Here are some typical scenarios when you should call to find out about getting a geriatric assessment or care management eldercare consultation:

1. You go to visit an elderly parent who does not live near you and find things are not what you expected.

2. Your siblings are at war over what to do to help Mom.

3. You’ve tried to bring in help or suggested safety changes and your elderly Dad won’t budge.

4. You have a friend or client who is caring for a spouse with dementia and you can see he or she is wearing out fast.

5. Mom’s at the hospital and the doctor says he doesn’t think she can return home alone.

To find qualified geriatric care managers in different areas of the country, you can contact us or visit the National Association of Professional Geriatric Care Manager’s website. When interviewing care managers, find out about their experience with similar situations, how they plan to approach your situation, and get detailed information about their experience, qualifications and fee structures.

It is always important to feel comfortable in hiring any professional, but especially so in the sensitive situations involved in health and eldercare. Because eldercare often involves a crisis, you may feel panicked to get some help. Any professional in eldercare should respond quickly and be able to provide you with information and answers to your questions to make an informed decision. In the growing field of eldercare there are many individuals getting into consulting or providing services to families, but not all of them have the expertise and standards you would expect. Professional care managers adhere to a strict code of ethics and standards of practice.

You may be concerned about spending money on professional advice and it may feel that this is very personal and something that should be handled within the family. For many families, getting an affordable professional care management consultation helps to set them in the right direction, saving valuable time and money. For these very personal and serious decisions, getting good, tailored advice will be well worth the initial costs.

Fees vary throughout the country, but most care managers offer a consultation and assessment for a one time fee, with no further obligation. This is valuable especially in a crisis, and the services and resources identified will often save you more than you pay. Similarly, care managers can tailor a plan for ongoing services for those that need help with tasks or oversight of care. Ask the care management company about assisting with long term care claims also if you have long-term care insurance.

Contact Aging Wisely today for information on Florida Geriatric Care Management, Eldercare Consultations, and Clearwater/Tampa Bay Senior Services. We welcome your questions via email or telephone!

727-447-5845
admin@agingwisely.com

Related posts:

1. Benefits of a Geriatric Care Management Assessment
2. 3/16 – “Geriatric Care Management”
3. The Positive Results of a Comprehensive Geriatric Assessment

Medicare, Medicaid, and Financing Long Term Care/Caregiving Costs

2012 Medicare Fact Sheet

Long Term Care and Medicaid

Eldercare Costs: Dollars and Sense

Click here for more on how Aging Wisely can help with insurance choices, navigating your coverage and understanding Medicare, Medicaid and other senior care benefits.

Memory Problems with Aging, Alzheimer’s and Dementia

What is Sundowner’s Syndrome?

Alzheimer’s, Dementia, Sundowner’s, Old Age-What is it??

Ten Warning Signs of Alzheimer’s Disease

Hospitalizations and the Elderly: Discharge Planning & Safe Transitions of Care

Problematic Transitions of Care: Concerns & Causes in Discharge Planning

Hospital Discharge Checklist for Families

Taking Control: What You Can Do to Ensure a Safe Discharge from the Hospital

Some other popular caregiving posts:

Assisted Living Options in Florida: Making Wise Choices

Gift Ideas for Seniors

A Caregiver’s Story: Interview with the Author of Mothering Mother

If you would like to receive regular updates from us with caregiving articles and important eldercare news in the coming year, we invite you to sign up for our blog RSS feed or monthly email newsletter.

Contact us for help today with caregiving issues, financial programs to assist with care, and comprehensive geriatric care management assessments and advocacy.

Related posts:

1. Resources & Services After Hospital Discharge: What Can You Expect?
2. Florida Senior Care – Eldercare Resources
3. Medicare 2011 Costs: Good News and Bad News

•Meet with your attorney (or contact us to get referred to one) to review your estate planning and advance care planning documents. Key documents you need to consider (and possibly update if you have not reviewed in a while, or have had life changes): Living Will, Healthcare Surrogate (health power of attorney), Durable Power of Attorney, Will and/or Trust.

•Talk with your family member about the execution of these documents, especially those you have designated as possibly substitute decision makers.

•Make sure potential decision-makers have copies of the relevant documents, as well as know where your important papers and key information are located.

•Organize your paperwork for this year’s taxes. Make sure to include receipts from charitable donations. If you’re having trouble keeping up with paperwork, you might want to consider daily money management assistance. If you’re helping a loved one, pay attention to any difficulties with paperwork, forgetting about bills or surprising purchases as these may be signs that it has become difficult for your loved one to manage financial affairs alone.

•Organize your health records. This will save you time and stress at various doctor’s appointments, ensure better continuity of care and help any family members who assist you (now or in the future). Minimally, set up a health notebook or file, with: list of medications (current and discontinued), diagnoses, allergies, surgeries and other key health history (it may also help to make notes of family health history). Consider secure, online programs for managing this information and better access.

Make it your New Year’s resolution to do at least one thing to age more wisely! Whether it be a health and wellness goal, a “bucket list” item, reducing stress or preparing with the checklist above, make it your goal to do something that will positively impact your quality of life.

Sign up for the Aging Wisely newsletter for great tips and articles each month and contact us if you have questions or need assistance with caregiving matters or resources for wise aging.

Related posts:

1. Eldercare Preparation: Legal Power to Make Decisions
2. Older Adults Concerns About Aging & Eldercare
3. Facebook | Aging Wisely, LLC

Preparing Ahead

Encourage your loved one to meet with a financial advisor and estate planning/elder law attorney. Know who your loved one’s advisors are and encourage open communication.

Execute important legal documents such as: Durable Power of Attorney, Healthcare Surrogate/POA, Living Will, Will/Trust.

Know the location of important papers-see our “document locator list”.

Ask if your loved one has thought about what they would like to do if assistance is needed (educate yourself on basic options/costs, consider family situation and realistic alternatives). Discuss expectations and what is realistic.

Open up the lines of communication: the more discussions can begin prior to crisis, the better. It helps if you have basic understanding of the financial situation and talking regularly can alert you to concerns and encourage discussion.

Offer assistance with areas in which your loved one feels comfortable letting you help. Consider hiring a home caregiver to help with household tasks, transportation, meal preparation and other needs.

First Signs

See “Am I in Denial?” handout for signs to watch for in your loved one.

Other potential red flags to watch for: your parent takes multiple medications or visits several medical specialists, recent hospitalizations, falls or injuries, confusion/memory loss, difficulty with financial management or excessive concerns regarding finances.

Try to ensure family visits regularly and/or hire a professional geriatric care manager to do spot checks if you cannot be there.

Watch carefully for concerns regarding proper handling of medications.

Have a home safety assessment/evaluation of resources to maintain independence.

Begin keeping a health record by creating a file or using an online system to maintain basic records, medical contacts, records of surgery or interventions (consider attending key medical appointments or hiring a patient advocate to do so).

Research potential assistance in the area-know key numbers and what might be available now and in future.

Get contact information for key professionals (attorney, tax advisor, financial advisor, doctors), friends and neighbors and make contacts where possible. Attend meetings and establish relationships with these professionals as your loved one allows. These relationships can “multiply your eyes and ears” and ensure professionals have the permission to contact you with concerns.

Have a family meeting or conference call to discuss concerns, duties and how to approach the situation.

Offer assistance with items such as financial management-bill paying, Medicare/insurance, coordinating medical appointments or engage professionals where needed.

Offer help with shopping, errands, driving, housecleaning.

Begin a more in depth look at resources and discussion regarding options.

Deteriorating Health/Crisis

Call on trusted professionals and ask them about resources.

Hire a geriatric care manager to do a professional assessment, which can assist with the following:
>>Understanding your loved one’s income and asset picture and how this will affect care options/resources. Do they have sufficient income stream to pay for care at home/up until what point? Can they afford privately paying for care facilities? What are costs in local area? If limited resources, what public benefits are available and how do they intersect with needs? How scarce are public benefits? What planning can be done? What does their various insurance cover?
>>Understanding care options and levels of care.
>>Putting monitoring systems into place and managing medical concerns and care.

Take advantage of windows of opportunity (parent has a fall, becomes hospitalized, brings up a concern or need for help with a task–these are key times to discuss wishes, look at options, and bring in help).

Is it Time for a Move?

Has it become too difficult to manage at home?

Have your parents been scammed or become particularly vulnerable or easily influenced by others?

Is the care needed to stay safe at home too costly?

Could your loved one benefit from the socialization of a group environment? Is your loved one isolated or relegated to contact primarily with care providers?

Understand what is available to help in home/community based services so you will know when those options are no longer enough or inappropriate. Similarly, understand the levels of care and settings available in facilities.

Consider the emotions involved and what the best approach might be. Confer with siblings and ensure you are on the same page first.

Know the reality: have you or your loved one visited a retirement community? Put aside past prejudices by seeing what there is to offer today in your area.

Consider professional assistance in choosing the right facility. A care manager can pinpoint options that are appropriate, save you a lot of time and frustration, give you the background on the quality and levels of care provided, and help coordinate the process.

Other resources that may be needed: moving company, estate sales, realtor, junk removal, storage unit, appraiser, cleaning service, home staging company, property manager, attorney, etc.

As Things Progress

Revisit your loved one’s wishes and take a step back to consider them as decisions need to be made.

Confer with medical professionals on prognosis, treatment options, and expected results. Ask questions and prepare ahead for appointments. Make sure the medical specialists are the right fit.

Take time to process emotions, care for yourself, share memories, and be with family.

Keep in mind quality of life and its meaning to your loved one. Don’t overlook small things: the comfort of favorite pajamas, the dignity of having a nice hairdo, a homemade treat or favorite drink or meal, a book or newspaper, or someone acknowledging the person’s memories and accomplishments.

Inquire about options such as hospice and palliative care. Educate yourself and talk to medical professionals about options, even if they do not raise them.

Take some time to work on organizing and simplifying, to cut down on the stress of dealing with financial and estate matters during caregiving and after death.

Ensure funeral arrangements have been made or you have at least talked to your loved ones about their wishes.

If you want to discuss your family’s eldercare situation or concerns about an aging parent, contact us for help. We also encourage you to sign up for our monthly email newsletter as a good way to stay educated on eldercare topics such as Medicare, caregiver resources and aging health.

Related posts:

1. Family Conflicts in Elder Care
2. Eldercare Preparation: Legal Power to Make Decisions

Aging Wisely, LLC was chosen as the 2011 winner of the Patient Advocacy Award in the category of “Patient Advocate Organization”. This award is presented by the Professional Patient Advocacy Institute, which is “a member organization and a community aligned around the common cause of providing advocacy for consumers as they strive to secure their healthcare needs and cover their insurance and financial matters”. These awards are intended to set the benchmark for recognizing those who provide leading patient advocacy on behalf of patients and their families.

Aging Wisely has been serving elders and a variety of clients and their families since 1998, providing care management and advocacy services. Aging Wisely serves clients in the Tampa Bay area, as well as consulting with families all across the country.

Aging Wisely not only assists clients and families on a daily basis with advocacy, but also reaches out to improve broader advocacy efforts in the community and improve overall healthcare and eldercare. Aging Wisely’s advocacy efforts also go beyond the local community and clients served. From an early stage, Aging Wisely focused on having a strong educational component in its website and other communications. Aging Wisely’s blog presents advocacy topics on a regular basis, which are also shared through social and traditional media to benefit consumers as well as professional colleagues. Aging Wisely’s blog and email newsletter were recognized as finalists in SeniorHomes.com “Best of the Web” last year, among many well-recognized national organizations. Over 2,000 people receive Aging Wisely’s monthly newsletter, keeping them apprised of recent healthcare news, eldercare resources and tips.

“We are proud that our team has been recognized for our advocacy efforts. As we have evolved as an organization over the years, we have strived to constantly improve and educate ourselves for our clients’ benefit. Our mission is all about ensuring quality of life in all aspects for the clients and families we serve,” says Linda Chamberlain, founder and President of Aging Wisely, LLC.

Contact us with questions or to learn more about Aging Wisely.

Visit Aging Wisely’s blog for advocacy and eldercare information.

Sign up for our email newsletter for monthly tips and news updates.

Related posts:

1. Tampa Bay Care Manager Wins National Award
2. Aging Wisely Moves to New Office Space
3. Aging Wisely April 2011 Care Manager Certifications

Aging Wisely receives many calls from family members all across the United States who have concerns about an elderly relative(s) living in Clearwater/Tampa Bay. Sometimes there has been a crisis such as a fall or hospitalization, or the loved one is trying to find out what eldercare resources and aging services exist in Florida. Many times the son or daughter is just concerned about Mom or Dad, perhaps after a recent visit in which things seem to have changed.

We have previously shared some resources to help caregivers with this topic:

Warning Signs for Family Members (Am I in Denial about Potential Problems?) & Resources to Help

10 Warning Signs of Dementia/Alzheimer’s Disease

Tips for Long-Distance Caregivers: What to do on a visit with your aging loved one

Signs and Symptoms of Depression in Older Adults

With the holidays (and wintery weather up north), this is a time of year when many long-distance family members visit their loved ones in Florida so we felt it was important to revisit this topic and offer some advice and tips. If you notice any of the signs in the articles above or see major changes in your loved one, it may be time to consider setting up an eldercare consultation, getting a geriatric care management assessment and/or bringing in some in-home senior care to ensure safety and wellbeing.

Here are some pointers about how you can prepare to handle concerns as a long-distance caregiver:

• Ask your parent, for planning purposes, if they are willing to introduce you to key professionals who you may have to interact with in case of an emergency or change. Find out for example, if your parent is willing, what various doctors’ offices need so that you are permitted to receive information (a healthcare surrogate document is important for you to act on someone’s behalf, but you may also need to assist your parent while he or she is still competent and typically the doctor’s office has a privacy form on which the patient can permit access). Get contact information for professionals such as your parent’s financial advisor and CPA and get introduced or attend an appointment if feasible.

• Has your parent executed advanced planning documents to allow someone to step in to make decisions when needed?

• Is your parent close with neighbors? Make sure they have your contact information in case of an emergency. Be conscious of not relying unrealistically on neighbors, however.

• Does your parent have a File or Vial of Life? This is information posted for emergency personnel, which includes emergency contact persons, medications, and conditions/diagnoses. Your local fire department and the Red Cross can usually provide the File or Vial of Life (The Vial is a medication-like vial that goes inside the refrigerator with the information inside, and a red dot to alert medical personnel that it is there, whereas the File of Life is a magnetic pouch which is placed on the refrigerator door). You may also contact Aging Wisely and we can provide you a complimentary File of Life.

• Consider installing a personal emergency response system (system to call for help).

• What type of plan do you have in place for checking in? Consider setting up a schedule of visits with various family members as well as checking in via telephone. A home health caregiver coming in weekly can also help ensure someone is there regularly and can help your parent with tasks he or she finds difficult.

Noticed some concerns on your recent visit or call with your elderly parent? Want to talk to someone about how to address your concerns with your loved one? Think it may be time to get a geriatric assessment to really get a pulse on how your aging parent is managing?

Contact Aging Wisely for answers, advice and peace of mind.

Related posts:

1. 10 Warning Signs of Alzheimer’s
2. Vial of Life
3. Long Distance Caregiving

Why is this happening more? There are a number of factors causing this phenomena, including regulatory and payment issues. As Medicare (and private insurers) crack down on hospitals and providers for what might be considered unnecessary care, the providers are more cautious about each case and carefully looking at criteria for admission. There are several sets of criteria that doctors and providers use to analyze the medical necessity of an admission…all of which means little to the average elderly person or caregiver. What you probably think is…”well, I spent the night at the hospital so I was admitted” or “My Mom has been at the hospital a few days now and so this should be like any other hospital stay”.

What’s the difference between being admitted and being under observation? Being admitted to the hospital is not a matter of spending the night, getting a lot of tests and care, etc. A doctor has to write an order specifically admitting you as an inpatient, based on his or her analysis of medical necessity/use of standard criteria. How do you know if you or your loved one has been admitted? Ask your doctor or the hospital to confirm for you. As a caregiver and patient advocate, it is vital to ask a lot of questions and take good notes on the hospital stay anyway, and it can come in handy for billing issues as well. If you are not comfortable with what questions to ask or reviewing a medical chart, consider the value of a professional patient advocate.

What difference does it make? The main reason to know about your status at the hospital is the potential costs you will face. Here is Medicare’s summary of what you will pay if you are not admitted to the hospital: “Medicare Part B covers outpatient hospital services. Generally, this means you pay a copayment for each individual outpatient hospital service. This amount may vary by service. Note: The copayment for a single outpatient hospital service can’t be more than the inpatient hospital deductible. However, your total copayment for all outpatient services may be more than the inpatient hospital deductible”. As an inpatient, you are covered under Medicare Part A, which has a deductible of $1132 ($1156 in 2012) for any stay up to 60 days. In addition, for Medicare to cover inpatient rehabilitation/nursing care, a person must have a three-day qualifying hospital stay. If you are not admitted to the hospital, you will not qualify. Each day in inpatient rehabilitation can cost hundreds of dollars, so this care can be quite costly to pay out of pocket when you may need this follow-up care for recovery.

Click here for Medicare’s overview of Hospital Inpatient vs. Outpatient Status.

Click here to read Aging Wisely’s Medicare 2012 fact sheet, with all of the Medicare costs and important information about coverage.

Contact us today for information and assistance with Medicare analysis and consultation, patient advocacy and eldercare/geriatric care management services in Tampa Bay/Clearwater, Florida.

Related posts:

1. Hospital Discharge: Checklist for Families
2. What Can You Do To Ensure a Safe Hospital Discharge for Elderly Loved Ones?
3. Resources & Services After Hospital Discharge: What Can You Expect?

There are a number of benefit programs designed to help our Veterans, but the system can often be complex to navigate. In honor of Veterans Day, we wanted to give an overview of some of the programs that are most applicable to aging veterans, or senior veterans needing care, medical help and other assistance as they age or deal with the progression of disabilities. This is not meant to be an exhaustive list of all benefits and all the details, but we will also provide some resources to continue your research. Many times elder clients, veteran or not, can benefit from starting with a care management assessment or family members may wish to take advantage of one of our eldercare consultations to pinpoint the variety of resources that might be available to help.

To start, one of our favorite resources in the state of Florida to help with Veterans’ Benefits is the county Veterans Services office. Each county in Florida has such an office, run by the county government, to help local Veterans navigate and access benefits. Here is information for the local county Veterans Services offices in Tampa Bay, Florida:

Pinellas County Veterans Service Office website
Main Office
2189 Cleveland St., Suite 201,
Clearwater, FL 33765
(727) 464-8460

St Petersburg Office
501 1st Avenue N., Suite 517,
St. Petersburg, FL 33701
(727) 582-7828

Pasco County Veterans Service Office website
West Pasco: 8620 Galen Wison Boulevard
Port Richey, FL 34668
(727)834-3282

East Pasco: 13853 15th Street
Dade City, FL 33525
(352)521-5172

Hillsborough County Veterans Affairs website
Flier with map and contact information for Hillsborough County Veterans Affairs offices.

Compensation and Pension: Some of the most common benefits provided to our elderly Veteran clients are in the Compensation and Pension category. As a brief overview: You may receive a monthly compensation if you are at least 10 percent disabled as a result of your military service. Also, you may receive a monthly pension if you are a wartime veteran with limited income and assets and are permanently and totally disabled or at least 65 years old. Many of our clients who do not have a disability rating from their wartime service are able to benefit from the pension as they age. The eligibility is based on having limited assets and income, but these requirements are typically less stringent than, for example, Medicaid qualifications.

Specifically, there are additional pension levels called “Aid & Attendance” and “Homebound” which provide higher benefit amounts for individuals needing care and assistance, which take in to account the Veteran’s medical/care expenses. Spouses/widows may also be eligible for pensions. Here is the VA page about Compensation and Pension Benefits for Veterans.

Additionally, Veterans who require Nursing Home care (not Assisted Living) due to a service-connected disability or are 70% to 100% service-connected may receive such care from the VA. Each VA hospital in the Tampa Bay area (Tampa and St. Petersburg/Bay Pines) has a nursing home. The VA hospitals each have one or more “contract” nursing homes in each county of their catchment areas. For example, Pinellas County has 17 contract nursing homes in the Bay Pines VA Hospital catchment area.

Veterans’ Health Care: There are several different ways to qualify to receive healthcare through the VA and at the VA medical centers and clinics across the country. To learn more, visit the Veterans Service Office or read more at the VA website link regarding healthcare.

Burial Allowances/Funeral Benefits: VA burial allowances are partial reimbursements of an eligible veteran’s burial and funeral costs.

How Much Does VA Pay?
Service-Related Death. VA will pay up to $2,000 toward burial expenses for deaths on or after September 11, 2001. VA will pay up to $1,500 for deaths prior to September 10, 2001. If the veteran is buried in a VA national cemetery, some or all of the cost of transporting the deceased may be reimbursed.

Nonservice-Related Death. VA will pay up to $300 toward burial and funeral expenses and a $300 plot-interment allowance for deaths on or after December 1, 2001. The plot-interment allowance is $150 for deaths prior to December 1, 2001. If the death happened while the veteran was in a VA hospital or under VA contracted nursing home care, some or all of the costs for transporting the veteran’s remains may be reimbursed.

For more on this, read the VA’s document on burial help or one of the county service offices.

We salute our Veterans for all that you have done for this country! It is our honor to serve Veterans and to help all of our elder clients to access the help and resources they need. Contact us at 727-448-0900 today for questions and assistance.

Related posts:

1. Finding Affordable Senior Care Options: Care Plans & Budgets for Eldercare
2. Senior Care Facility Gives Residents the Thrill of a Lifetime
3. Florida Senior Care – Eldercare Resources

We are currently in one of Medicare’s annual open enrollment periods. This year, from October 15th to December 7th, Medicare recipients can switch Medicare drug plans (Part D) and switch to or from a Medicare Advantage plan. Each Medicare recipient or caregiver should review their current coverage during this period. Plans make changes and it is likely you or your loved one has had some health changes, which may cause a different plan to be more appropriate for you. The changes you make become effective on January 1st. Additionally, from January 1st-February 14th, those enrolled in a Medicare Advantage plan can disenroll and switch back to regular Medicare (this is the only change that can be made during that period).

Medicare Advantage Plans are an option for receiving various Medicare benefits via a private insurance company. Typically, these plans will have preferred providers or networks (or providers may not accept the coverage due to the reimbursement rates) and may require a primary care physician or have other restrictions. They may also include additional benefits such as eye or dental care or gym memberships, and the deductibles, co-pays, etc. are usually less expensive for the recipient. If a person is enrolled in a Medicare Advantage Plan and is not pleased with the plan’s coverage and choices, there are several special enrollment periods to make changes.

You may, for example, be caring for an aging parent who is enrolled in a Medicare Advantage plan and becomes hospitalized. After the hospital stay, he/she may need inpatient rehabilitation care at a Skilled Nursing Facility. However, the Medicare Advantage Plan may have limited skilled nursing facilities within the network and you may not be pleased with the options. In that situation, there is what is known as the OEPI (Open Enrollment Period for Institutionalized Individuals). Persons “institutionalized” (i.e. residing in or moving in and out of a skilled nursing facility and other eligible institutions) have a continual enrollment period. The person can disenroll from a Medicare Advantage plan while in the facility and return to regular Medicare (or a different MA if accepting enrollment) the beginning of the next month.

There are other special enrollment periods for those wishing to switch plans, including a “trial period” when you first sign up for a Medicare Advantage Plan of 12 months, in which you can disenroll and switch back to standard Medicare at any time during that period. If you are concerned about coverage under any plan or do not understand a plan’s coverage decision, it is important to learn about your Medicare rights, including the right to appeal. Medicare and health insurance can be complicated to navigate, so it is vital to be your loved one’s advocate as a caregiver and to seek outside help when you have questions or difficulties.

We will be covering a number of the key issues that surprise caregivers about Medicare coverage in upcoming blog posts so stay tuned, or sign up for the Aging Wisely blog feed to get updates.

On November 17th, we are offering a free educational seminar, The Ins and Outs of Medicare, in honor of National Family Caregivers Month. Come learn more about Medicare coverage, questions to ask and how to better understand your coverage. We navigate the healthcare system every day with our clients, so let our expertise benefit your family.

If you would like help analyzing your Medicare plan during this year’s open enrollment period, or you are preparing to retire and want a complete analysis of your options and what you need to do regarding Medicare coverage, call us today at 727-447-5845 or fill out our contact form to discuss our Medicare Analysis services.

Related posts:

1. Medicare Part D Information
2. Medicare 2011 Changes
3. 2011 Medicare Fact Sheet

2012 Medicare Fact Sheet

Part A: “Hospital Insurance”, covers inpatient hospital, certain skilled nursing and skilled home health services. It does not cover long term or custodial care.

Part B: “Outpatient Services”, covers Medicare eligible physician’s services, outpatient hospital services, certain home health services or therapies, and durable medical equipment.

Part D: “Prescription Drug Coverage”, offered through stand alone plans via private insurers or as part of a Medicare Advantage Plan.

Medicare Advantage Plan (AKA Part C): Health Plans such as PPOs and HMOs that are approved by Medicare and run by private companies. Beneficiaries opting for Medicare Advantage chose to receive the various Medicare benefits through the insurer rather than the traditional Medicare program.

Medigap Plan (AKA Supplemental Policy): These policies help pay some of the costs not covered by regular Medicare (such as co-pays/deductibles).

This information provided by Aging Wisely, a comprehensive care management company offering medical advocacy and care management services. We offer a personalized Medicare Analysis package to help you through the Medicare maze, as well as assistance with benefits, resources, assessments and recommendations for your eldercare & disability needs. Contact us at 727-447-5845 or www.agingwisely.com.

Reference: medicare.gov or 1-800-MEDICARE

Initial eligibility: When you first become eligible for Medicare (age 65 or typically, 24 months after receiving Social Security Disability) your initial open enrollment for Parts B and D is a 7 month window (including the 3 months before and after month of eligibility). If you receive SS benefits, you will automatically receive a Medicare card and be signed up for Part B (follow instructions on your card if you wish to reject Part B). Part D requires you to sign up. If you are covered by an employer or other plan, your benefits coordinator can provide information on how it works with Medicare. If you will be covered by another entity, you should confirm the plan is “creditable” (the same or better than what Medicare offers) and save the letter of creditable coverage. If later, this coverage ends through no fault of the individual, you can enroll without penalty. During the first 6 months of Medicare eligibility you are also guaranteed issue for a Medigap/Supplemental policy.

Penalties: The penalty for not enrolling in a Part D plan is 1% of the national base premium multiplied by the number of months you did not enroll and were eligible (and went without creditable coverage for 63 continuous days or more), rounded to the nearest 10 cents. This amount is added to your monthly premium every month as long as you are enrolled. In most cases the only chance to enroll or switch plans after initial eligibility for Part D is the annual election period (10/15-12/7 with coverage beginning January 1st), although there are some special election periods for certain circumstances. Late enrollment for Part B carries a 10% per year penalty, if you did not have other “creditable coverage”.

Plan Costs: Many Part D plans have had what is known as a “donut hole” or coverage gap, meaning that once you received a certain amount of coverage each year, you pay all out of pocket costs until you reach “catastrophic coverage”. The donut hole will be incrementally decreased until it is eliminated in 2020. In 2012, recipients who hit the donut hole will receive a 50% discount on brand-name drugs while in the donut hole (but, the full cost of the drug is applied to overall credit for getting out of the donut hole).

Medicaid/Financial Assistance: People who are “Dual Eligibles”, eligible for both Medicaid and Medicare, will be automatically enrolled by Medicare into a Part D plan, but can chose another plan if they would like (from amongst certain “low cost” plans). Individuals will have co-pays on their medications through Part D, unless they are “institutionalized”, i.e. in a nursing home. There are several different types of Medicaid programs available with varying levels of benefits, as well as additional help through Social Security for those with limited income and assets.

Analyzing Plans: Medicare offers a plan compare tool online, which can show you the total estimated cost of the plan for the year based on current personal factors. To effectively use the tool, have all of your information available including your list of medications and dosages. Started in 2011, higher income individuals pay an income-adjusted amount on top of the Part D plan’s standard premium. We offer a personalized Medicare Analysis Package, for individuals who prefer to have an expert walk them through the analysis, explain options and assist in making smart decisions about healthcare coverage. Contact us today to learn more about how we can save you money and provide independent guidance.

Medicare Advantage: The Medicare Advantage Plans (AKA Part C) are privately run plans approved by Medicare, and generally combine a number of the different benefits into one plan. These include HMOs, PPOs, and Fee for Service plans. They are often able to include extra benefits such as health club memberships or vision/dental coverage. These plans may be appropriate for certain individuals, especially those looking for extra benefits at lower cost. However, it is important to understand the coverage and restrictions. The HMO and PPO plans have networks of providers, meaning the potential doctors, specialists, and rehabilitation choices may be limited. The Fee for Service plans do not have networks, but not all providers participate due to negotiated fees so your doctors and providers may not be available. Typically, you get your medication coverage through the Advantage plan and won’t be able to use a Medigap plan for costs while enrolled in Medicare Advantage (however, be aware if you drop a Medigap plan you will likely not be able to repurchase and will not be guaranteed issue). Clients should review all options carefully and weigh the pros and cons of each plan. If clients find themselves in a plan they do not like, there are options for disenrolling and returning to regular Medicare coverage.

It is also wise to reevaluate your Medicare plan choices each year during open enrollment, as the plans make modifications, more options become available, and your health status changes. Many Medicare recipients are not in the best plan for their current needs. Review your Medicare and You handbook (available online at medicare.gov) for rules & information.

Medicare generally does not cover: long term care, routine dental care, dentures, cosmetic surgery, hearing aids (some Medicare Advantage plans add extra benefits such as dental or vision).

Related posts:

1. 2010 Medicare Fact Sheet
2. 2011 Medicare Fact Sheet
3. Alzheimer’s Fact Sheet