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.

Top 5 Mistakes You Can Make During Open Enrollment

Now that summer is ending and school is beginning, it won’t be long before the busy open enrollment season is upon us. While most of us don’t look forward to wading through benefits descriptions, it’s important to put those feelings aside and invest some thought in the process. Taking time to study your options now could not only save you money, but also affect your health care choices for the coming year.

5 Mistakes to Avoid when Choosing Your Health Coverage.

Buying on price alone. Finding affordable insurance is getting harder and harder, but buying on price alone is often a mistake. Your monthly premium may be low, but can you really afford that high a deductible? Buying a high deductible plan under the assumption that you are healthy and never need to use doctors is risky. Are you prepared to pay the deductible if the need arises? Can you afford the cost shares that may kick in after the deductible is met? If your employer offers worksheets or modelers for comparing the available plans, take advantage of them and do the math.
Not considering your family’s situation. Of course, you can’t predict everything that might happen, but you can look at your current health status. If someone in your family has a medical condition, you can take their care plan – upcoming tests, specialist visits, and medications – into account. You will also want to look at your values and attitudes. If you like to be in charge of your care, you might be willing to pay extra for a plan that doesn’t require referrals to specialists.
Not verifying your providers’ participation status with your health plan. Providers who are considered in plan have a contract. Contracts change and it is not unusual to have providers cancel participation with a health plan. Just because your provider was “in network” and “participating” last year doesn’t necessarily make it so this year. Call the health plan and call your doc to verify. Check your health plan’s website for an up-to-date list of participating providers.
Renewing into the same benefit plan design. Benefit plans change each year. There may be new plan limits and exclusions. Don’t assume nothing has changed. Pay particular attention to your prescription benefit. Drugs lists often change at the time of open enrollment – impacting the tier that drug is on and how much you will pay out of pocket next time you renew your prescription.
Not taking advantage of opportunities to offset cost sharing, if offered. A Flexible Spending Account lets you to put aside pre-tax dollars to use for eligible medical expenses. If you can predict some of your deductible and copayment expenses for the coming year (based on your health needs and the plan design you choose) and put them in an FSA, you can save around 25% on your out-of-pocket expenses by paying with pre-tax dollars.

Perhaps the most important thing you can do is to ask questions. If you don’t understand a benefit offering, ask your Human Resources department. If you’re not sure how much you spent this year, see if you can download your claim history from your health plan’s web site or request a report. Make an informed decision this fall, so you can use your plan with confidence in 2012.

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

Mom’s Getting Older … Now What?

You decide to make an unannounced visit to your 82 year old mom to see how she’s REALLY doing The previous planned visits went pretty well, but you are starting to realize that things are not going as well as she would like you to believe. When you arrive in the early afternoon, she is still in her night gown and is sitting in the dark with all of her medicine bottles open and pills scattered on the table. She says that she is trying to figure out what to take and what she has already taken today. When you open the refrigerator to make her some lunch, nearly all of the food you brought her last week is still there and unopened, and she cannot remember if she had eaten breakfast this morning.

You realize that your mom can no longer manage by herself in her home.

You sit down and wonder … Now What ???

Now is the time to start the difficult conversations about what your mom wants for now and the future. She may not want to hear that she needs help or may have to make some changes to keep her safe.

Here are some tips to help you get started:

Keep in mind that she is probably frightened; frightened about losing her ability to do everyday things, frightened about making changes, frightened of becoming dependent on you and others, and frightened that you are going to “put her away.”
Have the discussion slowly and over several conversations so she can think and internalize what you are saying.
Think about whether a change you are considering is better for you or better for her. You will have to make both types of decisions, but it is important to be aware of why you are suggesting the change.
Do your homework, know what your options are before discussing any changes or alternatives.
Keep her in the loop and don’t forget to allow her participate in decisions about her care and living situation. You may ultimately have to decide on something she does not want, but she needs to be able to discuss her feelings and offer alternatives.

Here are some resources for you:

An independent Geriatric Care Manager: Will come into her home and perform a comprehensive assessment of her home environment for safety and accessibility, her ability to care for herself, and will provide a detailed report with specific recommendations.
An attorney: To be sure her Will, Living Will (or Health Care Proxy) are up to date and to have a Power of Attorney designated in the event she becomes unable to make decisions for herself.
Commission on Aging: Provides information about all of the state-funded programs for the elderly available in her state.
Senior Centers: May have social workers who can help you access senior services in her area. They also may provide day programs, discounted hot lunches, a variety of activities, and free or low-cost transportation to and from the senior center.
Meals-on-Wheels: Is a program that delivers prepared meals to the home. Depending on her income she may qualify for the meals at no charge or a discounted price.
A Health Care Advocate: A health care professional who can identify and evaluate appropriate resources for you and your mom, help you understand and organize her medicines, communicate with her doctors, and be there for you as your mom ages and her needs change.

Caring for the Caregiver

Are you part of the “Sandwich Generation”–caring for growing children and aging parents?

Being the care giver can be both difficult and rewarding. But it is often taxing physically and emotionally.

Emotionally, you are always on alert: when the phone rings, or always listening for that sound of distress. Your life is no longer your own, especially when you have to drop what you are doing or planned for the day to do for others.

Physically, you may not be sleeping well worrying about what needs to be done. You may be lifting from bed to chair to car and back. Or have to be available 24/7.

And who is taking of you?

I am sure you have heard this before, but it is true … You need to take care of yourself to be able to be at your best to care for others!

Here are some helpful suggestions:

Don’t be afraid to ask for help and take help when offered–you cannot do everything yourself
Practice good sleep habits to ensure plenty of good quality sleep
Set aside time for yourself, if it is only sitting quietly for several minutes a day
Exercise regularly to relieve stress and rejuvenate yourself
Feeling sad, scared, tired, angry and stressed is normal–find a good listener to share these feelings with
Let the little things go and focus on the big issues that really matter
Realize that no one is perfect and making a mistake is human
Be flexible and remember that there is more than one way to do things
Keep connected to your spiritual or religious foundation

We all tend to place our needs last, especially when there are others depending on us. You can sustain this for a short time, but the healthiest way for those you are caring for and for yourself is to try to make time to take care of you. Give yourself permission to make one small change for yourself and you’ll find that everyone wins!

Waking Up Confused: Postoperative Delirium in the Elderly

Preparing for surgery is stressful enough, with all the potential complications associated with a fix of whatever’s wrong. But add to the mix, the possibility of postoperative delirium and it’s downright scary. For reasons we don’t quite know, this condition is most associated with joint replacement and heart surgery, particularly in the elderly.

Postoperative delirium occurs in 1% to 61% of patients following anesthesia. It’s characterized by confusion, disorientation, fluctuating levels of consciousness, altered psychomotor activity, and disturbed sleep-wake cycles. These symptoms usually occur on the first or second day after surgery and worsen at night. Underlying dementia can complicate the situation, as symptoms are often confused by the treatment team. This happened to a client of ours with early stage Alzheimer’s disease. He underwent joint replacement surgery and woke from anesthesia experiencing hallucinations and agitation so severe he required restraints. In the following weeks, he slipped into critical confusion and depression. Fortunately, with aggressive advocacy on our part, his symptoms of dementia were distinguished from the delirium and he is now on the mend.

Age, dementia drugs, and certain metabolic diseases increase the risk of postoperative delirium. Approximately 30% of cases are related to drug toxicity, an often preventable risk factor. Before surgery, disclose all medical conditions and drugs and ask the anesthesiologist about your risks. While it’s impossible to prevent postoperative delirium in all surgeries, being prepared will help you and your family pave the way for your best recovery.

Choosing Your Health Care Advocate

Going it alone is NEVER the best choice when it comes to health care. Especially if you have time-sensitive treatments, a complicated diagnosis, or insurance issues to consider. When you need someone on your side — supporting your well-being, getting medical appointments, managing treatments plans or fighting for your benefit rights — you need a health advocate.

A relatively new response to today’s complicated health care system, health advocacy is considered a critical service by CNN and other news sources. Knowing when to hire an advocate, and how to choose one that’s right for you, is key to a successful outcome.

What’s the Problem?

Define your needs before looking for someone to help resolve issues. For example:

Do you need someone to oversee care being provided to yourself or a loved one?
Are your needs related to developing a plan of care for a particular diagnosis?
Is it an insurance issue? Are your benefits being denied?
Do you need help researching the latest technologies and treatments for a disease?
Are you worried about mom and dad living alone?
Will you need the advocate to be onsite at a hospital or facility?

Locating a Private Advocate

An internet search, using the key words “health care advocate” will direct you to advocate websites. Review their areas of expertise; narrow your choices and examine how their services meet your defined needs. Ask for referrals from friends, family members and physicians (use the terminology “case manager”).

Consider the Fit

Like physicians and health problems, advocates come in all shapes and sizes. Some have a “take charge” style” others are more laid back. Finding the right fit is critical. Things to consider:

Have they helped clients with similar issues?
If so, what do they consider a successful outcome?
How many client cases do they work on at the same time?
Do they have a resource network?
How easily can you reach them during the week? Off hours? Holidays?
How do they keep clients apprised of progress?
How does the advocate charge for services: hourly or set rate?

Health advocacy is typically private pay, with fees ranging from $100 – $200/hour. The right advocate will guide you through the health care maze and so that you get the benefits and treatments you need when you need them. And that’s priceless.

Palliative Care: Managing Your Well-Being During Serious Illness

You have an illness that is not going away. And every day it seems to get a little worse. Maybe you have unrelenting pain. Or reduced strength and ability. Maybe just getting around the house requires too much energy. You feel alone, tired and scared. What kind of care will help you live your best life while acknowledging the debilitating effects of your disease?

The answer is Palliative Care. This sub specialty of medicine provides compassionate medical care, helping to manage symptoms and drug side effects while working with you and your family to achieve a quality of life that addresses body, mind and spirit. Contrary to common belief, palliative care is not only for those who are terminally ill and in hospice; it’s widely available to patients suffering from debilitating symptoms of serious illness and those who are aggressively managing the disease.

According to the Center for Advanced Palliative Care, “Palliative care (pronounced pal-lee-uh-tiv) focuses on relief of the pain, stress and other debilitating symptoms of serious illness.” The palliative care team may consist of physicians, nurses, social workers, pharmacists and hospital chaplains. Anyone helping to advocate for your well-being should consider palliative care an essential component of your treatment plan.

Palliative Care —

Can be provided along with treatment focused on curing the disease or illness.
Is appropriate at any time during an illness and does not depend upon a prognosis.
May help control treatment side-effects
Focuses on control of pain, shortness of breath, fatigue, constipation, nausea, loss of appetite and difficulty sleeping.
Is individualized to the needs of each patient and their families and changes with the patient’s needs.
Provided by a team of doctors, nurses, social workers, chaplains, and other professionals to provide comfort and support for both the patient and family.

No matter where you are along the journey toward managing a serious illness, palliative care can help you achieve your goals for a fuller quality of life. For more information, visit www.getpalliativecare.org

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