Why Seniors Don’t Eat: It’s Complicated.

More than half of older adults who visit emergency departments are either malnourished or at risk for malnutrition, but not because of lack of access to health care, critical illness or dementia. Despite clear signs of malnutrition or risk of malnutrition, more than three-quarters had never previously been diagnosed with malnutrition, according to the results of a study published online in Annals of Emergency Medicine (“Malnutrition Among Cognitively Intact, Non-Critically Ill Older Adults in the Emergency Department”).

“We were surprised by the levels of malnutrition or risk of it among cognitively intact seniors visiting the ER, and even more surprised that most malnourished patients had never been told they were malnourished,” said lead study author Timothy Platts-Mills, MD, of the University of North Carolina Department of Emergency Medicine in Chapel Hill, N.C. “Depression and dental problems appear to be important contributors, as is difficulty buying groceries. Given that seniors visit ERs more than 20 million times a year in the U.S., emergency physicians have an opportunity to screen and intervene in ways that may be very helpful without being very costly.”

Of patients age 65 and older, 16 percent were malnourished and 60 percent were either malnourished or at risk for malnutrition. Of the malnourished patients, 77 percent denied have been previously diagnosed with malnutrition. Malnutrition was highest among patients with symptoms of depression (52 percent), those residing in assisted living (50 percent), those with difficulty eating (38 percent) and those reporting difficulty buying groceries (33 percent). Difficulty eating was mostly attributed to denture problems, dental pain or difficulty swallowing.

In this study, nearly all (95 percent) of patients had a primary care physician, nearly all (94 percent) lived in a private residence and nearly all (96 percent) had some type of health insurance. More than one-third (35 percent) had a college education.

Malnutrition is defined as lacking “adequate calories, protein or other nutrients needed for tissue maintenance and repair.”

“For patients who report difficulty buying groceries, Supplemental Nutrition Program, Meals on Wheels, Congregate Meals Programs or community-based food charities can be helpful, although other factors may also need to be addressed,” said Dr. Platts-Mills. “The growing role of the emergency department as community health resource makes it an essential place for identifying and addressing unmet needs of older adults. Implementation of oral nutritional supplementation is inexpensive and may reduce overall costs by accelerating recovery from illness and reducing readmissions.”


Can You Get Paid to Take Care of Your Parent?

Carol Levin – www.nextavenue.org

Many words are used to describe family caregivers — invisible, overwhelmed, hero, one is often just assumed. That word is “unpaid.” Although family caregivers are often praised as a critical part of the elder care workforce, most don’t get a paycheck.

Yet many caregivers need financial assistance. In addition to the emotional and physical stress, caregiving often brings money worries. Paying for medical supplies and drugs not fully covered by insurance, transportation, home adaptations, home care or any of the myriad other expenses brings havoc to a budget. It’s no wonder many family caregivers ask, “Can I get paid for taking care of my parents?”

It depends.

These are the differences which determine eligibility: which state you reside, the age or condition of the person you are caring, your relationship to that person, his or her income and assets and other considerations. State and federal programs noted below will not replace a full-time salary with benefits.

Options for Caregiver Pay

1. A long-term care insurance policy

If your family member has long-term care insurance that provides for the in-home care services, the policy may allow a family member to be paid. Some policies exclude people who live in the same household. Ask an experienced LTC agent to explain the policy’s benefits. If it is a reimbursement benefit, unless the benefits allow for reimbursement for a family, friend, or service organization services may only be provided and paid through a licensed home care company. 

2. A private contract with a family member

If a family member has savings or other resources and wants to pay you, a private contractor personal care agreement may work out well for both of you. But this option can lead to family conflict and emotional and legal problems. Make sure you consult an elder law attorney to draft a contract that explains your wages and your responsibilities. Your wages should be consistent with prevailing local rates. Any impact on inheritances should be clear. All interested parties (siblings, other relatives) should understand and approve the agreement.

3. Consumer-directed Medicaid programs

Every state but South Dakota has Medicaid programs which allow an eligible older adult to hire and train home care aides. These programs are often informally called Cash and Counseling, but each state has its own formal name and eligibility requirements. Family members or friends maybe hired; only 12 states allow spouses to be paid.

Once the request is approved, the state Medicaid agency creates an individualized budget based on needs and available resources. In California, for example, under Medi-Cal’s In-Home Supportive Services program, the value of the services cannot exceed $3,500 a month and generally averages around $2,200. The national average hourly wage for home-care service providers, including family, is around $11 an hour, although in some areas it may be as high as $15 to $17 an hour.

There is paperwork involved, and many participants use a financial management Services agency to manage tax and other requirements. (Your state Medicaid agency should be able to provide you with a list.)

Some states have programs for individuals who are not eligible for Medicaid or who have specific conditions such as traumatic brain injury. To find out what your state offers, contact your state Medicaid agency. Since many states do not have the word “Medicaid” in their agency’s title, check with the state department of health or your local Area Agency on Aging, which you can access through Eldercare Locator, a service offered by a federal agency.

4. Paid family leave

The federal Family Medical Leave Act protects workers’ employment when they take time off for the birth or adoption of a baby or to care for a seriously ill family member, but it is unpaid leave. California, New Jersey, and Rhode Island, however, have programs that give employees the right to paid leave for these major life events; New York has a law that goes into effect in January 2018; theDistrict of Columbia’s law will be active in 2020. Washington state also passed a law but implementation has been delayed.

Each state’s laws have different payment schedules and eligibility requirements.

5. Caregivers to veterans

The U.S. Department of Veterans Affairs (VA) has a number of caregiver support programs. For primary caregivers of veterans injured in military conflicts after 9/11, a 2010 law provides monthly stipends, the amount determined by a combination of hours and wages that would be paid to a home care aide. Other benefits to caregivers include travel expenses, access to health care insurance, mental health services and 30 days of respite a year.

Caregivers of other veterans who require assistance and are housebound may be eligible for the VA’s Aid and Attendance Pension Benefit. Some states have their own programs designated for veterans as well.

6. Vouchers for employed caregivers

In July 2017, Hawaii became the first state to provide financial assistance to full-time employed caregivers of older adults. The Kupuna Caregivers Act (kupuna means “grandparent” or “elder” in Hawaiian) provides up to $70 per day in vouchers for eligible caregivers that can be used to pay for services available through one of Hawaii’s Aging and Disability Resource Centers.

Services include adult day care, case management, home-delivered meals, and transportation. The legislature has allocated start-up funds of $600,000 for this program, which must be renewed in 2018.

7. Tax credits

Almost half the states (23) have some form of tax credit for caregivers of dependent older adults. There are different requirements for eligibility and for types of allowable expenses. Tax credits are not refunds; they allow a person to deduct a dollar amount from their state tax bill, sometimes a percentage of the amount on their federal tax return.

The federal Credit for Caring Act (H.R. 4808/S.2759) was introduced in May 2017; if passed, it would provide a federal tax credit of up to $3,000 for eligible employed family caregivers. Its prospects for passage are uncertain.

Other Sources of Support

Additional income for the family caregiver may not be the only solution to financial problems. Programs such as Supplemental Nutrition Assistance Program (SNAP) or Meals on Wheels may help provide food. Other programs pay for paratransit or homemaker services. Two places to start are Eldercare Locator and Benefits Checkup, provided by the National Council on Aging.

Consider the future. Caregiving that lasts for a few months may be difficult financially and emotionally but manageable. Caregiving that goes on for years presents financial, physical, and emotional challenges that require a comprehensive plan.


The Ethics of Adjusting Your Assets to Qualify for Medicaid

Ron Lieber – New York Times

At any given moment, there is a large group of citizens who want nothing more than to make absolutely certain that they are impoverished enough to qualify for Medicaid sooner rather than later. Someday, you might be one of them.

Welcome to the (perfectly legal) world of Medicaid planning, the plain-vanilla term for the mini-industry of lawyers and others who help people arrange their financial lives so they don’t spend every last dime on a nursing home. Once properly impoverished under the law, then Medicaid, which gets funding both from your state and the federal government, picks up the tab.

Whatever twists and turns the health insurance debates in Washington take, Medicaid will be at the center, and the program will probably affect you and your family more than you know. After all, if you run out of money in retirement, it is Medicaid that pays for most of your nursing home or home-based care.

The bill that contains the caps that Republican senators have proposed, which would remake Medicaid, seems for now to have a low chance of passing. But even if no bill survives, politicians on both sides of the aisle fear what demographics will do to the program’s costs. Most Americans haven’t saved enough to pay for decades of post-retirement living expenses and years of expensive end-of-life care, so it stands to reason that Medicaid will come under increasing strain.

The debate is not new, though it happens to be the rare topic on which the editorial boards of The New York Times (“Pretending to Be Poor”) and The Wall Street Journal (“Medicaid for Millionaires”) have agreed over the decades.

What are we talking about when we talk about Medicaid planning? First, you have to qualify. So let’s begin by putting a fat “generally” in front of every statement below, along with a warning that you should not try this at home alone. A lawyer experienced in the field is a necessity.

Medicaid eligibility for long-term care can differ by state and also by marital status. Generally, you can’t have income higher than $2,205 per month per person, including Social Security. Asset restrictions of just a few thousand dollars also apply, unless you’re a spouse who is not receiving care, in which case you can have up to $120,900 while your husband or wife qualifies for Medicaid. Homes don’t count in the asset calculation, though there is a cap on home equity if you’re single that is either $560,000 or up to $840,000, depending on the state. The Medicaid officials in your state can also tap your estate for repayment under certain circumstances.

To get within those limits, lawyers may encourage gifts to family members (though if they are within five years of a Medicaid application, there can be penalties), annuity purchases, trusts of various sorts and a certain type of long-term care insurance that can shield some assets from the Medicaid calculation once you’ve made a claim.

There are dozens of other nuances, maybe hundreds. Did I mention the need for a qualified lawyer? If you want to do some homework first, the book “How to Protect Your Family’s Assets From Devastating Nursing Home Costs” will give you a sense of what questions you need to ask.

However, you may want nothing to do with this. It would not surprise K. Gabriel Heiser, the lawyer who wrote the book. He’s heard from colleagues over the years who wanted no part of this work. This confused him, he said in an interview this week, given that many of them handled estate planning for wealthier clients. There, they helped people avoid paying millions to the government, whereas Mr. Heiser’s work merely helps clients get the government to pay a few hundred thousand for care on their behalf.
 That bit of relativism, however, does not erase a basic fact: Anyone who engages in legal Medicaid planning is attempting to qualify for a government program for the indigent when they do have at least some assets that could pay for their care.

Janet Kinzer, who lives in Silver Spring, Md., and whose father died last year at 92 with assets to spare, offered the most stinging rebuke: People who engage in such planning are privileged enough to be aware of it and can afford the legal fees. Shouldn’t tax dollars go only toward the care of people who lack such access?

The retorts are numerous. I heard several versions of the following in recent weeks: I’m a taxpayer and paid into this system. I was thrifty, and my neighbors were not. They went on vacation. In fact, I watched them go when I was home at Christmas, and they came back with suntans. And now my heirs should get nothing? To accuse me of gaming the system is absurd; I just don’t want to be taken by it.

If this sounds a bit like a sense of entitlement, that may not be far-off. In fact, several readers echoed something that Marcia Perna told me when I interviewed her about her late mother a few weeks ago. In plenty of other countries, she said, the government would pay for long-term care for everyone.

Now, take that to its logical conclusion. Here, Medicare pays the surgery and drug bills for people with heart disease and cancer. But dementia patients, like Ms. Perna’s mother, need expensive supervision, which Medicare doesn’t pay. That’s not fair, one might argue, so doing everything legally possible to get a dementia patient eligible for Medicaid is like a form of political protest that corrects an inequity.

 Then there are the parents who take the estate they bestow on their children as a point of pride. One adult child, who did not want to be named because her father is so emotional on the topic, said that he insisted on a trust even though she and her sibling did not ask for any money.
He is, she said, fighting for whatever is left of the meaning he can take from life in his 90s, while his wife slips away from dementia in front of his eyes. He grew up in the Depression, saw his friends evicted and their belongings tossed into the streets and had to move in with family himself. His friends are now dead and most of his relatives are gone. All he has done is sweat and scrimp and save so he could leave something behind. Any discussion about not doing so causes him to cry and have panic attacks. So should his daughter really have tried harder to talk him out of a trust?

Jennifer L. VanderVeen, a lawyer in South Bend, Ind., who delivered a presentation at a 2009 legal conference on the ethics of gifts as part of Medicaid planning, said that many of her clients come in with more practical concerns. For instance, they would prefer not to have to sell a small business or a farm that employs other family members in order to pay for long-term care.

Many of her clients aren’t wealthy enough to give big gifts to family members at least five years in advance of when they might first need care that Medicaid could pay for. After all, there is a lot of uncertainty about when that need might come, and what other expenses might precede it in the half-decade or more beforehand.

If you’re looking for another way to frame these issues, consider one other thing: If you or your relatives are already Medicaid-eligible by the time care is needed, there may be fewer choices available. Not every in-home caregiver or nursing home accepts Medicaid or has an unlimited capacity for people on Medicaid even if they do accept it.

Benefits for Veterans

two elder caucasian veterans

According to Census data, more than 20 million Americans are veterans of foreign wars. Roughly half of those veterans (9.2 million) are aged 65 and older, including more than 1.3 million World War II veterans over the age of 85.

Though our nation’s heroes may have the gift of longevity, with more years often comes a greater strain on financial resources. If you or a loved one is a veteran, read on to learn about the variety of public and private benefits that can help you afford to remain independent, healthy, and secure.

Types of veterans’ benefits

Veterans’ benefits come in many forms—from cash grants and education assistance to home and community-based services. Eligibility for many programs depends upon the length and type of service, whether you incurred any service-related disability, and your household income. Many of the programs described below are available to veterans of all ages who qualify.

Financial assistance

  • Veterans’ pensions are administered by the Veterans Administration (VA) and provide a monthly cash benefit to those 65 years of age or older or who are disabled at any age. The amount you receive depends on your income, number of dependents, and the program’s pension rate for the year of your application.
  • The VA Death Pension is a cash benefit awarded to the surviving spouse (who has not remarried) of a deceased veteran.
  • Disability payments are available to veterans who suffered an injury/disease or worsening of such a condition while on active duty. Extra compensation is available if you have very severe disabilities or limb loss, dependents, and/or a seriously disabled spouse.
  • Financial aid for education is also available through the Montgomery GI Bill Active Duty (MGIB-AD) or Post-9/11 GI Bill to help pay for tuition, books, fees, examinations, and housing expenses for graduate and undergraduate degrees, and vocational and technical training.

Health and long-term care

  • The Aid and Attendance (A&A) and Housebound benefits are two programs that provide financial help for veterans and surviving spouses who require the regular attendance of another person to assist in eating, bathing, dressing, and toileting. It also helps pay for care in assisted living facilities. This benefit is only available to those with a wartime service record (and their spouses) who are aged 65 and older and who also qualify for a VA basic pension.
  • The Choice Program can help you find health care services in your community, as an option to bypass waiting for appointments with the VA or traveling a long distance to get to a VA facility.
  • VA Blind Rehabilitation Services help you remain independent by providing services if you are blind or have low vision. The services can take place in an inpatient or outpatient facility or in your home, based on the level of need.
  • State veterans’ homes are facilities that provide services including rehabilitation and skilled nursing, long-term care, residential care, dementia care, and hospice care.
  • Telehealth brings routine health care services to your home via technology that connects you to your doctor.
  • Home hospice care provides comfort and support if you have an advanced stage of a terminal disease.

Home loans

  • Special housing grants offer cash benefits to those with certain service-connected disabilities to buy a home or to remodel your home to accommodate the disability.
  • Veterans’ home loans help members of the military secure mortgage loans to purchase a home. The VA administers a guaranteed mortgage loan through an approved lender. A VA loan will protect you if you end up having trouble paying your mortgage, as the VA will guarantee repayment of the loan to your lender.

State programs

State veterans’ benefits programs vary widely, and include:

  • Discounted hunting or fishing licenses for those with a service-connected disability.
  • License plates that recognize your time in service.
  • Educational assistance to attend any state-sponsored college or university.
  • Employment assistance and resources to help you find a job.

Help for caregivers

Caregivers of veterans may also be eligible to receive help through programs such as:

  • Adult Day Health Care (ADHC) services, which enable the veteran to participate in supervised, safe activities outside of the home, giving the caregiver an opportunity to take time for self-care.
  • Respite care of up to 30 days per year to provide a break from their caregiving duties.

Where to find these programs

All the programs listed above are included in BenefitsCheckUp.org, NCOA’s free and confidential online benefits screening tool.

Completing the BenefitsCheckUp® questionnaire will show whether you or a loved one are likely eligible for the programs, and provide information on where to get assistance with your application, including through the Veterans ON-line APPlication (also called VONAPP), a regional VA office, or the VA toll-free helpline at 1-800-827-1000.

If you live in one of NCOA’s local Benefits Enrollment Center service areas, you’ll also receive information on how to contact someone who can help you apply for all the benefits you may be missing.

Additionally, using BenefitsCheckUp® enables you to simultaneously screen for eligibility for programs that are not solely for veterans—including those that pay for medications, food, utilities, and more.

The Tele doctor Will See You Now

For a busy working mom like Kieran Geffert, the thought of having access to a doctor 24/7 via Facetime video on her phone was very intriguing. “I had read about how telemedicine was revolutionizing healthcare and people’s access to it,” she says. So when she got an email about a year ago from her HR office at work saying that her company, CBS Corporation in San Francisco, was offering the telemedicine service Doctor on Demand, she downloaded the app right away and linked it to her insurance. “Even though I was a little skeptical about how it would work, I thought, ‘I’ll have it all ready to go, should I need it.’ I’m all about preventive medicine and being on top of things.” A couple of months later, her teenage son developed a suspicious blister inside his lip. “It was bothering him and it just kind of looked funny. I thought, ‘Well, let’s try Doctor on Demand.'”

Geffert had no idea what to expect when she used the app to request an MD. “It was the weekend, and I thought it would be a long wait—maybe the doctor was biking up Mount Tam?” But within less than a minute she and her son were Facetiming with a physician in a white coat. She was able to use the camera on her phone to show him the blister on her son’s mouth. Suspecting a virus, the doctor delivered a prescription electronically to her local pharmacy, which she picked up about 15 minutes later. “My son started on the medicine, and in two days the blister was gone.” Impressed by the ease and speed of the experience—and the handy avoidance of scheduling an appointment, driving to a doctor’s office, and sitting in a crowded, potentially germ-filled waiting room—Geffert used Doctor on Demand three more times over the next year, including once to get steroids for a case of poison oak that had gone systemic. She Facetimed with a doctor as she was getting ready for work and was able to pick up the prescription when the pharmacy opened. “I was able to do it all by multitasking, and it didn’t take any time out of my day. It was great.”

Telemedicine, or telehealth—in which care is transmitted from providers to patients via telecommunications technology—is beginning to take off. One of the most game-changing trends in healthcare today, telemedicine is expected to reach seven million patient users by 2018, up from 350,000 users in 2013, according to a report by IHS Technology. “There are multiple signs that telemedicine’s time is coming, if not here,” says Ian Tong, MD, chief medical officer for Doctor on Demand. “One is that we’re seeing an evolution of patient behavior: Patients are coming to us and asking us to be able to take care of more complex problems. So there’s an appetite for more.” Tong adds that the adoption of telemedicine regulations and guidelines have increased nationwide. “More states have established more sophisticated guidelines around what they want to see a telemedicine program or provider be able to achieve in their platform and in their offering to patients.”

All told, this model of care is still in its infancy; many industry analysts believe that its most significant growth will happen in the next five to ten years. “It’s new, and so there’s some hesitation as to what is achievable over telemedicine,” says Ross Friedberg, general counsel for Doctor on Demand. “People wonder, can a physician provide me with good care this way? We’re so used to going to a doctor’s office and getting a physical exam. It takes a while for people’s attitudes to change as they get used to something new, especially when it comes to something as intimate as the doctor-patient relationship. But once people experience telemedicine, they discover its value and what can be achieved.”

Patients and caregivers stand to gain from the virtual experience. “Telemedicine is a more affordable healthcare option, and a lot more accessible,” says Friedberg. Not just for the privileged, telemedicine visits are often more affordable than urgent care, ranging from $0 when covered by insurance to $75 out of pocket, with most Doctor on Demand visits averaging about $49 (or more for mental-health counseling). For medical providers, it can lower overhead and offer more flexibility than an office or hospital-based practice. It can also help address much of what is wrong with our medical system today. “Part of the reason we exist is that our healthcare system is not working,” says Friedberg. “It’s become too expensive and disconnected from the needs of patients. When people start using telemedicine, if it’s a good program, they keep using it.”

A Return of the (Virtual) House Call

Even if it can’t meet every health care need (you can’t get stitches over Facetime, or have your telemedicine physician pop a dislocated shoulder back into place), telemedicine offers healthcare consumers more choice—and many patients find that empowering. While they’re all a little bit different, telemedicine services like Doctor on Demand, American Well, and MD Live are helping to bring back the 1950s house call, translated into modern mobile device culture. Doctors can “visit” you at home, even in the wee hours of the night. While something is lost in the virtual experience—physical presence and touch, for example—a lot is gained, too. “When I go to the pediatrician or my physician, there’s a lot going on,” says Geffert. “There’s something about the video visit that gives you a doctor’s undivided attention. It’s one to one. There’s no nurse knocking on the door and interrupting. They’re not typing everything you say into their laptop. They’re really present. You have their time, which I think is a valuable differentiator.”

Patients who worry about the limitations of virtual care are often surprised by what can be accomplished over their smartphone. “We can actually do a physical exam. We do it by walking the patient through one and showing them what to do,” says Tong. For example, if sinuses are the problem, an in-person doctor might press on them in various places and ask, ‘Does it hurt here? Or here?’ The provider will walk the patient through the same process and show them how and where to press on their own sinuses and asking them if it hurts. In some cases, depending on the service and its platform, patients can form relationships with their teledoctors, requesting them for appointments just like they can at brick-and-mortar practices.

As an alternative to urgent care or primary care, telemedicine can be a place to “go” on your phone if you suspect that you have the flu or a urinary tract infection. In some cases, when a teledoctor can assess the situation and assure the patient that it’s not necessary, telemedicine can help people avoid an emergency room visit. Especially when telemedicine is combined with health-tracking apps that monitor heart rate and other vital signs, it also has the potential to help manage chronic illnesses like diabetes or hypertension. “We’re reducing the burden of disease and providing more touch points for the patient,” says Tong. “People coming to multiple doctor appointments might have to deal with traffic and waiting rooms full of sick people. If we can cut those visits in half, for a diabetic, that’s a big reduction. This is the future of where we can go with telemedicine. That’s what makes me so passionate about it.”

The Rise of Holistic Tele-Care

While many doctors work for a telemedicine service like Doctor on Demand or American Well, a few doctors are branching out into telemedicine on their own. That is the case for Drs. Eugene Perlov and Lauren Shaiova, married MDs who practice in New York and offer telemedicine in addition to their in-person practices. They are also certified medical marijuana providers, which has thrown a lot of patients their way since New York legalized medical marijuana in 2014. “Once the dispensaries opened, it just blew up,” says Shaiova. “People from Brooklyn to Albany call us. They might have cancer or chronic pain, and they want an alternative to opioids. We’ll do a video encounter before we certify them. They transmit their medical records first so that we know they have a bona fide disease process commensurate with medical marijuana treatment.”


With today’s e-scribing technology, doctors can do almost everything electronically. “You can write a note in a patient’s electronic medical record, send a prescription to their pharmacy, order labs, do medical marijuana certification or primary care,” says Perlov. “Everything from counseling to lifestyle changes to nutrition and medications can go through this e-scribing portal.” For people in remote areas or housebound patients, telemedicine can be transformative. “An isolated mom who is depressed or anxious, and who doesn’t have time to see a doctor, can get telemedicine therapy or find groups online and get tremendous support,” adds Perlov.

Medicare Myths

Nearly everyone over the age of 65 depends on it, but myths and misconceptions around Medicare persist. The government-funded health insurance program for seniors will provide more cumulative lifetime benefits to average earners than Social Security by 2055, according to a study by the Urban Institute, but its complexities inspire a host of misconceptions.

Whether you will be new to Medicare or have gone through the process many times before, here’s how to navigate around unnecessary penalties, bad timing and costly stays you only thought were covered.

Myth 1: I can enroll anytime I want to.

If only it were that easy. While there are large windows of opportunity, if you miss them, you’ll hit a wall.

First-time enrollees have three months both before and after their 65th birthday for their initial enrollment period (IEP). The annual enrollment period (AEP) is October 15 through December 7, when you can make changes to your Medicare coverage.

Participants in traditional Medicare can switch to a Medicare Advantage plan during the open enrollment period, and seniors with Medicare Advantage can return to a traditional Medicare plan or change to a different Medicare Advantage plan without getting hit with a penalty.

Retirees can also switch from one Part D prescription drug plan to another, or add Part D to their coverage (although a late enrollment penalty may apply).

What you can’t do during open enrollment is a switch from Medicare Advantage to Medigap (see sidebar) or switch Medigap plans without answering medical questions. You also can’t join Part B, which covers outpatient care, preventive services, ambulance services, and durable medical equipment, unless you have a qualifying event.

Myth 2: Medicare pays for long-term care.

Many seniors are shocked to find out that Medicare is not going to pay for their golden years in a retirement home or assisted living facility. It will cover the first 20 days in a skilled nursing facility, if and only if the need is due to a hospital stay of at least three days. (Some Medicare Advantage plans will waive this requirement under certain circumstances). As of 2017, days 21 through 100 are no longer fully paid and require a co-pay of $164.50 per day.

Why are so many seniors taken by surprise, given how common long-term care has become? Experts speculate that it’s because they confuse Medicare and Medicaid, a needs-based alternative that kicks in when assets are depleted. Even then, Medicaid probably won’t cover the swanky place you’ve got your eye on; it is only available for eligible facilities.

Myth 3: Medicare covers all my health expenses.

“People usually think Medicare will cover everything, and that doesn’t work out well for clients who aren’t healthy,” says Joanne Giardini-Russell, Medicare advisor with Financial Architects Inc.

Should I Choose Medigap or Medicare Advantage?

One of the most confusing choices retirees must make is picking between supplemental Medigap and a Medicare Advantage health plan that covers Part A and B benefits.


With a Medigap policy, seniors have more physicians to choose from. All Medicare providers participate in Medigap. Out-of-pocket costs are low to none, but average premiums run about $150 to $200 a month and vary by age and health history.

Medigap policies come in 10 variations, no matter where you live. But they don’t include any coverage for Part D, so additional coverage for prescriptions is necessary. And while you’ll have to tote three cards in your purse or wallet (one for Medicare, one for Medigap and one for Part D coverage), payment is a snap. Medigap almost always cuts a check directly to providers after Medicare pays its share.

Medicare Advantage

Medicare Advantage programs require the use of plan providers only (HMO) or charge you extra for out-of-network services (PPO). Plans charge co-pays and carry deductibles of several thousand dollars per year. Premiums run from negligible to more than $100 per month, but all enrollees pay the same regardless of health history or age.

Most Medicare Advantage plans cover prescription drugs, and they are rated with a five-star system. Seniors only have to carry around their Medicare Advantage card for services, but there’s the additional hassle of paying co-pays and deductibles to providers.

The result: Medigap usually costs less for someone with major health problems. Despite higher premiums, out-of-pocket costs are typically much lower. However, if your prescription costs are high, you should factor in the additional cost of Part D coverage before making a decision. Healthier individuals can save money with Medicare Advantage’s lower premiums.

Hint: It’s important to review your choice every year at open enrollment, October 15 to December 7. At this time, Medicare Advantage and Part D plans can change or drop coverage for certain drugs or alter pricing on the same drug. Your Medicare Advantage plan can also change their network of doctors and facilities, adjust the way they cover a medical service, and/or drop additional benefits such as hearing, vision, and dental.

Medicare generally covers 80 percent of costs, and that 20 percent that isn’t covered can add up faster than you can slip on a banana peel. Consider the additional financial burden of dental, vision and hearing coverage, and it explains why so many seniors get supplemental insurance.

It’s important to realize, however, that you have a choice in additional insurance. Don’t just roll from the insurer you had at work into the Medicare Advantage plan the same insurer offers. You can choose between any Medicare Advantage plan offered, as well as Medigap. (See our guide, right) However, you can’t enroll in both.

Myth 4: Medicare is free.

Most people get hospital insurance (Part A) for free but are surprised that medical insurance (Part B) and prescription drug coverage (Part D) require a premium payment, which is dependent on their income. For 2017, the standard premium per month for Part B is $134, but most people with Social Security end up paying $109 a month on average, according to the U.S. Centers for Medicare and Medicaid Services.

Check if you may be eligible for the Limited Income Newly Eligible Transition (LINET) program, which is a temporary prescription drug plan for low-income Medicare beneficiaries who don’t have other prescription drug coverage. It helps get rid of gaps in coverage for those who aged into Medicare without getting a Part D plan.

The Affordable Care Act added coverage for an annual wellness exam and covers 100 percent of most preventive services such as cancer and diabetes screens, mammograms, bone mass measurements and more. Many seniors don’t realize these services are now free.

Myth 5: I don’t need to enroll in Medicare.

Even if you have other insurance, it could be crucial to enroll – and timing matters.

If you work in a company that employs fewer than 20 workers, the employer-sponsored health plan automatically becomes secondary to Medicare at age 65, and the Part B penalty kicks in. That penalty means premiums can go up almost 10 percent for every month you are eligible for Medicare but not enrolled. In addition, you can get hit with a similar penalty for Part D that costs 1 percent of the base cost, multiplied by the number of complete months you’re not covered.

Seniors covered by COBRA have no longer than eight months to sign up for Part B without incurring a penalty, even though COBRA may provide secondary coverage for a year or more after retirement.

Likewise, small business owners and seniors who are self-employed have to enroll in Medicare during their IEP, regardless of whether or not they buy insurance privately.

If your employer has 20 or more employees, it’s usually a good idea to at least sign up for the free Medicare Part A as soon as you’re eligible. But before you do, find out whether that will trigger a change in your current coverage.

Five ideas you need to consider for becoming a happy single retiree

No one sets out to be isolated and alone in retirement, but it can happen to anyone. “Americans are spending less time than ever in the married state,” says Susan Brown of the National Center for Family & Marriage Research at Bowling Green State University in Ohio. This “raises questions about who’s going to care for these people as they age and experience health declines.”

Baby boomers had fewer children than earlier generations, and significant numbers of baby boomers are childless, according to demographer Jonathan Vespa of the U.S. Census Bureau. “As people have fewer children, there are fewer people in that next generation to help take care of that older generation,” he says.

How will these elder orphans—people with no relatives to take care of them—navigate the treacherous waters of old age? Here are five tips for living your best life as a single older American:

1. Don’t wait.

Plan early for the financial consequences of aging alone. It’s never too early to save for retirement, strategize your best option for Social Security withdrawals or pay down your house. The point is to create the biggest nest egg possible to use in retirement. This is especially important for single adults who are more likely to need to pay for home care, ride services, and a retirement home.

Remember that 69 percent of Americans will require long-term care, although a mere 37 percent think they will, according to a survey by SeniorCare.com. That number increases for women, who tend to outlive their spouse and thus feel the effects in larger numbers than men.

2. Work at friendships.

Social connections are a vital component of aging well. A recent study found that for adults 50 years of age and older, those who felt loneliest were almost twice as likely to die within six years as those who felt least lonely, regardless of their health or social status.

Senior centers are a welcome source of friendship and social engagement in many communities. While programs vary, many local senior centers offer libraries, art classes, card and board games, and forays out for cultural events, while some supply a balanced daily meal with a chance to converse with others. Senior adults are also finding a sense of belonging in faith communities and churches, and metropolitan areas are increasingly home to secular communities as well for non-believers.

Maintaining friendships is critical for elder orphans. Depression occurs in almost 20 percent of people over the age of 64, according to the National Alliance on Mental Illness. The more things someone does to keep the body and the mind active, the better the outcome.

3. Appoint a legal delegate.

Before you are incapacitated by time or a medical event, choose a proxy who can help with medical decisions as your durable power of attorney appointee. They need to know what medications you’re on, your insurance information, your social security number and anything else that might be necessary for an emergency.

Various directives can cover a financial or medical power of attorney, a living will and/or advanced directives, such as Five Wishes, which serves as a legal document in most states when signed and witnessed.

Elder orphans without a trusted friend or relative can rely on an attorney who specializes in elder care law. Get a recommendation, and check online ratings for a reliable professional.

4. Evaluate a move.

If there is no compelling reason to stay where you are, elder orphans can use their single status as a bonus and make a move without having to consult a spouse. You may downsize into a tiny house, relocate to a less expensive city with a walkable neighborhood, or benefit from a college town with free classes and a vibrant atmosphere.

Realize that options diminish the older you are. For example, while you may be able to handle moving your household to a new community in your 60s, it becomes more difficult, both physically and emotionally, in your 70s, and very few seniors in their 80s would consider such a big change.

5. Take care of your body.

Avoid cognitive decline and the isolation of a wheelchair by feeding your body well and exercising regularly. Silver Sneakers exercise programs are widely available. Research studies continue to find strong links between diet and cognitive capacity, in addition to healthy foods creating stronger bodies for better mobility and a wider range of activities.

A nutrient-rich diet can even help you avoid disease. “Although food has classically been perceived as a means to provide energy and building material to the body,” according to a recent study of the diet’s effect on neurologic function, “its ability to prevent and protect against diseases is starting to be recognized.”

The Many Parts of Medicare — Helpful Information

Wendy Connick – Motley Fool

Many Americans know that Medicare has two parts — Part A and Part B — that cover health care and hospital care services. There are also other parts that cover a plethora of additional services. Understanding each part of Medicare can help you make smart health care decisions during retirement.

Let’s go over the various parts of Medicare and the benefits they provide.

Medicare Part A

Part A of Medicare provides hospital and hospice coverage. It will also cover some (but not many) types of long-term care. For example, Part A will cover the first 100 days in a semi-private room in a nursing home, but only if you spent at least three days in the hospital first and were sent to the nursing home based on a doctor’s recommendation.

Everyone who enrolls in Medicare is signed up for Part A by default. If you or your spouse earned enough in taxable wages during your working years to qualify for Social Security benefits, then there’s no charge for this part of Medicare. Otherwise, you’ll have to pay a monthly premium.

Medicare Part B

Part B of Medicare provides non-hospital-related coverage. It breaks its coverage down into “medically necessary services,” such as a visit to the doctor when you’re feeling ill, and “preventative services” like your annual physical. In addition to paying various doctor-visit-related expenses, Part B also covers things like ambulances and lab tests.

As with Part A, everyone who signs up for Medicare gets Part B by default. Unlike Part A, Part B always comes with a premium, which is based partly on your income — enrollees with a higher income may pay a higher premium. In 2017, the base premium is $134 per month. The maximum is $428.60 per month for enrollees making more than $214,000 per year (for individuals) or $428,000 per year (for married couples filing jointly). Most enrollees pay their Part B premiums out of their Social Security benefits.

Medicare Part C

Part C, also known as Medicare Advantage, is an optional part of Medicare, provided for enrollees who want more than minimal health insurance. Part C plans are provided by private insurance companies. They take the place of Part A and Part B, and they’re required to cover the health care expenses that are included in these two parts plus additional services, which vary from plan to plan. For example, you may opt for a Medicare Part C plan if you’d like dental and vision coverage, which is not included in Part A or Part B.

Because Part C plans vary so widely, their costs also cover quite a range. You can look up the plans available in your area on the Medicare website. Premiums and other cost-related information, such as deductibles, are listed in the plan descriptions. If you enroll in Part C, you’ll still need to pay the Part B premium, as well as any Part C premium.

Medicare Part D

Part D covers just one type of medical expense: prescription drugs. Many Part C plans already provide drug coverage, so if you have one of these plans, you won’t need Part D. Given how expensive many drugs are today, most other enrollees will want to get a Part D plan.

Like Part C plans, Part D plans vary in both their coverage levels and their expenses. You can expect to pay a premium for any Part D plan, plus a deductible, a co-pay, and possibly other costs as well.

Pill bottle with pills spilling out

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If you choose not to sign up for Part C, you may want to get a Medigap plan to cover health care expenses that aren’t included under original Medicare. Medigap policies are standardized and must follow one of 10 templates, each of which provides a different level of coverage.

Naturally, the Medigap templates that provide more coverage also tend to have higher premiums. But since Medigap policies are offered by private companies, the premiums can vary quite a bit, even between policies using the same plan template. Since policies under the same plan must have exactly the same coverage, it just makes sense to pick the one that’s cheaper.

What’s missing from Medicare

Nearly all health care-related expenses are covered by one or more parts of Medicare, with the notable exception being long-term care. Medicare does not consider long-term care to be a “medical expense,” so aside from certain nursing-home and home-care services with a clear medical component, it doesn’t provide any coverage. Therefore it’s a good idea to supplement your Medicare policies with a long-term care insurance policy. Given the likelihood that you’ll need long-term care at some point, such an insurance policy will provide a reserve fund and care support should you need care because of frailty, chronic health issue, or memory care. 

How Do We Know When Our Loved Ones Need Caregiving

The Ultimate Care Giver Expert.com

Caregiving need is on the rise for our loved ones

Our aging loved ones often deny that there is any problem with them and that they can manage all by themselves. At the same time, who wants to lose their independence with doing their routine tasks without help. After a certain age carrying out daily tasks becomes more and more difficult.

Aging is inevitable for our loved ones

Aging is an inevitable and natural process.  And the most compelling evidence is, it is in this phase of life that our loved ones need help the most. It is important for us to understand, that as we age, our physical capability and mental faculties undergo a decline. This is when the need for help almost becomes inevitable for our loved ones.

Assistance with daily living

To put it differently, from running errands to attending doctor’s appointments, bill payments to monthly groceries which we did in our younger years with ease, will now require help. For this reason, learning to recognize the early signs that indicate our loved ones need assistance helps in preventing major health concerns and to prevent our loved ones from accidents. For this reason, hiring a caregiver, or asking our children to help us with our daily activities is a good idea.

Signs that indicate our loved ones need caregiving

This is a checklist of some of the common signs that indicate it’s the time our loved ones need care and assistance with our daily activities.

  • Forgetful and feel lost
  • Remembering appointments and miss taking medications
  • Forgetful and tend to misplace things
  • Miss out on important dates and events
  • Begin to trust people we don’t know and sometimes even end up paying them money
  • Confused and struggle with monthly bills
  • Unable to handle both household chores and your social life
  • Become depressed easily
  • Being sad and avoid meeting people
  • Nothing in life seems to interest you any longer
  • Avoid activities that you previously enjoyed
In addition to the above-mentioned signs. There are certain physical as well as medical changes experienced by our loved ones. These signs include:
  • Feeling lethargy and the need for more sleep
  • Frequent falls
  • Difficulty in doing personal chores
  • Unable to take proper care of oneself
  • A change in eating habits
  • Difficulty in eating and dressing up independently
  • Experiencing difficulty in cleaning the house single-handedly
  • Requiring daily or weekly medical assistance in the form of therapies or dialysis
  • To be taken weekly for doctor’s appointments
  • Medications need to be evaluated or changed
  • Requiring medical equipment such as an oxygen tank

Do our aging loved ones need help or not?


  • Becoming confused while performing simple tasks for daily living
  • There is unexplained sudden weight loss
  • Change in dietary habits
  • Poor personal hygiene
  • Change in personality or behavior
  • Poor memory
  • Loss of balance while walking
  • The house is dirty and smells of urine
  • There is clutter
  • Appliances such as stove are left on
  • Hair is unkempt and improper grooming
Taking action when any of the above-mentioned warning signs take place will help our loved ones with major health issues. Arranging for caregivers at home itself may give our loved ones, their independence along with the assistance they need