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With health care costs on the rise, a growing number of Americans are throwing out the old way of seeing a doctor and turning to a membership model. A monthly or annual fee gets you direct access to a doctor, no insurance needed.Twenty years into her career, bogged down by red tape, too many patients and long days, Dr. Shaila Pai-Verma was looking for a better way to practice medicine.“I was just miserable,” she said. “The joy of medicine is gone and then you're just doing paperwork.”So, a year ago, she started a new primary care practice with a new business model.“The patient basically has a direct contract with the physician and they take insurance companies out of it,” she explained.Patients pay a flat monthly or yearly fee. In exchange, they receive a broad range of primary care services and quick, unlimited access to their doctor via in-person office visits, phone or by text.“Everyone wants everything immediate. And so, I think this is it. It's good, especially in this time for people to have access,” said Pai-Verma.Membership fees range from about 5 to 0 per month on average – about 0 less than having typical health insurance. Most patients still carry catastrophic coverage for emergency treatments and hospitalizations, but that insurance is usually only -100 a month, so patients still save money.For Bonnie Micheli and her family, it was all about access.“With this, it's just so much easier to just know that I can contact directly here within a few hours for any issues that I'm having,” said Micheli.In late September, a bipartisan proposal was introduced in Congress that would expand access to the model and allow people to use their health savings account for direct primary care (DPC).Because they see fewer patients than traditional practices, some critics say the model could worsen the shortage of primary care physicians, a trend that’s already driven by burnout.But according to a recent study, DPC members had 25% lower hospital admissions and the cost of emergency room claims was reduced by 54%.“There's less ER visits and you know, better health care for the patient,” said Pai-Verma.While there is still debate, for a growing number of Americans, like Micheli, it’s becoming a simplified health insurance alternative.“Honestly, it’s just so nice to know what I'm paying every month or if you do the annual, what you're getting for that money, and you know exactly who to go to when you have a problem.” 2467

What happened to Katie Hill shouldn’t happen to anyone. But, this moment requires more nuance, as Katie Hill’s story - our story - is also one of workplace abuse and harassment.— Rep. Katie Hill (@RepKatieHill) October 7, 2020 235

Whether it’s to earn rewards toward vacations or just finance everyday purchases, there’s strong demand for credit cards among older adults.According to a report from credit bureau Experian, baby boomers (those born between 1946 and 1964) carried an average of 4.8 credit cards in the second quarter of 2019, more than any other generation in the report.One might think that an older adult’s chances of getting approved for a new credit card would be relatively high. It’s a demographic that’s had more time to establish long credit histories, pay mortgages and exhibit responsible borrowing. The Equal Credit Opportunity Act even bars creditors from discriminating against an application on the basis of age.If you fall into that demographic, though, there are several reasons why it could be challenging for you to get approved for a new credit card. Here’s what could be influencing your creditworthiness, and what you can do about it.Why older adults could be denied creditLess incomeDuring the credit card application process, you’ll be asked to report your annual income or income that you have reasonable access to; the bank needs to make sure you’re able to pay back what you charge.If you’re retired, you may be living on less since you no longer have that steady employment income, and that can affect your chances of approval.The good news is that you can count more income than just a traditional salary, including things like:Social Security benefits.Income from a spouse or partner.Income from investments and retirement.Part-time or seasonal jobs.Dividends and interest.Thin or ‘invisible’ credit filesIf you’re an older American who’s worked hard over many years to pay off your mortgage and whittle down daily expenses, you may not think your credit scores matter much anymore. But you may be rudely awakened when you incur a large unexpected expense, want to downsize to an apartment, or try to open a new travel rewards credit card to help boost a retirement trip. Credit scores do indeed still matter, and some factors may be working against you.In order to even have a FICO credit score, you need to have credit activity reported to the U.S. credit bureaus at least once every six months. Plus, that credit line with activity on it must be at least six months old.So if you’re fully free of debt — say, you’ve long ago paid off your home, your car and other loans and haven’t had any other credit activity in a year or more — the bureaus simply may not have enough information about you. Your credit file may be too thin.According to a 2019 analysis from credit bureau Equifax, about 91.5 million consumers in the United States either have no credit file or have insufficient information in their files to generate a traditional credit score.Poor ‘mix of credit’Even if you’re an older American who’s actively using credit cards and paying them off on time and in full each month, it doesn’t ensure you’ll get approved for your next card. In fact, if you have only credit card accounts in your credit file but no installment accounts like mortgages or car loans, it can be a drag on your credit scores.That’s because credit scoring models also like to see a “mix of credit,” meaning a variety of accounts that show you have experience with different kinds of borrowing. There are two basic types of credit:Revolving: Doesn’t have a set end date or consistent balance. Credit cards and home equity lines of credit are the most common types.Installment: Installment loans have set end dates and require a standard payment every month. Mortgages and car loans are the best examples.If you have a long credit history of on-time payments as well as low credit utilization, then not having a mix of credit likely won’t be enough to make or break your creditworthiness. But lacking a mix of credit could drag down a borderline score and make it hard to qualify for a new credit card.Co-signing pitfallsDid you agree to co-sign on a personal loan for your son, or on student loans for your granddaughter? Your generous help may have had unintended consequences for your credit scores.When you co-sign a loan, both the loan and payment history show up on your credit reports as well as the borrower’s. If the person you co-signed for misses payments, it’s your score that will be negatively affected.Even if the person you co-signed for is making all their payments on time, the loan could still count against you. That’s because it can constitute a debt obligation that leaves you too little disposable income to qualify for a credit line in the eyes of issuers.5 ways older adults can boost their odds of credit card approvalEven if you’ve paid off your mortgage, have a thin or invisible credit file or have never used credit cards at all, there are still ways to improve your chances of getting a new credit card.Check your credit report: Pull your credit report regularly to make sure there are no errors. A credit card issuer could have incorrectly reported a late payment, or your report could show accounts that don’t belong to you at all. If you find anything wrong, dispute the errors right away. Make sure you continue to monitor your credit regularly.Become an authorized user: If you have a loved one with a strong credit history, ask if they’ll consider adding you as an authorized user on their credit card. The issuer will send the primary account holder a card with your name on it, and you may benefit from their good credit. It may not be enough to have a huge impact on your credit scores, but it could give you a bump relatively quickly.Build credit with a secured credit card: A secured credit card acts like a regular credit card in many ways, with one key difference: It requires an upfront deposit, which acts as your credit limit and protects the card issuer in case you’re unable to pay back what you charge. Use a secured card to help build credit in the near-term, then upgrade to a traditional credit card once your credit scores are in better shape.Consider a credit-building installment loan: A credit-builder loan holds the amount you borrow in a bank account while you make the payments. You generally won’t be able to access the money until you’ve paid off the loan, but those payments are reported to at least one of the credit bureaus. Not only can that help your credit scores, but it can also add to your credit mix.Don’t close long-held accounts: If you have some credit history but are trying to improve it, avoid closing any cards that you’ve held for years. The length of your credit history and average age of accounts are factors in your credit scores. Keep your oldest accounts open, but look to downgrade cards if they carry an annual fee that’s no longer worth it.More From NerdWalletI Paid Off My Credit Card Debt … Now What?How to Increase Your Chances of Credit Card ApprovalSmart Money Moves When Cash Is Tighter Than TimeErin Hurd is a writer at NerdWallet. Email: ehurd@nerdwallet.com. 6959

WILMINGTON, Del. (AP) — Democratic presidential candidate Joe Biden is confirming that he’s been tested at least once for the COVID-19 virus and promises he will be tested regularly during his campaign against President Donald Trump. Biden told reporters Friday of his testing protocol during a wide-ranging news conference he used to blast Trump for downplaying the virus and thus ensuring that it will continue to kill Americans and ravage the economy. For much of the summer, Biden’s advisers deflected questions about whether the former vice president was being tested himself as he anchored his campaign almost exclusively from his Delaware home, traveling sparingly as a precaution.Biden plans on resuming a relatively normal travel schedule after Labor Day. Since March, Biden has mostly held virtual events due to the coronavirus. 847

When he was diagnosed with two autoimmune diseases, Joel Hechler knew he’d be in for a battle. He didn’t realize maybe his toughest one would be with his insurance company.“I think they put the dollars ahead of a patient’s health,” Hechler said. “I don’t think they fully understand the impact the medicine will have on my long-term health and well-being."Hechler suffers from Crohn’s disease and ulcerative colitis, diseases that attack the lining of his digestive tract. Autoimmune conditions like his can’t be cured but, with the right medication, the symptoms can be controlled.  Finding the right medicine can be hard for those suffering from autoimmune diseases. Even if there are scores of drugs on the market, some patients might only respond to one. In Joel’s case, his doctor thought he’d have a better chance trying a drug called Remicade.“I received a letter from my insurance company that denied the Remicade on the basis that I have to try a different drug before I can get to Remicade," Hechler said.Hechler's insurance company, Premera Blue Cross, wouldn’t approve the drug his doctor prescribed because they wanted him to try a cheaper one first.It’s part of a program that health insurers nationwide use called step therapy, requiring that patients try less-costly drugs before “stepping up” to more expensive ones — even if doctors believes the cheaper drug won’t work.Dr. Larry Adler is president of Huron Gastro in Ypsilanti, Michigan and says he spends virtually every day battling insurance companies over step therapy drugs.“They have to fail this medicine first before they get the new drug,” Adler said. “That doesn’t make any sense.”Adler says it's common for patients to get sicker while waiting for step therapy to run its course.In Hechler's case, it took six weeks of fighting with his insurer to convince them that the cheaper drug wouldn’t be effective. As he was waiting, he was getting worse.“It got to the point where I had to be admitted to the hospital,” Hechler said. "I was very, very sick.”Step therapies are used by insurers to try to control skyrocketing prescription medicine costs, says Glen Perry, Director of Pharmacy Contracting and Sales for Blue Cross Blue Shield of Michigan.“These drugs can cost up to 0,000 per year. These are not cheap medications,” Perry said.“It seems like you’re telling patients that, in many cases, your insurer knows what’s best for you, rather than your doctor,” Jones said.“We are trying to provide the most cost effective and safe medication use,” Perry said, adding that when a doctor and insurer disagree over a drug, they can usually resolve the case within a few days without putting a patient at serious risk.“A delay of one or two days I don’t think is really going to make that much of a difference for the medical outcome of the patient," he said.But for many patients, like Phyllis Toole, the delay is longer than a few days.Phyllis suffers from rheumatoid arthritis, a condition where her body attacks her joints. When her doctor wanted to put her on Orencia, her insurance company HAP said she needed to first try a less expensive drug, Humira.But Phyllis’ doctor was worried about possible side effects and thought Humira could be risky.After battling for months, Phyllis says the whole thing made her feel more like a number than a patient. With her doctor and insurer in a standoff, she was forced to rely on samples of the drug she got from her doctor. HAP never approved her prescription.“They’re playing doctor, is what it feels like,” Toole said. “They’re saying this is what you can have for the symptoms you have. It may make you sicker, but this is what you can have.”HAP issued the following statement to Scripps station WXYZ in Detroit: 3800