Thursday, March 31, 2011

Peninsula Daily News column - 3-31-11 "Few Medicare Advantage Plans left"

This is Week #3 of describing the Medicare Machine. It is also March 31st, 2011.
                Today, from 2:00 to 4:00, a few of us will be lurking about Life Care Center of Port Townsend (aka Kah Tai) to talk about whatever you want to talk about, and eat cookies.
                Tomorrow is April 1st, which is April Fool’s Day – Symbolism is where you find it.
                OK, the Medicare Machine: I am not going to regurgitate the last two weeks’ columns, because that would place all of us squarely into the Department of Redundancy Department, so if you’re just walking into the middle of this, good luck.
                Remember the part about how you could delay enrolling in Part B because you were still employed? Well, if you retire, become unemployed or, for whatever reason lose your employment-related health insurance, you will have an 8-month “Special Enrollment Period” (SEP) to get into Part B, which starts the month AFTER your other insurance ends, and it the effective date of your Part B coverage will be the first day of the month following enrollment.
If you have prescription drug coverage through employment (or whomever/wherever) and it goes away, you will have a 63-day SEP to get into a Part D plan without incurring the dreaded Penalty.
Now, you may or may not recall that, last week, I vaulted over Part C, which most of us refer to, affectionately or ruefully, as “Advantage Plans.” Here’s the deal:
Basically, there are two ways to get Medicare: (1) “Original” Medicare, which means everything that we’ve been immersed in for the last three weeks, or (2) through a Medicare Advantage Plan. Advantage Plans are Medicare’s version of “managed care,” so the classic example would be a HMO (“health maintenance organization”). Most HMO’s in the world are places you go to and receive virtually all of your healthcare – Same place, same folks, same billing procedures, all your records in one place, same coffee, same magazines, etc – Many people who use HMO’s love them.
We do not have any HMO’s on the Peninsula, so there are various permutations of Advantage Plans, like “preferred provider organizations” and “private fee-for-service” plans, and others. Historically, some folks have really liked them because they tend to be cheap and, sometimes, offer benefits that “original” Medicare doesn’t offer, like some vision, hearing and/or preventive stuff. The down side has been that not all healthcare providers have accepted all Advantage Plans, so it was always a crap-shoot about who-accepted-what this year and, sometimes, there were some other funny little things like “facility charges” or whatnot – The litany was: READ THE CONTRACT.
Last year (which means THIS year – 2011), a lot of Advantage Plans went away. There are several reasons for this, some or all of which are “wonderful” or the “end of the world,” depending upon your socio-political views of the good ‘ole U.S. of A, and none of which matter if you’re just trying to understand the Medicare Machine, because “gone” is…Gone.
There are a few Advantage Plans around. If you become Medicare-eligible this year and want to learn more, go to www.medicare.gov and read it slowly and carefully, or call any of the numbers at the end of the column and ask for help, where decent people will help you, for free.
In as few words and as few weeks as possible, that’s what the Medicare Machine looks like, so reassure yourself about your attention span, and reward yourself with a cookie (or some celery, depending upon your socio-political views) and breathe, but beware of lulling yourself into a false sense of security or knowledge, and here’s why: Once you enter The Machine, you’ll begin to encounter unanticipated (although, often, GOOD) variations-on-themes, like the “Low Income Subsidy,” which can help pay for Part D-related stuff, or the “Medicare Savings Programs,” which help pay for Part B-related stuff, and on and on and…On.
Medicare does not pay for long-term care, long-term. It will pay for up to 100 days in a “skilled nursing facility” (read, “nursing home”) IF you need it and IF you meet certain eligibility requirements. It doesn’t usually pay for things like hearing aids or dental care or foot care – Note the use of the term, “usually.”
See? This isn’t easy stuff, but don’t panic: Most of us seem to be able to figure out most of this, most of the time, and usually with help – Help is allowed – So, you CAN do this, but understand that it will go BEST if you take your time, pay attention and think of it as your “job,” not just a quick, little “something” that you’ll get done between batches of cookies…
…because you won’t.
I know what you’re thinking: “There has GOT to be a way to beat this game!” You’re right, there is: Use it as little as possible, which means use “healthcare” as little as possible, which means stay as healthy as possible – And you don’t need me to tell you how to do that; besides, I probably wouldn’t listen to you on that subject, either.
Take the politics and the emotion out of all this, and remember that, if you’re old enough to care about this stuff, then you’ve been smart enough, for 60+ years, to survive in America, so you can do it – You just don’t want to.
I don’t blame you - Neither do I – So, I’m going to have a bumper sticker made:
“Medicare happens.”

Thursday, March 24, 2011

Peninsula Daily News column - 3-24-11 "Medicare kicks in when you turn 65"

Today is March 24, 2011, and in the interests of “full disclosure” (which almost never happens in the real world), be warned that I have not had a change of heart. I am going to continue to describe the view, from 30,000 feet, of the Medicare Machine.
                I am doing this to us for two reasons: (1) An awful lot of people are closing in on the age of Medicare maturity and have more than a passing interest in understanding how this thing works, and (2) an awful lot of people who are already on Medicare, and had deluded themselves (as do I) into thinking that they understand it, don’t. I know this to be true because an awful lot of you have said to me, in the last week, “I didn’t know that.” Note the repetitive use of the descriptor “awful,” then we’ll move on.
                Last week we were all about Part A, Part B, Part B penalties, COBRA coverage, tra la, and I have no intention of repeating all of that because I presume that you were paying attention and I like you, so I’m jumping right in to where we left off.
                Unless you’ve been on Social Security Disability Insurance (SSDI) for 23 months, you qualify for Medicare when you turn 65, and if you’re still working, please go back and have a look at last week’s column; if you’re not still employed, you have a 7-month “Initial Enrollment Period” (IEP) surrounding that 65th birthday: Three months BEFORE you’re 65th birthday, the month OF that birthday and three months AFTER your 65th period.
                So, if you turn 65 in May, you can enroll in Part B in February, March or April, and if you do, it will become effective on May 1st. If you enroll in May, it’ll kick-in on June 1st; in June, on August 1st; in July, on October 1st and in August, on November 1st – Because, that’s how it is.
                Now, take a deep breath, because I’m going to vault over Part C and go to straight to Part D, which you can think of as standing for “drugs” – Prescription drugs – Prescription drug coverage. Part D plans are “private,” meaning that they are offered by private insurance companies, not the Federal government. Like Part B, Part D has a penalty; actually, YOU will have The Penalty if you don’t sign-up for Part D when you’re eligible, and that penalty will never go away.
                Now, IF you are still employed at age 65 and have coverage through your employer, OR you get prescription drug coverage through a retiree health insurance or the VA or wherever, and IF it is “creditable” (which is an unnecessarily fancy word for “equal to or better than the Medicare Part D standard plan”), you can evade the dreaded penalty. The way that you can prove that you had “creditable coverage” is that each year (usually in the Fall) your company, plan, whomever will send you a letter saying so. Keep these letters, and put them someplace where you can actually find them.
                If you don’t have said prescription drug coverage, or if it isn’t “creditable,” consider enrolling in a Part D plan, because (1) it might help you pay for prescription drugs, and (2) you will sidestep the penalty ad infinitum.
                Time out: No, you don’t have to do this; in fact, you don’t have to do ANY of this! There is no law that says that you have to enroll in Medicare or any parts thereof. You can go your own way, roll the dice and take your chances – You only care about “penalties” if you change your mind down the way and decide to enroll in Medicare, then BOOM! Oops…But it’s up to you; most of us cave-in and enroll.
                There are two ways to get Part D coverage; one is through a private Part D plan, as noted above, and the other is through a Medicare Advantage plan. “Advantage Plans” are another moniker for “Part C,” which I vaulted over earlier, and will come back to, later (Hey: I never told you this was easy!).
                Here’s a test: Remember what “IEP” is? Go look a few paragraphs up and cheat, I did – Right! “Initial Enrollment Period!” So, the IEP for Part D works exactly the same way as the IEP for Part B! (NOTE: Re-read that last sentence. You actually understood it, didn’t you? Scary, huh? I know.)
                Beginning this year (2011, in case the migraine has already started), the “AEP” (Annual Enrollment Period) for Part D will run from October 15th through December 7th – We do this every year, “this” being review our Part D plans, because formularies and premiums change – Often. We do this every year because most of us can’t afford not to. Some of us don’t do it, because we’re _____ (fill-in the blank). Whatever changes we do or don’t make to our Part D plans become effective on January 1st of the next year.
                Get used to it.
                I had hoped to do this all in two columns; I also thought that Rome was built in a day – There’s a fine line between optimism and delusion, so we’ll carry on next week, but here’s something else that will happen next week, seven days from this very day, March 31st:
                A few of us are going to be at “Life Care Center of Port Townsend” (previously known as “Kah Tai Care Center” – 751 Kearney Street) from 2:00 to 4:00 p.m. to answer questions or engage in conversations about stuff like this, or long-term care or in-home care or Medicaid or Advance Directives or whatever-the-heck else you’d like to talk about.
                We are not going to give speeches. The reason we’re not going to give speeches is because, then, we’d be talking about what we want to talk about instead of what YOU want to talk about, which doesn’t usually help you, so come on.
                I presume there will be cookies; after three consecutive weeks of Medicare, there’d better be.

Tuesday, March 22, 2011

Peninsula Daily News column - 3-17-2011 "Everything to know about Medicare"

I tend to think of Medicare as the “Rube Goldberg approach to health insurance;” thus, it’s easy to get myopically focused on this-or-that moving part, or how this made that fall over, which made this other one stand up which caused this one over here to roll over and play dead.
                And in the course of that, completely lose track of what the whole machine looks like and we actually have to do in order to inject ourselves into the “The Machine” because, like it or not, for many of us, it’s the only game in town.
                This is not “Hooray for Medicare!” We are not required to like it, or to think it represents a stunningly insightful or logical method of health care (or health INSURANCE) delivery, but many, many, MANY of us are required to deal with it.
                Here’s another non-surprise: The “Baby Boomers” (“Silver Tsunami,” whatever) are bumping up against the Medicare machine. These folks were born between 1946 and 1964. There are 47 million people on Medicare now, and with the Boomers, that will spike to 80 million by 2030, which is only 19 years away; further, one in 10 Boomers are living below the Federal poverty line, the general trend is for many of us to keep working past age 65 and “full retirement age is now 66.
                So what? Well, that means that an awful lot of people whose primary knowledge of Medicare consisted of, “My parents have it,” need to understand how to access this Medicare machine and how to understand “It” - More or less, most of the time, so here we go.
                If you already “get” everything there is to know about Medicare, this is going to be pretty boring, so please occupy yourselves by e-mailing me your name and phone number, so we can start referring folks to you for help – I’m serious. No? OK, then, read on and just write off the next few minutes to “humoring Harvey.”
                And for the true wonks among us, I am not going to attempt to cover every detail and nuance of the Medicare Machine that could possibly touch anyone under any circumstances ever, because that doesn’t help most people – Agreed? OK.
                In the beginning there was Medicare. Medicare is health insurance.
                There are, generally, two ways to qualify for Medicare: You turn 65 or you hit month #24 of Social Security Disability Insurance (SSDI). If you turn 65 AND receive Social Security benefits, you will be auto-enrolled in Medicare Part A (think “hospital”) and Medicare Part B (think “doctor”). You will receive by mail a “Welcome to Medicare” kit, which borders on being self-explanatory – Well, more-or-less, mostly – If you actually read it…
                …then read it again.
                If you are under age 65 and on SSDI, you will be auto-enrolled in Medicare Parts A and B during month #23, which puts you on the cusp of the 24-month qualifying period.
                As previously noted, the “full retirement age” (meaning, the age at which you get to scoop up your full Social Security benefit, remembering you can get more if you work more) is now 66; thus, if you turn 65, are still working and not receiving Social Security benefits, you have to sign-up for Medicare. You sign up for Medicare by contacting Social Security – I know, but that’s how it’s done – You can also do that “online,” but let’s don’t get distracted by practicality.
                If you are still working and get health insurance through your employer, you might choose to delay enrolling in Part B – Why? Well, for openers, Part B costs you money, so why pay for something you don’t need – Yet.
                However, there is a pricey, lifeLONG penalty for NOT enrolling in Part B when you’re eligible, so you want to get this right (stay with me); also, “getting it right” will allow you to retain your “open enrollment period” for a Medigap plan. I know – Don’t panic.
                As shocking as it may be, Medicare does not pay for all of your health insurance stuff; actually, it only pays 80% of the Medicare-approved cost of the stuff it does cover. Many people buy private plans from insurance companies to pay for all or most of what Medicare doesn’t pay for. These are affectionately referred to as “Medigap” (aka “MedSUPP”) plans.
                If you do everything “right,” you have an “open enrollment period” for Medigap plans, which means that any plan has to accept you, regardless of pre-existing conditions or whatever else, whether they like it or not; otherwise, they can make you fill out a health questionnaire that was developed during The Inquisition and then, in all probability, reject you. You do not want that to happen.
                So: IF, when you turn 65, you are still working (or your spouse is still working) for an employer with at least 20 or more full-time employees (I don’t know why, and am well past caring) AND you (or he, or she) have health insurance through that employer, you can legitimately delay enrolling in Part B without incurring the dreaded penalty AND will still have access to that lovely “open enrollment period” for Medigaps down the way.
                IF all that is true and IF you have the nerve to change to a different job where all of that is still true, get a letter from the employer that you’re leaving stating the length of time that you were enrolled in that employer’s health insurance. You want this because it will prove that you can successfully evade The Penalty.
                Put it someplace where you can actually find it.
                If you retire from said employer (or quit, or whatever) and go onto COBRA (Note: If you have no idea what that is, you probably don’t need to know – Yet), sign up for Part B! “COBRA coverage” is NOT considered “active” employer insurance, thus – PENALTY! - To the tune of 10% per month for each year that you didn’t enroll in Part B, for the rest of your Medicare-haunted life.
                No, that’s not all, but that’s enough – For now. More next week, and Yes: If you followed all of this, you can take a day of respite from your dementia-inhibiting crossword puzzle…
                …and two aspirin.

Monday, March 14, 2011

Peninsula Daily News column 3-10-11 "There's a reason to use social media"

A couple of weeks ago I went on about, and confessed to more-than-a-bit of trepidation regarding, helping to launch our agency into the nether world of FACEBOOK (“Olympic Area Agency on Aging-Information & Assistance”).
                Admittedly, my uncharacteristically tentative attitude reflects exactly that: Mark’s attitude, as opposed to whether or not it’s a good idea because, clearly, it is – And it is, for a single reason: It works.
                So, I was forced to confront the obvious question, “What’s my problem?”
                Well, OK, there’s that, and there’s probably THAT, too! – But I’m talking about my “problem” regarding this whole “social media thing,” and reflection reveals that there may actually be two problems:
  1. I am an inherently private person, a clearly unfortunate character defect for someone who writes a weekly newspaper column and does a weekly radio show, and I just didn’t want to have to paste my life all over a “wall;”
  2. …and I just didn’t want to have to LEARN ANOTHER TECH “THING!”
…hmm…Well, it turns out that:
  1. I don’t have to, and…
  2. …I didn’t like the sound of that, in my own head, because you know what it sounds like? Right.
It sounds like what I hear all the time about “seniors,” “old people,” “the elderly,” so I did a little snooping and, of course, what we “hear all the time” is…Well, you know what it is.
It turns out that among “older people” (older than what?) who went online last year, the number using social networks grew twice as fast as the overall rate of Internet use for that group; in other words, we do this. And in order to know why we do this, we can turn to a growing number of “experts” scattered hither-and-yon about the country, who reveal (after careful and detailed study) that we do this because…There’s a reason for it!
I know, but it’s true.
Indeed, those of us who are old-enough-to-know-better and young-enough-not-to-care get involved in social networking – And technology, in general – Because we see a reason to do it. Example:
According to a 2009 study by AARP, about one third of us who are 75 or better live alone; now, I’ve been saying for years that the two biggest “threats” for Elders are “…ignorance and isolation,” so here’s a way to fight that isolation – And when you get on top of “isolation,” “ignorance” just tends to diminish, and I don’t care how old you are.
True: There are stories all over the country about folks who have rekindled by a life by participating in social networks because they’re SOCIAL – People connect with people! People tell stories and share memories and share jokes and support one another and…Care about one another.
And if technology can help do that, I’m for it.
Now, I know that a lot of kids (“kids” who have long-since forgotten the vicissitudes of puberty) are thinking: “Oh, SURE! I can’t get Dad (Mom, Grandma, Uncle Albert – Whomever) to get anywhere near ‘technology’!”
OK, but maybe that’s because you missed the basic TRUTH (well, after the “truth” that most of this “tech stuff” needs to be reasonably simple, help needs to be reasonably available and provided in understandable language and the hardware has to be reasonably easy to manipulate), which is: There has to be a reason for it.
Reasons like:
·         I can see pictures of my grandchildren;
·         I can communicate with my grandchildren;
·         I can communicate with my children (if need be);
·         A reading device, like “Kindle,” is a heck-of-a-lot lighter and easier to carry around than 8 big books;
·         Sitting in on the transcontinental Thanksgiving dinner via “Skype;”
·         …and I can have a life! – And about a gazillion others.
Very likely different reasons than those that might attract a 20-something, but “reasons,” nonetheless.
Isolation kills. Boredom kills. Uselessness, kills.
Learning new things, involvement, interaction define life, for most of us – That isn’t news – What is “news” is that there are new ways to do this, even home alone when you’re…Home alone.
So, here’s what I think: When you’re a part of “life,” you are rarely a victim of it.
And anything that helps do that, is a good thing.

Peninsula Daily News column 3-3-11 "Caregivers could take tax deductions"

I realize that most of us think of this time of year as “winter,” and not without good reason, “La Nina” or “El Nino” or “La Bamba” notwithstanding; however, another “thing” that characterizes this time of year is – Tax Season! – And I apologize for denting your carefully nurtured and likely well-deserved denial.
                Indeed, Tax Season!  And the Ides of April looms larger on a daily basis. Most of us who are not extraordinarily wealthy have more than a passing interest in any legitimate tax deduction that might present its happy self, and since extraordinarily wealthy people are probably not spending their time reading this column, I’ll presume that includes most of us, so stay with me here.
                According to the Wall Street Journal (where extraordinarily wealthy people probably DO spend some of their time), there are some tax deductions available to family “caregivers” – Interested? Me, too! So, let’s start with a couple of definitions.
                Most people who are family caregivers don’t think of themselves as “family caregivers” – They think of themselves as people who are simply doing the right thing – Doing what they’re “supposed to do” – Doing what they choose to do, out of love, so that “caregiver” word applies to somebody else – Wrong! I’m going to give you my standard definition, which is not quoted in the Wall Street Journal: A “caregiver” is somebody who is taking care of somebody who needs to be taken care of, whether they like it or not; a bit colloquial, perhaps, but adequate for our purposes here today.
                A “care recipient” is the person who is being cared FOR – Who is RECEIVING the care – OK? Now, here’s where you need to start paying attention.
                Some caregivers may be able to claim a care recipient as a dependent on their tax returns, which could reduce your taxable income by as much as $3,650 for the 2010 tax year. In order to qualify for that, you have to be providing more than half of a care recipient’s financial support for the year, and that person must be either a relative, living with you or on their own) OR a non-relative who has lived with you for the past year.
                The care recipient has to be a U.S. citizen or a legal resident of the U.S., Canada, or Mexico AND their gross income for last year cannot be more than $3,650, NOT counting Social Security; oh, and she or he can’t have filed a joint tax return.
                If said care recipient does share your home, when you’re running the numbers to see if you hit the “more than half” standard, you can include a share of your mortgage, utilities and housing-related expenses – That could help.
                Now, here’s a common scenario in my world: Several family members (usually the “kids,” but not always) are kicking-in together to keep Mom (or whomever) afloat. If all of you together meet the 50% or better mark for providing financial support to the care recipient, but no one of you does, the family could file a Revenue Service Form 2120, “Multiple Support Declaration,” wherein you collectively designate one of you to claim the dependent deduction for the year. Whoever pulls the long straw has to have provided at least 10% of the care recipient’s annual expenses.
                I know: That will work for some families, and not so well for others – And how do you divvy up the proceeds (or savings or bounty or whatever)? I don’t have the foggiest idea and would sooner play “chicken” with a freight train. Do not call me!
                Ever onward, caregivers who work at a paid job and either claim a care recipient as a dependent or couldn’t do that because of the $3,650 income requirement (see above) also may be able to claim a “dependent-care credit up to $1,050. According to the compassionate wording on IRS Form 2441, the care recipient must be unable to “…physically or mentally…care for himself or herself.”
                If you’re paying for some or all of a care recipient’s medical and/or dental (Dental?) expenses, and you itemize deductions, you might be able to subtract from your taxable income those medical or dental (Dental!) expenses that exceed 7.5% of your adjusted gross income, which means, exactly, what?
                Well, if your “adjusted gross income” happened to be $50,000, you could claim a deduction for the medical/dental bills you paid (as in, NOT paid by insurance) that were above $3,750. This could include insurance premiums, out-of-pocket dollars for doctors, hospitals and medical equipment and, in some cases, nursing home bills – Oh, and. you have to provide at least half of the recipient’s financial support to pull this off.
                Still there? OK, if you are a “single” caregiver (meaning, not married) you might be able to change your filing status to “head of household,” which would mean that more of your income would be taxed at a lower rate, and the standard-deduction amount would increase to $8,400 from $5,700 – That’s good.
                Now, here’s what will happen next: Some of you will contact me with detail and nuance regarding any or all of the above, and you will probably be mostly right, most of the time. And while I always appreciate enlightenment, I am not a tax professional, so if any of you are thinking that any of this might be worth the doing, I strongly suggest you talk to somebody who knows what they’re talking about, which could well include TAX-AIDE.
                My job is to say, “Hello! Here are some things that are out there that might do some caregivers some good,” because “caregivers” are good, decent people who are taking care of somebody who needs to be taken care of, whether they like it or not.
                And caregivers will take all the help they can get.