experience.

I am very renova zero pod refill proud of our WELL EMR Group who has worked tirelessly to successfully achieve conformance approval from Infoway and our WELL Digital Health Apps team who have made the service available through the apps.health marketplace.”PrescribeIT® enhances clinical communications, e-renewals, privacy and security. Prescriptions can now be sent directly from within OSCAR Pro EMR in a secure electronic format to the patient's pharmacy of choice and pharmacies can electronically request prescription renewals from the patient's health care provider. Electronic prescriptions are key renova zero pod refill for virtual visits as the patient does not have to rely on faxing prescriptions to pharmacies.

Furthermore, patient safety is increased due to prevention of data entry errors at the pharmacy and prescription fraud is decreased through direct transmission of the prescription from the prescriber to the pharmacy through the PrescribeIT® service.“We are excited about this partnership with WELL to make PrescribeIT® available to prescribers who use the OSCAR Pro EMR software,” said Jamie Bruce, Executive Vice President, Infoway. €œPrescribeIT® makes prescribing safer, renova zero pod refill more secure, easier and more convenient. PrescribeIT® is also an increasingly important tool in the prescriber’s virtual care toolbox.”WELL HEALTH TECHNOLOGIES CORP.Per.

“Hamed Shahbazi” Hamed ShahbaziChief renova zero pod refill Executive Officer, Chairman and DirectorAbout WELLWELL is an omni-channel digital health company whose overarching objective is to empower doctors to provide the best and most advanced care possible while leveraging the latest trends in digital health. As such, WELL owns and operates 25 primary health care clinics, is Canada's third largest digital Electronic Medical Records (EMR) supplier serving over 2,000 medical clinics, operates a leading national telehealth service and is a provider of digital health, billing and cybersecurity related technology solutions. WELL is renova zero pod refill an acquisitive company that follows a disciplined and accretive capital allocation strategy.

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Visit www.PrescribeIT.ca.Forward-Looking StatementsThis news release may contain "forward-looking statements" within the meaning of applicable Canadian securities laws, including, without limitation statements regarding. Improvement to overall patient care through renova zero pod refill clinical messaging. And the belief that the launch will ensure patient privacy and security of information.

Forward-looking statements are necessarily based upon a number of estimates and assumptions that, while considered renova zero pod refill reasonable by management, are inherently subject to significant business, economic and competitive uncertainties, and contingencies. These statements generally can be identified by the use of forward-looking words such as “may”, “should”, “will”, “could”, “intend”, “estimate”, “plan”, “anticipate”, “expect”, “believe” or “continue”, or the negative thereof or similar variations. Forward-looking statements involve known and unknown risks, uncertainties and other factors that may cause future results, performance or achievements to be materially different renova zero pod refill from the estimated future results, performance or achievements expressed or implied by those forward-looking statements and the forward-looking statements are not guarantees of future performance.

WELL’s statements expressed or implied by these forward-looking statements are subject to a number of risks, uncertainties, and conditions, many of which are outside of WELL 's control, and undue reliance should not be placed on such statements. Forward-looking statements are qualified in their entirety by inherent risks and uncertainties, renova zero pod refill including. Risks related to privacy and cyber security concerns.

Risks related to compatibility between the two platforms renova zero pod refill and solutions. And error free adoption, use and growth of the service renova zero pod refill. Except as required by securities law, WELL does not assume any obligation to update or revise any forward-looking statements, whether as a result of new information, events or otherwise.Neither the TSX nor its Regulation Services Provider (as that term is defined in policies of the TSX) accepts responsibility for the adequacy or accuracy of this release.-30-For further information:Pardeep S.

SanghaVP Corporate Strategy renova zero pod refill and Investor RelationsWELL Health Technologies Corp.604.572.6392This email address is being protected from spambots. You need JavaScript enabled to view it.Inquiries about PrescribeIT® Tania EnsorSenior Director, Marketing, Stakeholder Relations and Reputation Management, PrescribeIT®Canada Health Infoway416.707.6285Email UsFollow @PrescribeIT_CANew survey insights released to mark Digital Health Week 2020November 16, 2020 (Toronto) — Canadians and health care providers have met the unprecedented challenge of the skin care products renova head-on by embracing change in the way health care is delivered — from in-person to virtual. This week is Digital Health Week and to mark the occasion Canada Health Infoway (Infoway) is sharing research conducted in partnership with Environics that digs into this substantial shift and what Canadians want for renova zero pod refill their digital health future.

This latest research project, A Healthy Dialogue, is one of the largest public consultations about digital health ever conducted in Canada. The consultation reached more than 58,000 Canadians — including those underserved by the health system — who shared how they thought technology would impact their care experience.The research reveals[i]:An overwhelming majority (92%) of Canadians want technology that makes health care renova zero pod refill as convenient as other aspects of their lives.More than half (53%) of Canadians who have used health technology in the past year say it helped them avoid an in-person visit to a provider or an emergency room.Of those Canadians who received virtual care during the renova, 91% were satisfied with the experience, 86% agreed that virtual care tools can be important alternatives to seeing doctors in-person, and more than three-quarters (76%) are willing to use virtual care after the renova.“We’ve gone from talking about ways to further integrate digital health into everyday health care to living it. The events of the past year have accelerated our digital health progress significantly and have proven to Canadians just how important and helpful digital health can be,” says Michael Green, President and CEO of Infoway.

€œDigital Health Week is an important time to celebrate our progress and acknowledge the hard work of all those who have made it possible.”While technology can help reduce barriers and improve access to health care, the research also found that nearly six in 10 Canadians feel they don’t know enough about digital health apps renova zero pod refill and services. As Canada’s digital health agency, Infoway is committed to working with its partners to address these gaps through activities like Digital Health Week.About Infoway’s Commitment to ResearchA Healthy Dialogue is part of Infoway’s commitment to contributing to digital health research in Canada. To support renova zero pod refill health care organizations, clinicians, policy maker and patients, families and caregivers, Infoway conducts research into the value of digital health solutions as well as clinicians’ and Canadians’ attitudes and perceptions.

To learn more about the results from A Healthy Dialogue, please visit https://www.infoway-inforoute.ca/en/component/edocman/resources/reports/3850-a-healthy-dialogue-executive-summary. To learn about Infoway’s other research initiatives, please visit www.infoway-inforoute.ca/en/what-we-do/research-and-insights.About renova zero pod refill Digital Health Week — #ThinkDigitalHealthDigital Health Week was created to celebrate how digital health is transforming care across the country and to increase awareness about the value and benefits of digital health for all Canadians. Digital Health Week is supported by 60+ organizations.

Join the renova zero pod refill conversation and share your story. #ThinkDigitalHealth.About Canada Health InfowayInfoway helps to improve the health of Canadians by working with partners to accelerate the development, adoption and effective use of digital health across Canada. Through our investments, we renova zero pod refill help deliver better quality and access to care and more efficient delivery of health services for patients and clinicians.

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WELL) (the “Company” or “WELL”), a company focused on consolidating and modernizing clinical and digital assets within the primary health care sector, is pleased to announce it has partnered with Canada Health Infoway (“Infoway”) purchase renova online to integrate Infoway’s national e-prescribing service, PrescribeIT®, with WELL’s OSCAR Pro Electronic Medical Records (EMR) software. Physicians and health care practitioners using OSCAR Pro are now able to easily create, renew and cancel prescriptions electronically, while improving overall patient care through secure clinician messaging. WELL is offering an end-to-end solution from virtual and on-site patient consultation to electronic prescription, resulting in a better physician and patient experience purchase renova online.

By partnering with PrescribeIT®, health care practitioners, pharmacists and patients can have confidence that the solution ensures patient privacy and security of information. €œWe are very excited to launch our e-prescribing service with Infoway’s PrescribeIT®,” said purchase renova online Hamed Shahbazi, Chairman and CEO of WELL. €œElectronic prescriptions will be a key for making virtual visits more efficient and effective, and this integration with the WELL EMR network can help create a better patient experience.

I am very proud of our WELL EMR Group who has worked tirelessly to successfully achieve conformance approval from Infoway and our WELL Digital Health Apps team who have made the service available through the purchase renova online apps.health marketplace.”PrescribeIT® enhances clinical communications, e-renewals, privacy and security. Prescriptions can now be sent directly from within OSCAR Pro EMR in a secure electronic format to the patient's pharmacy of choice and pharmacies can electronically request prescription renewals from the patient's health care provider. Electronic prescriptions are key for virtual purchase renova online visits as the patient does not have to rely on faxing prescriptions to pharmacies.

Furthermore, patient safety is increased due to prevention of data entry errors at the pharmacy and prescription fraud is decreased through direct transmission of the prescription from the prescriber to the pharmacy through the PrescribeIT® service.“We are excited about this partnership with WELL to make PrescribeIT® available to prescribers who use the OSCAR Pro EMR software,” said Jamie Bruce, Executive Vice President, Infoway. €œPrescribeIT® makes prescribing safer, more secure, easier purchase renova online and more convenient. PrescribeIT® is also an increasingly important tool in the prescriber’s virtual care toolbox.”WELL HEALTH TECHNOLOGIES CORP.Per.

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WELL is publicly traded on the Toronto Stock Exchange under the symbol "WELL" and the Company was recognized as a TSX Venture 50 Company three years in a row in 2018, 2019 and 2020. To access the Company's telehealth purchase renova online service, visit. Tiahealth.com or virtualclinics.ca and for purchase renova online corporate information, visit.

Www.well.company.About Canada Health InfowayInfoway helps to improve the health of Canadians by working with partners to accelerate the development, adoption and effective use of digital health across Canada. Through our investments, we purchase renova online help deliver better quality and access to care and more efficient delivery of health services for patients and clinicians. Infoway is an independent, not-for-profit organization funded by the federal government.

Visit www.infoway-inforoute.ca.About PrescribeIT®Canada Health Infoway is working with Health Canada, the provinces and territories, and industry stakeholders to develop, operate and maintain the national e-prescribing service known as PrescribeIT® purchase renova online. PrescribeIT® will serve all Canadians, pharmacies and prescribers and provide safer and more effective medication management by enabling prescribers to transmit a prescription electronically between a prescriber’s electronic medical record (EMR) and the pharmacy management system (PMS) of a patient’s pharmacy of choice. PrescribeIT® will protect Canadians’ personal health information from being sold or used for commercial purchase renova online activities.

Visit www.PrescribeIT.ca.Forward-Looking StatementsThis news release may contain "forward-looking statements" within the meaning of applicable Canadian securities laws, including, without limitation statements regarding. Improvement to overall purchase renova online patient care through clinical messaging. And the belief that the launch will ensure patient privacy and security of information.

Forward-looking statements are purchase renova online necessarily based upon a number of estimates and assumptions that, while considered reasonable by management, are inherently subject to significant business, economic and competitive uncertainties, and contingencies. These statements generally can be identified by the use of forward-looking words such as “may”, “should”, “will”, “could”, “intend”, “estimate”, “plan”, “anticipate”, “expect”, “believe” or “continue”, or the negative thereof or similar variations. Forward-looking statements purchase renova online involve known and unknown risks, uncertainties and other factors that may cause future results, performance or achievements to be materially different from the estimated future results, performance or achievements expressed or implied by those forward-looking statements and the forward-looking statements are not guarantees of future performance.

WELL’s statements expressed or implied by these forward-looking statements are subject to a number of risks, uncertainties, and conditions, many of which are outside of WELL 's control, and undue reliance should not be placed on such statements. Forward-looking statements are qualified in their entirety by inherent purchase renova online risks and uncertainties, including. Risks related to privacy and cyber security concerns.

Risks related to compatibility between the two platforms purchase renova online and solutions. And error free adoption, use and growth of purchase renova online the service. Except as required by securities law, WELL does not assume any obligation to update or revise any forward-looking statements, whether as a result of new information, events or otherwise.Neither the TSX nor its Regulation Services Provider (as that term is defined in policies of the TSX) accepts responsibility for the adequacy or accuracy of this release.-30-For further information:Pardeep S.

SanghaVP Corporate Strategy and Investor RelationsWELL Health Technologies purchase renova online Corp.604.572.6392This email address is being protected from spambots. You need JavaScript enabled to view it.Inquiries about PrescribeIT® Tania EnsorSenior Director, Marketing, Stakeholder Relations and Reputation Management, PrescribeIT®Canada Health Infoway416.707.6285Email UsFollow @PrescribeIT_CANew survey insights released to mark Digital Health Week 2020November 16, 2020 (Toronto) — Canadians and health care providers have met the unprecedented challenge of the skin care products renova head-on by embracing change in the way health care is delivered — from in-person to virtual. This week is Digital Health Week and to mark the occasion Canada Health Infoway (Infoway) is sharing research conducted in partnership with Environics that digs into this substantial purchase renova online shift and what Canadians want for their digital health future.

This latest research project, A Healthy Dialogue, is one of the largest public consultations about digital health ever conducted in Canada. The consultation reached purchase renova online more than 58,000 Canadians — including those underserved by the health system — who shared how they thought technology would impact their care experience.The research reveals[i]:An overwhelming majority (92%) of Canadians want technology that makes health care as convenient as other aspects of their lives.More than half (53%) of Canadians who have used health technology in the past year say it helped them avoid an in-person visit to a provider or an emergency room.Of those Canadians who received virtual care during the renova, 91% were satisfied with the experience, 86% agreed that virtual care tools can be important alternatives to seeing doctors in-person, and more than three-quarters (76%) are willing to use virtual care after the renova.“We’ve gone from talking about ways to further integrate digital health into everyday health care to living it. The events of the past year have accelerated our digital health progress significantly and have proven to Canadians just how important and helpful digital health can be,” says Michael Green, President and CEO of Infoway.

€œDigital Health purchase renova online Week is an important time to celebrate our progress and acknowledge the hard work of all those who have made it possible.”While technology can help reduce barriers and improve access to health care, the research also found that nearly six in 10 Canadians feel they don’t know enough about digital health apps and services. As Canada’s digital health agency, Infoway is committed to working with its partners to address these gaps through activities like Digital Health Week.About Infoway’s Commitment to ResearchA Healthy Dialogue is part of Infoway’s commitment to contributing to digital health research in Canada. To support health care organizations, clinicians, policy maker and patients, families purchase renova online and caregivers, Infoway conducts research into the value of digital health solutions as well as clinicians’ and Canadians’ attitudes and perceptions.

To learn more about the results from A Healthy Dialogue, please visit https://www.infoway-inforoute.ca/en/component/edocman/resources/reports/3850-a-healthy-dialogue-executive-summary. To learn about Infoway’s other research initiatives, please visit www.infoway-inforoute.ca/en/what-we-do/research-and-insights.About Digital Health Week — #ThinkDigitalHealthDigital Health Week was created to celebrate how digital health is transforming care across the country and to increase awareness about the purchase renova online value and benefits of digital health for all Canadians. Digital Health Week is supported by 60+ organizations.

Join the conversation and share purchase renova online your story. #ThinkDigitalHealth.About Canada Health InfowayInfoway helps to improve the health of Canadians by working with partners to accelerate the development, adoption and effective use of digital health across Canada. Through our investments, we help deliver better quality and access to care and more efficient delivery of health services for patients and purchase renova online clinicians.

Infoway is an independent, not-for-profit organization funded by the federal government. Visit www.infoway-inforoute.ca.[i] purchase renova online A national survey of about 6,900 Canadians was conducted from December 2019-February 2020, pre-skin care products. A follow-up survey was conducted in June 2020 with about 2,200 of the original 6,900, to see if their views had shifted since the renova began.-30-Media Inquiries.

Renova tablet

The good news is that you’ve renova tablet got options — probably several, depending on the circumstances. Let’s take a look at what you need to know about health insurance if you’ve lost your job and are facing the loss of your employer-sponsored health coverage. Can I enroll in self-purchased insurance as soon as I’ve lost my job?. If you’re losing your job-based health insurance, you do not have to wait for the fall renova tablet open enrollment period to sign up for a new ACA-compliant plan. Although the skin care products-related special enrollment window for individual/family health plans has already ended in most states, you’ll qualify for your own special enrollment period due to the loss of your employer-sponsored health plan.

This will allow you to enroll in a plan through the marketplace/exchange and take advantage of the subsidies that are available (and bigger than ever, thanks to the American Rescue Plan), without having to wait until 2022 to get coverage. If you enroll prior to your coverage loss, your new plan will take effect the first of the month after your old plan ends, which means you’ll have seamless coverage if your old plan is ending renova tablet on the last day of the month. Your special enrollment period also continues for 60 days after your coverage loss, although you’d have a gap in coverage if you wait and enroll after your old plan ends, since your new plan wouldn’t take effect retroactively. If you’re in that situation, you might find that a short-term health plan is a good option for bridging the gap until your new plan takes effect. Short-term plans won’t cover pre-existing conditions and are not regulated by the Affordable Care Act (ACA) renova tablet.

But they can provide fairly good coverage for unexpected medical needs during a temporary window when you’d otherwise be uninsured. Be sure to check your options again during open enrollment If you sign up for coverage now in your special enrollment period, keep in mind that you’ll still need to re-evaluate your coverage during the upcoming open enrollment period, which begins November 1. Even though you’re renova tablet enrolling fairly late in 2021, your new plan will reset on January 1, with new pricing and possibly some coverage changes. There also might be new plans available in your area for 2022. So your special enrollment period (tied to your coverage loss) will be your opportunity to find the best plan to fit your needs for the rest of this year.

And if you’re still going to need self-purchased coverage in 2022, the upcoming open enrollment period will give renova tablet you a chance to make sure you optimize your coverage for next year as well. COBRA (or state continuation) versus self-purchased coverage Depending on the size of your employer, COBRA might be offered to you. And even if your employer is too small for COBRA, you might have access to state continuation (“mini-COBRA”), depending on where you live. Either of these options will allow you to temporarily continue the coverage you already have, instead of switching to a new renova tablet individual-market plan right away. If COBRA or state continuation is available, your employer will notify you and give you information about what you’ll need to do to activate the coverage continuation and how long you can keep it.

Normally, you have to pay the full cost of COBRA or state continuation coverage, including the portion that your employer previously paid on your behalf — which was likely the bulk of the premiums. But until the end of September 2021 (so for just one more month), as part of the American Rescue Plan (ARP), the federal government will renova tablet pay the full cost of COBRA or state continuation coverage for people who involuntarily lost their jobs. For much of this year, the soon-to-end COBRA subsidy has changed the calculus that normally goes into the decision of whether to continue an employer-sponsored plan or switch to a self-purchased individual/family plan. But after the end of September, the normal decision-making process will again apply. And you’ll renova tablet have a special enrollment period when the COBRA subsidy ends, which will allow you to transition to an individual/family plan at that point if you want to.

COBRA coverage vs individual-market health insurance Here’s what to keep in mind when you’re deciding between COBRA and an individual-market health plan – either initially, or after the COBRA subsidy ends on September 30. ACA marketplace subsidies are now available at all income levels, depending on the cost of coverage in your area (the American Rescue Plan eliminated the income cap for subsidy eligibility for 2021 and 2022). And the subsidies renova tablet are substantial, covering the majority of the premium cost for the majority of marketplace enrollees. Unless your employer is continuing to subsidize your COBRA coverage after the federal subsidy expires, you’ll probably find that the monthly premiums are lower if you enroll in a plan through the marketplace, as opposed to continuing your employer-sponsored plan. Have you already spent a significant amount of money on out-of-pocket costs under your employer-sponsored plan this year?.

You’ll almost certainly be starting over at $0 if you switch to an individual/family plan, even if it’s offered renova tablet by the same insurer that provides your employer-sponsored coverage. Depending on the specifics of your situation, the money you’ve already paid for out-of-pocket medical expenses this year could offset the lower premiums you’re likely to see in the marketplace. Do you have certain doctors or medical facilities you need to continue to use?. You’ll want to carefully check the provider networks of the renova tablet available individual/family plans to see if they’re in-network. And if there are specific medications that you need, you’ll want to be sure they’re on the formularies of the plans you’re considering.

Will you qualify for a premium subsidy if you switch to an individual/family plan?. If you do qualify, you’ll need renova tablet to shop in your exchange/marketplace, as subsidies are not available if you buy your plan directly from an insurance company. (You can call the number at the top of this page to be connected with a broker who can help you enroll in a plan through the exchange.) And again, as a result of the ARP, subsidies are larger and more widely available than usual. That will continue to be the case throughout 2022 as well. Free health insurance if you collected renova tablet unemployment in 2021 If you’re approved for even one week of unemployment compensation in 2021, you qualify for a premium subsidy that will fully cover the cost of the two lowest-cost Silver plans in the marketplace/exchange in your area, through the end of the year.

The subsidy will also likely cover the full cost of many of the Bronze plans, and possibly some of the Gold plans, depending on the pricing of plans where you live. This is a special subsidy rule created by the ARP, for 2021 only. In addition to the renova tablet subsidy that will allow you to get a free Silver plan, it will also ensure that any of the available Silver plans have full cost-sharing reductions. What if my income is too low for subsidies?. In order to qualify for premium subsidies for a plan purchased in the marketplace, you must not be eligible for Medicaid, Medicare, or an employer-sponsored plan, and your income has to be at least 100% of the federal poverty level.

(As noted above, for 2021 only, you’re eligible for subsidies if you receive unemployment compensation, regardless of your actual total income for the year, as long as you’re not eligible for Medicaid, Medicare, or an employer’s plan.) In most states, the renova tablet ACA’s expansion of Medicaid eligibility provides coverage to adults with household income up to 138% of the poverty level, with eligibility determined based on current monthly income. So if your income has suddenly dropped to $0, you’ll likely be eligible for Medicaid and could transition to Medicaid when your job-based coverage ends. Unfortunately, there are still 11 states where most adults face a coverage gap if their household income is below the federal poverty level. They aren’t eligible for renova tablet premium subsidies in the marketplace (unless they’ve received unemployment compensation in 2021 and can thus qualify for 2021 subsidies). This is an unfortunate situation that those 11 states have created for their low-income residents.

But there are strategies for avoiding the coverage gap if you’re in one of those states. And keep in mind that renova tablet subsidy eligibility in the marketplace is based on your household income for the whole year, even if your current monthly income is below the poverty level. So if you earned enough earlier in the year to be subsidy-eligible for 2021, you can enroll in a plan with subsidies based on that income, despite the fact that you might not earn anything else for the rest of the year. When open enrollment begins in November, you’ll need to project your 2022 income as accurately as possible, if you’re still needing to purchase your own coverage for 2022. But for the rest renova tablet of 2021, you can use the income you already earned this year to qualify for subsidies.

What if I’ll soon be eligible for Medicare?. There has been an increase recently in the number of people retiring in their late 50s or early 60s, before they’re eligible for Medicare. The ACA made this a more realistic option starting in 2014, thanks to premium subsidies and the elimination of medical underwriting renova tablet. And the ARP has boosted subsidies and made them more widely available for 2021 and 2022, making affordable coverage more accessible for early retirees. That’s especially true for those whose pre-retirement income might have made them ineligible for subsidies in the year they retired, due to the “subsidy cliff” (which has been eliminated by the ARP through the end of 2022).

So if you’re losing your job or choosing to leave it and you still have a few months renova tablet or a few years before you’ll be 65 and eligible for Medicare, rest assured that you won’t have to go uninsured. You’ll be able to sign up for a marketplace plan during your special enrollment period triggered by the loss of your employer-sponsored plan. And even if you earned a fairly robust income in the earlier part of the year, you might still qualify for premium subsidies to offset some of the cost of your new plan for the rest of 2021. You’ll then be able to update renova tablet your projected income for 2022 during the upcoming open enrollment period. Your subsidies will adjust in January to reflect your 2022 income.

And marketplace plans are always purchased on a month-to-month basis, so you’ll be able to cancel your coverage when you eventually transition to Medicare, regardless of when that happens. Don’t worry, get covered The short story on all of this? renova tablet. Coverage is available, and obtaining your own health plan isn’t as complicated as it might seem at first glance, even if you’ve had employer-sponsored coverage all your life. You can sign up outside of open enrollment if you’re losing your job-based insurance, and there’s a good chance you’ll qualify for financial assistance that will make your new plan affordable. You can learn more about the marketplace in your state and the available renova tablet plan options by selecting your state on this map.

And there are zero-cost enrollment assisters – Navigators and brokers – available throughout the country to help you make sense of it all. Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has renova tablet written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Although August 15 marked the end of a one-time skin care products-related special enrollment period (SEP) for marketplace health insurance in most states, the enhanced subsidies that enticed millions of consumers are still available for many individual-market buyers (as noted below, the SEP is ongoing in some states). The American Rescue Plan’s enhancements to the Affordable Care Act’s health insurance subsidies will continue long after the end of the skin care products SEP.

That means that when you do have an opportunity to buy coverage again – either through open enrollment or due to a personal renova tablet qualifying life event – you’ll likely find individual health insurance much less expensive than you might have expected. The ARP’s affordability provisions are still helping with premiums As we’ve noted over the past few months, the American Rescue Plan included numerous provisions that make ACA-compliant plans more affordable than ever. The additional health insurance subsidy enhancements delivered by the ARP include. Larger subsidies for people who were renova tablet already subsidy-eligible. The elimination of the “subsidy cliff,” making more people eligible for subsidies.

Free coverage with full cost-sharing reductions for people who have received any unemployment compensation this year. All of those benefits continue to be available renova tablet. The additional subsidies based on unemployment compensation continue through the end of 2021, while the other subsidy enhancements will be available through the end of 2022 (and possibly longer, if Congress extends them). How popular are the ARP’s subsidy enhancements?. HHS reported last week that more than 2.5 million people had already enrolled in coverage during the skin care products-related special enrollment period, and renova tablet that another 2.6 million existing marketplace enrollees had activated their ARP subsidies.

Among all of the new enrollees, average after-subsidy premiums were just $85/month, as opposed to $117/month before the ARP’s subsidies became available. And across all of the new and renewing enrollees, about 35% had obtained coverage with after-subsidy premiums of less than $10/month. That illustrates how substantial premium subsidies have renova tablet become under the ARP. And again, nothing has changed about those subsidies. The special enrollment window has ended in most states, but the subsidies are still available if you’re eligible to enroll for the remainder of 2021 — and again during open enrollment for 2022, which starts November 1.

So if you’re in a state where enrollment is still open, or if you’re eligible for an individual special enrollment period in any state, it’s certainly in your best renova tablet interest to see what plan options are available to you. Enrolling as soon as you’re eligible will mean that you’re able to start taking advantage of the ARP’s subsidies right away, rather than having to wait for open enrollment and coverage that starts in 2022. States where enrollment continues Although the skin care products SEP ended on August 15 in the states that use HealthCare.gov – and some of the states that run their own exchanges – enrollment is still actually ongoing in several states. Vermont renova tablet. Enrollment continues through October 1 (for uninsured residents).

Connecticut. General enrollment continues renova tablet through October 31. DC. General enrollment continues through the end of the renova emergency period. California.

Enrollment continues through December 31 for uninsured residents and those switching from off-exchange to on-exchange coverage. There is also a temporary wildfire-related SEP in California, for residents in areas where a state of emergency has been declared due to wildfires. In Minnesota, the general skin care products-related special enrollment period ended in mid-July. But the state’s marketplace is still allowing people to enroll or switch to a $0 premium plan if they have received unemployment compensation in 2021. New Jersey.

General enrollment continues through December 31. New York. General enrollment continues through December 31. Enrollment if you have a qualifying life event Not in one of those states?. Special enrollment periods are available to individuals who experience a wide range of “life changes.” The most common trigger for a personal SEP is a loss of other coverage — usually job-based coverage.

(Note that there’s usually only a 60-day window to enroll in a new plan after losing other coverage. But HealthCare.gov is making an exception for people who lost their coverage as long ago as January 2020, if they missed their enrollment deadline because they were “impacted by the skin care products emergency.” People who need to utilize this flexibility have to call the marketplace directly to qualify for a special enrollment period on a case-by-case basis.) In addition to a loss of coverage, there are also other situations in which you’ll qualify for a SEP. They include events such as the birth or adoption of a child, marriage (as long as at least one spouse already had minimum essential coverage), or even your grandmothered or grandfathered plan coming up for renewal. More opportunities to enroll in ACA-compliant coverage In addition to the states with ongoing skin care products-related enrollment periods and the individual SEPs triggered by qualifying life events, there are other circumstances under which you might still be eligible to enroll in affordable health coverage. If you’re eligible for Medicaid or CHIP in any state, enrollment continues year-round.

If you’re eligible for the Basic Health Programs in New York and Minnesota, you can enroll anytime. If you’re eligible for Connecticut’s new Covered Connecticut family program, you have until at least the end of 2021 to sign up for free coverage. If you’re newly eligible for the ConnectorCare program in Massachusetts (or if this is your first time enrolling in it), you can enroll anytime. Native Americans can enroll in marketplace plans year-round. Mark your calendar for 2022 open enrollment If you don’t have an enrollment period now, be sure to mark your calendar for the start of open enrollment on November 1.

That’s when you’ll be able to sign up for health coverage that will take effect in January, with coverage for essential health benefits and pre-existing conditions. During open enrollment, your medical history won’t matter, and neither will your coverage history. And if you’re already enrolled in an ACA-compliant plan – or soon will be – you’ll still want to pay attention to open enrollment this fall. There are new insurers joining the marketplaces in many areas, which might have an unexpected effect on your premium subsidy.

But the purchase renova online downside to having health insurance linked to employment is that losing your job will also mean losing your health insurance, adding stress to an already stressful situation. The good news is that you’ve got options — probably several, depending on the circumstances. Let’s take a look at what you need to know about health insurance if you’ve lost your job and are facing the loss of your employer-sponsored health coverage. Can I enroll in self-purchased insurance as purchase renova online soon as I’ve lost my job?. If you’re losing your job-based health insurance, you do not have to wait for the fall open enrollment period to sign up for a new ACA-compliant plan.

Although the skin care products-related special enrollment window for individual/family health plans has already ended in most states, you’ll qualify for your own special enrollment period due to the loss of your employer-sponsored health plan. This will allow you to enroll in a plan through the marketplace/exchange and take advantage of the subsidies that are available (and purchase renova online bigger than ever, thanks to the American Rescue Plan), without having to wait until 2022 to get coverage. If you enroll prior to your coverage loss, your new plan will take effect the first of the month after your old plan ends, which means you’ll have seamless coverage if your old plan is ending on the last day of the month. Your special enrollment period also continues for 60 days after your coverage loss, although you’d have a gap in coverage if you wait and enroll after your old plan ends, since your new plan wouldn’t take effect retroactively. If you’re in that situation, purchase renova online you might find that a short-term health plan is a good option for bridging the gap until your new plan takes effect.

Short-term plans won’t cover pre-existing conditions and are not regulated by the Affordable Care Act (ACA). But they can provide fairly good coverage for unexpected medical needs during a temporary window when you’d otherwise be uninsured. Be sure to check your purchase renova online options again during open enrollment If you sign up for coverage now in your special enrollment period, keep in mind that you’ll still need to re-evaluate your coverage during the upcoming open enrollment period, which begins November 1. Even though you’re enrolling fairly late in 2021, your new plan will reset on January 1, with new pricing and possibly some coverage changes. There also might be new plans available in your area for 2022.

So your special enrollment period (tied to your coverage loss) will be your opportunity to find purchase renova online the best plan to fit your needs for the rest of this year. And if you’re still going to need self-purchased coverage in 2022, the upcoming open enrollment period will give you a chance to make sure you optimize your coverage for next year as well. COBRA (or state continuation) versus self-purchased coverage Depending on the size of your employer, COBRA might be offered to you. And even purchase renova online if your employer is too small for COBRA, you might have access to state continuation (“mini-COBRA”), depending on where you live. Either of these options will allow you to temporarily continue the coverage you already have, instead of switching to a new individual-market plan right away.

If COBRA or state continuation is available, your employer will notify you and give you information about what you’ll need to do to activate the coverage continuation and how long you can keep it. Normally, you have to pay the purchase renova online full cost of COBRA or state continuation coverage, including the portion that your employer previously paid on your behalf — which was likely the bulk of the premiums. But until the end of September 2021 (so for just one more month), as part of the American Rescue Plan (ARP), the federal government will pay the full cost of COBRA or state continuation coverage for people who involuntarily lost their jobs. For much of this year, the soon-to-end COBRA subsidy has changed the calculus that normally goes into the decision of whether to continue an employer-sponsored plan or switch to a self-purchased individual/family plan. But after the purchase renova online end of September, the normal decision-making process will again apply.

And you’ll have a special enrollment period when the COBRA subsidy ends, which will allow you to transition to an individual/family plan at that point if you want to. COBRA coverage vs individual-market health insurance Here’s what to keep in mind when you’re deciding between COBRA and an individual-market health plan – either initially, or after the COBRA subsidy ends on September 30. ACA marketplace subsidies are now available at all income levels, depending purchase renova online on the cost of coverage in your area (the American Rescue Plan eliminated the income cap for subsidy eligibility for 2021 and 2022). And the subsidies are substantial, covering the majority of the premium cost for the majority of marketplace enrollees. Unless your employer is continuing to subsidize your COBRA coverage after the federal subsidy expires, you’ll probably find that the monthly premiums are lower if you enroll in a plan through the marketplace, as opposed to continuing your employer-sponsored plan.

Have you already spent a significant amount of money on out-of-pocket costs under your employer-sponsored plan purchase renova online this year?. You’ll almost certainly be starting over at $0 if you switch to an individual/family plan, even if it’s offered by the same insurer that provides your employer-sponsored coverage. Depending on the specifics of your situation, the money you’ve already paid for out-of-pocket medical expenses this year could offset the lower premiums you’re likely to see in the marketplace. Do you have certain doctors or purchase renova online medical facilities you need to continue to use?. You’ll want to carefully check the provider networks of the available individual/family plans to see if they’re in-network.

And if there are specific medications that you need, you’ll want to be sure they’re on the formularies of the plans you’re considering. Will you qualify for a premium subsidy if you purchase renova online switch to an individual/family plan?. If you do qualify, you’ll need to shop in your exchange/marketplace, as subsidies are not available if you buy your plan directly from an insurance company. (You can call the number at the top of this page to be connected with a broker who can help you enroll in a plan through the exchange.) And again, as a result of the ARP, subsidies are larger and more widely available than usual. That will continue to be the case throughout 2022 as well purchase renova online.

Free health insurance if you collected unemployment in 2021 If you’re approved for even one week of unemployment compensation in 2021, you qualify for a premium subsidy that will fully cover the cost of the two lowest-cost Silver plans in the marketplace/exchange in your area, through the end of the year. The subsidy will also likely cover the full cost of many of the Bronze plans, and possibly some of the Gold plans, depending on the pricing of plans where you live. This is a special subsidy rule created by purchase renova online the ARP, for 2021 only. In addition to the subsidy that will allow you to get a free Silver plan, it will also ensure that any of the available Silver plans have full cost-sharing reductions. What if my income is too low for subsidies?.

In order to qualify for premium subsidies for a plan purchased in the marketplace, you must not be eligible for Medicaid, Medicare, or an employer-sponsored plan, and your income has to be at least 100% of the federal purchase renova online poverty level. (As noted above, for 2021 only, you’re eligible for subsidies if you receive unemployment compensation, regardless of your actual total income for the year, as long as you’re not eligible for Medicaid, Medicare, or an employer’s plan.) In most states, the ACA’s expansion of Medicaid eligibility provides coverage to adults with household income up to 138% of the poverty level, with eligibility determined based on current monthly income. So if your income has suddenly dropped to $0, you’ll likely be eligible for Medicaid and could transition to Medicaid when your job-based coverage ends. Unfortunately, there are still 11 states where most adults face a purchase renova online coverage gap if their household income is below the federal poverty level. They aren’t eligible for premium subsidies in the marketplace (unless they’ve received unemployment compensation in 2021 and can thus qualify for 2021 subsidies).

This is an unfortunate situation that those 11 states have created for their low-income residents. But there are strategies for avoiding the coverage gap if you’re in one of those states purchase renova online. And keep in mind that subsidy eligibility in the marketplace is based on your household income for the whole year, even if your current monthly income is below the poverty level. So if you earned enough earlier in the year to be subsidy-eligible for 2021, you can enroll in a plan with subsidies based on that income, despite the fact that you might not earn anything else for the rest of the year. When open enrollment begins in November, purchase renova online you’ll need to project your 2022 income as accurately as possible, if you’re still needing to purchase your own coverage for 2022.

But for the rest of 2021, you can use the income you already earned this year to qualify for subsidies. What if I’ll soon be eligible for Medicare?. There has been an increase recently in the number of people retiring purchase renova online in their late 50s or early 60s, before they’re eligible for Medicare. The ACA made this a more realistic option starting in 2014, thanks to premium subsidies and the elimination of medical underwriting. And the ARP has boosted subsidies and made them more widely available for 2021 and 2022, making affordable coverage more accessible for early retirees.

That’s especially true for those whose pre-retirement income might have made them ineligible for subsidies in the purchase renova online year they retired, due to the “subsidy cliff” (which has been eliminated by the ARP through the end of 2022). So if you’re losing your job or choosing to leave it and you still have a few months or a few years before you’ll be 65 and eligible for Medicare, rest assured that you won’t have to go uninsured. You’ll be able to sign up for a marketplace plan during your special enrollment period triggered by the loss of your employer-sponsored plan. And even if you earned a fairly robust income in the earlier part of the year, you might still qualify for premium subsidies to offset some of the cost of your new plan for the rest of 2021 purchase renova online. You’ll then be able to update your projected income for 2022 during the upcoming open enrollment period.

Your subsidies will adjust in January to reflect your 2022 income. And marketplace plans are always purchased on a month-to-month basis, so you’ll be able to cancel your coverage when purchase renova online you eventually transition to Medicare, regardless of when that happens. Don’t worry, get covered The short story on all of this?. Coverage is available, and obtaining your own health plan isn’t as complicated as it might seem at first glance, even if you’ve had employer-sponsored coverage all your life. You can sign up outside of open enrollment if you’re losing your job-based insurance, and there’s a good chance you’ll qualify for financial assistance that will make your new plan affordable purchase renova online.

You can learn more about the marketplace in your state and the available plan options by selecting your state on this map. And there are zero-cost enrollment assisters – Navigators and brokers – available throughout the country to help you make sense of it all. Louise Norris is an individual health insurance broker who purchase renova online has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Although August 15 marked the end of a one-time skin care products-related special enrollment period (SEP) for marketplace health insurance in most states, the enhanced subsidies that enticed millions of consumers are still available for many individual-market buyers (as noted below, the SEP is ongoing in some states).

The American Rescue Plan’s enhancements to the Affordable Care Act’s health insurance subsidies will continue long purchase renova online after the end of the skin care products SEP. That means that when you do have an opportunity to buy coverage again – either through open enrollment or due to a personal qualifying life event – you’ll likely find individual health insurance much less expensive than you might have expected. The ARP’s affordability provisions are still helping with premiums As we’ve noted over the past few months, the American Rescue Plan included numerous provisions that make ACA-compliant plans more affordable than ever. The additional purchase renova online health insurance subsidy enhancements delivered by the ARP include. Larger subsidies for people who were already subsidy-eligible.

The elimination of the “subsidy cliff,” making more people eligible for subsidies. Free coverage with full cost-sharing reductions for people who have purchase renova online received any unemployment compensation this year. All of those benefits continue to be available. The additional subsidies based on unemployment compensation continue through the end of 2021, while the other subsidy enhancements will be available through the end of 2022 (and possibly longer, if Congress extends them). How popular are the purchase renova online ARP’s subsidy enhancements?.

HHS reported last week that more than 2.5 million people had already enrolled in coverage during the skin care products-related special enrollment period, and that another 2.6 million existing marketplace enrollees had activated their ARP subsidies. Among all of the new enrollees, average after-subsidy premiums were just $85/month, as opposed to $117/month before the ARP’s subsidies became available. And across all of the new and renewing enrollees, about 35% had obtained coverage with after-subsidy premiums of less than $10/month purchase renova online. That illustrates how substantial premium subsidies have become under the ARP. And again, nothing has changed about those subsidies.

The special enrollment window has purchase renova online ended in most states, but the subsidies are still available if you’re eligible to enroll for the remainder of 2021 — and again during open enrollment for 2022, which starts November 1. So if you’re in a state where enrollment is still open, or if you’re eligible for an individual special enrollment period in any state, it’s certainly in your best interest to see what plan options are available to you. Enrolling as soon as you’re eligible will mean that you’re able to start taking advantage of the ARP’s subsidies right away, rather than having to wait for open enrollment and coverage that starts in 2022. States where purchase renova online enrollment continues Although the skin care products SEP ended on August 15 in the states that use HealthCare.gov – and some of the states that run their own exchanges – enrollment is still actually ongoing in several states. Vermont.

Enrollment continues through October 1 (for uninsured residents). Connecticut. General enrollment continues through October 31. DC. General enrollment continues through the end of the renova emergency period.

California. Enrollment continues through December 31 for uninsured residents and those switching from off-exchange to on-exchange coverage. There is also a temporary wildfire-related SEP in California, for residents in areas where a state of emergency has been declared due to wildfires. In Minnesota, the general skin care products-related special enrollment period ended in mid-July. But the state’s marketplace is still allowing people to enroll or switch to a $0 premium plan if they have received unemployment compensation in 2021.

New Jersey. General enrollment continues through December 31. New York. General enrollment continues through December 31. Enrollment if you have a qualifying life event Not in one of those states?.

Special enrollment periods are available to individuals who experience a wide range of “life changes.” The most common trigger for a personal SEP is a loss of other coverage — usually job-based coverage. (Note that there’s usually only a 60-day window to enroll in a new plan after losing other coverage. But HealthCare.gov is making an exception for people who lost their coverage as long ago as January 2020, if they missed their enrollment deadline because they were “impacted by the skin care products emergency.” People who need to utilize this flexibility have to call the marketplace directly to qualify for a special enrollment period on a case-by-case basis.) In addition to a loss of coverage, there are also other situations in which you’ll qualify for a SEP. They include events such as the birth or adoption of a child, marriage (as long as at least one spouse already had minimum essential coverage), or even your grandmothered or grandfathered plan coming up for renewal. More opportunities to enroll in ACA-compliant coverage In addition to the states with ongoing skin care products-related enrollment periods and the individual SEPs triggered by qualifying life events, there are other circumstances under which you might still be eligible to enroll in affordable health coverage.

If you’re eligible for Medicaid or CHIP in any state, enrollment continues year-round. If you’re eligible for the Basic Health Programs in New York and Minnesota, you can enroll anytime. If you’re eligible for Connecticut’s new Covered Connecticut family program, you have until at least the end of 2021 to sign up for free coverage. If you’re newly eligible for the ConnectorCare program in Massachusetts (or if this is your first time enrolling in it), you can enroll anytime. Native Americans can enroll in marketplace plans year-round.

Mark your calendar for 2022 open enrollment If you don’t have an enrollment period now, be sure to mark your calendar for the start of open enrollment on November 1. That’s when you’ll be able to sign up for health coverage that will take effect in January, with coverage for essential health benefits and pre-existing conditions. During open enrollment, your medical history won’t matter, and neither will your coverage history. And if you’re already enrolled in an ACA-compliant plan – or soon will be – you’ll still want to pay attention to open enrollment this fall.

Renova side effects

As skin care products cases and hospitalizations hit record highs in renova side effects the United States, and the threat of a double-dip economic recession looms, many are calling for continued http://www.ec-monnaie-molsheim.ac-strasbourg.fr/recyclages/ and enhanced government stimulus. While it is paramount that policy makers do all they can to address these urgent national interests, they must also take a long-term view. How they decide to allocate economic recovery funds will have renova side effects lasting consequences, with the potential to either amplify or eradicate another deadly agent that has been freely proliferating for centuries. Fossil fuels.

The short-term symptoms resulting from the extraction and burning of fossil fuels have long manifested, with air pollution claiming millions of lives each year and plaguing millions more with diseases of the heart, lungs and brain in the U.S. And beyond renova side effects. In recent years, the longer-term symptoms have started to set in, with extreme weather events intensifying, food and water insecurity on the rise, and the first climate refugees, including Alaska’s coastal residents, being forced to abandon their homelands. As with the renova side effects differentiated impacts of the novel skin care, it is the most vulnerable and marginalized who bear the brunt of our fossil fuel-driven society.

Although it may seem odd to draw parallels between the novel skin care and fossil fuels, as a climate and public health researcher, I have spent most of 2020 working on two reports that compel me to make this connection. Published last week, the Lancet Countdown. Tracking Progress on Health and Climate Change renova side effects U.S. Policy Brief and the Production Gap Report both share one urgent message to U.S.

Policymakers. Do not allow skin care products renova side effects recovery measures to lock us into another global health crisis. The Lancet Countdown details how the effects of climate change are undeniable and worsening across the U.S. Over the renova side effects past two decades, for example, heat-related mortality for older persons has almost doubled.

In 2019, two billion hours of labor were lost because of extreme heat conditions in the service, manufacturing, agricultural and construction sectors. Not to mention 14 climate-related disasters each causing over a billion dollars in damages. €œAbove-normal” wildfire seasons in the renova side effects western U.S. And hurricane seasons in the Atlantic are becoming the new norm.

While no one is immune to these accelerating health risks, climate change is a threat multiplier that exacerbates existing health inequities and injustices. As documented by one case study in the policy brief, renova side effects the impacts of this year’s Hurricane Laura, one of the strongest hurricanes to ever hit Louisiana, were centered around the City of Lake Charles in Calcasieu Parish. This region is predominantly populated by Black and low-income communities, which have been enduring some of the highest levels of air pollution in the country stemming from the hundreds of oil, gas and chemical facilities situated along the Louisiana coast. Preliminary research suggests renova side effects that long-term exposure to air pollution may be associated with increased skin care products mortality and morbidity rates.

Indeed, commensurate with national patterns, the rate of skin care products s among Black people living in Calcasieu Parish is 1.7 times higher than that for white people. In order to stay on track to limit global warming below 1.5 degrees Celsius and avoid worsening climate-related health impacts, the Production Gap Report shows that fossil fuel–producing nations need to collectively cut global production by 6 percent per year from now to 2030. Instead, their existing energy plans foresee an average annual increase of 2 percent, which would lead to more than double the production consistent renova side effects with the 1.5 degree C limit by 2030. As the world’s largest oil and gas producer, the U.S.

Is a key contributor to this global production gap. And so far, despite widespread calls for a green renova side effects recovery, the U.S. Government has directed the majority of its energy-related recovery funds toward supporting fossil fuels. $72 billion renova side effects compared to $27 billion for clean energy, as of November.

These funds add to existing government assistance in the form of fossil fuel subsidies, rollbacks of more than 100 environmental regulations and refusal to strengthen air quality standards for another five years. But the incoming administration offers us a glimmer of hope. President-elect Biden has repeatedly committed to reentering the Paris renova side effects Agreement “on day one” and put forward a plan for achieving “a clean energy revolution and environmental justice.” Vice President-elect Harris has proposed the “first-ever global negotiation of the cooperative managed decline of fossil fuel production.” The Production Gap Report and Lancet Countdown outline ways to achieve these goals, including the elimination of fossil fuel subsidies and policy tools for leveraging decarbonization as an organizing theme for skin care products recovery efforts. In the U.S., the skin care products renova continues to demonstrate the brutal consequences that can occur when science is disregarded and responses are delayed or incommensurate with the scale and urgency of the problem—or absent altogether.

As the incoming administration seeks to address the current public health emergency, they must be sure to avoid worsening other health crises—air pollution and climate change—in the process. Doing so requires a managed, equitable renova side effects and urgent transition away from fossil fuels. The views and opinions expressed in this article are those of the author alone.Xavier Becerra, President-elect Joe Biden’s choice to head the Department of Health and Human Services, is set to be a renova-era secretary with no public health experience. Whether that matters depends on whom you ask renova side effects.

Becerra built his career in the U.S. House of Representatives before becoming California’s attorney general, and some wonder whether his political and legal skills would be the right fit to steer HHS through a health catastrophe that’s killing thousands of Americans every day. Although he would bring years renova side effects of health politics and policy work to the role, none of it comes from front-line experience as an executive or administrator running public health programs, managing patient care or controlling the spread of disease. Yet beyond the immediate skin care products crisis, many Democrats see Becerra as an important ally to undo what they view as years of damage from the Trump administration’s efforts to undermine the Affordable Care Act.

The Medicaid program, which provides coverage for more than 70 million Americans. Reproductive health renova side effects. And more. As California’s attorney general since 2017, Becerra has renova side effects been a thorn in the side of the Trump administration, filing 107 lawsuits to overturn federal action on the Affordable Care Act, contraception, immigration, workers’ rights, LGBT rights, education, consumer protection, gun violence and the environment.

€œskin care products is the biggest issue on the table, but it is not the only issue on the table,” said Dr. Georges Benjamin, executive director of the American Public Health Association. €œIf you look at renova side effects his body of work, he is not your traditional attorney. His body of work in the health area is substantial.

And I think that counts.” On Tuesday, Biden will formally introduce Becerra along with other candidates for top health renova side effects jobs, many with deep public health experience. They include Dr. Rochelle Walensky, an infectious disease expert at Harvard Medical School who practices at Massachusetts General Hospital in Boston, as the next director of the Centers for Disease Control and Prevention. Biden’s choice for skin care products “czar” is Jeffrey Zients, a private equity executive and former Obama administration official who will steer the renova response from the White House renova side effects.

Dr. Vivek Murthy is the nominee for U.S. Surgeon general, renova side effects a position he held in the final Obama years. Biden has said he will let the federal government’s longtime scientists guide his renova response, in particular those at the CDC, which is overseen by HHS.

President Donald Trump sidelined the agency, damaging its reputation as the world’s most trusted public health institution renova side effects. That Becerra’s deepest experience is political makes some observers wary. €œI think there’s always a danger of letting that sort of cloud the scientific and medical judgment of how best to do things. I hope they can manage that well,” said Jeffrey Morris, a biostatistics professor at the University of Pennsylvania who renova side effects has worked on skin care products issues.

He said he had mixed feelings about the Becerra selection. €œWhat is the leadership style, and is there going to be micromanaging from the top down into these organizations?. To me, that’s the key aspect.” Garry South, a Los Angeles-based Democratic strategist, called Becerra’s appointment “curious.” “A renova side effects lot of people are raising eyebrows—even those who are pleased and proud that Biden picked another Californian to join his administration,” South said. €œIf Republicans are looking to target a few Biden appointees for rejection, you can expect them to make the case that there is no logical nexus between a state attorney general and serving as secretary of Health and Human Services.” Still, Becerra, who as a member of Congress worked in the House Democratic leadership and was a member of the powerful Ways and Means Committee, has more health policy background and knowledge of U.S.

Health care finance and delivery systems than many previous heads of the sprawling HHS, which employs more than 80,000 people and has a $1.3 renova side effects trillion budget. For three years, Becerra has managed California’s Justice Department, with a $1.1 billion budget and 4,800 employees. As attorney general, he’s been deeply involved in crafting health policy. His office has gone after anti-competitive behavior from hospitals renova side effects.

And he’s sponsored legislation to take on drugmakers and pay-for-delay schemes. €œHe’s gone after powerful health care interests,” said Anthony Wright, executive director of the nonprofit Health Access California. Antitrust enforcement renova side effects is more commonly handled by the U.S. Department of Justice and the Federal Trade Commission.

But Becerra made it a priority as California’s top cop renova side effects. In May 2018, he brought an antitrust case against nonprofit health care giant Sutter Health, accusing the system of monopolistic practices that drove up the cost of medical care in Northern California. €œThis is a big ‘F’ deal,” Becerra said at a news conference unveiling the lawsuit. The case—which encompassed years of work by the department and his predecessors renova side effects and millions of pages of documents—alleged that Sutter had aggressively bought up hospitals and physician practices across the region and illegally exploited that market power for profit.

Health care costs in Northern California, where Sutter dominates with its 24 hospitals, are 20% to 30% higher than in Southern California, even after adjusting for Northern California’s higher cost of living, according to a 2018 study from the Nicholas C. Petris Center at the University of California-Berkeley that was cited in the complaint. In December 2019, Sutter agreed to pay $575 million to settle the case and promised to end a host of practices that Becerra alleged renova side effects stifled competition. Becerra channeled lessons learned from the Sutter case into an antitrust bill in the California legislature.

The legislation ultimately failed, but it would have given the attorney general power to review private equity- renova side effects or hedge fund-led mergers or acquisitions of a health care system or hospital. €œThe Sutter case is a blueprint for a national policy that could start to restore competition for the health care system and save American health care consumers billions of dollars right away,” said Glenn Melnick, a health care economist at the University of Southern California. He views Becerra as “a real expert in some of the most important issues facing our health care system, not just in California but nationally.” If confirmed by the Senate, Becerra supporters say, he will bring to the job a political acumen from his two decades-plus on Capitol Hill that’s likely to be an asset for the Biden administration as it negotiates renova relief bills and other health legislation with a politically divided Congress. Former California Democratic member of Congress Henry Waxman worked with nearly a renova side effects dozen HHS secretaries during his time on the House Energy and Commerce Committee.

He said he’s not worried that Becerra lacks experience leading a vast health care bureaucracy. The HHS secretary job, he renova side effects said, is one “where you need political skills to see how far you can get with other people in a political context.” That’s why most HHS secretaries, Republicans and Democrats, have had political backgrounds. Becerra “understands the policies and has a deep commitment to them,” he said. €œI think he’ll do well.” Public health officials say the job before Becerra is gigantic.

Dr. Gary Pace, the health officer in rural Lake County, California, said Becerra would be tasked with rebuilding a broken public health system. €œWe want a federal partner who can give us good guidance—we haven’t had that,” Pace said. €œFor him, I’d say what we need first is starting to get the CDC back into a flagship public health role, with trusted and timely evidence-based guidance.” Born in Sacramento to Mexican immigrant parents, Becerra would be the first Latino HHS secretary.

He was elected to Congress in his 30s and has been involved in national health legislation during the past two decades, even though he is more widely known for his involvement in immigration and tax issues. He joined the powerful House Ways and Means Committee, which oversees tax and health legislation, in the 1990s. The committee played a central role in the drafting of what would become the Affordable Care Act in 2010. While HHS oversees major federal health agencies, including the CDC, the Centers for Medicare &.

Medicaid Services, the Food and Drug Administration and the National Institutes of Health, it also has a wide-ranging human services portfolio, including oversight of child care and welfare programs, Head Start, programs for seniors and refugee resettlement. €œIt’s not like any one person is going to have everything,” said Dan Mendelson, a former Clinton administration health official, who called Becerra an “inspired choice.” “I think that the most important point is that this is a leader of a team and not the be-all and end-all.” California Healthline staff writers Rachel Bluth and Samantha Young contributed to this story. This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.The following essay is reprinted with permission from The Conversation, an online publication covering the latest research. Imagine you begin to feel ill on Thursday, a few days after returning from a trip.

You’re afraid it’s skin care products, so you get tested on Friday. Even under good circumstances, it will probably be at least Monday before a contact tracer calls from the health department. And then some phone tag may ensue before you speak with anyone—if you get a call at all. Once a contact tracer does reach you, you will be asked to remember all the people you were in close contact with, starting two days before you began feeling symptoms.

That means recalling all the places you went and the people you saw over the past week. It isn’t easy. As time passes, memories fade. Unfortunately, your contacts, unaware they were exposed to the skin care, may have already infected others.

Concerned about those delays, three of us and our colleague Ronald Fisher, all psychology professors with expertise in memory, developed read review a way for people who have been exposed to skin care products to effectively trace their recent contacts on their own. Self-driven contact tracing shouldn’t replace health department efforts. Professional teams of trained contact tracers are critical for locating the people you came in contact with but don’t know, such as at a restaurant or on an airplane, and then tracing the next ring of contacts. However, jump-starting the effort on your own can improve your chances of remembering and allow you to warn your contacts sooner.

Notifying contacts faster Contact tracing, along with testing and isolating people who are infected, is considered crucial for controlling the skin care’s spread until a treatment becomes widely available. Health department contact tracers try to notify and interview anyone who was within 6 feet of an infected person for a total of 15 minutes or more. Studies show that, to be effective, that notification needs to happen within a few days of the person’s symptoms appearing. But case numbers have gotten so high, it’s become impossible for many states and counties to keep up.

Some, including in Alaska, Missouri and Wisconsin, have urged residents to start notifying contacts on their own. We created CogTracer as a free online tool to help people start tracing those contacts using best-practice interviewing methods. With DIY contact tracing, the timetable changes. For example, while you’re waiting for your test, you can be given the link to the website and start walking yourself through a contact tracing interview.

How psychology can help jog your memory CogTracer uses prompts, in words and photos, to spark your memory for as many contacts and locations visited as possible. It urges you to look back at places that might have evidence of your movements that week, such as social media posts and credit card records, and it provides scientifically supported interviewing techniques to reduce the chances of forgetting a contact. Research in investigative interviewing shows that people can effectively remember events on their own when they have scientifically supported methods. One technique for remembering is known as context reinstatement.

It involves putting yourself back in a specific time and place. For example, if you attended a family gathering over the holidays, you might mentally recreate the event. You could think back on how you arrived and departed, what you wore, who was there, what you ate, what you heard and what you saw. The technique encourages closing your eyes during this process to help you concentrate.

€œReliving” this experience should make it easier to remember your close contacts at the event. Another important way to improve memory is varied retrieval. When you search your memory only once, or in the same way over and over, it is likely that something will be forgotten. What you recall depends on how you cue your memory.

If you prompt your memory in different ways, you’ll recall different things. CogTracer takes advantage of repeated and varied recall by including broad category cues, such as “people you interact with in homes” or words such as “babysitter,” that may trigger memories of nonroutine activities that may otherwise be forgotten. Applying these proven methods should result in more complete recall of those who could be at risk for contracting skin care products. Online tools can overcome other barriers, too This DIY approach can also help overcome other barriers to effective and timely contact tracing.

Because many people put a high premium on privacy, some are resistant to providing information to contact tracers. CogTracer is anonymous and private—you don’t enter any information, and you make your own lists. This provides a way for those who otherwise would not engage in the process to contribute to contact tracing efforts on their own terms. Additionally, non-English speakers may require an interpreter, further delaying the contact tracing process.

Online interviews can more quickly bridge these language gaps. As the renova rages, public health workers are engaged in Herculean efforts to fight this disease. By reimagining contact tracing and applying the science of memory, we can leverage the power of individuals to attack the problem from as many fronts as possible. This article was originally published on The Conversation.

Read the original article.Back in 2010, we celebrated the life of Martin Gardner, who died that year at the age of 95. He wrote the Mathematical Games column for Scientific American magazine for nearly 25 years, and he remains the gold standard for this publication's columnists. Upon Gardner's death, I interviewed his friend and protégé Douglas Hofstadter, the Pulitzer Prize–winning author of Gödel, Escher, Bach. An Eternal Golden Braid.

The book came out in 1979, when Hofstadter was 34. Which meant that in 2010 he was 65. And it struck me that it should take much longer to go from 34 to 65 than a mere 31 years. It really should take more like 50 years to go from being 34 to 65, I thought, even though the arithmetic regarding that transition was inarguably ironclad.

In a somewhat related vein, this issue of Scientific American marks 25 years since the first appearance of Anti Gravity. In 1995 I was 37 years old and in my salad days, when I was green in judgment. And in only 25 years I've turned into an alte kaker. I'm still green, but now it's because of digestive issues.

Horror movie maven David Cronenberg captured the weirdness of this fast-forwarding in the introduction to a 2014 English translation of Franz Kafka's The Metamorphosis. €œI woke up one morning recently to discover that I was a seventy-year-old man. Is this different from what happens to Gregor Samsa in The Metamorphosis?. He wakes up to find that he's become a near-human-sized beetle....

Our reactions, mine and Gregor's, are very similar. We are confused and bemused, and think that it's a momentary delusion.... These two scenarios, mine and Gregor's, seem so different, one might ask why I even bother to compare them. The source of the transformations is the same, I argue.

We have both awakened to a forced awareness of what we really are, and that awareness is profound and irreversible. In each case, the delusion soon proves to be a new, mandatory reality, and life does not continue as it did.” The previous more than 300 words of throat clearing is to set up the announcement that I'm hanging up my spikes. Well, in truth I hung up the spikes a very long time ago, when other kids my age started throwing breaking pitches. So let's say I'm hanging up my keyboard.

I'll still be making bad puns and snide remarks, of course, and I'll be ranting about antiscience politicians, but it'll mostly be just for the benefit, if you can call it that, of my wife and cats. Although it's not impossible that I may return to these pages from time to time when said wife and cats inform me that I really should share my golden nuggets of insight with a wider audience if that will get me out of the living room. By the way, I'd be remiss if I didn't note that the greatest commentary on The Metamorphosis occurs in Mel Brooks's 1967 movie The Producers, when the title characters are looking for the worst play in the world in order to guarantee a flop so they can keep most of the million dollars they raise rather than spend it on the production. Max Bialystock, brilliantly played by Zero Mostel, opens one of the hundreds of manuscripts around him and says, “‘Gregor Samsa awoke one morning to discover that he had been transformed into a giant cockroach.’ It's too good.” Which in fact it was.

Back to Cronenberg and his “mandatory reality.” In 2002 a White House official scoffed at journalist Ron Suskind for being in “the reality-based community.” The official explained, according to Suskind, “We're an empire now, and when we act, we create our own reality.” I had two responses to that anecdote and attitude then that I hold to today, as the current White House's relationship with reality seems literally psychotic. First, Scientific American is the voice of the reality-based community. Second, if you think you create your own reality, real reality will come back to bite you in the ass.To be an expectant mother, or the anxious partner of one, is to be keenly, even agonizingly aware of how chemicals affect a developing life. The basic advice is well known, and obsessively followed.

Alcohol in strict moderation, and no nicotine at all. Don’t mess with mercury. Folic acid is your friend. More protein and less caffeine.

Stay away from BPA, PBCs and PFA, and generally make an enemy of the unpronounceable. But, if we take the results of a provocative recent paper seriously, there may be another important, and deeply underappreciated chemical influence at work. A man’s odor. The research, by a team headed by Noam Sobel of the Weizmann Institute of Science, suggests that there is a relationship between women’s response to “social odors” contained in male sweat and the heartbreaking condition of unexplained repeated pregnancy loss (uRPL).

Specifically, in blind smell-tests, these scientists observed that women who had experienced uRPL were significantly better at identifying their spouse’s odor than age-matched controls. Additionally, their brains responded differently to nonspouse odors and they displayed unique olfactory neuroanatomy. Taken in the context of a large body of literature on chemosignaling in nonhuman animals, these results make it conceivable that the human nose could also communicate with the womb and may even influence a pregnancy. So far, the results are strictly correlative, and in no way point to male odor as some kind of pheromonal smoking gun that explains pregnancy loss.

Hypothetically, it could also be true that women experiencing uRPL have, on average, larger middle toes, larger whites of their eyes, thinner wrists and a proclivity for wearing purple socks. None of these would give one pause or prompt a serious search for some kind of causal link to pregnancy loss. Yet this particular link between smell and pregnancy loss is intriguing because of how prevalent and robust it is in other mammals, including primates. Many miscarriages still have unexplained causes, which makes any lead, correlative or not, a particularly interesting and worthwhile area of research.

The phenomenon of pregnancy block was first documented in mice by Hilda Bruce, in the 1950s. After the first signs of pregnancy, Bruce housed female mice with either the original “stud male” (the father), or a “strange male” that had not been encountered before. All the females housed with stud males carried their pregnancies to term, but a striking 30 percent of pregnancies were blocked in females housed with the strange male. The factor producing the block was likely related to the hormonal state of the males, since the incidence of block decreased by about 50 percent once the strange males were castrated.

In later studies that carefully controlled and isolated the potential ways that males could be influencing a pregnancy (presenting physical contact or damaging the brain’s olfactory centers) it was found that odor was both necessary and sufficient for what is now known as “the Bruce effect.” The most likely reason for this mysterious effect is that it’s an efficient, if merciless, mechanism for maximizing reproductive fitness. There’s no point investing in a resource-intensive pregnancy if the father is not around and a new male mouse is only going to kill the offspring. Similar controlled experiments can’t, of course, be ethically replicated in humans, so instead Sobel’s group set out to investigate changes in olfactory identification of mates for women who had already experienced pregnancy loss. If this Bruce-type effect existed in humans, we might expect it to show up as a difference in the detection or recognition of mate odor that could persist after pregnancy loss.

In the main experiment, the uRPL group was asked to identify their spouse’s soiled T-shirt by smell from a lineup including a stranger’s soiled T-shirt and a “blank” unsoiled shirt. The uRPL group performed significantly above chance in the task, and the experimenters noted, anecdotally, that many participants spontaneously offered remarks like “Oh, this is my spouse.” In contrast, an age-matched control group that had not experienced rUPL performed at only chance levels on this task. Although this result could in principle be explained by a more acute sense of smell, without any mate-specific olfactory alchemy, additional experiments seemed to rule out this possibility. When tested with a battery of general odor detection and identification tasks, the rUPL women performed no differently from the controls, indicating that the group’s heightened olfactory identification was mate-specific.

If there is a link between smell and pregnancy loss, then the neural events that mediate this are of considerable interest. In mice, the brain’s sorting of “studs” from “strangers” involves the vomeronasal system, an olfactory subsystem that was once called “the social nose” but which is now seen as even richer and more complex. Scientists have proposed a wide range of mechanisms to account for the “Bruce effect” in mice, including changes in neurogenesis (the birth and incorporation of new neurons). But, the most likely theory is the formation of a template memory in the vomeronasal system.

In the same way that your brain learns to “subtract out” your own smell (effectively recognizing the self as a nonthreatening or uninteresting stimulus), the pregnant mouse brain could do the same for a mate’s smell. Naturally, the neural mechanisms of mate identification cannot be studied in humans with anything close to the control, precision and granularity that are possible in mice. Still, Sobel’s group has made some interesting observations about social odor processing using fMRI that may hint at a neurological basis for the observed phenomenon. At a gross structural level, uRPL subjects tended to have smaller olfactory bulbs than their control counterparts (the olfactory bulb is an early and critical brain structure that receives direct sensory inputs from the nose).

In another experiment designed to monitor real-time neural responses to social odors, subjects were placed in a scanner while being shown arousing videos and smelling nonspousal odors presented at concentrations well below conscious detection. Interestingly, the scientists didn’t just observe a difference in the amount of stimulus-evoked brain activity between the two groups. Rather, they found a difference in the direction of the groups’ responses, with activity in the hypothalamus—a key regulator of basic physiological functions including sexual behavior and menstruation—decreasing in the control group and increasing in the uRPL group. Sobel’s studies show that something is noticeably different about social odor perception in women with repeated miscarriages, and that these differences influence how their brains process social odors.

While this could potentially hint at a “Bruce-like effect” in humans, there are still many questions left unanswered. The main one is that because of the experimental design (driven by the ethical constraints of working with humans) we don’t know in what direction the arrow of causality points. It could be that pregnancy loss has nothing to do with smell, and caused downstream changes in olfactory processing, in a sort of “backwards” Bruce effect, for example. And, even if odor does prove to be causal, it may also turn out that the effect owes more to the uniqueness of certain male odors than a difference in certain female brains.

Regardless of the end result, we are sure to learn something new and important about how we communicate using our most underappreciated sense..

As skin care products cases http://www.ec-monnaie-molsheim.ac-strasbourg.fr/recyclages/ and hospitalizations hit record highs in the United States, and the threat of a double-dip economic recession looms, many are calling for continued and enhanced government purchase renova online stimulus. While it is paramount that policy makers do all they can to address these urgent national interests, they must also take a long-term view. How they purchase renova online decide to allocate economic recovery funds will have lasting consequences, with the potential to either amplify or eradicate another deadly agent that has been freely proliferating for centuries. Fossil fuels.

The short-term symptoms resulting from the extraction and burning of fossil fuels have long manifested, with air pollution claiming millions of lives each year and plaguing millions more with diseases of the heart, lungs and brain in the U.S. And beyond purchase renova online. In recent years, the longer-term symptoms have started to set in, with extreme weather events intensifying, food and water insecurity on the rise, and the first climate refugees, including Alaska’s coastal residents, being forced to abandon their homelands. As with the differentiated impacts of the novel skin care, it is the most vulnerable and marginalized who bear the brunt of our purchase renova online fossil fuel-driven society.

Although it may seem odd to draw parallels between the novel skin care and fossil fuels, as a climate and public health researcher, I have spent most of 2020 working on two reports that compel me to make this connection. Published last week, the Lancet Countdown. Tracking Progress on Health and Climate purchase renova online Change U.S. Policy Brief and the Production Gap Report both share one urgent message to U.S.

Policymakers. Do not purchase renova online allow skin care products recovery measures to lock us into another global health crisis. The Lancet Countdown details how the effects of climate change are undeniable and worsening across the U.S. Over the past two decades, for example, heat-related mortality for purchase renova online older persons has almost doubled.

In 2019, two billion hours of labor were lost because of extreme heat conditions in the service, manufacturing, agricultural and construction sectors. Not to mention 14 climate-related disasters each causing over a billion dollars in damages. €œAbove-normal” wildfire seasons in the purchase renova online western U.S. And hurricane seasons in the Atlantic are becoming the new norm.

While no one is immune to these accelerating health risks, climate change is a threat multiplier that exacerbates existing health inequities and injustices. As documented by one case study in the policy brief, the impacts of this year’s Hurricane Laura, one of the strongest hurricanes to ever hit Louisiana, were centered around the City of Lake Charles in Calcasieu Parish purchase renova online. This region is predominantly populated by Black and low-income communities, which have been enduring some of the highest levels of air pollution in the country stemming from the hundreds of oil, gas and chemical facilities situated along the Louisiana coast. Preliminary research suggests that long-term exposure to air pollution may be associated purchase renova online with increased skin care products mortality and morbidity rates.

Indeed, commensurate with national patterns, the rate of skin care products s among Black people living in Calcasieu Parish is 1.7 times higher than that for white people. In order to stay on track to limit global warming below 1.5 degrees Celsius and avoid worsening climate-related health impacts, the Production Gap Report shows that fossil fuel–producing nations need to collectively cut global production by 6 percent per year from now to 2030. Instead, their existing energy plans foresee an average annual increase of 2 purchase renova online percent, which would lead to more than double the production consistent with the 1.5 degree C limit by 2030. As the world’s largest oil and gas producer, the U.S.

Is a key contributor to this global production gap. And so far, despite purchase renova online widespread calls for a green recovery, the U.S. Government has directed the majority of its energy-related recovery funds toward supporting fossil fuels. $72 billion compared to $27 billion for clean energy, as purchase renova online of November.

These funds add to existing government assistance in the form of fossil fuel subsidies, rollbacks of more than 100 environmental regulations and refusal to strengthen air quality standards for another five years. But the incoming administration offers us a glimmer of hope. President-elect Biden has repeatedly committed to reentering the Paris Agreement “on day one” and put forward a plan for achieving “a clean energy revolution and environmental justice.” Vice purchase renova online President-elect Harris has proposed the “first-ever global negotiation of the cooperative managed decline of fossil fuel production.” The Production Gap Report and Lancet Countdown outline ways to achieve these goals, including the elimination of fossil fuel subsidies and policy tools for leveraging decarbonization as an organizing theme for skin care products recovery efforts. In the U.S., the skin care products renova continues to demonstrate the brutal consequences that can occur when science is disregarded and responses are delayed or incommensurate with the scale and urgency of the problem—or absent altogether.

As the incoming administration seeks to address the current public health emergency, they must be sure to avoid worsening other health crises—air pollution and climate change—in the process. Doing so requires a managed, equitable purchase renova online and urgent transition away from fossil fuels. The views and opinions expressed in this article are those of the author alone.Xavier Becerra, President-elect Joe Biden’s choice to head the Department of Health and Human Services, is set to be a renova-era secretary with no public health experience. Whether that matters depends purchase renova online on whom you ask.

Becerra built his career in the U.S. House of Representatives before becoming California’s attorney general, and some wonder whether his political and legal skills would be the right fit to steer HHS through a health catastrophe that’s killing thousands of Americans every day. Although he would bring years of health politics and policy work to the purchase renova online role, none of it comes from front-line experience as an executive or administrator running public health programs, managing patient care or controlling the spread of disease. Yet beyond the immediate skin care products crisis, many Democrats see Becerra as an important ally to undo what they view as years of damage from the Trump administration’s efforts to undermine the Affordable Care Act.

The Medicaid program, which provides coverage for more than 70 million Americans. Reproductive health purchase renova online. And more. As California’s attorney general since 2017, Becerra has been a thorn in the side of the Trump administration, filing 107 lawsuits to overturn federal purchase renova online action on the Affordable Care Act, contraception, immigration, workers’ rights, LGBT rights, education, consumer protection, gun violence and the environment.

€œskin care products is the biggest issue on the table, but it is not the only issue on the table,” said Dr. Georges Benjamin, executive director of the American Public Health Association. €œIf you look purchase renova online at his body of work, he is not your traditional attorney. His body of work in the health area is substantial.

And I think that counts.” On Tuesday, Biden will formally introduce Becerra along with other candidates for top health jobs, many purchase renova online with deep public health experience. They include Dr. Rochelle Walensky, an infectious disease expert at Harvard Medical School who practices at Massachusetts General Hospital in Boston, as the next director of the Centers for Disease Control and Prevention. Biden’s choice for skin care products “czar” is Jeffrey Zients, a private equity executive and former Obama administration official who will steer the renova purchase renova online response from the White House.

Dr. Vivek Murthy is the nominee for U.S. Surgeon general, a position he held in the final Obama years purchase renova online. Biden has said he will let the federal government’s longtime scientists guide his renova response, in particular those at the CDC, which is overseen by HHS.

President Donald Trump sidelined the agency, damaging its reputation as the world’s most trusted purchase renova online public health institution. That Becerra’s deepest experience is political makes some observers wary. €œI think there’s always a danger of letting that sort of cloud the scientific and medical judgment of how best to do things. I hope they can manage that well,” said Jeffrey purchase renova online Morris, a biostatistics professor at the University of Pennsylvania who has worked on skin care products issues.

He said he had mixed feelings about the Becerra selection. €œWhat is the leadership style, and is there going to be micromanaging from the top down into these organizations?. To me, that’s the key aspect.” Garry South, a Los Angeles-based Democratic strategist, called Becerra’s appointment “curious.” “A lot of people are raising eyebrows—even those who are pleased and proud that Biden picked another Californian to purchase renova online join his administration,” South said. €œIf Republicans are looking to target a few Biden appointees for rejection, you can expect them to make the case that there is no logical nexus between a state attorney general and serving as secretary of Health and Human Services.” Still, Becerra, who as a member of Congress worked in the House Democratic leadership and was a member of the powerful Ways and Means Committee, has more health policy background and knowledge of U.S.

Health care finance purchase renova online and delivery systems than many previous heads of the sprawling HHS, which employs more than 80,000 people and has a $1.3 trillion budget. For three years, Becerra has managed California’s Justice Department, with a $1.1 billion budget and 4,800 employees. As attorney general, he’s been deeply involved in crafting health policy. His office has gone after anti-competitive behavior purchase renova online from hospitals.

And he’s sponsored legislation to take on drugmakers and pay-for-delay schemes. €œHe’s gone after powerful health care interests,” said Anthony Wright, executive director of the nonprofit Health Access California. Antitrust enforcement is more commonly handled purchase renova online by the U.S. Department of Justice and the Federal Trade Commission.

But Becerra made it a priority as California’s top purchase renova online cop. In May 2018, he brought an antitrust case against nonprofit health care giant Sutter Health, accusing the system of monopolistic practices that drove up the cost of medical care in Northern California. €œThis is a big ‘F’ deal,” Becerra said at a news conference unveiling the lawsuit. The case—which encompassed years purchase renova online of work by the department and his predecessors and millions of pages of documents—alleged that Sutter had aggressively bought up hospitals and physician practices across the region and illegally exploited that market power for profit.

Health care costs in Northern California, where Sutter dominates with its 24 hospitals, are 20% to 30% higher than in Southern California, even after adjusting for Northern California’s higher cost of living, according to a 2018 study from the Nicholas C. Petris Center at the University of California-Berkeley that was cited in the complaint. In December 2019, Sutter agreed to pay $575 million to settle the case and promised to end a host of purchase renova online practices that Becerra alleged stifled competition. Becerra channeled lessons learned from the Sutter case into an antitrust bill in the California legislature.

The legislation ultimately failed, but it would have given the attorney general power to review private equity- purchase renova online or hedge fund-led mergers or acquisitions of a health care system or hospital. €œThe Sutter case is a blueprint for a national policy that could start to restore competition for the health care system and save American health care consumers billions of dollars right away,” said Glenn Melnick, a health care economist at the University of Southern California. He views Becerra as “a real expert in some of the most important issues facing our health care system, not just in California but nationally.” If confirmed by the Senate, Becerra supporters say, he will bring to the job a political acumen from his two decades-plus on Capitol Hill that’s likely to be an asset for the Biden administration as it negotiates renova relief bills and other health legislation with a politically divided Congress. Former California Democratic member of Congress Henry Waxman worked with nearly a dozen purchase renova online HHS secretaries during his time on the House Energy and Commerce Committee.

He said he’s not worried that Becerra lacks experience leading a vast health care bureaucracy. The HHS secretary job, he said, is one “where purchase renova online you need political skills to see how far you can get with other people in a political context.” That’s why most HHS secretaries, Republicans and Democrats, have had political backgrounds. Becerra “understands the policies and has a deep commitment to them,” he said. €œI think he’ll do well.” Public health officials say the job before Becerra is gigantic.

Dr. Gary Pace, the health officer in rural Lake County, California, said Becerra would be tasked with rebuilding a broken public health system. €œWe want a federal partner who can give us good guidance—we haven’t had that,” Pace said. €œFor him, I’d say what we need first is starting to get the CDC back into a flagship public health role, with trusted and timely evidence-based guidance.” Born in Sacramento to Mexican immigrant parents, Becerra would be the first Latino HHS secretary.

He was elected to Congress in his 30s and has been involved in national health legislation during the past two decades, even though he is more widely known for his involvement in immigration and tax issues. He joined the powerful House Ways and Means Committee, which oversees tax and health legislation, in the 1990s. The committee played a central role in the drafting of what would become the Affordable Care Act in 2010. While HHS oversees major federal health agencies, including the CDC, the Centers for Medicare &.

Medicaid Services, the Food and Drug Administration and the National Institutes of Health, it also has a wide-ranging human services portfolio, including oversight of child care and welfare programs, Head Start, programs for seniors and refugee resettlement. €œIt’s not like any one person is going to have everything,” said Dan Mendelson, a former Clinton administration health official, who called Becerra an “inspired choice.” “I think that the most important point is that this is a leader of a team and not the be-all and end-all.” California Healthline staff writers Rachel Bluth and Samantha Young contributed to this story. This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.The following essay is reprinted with permission from The Conversation, an online publication covering the latest research. Imagine you begin to feel ill on Thursday, a few days after returning from a trip.

You’re afraid it’s skin care products, so you get tested on Friday. Even under good circumstances, it will probably be at least Monday before a contact tracer calls from the health department. And then some phone tag may ensue before you speak with anyone—if you get a call at all. Once a contact tracer does reach you, you will be asked to remember all the people you were in close contact with, starting two days before you began feeling symptoms.

That means recalling all the places you went and the people you saw over the past week. It isn’t easy. As time passes, memories fade. Unfortunately, your contacts, unaware they were exposed to the skin care, may have already infected others.

Concerned about those delays, three of us and our colleague Ronald Fisher, all psychology professors with expertise in memory, developed a way for people who have been exposed to skin care products to buy renova cream effectively trace their recent contacts on their own. Self-driven contact tracing shouldn’t replace health department efforts. Professional teams of trained contact tracers are critical for locating the people you came in contact with but don’t know, such as at a restaurant or on an airplane, and then tracing the next ring of contacts. However, jump-starting the effort on your own can improve your chances of remembering and allow you to warn your contacts sooner.

Notifying contacts faster Contact tracing, along with testing and isolating people who are infected, is considered crucial for controlling the skin care’s spread until a treatment becomes widely available. Health department contact tracers try to notify and interview anyone who was within 6 feet of an infected person for a total of 15 minutes or more. Studies show that, to be effective, that notification needs to happen within a few days of the person’s symptoms appearing. But case numbers have gotten so high, it’s become impossible for many states and counties to keep up.

Some, including in Alaska, Missouri and Wisconsin, have urged residents to start notifying contacts on their own. We created CogTracer as a free online tool to help people start tracing those contacts using best-practice interviewing methods. With DIY contact tracing, the timetable changes. For example, while you’re waiting for your test, you can be given the link to the website and start walking yourself through a contact tracing interview.

How psychology can help jog your memory CogTracer uses prompts, in words and photos, to spark your memory for as many contacts and locations visited as possible. It urges you to look back at places that might have evidence of your movements that week, such as social media posts and credit card records, and it provides scientifically supported interviewing techniques to reduce the chances of forgetting a contact. Research in investigative interviewing shows that people can effectively remember events on their own when they have scientifically supported methods. One technique for remembering is known as context reinstatement.

It involves putting yourself back in a specific time and place. For example, if you attended a family gathering over the holidays, you might mentally recreate the event. You could think back on how you arrived and departed, what you wore, who was there, what you ate, what you heard and what you saw. The technique encourages closing your eyes during this process to help you concentrate.

€œReliving” this experience should make it easier to remember your close contacts at the event. Another important way to improve memory is varied retrieval. When you search your memory only once, or in the same way over and over, it is likely that something will be forgotten. What you recall depends on how you cue your memory.

If you prompt your memory in different ways, you’ll recall different things. CogTracer takes advantage of repeated and varied recall by including broad category cues, such as “people you interact with in homes” or words such as “babysitter,” that may trigger memories of nonroutine activities that may otherwise be forgotten. Applying these proven methods should result in more complete recall of those who could be at risk for contracting skin care products. Online tools can overcome other barriers, too This DIY approach can also help overcome other barriers to effective and timely contact tracing.

Because many people put a high premium on privacy, some are resistant to providing information to contact tracers. CogTracer is anonymous and private—you don’t enter any information, and you make your own lists. This provides a way for those who otherwise would not engage in the process to contribute to contact tracing efforts on their own terms. Additionally, non-English speakers may require an interpreter, further delaying the contact tracing process.

Online interviews can more quickly bridge these language gaps. As the renova rages, public health workers are engaged in Herculean efforts to fight this disease. By reimagining contact tracing and applying the science of memory, we can leverage the power of individuals to attack the problem from as many fronts as possible. This article was originally published on The Conversation.

Read the original article.Back in 2010, we celebrated the life of Martin Gardner, who died that year at the age of 95. He wrote the Mathematical Games column for Scientific American magazine for nearly 25 years, and he remains the gold standard for this publication's columnists. Upon Gardner's death, I interviewed his friend and protégé Douglas Hofstadter, the Pulitzer Prize–winning author of Gödel, Escher, Bach. An Eternal Golden Braid.

The book came out in 1979, when Hofstadter was 34. Which meant that in 2010 he was 65. And it struck me that it should take much longer to go from 34 to 65 than a mere 31 years. It really should take more like 50 years to go from being 34 to 65, I thought, even though the arithmetic regarding that transition was inarguably ironclad.

In a somewhat related vein, this issue of Scientific American marks 25 years since the first appearance of Anti Gravity. In 1995 I was 37 years old and in my salad days, when I was green in judgment. And in only 25 years I've turned into an alte kaker. I'm still green, but now it's because of digestive issues.

Horror movie maven David Cronenberg captured the weirdness of this fast-forwarding in the introduction to a 2014 English translation of Franz Kafka's The Metamorphosis. €œI woke up one morning recently to discover that I was a seventy-year-old man. Is this different from what happens to Gregor Samsa in The Metamorphosis?. He wakes up to find that he's become a near-human-sized beetle....

Our reactions, mine and Gregor's, are very similar. We are confused and bemused, and think that it's a momentary delusion.... These two scenarios, mine and Gregor's, seem so different, one might ask why I even bother to compare them. The source of the transformations is the same, I argue.

We have both awakened to a forced awareness of what we really are, and that awareness is profound and irreversible. In each case, the delusion soon proves to be a new, mandatory reality, and life does not continue as it did.” The previous more than 300 words of throat clearing is to set up the announcement that I'm hanging up my spikes. Well, in truth I hung up the spikes a very long time ago, when other kids my age started throwing breaking pitches. So let's say I'm hanging up my keyboard.

I'll still be making bad puns and snide remarks, of course, and I'll be ranting about antiscience politicians, but it'll mostly be just for the benefit, if you can call it that, of my wife and cats. Although it's not impossible that I may return to these pages from time to time when said wife and cats inform me that I really should share my golden nuggets of insight with a wider audience if that will get me out of the living room. By the way, I'd be remiss if I didn't note that the greatest commentary on The Metamorphosis occurs in Mel Brooks's 1967 movie The Producers, when the title characters are looking for the worst play in the world in order to guarantee a flop so they can keep most of the million dollars they raise rather than spend it on the production. Max Bialystock, brilliantly played by Zero Mostel, opens one of the hundreds of manuscripts around him and says, “‘Gregor Samsa awoke one morning to discover that he had been transformed into a giant cockroach.’ It's too good.” Which in fact it was.

Back to Cronenberg and his “mandatory reality.” In 2002 a White House official scoffed at journalist Ron Suskind for being in “the reality-based community.” The official explained, according to Suskind, “We're an empire now, and when we act, we create our own reality.” I had two responses to that anecdote and attitude then that I hold to today, as the current White House's relationship with reality seems literally psychotic. First, Scientific American is the voice of the reality-based community. Second, if you think you create your own reality, real reality will come back to bite you in the ass.To be an expectant mother, or the anxious partner of one, is to be keenly, even agonizingly aware of how chemicals affect a developing life. The basic advice is well known, and obsessively followed.

Alcohol in strict moderation, and no nicotine at all. Don’t mess with mercury. Folic acid is your friend. More protein and less caffeine.

Stay away from BPA, PBCs and PFA, and generally make an enemy of the unpronounceable. But, if we take the results of a provocative recent paper seriously, there may be another important, and deeply underappreciated chemical influence at work. A man’s odor. The research, by a team headed by Noam Sobel of the Weizmann Institute of Science, suggests that there is a relationship between women’s response to “social odors” contained in male sweat and the heartbreaking condition of unexplained repeated pregnancy loss (uRPL).

Specifically, in blind smell-tests, these scientists observed that women who had experienced uRPL were significantly better at identifying their spouse’s odor than age-matched controls. Additionally, their brains responded differently to nonspouse odors and they displayed unique olfactory neuroanatomy. Taken in the context of a large body of literature on chemosignaling in nonhuman animals, these results make it conceivable that the human nose could also communicate with the womb and may even influence a pregnancy. So far, the results are strictly correlative, and in no way point to male odor as some kind of pheromonal smoking gun that explains pregnancy loss.

Hypothetically, it could also be true that women experiencing uRPL have, on average, larger middle toes, larger whites of their eyes, thinner wrists and a proclivity for wearing purple socks. None of these would give one pause or prompt a serious search for some kind of causal link to pregnancy loss. Yet this particular link between smell and pregnancy loss is intriguing because of how prevalent and robust it is in other mammals, including primates. Many miscarriages still have unexplained causes, which makes any lead, correlative or not, a particularly interesting and worthwhile area of research.

The phenomenon of pregnancy block was first documented in mice by Hilda Bruce, in the 1950s. After the first signs of pregnancy, Bruce housed female mice with either the original “stud male” (the father), or a “strange male” that had not been encountered before. All the females housed with stud males carried their pregnancies to term, but a striking 30 percent of pregnancies were blocked in females housed with the strange male. The factor producing the block was likely related to the hormonal state of the males, since the incidence of block decreased by about 50 percent once the strange males were castrated.

In later studies that carefully controlled and isolated the potential ways that males could be influencing a pregnancy (presenting physical contact or damaging the brain’s olfactory centers) it was found that odor was both necessary and sufficient for what is now known as “the Bruce effect.” The most likely reason for this mysterious effect is that it’s an efficient, if merciless, mechanism for maximizing reproductive fitness. There’s no point investing in a resource-intensive pregnancy if the father is not around and a new male mouse is only going to kill the offspring. Similar controlled experiments can’t, of course, be ethically replicated in humans, so instead Sobel’s group set out to investigate changes in olfactory identification of mates for women who had already experienced pregnancy loss. If this Bruce-type effect existed in humans, we might expect it to show up as a difference in the detection or recognition of mate odor that could persist after pregnancy loss.

In the main experiment, the uRPL group was asked to identify their spouse’s soiled T-shirt by smell from a lineup including a stranger’s soiled T-shirt and a “blank” unsoiled shirt. The uRPL group performed significantly above chance in the task, and the experimenters noted, anecdotally, that many participants spontaneously offered remarks like “Oh, this is my spouse.” In contrast, an age-matched control group that had not experienced rUPL performed at only chance levels on this task. Although this result could in principle be explained by a more acute sense of smell, without any mate-specific olfactory alchemy, additional experiments seemed to rule out this possibility. When tested with a battery of general odor detection and identification tasks, the rUPL women performed no differently from the controls, indicating that the group’s heightened olfactory identification was mate-specific.

If there is a link between smell and pregnancy loss, then the neural events that mediate this are of considerable interest. In mice, the brain’s sorting of “studs” from “strangers” involves the vomeronasal system, an olfactory subsystem that was once called “the social nose” but which is now seen as even richer and more complex. Scientists have proposed a wide range of mechanisms to account for the “Bruce effect” in mice, including changes in neurogenesis (the birth and incorporation of new neurons). But, the most likely theory is the formation of a template memory in the vomeronasal system.

In the same way that your brain learns to “subtract out” your own smell (effectively recognizing the self as a nonthreatening or uninteresting stimulus), the pregnant mouse brain could do the same for a mate’s smell. Naturally, the neural mechanisms of mate identification cannot be studied in humans with anything close to the control, precision and granularity that are possible in mice. Still, Sobel’s group has made some interesting observations about social odor processing using fMRI that may hint at a neurological basis for the observed phenomenon. At a gross structural level, uRPL subjects tended to have smaller olfactory bulbs than their control counterparts (the olfactory bulb is an early and critical brain structure that receives direct sensory inputs from the nose).

In another experiment designed to monitor real-time neural responses to social odors, subjects were placed in a scanner while being shown arousing videos and smelling nonspousal odors presented at concentrations well below conscious detection. Interestingly, the scientists didn’t just observe a difference in the amount of stimulus-evoked brain activity between the two groups. Rather, they found a difference in the direction of the groups’ responses, with activity in the hypothalamus—a key regulator of basic physiological functions including sexual behavior and menstruation—decreasing in the control group and increasing in the uRPL group. Sobel’s studies show that something is noticeably different about social odor perception in women with repeated miscarriages, and that these differences influence how their brains process social odors.

While this could potentially hint at a “Bruce-like effect” in humans, there are still many questions left unanswered. The main one is that because of the experimental design (driven by the ethical constraints of working with humans) we don’t know in what direction the arrow of causality points. It could be that pregnancy loss has nothing to do with smell, and caused downstream changes in olfactory processing, in a sort of “backwards” Bruce effect, for example. And, even if odor does prove to be causal, it may also turn out that the effect owes more to the uniqueness of certain male odors than a difference in certain female brains.

Regardless of the end result, we are sure to learn something new and important about how we communicate using our most underappreciated sense..

Renova no prescription

Maximizing health renova no prescription coverage for DAP clients. Before and after winning the case Outline prepared by Geoffrey Hale and Cathy Roberts - updated August 2012 This outline is intended to assist Disability Advocacy Program (DAP) advocates maximize health insurance coverage for clients they are representing on Social Security/SSI disability determinations. We begin with a discussion of coverage options available while your client’s DAP case is pending and then outline the effect winning the DAP case can have on your client’s access to health renova no prescription care coverage. How your client is affected will vary depending on the source and amount of disability income he or she receives after the successful appeal. I.

BACKGROUND renova no prescription. Public health coverage for your clients will primarily be provided by Medicaid and Medicare. The two programs are structured differently and have different eligibility criteria, but in order to provide the most complete renova no prescription coverage possible for your clients, they must work effectively together. Understanding their interactions is essential to ensuring benefits for your client. Here is a brief overview of the programs we will cover.

A. Medicaid. Medicaid is the public insurance program jointly funded by the federal, state and local governments for people of limited means. For federal Medicaid law, see 42 U.S.C. § 1396 et seq., 42 C.F.R.

§ 430 et seq. Regular Medicaid is described in New York’s State Plan and codified at N.Y. Soc. Serv. L.

§§ 122, 131, 363- 369-1. 18 N.Y.C.R.R. § 360, 505. New York also offers several additional programs to provide health care benefits to those whose income might be too high for Regular Medicaid. i.

Family Health Plus (FHPlus) is an extension of New York’s Medicaid program that provides health coverage for adults who are over-income for regular Medicaid. FHPlus is described in New York’s 1115 waiver and codified at N.Y. Soc. Serv. L.

§369-ee. ii. Child Health Plus (CHPlus) is a sliding scale premium program for children who are over-income for regular Medicaid. CHPlus is codified at N.Y. Pub.

Health L. §2510 et seq. b. Medicare. Medicare is the federal health insurance program providing coverage for the elderly, disabled, and people with end-stage renal disease.

Medicare is codified under title XVIII of the Social Security Law, see 42 U.S.C. § 1395 et seq., 42 C.F.R. § 400 et seq. Medicare is divided into four parts. i.

Part A covers hospital, skilled nursing facility, home health, and hospice care, with some deductibles and coinsurance. Most people are eligible for Part A at no cost. See 42 U.S.C. § 1395c, 42 C.F.R. Pt.

406. ii. Part B provides medical insurance for doctor’s visits and other outpatient medical services. Medicare Part B has significant cost-sharing components. There are monthly premiums (the standard premium in 2012 is $99.90.

In addition, there is a $135 annual deductible (which will increase to $155 in 2010) as well as 20% co-insurance for most covered out-patient services. See 42 U.S.C. § 1395k, 42 C.F.R. Pt. 407.

iii. Part C, also called Medicare Advantage, provides traditional Medicare coverage (Parts A and B) through private managed care insurers. See 42 U.S.C. § 1395w, 42 C.F.R. Pt.

422. Premium amounts for Medicare Advantage plans vary. Some Medicare Advantage plans include prescription drug coverage. iv. Part D is an optional prescription drug benefit available to anyone with Medicare Parts A and B.

See 42 U.S.C. § 1395w, 42 C.F.R. § 423.30(a)(1)(i) and (ii). Unlike Parts A and B, Part D benefits are provided directly through private plans offered by insurance companies. In order to receive prescription drug coverage, a Medicare beneficiary must join a Part D Plan or participate in a Medicare Advantage plan that provides prescription drug coverage.

C. Medicare Savings Programs (MSPs). Funded by the State Medicaid program, MSPs help eligible individuals meet some or all of their cost-sharing obligations under Medicare. See N.Y. Soc.

Serv. L. § 367-a(3)(a), (b), and (d). There are three separate MSPs, each with different eligibility requirements and providing different benefits. i.

Qualified Medicare Beneficiary (QMB). The QMB program provides the most comprehensive benefits. Available to those with incomes at or below 100% of the Federal Poverty Level (FPL), the QMB program covers virtually all Medicare cost-sharing obligations. Part B premiums, Part A premiums, if there are any, and any and all deductibles and co-insurance. ii.

Special Low-Income Medicare Beneficiary (SLMB). For those with incomes between 100% and 120% FPL, the SLMB program will cover Part B premiums only. iii. Qualified Individual (QI-1). For those with incomes between 120% and 135% FPL, but not otherwise Medicaid eligible, the QI-1 program covers Medicare Part B premiums.

D. Medicare Part D Low Income Subsidy (LIS or “Extra Help”). LIS is a federal subsidy administered by CMS that helps Medicare beneficiaries with limited income and/or resources pay for some or most of the costs of Medicare prescription drug coverage. See 42 C.F.R. § 423.773.

Some of the costs covered in full or in part by LIS include the monthly premiums, annual deductible, co-payments, and the coverage gap. Individuals eligible for Medicaid, SSI, or MSP are deemed eligible for full LIS benefitsSee 42 C.F.R. § 423.773(c). LIS applications are treated as (“deemed”) applications for MSP benefits, See the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, Pub. Law 110-275.

II. WHILE THE DAP APPEAL IS PENDING Does your client have health insurance?. If not, why isn’t s/he getting Medicaid, Family Health Plus or Child Health Plus?. There have been many recent changes which expand eligibility and streamline the application process. All/most of your DAP clients should qualify.

Significant changes to Medicaid include. Elimination of the resource test for certain categories of Medicaid applicants/recipients and all applicants to the Family Health Plus program. N.Y. Soc. Serv.

L. §369-ee (2), as amended by L. 2009, c. 58, pt. C, § 59-d.

As of October 1, 2009, a resource test is no longer required for these categories. Elimination of the fingerprinting requirement. N.Y. Soc. Serv.

L. §369-ee, as amended by L. 2009, c. 58, pt. C, § 62.

Elimination of the waiting period for CHPlus. N.Y. Pub. Health L. §2511, as amended by L.

2008, c. 58. Elimination of the face-to-face interview requirement for Medicaid, effective April 1, 2010. N.Y. Soc.

Serv. L. §366-a (1), as amended by L. 2009, c. 58, pt.

C, § 60. Higher income levels for Single Adults and Childless Couples. N.Y. Soc. Serv.

L. §366(1)(a)(1),(8) as amended by L. 2008, c. 58. See also.

GIS 08 MA/022. Higher income levels for Medicaid’s Medically Needy program. N.Y. Soc. Serv.

L. §366(2)(a)(7) as amended by L. 2008, c. 58. See also.

GIS 08 MA/022 More detailed information on recent changes to Medicaid is available at. III. AFTER CLIENT IS AWARDED DAP BENEFITS a. Medicaid eligibility. Clients receiving even $1.00 of SSI should qualify for Medicaid automatically.

The process for qualifying will differ, however, depending on the source of payment. 1. Clients Receiving SSI Only. i. These clients are eligible for full Medicaid without a spend-down.

ii. Medicaid coverage is automatic. No separate application/ recertification required. iii. Most SSI-only recipients are required to participate in Medicaid managed care.

2. Concurrent (SSI/SSD) cases. Eligible for full Medicaid since receiving SSI. See N.Y. Soc.

I. They can still qualify for Medicaid but may have a spend-down. Federal Law allows states to use a “spend-down” to extend Medicaid to “medically needy” persons in the federal mandatory categories (children, caretakers, elderly and disabled people) whose income or resources are above the eligibility level for regular Medicaid. See 42 U.S.C. § 1396 (a) (10) (ii) (XIII).

ii. Under spend-down, applicants in New York’s Medically Needy program can qualify for Medicaid once their income/resources, minus incurred medical expenses, fall below the specified level. For an explanation of spend-down, see 96 ADM 15. B. Family Health Plus Until your client qualifies for Medicare, those over-income for Medicaid may qualify for Family Health Plus without needing to satisfy a spend-down.

It covers adults without children with income up to 100% of the FPL and adults with children up to 150% of the FPL.[1] The eligibility tests are the same as for regular Medicaid with two additional requirements. Applicants must be between the ages of 19 and 64 and they generally must be uninsured. See N.Y. Soc. Serv.

L. § 369-ee et. Seq. Once your client begins to receive Medicare, he or she will not be eligible for FHP, because FHP is generally only available to those without insurance. For more information on FHP see our article on Family Health Plus.

IV. LOOMING ISSUES - MEDICARE ELIGIBILITY (WHETHER YOU LIKE IT OR NOT) a. SSI-only cases Clients receiving only SSI aren’t eligible for Medicare until they turn 65, unless they also have End Stage Renal Disease. B. Concurrent (SSD and SSI) cases 1.

Medicare eligibility kicks in beginning with 25th month of SSD receipt. See 42 U.S.C. § 426(f). Exception. In 2000, Congress eliminated the 24-month waiting period for people diagnosed with ALS (Lou Gehrig’s Disease.) See 42 U.S.C.

§ 426 (h) 2. Enrollment in Medicare is a condition of eligibility for Medicaid coverage. These clients cannot decline Medicare coverage. (05 OMM/ADM 5. Medicaid Reference Guide p.

344.1) 3. Medicare coverage is not free. Although most individuals receive Part A without any premium, Part B has monthly premiums and significant cost-sharing components. 4. Medicaid and/or the Medicare Savings Program (MSP) should pick up most of Medicare’s cost sharing.

Most SSI beneficiaries are eligible not only for full Medicaid, but also for the most comprehensive MSP, the Qualified Medicare Beneficiary (QMB) program. I. Parts A &. B (hospital and outpatient/doctors visits). A.

Medicaid will pick up premiums, deductibles, co-pays. N.Y. Soc. Serv. L.

§ 367-a (3) (a). For those not enrolled in an MSP, SSA normally deducts the Part B premium directly from the monthly check. However, SSI recipients are supposed to be enrolled automatically in QMB, and Medicaid is responsible for covering the premiums. Part B premiums should never be deducted from these clients’ checks.[1] Medicaid and QMB-only recipients should NEVER be billed directly for Part A or B services. Even non-Medicaid providers are supposed to be able to bill Medicaid directly for services.[2] Clients are only responsible for Medicaid co-pay amount.

See 42 U.S.C. § 1396a (n) ii. Part D (prescription drugs). a. Clients enrolled in Medicaid and/or MSP are deemed eligible for Low Income Subsidy (LIS aka Extra Help).

See 42 C.F.R. § 423.773(c). SSA POMS SI § 01715.005A.5. New York State If client doesn’t enroll in Part D plan on his/her own, s/he will be automatically assigned to a benchmark[3] plan. See 42 C.F.R.

§ 423.34 (d). LIS will pick up most of cost-sharing.[3] Because your clients are eligible for full LIS, they should have NO deductible and NO premium if they are in a benchmark plan, and will not be subject to the coverage gap (aka “donut hole”). See 42 C.F.R. §§ 423.780 and 423.782. The full LIS beneficiary will also have co-pays limited to either $1.10 or $3.30 (2010 amounts).

See 42 C.F.R. § 423.104 (d) (5) (A). Other important points to remember. - Medicaid co-pay rules do not apply to Part D drugs. - Your client’s plan may not cover all his/her drugs.

- You can help your clients find the plan that best suits their needs. To figure out what the best Part D plans are best for your particular client, go to www.medicare.gov. Click on “formulary finder” and plug in your client’s medication list. You can enroll in a Part D plan through www.medicare.gov, or by contacting the plan directly. €“ Your clients can switch plans at any time during the year.

Iii. Part C (“Medicare Advantage”). a. Medicare Advantage plans provide traditional Medicare coverage (Parts A and B) through private managed care insurers. See 42 U.S.C.

§ 1395w, 42 C.F.R. Pt. 422. Medicare Advantage participation is voluntary. For those clients enrolled in Medicare Advantage Plans, the QMB cost sharing obligations are the same as they are under traditional Medicare.

Medicaid must cover any premiums required by the plan, up to the Part B premium amount. Medicaid must also cover any co-payments and co-insurance under the plan. As with traditional Medicare, both providers and plans are prohibited from billing the beneficiary directly for these co-payments. C. SSD only individuals.

1. Same Medicare eligibility criteria (24 month waiting period, except for persons w/ ALS). I. During the 24 month waiting period, explore eligibility for Medicaid or Family Health Plus. 2.

Once Medicare eligibility begins. ii. Parts A &. B. SSA will automatically enroll your client.

Part B premiums will be deducted from monthly Social Security benefits. (Part A will be free – no monthly premium) Clients have the right to decline ongoing Part B coverage, BUT this is almost never a good idea, and can cause all sorts of headaches if client ever wants to enroll in Part B in the future. (late enrollment penalty and can’t enroll outside of annual enrollment period, unless person is eligible for Medicare Savings Program – see more below) Clients can decline “retro” Part B coverage with no penalty on the Medicare side – just make sure they don’t actually need the coverage. Risky to decline if they had other coverage during the retro period – their other coverage may require that Medicare be utilized if available. Part A and Part B also have deductibles and co-pays.

Medicaid and/or the MSPs can help cover this cost sharing. iii. Part D. Client must affirmatively enroll in Part D, unless they receive LIS. See 42 U.S.C.

§ 1395w-101 (b) (2), 42 C.F.R. § 423.38 (a). Enrollment is done through individual private plans. LIS recipients will be auto-assigned to a Part D benchmark plan if they have not selected a plan on their own. Client can decline Part D coverage with no penalty if s/he has “comparable coverage.” 42 C.F.R.

§ 423.34 (d) (3) (i). If no comparable coverage, person faces possible late enrollment penalty &. Limited enrollment periods. 42 C.F.R. § 423.46.

However, clients receiving LIS do not incur any late enrollment penalty. 42 C.F.R. § 423.780 (e). Part D has a substantial cost-sharing component – deductibles, premiums and co-pays which vary from plan to plan. There is also the coverage gap, also known as “donut hole,” which can leave beneficiaries picking up 100% of the cost of their drugs until/unless a catastrophic spending limit is reached.

The LIS program can help with Part D cost-sharing. Use Medicare’s website to figure out what plan is best for your client. (Go to www.medicare.gov , click on “formulary finder” and plug in your client’s medication list. ) You can also enroll in a Part D plan directly through www.medicare.gov. Iii.

Help with Medicare cost-sharing a. Medicaid – After eligibility for Medicare starts, client may still be eligible for Medicaid, with or without a spend-down. There are lots of ways to help clients meet their spend-down – including - Medicare cost sharing amounts (deductibles, premiums, co-pays) - over the counter medications if prescribed by a doctor. - expenses paid by state-funded programs like EPIC and ADAP. - medical bills of person’s spouse or child.

- health insurance premiums. - joining a pooled Supplemental Needs Trust (SNT). B. Medicare Savings Program (MSP) – If client is not eligible for Medicaid, explore eligibility for Medicare Savings Program (MSP). MSP pays for Part B premiums and gets you into the Part D LIS.

There are no asset limits in the Medicare Savings Program. One of the MSPs (QMB), also covers all cost sharing for Parts A &. B. If your client is eligible for Medicaid AND MSP, enrolling in MSP may subject him/her to, or increase a spend-down, because Medicaid and the various MSPs have different income eligibility levels. It is the client’s choice as to whether or not to be enrolled into MSP.

C. Part D Low Income Subsidy (LIS) – If your client is not eligible for MSP or Medicaid, s/he may still be eligible for Part D Low Income Subsidy. Applications for LIS are also be treated as applications for MSP, unless the client affirmatively indicates that s/he does not want to apply for MSP. d. Medicare supplemental insurance (Medigap) -- Medigap is supplemental private insurance coverage that covers all or some of the deductibles and coinsurance for Medicare Parts A and B.

Medigap is not available to people enrolled in Part C. E. Medicare Advantage – Medicare Advantage plans “package” Medicare (Part A and B) benefits, with or without Part D coverage, through a private health insurance plan. The cost-sharing structure (deductible, premium, co-pays) varies from plan to plan. For a list of Medicare Advantage plans in your area, go to www.medicare.gov – click on “find health plans.” f.

NY Prescription Saver Card -- NYP$ is a state-sponsored pharmacy discount card that can lower the cost of prescriptions by as much as 60 percent on generics and 30 percent on brand name drugs. Can be used during the Part D “donut hole” (coverage gap) g. For clients living with HIV. ADAP [AIDS Drug Assistance Program] ADAP provides free medications for the treatment of HIV/AIDS and opportunistic s. ADAP can be used to help meet a Medicaid spenddown and get into the Part D Low Income subsidy.

For more information about ADAP, go to V. GETTING MEDICAID IN THE DISABLED CATEGORY AFTER AN SSI/SSDI DENIAL What if your client's application for SSI or SSDI is denied based on SSA's finding that they were not "disabled?. " Obviously, you have your appeals work cut out for you, but in the meantime, what can they do about health insurance?. It is still possible to have Medicaid make a separate disability determination that is not controlled by the unfavorable SSA determination in certain situations. Specifically, an applicant is entitled to a new disability determination where he/she.

alleges a different or additional disabling condition than that considered by SSA in making its determination. Or alleges less than 12 months after the most recent unfavorable SSA disability determination that his/her condition has changed or deteriorated, alleges a new period of disability which meets the duration requirement, and SSA has refused to reopen or reconsider the allegations, or the individual is now ineligible for SSA benefits for a non-medical reason. Or alleges more than 12 months after the most recent unfavorable SSA disability determination that his/her condition has changed or deteriorated since the SSA determination and alleges a new period of disability which meets the duration requirement, and has not applied to SSA regarding these allegations. See GIS 10-MA-014 and 08 OHIP/INF-03.[4] [1] Potential wrinkle – for some clients Medicaid is not automatically pick up cost-sharing. In Monroe County we have had several cases where SSA began deducting Medicare Part B premiums from the checks of clients who were receiving SSI and Medicaid and then qualified for Medicare.

The process should be automatic. Please contact Geoffrey Hale in our Rochester office if you encounter any cases like this. [2]Under terms established to provide benefits for QMBs, a provider agreement necessary for reimbursement “may be executed through the submission of a claim to the Medicaid agency requesting Medicaid payment for Medicare deductibles and coinsurance for QMBs.” CMS State Medicaid Manual, Chapter 3, Eligibility, 3490.14 (b), available at. http://www.cms.hhs.gov/Manuals/PBM/itemdetail.asp?. ItemID=CMS021927.

[3]Benchmark plans are free if you are an LIS recipient. The amount of the benchmark changes from year to year. In 2013, a Part D plan in New York State is considered benchmark if it provides basic Part D coverage and its monthly premium is $43.22 or less. [4] These citations courtesy of Jim Murphy at Legal Services of Central New York. This site provides general information only.

This is not legal advice. You can only obtain legal advice from a lawyer. In addition, your use of this site does not create an attorney-client relationship. To contact a lawyer, visit http://lawhelp.org/ny. We make every effort to keep these materials and links up-to-date and in accordance with New York City, New York state and federal law.

However, we do not guarantee the accuracy of this information..

Maximizing health coverage for DAP clients purchase renova online. Before and after winning the case Outline prepared by Geoffrey Hale and Cathy Roberts - updated August 2012 This outline is intended to assist Disability Advocacy Program (DAP) advocates maximize health insurance coverage for clients they are representing on Social Security/SSI disability determinations. We purchase renova online begin with a discussion of coverage options available while your client’s DAP case is pending and then outline the effect winning the DAP case can have on your client’s access to health care coverage. How your client is affected will vary depending on the source and amount of disability income he or she receives after the successful appeal. I.

BACKGROUND purchase renova online. Public health coverage for your clients will primarily be provided by Medicaid and Medicare. The two programs are structured differently and have different purchase renova online eligibility criteria, but in order to provide the most complete coverage possible for your clients, they must work effectively together. Understanding their interactions is essential to ensuring benefits for your client. Here is a brief overview of the programs we will cover.

A. Medicaid. Medicaid is the public insurance program jointly funded by the federal, state and local governments for people of limited means. For federal Medicaid law, see 42 U.S.C. § 1396 et seq., 42 C.F.R.

§ 430 et seq. Regular Medicaid is described in New York’s State Plan and codified at N.Y. Soc. Serv. L.

§§ 122, 131, 363- 369-1. 18 N.Y.C.R.R. § 360, 505. New York also offers several additional programs to provide health care benefits to those whose income might be too high for Regular Medicaid. i.

Family Health Plus (FHPlus) is an extension of New York’s Medicaid program that provides health coverage for adults who are over-income for regular Medicaid. FHPlus is described in New York’s 1115 waiver and codified at N.Y. Soc. Serv. L.

§369-ee. ii. Child Health Plus (CHPlus) is a sliding scale premium program for children who are over-income for regular Medicaid. CHPlus is codified at N.Y. Pub.

Health L. §2510 et seq. b. Medicare. Medicare is the federal health insurance program providing coverage for the elderly, disabled, and people with end-stage renal disease.

Medicare is codified under title XVIII of the Social Security Law, see 42 U.S.C. § 1395 et seq., 42 C.F.R. § 400 et seq. Medicare is divided into four parts. i.

Part A covers hospital, skilled nursing facility, home health, and hospice care, with some deductibles and coinsurance. Most people are eligible for Part A at no cost. See 42 U.S.C. § 1395c, 42 C.F.R. Pt.

406. ii. Part B provides medical insurance for doctor’s visits and other outpatient medical services. Medicare Part B has significant cost-sharing components. There are monthly premiums (the standard premium in 2012 is $99.90.

In addition, there is a $135 annual deductible (which will increase to $155 in 2010) as well as 20% co-insurance for most covered out-patient services. See 42 U.S.C. § 1395k, 42 C.F.R. Pt. 407.

iii. Part C, also called Medicare Advantage, provides traditional Medicare coverage (Parts A and B) through private managed care insurers. See 42 U.S.C. § 1395w, 42 C.F.R. Pt.

422. Premium amounts for Medicare Advantage plans vary. Some Medicare Advantage plans include prescription drug coverage. iv. Part D is an optional prescription drug benefit available to anyone with Medicare Parts A and B.

See 42 U.S.C. § 1395w, 42 C.F.R. § 423.30(a)(1)(i) and (ii). Unlike Parts A and B, Part D benefits are provided directly through private plans offered by insurance companies. In order to receive prescription drug coverage, a Medicare beneficiary must join a Part D Plan or participate in a Medicare Advantage plan that provides prescription drug coverage.

C. Medicare Savings Programs (MSPs). Funded by the State Medicaid program, MSPs help eligible individuals meet some or all of their cost-sharing obligations under Medicare. See N.Y. Soc.

Serv. L. § 367-a(3)(a), (b), and (d). There are three separate MSPs, each with different eligibility requirements and providing different benefits. i.

Qualified Medicare Beneficiary (QMB). The QMB program provides the most comprehensive benefits. Available to those with incomes at or below 100% of the Federal Poverty Level (FPL), the QMB program covers virtually all Medicare cost-sharing obligations. Part B premiums, Part A premiums, if there are any, and any and all deductibles and co-insurance. ii.

Special Low-Income Medicare Beneficiary (SLMB). For those with incomes between 100% and 120% FPL, the SLMB program will cover Part B premiums only. iii. Qualified Individual (QI-1). For those with incomes between 120% and 135% FPL, but not otherwise Medicaid eligible, the QI-1 program covers Medicare Part B premiums.

D. Medicare Part D Low Income Subsidy (LIS or “Extra Help”). LIS is a federal subsidy administered by CMS that helps Medicare beneficiaries with limited income and/or resources pay for some or most of the costs of Medicare prescription drug coverage. See 42 C.F.R. § 423.773.

Some of the costs covered in full or in part by LIS include the monthly premiums, annual deductible, co-payments, and the coverage gap. Individuals eligible for Medicaid, SSI, or MSP are deemed eligible for full LIS benefitsSee 42 C.F.R. § 423.773(c). LIS applications are treated as (“deemed”) applications for MSP benefits, See the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, Pub. Law 110-275.

II. WHILE THE DAP APPEAL IS PENDING Does your client have health insurance?. If not, why isn’t s/he getting Medicaid, Family Health Plus or Child Health Plus?. There have been many recent changes which expand eligibility and streamline the application process. All/most of your DAP clients should qualify.

Significant changes to Medicaid include. Elimination of the resource test for certain categories of Medicaid applicants/recipients and all applicants to the Family Health Plus program. N.Y. Soc. Serv.

L. §369-ee (2), as amended by L. 2009, c. 58, pt. C, § 59-d.

As of October 1, 2009, a resource test is no longer required for these categories. Elimination of the fingerprinting requirement. N.Y. Soc. Serv.

L. §369-ee, as amended by L. 2009, c. 58, pt. C, § 62.

Elimination of the waiting period for CHPlus. N.Y. Pub. Health L. §2511, as amended by L.

2008, c. 58. Elimination of the face-to-face interview requirement for Medicaid, effective April 1, 2010. N.Y. Soc.

Serv. L. §366-a (1), as amended by L. 2009, c. 58, pt.

C, § 60. Higher income levels for Single Adults and Childless Couples. N.Y. Soc. Serv.

L. §366(1)(a)(1),(8) as amended by L. 2008, c. 58. See also.

GIS 08 MA/022. Higher income levels for Medicaid’s Medically Needy program. N.Y. Soc. Serv.

L. §366(2)(a)(7) as amended by L. 2008, c. 58. See also.

GIS 08 MA/022 More detailed information on recent changes to Medicaid is available at. III. AFTER CLIENT IS AWARDED DAP BENEFITS a. Medicaid eligibility. Clients receiving even $1.00 of SSI should qualify for Medicaid automatically.

The process for qualifying will differ, however, depending on the source of payment. 1. Clients Receiving SSI Only. i. These clients are eligible for full Medicaid without a spend-down.

ii. Medicaid coverage is automatic. No separate application/ recertification required. iii. Most SSI-only recipients are required to participate in Medicaid managed care.

2. Concurrent (SSI/SSD) cases. Eligible for full Medicaid since receiving SSI. See N.Y. Soc.

I. They can still qualify for Medicaid but may have a spend-down. Federal Law allows states to use a “spend-down” to extend Medicaid to “medically needy” persons in the federal mandatory categories (children, caretakers, elderly and disabled people) whose income or resources are above the eligibility level for regular Medicaid. See 42 U.S.C. § 1396 (a) (10) (ii) (XIII).

ii. Under spend-down, applicants in New York’s Medically Needy program can qualify for Medicaid once their income/resources, minus incurred medical expenses, fall below the specified level. For an explanation of spend-down, see 96 ADM 15. B. Family Health Plus Until your client qualifies for Medicare, those over-income for Medicaid may qualify for Family Health Plus without needing to satisfy a spend-down.

It covers adults without children with income up to 100% of the FPL and adults with children up to 150% of the FPL.[1] The eligibility tests are the same as for regular Medicaid with two additional requirements. Applicants must be between the ages of 19 and 64 and they generally must be uninsured. See N.Y. Soc. Serv.

L. § 369-ee et. Seq. Once your client begins to receive Medicare, he or she will not be eligible for FHP, because FHP is generally only available to those without insurance. For more information on FHP see our article on Family Health Plus.

IV. LOOMING ISSUES - MEDICARE ELIGIBILITY (WHETHER YOU LIKE IT OR NOT) a. SSI-only cases Clients receiving only SSI aren’t eligible for Medicare until they turn 65, unless they also have End Stage Renal Disease. B. Concurrent (SSD and SSI) cases 1.

Medicare eligibility kicks in beginning with 25th month of SSD receipt. See 42 U.S.C. § 426(f). Exception. In 2000, Congress eliminated the 24-month waiting period for people diagnosed with ALS (Lou Gehrig’s Disease.) See 42 U.S.C.

§ 426 (h) 2. Enrollment in Medicare is a condition of eligibility for Medicaid coverage. These clients cannot decline Medicare coverage. (05 OMM/ADM 5. Medicaid Reference Guide p.

344.1) 3. Medicare coverage is not free. Although most individuals receive Part A without any premium, Part B has monthly premiums and significant cost-sharing components. 4. Medicaid and/or the Medicare Savings Program (MSP) should pick up most of Medicare’s cost sharing.

Most SSI beneficiaries are eligible not only for full Medicaid, but also for the most comprehensive MSP, the Qualified Medicare Beneficiary (QMB) program. I. Parts A &. B (hospital and outpatient/doctors visits). A.

Medicaid will pick up premiums, deductibles, co-pays. N.Y. Soc. Serv. L.

§ 367-a (3) (a). For those not enrolled in an MSP, SSA normally deducts the Part B premium directly from the monthly check. However, SSI recipients are supposed to be enrolled automatically in QMB, and Medicaid is responsible for covering the premiums. Part B premiums should never be deducted from these clients’ checks.[1] Medicaid and QMB-only recipients should NEVER be billed directly for Part A or B services. Even non-Medicaid providers are supposed to be able to bill Medicaid directly for services.[2] Clients are only responsible for Medicaid co-pay amount.

See 42 U.S.C. § 1396a (n) ii. Part D (prescription drugs). a. Clients enrolled in Medicaid and/or MSP are deemed eligible for Low Income Subsidy (LIS aka Extra Help).

See 42 C.F.R. § 423.773(c). SSA POMS SI § 01715.005A.5. New York State If client doesn’t enroll in Part D plan on his/her own, s/he will be automatically assigned to a benchmark[3] plan. See 42 C.F.R.

§ 423.34 (d). LIS will pick up most of cost-sharing.[3] Because your clients are eligible for full LIS, they should have NO deductible and NO premium if they are in a benchmark plan, and will not be subject to the coverage gap (aka “donut hole”). See 42 C.F.R. §§ 423.780 and 423.782. The full LIS beneficiary will also have co-pays limited to either $1.10 or $3.30 (2010 amounts).

See 42 C.F.R. § 423.104 (d) (5) (A). Other important points to remember. - Medicaid co-pay rules do not apply to Part D drugs. - Your client’s plan may not cover all his/her drugs.

- You can help your clients find the plan that best suits their needs. To figure out what the best Part D plans are best for your particular client, go to www.medicare.gov. Click on “formulary finder” and plug in your client’s medication list. You can enroll in a Part D plan through www.medicare.gov, or by contacting the plan directly. €“ Your clients can switch plans at any time during the year.

Iii. Part C (“Medicare Advantage”). a. Medicare Advantage plans provide traditional Medicare coverage (Parts A and B) through private managed care insurers. See 42 U.S.C.

§ 1395w, 42 C.F.R. Pt. 422. Medicare Advantage participation is voluntary. For those clients enrolled in Medicare Advantage Plans, the QMB cost sharing obligations are the same as they are under traditional Medicare.

Medicaid must cover any premiums required by the plan, up to the Part B premium amount. Medicaid must also cover any co-payments and co-insurance under the plan. As with traditional Medicare, both providers and plans are prohibited from billing the beneficiary directly for these co-payments. C. SSD only individuals.

1. Same Medicare eligibility criteria (24 month waiting period, except for persons w/ ALS). I. During the 24 month waiting period, explore eligibility for Medicaid or Family Health Plus. 2.

Once Medicare eligibility begins. ii. Parts A &. B. SSA will automatically enroll your client.

Part B premiums will be deducted from monthly Social Security benefits. (Part A will be free – no monthly premium) Clients have the right to decline ongoing Part B coverage, BUT this is almost never a good idea, and can cause all sorts of headaches if client ever wants to enroll in Part B in the future. (late enrollment penalty and can’t enroll outside of annual enrollment period, unless person is eligible for Medicare Savings Program – see more below) Clients can decline “retro” Part B coverage with no penalty on the Medicare side – just make sure they don’t actually need the coverage. Risky to decline if they had other coverage during the retro period – their other coverage may require that Medicare be utilized if available. Part A and Part B also have deductibles and co-pays.

Medicaid and/or the MSPs can help cover this cost sharing. iii. Part D. Client must affirmatively enroll in Part D, unless they receive LIS. See 42 U.S.C.

§ 1395w-101 (b) (2), 42 C.F.R. § 423.38 (a). Enrollment is done through individual private plans. LIS recipients will be auto-assigned to a Part D benchmark plan if they have not selected a plan on their own. Client can decline Part D coverage with no penalty if s/he has “comparable coverage.” 42 C.F.R.

§ 423.34 (d) (3) (i). If no comparable coverage, person faces possible late enrollment penalty &. Limited enrollment periods. 42 C.F.R. § 423.46.

However, clients receiving LIS do not incur any late enrollment penalty. 42 C.F.R. § 423.780 (e). Part D has a substantial cost-sharing component – deductibles, premiums and co-pays which vary from plan to plan. There is also the coverage gap, also known as “donut hole,” which can leave beneficiaries picking up 100% of the cost of their drugs until/unless a catastrophic spending limit is reached.

The LIS program can help with Part D cost-sharing. Use Medicare’s website to figure out what plan is best for your client. (Go to www.medicare.gov , click on “formulary finder” and plug in your client’s medication list. ) You can also enroll in a Part D plan directly through www.medicare.gov. Iii.

Help with Medicare cost-sharing a. Medicaid – After eligibility for Medicare starts, client may still be eligible for Medicaid, with or without a spend-down. There are lots of ways to help clients meet their spend-down – including - Medicare cost sharing amounts (deductibles, premiums, co-pays) - over the counter medications if prescribed by a doctor. - expenses paid by state-funded programs like EPIC and ADAP. - medical bills of person’s spouse or child.

- health insurance premiums. - joining a pooled Supplemental Needs Trust (SNT). B. Medicare Savings Program (MSP) – If client is not eligible for Medicaid, explore eligibility for Medicare Savings Program (MSP). MSP pays for Part B premiums and gets you into the Part D LIS.

There are no asset limits in the Medicare Savings Program. One of the MSPs (QMB), also covers all cost sharing for Parts A &. B. If your client is eligible for Medicaid AND MSP, enrolling in MSP may subject him/her to, or increase a spend-down, because Medicaid and the various MSPs have different income eligibility levels. It is the client’s choice as to whether or not to be enrolled into MSP.

C. Part D Low Income Subsidy (LIS) – If your client is not eligible for MSP or Medicaid, s/he may still be eligible for Part D Low Income Subsidy. Applications for LIS are also be treated as applications for MSP, unless the client affirmatively indicates that s/he does not want to apply for MSP. d. Medicare supplemental insurance (Medigap) -- Medigap is supplemental private insurance coverage that covers all or some of the deductibles and coinsurance for Medicare Parts A and B.

Medigap is not available to people enrolled in Part C. E. Medicare Advantage – Medicare Advantage plans “package” Medicare (Part A and B) benefits, with or without Part D coverage, through a private health insurance plan. The cost-sharing structure (deductible, premium, co-pays) varies from plan to plan. For a list of Medicare Advantage plans in your area, go to www.medicare.gov – click on “find health plans.” f.

NY Prescription Saver Card -- NYP$ is a state-sponsored pharmacy discount card that can lower the cost of prescriptions by as much as 60 percent on generics and 30 percent on brand name drugs. Can be used during the Part D “donut hole” (coverage gap) g. For clients living with HIV. ADAP [AIDS Drug Assistance Program] ADAP provides free medications for the treatment of HIV/AIDS and opportunistic s. ADAP can be used to help meet a Medicaid spenddown and get into the Part D Low Income subsidy.

For more information about ADAP, go to V. GETTING MEDICAID IN THE DISABLED CATEGORY AFTER AN SSI/SSDI DENIAL What if your client's application for SSI or SSDI is denied based on SSA's finding that they were not "disabled?. " Obviously, you have your appeals work cut out for you, but in the meantime, what can they do about health insurance?. It is still possible to have Medicaid make a separate disability determination that is not controlled by the unfavorable SSA determination in certain situations. Specifically, an applicant is entitled to a new disability determination where he/she.

alleges a different or additional disabling condition than that considered by SSA in making its determination. Or alleges less than 12 months after the most recent unfavorable SSA disability determination that his/her condition has changed or deteriorated, alleges a new period of disability which meets the duration requirement, and SSA has refused to reopen or reconsider the allegations, or the individual is now ineligible for SSA benefits for a non-medical reason. Or alleges more than 12 months after the most recent unfavorable SSA disability determination that his/her condition has changed or deteriorated since the SSA determination and alleges a new period of disability which meets the duration requirement, and has not applied to SSA regarding these allegations. See GIS 10-MA-014 and 08 OHIP/INF-03.[4] [1] Potential wrinkle – for some clients Medicaid is not automatically pick up cost-sharing. In Monroe County we have had several cases where SSA began deducting Medicare Part B premiums from the checks of clients who were receiving SSI and Medicaid and then qualified for Medicare.

The process should be automatic. Please contact Geoffrey Hale in our Rochester office if you encounter any cases like this. [2]Under terms established to provide benefits for QMBs, a provider agreement necessary for reimbursement “may be executed through the submission of a claim to the Medicaid agency requesting Medicaid payment for Medicare deductibles and coinsurance for QMBs.” CMS State Medicaid Manual, Chapter 3, Eligibility, 3490.14 (b), available at. http://www.cms.hhs.gov/Manuals/PBM/itemdetail.asp?. ItemID=CMS021927.

[3]Benchmark plans are free if you are an LIS recipient. The amount of the benchmark changes from year to year. In 2013, a Part D plan in New York State is considered benchmark if it provides basic Part D coverage and its monthly premium is $43.22 or less. [4] These citations courtesy of Jim Murphy at Legal Services of Central New York. This site provides general information only.

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