What are Biggest Medicare Open Enrollment Mistakes?

MSN’s recent article entitled “Don’t make these 5 common Medicare mistakes during open enrollment,” provides some of the common Medicare open enrollment mistakes:

  1. Not checking your doctors for 2023. If you have a Medicare Advantage plan, you have to get medical care from doctors in the plan’s network. However, a plan’s network can change at any time. Therefore, before you decide to stick with the plan you’re in, make certain your preferred medical providers are still in the plan’s network in 2023. The best thing is to call the doctor’s office and just confirm with them.
  2. Failing to compare prescription drug plans. No matter if you have Original Medicare or Medicare Advantage, your prescription drug coverage comes from a private insurance company. As a result, it may change what it covers each year. Your regular prescription medication may cost more in 2023, or an insurer may not cover it at all. Another plan may also cover it for less. It is, therefore, wise to plug your drugs into Medicare.gov to see what plans they suggest for you. If you log into your account at Medicare.gov, your medication history is already there.
  3. Believing all doctors will take your PPO plan during open enrollment. A preferred provider organization (PPO) plan is a health plan that lets members see out-of-network doctors but usually at a higher price. People sometimes think because they have a Medicare Advantage PPO, they’ll be able to go to any doctor they want. However, providers don’t always take out-of-network coverage and can simply refuse someone at the point of service, if they don’t want to bill the plan.
  4. Being influenced by the splashy ads. Medicare open enrollment season means Medicare commercials abound, and Medicare Advantage plans have appealing things to offer such as no premiums and some coverage for hearing, dental and vision care. However, shopping for your health coverage is about more than the side benefits. In fact, most don’t cover much dental, and hearing aid coverage is limited. This isn’t the reason to change your plan. It is more important to make sure that the plan covers your doctors and prescriptions for next year.
  5. Waiting too long to ask for help. Medicare open enrollment ends December 7. However, you don’t want to wait to start your research. If you have questions, you can get help through programs like the State Health Insurance Assistance Program, or SHIP. Counselors at SHIP programs can offer free assistance with your Medicare choices.

Reference: MSN (Nov. 21, 2022) “Don’t make these 5 common Medicare mistakes during open enrollment”


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Rehab – Who Pays the Bills when Medicare Runs Out?

Many families will face the reality that at some point an aging family member must go to a nursing home, also called rehab. They provide things assisted living homes aren’t licensed to give, such as skilled care. For instance, an aging parent has surgery and needs therapy during the recovery period. They’re sent from the hospital to a nursing home where therapy is offered, explains Forbes’ recent article entitled “Paying For Nursing Homes: Beware Of Illegal Debt Collection Practices.”

The cost of a long-term nursing home stay, beyond the allowable maximum under Medicare of 100 days, is usually a surprise. According to the annual Genworth cost of care study, and adjusting for inflation, in 2021, the annual median cost of a single room in a nursing home was $108,405.

The CFPB analyzed the risks to family caregivers and friends who enter into contracts for a loved one’s admission to a nursing home. Although it’s illegal, some nursing homes continue the practice of making admission of the senior dependent on the caregiver or other signing a contract making the caregiver the “responsible party”. It forces the family with the immediate need of placing the loved one into the home to sign whatever it takes to get them admitted.

After that, the nursing home can go after the signer to collect the debt for payment after the elder’s Medicare runs out, or the elder’s own funds are depleted. Some residents have run of out funds and have applied for Medicaid. However, processing those applications can take months. All the while, the debt grows for essential care. Some of these nursing homes send the bills to collection agencies, report the unpaid debts to credit reporting agencies and even file lawsuits against the unwitting signatories on those coerced admission contracts. The nursing home’s initial contract and their debt collection practices are illegal under federal law.

If your loved one must go to a nursing home or rehab facility, never sign anything that indicates you’re the legal representative or responsible party. Don’t submit to pressure tactics, if someone wants to force you to sign such a contract. If you encounter these tactics, tell them that it’s illegal under the Federal Nursing Home Reform Act.

Do your research before your loved one must enter such a home for any reason. You may not have much notice but ask to see their admission contract ahead of time. If you see these types of clauses in it about being responsible for the resident’s bills, look elsewhere.

Finally, seek the advice of an elder law attorney for any nursing home or other care contract you don’t understand. These contracts can be full of pitfalls, and the unsuspecting can be caught up in an illegally created trap. An elder law attorney can help you through your decision-making process.

Reference: Forbes (Sep. 13, 2022) “Paying For Nursing Homes: Beware Of Illegal Debt Collection Practices”


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Do Hospice Patients Recover?

There are several dimensions to hospice care, and a recent article in Seasons titled “How common is it for hospice patients to recover?” discusses each of them. The article notes that it’s highly unusual for hospice patients to “recover.” The diseases that prompt people to come into hospice initially are conditions that, by definition, aren’t curable.

However, it’s not uncommon for patients to experience stabilization of their condition. For example, a patient may have experienced a significant stroke from which his or her physician doesn’t think they can recover, so they are admitted to hospice. He or she may begin to experience some stabilization, despite the fact they remain significantly compromised—and they no longer qualify for services.

Some patients are admitted to the hospice with critical diseases – fractures, trauma, infections, sepsis, etc. – from which they are likely to die. However, ultimately, frequently and inexplicably, they don’t.

Similarly, patients with chronic, progressive diseases, such as Alzheimer’s, congestive heart failure, or chronic lung disease, may have a trajectory that suggests they won’t survive more than a few months, making them eligible for services. However, with the provision of hospice services and control of problematic symptoms, their trajectory may change—no longer anticipating a short course.

Regulators know that conditions may change, and patients once eligible for hospice may no longer have a terminal condition that might qualify them for hospice. They are sometimes called “hospice graduates.”

Most facilities see about 5-15% of their admitted patients who ultimately “graduate” and are discharged from hospice services.

In addition, there’s a rare but identified condition referred to as “vanishing cancer syndrome.” This is a circumstance in which a cancer is definitively diagnosed, with no treatments offered, or progression despite treatment. The patient is admitted to hospice, but several months later, the patient hasn’t passed away and seems to be improving.

Further studies demonstrate the cancer is no longer there. Theories ranging from a “super immune” response to a miracle have been proposed, but an explanation for the phenomenon remains elusive.

Aftercare is individualized and would typically include some aspects of home health services and/or private duty resources, as well as ongoing management by the patient’s primary medical team.

Reference: Seasons (Aug. 17, 2022) “How common is it for hospice patients to recover?”


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Tips on Finding the Right In-Home Aide

In-Home Aide – About 90% of older adults would prefer to age in place, rather than move into an assisted living facility or nursing home, according to an AARP survey.

WRAL’s recent article entitled “How to choose an in-home health aide” says that, fortunately, you can have good health care and independent living with an in-home aide. An aide can provide you with care for a short amount of time during the day or can stay with you around the clock. Depending on your needs, an aide can help with many tasks. These include things such as:

  • Chores, such as laundry, cooking and shopping
  • Daily activities, such as bathing, dressing, eating, grooming, moving from one place to another and toileting
  • Monitoring vital signs, like blood pressure, respiration, and pulse
  • Keep an eye on your physical and mental health, including your level of exercise and how much you are eating, drinking, and going to the bathroom; and
  • Assist in emergencies, like an accident, heart attack, or stroke.

There are a number of actions to take when you hire an in-home health aide. Here’s the rundown:

  1. Determine what kind of care, and how much, you need.
  2. Decide if you want to hire through an agency or on your own. The advantages of using an agency are that you will get a prescreened aide and will have backup care when that person is unavailable. You also won’t have to be concerned about offering benefits as an employer because the agency takes care of those.
  3. Consider what you can afford. If you qualify for Medicare or have long-term care insurance, some or all your care may be paid for. If you use an agency, the Mayo Clinic suggests you ask for written, detailed explanations of all services and fees associated with home care. Once you have this from several agencies, you’ll be able to choose the best one for your budget. If you hire a home health aide yourself, remember to think about sick days, holidays, vacation, payroll taxes and Social Security. That is because your aide will be considered a household employee.
  4. After you’ve found your health aide, create a care plan, which may include the following:
  • The days and hours you need assistance
  • The daily tasks that need to be completed
  • A schedule of appointments and medication times
  • A list of contacts, such as your doctor’s information
  • An emergency plan; as well as
  • Any of your personal preferences.

Re-evaluate your care plan every few months. Ask your family to discuss this with you because having loved ones on board will be helpful in the future, when you may need more support as you continue to age in place.

Reference: WRAL (April 17, 2022) “How to choose an in-home health aide”


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How Bad Is Caregiver Burnout?

COVID-19 has created unprecedented burdens for caregivers. This is especially true for those in the “Sandwich Generation” who live in multigenerational households with their older parents and their own children.

A record 41 million Americans are serving as caregivers for an elderly parent, spouse or someone who struggles with day-to-day tasks, according to KIII TV’s recent article entitled “Senior care providers give insight on worker fatigue, how it impacts their health.”

According to a new survey by Seniorly, a national network of senior care advisors, besides losing members of the workforce who give up their jobs to take care of others, over the past six years, the percentage of family caregivers who say their own health status is fair or poor nearly doubled, going from 12% to 21%.

Clint Rendall with Aadi Bioscience, biopharmaceutical company, agrees that being a caregiver can place a lot of mental strain on individuals.

“We get so stressed personally,” Rendall said. “Whether that’s with the workplace, or providing care for someone that we stop caring for ourselves and then it’s sort of a vicious cycle.”

For example, the 65-plus population in Texas is projected to grow from 3.9 million to 5.6 million by 2030, according to AARP.

Other key findings in the Seniorly survey say that among states, Texas is number three in multigenerational households at 4.9%, and the nursing shortage has made the state the ninth highest in the country in nursing care workers to the number of seniors.

Among the 54 million Americans 65 or older, there is a 70% chance that at some point, a senior will need long-term care services. For most people, that care is provided in their homes and often by those who are unpaid, such as spouses, adult children and other loved ones.

One relief program designed for caregivers is respite care, where a loved one can be cared for without family aid for up to several hours or days a week.

Mary Ann Mondragon, who is a caregiver specialist at Caregivers SOS, a WellMed charitable foundation program, said there is lots of help available.

“We have training. We have classes for the caregivers. We have a stress busting class that will actually be starting in April. And it’s a nine week class,” Mondragon said.

“And it helps the family caregivers learn how to take care of their loved ones. How to take care of themselves more importantly.”

Reference: KIII TV (March 29, 2022) “Senior care providers give insight on worker fatigue, how it impacts their health”


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Risk Factors and Dementia Cases

Research suggests that a large portion of dementia cases could be prevented, especially among Black and Hispanic adults, who had the highest percentage of combined risk factors, says Medical Express’ recent article entitled “These three risk factors may have the biggest impact on dementia cases.”

“There are things people can do that can raise or lower their individual risk” for dementia, said Mark Lee, a Ph.D. candidate at the University of Minnesota in Minneapolis. He led the study presented Friday at the American Heart Association’s Epidemiology and Prevention, Lifestyle and Cardiometabolic Health conference.

As the population ages, the number of dementia cases in the U.S. has been increasing. About 5.8 million U.S. adults currently live with Alzheimer’s disease and related dementia. That number is expected to hit 14 million by 2060. The CDC says Black and Hispanic adults will see the largest increases. Among Hispanic adults, cases are expected to rise sevenfold, while cases among aging Black adults are expected to quadruple. These higher rates among Black and Hispanic people may be due to higher rates of heart disease and diabetes, which are linked to dementia risk. Social determinants of health—such as lower levels of education and higher poverty rates—also play a role.

Previous research identified 12 modifiable risk factors believed to be responsible for about 40% of dementia cases worldwide. A 2020 report by The Lancet Commission listed these:

  • Lower education level
  • Hearing loss
  • Traumatic brain injury
  • High blood pressure
  • Excessive alcohol consumption
  • Obesity
  • Smoking
  • Depression
  • Social isolation
  • A lack of physical activity
  • Diabetes; and
  • Air pollution.

In the new study, researchers wanted to see if some risk factors had a greater influence than others on dementia rates—and how that differed among Black, Hispanic, Asian and White adults. When they compiled data from the CDC’s National Health and Nutrition Examination Survey and five other datasets, they saw that overall, 42.4% of dementia cases in the U.S. were attributable to the 12 factors. Three heart-related factors were driving most of that risk across races. High blood pressure, also known as hypertension, contributed to 6.7% of those cases; obesity to 7% and physical inactivity to 6.7%.

The percentage of dementia cases attributable to those three risk factors was highest among Black adults. However, the percentage of all 12 risk factors combined was highest among Hispanic people. Asian people had the lowest percentage of combined risk factors. These findings point to the need for better strategies to reduce heart-related risk factors, which would, in turn, reduce dementia risk population-wide. This can, in part, be done through lifestyle changes, combined with medication as needed, said Priya Palta, an assistant professor of medical sciences and epidemiology at Columbia University in New York City.

“Maintaining a cognitively and physically active lifestyle and controlling risk factor levels pharmacologically, when necessary, throughout one’s life course is critical for later-life brain health and is likely to impact many of the risk factors examined in this study,” said Palta, who was not involved in the research.

Lee said the next step is to see which interventions are most effective for reducing each of the 12 modifiable dementia risk factors. He also said a deeper investigation is required into the social determinants of health underlying racial disparities, such as the disproportionately high rate of hypertension among Black adults.

“That’s a really important direction we need to move to if we are serious about achieving equity in health interventions.”

Reference: Medical Express (March 6, 2022) “These three risk factors may have the biggest impact on dementia cases”


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Is Palliative Care a Benefit to All Seniors?

Palliative care can give relief to those with severe, but not necessarily life-ending, health conditions. However, frequently patients and their physicians fails to understand that they can take use a team-based treatment approach that may include social workers and community support, says Next Avenue’s recent article entitled “Palliative Care is Not Just for the Dying.”

“The big misconception about palliative care in general is that you need to be dying to get it,” said Dr. Andrew Esch, a palliative care specialist and consultant for the Center to Advance Palliative Care (CAPC) in Tampa, Florida.

The pandemic has helped counter that view, Esch and others told Next Avenue. Doctors now realize the benefits to people living with COVID-19 and their families. A palliative care team tries to take a holistic view of the patient’s world, instead of focusing solely on treating the primary condition.

Note that you do not have to be imminently dying to get these services. Receiving palliative services does not mean that you are somehow giving up on treating an illness. Instead, people with cancer, for example, can rely on the symptom-based approach of care to build their strength, so they are better able to withstand chemotherapy. Those with conditions like multiple sclerosis or Parkinson’s disease can also benefit, as can those with Alzheimer’s disease.

Palliative care is “really appropriate for anybody with a diagnosis of a serious illness, regardless of prognosis,” said Brynn Bowman, CAPC’s chief executive officer. Most insurance plans cover palliative care, just as they would any other specialist service. CAPC manages a website that can help patients find specialist care providers by ZIP code.

“What palliative care aims to do is provide relief from the symptoms and stress of the illness,” Bowman said. That may include managing pain and other symptoms, supporting the family, or helping people match their treatment options to their goals. The objective is to improve the quality of life for patients and families. Palliative care is based on need, not prognosis, and the earlier the team gets involved, the better.

The COVID-19 pandemic has boosted the need for such care and shifted medicine in ways that are likely to bring the specialty to the forefront, practitioners said. The complex nature of the disease and its effects on family members and caregivers make COVID-19 a perfect example of why such care is essential.

A palliative care approach helps with the “brain fog” many people experience after spending time in an intensive-care unit, as well as the “lingering malaise” many COVID sufferers report. The general malaise brought about by the pandemic has also brought palliative care into focus, Esch said.

“There’s almost a parallel epidemic of a mental health crisis right now,” and people with underlying conditions are seeing their symptoms exacerbated by stress even if they have not contracted the virus themselves, he said, adding, “There’s a lot of suffering right now, and that’s really the intersection we sit in.”

“COVID has helped both providers and patients really focus on the need to think about what’s most important to them, where they want to get their medical care, and how,” said Dr. Kim Bower, of San Diego, Calif., medical director of the palliative care program at Blue Shield of California.

Reference: Next Avenue (Feb. 21, 2022) “Palliative Care is Not Just for the Dying”


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What Does a Good Hospital Discharge Plan Look Like for My Dad?

Hospital Discharge – Kistein Monkhouse, CEO & founder of Patient Orator, a digital startup helping underserved patients close the communication gap with their health care team, says that communications issues between patients and caregiving teams happen often. As a result, it is critical for people to know and understand their rights. “It’s a highly emotional time and especially if it’s an emergency, the urgency is around seeking care, not focusing on your rights as a patient. Then something happens and you are left wondering what to do,” Monkhouse said.

Next Avenue’s recent article entitled “Discharge Planning: Know Your Rights” says that hospitalization can be especially challenging for people impacted by health disparities, whether it’s people of color, or LGBTQ+, women, or older adults, according to Monkhouse. Insurance is a huge driver of early hospital discharge, and in fairness, she said, hospitals do not want patients to get any infections while there. Therefore, sending them home is frequently the safer option.

However, if a senior in the hospital cannot perform “activities of daily living,” such as getting to the bathroom on their own, getting dressed, eating independently, or taking care of personal hygiene, it is probably too soon. Monkhouse said it is important the person be able to stand up on their own without being afraid of falling.

It is usually the family caregiver who must step in during the discharge planning process, especially if the patient cannot advocate strongly on their own behalf. Good hosptial discharge planning for patients, their families and their care providers means more successful transitions from one care setting to another. Medicare-participating hospitals must deliver valid, written notice that states a patient’s rights as a hospital patient, including discharge appeal rights.

This notice should be provided at the time of admission, or within two days of entering a facility. About 40 states have or will soon implement the Caregiver Advise, Record, Enable (CARE) Act. That is a model state law developed by AARP to help family caregivers, as their loved ones transition from hospital to home. The CARE Act requires hospitals to:

  • Record the name of the family caregiver on the medical record of the loved one;
  • Tell family caregivers when their loved one is to be discharged; and
  • Provide the family caregiver with education and instruction of the medical tasks he or she will need to perform for the patient at home.

A discharge plan should be provided in writing and should include the following:

  • Where and how a patient will get care after discharge;
  • What the patient and his or her support groups can do to help with recovery;
  • Any health care issues that might occur in the new care setting;
  • Clear explanations about medications going into the new care setting;
  • Arranging for necessary equipment or supplies for activities of daily living;
  • Resources available to help cope with and manage the illness or condition; and
  • Available resources to help with care-related costs.

Note that hospitals must display a Patient Bill of Rights.

Reference: Next Avenue (Feb. 4, 2022) “Discharge Planning: Know Your Rights”


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Handling Guilt When Moving Loved One to Assisted Living Versus Nursing Home

Just 5% said they wanted to be cared for in an assisted living community, and only about 13% actually moved into a community.

McKnight’s Senior Living’s recent article entitled “Family feels less guilt when loved one moves to assisted living versus nursing home: study” says that a family that moved an older adult into assisted living reported having greater feelings of guilt related to that move due to limits in their ability to provide assistance (35%) compared with providing care at home (22%), moving an older adult into a caregiver’s home (15%), or moving an older adult to an adult day facility (9%). However, the feelings of guilt were more for families with loved ones that moved into nursing homes(40%).

The pandemic increased the belief in the importance of early planning. About a third (29%) of respondents in 2021 said they believed in long-term care insurance, compared with 15% in 2018. However, the number of people who actually bought long-term care insurance hasn’t changed significantly (14% as in 2018). The study points out that insurance impacts where care is delivered. Owners of long-term care insurance (25%) were significantly more likely than non-owners (11%) to receive care in an assisted living community, where, researchers said, residents may have more space and better accommodations than what typically is provided in nursing homes.

Compared with 2018, family caregivers were more likely to use professionals when looking for support and knowledge about caregiving options. This included social workers (23% of respondents said they used them in 2021; compared to just 18% in 2018), financial professionals (20% from 17%), and attorneys or elder law specialists (11% up from 7%). The primary “helpful” resources for family caregivers in 2021 were television programs (70%), internet-based social networks (68%), attorneys or elder law specialists (66%), financial advisers (65%) and nonprofit groups (61%).

However, the average time families spent researching professional caregivers dropped from 7.6 hours in 2018 to 6.8 hours in 2021. Overall, the study found longer lifespans and more demand for complex care are complicating caregiving. Care needs are more severe and longer lasting compared with 2018 study results, the researchers found.

According to the most recent research, about half (49%) of care recipients need assistance with all activities of daily living. That’s an increase from 39% in 2018. And the average duration of care needed rose from 3 years to 3½ years.

Seniors also have more age-related limitations (47% had such limitations in 2021, up from 44% in 2018), cognitive impairments (32%, up from 26%) and accidents requiring rehabilitation (23%, up from 21%).

Reference: McKnight’s Senior Living (Nov. 2, 2021) “Family feels less guilt when loved one moves to assisted living versus nursing home: study”


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Dental, Vision and Hearing Benefits Covered by Medicare?

Many working-age people think that Medicare covers all types of health care that an older person may need. However, it doesn’t.

US Newsrecent article entitled “Dental, Vision and Hearing Benefits for Medicare” says that some of the biggest gaps involve dental, vision and hearing services. Medicare doesn’t cover dental cleanings or root canals, nor does it include everyday eyeglasses or hearing aids. A 2019 Kaiser Foundation report found that about two-thirds of Medicare recipients didn’t have dental coverage, nearly 50% had not seen a dentist in the past year and about 1 in 7 had lost all their teeth.

However, Democrats in Congress are trying to make those benefits a regular part of Medicare under major legislation expected later this year to advance President Joe Biden’s domestic spending agenda. Proponents of the bill say that expansion of the program is overdue.

Progressives want dental, vision and hearing coverage. Their aim is to provide a comprehensive benefit available to as many Medicare recipients as possible without delays, such as an extended phase-in period. However, adding more benefits to Medicare is expensive. This push will also have to compete with other priorities on Democrats’ health care wish list.

Republicans are expected to oppose the far-reaching Biden agenda legislation into which Medicare benefits would get sprinkled. Democrats would have to pass the bill under special budget rules allowing a simple majority to clear the Senate.

The most expedient approach looks to be making dental, vision, and hearing coverage a part of Medicare Part B, which pays for outpatient care. Part B is voluntary, but most of Medicare’s more than 60 million beneficiaries enroll in this service. Part B has a premium, and most people now pay $148.50 a month. It’s thought to be a good deal because taxpayers cover 75% of the overall cost of the insurance. Premiums are expected to go up with comprehensive benefits, but the cost would be spread broadly.

Most of those with private Medicare Advantage plans already have some sort of dental coverage, but it can vary. If dental, vision and hearing benefits were made standard under Part B, the Medicare Advantage plans would also be required to provide them.

The comprehensive dental coverage would include regular preventive care, such as cleanings and X-rays, minor work, such as fillings and major work including root canals, crowns, and dentures. The vision coverage would include eyeglasses and contacts, required exams and fittings. Hearing coverage would include hearing aids and their maintenance, along with audiology services.

The coverage expansion was a component of a larger effort that would have empowered Medicare to negotiate prescription drug prices. Some of the savings from drug costs would have been invested back into the program.

Another major gap in coverage — retail pharmacy prescription drugs — wasn’t included until 2003. It is also important to remember that long-term care isn’t covered by Medicare.

Reference: US News (June 26, 2021) “Dental, Vision and Hearing Benefits for Medicare”


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