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Thanks to the Affordable can you buy lasix online Care Act (ACA, also known as Obamacare), there are high-quality, comprehensive health insurance plans available in every state for people who need to purchase their own health insurance. And it’s currently open enrollment season for those plans. Until December 15 (or later, in several states), people who need coverage can enroll – regardless of can you buy lasix online their medical history or prior coverage.But differentiating between ACA-compliant plans and lesser-quality options can be harder than it might sound.Where can I buy an ACA-compliant health plan?. For starters, there are numerous sources of ACA-compliant individual-market plans:In each state there’s one exchange website (HealthCare.gov in 36 states.

A state-run can you buy lasix online exchange site in 14 states and DC). The government sites all have “see plans and prices” tools that enable you to determine whether you’re eligible for government help to pay premiums and possibly reduce out-of-pocket costs. If you are eligible, you should either enroll via the federal or state exchange or make sure that any broker you work with shows you all ACA-compliant plans to which your subsidy applies.Numerous insurers and web brokers are approved can you buy lasix online enhanced direct enrollment entities and can help consumers enroll in on-exchange plans via their own websites. In the first week of open enrollment for 2021 health plans, a quarter of the on-exchange enrollments in states that use HealthCare.gov were actually completed via Health Sherpa’s website (Health Sherpa is an enhanced direct enrollment entity that only sells ACA-compliant plans).Brokers and navigators certified by the exchanges in each state help consumers through the process of enrolling in a plan through the exchange.

(This tool on can you buy lasix online HealthCare.gov can help you find assistance in your area. The state-run exchanges have similar tools.) These professionals should also help you determine whether you’re subsidy-eligible before showing plans and quoting prices.And then there are also fully ACA-compliant plans sold outside the exchanges (everywhere except DC), purchased directly from the insurer or with the help of an agent or broker. These are often referred to as “off-exchange” options.Before shopping anywhere outside the government can you buy lasix online exchanges, once again, determine whether you are likely eligible for government help paying for coverage. You can use our tool to quickly and anonymously see if you might be eligible for a subsidy.But in addition to those options, there are a great number of other plans available that don’t conform to the ACA’s rules.

Some aren’t even regulated as insurance at all (eg, healthcare sharing can you buy lasix online ministry plans, direct primary care plans, and Farm Bureau plans in some states).How can I spot a plan disguised as ACA-compliant health insurance?. Some plans can be very cleverly disguised to look as if they’re compliant with the ACA. They might be described with terms like “Gold” or “Silver” (which are can you buy lasix online used for ACA-compliant plans to differentiate the level of coverage provided by the plans). They might be marketed with urgent-sounding messages about open enrollment deadlines, when in fact, these non-compliant plans tend to be available for purchase year-round.And they’re quite likely to show up when you search online for “Obamacare plans” or “health insurance” or something similar.

They may also be labeled as “Trumpcare,” despite the fact that there’s no such thing — GOP-backed legislation can you buy lasix online to repeal and replace the ACA never came to fruition.People who enroll in these plans may not realize that they’ve got sub-par coverage until they end up needing significant medical care. But by then it’s too late.Ask these questions to ensure you’re buying real ACA coverageUse our calculator to estimate how much you could save on your ACA-compliant health insurance premiums.Here are five questions you can ask when you’re trying to determine whether a health plan is compliant with the ACA, and whether it will actually be there for you when the chips are down:1. €œDoes this plan require any sort of medical underwriting?. Will my health history be taken into consideration either during the application process, or after I’m enrolled and have a claim? can you buy lasix online.

€If access to a plan depends on your medical history, the plan is not ACA-compliant.If premiums are based on anything other than your age, zip code, and tobacco use, the plan is not ACA-compliant.A couple more things to keep in mind:A thorough broker helping you enroll in an ACA-compliant plan will still ask you questions about which doctors you see and any prescription drugs you take. This has nothing can you buy lasix online to do with medical underwriting. It’s because each plan has different provider networks and covered drug lists, and you want to make sure the one you pick will cover your doctor and your medications. The federal and state exchanges can you buy lasix online also have DIY plan selection tools that ask questions about your doctors and prescriptions to help you choose a plan.Although premiums are only based on age, location, and tobacco use, there are other factors – such as your income and whether you have access to an employer-sponsored plan – that will be taken into consideration if you want to apply for a premium subsidy.

(Most consumers who shop in the exchange end up qualifying for subsidies. Once again, can you buy lasix online you can use our anonymous tool to quickly see if you might be eligible for a subsidy.)2. €œWill pre-existing conditions be covered as soon as the policy takes effect?. €If the answer can you buy lasix online is no, the plan is not compliant with the ACA.3.

€œIs this plan guaranteed-renewable as long as I continue to pay the premiums?. Or, if can you buy lasix online the insurer stops offering this plan, is a switch to a comparable plan guaranteed as long as I continue to pay the premiums?. €If the answer is no, the plan is not compliant with the ACA.4. €œDoes this plan can you buy lasix online cover maternity care, prescription drugs (including specialty drugs), and mental health care?.

€If the answer is no, the plan is not compliant with the ACA. Maternity care, prescriptions, and mental health care are all among can you buy lasix online the essential health benefits (EHBs) that all ACA-compliant individual (and small-group) plans are required to cover. But if you just ask whether the plan covers essential health benefits, the salesperson might say “yes” because the plan covers other EHBs. Maternity care, high-cost prescriptions, and mental health care are some of the EHBs that are most frequently lacking on non-ACA-compliant plans.5.

€œDoes this plan absolutely can you buy lasix online cap my out-of-pocket costs for medically necessary care as long as I stay in-network?. €If the answer is no, the plan is not compliant with the ACA. All ACA-compliant plans are required to cap in-network out-of-pocket costs for essential health benefits at no can you buy lasix online more than $8,550 for a single individual in 2021.This question helps to identify fixed indemnity plans, which are not regulated by the ACA. Fixed indemnity plans cap the benefits as opposed to capping your out-of-pocket exposure.

In the event of a serious medical condition, can you buy lasix online that can end up being a significant problem.A non-compliant plan may claim to have a cap on out-of-pocket costs. If that plan has no network, however – if it boasts that it’s good with any provider – that means that hospitals and doctors have not agreed to accept the insurer’s payment as full payment. In that case, you will likely be subject to balance billing, meaning that hospitals or doctors may bill you for the difference between what the plan pays them and what they think they can you buy lasix online should be paid. ACA-compliant plans have provider networks, and as long as you only use providers within the network (and meet any prior authorization requirements), your out-of-pocket costs will be capped and you won’t be responsible for additional balance billing.

[“Surprise” balance billing can still be an can you buy lasix online issue in emergencies and when out-of-network providers perform services at in-network facilities. The more you understand about this, the better you can protect yourself.]Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of can you buy lasix online opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.It’s no secret that health insurance is – and always has been – expensive.

The very fact that you’re reading this article suggests that you’re wondering whether can you buy lasix online health insurance can be affordable.The answer is that affordable health coverage is out there and is possible – if you don’t overlook some obvious strategies that will decrease your insurance costs.Health insurance is expensive …First of all, expensive health insurance isn’t limited to the individual market.Total annual premium cost for employer-sponsored coverage averaged $623/month for single employees in 2020. In the individual market, the average premium for plans purchased through the health insurance exchanges was $576/month. And those numbers are for single individuals — it’s a lot more expensive if you’re can you buy lasix online covering a family.Why are Americans seemingly not as outraged about employer-sponsored (ESI) coverage costs?. It’s because if you have employer-sponsored insurance, your employer likely pays a large chunk of your premiums.

(The average employer pays $519/month of that $623/month total.) Not only that, but taxpayers chip in a hefty chunk of change to subsidize those with ESI.… but it doesn’t have to beAre people with ESI can you buy lasix online the only Americans who deserve subsidized coverage?. The drafters of the Affordable Care Act (aka Obamacare) didn’t think so. So, while people in the individual health insurance market historically had to pay the full cost of coverage on their own, the Affordable Care Act changed that.In fact, about 9.2 million people received premium tax credits (subsidies) to offset a significant portion of their premiums in the individual market in 2020. On average, their can you buy lasix online subsidies amounted to $491/month, covering the majority of their total premiums.

(Throughout this article, we’ll use the terms “premium tax credit” and “premium subsidy” interchangeably, since they’re the same thing.)And in places where health insurance is more expensive than average, the subsidies are larger than average too. For example, a family of four (parents age 45) in Rock Springs, Wyoming with an income of $97,000 will qualify for a can you buy lasix online premium subsidy of over $2,000 per month in 2021, and several of the available plans will be free after that subsidy is applied (ie, their full-price cost is less than the amount of the premium tax credit, so they end up having no premium at all).There are examples like this in many states, although not all areas have super-low-cost Bronze plans. (It depends on how the cost of cost-sharing reductions (CSR) has been added to premiums, how many insurers offer coverage in a given area, and the way insurers have structured their product offerings.)1. Subsidies deliver affordabilityBut the takeaway here is that your very obvious first step toward more affordable coverage should be to spend a few minutes can you buy lasix online checking to see how big your subsidy would be, and how much you’d have to pay in after-subsidy premiums for the various plans available in your area.

You can calculate your subsidy here. Open enrollment for 2021 health coverage continues until at least December 15 can you buy lasix online nationwide, and there are several states where it will extend into January. If you’ve got questions about open enrollment, our comprehensive guide is a good place to start. After open enrollment ends, you can only enroll in an individual major medical plan if you experience a qualifying event.If you’re eligible for a premium tax credit, selecting a metal-level plan in the exchange is the only way to get your tax can you buy lasix online credit.

And from one year to the next, don’t rely on auto-renewal, as you might miss out on some amazing deals that weren’t available in prior years, due to the way pricing varies from one plan to another each year.If you have off-exchange coverage, know that you may be one of the estimated 2.5 million people who could get premium subsidies if they simply bought an exchange plan. If you’re eligible for premium subsidies and buying off-exchange coverage, you can you buy lasix online could be leaving a considerable amount of money on the table, since subsidies are only available in the exchange. If you experience a qualifying event during the year, you’ll be able to switch to an exchange plan mid-year, and anyone can switch from off-exchange to on-exchange during open enrollment each fall, with coverage effective January 1.2. Turbo-charge your premium subsidyAre substantial premium subsidies the only way can you buy lasix online to reduce your health care costs?.

Again, thanks to the ACA, no.If your household income (there’s an ACA-specific calculation for that) is less than 250 percent of the federal poverty level (FPL), you may be eligible for cost-sharing reductions (CSR), which reduce enrollees’ costs by lowering your maximum out-of-pocket exposure and by increasing your plan’s actuarial value.(The Trump Administration announced in October 2017 that funding for CSR would end immediately, but the CSR benefits themselves are still available to eligible enrollees — nothing has changed about eligibility. And because the cost of CSR has been can you buy lasix online added to silver plan premiums in most areas, premium tax credits are also much larger than they were prior to 2018, making after-subsidy premiums more affordable for many enrollees.)To receive CSR benefits, you must. This chart shows the income levels that correspond to those ranges in any of the states where Medicaid has been expanded (the green, orange, and blue segments). Although CSR benefits extend up to 250 percent of the poverty level, they’re strongest for people with income under 200 percent of the poverty level.

People with income between 200 and 250 percent of FPL sometimes find that they’re better off with a Bronze or Gold plan, despite being eligible for CSR can you buy lasix online benefits on Silver plans.If you’re eligible for CSR benefits, you’ll want to pay particular attention to Silver plans in the exchange, despite the fact that they’ll cost more than the available Bronze plans. If you’re eligible for CSR benefits and you’re using HealthCare.gov, the Silver plans will be tagged with a little yellow banner that says “extra savings.” (State-run exchanges also have ways of designating that CSR benefits are included in the Silver plans, if you’re eligible.) If you work with a broker who is certified by the exchange, including healthinsurance.org’s trusted partners, he or she will be able to help you determine whether you’re eligible for CSR benefits and highlight the plans that include those benefits.PRO TIP. If you’re eligible for can you buy lasix online cost-sharing reductions, do some math to determine whether you’ll be better off with a low-premium Bronze plan with high out-of-pocket costs, a Silver plan that comes with a higher premium but lower out-of-pocket costs (with built-in CSR benefits), or even a Gold plan that might have premiums and out-of-pocket costs that are similar to the Silver plans. (Remember that premiums have been very odd since 2018, with Gold plans sometimes priced lower than Silver plans).

There’s no right answer here – it depends can you buy lasix online on your health, your risk tolerance, and your budget. And again, a broker who is certified by the exchange can help you make sense of all this and figure out what plan will best fit your needs and budget.3. Don’t give up after open enrollment.Open enrollment is the easiest and most obvious time to enroll in an individual market health plan can you buy lasix online. You won’t have to prove that you experienced a qualifying event, and there will be no requirement that you had coverage prior to enrolling in the new plan.

But even after open enrollment ends, you may still be can you buy lasix online able to enroll. And if you’re eligible for a premium subsidy or CSR, you’ll be able to start receiving those benefit when you enroll. 4. Run the numbers again.Premium subsidy eligibility ranges are straightforward.

(Premium subsidy eligibility extends to incomes up to 400 percent of the poverty level, and cost-sharing subsidy eligibility extends to incomes up to 250 percent of the poverty level. For a family of four in 2021, that’s $104,800 and $65,500, respectively. Note that these amounts are based on the 2020 poverty level numbers, as the prior year’s numbers are always used to determine subsidy eligibility.)But if it appears at first glance that your income is a bit too high (and you’re facing the subsidy cliff as a result) for you to be eligible for premium tax credits (or cost-sharing reductions), consider talking with a tax professional. There are several options for reducing your MAGI into the subsidy-eligible range, and they’re not as complicated as they might seem at first glance (MAGI stands for modified adjusted gross income.

The calculation for it is specific to the ACA, and is different from general MAGI used for other purposes).In general, contributions to a pre-tax retirement account will lower your MAGI, as will contributions to a health savings account (HSA). You can put money in a retirement account offered by your employer, or one that you establish on your own if you’re self-employed. Traditional IRA contributions also work to reduce MAGI, and depending on your income, you may be able to contribute to multiple retirement accounts. As long as you have HSA-qualified health insurance (ie, an HDHP), you can contribute to an HSA.And if you’re self-employed, the health insurance premiums you pay (but not the part that’s covered by a premium subsidy) can be deducted from your income, leaving you with a lower MAGI that’s potentially subsidy-eligible.What’s the difference?.

In some cases, the difference between getting subsidies and not getting subsidies can amount to tens of thousands of dollars per year.5. Tailor your coverage to your situationShopping for health insurance should involve at least a little math, and there’s more to it than just comparing premiums. Here’s a rundown of the basics of comparing health plans.There’s no single right answer, and plans vary considerably from one area to another. Your cousin might have scored a $2/month Bronze plan, but plans like that might not be available in your area, or you might find that a $200/month Gold plan ends up being a better option for you.With that said, there are a few things to keep in mind when you’re considering your options:You don’t have to put all members of your family on the same plan.

If only one family member is anticipating significant medical costs or needs to have access to a particular insurer’s drug formulary and/or provider network, splitting the family onto two different plans might be the best solution (and the exchange can do this for you, with your premium subsidy applied). Keep in mind that your total family out-of-pocket exposure will be higher this way, since the family out-of-pocket maximum only applies to family members on one plan.If you’re anticipating very high medical costs (ie, you’re going to hit the maximum out-of-pocket on any plan), a Bronze plan with low premiums might actually end up being a better deal – in terms of total premiums plus total out-of-pocket costs – than a more robust (and more expensive) plan.If you want to contribute money to an HSA in order to reduce your modified adjusted gross income (MAGI) and qualify for premium subsidies, you’ll want to focus on HSA-qualified high-deductible health plans. There may only be one or two available in your area, but almost all parts of the country do have at least on HDHP available. (You may have to look in the plan details to tell for sure, but these plans often have HSA as part of their name).

6. Still smoke?. Here’s a huge reason to quit.Under the ACA, health insurance companies are no longer allowed to adjust enrollees’ premiums based on their medical history. But tobacco use is the one exception.

Insurance companies can charge smokers up to 50 percent more than non-smokers (some states have set a lower limit), and premium subsidies are based on the cost of coverage for non-smoker, so smokers have to pay the surcharge themselves, even if they qualify for premium subsidies.The tobacco surcharge in the ACA is controversial, and may actually be counterproductive. But for better or worse, it’s part of the current legal structure. If you smoke, know that tobacco cessation intervention is one of the preventive care services covered at no cost on all ACA-compliant plans. And if you quit, you’ll end up with lower insurance rates.7.

Enroll in Medicaid or CHIP if you’re eligibleExpansion of Medicaid was a cornerstone of the ACA’s provisions for reducing the uninsured rate in the United State – and it’s worked remarkably well in the states that accepted federal funding to expand coverage. Since late 2013, enrollment in Medicaid and CHIP has grown by more than 19 million people, many of whom became eligible thanks to the ACA’s expansion of coverage.There are still 14 states that have not expanded Medicaid. But if you’re in a state that has expanded coverage, you can get free or very low-cost coverage if your income doesn’t exceed 138 percent of the poverty level. (For a single individual, that’s currently $17,608.

For a family of four, it’s $36,156.)CHIP (Children’s Health Insurance Program) coverage is available to kids whose household income can be quite a bit higher than the Medicaid eligibility cut off, and the Medicaid cutoff itself is higher for kids than it is for adults. So you might find that your kids can qualify for very low-cost coverage even if your income is too high for Medicaid. It’s quite common for parents to qualify for premium subsidies in the exchange while their kids qualify for Medicaid or CHIP instead. If your kids are eligible for Medicaid or CHIP, the exchange will sort that out for you when you apply for coverage.8.

Short-term plans and other non-ACA-compliant plansIf there is no way that you’ll qualify for premium subsidies and you’ve determined that all of the plans available in your area are unaffordable, a plan that isn’t ACA-compliant is a better option than going uninsured altogether.Depending on where you live, you may be able to purchase a short-term plan with a term limit of up to 364 days, and it may be renewable for a total duration of up to three years. You may also be able to purchase a bundled product that combines a short-term plan with a fixed-indemnity plan. Accident supplements and critical illness plans are also available, although they’re designed to supplement other coverage rather than serve as stand-alone coverage.A plan purchased in the non-ACA-compliant market are not considered minimum essential coverage, and will not fulfill the individual mandates that exist in DC, New Jersey, Massachusetts, Rhode Island, and California. But there is no longer a federal penalty for being without minimum essential coverage.It’s important to understand the drawbacks of short-term health plans, which are numerous.

But if your other alternative is to go without coverage altogether, a short-term plan is certainly better than nothing.There are other non-ACA-compliant health plans available in some areas, including Farm Bureau plans in some states. Regardless of the type of coverage you’re considering, you’ll want to carefully read all of the fine print — and that’s especially true if you’re looking at a plan that’s not compliant with the ACA. 9. Health care sharing ministries and direct primary care plansHealth care sharing ministries are another option that appeal to some people who can’t afford ACA-compliant coverage.

Sharing ministry coverage is not considered health insurance, and is not regulated by state insurance commissioners (the majority of the states explicitly exempt sharing ministry plans from state insurance laws and regulations).If you opt to join a health care sharing ministry, your mileage may vary. Some people love them, and others find themselves counting down the days until the next open enrollment so that they can switch back to an ACA-compliant plan. Be sure to read all the fine print, and make sure that the sharing ministry’s lifestyle requirement actually match your lifestyle. There is no doubt that ACA-compliant coverage is a more solid safety net than a health care sharing ministry.

But if your plan is to go without any coverage at all, a sharing ministry is a better option.Some people opt to combine a health care sharing ministry plan with a direct primary care plan. Again, your mileage may vary. You need to be aware that the majority of the states have also exempted direct primary care arrangements from insurance laws and oversight. So if you’re relying on a combination of two plans that are both exempt from state and federal insurance laws, your state’s insurance department will not be able to intervene on your behalf if you run into problems.

And the fact that the plans are not considered insurance means that they are not subject to a contractual obligation to pay claims. Again, read the fine print and make sure you understand what you’re getting — and not getting — when you sign up for these plans.10. Discount plansMedical and prescription discount plans are another possibility, but they should be seen as a last resort, and should not be mistaken for adequate stand-alone coverage. They may be beneficial when combined with something like a fixed-indemnity plan, but again, your mileage will vary.The discounts aren’t guaranteed, and tend to be more substantial for lower-cost services.

You’ll get a discount when you use medical providers who participate in the program, but your out-of-pocket exposure won’t be capped, and will be considerable if you end up needing extensive medical care.How pharmacy discount cards reward usersFinal tipsIf you’ve read through these tips and you’re still not certain you can find affordable coverage, it’s always a good idea to consult a trustworthy broker who can help you wade through the available options. Clarify whether the plans they’re presenting to you are ACA-compliant or non-compliant, or a mixture of both.And as always, before you sign on, read the fine print. Ask about drug formularies and provider networks if that’s important to you.Don’t go uninsured. You’re not invincible, and while health coverage is expensive, health care is really expensive.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006.

She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts..

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[embedded content]This video is best viewed in Chrome or Firefox.hypertension medications’s record surges along with the discovery of lasix cost more contagious variants of the hypertension make getting as many people vaccinated as soon as possible critical for ending the lasix. €œEvery time the lasix multiplies in a body, there is a chance for mutation,” said Stuart Cohen, UC Davis Health chief of the Division of Infectious Diseases and director of hospital epidemiology and control. He was talking on a UC Davis lasix cost LIVE about the hypertension medications treatments.

€œIf it doesn’t have people to go into, there will be no mutations.” UC Davis Health is vaccinating its most vulnerable patients over 75 and is partnering with Sacramento County to vaccinate other high-priority groups.His hope is that enough people will get vaccinated to reach a level of herd immunity relatively soon – possibly within the coming months or by the end of the year – so the hypertension won’t be able to keep mutating. If it does continue to mutate, lasix cost Cohen worries the lasix might eventually create a variant that can evade the treatment. “If we slowly, slowly roll out the treatment, that’s the perfect way to generate mutants (because treatment-resistant variants will have a survival advantage and could multiply),” he said.

€œIf we get people vaccinated quickly, then we have a fighting chance to stop it.” Learn lasix cost more about patient vaccinations at UC Davis Health. Cohen and Stephen McSorley, a UC Davis professor in the School of Veterinary Medicine and director of the Center for Immunology and Infectious Diseases at UC Davis, both said that everything they know about the Pfizer/BioNTech and Moderna treatments show both are effective and safe. €œIf we slowly, slowly roll out the treatment, that’s the perfect way to generate mutants.

If we get people vaccinated lasix cost quickly, then we have a fighting chance to stop it.” — Stuart CohenClinical trials showed both treatments are about 95% effective, and though some people have a day or two of reactions, there is no evidence of any long-term effects. But both men said they worry about some people’s hesitancy to get vaccinated, or worse, about anti-vaccination activists spreading misinformation. €œI’m old enough, I had classmates lasix cost with polio,” Cohen said.

€œThe herd immunity we have now from polio or measles or other diseases is from vaccinations, and it’s what allows people who don’t believe in treatments to get away with it.” How the hypertension medications treatments workMcSorley said the hypertension medications treatments have a slightly different design than previous treatments, but they work the way all treatments work. €œThey try to fool your lasix cost immune system into thinking you’ve had this before,” he said. €œYour body has the capacity to respond to any .

If an alien race came from outer space lasix cost with a pathogen, you actually have the ability to respond to that.” “Your body has the capacity to respond to any . If an alien race came from outer space with a pathogen, you actually have the ability to respond to that.”— Stephen McSorleyBut often our immune systems need to be taught how to do that. That’s what the treatment does.

It teaches our bodies to make more cells that recognize the , and it teaches them how to find it and how to combat it, lasix cost McSorley said. The hypertension medications treatments use a system that started to be developed during the 2003 SARS outbreak. It injects lasix cost us with messenger RNA (mRNA), which is natural in our bodies.

The mRNA teaches our cells to build the spike protein on the hypertension. €œYour immune system responds to that, and now lasix cost it’s ready to respond to the hypertension,” McSorley said. More highlights from the question and answer session with viewersThe treatments require two doses, and both scientists urged people to get both shots on the prescribed schedule that came out of the clinical trials – which is 21 days apart for Pfizer’s treatment and 28 days with Moderna’s.

€œThe second lasix cost dose will always boost the immune response,” McSorley said. €œIs the 21 days or 28 days totally fixed?. Can you wait longer?.

€ said lasix cost Cohen, “I don’t know the answer. But I do know the best way to take it is the way it’s been studied. Freelancing is not a good idea.” Some immunity lasix cost starts 10-14 days after the first dose, but full immunity appears 7 to 14 days after the second, according to the studies.

€œIf you get just one shot,” Cohen said, “we don’t know how long the immune response will last or if one dose will even do anybody any good.” It’s unclear if the treatments actually prevent us from getting infected with hypertension medications or if a vaccinated person can spread the lasix. That’s why masking lasix cost and social distancing are still crucial. €œMany of us believe the treatment prevents .

That’s how other treatments work. We just don’t lasix cost have data for that yet,” Cohen said. €œWe do know it keeps people from getting sick.” “The studies were designed to keep people out of the hospital,” McSorley said.

€œThey weren’t studying whether you can lasix cost spread . That’s coming.” Among other advice from McSorley and Cohen. It’s OK to get vaccinated if you have a cold lasix cost (though if you’re feeling lousy, you might want to wait).

People who’ve had hypertension medications still should get vaccinated, but it’s best to wait until 90 days after all symptoms are gone. Don’t worry about which lasix cost treatment you get. They are too much alike.

“People ask whether I would choose to take the Pfizer or the Moderna treatment,” Cohen said. €œI say, ‘I’ll take lasix cost the one they have. Whichever comes first.’ The only thing to know is, get vaccinated.” Read more about the treatments from UC Davis Health experts.Elizabeth Morris has been appointed chair of the UC Davis School of Medicine Department of Radiology and will assume the post on Jan.

18, 2021 lasix cost. The Cal Aggie alumna has conducted extensive research optimizing the use of newer techniques such as magnetic resonance imaging (MRI) to detect breast cancer early, with the goal of finding breast cancer lesions when they are small and treatable. Elizabeth Morris is the new chair of the UC Davis School of Medicine radiology lasix cost department.Morris is an internationally recognized expert in breast disease and the use of MRI, and the author of the book “Breast MRI.

Diagnosis and Intervention” and numerous published papers. Her recent research efforts have involved using imaging biomarkers to assess risk and treatment response.“Morris is a pioneer in high-risk breast cancer screening,” said lasix cost Allison Brashear, dean of the UC Davis School of Medicine. €œWith her intellectual force and passion for innovation, we are confident she will lead the Department of Radiology into the next era in MRI, ultrasound, contrast-enhanced digital mammography, and tomosynthesis—all of which will ensure UC Davis Health patients get the most advanced care.”Morris comes to the UC Davis School of Medicine from Memorial Sloan Kettering Cancer Center (MSKCC) where she was chief of Breast Imaging Services as well as professor of radiology at Weill Cornell Medical College and the Larry Norton Endowed Chair.

After graduating summa cum laude from UC Davis, Morris received her medical degree from UC San Francisco. She completed her residency at Cornell University Medical College and her breast imaging fellowship at MSKCC.“It is my privilege and lasix cost pleasure to return to UC Davis and I am deeply grateful for this opportunity,” said Morris. “I endeavor to uphold and enhance UC Davis’ world-class reputation as a leader in imaging technology and contemporary research programs as it continues to serve a large and diverse community.”Morris is a fellow of the American College of Radiology (ACR), Society of Breast Imaging (SBI) and International Society of MR in Medicine (ISMRM).

She currently serves as director-at-large/chair of the fellows for the lasix cost SBI.Morris was selected following a national search and succeeds Raymond Dougherty, who served as the UC Davis Department of Radiology chair for 12 years. €œWe extend our gratitude to interim department chair and radiology professor Shadi Aminololama-Shakeri for an excellent job leading the department and providing uninterrupted services while new procedures were implemented to protect patients and staff during the hypertension medications lasix,” said Brashear. €œWe also thank the recruitment advisory lasix cost committee, co-chaired by Drs.

Lydia Howell and Luis Fernando Santana for their time and expertise in this important recruitment.”The UC Davis Department of Radiology performs imaging and therapeutic procedures for patients throughout Northern and Central California. Visit the UC Davis Department of Radiology website to learn how the department utilizes imaging to achieve a greater understanding of health, disease and the delivery of appropriate and cost-effective care..

[embedded content]This video is best viewed in Chrome or Firefox.hypertension medications’s record surges along with the discovery of more contagious variants of the hypertension make getting as many people vaccinated as soon as possible critical for ending the can you buy lasix online lasix. €œEvery time the lasix multiplies in a body, there is a chance for mutation,” said Stuart Cohen, UC Davis Health chief of the Division of Infectious Diseases and director of hospital epidemiology and control. He was talking on a can you buy lasix online UC Davis LIVE about the hypertension medications treatments. €œIf it doesn’t have people to go into, there will be no mutations.” UC Davis Health is vaccinating its most vulnerable patients over 75 and is partnering with Sacramento County to vaccinate other high-priority groups.His hope is that enough people will get vaccinated to reach a level of herd immunity relatively soon – possibly within the coming months or by the end of the year – so the hypertension won’t be able to keep mutating. If it does continue to mutate, Cohen worries the lasix might eventually create can you buy lasix online a variant that can evade the treatment.

“If we slowly, slowly roll out the treatment, that’s the perfect way to generate mutants (because treatment-resistant variants will have a survival advantage and could multiply),” he said. €œIf we get people vaccinated quickly, then we have can you buy lasix online a fighting chance to stop it.” Learn more about patient vaccinations at UC Davis Health. Cohen and Stephen McSorley, a UC Davis professor in the School of Veterinary Medicine and director of the Center for Immunology and Infectious Diseases at UC Davis, both said that everything they know about the Pfizer/BioNTech and Moderna treatments show both are effective and safe. €œIf we slowly, slowly roll out the treatment, that’s the perfect way to generate mutants. If we get people vaccinated quickly, then we have a fighting chance to stop it.” — Stuart CohenClinical trials showed both treatments are about 95% effective, and though some people have a day or two of reactions, can you buy lasix online there is no evidence of any long-term effects.

But both men said they worry about some people’s hesitancy to get vaccinated, or worse, about anti-vaccination activists spreading misinformation. €œI’m old enough, I had can you buy lasix online classmates with polio,” Cohen said. €œThe herd immunity we have now from polio or measles or other diseases is from vaccinations, and it’s what allows people who don’t believe in treatments to get away with it.” How the hypertension medications treatments workMcSorley said the hypertension medications treatments have a slightly different design than previous treatments, but they work the way all treatments work. €œThey try to fool your immune system into thinking you’ve had this before,” he said can you buy lasix online. €œYour body has the capacity to respond to any .

If an alien race came from outer space with a pathogen, you actually have the ability to respond can you buy lasix online to that.” “Your body has the capacity to respond to any . If an alien race came from outer space with a pathogen, you actually have the ability to respond to that.”— Stephen McSorleyBut often our immune systems need to be taught how to do that. That’s what the treatment does. It teaches our bodies to make more cells that can you buy lasix online recognize the , and it teaches them how to find it and how to combat it, McSorley said. The hypertension medications treatments use a system that started to be developed during the 2003 SARS outbreak.

It injects us with messenger RNA (mRNA), which is natural in can you buy lasix online our bodies. The mRNA teaches our cells to build the spike protein on the hypertension. €œYour immune system responds to that, and now it’s ready to respond can you buy lasix online to the hypertension,” McSorley said. More highlights from the question and answer session with viewersThe treatments require two doses, and both scientists urged people to get both shots on the prescribed schedule that came out of the clinical trials – which is 21 days apart for Pfizer’s treatment and 28 days with Moderna’s. €œThe second dose will always boost the can you buy lasix online immune response,” McSorley said.

€œIs the 21 days or 28 days totally fixed?. Can you wait longer?. € said Cohen, “I don’t know the answer can you buy lasix online. But I do know the best way to take it is the way it’s been studied. Freelancing is not a good idea.” Some immunity starts 10-14 can you buy lasix online days after the first dose, but full immunity appears 7 to 14 days after the second, according to the studies.

€œIf you get just one shot,” Cohen said, “we don’t know how long the immune response will last or if one dose will even do anybody any good.” It’s unclear if the treatments actually prevent us from getting infected with hypertension medications or if a vaccinated person can spread the lasix. That’s why can you buy lasix online masking and social distancing are still crucial. €œMany of us believe the treatment prevents . That’s how other treatments work. We just don’t have data for that can you buy lasix online yet,” Cohen said.

€œWe do know it keeps people from getting sick.” “The studies were designed to keep people out of the hospital,” McSorley said. €œThey weren’t can you buy lasix online studying whether you can spread . That’s coming.” Among other advice from McSorley and Cohen. It’s OK to get vaccinated can you buy lasix online if you have a cold (though if you’re feeling lousy, you might want to wait). People who’ve had hypertension medications still should get vaccinated, but it’s best to wait until 90 days after all symptoms are gone.

Don’t worry about which treatment can you buy lasix online you get. They are too much alike. “People ask whether I would choose to take the Pfizer or the Moderna treatment,” Cohen said. €œI say, ‘I’ll take the one they have can you buy lasix online. Whichever comes first.’ The only thing to know is, get vaccinated.” Read more about the treatments from UC Davis Health experts.Elizabeth Morris has been appointed chair of the UC Davis School of Medicine Department of Radiology and will assume the post on Jan.

18, 2021 can you buy lasix online. The Cal Aggie alumna has conducted extensive research optimizing the use of newer techniques such as magnetic resonance imaging (MRI) to detect breast cancer early, with the goal of finding breast cancer lesions when they are small and treatable. Elizabeth Morris is the new chair of the UC Davis School of Medicine radiology department.Morris is an internationally recognized expert in breast disease and the use of MRI, can you buy lasix online and the author of the book “Breast MRI. Diagnosis and Intervention” and numerous published papers. Her recent research efforts have involved using imaging biomarkers to assess risk can you buy lasix online and treatment response.“Morris is a pioneer in high-risk breast cancer screening,” said Allison Brashear, dean of the UC Davis School of Medicine.

€œWith her intellectual force and passion for innovation, we are confident she will lead the Department of Radiology into the next era in MRI, ultrasound, contrast-enhanced digital mammography, and tomosynthesis—all of which will ensure UC Davis Health patients get the most advanced care.”Morris comes to the UC Davis School of Medicine from Memorial Sloan Kettering Cancer Center (MSKCC) where she was chief of Breast Imaging Services as well as professor of radiology at Weill Cornell Medical College and the Larry Norton Endowed Chair. After graduating summa cum laude from UC Davis, Morris received her medical degree from UC San Francisco. She completed her residency at Cornell University can you buy lasix online Medical College and her breast imaging fellowship at MSKCC.“It is my privilege and pleasure to return to UC Davis and I am deeply grateful for this opportunity,” said Morris. “I endeavor to uphold and enhance UC Davis’ world-class reputation as a leader in imaging technology and contemporary research programs as it continues to serve a large and diverse community.”Morris is a fellow of the American College of Radiology (ACR), Society of Breast Imaging (SBI) and International Society of MR in Medicine (ISMRM). She currently serves as director-at-large/chair of the fellows for the SBI.Morris was selected following a national search and succeeds Raymond Dougherty, who served as the UC Davis Department of Radiology chair for can you buy lasix online 12 years.

€œWe extend our gratitude to interim department chair and radiology professor Shadi Aminololama-Shakeri for an excellent job leading the department and providing uninterrupted services while new procedures were implemented to protect patients and staff during the hypertension medications lasix,” said Brashear. €œWe also thank the recruitment advisory committee, co-chaired by Drs can you buy lasix online. Lydia Howell and Luis Fernando Santana for their time and expertise in this important recruitment.”The UC Davis Department of Radiology performs imaging and therapeutic procedures for patients throughout Northern and Central California. Visit the UC Davis Department of Radiology website to learn how the department utilizes imaging to achieve a greater understanding of health, disease and the delivery of appropriate and cost-effective care..

What is Lasix?

FUROSEMIDE is a diuretic. It helps you make more urine and to lose salt and excess water from your body. Lasix is used to treat high blood pressure, and edema or swelling from heart, kidney or liver disease.

Lasix otc equivalent

We live in check this site out unprecedented lasix otc equivalent times. But what makes them without parallel is not the current lasix crisis nor the continued problems facing minorities in our institutions. Rather, it’s that for the first time, the problems of accessibility, rights and freedoms are now lasix otc equivalent invading privileged spaces.

There can be no ‘getting back to normal’, because ‘normal’ only ever benefited the white, Western, patriarchal, abled and cis ideals. For many, the world is not suddenly on fire. €¦IntroductionMinecraft is a computer game lasix otc equivalent with no specific goals to accomplish.

The gameworld consists of three-dimensional (3D) cubes and objects which the player (Steve) can mine and build into infinitely complex (and logically impossible) structures. Steve sometimes encounters other characters (‘mobs’), such as animals and hostile creatures lasix otc equivalent. He can ‘spawn’ and destroy them.

While it looks like a harmless game of logical construction, it conveys some worryingly delusive ideas about the real world. The difference between lasix otc equivalent real and imagined structures is at the heart of the age-old debate around categorising mental disorders.Classification in mental health has had various forms throughout history. Mack and colleagues set out a history of psychiatric classification beginning in 2600 BC with Egyptian references to melancholia and hysteria.

Through the Ancient Greeks with Hippocrates’ phrenitis, mania, melancholia, epilepsy, hysteria and Scythian disease lasix otc equivalent. Through the Renaissance period. Through to 19th-century psychiatry featuring Pinel (known as the first psychiatrist), Kraepelin (known for observational classification) and Freud (known for classifying neurosis and psychosis).1Although the history of psychiatric classification identifies some common trends such as the labels ‘melancholia’ and ‘hysteria’ which have survived millennia, the label ‘depression’ is relatively new.

The earliest lasix otc equivalent usage noted by Snaith is from 1899. €˜in simple pathological depression…the patient exhibits a growing indifference to his former pursuits…’.2 Snaith noted that early 20th-century psychiatrists like Adolf Meyer hoped that ‘depression’ would come to encompass a broad category under which descriptions of subtypes would emerge. This did not happen lasix otc equivalent until the middle of the 20th century.

With the publication of the sixth International Classification of Diseases (ICD) in 1948 and the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952 and their subsequent revisions, the latter half of the 20th century has seen depression subtype labels proliferate. In their study of the social determinants of diagnostic labels in depression, McPherson and Armstrong illustrate how the codification of depression subtypes in the latter half of the 20th century has been shaped by the evolving context of psychiatry, including power struggles within the profession, a move to community care and the development of psychopharmacology.3During this period, McPherson and Armstrong describe how subsequent versions of the DSM served as battlegrounds for professional disputes and philosophical quarrels around categorisation of mental disorders. DSM I and DSM II have been described as products of an American Psychiatric Association dominated by psychoanalytic psychiatrists.4 DSM III and DSM III-R have been described as a radical rejection of psychoanalytic thinking, a ‘neo-Kraepelinian revolution’, a reference to the observational descriptive techniques of 19th-century psychiatrist Emil Kraepelin who classified mental disorders lasix otc equivalent into two broad categories.

€˜dementia praecox’ and ‘manic-depression’.5 DSM III was seen by some as a turning point in the use of the medical model of mental illness, through provision of specific inclusion and exclusion criteria, and use of field trials and a multiaxial system.6 These latter technocratic additions to psychiatric labelling served to engender a much closer alignment between psychiatry, science and medicine.The codification of mental disorders in manuals has been described by Thomas Schacht as intrinsic to the relationship between science and politics and the way in which psychiatrists gain significant social power by aligning themselves to science.7 His argument drew on Szasz, who saw the mental health establishment as a therapeutic state. Zimbardo, who described psychiatric care as lasix otc equivalent a controlling force. And Foucault, who described the categorisation of the mentally ill as a force for isolating ‘the other’.

Diagnostic critique has been further developed through a cultural relativist lens in that what Western psychiatrists classify as a depression is constructed differently in other cultures.8 Considering these limitations, some critics have gone so far as to argue that psychiatric diagnostic systems should be abolished.9Yet architects of DSM manuals have worked hard to ensure the technology of classification is regarded as genuine scientific activity with sound roots in philosophy of science. In their philosophical defence of DSM IV, Allen Frances and colleagues address their critics under the headings ‘nominalism vs realism’, ‘empiricism vs rationalism’ and ‘categorical vs dimensional’.10 The implication is that there are opposing stances in which a choice must be made or a middle lasix otc equivalent ground forged by those reasonable enough to recognise the need for pragmatism in the service of clinical utility. The nominalism–realism debate is illustrated using as metaphor three different stances a cricket umpire might take on calling strikes and balls.

The discussion sets out two of these lasix otc equivalent as extreme views. €˜at one extreme…those who take a reductionistically realistic view of the world’ versus ‘the solipsistic nominalists…might content that nothing exists’. Szasz, who is characterised as holding particularly extreme views, is named as an archetypal solipsist.

There is implied to lasix otc equivalent be a degree of arrogance associated with this view in the illustrative example in which the umpire states ‘there are no balls and there are no strikes until I call them’. Frances therefore sets up a means of grouping two kinds of people as philosophical extremists who can be dismissed, while avoiding addressing the philosophical problems they pose.Frances provides little if any justification for the middle ground stance, ‘There are balls and there are strikes and I call them as I see them’, other than to focus on its clinical utility and the lack of clinical utility in the alternatives ‘naïve realism’ and ‘heuristically barren solipsism’. The natural conclusion the reader is invited to reach is that a lasix otc equivalent middle ground of a heuristic concept is naturally right because it is not extreme and is naturally useful clinically, without specifying in what way this stance is coherent, resolves the two alternatives, and in what way a heuristic construct that is not ‘real’ can be subject to scientific testing.Similarly, in discussing the ‘categorical vs dimensional’, Frances promotes the ‘prototype approach’.

Those holding opposing views are labelled as ‘dualists’ or ‘dichotomisers’. The prototypical approach is again put forward as a clinically useful middle ground. Illustrations are lasix otc equivalent drawn from natural science.

€˜a triangle and a square are never the same’, inciting the reader to consider science as value-free. The prototypical approach emerges as a natural solution, yet the authors do not address how a diagnostic prototype resolves the issues posed by the two alternatives, nor lasix otc equivalent how a prototype can be subjected to natural science methods.The argument presented here is not a defence of solipsism or dualism. Rather it aims to illustrate that if for pragmatic purposes clinicians and policymakers choose to gloss over the philosophical flaws in classification practices, it is then risky to move beyond the heuristic and apply natural science methods to these constructs adding multiple layers of technocratic subclassification.

Doing so is more like playing Minecraft than cricket. The National Institute for Health and Care Excellence (NICE) guideline for depression is taken as an example of the philosophical errors that can follow from playing Minecraft with unsound heuristic devices, specifically subcategories lasix otc equivalent of persistent forms of depression. As well as serving a clinical purpose, diagnosis in medicine is a way of allocating resources for insurance companies and constructing clinical guidelines, which in turn determine rationing within the National Health Service.

The consequences for lasix otc equivalent recipients of healthcare are therefore significant. Clinical utility is arguably not being served at all and patients are left at risk of poor-quality care.Heterogeneity of persistent depressionAndrea Jobst and colleagues note that ‘because of their chronic clinical course, approximately 40% of CD [chronic depression] patients also fulfil criteria for TRD [treatment resistant depression]…usually defined by the number of non-successful biological treatments’.11 This position is reflected in the DSM VAmerican Psychiatric Association (2013), the European Psychiatric Association (EPA) guidance and the ICD-11(World Health Organisation, 2018), which all use a ‘persistent’ depression category, acknowledging a loosely defined mixed group of long-term, difficult-to-treat depressive conditions, often associated with dysthymia and comorbid common mental disorders, various personality traits and psychosocial disability.In contrast, the NICE 2018 draft guideline separates treatments into those for ‘new episodes’ of depression. €˜further-line’ treatment of depression (equivalent to TRD), CD and ‘depression with co-morbidities’.

The latter is subdivided into treatments for lasix otc equivalent ‘complex depression’ and ‘psychotic depression’. These categories and subcategories introduce an unfortunate sense of certainty as though these labels represent real things. An analysis follows of how these definitions play out in terms lasix otc equivalent of grouping of randomised controlled trials in the NICE evidence review.

Specifically, the analysis reveals the overlap between populations in trials which have been separated into discrete categories, revealing significant limitations to the utility of the category labels.The NICE definition of CD requires trial samples to meet the criteria for major depressive disorder (MDD) for 2 years. Dysthymia and double depression (MDD superimposed on dysthymia) were included. If 75% of the trial population met these criteria, lasix otc equivalent the trial was reviewed in the CD category.12 The definition of TRD (or ‘further-line treatments’) required that the trial sample had demonstrated a ‘limited response to previous treatment’ and randomised to the further-line treatment at this point.

If 80% of the trial participants met these criteria, it was reviewed in the TRD category.13 Complex depression was defined as ‘depression co-existing with personality disorder’. To be classed as complex, 51% of trial participants had to have personality disorder (PD).14It is immediately clear from these definitions that there is lasix otc equivalent a potential problem with attempting to categorise trial populations into just one of these categories. These populations are likely to overlap, whether or not a trial protocol sets out to explicitly record all of this information.

The analysis below will illustrate this using examples from within the NICE review.Cataloguing complexity in trial populationsWithin the category of further-line treatments (TRD), 64 trials were reviewed. Comparisons within these trials were lasix otc equivalent further subcategorised into ‘dose escalation strategies’, ‘augmentation strategies’ and ‘switching strategies’. In drilling down by way of illustration, this analysis considers the 51 trials in the augmentation strategy evidence review.

Of these, two were classified by the reviewers as also fulfilling the criteria for CD but were not analysed in the CD category (Study IDs. Fonagy 2015 lasix otc equivalent and Kocsis 200915). About half of the trials (23/51) did not report the mean duration of episode, meaning that it is not possible to know what percentage of participants also met the criteria for CD.

Of trials that did report episode duration, 17 reported a lasix otc equivalent mean duration longer than 24 months. While the standard deviations varied in size or were unreported, the mean indicates a good likelihood that a significant proportion of the participants across these 51 trials met the criteria for CD.Details of baseline employment, trauma history, suicidality, physical comorbidity, axis I comorbidity and PD (all clinical indicators of complexity, severity and chronicity) were not collated by NICE. For the present analysis, all 51 publications were examined and data compiled concerning clinical complexity in the trial populations.

Only 14 of 51 trials report lasix otc equivalent employment data. Of those that do, unemployment ranges from 12% to 56% across trial samples. None of the trials report lasix otc equivalent trauma history.

About half of the trials (26/51) excluded people who were considered a suicide risk. The others did not.A large proportion of trials (30/51) did not provide any data on axis 1 comorbidity. Of these, 18 did not exclude any diagnoses, while 12 excluded some (but lasix otc equivalent not all) disorders.

The most common diagnoses excluded were psychotic disorders, substance or alcohol abuse, and bipolar disorder (excluded in 26, 25 and 23 trials, respectively). Only 7 of 51 trials clearly stated that all axis 1 diagnoses were excluded lasix otc equivalent. This leaves only 13 studies providing any data about comorbidity.

Of these, 9 gave partial data on one or two conditions, while 4 reported either the mean number of disorders (range 1.96–2.9) or the percentage of participants (range 68.1–96.7) with any comorbid diagnosis (Nierenberg 2003a, Nierenberg 2006, Watkins 2011a, Town 201715).The majority of trials (46/51) did not report the prevalence of PD. Many stated PD as an lasix otc equivalent exclusion criterion but without defining a threshold for exclusion. For example, PD could be excluded if it ‘impacted’ the depression, if it was ‘significant’, ‘severe’ or ‘persistent’.

Some excluded certain PDs (such as lasix otc equivalent antisocial or borderline) and not others but without reporting the prevalence of those not excluded. In the five trials where prevalence was clear, prevalence ranged from 0% (Ravindran 2008a15), where all PDs were excluded, to 87.5% of the sample (Town 201715). Two studies reported the mean number of PDs.

2.0 (Nierenberg 2003a) and 0.85 (Watkins 2011a15).The majority of trials (43/51) did not report the prevalence of physical lasix otc equivalent illness. Many stated illness as an exclusion criterion, but the definitions and thresholds were vague and could be interpreted in different ways. For example, illness could be excluded if it was ‘unstable’, ‘serious’, ‘significant’, ‘relevant’, or would ‘contraindicate’ or ‘impact’ the lasix otc equivalent medication.

Of the eight trials reporting information about physical health, there was a wide variation. Four reported prevalence varying from 7.6% having a disability (Eisendrath 201615) to 90.9% having an illness or disability (Town 201715). Four used scales lasix otc equivalent of physical health.

Two indicating mild problems (Nierenberg 2006, Lavretsky 201115) and two indicating moderately high levels of illness (Thase 2007, Fang 201015).The NICE review also divided trial populations into a dichotomy of ‘more severe’ and ‘less severe’ on the grounds that this would be a clinically useful classification for general practitioners. NICE applied a bespoke methodology for creating this dichotomy, abandoning validated measure thresholds in order first to generate two ‘homogeneous’ groups to ‘facilitate analysis’, and second to create an algorithm to ‘read across’ different measures (such as the Beck Depression lasix otc equivalent Inventory, the Hamilton Rating Scale for Depression (HRSD) and the Montgomery-Asberg Depression Rating Scale).16 Examining trials which use more than one of these measures reveals problems in the algorithm. Of the 51 trials, there are 6 instances in which the study population falls into NICE’s more severe category according to one measure and into the less severe category according to another.

In four of these trials, NICE chose the less severe category (Souza 2016, Watkins 2011a, Fonagy 2015, Town 201715). The other two trials were designated more severe (Barbee 2011, Dunner lasix otc equivalent 200715). Only 17 of 51 trials reported two or more depression scale measures, leaving much unknown about whether other study populations could count as both more severe and less severe.Absence of knowledge or knowledge of absence?.

A key philosophical error in lasix otc equivalent science is to confuse an absence of knowledge with knowledge of absence. It is likely that some of the study populations deemed lacking in complexity or severity could actually have high degrees of complexity and/or severity. Data to demonstrate this may either fall foul of a guideline committee decision to prioritise certain information over other conflicting information (as in the severity algorithm).

The information may lasix otc equivalent be non-existent as it was not collected. It may be somewhere in the publication pipeline. Or it lasix otc equivalent may be sitting in a database with a research team that has run out of funds for supplementary analyses.

Wherever those data are or are not, their absence from published articles does not define the phenomenology of depression for the patients who took part. As a case in point, data from the Fonagy 2015 trial presented at conferences but not published reveal that PD prevalence data would place the trial well within the NICE complex depression category, and that the sample had high levels of past trauma and physical condition comorbidity. The trial also meets the guideline criteria for CD according to the guideline’s own appendices.17 Reported axis 1 comorbidity was high (75.2% had anxiety disorder, 18.6% had substance abuse disorder, 13.2% had eating disorder).18 The mean depression scores at baseline were 36.5 on the Beck Depression Inventory and 20.1 on the HRSD (severe and lasix otc equivalent very severe, respectively, according to published cut-off scores).

NICE categorised this population as less severe TRD, not CD and not complex.Notes1. Avram H lasix otc equivalent. Mack et al.

(1994), “A Brief History of Psychiatric Classification. From the lasix otc equivalent Ancients to DSM-IV,” Psychiatric Clinics 17, no. 3.

Snaith (1987), “The Concepts of Mild Depression,” British Journal of Psychiatry 150, no. 3. 387.3.

Susan McPherson and David Armstrong (2006), “Social Determinants of Diagnostic Labels in Depression,” Social Science &. Medicine 62, no. 1.

52–7.4. Gerald N. Grob (1991), “Origins of DSM-I.

A Study in Appearance and Reality,” The American Journal of Psychiatry. 421–31.5. Wilson M.

Compton and Samuel B. Guze (1995), “The Neo-Kraepelinian Revolution in Psychiatric Diagnosis,” European Archives of Psychiatry and Clinical Neuroscience 245, no. 4.

198–9.6. Gerald L. Klerman (1984), “A Debate on DSM-III.

The Advantages of DSM-III,” The American Journal of Psychiatry. 539–42.7. Thomas E.

Schacht (1985), “DSM-III and the Politics of Truth,” American Psychologist. 513–5.8. Daniel F.

Hartner and Kari L. Theurer (2018), “Psychiatry Should Not Seek Mechanisms of Disorder,” Journal of Theoretical and Philosophical Psychology 38, no. 4.

189–204.9. Sami Timimi (2014), “No More Psychiatric Labels. Why Formal Psychiatric Diagnostic Systems Should Be Abolished,” Journal of Clinical and Health Psychology 14, no.

(1994), “DSM-IV Meets Philosophy,” The Journal of Medicine and Philosophy. A Forum for Bioethics and Philosophy of Medicine 19, no. 3.

207–18.11. Andrea Jobst et al. (2016), “European Psychiatric Association Guidance on Psychotherapy in Chronic Depression Across Europe,” European Psychiatry 33.

20.12. National Institute for Health and Care Excellence (2018), Depression in Adults. Treatment and Management.

Draft for Consultation, https://www.nice.org.uk/guidance/gid-cgwave0725/documents/full-guideline-updated, 507.13. Ibid., 351–62.14. Ibid., 597.15.

Note that in order to refer to specific trials reviewed in the guideline, rather than the full citation, the Study IDs from column A in appendix J5 have been used. See www.nice.org.uk/guidance/gid-cgwave0725/documents/addendum-appendix-9 for details and full references.16. National Institute for Health and Care Excellence (2018), Depression in Adults.

Treatment and Management. Second Consultation on Draft Guideline – Stakeholder Comments Table, https://www.nice.org.uk/guidance/gid-cgwave0725/documents/consultation-comments-and-responses-2, 420–1.17. National Institute for Health and Care Excellence (2018), Depression in Adults, appendix J5.18.

Peter Fonagy et al. (2015), “Pragmatic Randomized Controlled Trial of Long-Term Psychoanalytic Psychotherapy for Treatment-Resistant Depression. The Tavistock Adult Depression Study (TADS),” World Psychiatry 14, no.

3. 312–21.19. American Psychological Association (2018), Clinical Practice Guideline for the Treatment of Depression in Children, Adolescents, and Young, Middle-aged, and Older Adults.

Draft.20. Jacqui Thornton (2018), “Depression in Adults. Campaigners and Doctors Demand Full Revision of NICE Guidance,” BMJ 361.

We live in unprecedented times can you buy lasix online. But what makes them without parallel is not the current lasix crisis nor the continued problems facing minorities in our institutions. Rather, it’s that for the first time, the problems of accessibility, rights and freedoms are can you buy lasix online now invading privileged spaces.

There can be no ‘getting back to normal’, because ‘normal’ only ever benefited the white, Western, patriarchal, abled and cis ideals. For many, the world is not suddenly on fire. €¦IntroductionMinecraft is a computer game with no specific can you buy lasix online goals to accomplish.

The gameworld consists of three-dimensional (3D) cubes and objects which the player (Steve) can mine and build into infinitely complex (and logically impossible) structures. Steve sometimes encounters other characters (‘mobs’), such as animals and hostile creatures can you buy lasix online. He can ‘spawn’ and destroy them.

While it looks like a harmless game of logical construction, it conveys some worryingly delusive ideas about the real world. The difference between real and imagined structures is at the can you buy lasix online heart of the age-old debate around categorising mental disorders.Classification in mental health has had various forms throughout history. Mack and colleagues set out a history of psychiatric classification beginning in 2600 BC with Egyptian references to melancholia and hysteria.

Through the can you buy lasix online Ancient Greeks with Hippocrates’ phrenitis, mania, melancholia, epilepsy, hysteria and Scythian disease. Through the Renaissance period. Through to 19th-century psychiatry featuring Pinel (known as the first psychiatrist), Kraepelin (known for observational classification) and Freud (known for classifying neurosis and psychosis).1Although the history of psychiatric classification identifies some common trends such as the labels ‘melancholia’ and ‘hysteria’ which have survived millennia, the label ‘depression’ is relatively new.

The earliest usage noted by Snaith is from can you buy lasix online 1899. €˜in simple pathological depression…the patient exhibits a growing indifference to his former pursuits…’.2 Snaith noted that early 20th-century psychiatrists like Adolf Meyer hoped that ‘depression’ would come to encompass a broad category under which descriptions of subtypes would emerge. This did not happen until the middle of the 20th century can you buy lasix online.

With the publication of the sixth International Classification of Diseases (ICD) in 1948 and the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952 and their subsequent revisions, the latter half of the 20th century has seen depression subtype labels proliferate. In their study of the social determinants of diagnostic labels in depression, McPherson and Armstrong illustrate how the codification of depression subtypes in the latter half of the 20th century has been shaped by the evolving context of psychiatry, including power struggles within the profession, a move to community care and the development of psychopharmacology.3During this period, McPherson and Armstrong describe how subsequent versions of the DSM served as battlegrounds for professional disputes and philosophical quarrels around categorisation of mental disorders. DSM I and DSM II have been described as products of an American Psychiatric Association dominated by psychoanalytic psychiatrists.4 DSM III and DSM III-R have been described as a radical rejection of psychoanalytic thinking, a ‘neo-Kraepelinian revolution’, a reference to the observational descriptive techniques of 19th-century psychiatrist Emil can you buy lasix online Kraepelin who classified mental disorders into two broad categories.

€˜dementia praecox’ and ‘manic-depression’.5 DSM III was seen by some as a turning point in the use of the medical model of mental illness, through provision of specific inclusion and exclusion criteria, and use of field trials and a multiaxial system.6 These latter technocratic additions to psychiatric labelling served to engender a much closer alignment between psychiatry, science and medicine.The codification of mental disorders in manuals has been described by Thomas Schacht as intrinsic to the relationship between science and politics and the way in which psychiatrists gain significant social power by aligning themselves to science.7 His argument drew on Szasz, who saw the mental health establishment as a therapeutic state. Zimbardo, who described psychiatric care as a can you buy lasix online controlling force. And Foucault, who described the categorisation of the mentally ill as a force for isolating ‘the other’.

Diagnostic critique has been further developed through a cultural relativist lens in that what Western psychiatrists classify as a depression is constructed differently in other cultures.8 Considering these limitations, some critics have gone so far as to argue that psychiatric diagnostic systems should be abolished.9Yet architects of DSM manuals have worked hard to ensure the technology of classification is regarded as genuine scientific activity with sound roots in philosophy of science. In their philosophical defence of DSM IV, Allen Frances and colleagues address their critics under the headings ‘nominalism vs realism’, ‘empiricism vs rationalism’ and ‘categorical vs dimensional’.10 The implication is that there are opposing stances in which a choice must be made or a middle ground forged by those reasonable enough to recognise the need for pragmatism in can you buy lasix online the service of clinical utility. The nominalism–realism debate is illustrated using as metaphor three different stances a cricket umpire might take on calling strikes and balls.

The discussion can you buy lasix online sets out two of these as extreme views. €˜at one extreme…those who take a reductionistically realistic view of the world’ versus ‘the solipsistic nominalists…might content that nothing exists’. Szasz, who is characterised as holding particularly extreme views, is named as an archetypal solipsist.

There is can you buy lasix online implied to be a degree of arrogance associated with this view in the illustrative example in which the umpire states ‘there are no balls and there are no strikes until I call them’. Frances therefore sets up a means of grouping two kinds of people as philosophical extremists who can be dismissed, while avoiding addressing the philosophical problems they pose.Frances provides little if any justification for the middle ground stance, ‘There are balls and there are strikes and I call them as I see them’, other than to focus on its clinical utility and the lack of clinical utility in the alternatives ‘naïve realism’ and ‘heuristically barren solipsism’. The natural conclusion the reader is invited to reach is that a middle ground of a heuristic concept is naturally right because it is not extreme and is naturally useful clinically, without specifying in what way this stance is coherent, resolves the two alternatives, and in what way a heuristic construct that is not ‘real’ can be subject to scientific testing.Similarly, in discussing the ‘categorical vs dimensional’, Frances can you buy lasix online promotes the ‘prototype approach’.

Those holding opposing views are labelled as ‘dualists’ or ‘dichotomisers’. The prototypical approach is again put forward as a clinically useful middle ground. Illustrations are drawn from can you buy lasix online natural science.

€˜a triangle and a square are never the same’, inciting the reader to consider science as value-free. The prototypical approach emerges as a natural solution, can you buy lasix online yet the authors do not address how a diagnostic prototype resolves the issues posed by the two alternatives, nor how a prototype can be subjected to natural science methods.The argument presented here is not a defence of solipsism or dualism. Rather it aims to illustrate that if for pragmatic purposes clinicians and policymakers choose to gloss over the philosophical flaws in classification practices, it is then risky to move beyond the heuristic and apply natural science methods to these constructs adding multiple layers of technocratic subclassification.

Doing so is more like playing Minecraft than cricket. The National Institute for Health and Care Excellence (NICE) guideline for depression is taken as an can you buy lasix online example of the philosophical errors that can follow from playing Minecraft with unsound heuristic devices, specifically subcategories of persistent forms of depression. As well as serving a clinical purpose, diagnosis in medicine is a way of allocating resources for insurance companies and constructing clinical guidelines, which in turn determine rationing within the National Health Service.

The consequences for recipients of healthcare are can you buy lasix online therefore significant. Clinical utility is arguably not being served at all and patients are left at risk of poor-quality care.Heterogeneity of persistent depressionAndrea Jobst and colleagues note that ‘because of their chronic clinical course, approximately 40% of CD [chronic depression] patients also fulfil criteria for TRD [treatment resistant depression]…usually defined by the number of non-successful biological treatments’.11 This position is reflected in the DSM VAmerican Psychiatric Association (2013), the European Psychiatric Association (EPA) guidance and the ICD-11(World Health Organisation, 2018), which all use a ‘persistent’ depression category, acknowledging a loosely defined mixed group of long-term, difficult-to-treat depressive conditions, often associated with dysthymia and comorbid common mental disorders, various personality traits and psychosocial disability.In contrast, the NICE 2018 draft guideline separates treatments into those for ‘new episodes’ of depression. €˜further-line’ treatment of depression (equivalent to TRD), CD and ‘depression with co-morbidities’.

The latter is subdivided into treatments for ‘complex depression’ and ‘psychotic can you buy lasix online depression’. These categories and subcategories introduce an unfortunate sense of certainty as though these labels represent real things. An analysis follows of how these definitions play out in terms of grouping of randomised controlled can you buy lasix online trials in the NICE evidence review.

Specifically, the analysis reveals the overlap between populations in trials which have been separated into discrete categories, revealing significant limitations to the utility of the category labels.The NICE definition of CD requires trial samples to meet the criteria for major depressive disorder (MDD) for 2 years. Dysthymia and double depression (MDD superimposed on dysthymia) were included. If 75% of the trial population met these criteria, the trial was reviewed in the CD category.12 The definition of TRD (or ‘further-line treatments’) required that the trial sample can you buy lasix online had demonstrated a ‘limited response to previous treatment’ and randomised to the further-line treatment at this point.

If 80% of the trial participants met these criteria, it was reviewed in the TRD category.13 Complex depression was defined as ‘depression co-existing with personality disorder’. To be classed as complex, 51% of trial participants had to have personality disorder (PD).14It is immediately clear can you buy lasix online from these definitions that there is a potential problem with attempting to categorise trial populations into just one of these categories. These populations are likely to overlap, whether or not a trial protocol sets out to explicitly record all of this information.

The analysis below will illustrate this using examples from within the NICE review.Cataloguing complexity in trial populationsWithin the category of further-line treatments (TRD), 64 trials were reviewed. Comparisons within can you buy lasix online these trials were further subcategorised into ‘dose escalation strategies’, ‘augmentation strategies’ and ‘switching strategies’. In drilling down by way of illustration, this analysis considers the 51 trials in the augmentation strategy evidence review.

Of these, two were classified by the reviewers as also fulfilling the criteria for CD but were not analysed in the CD category (Study IDs. Fonagy 2015 and Kocsis can you buy lasix online 200915). About half of the trials (23/51) did not report the mean duration of episode, meaning that it is not possible to know what percentage of participants also met the criteria for CD.

Of trials that did report episode duration, 17 reported a mean can you buy lasix online duration longer than 24 months. While the standard deviations varied in size or were unreported, the mean indicates a good likelihood that a significant proportion of the participants across these 51 trials met the criteria for CD.Details of baseline employment, trauma history, suicidality, physical comorbidity, axis I comorbidity and PD (all clinical indicators of complexity, severity and chronicity) were not collated by NICE. For the present analysis, all 51 publications were examined and data compiled concerning clinical complexity in the trial populations.

Only 14 of 51 trials report can you buy lasix online employment data. Of those that do, unemployment ranges from 12% to 56% across trial samples. None of the trials report trauma history can you buy lasix online.

About half of the trials (26/51) excluded people who were considered a suicide risk. The others did not.A large proportion of trials (30/51) did not provide any data on axis 1 comorbidity. Of these, 18 did not exclude can you buy lasix online any diagnoses, while 12 excluded some (but not all) disorders.

The most common diagnoses excluded were psychotic disorders, substance or alcohol abuse, and bipolar disorder (excluded in 26, 25 and 23 trials, respectively). Only 7 can you buy lasix online of 51 trials clearly stated that all axis 1 diagnoses were excluded. This leaves only 13 studies providing any data about comorbidity.

Of these, 9 gave partial data on one or two conditions, while 4 reported either the mean number of disorders (range 1.96–2.9) or the percentage of participants (range 68.1–96.7) with any comorbid diagnosis (Nierenberg 2003a, Nierenberg 2006, Watkins 2011a, Town 201715).The majority of trials (46/51) did not report the prevalence of PD. Many stated PD can you buy lasix online as an exclusion criterion but without defining a threshold for exclusion. For example, PD could be excluded if it ‘impacted’ the depression, if it was ‘significant’, ‘severe’ or ‘persistent’.

Some excluded certain PDs (such as antisocial or borderline) and not can you buy lasix online others but without reporting the prevalence of those not excluded. In the five trials where prevalence was clear, prevalence ranged from 0% (Ravindran 2008a15), where all PDs were excluded, to 87.5% of the sample (Town 201715). Two studies reported the mean number of PDs.

2.0 (Nierenberg 2003a) and 0.85 (Watkins 2011a15).The majority of trials can you buy lasix online (43/51) did not report the prevalence of physical illness. Many stated illness as an exclusion criterion, but the definitions and thresholds were vague and could be interpreted in different ways. For example, illness could be excluded if it was ‘unstable’, ‘serious’, ‘significant’, ‘relevant’, can you buy lasix online or would ‘contraindicate’ or ‘impact’ the medication.

Of the eight trials reporting information about physical health, there was a wide variation. Four reported prevalence varying from 7.6% having a disability (Eisendrath 201615) to 90.9% having an illness or disability (Town 201715). Four used scales of physical health can you buy lasix online.

Two indicating mild problems (Nierenberg 2006, Lavretsky 201115) and two indicating moderately high levels of illness (Thase 2007, Fang 201015).The NICE review also divided trial populations into a dichotomy of ‘more severe’ and ‘less severe’ on the grounds that this would be a clinically useful classification for general practitioners. NICE applied a bespoke methodology for creating this dichotomy, abandoning validated measure thresholds in order first to generate two can you buy lasix online ‘homogeneous’ groups to ‘facilitate analysis’, and second to create an algorithm to ‘read across’ different measures (such as the Beck Depression Inventory, the Hamilton Rating Scale for Depression (HRSD) and the Montgomery-Asberg Depression Rating Scale).16 Examining trials which use more than one of these measures reveals problems in the algorithm. Of the 51 trials, there are 6 instances in which the study population falls into NICE’s more severe category according to one measure and into the less severe category according to another.

In four of these trials, NICE chose the less severe category (Souza 2016, Watkins 2011a, Fonagy 2015, Town 201715). The other can you buy lasix online two trials were designated more severe (Barbee 2011, Dunner 200715). Only 17 of 51 trials reported two or more depression scale measures, leaving much unknown about whether other study populations could count as both more severe and less severe.Absence of knowledge or knowledge of absence?.

A key philosophical can you buy lasix online error in science is to confuse an absence of knowledge with knowledge of absence. It is likely that some of the study populations deemed lacking in complexity or severity could actually have high degrees of complexity and/or severity. Data to demonstrate this may either fall foul of a guideline committee decision to prioritise certain information over other conflicting information (as in the severity algorithm).

The information can you buy lasix online may be non-existent as it was not collected. It may be somewhere in the publication pipeline. Or it may be sitting in a database with a research team that has run out can you buy lasix online of funds for supplementary analyses.

Wherever those data are or are not, their absence from published articles does not define the phenomenology of depression for the patients who took part. As a case in point, data from the Fonagy 2015 trial presented at conferences but not published reveal that PD prevalence data would place the trial well within the NICE complex depression category, and that the sample had high levels of past trauma and physical condition comorbidity. The trial also meets the guideline criteria for CD according to the guideline’s own appendices.17 Reported axis 1 comorbidity was high (75.2% had anxiety disorder, 18.6% had substance abuse disorder, 13.2% had eating disorder).18 The mean depression scores at baseline were 36.5 can you buy lasix online on the Beck Depression Inventory and 20.1 on the HRSD (severe and very severe, respectively, according to published cut-off scores).

NICE categorised this population as less severe TRD, not CD and not complex.Notes1. Avram H can you buy lasix online. Mack et al.

(1994), “A Brief History of Psychiatric Classification. From the Ancients to can you buy lasix online DSM-IV,” Psychiatric Clinics 17, no. 3.

Snaith (1987), “The Concepts of Mild Depression,” British Journal of Psychiatry 150, no. 3. 387.3.

Susan McPherson and David Armstrong (2006), “Social Determinants of Diagnostic Labels in Depression,” Social Science &. Medicine 62, no. 1.

52–7.4. Gerald N. Grob (1991), “Origins of DSM-I.

A Study in Appearance and Reality,” The American Journal of Psychiatry. 421–31.5. Wilson M.

Compton and Samuel B. Guze (1995), “The Neo-Kraepelinian Revolution in Psychiatric Diagnosis,” European Archives of Psychiatry and Clinical Neuroscience 245, no. 4.

198–9.6. Gerald L. Klerman (1984), “A Debate on DSM-III.

The Advantages of DSM-III,” The American Journal of Psychiatry. 539–42.7. Thomas E.

Schacht (1985), “DSM-III and the Politics of Truth,” American Psychologist. 513–5.8. Daniel F.

Hartner and Kari L. Theurer (2018), “Psychiatry Should Not Seek Mechanisms of Disorder,” Journal of Theoretical and Philosophical Psychology 38, no. 4.

189–204.9. Sami Timimi (2014), “No More Psychiatric Labels. Why Formal Psychiatric Diagnostic Systems Should Be Abolished,” Journal of Clinical and Health Psychology 14, no.

(1994), “DSM-IV Meets Philosophy,” The Journal of Medicine and Philosophy. A Forum for Bioethics and Philosophy of Medicine 19, no. 3.

207–18.11. Andrea Jobst et al. (2016), “European Psychiatric Association Guidance on Psychotherapy in Chronic Depression Across Europe,” European Psychiatry 33.

20.12. National Institute for Health and Care Excellence (2018), Depression in Adults. Treatment and Management.

Draft for Consultation, https://www.nice.org.uk/guidance/gid-cgwave0725/documents/full-guideline-updated, 507.13. Ibid., 351–62.14. Ibid., 597.15.

Note that in order to refer to specific trials reviewed in the guideline, rather than the full citation, the Study IDs from column A in appendix J5 have been used. See www.nice.org.uk/guidance/gid-cgwave0725/documents/addendum-appendix-9 for details and full references.16. National Institute for Health and Care Excellence (2018), Depression in Adults.

Treatment and Management. Second Consultation on Draft Guideline – Stakeholder Comments Table, https://www.nice.org.uk/guidance/gid-cgwave0725/documents/consultation-comments-and-responses-2, 420–1.17. National Institute for Health and Care Excellence (2018), Depression in Adults, appendix J5.18.

Peter Fonagy et al. (2015), “Pragmatic Randomized Controlled Trial of Long-Term Psychoanalytic Psychotherapy for Treatment-Resistant Depression. The Tavistock Adult Depression Study (TADS),” World Psychiatry 14, no.

3. 312–21.19. American Psychological Association (2018), Clinical Practice Guideline for the Treatment of Depression in Children, Adolescents, and Young, Middle-aged, and Older Adults.

Draft.20. Jacqui Thornton (2018), “Depression in Adults. Campaigners and Doctors Demand Full Revision of NICE Guidance,” BMJ 361.

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2) does lasix help with pneumonia by enrolling in a Medicare Savings Program. The Medicare Savings Program includes the Qualified Medicare Beneficiary (QMB) program, which covers beneficiaries up to 100% FPL. Specified Low-Income Medicare Beneficiary (SLIMB), for those between 100-120%.

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See current co-pay levels here does lasix help with pneumonia. Partial Extra Help. Beneficiaries between 135%-150% FPL receive "partial" Extra Help, which limits the Part D deductible to $89 (2020 figure - click here for updated chart).

Sets sliding does lasix help with pneumonia scale fees for monthly premiums. And limits co-pays to 15%, until the beneficiary reaches the catastrophic coverage limit, at which point co-pays are limited to a $8.95 maximum (2020 or see current amount here) or 5% of the drug cost, whichever is greater. 2) Facilitated enrollment into a Part D plan Extra Help recipients who aren’t already enrolled in a Part D plan and don’t want to choose one on their own will be automatically enrolled into a benchmark plan by CMS.

This facilitated enrollment does lasix help with pneumonia ensures that Extra Help recipients have Part D coverage. However, the downside to facilitated enrollment is that the plan may not be the best “fit” for the beneficiary, if it doesn’t cover all his/her drugs, assesses a higher tier level for covered drugs than other comparable plans, and/or requires the beneficiary to go through administrative hoops like prior authorization, quantity limits and/or step therapy. Fortunately, Extra Help recipients can always enroll in a new plan … see #3 below.

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4) No late enrollment penalty Non LIS beneficiaries generally face a premium penalty (higher monthly premium) if they delayed their enrollment into Part D, meaning that they didn’t does lasix help with pneumonia enroll when they were initially eligible and didn’t have “creditable coverage.” Extra Help recipients do not have to worry about this problem – the late enrollment penalty provision does not apply to LIS beneficiaries. 1) For “deemed” beneficiaries (Medicaid/Medicare Savings Program recipients). Extra Help status lasts at least until the end of the current calendar year, even if the individual loses their Medicaid or Medicare Savings Program coverage during that year.

Individuals who receive Medicaid or a Medicare Savings Program any month between July and does lasix help with pneumonia December keep their LIS status for the remainder of that calendar year and the following year. Getting Medicaid coverage for even just a short period of time (ie, meeting a spenddown for just one month) can help ensure that the individual obtains Extra Help coverage for at least 6 months, and possibly as long as 18 months. TIP.

People with does lasix help with pneumonia a high spend-down who want to receive Medicaid for just one month in order to get Extra Help for 6-18 months can use past medical bills to meet their spend-down for that one month. There are different rules for using past paid medical bills verses past unpaid medical bills. For information see Spend down training materials.

Individuals who are losing their deemed status at the end of a calendar year because they are no longer receiving Medicaid or the Medicare Savings Program should be does lasix help with pneumonia notified in advance by SSA, and given an opportunity to file an Extra Help application through SSA. 2) For “non-deemed” beneficiaries (those who filed their LIS applications through SSA) Non-deemed beneficiaries retain their LIS status until/unless SSA does a redetermination and finds the individual ineligible for Extra Help. There are no reporting requirements per se in the Extra Help program, but beneficiaries must respond to SSA’s redetermination request.

What to do if the Part D plan doesn't know that someone has Extra Help Sometimes there are lengthy delays between does lasix help with pneumonia the date that someone is approved for Medicaid or a Medicare Savings Program and when that information is formally conveyed to the Part D plan by CMS. As a practical matter, this often results in beneficiaries being charged co-pays, premiums and/or deductibles that they can't afford and shouldn't have to pay. To protect LIS beneficiaries, CMS has a "Best Available Evidence" policy which requires plans to accept alternative forms of proof of someone's LIS status and adjust the person's cost-sharing obligation accordingly.

LIS beneficiaries who are being charged improperly should be sure to contact does lasix help with pneumonia their plan and provide proof of their LIS status. If the plan still won't recognize their LIS status, the person or their advocate should file a complaint with the CMS regional office. The federal regulations governing the Low Income Subsidy program can be found at 42 CFR Subpart P (sections 423.771 through 423.800).

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Medicaid recipients, including those who meet a can you buy lasix online spenddown, are "deemed" into LIS (automatically enrolled by SSA) and don't have to check file a separate application for Extra Help. See more below about how receiving Medicaid just for one month can qualify you for Full Extra Help for up to 18 months. 2) by enrolling in a Medicare Savings Program.

The Medicare Savings Program includes the Qualified Medicare Beneficiary (QMB) program, which covers beneficiaries up to 100% FPL can you buy lasix online. Specified Low-Income Medicare Beneficiary (SLIMB), for those between 100-120%. And the Qualified Individual (QI-1) program, for individuals between 120-135% FPL.

There are no resource tests in can you buy lasix online New York's Medicare Savings Program.) The New York State Department of Health posts the Medicare Savings Program income guidelines on their website. Just like Medicaid, Medicare Savings Program recipients are deemed into LIS and don't need to apply through SSA. For more information see this article.

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You can also find out information about can you buy lasix online Extra Help in many different languages. See Medicare Rights Center chart on Extra Help Income and Asset Limits - updated annually You can apply for Extra Help and MSP at the same time through SSA. SSA will forward your Extra Help application data to the New York State Department of Health, who will use that data to assess your eligibility for MSP.

Individuals who apply for LIS through SSA and those who are deemed into LIS should receive written confirmation of their can you buy lasix online Extra Help status through SSA. Of course, individuals who apply for LIS through SSA and are found ineligible are also entitled to a written notice and have appeal rights. Benefits of Extra Help 1) Assistance with Part D cost-sharing The Extra Help program provides a subsidy which covers most (but not all) of beneficiary’s cost sharing obligations.

Extra Help beneficiaries do can you buy lasix online not have to worry about hitting the “donut hole” – the LIS subsidy continues to cover them through the donut hole and into catastrophic coverage. Full Extra Help. LIS beneficiaries with incomes up to 135% FPL are generally eligible for "full" Extra Help -- meaning they pay no Part D deductible, no charge for monthly premiums up to the benchmark amount, and fixed, relatively low co-pays (between $1.30 and $8.95 for 2020 depending on the person's income level and the tier category of the drug.

Medicaid beneficiaries in nursing homes, waiver programs, or managed long term can you buy lasix online care have $0 co-pays). Full Extra Help beneficiaries who hit the catastrophic coverage limit have $0 co-pays. See current co-pay levels here.

Partial Extra Help can you buy lasix online. Beneficiaries between 135%-150% FPL receive "partial" Extra Help, which limits the Part D deductible to $89 (2020 figure - click here for updated chart). Sets sliding scale fees for monthly premiums.

And limits co-pays to 15%, until the beneficiary reaches the catastrophic coverage limit, at which point co-pays are limited to a $8.95 maximum (2020 or see current amount can you buy lasix online here) or 5% of the drug cost, whichever is greater. 2) Facilitated enrollment into a Part D plan Extra Help recipients who aren’t already enrolled in a Part D plan and don’t want to choose one on their own will be automatically enrolled into a benchmark plan by CMS. This facilitated enrollment ensures that Extra Help recipients have Part D coverage.

However, the downside to facilitated enrollment is that the plan may not be the best “fit” for the beneficiary, if it doesn’t cover all his/her drugs, assesses a can you buy lasix online higher tier level for covered drugs than other comparable plans, and/or requires the beneficiary to go through administrative hoops like prior authorization, quantity limits and/or step therapy. Fortunately, Extra Help recipients can always enroll in a new plan … see #3 below. 3) Continuous special enrollment period Extra Help recipients have a continuous special enrollment period, meaning that they can switch plans at any time.

They are not “locked into” the annual open can you buy lasix online enrollment period (October 15-December 7). NOTE. This changed in 2019.

Starting in 2019, those with Extra Help will no can you buy lasix online longer have a continuous enrollment period. Instead, Extra Help recipients will be eligible to enroll no more than once per quarter for each of the first three quarters of the year. 4) No late enrollment penalty Non LIS beneficiaries generally face a premium penalty (higher monthly premium) if they delayed their enrollment into Part D, meaning that they didn’t enroll when they were initially eligible and didn’t have “creditable coverage.” Extra Help recipients do not have to worry about this problem – the late enrollment penalty provision does not apply to LIS beneficiaries.

1) For can you buy lasix online “deemed” beneficiaries (Medicaid/Medicare Savings Program recipients). Extra Help status lasts at least until the end of the current calendar year, even if the individual loses their Medicaid or Medicare Savings Program coverage during that year. Individuals who receive Medicaid or a Medicare Savings Program any month between July and December keep their LIS status for the remainder of that calendar year and the following year.

Getting Medicaid coverage for even just a short period of time (ie, meeting a spenddown for just one month) can help ensure that the individual obtains Extra Help coverage for at least can you buy lasix online 6 months, and possibly as long as 18 months. TIP. People with a high spend-down who want to receive Medicaid for just one month in order to get Extra Help for 6-18 months can use past medical bills to meet their spend-down for that one month.

There are different rules for can you buy lasix online using past paid medical bills verses past unpaid medical bills. For information see Spend down training materials. Individuals who are losing their deemed status at the end of a calendar year because they are no longer receiving Medicaid or the Medicare Savings Program should be notified in advance by SSA, and given an opportunity to file an Extra Help application through SSA.

2) For “non-deemed” beneficiaries (those who filed their LIS applications through SSA) Non-deemed beneficiaries retain their LIS status until/unless SSA does can you buy lasix online a redetermination and finds the individual ineligible for Extra Help. There are no reporting requirements per se in the Extra Help program, but beneficiaries must respond to SSA’s redetermination request. What to do if the Part D plan doesn't know that someone has Extra Help Sometimes there are lengthy delays between the date that someone is approved for Medicaid or a Medicare Savings Program and when that information is formally conveyed to the Part D plan by CMS.

As a practical matter, this often results in beneficiaries being charged co-pays, premiums and/or deductibles can you buy lasix online that they can't afford and shouldn't have to pay. To protect LIS beneficiaries, CMS has a "Best Available Evidence" policy which requires plans to accept alternative forms of proof of someone's LIS status and adjust the person's cost-sharing obligation accordingly. LIS beneficiaries who are being charged improperly should be sure to contact their plan and provide proof of their LIS status.

If the plan still won't recognize their LIS status, the person or their advocate should file a complaint with the CMS regional office. The federal regulations governing the Low Income Subsidy program can be found at 42 CFR Subpart P (sections 423.771 through 423.800). Also, CMS provides detailed guidance on the LIS provisions in chapter 13 of its Medicare Prescription Drug Benefit Manual.

This article was authored by the Empire Justice Center..