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Tips for choosing the Medicare plan that’s right for you


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(BPT) – Fall and winter don’t just bring cooler temperatures and the holidays — the final seasons of the year also mean open enrollment for Medicare. For most seniors in the United States, the period between Oct. 15 and Dec. 7 is the only time they can switch or make changes to their Medicare insurance plan.

“As people age, their health care needs evolve,” says Dawn Maroney, chief growth and strategy officer for Alignment Healthcare. “When that happens, they may find the Medicare plan they first chose when they became eligible no longer meets all their needs. This open enrollment period is their yearly opportunity to re-evaluate whether to continue with their plan or switch to another, with changes becoming effective the first of the new year.”

Medicare basics

Most Americans are aware that Medicare is a government program designed to ensure people older than 65 have access to affordable health insurance. The program can also cover people younger than 65 who have certain disabilities.

The Medicare program has four parts, according to Medicare.gov: A, B, C and D.

* Medicare Part A helps pay for in-patient hospital stays, care in a skilled nursing facility and hospice care.

* Medicare Part B helps cover care by doctors or other health care providers, outpatient services, some medical equipment and some preventive services.

* Medicare Part C (also known as Medicare Advantage) covers everything included in parts A and B, and usually includes Medicare prescription drug coverage as part of the plan. Medicare Advantage plans may include extra benefits and services for an extra cost. Medicare-approved private insurance companies, such as Alignment Healthcare’s Alignment Health Plan, run Medicare Advantage plans.

* Medicare Part D helps cover the cost of prescription medications and is run by Medicare-approved private insurance companies.

Original Medicare versus Medicare Advantage

Most people think of Medicare parts A and B as Original Medicare, in which the government pays directly for the health care services received. People with Original Medicare can see any doctor and hospital that accepts Medicare in the country, without prior approval from Medicare or their primary care physician. Most people do not pay a monthly premium for Part A if they paid taxes while working; everyone pays a monthly premium for Part B, based on income. The standard premium for Part B in 2017 was $134 per month, which is deducted from the individual’s Social Security benefits.

Original Medicare pays for about 80 percent of the total costs of health care. The patient is responsible for the remaining 20 percent, which can mean high out-of-pocket costs in the event of a hospitalization or other events requiring significant medical attention. To offset the financial burden of that 20 percent, some people choose to purchase supplemental insurance, called Medigap.

Private insurance companies offer Medigap to cover things Medicare doesn’t, such as deductibles, co-pays and co-insurance — but, keep in mind, Medigap only supplements Original Medicare benefits. Further, if you do not apply for Medigap in the first six months of becoming eligible, there’s no guarantee that an insurance company will sell you a Medigap policy.

With Medicare Advantage, government-approved private companies administer health plans that cover everything Original Medicare does, but can do so with different rules, costs and restrictions that can change every year. For example, a private Medicare plan may require your physician to request permission before performing a procedure in order to be paid by the plan. Medicare Advantage plans, however, usually cover extras that Original Medicare does not, like dental care, vision services, hearing exams and gym memberships.

Most Medicare Advantage plans also include prescription drug coverage (Medicare Part D), which is not included in Original Medicare, at no additional cost. If you elect to enroll in a Medicare Advantage plan, you still have Medicare — this means that you must still pay your monthly premiums for parts A and B, in addition to a monthly premium for Part C, if applicable. Many Medicare Advantage plans are available for no additional monthly premium.

Considerations when choosing

When choosing between Original Medicare and Medicare Advantage, you should consider these questions:

* How likely is it your health needs will change down the road? Since health changes as you age, chances are your treatment needs will, too. If you don’t enroll in the additional insurance and drug coverage when you first sign up for Original Medicare, you may pay a monthly penalty for enrolling later and may not be eligible for additional Medigap coverage.

* Are you still working past age 65? If so, you will probably want to enroll in Part A, because there generally are no monthly premiums, and it may supplement your employer’s insurance plan. You might choose to delay enrolling in Part B, but it depends on your health coverage. Everyone has to pay a monthly premium for Part B.

* Is it more important to you to have lower or no premiums or lower out-of-pocket costs? With Original Medicare, you may pay more out of pocket without supplemental insurance and prescription drug coverage. Medicare Advantage includes supplemental insurance and sometimes prescription drug coverage, too.

* How important is it to keep your doctor? Original Medicare is accepted by any doctor or hospital that accepts Medicare, without referral. Medicare Advantage plans allow you to select a doctor from the plan network, which is usually very large; your current health care providers are likely to be in the network already.

* Do you regularly take prescription medication for chronic conditions? Prescription drug coverage is not included in Original Medicare, and if you fail to sign up for Part D at the time you enroll, you could pay a penalty for adding it later. Most Medicare Advantage plans do cover prescription drugs.

“Medicare Advantage allows patients to receive the care they need to stay well and keeps their budgets in check with set costs and annual maximums,” Maroney says. “It’s an ideal solution for patients who need frequent care or who struggle to meet medical expenses.”

To learn more about Medicare, visit www.Medicare.gov. For information about Alignment Healthcare and its affiliated Medicare Advantage plans, visit www.alignmenthealthcare.com.

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Medicare Advantage: 20 years, 20 million people and 4 factors

(BPT) – In 1997, the federal government created the Medicare + Choice program — later renamed Medicare Advantage — to enhance consumer choice and more efficiently deliver Medicare benefits to older Americans.

You may have heard of Medicare Advantage, but maybe you don’t know exactly what it is, what it offers and how it can help you.

Today, Medicare Advantage serves almost 20 million people — a nearly 50 percent increase from even five years ago, according to the Centers for Medicare & Medicaid Services.

Here are four important factors in why people choose Medicare Advantage:

1. Simplicity and convenience. Medicare Advantage plans combine all your Medicare coverage, including Original Medicare (Parts A and B), and often prescription drug coverage, into one plan so you only have one card to carry.

2. Predictable costs. Managing your health care costs can be especially important if you are living on a fixed budget. Many Medicare Advantage plans offer additional benefits for a $0 premium beyond the premium for Original Medicare and have set limits on what you have to pay out of pocket. Brian Thompson, CEO of UnitedHealthcare Medicare & Retirement, explains, “Original Medicare generally covers about 80 percent of a person’s costs for doctor visits and other outpatient care, leaving the individual responsible for the rest, with no limit to what that cost may be. Medicare Advantage, on the other hand, offers peace of mind and helps you plan your health care expenses by capping how much you may have to pay out of your own pocket in a given year.”

3. Care Coordination. Boston Consulting Group (BCG) analyzed 3 million Medicare claims and found that Medicare Advantage members have shorter hospital stays and fewer readmissions within 30 days of leaving. Medicare Advantage plan members are also more likely to receive preventive care to keep chronic illnesses in check, according to researchers.

A possible explanation for the favorable outcomes: care coordination. Thompson says, “The health care system is complex. With Medicare Advantage plans, doctors work as a comprehensive team, led by a primary care doctor, and together with the health plan, they help members receive the care they need. This can create more convenience and value for the member and ultimately lead to better health.”

4. Choice. Thompson also points out that “every day more than 10,000 baby boomers turn 65, and they expect to have choices.” Medicare Advantage plans come in a wide variety of options, so people can choose one that meets their unique health and budget needs. Many offer programs to support people with diabetes and other chronic conditions, and most offer additional benefits not covered by Original Medicare. Perks may include prescription drug, dental, vision and hearing coverage, home visits, 24/7 access to health care professionals and gym memberships.

If you want to learn more about Medicare and options available to you, visit MedicareMadeClear.com. You can also learn more about Medicare Advantage at UHCMedicarePlans.com.

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan’s contract renewal with Medicare.

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Turning 65? Choosing the right Medicare Part D plan starts with 4 simple rules

(BPT) – If you’re turning 65 in 2017 or 2018, you’re one of 10,000 people who become Medicare-eligible each day. Choosing Medicare prescription drug coverage can be confusing, especially for the first time. You may have questions about which plan fits your healthcare needs and budget or how to enroll. The good news is, it doesn’t have to be overwhelming if you know these four rules.

Rule #1: Lower premium plans may mean higher costs. Plans with a lower premium may end up costing more in the long run if they have higher drug copays, which can really add up.

Rule #2: Not every plan covers every drug. Drug lists (formularies) can change every year and so can the drugs you take. Be sure to check your plan’s formulary each year to make sure any medications you take are covered.

Rule #3: Check that there are pharmacies close to you. That way, it’s easier to fill your prescriptions. Select a plan with a wide range of “preferred” pharmacies, which typically offer lower co-pays than standard pharmacies in the network. Also, see if using a home delivery pharmacy or a 90-day supply could lower your costs even more.

Rule #4: Look for 24/7 access to pharmacists and Medicare experts who can answer questions about your medicines and offer drug safety tips, money-saving alternatives and expertise in drugs to treat specific conditions.

Also, remember to check the Medicare Part D plan’s Star Rating. This is the overall quality and performance rating (out of 5 stars) based on member satisfaction surveys and other measures by The Centers for Medicare & Medicaid Services (CMS).

For more information, please visit www.Medicare.gov or www.RoadmapForMedicare.com. To talk to an Express Scripts Medicare adviser, call 1.866.544.3794, 8 a.m. to 8 p.m., 7 days a week (TTY users: 1.800.716.3231).

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New ways to comparison shop for health care

(BPT) – As our nation seeks solutions to help improve the health care system, there is at least one goal we can all agree on: the importance of making health care quality and cost information more accessible to all Americans.

This is an important effort that has the potential to help improve health outcomes and make care more affordable — laudable goals considering the nation’s health care system ranks among the least efficient in the world, according to a recent Bloomberg analysis.

More widespread use of health quality and cost resources may be part of the solution. Providing health care prices to consumers, health care professionals and other stakeholders could reduce U.S. health care spending by more than $100 billion during the next decade, according to a 2014 report by the Gary and Mary West Health Policy Center.

That is in part because there are significant price variations for health care services and procedures at hospitals and doctors’ offices nationwide, yet a study by Families U.S.A. concluded that higher-priced care providers do not necessarily deliver higher-quality care or better health outcomes.

Fortunately, there are many new online and mobile resources that help enable people to access health care quality and cost information, helping them to comparison shop for health care as they would with other consumer products and services. And people are starting to take action: nearly one third of Americans have used the internet or mobile apps during the last year to comparison shop for health care, up from 14 percent in 2012, according to a recent UnitedHealthcare survey.

These resources are far more accurate and useful than those of past generations, and in some cases provide people with estimates based on actual contracted rates with physicians and hospitals, including likely out-of-pocket costs based on their current health plan benefits. Some resources also include quality information about specific physicians, as determined by independent standards.

There are many resources people can consider when shopping for health care. In addition to online and mobile resources, people can call their health plan to discuss quality and cost transparency information, as well as talk with their health care professional about alternative treatment settings, including urgent care and telehealth options. Public websites, such as www.uhc.com/transparency and www.guroo.com, also can help enable access to market-average prices for hundreds of medical services in cities nationwide.

These resources can help people save money and select health care professionals based on objective information. A UnitedHealthcare analysis showed that people who use online or mobile transparency resources are more likely to select health care providers rated on quality and cost-efficiency across all specialties, including for primary care (7 percent more likely) and orthopedics (9 percent more likely). In addition, the analysis found that people who use the transparency resources before receiving health care services pay 36 percent less than non-users.

As people take greater responsibility for their health care decisions and the cost of medical treatments, transparency resources are becoming important tools to help consumers access quality care and avoid surprise medical bills.

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Tips to help save money on prescription drug costs

(BPT) – Modern medications can work wonders, improving quality of life, curing illness and even saving lives. However, those miracles can come at a high cost, as anyone who’s had to pay for branded prescription medication knows. In fact, spending on prescription drugs has increased 73 percent in the past seven years, according to a new report from the Blue Cross Blue Shield Association (BCBSA).

What’s driving the increase

The Health of America Report found prescription drug spending by Blue Cross and Blue Shield (BCBS) members increased 10 percent annually since 2010. High costs of patent-protected drugs account for the lion’s share of the total increase.

Generic drugs account for 82 percent of total prescriptions filled, but account for just 37 percent of total drug spending. By contrast, patent-protected prescription drugs comprise less than 10 percent of all prescriptions filled but account for 63 percent of total drug spending, the report found.

“Experience and past price trends suggest drug costs will continue to rise in the future,” says Maureen Sullivan, chief strategy and innovation officer for BCBS. “The need for more affordable generic alternatives to costly patent-protected brand-name pharmaceuticals is urgent. As prices continue to rise, more consumers will be looking for ways to curb the cost of their medications.”

What you can do

It is possible to lower your drug costs while still taking the medications your doctor has prescribed to help your health. BCBSA offers some guidance:

* If your doctor prescribes a costly name-brand medication, ask your physician or pharmacist if a generic version is available. Generic drugs are identical to their brand-name equivalents in dosage form, safety, strength and quality, how you take them, performance and intended use, according to the Food and Drug Administration. Generics typically cost less than name-brand medications. The BCBSA report shows how costs for medicines like Lipitor (atorvastatin) and Avapro (irbesartan) plummet when generic alternatives become available.

* It may be possible for your doctor to prescribe a higher strength than you need of a particular medication and allow you to split the tablet or pill to get the lower dose you need at a lower cost. In fact, many pills that can be safely split come pre-scored with an indentation that makes it easier to cut them in half. However, not all prescription medications can be safely split, so be sure to talk to your doctor or pharmacist about whether it’s safe to split your medications.

* Ordering prescription medications through the mail could lower drug costs, but it’s important to ensure you’re buying from your pharmacy benefit manager, typically listed on the back of an insurance card. The FDA recommends you only purchase drugs from organizations located in the U.S. and licensed by the state board of pharmacy where the company operates (find a list of state boards of pharmacy at www.nabp.info). The mail order pharmacy should have a licensed pharmacist available to answer your questions, require a prescription from your doctor in order to sell you medication, and have someone you can talk to directly if you have questions or problems.

* Another way to reduce drug costs is to ask your doctor to write your prescription for a 90-day supply so that you will get a three-month supply of the medication for the price of one co-pay.

* Finally, review your prescriptions with your doctor at least every six months to ensure you’re not taking any more medicines than you absolutely need. However, never skip doses of medicine, avoid refilling a prescription or stop taking medicine altogether without first consulting your doctor.

For more information about prescription drug costs, and to read the full Health of America report, visit www.bcbs.com/healthofamerica.

All product names, logos, and brands are property of their respective owners and used for identification purposes only. Use of these names, logos, and brands does not imply endorsement.

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Tips to reduce your health care expenses

(BPT) – Health care costs are in the news all the time. You hear about them at work and when you’re with friends and family. The comments are always the same. Health care is getting more and more expensive and it seems to be outpacing the money you make.

Fortunately you’re not helpless when it comes to controlling your health care costs. While some treatments simply have to be done in order to support your health, there are other things you can do to protect yourself and your loved ones while looking out for your pocketbook at the same time.

Employ these five tips today and you’ll enjoy the care you need without breaking your budget.

* Focus on your health first. When it comes to controlling your health care expenses, you actually have more control than you think – a lot more. The decisions you make every day – what to eat, whether or not to smoke, how much to exercise – all play a dramatic role in your overall health. So take charge, dine on fruits and vegetables, take a run and kick that nicotine habit for good. Each of these little decisions will benefit your health and your budget.

* Be decisive with your deductible. Your insurance deductible is a fixed cost and one you’ll pay every single year before receiving network coverage support. But once it’s paid, you’ll enjoy the full coverage of your plan. Thus, if you have another treatment or procedure coming up, don’t put it off any longer than you have to. Undergoing additional procedures in the same year means you get more coverage while paying only one deductible. Many health plans also cover preventive services in full, without going against a deductible.

* Be smart about where you go for care. While health care facilities across the country are all capable of delivering compassionate, quality care, they are not all priced the same. According to a Blue Cross Blue Shield, The Health of America Report, 29.8 percent of emergency room visits were for conditions that could have been treated in retail clinics. The same research also found consumers saved money on out-of-pocket costs by visiting retail clinics for routine services when compared to doctor’s offices, and the visits were much more inexpensive than receiving the same treatment in the emergency room, according to the Blue Cross Blue Shield Association.

* Ask questions. Your provider may know best, but it’s all about your health. Don’t be afraid to ask questions, not only about the procedure itself, but about the price of the procedure and if there is anything you can do to reduce the expense. Sometimes there may be something you can do on your own that supports your health and lessens your costs at the same time.

* Embrace an HSA. Health Savings Accounts (HSAs) provide a cost-effective way for people who don’t use a lot of health care services, to access care and pay for services up until they reach their deductible. Plus the money you save in your HSA can be used to pay for co-insurance payments or co-pays at your doctor’s office, and it’s also an eligible tax write off, opening the door to further savings. There are ways you can manage your health care spending. Follow the tips above and be an active participant in your role as a health care consumer and you’ll be surprised at how much you save. To learn more about the The Health of America Report, visit www.bcbs.com/healthofamerica.

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The rising burden of Alzheimer’s disease on health costs, caregiver health and 65+ population

(BPT) – Kristen Beatty’s 78-year-old father, Ray, was diagnosed with Alzheimer’s about 10 years ago. Since then, he has developed a sense of paranoia, insomnia and the delusion that people are stealing from him. Though Beatty and her brother constantly reassure their father to allay his fears, the daily struggle can take its toll. Beatty’s mother, Sue, had previously cared for Ray for about five years. In 2012, Sue died unexpectedly of a heart attack, or as Beatty puts it, she died of a broken heart.

“She was exhausted from the constant care and the pressure that came with it,” Beatty said. “She was eating super healthy, walking every day and taking very good care of herself, so I truly believe it was the stress. My brother and I feel guilty because we could have supported her better, but she wouldn’t ask for help. She wouldn’t consider moving him to a facility or going to support groups.”

The stress and the pressure Beatty’s mother faced is not unlike the experiences of millions of other Alzheimer’s caregivers around the nation, who primarily care for people with the disease because of their desire to keep their family member at home, their proximity to the person with dementia or their perceived obligation — all pressures that can lead to harsh consequences for caregivers.

For example, more than one in three caregivers for people with Alzheimer’s or other dementias report their health has gotten worse due to care responsibilities, compared with one out of five caregivers for older people without dementia. And depression and anxiety are more common among dementia caregivers than among people providing care for individuals with certain other conditions.

These findings are part of the Alzheimer’s Association “2017 Alzheimer’s Disease Facts and Figures report,” released recently. The report analyzes new research about cost, prevalence, incidence, caregiving, and mortality and morbidity. The report found a dramatic surge in deaths from Alzheimer’s — the only cause of death among the top 10 in America that cannot be prevented, cured or even slowed. Meanwhile, deaths from other major causes are decreasing. Between 2000 and 2014, deaths from heart disease decreased 14 percent, but deaths from Alzheimer’s increased 89 percent.

Another finding was the growing cost burden of Alzheimer’s. For the first time ever, it now costs over a quarter of a trillion dollars ($259 billion) annually to care for individuals living with Alzheimer’s and other dementias in the United States — $56 billion of which is coming right from individuals’ pockets. According to the report, out-of-pocket costs for people affected by Alzheimer’s are startlingly high, despite support from Medicare and Medicaid. In fact, annual per-person payments for seniors with Alzheimer’s and other dementias are almost five times higher ($10,315) than those for seniors without these conditions ($2,232).

According to Beth Kallmyer, vice president of constituent services for the Alzheimer’s Association, providing ongoing support for the estimated 5.5 million Americans living with Alzheimer’s will need to remain a national policy priority moving forward, as the population at risk for Alzheimer’s is projected to nearly double from 48 million to 88 million by 2050.

“As the number of people with Alzheimer’s continues to grow, so does the impact and cost of providing care to our health system and the millions of unpaid caregivers,” Kallmyer said. “While we’ve seen increases in federal research funding and access to critical care planning and support services, there’s still an urgent need to expand options and support for family-centered and community care and to fund more research that can bring us closer to effective treatment options and, ultimately, a cure.”

To read the full Facts and Figures report, visit www.alz.org/facts. For comprehensive information, support and resources on Alzheimer’s caregiving, visit www.alz.org/care/overview.asp.

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Tips to feel financially empowered when living with a chronic disease

(BPT) – For most people, planning for a financially secure future is complicated. It’s difficult to balance how much money you should be saving with what you need to live on now. When you add a chronic illness – such as rheumatoid arthritis (RA) – into the mix, managing finances becomes even more complex and critical.

An estimated 1.6 million Americans have RA,[i],[ii] an autoimmune disease that causes a range of symptoms including pain and swelling in the joints.[iii] Living with RA could lead to continuous management of symptoms and lifestyle changes – and could also mean added expenses. While RA can impose a substantial burden of cost on people with the condition,[iv] many people may not think about the financial impact of RA at the time they are diagnosed, which can add more stress down the road. It’s important to think about finances as early as possible and seek out resources that can help reduce the stress.

The good news is there are steps people living with RA can take from the time of diagnosis and throughout their RA journey to keep finances on track. Knowing where to start can be the hardest part.

Below are some tips that can help you set yourself up for financial success:

  • OVERCOME GUILT AND STIGMA — The first hurdle when tackling tough issues like finances is overcoming the guilt and stigma associated with money. Many people may feel guilty if medical bills compete with other financial priorities and prevent you from spending on other items for yourself and your family. You may also feel ashamed when talking about the financial burden of RA with others who don’t have a chronic illness. However, it’s important to take care of yourself and not skip recommended treatments or appointments – a healthier you now could mean less medical-related expenses later.
  • DEVELOP YOUR FINANCIAL FOUNDATION — Typical budgeting templates may not account for costs associated with RA, but it’s important to consider them as part of your reoccurring monthly expenses. Find an affordable planner or service that will help you to consider the expected (and unexpected!) expenses associated with your condition, along with future lifestyle and financial goals that are tailored to your needs.
  • MASTER BUDGETING — Financial planners recommend using the 50/20/30 rule to budget – set aside 50 percent of your monthly income on fixed expenses (i.e., rent or mortgage, car payments, gym memberships, and recurring medical bills), 20 percent toward your financial goals and savings (i.e., paying off debt, retirement and building an emergency fund) and 30 percent on non-essentials (i.e., shopping and entertainment).
  • REDUCE CREDIT CARD DEBT AND IMPROVE CREDIT SCORES Every credit card opened under your name affects your credit score, which can impact your ability to borrow money in the future. Consolidate accounts, organize records and set up automated deposits or online payments on credit cards, utilities and medical bills. Expert tip: Close only one credit card per year to avoid negatively affecting your credit score.
  • FIND PROGRAMS TO HELP WITH TREATMENT COSTS — Many companies also have services that can help you get access to treatments at lower costs. If you’re on Medicare, review your Part D prescription drug or Advantage plan, taking into account how your RA may change over time.

After you’ve put an initial financial plan in place, review it annually to make sure it’s keeping up with the way your life and health are changing. Having RA can make finances difficult, but there are steps you can take to help make managing them easier.

Don’t let RA keep you from feeling financially empowered. Visit www.Arthritis.com for even more tips from financial expert and founder of LearnVest, Alexa von Tobel.

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[i] Sacks J, Lou Y, Helmick C. Prevalence of specific types of arthritis and other rheumatic conditions in the ambulatory health care system in the United States 2001-2005. Arthritis Care Res. 2010;62(4):460-464.

[ii] Howden L, Meyer J. U.S. Census Bureau results — U.S. Census Bureau, 2010 Census Summary File 1. 2010.

[iii] Lee DM, Weinblatt ME. Rheumatoid arthritis. Lancet. 2001;358:903-911.

[iv] Birnbaum H, Pike C, Kaufman R, Marynchenko M, Kidolezi Y. Societal cost of rheumatoid arthritis patients in the US. Curr Med Res Opin. 2010;26:77-90.

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