Cholesterol guidelines: More on statins

New guidelines about cholesterol levels and treatment were supposed to clear things up, but I'm just more confused.

Should I be taking statin drugs every day just because my LDL cholesterol number is high, which is "bad," and even though my HDL cholesterol is also high, which is "good."

Under these new guidelines, nearly half the U.S. population would be using statins to stave off heart attacks and strokes, according to Dr. Nortin Hadler, a UNC Chapel Hill professor of medicine and microbiology/immunology.

In a recent article for Scientific American, Hadler and his co-author remind us that these drugs are not without potential side effects and will offer no substantive benefits to many.

The article, entitled "How Clinical Guidelines Can Fail Both Doctors and Patients," says the authors of the new guidelines "were faced with robust data that demonstrates a correlation between cholesterol level and clinical outcomes over time. But despite the substantive science behind the connection, the correlation is weak. The guideline neglects to emphasize this fact."

Hadler, widely known for writing books such as "Worried Well" and "Citizen Patient," is skeptical about much of the treatment that medical doctors recommend today, including such broad prescribing of cholesterol-fighting drugs.

Here's is a link to the piece co-authored by Hadler and Dr. Robert McNutt, a former editor at the Journal of the American Medical Association  and the Journal of General Internal Medicine. McNutt is a professor of Medicine at the University of Wisconsin and Rush University Medical Center.

Remember to figure health care costs in retirement

How much money does it take to retire?

Partly, it will depend on your health.

The New York Times recently probed this question through the story of Jeff Strack, a 61-year-old Charlotte sales manager who is considering retirement.

Fidelity Investments estimates that the average married couple retiring this year at age 65 will need $220,000 to cover health costs throughout retirement, the Times story said. That figure is less than last year’s estimate of $240,000 because of lower-than-expected Medicare spending, Fidelity said. Also, people have cut back on medical care during the lackluster economy, and increases in payments to doctors and health plans have slowed under the Affordable Care Act. But the number is still daunting.

The Times also quotes the Employee Benefit Research Institute, which estimates that a married couple retiring in 2013 at age 65 with traditional Medicare (with a prescription drug plan, a generous supplemental plan and median drug costs) will need $255,000 to have a 90 percent chance of having enough money for health care costs throughout their retirement.

Maternity coverage: Men have babies, too

Under the Affordable Care Act, certain essential benefits are required to be provided by every health insurance plan, and that's why some people are getting letters from their insurers notifying them that less comprehensive insurance plans are being cancelled.

Many people in their 50s and 60s have been asking why they have to pay for benefits they don't need, such as maternity coverage.

Here's a story from the Los Angeles Times that tackles that question.

Kaiser estimates 684,000 North Carolinians are eligible for insurance premium subsidies

A new report from the Kaiser Family Foundation estimates that 684,000 North Carolinians will be eligible for tax credits if they buy coverage through the Affordable Care Act marketplace next year. 

Estimates for each state reflect demographic information, including how many lack insurance now, their income levels, or buy their own coverage now and their income levels, as well as whether each state is expanding its Medicaid program.

Here is a link to the full report that includes a table showing each state’s data.  

There is also ZIP-code-specific calculator that can estimate the premiums and tax subsidies people might get if they purchased coverage on the exchange – based on relevant information such as ZIP code, age, family size and income.  

The federal premium subsidies, in the form of tax credits, are designed to help low- and moderate-income people buy private health insurance. 

To qualify for tax credits, people must earn between 100 and 400 percent of the federal poverty level (that's $23,550 and $94,200 annually for a family of four). They must also not be eligible for affordable coverage from an employer or from Medicaid or Medicare. People who are not lawfully present in the country or who are incarcerated are not eligible for tax credits. 

In states that expand Medicaid under the Affordable Care Act,  uninsured residents with incomes up to 138 percent of the federal poverty level will qualify for Medicaid. In states that do not expand, uninsured residents between 100 percent and 138 percent of the federal poverty level generally will be eligible for tax credits, but those with lower incomes generally will be left without assistance. 

The new analysis estimates that about 29 million people nationally are potential customers for the exchange, including currently uninsured people and those who buy private insurance on their own now through the existing markets for non-group insurance. People who buy coverage also will face deductibles and other cost-sharing, depending on the plan they chose, though some of those who are eligible for tax credits will be eligible for additional assistance with their cost-sharing.