Archive for October, 2018

Financial planning and Medicare

By Steven Merrell, Financial Planning: Let’s talk Medicare

If you are one of the 44 million Americans currently covered by Medicare, you probably know that Medicare’s annual open enrollment period just started. Between now and Dec. 7, you have the opportunity to make adjustments to your Medicare coverage.

Paying for health care is one of the biggest financial challenges many people face in retirement. If you are 65 or older, Medicare is probably an important part of your financial picture. However, if you are new to Medicare, you may be surprised by Medicare’s complexity and the gaps in your coverage.

You can choose between two general directions for your Medicare coverage: Original Medicare and Medicare Advantage plans. Original Medicare, in turn, is divided into two parts. Part A covers inpatient hospital care, skilled nursing facilities (when medically necessary), hospice care and home health care. Part B covers doctor visits and outpatient care and other medically necessary services like ambulance services, clinical research and durable medical equipment. Optional Part D covers prescription drugs and is purchased from private insurance companies.

Original Medicare does not cover everything. For example, while Part A covers hospitalization and skilled nursing facilities, it only covers acute care. If you need long-term care, also known as custodial care, Medicare will not cover it. Medicare also excludes most dental care, eye exams for prescription glasses, dentures, hearing aids and exams for fitting them, acupuncture and routine foot care. If you want to find out if your particular need is covered by Original Medicare, you can search for your item or service on the Medicare coverage website: www.medicare.gov/coverage.

Most people do not pay a premium for Part A, but they do pay a deductible of $1,340 for each benefit period and coinsurance for hospitalization. Part B premiums start at $134 per month but can be higher depending on your income. In addition, for Part B you will pay a deductible of $183 per year and coinsurance above that amount equal to 20 percent of the Medicare-approved charge for most doctor services, including the services provided by your doctors while you are in the hospital.

In a catastrophic scenario, there is no limit to the amount you can owe under Original Medicare. Consequently, many people purchase a supplemental policy, also known as Medigap insurance. Medigap insurance is issued by private companies, but the policies are standardized by law to comply with Medicare requirements. There are 10 standard Medigap policies available each with different coverage limits.

If you find this confusing, you are not alone. In fact, this confusion is why Medicare Advantage plans have become so popular in recent years. By law, Medicare Advantage plans are required to provide everything that is covered by Original Medicare. The only exception is hospice care, which continues to be provided by Original Medicare Part A.

Steven C. Merrell is an investment adviser and partner at Monterey Private Wealth Inc. in Monterey, CA. 

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5 advantages of early election of hospice benefits in assisted living and skilled nursing

Published in McKnight’s Senior Living by Rhea Go-Coloma, LMSW

For many, hospice care is associated with care received in the home. When provided early enough for residents in assisted living facilities and nursing homes, however, hospice care can provide important benefits for the resident and facility operator alike.

Hospice care, which is covered by Medicare and most private health insurance plans, eases pain and alleviates discomfort when a resident’s illness no longer is responding to treatment.

In fact, about one-third of assisted living residents receive end-of-life care at the community they have made their home. When residents become terminally ill, however, operators must provide care that may go beyond their capabilities.

When this happens, residents may be better served in a hospital or nursing home setting, but frequently it’s in the best interests of the resident to remain in the assisted living community. This is largely because residents have grown accustomed to the people and environment and feel the most at home.

When an assisted living community resident opts for hospice care, he or she also may be able to remain in the facility during the last months of life. This is best achieved when the assisted living community operator partners with an outside hospice provider. In this situation, it’s important for both organizations to work closely together to provide the best possible care for the resident.

Whether the hospice care is being provided in an assisted living community or nursing home, good communication between the family, staff, hospice staff and caregivers is important. Equally critical for success is early adoption of hospice care.

Early adoption of hospice makes all the difference

When adopted early, hospice care offers significant benefits for residents and families. Significantly, hospice healthcare specialists help residents and their families prioritize wishes and goals, creating a greater sense of ease and comfort.

Team-oriented hospice healthcare specialists work with the staff members of the assisted living community or nursing home to coordinate and plan care. Here’s a look at the five most important advantages of early election of hospice care for residents, families and facilities striving to meet the needs of these individuals:

Family support. Early involvement of an interdisciplinary team of hospice specialists helps families on many fronts: teaching family members how to care for the person who is ill, providing support and counseling to family and friends, offering education about the care process.

The hospice team also is there to help families clarify patient wishes, establish physician and patient relationships and balance family dynamics during this stressful time. Bottom line: hospice provides a way for residents to have a diverse group of committed professionals advocating for their needs.

Care goals. Hospice gives families the time they need to discuss goals of care, including an advance directive, a legal document that spells out end-of-life care ahead of time. The hospice team — including doctors, nurses, therapists, healthcare aides, clergy and social workers — addresses every aspect of a resident’s illness, with emphasis on controlling and reducing pain and discomfort. Team members provide symptom management and pain relief, increase quality of life and relieve patient suffering.

Family counseling. Guidance and support are a crucial feature of hospice, helping families deal with the range of emotions that surround this difficult time, offering guidance from social workers and chaplains. Hospice also offers bereavement and grief counseling after a loved one has passed, and it helps with some of the after-death tasks that need to be completed. Ultimately, choosing hospice care early makes end-of-life a calming and successful experience during a difficult time.

Dignity for the resident. Hospice offers the resident a chance to die with dignity. Hospice patients are not hooked up to loud machines, their vital signs are not constantly checked by medical personnel and they do not undergo invasive procedures to prolong life. It’s about respecting patient wishes.

By making arrangement to provide hospice care, operators of assisted living communities and nursing homes can make it possible for residents and families to focus on spending time with their loved one and not dealing with the red tape and medical procedures associated with hospital care.

 

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Suggestions for adult children caring for aging parents

Published in OA Online By Raylene Weaver, LPC of Centers for Children and Families

The Beatles will always be one of my favorite groups. One of their songs that has hit home with me while thinking about this particular article is, “When I’m Sixty-four”.

People want to be needed and appreciated especially when approaching a time in life when it’s easy to be disregarded or forgotten. The aging process can be stressful, causing some to suffer anxiousness and sadness. Several of my clients and friends have faced or are facing tough decisions that are affecting their parents and themselves. I would like to pass on a few suggestions regarding the physical, emotional, mental and financial aspects of AGING that might alleviate some of the stress that can definitely arise for all concerned.

A…ASK parents specific questions concerning their health. Do family members know their medical history, names of their doctors, any medications they might be taking or appointments they are scheduled on a regular basis? If on Medicaid or Medicare, do they also carry supplemental insurance? Are all financial papers, investments, bank account information, bill payment procedures, updated will, computer passwords and any other important documents or information easily accessible? Do they have a bereavement plan?

G…GUILTY feelings about wanting to be prepared by creating a plan for a parent’s future? Questions concerning the private aspects of their lives might seem like prying but this can hopefully be of some consolation for parents, knowing that they will be taken care of “when the time comes”. The objective for the children is to be “in the know” not to be “nosey”.

I…INDEPENDENT lifestyle is what one wants for aging parents. Parents hope to be independent for as long as possible. They want to continue to travel, take care of their own bills, shop, visit friends and attend worship services. Children sometimes become too “helpful” when parents are capable of handling chores and projects and making decisions for their future. Parents do need family members visiting and checking in on them, showing care and concern, just not insisting on control.

N…NECESSARY intervention will be inevitable for many parents. Knowing when to step in and offer the appropriate type of care and assistance can be stressful. Emotions will surface that might not have been seen or experienced before. When going thru matters for instance, pertaining to insisting a parent not drive any longer, taking over their physical and financial aspects of daily life or ultimately moving them into a facility for mental or physical issues or children becoming caretakers of parents in their own homes, professional agencies might be considered. Seeking assistance from those in the medical field, state/local agencies and counseling professionals might become necessary. But until this time arises…

G…GIVE the gift of respect, love and kindness to parents. They are experiencing and living life to the best of their abilities like their children. One article I came across by Evan H Farr, “What Aging Parents Really Want from Their Adult Children”, stated that adult children should: 1) make suggestions instead of giving orders, 2) pick your battles about what parents can and cannot do, 3) reframe, don’t blame and 4) stop and think how you would want to be treated.

So I guess that brings me back to the Beatles. A couple of the lines from Paul and John’s song says, “Will you still need me, will you still feed, me when I’m sixty-four?” Can I just ask…when I’m 74, 84, 94?

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