How Long to Keep Tax Records and Other Documents

You'll also want to safely keep other documents 

for the right amount of time

From FB: Consumer Reports / Last updated: March 08, 2018

Tax season is the perfect time to start culling your paper piles and computer files and getting everything in order. You've already delved into your financial records, so you might as well take the time to organize them. 

There are plenty of good reasons to do this. One is that if you haven't yet completed your taxes, getting your paperwork in order will reduce tax-preparation stress. And if you have already filed your taxes, you'll want to know how long to keep tax records and other financial papers in case you're audited.

There are other instances when being organized can pay off. If you're meeting with a financial adviser or an attorney, you don't want to spend hours wading through clutter to find the documents you need.

If there's a fire, flood, or theft, you'll need access to essential documents quickly. And if you become ill, well-organized paperwork will make it easier for your loved ones to find your healthcare power of attorney, insurance policies, medical records, and outstanding bills.

So what should you do? Divide your financial papers into four categories: papers that you need to keep for the calendar year or less; papers that can be destroyed when you no longer own the items they cover; tax records (we'll tell you how long to keep tax records), and papers to keep indefinitely.

How to Organize Your Records

Keep for less than a year In this file, store your ATM, bank-deposit, and credit card receipts until you reconcile them with your monthly statements. Once you've done that, shred the paper documents (to avoid ID theft) or securely trash electronic files unless you need them to support your tax return. Keep insurance policies and investment statements until new ones arrive. 

Keep for a year or more  You'll want to hold onto loan documents until the loan is paid off. That will often be for more than a year. Then toss those papers. If you own one or more vehicles, hold onto the titles until you sell them. If you have investments in stocks, bonds, mutual funds, or anything else, keep the investment purchase confirmations until you sell the investment so you can establish your cost basis and holding period. (If that information appears on your annual statements, you can keep those instead.)

Keep for seven years  If you fail to report more than 25 percent of your gross income on your tax returns, the government has six years to collect the tax or start legal proceedings. So when it comes to determining how long to keep tax records—electronic and paper—we recommend seven years, just in case.

Keep forever  Essential records such as birth and death certificates, marriage licenses, divorce decrees, Social Security cards, and military discharge papers should be kept indefinitely. Also hold on to defined-benefit plan documents, estate-planning documents, life-insurance policies, and an inventory of your bank safe deposit box (share a copy with your executor or your attorney).

How to Store Your Files

• Use a fireproof safe or password-protected electronic file for the following: Bank and investment statements, estate-planning documents, pension information, insurance policies, pay stubs, tax documents, and your safe deposit box inventory list.                                                                                                                               
• Invest in a safe deposit box for papers that can't be easily replaced: Original birth and death certificates, Social Security cards, passports, life-insurance documents, marriage and divorce decrees, military discharge information, vehicle titles, an inventory of your home's contents (in case you need to make an insurance claim), and loan documents.

5 questions with health literacy expert Beccah Rothschild

Below is some valuable advice from my colleague/friend, Beccah. 

Thanks to Amino / Sophia Lee / March 6, 2018

Last week, we sat down with with Beccah Rothschild, a health and adult literacy expert with more than 20 years of experience in the field. Her passion revolves around ensuring that information is accessible and available to everyone — regardless of educational, literacy, cultural, or linguistic background. In this Q&A, we cover topics that range from tips for effectively educating people on healthcare to the role employers play in protecting their employees from financial harm.

Q1: You educate patients about the overuse of healthcare treatments. What are some commonly over prescribed treatments, and what is your advice to get people to think twice about them?

Examples of commonly overused tests, procedures, and medications include antibiotics for colds, imaging tests for low back pain and headaches, and C-sections in healthy pregnancies. These may not be the most overused treatments or tests, but they’re ones healthcare consumers frequently encounter. Another interesting overuse case is the Pap test. For a long time, the standard was to get one annually, but the latest research shows that most women — depending on their age, medical history, and risks — only need one every three to five years. When I started to write about this topic, a lot of women — especially aged 45-50 and above — pushed back saying they were taught to get it every year. It’s interesting because these women don’t actually want to get this uncomfortable test done annually (who would?), but it just goes to show how challenging it is to change the culture around medical testing.

In terms of my best advice, I’ve found that if you talk in generalities about the physical and financial harm of overuse, people are less inclined to act in their best interest. For instance, if you say: “ordering unnecessary tests makes insurance premiums go up and causes people to pay more for care,” it doesn’t resonate because it doesn’t hit you personally. But if you say: “if you get this test done, you’re going to pay $2,000 out-of-pocket for something that you don’t need — and might even harm you,” it clicks. You really need to appeal to people on a personal level.

Q2: What role do employers play in helping their employees with regard to health literacy?

The employer has a huge responsibility to ensure that the health insurance information employees receive is readable, understandable, and written in a way that’s not full of jargon. The average person doesn’t understand what a deductible, copay, or coinsurance is, so the employer has the obligation to make sure this type of information is provided in a way that employees can understand, use, and act on it.

Insurance companies play a role in this as well. Fortunately, insurance companies have really stepped up to try and make materials easier to understand — but there’s still a long ways to go. There’s been huge progress though compared to back in 2003 or 2004 when health literacy was just becoming a much wider-known issue, which is around when I was involved in starting up the California Health Literacy Initiative — the first statewide health literacy project ever. Ultimately, it must be a shared responsibility between both insurance companies and employers to make sure the healthcare they provide is easy to understand and access.

It’s also important for employees to trust the information from their employers. A good way to do this is for employers to share information that’s data-driven, evidence-based, and comes from a trusted third-party. People also need to understand that the information they’re getting from their employer isn’t going to impact their benefits. It’s common for employees to be worried about going to the HR or management and saying “I’m considering getting pregnant” or “I have a chronic condition” because they fear retribution, judgement, being passed over for a promotion, or having certain benefits taken away.

Q3: What’s your advice for chronically ill patients who frequently interact with the healthcare system?

Ask questions and take notes. A few years ago, my mom — who lives across the country from me — simultaneously had two cancers. For every single appointment, my parents conference called me in. And before every appointment, I would send them a list of questions ahead of time. You would never go into a meeting without an agenda, so why would you go to a doctor’s appointment without one?

While on the call, I would take notes verbatim while my dad asked the questions. Doctors knew that I was on the phone and taking notes, so it was very transparent — especially when I would pipe in with clarifying questions. After the appointment, I would write up the notes and distribute them to members of the family so we all knew exactly what was going on and could follow up with more questions if needed. If you don’t do this, or some version of this, you leave the appointment and forget things or perhaps misinterpret them. You can also always ask at your appointment if you can record the conversation. And if the doctor says no, find someone else to go to. Don’t forget that the healthcare provider works for you, not the other way around. I can’t stress that enough.

Q4: What are your biggest takeaways when it comes to educating people about healthcare?

I would say there are two major takeaways:

Keep it short and simple. It’s hard to do this because healthcare is so complex. I always want people to have all the information possible so they can make the best decision. But what I learned is that very few people want that — whether it’s an executive in the C-suite or someone with limited literacy skills, most people don’t have the time or capability to read through so much information.

If you tell someone what not to do, you also have to tell them what to do. It’s important to frame things in a positive way for people who are in pain, frustrated by their situations, or scared. For instance, if you say “it’s not a good idea to get treatment ABC,” you should also say “instead, I’m going to give you XYZ and it will still help you.” People need to be reassured that they have options and that they’re going to be ok.

Q5: If you could wave a magic wand and make a single change to improve the future of health literacy, what would you wish for?

I would do a major overhaul of our culture of healthcare. I wish it would change so that patients understand they are consumers and see healthcare as a consumer good. For instance, when you go to buy a car or fridge, you always ask how much it costs, how long it will last — and you negotiate on the price. But when it comes to healthcare, people don’t know that the price of filling a prescription varies widely depending on where you go. They don’t know that you can negotiate costs with a hospital if you’re paying out-of-pocket or with cash. They don’t know that the quality of care varies wildly. And it’s all because they don’t think of healthcare as a consumer good, so they don’t ask the important questions. I want to shake up the culture of healthcare and make these conversations actually happen.

https://amino.com/blog/5-questions-with-health-literacy-expert-beccah-rothschild/

How Low Should Your Blood Sugar Go?

Important new guidance for those with type 2 diabetes

From FB: Consumer Reports / Hallie Levine / March 5 2018

People with type 2 diabetes are typically advised to aim for levels of blood sugar, or glucose—the energy from food that fuels our cells and organs—that are close to those for people without diabetes. But just how near-normal these levels should go has long been a matter of disagreement.

Today, after reviewing the current guidelines, the American College of Physicians (ACP) advised that most people with type 2 diabetes not go below 7 percent on the HbA1c test, which measures long-term blood sugar control.

Often, doctors encourage them to strive for an HbA1c of 6.5, which can require high doses of multiple medications. (Normal is less than 5.7, while 5.7 to 6.4 is considered prediabetes—and anything higher is diabetes.) 

But when the ACP analyzed the evidence behind the guidelines, they found that bringing blood sugar levels down to between 7 and 8 was enough to reduce the risks of major diabetes complications such as heart attack, stroke, and damage to eyes, nerves, kidneys, and feet.

“Going lower than that didn’t provide any more benefit, and, in fact, in some cases caused harm by causing blood sugar to drop too low,” explains Jack Ende, M.D., president of the ACP. And left untreated for long enough, low blood sugar, or hypoglycemia, can cause seizures, heart attack, or stroke.

The ACP recommendations are in line with what Consumer Reports and some other organizations have been saying for several years. “It’s much more consistent with what current evidence suggests: Aggressive treatment isn’t just unnecessary for many people but is potentially harmful,” says endocrinologist Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser.

Not everyone agrees. The American Diabetes Association (ADA), for example, considers an HbA1c of less than 7 percent suitable for the majority of those with type 2 diabetes.

“By lumping ‘most’ people with type 2 diabetes into a 7 percent to 8 percent target range, ACP’s new guidance may cause potential harm to those who may safely benefit from lower evidence-based targets,” says William Cefalu, M.D., chief scientific medical and mission officer at the ADA. 

If you’re currently being treated for type 2 diabetes, here’s what you need to know to make sure that your blood sugar is at the level that’s right for you.

The New Recommendations

To develop its new advice, the ACP reviewed six sets of blood sugar guidelines—from organizations such as the ADA and the American Association of Clinical Endocrinologists—and the evidence behind them. Four of the six recommend a target of 7 percent or lower, and two guidelines suggest a range and advise that doctors take factors such as age and other health issues into consideration.

All the guidelines are based primarily on the findings from five major clinical trials. Some of the trials determined that lowering HbA1c to less than 7 slightly reduced the risk of eye and kidney damage, and others did not.

And, the ACP found, the trials didn’t consistently show that maintaining very low HbA1c numbers helped reduce heart attack, stroke, or deaths overall.

In addition, the evidence suggested that such tight blood sugar control seemed to lead to much higher rates of hypoglycemia—and resulting hospitalizations. 

“Based on our analysis, we felt that the evidence showed that going below 7 percent didn’t reduce deaths or macrovascular complications such as heart attack or stroke, but it did cause harms such as low blood sugar,” Ende says.

In fact, some research found that people who lowered their HbA1c levels to less than 6.5 had a higher risk of death from heart disease than those who were generally between 7 and 8.

The ACCORD study, for example, found that people on intensive drug treatment who got their HbA1c lower than 6 were more than 20 percent more likely to die of any cause, 35 percent more likely to die from heart disease, and almost twice as likely to gain more than 22 pounds.

“When people’s blood sugar gets too low, their body responds as if it’s under major stress: Their heart rate increases and they sweat, both of which increase risk of a cardiac event,” Ende says.

What Should You Do?

The ACP now not only recommends aiming for an HbA1c level of between 7 and 8 percent but also advises that people who dip below 6.5 percent have their diabetes medication doses lowered.

“In these patients it’s reasonable to scale back on dosage and instead encourage them to get their numbers even lower through lifestyle changes such as losing weight and exercising, which carry the same risk-reduction benefits without the potential harm of drugs,” Ende says.

That said, if you have type 2 diabetes, and are younger than 65 and in good health, it’s reasonable to aim for an HbA1c between 6.5 and 7, Lipman says. “And if you’re slightly above the 7 mark—say at 7.1 or 7.2—there’s no reason to push yourself to go any lower. By doing so, you begin to flirt with episodes of low blood sugar,” he says.

If you’re older, and have co-existing health conditions such as heart or lung disease, an HbA1c between 7 and 8 is fine. “In this group, especially if life expectancy is less than a decade, it doesn’t pay to be too strict about it,” Lipman says. That’s because the main purpose of treatment for this group is to prevent symptoms that occur from high blood sugar, such as increased urination, dehydration, and unwanted weight loss, he adds.  

Whether you use diabetes medication or not, it’s important to focus on lifestyle changes—even if your blood sugar is under control.

“Many times, type 2 diabetes can be completely reversed by getting down to a normal weight,” says Michael Hochman, M.D., M.P.H., assistant professor of clinical medicine at the Keck School of Medicine at the University of Southern California and director of the USC Gehr Family Center for Health Systems Science.

One study published in the medical journal The Lancet this past December, for instance, found that about half of people with type 2 diabetes who underwent an intensive weight-management program went into complete remission.

“It’s important for patients to realize that if they are proactive enough about lifestyle, they may not need to be on medication at all,” Hochman says.