February 28, 2019  Leslie Trichka Beery, VIS Chair and Webmaster, Women’s Issues Chair,  Fort Morgan Chapter, NSDAR

After determining where things are and some of the basic decisions if an emergency is to happen, organizing everything as described in the last post is of utmost importance. In our current situation it took several months to get to a comfortable level of knowing where important documentation is located and what all of the household bills were. Once we were able to determine money coming in and money going out we were able to make better decisions for our parents. Throughout the process of finding a stable ground we were forced to deal with the “right now” needs of healthcare, home care and navigating through the many layers of insurance. Each person is qualified for Medicare at different times in their lives and will at some point use a version of Medicare or Veterans Administration benefits. We are using both and having to figure out which one picks up where the other leaves off. Make notes of all of your insurance policies; Accidental death, dental, disability, hospitalization, long term care, major medical, medicare, medicare advantage, medicare part D prescription drug insurance, medicare supplemental insurance (medigap), surgical, travel, vision, etc.. 

Most people 65 and over are covered by traditional Medicare. Medicare Part A (which has no premium) covers hospitalization, and Medicare Part B (typically $104.90 a month) covers doctors’ visits and outpatient expenses. Together, parts A and B pay the bulk of seniors’ medical expenses. Each part exacts co-payments and deductibles. Traditional Medicare allows patients to use any doctor who accepts Medicare payments, but it can sometimes be difficult to find those doctors, especially in the case of psychiatrists and some specialists. You can search for doctors near your parent who accept Medicare assignment by going to www.medicare.gov and clicking on “Find doctors & other health professionals.”

Many seniors buy a standardized Medicare supplement plan (sometimes called medigap) to pick up out-of-pocket expenses. These supplemental plans automatically fill in gaps in coverage, so claims problems are few. Medicare doesn’t provide prescription-drug coverage. For that, most people buy a separate Medicare Part D plan, offered by private insurers. Seniors who have retiree health insurance can use it to fill the gaps in medical and drug coverage rather than buy a supplemental plan and Part D.

About one-fourth of seniors are enrolled in Medicare Advantage plans, which cover both medical and drug costs. These plans, provided by private insurers, follow the framework of traditional Medicare. Unlike traditional Medicare, however, patients are generally limited to a network of doctors and hospitals. Medicare Advantage premiums tend to be lower than the total premiums for Medicare plus medigap and Part D coverage, but you usually pay more in out-of-pocket costs than with Medicare, medigap and Part D combined. Confusion about network requirements can cause complications with claims you wouldn’t have with traditional Medicare. Pick the right plan. One way to avoid Medicare problems is to pick the right Part D or Medicare Advantage plan for your needs. You can do that during open enrollment, from October 15 to December 7 every year.

Everyone should get a Medicare summary notice showing the services that providers billed to Medicare over the past three months; what Medicare paid; and the amount you or your loved one owes the provider (similar to an explanation of benefits from a private insurer). Match this notice with any bills received from the provider to make sure the claim has been processed.
My parents are part of what is called United Healthcare AARP Medicare which is a HMO Medicare managed by New West Physicians. This type of Medicare is managed healthcare that goes through referrals and case management for everything. The great thing about this has been that each of my parents is assigned a case manager that is a phone call away and gives one on one support. I cannot emphasize enough how important it is to ask questions of the doctors, nurses, facilities and Medicare. Document everything you are told with dates and who you spoke to. This may be information that you will need to refer to if there are problems later on or questions about bills. With my step-dad’s care, he was in a skilled nursing facility for 100 days under Medicare and was to receive physical therapy and daily care. We ended up working with Medicare to de-certify the facility with our documentation and event accounts and also pictures that we had taken. Not every experience is straight-forward and pleasant. There are many broken pieces and parts of the healthcare system and it is easy for you or your loved one to get lost in the shuffle. It takes a true advocate to help someone. Asking questions, being present at all physician visits, keeping copies of all orders, researching medications, and knowing what is going on is key for you or your loved one to be taken care of properly. 
If you are involved in a situation where VA benefits are used, it is beneficial to understand Medicare because the VA uses Medicare as their model for coverage and documentation. Just like Medicare you are assigned a case worker or case manager to help understand and get where you need to go within the VA system. The VA system is based on a priority table to determine what priority group you fall into for benefits and amount of co-pays. This priority table can be researched at https://www.va.gov/healthbenefits/resources/publications/IB10-441_enrollment_priority_groups.pdf 
To find out if you are eligible for VA benefits of any kind you can visit this website and quickly determine your eligibility: https://www.va.gov/healthbenefits/resources/publications/hbco/hbco_enrollment_eligibility.asp
Resources to keep and use:
It is important to understand healthcare coverages and co-pays and how they align with the current health issues. Projecting costs and determining how a long term care situation will be handled is one of the most important decisions you will make. This will affect all financial decisions as well. For example: if you or a loved one needs long term care in a facility, this is not covered by Medicare or the VA (unless you fall into a priority group that will cover it) and you will need to find a way to pay for it. After that, you may apply for Medicaid (different than Medicare) but they will force you to financially show that you do not have the resources to pay for the long term care. Property, vehicles, pensions, social security benefits, bank accounts, IRA’s, investments, etc.. all will be up for liquidation to satisfy costs. This is the part that typically frustrates people and in so many cases forces families to become caregivers since there is no other option. The VA is similar in requiring that a certain level of financial resource be used up before they will pay for everything when long term care is needed. Research in this area can save a lot of headaches and uncertainty later when care is needed and you or family members are not sure of what to do. 
Sometimes death is sudden or after a long illness but either way it is a huge tidal wave of emotion for everyone. Having everything in order can help family know what your wishes (or your loved one if you are helping to prepare) are and how to proceed. Your preparations now will help so many people trying to figure out grief to not be additionally overwhelmed with paperwork, decisions or not knowing what you would have wanted. Clear documentation that is shared with family beforehand about final arrangements and knowing preferences ahead of time makes it all so much easier for family members to make the right choices.
To close this series we will look at final arrangements to include with any documentation that you have prepared.  
 My To-Do Checklist
Done             Need To Do         
                                         Confirm wishes regarding organ or body donation and autopsy
                                         Locate or support steps to create an ethical will
                                          Know wishes for the body
                                          Consider commemoration after death
                                          Plan for burial
                                          Check out burial benefits for veterans
                                          Locate or support steps to create a will
                                          Locate or support steps to create a letter of instruction
Download the Final arrangements action checklists Here:  Checklist_for_My_Family_Chapter_10_checklists
I hope that you found some information useful in the series on Aging that we have put together for you. The bottomline point that we stress is preparation and documentation. This is similar to DAR requirements for proof of lineage and running a NSDAR chapter. I think we can all agree that planning is key to success at most anything that we do in life. We would like to also show that the same planning and preparation is necessary in end of life and making your family successful in an emotional time. This series is not all encompassing of everything that will be required but it is a good starting point for anyone to put together a binder or box of information. Use your google search engine or any of the resources that we have listed. Also contact us if you have any questions or need further resource ideas!