My Medicare Annual Enrollment Period packet has arrived, it seems like a lot of information, what should I watch for? Kathleen W., Morton, IL

These plans can change yearly, so review your plan’s annual renewal information carefully.  Some people may receive a letter from their MA (Medicare Advantage) or Part D (Medicare Drug Plans) company discontinuing their plan for 2016. If this happens to you, you will need to take some action or you will be put back into original Medicare by default.  On the other hand, this letter will guarantee that you can move to any plan in the state, so do not throw it away.

Additionally, ensure that you:

·         Review your benefits, they may have changed

·         Check to make sure that your providers are still listed as in network

·         Make sure your drugs are covered, watch for any new restrictions

·         Look at your copays for the new year

·         Contact your insurance company with any questions

·         Consider consulting a  local insurance agent, they know the environment for the new year as it applies locally, typically better than someone from a national organization

·         Be an advocate for yourself, ask questions about what matters to you and take the time to get answers

·         Remember that nothing comes ‘free,’ a low-cost plan is likely that way for a reason

What is patient advocacy, really? Is this service for me? –Melanie J., Bloomington, IL

A patient advocate is a consultant who supports a client with a variety of needs, both in a medical setting and at home.  They may be a medical professional, a social worker, or a lay person with experience with chronic disease or with helping a loved one navigate their own health journey.

In a medical setting, patient advocates can accompany clients to doctor appointments or outpatient rehab sessions.  As a result, they can communicate with medical staff and family members about the patient’s ongoing condition, medical compliance and related concerns.  They can also help with the filing of insurance and medical claims.  Through home visits, they develop a relationship with the patient and monitor health progress by taking vitals, overseeing the correct use of medical supplies and equipment as well as keeping track of medication usage.  They may also make suggestions for physical changes to the home environment to ensure safety by assessing fall risk and potential hazards due to limited mobility.

Ultimately the patient advocate can serve many functions, but their primary function is to advise and assist throughout the treatment process. Patient advocates are often vital for major decisions in the change of care or environment, such as when it is too risky to have a patient living alone, or when to begin worrying about quality of life over aggressive treatment. Ultimately, it is the job of the advocate to help patients and their families navigate the healthcare system.

Is it in my best interest to utilize a private patient advocate, even when advocacy has been assigned through my insurance already? –Carlene G., Peoria, IL

While any patient advocate will help in navigating through tough medical struggles, both at home and in the hospital, it is important to note that there is often times a level of loyalty toward the wishes of whoever is ‘footing the bill,’ so to speak.

For instance, an insurance appointed advocate will likely have some level of the insurance company’s interests in mind. While it is unlikely they would ever provide bad or dangerous advice for the patient, they will likely have the reduction of cost to the insurance company in mind.

Advocates can also be appointed by the hospital itself, but they may also have their own goals in mind. Many hospitals receive a small penalty for patients being readmitted to the hospital within a certain period, and a hospital appointed advocate may have this or other things in mind when recommending a course of action.

While the difference may be slight, being the sole employer of a patient advocate does insure that their allegiances lie solely with the patient and their families. Perhaps just receiving a consultation from a private advocate to supplement your appointed advocate would suffice, but it is definitely something to keep in mind.

What are “triggers,” and are they truly necessary for payable claims in Long-Term Coverage Insurance, and how do I watch for them? Jen A., Peoria Heights, IL

'Triggers' are essentially the conditions necessary for benefits to be payable. To make LTC claims for specific diseases or disorders there are often a list of many possible triggers, with a set number necessary to make a claim based upon that condition.

For instance, if one seeks long term care in a facility based upon a struggle with dementia, usually two of 5 or 6 triggers are required for the insurance company to deem payment of the claim to cover the facilities costs necessary. These triggers are very specific, such as whether or not the person needs 24 hour care, and if not whether or not they can properly bathe or dress alone, and triggers such as eating without assistance.  Assistance could mean standby or substantial assistance.  Standby assistance is much easier to meet.

The reason this question comes up so often is that these triggers, and the failure to prove them to insurance companies, can often lead to a lack of payment for coverage that has been purchased and is, in fact, owed. The difference between understanding the triggers in insurance plans purchased, or to be purchased, can be the difference between many thousands of dollars in payable claims each month.

My advice: seek professional help both when purchasing your LTC plans and when it comes time to make a claim.

When preparing care for an adult with Alzheimer’s (still in early stages), what changes can I make now to prepare for the future challenges? Lisa F., Morton, IL

Think of what you can afford to commit later on down the road. The average caregiver can easily spend up to 20 hours (or more) a week caring for someone with this disease. This can obviously cause one to have to quit or cut back on work.  Some basic things you can do now to prepare are:

• Prepare legal documents in advance (any possible future inheritance to be changed
• Align insurance with future needs (review beneficiary arrangements)
• Get in touch with the whole family, get them on board with any plans now if possible
• Investigate, and potentially contact, home health and facility options
• Monitor the disease, be prepared for changes before they are necessary
• Stay informed! Be realistic.  Ask questions and seek out professional guidance

It is important to remember you are not alone. Utilizing tools now can take you a long way in the future.

How should I determine which assisted living options might be best to consider for my parents? -Anonymous, Peoria, IL

The better question in this regard is “what do I need to ask?” The idea here is that you need to ask yourself, your parents, and anyone else involved what needs have arisen already, and where the future will take you. For instance, depending on a diagnosis the answers here could change greatly.

If considering home health care the questions you should ask are things like:

•       A tough question - When should my parents stop driving
•      Who will take care of them
•      Who will pay for it

·         Is home health a long-term or short-term solution

Similar questions can be posed for facilities, and you can find a good deal of information on local facilities at http://www.livingbyyourdesigninc.com/facilities.php

The key to any plan for later years is tailoring to fit your family’s specific needs.  Remember, your parents are the captain of their ship.

In recent posts and articles you have mentioned “preparing legal documents,” what exactly does this mean beyond just assembling a will, and what should I watch out for? -Suzanne K, Peoria, IL

Suzanne,

Jargon and industry terms are sometimes difficult to understand, for many families going through this time in their lives. When we say the term ‘legal documents,’ typically we are referring to Powers of Attorney and a will, or any preparatory legally binding document that gives direction for the future.

Primarily, this includes the following, all of which should be discussed in detail with all parties involved and should only be done through a lawyer:

·         

• Getting a will written that includes advance directives and wishes.
•  Include POA (powers of attorney) for healthcare and finances.
•  In some cases a trust may be in order.

There is a lot to say on this matter, and each family will have different needs. My recommendation is to secure legal advice if there have been changes since you last had legal documents drawn up, and assess where your family’s greatest needs are. 

Question : I have a parent with early to mid-stage Alzheimer’s and am concerned about potential future needs. I have some ideas for how I would like this process to go for my family, but am not sure how or when it is appropriate to bring this up. When is the right time to start talks with my other parent and siblings? -Zachary S. Princeton, IL

This can be a difficult question to pose for families dealing with any chronic illness. Due to Alzheimer’s trademark neurodegenerative properties it can be especially difficult. Although it may be difficult to speak of at this time, the pros to planning for this kind of thing typically outweigh the cons. The outcomes of any crises that arise later are likely to be far worse without a plan in place. If a facility is needed on short notice the family may have little choice where to send their loved one, and will instead have to settle for wherever openings are present. These types of scrambles could lead to you, or your siblings, missing work and dealing with a good deal of unnecessary stress. My advice is to consider what will motivate your other parent or siblings in to action to plan for the what-if situations. These could include the family home, residential accommodations, power of attorney, etc. 

What advice do you have for an adult with children looking to plan for their parent’s final years? -Susan N. Morton, IL

If you are in this sandwich generation (age 45 -55 helping parents and with children at home), then planning now is the best advice to give. Some action steps to take at this time will be sorting out legal, financial, residential, mental and physical healthcare elements prior to a crisis. Engage any siblings you may have in the planning and figure out how to begin involving them now so that one of you is not bearing all future legal and, potentially, financial burdens alone.