News

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.

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.

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

Medicare Open Enrollment

Medicare Open Enrollment – Tis the Season

When the end of summer and the fall season beginning, it signals for those of us in health care that the season of open enrollment will be upon us. Open Enrollment is the time when employers give employees the opportunity to review their insurance benefits, and make decide to renew or make changes.

If you are a Medicare beneficiary the government gives you the opportunity to review your coverage options as well. This year the open enrollment begins earlier than prior years and ends earlier as well. The open enrollment period begins October 15 and ends December 7^th. Enrollees in “original” Medicare can move into a Medicare Advantage Plan during this time. Medicare Advantage enrollees can move into “original” Medicare.

Don’t miss this opportunity to review you current coverage and evaluate whether or not a different Medicare option is a better choice for you in 2012. According to a recent survey done by National Council on Aging and United Healthcare, 46% of seniors have never shopped around for the best Medicare coverage. Medicare should have the 2012 options and pricing available on their website on October 1. Medicare Part D (prescription drug plan) options can also be changed at this time.

While a plethora of choices can be paralyzing for some, here are a few areas to review before looking at your options:

Ø Have you have any new medical issues identified in 2011?

Ø Are these issues likely to continue in 2012?

Ø Have your medications changed in any way? This includes changes to frequency and dosage?

Ø Do you have new medical specialists on your care team? If so, do they participate in Medicare? Do they participate in any local Medicare Advantage plans?

Ø Are you pleased with your current coverage?

Ø Have you moved or plan to move in 2012.

Taking the time to do your homework – understand your own needs, your budget and what your options may save you considerable dollars in 2012.

Confused? Overwhelmed by your choices? Get help! Each state has a organization armed with trained Medicare. Contact the local Area Agency on Aging office . Or, you can call Health Champion, we are in your corner!

Travels with Al

My husband and I decided we would drive to Michigan with his 88-year old father. There were family members he wanted to reconnect with and old haunts he wanted to revisit, probably for the last time. We knew that he could not tolerate flying and had always loved to travel by car. He was really looking forward to the trip and talked about it often as the time drew near.

My father-in-law, Al, has mild dementia. He moved in with us 10 months ago, and we thought we were prepared for the challenges this trip would present to both him and us. He is pretty independent at home and takes care of himself during the day.

We all packed a week’s worth of clothing. I decided to take some emergency supplies – men’s incontinence guards and a washable bed pad – in the event the bathrooms were too far apart.

The first three hours were uneventful. All of a sudden, Al started to groan in pain and lost control of his bladder. Fortunately, we were just coming to a rest area, where he “dashed” out of the car. Unfortunately, we were too late and he had to change his pants.

That was just the start for him. He could not last longer than 50 minutes before he was overcome with intense pain and incontinence. We stopped at every 50 minutes or less, but still he went through all of his pants and the guards were not sufficient protection. Unfortunately, he had to ride the last couple of hours in wet pants sitting on the bed pad. That was a humiliating day for him.

We washed all of his clothes that night and started the next morning all fresh and clean.

We spent the next days visiting his friends and family, people he had been excited to see. They were all either living at home with home health aides or in nursing homes. During the visits, Al was not his usual talkative self. He would sit quietly in a corner or by the door and appeared depressed. One evening he appeared frightened and said that he wanted to see them all at first, but could only stand about 15 minutes, then wanted “to push them away.” He “did not expect that they would all be so old.”

Our drive back was not as difficult for Al. He was determined not to repeat his previous experience and would argue with us when we practically forced him to use the bathrooms. He was very quiet and appeared depressed. All in all we were relieved to get back home!

I realized that I had underestimated Al’s limitations. He appears to function relatively well in his familiar surroundings and within his daily routine. But looking back on the trip, at times he was frightened and confused and did not know how to respond to his friends and family because they were not as he remembered them.

Since returning, he has talked about how difficult the trip was and rarely mentions who he visited. If I knew Al would hve had such a difficult time, would I have taken him to Michigan? I honestly do not know.

Choosing home care services for the loved one in your life

Making the decision to hire a home care service to provide care for your loved one is an important decision and can, at the same time, be very difficult. If an illness or recovery from surgery requires nursing care or physical therapy, a physician may order skilled home care services that provide both skilled providers and personal aides. Your decision is then based on the obvious medical determinations made by the doctor. But what if you as the family caregiver must determine the extent of care needed without the help of a doctor?

Each home care situation is unique. In the beginning, family or friends step in to help with simple tasks and support for aging seniors who want to stay in their homes. As long term care needs progress, more time is required to manage those self-directed funds needs. Physical and mental conditions change with aging making usually routine hygiene and daily living activities difficult for an aging individual. Even with the healthiest of seniors, the ability to drive a car, shop for groceries or do general housekeeping eventually needs to be relinquished to the responsibility of another person. How you determine what type of home care is best for your situation and which home care provider is right for your loved one is critically important to achieving and creating a successful supportive environment for your loved one. Here is a link to an article with some helpful advice.:http://www.planforcare.org

Of course, sometimes bringing in a geriatric care manager or health care advocate who can assist in navigating the choices and decisions is the better approach.

Medicare – Enrollment

“Now What” Series

At Health Champion, we hear the phrase “Now What?” from our clients so often, we have decided to create a series of “Now What” blogs.

We hope that these posts will provide you the insight and advice you need to become a successful health care consumer.

Our first “Now What” blog pertains to the following scenario:

You are turning 65, still working and plan on continuing to work. Now what should you do about Medicare, if anything?

If you have health benefits from your employer and you are continuing to work, you should sign up for Medicare Part A. You should also speak to your human resources department to determine whether or not to sign up for Medicare Part B. If you decide to enroll in Medicare Part B, then the question is, which of your insurances is the primary payer of your health care? In general, the size of the employer group determines who is primary payer for “the working aged”. (Could we please replace that phrase with something like “HIP Older Person?). Ask your human resources department who your primary payer is.

If you have worked 40 or more quarters you are eligible for Medicare Part A when you turn 65. Medicare Part A covers inpatient hospitalizations, skilled nursing, home health and hospice care and some selected outpatient services. If you have worked the 40 or more quarters there is no cost for Medicare Part A. Most individuals who are receiving Social Security will be automatically be enrolled in Medicare Part A – on the first day of the month you turn 65. If you are not receiving Social Security at age 65, you are still eligible for Medicare, but you will have to enroll yourself by contacting Social Security.

Medicare Part B, which covers physician costs among other types of services, is an option that you must elect. You should enroll in Part B 3 months before the month you turn 65, but can also enroll the month you turn 65 and 3 months after your 65 birthday. You do that by contacting your local Social Security office or on the Social Security website.

If you chose to continue to work past your 65^th birthday, and you are receiving employer sponsored health insurance, you can defer your enrollment into both Parts A and Part B. When your employer coverage ends, you can elect Part A and enroll in Part B. This is called a “special enrollment period.” The 8-month “special enrollment period” begins the month after the employment ends or the group health plan coverage ends, whichever happens first.

A word of caution, if you fail to take advantage of the special enrollment period, you risk paying a penalty later. www.medicare.gov is good resource for general overview of enrollment periods.

For more information go to:

Medicare: www.medicare.gov

Social Security Administration: 1-800-772-1213 or www.ssa.gov.

Your friend at Health Champion,

Ida

Health Champion Blog

"In Your Corner"