If you are a O4 or above, the 29 Palms Director of Medical Services (DMS) position is rolling this summer. As always, you either need to already be there, have orders there, or an e-mail from your Detailer saying you can apply. The deadline is 1 APR and the details are in this document:
Here’s a link to this 6 minute video:
Here’s a transcript:
Date: February 18, 2020
Title: VADM (Ret.) Raquel Bono on Government Matters
Source: Government Matters
Francis Rose: The Secretary of the Army Ryan McCarthy wants to put a hold on
transferring the Army’s medical treatment facilities to the Defense Health
Agency, at least for now. He says he’s concerned about a lack of performance
and planning. Vice Admiral Raquel Bono, U.S. Navy retired, former Director
of the Defense Health Agency, Rocky, welcome back, it’s great to have you.
VADM Bono: Thank you.
Rose: What do you see when you look at the reports about Secretary McCarthy,
his concerns about the DHA, based on your experience from inside the
Bono: I think the most important thing Francis, is the people are continuing
to work together towards the end goal. It’s very clear where Congress wants
us to go and the work that the Defense Health Agency — with the Services
— has already put in place quite a few changes.
Rose: What are the changes that are happening? What are the changes that
it’s your takeaway that Secretary McCarthy wants that he hasn’t seen yet?
Bono: Yes, so I believe that as I was leaving, we had already transferred
some of the MTFs to the Defense Health Agency, and with the beginning of
this new calendar year there were going to be some new military treatment
facilities that were going to be rolling over. And so, I believe that in
that, we already had an established set of metrics that we wanted to use to
monitor the progress. I think it’s wise to be able to stop and assess those
metrics and make sure that the progress that we wanted to achieve is
Rose: A Federal News Network reports say that Secretary McCarthy wants to
halt the transition until a detailed budget strategy and plan to transfer
functions from the Services is delivered. What has to happen – I know you’re
not inside the Agency now, but based on your knowledge how far along is that
effort and what does that look like? Does that answer the concerns do you
think that Secretary McCarthy and other military leaders maybe in the other
branches might have if how this shift of MTFs is happening?
Bono: Well, I think the nice thing about it before I left, is that we had
the conversations with the Services to understand how best to undertake a
transfer of function that would include not only the capabilities, but the
personnel involved. So, I believe that that conversation has already been
put in place, those plans have already been laid out, and what is probably
of merit is going over and perhaps doing a rehearsal of capability, and
being able to show how that actually plays out.
Rose: What did you find were the major differences among the branches and
the way they provided care to their members?
Bono: There are always differences in delivery, also differences in how
appointments are made, and so what the overall goal for the Defense Health
Agency was to make the experience of care for our patients similar, no
matter where they went to get their care.
Rose: That strikes me as kind of back office stuff, that’s not the way, the
type of care that maybe an airman needs to receive compared to the way that
the type of care that a soldier needs to receive. I imagine there are some
differences, but not major differences… maybe I don’t know what I’m talking
about, I’m not a medical professional, but you are. Are there major
differences between what a cohort of airmen need, versus a cohort of
sailors, versus a cohort of Marines, versus a cohort of soldiers?
Bono: Well, there’s always going to be unique nuances, depending on the
Service, but you’re right, most of the care that we give is primary care,
preventive care and when needed, specialty care, and all of that is pretty
Rose: What do you think are the major milestones that we should watch coming
out of DHA, not necessarily just pertinent to the concerns that the Army
has, but also more broadly?
Bono: You’ll continue to see more of the MTFs coming under the Defense
Health Agency. You’ll also probably see identification of markets where
there are collections of military treatment facilities in certain geographic
areas that will also start migrating to the Defense Health Agency, and in
the backdrop of that you’ll also see coordination and parallel movement with
the deployment of the electronic health record, MHS GENESIS, and then you’ll
also see refinement of the TRICARE health plan.
Rose: When you mentioned the movement of places where there are a number of
facilities, everybody hates the word consolidation, but it strikes me, the
quantity of care that DHA provides will have to equal the quantity of care
that’s provided, so consolidation isn’t necessarily a dirty word in this
case, is it?
Bono: No, as a matter of fact, that’s where a lot of the efficiencies will
be realized, by consolidating as you mentioned previously, those back-office
Rose: The back-office function consolidation, what does that look like? How
is that continuing and what are the gains that the person who is seeking
care from DHA will see? Will it make a difference to that person?
Bono: It shouldn’t make an obvious difference. Where they will probably
experience a difference, and this is actually the goal, is in their
experience of care. So how they make an appointment on the east coast should
be the same as they make an appointment on the west coast.
Rose: GENESIS is the backbone of that, right?
Bono: GENESIS has a very large role to play in that, exactly.
Rose: What are the markers we should watch for on GENESIS moving forward?
Bono: GENESIS is actually moving really nicely now. And now that we
understand what some of our challenges are in the infrastructure area and
what we needed to do, the Defense Health Agency is continuing that, and then
as the migration of medical devices and user devices to that new network, as
well as the adoption of workflows.
Rose: Was the big game changer for the GENESIS rollout the shift in the way
that you trained providers how to use it?
Bono: That had a big, big impact on that.
Rose: The big change there from, I believe that last time we talked before
you retired was that you were training people before how to use software and
you kind of shifted that mindset to get them to understand this is just a
facilitator to provide the care, here’s how you provide care in the context
of this new thing, is that a fair statement?
Bono: Yes, absolutely.
Rose: Admiral Bono thanks very much for coming on, it’s great to have you
Bono: My pleasure thank you.
(Note: I receive no compensation if you use DI4MDs for your insurance needs. I continue to lose $99 per year on this blog.)
Disability insurance which protects military physicians and dentist’s greatest asset continues to be a very limited market with few insurance companies and agents providing this critical protection. The available plan options depend on which stage of your medical/dental career you are in.
For military physicians and dentists at any stage of their medical career, MassMutual will provide the recommended specialty specific / own occupation disability coverage. MassMutual continues to be the only company that offers a non-cancelable and guaranteed renewable policy to age 65 and is the first policy we recommend. This policy is now available in all states.
For military physicians and dentists who have completed training, Lloyd’s is also available and can work well as a supplement to MassMutual coverage or if there is a medical issue. However, the policy does not contain the same premium and renewability guarantees as MassMutual’s policy.
If you are a resident or fellow and are at least 60 days away from graduating, in addition to MassMutual another option is a policy with Ameritas. However, you should be aware that Ameritas does not cover disabilities resulting from military service when scheduled active duty is more than 3 months. You do have the option of suspending the policy. Suspending the policy locks in your current insurability but does not provide any coverage during the suspension (though no premiums would be due either).
If you are in medical school and more than 180 days away from starting a military residency, in addition to MassMutual and Ameritas you will be able to apply for a policy with Standard. However, Standard will not cover disabilities resulting from military training, action, or conflict. Like Ameritas, you have the option of suspending the policy. Principal and Guardian may also be available if you are still in medical school. However, unlike the voluntary suspension option with Ameritas and Standard, Principal and Guardian require that your policy be suspended once you enter active duty. All medical students can obtain disability coverage without income qualification.
One crucial fact to be aware of when obtaining disability coverage is the medical underwriting requirement. Since military medical exams are extremely thorough and document any medical condition it is important to establish coverage early in your medical career before any conditions or ailments appear. Depending on the medical condition you may be declined coverage, issued a policy with a waiver/exclusion for the pre-existing condition(s) or issued with an increased premium. Even a combination of the latter two is possible. This can be avoided if you apply now so you can have the protection you need later. A policy with an option that will allow you to purchase additional coverage in the future regardless of health can be established to fit any budget. A graded premium structure can also be used to reduce the initial premium outlay for residents and medical students.
There is no better time than now to establish the type of policy you need to protect your medical or dental career in the event of disability. Please contact us below to begin:
DI4MDS – Andy Borgia, CLU and D.K. Unger – www.DI4MDS.com
10505 Sorrento Valley Rd., #250
San Diego, CA 92121
858-523-7511 or 858-523-7529 after 5pm PT
Here is a link to the article:
Here is a new booklet that answers frequently asked questions about the Navy Health Professions Scholarship Program (HPSP). It should be useful to anyone helping us recruit or for anyone interested in the program:
Thanks to CDR Brett Chamberlin for developing it!
The 7th (and optional) step to financial freedom is to save for future college expenses.
Only a small percentage of students get enough financial aid to cover their tuition, housing, books, and fees. As a result, saving for college is a major financial goal for many people. Luckily, it is as easy as 3 numbers…5-2-9, as in using a 529 plan. 529 plans allow parents or grandparents to put money aside in a tax advantaged way that can later be used for college. In addition, those of us in the military who are willing to serve a little longer can transfer our GI Bill to our children, which can help with college costs, sometimes covering them completely. That’s my plan, as I’ve got two kids and two GI Bills.
How Expensive is College?
According to the National Center for Education Statistics, for the 2016–17 academic year, annual current dollar prices for undergraduate tuition, fees, room, and board were estimated to be $17,237 at public institutions, $44,551 at private nonprofit institutions, and $25,431 at private for-profit institutions. If that wasn’t enough, educational costs are increasing at a 6% rate annually.
How Can You Limit Costs?
Get your kids to go to a state or public school. Once you’ve got your degree and are working, no one really cares where you went to school. Work ethic, intelligence, creativity, and other characteristics make or break your success, not an Ivy League pedigree. State schools are just fine.
One other strategy is to have your kids go to a community college for the first 1-2 years of their education, later transferring to a four year college or university and getting their degree.
The money in 529 plans can be invested in stock and bond funds. As long as the withdrawals are used for qualified higher educational expenses, the investment gains are free from federal taxation.
As of 2020, you can contribute as much as $15,000/year to each child without incurring the federal gift tax. In addition, you can pre-fund up to 5 years of these contributions, or $75,000 in 1 year. Couples can give $150,000.
Sound too good to be true? Well, it is true, which is why 529 plans have come to dominate the college saving game.
Downsides of a 529 Plan
If you don’t use the proceeds of your 529 plan for educational expenses, your gains are subject to income tax and a 10% penalty. In addition, colleges will consider 529 assets when determining need-based financial aid. If you believe you’ll be eligible for financial aid, you might be better off keeping the assets in your name or the names of the grandparents.
That said, the amount you’ve saved for college has much less of an impact on your financial aid than your overall income does. In other words, families with high incomes will be expected to pay for at least part of college regardless of whether they saved for college.
As Usual, Taxes and Costs Matter
Not all 529 plans are perfect. Each state offers a plan, and you can use the plan from any state. You are not limited to the one you live in.
There may be some state tax benefits if you use your state’s plan, but just like with all investments you have to see if those tax benefits outweigh the other features of the plan. Some states have high fees and expenses or have less than optimal investment options. Some states give you tax benefits no matter which states’ plan you use.
Which 529 plan do I use? Regular readers would guess that I use whichever state’s plan is run by Vanguard, and they’d be correct! Vanguard administers the Nevada plan, which is what I use. They also provide management and services in the Colorado, Iowa, Missouri, and New York plans. Many states, though, offer Vanguard and other low cost investment options.
You find a lot of good information on 529 plans at:
Other Types of Accounts
Here is a great table from the Vanguard website that compares benefits offered by 529 plans against various other types of accounts people use to save for college:
|529 Plan||Uniform Gifts/Transfers to Minors Act (UGMA/UTMA)||General Investment Account||Education Savings Account (ESA)|
|State tax breaks||X|
|Federal tax breaks||X||X|
|Low financial aid impact||X||X||X|
|High contribution limits||X||X||X|
|Access to your money||X||X||X|
As you can see, while there are other options, the 529 offers the most benefits. Some people advocate using Roth IRAs, whole life insurance, or ultra-conservative investments like certificates of deposit (CDs) or savings accounts, but this is generally a bad idea.
You need your IRAs to save for retirement, not college. Saving for retirement is your top priority, even over funding the college education of your children. You can borrow money to pay for college, but you can’t borrow money to retire.
Life insurance is expensive and generally offers very low investment returns. CDs and savings accounts aren’t expensive, but their investment returns are just as anemic. With educational inflation at 6% annually, it will be hard enough for stocks and bonds to keep up let alone life insurance or CDs/savings accounts.
The GI Bill
If you have served in the military after September 11, 2001, you are eligible for the Post-911 GI Bill. It covers four academic years, including tuition and fees, housing, and books up to 100% of the cost of the most expensive public school in your state. For private schools in 2019-2020, it will cover up to $24,476.79 of costs. Some more expensive schools participate in the Yellow Ribbon Program to bring their tuition down closer to what the government will pay. In some situations, you can transfer the GI Bill to your spouse or children.
You can find a ton of information on the GI Bill at this website:
Specific information about transferring your GI Bill is here:
What’s the Bottom Line?
529 plans have become the go-to account for most people saving for college. Go to SavingForCollege.com to find out which state’s plan is right for you. If you have a GI Bill and are willing to transfer it to your children for their future college expenses, check out the link above for all the details
This one from Forbes is certainly interesting:
Here are my favorites this week:
Here are the rest of the articles: