Keeping Up with Medicare – 2012

Medicare is constantly changing and keeping up with what’s new will help you get the most from Medicare.
There are several changes that have occurred for 2012. Here are some of the highlights:
 Between January 1–February 14, if you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.
 Medicare plans are rated for quality by a 5-star rating with 1 star being the lowest and 5 stars the highest. Between December 8, 2011 and November 30, 2012, if you are enrolled in a Medicare Advantage or Medicare Part D prescription plan you can join or switch to a plan that has a 5-STAR rating IF ONE IS AVAILABLE IN YOUR AREA. This can be done only one time during the year.

o NOTE: if you take this opportunity and enroll in a 5-star Medicare Advantage plan that does not provide prescription benefits you will not be able to enroll in a Part D (prescription) plan and you will not have prescription drug benefits until open enrollment which is from October 15 to December 7 2012. So choose wisely!!

o There are not 5-star plans available in many areas of the country. Check the Plan Finder Tool on the www.Medicare.gov website to see if any are available in your area.

 The Donut Hole (the Part D coverage gap) continues to slowly close , one of the positive benefits from the Affordable Care Act passed in March 2010. In 2012 you will continue to pay only 50% of the cost for brand named drugs and your discount for generic drugs will double to 14%. Both discounts will gradually increase until beneficiaries pay just 25% of their drug costs in 2020.
 Medicare now covers screening and counseling for alcohol misuse, depression, and obesity
I you are confused about Medicare there are experts you can speak to. Look for your state’s Department of Aging, or call a Health Care Advocate!

Tips and Resources for Identifying a Nursing Home for a loved One

Are you faced with a loved one who needs to move into a nursing home?
How do you know where to look and what to look for?
This is a daunting job. For instance, there are 238 nursing homes in Connecticut, 635 in New York, 662 in Florida. So where do you start?
The best approach is to do your home work. Here are some resources to help you get started.
1. The National Clearing House–Long Term Care Information is a great place to start when you are considering long term care. This can be found at: http://longtermcare.gov/LTC/Main_Site/Planning/Index.aspx
2. The Medicare website has evaluations of all Medicare and/or Medicaid certified nursing homes. These evaluations are displayed on a 1-5 star scale and are based on the results of yearly state inspections. To access the nursing home compare go to www.medicare.gov , click on Facilities and Doctors on the left hand side and then choose Compare Nursing Homes. You can get a list of nursing homes in a specific area or enter the name of the nursing home you want to evaluate.
3. Medicare also has a pamphlet called Your Guide to Choosing a Nursing Home. This can be found online at http://www.medicare.gov/publications/pubs/pdf/02174.pdf
Once you have some idea which facilities you want to visit:
1. Talk to friends and co-workers who have loved ones in a nursing home for information about the home they are familiar with … the good and the bad
2. If you are going to be responsible for monitoring their care … and no matter how wonderful the facility is, every resident needs someone to frequently monitor their care … try to choose a facility that is close to home or work so it is convenient for you to visit.
3. Tour the facilities you are considering if you can. Then show up at another time unannounced and walk around
4. Look to see what the residents are doing, are they all lined up in wheel chairs around the nurse’s station or are they engaged in activities?
5. Ask tough questions when you visit:

a. aide to resident ratio
b. when and who and when do they contact in case of an emergency or adverse event
c. what is the activity schedule and how do they decide who participates
d. Ask to speak to a few families who have a resident in the facility
e. Ask for a copy of their last state inspection-they have to have it displayed

And remember, once your loved one is settled in their new home, visit at odd times, participate in the quarterly family conferences, and make yourself a visible presence!

Recognizing the Need for outside Help in Caregiving

Caregivers often don’t recognize when they are in over their heads, and often get to a breaking point. After a prolonged period of time, caregiving can become too difficult to endure any longer. Short-term the caregiver can handle it. Long-term, help is needed. Outside help at this point is needed.

A typical pattern with an overloaded caregiver may unfold as follows:

1 to 18 months – the caregiver is confident, has everything under control and is coping well. Other friends and family are lending support.
20 to 36 months – the caregiver may be taking medication to sleep and control mood swings. Outside help dwindles away and except for trips to the store or doctor, the caregiver has severed most social contacts. The caregiver feels alone and helpless.
38 to 50 months – Besides needing tranquilizers or antidepressants, the caregiver’s physical health is beginning to deteriorate. Lack of focus and sheer fatigue cloud judgment and the caregiver is often unable to make rational decisions or ask for help.

It is often at this stage that family or friends intercede and find other solutions for care. This may include respite care, hiring home health aides or putting the disabled loved one in a facility. Without intervention, the caregiver may become a candidate for long term care as well.

With the holiday season upon us, caregivers feel even more stress — with planning, shopping and participating in holiday activities. This is a perfect time for family and friends to step up and provide some respite time and caregiving help. Whether it is provided personally or arranged as a gift of services to be provided by a professional respite company or home care provider, it is a welcome gift.

NINE WAYS TO TAKE CHARGE OF YOUR HEALTH CARE DOLLARS IN 2012

Now more than ever, watching and budgeting for health care is important. Being organized around your health care dollars is one way to avoid spending unwisely.

1. Know thy health plan – Familiarize yourself with your health plan documents; knowing what is not covered is as or more important than what is covered. Nothing is worst than having a test/lab procedure or seeing a specialists only to find out your health plan won’t cover it!

2. Keep your health plan and medical information in an accessible place. Get a binder to place all your important medical and health plan related information.

3. Be aware of any changes in your plan for this year, you may find that changes have been made to services you have received in the past.

4. Discard of all of our old health plan cards.

5. If you have more than one health plan, are you sure you know who pays first?

6. Remember to take your new cards to all doctor appointments and to the pharmacy.

7. If you plan includes an up front deductible, take advantage of those services you can obtain prior to reaching the deductible. Preventative services such as mammograms and flu shots may be covered at no charge.

8. Make it a habit to check your Explanation of Benefits when they arrive for accuracy to be sure you are being charged appropriately for your medical care.

9. If you’re caring for your senior parents or relatives, prepare for emergencies by having their list of current medicines, legal documents and copies of their health insurance cards available to grab and run.

Being vigilant will save you time, angst and money.

Where do we go from here? Discharge planning after your senior parent’s ER visit

After all of the tests and waiting and treatments are completed, it is time to decide what the next steps are for your Mom or Dad. Here are some possible scenarios.

Scenario 1: The doctor wants your father to stay in the hospital

Ø The first question is … Why?

If it is for a blood test or x-ray that is needed tomorrow, can it be arranged and completed on an outpatient basis?
If it is because he should not be alone for the first 24 hours, can your dad go home with you or can you stay with him?
Does he live in an assisted living facility where you can arrange some nursing care and monitoring?
Can he be sent home with in-home supports you can arrange, such as private home health aides?

Ø The second question is … Will he be admitted or placed in an observation bed?

Keeping your father in the hospital does not necessarily mean that he is going to be admitted!
If the doctor is planning to place your father in an observation bed that means that:

– MEDICARE WILL NOT PAY FOR ANY OF THE HOSPITAL BILLS INCURRED ONCE THE ER TREATMENT IS COMPLETED, AND

– IF YOUR FATHER HAS TO BE TRANSFERRED TO A SKILLED NURSING FACILITY FROM THE HOSPITAL FOR REHABILITATION WITHOUT BEING ADMITTED, MEDICARE WILL NOT PAY FOR ANY OF THE BILLS FROM THE REHAB FACILITY.

If the doctor is planning to admit your father to the hospital, that means that Medicare will most likely pay for his hospital bills, as long as it is a medically necessary admission.

Scenario 2: The doctor wants to discharge your mother

Ø Where will your mother go?

If she lives alone in an apartment or house

– Does she need someone to be with her for a day, a week, or longer?

– Does she have stairs to get to her bedroom or bathroom that are now an obstacle?

If she lives in an assisted living facility, do you need to contact them for added services and supports to be in place before she returns home?

– Can they have these supports available to her immediately upon her return, or does it take some time for them to arrange theses?

Before your parent leaves the ER

Regardless of where your parent will be going, there are several issues you need to discuss with the doctor before your parent leaves the ER.

Need assistance? Wondering what the right thing to do is? Give us a call!

In good health,

The Health Champion Team

Are You Prepared: Going to the Emergency Room-Part One

No one usually plans to go to the Emergency Room, but if you are one of 48.9 million adults caring for a parent or other senior in your life, consider this:

Adults over the age of 85 will have more than 6 ER visits before end of life. The typical reason for a visit is a fall. You may get the call from your loved one, or a neighbor may call to let you know that an “ambulance” has been called; or, it may be the assisted living staff that notifies you.

Are you prepared to be the best advocate you can be for your loved one? Not unlike the time in our lives when we prepared our “overnight” bag in preparation for the baby’s arrival, taking the time to organize and arm yourself with the following information about your parent(s), will effectively minimize the chaos that occurs when a loved one goes to the emergency room.

Here is Health Champion’s Emergency Room Checklist that will help you prepare for the inevitable time when you are called to join your loved one. Your Emergency Room kit should include:

♦ List of current medications, dosage and prescribing physician. It also helps to have the name and number of the local pharmacy your parent uses.
♦ Medication and food allergies.
♦ Current medical diagnoses and treatments and names of physicians involved in the care.
♦History of recent falls, if any. Does your parent need assistance to walk? Can they get up from a chair unaided?
♦ Brief history of prior medical issues (for example, is there a prior history of stroke, heart attack?).
♦ Any implantable devices? For example, does Mom or Dad have a pacemaker in place? Or, had a knee or hip replacement?
♦Copy of advanced directives and/or living will.
♦ Copy of power of attorney, if it is in place.
♦ Insurance information and copy of card(s) – Medicare, Medigap plan, Medicare Advantage plan and Medicare Part D, if applicable.
♦ Pad and writing implement to keep track of the event. It may be helpful to note the arrival time, name of the emergency room physician in charge of your parent’s case, names of the nursing staff involved in the care and any lab or diagnostic tests that are done.
♦ A small blanket or bed throw – not all Emergency Rooms are plush with comfort supplies and the ER can be cold.
♦ Snacks for the caregiver – you can expect to be in the emergency room between 4-6 hours. Depending on the time of day, the cafeteria may not be open and having some quick healthy snacks (granola bar, raisins etc.) may be better than the vending machine options.
♦ Take your book, kindle or ipad – there is a lot of downtime in the emergency room.

Last but not least, be prepared for a discussion about discharge planning. Depending on the outcome of the emergency room examination, mom or dad may not be immediately returning home. Are you prepared to have them go home with you? Be admitted to the hospital? Be admitted to a rehab facility? Next week’s blog will address things you should consider for each scenario.

Is Mom OK?

Are you noticing that your mom or dad is starting to struggle with everyday activities?

Are they not bathing or showering as often as you think they should?

Is their refrigerator full of food that should have been discarded weeks ago?

Is your once meticulous mom or dad wearing clothing with food spots all over the front of their shirt?

Are you worried that they are not eating well and appear to be losing weight?

Do they not tell you that they have fallen or went to emergency room until days later?

You are not alone. Over 22 million households in the U.S. are caring for a friend or relative aged 50 years or older. So why is it so difficult?

Our older adults are trying to cope with a world that is becoming more complex while their world is growing smaller, confusing and more difficult to manage.

Consider this:

You are dealing with people have always been independent and desperately trying to remain so
What you may think is the best solution for a problem may be very difficult for them to understand or do
They are trying very hard not to be a burden to anyone or interfere with your busy life
They may be embarrassed to ask for help
Your roles are changing you are becoming the caretaker, a role they are used to having

There are no good answers. We are all dealing with the frustration of trying to keep them safe and yet maintain their independence. They are dealing with the frustration of knowing that they can no longer do what they used do. So we all end up frustrated!

Engaging an expert who is not a family member to have the frank discussions makes it easier for everyone. It is a relief to discuss your concerns with someone who knows what supports are available, has the expertise to offer suggestions and solutions, and knows how to navigate the system on your behalf.

So arrange a time and place when everyone can come together and start the tough discussions. It will most likely take several meetings over time, but be patient, listen to each other, and let your expert guide you. You are essentially looking for short term solutions and a long term plan. Document the plan and make sure that family members are aware of the plan and are on board. Issues and disagreements about a plan of care for Mom or Dad should be worked out before the plan needs to be implemented.

Not sure where to begin? Some excellent resources can be found on the following websites:

Elder Care Matters www.eldercarematters.com;

National Alliance for Caregiving www.caregiving.org

National Association of Professional Geriatric Care Managers wwwcaremanager.org

In good health,

The Health Champion Team

www.healthchampion.net

Medicare Open Enrollment is NOW- What Should You Do?

Medicare Open Enrollment is earlier this year—October 15 to December 7, 2011.

To save you money and angst, you need to reevaluate your Medicare coverage every year at Open Enrollment!
So let’s get started.
Quick Medicare Primer:

Original Medicare has 2 parts
Part A covers in-patient (hospital) costs-is free for anyone who worked for 10 years and contributed to Medicare through payroll deductions

Part B covers out-patient (doctor visits) costs-has a monthly premium that is deducted from your Social Security check

BUT KEEP IN MIND THAT MEDICARE DOES NOT PAY FOR EVERYTHING YOUR DOCTOR ORDERS AND MEDICARE DOES NOT COVER THE COMPLETE COST OF MEDICAL CARE

You can have just Original Medicare but you are then responsible for all of the medical bills that Medicare does not cover and you will have to pay full price for all of your prescription medicine … OR you can choose additional insurance coverage to help pay for these additional bills.

There are several choices to help cover some of the costs that Medicare does not pay and to lower the cost of your prescription drugs. To take advantage of any of these choices you must have both Medicare Parts A and B.

So here comes the confusing part!

Private insurance companies offer health insurance policies that pay for many of the charges Medicare does not pay for. These are called Medicare Supplement or Medigap Plans. There are 11 different types of plans to choose from. They vary in price and what they pay for.

In general, these are best if you several medical problems, or if you travel, or if you live in more than 1 area of the U.S. during the year, if you want to be able to choose your doctors or treatment facilities without dealing with a restrictive network.

Advantages of choosing one of these plans:

• You can go to any doctor who treats Medicare patients
• You do not have to have a referral to see a specialist
• You will not have to pay a copay when you see a doctor
• You can travel within the U.S. or live in more than one area of the U.S. and get medical care covered by your insurance

Disadvantages of choosing one of these plans:

• Medigap plans do not provide prescription drug coverage, so you must also purchase a Medicare Part D (Medicare Prescription Drug) Plan
• A Medigap plan plus a Medicare Part D plan can be more expensive than purchasing a Medicare Advantage (Medicare Part C) plan—see below

The alternative to adding a Medigap Plan plus a Medicare Prescription Drug Plan (Medicare Part D) to Original Medicare is to choose what is called a Medicare Advantage (Medicare Part C) Plan. These plans are also offered by private insurance companies and the number of plans available to you depends upon what state you live in.

Advantages of these plans
• They are often less expensive than adding Medigap plus a Medicare Prescription Plan (Medicare Part D) to Original Medicare
• These plans are all inclusive-they provide both medical and prescription drug coverage
• They must offer the same level of coverage as Original Medicare, and often have additional coverage—such as limited dental, eye care, and other services—available for an additional monthly cost or no additional cost

Disadvantages of these plans

• They are usually (but not always) HMO plans which means you can only to be treated by doctors in their network for the plan to pay for your medical care
• You will have to pay a copay every time you see a doctor or get a covered service
• If you need medical care outside of the area where you live, these plans only will pay for emergency treatment-you cannot see doctors out of your area

So now it is Open Enrollment:

So what does that mean?

Every year during Open Enrollment anyone who has Medicare—regardless of what type of a plan—should review plan(s) you had this year, look at the plans that are offered for the next year and choose to change your Medicare choices or stay with what you have.

During this time you can:

• Change from Original Medicare to an Advantage plan
• Change from an Advantage plan to Original Medicare
• Switch from one Medicare Advantage plan to a different Medicare Advantage plan
• Switch from a Medicare Advantage plan that offers prescription drug coverage to a Medicare Advantage plan that does not offer prescription drug coverage
• Join a Medicare Prescription Drug Plan (Medicare Part D)
• Drop you Medicare Prescription Drug Plan completely

Why is it important to reevaluate your Medicare coverage every year?

Very simply, things change!!

If any of the following have changed since last year at this time, you need to reevaluate your medical and drug coverage. If you don’t, you may be stuck with a plan that is more expensive or does not cover medical expenses you will need next year.

• Have the medicines you were taking changed?
• Do you have new doctors?
• Do you have a new diagnosis?
• Are you planning any surgeries next year?
• Are you planning to travel or live someplace else during part of the year
• Have you moved?
• Are the doctors you want to see no longer on your plan?
• Are you unhappy with the medical and/or prescription plans you had this year?

So how do you figure out which medical and prescription drug plans are available for next year and which is the best one for you?

You can go to www.medicare.gov and use their site to evaluate next year’s plans
You can contact your state Department of Social Services to see if they have a State Unit on Aging
You can look online for a non-profit group in your area that helps people with Medicare questions
You can ask a friend or relative to help you
You can hire a Private Health Care Advocate to evaluate your current medical and drug status and match you with the best plan(s) for you for next year

However you do it …DO IT

Inpatient or Outpatient ?

If you are a Medicare Beneficiary, knowing your patient status during a hospital or emergency room visit will impact reimbursement and your out of pocket expenses.

If you have a loved one who has recently been to the ER and stayed overnight in the hospital you need to be aware of the following:

Your hospital status (whether you are considered an inpatient or an outpatient) depends on whether or not your physician has written orders for an inpatient admission. In other words, your doctor has evaluated your physical status and made a determination that you need to be admitted to the hospital. Your head on the hospital pillow or lying in a bed in a hospital room does not mean you have been admitted. Only having a written physician hospital admission orders makes your status an inpatient.

You are an outpatient if you getting emergency services, being watched or observed or having outpatient tests, your status is considered outpatient.

Consider this…You go the emergency room with chest pain and the hospital keeps you for 2 nights for observation – your status is Outpatient and reimbursement is under Part B. Part B covers your physician services and hospital outpatient services such as lab tests. Part B has a deductible and coinsurance. Part A in this situation will not reimbursement or pay for any of the services.

Depending on the amount of services your balance at the hospital can add up. To avoid any financial surprises, it is best to verify your status and if possible keep a log of services rendered.

For more information check the Medicare website, www.medicare.gov/publications

Could Your Family Benefit from a Geriatric Case Manager?

For those of us in the so-called sandwich generation, the following scenario is being played out repeatedly.

Mom and Dad are doing just fine, living a good life in __________ (insert state, town). Mom or Dad needed a __________ (hip, knee, valve replacement, etc.) They made it through the surgery just fine, but now they are not bouncing back to what was their pre-surgical state. You are nervous that something is wrong – you are not sure what – but as you are not living nearby, you need HELP!

If your parents are still living independently, one option is to find a local geriatric case manager who can make a home visit and assess the situation. According to the National Association of Geriatric Case Managers, a geriatric case manager is a health and human services specialist who helps families caring for older relatives. The GCM is trained and experienced in any of several fields related to care management, including nursing, gerontology, social work, or psychology, and can:

Conduct care-planning assessments to identify problems and to provide solutions.
Screen, arrange, and monitor in-home help.
Provide short- or long-term eldercare assistance for those engaged in local or long-distance caregiving.

In short, a geriatric case manager can be an excellent resource. To find a local geriatric case manager, you can check the following resources:

Health Champion

National Association of Professional Geriatric Case Managers

AdvoConnection

Health Champion Blog

"In Your Corner"