Which Medicare Plan?

Can you solve this word problem?

If A + B = C and D is only sometimes included in C, how many prescriptions does it take to make any sense of Medicare?

Does Medicare seem like an unsolvable word problem to you? If so, you are not alone. We’ve done our best to simplify it and pull out the key details that are really helpful to know.

Medicare’s open enrollment (aka Annual Election Period) is from typically in October through December every year. What does this mean for you? Why should you look at your policy and do you have to? Medicare says the answer is based on what type of plan you currently have. 

  • If you have Original Medicare (aka Part A and Part B) plus a supplemental plan (often called a Medigap) and are happy with your coverage, you do not need to make a change.
  • If you have a Part C Plan (aka Medicare Advantage) or a Part D plan, you should review all your coverage options even if you are happy with your current coverage because plans change their costs and benefits every year. To do that, read your Annual Notice of Change (ANOC), which you should have received from your plan by September 30. It lists the changes in your plan, such as the premium and copays, and will compare the benefits in 2023 with those in 2022. 

TIP: You are likely getting a LOT of solicitations related to Medicare right now. You can throw most of it out, but keep anything mailed to you from the Social Security office or the Centers for Medicare & Medicaid Services.

What if you want to make a change to your plan?

According to Medicare, if you want to make a change, the best way to enroll in a new plan is to call 1-800-MEDICARE (1-800-633-4227). Enrolling in a new plan directly through Medicare is the best way to protect yourself if there are problems with your enrollment. Medicare suggests that you write down everything about the conversation when you enroll through Medicare, including the date, the representative you spoke to, and any outcomes or next steps.

What about Medicare overall? What’s good to know about the different plans? Well, we’ve covered that here…

What is Medicare Part C? (aka Medicare Advantage Plans)

Part C bundles Part A and Part B and provides additional benefits. Here are some key things to know about Medicare Part C:

  • Plans are offered by private companies approved by Medicare. 
  • In most cases, you will need to use doctors that are in the plan’s network in order to get the lowest co-pays.
  • Plans may have lower out-of-pocket costs than coverage just under Part A and Part B.  
  • Each plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). 
  • Not all plans include coverage for prescription drugs so if you need prescription drug coverage, be sure to pick a plan that includes that.
  • Plans may offer some extra benefits that Plan A and Plan B don’t cover – like vision, hearing, and dental services.
  • Part D may be included in Part C.
  • The plan may include coverage for home modification and transportation to/from doctor appointments. 
  • Part C can be a good option for people with a limited income. 
  • The plan rules can change each year so you’ll want to review it every fall.

TIP: If you are shopping for a new plan and want free quotes and to compare or enroll in a Medicare Advantage plan in your area. This U.S. News World Report offers a list of the Best Medicare Plan Insurance Companies 2023.

What is Medicare Part D?

Medicare Part D helps cover the cost of prescription drugs, including many recommended shots and vaccines. (Just remember the word “drugs” begins with “D”.)

Here are some key things to know about Part D:

  • Plans are offered by private companies.
  • Anyone who has Part A or Part B is eligible for Medicare Part D. 
  • Joining a Part D plan is voluntary and you pay an extra monthly premium for the coverage.
  • Part D benefits are available as a standalone plan added to Plan A and B.
  • Part D may be included in Part C. 
  • TIP: Since insurance companies have different prescription drugs on their approved list, it’s important to check to make sure your current prescriptions are covered under the plan you are selecting. 

We haven’t gotten to Medigap yet, but if you already know you want help from someone to sort out your Medicare coverage, you can call your State Health Insurance Program (SHIP) for free and unbiased advice about Medicare programs. 

What is Medigap? (aka Plan G or Plan K)

Medigap is extra insurance you can buy from a private company that helps pay for things like your deductibles and copays. Basically it fills the gap between your Medicare benefit and what you’d pay out of pocket that is normally the percentage of your share. Here are some key things to know about Medigap:

  • It is purchased from a private insurance company. 
  • Medigap may be good for those with chronic illnesses or those who need expensive medical procedures.
  • The Medigap monthly premium is in addition to the monthly Part B premium that you pay to Medicare.
  • Medigap plans cost more than Part C plans because they are more comprehensive. 
  • Medigap plans allow you freedom of choice in your medical care. You can see any physician or healthcare provider that participates in Medicare (nearly 900,000 providers across the nation).
  • There are no networks and no referral needed nor are you required to choose a Primary Care Physician.
  • To sign up for Medigap, you must be enrolled in both Medicare Parts A and B. 
  • Medigap policies do not include Part D, so you will purchase your drug plan separately.
  • More information about Medigap can be found in the Centers for Medicare & Medicaid Services Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare
  • You can buy a Medigap policy from any insurance company that is licensed in your state to sell one.
  • FYI: Medicare beneficiaries who are also eligible for Medicaid do not need Medigap insurance since Medicaid will cover the cost of their health care expenses.

Finally, what is the difference between Medicare and Medicaid?

These two terms are so similar it’s easy to confuse them! Here is some help defining them and keeping them straight. 

Medicare and Medicaid are two separate, government-run programs. They are operated and funded by different parts of the government and primarily serve different groups.

  • Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income.
  • Medicaid is a state and federal program that provides health coverage if you have a very low income.

If you are eligible for both Medicare and Medicaid (dually eligible), you can have both. They will work together to provide you with health coverage and lower your costs.

Make sure you remember the difference between the terms Medicare and Medicaid* since they are very easy to confuse. Try this trick to help…

Medicaid: Think of how it ends in “aid”. That will help you remember that it has to do with “financial AID”. *Medicaid is called Medi-Cal in California

Medicare: Think of how it ends in “care”. That will help you remember that it has to do with on-going “health CARE”

As always, if you want help making sense of any of this, contact Ways & Wane at hello@waysandwane.com! 

By consuming this information, you acknowledge and agree to assume the risk of any injury or harm that may result to any person resulting in whole or in part from actions or inactions and waive all claims against Ways & Wane, together with its subsidiaries, affiliates, officers, directors, agents, employees, attorneys, consultants, or advisors except those arising out of any gross negligence or wanton misconduct of Ways & Wane. 

Do a Benefits Checkup

Get ready for Medicare Open Enrollment

“Dad, what is this regular charge deducted from your checking account?”

Dad: “I don’t know what that is for.”

“Well you are paying for it every month and if you don’t know what it is, I’m going to cancel it.” (Two hours of phone calls later, it’s canceled.)

The next week….

Dad (calling confused and panicked): “I’m at the pharmacy and they told me my medication isn’t covered! They said the insurance plan for my medicine was canceled!? I have to have that coverage!” 

Do you speak “Benefits”?

It’s a true story! If the daughter had known that his Medicare Part D was charged on his credit card monthly, it would have saved a lot of headache.

But making sense of benefits and coverage is not easy. However, when you look at what it costs not to have the right benefit coverage it’s definitely worth getting it sorted out. With Medicare open enrollment from October 15th to December 7th, now is the ideal time for a “benefits check-up”. 

You can’t do your own mammogram, but you can do your own benefits check.

Three steps to do a benefits self-check:

  1. If you want help figuring out which Medicare program is best for the older adult’s situation, you can call your State Health Insurance Program (SHIP) for free counseling and assistance. This is a great option to get one-on-one guidance regarding Medicare.
  1. Most people on Medicare have a supplemental insurance plan, but not all of them know or use all of the benefits available to them under their supplemental insurance plan. For example, some plans offer things like meal delivery, some have a “store” and give an allowance for things such as medical equipment and coverage for over the counter medicines. If you aren’t sure what the supplemental insurance covers, call the company with a list of the older adult’s needs in mind and see what benefits are offered to address those needs. 
  1. If there is any chance the older adult qualifies for Medicaid, you can take this preliminary test through the American Council on Aging’s website. Once you have a sense of the likelihood of them qualifying you can move forward with that application. Once someone is covered by Medicaid the benefits include inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others.

Two more helpful tips:

  1. To see a list of surprising things covered by Medicare and a graphic that outlines the differences in Parts A, B, C and D, you can read our post titled, “Medicare Covers This”.
  2. Make sure you remember the difference between the terms Medicare and Medicaid since they are very easy to confuse. Try the following trick to help.
    Medicaid: Think of how it ends in “aid”. That will help you remember that it has to do with “financial AID”.
    Medicare: Think of how it ends in “care”. That will help you remember that it has to do with on-going “health CARE”

Here’s the best news! If you want to make sure you have the best benefit plan and coverage for your older adult and you don’t want to figure it out yourself, we have the perfect solution for you. A Ways & Wane Certified Care Advisor can do it all for you. (They can help you start the Medicaid application process.) They will take the time to understand your particular needs and situation and have the expertise to make sure the best coverage is in place.

May you find joy in loving one another well.

Elizabeth Dameron-Drew is the Co-founder and President of Ways & Wane. She walked closely with her own father through his years of waning. She lives near Seattle with her two teenage sons, husband and two rescue dogs. 

Medicare covers this

Don’t spend your hard-earned money on items that insurance will cover

“Family caregivers also spend on average 20% of their already-lower earnings on caregiving-related expenses — money they are not saving for their own futures.” (Forbes, 2021)

Ellen’s mom has trouble sleeping and is having some trouble with incontinence. Ellen spends quite a lot of money per year on sleeping aids and adult “underwear”. She heard about sleep apnea and a CPAP machine and wondered if that was something she should ask her mother’s doctor about. Little did she know that Medicare would cover both of these items.

Wouldn’t it be great to get the most out of Medicare coverage? We chased down some of the items that you may be paying for—and found that Medicare will pay instead!

When you sign up for Medicare, you have to sign up for the Original Medicare policy, which includes Parts A and B. Medicare Part C, is also known as the Medicare Advantage policy. Medicare Part D is an optional add on, just like Part C. Read about the differences of Parts A, B, C and D on medicare.gov.

Medicare covers a range of things, including some products and services that you buy. We pulled together a list of eight items that you may not know are covered by Medicare.

Are you paying for these 8 items?

#1 COVID Test

You pay nothing for this test when you get it from a laboratory, pharmacy, doctor, or hospital, and when Medicare covers this test in your local area.

#2 Screening for Depression

Medicare Part B covers one depression screening per year. 

#3 Incontinence Supplies

There are some Part C plans available throughout the country that will offer benefits for products like adult diapers. Yet, these plans are only in specific service areas. In some cases, no plans with this benefit may exist in your location, but it’s worth checking.

#4 Insulin

Starting January 1, 2021, you may be able to get Medicare drug coverage through the Part D Senior Savings Model that offers broad access to many types of insulin for no more than $35 for a month’s supply. You can get this savings on insulin if you join a Medicare drug plan or Medicare Advantage Plan with drug coverage that participates in the insulin savings model. This model lets you choose among drug plans that offer insulin at a predictable and affordable cost.

#5 A CPAP Machine

One surprising piece of equipment that is typically covered, partially, by Medicare is a Continuous Positive Airway Pressure (CPAP) Therapy equipment. This machine helps those who are diagnosed with obstructive sleep apnea to breath and sleep better through the night. It also helps those who are sleeping with them from whacking them with pillows to keep them from snoring.

#6 Advance Care Planning 

Advanced care is planning for care you would get if you become unable to speak for yourself.

Medicare Part B covers voluntary advance care planning as part of your yearly “Wellness” visit. The medical staff can help you fill out an advance care directive or POLST form. Medicare may also cover this service as part of your medical treatment. 

#7 Hospice / Palliative Care

There are plenty of Medicare-approved hospices across the country under the Original Medical policy. To qualify for hospice care, a hospice doctor and your doctor (if you have one) must certify that you’re terminally ill, meaning you have a life expectancy of 6 months or less.

#8 Smoking & Tobacco Cessation Counseling 

Medicare Part B covers up to 8 visits of smoking and tobacco-use cessation counseling visits in a 12-month period.

We have done our best to make certain this information is accurate, but confirmation of coverage can only be confirmed through your particular Medicare plan and provider. 

May you find joy in loving one another well.

Elizabeth Dameron-Drew is the Co-founder and President of Ways & Wane. She walked closely with her own father through his years of waning. She lives near Seattle with her two teenage sons, husband and two rescue dogs. 

Grants for respite care

a brief interval of rest or relief.

Respite care provides short-term relief for primary caregivers. It can be arranged for just an afternoon or for several days or weeks. Especially with some Adult Day Centers not yet open after the COVID restrictions were put in place, other sources of respite help may be hard to find. But there’s hope in securing respite help through specific grants.

Define your needs

AARP recommends starting by asking yourself a few questions: 

• What do you need? Three hours off, twice a week? Twenty-four hours away from the house? A regular day (or night) out with your spouse or friends? A combination of the above?

• What does your loved one need? Meals? Laundry? Light housekeeping? Personal care? Daily walks? Medical help? List every job, large and small.

• Who can pinch-hit? Cast a wide net. List family near and far, your friends and your loved one’s friends.

Three Respite Grant Options

Once you have your needs defined, pursue these three respite care resources:

Dementia Home Care Grant

HFC and Home Instead offer grants specifically for respite care if your older adult meets the following criteria:

  • Currently living at home with Alzheimer’s disease or related dementia.
  • Caregiver(s) facing financial and emotional hardships due to the unique challenges of Alzheimer’s or related Dementia.
  • Resides in the United States or Canada

Watch their video for suggestions on how to complete the grant application. They want to hear your specific story. The applications are reviewed bi-monthly and they say you will get a response within 60 days.

Respite Relief through the VA

There is a grant available through the Elizabeth Dole Foundation that “offers family caregivers of veterans access to no-cost, short-term relief with the help of CareLinx in-home care professionals.” They state that the in-home care professionals can provide companionship, light housekeeping, grocery shopping and meal preparation, transportation, mobility support/transferring, exercise, toileting, bathing, and dressing and grooming. Here’s a link to a Grant Q&A and a link to the application itself. 

Read more about VA support in this article: Veteran? Get Paid or Get Money for Caring

Eldercare Financial Assistance Locator 

This tool helps you find the programs for which you or your older adult are currently eligible as well as those programs for which you might become eligible as your situation changes. You answer a few questions and they narrow down what you qualify for with over 400 programs including federal, state, and local governments, the VA, non-profits and private organizations.

You may also be interested in this article: Respite Care Provided through Hospice for a Dementia Patient

With the processing time in mind, it’s probably best to begin a process right away, even before you are sure you need it. Support in your caregiving journey is not just good, it’s important and respite is not just good, it’s essential. 

May you find joy in loving one another well.

Elizabeth Dameron-Drew is the Co-founder and President of Ways & Wane. She walked closely with her own father through his years of waning. She lives near Seattle with her two teenage sons, husband and two rescue dogs. When she’s not working on this platform she’s probably creating books, doing research or planning a dinner party while listening to the rain and thinking about her next creative endeavor.

Paying for Dementia Care

We interviewed Kathryn Cherkas from the Alzheimer’s Association about paying for care. Here’s what she said:

“[For] the majority of people in America, affording care is a challenge. What the association can do as a whole is advise the best timeline for planning out finances.Our legal and financial planning course covers this and really demonstrates the importance of making these decisions early so that [it is] the person living with dementia’s decision, [so] their wishes are known and considered in all plans.

Our chapter here on the Central Coast does offer . . . “

[The Alzheimer’s Association course] demonstrates the importance of making these decisions early so that [it is] the person living with dementia’s decision.

Kathryn Cherkas, Alzheimer’s Association

Find more articles about paying for care:

Three Ways to Pay for Long-Term Care

This Company Benefit Could Save You Thousands

This company benefit could save you thousands in caregiving expenses

Will your company pay for eldercare?

As you assist your elderly parent or in-law, you may not think about your employer as a resource. Instead you wonder if they are getting the most out of Medicare benefits and worry about their physical or cognitive decline. 

woman on phone looking worriedMany employers offer a benefit to support your caregiving efforts. In fact, a Bank of America survey found that while 88 percent of the surveyed employers offer some type of caregiving resources, 71 percent of workers are unaware of these offerings, and just 34 percent have taken advantage of them.

Caregiving in the spotlight

With the proposed American Family Plan offering paid family leave to care for an older adult and the outcry over women caregivers leaving the workplace, employers are in the hotseat to offer more caregiving benefits. If your company does offer eldercare benefits, they likely exist within one of five different areas. If they don’t, now is the time to politely ask your human resources contact to consider adding an eldercare benefit. 

A sibling or their partner can also qualify for an eldercare company benefit to provide assistance. Asking them to check into their company benefit can be a good way to get siblings involved.

Five places to look for it

An eldercare benefit may fall into several areas within a company:

  • Adult care
    Like a child daycare benefit, some employers cover backup in-home care or adult daycare.
  • Employee Assistance Program
    The EAP may provide eldercare navigation resources to help you find in-home care, pay for care, determine which legal documents you need and more.
  • Employee Resource Group
    Some large companies offer an Employee Resource Group (ERG) supporting employees caring for an older adult. Employees experiencing similar eldercare challenges may meet regularly to share resources and support.
  • Dependent Care Flexible Spending Account
    Using pre-tax dollars to private pay for eldercare expenses, can save you 20% or more depending on your tax bracket. According to the Society of Human Resource Management, “While the benefit is most often used to pay for child day care, elder care also is eligible for reimbursement with a DCFSA if the adult lives with the account holder at least eight hours of the day and is claimed as a dependent on the account holder’s federal tax return.”
  • Family Leave
    Some companies offer a leave of absence that is paid, unpaid or a combination of the two so that you can attend to your loved one’s needs for an extended period of time. This can be especially useful during intense times of transition from hospital to rehab to another living situation. 

    Email your HR department

    Within larger companies, it can be difficult to find what benefits exist and how to access them. Copy and paste this message into an email and send to your human resources department:

    To Human Resources:
    Does our company offer any kind of eldercare benefit?
    Do we have an eldercare Employee Resource Group?
    What is our family leave policy as it relates to caring for an older adult?
    As I look forward, this benefit would be helpful.
    If we are considering a caregiver benefit, Ways & Wane solves eldercare challenges for busy professionals. I’d like to work with them. Will you reimburse employees for that expense?

    Your employer values your focused contributions; offering caregiver benefits allows you to do your best work and creates a high return on investment for your employer.

    Debbie McDonald is founder of the iCareToo movement and CEO of Ways & Wane, a benefit that solves eldercare challenges for busy professionals.

    Respite Care Provided Through Hospice for a Dementia Patient

    Hospice Qualifies You for Respite Care

    It isn’t what you think.

    The hospice representative called to let me know that dad qualified for the program. 

    I told her, “I think we’re still okay to hold off.” 

    Two weeks later she called, “Do you want to rethink hospice care?” 

    I said no. 

    My dad’s dementia had become more severe, but he was still talking and eating well and he (mostly) knew who I was. That said, no one knows your person like you do. You can see how they are slipping away while others may not detect it. 

    It sounded so final to engage hospice.

    We had no idea how quickly he would decline. Within two weeks, he was gone.

    Grandpa holding grandson

    While I do my best to live my life without regrets, believing first to trust that things do not happen by chance, I wondered how his last days would have been different had we engaged hospice sooner. 

    Could I have been with him in those last moments? Would he have been more comfortable? Would my sister and brother and his grandchildren have been able to say good-bye? 

    A nurse would have visited him frequently, making sure he was comfortable. We would have had someone to call 24 hours a day, instead of the reluctant once-a-month visit from his doctor’s office. There would have been on-site medication oversight and administration. We would have truly known his condition.

    People are either afraid of hospice or wish they’d engaged hospice earlier. I’d like to highlight a few of the facts here, particularly as it relates to dementia, and explain how hospice can support the caregiver with respite care. 

    Three points about hospice according to Medicare

    1. To qualify for hospice care, a hospice doctor and your doctor (if you have one) must certify that you’re terminally ill, meaning you have a life expectancy of 6 months or less. 
    2. When you agree to hospice care, you’re agreeing to comfort care (palliative care) instead of care to cure the illness. 
    3. You also must sign a statement choosing hospice care instead of other benefits Medicare covers to treat the terminal illness and related conditions. 

    One of the services hospice provides is respite care for the family caregiver. 

    Especially when caring for someone with dementia or Alzheimer’s, the mental, emotional and physical toll on the caregiver can be enormous, making respite for the caregiver essential. 

    Here are four things to know about respite care through hospice:

    1. Depending on the terminal illness and related conditions, the plan of care the hospice team creates can include inpatient respite care, which is care provided in a Medicare-approved facility (like an inpatient facility, hospital, or nursing home), so that the usual caregiver can rest. 
    2. Your hospice provider will arrange this for you. 
    3. Patient transport is included and you can stay up to 5 days each time you get respite care. 
    4. You can get respite care more than once, but only on an occasional basis. 

    For more information about paying for care, check this video by Author Cameron Huddleston.

    Dementia is a disease with no cure so it qualifies as terminal, which qualifies a dementia patient for hospice. But how then is life expectancy predicted? 

    Crossroads Hospice and Palliative Care, a private company serving a handful of states, mainly in the Eastern U.S., says this about eligibility. For patients with dementia, it may be time to consider hospice when the patient’s physical condition begins to decline. According to Crossroads, some key things to look for include:

    • A diagnosis of other conditions as COPD, CHF, cancer or congenital heart disease
    • An increase in hospitalizations, frequent visits to the doctor and/or trips to the ER
    • A diagnosis or pneumonia or sepsis
    • Weight loss or dehydration due to challenges in eating/drinking
    • Speech limited to six words or less per day
    • Difficult swallowing or choking on liquids or food
    • Urinary and fecal incontinence
    • Unable to sit upright without armrests on chairs or may slip out of chairs and require sitting in special chairs
    • Unable to walk without assistance such as a walker or now requiring a wheelchair
    • Unable to sit up without assistance (will slump over if not supported)
    • No longer able to smile

    Check the Hospice Foundation of America for what is included and not included in hospice care, how to choose a provider and how to begin the process.

    This Sunday, June 13th marks the two year anniversary of my dad’s last breath on this earth. I’ll be taking off on a family road trip that day and thinking a lot about how much he loved to drive and explore and what an honor it was to call him daddio.

    May you find joy in loving one another well.

    Elizabeth Dameron-Drew is the Co-founder and President of Ways & Wane. She walked closely with her own father through his years of waning. She lives near Seattle with her two teenage sons, husband and two rescue dogs. When she’s not working on Ways & Wane she’s probably creating books, doing research work or planning a dinner party while listening to the rain and thinking about her next creative endeavor.

    How much does it cost to care for an elderly person?

    Nursing homes, assisted living, wheelchairs, walkers, prescription copays—the costs add up.

    The Alzheimer’s Association estimated end-of-life care costs in 2016 were between $217,820 and $341,651. 

    Sometimes, otherwise healthy loved ones need a short dose of care as they recover from an acute medical episode like a broken leg. Other times a fall triggers a path of steady decline with cascading assistance needs. Skilled nursing or assisted living can become necessary, which can be expensive.

    If your senior’s health is faltering, costs not covered by insurance add stress to an emotionally charged situation.

    There are three key “aging shocks” that surprise families: 

    • uncovered costs of prescription drugs, 
    • the costs of medical care that are not paid by Medicare or private insurance, 
    • the actual costs of private insurance that partially fills in the gaps left by Medicare, and the uncovered costs of long-term care.
      –Health Services Research: The 2030 Problem: Caring for Aging Baby Boomers

    For the estimated 7 million individuals who provide long distance care, actual out of pocket expenses amount to almost $5,000 per month. For caregivers who have, or are considering leaving the workforce to care for an ailing parent, the costs are even greater—over $650,000 in forfeited salaries, benefits and pensions.

    • 70% of adults who are 65 years old will require some level of long-term care throughout the rest of their life,
      2018 – U.S. Department of Health and Human Services
    • 2 years: Average number of years that individuals age 65 and older will have a high long-term care need during their lifetimes.
    • $350,174: The average lifetime cost of care for an individual who has dementia,
      2018 – Alzheimer’s Association
    • 1 in 4: The number of adults who are 45 years old or older who are financially unprepared for long-term care expenses,
      2015 – AARP
    • 13% percent of adults will pay at least $150,000 in lifetime long-term care expenses out of their own pocket.
      2018 – U.S. Department of Health and Human Services
    Discover hidden ways to save money

    looking at cost of nursing home on computerYou can decrease the personal and economic costs of caregiving through careful research and planning. Think about what happens when you go to the grocery store with and without a shopping list. You will feel much better when you know your options and develop back-up plans before you absolutely need to help your senior make a long-term care decision. 

    Whether you are currently faced with the dilemma of how to pay for long-term care or are planning for the future, these are the steps to systematically approach the challenge: 

    • Review your senior’s assets
    • Determine potential long-term care cost
    • Evaluate ways to cover long-term care

    Step One: Review Your Senior’s Assets

    • Identify all sources of income and expenses for your senior by filling out this Asset Calculator. It will help you determine their eligibility for Medicaid.
    • Find and review insurance policies, including life, medical, home, car, etc.
    • Find a financial professional to advise you on managing your senior’s assets.  The Senate Committee on Aging recommends looking for someone with a financial gerontology certification; however the Securities and Exchange Commission does not endorse any financial advisor titles, like elder specialist. 
      • Ask your employer if they offer financial counseling services.

      Step Two: Determine potential long-term care cost.

      You can estimate the cost of your senior’s long-term care using this online calculator. When we researched options for my father, this calculator was pretty accurate for where we live in California.

      Step Three: Evaluate ways to pay for long-term care.

      There are three options to pay for or reduce the cost of long-term care:

      • government programs,
      • insurance programs or
      • personal assets

      We will start with reviewing government programs to find out which costs they cover.

      Find out what Medicare or Medicaid covers.

      video on how much long-term care costsAccording to the U.S. Dept. of Health and Human Services . . . 

      Medicare only pays for long-term care if skilled services or rehabilitative care are required:

      • In a nursing home for a maximum of 100 days, however, the average Medicare covered stay is much shorter (22 days).
      • At home combined with skilled home health or other skilled in-home services. Generally, long-term care services are covered for only for a short period of time.
      • Does not pay for non-skilled assistance with Activities of Daily Living (ADL), which make up the majority of long-term care services.

      Medicaid (program name varies by state):

      • Does pay for the largest share of long-term care services, but to qualify, your senior’s income and assets must be below a certain level and they must meet minimum state eligibility requirements.
      • Ask about federal or state funds available to pay caregivers by contacting the Eldercare Locator. Reach them online or by calling 800-677-1116, Monday – Friday, 9am – 8pm EST. Find your local office number on their website by adding your zip code. They can also inform you about other local caregiving services, like those provided under the National Family Caregiver Support Program. 
      • Call your State Health Insurance Program (SHIP) for FREE advice about Medicare programs. Find the number for your state.
      Time to review your senior’s insurance programs. 
      • If your senior has long-term care insurance, call your senior’s long-term care insurance provider to ask about guidelines for paying a caregiver.
      • If you are wondering if they should get long-term care insurance, check estimates with this online calculator. Advanced age and physical health can affect one’s ability to qualify for long-term care insurance.
      • If your senior has life insurance, call your senior’s life insurance provider and ask about the following options.
      • Ask about converting life insurance to a Long-Term Care Benefit Plan Account. By exchanging a life insurance policy for a long-term Care Benefit Plan, the benefits go toward long-term care including assisted living, home health care, and nursing homes. Benefits are deposited into a FDIC-insured benefit account that follows federal and state banking regulations and is held by a nationally chartered bank and trust company. The benefit payments are then made directly to the health care facility on a monthly basis.
      • Ask about an Accelerated Death Benefit, in which your senior would receive a tax-free advance on the life insurance death benefit while they are still alive.
      • Ask about the present value of the policy and if it is an option to sell it to pay for long-term care.
      • Ask about selling the policy to a third-party, called a viatical settlement. This option is only available if the insured is terminally ill with a life expectancy of two years or less.
      Time to review their personal assets.
      • If your senior owns a home, search for an authorized reverse mortgage counselor in your state. A reverse mortgage is a special type of home equity loan that allows you to receive cash (to pay for long-term care) against the value of your home without selling it. There are no restrictions on how you spend the money and you can receive it monthly or in one lump sum. You have to be 62 or older. Here is a helpful Consumer Financial Protection reverse mortgage guide.
      • Call a financial advisor and ask about a charitable remainder trust. This trust allows you to use assets to pay for long-term care services while contributing to a charity of their choice and reducing your tax burden at the same time. You can set up the trust so that they receive payments from the trust to use for long-term care services while they are alive.
      • Talk to your employer about covering your senior’s expenses pre-tax on a Flexible Spending Account plan. 

      Find more answers to your long-term care questions with the help of a Digital Social Worker. Step-by-step you will uncover more answers to pay for your senior’s long-term care so it doesn’t dramatically affect your own accounts.

      May you have peace at all times in every way as you help your senior in their waning phase of life.

      Debbie McDonald is the Founder of Ways & Wane, an online platform that helps you help your aging parent. She lives in Northern California with her husband.

      Veteran? Get Paid or Get Money for Caring

      elderly veteran One of our GoKit users found the perfect assisted living facility in Florida for her father. Although at over $4,000 per month, the payments were quite a burden. After a few months, she discovered that her father was eligible for a VA housing benefit of $2,000/month, which was retroactive to the time he moved in. While not every veteran is eligible for this benefit, the VA caregiver program expanded on October 1, 2020 to offer more services.

      Veteran’s Affairs offers two levels of support for caregivers: a general program available to all veterans and their families and a more comprehensive program with more strict criteria. The VA trains regional Caregiver Support Coordinators to help you understand which program addresses your situation at no charge.

      The Program of General Caregiver Support Services (PGCSS) provides resources, education and support to caregivers of Veterans. The Veteran does not need to have a service-connected condition, for which the caregiver is needed, and may have served during any era. No formal application is required.

      While the General program offers a range of supportive services, my favorite is the FREE caregiver coaching. You receive four individual sessions over the course of 2-3 months. The coach will provide you with a workbook and help you with a variety of issues caregivers face. They will coach you in stress management, problem solving, self-care and healthy behaviors, as well as, Veteran safety, behaviors, problems or concerns linked to a diagnosis. Your assigned coach will call you for a total of four sessions, over a two to three-month period.  Learn more about the REACH VA Program. Ask your Caregiver Support Coordinator about it.

      The Program of Comprehensive Assistance for Family Caregivers (PCAFC) is for eligible Veterans who have incurred a serious injury in the line of duty on or before May 7, 1975 or on or after September 11, 2001. This program provides resources, education, support, a financial stipend, and health insurance (if eligible), beneficiary travel (if eligible), to caregivers of eligible Veterans.

      If you are the primary caregiver, you may receive:
      A monthly stipend (paid directly to you as the caregiver.)
      Access to health care insurance through Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), if you do not already have health insurance.
      Mental health counseling.
      Certain beneficiary travel benefits when traveling with the Veteran to appointments. Note for specific details, speak to your Caregiver Support Coordinator.
      At least 30 days of respite care per year, for the Veteran. Respite is short term relief for someone else to care for the Veteran while you take a break.
      If you are the secondary caregiver, you may receive:
      – Mental health counseling.
      – Certain beneficiary travel benefits when traveling with the Veteran to appointments. Note for specific details, speak to your Caregiver Support Coordinator.
      – At least 30 days of respite care, per year for the Veteran. Respite is short term relief for someone else to care for the Veteran while you take a break.
      To enroll or find out which programs your senior qualifies for, find a Caregiver Support Coordinator in your area.

      Be sure to check the VA Caregiver Support Hotline for updates or subscribe to receive email updates and information about VA Caregiver Support Program services.

      The VA Caregiver Services may help you love your senior well!