Click on the 'Listen' button above to hear this interview.

Yesterday in Chicago, Vice President Joe Biden spoke to one of the largest annual meetings of cancer researchers in the world, and he urged them to work together.

"You're spending hundreds of millions of dollars. Imagine, imagine if it was coordinated,” the vice president said.

That is the mission that President Obama gave the vice president in January, when he announced the cancer "moonshot." Biden was in Chicago to promote a new database of genomic and clinical cancer patient data that will allow researchers to access more data than ever before. The hope is to identify patterns in how patients with different cancers respond to treatments to tailor future interventions more precisely.

But whether it is cancer or heart disease, a stroke or diabetes, the greatest risk factor for the developed world's most deadly diseases is age. So researchers like Matt Kaeberlein, who is co-director of the University of Washington's Nathan Shock Center of Excellence in the Basic Biology of Aging, are trying to slow down the aging process itself.

Here, The Takeaway speaks to Dr. Kaeberlein about his recent study that found certain drugs delayed aging in lab animals.

86-year-old Joy Bergman is struggling to keep her life under control. She’s single-handedly caring for her husband who’s suffering from Alzheimer’s – plus she’s trying to hang onto her job as a museum conservator despite her bewilderment with modern technology – and, above all, she’s hiding the severity of her problems so that her adult children won’t worry about her – or worse – try to take control. Joy is the heroine of the 10th novel by Cathleen Schine, They May Not Mean To, But They Do. 

Event: Cathleen Schine will be giving a reading at the Barnes and Nobles, Upper West Side (82nd & Broadway) at 7:00 p.m. She will also be in conversation with Meg Wolitzer.

Aging has evolved over millions of years to prevent an ecological crisis. In Cracking the Aging Code: The New Science of Growing Old-And What It Means for Staying Young  theoretical biologist Josh Mitteldorf reveals the newly discovered complexity behind evolution and aging, and why aging and death are crucial to the survival of the human race.

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JUDY WOODRUFF: The American middle class is shrinking and struggling. The six-year-long economic recovery is showing some signs of slowing. And the pronounced wealth divide in the U.S. may get worse without bigger steps.

That warning was part of a new report issued today about the U.S. economy by the International Monetary Fund.

I sat down with its managing director, Christine Lagarde, at IMF headquarters here in Washington earlier today to hear more of her concerns about what’s happening to the middle class and the poor, and what could be done about it.

Managing Director Christine Lagarde, thank you for talking with us.

CHRISTINE LAGARDE, Managing Director, International Monetary Fund: Pleasure.

JUDY WOODRUFF: So, this latest report from the IMF looks at the American economy, says it is in good shape overall, shows resiliency, but then it goes on to point out a number of factors that provide concern for the future.

And one of them has to do with the shrinkage of the American middle class. What do you and your colleagues see, and what concerns you?

CHRISTINE LAGARDE: We are seeing a shrinking of the middle class.

If you look at the size of the middle class in 1975, it was roughly 60 percent of total population. If you look at the middle class today, it is about 50 percent. So, that’s a significant decline of the middle class. And it is an economic issue, because the middle class has always been the consumption force of this nation.

The upper class doesn’t spend as much. The lower class doesn’t have as much to spend. So, the maximum impact in terms of consumption is generated by the middle class.

JUDY WOODRUFF: What’s happening here? You also write in the report your concern about the so-called labor force participation rate, the number of people who are actually working.

And we know that there is concern about the number of men and women who are able to find a job. What do you see there?

CHRISTINE LAGARDE: What we are seeing is something that affects us all, which is aging.

The U.S. population is aging, like in other economies of the world, and, as a result, the participation of active workers in the economy is declining. Now, we cannot stop the course of time, but what policies can do is encourage people who are not joining the workplace, the job market, to actually do so.

And I would point to a couple of policies. One is support given to women. And, by that, I mean maternity leave policy that would help them face the decision of, do I stay or do I go? Second, child care support, and not just child actually, but the kind of support that would help families look after a child or look after an elderly, because, with aging, we will have to support more parents or grandparents.

JUDY WOODRUFF: And you’re describing a real squeeze on the middle class in this country.

CHRISTINE LAGARDE: Yes, there is that squeeze. And that’s where you head in the directions of people feeling insecure, people not wanting to move from one job to the other, people not spending as much as they would otherwise do.

Those behaviors, those decisions have an economic impact on our growth.

JUDY WOODRUFF: Help us understand, what’s the connection with the overall economy?

CHRISTINE LAGARDE: Well, the major engine for growth in this country and in quite a few advanced economies as well is typically consumption.

When the U.S. consumer consumes, there is demand, more demand, and, therefore, the U.S. manufacturers must manufacture more. If they have to manufacture more, they have to create more jobs. It’s a fairly simple virtuous circle that is generally initiated by consumption.

JUDY WOODRUFF: A number of remedies you lay out would cost money. They would require action by the Congress at a time when this country is very politically polarized. How realistic do you think your recommendations are at a time like this?

CHRISTINE LAGARDE: I see one area where there is some agreement.

And that’s on the Earned Income Tax Credit, which, if combined with the minimum wage increase, would certainly bring people up and would boost consumption. So, on the Earned Income Tax Credit, there seems to be common ground.

I hope we can find many of those small-ticket items which will push the envelope further and increase growth in the U.S.

JUDY WOODRUFF: And if these remedies that you lay out are not enacted, what’s your concern for the future of the economy?

CHRISTINE LAGARDE: You know, if those issues such as low participation in the labor force, increased poverty, reduced productivity and polarization in terms of income are not addressed, then the U.S. economy will face what I have called this new mediocre, where potential growth is lower, there is growth, there is a degree of recovery, but not sufficiently to bring people out of those poverty levels that we talked about, not enough to increase the middle class, and not enough to address the unemployment of those who are still looking for jobs.

But those forces, poverty, participation, productivity, and polarization of income, are there to stay unless they are addressed.

JUDY WOODRUFF: Finally, a different question.

Voters go to the polls tomorrow in Great Britain to say one way or another whether their country should leave the European Union. You have been clear. You have made public statements about how you think this, if it happens, would be harmful to Great Britain, to other parts of the world.

How do you see the effect on the United States if there is a vote to leave, Brexit, to leave the European Union?

CHRISTINE LAGARDE: Well, if the U.K. decided to leave the European Union, there would be some effect on the U.S. economy. How big that effect would be, difficult to say.

There are two channels of communication of uncertainty and lack of demand. One is through trade, less trade between the U.S. and the U.K. most likely. But it’s not a huge volume. So that impact would be relatively low.

However, on the financial front, because of the role played by London as a financial center, because of the potential impact on volatility, on the anxiety of people who then sort of fly to — fly their money to safe havens, then there could be a significant impact on the U.S. economy.

JUDY WOODRUFF: So, Americans should be watching closely?

CHRISTINE LAGARDE: I think we should all be watching closely, yes. And I hope the right decision is made, but it’s for the U.K. people to decide.

JUDY WOODRUFF: Christine Lagarde, the managing director of the IMF, thank you very much.

CHRISTINE LAGARDE: Thank you, Judy.

The post Sobering IMF report on U.S. economy cites dwindling middle class, growing income equality appeared first on PBS NewsHour.

Medicare is prevented by law from negotiating with drug companies over their prices. In recent years, the price tag for people who must take expensive new drugs has risen at an alarming rate, writes aging expert Phil Moeller. Credit: Flickr user ep_jhu

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need in “Ask Phil.” Send your questions to Phil.

Marcy – Ill.: Is there anything I can do about prohibitively expensive medications I will need to take for the rest of my life?  I take three medicines with no generic alternative. My doctor told me that they were “covered” by Medicare. Now, I’ve come to find out that even on the most comprehensive and expensive drug plans, I will pay more than $1,000 a month just for the drugs, not for the premiums or any other Medicare expenses. I have some resources, but this will deplete them in a few years.  I am not poor enough to qualify for assistance, but soon will be. I know now I should have done more research on what my doctor told me and perhaps worked until I died or was fired, so I could stay on employer insurance, but that bridge is burned, and I surely will never get another job with benefits. Is there any relief for astronomical drug costs?

Phil Moeller: Marcy, I’m so sorry to learn that you have been victim of another of Medicare’s major gotchas. Medicare is prevented by law from negotiating with drug companies over their prices. This was a pro-business feature of the 2003 law that created Medicare’s Part D prescription drug insurance program. We have been paying for it ever since, and the price tag has risen at an alarming rate in recent years for people who must take expensive new drugs. Miracles or not, they can devastate personal and family finances. Even the prices of some generics have soared.

READ MORE: Medicare’s catastrophic drug insurance can be a catastrophe for consumers

Having said this, I wonder if you’ve factored in the effect of Part D’s coverage of drugs in the so-called “catastrophic” tier of the program? Once you and your Medicare insurer have paid a total of $3,310 for drugs this year, you will enter the so-called donut hole and will need to shoulder a greater share of drug expenses until your out-of-pocket spending has hit $4,850. At this point, you will have entered the catastrophic tier of your coverage. In this tier, you need to pay only a few dollars for each prescription or 5 percent, whichever amount is greater. Now, 5 percent of a big number can still be a hefty amount. But I doubt that it will total $1,000 a month.

If you need help calculating your Part D costs, get in touch with the State Health Insurance Assistance Program or the Medicare Rights Center. Please let me know how things turn out. If your costs are still going to average $1,000 a month, there may be some other private prescription support programs available to you. Let me know, and I’ll provide information about them.

Mary – Ill.: I am turning 66 in August. Several months after I turned 65, I discovered I “had to” file for Medicare Part A at age 65. So I did about six months after I turned 65. But since I was still working and had no plans to retire until I was 66, I continued my health savings account contributions. Now, I find out what I did was illegal, and I am liable for tax fines on the HSA contributions. Our human resources manager never mentioned this conflict, which annoys me. Can I rescind this or fix it? I have since retired, two months prior to reaching my full retirement age of 66. But I have not filed for Social Security or any other part of Medicare. If I can’t rescind or fix this, can my penalty only be for the months after I filed and not retroactive to August 2015? I read you can withdraw from Part A, but also read that that could jeopardize my Medicare and benefits for life. HELP!

Phil Moeller: Mary, you have been ensnared in a nasty Medicare gotcha. First off, there was no requirement that you file for Part A when you turned 65. Whoever told you this was wrong. So long as you have active health insurance from your employer, you did not have to file for any part of Medicare at age 65 (or at any older age, for that matter). Now, I advise folks without an HSA that getting Part A at 65 is a good idea. Anyone with enough earnings to qualify for Social Security (either directly or as a spouse or even former spouse of a qualified person) can get Part A without paying any premium. Should they need hospital care, which is what Part A covers, some expenses their private health insurance does not fully cover can be picked up by Part A. It thus can help and should never cost the person more money than not having the coverage.

However, as prior Ask Phil pieces have explained, having Part A is regarded as being on Medicare, and folks on Medicare are disqualified from participating in a tax-favored HSA plan. Continuing to make such contributions is, as you note, not only disallowed, but can also expose you to tax penalties. In fact, in a rule only a crystal ball seer could love, you must stop such contributions six months before your HSA eligibility expires!

In theory, you could rescind your Part A election and continue participating in the HSA. But since you have retired, I fear getting the timing right would be a nightmare. You would need to suspend Part A up to but no later than your effective Medicare coverage date. You have several months to enroll in Medicare following your retirement and the end of your employer health insurance. But timing this too closely risks having no health insurance at all for a short period, so I think people should enroll in Medicare as soon as they need to and not risk exposing themselves to an uninsured health event.

READ MORE: Should you stay on your employer health insurance or get Medicare?

I’d call a Medicare counselor, at the State Health Insurance Assistance Program or the Medicare Rights Center. See if someone can help you. However, while I believe you have the right to avoid an IRS penalty here, I’m afraid that in the real world you might be better off just paying the penalty and moving on. I know. I’m never supposed to admit defeat and should always argue that consumers need to stand up for their rights. Sadly, you are dealing with Social Security, Medicare and the IRS here. Don Quixote’s task was simple by comparison. Good luck, and please let me know how you fare.

Anonymous – Fla.: I live on my Social Security retirement income and am now getting $555 a month. That’s the only income I have. My medical coverage now is through the city of Jacksonville, since I live below the poverty level. I get Medicare next year when I reach 65. Will I have to pay anything out of my Social Security payments to Medicare?

Phil Moeller: You should call a SHIP counselor in Florida and find out how Medicare’s lower-income support programs for your area compare with the help you now get from Jacksonville. My first take is that you should not have to pay for Medicare if your only income is that monthly $555 Social Security payment. But you are smart to plan ahead, and counselors should be able to help you.

Sue – Pa.: I am 64 and will be 65 in January. My husband carries medical insurance for us through his work. My husband is 62. Do I have to sign up for Medicare? Would it be advantageous to do so? How would I sign up if I had to? Thank you. This is all very confusing.  My home mailbox is always getting Medicare notices.

Phil Moeller: Yes, it certainly can be confusing. When a friend of mine was nearing his 65th birthday, his mail from Medicare insurers literally filed up a grocery bag! Look at my answer above to Mary’s question. You need not sign up for Medicare at 65 if you’re still covered by your husband’s health plan. But you might want to get premium-free Part A of Medicare if his health plan does not include a health savings account.

FOLLOWING UP

Nancy – N.J.: I am a New Jersey SHIP (State Health Insurance Assistance Program) counselor and have encountered basically the same problem as the person you wrote about in “Getting trapped in the regulatory morass of Social Security and Medicare.” Our client collected on her ex-husband’s Social Security record. She switched to her own retirement benefit at age 70 and encountered a changed Medicare number, just as in your earlier example. Usually, Medicare will see both numbers, and there will be no problem. But in this case, Social Security somehow cancelled her previous Medicare coverage. Her Medicare Advantage plan thus has been cancelled and this insurer is trying to recover earlier insured payments that it made to providers. She has been working to solve this mistake for nearly five months, including communications with her Medicare Advantage plan, Medicare, the Social Security Administration and her U.S. senator’s office. They say it will be a while longer before matters can be addressed. I am told only the Social Security Administration can fix this and not Medicare. As a SHIP counselor, I have no standing with the Social Security Administration. Your earlier column asked readers to stay tuned for the next chapter of this situation, so I am staying tuned and wonder if you have any solution or ideas?

READ MORE: Getting trapped in the regulatory morass of Social Security and Medicare

Phil Moeller: Nancy is among an understandably large percentage of the human race that does not read and memorize every word that I write. Imagine that! As it turns out, I did provide an update to this situation in a later column. While I do love to drive up my online traffic numbers, I will save Nancy the trouble of searching for this item, which is reproduced here:

I wrote about a financial adviser whose client and her husband had run afoul of both Social Security and Medicare. The government linked their Social Security numbers and the woman’s effort to file and suspend her Social Security somehow led to her losing her Medicare coverage! As the old Ripley’s “Believe It or Not” stories used to say, we can’t make this stuff up, folks.

Her adviser reports that the women’s situation is being straightened out, but that she is still exposed to nearly a month-long period when she will have no Medicare. Let’s pray she remains in good health until her insurance coverage resumes. In the meantime, a Social Security spokeswoman reports that it is not uncommon for two spouses’ Social Security numbers to become linked. Here is what she writes:

In your message, you state that her Medicare is now under her spouse’s Social Security number (SSN). I can confirm this change occurs when a Medicare only entitlement on a SSN converts to a monthly benefit entitlement on a different SSN. However, the start date of entitlement to the Medicare coverage on the old record does not change when it converts to the new SSN.

Additionally, a new health insurance card is issued when an individual status changes. For the card issuance policy and corroboration, see HI 00901.045: Health Insurance Card – Policy and HI 00901.065: Health Insurance Card Issuance.

I include this explanation in full, because A) Social Security has on occasion quibbled with how its comments are translated, and B) you need to see how clearly the agency explains its own rules.

Of course, this response may not help Nancy or her client. So, I will send this item to the Social Security Administration, along with Nancy’s email address, with a request to please expedite this matter. Nancy, if you hear back from these folks, please let me know how things went for your client.

AND YET ANOTHER REQUEST FOR INFORMED GOVERNANCE

The aforementioned SHIP program appears to have once again dodged a wrongheaded effort to kill its $52 million in annual federal spending support. Perhaps SHIP was inadvertently caught in the fiscal crosshairs of conservative lawmakers after bigger game. Whatever its real or perceived sins, however, the program’s retention and even expansion is needed by those older and disabled Americans who must navigate Medicare and its endless gauntlet of complex if not unfathomable rules. SHIP’s funding supports a largely volunteer counseling program that millions of Medicare beneficiaries turn to, often as a last resort, for problems they cannot solve on their own. For now, the program’s annual appropriation appears secure.

I urge and implore congressional leaders to give serious thought to this question: How much healthier and financially better off would the nation be if consumers were more informed about Medicare and equipped with the tools to make better decisions about how to purchase and use it?

The post Is there any relief for astronomical drug costs? appeared first on PBS NewsHour.

Photo by Shannon Stapleton/Reuters

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need in “Ask Phil.” Send your questions to Phil.

Lauren – Mass.: For the past three years my income has been $30,000. We have a small cottage that we want to sell. We bought it for $135,000, and we’re selling for $230,000 with a capital gain of $20,000. My husband is not on the deed. I will be 64 in October. What happens to my Medicare benefit?

Phil Moeller: Regardless of changes in your future taxable income, nothing would happen to your Medicare benefit. However, it could be another matter when it comes to how much you pay for that benefit. People who must pay Medicare’s premiums for Part B and Part D — and nearly everyone on Medicare does — face high-income surcharges under what’s called the program’s income-related monthly adjustment amount, also known as IRMAA. The surcharges begin kicking in when a couple’s modified adjusted gross income, or MAGI, exceeds $170,000 a year ($85,000 for a single person). There’s a two-year lag between when you earn the money and when it will affect IRMAA charges. Premiums in 2016, for example, are based on 2014 tax returns. If you file for Medicare when you turn 65 in late 2017, for example, your premiums would be based on your 2015 tax return. Now, it doesn’t appear that your home sale would boost your MAGI enough to trigger these surcharges. But if it did, it would not show up until your 2016 tax return, meaning it would not affect your Medicare premiums until 2018. But as I said, it doesn’t look like your taxable income would jump enough to trigger the surcharges for even a single year.

Jackie – S.C.: I have power of attorney for a person whose nursing home bill is $1,350 per month, with medicine costs of another $175. He only draws $1,338 per month in retirement income. He had additional savings that helped cover costs, but those funds are gone and now he faces eviction. Is there anything we can do to help cover his medicine costs?

Phil Moeller: Yes. I am assuming he is dually eligible for Medicaid and Medicare, because your note did not mention anything about Medicare premiums. Medicaid should help with these drug expenses. However, the income figure you provided may be net of his Medicare premiums. If so, Medicare’s Extra Help program might defray some or even all of the costs of his medications. Call a Medicare counselor with the State Health Insurance Assistance Program in South Carolina, and see what can be done.

Wayne – Wash.: I am age 69 and have Medicare Part A coverage. I thought I could cancel Medicare Part A and legally enroll in my employer’s health savings account program, but I found out I could not unenroll in Part A. The HSA started in 2016. My last contribution was in Apr 2016:

Year to date contribution is $6,696.09.

Year to date distribution is $5,294.33.

Current fair market value of the account is $1,402.29.

My question is how do I “zero” out the account? The HSA has suggested the following: I send them $5,294.33 to cover the distributions and do a withdrawal of $6,696.62 ($5,294.33 + $1,402.29). This will in effect set the account to $0.00 and “close” the account.

The other option I can envision is to withdraw the unspent amount of $1,402.29 (which will close the account) and then just pay the taxes and penalties on the contribution of $6,696.09.

Phil Moeller: I don’t know why you can’t unenroll from Part A. Unless you are already receiving Social Security payments, you can unenroll. However, I’ll assume your reasons are valid.

As for the HSA itself, I see no reason why you should repay all the money that’s been distributed from the plan. Most of these dollars came from you, didn’t they? In my view — and I am not claiming to be an expert here — the only dollars you would need to repay would be the ones the company contributed on your behalf. You would also need to pay back the amount of the tax benefits you claimed on the account. Your HSA should have this information.

While you could face an IRS penalty for improperly claiming the tax benefits in the first place, my experience is that if you take care of this within a tax year and have no improper tax deductions on your 2016 tax return, you will escape a penalty.

The unspent funds are supposed to be used for qualifying medical expenses. So simply withdrawing them yourself may be unwise. Odds are that repaying any company contributions and tax benefits would represent an amount close to or even greater than the balance of unspent funds. So, I’d ask the company if it would back out these amounts from your account balance. If there is a remaining balance of your own, post-tax funds, can the company switch these into whatever health plan you’re now using? Also, would it move some if not all of its HSA contributions into your new insurance plan?

Best of luck, and please let me know how all this turns out. If there are other readers who have faced similar problems, please chime in as well. These HSA “gotchas” have been a major problem for lots of folks.

Ellen – Kan.: I will turn 65 soon, but am still working full time, and because of my husband’s sudden death two years ago, I will still need to work for several years. I have good health insurance with my small consulting company employer. Do I have to file for Medicare?

Peter – Va.: I turned 65 in April, but I am still employed full time and have health coverage through my employer. Should I sign up now for Medicare Part A, or should I wait until I retire and/or I lose health converge?

Betty: I am turning 65 in August. I plan to continue working and keep my high-deductible insurance plan through my employer. I contacted my state’s Office on Aging, and the woman I spoke with (perhaps a volunteer) said that I don’t need to do anything until I retire and switch to Medicare. But I read elsewhere that it is necessary to fill out an application indicating “on the back” that I am declining Medicare at this time. I’ve only seen an online application option, so I don’t know whether or how I need to indicate that I don’t want Medicare this year. My concern is that I don’t want to be hit with a penalty later because of a requirement I wasn’t aware of.

Phil Moeller: So long as you have a valid group employer health plan, you do not have to file for Medicare when you turn 65.

However, if you do not have a high-deductible health plan, you might want to enroll in Part A of Medicare, which covers hospital care. Part A charges no premiums to people who have worked enough to qualify for Social Security benefits. It can come in handy to cover some hospital expenses that are not fully paid by your employer health plan. However, Part A invalidates the use of an HSA health plan.

Also, to Ellen, you are eligible for Social Security survivor benefits. I don’t know if you’ve claimed them, but if not, you might want to do so. If they are less than your own retirement benefits would be at age 70, you should file for them right away. If your husband made a lot of money and your survivor benefit will be larger than your own retirement benefit, I would advise you to wait to file for it until it reaches its maximum value when you turn 66.

Ellen’s follow-up: God bless you for getting back to me so quickly and putting my mind at ease. My husband made less than I do, and I was advised not to claim them when he died two years ago. So if I understand you correctly, I can file for them now and not jeopardize the benefits I get from my wages when I retire? Will the IRS take part of his Social Security benefits if I do opt to get them?

Phil’s follow-up: Yes. You can file for them without jeopardizing your own retirement benefits later. Make sure that the person at Social Security you deal with understands that you are electing to claim only your survivor benefit. Depending on your total income, a portion of your Social Security benefits may be taxed.

The post How selling a home may affect what you pay for Medicare appeared first on PBS NewsHour.

Tessa Hadley reads her story “Dido's Lament,” from the August 8 & 15, 2016, issue of the magazine. Hadley has published six novels and four story collections, including “Sunstroke and Other Stories” and “Married Love.” She won this year’s Windham Campbell Prize for Fiction. She has been publishing fiction in The New Yorker since 2002.

Could advances in medicine and technology allow us to live longer — a lot longer? Decades, perhaps centuries? Eve Herold, former director of the Office of Communications and Public Affairs at the American Psychiatric Association, investigates the medical technologies that could extend the human lifespan for hundreds of years in Beyond Human: How Cutting Edge Science is Extending Our Lives. She also looks at the practical and ethical issues which could arise when this technology becomes available.

Photo by Flickr user Rosie O’Beirne.

Low-income Californians who are elderly and disabled were less likely to go to the emergency room or be hospitalized after their in-home caregivers participated in an intensive training program, according to a report.

Under a pilot program, nearly 6,000 aides in Los Angeles, San Bernardino and Contra Costa counties were trained in CPR and first aid, as well infection control, medications, chronic diseases and other areas. All were workers of the In-Home Supportive Services program, who are paid by the state to care for low-income seniors and people with disabilities, many of them relatives.

Researchers at the University of California, San Francisco based their analysis on the results in Contra Costa County, which they said produced the most complete and reliable data.

UCSF professor emeritus Bob Newcomer said they compared insurance claims on 136 at-risk elderly and disabled residents whose caregivers were trained with the claims from more than 2,000 similar residents whose caregivers did not receive the training. Though the sample was small, Newcomer said he was encouraged by the findings.

“Training shows a lot of promise,” he said.

The rate of repeated emergency room visits declined by 24 percent, on average, in the first year after caregivers were trained and 41 percent in the second year, according to the UCSF analysis.

The  demand for in-home caregivers is rising nationwide as the population ages and people develop dementia or live longer with chronic diseases. Caregivers typically help elderly and disabled people with bathing, dressing, eating and getting to medical appointments. The work is largely unpaid and done by family members, but some states pay caregivers for eligible low-income residents through their Medicaid programs.

There are currently no federal training requirements for in-home caregivers, even if they are paid with taxpayer dollars. Around the country, however, training programs have been developed and tested, according to the Paraprofessional Healthcare Institute, an advocacy group that also provides training. Among the states that have tried different types of instruction are Massachusetts, North Carolina and Michigan.

California’s In-Home Supportive Services program pays caregivers to help about half a million elderly and disabled people stay in their homes rather than be placed in institutions. To qualify for the care, seniors must be eligible for Medi-Cal, be 65 or older, and be blind or disabled.

The caregivers in all three counties, 44 percent of whom did not have a high school education, voluntarily attended about 60 hours of classes and completed 13 hours of related work at home. The people they cared for also took part in some of the classes, which were conducted in several languages.

Caregivers who were trained told researchers they felt better equipped to do their jobs and communicate with clients and their doctors, according to the report.

One of the caregivers, Andrew O’Bryan, said he was especially happy to learn CPR in case his mother has an emergency. For more than eight years, he has been paid by IHSS to care for his 67-year-old mom, Anabelle O’Bryan, who he said has diabetes, congestive heart failure, arthritis and high blood pressure.

O’Bryan, who lives in Oakley, a city in Contra Costa County, said he also learned what to ask when he accompanies her to the doctor and how to decide if she needs to go to the hospital.

“Now I am more equipped to spot things” before they get worse, he said.

For example, O’Bryan said he knows to elevate her feet when they get swollen rather than immediately take her to the ER.

Annabelle O’Bryan said she is more confident in her son’s abilities after he took the class, and she knows that he is helping her stay healthier.

“He is really on top of me not eating the sugar,” she said. “He is really careful about that.”

Newcomer of UCSF said that because the caregivers are in the patients’ homes for hours, they can be the “eyes and the ears” for physicians and other medical providers. They can tell the doctors “if the person is more confused, or is refusing to eat, or that the status is changing,” he said.

The results of the study show that caregivers play a pivotal role in helping keep people out of the hospital, said Corinne Eldridge, executive director of the California Long-Term Care Education Center. The nonprofit center was founded in 2000 by members of the Service Employees International Union, which represents many IHSS workers.

During the training sessions, Eldridge said, the caregivers learned skills such as how to read medication labels or provide the best diet for a diabetic patient. Like Andrew O’Bryan, they also became more confident about handling worrisome situations, such as deciding when to call a doctor or dial 911.

Eldridge said the center is now hoping to gain support from Medi-Cal health plans to help pay for the training as a way to reduce health care costs.

“We really see training as part of the solution in order to provide better care … and frankly as a way to invest in the workforce,” she said.

Blue Shield of California Foundation helps fund Kaiser Health News coverage in California. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. You can view the original report on its website.

The post Teaching in-home caregivers seems to pay off, report says appeared first on PBS NewsHour.

Phil Moeller answers your questions on aging and retirement. Photo by Getty Images

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need in “Ask Phil.” Send your questions to Phil.

Check out his new Recommended Reading section with links to notable stories and reports at the end of today’s post.

Anna – Ill.: If the powers that be are looking at health outcomes when they spend Medicare dollars, why did Congress decide in 2008 that a cut in therapy benefits was a smart thing to do? In 2008, I was not yet 65, so I didn’t notice this change. But now that I am past 65 and having balance “issues,” the 2008 cut in therapy benefits does affect me. One of the leading causes of sending seniors into assisted care facilities is balance issues (falls), and many seniors soon run out of funds and have to rely upon Medicaid to pay for housing them in these facilities. Is it not more fiscally responsible to spend a few thousand dollars on balance therapy now rather than tens of thousands of dollars each month to “house” seniors in such facilities?

Phil Moeller: Caps on Medicare therapy services have been a contested topic for years. For 2016, the caps are $1,960 for physical therapy and speech-language pathology services combined, according to the Centers for Medicare & Medicaid Services. There’s another limit of $1,960 for occupational therapy services. However, there is an exceptions process that permits people to seek coverage when their total incurred therapy expenses exceed $3,700 during a calendar year. This exceptions process was in place in 2008 and has been extended every year since then. The American Physical Therapy Association has an extensive legislative history of therapy caps that provides the details. So, on this score, it’s not clear to me what cuts your referring to. Having said that, you and many other reasonable people could argue that the caps themselves are too low and need to be raised.

Diane – Md.: I am 65 and enrolled in Medicare. After this enrollment, I took a position with a 1,500-person firm and now have Blue Cross as my primary health insurance with Medicare as my second. I would like to use the health savings account option with Blue Cross, but have been told that I can’t have an HSA and Medicare. Is this true even if Medicare is the secondary provider?

Phil Moeller: Yes, according to the Medicare Rights Center. Having Medicare in any capacity makes it illegal for you to participate in an HSA or continue participating if you had one when you enrolled in Medicare. Further, as I’ve written before, signing up for Social Security requires you to have Part A of Medicare, which also nixes HSA participation.

READ MORE: Why health savings accounts and Medicare don’t mix

However, the fact that you went back to work and now have employer insurance provides you the right to drop Medicare without facing penalties later on when you leave work and need to re-enroll. If there are benefits having Medicare as a secondary payer, you should compare them with the tax benefits of having an HSA plan and decide which path is better for you.

If you do decide to drop Medicare, Social Security rules require a personal interview before approving your request. You also must complete form CMS-1763— Request for Termination of Premium Hospital and/or Supplementary Medical Insurance. Be warned: Supplementary Medical Insurance is Medicare’s term for Part B; don’t confuse it with Medicare Advantage.

Connie – Ontario: I’m a 68-year-old U.S. citizen with dual U.S.-Canadian citizenship, and I reside in Canada. When I turned 65, both my Canadian husband (non-U.S. citizen resident) and I qualified for and received Medicare cards (Medicare A only). If we were in an accident or serious illness while in the U.S. that required hospitalization, what would and would not be covered?

Phil Moeller: You certainly would be able to use your Part A insurance for hospital expenses and related institutional medical care, according to counselors at the State Health Insurance Assistance Program. If your husband’s Part A was valid, so would he, although it’s not clear to me why he would qualify for Part A unless he had spent substantial time working in the U.S. Part A only covers hospital expenses. If you needed to pay for doctors, outpatient costs, medical equipment or drugs, these would not be covered unless you had additional Medicare coverages for which you would need to pay premiums. In that event, you might face stiff late-enrollment penalties for not signing up for Parts B or D of Medicare when you first turned 65 and enrolled in Part A.

If either of you have Canadian health coverage, which I assume you do, you should explore whether it helps at all with medical needs that occur in the U.S.

READ MORE: When to consider Obamacare instead of Medicare

Linda Jo – Mich.: My mother is 93 years old and has been living abroad for several years. Until recently, her Medicare Part B premium was deducted from her monthly Social Security benefit payment. She asked to change this and stop paying Medicare Part B premiums. She was told by a person in a U.S. embassy Social Security office that she could reclaim from 12 to 18 months of payment of the Medicare Part B that had been deducted from her monthly benefit. Is this correct?

Phil Moeller: I don’t think so, but the Social Security spokeswoman I contacted was not able to give a definitive answer without more specifics about your mother’s situation. By law, Part B premiums must be deducted from Social Security payments for anyone participating in both programs. So the only way to stop these premiums from being deducted is to disenroll from Part B. I assume this is what your mother wanted to do and further assume it’s because Medicare doesn’t cover her outside the U.S., and she doesn’t travel back here enough to want the coverage when she is in the states.

If she does leave Part B, she normally would not be entitled to any premium refunds. See pages 30 and 31 of this document for details.

The only wild card here I can think of is whether she may be able to make a case that her effective Part B termination date should have been 12 to 18 months earlier, thereby entitling her to refunds tied to that earlier termination date. Your note makes no mention of this, so my best judgment is that the person in the embassy office was incorrect.

FOLLOW UP

Many readers had questions about a recent Ask Phil piece on high-income surcharges for Medicare premiums dealt with how selling a home can affect your premiums.

Steve – Wyo.: I just read your response to the woman who wondered about the potential effect of selling her home, with a capital gains realization, on her Medicare benefits. Your response clarified the issue with regard to triggering “surcharges” above the $85,000 threshold. What if that capital gain is immediately reinvested in another home? Would it count as income as such?

Charles – La.: Is this after the $250,000 to $500,000 home sale exclusion (primary home)? Do you understand that gains on the sale of a second home are taxable?

Sharon – Calif.: If I sell my principal residence and get $500,000 profit, I am qualified for the $500,000 tax exemption for couples so my profit will be zero in my tax return. In my case, I don’t have to worry about IRMAA, do I? [IRMAA stands for the Income-Related Monthly Adjustment Amount, which is the mouthful of words used to describe these surcharges.]

John – Calif.: In 2018, I will be hit with a very substantial MAGI [modified adjusted gross income] surcharge due to a one-time event, the sale of my business in 2016. My annual MAGI after the sale of my business will, once again, be less than $170,000. Is there a way to get my MAGI surcharge removed? I am married and retired in 2016.

Smilie – Maine: The sale of a primary residence owned and used as such for two out of five years would, under the facts of your recent post, be excluded from capital gain recognition ($250,000 exclusion per spouse), and I believe the instructions to Form 1040 provide that such sales should not be reported. See Internal Revenue Code section 121.

READ MORE: How selling a home may affect what you pay for Medicare

Phil Moeller: Thanks to all. It seems to me the key variable here is whether the income event (sale of a home or business for these readers) is included in MAGI. This is the definition of income that is used to calculate IRMAA surcharges. In the case of the sale of a primary residence, only amounts above the exclusion thresholds would be included in MAGI. The sale of a business would be a different matter, as would the sale of a second vacation home (which was the case in the Ask Phil column). Any bump in MAGI that triggers IRMAA surcharges should go away as soon as MAGI declines, keeping in mind that there is a two-year lag between the year the income is taxed and when Medicare premiums are determined. So, as John notes above, his 2018 IRMAA will be determined by his 2016 tax return.

RECOMMENDED READING

New Medicare Law to Notify Patients of Loophole in Nursing Home Coverage

Hospitals have the right to accept patients for what are called observational stays as opposed to formally admitting them. Medicare has different insurance rules for these situations and may charge people more for observational stays than formal admissions, even if the care is identical. In addition, Medicare will not cover subsequent care in a skilled nursing facility if a patient’s hospital stay was only observational. This is a bad policy, as described last year in an Ask Phil column. Under terms of a new law, hospitals will have to at least tell patients their admission status, which might help some people save money or appeal the hospital’s decision while there is still time to do something about it. Better still would be to revise the rules altogether and change the underlying rules. (Source: The New York Times.)

Closed Social Security offices, furloughed staff under GOP cuts, agency warns

Social Security Administration officials warn that the latest appropriations bill supported by congressional Republicans would further harm the agency’s already compromised ability to serve growing consumer demand for help. (Source: The Washington Post.)

CMS’ new star ratings are unfair to teaching and safety net hospitals

The Centers for Medicare & Medicaid Services recently issued a single star rating on the nation’s hospitals. Its stated goal was to give people a single, easy-to-understand summary of the quality of the nation’s hospitals. Reducing the many complexities of hospital operations and quality to a single indicator has provoked considerable opposition. (Source: Modern Healthcare.)

CMS also recently added new quality measures to its nursing home star ratings system. As with nearly everything CMS does, these changes also generated concern.

The post Why doesn’t Medicare cover more for physical therapy? appeared first on PBS NewsHour.

On today's show:

• David Wallace-Wells, Features Director at New York Magazine, recounts his frightening experience at Kennedy Airport last week, when reports of an active shooter - though there wasn't one - caused total chaos for travelers.
• Rachel Abrams, New York Times reporter, and Tina Sigurdson, general counsel for the Environmental Working Group, talk about the proposed legislation to require the FDA to regulate cosmetics.
• Reverend William Barber, president of the North Carolina chapter of the NAACP and pastor at Greenleaf Christian Church, talks about his new initiative and his DNC speech.
• Richard Bribiescas, professor of anthropology and ecology and evolutionary biology at Yale University, discusse how natural selection affected the way men grow old and how that affects human society.
• Have you dropped a person off at college recently? How did his/her packing list differ from yours? Listeners call in about the changing nature of what one brings to college.

Richard Bribiescas, professor of anthropology and ecology and evolutionary biology at Yale University, deputy provost for faculty development and diversity and the author of How Men Age: What Evolution Reveals about Male Health and Mortality (Princeton University Press, 2016), studies the way men age, not the medical story, but how natural selection affected the way men grow old and how that affects human society.

If you knew you were going to live to 100, how would it affect the way you live your life? Photo by Paul Bradbury/Getty Images

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need in “Ask Phil.” Send your questions to Phil.

Check out his new Recommended Reading section with links to notable stories and reports at the end of today’s post.

If you knew you were going to live to 100, how would it affect the way you live your life? Today, very few people have such certitude. But according to a provocative new book, “The 100-Year Life,” more and more will, as sustained longevity gains continue adding years to our lives.

More significantly, British academics Lynda Gratton and Andrew Scott argue, the prospect of such long lives will become part of younger people’s life view. It’s one thing if an 85-year-old concludes she will live to 100. But if a 25-year-old is convinced she still has 75 years of life in front of her, the implications are likely far more substantial.

We already are seeing a sustained deferral of marriage and childbearing decisions until later ages. The movement of people into full-time careers in their 20s likewise seems more and more to be delayed until their 30s. More research needs to be done about the extent to which people are changing behaviors because they believe they will live longer.

For example, it is easy to chalk up some trends to economic upheaval and related pressures. People with attractive career paths, especially women, are swayed by the logic of spending additional years cementing their professional futures before having families. Those without such appealing paths — of which there are far too many these days — may be forced to bunk in  at their parents’ homes.

As a result, a snapshot of people in their mid-30s today can look a lot like a picture taken 30 years ago of people in their mid-20s. There is, of course, no single image that can capture the diversity of ways people choose or are forced to live their lives. And who would want to travel along such a narrow proscribed path anyway?

The point here, and the point of the book, is that such changes have occurred and will more and more become the new normal. Yes, technology and shifting economic realities certainly play a role here. But, Gratton and Scott argue, so does the inexorable conclusion that longer and longer lives are in store for us.

I have some quibbles with this book, which has been shortlisted by the Financial Times as a candidate for the best business book of the year. Trying to suss out the ways that longevity will change our lives requires a better crystal ball than they (or, certainly, I) possess.

It’s also very hard to separate the effects of longevity from the impact of technological change. In an email exchange, Stone agreed with this, but said longevity gains deserve more of a marquee placement than they’ve received.

“Every generation tends to benefit from better technology and longer longevity. However, the technological change seems disruptive and discrete and so is much discussed, whereas the longevity is slow and constant and tends not to be of much focus.”

Quibbles aside, I have no argument with the growing likelihood that living to 100 someday will be a ho-hum milestone or that people and institutions should be spending more time thinking about how they need to prepare for these added years.

I also think the authors are on sound ground when they argue that the basic units of modern life must change. These units, which they describe as a “three-stage life,” include education, work and retirement. I think you could toss childhood into that first stage if you like and look at it as a period of development and preparation that younger people must complete before they’re ready to be on their own.

Likewise, there are broader models available in the second and third stages. For many people, the work stage of their lives also includes raising families — hardly an inconsequential afterthought. The broader point is that people spend their first 20 years or so in stage one, their next 40-plus years in stage two and the rest of their lives in stage three.

In a 100-year life, however, retiring at 65 is not feasible for most people. They simply do not have the financial resources to afford retirements lasting 35 years. They also may not have the patience to spend so many years on the sidelines of a life where they had long been active. We’ve already begun seeing responses to these pressures.

More people in their late 60s and 70s have remained in the workforce. Investment and job losses caused by the Great Recession are often cited as a powerful driver of this change. But looked at through the lens of “The 100-Year Life,” the possibilities of longer retirements also emerge as a factor.

The three-stage life increasingly will not be a workable model for people who must anticipate longer lives. Instead, the authors argue, people will be developing multi-stage lives. They will feel increasingly comfortable, but also practically driven to break their careers into more pieces, moving in and out of the workforce and going back to school to maintain and sharpen job skills. Parents will adopt patterns of shifting domestic duties among partners to spend more time with their younger children.

As people approach their mid-60s and 70s, they too will need to develop additional stages of life. We’re already seeing this in today’s “encore careers” movements. It will need to expand further in a world of longer life spans. Here, the risk-taking and entrepreneurial mindsets now associated with younger people could be adopted by people in their 70s and 80s.

“Imagine you will have two or three different careers,” the authors write, “one perhaps when you maximize your finances and work long hours and long weeks; at another stage you balance work with family, or want to position your life around jobs that make a strong social contribution. The gift of living for longer means you don’t have to be forced into either/or choices.”

This liberating longer-life view is, of course, much more feasible for highly educated and better-compensated people. For those on the lower rungs, choice is not so much the word that comes to mind. Without economic resources and options, the prospect of living to 100 is not so much fun. Worries about running out of money or of illness-plagued decades can predominate. Touting multi-stage lives to such folks can be a cruel form of humor.

“The danger is that the gift of a long life will only be open to those with the income and education to construct the changes and transitions required,” the book notes. “It is therefore crucial that governments begin now to construct a package of measures to support those less fortunate.… It is unacceptable that a good long life should only be an option for a privileged minority.”

In practice, of course, that seems exactly what will happen in the near term. If government does step up, such actions are not likely to occur until long after that better-enabled minority has been playing and winning the longevity game for some time.

RECOMMENDED READING

“Why Forcing People to Text to Log Onto Their Social Security Account Was a Mistake”

Social Security changed its mind last week and withdrew a hastily launched requirement that people needed to use their smartphones to access their online Social Security accounts. The Social Security Administration seems to have a tin ear when it comes to evaluating public needs and preferences and certainly did so here. Millions of people were unable to comply with the new rules nor fathom why it was needed. The agency’s motives were commendable. Increasing the security of personal wage and benefits information is important. But this effort was not well conceived. (Source: Mark Miller for Reuters via Money.)

“Private Equity Pursues Profits in Keeping the Elderly at Home”

Can the profit motive succeed where good intentions have fallen short? A potentially marvelous Medicaid program to help frail and mostly older people stay in their homes is about to find out. It’s called the PACE program, an acronym that stands for Program of All-Inclusive Care for the Elderly. Medicare does not pay for nonmedical long-term care services, but Medicaid does. However, the government’s tab for nursing-home care can be very steep. Rather than putting people into nursing homes, PACE provides them with at-home support services and provides transportation for them to a PACE center, where they can receive medical care, counseling and a daytime program of activities. All of these services, it turns out, can be provided for less money than a nursing home would cost. Not only does the government save money, but the quality of life enjoyed by PACE participants can be superior. Historically, PACE programs have been run by nonprofits, and not many people are enrolled in them. Recent regulatory changes have allowed for-profit companies to create PACE programs. Now, attention will be focused on how these companies balance the prospect of making money off of PACE participants with the quality of services they provide. (Source: Sarah Varney for The New York Times in collaboration with Kaiser Health News.)

“Are insurance policies saving patients money, or keeping them from the treatment they need?”

In an effort to save money, Medicare and other health insurers have the right to require doctors and patients to try less expensive drugs and procedures. If these efforts do not produce good results, people are then free to try progressively more expensive therapies until they find one that works for them. In a world of costlier medicine, these “step therapy” programs are likely to become more widespread. So, too, will be concerns that patient welfare is being sacrificed in the interest of corporate profits. (Source: Bob Tedeschi for STAT.)

The post Column: Will increasing longevity change the way you live? appeared first on PBS NewsHour.

Aging and retirement expert Phil Moeller answers your questions. Photo by Joe Raedle/Getty Images

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need in “Ask Phil.” Send your questions to Phil.

Check out his new Recommended Reading section with links to notable stories and reports at the end of today’s post.

Michael – N.J.: I have Medicare Parts A and B and a Medigap plan. I am 66, and I’m about to start getting Social Security in October. I was diagnosed with multiple myeloma early this year, and found out (too late of course) that Medicare will not cover the stem cell transplant I need from my identical twin brother.

I’m researching adding private coverage, but it doesn’t look promising. I have been reading that private insurers cannot legally write policies if they know you have Medicare. So I am considering dropping Medicare and getting a private plan that would cover this.

However, this looks even less palatable. I understand that to give up Part A means I forfeit future and past Social Security payouts. Also, if I give up Part B and later do re-enroll, my Medigap plan is no longer guaranteed issue.

Am I understanding this correctly? Am I missing any promising loopholes?

Phil Moeller: A spokeswoman for the Centers for Medicare & Medicaid Services confirmed that Medicare generally does not cover these tests. However, as with much of Medicare, there may be an exception for some Medicare beneficiaries with multiple myeloma who require allogeneic hematopoietic stem cell transplantation. The qualifications seem narrow, but you should check them out and follow up if it looks promising.

As for getting private coverage, I doubt you will find any takers. Even if you dropped Medicare and Social Security — which I do not recommend — I know of no private insurer who would take you on with this pre-existing condition. And if you did find one, the premiums likely would be higher than you could afford.

I wish I had better news. I hope you can find the help you seek.

Janet – Fla.: I am a 55-year-old woman. I have been receiving Medicare since 2005 when I became a disability claimant. I work part time from home, but between doctor’s payments and way over-the-top prescription drug prices, I need help. For example, a monthly prescription I used to pay $10 for is now $275 a month! I have prescription and medical insurance with Humana. Am I financially better off to just use my Medicare and not use private insurance? Supplemental insurance seems expensive.

Phil Moeller: Janet, I am so sorry that you are getting hammered by such outlandish price increases for your medications. Unfortunately, you are in the same boat as millions of other Americans. Tell me what drug you’re taking, and maybe we can embarrass the manufacturer like the maker of EpiPens was embarrassed. That manufacturer consequently agreed to make its product more affordable. And its price gouging, by the way, was only 500 to 600 percent. Yours is 2,750 percent!

READ MORE: Did outcry on social media lead to Mylan’s generic EpiPen?

Depending on your income, you may qualify for Medicare savings programs, including its Extra Help program for prescription drugs. Call a Medicare counselor in your state who works for the free State Health Insurance Assistance Program, see if you qualify and get help applying for benefits. In the meantime, you should look at Medicare’s Plan Finder online tool and see if Humana’s price for this medication is what other drug plan insurers also charge where you live. If you can find this medication at lower cost in another plan, you should consider switching to that plan for 2017 during this year’s annual Medicare open enrollment period, which runs from Oct. 15 through Dec. 7.

Another possibility you could consider is shopping for your health insurance on the Florida state insurance exchange created by the Affordable Care Act. While you are eligible for Medicare because of your disability, you do not have to enroll in Medicare until you are 65. The exchange plan may be cheaper than Medicare. The State Health Insurance Assistance Program might be able to help you find out. As for supplemental insurance, it’s not only costly, but it doesn’t even cover drugs.

READ MORE: Is there any relief for astronomical drug costs?

Lisa – Ga.: I am a Social Security Disability Income recipient and hope to move out of the country to Germany or someplace similar in Europe. I am currently 46. I know some countries it is acceptable to relocate on SSDI. I wish to be independent, but the chaos of politics and living where the buses don’t run and in a society that demonizes disability (especially cognitive) is tiresome. I speak conversational German, which I learned after a traumatic brain injury, but before subsequent brain injuries 12 years ago.  If I am receiving SSDI and can speak the language well enough to get by, what happens with my medical coverage? Can I live overseas? Please advise. I was a paralegal as well. I earned that degree in 1999 after my injury in 1996. I understand the law.

Phil Moeller: Lisa, you are already overcoming more obstacles than people without disabilities ever confront. I applaud your desire to be independent. I’m also sorry you’ve had such negative experiences in the U.S. The first part of your question is easy. If you get SSDI, these payments will continue to be sent to you if you relocate outside the U.S. to Germany. Social Security payments are not sent to people in all countries, but they are provided to people in Germany. The agency has an online screening tool that discloses the rules in different countries. However, you must become a legal resident of Germany (see page 6 of this document) for your Social Security payments to continue.

READ MORE: Why doesn’t Medicare cover more for physical therapy?

Even if you can jump through these hoops, getting medical insurance is not such an easy matter. I assume you are now on Medicare. It does not cover medical care outside the U.S. You would most likely need to get health insurance in your new country of residence. This could be a challenge, especially if you do not have a job and would be living only on your SSDI income. I would begin by joining some online discussion groups of ex-pats living in different European countries. There may be a lot of relocation issues you’d face beyond health insurance, and you should take the time to learn about them and plan your move. Next, I’d find a few insurance brokers who specialize in German health insurance. I say “a few,” because you will want to speak to several people to make sure you’re getting the best deal. I wish you the best of luck. Please let me know if I can be of further help.

Christopher – Mexico: I turned 65 in March, and I retired in Mexico about 100 miles south of the border. I began collecting retirement benefits at 62, and when I turned 65, my online account information was updated to say I was automatically enrolled in Medicare Part A. This is fine with me. In a pinch, I figured I could take a bus or taxi to the border for medical treatment if need be. Here’s my problem: I have never received a Medicare ID card. I used the online service every month to request one to no avail, and I called and spoke with the kind folks at the office in the states and they said they initiated a card replacement. The online service was recently changed to require a cell phone text message so now I can’t even check it out online.

Phil Moeller: Your Medicare card is supposed to be mailed to the address that is connected with your Social Security account. Assuming this address is in Mexico, that’s where the card should go. I’d call or email Social Security again and keep asking them to send you the card. Also, the agency’s requirement that people use a text message as part of its online security process was very short-lived. Many seniors do not have smartphones and do not text. They spoke up, along with advocacy groups, and the agency quickly reversed itself and abandoned the policy. So at least you will be able to access your online account once again.

READ MORE: I can get my Social Security abroad, so why not my Medicare?

Having said this, I don’t know that having a Part A card is going to do you much good. Part A charges no premiums to people who qualify for Social Security payments. That makes it a nice benefit. But it covers only hospital costs. If you really want to have medical treatment when you return to the U.S., you’d also need Part B of Medicare to cover doctors and outpatient clinics. And you’d need Part D to have your prescription drugs covered. Parts B and D both carry monthly premiums. You might get both of these rolled into a low-cost Medicare Advantage plan, but you’d need a U.S. address to document that you’re in the plan’s service area. I’d call some insurance brokers specializing in ex-pat coverage for folks living in Mexico and see what they suggest.

Carol – Ga.: My husband is on disability and will automatically be registered for Medicare next year. Should I still cover him on my insurance at work? Do I need to register him for Parts B and D?

Phil Moeller: It normally takes about 30 months between the date someone is approved for Social Security disability payments and when they can begin participating in Medicare. This is a wonderful safeguard for people with disabilities, providing them guaranteed access to insurance even at very young ages. However, in your situation there is no requirement that he has to take Medicare. Now, I don’t know exactly why you think your husband will automatically be registered for Medicare next year. Perhaps it’s because he’s turning 65 or simply that it will have been 30 months since he was approved for disability. Whatever the reason, he does not have to sign up for more than Part A of Medicare (which he automatically received upon commencing disability payments) as long as he is covered by your employer insurance plan and your employer has at least 20 people on the payroll (there are different Medicare rules for smaller employers). If he receives a Part B Medicare card from Social Security, he should call them and say he rejects the coverage and wants to return the card. Best of luck!

Sherry – Ariz.: I signed up for Medicare when I turned 65 in May of this year. I work full time and I had much better insurance through Walmart. Can I go back on the Walmart insurance during open enrollment this coming fall?

READ MORE: Should you stay on your employer health insurance or get Medicare?

Phil Moeller: As I just told Carol, you do not have to get Medicare when you turn 65 (or 75 or even 85) so long as you have health insurance from your employer and it employs more than 20 people. Walmart, of course, employs a lot more than 20 people! So I don’t know why you signed up for Medicare. Whatever the reason, if you have left the Walmart insurance plan, you may have trouble getting back into it. Before you drop Medicare, talk to someone at Walmart in the employee benefits department and understand exactly what your options are for resuming employer insurance.

Jonathan: In regards to taking Social Security benefits and then being unable to contribute to an health savings account, what’s the policy if a person claims a spousal benefit from Social Security, delays their own retirement benefit until 70 and continues to work?  Can they still contribute to their HSA under this claiming strategy?

READ MORE: Why health savings accounts and Medicare don’t mix

Phil Moeller: No, they can’t. Claiming any benefit, even a spousal benefit, will trigger the mandatory enrollment in Part A of Medicare. This enrollment qualifies as being on Medicare and thus disallows continue contributions to an HSA. Sorry!

Debbie – Wash.: My husband is turning 65 in January 2017, but has been medically retired since 2003. He has had Medicare since then. Since 1991, I have had very good private health insurance that covers both of us. I’m writing because whenever we make appointments or go to the hospital, he is always referred to as a Medicare patient. Sometimes we are told that a physician is not seeing any more “Medicare” patients, even though we have secondary private insurance and Tricare for Life. Is there a way not to have Medicare without penalty and have our private insurance the primary payer? It seems that being a “Medicare patient” only makes things worse.

Phil Moeller: Are you paying any premiums to Medicare for your husband’s insurance? I hope not and that the only kind of Medicare he’s had is premium-free Part A. As I’ve told other readers in today’s column, he does not have to have Medicare so long as he is covered on your employer’s plan. Now, I can’t tell for sure if you are still actively employed or whether your “very good private health insurance” is actually a retiree insurance plan. These plans nearly always require a person to have Medicare when they turn 65, because the plans become the secondary payer of health claims, and Medicare becomes the primary payer. That’s certainly the case with Tricare for Life. And if you have a secondary private insurance plan, then Tricare for Life would move to third place and wouldn’t pay claims until your primary and secondary carriers had paid their share of covered expenses.

RECOMMENDED READING

Audits Of Some Medicare Advantage Plans Reveal Pervasive Overcharging

Fred Schulte continues his compelling coverage of how some Medicare Advantage insurers have been gaming the system to get the government to pay them more money than is needed to provide insurance to some of their Medicare policyholders. Medicare Advantage is the private insurance product that is required to provide at least the same coverage as Original Medicare (Parts A and B) and usually includes a Part D prescription drug plan as well. Insurers receive per-beneficiary payments from the government that are based on the health of the beneficiary. By overstating how sick a person is, an insurer can get a higher fixed payment to cover that person. (Source: Fred Schulte for The Center for Public Integrity via NPR.)

How to include your digital assets in your estate plan

It’s hard enough to get your final wishes properly expressed in your will. Now, you have to worry about your digital afterlife as well! However, what used to be an oddity is moving mainstream. Here’s a helpful “how to” piece about making sure your Facebook page has a final resting place as nice as yours. (Source: Andrea Coombs for MarketWatch.)

Tax Credits for Ramps, Grab Bars to Help Seniors Stay at Home

Here’s another practical piece on efforts in some states to permit tax reductions for “age friendly” home improvements that help older and disabled people to continue living in their homes. (Source: Jenni Bergal for Stateline from The Pew Charitable Trusts.)

The post Medicare won’t cover a procedure I need. Can I get private insurance? appeared first on PBS NewsHour.

When you hear a singer like the late Whitney Houston belt out a song like “I Will Always Love You,” you’re listening to a marvel of vocal skill. But there’s no anatomical difference between her vocal system and yours.

Great singers “don’t have bigger lungs,” says voice rehabilitation specialist Linda Carroll. Neither do they have bigger vocal muscles. According to Dr. Steven Zeitels, director of the Voice Center at Massachusetts General Hospital, “I can place all your vocal muscles into one corner of one facial muscle.” Those vocal muscles move the vocal folds, ligaments that vibrate to make the sounds of speech and singing.

So without bigger lungs or muscles, how do singers do it? It’s all about the way the sound resonates in their body, according to the opera soprano Renée Fleming. “If you take any kind of instrument — whether it’s a violin or a piano — the strings sort of represent what the vocal folds do." Singing, she says, is like plucking a string. “If you do that with a rubber band, it just makes a ‘twang’ sound, but if you put that string on a box, then it resonates and creates a beautiful sound.” It’s the same for the voice, she says. “You’re putting air through the folds, they vibrate and the resonating chambers, which are your mouth, your throat, your sinuses, create the color.”

Singers of all ages come into Dr. Zeitels’ medical practice with trauma caused by breathing dried-out air in planes or singing in towns or buildings that have unfamiliar allergens. Renée Fleming says trauma can also come from the type of singing you do. “It’s pop and musical theater singing — particularly with girls — and rock singing for men that’s very hard on the voice,” she says. 

Aerosmith’s lead singer, Steven Tyler, is nearly 70 and has been torturing his vocal folds since he was a teenager. Tyler is one of Dr. Zeitels’ patients. One night, right in the middle of that famous high note in “Dream On,” Tyler ruptured a blood vessel in his vocal fold. His voice cut out completely. Dr. Zeitels performed surgery with a laser to seal the blood vessels, and today, Tyler can sing “Dream On” as loudly as when he was 25 years old. 

David Fahrenthold, a political reporter with The Washington Post discusses his investigation into Donald Trump's charitable donations. Filmmakers Ken Burns and Artemis Joukowsky discuss their new film, "Defying the Nazis: The Sharp's War." Affinity Konar on her novel, Mischling, about a set of twins who arrive at Auschwitz and become part of Josef Mengele’s experiments. Champion open-water swimmer Lynne Cox on her new book Swimming in the Sink: An Episode of the Heart. Journalist and author Ian Brown on his memoir Sixty: The Beginning of the End, Or the End of the Beginning?

Journalist and author Ian Brown talks about his memoir Sixty: The Beginning of the End, Or the End of the Beginning? He candidly confronts aging, and asks whether turning 60 means that he’s “soon to be elderly" and at "the age when the body begins to dominate the mind, or vice versa, when time begins to disappear and loom, but never in a good way, when you have no choice but to admit that people have stopped looking your way, and that in fact they stopped twenty years ago."

 Event: On Tuesday, September 20th 12 p.m., Ian Brown will be at the 92nd Street Y (Lexington Avenue at 92nd St) to discuss his memoir. Tickets are available on their website.

Hisham Uadadeh enrolls in a health insurance plan under the Affordable Care Act at Leading Insurance Agency in Miami, Florida. Photo by Joe Raedle/Getty Images

Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need in “Ask Phil.” Send your questions to Phil.

Check out his new Recommended Reading section with links to notable stories and reports at the end of today’s post.

Stuart – Texas: I am unable to work and have been receiving disability since 2006. I am not yet 60 years old. When the Affordable Care Act began in 2014, I enrolled in an individual plan through the marketplace and was granted a subsidy because of my income. When I re-enrolled in 2015, the folks at Healthcare.gov refused to give me the subsidy, because I was technically on the Medicare roll (Part A only because of my disability). Now, in 2016, Social Security has added me to Part B, costing me even more. I now am paying a full individual premium through the marketplace plus the Medicare payment of $158 per month. I am not benefiting whatsoever from the Medicare plan. What options do I have?

Phil Moeller: Readers dying to know about the interactions of Medicare and the Affordable Care Act have struck gold today. Of course, I grant you that this might not be an enormous group, but I shall press on nonetheless. Unfortunately, the facts aren’t so favorable for Stuart. I have been in touch with both Medicare and Social Security about this. I have not shared Stuart’s name, so their responses are necessarily general. But I think the situation is clear, especially where it concerns Medicare.

By design, state health exchanges and Medicare are not supposed to work together. Most people signing up for health insurance on a state exchange qualify for subsidies that are often substantial. Given this federal support, providing such subsidies to Medicare beneficiaries would amount to a double subsidy. While Part A of Medicare, which covers hospital expenses, is fully funded by worker payroll taxes, the other parts of Medicare are not fully covered. In fact, taxpayers foot the bill for about 75 percent of Part B expenses and a hefty share of Part D drug expenses and Medicare Advantage plans as well. While Medicare premiums can be expensive for many older and disabled Americans, they would be unaffordable for most of us if we had to pay the full cost of the programs.

A person on Medicare is not entitled to also receive subsidies when they buy an ACA policy on a state exchange. And a person age 65 or older is not even permitted to buy an ACA policy in most situations. The exception is for older persons who do not qualify for premium-free Part A coverage. To qualify, they need to have worked at least 40 quarters (10 years) at jobs where they paid Social Security payroll taxes. Or they need to be married or have been married to someone who worked that many quarters. If not, they will have to pay steep Part A premiums that can exceed $400 a month. This small group of people may continue to purchase ACA policies.

However, ACA subsidies are not available to Medicare beneficiaries who qualify for premium-free Part A coverage. This includes Stuart. Now, I do not know whether Stuart was covered by Medicare at any period from the time of his disability until he signed up on a state exchange in 2015. But he was still on Medicare. How can this be? Because anyone receiving Social Security benefits must, by law, also receive Part A. And anyone receiving Part A is considered to be a Medicare beneficiary. This fact alone — which I grant may appear unfair in some circumstances — is a disqualifying factor when it comes to ACA subsidies, according to Medicare. Someone having either Part A or Part C of Medicare (Part C is the formal name of Medicare Advantage plans) is deemed by the agency to have what’s called Minimum Essential Coverage, or MEC, and having MEC disallows them from receiving any ACA financial support.

My guess is that while Stuart thinks he is getting a bad deal by losing his subsidy this year, the fact is that he never should have been entitled to a subsidy in 2015. The fact that he was is a not uncommon oversight; its one that Medicare has been working to correct. Here’s a statement to that effect from the agency:

CMS is reaching out to the small number of consumers enrolled in both Medicare and Health Insurance Marketplace coverage with financial assistance. We are doing this to make sure they take action to end their Marketplace coverage with advance payments of the premium tax credit because they are receiving Minimum Essential Coverage (MEC) Medicare, and thus are not eligible for this financial assistance. It’s important that such consumers do this in a timely manner, to help reduce the amount of advance payments of the premium tax credit the tax filer(s) may have to pay back when they file their federal income tax return. We’re committed to helping consumers with Marketplace coverage and will continue to work with them to understand their options.

So Stuart is 0-for-1 so far. In terms of being signed up by Social Security for Part B of Medicare, it seems to me he is correct that this is inappropriate. However, as I’ll explain, it could be that he winds up needing Part B.

A Social Security spokeswoman said she knows of no reason why Stuart would have been enrolled in Part B. Going back to 2006, when he qualified for disability payments, it’s quite possible that Social Security automatically signed him up for Part B when he became eligible for Medicare. This normally takes at least two years after disability payments have begun. And being entitled to Medicare at any age because of a disability is normally a helpful benefit.

However, Stuart did not have to accept Part B, and it appears he did not. He may have had other private health insurance himself or been insured on his spouse’s health policy. I don’t know. But it’s pretty clear he did not have Part B until Social Security enrolled him in it earlier this year.

“Based on the facts presented in this case,” the Social Security spokeswoman said, “I can’t think of any reason Social Security would have automatically enrolled this disability beneficiary into Medicare Part B 10 years after entitlement to disability benefits.”

If Stuart wants to pursue this matter and avoid paying Part B premiums, I’d suggest he call a local office of the State Health Insurance Assistance Program (SHIP) and ask a Medicare counselor to help him. SHIP deals more with Medicare than Social Security, so he may have to contact Social Security directly, which is what the agency suggested.

However, having lost his ACA income subsidy, there’s a good chance that Stuart’s best insurance deal would actually be to drop his ACA policy, purchase Part B and move onto Medicare. He can do this during the Medicare open enrollment period that begins Oct. 15 and extends through Dec. 7, and his new coverage would take effect next January. This decision means some more homework for Stuart to determine the mix of Medicare policies that make the most sense for him and to then shop for the best available policies. Future installments of Ask Phil will be dealing with open enrollment and can help guide Stuart and others in deciding whether what Medicare coverage they should have in 2017.

David – Calif.: Are there Medicare Advantage plans with a “Passport” feature that provide coverage benefits in two different states? I spend about seven months in California and five months in Washington state each year. Can I just enroll in a new Medicare Advantage plan when I move back and forth?

Phil Moeller: Passport is a trade name used by UnitedHealthcare and describes the portability feature offered by some of its Medicare Advantage plans. While UnitedHealthcare does offer the Passport feature on some Washington plans, a spokeswoman says, it is not available in California. So you are out of luck regarding this particular feature. I have not heard if other insurers offer similar Medicare Advantage plans, but perhaps some readers have. If so, please let me know, and I’ll pass the information on to David.

The idea of enrolling in a new Medicare Advantage plan every time you move back to one of these states is possible in theory, but challenging in practice. According to UnitedHealthcare, you would need to change your legal address every time you move, and make sure the new address has been registered with the Social Security Administration. It is the official arbiter of Medicare enrollments. Even if you do this, enrolling in a new plan every five or seven months would play havoc with your plan deductibles, which would need to be reset every time you switch to a new plan.

If a Medicare Advantage plan does not seem feasible given these constraints, you also could use the upcoming Medicare annual open enrollment period to switch to original Medicare (Parts A and B) plus a stand-alone Part D drug plan. You also should explore whether you can get a Medigap plan to close any coverage gaps in original Medicare. If you’re interested in Medigap, you should use Medicare’s Medigap tool to identify the best policies for you available at your current legal address. Then contact the insurers to see if they will sell to you and what their terms would be. Newcomers to Medicare have guaranteed access rights to Medigap policies on favorable terms. But people already on Medicare may not have these right, so you should check first. Open enrollment runs from Oct. 15 through Dec. 7. Good luck!

RECOMMENDED READING

Snapshot of Where Hillary Clinton and Donald Trump Stand on Seven Health Care Issues

Older and disabled Americans have a lot at stake in the upcoming Presidential election. Trying to get an impartial assessment of the issues is hard. The Kaiser Family Foundation certainly is biased to the extent it generally supports more health benefits for people. But its arguments are fact-based and very useful. (Source: Kaiser Family Foundation.)

Social Security Should Give Seniors Better Advice About When to Start Benefits

When Larry Kotlikoff, Paul Solman and I wrote our Social Security book last year, we often felt we had walked out onto a very long pier. Readers kept telling us about all the problems and mistakes they were encountering in their efforts to get the Social Security benefits to which they were entitled. But the Social Security Administration kept saying that it was doing a wonderful job, that its websites were winning awards for transparency and effective consumer communications and that its approval ratings were off the charts. Now, according to a recent report from the Government Accountability Office, it turns out that we have a whole lot of company on that pier. The Social Security Administration and its employees are not doing a particularly good job of helping people or of telling them about their benefit choices, the Government Accountability Office found. (Source: Mark Miller for Reuters.)

The Doctor Is In. In Your House, That Is.

Rising numbers of older Americans are “aging in place” — staying in their homes well into their later years. People always have preferred to stay in their homes as they age, and advances in “telehealth” and related technologies promise to deliver good and cost-effective care in the home. The trend is also being supported by the rise of age-friendly home design and retrofits, such as safer bathrooms and wheelchair accessible homes and rooms. Now, the push is on for Medicare to ease its restrictions and expand its coverage of in-home care. (Source: John Wasik for The New York Times.)

The post How do the Affordable Care Act and Medicare interact? appeared first on PBS NewsHour.

105-year-old Japanese Hidekichi Miyazaki poses like Jamaica’s Usain Bolt in front of an electric board showing his 100-metre record time of 42.22 seconds at an athletic field in Kyoto, Japan, in this photo taken September 23, 2015. Japanese centenarian Hidekichi Miyazaki set a record as the world’s oldest competitive sprinter a day after turning 105. Photo by Kyodo/REUTERS

Humans have squeezed almost as much they can out of their natural lifespans and are approaching the biological limit of how long they can extend their years.

So suggests a paper published Wednesday in Nature that argues that the human lifespan appears to be fixed. By analyzing demographic data, the authors write that the number of years any one human can live has a natural cap and is restricted by all the biological time bombs that can take us down.

Even if scientists are able to slow some aspects of aging, they say, there are plenty more that can kill us.

“There’s no doubt that these intrinsic aging processes, they limit our lifespan,” said Jan Vijg, an author of the paper and a genetics and aging researcher at Albert Einstein College of Medicine in New York. “There are so many genetic variants that could have a bad effect on you when you’re old. What are you going to do? Develop a drug for all of them?”

The record for longest known lifespan went to a Frenchwoman named Jeanne Calment, who died in 1997 at 122. Based on the analysis, the authors found that the global population would need to be 10,000 times bigger for someone to have a chance of reaching 126 years old in a given year.

The paper will likely fuel the debate over the value of aging research and whether limited funding should be devoted to trying to study something as nebulous as longevity.

“There are some people interested and excited about longevity research, and there are a lot of people who think it’s something we shouldn’t be doing,” said Coleen Murphy, an aging researcher at Princeton who was not involved in the new paper. She said she hoped the takeaway from the paper wouldn’t be the latter.

The hope that we can extend our lifespans comes in part from studies showing it is possible to extend the lifespans of some species. In 1993, for example, researchers discovered a mutation that doubled the lifespan of a worm. Other longevity genes have been found in groups of people who are more likely to live longer than others.

Even though Vijg doubts longevity research will help people live to 130, he said it could uncover treatments for conditions that afflict people in their 60s. He said such work could help more people live better and longer lives generally — a point echoed by aging researchers in defense of their work.

Jeanne Calment, who died in 1997 at 122, lived longer than any person in recorded history. Jean-Paul Pelisser/REUTERS/

Inspired by the buzz around longevity research, a number of companies seeking to delay aging have sprung up in recent years, including Calico (launched by Google) and Craig Venter’s Human Longevity. Major pharmaceutical companies including Novartis and GlaxoSmithKline have also pursued antiaging treatments.

For their analysis, Vijg and his coauthors — Xiao Dong and Brandon Milholland, also of Einstein — looked at data from about 40 countries in the Human Mortality Database, a joint project of the University of California, Berkeley, and the Max Planck Institute for Demographic Research in Rostock, Germany.

They found that while life expectancy — how long people can anticipate living — surged over the past century in developed countries, the rate of change drops after people hit old age. This, the authors write, “points towards diminishing gains in reduction of late-life mortality and a possible limit to human lifespan.”

Looking at the same data, the researchers found that year-to-year survival improvements — the idea being that if you were born in 1960, you could expect to live longer than someone born in 1959 — hit a plateau around 1980 and have remained fairly flat since then. Someone born in 2000 might not expect to live longer than someone born in 1999.

READ MORE: Can a worm’s lifespan hold the secrets to human aging?

The authors also examined the maximum age of death each year of people in Japan, France, the United Kingdom, and the United States — the countries with the most supercentenarians (people who live to 110). Although the researchers acknowledge they had only limited data, they found the maximum age rose until the mid-1990s and has since declined slightly.

In a separate editorial published in Nature Wednesday, another researcher echoed the findings of the paper, saying that biological underpinnings of aging set different species’ average lifespans. If that’s the case, he said, then “why would anyone think that people could live for much longer than we do now?”

“The crucial question is how much more survival time can be gained through medical technology,” wrote Jay Olshansky of the University of Illinois at Chicago. “With fixed life-history traits, it would seem that we are running up against a formidable barrier.”

Other researchers not involved with the paper said the analysis relied on the best available data, but that it underestimates the potential of scientific discovery.

Murphy said she agreed that there were natural limits to lifespans, but that unnatural limits could exist as well. “It’s not like we’ve tested every drug,” she said.

READ MORE: Can we ‘cure’ aging? Scientists disagree

In a way, researchers say, it can be hard to imagine an area that exists beyond a supposed limit until someone discovers the way to push past it. Before the discovery of antibiotics, many people would have found it impossible to believe people could live as long and as healthily as we do now.

“We don’t know yet what the impact will be of new pharmaceuticals, new technologies,” said David Sinclair, an aging researcher at Harvard Medical School. “The past doesn’t predict the future when it comes to technology.”

Sinclair — who helped start the longevity company CohBar, among other companies — said that discovering the body’s natural repair pathways and rejuvenating them to work like they did when they were younger could change not only how long people live, but how well they live.

“The goal of this research is not to keep people in the nursing home for longer,” he said. “It’s to keep them out of nursing homes for longer.”

Vijg said he doubts that scientists will discover some sort of master regulator that can affect all the age-related processes and diseases that he says constrain our lifespan. But, he said: “Maybe what I now think is impossible may be possible.”

This article is reproduced with permission from STAT. It was first published on Oct. 6, 2016. Find the original story here.

The post Even with medical advances, humans may not live past 130, study says appeared first on PBS NewsHour.

Sônia Braga stars in “Aquarius,” directed by Kleber Mendonca Filho. Braga plays Clara, a 65-year-old widow and retired music critic, who is the last resident of the Aquarius, one of the few old buildings standing in a rapidly changing seaside Recife neighborhood in Brazil. Clara vows to live in the building until her death, but must fend off developers to preserve her home and her memories.

"Aquarius" opens Friday, October 14th at the Angelika Film Center (18 West Houston Street, b/w Broadway & Mercer).