Color of Money Live (November 16)

Nov 16, 2017

Join Washington Post nationally syndicated personal finance columnist Michelle Singletary for an online discussion.

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I'm so glad you have joined me today. And I've got a wonderful guest to take your questions about open enrollment. She's a physician turned financial planner. She's got a heart to serve the needs of regular folk. So pick her brain today.

And as always looking for those testimonies. 

Let's get started.

My husbands company was recently acquired. His former company paid our insurance premiums in full for a CDHP and they contributed to an HSA for us. New company is offering both a CDHP and PPO option, but the premium will be paid in part by us, and for the CDHP, no contribution to the HSA. They are offering raises to compensate for the increased cost, but only if we choose one of the plans they offer. Complicating this is that my company offers several options (large state university), likely better coverage, and lower premium costs to us. But we won't get his increase in salary. We've considered going with his for a year, and then switching to mine, but our open enrollment periods are a different times of year. His is several months earlier. So if we dropped his at some point, we'd have to go without (not happening) until my open enrollment or I'm guessing we'd have to double pay for a while (enroll in mine and have double coverage, then drop his at his next open enrollment). Is that how that would work? And can I express my dismay that open enrollments aren't all at the same time of year! I was so surprised by that.

This is a tough situation. You'll have to run the numbers to determine what is the best option for you. One option to consider - depending on the deductibles, premiums and how much your employers pay, you may want to go on your workplace plan and your husband go on his workplace plan. 

Share your story with your Congressional leaders. They have no clue the hassle their constituents are having with open enrollment issues and costs, including the lost productivity from having to wade through these decisions every year.

Hi Michelle, I've been waiting years to tell you this testimony. We've got an appointment at the bank tomorrow to pay off the mortgage! We have a lot to be grateful for, but my spouse has developed some serious health issues (grateful for our health insurance), and paying off our mortgage now means we have more flexibility in how we tackle our situation. (Don't worry, we still have savings to cover medical expenses.) Thanks for all your advice over the years!

I'm so sorry about the health issues. But I'm so happy you have managed your finances in a way that you can get that mortgage monkey off your back so that you can deal with this crisis without financial worry. 

Cheers to you! And when you pay it off at the bank, give a shout for me. I'll feel it wherever I am. (But not too loud. Don't want to scare the bank folk).

It's open season for health insurance at work, and I'm lucky to have dozens of options to choose from. HR suggested we estimate whether we have low, average, or high expenses, but no one could tell us how to calculate our cost. I could add up all my copays and out-of-pocket expenses, but since it varies depending on your plan, I'm not sure how this would give useful info. Would you please advise on how I can get a rough ballpark figure of my healthcare expenses to use when comparing plans that are VERY different?

The easiest way to do this is to consider your health and your attitude toward health care usage first.

If you have good health and rarely go to the doctor, you can pick lower cost plans with higher deductibles. However, it is important to have money set aside to cover the deductibles just in case you develop an illness.

If you have health issues and go to the doctor regularly, it is probably better to choose a lower deductible plan.

If you have a great primary care physician and don't mind getting referrals, it is okay to go with an HMO instead of a PPO. However, if you want choice and don't want to get referrals, pay more for the PPO>

I would challenge you that the China incident reflects on a general culture of U.S. entitlement. However, I think it does reflect on the level of entitlement within U.S. "professional" college athletics. Oftentimes, these athletes receive all kinds of financial and other benefits while ostensibly "in school". Grades, money, cars, jewelry, computers, video game consoles, sometimes even girlfriends. Why wouldn't a young adult who has been groomed throughout high school and college to think that they *should* be given free things believe that they can just steal from a store without consequence? So, please don't lump in college athlete entitlement with the rest of the people in the U.S., the majority of whom know that stealing is wrong.

I hear you and respect your opinion. But I can lump in the rest of America because I get to hear from a lot of folks with entitlement issues. It is not just elite athletes. We are about to embark on the biggest time for entitlement -- Christmas. The question I was asking is why would they risk so much? And it's not just about stealing.

People bind themselves to debt and steal from their future to have stuff. And where do the kids learn entitlement from? 

Just asking? 

About a year ago I received a letter informing me that I had an IRA from a previous employee that I wasn't aware of. I had to jump through some hoops to prove that the money was mine, and now I'm starting to receive statements. The problem is that the IRA is about $2000. So far I have earned about $6 in growth, but spent $20 in fees. Considering that the stock market is doing pretty well right now, I'm afraid that it's not likely to get better. Would I be better off just cashing it out and taking the penalty rather than waiting until I'm 65? (I'm 45 now).

Roll it over into a low cost brokerage firm with low fees. It is important to save for your future and this is a good place to start. 

Make sure it is invested in a diversified portfolio - given the amount, a target date retirement fund is probably your best bet.

And start saving more to make it grow!

Also, when you do the rollover make sure the funds are directly given to the financial institution to prevent a taxable event. 

But I agree with Carolyn, invested right with much lower fees this found money can work for you over the years. It's not chump change!

I don't think the UCLA players says anything about a US culture of entitlement. It is one incident of young men making a stupid decision. I expect they don't even know why they did it. Stupid decisions to shoplift were a thing back in the good old days, too after all. If you want evidence of the US culture of entitlement, let's take a look a tax plan that cuts key deductions for the middle class, student loans and property taxes, while handing the 0.01 percent billions in tax cuts by eliminating the estate tax.

They know. We know. They wanted the brand name stuff. This isn't just about kids being kids. It's like underage or college drinking. It says a lot about who we are and why we think such things are no big deal -- until they are a big deal. 

 

Can you discuss how being enrolled in Medicare affects your choice between standard and basic coverage of your federal health insurance?

Your federal coverage will be primary until you retire so the rules for the standard or basic plan are followed. 

How do you know when to take SS? I've just turned 64 and if I wait until age 70 I'm not convinced that SS will not have been severely cut back or the age for retirement benefits will be raised. It feels like I should get what I can out of the system I've paid into for so many years. I'm self-employed and have savings, investments, and an annuity; my husband will have a pension + SS when he retires. What do you think? Sooner or later?

This depends on health and current income. Most likely, if you are healthy and have good longevity, it is probably best to delay social security for as long as you can.

People have worried for years about social security being cut. In reality, when changes are made, people close to social security age are grandfathered in under the old rules. 

It is probably best for you to consult an hourly financial planner to look at your current income and run a social security analysis. 

Michelle, Yesterday while I was waiting in line at the pharmacy I over heard bits and pieces of a conversation between the pharmacist and an elderly gentleman. Evidently he had reached his max in benefits and his prescription was going to cost $452 to fill. The pharmacist asked the gentleman if he still wanted the medicine...after a short pause the elderly man replied yes. I did not pry into this man's personal business but as a cancer survivor this situation left me concerned. I know from personal experience how unethical and I believe even criminal these insurance companies conduct business. After I was diagnosed with breast cancer, according to my doctor, my treatment plan was pre approved by my insurance provider before I received one drop of chemo...in fact my first day of chemo was delayed by several hours waiting for final approval from my insurance provider. Then months into my treatment my insurance provider sends me statements of responsibility detailing that I owed $52,000 for four rounds of chemo and I was responsible for 100% of my treatment. Do you know the amount of stress this put on me? It has been eighteen months since my last chemo and my doctor's office is still getting the runaround from my insurance company. I think the insurance companies are American's biggest obstacle.

This is a travesty and insurance companies and pharmacy benefit managers are the culprit. Everyone needs to call Congress and tell them they need to FIX THE HEALTH CARE SYSTEM. The current arguments about who is going to pay for care is not helping us at all. 

I'm so sorry for what you went through and what you are going through. 

I agree with Carolyn, we can't let this go on. This debate about health care isn't about "them over there." It's about you and me. And now we see the GOP trying to shoehorn in a change to the ACA that could help bring down the exchanges. Even with its flaws it's more than some people have ever had.

My husband and I talk about retirement and the No. goal for us is to make sure we have health care between the years we want to stop and when Medicare kicks in. We are good savers but one major health scare and we could be facing health costs that will seriously eat away at those savings. 

Maybe I am Ebenezer. My family just doesn't go hog wild and have mounds of boxes under the tree. The kids are grown and on their own, no grandkids. I asked what they wanted. One wants cash towards a big home improvement project. The other wants gift cards to buy work clothing for a new job. I'll get something small for each to open but why get lots of stuff they don't want or need? My spouse and are are the same way with each other. It's like people think they are failing if they don't spend $1000 on Christmas gifts.

You are Ebenezer but not how you think. The end of that story was about how he truly understood the love of giving but not in the sense of "stuff." Although giving isn't my love language, I understand how some people like to give and receive. Where I go nuts is when people give until it hurts in terms of going into debt or at the expense of having a financial savings cushion. Or by spoiling their children creating entitled brats. That's where we go wrong during the holiday season. 

I'm mid-50s, no kids, and can't make up my mind about this. Can you give me some pointers on how to best approach the decision?

There are a number of considerations. First, do you want to leave anyone money when you die? If not, you should have at least two years of long term care expenses set aside so you can get into a facility you would like. You can either self insure or buy a long term care plan. 

If you are very healthy, your risk of dementia is higher, so you need at least five years of care covered. If you can't afford this, consider long term care insurance.

Michelle, love your column - especially in these scary times. One of the idenity protection services has an advertisement about ID theft and stealing from your 401K. Have you addressed this issue? How could they do it? Can we put a lock on these accounts? Do I really need to hire someone to watch these issues for me if I read my quarterly reports? I am skeptical because this same service uses Equifax (I think you may have shared that information), so I take their advertisement with a heaping grain of salt. Thank you!

Thank you for your kind comments.

And I agree. These are scary times when it comes to our information. But don't let the companies scare you into getting a service you don't need.

I regularly check my 401k now. And I've put alerts on my accounts if any transaction is made. 

Also for your accounts, if available, activate two-factor authentication, which will help thwart any unauthorized action in your account.  

I'm driving a van full of 15 & 16 year old boys to Raleigh and back this weekend. What audio book can you recommend that would be good for these kids to listen to and still interesting to me? They are mostly first-generation kids who are not getting a lot of financial discussions at home. I was thinking Blink by Gladwell...but if there is something more finance related, but told in an interesting way, I'd appreciate it.

I had to chuckle because if I did this my kids -- and believe me they are very financially savvy -- would just roll their eyes.

So honestly, I don't think it will work. Instead, just ask some open-ended questions.

-- Hey what do you guys think about the UCLA players?

-- Are you guys worried about college costs?

-- Joke that you have a $1,000 to give them. What would they do with it?

Make the money talk fun and casual. 

Maybe it's a bad analogy, but I'm risk averse. I've been in the position of being able to afford the higher premium, so I generally choose a pretty low deductible/out of pocket plan. I'm also getting older, so I expect to have to use the benefit. It works for me. But unless you never leave town, again assuming you can afford the premium, why would you choose an HMO? Don't get sick/hurt when you're away.

Basically, you would choose an HMO if you have a good primary care provider who you know will do the right thing for you. If you travel, it will still cover emergencies.

I have a family of five and I choose the HMO option because it was more affordable. I also like having most of the health folks in one building -- eye, primary care, pharmacy, etc. And I've traveled and had to get healthcare and it was no problem. If the HMO didn't have a facility in the area, I just had to have the health folks call the HMO and get approval for my care. No problem at all. 

So this is scary. What an awful trade-off.

Sad and true. 

I try to make sure everyone is living a great life in the present - we work on that first before planning for a future that is uncertain.

I'm a former fed who retired well before 65. I still have my Federal health insurance (in my case GEHA). Although it's a few years until I reach 65, I'm a little confused as to what to do with my FEHB plan then. Do most people keep them as a supplement to the )now-primary Medicare, or do they drop them and wade through Medicare supplement plans?

Most people end up keeping their FEHB plan to act as their Medigap plan. However, it will be important to determine the best option at the time as the landscape is rapidly changing.

Unless the husband's insurance was far superior, I suggest they use individual insurance at their employer. Over the years when I worked I found that if we had a family plan which couples usually get, we would often pay for stuff we didn't need and it cost more. If the wife still needs maternity benefits, she would probably get it under the individual plan. Just because you are married (she didn't say if they had children one of them if they did could still cover the children)) doesn't mean you can't take individual insurance. Employers have different enrollment periods. It is worth reminding people that most large employers are actually self insured and the insurance company is just operating whatever plan chosen by the employer. That means next year a different company could be operating the plan with different costs, rules, etc. whatever is beneficial to their client.

Exactly!

Have been following your chats for years. Always been comfortable and never saved much. Finally started a life happens/emergency fund while trying to pay down all the cards. Last week, big rain, wondered why there was a puddle in the living room. Need new roof. Didn't have it all but had 1/2 saved in the fund. Hurt a little but not as much as it could. Got very low interest financing for the 1/2 I didn't have and now starting that fund again from $0. If I had listened to you earlier I could've saved it all and "woo-hood" but maybe I can just "woo" instead of woe! Thanks for the always sound, and non-judgmental advice.

Michelle is fabulous!

Start saving again. :)

You have a FULL testimony and you get FULL credit for starting when you did. I get it. Life happens. We do what we do. But when you knew better you started to do better and that counts for a lot in my book.

So good for you for having the half. And I wouldn't fuss that you financed the rest. A roof is a need!

Now go forth and build back up that pot. But this keep the two pots separate

-- Emergency fund (3 to six months living expenses) Don't worry about funding it fully while you are getting out of debt. Just start with something.

-- Life Happens fund. That's the car broke down, roof needs fixing- fund. 

So if you have say an extra $200 a month, fill up the life happens fund to say $1,000. After that take $100 and put in the emergency fund and the other $100 to continue building up the life happens fund. 

It's really hard to plan for retirement with the huge unknown of medical costs. Of course we can't know how much medical care we'll need or what kind, but also there's no way to predict what a doctor's office visit or a bottle of medicine will cost in 10 , 20, 30 years. Do you have a rule of thumb for how much to set aside for medical expenses?

This one is really tough as no one can predict the future. There is not a good rule of thumb. If health care inflation doesn't change, health care will make up 50% of our economy in the next 30 years - this isn't sustainable! Something will have to change.

In general, I use current health care expenses and add in estimated costs for health insurance once a person is no longer working. HOWEVER, and that is a big however, people need to learn how to better control what they can and utilize how to use the health care system cost efficiently - becoming an empowered patient and having clear advance directives are two areas people can make an impact in health spending. 

I'm a federal employee and while I generally stick with the same health insurance plan, I changed a few years ago after finding a better plan for me. Overall, I think most of my colleagues just stick with what they know and don't change much. The one thing I keep telling myself to do (and which I keep forgetting about) is to check up on other things. How much should I contribute to my flexible spending account? Should I lower my coverage on dental coverage? Maybe I can finally get my (aging) mom that long term care coverage? What about life insurance? It's a lot to take in! I understand a lot of this isn't tied to the open season (which is the tail end of the calendar year) but with so much to think about, holidays, and other commitments, I often forget some of these other questions and postpone. But this year will be different. I'm committed to looking in greater detail on some of these issues!

Congrats on doing this!

One thing many healthy people don't realize is that sometimes they can get insurance products cheaper on their own as opposed to going with their employer's offering. Generally, people with significant health issues do better with the employer offerings.

Read the link in this question. 

I'm planning on running some calculations this weekend - I'm now in the "needs prescription glasses" and "needs to have old fillings replaced" categories. I have a general idea of how much each of those runs each year, and am evaluating the plans offered. Do you have any general guidance? I already use the FSA option for my non-covered expenses.

Make sure you look at the benefits offered and they outweigh the costs of the plan. Especially with dental, if you need a lot of work done, you may be able to spread out the work over a few years to get the maximum benefit from each plan.

And never let FSA money go to waste! Glasses break, so get extra pairs just in case if you need to use your money.

People often will complain about how expensive a particular plan is for the premiums (say $15K for a year) and how high the deductible is (say $7K) and then declare that they have to pay $22K (in this example) before they get any benefit. But that is not how health insurance works, especially not ACA compliant plans. The fist thing your health insurance company does for you is negotiate the rate you pay. So a doctor may charge $450 for an appointment, but your insurance will negotiate that rate down to $215 even before it starts paying a percent of the total after you reach your deductible. The biggest issue may be with tests. Some blood work is billed at a rate that easily 5 to 10 times as much as the insurance company price ($50 to $60 vs $11 or even $5). And while you might be able to negotiate with your doctor's office, good luck trying to negotiate with the phlebotomist at a your local office of a big medical lab. They just don't have the authority to do anything. And in an ACA compliant plan, you get some preventative stuff included (basic physical, birth control, etc.) even if you haven't met any deductible at all. It drives me crazy when the people there to "defend" the insurance don't even point out that having a plan reduces your costs even if you don't meet your deductible for the year. I'm fortunate to have a really great plan without a high deductible, but when I read the explanation of benefits, I realize that it is often the negotiated rate that is more important financially than only having to pay my co-pays.

You are exactly right. However, our health care system is way too costly to begin with! I recommend that everyone read Elizabeth Rosenthal's book "An American Sickness" to learn just how badly each entity in the system is raking us over the coals! And then complain to Congress. 

I've had very good care from our HMO - perhaps because I grew up in the UK and am used to navigating the NHS. Kaiser is a leader in using technology well - I could e-mail my doctors before anyone else could etc. Also - all my medical info is in one place and accessible by all healthcare providers which makes my care more integrated and less likely for there to be mistakes. Yes, I have to spend time looking for good doctors I trust - but doesn't everyone? I think the only real cause for concern is if I get something unusual and would have to see one of the few doctors in the country who know about it. That could indeed get tricky - but at least I wouldn't have such stress over my cancer care like the poster above. HMOs are not always worse.

I have Kaiser and have been very pleased. In fact, a Kaiser doctor saved my daughter's life. She developed a very rare condition and just so happens a Kaiser doctor was trained to spot it. She was literally on her death bed but through it all Kaiser kept approving experimental treatments. One eventually worked -- days before they said my daughter would probably be dead. But I've also heard horror stories about HMOs. You just never know really. 

My wife and I take different medications and some are generic and some name brand. Is there a website or and organization we can go and find out which plan will work best for us. In other words most economical for us retired and living on fixed income. Thank you so much

Actually, the Medicare site has the best search out there. Here is the link: https://www.medicare.gov/find-a-plan/questions/home.aspx 

Yes, please use the link. I was on it earlier this week and you can input all the drugs you use to find a plan that works. 

Yes - I know they will roll their eyes, and they usually wear headphones, but the other day I was listening to Hidden Brain and every now and then they would chuckle along to it - so I know they are half listening. We did discuss the UCLA players last night on the carpool. All of them were shocked that people with money would do that, I referred back to Winona Ryder...it was an interesting conversation. Also - we'll be going to visit Duke & NC State - both as time wasters and because we are close - the $$ for tuition is sure to come up as a topic. thanks!

So you just gave me an idea. How about instead of a book, pike into the car a podcast about money. Anyone got a good podcast they can recommend?

Re: Medicare and FEHB - What factors do you consider when choosing between standard and basic coverage? I currently have BCBS as my secondary payer.

The big difference is the basic option requires you to use preferred providers to receive benefits. The standard option has a calendar year deductible and basic does not. 

When you say "self-insure" what dollar amounts are we talking? I live in California and I'm sure that would be expensive. Also, my husbands family has had short longevity and my family's history is longer.

The more important thing is how is your and your husband's health and lifestyle? My family has low longevity, but they had unhealthy lifestyles.

A great cost calculator is available on the Genworth site: https://www.genworth.com/about-us/industry-expertise/cost-of-care.html

I just wanted to make a comment here. Please take the time to look at your options during open seasons. I just changed my health insurance today because the premiums were going up a lot bi-weekly and in the past I've always just bit the bullet and let the increase go through without reading everything. Saving $100 a month isn't a ton, but it's SOMETHING. Thanks for all you do Michelle!

Really good advice.

People please, please read the open enrollment material. I just did a column in which one survey said 80% of employers said most of their workers don't read what they send.

Hi, Michelle; You've written before about the difficulties of being The Successful One in a poor family. I'm tearing my hair out. My sister has lost everything since her husband died, and it's all her own fault. She has the worst judgment you can imagine. You know those cons that you just can't believe anyone falls for? She falls for those. She supported a boyfriend and his "cousin and her children" in one of her rental houses (rent-free), stopped making her own house payments so she could give them money...really, if I told you all the stories, you would pound your head on they keyboard. We have begged and pleaded with her not to do these things, but she has never listened. She's lost the rental houses, she's lost the house, and she is about to be homeless. She can't stay with us because we know she would never, ever leave. She has no interest in any advice from us. She sure wants money, though. How do I simply stand back and say, "I didn't make this mess, and I can't fix it?" The rest of my family will surely, 100% blame me if I let her be homeless.

This is really tough. We can't save the world, including our family. It is important to clearly define what you are willing to do and not do - a great book to help learn how to have these hard conversations is "Fierce Conversations" by Susan Scott.

If the family is laying a guilt trip, it is good to talk with a therapist. Just because they are laying it on you doesn't mean you have to pick it up. A therapist can teach you how to deal with this.

I so know what you are going through. 

Look, it's hard to see someone homeless. But sometimes people won't change until they hit bottom. 

You can't make grown people do right. 

Be there for love and support and what you are willing to do financially. If you can't take her in, don't. 

And I so agree with Carolyn that you might need to see a therapist to deal with the guilt that you shouldn't have.

realized this year that "Consumer Driver Health Plan" actually means the insurance companies can blame the consumer! You needed those expensive eye drops so you don't lose your vision? Your kid needed a procedure so he wasn't having 20 minute nosebleeds every day at school? Your fault we're not covering it at all since you have a ridiculous deductible. That will teach you to need medical care!! *sarcasm*

Health care coverage should be reliable and patients shouldn't have to fight the system.

Call Congress over and over and tell them to fix our health care system. All they talk about is arguing over who will pay. They need to stop this madness!

I have worked with my current planner/advisor for about 10 years and am not happy. Most of his clients have seven figures while I am in the high six figures, and I don't get the same level of services. What things should I consider as I decide whether to (i) hire someone new (I've interviewed one person so far and am unlikely to go with him. It's hard to find someone I feel I can trust), (ii) invest myself through Vanguard or similar, or (iii) go with a roboadvisor such as Betterment? Thank you.

Depends on your age/complexity of your situation. Since you are in the high six figures, you probably have some complex planning needs above and beyond investments. There are many good advisers through NAPFA - https://www.napfa.org/ 

If you are younger and don't have a lot of moving parts, you may be fine with Vanguard or Betterment. If you are older and close to not working, it is probably better to have a relationship with someone who can look out for you. The key is to look for a fee only fiduciary to help you.

Carry-over from last week: I am another TSP millionaire. I retired at age 55 with slightly less than half that, but left it alone to grow, living on my pension plus earnings from my husband's job. Eventually, thanks to keeping it invested in the stock funds, it hit $1,000,000, and then I felt comfortable to start taking withdrawals. Since then (about six years ago), it has fluctuated some but is still over that magic number. How I did: invested the maximum for as long as I could, stayed heavily invested in the stock funds, but also paid attention to market indicators and moved into the government bond fund sometimes to conserve principal. That helped me survive two major downturns with minimal losses. Also, I did not take more than 4% of my total when I started withdrawals. I am now 67 and I am still heavily in stocks, figuring I could easily live another 25 or more years. Don't be in a rush to be too conservative if you are in good health and have a family history of longevity.

Since you are living on your money, I am concerned about the heavy stock position. People living in the last 30 years have severe recency bias - they are used to the market bouncing back quickly when there are downturns. After the great depression, it took the market 20 years to bounce back. That is a long time in human years! :) 

If you don't need the money, you can take all the risk you want if you are okay with the losses. In 2008-2009, you would have had a 40% loss. Are you good with that now that you are living on the money and have given up your safest asset - your ability to learn more money?

Why are individual plans so expensive - and so useless? I've looked several times over the last few years and the premiums are almost exactly what my basic out-of-pocket costs would be for two cleanings a year. And that's usually ALL they will pay for; the list of what they won't pay is much longer than what they will.

I agree! In general, the only plans I've found useful are usually employer based. Best to pay for dental using FSA and HSA's if you have them available. 

Great chat today. Special thanks to my guest Carolyn McClanahan. We think so much alike. Love her advice.

Appreciate you all. And just a heads up. No chat next week because of the Thanksgiving holiday. 

Eat and be merry but don't eat too much or spend too much!

 

In This Chat
Michelle Singletary
Michelle Singletary writes the nationally syndicated personal finance column, "The Color of Money," which appears in The Post on Wednesday and Sunday and is carried in more than 120 newspapers.

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Carolyn McClanahan
Carolyn McClanahan, M.D. CFP® is a physician turned fee-only financial planner. In addition to her financial planning practice, she speaks and writes on the intersections of health and personal finance, including aging, health care costs and long-term care issues.
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