Navigating Medicare and Medicaid

If you’re caring for someone over the age of 65, chances are that you know something about Medicare, the health insurance program that covers nearly all older Americans. But there’s another really important program that you need to know about: MediCAID.

Medicaid is important because it’s the safety net when everything falls apart. When your frail mother has been caring for your dad at home alone for five years and she can’t do it any longer. When 24 hour a day home care is too expensive, and still not enough to keep your dad safe. And, then when his nursing home care quickly depletes their savings.

Maybe you’ve only heard about Medicaid as a program that provides health insurance under Obamacare. Well, for much longer than we’ve had Obamacare, Medicaid has been paying for nursing home care and in-home care for people who are very frail or disabled and whose income and assets are low or have been depleted by the costs of care.

Read: 5 Common Misconceptions About Medicaid

Currently, there are over 8 million Medicare beneficiaries who are also eligible for the full Medicaid benefit package, which includes varying degrees of LTC (long-term care) and coverage of their Medicare Part B premium, as well as deductibles and coinsurance. There are also another 4 million or so Medicare beneficiaries whose income is too high for the full Medicaid benefit package but who get some help from Medicaid paying Medicare out of pocket costs.

If you’re a caregiver for one of these 12 million folks, you don’t need me to tell you how confusing this all can be. For those of you who aren’t, think about how hard you’re already working to manage Medicare and now imagine layering another completely different program on top of that. It’s a full-time job in addition to all your other full-time jobs.

What’s especially confusing is that Medicare is basically one program that’s the same for everyone in the country, but Medicaid is different in every state. Each state has different rules about who qualifies for Medicaid and the available benefits, and some states are more generous than others. So, for example, one state will practically guarantee home-based services and supports for in-need older adults with monthly incomes as high as about $2500, while another state sets the income threshold much lower AND has a long waiting list for services.

A big issue is that, even if you qualify for both programs, they are rarely coordinated with each other. Family caregivers are faced with navigating two different sets of program rules and requirements, on top of coordinating all the other services their loved one needs and uses. Usually, for example, doctors, who are paid by Medicare, have no idea about the Medicaid long-term care services someone might be receiving at home to help with such things as bathing, dressing, or eating. These providers don’t talk to each other, in part, because the programs aren’t coordinated.

The good news is a few states are very organized. They’ve worked hard in collaboration with federal government staff to create a “one stop shop” where you can choose for both Medicare and Medicaid. These programs often assign the participants a care manager or case worker who helps coordinate everything. For example, Minnesota offers the Minnesota Senior Health Options program that “combines separate health programs and support systems into one health care package.”

The bad news is that a lot of states are still struggling to make the programs work better together and some states haven’t really tried. On the bright side there are a lot of philanthropies, experts and policymakers working to fix this. But they need our help. The solutions they develop MUST REFLECT your experience and SOLVE YOUR problems.

To that end, a wonderful foundation, Arnold Ventures, wants to hear directly from you about your current care experiences with the many services you might be arranging and managing. Services such as medications, medical equipment, physician services and in-home care and behavioral health services. They’re hosting a series of focus groups where I will be leading an hour-long confidential conversation about the care you provide and how well you are supported.

Arnold Ventures, together with my team, will use this input to recommend solutions to policymakers. If you are interested in participating, please go to this page and share your contact information so we can send you more information.

In the meantime, if you’re taking care of someone who is enrolled in both Medicare and Medicaid, here are some tips for getting the best support you can.

The “PACE” Program. The Program for All-Inclusive Care for the Elderly (PACE) is a great program that many states offer through which very frail older adults who live in the community and are enrolled in both Medicare and Medicaid can get services bundled into one package and delivered through adult day services. The program is widely seen as the gold standard for care coordination and integration. Unfortunately, not all states offer PACE but there may be one in your area. To check, you can consult google or go to the PACEFinder resources on the National PACE Association website.

Area Agencies on Aging (AAA). Some states contract with AAAs to help manage access to Medicaid resources. It’s worth checking out. Call your local AAA – which you can find here – to see what kind of information and support they provide.

State Health Insurance Assistance Programs. These programs are funded federally but available locally to help you navigate Medicare. It’s free — You can find out more here.

Daughterhood Circles. Don’t forget to check out whether there’s a Daughterhood Circle operating in your area or your state. Many meet virtually so you can join even if you’re not in the same neighborhood. The listing is on our website here. If you’d like to start a Circle and become a Circle leader, get in touch with us here.

‘Daughterhood Circles’ offer family caregivers a way to connect

(Article Reposted with permission from Memorywell.com)

Think of it as a mom’s group for a different and less joyful chapter of life.

One woman struggles to understand why her mom won’t leave her room. Another woman, whose mother now lives with her, wonders on really bad days how this became her life. A third is determined to remember her stepmother from a different time, before the disease that recently took her life made her so angry.

It’s a Tuesday evening at a tapas and wine bar in Marietta, Georgia, a suburb outside Atlanta, and seven women have gathered to honor one another.

“Here’s to caregivers,” says the organizer, as they raise and clink their glasses.

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Making Medicare Choices for Your Parents

“My dad doesn’t have Medicare!” A friend said to me recently.

“What?” I responded. This seemed unlikely. Pretty much everyone over age 65 has some form of Medicare and my friend’s dad is at least 90 years old.

Then he explained, “Dad has something called ‘Blue Cross advantage.’”

I explained that his dad does have Medicare but it’s a particular form of Medicare that private health plans (like BlueCross BlueShield) offer. It’s called “Medicare Advantage.”

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3 Resources to Ease Caregiver Money Worries

In a recent survey, AARP found that about three-quarters of all caregivers spend, on average, 20 percent of their household income on caregiving.

This is on top of the estimated $470 billion in unpaid care that they provide; and doesn’t include the potential lost income due to work-related strain that over half of caregivers report.

It’s clear that caring for a family member creates a financial hardship for many, and even a catastrophe for some; especially when caring for someone with dementia or Alzheimer’s Disease.

If you’ve experienced it, you know that there’s nothing worse than feeling financially strapped! Especially if you’re also feeling overwhelmed by caregiving responsibilities. So, if you are facing economic strain because of a caregiving situation, here are a few organizations that may be able to help.

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Caring for Aging Parents – A Sibling’s Survival Guide

There are many heartbreaking moments to navigate when our parents start to depend on us for care. But few are as painful as fighting with our siblings.

This doesn’t always happen. Sibling relationships can be a source of strength and comfort as parents grow older. But, more often than not, friends tell me about severe conflicts they have with their brothers and sisters, and the suffering it causes.

Like so much to do with caregiving, these clashes often come as a surprise. No one imagines that by caring for their aging parents, they’ll be thrust into such emotionally charged interactions with their siblings. It’s such a shock to go from seeing family once a year over the holidays to navigating our parents needs together daily.

Taking care of parents puts incredible stress on interactions between adult children. The fragile scaffolding of sibling relationships, so carefully constructed over a lifetime, often comes crashing down.

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Ending Loneliness in Caregiving

Other than death of a loved one, few things are more disorienting than making the shift from being cared for by your parents to caring for them.

This transition is made even more challenging because it usually comes as such a surprise. And it’s not just the biologically wired blind spot we have against our parents’ vulnerability. It’s the utter shock that, when it happens, there’s no place to turn for help. It’s like trying to climb a rock face without any toeholds or crevices where you can grab on, and then scaling it without a net.

The problem with our aging system is that even though there’s a lot of information out there to help, the situations most caregivers confront are so incredibly complex, unique and specific (e.g., Why won’t rehab providers accept my Dad?) that they can’t find exactly what they need. Or they want the one exact right answer to a very complex question that doesn’t have right answers.

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Don’t be Surprised by Medicare’s Out-of-Pocket Costs

My friend Quentin Fottrell is the Moneyologist columnist over at MarketWatch. He recently shared with his facebook group a reader question about whether a woman should help her 75-year-old sister with medical-related credit card debt.

Two commenters asked, “Why does she have medical costs? Isn’t she on Medicare?” They thought that Medicare covered most healthcare costs for older adults.

Unfortunately, this simply isn’t true. While Medicare is the primary health insurer for most older adults, it only pays a part of the healthcare bill. There are three kinds of out-of-pocket costs that we face!

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4 Tips for Talking to Your Parents About Death

Earlier this year, I wrote a blog about how important it is to prepare for end-of-life decisions you might have to make on behalf of your parents. I wrote about advance directives, and having important conversations with doctors and family.

I culled so much good advice from books and articles that it inspired me to talk to my own family.

Here’s how that went down.

Me to Dad: So, Dad, I’m writing a blog about preparing for end-of-life decisions and it occurred to me that we haven’t really talked about what you and mom want.
Dad: You think we’re DYING!?
(End of conversation)

Me to Sister: So, I’ve figured this all out. I’ll tell Mom and Dad that you should be the financial power of attorney because you’re good with money and I’ll be the healthcare power of attorney because I’m good with healthcare
Sister: * ? *
Me: Oh, see, I was thinking we should get Mom and Dad to focus on creating their advance directives — you know, end-of-life planning
Sister: Is there a book I can read about this?
Me: You know I’m an expert, right? Don’t you trust me?
(End of conversation)

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Medicare Therapy Rules Made Easy

Most of us take for granted that we can get out of bed in the morning and do all the things necessary to head out and face our day. You know… the simple everyday things like moving around our house, showering, getting dressed and eating breakfast. I might be a little foggy most mornings but I don’t think about whether I’ll face an enormous challenge in measuring out the coffee or pouring the milk. The point is the routine is just that…routine.

But if your parent is frail, you know that there’s nothing routine about these activities — that for them, doing even the simplest things just can’t be taken for granted anymore.

The mobility and functioning that’s essential to independence and safety suddenly becomes a big effort. And, Daughterhood really happens when we have to get involved in helping our parents do the things that they can no longer do by themselves. This is when their lives and ours get hard.

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A Go-To Guide For Understanding Your Aging Parents’ Rehabilitation

I was 30 weeks pregnant with my daughter when a routine doctor’s visit uncovered the fact that a disconnected placenta had cut her off from getting food and water. Essentially, she was starving in utero. Later that same day, my girl was born by emergency C-section weighing in at just over 2 pounds.

Her early birth kicked off years of specialized healthcare and education, most of which was therapy to help her walk, talk and manipulate the tools she’d need to do even the simplest things like eat, use a pencil, and play with her toys.

I’m happy to report that today she’s a strapping 5’7” teenager who plays softball and the piano. And, while her gritty personality had a lot to do with her success, so did the physical, occupational and speech therapists working with her.

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