HELP LINE: Mark Harvey tackles your questions

Reader-submitted questions about health insurance, dementia and Adult Family Homes are answered

I WANT YOU to know that this entire column is your fault.

That’s right: You guys have emailed these questions to me, and I’ve been saving them up, so here we go.

If you don’t see your particular question here, it’s probably because a) we had a private exchange on the matter, b) I don’t know the answer and couldn’t find anybody anyone who does or c) your question was grossly inappropriate for a family-oriented newspaper.

Q: What is a health savings account? Can I have one of those and Medicare at the same time?

A: A health savings account (you might have seen the acronym “HSA”) is an account that works with high-deductible health plans, which tend to be less expensive premium-wise but have (guess what?) high deductibles.

The most common scenario is having an HSA through a current employer so you contribute to it on a tax-free (“pre-tax”) basis, and you can then use those funds to pay for qualified health expenses within certain IRS requirements, an obvious example being those high deductibles.

Can you have an HSA with Medicare?

No. You cannot be enrolled in Medicare Part A and/or Part B and contribute to an HSA.

You can continue to withdraw money from an HSA to pay for expenses such as Medicare deductibles, premiums, etc., and it will continue to be tax-free, but you can’t contribute.

As an aside (or sideways), you want to stop contributing to your HSA six months before you start collecting Social Security.

Many of us don’t take Medicare when we’re first eligible, for any number of good reasons, but that doesn’t mean that we might not start collecting Social Security.

The reason for this is that when you apply for Social Security, Medicare Part A (which is free for most of us) is often retroactive for many of us to up to six months, and you can’t contribute to an HSA and be on Medicare, remember?

It’s a tax penalty.

Q: What have I heard about flu vaccine and Type 2 diabetes?

A: I have no idea what you’ve heard, but I can tell you what I’ve heard — specifically, a seven-year study suggests that folks with Type 2 diabetes who do get flu vaccine are 30 percent less apt to have a stroke and 22 percent less likely to have heart failure.

If it were me, I’d get the flu vaccine. (As a matter of fact, I do.)

Q: I’ll be on Medicare in a few months, so I’m covered for long-term care, right?

A: Wrong.

Medicare does not cover long-term care. True, there’s the whole thing about being covered for a certain amount of time in a skilled nursing facility if you spent so many nights admitted to a hospital, but that’s only for recovery/rehabilitation, not long-term care.

Medicaid does cover long-term care, but that’s a bit more complicated. Let me know whether you care.

Q: I’ve suddenly started forgetting things and I’m scared to death. Am I getting dementia?

A: I am in no way qualified to diagnose anything in anyone.

So if this is a genuine concern to you, get to your doctor or primary health care provider ASAP.

Now, here’s my social worker take: The fact that you’ve noticed this and you’re worried and you’re asking would lead me to suspect that it isn’t dementia.

But it is something. Have you had a recent change in medications? A change in your physical/medical status? Are you particularly stressed?

We all forget stuff and we all need to learn to avoid freaking out simply because we space out on the car keys, but if this is a relatively sudden change, then it’s worth getting to your doctor.

It probably isn’t life-threatening, but you need to address whatever it is because it’s messing with your life.

Q: How can I get my dad to take care of himself the way he should?

A: I doubt you can. The reason I doubt that is because I’m going to guess that your “should” is not his.

Try this: We all stumble through life juggling important for vs. important to.

“Important for” is about taking care of ourselves, being safe, being responsible, doing all the right stuff, etc. ad infinitum.

“Important to” is about what means something to us personally.

For instance, it’s probably important for me to eat more kale and stuff like that, but it’s not important to me, so I don’t.

It’s probably important for me to save every red cent I can get my hands on, but what’s important to me is to spend a bit on my best friend (to whom I am married), so I try to balance those things.

Get it? Important for vs. important to.

I suspect that you’re telling your dad what’s important for him and not listening to (or acknowledging) what’s important to him.

What often happens is that if we do better at the latter, we often see improvement in the former, but we have to remember whose life it is.

I, for one, refuse to destroy a relationship because I want somebody to do what I want them to do, even in the name of love.

Q: How can I get my son to quit bugging me about taking care of myself the way he thinks I should?

A: Threaten to tell his spouse about that one particular weekend when he was in high school.

Q: I’m interested in starting up an Adult Family Home. What do I need to know?

A: A lot of people might not know what you’re talking about, so let’s start with that.

An Adult Family Home is simply a private residence that has been converted, licensed and staffed to care for folks who need care but don’t need (or perhaps want) a full-tilt nursing home.

The maximum capacity is six residents, but many stay at four or below.

This is an important long-term care option that is in desperately short supply on the North Olympic Peninsula.

Your question is timely because this coming Friday, there’s going to be a workshop on the nuts ’n’ bolts of opening an Adult Family Home called (coincidentally) “The Nuts and Bolts of Opening an Adult Family Home.”

It’ll be from 11 a.m. to 1 p.m. at the Home &Community Services office in Port Townsend, 915 Sheridan St., Suite 201, and it’ll be free.

I hope you attend this workshop.


Mark Harvey is director of Clallam/Jefferson Senior Information &Assistance, which operates through the Olympic Area Agency on Aging. He is also a member of the Community Advocates for Rural Elders partnership. He can be reached at 360-452-3221 (Port Angeles-Sequim), 360-385-2552 (Jefferson County) or 360-374-9496 (West End), or by emailing

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