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How to Avoid Medicare Scams

How to Avoid Medicare Scams

By far the largest types of insurance fraud are scams against government and private health care insurers. Scammers frequently target government insurance like Medicare by stealing newly issued medical ID cards and then stealing identities. The Coalition Against Insurance Fraud estimates that tens of billions of dollars are lost annually to these types of fraud. Additionally, medical identity theft is now a top complaint received by the Federal Trade Commission. Billing fraud is also responsible for huge losses to Medicare funds and is difficult to assess as it can be a billing error or intentional fraud. 

How does this affect a senior on an individual level? Scammers typically pose as Medicare officials and ask people to pay for their new cards which in reality are free. Or they phone a potential victim with false news of a refund and ask for the person’s ID number and bank account number to deposit the refund. “Right now … everyone is being inundated with TV commercials, brochures and other official-looking documents in the mail about all the Medicare Advantage plans. It’s so confusing, and in an environment like that, fraud is rampant,” says Micki Nozaki of the California Senior Medicare Patrol. There are more than 50 million Medicare beneficiaries who can annually opt to swap Medicare Advantage and Part D prescription drug plans which provide scammers with the opportunity to prey on vast numbers of seniors.

The Centers for Medicare and Medicaid Services have a list of tips to help prevent fraud. The first and foremost is to protect your Medicare and Social Security numbers vigilantly. It suggests treating your Medicare card like you would a credit card and do not provide the number to anyone other than your doctor, or people you know should have it. Become educated about Medicare with regards to your rights and what a provider can and cannot bill to Medicare. Review your doctor bills carefully, looking for services billed for but not provided to you. Remember that nothing is free with regards to medical care; never accept offers of money or gifts of free services. Be suspicious of your provider if they tell you they know how to “bill Medicare” to pay for a procedure or a service that is not typically covered. Before leaving your pharmacy check to be sure your medication is correct, including the full amount prescribed and whether or not you received a generic or brand name medicine. If your prescription is in error report the problem to the pharmacist before leaving. 

Remember Medicare will never visit, call, or email you and ask for personal information such as your Medicare number, Social Security Number, address, or bank account number. Medicare already has this information and does not need you to provide it. Even when Medicare issues new cards that no longer contain your social security number in April of 2019 you will not be required to do anything. You can assume that anyone who claims to be helping you with Medicare and asks for your personal or financial information is a scam artist so close the door, hang up the phone, or delete the email.

When it is time to compare plans be sure to meet with a trustworthy advisor. Some insurance representatives give the industry a bad name by selling you a policy or plan that does not suit your needs or your budget. Some agents go so far as to ask you to sign a release form allowing them to make decisions on your behalf. Never sign anything related to Medicare without first reading it carefully. Additionally, it is a good practice to have a family member or lawyer review the document before signing it. The non-profit National Council on Aging (NCOA) has a free, brief assessment that allows you to compare plans online. You can also contact your local State Health Insurance Assistance Program (SHIP). SHIPs is a provider of free, federally-funded Medicare counseling via a trained volunteer or staff member. 

Medicare fraud wastes billions of taxpayer dollars annually. Carefully review your medical bills and have inaccuracies corrected. Guard your personal information vigilantly and be wary of people asking you to provide that information. Meet with a trusted insurance advisor or compare medical plan options using the sites listed above. If you are unsure about something call Medicare directly for clarification. 

If you have questions or would like to discuss anything you’ve read, please don’t hesitate to contact us at 1.800.660.7564 or by emailing us at info@covertlaw.com.

Leaving Well: A Step-by-Step Process

Leaving Well: A Step-by-Step Process

Contemplating our own death is one of the hardest challenges we will ever have to face. Yet, if we want our dying to be meaningful and merciful, it is imperative that we think about it while we still can. Most of us want to die at home, in a familiar and peaceful setting surrounded by loved ones. We would much rather not spend our last moments in an emergency room or ICU, with strangers futilely pounding on our chests and our families relegated to the waiting room. 

With those two alternatives in mind, we need to do all we can to keep control, as much as possible, of decisions that need to be made long before our final moments. We need to think carefully, well in advance, about what makes life worth living, and where pain and limitation have so eroded that quality of life that we would prefer not to go there. 

These are notoriously difficult questions, but it is vital to address them anyway. For example, Terri Schiavo spent nearly half her young life unconscious in a condition known as a “persistent vegetative state,” being kept alive by a feeding tube. Her husband and friends claimed that before her severe brain injury, she said that she would not want her life sustained by machines. Unfortunately, she never put that wish in writing. On the other side, her devout family and right-to-life supporters insisted that she be kept alive despite her dire condition. After protracted litigation, Ms. Schiavo’s husband prevailed, the feeding tube was withdrawn, and, fifteen years after she was injured and never having regained consciousness, she was finally allowed to die.

Since her passing, the law has evolved nationwide to encourage us all to document final wishes, to avoid the anguish and uncertainty of Ms. Schiavo’s situation. There are a number of documents available in your state for that purpose. The umbrella term for these is “advance health-care directives.” 

It’s our job as lawyers to help you sort through the various directives needed to express your wishes. Here is a step-by-step guide to begin the conversation about final wishes, and to understand which document does what when.

 

1. If you are over the age of 18, appoint a health-care agent to speak for you when you can’t.

Decide who, among those who know you well, is best suited to take on this responsibility. That person must possess good communication skills, remain calm in difficult situations, and be able to deal flexibly with complexity that might arise in reconciling your wishes with available medical options. Depending on which state you live in, your agent can also be called a “health care proxy.”

Sit down with that person and discuss your wishes in various scenarios. This is not an easy conversation to have, but there are guides available to help you. Visit “The Conversation” 

https://theconversationproject.org/

and download the starter kit. 

http://theconversationproject.org/wp-content/uploads/2015/09/TCP_StarterKit_Final.pdf

 

2. Health Care Power of Attorney (HCPOA)

Once you have had that conversation, visit your lawyer to name your agent formally  in an HCPOA document. HCPOA conveys legal authority on your agent or proxy to express your health-care decisions when you are unable to.  Here in Florida we refer to this document as a Designation of Health Care Surrogate.

 

3. HIPAA authorization

Your agent or proxy will also need access to your otherwise-private medical information. This is best done by a standardized document that complies with the federal Health Insurance Portability and Accountability Act (HIPAA). Without this authorization, your agent will be unable to obtain the medical information necessary to exercise the authority you want him or her to have.

Now armed with your agent and the HCPOA and HIPAA documents, you will know that if you were to meet with an accident or lose consciousness, you have chosen and empowered an advocate to speak for you. You should review and update these documents every five years or so.

The next three documents are important at the end of life. All these documents should stipulate that you desire comfort care, to keep you clean and as pain-free as possible. Remember, though, that you must create these documents while you are still able to know and communicate your wishes, so it’s best to do the next two documents at the same time that you do your HCPOA and HIPAA.

 

4. Living Will (also known as Physician’s Directive)

This document is for use when you are not enjoying quality of life. Either death is imminent; you are in a persistent vegetative state; or you are permanently unconscious, permanently confused, or unable to care for yourself. If you have no awareness of others; can’t remember or understand or express yourself; or are unable to move, bathe, or dress yourself, it’s advisable to have expressed, in advance, the kind of treatment you want to receive or not receive. 

A living will expresses your choice as to whether you do, or do not, want artificial measures that will merely prolong your life but not improve it. Those measures, among others, may include CPR if your heart stops, or breathing or feeding tubes, or repeated courses of antibiotics or chemotherapy.

You may also require physicians, and not your agent, to be the ones to decide whether to cease life-prolonging procedures as you would like. This decision will relieve your agent from the heavy responsibility of making that irreversible choice.  

Living wills are legal in almost every state. Ask your lawyer. Don’t make this kind of document yourself. Otherwise you risk that the document may be misinterpreted, with drastic consequences.

 

5.  Specialized Directives

Medical decision-making varies depending on specific health conditions, so specific directives may be tailor-made for those conditions. For example, people suffering from advanced dementia benefit from a directive, in addition to the HCPOA or living will, specifically requesting that hand-feeding be ceased when the person can no longer speak, recognize loved ones, or move purposefully. Otherwise, caregivers are obligated to cajole or demand that the patient be fed by hand, taking advantage of a primitive reflex to open the mouth. This risks that the person may inhale the mush instead of swallowing it, in some cases causing pneumonia. 

For this kind of condition, ask your lawyer to prepare a specific directive tailored for advanced dementia, using the directives created by End of Life Washington 

https://endoflifewa.org/

or End of Life Choices New York.

https://endoflifechoicesny.org/

 

If, however, you suffer from a neurological illness like Lou Gehrig’s disease (ALS) or advanced Parkinson’s, even though most of us would decline mechanical treatments, those same treatments may be important aids to preserve quality of life for people with those conditions.

Again, remember that you must create these documents while you still have the capacity to communicate your wishes. Living wills should be reviewed every six months, because wishes can change depending on the progress of the illness.

 

6.  DNR or POLST or MOLST

This is a brightly colored, short-form document that is primarily intended for emergency responders when the patient is frail and is likely to die within a year. It is designed to be immediately recognizable by hospitals and EMS personnel, to express that when the patient is unresponsive, cardio-pulmonary resuscitation (CPR) and other aggressive treatments are desired or not desired (DNR). 

This document should be filled out in consultation with the patient’s physician. The acronyms stand for “physicians’ orders for life-sustaining treatment” or “medical orders for life-sustaining treatment.”  Many states provide for this kind of document. 

 

7.  Make Your Documents Known

When it comes time to use your documents, they must be readily available. Give a copy of them to your agent or proxy, make sure they are included in your medical records, and, if you are in need of the POLST or MOLST, post it beside your bed or on your fridge where EMT knows to look for it. If your documents can’t be found, or if your agent or family don’t understand them or ignore them, you will have spent your time, effort, and money in vain.  Here at Covert Law we provide all of our clients with a secure, encrypted online Client Portal to which you can give access to your helpers and family, and where all of your important legal documents and health care materials are stored.  See:  https://www.covertlaw.com/client_portal/client_portal.php

But if all goes according to your wishes, you will have done your best to create a good death, one that is as meaningful as possible for all concerned. If we can assist in helping you with any of the documents above, we would be honored to do so.  As always, if you have any questions or concerns, please feel free to contact us at Covert Law by calling 1.800.660.7564 or email us at info@covertlaw.com.

Balancing Caregiving and Your Career

Balancing Caregiving and Your Career

Providing care for a senior family member, particularly long-term care, can bring about lost wages and missed opportunities for the caregiver. A report by Genworth entitled Beyond Dollars 2018 shows that although statistically having to miss work to provide care is down 7% from 2015, overall 70% of caregivers still report missing work because of caregiving responsibilities. While the percentage remains high, employers are better able and more likely to meet the needs of an employee who also routinely provides family caregiving services. The corporate shift to create flexibility and policy that addresses caregiver needs in the workplace will continue to increase as the baby boomer population ages. The change is welcome as, on average, caregivers spend 21 hours every week providing care. 

impact of caregiving.png

Genworth:  Beyond Dollars Report

 

Flexible work hour policies are having a positive effect as caregiver employees can transport their loved one to a daytime doctor appointment or other scheduled event. Some of the employee’s workload is being shifted to online work remotely from their home while other employers will allow a coworker to donate vacation or sick time to a caregiving employee.Julie Westermann of Genworth toldMcKnight’s Senior Living“Access to caregiver support or employee resource groups is another benefit. Also, counseling, coaching or wellness programs specific to supporting caregivers themselves and the financial and legal implications.” There are additional policies and benefits available for family caregiver support that include subsidized in-home back up care and emergency care, and other low-cost or free resources and services.

It is widely projected that 70% of all seniors will need long-term care during their lifetime. Increasingly that care is being provided in the home by family, and the ages of both parties involved are becoming younger. Genworth found that the average age of a care recipient in 2018 is 66. Comparatively in 2010 62% were older than 75. The age of caregivers has shifted from an average age of 53 in 2010 to an average age of 47 in 2018. Fully 58% of family caregivers are now in the 25 – 54 year age bracket.

As the need for senior caregiving increases, employers will have to continue increasing accommodations to employees who are also family caregivers. For career planning purposes a family caregiver should take full advantage of coaching and support programs that outline future financial and legal implications of caregiving as it relates to their employment. Mitigating negative circumstances before they present themselves is the goal. The sooner a realistic assessment of needs for the senior is handled the sooner a caregiver can put a plan in place to protect their livelihood and future retirement.

Employers understand the negative impact that absences, reduced hours and chronic tardiness have on productivity and the bottom line. A caregiver must strategize how best to cover the responsibilities that could put their career in jeopardy. Corporate policy changes and additional resources regarding employees who are also caregivers are helping make this situation mutually agreeable. The percentage of caregivers reporting negative impacts on their career due to caregiving is dropping. While this is a positive sign, there is a lot of groundwork to do to ensure caregivers have the opportunity to retain their job without undue financial loss or penalty.

Remember that most seniors or near seniors are in denial about their potential need for care and most caregivers sort of fall into their role after an adverse health event of a family loved one. A caregiver’s savings and retirements funds are put at risk when no planning is in place. Planning can help to reduce stress and negative impacts on future caregiver status as well as career success.

If we can help answer questions about planning options available to your or a loved on, please don’t hesitate to reach out by calling us at 1.800.660.7564.

Holding a Family Caregiving Meeting

Holding a Family Caregiving Meeting

A family caregiving meeting is an essential tool when dealing with the care of an aging loved one. These meetings are beneficial for helping to keep all family members abreast of decisions that need to be made, changes in diagnosis or prognosis, and help to ensure that all family members feel that they have a voice. Family meetings can also help to keep caregiving responsibilities from falling solely on the shoulders of one family member. In addition, family caregiving meetings can foster cooperation among family members and lessen the stress associated with caring for an aging loved one.

Who should attend a family caregiving meeting?

There are a number of people who should be included in a family caregiving meeting. First and foremost, it is important to include the aging loved one in the meeting whenever possible. This helps the aging loved one to feel that they are being heard and that their opinions and thoughts are being considered. If a spouse is living, the spouse should be included, as well as any children and possibly siblings of the aging person. Some families may choose to include other family members, but this really varies from one family to another. Anyone else involved in care for the person should also be there. This could include paid caregivers, family friends, or neighbors. Depending on family dynamics, a facilitator can be helpful in running the meeting.

When should a family have a caregiving meeting?

First it is important to note that family caregiving meetings are not a one and done event. They must occur on a regular basis. The first family meeting can occur before an aging loved one actually needs care. This can give the person who may eventually need care more say in their future care, but often times this does not occur. Most families find that the initial meeting needs to occur when an aging loved when begins to show signs of needing care or when a diagnosis is given that determines care will soon be needed. In addition, meetings should be scheduled regular to discuss changes in diagnosis, prognosis, or general needs of the loved one or the caregivers.

How can a family hold a successful caregiving meeting?

The key to having a successful caregiving meeting is cooperation. This doesn’t mean that family members will agree on everything, but it is important that all family members are respectfully heard and considered. Families must be willing to compromise and seek the best plan for their aging loved one. Additionally, a smoothly run meeting should have an agenda and families should try to stay focused on the items included on the agenda. When holding a meeting, always put things in writing and be sure that all those involved get a copy of the important information and everyone’s responsibilities.

What challenges do families face in caregiving meetings?

One of the biggest challenges to family caregiving meetings is the family’s history. All families have their own dynamics that can cause problems in a caregiving meeting. There may be members of the family who are at odds with one another, creating an obstacle to having a successful caregiving meeting. The role that each family member plays can be a challenge. Some members may be overbearing and demand control, while others are peacemakers and do not feel free to share their thoughts. Another challenge is that some family members may be in denial of the severity of an aging loved one’s needs which could make it difficult to get a consensus for care.

Family caregiving meetings are beneficial and necessary when an aging loved one can no longer care for themselves. These meetings can help to divide the responsibilities of caregiving and reduce stress placed on the family members. It is important that families remember that the meetings are for the care of their loved one and cooperate with one another to help the process to run more smoothly and successfully.  If you have any questions about something you have read here about holding a family caregiving meeting, or about anything else, please feel free to contact us at 1.800.660.7564 or email us at info@covertlaw.com.

The Stress of Caregiving on the Sandwich Generation

The Stress of Caregiving on the Sandwich Generation

Dorothy Miller, a social worker, first created the term “sandwich generation” in 1981. A Journalist, Carol Abaya, continued to study and add to what the term means. In 2006, Miriam Webster included the term, sandwich generation, in the dictionary for the first time. The sandwich generation is defined as a generation of people who care for their aging parents while supporting their own children. It is believed that this is occurring because of the increase in life span for adults and also because of delayed parenting. This means that medicine and technology are allowing people to live longer and couples are waiting to start families at a later age. Therefore, leaving people sandwiched between caring for aging loved ones and young children. This can lead to some potential problems for the sandwich generation.

Issues for the Sandwich Generation

One major issue for the sandwich generation is financial burdens. Because many in the sandwich generation may not have anticipated have to provide for the needs of their aging parents, they may be stretched thin financially. Another issue for this group that is often compounded by financial struggle is stress. When pulling double duty of caring for children and aging parents, stress is an understandable and expected side effect. Whatever the living situation of the aging parent, the responsibilities of caring for the aging parent often adds to the already busy schedule related to parenting their own children. The sandwich generation then fills pulled in too many directions. This can often leave them feeling as though they do not have enough of themselves to give to everyone they need which in turn leads to guilt and burnout.

If these issues continue to mount, then depression can become another issue for the sandwich generation. Depression can set in when the sandwich generation has little time for hobbies or social interactions, leaving them feeling isolated. The stress and financial burdens can contribute to feelings of depression. The bottom line is that the sandwich generation must recognize these potential problems and find ways to deal with them. Otherwise they will be ineffective in their care for aging parents and their own children and the pressure will continue to mount.

Dealing with Issues for the Sandwich Generation

In order to be a good caregiver, the sandwich generation must find ways to take care of themselves and to ask for and accept help when necessary. One way for the sandwich generation to find times for themselves is respite care. Respite care provides short-term relief from caregiving responsibilities. Respite car provides a way for caregivers to can find time for themselves and take care of family responsibilities.

Caregivers can plan ahead for tasks and finances to help tackle stress and financial burdens. Having a family meeting to delegate responsibilities to other family members can be very beneficial. This means giving up some things to the spouse and children. Extended family can also help to share the responsibility of caregiving, so meeting with siblings or other involved family members to share the task of caring for the aging parent can help to lessen the burden on one person. Having a close friend to talk to about the struggles can also be a very therapeutic way to deal with the stress experienced by the sandwich generation.

Being a member of the sandwich generation has many challenges. The demands on a person caring for aging parents while also raising their own family can be overwhelming. Self-care is essential to avoiding the pitfalls associated with caregiving. In addition, it is important to remember that it is perfectly acceptable to seek or ask for help in order to maintain mental health and provide good care for everyone.

If you have any questions about something you have read or would like additional information, please feel free to contact us at 1.800.660.7564 or email us at info@covertlaw.com.

The Internet of Medical Things

The Internet of Medical Things

The Centers for Medicare and Medicaid Services are looking to the future of the US health care system, and it is projected to be overloaded with seniors needing medical care. In 2010 the US elderly population accounted for about 13 percent of the US population yet accounted for 34 percent of the total health care expenditure. That percentage will continue to increase because of increasing longevity in the growing senior community. Depending on the region, estimates about the future costs of elderly health care may more than double between the ages of 70 and 90. 

Government medical programs and services, insurers and manufacturers are tasked with finding ways to reduce the enormity of health care costs in particular as it pertains to senior care needs solutions. Lower costs and increasing efficiencies are the mandates to address the looming potential expenditure crisis. Enter the Internet of Medical Things (IoMT). 

Digital technologies and their application to senior medical needs offer the best hope to address existing and future needs. You may have already read about the Internet of Things (IoT) which is a network of devices such as home appliances, software actuators, and vehicles including wheelchairs, not traditionally extended to internet connectivity. The IoMT is similar but reserved for a collection of medical devices and their applications that connect to healthcare information technology systems through online computer networks. The medical devices are digitally linked to Wi-Fi that allows machine to machine communication and throughputs of data collection. The captured data can be stored and analyzed all the way from individual to metadata levels. The importance of controlling senior medical costs now and in the future cannot be understated. 

Vitals-tracking wearables are already well-known medical devices. These devices monitor everything from daily physical activity levels, hypertension, cardiac ailments, diabetic levels and more. The devices send vital signs over the internet to medical monitoring staff who can alert health care providers when vital signs are out of the patient’s range of normal. Vitals-tracking wearables are also used in assisted living facilities, nursing homes and hospitals to help nurses and off-site physicians continuously monitor seniors’ vital signs passively. 

Medication adherence tools are an electronic reminder system for proper consumption of prescription and other medications.  These tools reduce the chances of missing or overdosing on medications. Medical adherence tools can decrease the number of hospitalizations or 911 calls prompted by the potentially serious consequences of improper dosing of medications thus saving costs on unintended medical attention. 

Virtual home assistants are increasingly found in senior homes providing daily assistance such as environmental controls, medical advice, calendar reminders, as well as social connections to family and friends which reduces the risk of isolation and therefore can reduce depression. All of the benefits that a virtual home assistant can provide considerably reduce unnecessary life stresses and health problems which reduce costs. 

Biomarker portable diagnostic devices are a staple in the senior age group as they need to be tested more frequently than most segments of the population. Rather than a trip to a pathology lab for blood testing et al., these smart and portable diagnostic devices can allow the senior to perform testing in the comfort of their own homes and get results that are formatted to be instantly shareable with medical care providers. The convenience factor and proactive nature of these devices allow for more frequent testing which can lead to early disease detection and its treatment which lowers the costs of health care. 

Emergency assistance, fall detection, and “navigation guidance” back to their residence for dementia patients are all part of the personal emergency response systems available to seniors. Some of the fall detection systems are now equipping seniors with sensor belts that can identify a change in gait and can even deploy airbags to prevent injuries due to unintended falls. Fall-related health care costs can be staggering as it can include hospitalization in the event bones are broken, or a severe head injury occurs. These fall detection systems will trigger alerts to designated emergency contacts in the event of fall, emergency medical need, or re-homing of dementia or Alzheimer patient.  

Seniors with disabilities including sensory and cognitive impairment can use disability assistance tools to control selection and volumes of streaming music, on-off switch programs for televisions, lights and thermostat controls. Many of these systems are being developed for voice recognition to reduce the need to interact with screens and buttons. Some of the existing tools include customizable colored buttons installed in the residence of the senior that alerts them to perform daily tasks like brushing their teeth. Upon completion of the task, the senior presses the button and the device activates the next task in the customized sequence. When a senior can manage their environment without the constant need for supervision, it lowers health care costs. 

Nearly everyone is familiar with the concept of the smart implant known as the pacemaker that controls the heart rhythm of the wearer and can communicate patient data via smartphone apps to their physician. Now there are newer smart implants. These include glucose sensors, dedicated readers, smart knee, shoulder and spine implants, and orthopedic implants which can communicate post-surgery performance. These implants provide real-time data of patient condition to medical professionals who quickly assess if early intervention is required when a problem arises thus lowering medical costs. 

Smart home senior facilities have arrived. Residences receive wrist-worn wearables that can free up care providing staff as the devices are tied into machine learning and predictive analytics determining insights into deviations from the senior’s daily routine. Some are designated into three types of color-coded alerts such as red for night wandering or potential fall, orange for changes in the routine of daily living such as irregular eating, and yellow for environmental issues such as leaving a stove on or a refrigerator open. This technology allows health care professionals to monitor patients while multi-tasking other facility operational tasks saving health care costs. Similarly, family caregivers can use remote monitoring tools that enable oversight without having direct contact with their loved one. Alerts are sent when daily routines are detected to deviate from the norm allowing the family member to contact their senior to ensure all is well. Remote monitoring tools can help family caregivers remain at work and on task in their own lives while still adequately watching over their loved one. 

While the internet of medical things holds great promise to curb excessive increases in senior health care costs, there are some cautionary tales. What if an internet service provider “goes down” and no Wi-Fi is available to maintain connectivity to health care professionals? Lately, the number of natural disasters in this country calls attention to what will happen to senior digital monitoring when the lights go out during a fire, flood, hurricane or tornado. Will there be a backup generator to keep the devices online? Will there be anyone in the affected disaster zone online to interpret the medical data a vital tracking wearable uploads? What if the medical device fails for mechanical reasons? Can all aging seniors cope with this level of technology? While these remain potential disaster scenarios the more massive disaster is not addressing the overwhelming costs of senior health care for an increasingly elderly population. The internet of medical things is the logical, efficient, and effective solution for now. 

If you have questions about what you have read or would like to speak with us about you or a loved one’s legal needs, please don’t hesitate to reach out at 1.800.660.7564 or email us at info@covertlaw.com.

Neuroscientists’ Sleep Recommendations for Women

Neuroscientists’ Sleep Recommendations for Women

Sleeping is one of the most important things you can do for your overall health and well being. The amount of sleep you get is particularly crucial if you are a woman – new studies indicate the traditional recommendation of eight hours is not enough. If you are a woman aged 50 or older, you will likely live longer than the men in that same age group. A longer lifespan presents additional challenges to staying healthy, and as a woman, if you do not get enough quality sleep, it will negatively impact your health. 

Biological differences between the genders play a role in sleep needs. Neuroscientist research has concluded that women need more than eight hours of sleep each night or they are not well rested. The general reason for this is that the female brain is more active than the male counterpart and requires more rest to recover and repair itself from the damage that was done throughout the day. 

While you sleep many things are taking place; the body can recover and repair itself from the happenings of the day. Compounds are being synthesized for energy while cells and organs get replenished. The Mayo Clinic reports that lack of sleep increases the risk of daytime sleepiness, weight gain, heart disease, and reportedly forms of dementia like Alzheimer’s. Alzheimer’s disease is thought to be caused by an excess of amyloids (aggregates of proteins) in the brain. As women go into a deep state of sleep, these proteins get cleared from the brain. There is a connection between the quality and quantity of women’s sleep and a healthy brain. Nearly 66% of people living with Alzheimer’s are women, and surveys show that 40% of adult Americans get less than 7 hours of sleep per night – the overall average amount of time spent sleeping for all adult Americans is 6.9 hours. Lack of sleep for women has disastrous consequences for their health.

Proper hours and quality sleep decrease stress levels, which is beneficial to cardiovascular health. Good sleep affords women better attention capabilities, better memory function and may increase creativity. Sleep also helps the body to maintain a healthy weight as women with proper rest lose more fat, provided they are eating healthy foods. Plenty of sleep also supports a woman’s skin and overall appearance. The adage “beauty rest” is a real thing.

There are some things that women can do to help improve the quality of their sleep. Exercising on a daily basis is key to proper rest. Turning off the television and putting away the cellular phones at least one hour before bedtime allows your brain to wind down to a more restful state and gets you away from the blue light emissions that can affect the quality of your sleep. Avoid alcohol and coffee before sleeping and develop a healthy bedtime routine. Have a set time for lights out and stick with it.  Make sure your mattress and pillow suit your sleep needs.

Women require more sleep than their male counterparts. Sadly, many women may not know this or have a feeling of guilt if they take the time to sleep more. However, a well-rested woman is capable of being more productive during her day than a tired one. A well-rested woman has a much better chance of being healthy and disease free. It is essential to take the proper steps to ensure you or the women in your life are getting enough sleep. Taking care of your physical self through adequate sleep is one of the most important things a woman can do – it can help you remain healthier as you age. To have a successful and enjoyable life in your later years, plan for sleep and make it a priority to get enough of it. Planning for your later years and striving to be fit both physically and mentally are a necessity for successful aging. Women have unique needs that must be addressed. Contact our office today and schedule an appointment to discuss how we can help you with your planning and care by calling 1.800.660.7564 or by emailing us at info@covertlaw.com.

The Surprising Health Risks of Hearing Loss

The Surprising Health Risks of Hearing Loss

The findings from a 10 year study by the Journal of the American Medical Association have reported a link between hearing loss and health risks. The risks include a 50% greater risk of dementia, a 40% greater risk of developing depression and a nearly 30% higher risk of accidental falls. While hearing loss is becoming more prevalent in younger people due to the use of earbuds and noise pollution, it is the elderly population who are more quickly and significantly affected by adverse health risks because of their hearing loss.  

There is a wide range of reasons that account for hearing loss. Some are genetic while others include noise exposure, medications, head injuries, and infections. While hearing loss is a frustrating experience for those who have it, along with their loved ones, the worst option is to ignore the condition. The sooner your hearing is tested, the better your ability to proactively save yourself from associated health risks due to hearing loss. According to John Hopkins University, brain scans indicate that loss of hearing has even been associated with more rapid rates of brain atrophy. 

One of the first symptoms of hearing loss is trouble detecting high-pitched or soft sounds. This form of hearing loss is associated with stereocilia, which is the damaging of the fragile hair cells that convert sound waves into electrical signals your brain can understand. For example, high-pitched sounds might include children’s voices while soft sounds include phone conversations or background noise in a restaurant. If you are having any trouble hearing these softer or high-pitched sounds, make an audiologist appointment for a hearing assessment to get a baseline reading. Loss of hearing contributes to social isolation and the longer you wait to address hearing loss, the greater the risk of cognition problems. Meaning, you may hear the words but not be able to process their meaning.

Other than cost, there is no downside to hearing aids anymore. They are discreet, easy to learn how to use, and professionally adjustable over time to compensate for increased hearing loss. Once you factor in the cost of a potential fall, increased risk of dementia, social isolation and depression, the cost of a hearing aid is comparatively minimal. If your hearing loss is profound already, there are cochlear implants, which are devices implanted into the inner ear to stimulate the auditory nerve. These devices can help to restore sound perception in adults with more extreme hearing loss. Your walking motor skills are dependent upon your hearing to pick up subtle cues that help you maintain your balance. Hearing loss mutes these critical cues and makes your brain work harder to pick up sounds, which can then interfere with some of the mental processes needed for safe walking.

 

While it is not yet proven that treating hearing loss can prevent dementia, unintended falls, or social isolation and depression, it is important to investigate as more than two-thirds of adults over the age of 70 have significant hearing loss that can impact their everyday quality of life. Older adults with hearing problems left untreated also incur substantially higher overall costs of health care. At the ten-year mark of untreated hearing loss in an older adults, the incidence of hospitalization increases by 50% or so. There are also higher rates of hospital readmission and an increased likelihood for emergency room visits when compared to those elderly adults without hearing loss.

 

Communication between patient and health care provider is also problematic for those adults with hearing loss. A patient has less participation in their health care plan and can often become confused as to their diagnosis and possible courses of action for treatment.  Also, following instructions post appointment or hospital discharge can be problematic. Costs associated with untreated hearing loss have prompted both health care companies and insurers to find better ways to serve patients with hearing loss.  

 

Nearly 27 million Americans age 50 or more have hearing loss while only one in seven uses a hearing aid or implant device. Hearing is often the most overlooked of the five human senses: taste, sight, touch, smell, and sound. Your ability to hear is incredibly important and the longer you put off addressing a hearing problem, the greater the possibility of associated adverse health events. Make good hearing part of your overall plan to age successfully. Like retirement planning and elder law planning, the sooner you address the issue, the better the outcome will be. Contact our office today and schedule an appointment to discuss how we can help you with your planning by calling us at 1.800.660.7564 or by emailing us at info@covertlaw.com.

The Senior Safe Act

The Senior Safe Act

The Senior Safe Act, signed into law by President Trump earlier this year, is designed to protect our elders from financial abuse from either within a family or support system, or by scam artists preying upon them. Tens of billions of dollars each year are illegally taken from US seniors and these numbers only reflect the crimes being reported. 

Issue

Percentage of cases reported

Third-party abuse/exploitation

27%

Account distributions

26%

Family member, trustee or power of attorney taking advantage

23%

Diminished capacity

12%

Combined diminished capacity and third-party abuse

12%

Fraud

6.30%

Elder exploitation

5.70%

Friend, housekeeper or caretaker taking advantage

<1%

Excessive withdrawals

<1%

SOURCE: North American Securities Administrators Association

 

Often a senior does not report financial abuse or identity theft because they are unaware, embarrassed, or worse, they think that someone will deem them mentally unfit and they might be “put away” as a consequence of having been exploited. While these are real issues and fears experienced by elderly people, the scale of financial exploitation is so great it has to be addressed.  This is why the enacted Senior Safe Act, coupled with the Elder Abuse Prevention and Prosecution Act (signed into law October 2017), as well as two Financial Industry Regulatory Authority (FINRA) rule changes (which have already taken effect), will provide the legal protections and financial industry framework our senior population need and deserve. One of the most important aspects of the new FINRA rules is the ability for member firms to place a temporary hold on disbursement of funds or securities when there is a reasonable belief that a senior is experiencing financial exploitation, thus protecting assets before they are taken from the senior. This new rule, in conjunction with the Senior Safe Act, can help keep seniors’ assets from vanishing.

The Senior Safe Act, which was originally initiated by Rep. Bruce Poliquin of Maine, is based on the already existing program in that state with the same name. Similar to the Maine program, the federal legislation allows insurance and financial advisors to report incidence of suspected cases of financial fraud involving their senior clients to financial institutions, who in turn could pass the suspicions on to the proper authorities. 

As long as the insurance and financial institutions elevate concerns in good faith and their employees have received the proper training, the law will protect the institution and its workers from liability in a civil or administrative proceeding where information had been presented to authorities in the hopes of protecting a senior client from financial abuses or identity theft. The training includes a collaborative effort between state and federal regulators, financial firms and legal organizations, credit unions, broker-dealers, insurance companies and agencies, and investment advisers to educate employees on how to spot and report suspected elder financial abuse. 

Seniors who are most active in communicating with a trusted professional third party about their finances are the least likely to fall victim to financial fraud. Counterintuitively, most financial fraud happens to seniors who do not display signs of cognitive impairment. Senior participation with professional and properly trained employees of financial institutions is the back-story of this bill. All of the legal protections of the Senior Safe Act will achieve nothing if there is no participation by seniors. 

It is advisable to find a trusted professional adviser to help protect seniors against financial abuse and identity theft. The Senior Safe Act should make it much easier for seniors to find a properly trained individual who will monitor their financial accounts and be able to report signs of potential trouble to authorities. That trusted individual will be able to identify the warning signs of common scams and educate seniors as to how best to protect themselves; such as how often to check credit ratings for signs of identity theft, reviewing financial statements, identifying common phone and online scams, and more. The laws are in place to help seniors stay protected. Get protected by becoming more involved in your own personal financial world. Contact our office today and schedule an appointment to discuss how we can help you with your planning and participation – 1.800.660.7564 or email us at info@covertlaw.com.

Safer Shopping for Seniors

Safer Shopping for Seniors

When we think of shopping, there are certain risks that are always a possibility. Unfortunately, seniors are often more vulnerable to these risks. The holiday season often brings with it criminals who are targeting shoppers, both in stores and online. Below are some tips to help senior shoppers stay safe whether shopping with mobility issues, shopping in general, or shopping online.

 

General Shopping Safety Tips for Seniors

Shopping can often be overwhelming for all of us, including seniors. Seniors often are less mobile and may move more slowly than others in crowded stores, thus putting them at greater risk for criminal activity. Here are some tips to make shopping safe and successful for you or your elderly loved one.

 

  1. Shop early in the day, especially on weekdays, to avoid large crowds. Often this is a time when stores are less crowded and seniors can navigate the stores more easily. Another benefit to shopping on weekdays is that many stores offer senior discounts throughout the week. During weekends and evenings after work, many stores become overcrowded and more difficult to get around.
  2. Have a “shopping buddy.” Shopping with a friend gives added safety if you or your loved one has issues with mobility. There’s much to the saying, “safety in numbers.” Plus, shopping with a buddy makes shopping more enjoyable.
  3. Don’t wait until the last minute. Often stores are busy in the last few days before the holidays. Shoppers can become less careful and more irritable which can present problems for seniors.
  4. Always keep your car locked and store packages in the trunk or out of sight. This will help deter thieves from breaking into the vehicle.
  5. Shop during daylight hours whenever possible. If it is necessary to shop at night, park as close as possible to the door and always in well-lit areas. The light often serves to deter predators.
  6. Be aware of your surroundings and personal belongings. This can go a long way in helping to protect seniors from those who may attempt to take advantage of them or who may try to steal personal belongings.

 

Online Shopping Safety Tips for Seniors

There are many unscrupulous people who attempt to scam online shoppers. Being aware of this fact and shopping with eyes wide open is key in keeping financial information safe while online shopping. Below are some tips for seniors to remember while online shopping.

  1. Many online sellers offer excellent deals, but it is important to remember that if a deal seems too good to be true it probably is. Check on unknown companies. A quick Google search can provide reviews or information about the legitimacy of online companies.
  2. Create strong and unique passwords. This makes it more difficult for hackers and those trying to steal personal information to get into the accounts. Unique passwords can be difficult to remember, so be sure to keep them written down and in a safe place.
  3. Shop with trusted and known retailers. Most of these websites provide built in security for their shoppers.
  4. Watch extra costs such as shipping. Companies will sometimes offer low prices, but then increase shipping prices to recoup some money.

 

For seniors, shopping can sometimes seem overwhelming no matter what method of shopping is chosen. It doesn’t have to be. It can be a fun and enjoyable experience just by following these safety tips. 

 

If you have any questions about something you have read or would like additional information, please feel free to contact us at 1.800.660.7564 or email us at info@covertlaw.com.

 

Emotional Support Animals and Seniors

Emotional Support Animals and Seniors

Most of us know what a service animal is, but the use of emotional support animals is becoming more and more common. So, what is an emotional support animal? An emotional support animal is a companion animal that provides benefits to a person who has an emotional or mental health disorder. In order to be characterized as an emotional support animal, documentation from a health professional must be obtained for the animal. Mostly commonly, these animals are dogs, but other animals can serve as emotional support animals. It is becoming more evident that these emotional support animals can provide some real benefits to the health and wellness of the senior population. Whether depressed, dealing with ongoing disabilities, or chronic illnesses, emotional support animals can be one of the best treatment options out there.

Emotional Support Animals and Physical Health

Emotional support animals can provide a reason for seniors to get out and remain active. For example, a dog needs to be walked. Walking the dog, provides the senior with physical exercise. Exercise is a much-needed part of a healthy lifestyle for seniors and can even improve mobility. The American Heart Association has even stated that people with heart disease who own a dog outlive those who do not. Similar health benefits can be found for other chronic illnesses such as diabetes. In arthritis sufferers, petting an animal can help to work out the arm.

Emotional Support Animals and Mental Health

Having an emotional support animal also helps to reduce depression and anxiety. It can reduce the stress hormone, cortisol, and increase serotonin, a feel-good hormone. Major triggers for depression in elderly people are loneliness and isolation. With an emotional support animal, many seniors often find companionship and friendship that helps them to cope with loneliness and isolation, and can alleviate depression for the senior. It can also help in coping with a loss of a spouse.

In addition, having an emotional support animal can provide mental stimulation for seniors. This can come in the form of talking about animals or even reading about them. This is of great benefit to those suffering from dementia and Alzheimer’s disease. Often those with dementia or Alzheimer’s suffer from bouts of agitation, emotional support dogs can help to calm them down. Those who suffer from loss of appetite due to these diseases have had improved appetite having an emotional support animal.

Types of Emotional Support Animals

As previously stated, dogs are the most common of the emotional support animals, but there are other options. Cats, like dogs, are a fairly common choice. Birds can be an option for people who do not have a lot of space. Birds also do not require a lot of maintenance which makes them ideal for seniors. Birds come in many varieties, so be sure to research to find the right bird. Fish are an option for people who may be allergic to furry pets. The companionship offered by other pets is not there, but watching the fish can be calming and relaxing. Smaller furry animals such as rabbits, hamsters, mice, and even domestic rats. These animals also don’t require a lot of space, but can be handled and many are affectionate animals, good for companionship.

The support for emotional support animals and seniors is fairly recent, but studies on the effectiveness of these animals continue to be surfacing. Service animals have proven to be of great service to people with disabilities over the years, but the benefits do not stop with service animals. If you or a senior loved one is experiencing chronic illness or mental disorders, consider talking to the family and doctor about getting an emotional support animal. This can greatly improve quality of life and increase the length of life.

If you have any questions, please feel free to contact us at 1.800.660.7564.

Solo aging, independent living and housemates

Solo aging in the baby boomer generation is becoming more prevalent, but many Americans are running out of family caregivers to assist them in their quest for elderly living independence. The ratio of caregivers to care recipients has fallen and is projected to continue to do so for the next forty years. According to the Pew Research Center, the rate of childlessness among baby boomers is about 20 percent. That number is double the previous generation. Additionally, these boomers who are aging solo, without a spouse or partner and have children living more than 500 miles away, bring the total of solo agers in America to nearly 40 percent of adults over the age of 65.

Because solo agers who own their own home prefer to reside there, many of them are finding creative ways to share costs as well as reduce the workload, stress, and isolation of living alone. Welcome to your new housemate, but don’t call them that and don’t call them roommate either. The boomer generation is adopting the term “POSSSLQ,” (pronounced “possle-cue”) short for People of Similar Sensibilities Sharing Living Quarters. This moniker is a wink at the former US Census Bureau designation for unmarried couples; “Persons of the Opposite Sex Sharing Living Quarters.” Whatever the preferred terminology, this new housemate trend is a demographic and economic shift which is redefining the “golden years” of retirement. 

It is no surprise that at a historic shortage of homes pushing up housing costs coupled with the fact that many boomers realize they have not saved nearly enough for retirement has fueled this housemate solution. Some of the best ground rules to follow are to find someone you may already know, perhaps of similar background. Also, keep your “POSSSLQ” in a narrow age range to your own. Seniors who are looking to be housemates and are of a certain age can find each other on websites, some of which are Roommates4Boomers and Let’s Share Housing. It is a great way to stretch retirement dollars and still have independence in a shared living experience without loneliness or feeling like a burden to family.

Women account for most of these new housemate living arrangements. Women tend to live longer and have less in retirement savings as compared to their male counterparts. Women also tend to be more adept at making a home and creating companionable spaces in which to cohabitate. 

The rules of roommates are usually broad and general. Some specific ground rules may be non-negotiable such as pets, loud music, or romantic sleepovers; however many women have a more flexible approach and often work out smaller details in day to day conversation. Often the secret to housemate living is to embrace its unexpected nature so long as an established basic framework remains intact. These boomer housemates are expressing creativity in problem-solving issues related to their golden years and want their focus to be on living life rather than the end of life planning.

The cautionary tale of baby boomer housemate living is to be confident you enter into the relationship with a legal document that outlines home ownership, household expenses, chore responsibilities, house rules, as well as identification of objects you already own in your home (if the owner) or what you may bring into the house (as the new housemate). Remember that you spend the first half of your life trying to get something and the second half of your life trying to keep it. Another issue to discuss and lay legal ground rules for is what happens in the case a housemate gets a diagnosis of dementia? A housemate living situation should not evolve into a caretaker situation. 

Whether you are the homeowner or the housemate, it is imperative to have a legal document signed and notarized defining the living arrangement. Contact our office today and schedule an appointment to discuss how we can help with the planning and execution of a housemate agreement.

Making Sure Your Estate Plan Reflects Your Wishes

Make Sure Your Estate Plan Reflects Your Wishes

Jack and Doris wanted to divide their property equally between their three children. The house should to go to daughter Mary who loved it, and the rest of their estate should be apportioned equally between sons Bob and Francis.

Jack and Doris’s attorney drafted a will distributing the modest remainder to the sons and the attorney filed a beneficiary deed leaving the house to Mary. A beneficiary deed – or transfer-on-death deed – is a useful and efficient way to leave real estate to heirs without going through expensive and protracted probate proceedings.

Years passed. Jack died and, late in life, Doris was diagnosed with cancer. She had forgotten about the earlier plan. She wrote out a will leaving her property equally to her three children.

After Doris died, the children were unhappy to discover a conflict between the old beneficiary deed and the new handwritten will. The will was legally binding but, because beneficiary deeds take precedence, Mary ended up getting more than her parents had intended. She got the house through the beneficiary deed and then an additional one-third of the remaining property through the will. This was not what Jack and Doris had wanted and the inequity strained the relationship between the children.

Remember: Your estate plan is not a time capsule, preserving relics for future discovery. Be sure to talk to an attorney to update your plan in the event of illness or change in circumstances. Please feel free to contact us – we would be happy to help.

3 Reasons Veterans Should Have a Professional Advocate

3 Reasons Veterans Should Have a Professional Advocate

The number of sad stories of veterans’ benefits getting tied up in the system is not only sad but startling. A quick internet search can lead to story after story of veterans who have struggled to receive the benefits that are owed to them. Robert DiCicco spent his final years battling through the red tape to get his benefits and pay for the bills to his assisted living facility. The sad part is he didn’t live to see it. The benefits he was owed did come through ten days after his death, but they were taken back by the Veteran’s Administration. The DiCicco family had to begin again as his wife was left to fight for the benefits as his beneficiary. The unfortunate part is that these stories are far too common. In fact, many veterans die or give up before they ever receive benefits. Knowing how and finding a professional advocate is a veteran’s best option.

1. Success rates are boosted with a professional advocate.

The National Organization of Veteran’s Advocates, Inc. (NOVA) reports that veterans represented by attorneys have the lowest denial rate in front of the Board of Veteran’s Appeals (BVA). NOVA also notes that veterans with attorney representation are more likely to have their appeals allowed by the BVA. Another great benefit to having an attorney is the Equal Access to Justice Act. This act says that if the attorney wins the appeal, then the government must pay the veteran’s legal fees. Therefore, the attorney gets paid without affecting the veteran’s benefits.

2. Qualified attorneys know their way around the process.

Attorneys who specialize in veteran’s benefits cases understand the process. These attorneys know what paperwork needs to be filed and when. They can also walk the veteran through the process. Attorneys can read and understand the case files and records which can help the veteran maximize their benefits and even find benefits the veteran may not be aware of. After assessing case files, the attorney can determine the most efficient path to take to achieve these goals. In a system where many veterans are waiting years for benefits, there is a huge benefit to using an attorney.

3. Having a professional advocate provides personalized help.

A veteran with an attorney advocating for their case has personalized help. Case managers and people within the system cannot provide this kind of assistance to their clients as they are dealing with a multitude of cases. Attorneys and firms generally only take on the number of cases they have time to give attention to, allowing them to fight on your behalf. In addition, an attorney is able to answer claims related questions the veteran may have in a timely manner. Without an attorney, the only way the veteran can get answers is by calling the VA and often waiting long periods of time for answers. An experienced attorney can also help the client to know what records are needed to support claims and to provide sworn statements when necessary. You can be assured that if the BVA is hearing an appeal, they have an attorney. Therefore, it stands to reason that the veteran would want to even out the playing field by having an attorney as well.

When it comes to something as important as veteran’s benefits, it only makes sense that a veteran is better off with someone who knows the ins and outs of the process. It is the job of the attorney to advocate for their client, but they also provide support and information which is invaluable. If you don’t want to end up like Robert DiCicco and countless others like him, consider getting an attorney as soon as possible to help with your claim.

If you have any questions about something you have read or would like additional information, please call us at 1.800.660.7564 or visit our website:  www.covertlaw.com.

Medicare Advantage Plans to Offer Greater Benefits in 2019

Medicare Advantage Plans to Offer Greater Benefits in 2019
 

On April 2, the Centers for Medicare & Medicaid Services (CMS) expanded how it defines the “primarily health-related” benefits that insurers are allowed to include in their Medicare Advantage policies. As a result, when these plans roll out their coverage for 2019, new benefits may include air conditioners for people with asthma, healthy groceries, rides to medical appointments, home-delivered meals, and non-skilled home-care services.

In this issue of The ElderCounselor, we will look at how Medicare Advantage Plans work, the benefits they provide, what the expansion means, and how it may impact both seniors and the plan providers.

Background

Medicare is government-sponsored health care for those age 65 years and older. Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part B covers doctors’ services, outpatient care, medical supplies, and preventative services.

However, there are deductibles and copayments for Medicare that can add up quickly. Also, there is no limit on annual out-of-pocket expenses. Most people buy a supplemental insurance policy, called Medigap insurance. It “fills in the gaps” of Medicare and pays deductibles and copayments. These policies are sold through private insurance companies approved by Medicare. Prescription drug coverage is also sold separately as Part D through private insurance companies.

Many seniors like the flexibility this combination provides because they can go to any health care provider or facility that accepts Medicare. Medicare pays its share of the approved amount for covered health care costs first, and then Medigap pays its share. However, Medicare can and does deny coverage for a procedure or treatment that it rules is medically unnecessary, and Medigap will only pay its share if Medicare pays first.

Also, there are some expenses that Medicare does not cover that are important to seniors, including hearing aids, vision care and dental care.

What Are Medicare Advantage Plans and How Do They Work?

Medicare Advantage Plans, sometimes called Part C, are sold by private insurance companies as an alternative to Original Medicare. If you join a Medicare Advantage Plan, you still have Medicare, but you receive Part A (hospital insurance) and Part B (medical insurance) coverage from the Medicare Advantage Plan, not from Original Medicare. However, Original Medicare will still cover the costs for hospice care, some new Medicare benefits, and some costs for clinical research studies.

Medicare pays a fixed amount for care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare and they must cover all of the services that Original Medicare covers. However, if one chooses a Medicare Advantage Plan, they cannot use a Medigap policy. In fact, it is against the law for someone to sell a senior on a Medicare Advantage Plan a Medigap policy unless that person is switching back to Original Medicare. (Changing plans is allowed once each year, during open enrollment in the fall.)

Medicare Advantage Plans work like HMOs and PPOs. Generally, a Medicare recipient must use facilities, physicians, and pharmacies that participate in the plan’s network. Some allow for non-network coverage. Emergency and urgently needed care are covered both in- and out-of-network.

One of the draws for seniors is that Medicare Advantage Plans offer benefits that Medicare does not, including vision, hearing, dental, gym memberships, and health/wellness programs. There are also cost savings. The monthly premium usually includes Medicare prescription drug coverage (Part D). And, while there may be a copayment for covered services, there is an annual limit on out-of-pocket costs. So, once a senior reaches a certain limit, they will pay nothing for covered services for the rest of the year.

Some Shortcomings of Medicare Advantage Plans

There is a multitude of Medicare Advantage Plans, even within one service area. This can be confusing to consumers who must re-evaluate them each year. Each plan can charge different out-of-pocket costs. They can also have different rules for how services are received, such as whether a referral is needed to see a specialist. And they usually have different networks of facilities and providers.

Each year, plans set the amounts they charge for premiums, copays, deductibles, and services. The plan (rather than Medicare) decides how much someone pays for the covered services, and it is allowed to change how much the insured would pay only once a year, on January (This is the effective date of coverage for each fall’s open enrollment.) However, they can change their network providers and facilities at any time during the year.

When considering a Medicare Advantage Plan, consumers must be diligent about understanding which facilities and physicians are included in its network, where they are located, and how to use the plan for routine and emergency care.

A plan can also choose not to cover the costs of services that are not medically necessary under Medicare, so it is advisable for a patient to check before they have the service or procedure done. If someone needs a service that the plan says is not medically necessary, they may have to pay all the costs of the service. But that patient would have a right to appeal the decision. They can also ask for a written advance coverage decision to make sure a service is medically necessary and will be covered.

Still, of the 61 million people enrolled in Medicare last year, 20 million have opted for a Medicare Advantage Plan. One reason may be that, in recent years, many families have become accustomed to HMOs and PPOs for their health insurance as lower-cost alternatives to traditional health care.

What the CMS Ruling Means

According to the CMS, the new rules will expand benefits to items and services that may not be directly considered medical treatment but will provide care and devices that prevent or treat illness or injuries, compensate for physical impairments, address the psychological effects of illness or injuries, or reduce emergency medical care. The goal is to keep people healthy and well, making it easier for them to live longer and more independently. A physician’s order or prescription will not be required, but the new benefits must be “medically appropriate” and recommended by a licensed health care provider.

Details of the Medicare Advantage Plan benefit packages for 2019 must first be approved by CMS and will be released in the fall when the annual open enrollment begins. But plan providers already have ideas of what they could include.

In addition to transportation to doctors’ offices or better food options, some health insurance experts said additional benefits could include simple modifications in beneficiaries’ homes, such as installing grab bars in the bathroom, or aides to help with daily activities, including dressing, eating, and other personal care needs. The goal is to focus on avoiding injuries or exacerbating existing health conditions.

Non-skilled in-home care services will also be allowed for the first time as a supplemental benefit, providing they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room use.

Home health care providers have already partnered with Medicare Advantage Plans, and many believe the plans will be willing to pay for non-skilled in-home care with an eye on saving money over the long-term. Medicare Advantage Plans have greater flexibility than the fee-for-service providers have, and in many cases do not have a homebound requirement. Because they receive a set amount per patient from Medicare, they would be more inclined to provide any services, including private duty nursing, to ensure the patient doesn’t cost them more money than necessary.

What to Watch

Seniors on Medicare have said that when considering Medicare Advantage Plans, access to certain hospitals and doctors is a top priority for them. Original Medicare includes the vast majority of providers and the broadest possible provider network.

But Medicare Advantage Plans are gaining in popularity. According to CMS, in 2015, 35% of Medicare beneficiaries were participants in Medicare Advantage Plans. That number is expected to grow quickly over the next several years. New, attractive benefits coming in 2019 (especially non-skilled in-home care) will likely persuade even more seniors to join Medicare Advantage Plans.

That’s certainly good news for the Medicare Advantage Plan industry. And it will be good for seniors if it lets them stay in their homes longer and lead healthier, more independent lives.

Sources

https://homehealthcarenews.com/2018/04/cms-officially-adds-non-skilled-in-home-care-as-medicare-advantage-benefit/

https://khn.org/news/medicare-advantage-plans-cleared-to-go-beyond-medical-coverage-even-groceries/

https://www.medicare.gov

To comply with the U.S. Treasury regulations, we must inform you that (i) any U.S. federal tax advice contained in this newsletter was not intended or written to be used, and cannot be used, by any person for the purpose of avoiding U.S. federal tax penalties that may be imposed on such person and (ii) each taxpayer should seek advice from their tax advisor based on the taxpayer’s particular circumstances.

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Covert | Law

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