My friends talk about a Prescription Drug "Donut Hole". Can you explain what that means?

Medicare Prescription Drug, Part D covers prescription medications. Part D plans have an initial coverage period (in 20016 up to $3,310 in medication costs), which may include a deductible. Then the person would most commonly have a coverage gap or donut hole. Drug manufacturers write off a portion of the drug costs during this period so that the insured pays 45% of brand RX costs and 57% of generic costs. After the insured has paid $4,850 out of pocket, the Part D plan pays all but 5% of drug costs or a small co-pay.

Recently I started looking for a place for my mom to live. I found this process confusing. So, what should I look for when looking at senior living communities? John H., Dunlap, IL

When looking for a senior living community one cannot afford to make a poor decision. This can become a very stressful time for all family members. But where to start? Sometimes it is good to know what mistakes people make while doing this search. Selecting a senior living community can be made easier if you plan ahead as opposed to waiting until change in health or a chronic condition worsens. Assuming one is planning; the first mistake is: 1. Not researching what types of senior communities are available. In Central Illinois, there are clearly about four types of senior living communities: Endowment Homes, CCRCs, Assisted Living, Supportive Living and Independent Living. Basic differences in homes include. Endowment home- will care for individual once a resident for the rest of their journey. CCRCs- continuing care retirement community- tiered approach to the aging process and has all services necessary for future living including a skilled nursing unit. Assisted living- provides some nursing care, housekeeping, and prepared meals as needed. Supportive living- Care much like assisted living, but may be more appropriate for lower-income older persons. A person may spend all of their assets and stay here while going onto Medicaid. Independent living- facilities for the elderly that are less restrictive. There may be an arrangement with a home care company that can be hired on an individual basis on site. Residents in independent living are considered to be living in their own independent apartment.

Recently I started looking for a place for my mom to live. I found this process confusing. So, what should I look for when looking at senior living communities? John H., Dunlap, IL

When looking for a senior living community one cannot afford to make a poor decision. This can become a very stressful time for all family members. But where to start? Sometimes it is good to know what mistakes people make while doing this search. Selecting a senior living community can be made easier if you plan ahead as opposed to waiting until change in health or a chronic condition worsens. Assuming one is planning; the first mistake is: 1. Not researching what types of senior communities are available. In Central Illinois, there are clearly about four types of senior living communities: Endowment Homes, CCRCs, Assisted Living, Supportive Living and Independent Living. - Basic differences in homes include Endowment home- will care for individual once a resident for the rest of their journey. CCRCs- continuing care retirement community- tiered approach to the aging process and has all services necessary for future living including a skilled nursing unit. Assisted living- provides some nursing care, housekeeping, and prepared meals as needed. Supportive living- Care much like assisted living, but may be more appropriate for lower-income older persons. A person may spend all of their assets and stay here while going onto Medicaid. Independent living- facilities for the elderly that are less restrictive. There may be an arrangement with a home care company that can be hired on an individual basis on site. Residents in independent living are considered to be living in their own independent apartment.

Should I opt out of my Medicare Advantage Plan if I am expecting a major procedure in 2016? -Timothy J., Peoria, IL

This is a great question, and involves a bit of number crunching on your end. The first thing to note is that this will vary on a case-by-case basis, but looking at potential costs, especially between Medicare Advantage Plans (MAP, or MAPD with prescriptions) and Original Medicare with Supplemental Plans and Part-D for drugs, is something I get asked about quite a lot. Here is how to think about this to find the best solution:

First – If you are thinking of switching now, you are acting at the right time. You have until February 14, 2016 (it is always January 1^st to February 14^th each year) to opt in or out of MAPD, without special exceptions granted in certain circumstances year-round.

Second – This is truly a numbers game, if number crunching is not your cup of tea, please consult a professional, the following is for the DIY folks only!

To figure out if switching is right for you, find out approximately how much it will cost for your procedure, new medication, and each day you expect to spend in the hospital under MAPD and add all of that together (do not forget to take in to account your deductibles, out of pocket maximums, etc.). Now, divide that number by 12 and add it to your monthly premium, this number is your expected cost per month under MAPD. Now, if you find that your expected monthly costs are far higher under MAPD than Medicare with supplemental plans, then your answer is simple.

Finally – If you want to disenroll from an MA-only or a MAPD plan and return to Original Medicare during the allotted time mentioned above, you have a special election period (SEP) to join a Part D prescription plan.

• If you have a MAPD plan, you can either 1) submit a disenrollment request to your MAPD plan and then enroll in a Part D plan, or 2) the easiest way is to properly enroll in a Part D plan first, which then automatically disenrolls you from your MAPD.
• If you have an MA only plan, if just going back to Original Medicare - you must request disenrollment from your MA plan.  If also enrolling in a Part D (RX plan), you may properly enroll in a Part D plan and that will cause your dis-enrollment in the MA plan.

Of course, you should always speak to a professional before committing to any large changes such as this, but it is always a good thing to have a general grasp on your insurance coverage for the year at the start of the year.

My son is turning 26, and this year will become ineligible to remain on my employer-provided health insurance. He has a low/moderate wage job (makes about $30,000 a year) that does not offer health insurance as an option, and is considering using Healthcare.gov to get insured. Are there any pros or cons we should be aware of? -Lynn G., Peoria, IL

First off, Healthcare.gov is an extension of the Affordable Care Act (ACA), also known as Obamacare. ACA was made to be an option for those, especially in an income range up to 138% of federal poverty level (a range up to about $47,000 for a single person), to receive coverage with reduced cost. This cost comes in the form of a tax-break or subsidy to be applied directly to premiums or when filing taxes at the end of the year.

It is important to note, however, that insurance agents can still be involved in this process, and many resources can be used other than Healthcare.gov. We advise you always speak to an ACA insurance professional to find what coverage you need and help to navigate this process beyond just pricing premiums.

Also - Open enrollment ends very soon, January 31^st, 2016, meaning that unless your son, or any party interested, were to meet the specific criteria to apply out of the enrollment season - the window to apply for ACA insurance is closing fast.

As with any insurance, consider what level of coverage is needed for the individual. Many healthy 26 year-olds only seek catastrophic insurance with minor coverage for things like visits, and little worry for out of network services. This will vary radically on a case-by-case basis, so figure out what level of coverage works best for you. Of course, talking to a professional agent will likely be a huge help.

My parents are aging and still live in my childhood home. I feel that they should not stay there much longer, but am unsure when the right point to have that conversation is. What should I look for? –Bridgette R, Bloomington IL

Often times this does become a tough issue for both parties. They may feel the same way you do, but be unsure of what that could mean to the children and grandchildren. Things like ‘but where will we celebrate the Holidays?’ often prevent grandparents from downsizing their homes, shift to living with family, assisted living or other options.

Look for the signs.

• Are they using the rooms upstairs or having difficulty doing so?
• Is the yard as maintained as it used to be?
• Is there a risk of falling in the home?

Sometimes the answer is not for them to leave, but to augment the environment. Being vigilant about the signs of your parents being overburdened and assisting with altering their environment can keep them happy and healthy in their home longer.

Whatever happens, research assisted living homes now for the future. Figure out who offers what and where, and have an idea long before anyone needs a facility which you may prefer. Living By Your Design has a free senior community referral service that can help you match your needs and wishes with available communities in the area.

I will soon take start my Social Security collection, what are some tips to help offset some costs post-retirement? -Deborah G, Peoria IL

On top of your regular finances in the later years (pension, 401k, social security, etc.), it is wise of you to consider other ways to help mitigate costs in retirement. Here are some things we recommend frequently to help with just this:

•  Schedule an appointment with your insurance agent to update policies every year.  At this point in life the needs of your care will change over time, and your insurance coverage will likely need amending to accommodate that. Always make sure you have the best coverage for your needs and medication, your plan should feel yours.
•   If you or your spouse is a United States Veteran and either of you require daily assistance with medications or self-care, you may be eligible for a monthly Veteran’s pension to augment your Social Security or other pension income.
• Consider long-term care policies.  If you already have it, read the fine print. These products have changed over the years so review your coverage to make sure you understand what it does and does not cover.
• Seek out a trusted third-party specialist to help navigate these things. There is a community of professionals that want to help you.