These plans can change yearly, so review your plan’s annual renewal information carefully. Some people may receive a letter from their MA (Medicare Advantage) or Part D (Medicare Drug Plans) company discontinuing their plan for 2016. If this happens to you, you will need to take some action or you will be put back into original Medicare by default. On the other hand, this letter will guarantee that you can move to any plan in the state, so do not throw it away.

• Review your benefits, they may have changed
• Check to make sure that your providers are still listed as in network
• Make sure your drugs are covered, watch for any new restrictions
• Look at your copays for the new year
• Contact your insurance company with any questions
• Consider consulting a local insurance agent, they know the environment for the new year as it applies locally, typically better than someone from a national
• organization
• Be an advocate for yourself, ask questions about what matters to you and take the time to get answers
• Remember that nothing comes ‘free,’ a low-cost plan is likely that way for a reason

On top of your regular finances in the later years (pension, 401k, social security, etc.), it is wise of you to consider other ways to help mitigate costs in retirement. Here are some things we recommend frequently to help with just this:

• Schedule an appointment with your insurance agent to update policies every year. At this point in life the needs of your care will change over time, and your insurance coverage will likely need amending to accommodate that. Always make sure you have the best coverage for your needs and medication, your plan should feel yours.
• If you or your spouse is a United States Veteran and either of you require daily assistance with medications or self-care, you may be eligible for a monthly Veteran’s pension to augment your Social Security or other pension income.
  Consider long-term care policies. If you already have it, read the fine print. These products have changed over the years so review your coverage to make sure you understand what it does and does not cover.
• Seek out a trusted third-party specialist to help navigate these things. There is a community of professionals that want to help you.

Often times this does become a tough issue for both parties. They may feel the same way you do, but be unsure of what that could mean to the children and grandchildren. Things like ‘but where will we celebrate the Holidays?’ often prevent grandparents from downsizing their homes, shift to living with family, assisted living or other options.

• Are they using the rooms upstairs or having difficulty doing so?
• Is the yard as maintained as it used to be?
• Is there a risk of falling in the home?

First off, Healthcare.gov is an extension of the Affordable Care Act (ACA), also known as Obamacare. ACA was made to be an option for those, especially in an income range up to 138% of federal poverty level (a range up to about $47,000 for a single person), to receive coverage with reduced cost. This cost comes in the form of a tax-break or subsidy to be applied directly to premiums or when filing taxes at the end of the year.

This is a great question, and involves a bit of number crunching on your end. The first thing to note is that this will vary on a case-by-case basis, but looking at potential costs, especially between Medicare Advantage Plans (MAP, or MAPD with prescriptions) and Original Medicare with Supplemental Plans and Part-D for drugs, is something I get asked about quite a lot. Here is how to think about this to find the best solution:

• If you have a MAPD plan, you can either 1) submit a disenrollment request to your MAPD plan and then enroll in a Part D plan, or 2) the easiest way is to properly enroll in a Part D plan first, which then automatically disenrolls you from your MAPD.
• If you have an MA only plan, if just going back to Original Medicare – you must request disenrollment from your MA plan. If also enrolling in a Part D (RX plan), you may properly enroll in a Part D plan and that will cause your dis-enrollment in the MA plan.

Medicare Prescription Drug, Part D covers prescription medications. Part D plans have an initial coverage period (in 20016 up to $3,310 in medication costs), which may include a deductible. Then the person would most commonly have a coverage gap or donut hole. Drug manufacturers write off a portion of the drug costs during this period so that the insured pays 45% of brand RX costs and 57% of generic costs. After the insured has paid $4,850 out of pocket, the Part D plan pays all but 5% of drug costs or a small co-pay.

A patient advocate is a consultant who supports a client with a variety of needs, both in a medical setting and at home. They may be a medical professional, a social worker, or a lay person with experience with chronic disease or with helping a loved one navigate their own health journey.

“Triggers” are essentially the conditions necessary for benefits to be payable. To make LTC claims for specific diseases or disorders there are often a list of many possible triggers, with a set number necessary to make a claim based upon that condition.

Think of what you can afford to commit later on down the road. The average caregiver can easily spend up to 20 hours (or more) a week caring for someone with this disease. This can obviously cause one to have to quit or cut back on work.  Some basic things you can do now to prepare are:

• Prepare legal documents in advance (any possible future inheritance to be changed
• Align insurance with future needs (review beneficiary arrangements)
• Get in touch with the whole family, get them on board with any plans now if possible
• Investigate, and potentially contact, home health and facility options
• Monitor the disease, be prepared for changes before they are necessary
• Stay informed! Be realistic.  Ask questions and seek out professional guidance

The better question in this regard is “what do I need to ask?” The idea here is that you need to ask yourself, your parents, and anyone else involved what needs have arisen already, and where the future will take you. For instance, depending on a diagnosis the answers here could change greatly.

• A tough question – When should my parents stop driving
• Who will take care of them
• Who will pay for it
• Is home health a long-term or short-term solution

Suzanne,

• Getting a will written that includes advance directives and wishes.
• Include POA (powers of attorney) for healthcare and finances.
• In some cases a trust may be in order.

This can be a difficult question to pose for families dealing with any chronic illness. Due to Alzheimer’s trademark neuro-degenerative properties it can be especially difficult. Although it may be difficult to speak of at this time, the pros to planning for this kind of thing typically outweigh the cons. The outcomes of any crises that arise later are likely to be far worse without a plan in place. If a facility is needed on short notice the family may have little choice where to send their loved one, and will instead have to settle for wherever openings are present. These types of scrambles could lead to you, or your siblings, missing work and dealing with a good deal of unnecessary stress. My advice is to consider what will motivate your other parent or siblings in to action to plan for the what-if situations. These could include the family home, residential accommodations, power of attorney, etc.

This is a great question. Many times if an adult child and family are actively involved in getting together and helping their parents starting around age 60 or so, parents tend to listen and follow the advise of their adult children more so. This question is very good and look to my May Column in Healthy Cells to read more.

The best way to prepare for a future financial event is to have a financial power of attorney in place. Secure legal advice to obtain this document.

For (Original) Medicare to pay for skilled nursing home (SNF) services, a your father would need to have been hospitalized as an inpatient for 3 days and then confined in the SNF within 30 days. Medicare would pay the first 20 days if be receiving a high level of skilled care. Medicare would continue paying for skilled care with a co-pay as long as 100 days in a benefit period. Ability to pay is not a factor.

You have several options, but perhaps the best is to look to an assisted living facility where mom can stay for several weeks while you are gone. You will need to privately pay, but I believe you will find the price fair and about the same as a hotel room.

The way the LTC claim is presented may be critical in getting a claim which meets criteria paid quickly and correctly. We can help you examine his situation and help him make claim.

Some, but not all, retirement communities allow residents to keep their small pets. Usually, a dog would need to be 30 lbs or less.