medicare and medicaid

The Difference Between Medicare and Medicaid

Medicare vs. Medicaid: What’s the difference?

The simple answer: Medicare and Medicaid are two different healthcare programs with different functions and beneficiaries. The oversimplified answer: Medicare is a federal healthcare insurance program primarily for seniors regardless of income. Medicaid is a joint program between federal and state agencies to provide healthcare to low income people of all ages.

Here is a short video with mnemonic cues to help explain by Pixorize.

What is Medicare?

Medicare is an insurance program. Medical bills are paid from trust funds which those covered have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients. Patients pay part of costs through deductibles for hospital and other costs. 

Small monthly premiums are required for non-hospital coverage. Medicare is a federal program. It is basically the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services, an agency of the federal government.

For more information regarding Medicare and its components, visit http://www.medicare.gov.

Medicare is a federal health insurance program for:

  • People age 65 or older.
  • People under age 65 with certain disabilities.
  • People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Consumers contribute to some of the costs of Medicare through premiums, deductibles and copayments.

How do I enroll in Medicare?

You can call the Social Security Administration at 1-800-772-1213 to enroll in Medicare or to ask questions about whether you are eligible. You can also visit their website at www.socialsecurity.gov.

The Medicare.gov website also has a tool to help you determine if you are eligible for Medicare and when you can enroll. It is called the Medicare Eligibility Tool.

If you already receive benefits from Social Security:

If you already get benefits from Social Security or the Railroad Retirement Board, you are automatically entitled to Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) starting the first day of the month you turn age 65. You will not need to do anything to enroll. Your Medicare card will be mailed to you about 3 months before your 65th birthday. If your 65th birthday is February 20, 2010, your Medicare effective date would be February 1, 2010. (Note: if your birthday is on the 1st day of any month, Medicare Part A and Part B will be effective the 1st day of the prior month. For example, if your 65th birthday is February 1, 2010, your Medicare effective date would be January 1, 2010.)

If you are not getting Social Security benefits:

If you are not getting Social Security benefits, you can apply for retirement benefits online. If you would like to file for Medicare only, you can apply by calling 1-800-772-1213.

If you are under age 65 and disabled:

If you are under age 65 and disabled, and have been entitled to disability benefits under Social Security or the Railroad Retirement Board for 24 months, you will be automatically entitled to Medicare Part A and Part B beginning the 25th month of disability benefit entitlement. You will not need to do anything to enroll in Medicare. Your Medicare card will be mailed to you about 3 months before your Medicare entitlement date. (Note: If you are under age 65 and have Lou Gehrig’s disease (ALS), you get your Medicare benefits the first month you get disability benefits from Social Security or the Railroad Retirement Board.) For more information about enrollment, call the Social Security Administration at 1-800-772-1213 or visit the Social Security website. See also Social Security’s Medicare FAQs.

For more information, see Medicare.gov

aged family at home senior and adult

Medicare Benefits are broken into Medicare part A,B, C and D that help cover specific services

Medicare Part A (Hospital Insurance) – 

Part A helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. Most people don’t pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working.

Medicare Part B (Medical Insurance) – 

Part B helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. Most people pay a monthly premium for Part B.

Medicare Part D (Prescription Drug Coverage) – 

Medicare Part D is also known as Medicare Prescription Drug plan. Medicare prescription drug coverage is available to everyone with Medicare. To get Medicare prescription drug coverage, people must join a plan approved by Medicare that offers Medicare drug coverage. Most people pay a monthly premium for Part D.

Medicare Advantage Plan-

Medicare Advantage Plan is offered by a private company that contracts with Medicare to provide you with all your Medicare Part A and Part B benefits. In most cases, Medicare Advantage Plans also offer Medicare prescription drug coverage. A Medicare Advantage Plan can be an HMO, PPO, or a Private Fee for- Service Plan. May sometimes be referred to as Medicare Part C.

Medicare Certified-

Medicare Certified facilities can offer services to individuals receiving Medicare benefits in exchange for reimbursement from Medicare.

Medicare Advantage PlanMedicare Part C

Medicare Advantage Plan is offered by a private company that contracts with Medicare to provide you with all of your Medicare Part A and Part B benefits. In most cases, Medicare Advantage Plans also offer Medicare prescription drug coverage. A Medicare Advantage Plan can be an HMO, PPO, or a Private Fee for Service Plan. 

health-insurance-policy

**Formerly known as Medicare Part C or “Medicare+Choice These are Medicare-approved private insurance plans, including HMOs, PPOs, private fee-for-service plans, and medical saving accounts. These plans may or may not include prescription drug coverage. The M+C program in Part C of Medicare was renamed the Medicare Advantage (MA) Program under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which was enacted in December 2003. The MMA updated and improved the choice of plans for beneficiaries under Part C, and changed the way benefits are established and payments are made. Under the MMA, beneficiaries may choose from additional plan options, including regional PPO (RPPO) plans and special needs plans (SNPs). 

Medigap (Medicare Supplement Health Insurance)

Medicare Supplemental Insurance is private insurance (often called Medigap) that pays Medicare’s deductibles and co-insurances and may cover services not covered by Medicare.

A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will each pay its share of covered health care costs.

Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium. In addition, you will have to pay a premium to the Medigap insurance company.

If you’re a person with Medicare or help a person with Medicare, visit Medicare.gov to find more information about Medicare. 

What Is Medicaid?

Medicaid is an general assistance program. Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities.

Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required.

Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.

Each state Medicaid agency has full responsibility for all aspects of the administration and operation of the Medicaid program in their state, including determining eligibility for and enrollment into their program.

Medicaid Eligibility Requirements

Medicaid eligibility criteria vary from state to state. Many states have expanded their Medicaid programs to cover more low-income adults. If you are unsure if you might qualify for Medicaid, you should apply.

You might be eligible depending on your household income, family size, age, disability, and other factors. You must be a United States (U.S.) citizen, a U.S. national, or have a satisfactory immigration status to be eligible for full benefits.

Visit HealthCare.gov to take a quick screening to help you determine your eligibility for Medicaid or other health insurance options. Please contact your state for all state-related Medicaid questions.

When to contact your State Medicaid Agency

In order to assist you in getting a timely response, please contact your State Medicaid Agency (click your state link above) for any questions on the following:

  • Medicaid Eligibility
  • Coverage and Services
  • Liens and Third Party Liability (other insurance)
  • Provider Enrollment
  • Medicaid Claims
  • Lost Medicaid Card/ Replacement
  • Finding a Medicaid/CHIP Provider
  • Status of a Medicaid/CHIP Application

If you need assistance in any of the areas noted, you will need to contact the agency for Medicaid/CHIP in your state of residence or the state you have questions about in order to receive assistance. Please contact your state for all state-related Medicaid questions.

Medicaid Contact Information by State and Territory

Alaska

 Alaska Medicaid

American Samoa

Arizona

 Arizona Health Care Cost Containment System (AHCCCS)

Arkansas

 Arkansas Medicaid

Colorado

 Health First Colorado

Connecticut

 Connecticut Medicaid

Delaware

 Delaware Medicaid & Medical Assistance

Guam

  • Eligibility
  • Enrollment
  • Home Page
  • Department of Public Health and Social Services / Division of Public Welfare
    735-7519, 735-3540, 735-7256 or 735-7375 (Central Office – Mangilao)
    635-7429 or 635-7488 (Northern Office – Dededo)
    828-7542 or 828-8524 (Southern Office – Inarajan)
CareAvailability

CareAvailability

Written by The CareAvailability Team
Experts in the senior care & retirement living industries here to share as much advice, guidance and love as possible.
estate planning

Estate Planning

Estate Planning, Managing Assets, and Advance Directives

We are all living longer lives, but with longevity comes the complications of aging. Older adults today are facing significant threats from strokes to dementia. These conditions and many others are leaving our seniors without their voice and the opportunity to choose how they wish to live. A thoughtful estate plan gives us the opportunity to tell others how we would like to be cared for in the event that we can no longer make our own decisions.

What Is Estate Planning?

At a minimum, a good estate plan will consist of several different legal documents including a Will, Power of Attorney, and Advance Directive, but may also include a Trust. Estate planning is the act of putting your wishes on paper in a manner that the law will recognize and uphold.

Estate planning should never be solely about where your belongings go when you die, but should also include what happens to you if you have a stroke, Alzheimer’s, Parkinson’s disease, or an accident and you lose your ability to make reasoned decisions.

No one can predict when unexpected medical situations will happen. An advance directive helps loved ones, and medical personnel make important decisions during a crisis. Having an advance directive in place ensures that your wishes regarding your health care are carried out, even when you’re unable to make your wishes known.

Free Download: Oregon Advance Directive Blank Template

A fillable blank advanced directive for Oregon residents courtesy of
Rose Elder Law LLC in Lake Oswego, OR.

Michael Rose

Michael Rose

Rose Elder Law
Visit Website
Phone (503) 371-9636
Michael Rose is an Elder Law Attorney based in Lake Oswego, Oregon. His practice is focused on assisting clients through the retirement years with thoughtful estate plans and crisis management. He earned his Juris Doctor degree from Willamette University College of Law and his undergraduate degree from Brigham Young University. Michael comes from a long line of Oregonians who helped to settle the Mid-Willamette valley. He is a husband and father of five.
homecare

A Guide to Homecare

Senior Homecare Options: How to find the right fit for you

It’s never too early to choose a home care agency that you can rely on when life doesn’t go as planned. Whether it’s a little help around the house or more involved care, you should look for a home care agency that can safely meet all of your needs every step of the way.

Are you or a loved one resistant to the idea of receiving care?

Chances are that you just haven’t found the right agency. Simply starting the conversation with a reputable home care agency and building trust can do wonders for melting away resistance. We hope you find this guide helpful as you go forward in search of the right In Home Care Provider in your community.

When is the right time to hire home care?

Most of us want to remain as independent as possible. Sometimes, all that may be required is a simple medication reminder.  However, if getting ready for your day has become more difficult and you require some assistance with activities of daily living (ADLs) such as bathing, grooming and getting dressed, there are caregivers that can assist with these tasks.  The first step is realizing that you need additional support and then asking for it.

Asking for help and the fear of losing independence and control can be challenging.  There are community resources available to discuss these very topics, including: Registered Nurses and social workers.  These professionals are well versed on what resources are available in your area.

Next, take some time to consider whether or not you’ll stay in your home or move to community.  Monthly charges range from $2,000 to $12,000 per month (depending on the level of care). Your financial situation and family support system will likely influence your decision to stay at home with extra help; or move to a community.  This is a tough decision and may require downsizing and selling your home.

How do I pay for home care services?

Although paying for home care can be expensive, there are many options for seniors and their families. Learning more about Medicaid, Medicare, long-term care insurance, and various state programs can help older adults as they navigate the financial aspect of long-term care.

  • Medicaid: Funding for those with limited financial resources may receive assistance with some or all of their home care expenses from Medicaid.
  • Medicare: Available to all adults 65 and older. However, Medicare is meant for acute health episodes, and not long-term care. Those that are homebound, need skilled services, and require intermittent help may be able to receive some home health care services under Medicare funding.
  • Long Term Care Insurance:  Each policy is different, with some covering only nursing home costs- but many current policies allow for homecare services.
  • State Programs: Older adults that do not qualify for larger government programs like Medicaid may qualify for more local state programs, because states have greater freedom in establishing requirements for their programs.
  • Private Pay: Many families choose to perform many of the home care services for a loved one themselves. Yet, some seniors require skilled services. For families that do not meet eligibility requirements of certain programs, out of pocket funding may be unavoidable.
  • Non profit support: There are many other non-profit organizations, volunteer groups, or faith based organizations that may also help. Check your local area agency on aging for more information.

Comparisons & Definitions for Care At Home

There are so many choices for caregiving services at home. Which one is right for me, my loved one or my client? Let’s define each avenue, looking at the differences to help you determine the best fit.

Full Service Home Care:

  • Licensed Agency; Services not limited with memory loss or dementia
  • Provides non-medical, skilled caregiving, case management & nursing services
  • Required to screen, employ & supervise caregiver
  • Cost based on services provided, comparable at non-medical level
  • The most comprehensive package of services

Non-Medical Home Care:

  • Limited to non-medical services, and companion care
  • May provide medication reminders or assistance to oriented client only
  • No skilled services provide, No Nurse on staff
  • Required to screen, employ & supervise caregiver
  • Cost comparable at non-medical level

Caregiver Registry:

  • Licensed Caregiver Registry Agency
  • Screens & verifies competency of caregivers
  • Does NOT employ or supervise caregiver, client takes on employer responsibilities & risks
  • No skilled care, case management or nursing services
  • Cost Registry Fee + Caregiver Cost; comparable-higher at non-medical level

Case Management Company:

  • Not Licensed to provide caregiving or nursing services
  • Does not employ caregivers, client takes on employer responsibilities & risks
  • Professional Case Manager’s & RN’s supervise, usually $70-$110.00/hour
  • Cost Professional fee + Caregiver Cost; comparable-higher at non-medical level

CEP (Client Employed Provider) Program:

  • Not Licensed; Caregiver Registry; State of Oregon; Medicaid
  • Program does not screen, employ or supervise, client takes on employer responsibilities & risks
  • Screens with Criminal Background Check only
  • Operates much like an on-line listing service
young-caretaker

How to Choose an In-Home Care Agency

You will need to “shop around” to find a Home Care provider in your community that has the correct licensure, experience, and knowledge to provide the care you or your loved one will need. Costs for care giving services are, in general, similar across In Home Care providers in a given geographical area regardless if they are licensed to provide non-medical services only or are able to provide medication management, skilled care giving, case management & nursing services as well.

Take your time and do this in steps.

1. Do your homework, evaluate the care needs:

Before you make your first phone call, thoroughly consider what the care needs are. Ask yourself the following questions:

  • Do we need assistance with companionship, cooking and light housework?

  • Do we need someone who can provide hands-on care? For example: assistance with bathing, dressing or mobility.

  • Do we need a caregiver that speaks a particular language?

  • Do we need a care provider who can drive?

  • Will your family have the support of a Home Health Agency or a Hospice Agency that the In Home Care Provider will need to work with?

You will need to contract with an agency who has the ability to provide the services needed now and those that can be reasonably anticipated in the future.

Non-medical agencies cannot remind or assist with medications for client’s who have a memory loss or dementia diagnosis. Further, in order for any In Home Care Agency to remind or assist you with medications, you must be able to tell the representative of the agency what, how much, when and why you take each of the medications your doctor has ordered you to take. In other words, you must be assessed competent to “self direct” the caregiver who will work with you. If you cannot do this, you must contract for In Home Care services with a full service agency.

Starting care with a Home Care Agency that is strictly non-medical means that if your needs increase, the agency will not be able to progress with you to provide the needed services. This will force you to establish a new relationship with a more qualified agency, all at a time when you or your loved ones health is declining.

To determine if you need a full service agency now, ask yourself the following questions:

  • Is there a memory loss diagnosis such as: short term memory loss, dementia or Alzheimer’s disease or is the client becoming more confused & forgetful?
  • Do we need skilled medical assistance for things like blood pressure, blood sugar testing, medication administration, wound care or tube/drain/bag maintenance?
  • Do we need a care provider trained to perform a special task of nursing, to use special equipment, to assist with transfers or ambulation, to manage medications, tube feeding or provide end of life (Hospice) comfort care?
  • Do you need case management services? The services provided by a case manager include assessments, planning, advocacy, and presenting options to meet the individuals specific needs.

2. Evaluate the Home Care Agency Candidates:

Now that you have an idea of the services you or your loved one will need, it’s time to call each agency and ask each In Home Care Agency Representative these questions:

  • How long has the agency been in business in this community?
  • Is the agency a local private agency or a franchised agency?
  • Is it possible to interview a caregiver to determine compatibility prior to the caregiver working for me?
  • Does the agency employ the caregiver and act as the employer of record?
  • How are the caregivers who work for the agency screened, trained & supervised?
  • Does the agency have a nurse on staff who provides service planning, oversight and training?
  • Is the agency licensed to provide medication and nursing services as well as non-medical services?
  • Does the agency provide bonding & workers compensation insurance?
  • How much will the needed services cost?
  • How much notice & what is the process for starting services?
  • How does the agency assist me to bill and receive payment from my insurance?
  • What happens if I don’t find the provider the agency sends acceptable?
  • What if I need to speak to the agency representative after hours?

3. Make the right choice for you or your loved one:

Based on the answers to the above questions & your conversation with the agency representative, ask yourself these questions:

  • Was I satisfied with the answers to the questions I asked the agency?
  • Was I satisfied with the reviews I found on-line and/or the testimonials I found on the agency’s web page?
  • Did I feel comfortable with the experience, knowledge and ability of the agency to provide my services?
  • Did the person I spoke to follow through with any promised information request?
  • Is the agency licensed to provide skilled care giving, case management & nursing services, as well as non-medical services?
  • Is the agency available by phone at all hours for assistance with any issues I have that may need immediate attention?
  • Is the cost for services appropriate to the level of care I will receive?

Additional Questions you may want to ask a home care agency

Agency Information

  • Is the agency a franchise or locally owned and operated?
  • Is the agency licensed by the State Department of Health?
  • Is the agency licensed for both home care and home health?
  • Does the agency have liability insurance?
  • Can the agency respond to you 24/7?

Caregiver Information

  • Are employees licensed, bonded & insured? Or are they independent contractors?
  • Does the agency test skills, conduct behavioral interviews and verify caregiver credentials?
  • Are caregivers required to have current certifications for First Aid, CPR, and TB?
  • Are caregivers provided continuing education/training?
  • Can authorized individuals monitor care and make requests online in real time?
  • Does the agency offer a caregiver replacement when the “fit” may not be right?

Documentation and Supervision

  • Does an RN/MSW/Care Manager conduct a free home care assessment?
  • Does an RN/MSW/Care Manager create a home care plan?
  • Does an RN/MSW/Care Manager supervise the caregivers?
  • Do caregivers receive client orientation before arriving at a client’s home?

Policies and Cost

  • Can services be cancelled with a 4-hour notification?
  • Does the agency offer flexible scheduling, custom care plans, and  a continuum of care?
  • Does the agency have weekly or monthly minimums?
  • What is the hourly minimum per shift?
  • Does the agency offer home care discounts?
  • What is the required deposit?
  • Will the agency accept long-term care insurance?

Elder care tips: Ensuring a beneficial relationship with a care provider

Developing an elder care plan for your aging loved ones enables you to ensure your parents get the care and assistance that will meet their physical, cognitive, medical, mobility, and emotional needs on a daily basis.

While it is completely normal for you to want to take on all of the responsibilities of caring for your seniors, handling all of these tasks on your own would likely not work out in the long term. Trying to add all of these responsibilities to everything you already do to take care of your own personal lives can leave you exhausted and incapable of giving your best to any of your responsibilities.

Hiring an elderly health care services provider as part of your elder care plan enables you to entrust that professional with some of the responsibilities of caring for your parents so that you can focus your time and energy more efficiently and effectively.

care-assistant-handing-coffee-cup-to-senior-woman-min

Use these tips to help your parents enjoy the best relationship possible with their care provider:

1. Plan Thoroughly: 

Have a clear idea of what you and your parents expect from the relationship with your care provider. Clarifying these expectations enables you to pursue the factors of the relationship that you see as most important and allows you to narrow your focus when seeking out a care provider.

2. Think Family First: 

Before you get a care provider involved, consider your family contribution to the care plan first. Determine how much you can practically do for your parents and ask how much your siblings would like to do. This makes it easier for you decide how much responsibility the care provider will need to take so you can give clear guidelines from the beginning and avoid confusion.

3. Communicate Openly: 

It is important to see the elderly health care services provider as an employee rather than someone who is doing you a favor by taking care of your parents. Communicate openly with the care provider about your expectations, your standards of performance, and your feelings about their care for your parents so that they can continue to improve.

4. Support Individuality: 

You want to be an active part of your parents’ care, but in order to support a quality relationship, you need to give them the space and freedom to create and build that relationship on their own. Support your parents’ ability to get to know the care provider and enjoy spending time with them on their own terms, including participating in activities, going on outings, and creating their own approaches to handling care tasks.

CareAvailability

CareAvailability

Written by The CareAvailability Team
Experts in the senior care & retirement living industries here to share as much advice, guidance and love as possible.
senior housing

Navigating Senior Housing Options

Navigating Senior Housing: Advisors and Referral Agencies, Transitions, and Your Security

When you or a loved one is faced with needing to find the best options for senior housing it can often feel like a maze. We know how important it is to not only be aware of what options are available but also to know where you can go for additional help. That’s why we created this article to help you navigate the complex world of senior housing and how to work with a senior care advisor. 

Where do I begin when navigating housing options?

The doctor just informed you that it would be unsafe for your senior loved one to return to their home without 24/7 supervision. You have limited time to find a new ‘home’. Where do you begin to find your way through the maze of housing options, care needs, budget and amenities? 

Don’t go it alone, referral agencies and placement consultants are a valuable resource to save time and anxiety. These professionals are familiar with the numerous options and availability. Many also review the state survey and public disclosure file for any record of criminal activity or lack of compliance with laws/rules.

Step 1: Gain detailed knowledge of the assistance/needs of the resident.

This will narrow the type of community to those that are licensed and capable of providing the proper care. It may be awkward for families to ask the personal questions related to care needs and personal assistance; sometimes an objective third person is able to ask more detailed questions and uncover concerns or fears while helping the resident maintain a sense of privacy.

Step 2: Know your budget.

Community fees may vary, with application fees, deposits, levels of care and ancillary services. A placement consultant may be able to help you to better balance the big picture.

Step 3: Focus on the geographic area that fits best.

This is a new chapter in their life, and they will be creating a whole new social network. The goal is to accommodate frequent visitation of the resident’s support system. Proximity to an established network of friends and family is an important factor, should any healthcare or emotional changes occur.

Step 4: Visit the communities.

After narrowing the field to those that best fit your needs, you will be better able to look at the amenities, services and activities. Get to know the activities offered, meet the staff, and try the food. These are the things that make a community feel like home and help aid the adjustment process.

What is a Senior Care Advisor, or Referral Agency?

Every industry has experts that can be used to educate and guide you along the best path. A quality expert is going to help avoid common pitfalls and mistakes, as well as maximize your time and money.

The process of aging and finding Long Term Care is no exception. Those who choose to take that next step in education can obtain this title and show they have studied the wide range of issues that could arise as someone ages. An advisor should also research licensing, inspections reports, and any state violations of every facility to ensure they are only recommending the highest quality options for any given situation.

Why work with a referral agency?

A Senior Care Advisor is your expert in the challenges of aging. It is someone who can sit down and learn everything about your situation to best guide you. Some examples of information an advisor should ask are: Medical/Health Information,  Geographic Needs, Financial Requirements, Veteran Status, Long-Term Care Insurance, Mobility Concerns, Cognitive Abilities, Personal Care Needs, Meal Preferences, Socialization/Hobbies, and/or Estate Planning.

senior referral agent

An advisor really must have a clear understanding of everything that is going on before they can start looking at next steps. This process can be equated to assembling a puzzle. You give an advisor an idea of what the end result should look like, hand them all of the pieces needed for assembly, and let them go about piecing everything together. A quality advisor will know all of the options and help navigate this confusing industry to find the perfect solutions for your needs. Keep in mind an advisor is not making decisions on your behalf; this is why it’s crucial you find an advisor you connect with and trust.

The advisor is typically compensated by the long-term care facilities; because of this compensation model an advisor should not be a sales person pushing one particular solution. Their goal should be to provide the highest quality options and present them so you can make the best decisions possible. Given that they have already visited hundreds of these long-term care options, you do not have to start from the beginning. They can quickly recommend the best options and you only have to visit a handful of places. This gives you the ability to focus time and energy on your loved ones. So if you find yourself in need of guidance in these areas, find a quality Senior Care Advisor for help.

Benefits of a Referral Agency

People tend to fall into two broad categories when it comes to big decisions or difficult tasks… the first are those who are determined to take care of it themselves, just wade right in and see what happens; and the second are those who look for input from those who may have been there before or at least have seen how things turned out.

Neither one is right or wrong, just different.  For example: there are two families needing to find suitable housing for an elderly parent who has specific needs and definite preferences to be addressed, referral agencies are well-equipped to be of help to both camps.

For the “do-it-myselfer”, the referral agency can help by giving information on what the senior housing industry looks like, what major things to look for, and avoid, and to provide some explanation of terminology.  This family is then better prepared to go out and find options for their elder.

For the “I-could-use-some-help” types, the referral agency is a trove of information and experience regarding the whole issue of helping seniors move along on their journey.  The agency gathers pertinent information regarding care needs, likes, dislikes, geographic preferences and financial parameters.  With this information the agency provides the senior and/or family with options, tours the options with the family, answers their questions and provides a sounding board to allow them to make an informed decision.

The time saved by the family seeking help from a referral agency is better used to get the senior integrated into their new environment and to get the whole family back on track.

insurance-agent-at-work

The best parts about actively taking a referral agency’s help are:
(1) they know the options, (2) they know the providers and (3) they take on the leg-work.
Oh, and the best part, (4) the referral agency helps you for free. 

How you benefit from having a neutral third party

Referral agents begin by asking questions to become clear on how they can best help you. Whether you choose to look at options on your own or whether you enlist the help of a referral agency, the rent and care fees you pay are the same. 

The senior referral industry is regulated by your State’s Department of Human Services.  In some states,  senior referral agencies are required to register with the state as well.  In Oregon, all agents must meet DHS guidelines to register and must follow the rules set forth by DHS to ensure families are receiving quality information by qualified individuals. Referral agents do not make decisions for you, but they help frame situations to allow you to understand what options you have and they support you in your decision-making process.

Be extremely cautious about providing your contact information to online referral agencies when searching for the options

Placing your name into various websites can launch a barrage of phone calls of solicitations from businesses and agencies that aren’t even of interest to you. If you plan to work with a referral agency, select a local senior advisor that will tour and be with you each step of the way.

sad-senior-woman-hugging-dog

Why is the transition and moving to assisted living or memory care so hard?

We have hope for improvement

When we love someone, we never want to “give up” on them.  We hold a deep-seated belief that if we keep looking for solutions, treatments or therapies, our loved one will get better.  Unfortunately, the aging process of both the body and the mind is a downhill path.  What makes things confusing is that in our world of information and options, we are compelled to continue seeking solutions.  Further clouding the situation is that the downhill decline is not always noticeable. Older adults have good days and bad days. When a loved one has good days, we don’t want to disrupt the quality of life we see them experiencing.

We remember them as they were.  

It’s easy for us to take notice when a friend is struggling with caring for an aging parent; when it’s our own parent, we frequently can’t see the obvious changes that are occurring. We remember the strong and capable adult of the past. We don’t want to acknowledge the changes because then there will have to be difficult and disruptive decisions that needs to be made. Don’t go it alone, referral agencies and placement consultants are a valuable resource to save time and anxiety. These professionals are familiar with the numerous options and availability. Many also review the state survey and public disclosure file for any record of criminal activity or lack of compliance with laws/rules.

Family dynamics can cloud the real issues. 

Family members may disagree on what care is needed, and it is often the case that one or more people may purposefully attempt to convince the family to allow the older adult to remain in their own home.  Sometimes in-home care is a good solution, and other times it is not a workable or feasible long-term solution. Allowing our own personal preferences to cloud our thinking is not helpful to a frail senior. Enlisting knowledgeable outside help who look at your situation and help introduce you to specific senior care communities will reduce the amount of family conflict. 

asian-daughter-or-care-assistant-helping-support

Security and Online Senior Living Referral Services

While researching Senior Living options online for yourself or a loved one you may be unaware of what happens with your information, and the level of your own security.

If you google search Assisted Living, a list of Online Senior Referral companies will appear. They require you to enter your information that includes: phone number, email, address, health and finances. All before being directed to a list of options.The  companies also put you on a “list.” That list is sent to numerous communities where your information will be entered into multiple databases and viewed by anyone that can access that data. You will then receive emails and phone calls from every community on the “list.”

Once the online service puts you on their list they “own” you as a “lead.” This remains true whether you move in soon, years later or even correspond with that company. This is how they receive compensation.

DO NOT give out your information to receive pricing or a list of communities.

A secure way to narrow down Senior Living options is to use a Local Senior Living Advisor. They will be willing to meet with you, in person, to assess your loved ones’ specific needs. The Advisor will then, recommend the best options, coordinate the tours and take you to see those recommended options. A Trusted Senior Living Advisor visits communities regularly and knows whom has stable staff, happy residents, good food and quality care. Online Referral companies are unable to provide this level of service.

A Local Senior Living Advisor will be your one point of contact. Only that advisor will have your information unless you wish to give it to the toured communities. This will eliminate needless contact from multiple communities and from the online referral service itself. A Local Advisor can assist you with negotiating costs, recommend resources for: downsizing, selling a home, moving and assist with the necessary paperwork to get moved into a community.

An Important Difference:

On CareAvailability, we do NOT require your contact details to search, and we provide the contact information for each provider. CareAvailability is NOT a referral agency, only a database of providers and we list all of them to create a comprehensive list. You can contact the community when you are ready and you can decide what information you wish to share.

You can search our affiliate site, Retirement Connection for “Referral Service and Housing Specialists” for local referral agencies and additional help.

Below are links to find an advisor in your area:

Several different agencies contributed to this article, Including: 1st Choice Senior Placement, Dedicated Care Solutions, Portland Senior Housing, Senior One Source.
CareAvailability

CareAvailability

Written by The CareAvailability Team
Experts in the senior care & retirement living industries here to share as much advice, guidance and love as possible.
medicare advantage

Get the Scoop on Medicare Advantage

Benefits, Services, and Costs of Medicare Advantage Plans

More than 23 million Americans currently receive their health benefits through a Medicare Advantage plan. There’s much to like about these plans, which provide extra services and make coverage more affordable than traditional Medicare by capping out-of-pocket costs. It’s no surprise that a 2018 poll found a whopping 90% of people with Medicare Advantage plans are satisfied with their coverage. But do you understand the ins and outs of Medicare Advantage? 

What is a Medicare Advantage Plan?

Medicare Advantage plans (also known as Medicare Part C) are offered by private health insurance providers that have been approved by Medicare. These companies receive government funding to cover your Medicare benefits and keep you healthy.

With traditional Medicare, the federal government pays your providers directly.

What do Medicare Advantage Plans Cover?

If you join a Medicare Advantage plan, that plan will provide all of your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage. But that’s not all.

Medicare Advantage plans cover many things that traditional Medicare doesn’t cover. These extras can include vision, hearing and dental benefits, as well as wellness programs. Many Medicare Advantage plans give seniors access to affordable prescription drug plans, often at no additional cost.

And all Medicare Advantage plans limit the amount you must spend out of pocket for deductibles, copayments, and coinsurance each year for covered Medicare services.

Who is eligible to purchase a Medicare Advantage plan?

You must already be covered by Medicare Parts A and B to join a Medicare Advantage plan. You also must live in the Medicare Advantage plan’s service area.

The Medicare Annual Election Period (AEP) which lasts from mid-October until early December, is when you can initially sign up, switch, or leave your Medicare Advantage plan.  You can also switch Medicare Advantage plans or from Medicare Advantage to traditional Medicare from January 1 until March 31 if you change your mind.

Are all Medicare Advantage plans the same?

There are different options to meet different health and financial needs. Just as with individual or employer-sponsored insurance, several types of Medicare Advantage policies are available. The most common types of Medicare Advantage plans are:

  • Health Maintenance Organizations (HMOs)
  • Preferred Provider Organizations (PPOs)

You also may see Medicare Advantage plans called Private Fee-for-Service (PFFS) and Medical Savings Account (MSA) plans.

If you are eligible for Medicaid, have a chronic condition, or live in a nursing home, you may also be able to sign up for another type of Medicare Advantage tailored to your specific needs called a Special Needs Plan (SNP).

notepad with medicare advantage written on it

While many Medicare Advantage plans are available at no additional cost, some charge premiums or have costs for optional services. Which providers are in the plan’s network also varies. That means it’s important to comparison-shop carefully, just as you do for other important expenditures. 

You’ll want to understand specific costs and benefits before you join. The online tool Medicare Plan Finder at Medicare.gov can help you can find and compare policies in your area.

Is a Medicare Advantage plan the same thing as a Medicare Supplement Insurance (Medigap) policy?

No. A Medigap policy is private insurance that helps supplement traditional Medicare. This means it helps pay some of the health care costs that traditional Medicare doesn’t cover (like copayments, coinsurance, and deductibles).  

While a Medigap policy does help to supplement the Medicare Hospital (Part A) and Medical (Part B) coverage, it does not include Prescription Drugs (Part D) and this would need to be purchased separately, if choosing Medigap.

CareAvailability

CareAvailability

Written by The CareAvailability Team
Experts in the senior care & retirement living industries here to share as much advice, guidance and love as possible.
elderly person playing memory games who has dementia

Dementia, Alzheimer’s Disease, and Early Warning Signs

Dementia & Alzheimer's Disease: Early Detection & Diagnosis

Every 65 seconds, someone in the United States is diagnosed with Alzheimer’s Disease, a progressive and degenerative disease of the brain. Dementia is an umbrella term that means memory loss and/or confusion; and Alzheimer’s Disease is the most common form of dementia in seniors. Alzheimer’s Disease affects memory, behavior, and thinking. 

While there is no cure for the disease that affects 5.8 million Americans, early detection and diagnosis is important for a number of reasons that are listed below. Memory Loss is not a normal part of aging.

10 Early Signs and Symptoms of Alzheimer's

1. Memory loss that disrupts daily life

One of the most common signs of Alzheimer’s disease, especially in the early stage, is forgetting recently learned information. Others include forgetting important dates or events, asking for the same questions over and over, and increasingly needing to rely on memory aids (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own.

What’s a typical age-related change?
Sometimes forgetting names or appointments, but remembering them later.

2. Challenges in Planning or Problem Solving

Some people living with dementia may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.

What’s a typical age-related change?
Making occasional errors when managing finances or household

3. Difficulty completing familiar tasks

People with Alzheimer’s often find it hard to complete daily tasks. Sometimes they may have trouble driving to a familiar location, organizing a grocery list or remembering the rules of a favorite game.

What’s a typical age-related change?
Occasionally needing help to use microwave settings or to record a TV show.

4. Confusion with time or place

People living with Alzheimer’s can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there.

What’s a typical age-related change?
Getting confused about the day of the week but figuring it out later.

5. Trouble understanding visual images and spatial relationships

For some people, having vision problems is a sign of Alzheimer’s. This may lead to difficulty with balance or trouble reading. They may also have problems judging distance and determining color or contrast, causing issues with driving.

What’s a typical age-related change?
Vision changes related to cataracts.

6. New problems with words in speaking or writing

People living with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have trouble naming a familiar object or use the wrong name (e.g., calling a “watch” a “hand-clock”).

What’s a typical age-related change?
Sometimes having trouble finding the right word.

7. Misplacing things and losing the ability to retrace steps

A person living with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. He or she may accuse others of stealing, especially as the disease progresses.

What’s a typical age-related change?
Misplacing things from time to time and retracing steps to find them.

8. Decreased or poor judgement

Individuals may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money or pay less attention to grooming or keeping themselves clean.

What’s a typical age-related change?
Making a bad decision or mistake once in a while, like neglecting to change the oil in the car.

9. Withdrawal from work or social activities

A person living with Alzheimer’s disease may experience changes in the ability to hold or follow a conversation. As a result, he or she may withdraw from hobbies, social activities or other engagements. They may have trouble
keeping up with a favorite team or activity.

What’s a typical age-related change?
Sometimes feeling uninterested in family or social obligations.

10. Changes in mood and personality

Individuals living with Alzheimer’s may experience mood and personality changes. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, with friends or when out of their
comfort zone.

What’s a typical age-related change?
Developing very specific ways of doing things and becoming irritable when a routine is disrupted.

Get checked.

Early detection matters. If you notice one or more signs in yourself or another person, it can be difficult to know what to do.

It’s natural to feel uncertain or nervous about discussing these changes with others. Voicing worries about your own health might make them seem more “real.” Or, you may fear upsetting someone by sharing observations about changes in his or her abilities or behavior. However, these are significant health concerns that should be evaluated by a doctor, and it’s important to take action to figure out what’s going on.

What to do if you notice these signs

If you notice any of the 10 Warning Signs of Alzheimer’s in yourself or someone you know, don’t ignore them. Schedule an appointment with your doctor.

With early detection, you can explore treatments that may provide some relief of symptoms and help you maintain a level of independence longer, as well as increase your chances of participating in clinical drug trials that help advance research.

An early diagnosis of Alzheimer’s provides a range of benefits for the individuals who are diagnosed.

  • Medical benefits
  • Emotional and social benefits
  • More time to plan for the future
  • Cost savings

The information in this article is sourced from the Alzheimer’s Association’s website.

Article written in part by the Alzheimer’s Association 
https://www.alz.org/
24/7 HELPLINE 800.272.3900

senior couple looking over finances on computer

Ten Asset Preservation Mistakes Made by Seniors

Preparing & Preserving your Assets: Ten Common Mistakes

Protecting your life’s work and accumulated wealth is top of mind for aging people as they start to think about preparing for the possibility of needing care at some point in their life. There are great benefits to discussing options and planning early (while capacity is not an issue) so you and your loved ones can have peace of mind knowing they are prepared for whatever disability may come.

The Ten Most Common Mistakes:

  1. Transferring all assets to children or other relatives. This almost always results in a penalty period of ineligibility that begins after application for Medicaid and other public assistance. Tax consequences can be significant. Make gifts only with legal counsel.
  2. Selling the family home to pay for nursing home costs. This is often not required, yet many still believe that the home must be sold to pay for care.
  3. Relying only on a will or living trust. A will has no effect until approved in probate proceedings after death. A living trust is preferable in most cases, but generally does not protect assets from government claims for payback.
  4. Relying on Medicare or health insurance. Neither one pays for the cost of long terms care in a nursing home or assisted living. Costs typically run between $5000 and $6000 and most families will quickly run through their life savings.
  5. Putting a family member on accounts as a joint owner. This subjects the account to the risks associated with the joint owner’s life – divorce, bankruptcy, lawsuit. This can also result in disqualification periods for Medicaid eligibility. There are better ways to avoid these legal problems.
  6. Using a pre-printed form for power of attorney. These documents may be useful for small accounts and simple transactions but usually lack the express language needed for more complex affairs and for Medicaid eligibility transactions. Have one prepared for your situation by an elder law specialist.
  7. Using a form will or living trust. These are cheap and available from bookstores and internet. But they are almost always not suitable or correct for your situation. Lawyers earn substantial fees “fixing” these do-it-yourself wills and trusts.
  8. Purchasing a “Medicaid annuity” or other financial products to shelter assets. Use caution when relying on the advice of “senior advisors” who may not understand your situation.
  9. Applying for a guardianship or conservatorship. These proceedings to handle a person’s incapacity are costly, time-consuming and restrictive. With proper planning, these can be avoided in most cases.
  10. Ignoring Medicaid estate recovery. The state can and does proceed with liens and other proceedings to recoup benefits paid out on your elder’s behalf. In appropriate circumstances, this can be avoided with proper planning.

Note: Laws governing Medicaid eligibility, Medicaid asset recovery and estate preservation are complex and vary between states. A qualified Elder Law Attorney can help you avoid these common mistakes.

Medicaid FAQs

Q: Medicare paid for Dad’s hospital after his stroke. Won’t Medicare pay for nursing homes, too? 

A:  No. Medicare and Medicaid are two different programs. Medicaid may pay for long term care if your dad qualifies. Medicaid rules are complicated and change over time.

Q: Mom can’t take care of Dad at home anymore. To qualify for Medicaid, will they have to sell their house and spend down all their investments?

A: Your parents residence is exempt, so they can keep the house. Depending on the value of their investments, your parents may have to “spend down” some assets. They can spend down “dumb” or they can spend down “smart.”  With help from an experienced elder lawyer, they can spend down “smart” or even avoid a spend down entirely.

Happy retired man holding his piggy bank

Q: Will Medicaid take my parents’ house or put a lien on it?

A: No. Medicaid does not put a lien on the house. However, Medicaid may make a claim against your Dad’s estate for payback after he passes away.  An experienced elder lawyer may help your parents with legal ways to avoid a claim entirely or at least delay the claim until after your Mom passes away.

Q: Is it legal for Mom and Dad to retitle or transfer their property to me so they will qualify for Medicaid?

A: Actually, it is perfectly legal, but it must be done very carefully, because Medicaid recipients will face a “period of ineligibility” based on the timing and the amount of the gift.  There is a 5 year “look back” that applies in ways you may not expect. Don’t try this at home.

Q: Mom and Dad had their wills done years ago. Is there anything else they should do to plan ahead for long term care?

A: Yes. Here is their homework assignment:

  • Get a durable power of attorney from an experienced elder lawyer so Mom and Dad can legally sign documents for each other. For transactions to obtain Medicaid eligibility down the road, special provisions are required. A cheap power of attorney from the stationery store may be “legal,” but it may not work.
  • Get an advance directive so Mom and Dad can legally make end-of-life health care decisions for each other.
  • Consider long term care insurance.
  • Plan ahead with an experienced elder lawyer to preserve their assets for their care.

Planning for Disability

No one likes to think about the possibility of their own disability or the disability of a loved one. However, statistics are clear that we should all plan for this possibility. The US Department of Health and Human Services estimates that 70% of Americans age 65 or older will need long term care during their lifetime. Not surprisingly, the likelihood of needing long term care increases with age. This is significant because Americans are living longer and care costs can quickly consume financial resources. A recent Harvard study indicates that 69% of single people and 34% of married couples would exhaust their assets after just 13 weeks in a nursing home.

swim coach with elderly woman

There are four ways to pay for long term care:

  1. Private pay. Though not realistic for everyone, this option offers the greatest number of choices in care.
  2. Long term care insurance. If medically eligible and able to afford premiums, this is a good way to pay for some or all long term care costs.
  3. VA Benefits. Many veterans and their spouses are unaware that pension benefits may be available to them. Benefits may not cover the entire cost of care, but can help significantly.
  4. Medicaid. While not accepted by every care provider, Medicaid benefits can cover the entire cost of care for those who qualify. Always consult an experienced elder law attorney before beginning a Medicaid “spend-down.”

Here’s what you can do to be prepared:

  • Discuss options and plan early (while capacity is not an issue) so you and your loved ones can have peace of mind knowing they are prepared for whatever disability may come.
  • Be aware of heightened health risks for those who work long hours caring for a spouse or family member, and include a paid care provider if possible.
  • Investigate insurance and VA benefits options that may be available.
  • Consult an experienced elder law attorney, who will create a plan to safeguard personal wellbeing and property in the event of disability, and to allocate and protect assets that may be at risk of being depleted by out-of-pocket health care costs. 
Tom Pixton

Tom Pixton

Pixton Law Group
Visit Website
Phone (503) 968-2020
J. Tomas Pixton is a seasoned elder law and estate planning attorney with more than 25 years of experience advising families about how to find and pay for quality long-term care and how to preserve seniors’ hard-earned assets. Tom is a member of the National Academy of Elder Law Attorneys, WealthCounsel, and the Estate Planning and Elder Law sections of the Oregon State Bar.