Affordable Care Act & Insurance: April 2013
By: Diane Keefe, Geriatric Care Manager
Affordable Care Act
Healthcare currently costs 25% of the economy. People are living longer with multiple conditions. Because of the recent economic downturn, many of those 50+ have lost significant savings for their retirement. This Act will provide everyone with affordable insurance.
Here are the exceptions:
- Those 18 to 25 can get castastrophic insurance only.
- Those on Medicare will not need to be on it.
- Anyone objecting based on religious beliefs.
What It Covers |
The Affordable Care Act is 900 pages outlining the following:
- An insurance pool is being created which will provide health insurance to everyone regardless of pre-existing conditions. The larger the pool, the more costs can be spread around.
- There will be a 30-60 day enrollment period
- If you have a change of life circumstance i.e. divorced or widowed, you will be able to get insurance immediately.
- In the current version, doctors will be incentivized to talk to one another regarding the care of a patient.
- If a person has low income, the government will pay their premium
- If they are over 400% of poverty level, they will need to pay 10% of their income on insurance
- Employers with over 50 employees will be required to provide insurance for them. There may be higher co-pays.
- Doctors will be required to be online with medical records in 2014.
- States will be required to have an exchange ready by January 2014 or to let the federal government handle it. Missouri opted to have the federal government handle it.
- Children can be on the parent’s policy until they are 26 despite living somewhere else.
- Hospitals will be required to ensure that care continues upon discharge and there is no re-admittance within 30 days. Hospitals will not be paid for infections picked up during the hospitalization.
- Those in the age bracket of 55-64 will be charged more because they are likely to use more health care. They will be asked if they smoke and if they are obese.
Possible Negative Consequences |
Here are some possible negative consequences from the Act. It is a starting point.
If employees work less than 29 hours, these employees will not be counted toward fines if the employer is not providing insurance. Currently, taxes and fees in the law are directed to industry.
Women pay more for insurance over a lifetime because they have children; live longer and are more apt to use the system.
40% of rural hospitals will go out of business because they cannot afford to take in the uninsured. Rural people will not have enough professionals to serve them. They will be directed to the closest cities. More will be served by Nurse-Practitioners.
Some insurance policies have been grandfathered in. This will only continue if premiums are not changed or there are no other changes in the policy itself.
The cost of premiums may go up.
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Understanding Medigap Policies
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Medigap policies were put into place to cover out of pocket expenses that Medicare did not cover. They offer 6 months of guaranteed issue meaning that you don’t have to qualify during that time period. After that, you may have to meet certain criteria and premiums may be higher.
Here is what all Medigap plans A through N cover:
- Coinsurance for day 61-90 of inpatient hospitalization
- Coinsurance for lifetime reserve days 91-150
- Coverage for an additional 365 days of inpatient hospital care in your lifetime
- Coverage for the first three pints of blood
- Coverage for 20% coinsurance for Part B services
- Coverage for hospice 5% coinsurance for Medicare-approved charges for inpatient respite care and 5% coinsurance for prescription pain medications
The plans A through N differ in what they cover from this point. Some offer coverage for foreign travel emergency, portions of the skilled nursing coinsurance, coverage of Part A deductibles and out of pocket expense.
These plans offer a Special Trial Right to try out the Advantage Plans for up to a year. They give you the right to convert back at any time during that year if you are dissatisfied with the plan. On thewww.medicare.gov website, there is a listing of star rated plans. These are plans that have a higher rate of customer satisfaction. If you are on a lower rated plan, Medicare will notify you so that you can switch to a higher rated plan during your next Open Enrollment period.
Open Enrollment for the Medigap policies is the anniversary date of your policy so it is unique to the person being insured.
March 2013- Evaluating Mobility Needs
By: Diane Keefe, Geriatric Care Manager
Evaluating Mobility Needs |
Mobility represents a challenge to an older adult’s independence and autonomy. Mobility can be on several levels:
1) How does the older adult ambulate in the home and around the neighborhood?
2) How does the older adult move around in the community?
3) How does the older adult perform when driving?
Helping Elders Thrive |
When people age, it affects them physically, mentally and emotionally. Physically, eyesight may begin to decline especially if they have problems with cataracts, glaucoma or macular degeneration.How do they walk? Is it slow and lumbering or brisk and sure? Gait is very predictive of longevity. If they are shuffling, it may indicate an impending health condition that needs the attention of a physician. Physical therapy may be prescribed to build weakened muscles. It is one of the reasons light weights workouts are recommended.
Balance and coordination can be strengthened by closing eyes and touching a nose or other part of the body. Walk with someone monitoring while eyes are closed. This heightens center of balance.
Dementia Impacts Driving Mobility |
Many older adults are taking medications. These medications can impact their ability to think and react behind the wheel. Mentally, dementia can cause confusion in a situation which requires a quick response.At 85, 50% of older adults experience some form of dementia. Older adults who have been diagnosed by a physician as having dementia or Alzheimer’s should be assessed regarding their ability to drive. Dementia can also impact balance and coordination which puts the individual at higher risk for falls.
Meeting Emotional Needs
By: Diane Keefe, Geriatric Care Manager
What are the key needs that older adults have?
- They need to feel safe
- They need to feel needed and loved
- They need a sense of purpose in their lives
- They want independence and autonomy
This means that although they love their children very much, they still want to determine what is happening in their life themselves. Most research indicates that older adults do not want to live with their children and they do not want to be a burden to them.
Helping Elders Thrive |
Your loved one can thrive when they feel they are still part of life and involved in the activity of it. Many older adults admit that they need more time alone but they like to be included in social activities with family and friends. That is why the retirement communities do seem to be a great solution for some older adults. The built in social atmosphere helps many elders who were languishing at home to feel part of a community where their presence is noted and appreciated. Their peers are going through some of the same challenges and they can share the experiences together.Other activities that promote social engagement include Adult Day Centers, Senior Centers and senior programming which is part of community governments or continuing education. They offer day trips, activities, food and social interaction with peers.
Brain Stimulating Activities |
Many older adults 65+ can attend college classes for low cost or no cost. They audit so there are no tests but it does keep the mind active and engaged.Here are some websites that will help to keep minds active and learning while having fun:
5 Keys to Improving Your Overall Well-being |
1. Maintain a positive outlook on life and keep your sense of humor.
2. Exercise every day at least 30 minutes.
3. Learn something new
4. Eat a Mediterranean style diet utilizing mostly fruits, vegetables, whole grains and minimal meat. Cook using olive, coconut or canola oils. Limit alcohol and avoid smoking.
5. Get adequate amounts of sleep.
There are many more that could have been added but these are the basics.Most of all, enjoy and appreciate life! Most people don’t regret not going working enough. Instead they focus on the relationships they missed or could have appreciated more.
2. Exercise every day at least 30 minutes.
3. Learn something new
4. Eat a Mediterranean style diet utilizing mostly fruits, vegetables, whole grains and minimal meat. Cook using olive, coconut or canola oils. Limit alcohol and avoid smoking.
5. Get adequate amounts of sleep.
There are many more that could have been added but these are the basics.Most of all, enjoy and appreciate life! Most people don’t regret not going working enough. Instead they focus on the relationships they missed or could have appreciated more.
Honoring Seniors With Dementia January , 2013
By: Diane Keefe, Geriatric Care Manager
Just Diagnosed with Alzheimer’s?
 You may have suspected that your brain was not working properly. Now you have confirmed that there is a medical reason why your brain has not been functioning properly and all other possible medical conditions have been eliminated.
In some ways, it may be a relief that you now know you are not crazy. On the other hand, you may feel angry that this has happened or even be in denial about your condition. There will be good days and then there will be bad days.
Here are some things that you can do to be proactive for yourself or loved one:
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December 2012: Difficultly Sleeping?
By: Diane Keefe, Geriatric Care Manager
8 Indicators That You Have Sleep Apnea |
If you have these symptoms or conditions, you should be checked by a physician specializing in sleep disorders:
- Daytime sleepiness regularly
- Your partner complains about your snoring
- Abnormal breathing patterns at night
- You stop breathing 3 times at night
- You fall asleep while driving
- You fall asleep while reading
- Short neck
If you have 3 or more of these conditions, you should make an appointment immediately.
Good Sleep Is Key to Functioning Better |
What is Causing You to Lose Sleep?
Many factors contribute to lack of good sleep. As a person ages, they are more prone to poor sleep caused by having to go to the bathroom more frequently. Drinking caffeine too close to bedtime. Here are a few tips to improve sleep:
- Stop drinking fluids 3 hours before bedtime.
- Use compression stockings if you encounter swelling in the legs. Elevate the legs 1-2 hours before sleeping.
- Treat urinary tract issues before they become a problem. Often cranberry juice or extract helps.
- Do not read or watch TV in the room where you sleep.
- Practice a bedtime ritual that helps you to sleep. i.e. soft music or aromatics.
- Get more exercise.
- Take short vs. longer daytime naps.
- Keep the bedroom dark. Even a little light can disrupt sleep.
- Limit your sugar intake.
If you find that you are awake after trying to fall asleep for more than 15 minutes, get up and do an activity. Then go back to sleep later.
There may be times when you feel mental confusion or fuzziness. Many factors affect the brain’s function. Since the brain utilizes up to 25% of the oxygen in the body, it must be pumped from the heart. If you don’t exercise regularly and spend a lot of time sitting in a chair, you will experience mental dullness. If you have sleep apnea or snore a lot, you are depriving your brain of oxygen. You may want to be tested to make sure this is not your problem.
Why is Lack of Sleep So Dangerous? |
Lack of sleep can cause a lack of spatial awareness and increase the chance of falls or accidents. Poor sleep can contribute to depression and lower immune system activity making a person more receptive to illness and disease. Sleep helps the body to restore and rejuvenate systems. Insomnia can cause chronic pain, heart failure, COPD and neurological disorders. While people with Parkinson’s have more fragmented sleep, those individuals with Alzheimer’s tend to have increased levels of sleep. They have frequent awakenings with a decrease in slow wave and REM sleep. Currently, melatonin is the only therapy without side effects. Research done in Europe has shown that many people with Alzheimer’s or dementia have sleep apnea.
By taking a short nap in the afternoon, it helps your body to revitalize body systems. It is the equivalent to rebooting your computer. Also, practice breathing deeply to the count of 6 and then breathing out to the count of 6. Do this 15 times to engage your parasympathetic nervous system which helps you to relax. If you do this before going to bed, you will sleep a more relaxed sleep. Practicing meditation, taking a hot bath or listening to a hypnotic tape are other forms of increasing relaxation.
Holidays Are An Excellent Time to Observe How Your Loved Ones Are Doing
By: Diane Keefe, Geriatric Care Manager
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October 2012: Medicare Basics
By: Diane Keefe, Geriatric Care Manager
Know About Medicare |
Ten thousand Boomers are turning 65 every day and many of them are getting signed up for Medicare. Medicare is a federal health insurance program for individuals over 65. Once a person signs up for Social Security, they are automatically enrolled in Medicare. However, if they have not yet begun to collect Social Security, then they will need to speak to a Social Security representative up to 3 months before their 65th birthday. Even if an individual decides to wait or is covered under a spouses medical plan at work, it is important to talk to a representative so that they know what the rules are. Otherwise, they may end up paying higher rates from the point they enroll.
There are several parts to the Medicare coverage. Part A covers hospital stays and hospice services; Part B covers physician services, lab costs, and other therapy. Medicare C covers managed care plans and Medicare D covers drug prescriptions. Medigap policies are insurance plans to cover the out of pocket expenses that Medicare does not cover such as out-of-pocket costs for Medicare coinsurance and deductibles or services not covered by Medicare. It will also pay if costs exceed the Medigap premium.
What Does It Cover?
Here is a snapshot of what Medicare does and does not cover. It does pay for emergency care, a second opinion by a Medicare-approved doctor, lab costs and outpatient mental health. Some diabetes supplies and services are also paid for by Medicare. It does not pay for in-home care, health care while traveling outside the US, insulin and syringes used by diabetic patients.
What is Medical Necessity?
A very important concept to understand when dealing with insurance in general is the term “medically necessary”. ”Medically Necessary” is a term that is used to determine if care is warranted. Certain procedures are deemed to be medically necessary in order to begin healing. However, other procedures while they may improve condition or speed recovery are not determined to be medically necessary to the healing process. If you dispute the determination, you can appeal the decision and your doctor and a second opinion doctor will need to make a case for the procedure being recommended. There are time limits and guidelines for making these appeals. Be sure to adhere to them.
As a caregiver speaking on behalf of a parent, you will need to file a Form CMS 1696-U4 which allows access about benefits from both the SSA and Medicare. Your parents will be asked to join you on a call to give their consent for you being able to access their information. To get a form, call 1-800-633-4227 or download it from www.medicare.gov. To reach the Social Security Administration, go towww.ssa.gov or 800-772-1213.
Medicare Open Enrollment begins Oct. 15th to Dec. 7th |
What is Open Enrollment? It is the period when you can re-evaluate your choices in coverage for Medicare Part A, B, C, and D for the upcoming year. Use the evaluator provided by Medicare at www.benefitscheckup.org. Consider costs, quality of care, and your needs in mind when evaluating options.
Maintain a Personal Health Record |
A Personal Health Record is critical to a caregiver when speaking on behalf of their loved one. For a form offered by Medicare, go to www.medicare.gov/phr. The Blueprint for Care workbook offered on the Caring for Parents Together website offers the personal health history, medication list templates, emergency contact forms, legal documents checklist, end of life wishes template, a safety checklist and much more. Go towww.caringforparentstogether.com to find out more.
Report Medicare Fraud |
Medicare fraud happens every day. Have your loved one safeguard their card number and never give it out over the phone. If a salesperson comes to the door uninvited, do not let them in. Never sign anything without first having read it. Do not be pressured! Making changes to Medicare is a very serious matter. Make sure it is right for you! Call the local SHIP Program at 1-800-390-3330 to discuss your changes and verify that you are making a good move. Do your investigation about the options before talking to any sales representative.
If you suspect billing fraud on behalf of a provider, call the fraud hotline of the Department of Health and Human Services at 800-447-8477. Educate yourself about health care costs and procedures ahead of time so you will know what to expect.
November 2012- First Place To Visit
By: Diane Keefe, Geriatric Care Manager
While you are visiting during the holidays, you may notice some signs that your parent may be struggling. This issue is dedicated to informing you of options in helping your parents keep their independence and autonomy as long as possible.
First Place To Visit |
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information available to seniors. It was originally formed to help older adults through the journey of aging as an initiative of the Dept. of Health and Senior Services. TheAAAs offer care management, information and assistance, adult day services, senior centers, Meals On Wheels, respite services, assistance during the Open Enrollment period of Medicare options, tax assistance, legal assistance and more.
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Caregiver Tip No. 1 Arrange Help
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Help select and arrange services to help your parent remain in their home such as yard maintenance, home repair services, gutter cleaning and housekeeping assistance.
As adults age, they may not feel as comfortable driving in inclement weather but still may need to make that trip to the drug store or grocery store. There are many places that deliver now, i.e. drug stores, grocery stores, dry cleaning and laundry stores. Check to see what is available in their area. Offer to take them where they need to go or hire someone to do it. This may be a way to earn money for a grandson or granddaughter who has not had their license that long and needs the experience of driving. They will be less likely to drive recklessly with an older adult in the car.
Caregiver Tip No. 2
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Here is the link to AARP’s Home Safety Checklist: http://assets.aarp.org/external_sites/caregiving/checklists/checklist_homeSafety.html .
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no longer have any control. Their fears are not unwarranted. Many children will come in and just take over. This makes an older adult feel helpless and unneeded. They need a sense of purpose. What can they do now with changing conditions? Sometimes, just having supports put in place can make a difference.
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Website that guides you in creating an emergency preparedness plan. http://www.redcross.org/prepare/location/home-family/seniors
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Concerned But Don’t Live Close By?
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If you don’t live close, hire a Geriatric Care Manager who lives in their area and knows all the resources. They will conduct an assessment and give you an accurate picture of how things are working out for your parents as well as what they will need from you. You can then decide how to proceed. Go tohttp://www.caremanager.org and input your parent’s zipcode to find a Care Manager in their area.You may also want to pick up a copy of the local Older Adult Resource Guide. The Area Agency on Aging or United Way will know where to find this information.
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Medicare Open Enrollment Ends Dec. 5th!
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By: Diane Keefe, Geriatric Care Manager
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