Savvy Senior – November Columns
- How to Arrange Your Own Cremation Service
- If You’re 65 or Older, It’s Time to Get Your Pneumonia Shot
- How SSI Benefits Can Help Struggling Seniors and the Disabled
- How to Find a Cheaper Medicare Prescription Drug Plan
- Best CPAP Alternatives for Sleep Apnea
How to Arrange Your Own Cremation Service
Dear Savvy Senior,
I would like to arrange a simple cremation that doesn’t cost me, or my family, a lot of money. Can you offer any tips that can help me with this?
Still Kicking
Dear Kicking,
If you’re looking for a simple and affordable way to go, cremation is an excellent choice, and one that’s become exceedingly popular in the United States. About 60 percent of Americans are now choosing cremation over a traditional burial, versus only around 20 percent in the mid-1990s.
Why the big shift? Price is a key reason. A basic cremation can cost as little as $700 to $1,200, depending on your location and provider, versus $7,500 or more for a traditional funeral and cemetery burial. Geography is another factor, as many families are spread across the country, making future gravesite visits less common.
Here are a few tips to help you arrange your cremation and ensure you get a good deal.
Shop Around
You can arrange a cremation through a funeral home or a cremation-only business, but it’s wise to shop around because prices vary widely. It’s not unusual for one funeral home to charge $1,000, while another charges $4,000 or more for the same service.
Call five or six funeral homes or cremation-only businesses in your area and ask them how much they charge for a “direct cremation,” which is the most affordable option there is. With direct cremation, there’s no embalming, viewing or memorial service. It only includes the essentials: transportation of the body; required paperwork such as death certificates; the cremation itself; and return of the ashes to the family, usually within a week.
If you want a viewing, memorial service or anything beyond what a direct cremation provides, ask the funeral home for an itemized price list so you know exactly what you’re paying for. All funeral providers are required by law to provide this.
To locate nearby funeral homes, Google “cremation” or “funeral” followed by your city and state. You can also shop and compare prices from funeral homes in your area at Funeralocity.com.
Cheaper Urns
The urn is another item that can drive up your cremation costs. Funeral home urns usually cost around $100 to $350, but you aren’t required to get one.
After cremation, your family will receive your ashes in a thick plastic bag inside a cardboard box. This is all they need if you intend to have your ashes scattered, but if your family wants something to display, Amazon.com and Walmart.com both sell a wide variety of urns for under $50.
Green Cremation
If you’re an environmentally conscious person, there’s also a green cremation option you should know about called “alkaline hydrolysis” that chemically dissolve the body. This is a gentler, more eco-friendly process than traditional cremation, which uses combustion. It’s legal in more than 20 states, and costs around $2,000 to $3,500. Google search “alkaline hydrolysis” followed by your city or state to find for a provider.
Free Cremation
If you’re interested in a free final farewell, you may want to consider donating your body to a university medical facility. After using your body for medical research or surgical practice they will cremate your remains for free, and either bury or scatter your ashes in a local cemetery or return them to your family, usually within a year.
To find a medical school near you that accepts body donations, the University of Florida offers an online directory at Anatbd.acb.med.ufl.edu/usprograms.
Whatever arrangements you end up making, make sure you tell your family your wishes so they will know what to do and who to call after your death. Also, if you have a written agreement with any funeral/cremation provider, give them a copy to let them know if you’ve prepaid or not.
If You’re 65 or Older, It’s Time to Get Your Pneumonia Shot
Dear Savvy Senior,
I recently turned 65 and would like to know if am supposed to get the pneumonia vaccine? And if so, which type of vaccine do I need and is it covered by Medicare?
Relatively Healthy
Dear Relatively,
Yes, the Centers for Disease Control and Prevention (CDC) does indeed recommend the “pneumococcal vaccines” for pneumonia for adults age 65 and older. They’re also recommended for younger people with long-term health issues or weak immune systems, as well as children under 5 and people who smoke.
Pneumonia, which can happen anytime – not just during the cold months – can be a serious and even life-threatening condition. Each year, pneumonia causes a whopping 1.5 million people to visit medical emergency departments in the U.S. and causes roughly 50,000 deaths.
A recent study found that the use of pneumonia vaccines is associated with a 24 percent decreased risk of death, but vaccination rates aren’t that high.
Around 67 percent of adults over the age of 65 are vaccinated against pneumonia, and just 24 percent of younger people (19-64 years old) at risk for pneumonia are vaccinated. The main reasons for this are because many people are unsure whether they need the vaccine, while others aren’t even aware a vaccine exists.
Types of Vaccines
There are three different vaccines available, some more appropriate for certain people than others. They are the pneumococcal polysaccharide vaccine PPSV23 (Pneumovax23), the pneumococcal conjugate vaccine PCV15 (Vaxneuvance) and PCV20 (Prevnar 20). The numbers indicate how many strains, or serotypes, of streptococcus pneumoniae are included in the vaccine.
So, which vaccine should you get?
If you’ve never been vaccinated for pneumonia, the newer PCV20 is the top choice – it covers the 20 most common serotypes now.
If that vaccine is not available in your area, you can get the PCV15 vaccine, followed one year later by PPSV23.
If you had the earlier PCV13 (but not PCV15), or the PPSV23 at or after age 65, you’re likely eligible to get the PCV20 for increased protection.
But because of the different possibilities, you need to talk to your doctor or pharmacist about the most effective option for you.
Side effects of these vaccines tend to be mild, but may include feeling achy and tired as well as redness, swelling and soreness where the injection was given.
You’ll also be happy to know that Medicare Part B covers both single dose and two-dose pneumococcal shots, and you only need to get it once. Unlike the flu shot, which is given annually.
Most local pharmacies and community health clinics offer pneumococcal vaccines, but you may want to call ahead just to be sure.
For more information, visit the CDC’s Pneumococcal Vaccination webpage at CDC.gov/vaccines/vpd/pneumo/index.html.
Other Vaccines
To avoid getting pneumonia as a consequence of a viral infection, you should also consider getting a flu shot, RSV shot and a Covid-19 booster in the fall.
While vaccines cannot prevent every case of pneumonia (or other conditions they’re given for), those who get them usually have milder infections, a shorter course of illness and fewer serious complications than people who don’t get vaccinated.
The flu shot and Covid booster are both covered by Medicare Part B, while the RSV vaccine (which is recommended every other year) is covered under Medicare (Part D) prescription drug plans. All three shots can also be given simultaneously.
How SSI Benefits Can Help Struggling Seniors and the Disabled
Dear Savvy Senior,
What can you tell me about the SSI program and what are the eligibility requirements for seniors? I’m trying to help my elderly aunt who is very low-income.
Searching Niece
Dear Searching,
The SSI program that you’re enquiring about, which stands for Supplemental Security Income, is a program administered by the Social Security Administration (SSA) that provides monthly cash benefits to people that are disabled or over 65 based on financial need.
Currently, around 7.5 million people are receiving SSI benefits, but many more are now eligible as the SSA recently expanded access benefits by tweaking some of the rules. Here’s what you should know.
Eligibility Requirements
To qualify for SSI your aunt must be either age 65 or older, blind or disabled, and must be a U.S. citizen or lawful resident. She must also have limited income and assets.
Her income as an individual must generally be under $1,971 per monthly, or $2,915 for couples. Countable income includes wages or any other kind of money your aunt earned from working, plus money she gets from other sources like unemployment, Social Security retirement, or gifts from friends, but also, free shelter.
And her assets must also be less than $2,000 or $3,000 for couples. This includes cash, bank accounts, other personal property, and anything else that could potentially be converted to cash. Her home, household goods and one vehicle, along with life insurance policies and burial funds valued under $1,500, do not count towards countable assets.
In 2024, the maximum SSI payment is $943 a month for an individual or $1,415 a month for a couple. But, if eligible, the amount your aunt would receive may be lower based on her income, living situation and some other factors.
To help you determine if your aunt is eligible for SSI, help her take the Social Security Administration’s benefits screening test at SSAbest.benefits.gov. This online questionnaire takes approximately 5 minutes to complete and screens for a variety of benefits, not just SSI.
You should also know that most states – except Arizona, Arkansas, Mississippi, North Dakota, Tennessee and West Virginia – supplement the federal SSI payment with payments of their own. In some of the states that pay a supplement, your aunt may qualify for the state payment even if she doesn’t meet the federal SSI eligibility criteria.
How to Apply
If you think that your aunt is eligible for SSI, she (or you) can begin the application process and complete a large part of it online at SSA.gov/apply/ssi. If she’s disabled, she can apply for both SSI and Social Security Disability at SSA.gov/disability. Or, if she can’t apply online, call 800-772-1213 and set up an appointment with her local Social Security office.
To help make the application process go quickly and smoothly, your aunt will need her Social Security number; birth certificate or other proof of age; information about the home where she lives, such as her mortgage, or lease and the landlord’s name; payroll slips, bank books, insurance policies, burial fund records and other information about her income and the things she owns; her proof of U.S. citizenship or eligible noncitizen status; and if she is applying for SSI because she is disabled or blind, the names, addresses and telephone numbers of doctors, hospitals and clinics that have information related to her condition.
For more information visit SSA.gov/ssi or see Social Security’s online SSI publication at SSA.gov/pubs/EN-05-11000.pdf.
Other Assistance Programs
Depending on your aunt’s income, there are other financial assistance programs that may be able to help her like Medicare Savings Programs, prescription drug assistance, food stamps and energy assistance. To locate these programs, and learn how to apply for them, go to BenefitsCheckUp.org.
How to Find a Cheaper Medicare Prescription Drug Plan
Dear Savvy Senior,
What’s the easiest way to compare Medicare Part D prescription drug plans? My Part D premium is increasing again in 2025, so I would like to use the fall open enrollment to find and sign up for a cheaper plan.
Shopping Around
Dear Shopping,
I’m happy to hear you’re comparing your Medicare coverage options this fall! Research shows that many Medicare beneficiaries with Part D coverage can lower their prescription drug costs by shopping among plans each year during the open enrollment season, which runs Oct. 15 to Dec. 7.
There could be another Part D plan in your area that covers the drugs you take with fewer restrictions or with lower costs. You never know until you look.
You’ll also be happy to know that thanks to the Inflation Reduction Act, in 2025 annual out-of-pocket costs will be capped at $2,000 for all Medicare Part D beneficiaries.
Here are some tips and tools to help you shop and compare Part D plans.
Plan Finder Tool
If you have internet access and are comfortable using a computer, you can easily shop for and compare all Medicare drug plans in your area and enroll in a new plan online, and it only takes a few minutes.
Just go to Medicare’s Plan Finder Tool at Medicare.gov/find-a-plan. You can do a general search on the right side of the page, under the title “Continue without logging in.” If you wish to save your drugs and pharmacy information, you can log into or create your Medicare account on the left side of the page.
Next, type in your ZIP code and choose the type of coverage you’re looking for, enter the drugs you take, choose the pharmacies you use, and indicate whether you are interested in a mail order option.
The plan finder will then display results for plans in your area. Be aware that a plan may not cover all the drugs you take, but it may cover alternatives. It will also tell you if the plan has a deductible and how much the monthly premium is.
Initially, the plans will be sorted by “lowest drug + premium costs.” This is the closest estimate to what you may pay out of pocket for your Part D coverage for the year. You can select “plan details” to find out more specifics about coverage, including any coverage restrictions that might apply to your drugs.
Before enrolling, it is a good idea to call the plan directly to confirm any information you read on plan finder, as information may not be completely up to date.
If you need help, you can call Medicare at 800-633-4227 and they can do this for you over the phone. Or contact your State Health Insurance Assistance Program (SHIP), which provides free unbiased Medicare counseling. To find a local SHIP counselor call 877-839-2675 or see ShipHelp.org.
Any changes to coverage you make will take effect Jan. 1, 2025. If you take no action during open enrollment, your current coverage will continue next year.
Extra Help
If you’re lower-income and having a hard time paying your medication costs, you may be eligible for Medicare’s “Extra Help” program. This is a federal low-income subsidy that helps pay Part D premiums, deductibles and copayments.
To be eligible, your annual income must be under $22,590 or $30,660 for married couples living together, and your assets (not counting your home, personal possessions, vehicles, life insurance policies or burial expenses) must be below $17,220 or $34,360 for married couples. For more information or to apply, call Social Security at 800-772-1213 or visit SSA.gov/medicare/part-d-extra-help.
Best CPAP Alternatives for Sleep Apnea
Dear Savvy Senior,
I’ve been diagnosed with sleep apnea and have been trying to use a CPAP device for the past six months but can’t tolerate it. Are there any alternative treatment options you can tell me about?
Sleepy Sam
Dear Sam,
I’m sorry to hear your CPAP mask is keeping you awake at night, but I’m happy to hear that you’re addressing your obstructive sleep apnea (OSA) problem. Left untreated, OSA is linked to daytime sleepiness and an increased risk of anxiety, diabetes, hypertension and stroke.
For those whose aren’t familiar, OSA causes your breathing to pause during sleep because something blocks your airway, like your tongue or relaxed throat muscles. Losing weight, quitting smoking, and limiting alcohol can all help ease obstructive sleep apnea symptoms such as snoring.
The primary treatment for people with moderate or severe OSA is a continuous positive airway pressure (CPAP) machine, which keeps your airway open by pumping air through a mask you wear over your mouth and/or nose when you sleep.
But many people, like yourself, have difficulty tolerating CPAP and don’t stick with it. But CPAP machines have become smaller and quieter, with more comfortable options available. And for some people with mild to moderate OSA, less invasive alternatives to CPAP may be worth considering. Here are several to ask your doctor about.
Dental device: This is designed to move the jaw so that the tongue shifts toward the front of the mouth to help keep the airway open. It’s one of the primary alternatives to CPAP and can also be used with CPAP to help make severe obstructive sleep apnea milder.
A dentist who specializes in sleep medicine (find one at dentalsleep.org) will be able to customize its fit to help your breathing without causing harm to your bite or teeth. These custom-made oral appliances can cost between $2,000 and $4,000 but may be covered by insurance.
There are much cheaper options available online to treat snoring, but experts say these may not help with OSA, and could move teeth out of place or cause jaw issues if they’re not properly fitted.
Position therapy: For some, sleeping on the back can make obstructive sleep apnea dramatically worse. In these cases, switching to side sleeping – perhaps using pillows or a tennis ball attached to a shirt back – can sometimes help.
Tongue trainer: In 2021, the Food and Drug Administration approved a tongue-stimulating device for mild sleep apnea called eXciteOSA (exciteosa.com), which people wear for 20 minutes a day for six weeks and then 20 minutes a couple of times a week indefinitely. It costs $1,650 and is not covered by insurance.
Surgery: Those who can’t tolerate CPAP could have upper airway surgery to reduce the size of their soft palate or other tissue in their throat. But such options don’t always work, have serious potential complications, and cannot be reversed. So, in general, they should not be first-line treatments.
A newer option is a surgically implanted device called Inspire (inspiresleep.com). Approved in 2014, it stimulates a nerve that moves your tongue to keep your airway open. Inspire can be removed if it is not tolerated, but it should also be tried only if someone is unable to use CPAP, and it is not an option for everyone.
Drug therapy: A new study, recently published in the New England Journal of Medicine, found that tirzepatide – the main ingredient found in type 2 diabetes medication Mounjaro and weight loss treatment Zepbound – helps reduce symptom severity by almost two-thirds in adults with obesity and obstructive sleep apnea. Ask your doctor about this option.
