Living in a rural community shouldn’t have to come with a hefty price tag for health care.

Thanks to the Affordable Care Act, it no longer has to.

The Affordable Care Act (ACA) is already making a difference in the lives of millions of rural Americans, including families right here in California.

Prior to the ACA, many rural families had a hard time finding affordable insurance coverage, paying an average of nearly half of their costs out of their own pockets.

Today, thanks to the ACA, families in California can choose from a variety of affordable insurance plans and many will qualify for financial assistance to help them pay for coverage.

To sign up, visit www.healthcare.gov or call 1-800-318-2596 if you need help.

For those who enroll by Feb. 15, coverage will begin on March 1.

But don’t wait too long to sign up for health insurance coverage – the last day to sign up during this open enrollment period is Feb. 15.

Even if you already have coverage through the Marketplace, it pays to go back and review your plan. You may be able to find a plan that saves you money, offers more services, or includes more doctors. In fact, eight in 10 current Marketplace enrollees can get coverage for $100 or less in 2015 after tax credits.

In addition to providing affordable health insurance options for rural families, the ACA also does things to address the underlying challenges to staying healthy in rural America.

Insurance companies are now forbidden from denying you coverage if you have a pre-existing condition and they are required to cover preventive care.

That’s good news for rural Americans who, on average, suffer from higher rates of chronic conditions like diabetes, heart disease, and high blood pressure than those living in urban areas.

It also expands support for the National Health Service Corps, which offers scholarships and loan repayment to doctors and nurses in return for practicing in rural communities.

More than 3,500 Corps members now serve in rural areas, and an average of 86 percent of them will remain in their communities even after completing their service. These investments help keep a steady stream of young, motivated doctors and nurses in rural America.

That’s a good thing because while one in five Americans lives in a rural community, just ten percent of doctors practice there.

The ACA also invests significantly in expanding services at community health centers, where 7.5 million rural Americans get access to primary and preventive care.

That comes on top of the more than $3 billion USDA has invested since 2009 to strengthen health infrastructure in rural areas, build rural hospitals and health clinics, and expanded access to health care in remote areas through telemedicine. 

Weeks ago, we announced an additional $10 million in grants to improve access to health care in rural America, including $486,132 to help California Telehealth Network extend telemedicine services linking rural patients in eight California counties to specialty health care services not otherwise available in these rural areas.

The Affordable Care Act gives hardworking rural families in California the financial security and peace of mind they deserve. It makes rural communities stronger and rural families healthier.

Remember you can sign up at www.healthcare.gov or call 1-800-318-2596 for more information.

Glenda Humiston is the California State Director for USDA Rural Development. She oversees the agency's 40-plus programs and invested nearly $1 billion in California's rural communities during fiscal year 2014.

At holiday time, many people who are dealing with loss are caught in a dilemma between the need to grieve and the pressure to get into the spirit of the season.

Holidays or not, it is important for people who feel grief to find ways to take care of themselves.

Here are 10 tips for dealing with loss during the holidays from Hospice Services of Lake County.

1. Plan how and where you spend your time during the holidays. Scale back on activities if you want to.

2. Select a candle in your loved one’s favorite color and scent. Place it in a special area of your home and light it at a significant time throughout the holidays, signifying the light of the love that lives on in your heart.

3. Give yourself permission to express your feelings. If you feel an urge to cry, let the tears flow. Tears are healing.

4. Write an “un-sent letter” to your loved one expressing what you honestly feel toward him or her in that moment. After you compose the letter, you may decide to place it in a book, album or drawer in your home, leave it at a memorial site, throw it away, or even burn it and let the ashes symbolically rise.

5. When you are especially missing your loved one, call family members or dear friends and share your feelings. If they knew him or her, consider asking them to share some memories of times they shared with your loved one.

6. If you live within driving distance of the cemetery, decorate the memorial site with a holiday theme.

7. Play music that is comforting and meaningful to you. Take a few moments to close your eyes and feel the music within the center of your being.

8. Give money you would have spent for gifts for your absent loved one to a charity in your loved one’s name.

9. Read a book or article on grief. Some suggestions are: “Don’t Take My Grief Away From Me” by Doug Manning; “The Comfort Book For Those Who Mourn,” compiled by Anna Trimiew; and “A Grief Observed” by C.S. Lewis.

10. Remember that the anticipation of holidays without your loved one is often harder than the actual holidays themselves.

Linda Laing, MFT, is manager of bereavement services for Hospice Services of Lake County, Calif., http://www.lakecountyhospice.org/ .

My wife and I were drawn to Hidden Valley Lake a few years ago, where we found the great community and amenities we didn’t have in Santa Rosa.

We now find that community sharply divided over our association’s management of those amenities. We’re surrounded by cliques of golfers, non-golfers, movers and shakers, and fiscal frugals.

Some insist we’re a golfing community, which is no longer the case as fewer than 13 percent of us golf on our course, only 6 percent regularly enough to purchase golf memberships.

Others claim we’re more of a working-family community than a golfers’ enclave. However, this view ignores the importance of the golf course in our community.

My wife and I paid a premium for our home on the golf course but are concerned about how it’s managed, along with social shifts that imperil the golf course’s future and our quality of life.

Our golf operation has been subsidized between $419,870 and $694,243 annually over the past nine years. Our director of golf has increased the number of rounds played since 2010 by a third, and we’re now slightly above the national average for 18-hole courses.

But during that same period the number of full golf memberships has declined and last year we saw a substantial increase in the subsidy to the highest it’s ever been.

The golf course is our largest and understandably most expensive amenity to maintain. But our other amenities aren’t maintained to anywhere near the same standard.

This is especially true of our Hidden Valley Lake itself. In www.hvlclarified.org’s “The Quality of Our Lake,” sediment buildup was cited as a longstanding quality issue yet the proposed 2015 budget is the first to identify funds to address it.

It remains to be seen if these funds will survive the board’s final cut in the approved budget.

Additionally, the golf subsidy represents well over 40 percent of the golf course’s operating budget.

Because non-residents pay only 30 percent more to play on our course, association assessments are used to subsidize public play in addition to member play.

Golf is declining in popularity across the country, particularly among younger players. An increasing majority – 86 percent – of Hidden Valley Lake residents are working families and their children.

Although our community has historically attracted golfing retirees it’s unlikely to be the major draw for new residents in the future.

As our baby boomers age out of the sport over the next 15 years, our affordable housing and accessibility to good jobs in Napa and Sonoma counties will continue to attract working class families.

Golf course operating costs are likely to continue climbing, compounded by the ongoing drought. As our demographics shift and our golf population declines, support for the golf subsidy among the members is likely to decline as well.

Future HVLA Board directors face an increasing challenge in justifying the golf subsidy to association members. Maintaining our current golf operations management approach will likely bring HVLA to a breaking point.

As a former director recently told me, our board is obligated to maintain our amenities but they’re not obligated to keep them. If a future majority of directors feel the golf subsidy isn’t justified they simply have to let the members who elected them vote in agreement with them to eliminate all or part of the course.

Our golf course has historically been run as an amenity open to the public. We should start running it as a business and subsidize it only to the minimum required for the benefit of Association members.

This difference may sound trivial but it’s not. The change starts with a golf operations feasibility study. Such a feasibility study was a board agenda item in June, but has since disappeared from the association’s agenda without explanation.

Operating as a business also means developing a business plan, benchmarking with other operations and consulting with industry experts.

The last time the association consulted a golf management expert was in 2008. After only a few hours' visit the board pursued no operational assessment, review of finances or other recommendations.

In “Golfer’s Paradise,” published on www.hvlarising.org , Steven Greenberg cited a reduction to and elimination of golf subsidies made at our sister communities in advocating for a management expert to review our golf operation and offer recommendations.

Hvlclarified.org’s “Apples, Oranges, Lemons” was published as a rebuttal, identifying important differences between us and our sister communities in an attempt to discredit Greenberg. Yet it failed to discredit the validity of his argument that an outside expert might be able to help reduce our subsidy.

The more residents we have golfing and the more often they play, the more revenue generated and the easier it will be to justify a subsidy.

A new player recruitment program could make an impact. Rather than losing our subsidies to operating costs we could invest some in providing free club rentals and beginner lessons to residents, such as the PGA’s Get Golf Ready in 5 Days program.

This could be partnered with an ambassador program to pair our seasoned golfers with rookies and build our community relationships.

Pay-per-hole memberships at off-peak times would allow those of us with limited time to enjoy golf more often and also enhance revenues.

Every evening I look out on an empty course and wish I could pay a few dollars to play the two holes between my house and Mulligan’s to unwind at the end of the day. But I rarely golf because like most working adults in Hidden Valley Lake I don’t have enough time to play 18 or even 9 holes regularly.

As the only 18-hole golf course open to the public in Lake County, the fate of our course has implications for county-wide tourism.

To ensure we can all enjoy and benefit from our golf course well into the future, it’s time for our Board of Directors to show HVLA members they’re serious about increasing member utilization of the golf course, managing the golf subsidy, and maintaining all of our amenities to the same high standard.

Sky Pile is an environmental health & safety consultant and coaches middle school cross country and track in Santa Rosa. He volunteers on Sonoma County’s Community Activity and Nutrition Coalition’s Physical Activity Subcommittee to promote physical activity opportunities throughout the community. Sky holds master’s degrees in kinesiology and public health. He and his wife have lived in Hidden Valley Lake, Calif., since 2011.

Good news for people with Medicare in 2015: Part B costs will remain the same as in 2014.

Medicare Part B helps pay for doctor bills, outpatient care, durable medical equipment, and other items. It requires a monthly premium and an annual deductible.

I’m happy to report that Part B costs for 2015 will be identical to 2014: $104.90 a month for the premium (for most beneficiaries), and $147 for the deductible.

Most people with Medicare don’t pay any premium for Part A, which helps covers hospital care. But for those who do, the 2015 premium is dropping, from a maximum of $426 per month to $407 per month.

The annual deductible is going up a little, from $1,216 in 2014 to $1,260 in 2015. Once you pay the deductible, Medicare covers your first 60 days of hospitalization with no co-insurance.

Thanks to the Affordable Care Act, people with Medicare no longer have co-pays for a long list of Medicare-covered preventive health services.

Preventive shots and screenings are intended to keep you healthy and to detect disease in the earliest stages, when it’s most treatable.

Medicare’s preventive health services include vaccinations for flu and Hepatitis B; screenings for colorectal, breast, and prostate cancer; screenings and counseling for diabetes and depression; cardiovascular disease screenings; and counseling to help you stop smoking or abusing alcohol.

In addition, you can get a one-time “Welcome to Medicare” visit with your doctor, during the first 12 months you’re enrolled in Part B. During this visit you and your doctor can review your medical and social history, and your physician can recommend specific preventive screenings for you, if needed.

Medicare also now covers an annual “wellness” visit with your doctor. This visit is intended to develop or update a personalized plan to prevent disease or disability based on your current health and risk factors.

Another benefit of the Affordable Care Act is that it’s gradually closing the “donut hole,” or coverage gap, in Medicare Part D, the prescription drug program.

The coverage gap begins after you and your drug plan together have spent a certain amount for covered drugs. In 2015, once you enter the gap, you pay 45 percent of the plan’s cost for covered brand-name drugs and 65 percent of the plan’s cost for covered generic drugs until you reach the end of the gap.

However, not everyone will enter the coverage gap because their drug costs won’t be high enough. (There’s a full explanation of the coverage gap in the “Medicare & You” handbook for 2015, which is online at: http://www.medicare.gov/Pubs/pdf/10050.pdf .) The gap is scheduled to be completely closed by 2020.

Finally, Medicare has expanded its “Blue Button” feature to provide better access to your Medicare claims and personal health information.

With the Blue Button you can download 12-36 months of claims information for Part A and Part B, and 12 months of claims information for Part D.

This information can help you make more informed decisions about your care and give your healthcare providers a more complete view of your health history.

You can find the Blue Button at www.MyMedicare.gov .

Once you’ve used the Blue Button, there are a variety of health applications and services to analyze your health information.

Visit www.bluebuttonconnector.healthit.gov to learn more about these useful tools and how to protect your health information once it’s in your hands.

David Sayen is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada, and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).

Medicare’s annual open enrollment season is underway, and I want to encourage everyone with Medicare to review their current health and prescription drug coverage.

Open enrollment began Oct. 15 and runs through Dec. 7, 2014. If you want to change your Medicare Advantage or Medicare Part D (prescription drug) plan, this is the time of year to do it. Any new coverage you select will take effect Jan. 1, 2015.

If you have Original (traditional) Medicare and you’re satisfied with it, you don’t need to do anything during open enrollment.

My agency, the Centers for Medicare & Medicaid Services, or CMS, announced recently that the average Medicare Advantage premium for 2015 is projected to be $33.90 monthly. CMS also estimated that the average basic Part D premium in 2015 would be $32 per month.

Since passage of the Affordable Care Act in 2010, enrollment in Medicare Advantage has increased 42 percent to an all-time high of more than 16 million people. Medicare Advantage premiums, meanwhile, have decreased 6 percent.

The law is also closing the Part D “donut hole,” with more than 8.3 million people saving more than $12 billion on prescription drugs through last July.

Meanwhile, the quality of Medicare Advantage and Part D plans continues to improve. This year, people with Medicare who enroll in such plans will have access to more high-rated, four- and five-star plans than ever before.

About 60 percent of Medicare Advantage enrollees are now in plans earning four or more stars in 2015, compared to an estimated 17 percent in 2009.

Likewise, about 53 percent of Part D enrollees are currently in Part D plans with four or more stars for 2015, compared to 16 percent in 2009.

Medicare plans’ coverage options and costs can change each year, and Medicare beneficiaries should evaluate their current coverage and choices and select the plan that best meets their needs. If you think your current coverage will meet your needs for 2015, you don’t need to change anything.

A variety of resources are available to help you compare your current coverage with new plan offerings for 2015.

You can:

– Visit www.medicare.gov to review plans available in your area, as well as their costs, and enroll in a new plan if you decide to. Open enrollment information is available in Spanish.
– Call 1-800-MEDICARE (1-800-633-4227) for around-the-clock assistance to find out more about your coverage options. TTY users should call 1-877-486-2048. Counseling is available in a wide variety of languages.
– Review the 2015 Medicare & You handbook. This handbook has been mailed to the homes of people with Medicare and it’s also online at: www.medicare.gov/pubs/pdf/10050.pdf .
– Get free, unbiased, one-on-one counseling from your local State Health Insurance Assistance Program (SHIP).

Local SHIP contact information can be found:

– At www.medicare.gov/contacts/organization-search-criteria.aspx or;
– On the back of the 2015 Medicare & You handbook or;
– By calling Medicare (at 1-800 number above).

People with Medicare who have limited income and resources may qualify for Extra Help to pay for their Part D drug plans. There’s no cost or obligation to apply for Extra Help.

Medicare beneficiaries, family members, or caregivers can apply online at www.socialsecurity.gov/prescriptionhelp or call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778) to find out more.

Better quality in Medicare Advantage and Part D plans isn’t the only good news for people with Medicare.

For most seniors who have Original Medicare, the 2015 Part B premium will stay unchanged for a second consecutive year, at $104.90.

This means more of your retirement income and any increase in Social Security benefits will stay in your pocket. The Part B deductible will stay the same as well.

David Sayen is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada, and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).

Reading isn't just for education. Reading is supposed to be fun!

It just so happens that reading just for the joy of it also has some big educational benefits for students.

The Organization for Economic Co-Operation and Development found that reading for enjoyment was a more important marker for children’s success in school than their family’s income, education or occupation.

Research done at the Institute for Education in London had similar results. They found that a love of reading was more important for a child’s educational success than having a parent who had attended college.

The study states that, “The combined effect on children's progress of reading books often, going to the library regularly and reading newspapers at 16 was four times greater than the advantage children gained from having a parent with a degree.”

Common Sense Media published a report that found that the percentage of 9 year old children reading for pleasure has dropped 5 percent from 81 percent in 1984 to 76 percent in 2013.

The report shows that older children read for pleasure even less. About half of 17 year old teenagers report reading for pleasure less than twice a year.

This is unfortunate because children who do not develop a love of reading at a young age often miss the benefits of the reading they are assigned in school.

Children can fall behind as they develop the feeling that reading is boring. This leads to less developed language and literacy skills that can harm the child throughout school and their adult life.

The good news is that it only takes one role model to share the joy of reading with a child.

It can be as simple as reading for pleasure yourself, sharing your favorites from childhood, and helping children find the books that match their interests.

Do you have a child in your life you can be a model reader for? Take a field trip to the library!

Find more information about your local library at http://library.lakecountyca.gov/ .

Christopher Veach is the county librarian for Lake County, Calif.