by Sanjay Gupta
Choose Health Care Plans Wisely
Medical debt spiked $2.8 billion, or about 6.5 percent, from the end of May 2020 to the end of March 2021, and past-due medical debt grew by nearly 9 percent, from $19.6 million to $21.4 million.3 People who got really sick without proper health coverage or who faced ongoing health problems and endless doctor visits to treat long-haul COVID suffered huge economic fallouts. Many people lost health care coverage altogether with their jobs.
The Affordable Care Act (ACA) has been a solution for many people who would otherwise not have access to medical insurance (when it’s open enrollment, you can buy plans on HealthCare.gov—some without any premium if you qualify). The ACA bars insurers from discriminating against people with medical conditions or charging them more than healthier policyholders. This is especially good news for former COVID patients who could face a range of long-term physical or mental effects, including lung damage, heart problems, or neurological conditions including depression. Although some of these issues will heal with time, others may turn out to be long-standing problems. When shopping for health insurance, here are a few important tips:
• Make sure you choose an ACA-qualified plan, and shop around to consider all the plans available to you in your region. Non-ACA plans may be enticing for their lower price tag, but they offer less comprehensive coverage and are not eligible for federal subsidies that help people who qualify pay for the cost of the premiums. A short-term, limited-duration plan is never going to be the right decision. Spend some time doing your homework, and ask lots of questions.
• Stay in your network. Make sure the doctors, specialists, and hospitals you use are in your plan’s network. If you find yourself seeking out-of-network care, you will pile on debt because those bills will come in and you won’t have coverage. Sometimes working with a broker for health care policies can help you navigate this more easily (brokers don’t typically charge you for their services since they get paid by insurance companies). If you’re a COVID survivor, factor in the possibility of needing more coverage for more doctor visits and access to specialists. As I’ll note later, you’ll want access to multidisciplinary clinics where teams of doctors from various fields of medicine work together. HealthCare.gov has a “find local help” button that can refer you by zip code to navigators, assisters, and brokers. When you’re looking for coverage to meet each individual family member’s specific needs, it helps to speak to someone about what’s available and within your budget.
• Factor in deductibles. You must meet a deductible before the better part of financial assistance kicks in. In most cases, the higher the premium you pay, the lower the deductible will be. But getting past a high deductible can be difficult if you’ve chosen a plan with a low premium and you need complex care at once or expensive prescription drugs. Those with ongoing health conditions need to carefully weigh the expected annual out-of-pocket costs for various health plans. And be wary of “zero-deductible” plans, because these may have hidden costs you don’t realize until you’re billed. Read all the fine print.
Rebuild Emergency Funds and Financial Cushions
For many families, the pandemic led to financial distress as people lost jobs and had medical bills piling up. Any emergency funds, if they existed, have been drained. Now is the time to create a post-COVID spending plan that prioritizes establishing (or reestablishing) that emergency fund—before paying off debt or planning lavish vacations (I know; after all this isolation, the urge to “get back” to life might lead to overspending on all the things that we have missed most). According to disaster financial planners I interviewed, you should aim to save up to a full year’s worth of living expenses in your family emergency fund. Prioritize bills you must pay (e.g., rent, mortgage, car, insurance), and funnel as much cash as you can toward your emergency fund until it’s full. The goal is to remain as flexible as possible with cash to best prepare for another pandemic.
Personal finance expert Suze Orman maintains a lot of practical advice and tools on her site, SuzeOrman.com. Although she doesn’t usually advise that people prioritize saving over paying off high-interest debt, she also knows these aren’t typical times. During the acute phase of a pandemic, saving cash above all else is sometimes the right strategy as long as you have mapped out a plan to eventually pay attention to debt and credit scores later. However, no matter which phase we’re in, a priority to save and maintain those emergency funds is always good advice. In Orman’s words, “An emergency savings fund is not an investment. It is security. It is peace of mind. It is protection.” To that I’ll add, it’s smart pandemic preparation.
Have an Advance Health Directive in Place
It took many families a grim trip to the hospital with severe COVID to realize they had never thought about end-of-life decisions. Many families faced abrupt decisions about the kind of care they wanted for themselves or their loved ones. And many of these difficult conversations had to happen over the phone since the pandemic prevented families from entering hospitals to help loved ones fight through the illness by the bedside or, worse, prepare to die. When the pandemic struck, people filled out advance directives at five times the rate they had before. Unfortunately, fewer than a third of healthy US adults have an advance directive. This legal document can give instructions about the kind of medical care you prefer if you become seriously ill and are at the end of your life. You can specify the types of medical treatments you do and do not wish to receive and can designate someone who will make sure that your health care decisions are followed. Would you want everything possible done to keep your vital organs working? If your kidneys start to fail, would you want to be put on dialysis? What if you need chest compressions, placement of a breathing tube, or defibrillation?
You do not want your family to be making these kinds of decisions while in crisis mode. Advance medical directives are often included in traditional will and trust packages, but they can be executed on their own. (As a resource, AARP offers links to free, downloadable advance directive forms for each state. For some states, living will and health care proxy forms are combined into one document. For other states, the forms are separate. Another resource to check out is the University of Pennsylvania’s free tool at OurCareWishes.org.)
I recommend every family make it a goal to organize these important legal documents no matter how much value they think is in their “estate.” A family or estate attorney can help draft and execute these important documents, including durable power of attorney (designating who can make financial and other decisions when someone is no longer able) and instructions for where assets go once you’re gone—even if those assets are purely sentimental, like your collection of sports memorabilia. These documents tend to be lengthy and detailed, and they specify some of the most practical but difficult decisions that you must eventually face. Forgoing these documents can be financially ruinous to families—triggering unexpected medical bills left to loved ones dealing with the financial aftermath. When a person does not have an advance directive, extraordinary and aggressive measures to save a life could be taken with enormous costs. I realize that these conversations are not fun to have and involve tough, serious hypotheticals to consider, but ask anyone who has been through the experience of not having these documents in place when they were needed, and he or she will strongly encourage you to get them done. Look at completing an advance directive as a belated holiday gift to your family this season.
Travel Smartly
This one is easy: Follow the CDC’s guidelines to know where it’s relatively safe to travel both domestically and internationally (surprise: Domestic travel is not inherently safer than international travel if there are hot spots at home and COVID-free places abroad). Even if you’re vaccinated, you’ll want to plan ahead and do your homework. Before booking lodging or transportation, find out the company’s COVID cleaning procedure, whether there’s a vaccination and face mask policy, and what happens if you decide to cancel. Check for restrictions at your destinati
on and anywhere you might stop along the way. Don’t know whether to brave flying or go by car? Both bear risks. Most viruses don’t spread easily on flights because of how air is exchanged and filtered in airplanes. But crowded flights, security lines, and airport terminals make physical distancing difficult. Once at your destination, follow local rules and recommendations, and you’ll stay safe. Consider buying what’s called Cancel for Any Reason travel insurance (standard travel insurance likely won’t cover COVID-related trip changes), which will generally reimburse you 75 percent of your travel costs.
Here are some additional tips:
• Aim for vacations that keep you mostly outdoors where spread of the virus is minimal.
• Look for all-in-one resorts that offer an abundance of space, and maintain strict COVID-sensitive protocols. Or rent a house where exposure risk is low in the area and the rental company has implemented exhaustive cleaning protocols and checklists. No matter where you are, your biggest risk of infection remains prolonged indoor, face-to-face contact with unmasked people. One of the most important factors to consider when renting is who you’re going to share your space with.
• Take a guided trip with a respected operator that organizes a COVID-safe journey. If you want to go on a cruise, you might want to save long-distance Caribbean or European voyages for the postpandemic era, and instead, stay within the United States by selecting one of many small ships that travel our finest water routes, such as the Great Lakes, Chesapeake Bay, and the Mississippi, Snake, and Columbia Rivers. Coastal communities on the Atlantic, Pacific, or Gulf offer trips on their nearby waters. Because cruise liners may not mandate vaccination for passengers or crew, it’s up to you to ask questions and choose the liners that have the safest, strictest COVID protocols. The nature of a cruise ship—tight quarters, shared spaces, lots of contact with strangers—makes these voyages uniquely risky when there’s a bug on board. Remember, it only took one confirmed individual to infect hundreds on the Diamond Princess in 2020.
Vaccine passports may be necessary while traveling. This can entail physical cards or cell phone apps that show your vaccinated status. There probably won’t be a universal system, so you’ll have to comply with whatever passport rules are established. In the United States, it’s up to individual states, universities, and businesses to decide whether they want to require such passports. At this writing, there are no plans for a universal federal vaccination database or a mandate. If you’re carrying around your CDC-issued vaccination card in your wallet, make a digital copy and save the original in a safe, locked place at home or in a bank safety deposit box where you keep other important documents. Until vaccines are approved for all children, traveling with unvaccinated kids adds another complicated layer. You’ll want to continue to protect them as much as possible from exposure, which means continuing to wear masks, wash hands, and physical distance from other people. While zero risk is not a practical goal, we should still do the basics to minimize risk as much as possible without sacrificing a fulfilling life.
Rethink Long-Term Care Facilities for Aging Parents
Some of the most heartbreaking images from the early days of the pandemic were taken in nursing homes and retirement communities ravaged by the virus. Many assisted-living facilities became death traps for older people who were exposed to the virus. The combination of age and underlying health conditions in a closed, shared setting made them exceptionally vulnerable: About 8 percent of people who live in US long-term care facilities have died of COVID—nearly 1 in 12.4 In nursing homes, the figure is nearly 1 in 10. Throughout the pandemic, long-term care facility deaths made up over a third of all US deaths.
Although these places should now have a plan to protect residents, workers, volunteers, and visitors from a COVID outbreak, I believe most people will think carefully about sending a beloved family member to one of these facilities. Many factors make these spaces vulnerable to viral and bacterial diseases: frequent physical contact between residents and staff, employees who shuffle in and out and work in many facilities, and residents sharing rooms where physical distancing is difficult.
Problems with infection control in these settings predate the pandemic. A May 2020 report from the US Government Accountability Office found that four in five nursing homes surveyed between 2013 and 2017 were cited for deficiencies in infection prevention and control, leading the Centers for Medicare and Medicaid Services (CMS) to announce tougher rules for infection-control inspections and enforcement.5 The CMS now requires nursing homes to tell residents and their families or representatives within twelve hours if a COVID case is confirmed on-site. The information must also be reported to the CDC and is compiled in an online data set where you can find week-by-week case numbers at individual facilities.
Although we now can rely on vaccines to keep residents and staff safer, we cannot assume that everyone’s vaccination status will remain the same. Long-term care facilities have been one of the great success stories of vaccination for COVID, as rates of the disease in nursing homes decreased by more than 80 percent since vaccination began, but nearly a quarter of nursing home and assisted care facility staff have no plans to get the vaccine. Many more may skip booster shots in the future. Note that unlike nursing homes, assisted-living facilities do not typically have federal oversight. For example, the CMS rules on disclosing COVID cases to residents and family members do not apply to assisted-living facilities, which are licensed by the states.
Choose nursing homes and assisted-living facilities carefully. If you have a loved one in an assisted-living community and have questions or concerns about its COVID caseload and protocols, contact the facility and ask to speak to an administrator. You can also raise issues to your state’s department of health or department of aging. Consider these questions to ask at a potential long-term care facility:
What are your protocols for testing residents and staff?
Do you mandate vaccines? (I would choose a transparent facility where vaccination for COVID is a condition of employment. In fact, vaccination rates for staff should be made readily available to interested family members. Note that in institutions where influenza vaccination is mandatory, vaccine rates of around 98 percent can be achieved compared to vaccination rates below 50 percent in health care facilities where it’s not mandatory.)
What happens when there is an outbreak?
What safety protocols are in place to prevent a COVID outbreak?
How do you maintain and support your staff? (Retaining excellent workers is key to a good facility.)
Be Okay with Shifting Social Circles
Pandemics are divisive by nature as people wrestle with how to respond. COVID has been no different, as experienced by families and friends who spar over public health measures and the severity of the pandemic. Everyone has his or her own version of what’s right. I think we all know someone who didn’t abide by the rules at the height of the outbreak and tested our tolerance for such behavior. The politicization of the pandemic in the United States has made it especially hard to maintain social graces with so many competing values. We’ve all had to modify our social norms in ways that complicate how we work, interact with others, and generally go about our days. When our lives are at risk, other people’s opinions over what it means to be safe suddenly bear more weight than casual differences on matters unrelated to health and wellness. Things can get tricky when people’s boundaries and perceived levels of safety are in conflict.
Relationships may be permanently affected by this pandemic, and that’s okay. Many people’s social lives were already fraying before the pandemic, and the winnowing to essential, first-tier people may have been a relief. There’s solace in a pared-down social life. We had a chance to reset our social lives and set new boundaries. The pandemic revealed which relationships are worth keeping and nourishing (and, yes, friendship breaks are entirely normal regardless of a pandemic).
With life returning to a semblance of normalcy, how do you respond to people who m
ake you feel uncomfortable by inviting you to attend their big indoor party where you believe that many guests are unvaccinated? Be honest, and kindly tell them you don’t feel comfortable spending time with them in a particular setting. Think about your relationship—what you know about the people, where they are coming from—and determine how to interact with them. This isn’t about trying to change their minds. It’s about standing up for your own needs, feelings, and values. On my podcast, I spent a lot of time speaking to scientists about the virus, but also about how they navigate their own lives, given their background. A few themes emerged.
Use “I” statements so you don’t come across as accusatory: “I am not comfortable.” And if they tease you or get angry, say, “I hear you. I might feel the same way if I were in your position.” You can go further: “I’m just not willing or able to do this. This is about me. I’m now feeling like I’m not being heard, and that’s really hard, given our friendship. Can we talk about that?” In some instances, you may have to walk away from a conversation and stop engaging. Avoid jumping into heated, overly charged conversations where there’s a lack of empathy and compassion. If you’re tempted to tell someone, “You’re crazy!” it’s not going to go well. And if you feel the need to challenge someone’s thoughts or ideas about pandemic behavior, start with, “Where are you hearing that?” or “Please tell me more about your perspective so I can try to understand.” Listen to their concerns without judgment. You want to address their anxiety with compassion and show you care about their welfare. This helps build trust. It also validates their concerns. You can even share your own doubts and worries and point to resources that helped you make a particular decision. Present information you can back up with an apolitical article or post from a credible source to which the person might respond positively. Try and give them a sense of ownership of the new knowledge. Keep the conversation collaborative rather than one-sided, like you’re both learning and taking things as they come step by step.
