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Medicare Plans

Medigap Supplement Plan

by Kimberly Johnson
written by Kimberly Johnson

If you want to stay in original Medicare, you may want to look into your options for supplement plan coverage. Without such coverage, your out-of-pocket costs could be high if you require medical care. Supplement plan insurance helps pay the deductibles and coinsurance costs that original Medicare does not cover.
You may be able to get supplement plan insurance from a former employer or union. If not, you can buy Medicare supplement plan insurance (Medigap) directly from an insurance company.
If you want to buy a Medicare supplement plan insurance policy, known as Medigap, you must decide which benefit package to buy and which insurer to use. Before making a decision, you should clearly understand what benefits are covered and how to compare plans.
There are 10 different standardized Medigap Supplement plan, labeled A-N. Not all plans are available in all areas. Each Medigap Supplement Plan pays for a particular set of benefits.
The cost of your Medigap Supplement Plan policy depends on the type of Medigap Supplement Plan you choose, the company from which you buy it, and the cost of Medigap Supplement Plan in the state where you live. Once you have chosen the plan you want, it pays to shop around. Plans with the same letter name offer the same benefits, but the premiums vary from company to company. If you buy your Medigap Supplement Plan policy during your open enrollment period or other federally mandated times, your premium cannot vary based on your health status.
No insurance policy fills gaps in coverage for Medicare HMOs or any of the other Medicare private health plans. Should you select an HMO, PPO, or other type of plan, you should budget for any costs that the plan doesn’t cover. Many have a cap on the annual out-of-pocket costs that you are required to pay.

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Guide to Choosing a Part D Prescription Drug Plan
Prescription Programs

Prescription Drug Coverage

by Jeff Dailey
written by Jeff Dailey

When you join Medicare you may want to add coverage for your prescription medications. Medicare Prescription Drug Coverage (MPDC, or Part D) will cover both brand-name drugs and generic at participating pharmacies. Part D helps to protect you from unexpected drug expenses and help you better predict your medical spending.
If you want to enroll in Medicare Part D, make sure to do so when first eligible. If you do so at a later date, you will have to pay penalty fees that will last as long as you have the drug plan. When you do choose to join Medicare Part D, your premium cost will increase by a minimum of 1% per month for every month that you waited to join.
Prescription Drug CoverageYou can receive prescription drug coverage either by enrolling in a Medicare Advantage Plan (or any health plan that includes drug coverage) or by joining the new Medicare Prescription Drug Plan. Before you choose a plan, check that the pharmacies in the plan are convenient for you; or if not see if it offers mail order prescriptions. You should also review the formulary list of all the drugs the Medicare drug plan covers.
Coverage:

  • Formulary: a list of all drugs that a Medicare drug plan covers. Includes generic and brand name drugs.
  • Prior Authorization: Some drugs cost more than others, even though the less pricey drug is just as effective. Other drugs may have more side effects, or restrictions on how long they can be taken. To help ensure drugs are being taken properly, and when truly needed, some plans may require “prior authorization”. Prior authorization is when your doctor provides the plan with proof that there is a medically necessary reason you must use a particular drug.

Coverage Gap:

  • If you have high drug costs, you may consider which plans offer additional coverage until you spend $4.350 out-of-pocket. In some plans, if your costs reach an initial coverage limit, then you pay 100% of your prescription costs. This is called the coverage gap. This “gap” in coverage is generally above $2,700 in total drug costs until you spend $4,350 out-of-pocket. Some plans might offer some coverage during the gap. Even in plans where you pay 100% of covered drug costs after a certain limit, you would still pay less for your prescriptions than you would without this drug coverage.

Convenience:

  • Drug plans have to contract with certain pharmacies in your area. Check your plan to see which pharmacies are included. Some plans will also offer mail order prescriptions.

How does Medicare Prescription Drug Coverage work with Employer or Union coverage?

  • If your drug coverage from your employer/union is on average at least as good as MPDC, you can keep it as long as its offered.
  • If your employer/union coverage stops, you will have a special enrollment period to sign up for MPDC (with no penalty fee).
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Preventing Holiday Shopping Identity Theft
Fraud & Security

Protect Yourself From Medicare Fraud

by Jeff Dailey
written by Jeff Dailey

Most doctors, pharmacists, plans, and other health care providers who work with Medicare are honest. Unfortunately, there a few that are dishonest. Medicare is working with other government agencies to protect you and Medicare. Medicare fraud happens when Medicare is billed for services or supplies you never got. Medicare fraud costs Medicare a lot of money each year. You pay for it with higher premiums. Protect Yourself From Medicare Fraud
 

The following are examples of possible Medicare fraud:

  • A health care provider bills Medicare for services you never got.
  • A supplier bills Medicare for equipment different than what they provided to you. Someone uses another person’s Medicare card to get medical care, supplies, or equipment.
  • Someone bills Medicare for home medical equipment after it has been returned.
  • A company offers a Medicare drug plan that hasn’t been approved by Medicare.
  • A company uses false information to mislead you into joining a Medicare plan.

If you believe a Medicare plan or provider has misled you, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. When you get health care services, you may want to save the receipts you get from providers. Use your receipts to check for mistakes on statements you get. These include the Medicare Summary Notice if you have Original Medicare, or similar statements that list the services you got or prescriptions you filled.
If you suspect billing fraud, here’s what you can do:

  • Contact your health care provider to be sure the bill is correct.
  • Call 1-800-MEDICARE
  • Call the Inspector General’s hotline at 1-800-HHS-TIPS. (1-800-447-8477). TTY users should call 1-800-377-4950. You can also send an email to HHSTips@oig.hhs.gov.

Fighting Fraud Can Pay
You may get a reward of up to $1,000 if you meet all these conditions:

  • You report suspected Medicare fraud
  • The Inspector General’s Office reviews your suspicion
  • The suspected fraud you report isn’t already being investigated
  • Your report leads directly to the recovery of at least $100 of Medicare money

For more information, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Note: For your protection, your full Medicare number is no longer printed on your Medicare Summary Notice. The first 5 digits of your number are replaced with “Xs.”
How Medicare Protects You
Medicare works with other government agencies to protect Medicare from fraud and to protect you from identity theft. With help from honest health care providers, suppliers, law enforcement, and citizens like you, Medicare is improving its ability to prevent fraud and identity theft. Some dishonest health care providers have been removed from Medicare, and some have gone to jail. These actions are saving money for taxpayers and protecting Medicare for the future. Below and on the next page are other ways Medicare is working to protect you.
You Are Protected from Discrimination
Every company or agency that works with Medicare must obey the law. You can’t be treated differently because of your race, color, national origin, disability, age, religion, or sex. If you think that you haven’t been treated fairly for any of these reasons, call the Department of Health and Human Services, Office for Civil Rights for your state, or call toll-free 1-800-368-1019. TTY users should call 1-800-537-7697. You can also visit www.hhs.gov/ocr for more information.
The Medicare Beneficiary Ombudsman
An “ombudsman” is a person who reviews issues and helps to resolve them. The Medicare Beneficiary Ombudsman shares information with the Secretary of Health and Human Services, Congress, and other organizations about what works well and what doesn’t work well in Medicare. The Ombudsman helps improve the quality of the services and care you get from Medicare by reporting problems and making recommendations.
How Does the Medicare Beneficiary Ombudsman Help You?
The Ombudsman makes sure information is available to all people with Medicare about the following:

  • Your Medicare coverage
  • Information to help you make good health care decisions
  • Your Medicare rights and protections
  • How you can get issues resolved
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Medicare Plans

The Basics of Medicare & Choosing the Right Plan

by Jeff Dailey
written by Jeff Dailey

shutterstock_109645904 (1)When you reach 65, you face an important milestone: You are now eligible for Medicare.
Contrary to popular belief, Medicare is not free, and it’s important to understand the ins and outs of Medicare before you sign up. Making the wrong choices can be expensive.
Even if you’ve been on Medicare for years, you may want to re-evaluate your options annually to make sure you’ve got the right plan. The annual open enrollment period, during which you can switch Medicare plans, runs Oct. 15 through Dec. 7.
“I think everyone should consider switching,” says Lita Epstein, author of “The Complete Idiot’s Guide to Social Security and Medicare.” “Plans change, benefits change, and the premiums change.”
It’s especially important to re-evaluate your options if you have a Medicare Part D drug plan or a Medicare Advantage plan because those plans can change significantly from year to year, dropping and adding drugs and doctors or changing copays and deductibles. “Even if they’re completely happy with their plan, they have to look because things change,” says Diane J. Omdahl, founder and Medicare expert at 65 Incorporated, which helps people choose Medicare coverage.
Medicare plans are actually broken into multiple parts:

  • Part A covers hospital care, skilled nursing, hospice and some home health care. If you or your spouse has at least 10 years of Social Security work history, this part is free. If you don’t have that work history, it can be up to $407 per month. Your premium amount is determined by how many Social Security work credits you have.
  • Part B covers doctor visits, preventive care, outpatient care and hospitals and some home health care. In 2015, this part cost $104.90 a month for Medicare beneficiaries whose incomes are $85,000 a year or less ($170,000 for a couple) and up to $335.70 for those whose annual income exceeds $214,000.
  • Part C is also known as a Medicare Advantage plan. It substitutes for parts A and B and, in most cases, Part D, the drug plan. Premiums range from $0 to more than $100 a month, varying by location and coverage. According to the Centers for Medicare & Medicaid Services, the average premium in 2016 will be $32.60.
  • Part D covers prescription drugs. Premiums are about $15 to $50 per month.

The first big decision Medicare beneficiaries must make is whether to go with traditional Medicare (parts A, B and D) or a Medicare Advantage plan (Part C). Medicare Advantage plans have lower premiums, but they usually require members to get their care only from network doctors and hospitals. Both options have deductibles, copays and co-insurance, where you pay a percentage of the bill.
“They look at their lives, they look at their health, they look at their pocketbooks, and they chose the parts they want,” Omdahl says.
Those who choose traditional Medicare usually add a Medigap policy, which is a supplemental policy that covers what Medicare doesn’t. There are 10 types of Medigap policies, offered by private insurers or via groups such as AARP, and costs vary considerably, based on gender, age, health, whether you smoke, location and company. Weiss Ratings found the national average for Plan F, the most popular option, was $162 to $5,674 annually.
“You can go through your life with just A and B, but the out-of-pocket costs will get you,” Omdahl says. The reason is Medicare lacks a maximum for out-of-pocket costs. But with a Medigap policy, most of those costs are covered.
About 32 percent of Americans are expected to choose Medicare Advantage plans next year, according to the CMS. Those plans, a combination of HMOs and PPOs, have an out-of-pocket limit. But customers tend to pay more in copays and co-insurance than they do with traditional Medicare, plus have access to fewer doctors and hospitals. Some of the plans include vision, dental and hearing coverage, which is not covered by traditional Medicare, but those services are offered from a limited network of providers.
“If you’re healthy and you’re younger … it can be cheaper,” Epstein says. “If you absolutely can’t afford to take a Medigap supplement, a Medicare Advantage plan is going to be the best option.”
Her advice to those who can afford it, however, is to choose traditional Medicare with a supplement because that option offers greater access to top specialists and doesn’t require the insurance company to approve specific treatments. “Managed health care is going to be managed by the insurance company,” she says.
“It’s very, very important that you look at those copays and compare them,” Epstein says. “By the time you figure in one hospitalization, it’s about the same,” she says of the total cost of traditional Medicare and Medicare Advantage plans.
No matter what your retirement age, you become eligible for Medicare when you turn 65 and you can sign up the three months before your birthday, your birth month and the three months after. If you don’t sign up during this seven-month period, even if you’re still working, you may face a long-term penalty. “They cannot wait until the last minute because of the backlog at Social Security,” Omdahl says.
If you start with traditional Medicare and a Medigap supplement, your supplement rate is not based on your health record. But if you start with a Medicare Advantage plan and then switch to traditional Medicare later, the company offering the supplemental coverage will base your premium on your health history and may even deny coverage. “It’s a real risk because everybody’s going to get something as they get older,” Epstein says.
Americans who are very low income may be eligible for extra help with Medicare premiums and health care costs. Beneficiaries in this financial situation can find additional guidance from Medicare.gov.
The system is complex, and most people should seek help when choosing a plan. There is lots of information at Medicare.gov, at AARP.org and on the Consumer Reports website. If you’re considering several Medicare Advantage plans, call the company that offers each one to verify that the coverage is what you think it is.
You can find ratings of Medicare Advantage plans from the National Committee for Quality Assurance. You can also get phone or in-person help from your State Health Insurance Assistance Programs. Those agencies often maintain office hours at senior centers or other locations.
By Teresa Mears of US News & World Report

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Medicare Rules You Must Know
Medicare Plans

Medicare Rules You Must Know

by Jeff Dailey
written by Jeff Dailey

Learn about these must-know facts about retiree healthcare.

Healthcare is an essential need for everyone, and it becomes even more important as you age and require more medical services. The Medicare program is a vital component of getting American seniors the healthcare they need, but it comes with some rules that many people find confusing or difficult to follow. Below, we’ve called out five key Medicare rules that should be foremost on your mind as you prepare for your golden years. Medicare Rules You Must Know
medicare1. When to apply for Medicare
Most people become eligible to receive Medicare when they reach age 65. As long as you or your spouse worked long enough to get Medicare coverage — typically 10 years — then it makes sense to apply for free hospital coverage under Medicare Part A at your earliest opportunity. You can file an application for Medicare as early as three months before you turn 65. Moreover, if you’ve applied for Social Security benefits earlier than that, then your Medicare Part A coverage will typically begin automatically on your 65th birthday.
Medicare Part B medical care coverage requires paying a monthly premium, so if you have other sources of coverage, you might not want to enroll automatically in the program. For instance, those who have group health coverage under an employer plan can wait beyond age 65 to sign up for Medicare Part B, and then sign up later when their other coverage ends. Again, though, applying three months prior to turning 65 is the best time to get Part B, and you can get automatic coverage if you so choose if you apply for early Social Security benefits.
2. Penalties for applying late for Medicare
The reason it’s important to apply for Medicare at the right time is that you can owe penalties if you get coverage late. Those who qualify for premium-free Part A coverage won’t face late penalties, but for Part B coverage, every 12 months that you go without enrolling when you should have will send your monthly premiums up by 10% for the rest of your life. Part D prescription drug coverage penalties for applying late can also apply if you chose not to get a policy when you were first able to do so.
As discussed above, some people have other sources of coverage through work or a spouse’s health plan. Such people get a special enrollment period starting the month after the qualifying coverage ends and extending for eight months. As long as you sign up for Medicare during that period, you typically won’t owe a penalty.
3. What Medicare Advantage plans offer that original Medicare doesn’t
Medicare Advantage plans, also known as Medicare Part C, have features that traditional Medicare doesn’t. Most Medicare Advantage plans are designed to have more complete coverage than traditional Medicare, offering out-of-pocket maximums and different copayment and coinsurance options that can change the amount you have to pay for medical services. By using managed care options, Medicare Advantage plans can cut costs and pass on savings to policyholders through better benefits or lower premiums. However, these plans can also have restrictions on which medical professionals you can use to take advantage of the best coverage options available. It pays to look closely at all your options to pick the one that best fits your needs.
4. When you can change your coverage
Annual enrollment periods allow you to switch between different Medicare offerings. From October 15 to December 7, you can change between original Medicare and a Medicare Advantage Plan, or you can switch between Medicare Advantage plans. You can also make changes to your prescription drug coverage during that period, whether it involves getting an integrated Medicare Advantage plan that offers such coverage or getting a separate policy under Medicare Part D.
A second period specifically allows you to go from a Medicare Advantage plan back to original Medicare, but no other changes are allowed. This period extends from January 1 to February 14.
5. How to deal with disputes over coverage
You’re allowed to appeal a decision that Medicare or a Medicare Advantage or Prescription Drug plan provider makes concerning your coverage. If you’re denied coverage, then you’ll typically go through a five-step process. First, you can seek a redetermination by the company handling claims for Medicare. If that doesn’t work, then a qualified independent contractor will reconsider the decision. Your next recourse is a hearing before an administrative law judge, and if that fails, then a Medicare Appeals Council can review the case. Finally, you have the right to take the case to federal court for a judicial review.
Medicare is an essential part of your financial planning, and understanding these rules will go a long way to making sure you have the coverage you deserve. Keep these rules in mind, and you’ll be able to make better decisions about Medicare when the time comes.

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Planning your Medicare Plan
Medicare Plans

Planning your Medicare Plan

by Jeff Dailey
written by Jeff Dailey

Commonly Overlooked Pieces of Your Medicare Retirement Plan
Medicare enrollment can be a confusing and overwhelming experience, especially for first-time enrollees. The variety of plans and the costs associated with each can make it difficult to compare and gain a complete understanding of your total annual costs. Even if you have a comprehensive retirement plan that takes into account your health, circumstances can change. There is no crystal ball to tell you how your retirement will unfold. Planning your Medicare Plan
While impossible to forecast your future health, there are several ways to prepare for the unexpected and protect your retirement plan, and your health. Planning your Medicare Plan
So, how do you best predict your medication expenses? Evaluating your current health and lifestyle is a good place to begin:

  • Do you have any chronic conditions, or pre-conditions?
  • Are you active? Do you maintain a healthy diet?
  • Do you take medications for non-chronic conditions or ailments that may be expected to continue?
  • Do you have a family history of chronic conditions?

Be honest when answering these questions, as they’ll set an important baseline. For example, if you have been diagnosed with prediabetes, it is possible diabetes could be in your future. Patients with diabetes spend an average of $13,700 annually on medical expenses.
Your planning should also take into account potential medication price increases, which can often rise much faster than the prices of other consumer goods. The average American will likely have at least one chronic condition and end up spending nearly a quarter of a million dollars through retirement on healthcare costs, so these predictions are vital in planning.
Think about ways to save. Consider plans that offer lower copayments for generics, and have generic equivalents or alternatives on their formulary – or list of covered medications – to the medications you take. Using generics, you can often save up to two/thirds on your prescriptions. Planning your Medicare Plan
Switching delivery methods, brands, or even pharmacies may also provide some cost savings, and many plans even have online tools that can help you compare these costs. Always take your medication as prescribed. Skipping doses can feel like it’s making a prescription last longer, but the long-term health effects and potential associated costs make skipping doses ineffective and possibly even dangerous.
Expect the unexpected. You can never accurately predict all of your healthcare costs. Have contingency plans in place for any unanticipated medical expenses. These can range from car accidents to surprise diagnoses, which may impact you directly, or indirectly through a loved one. Surprise costs aren’t so much a matter of “if” they happen, but rather “when” they happen, and you’ll thank yourself later if you build in a buffer.
You’ll never be sure of what tomorrow brings until it arrives, but with thorough planning and preparation, you can ensure that you’ll be ready to take on whatever comes your way. These commonly-overlooked issues are a great place to start, but only by fully evaluating every option available to you, in the context of your own individual health, will you be able to choose the best plan for you now, and in the future. For more information and helpful tips, sign up for a free newsletter about retirement planning and Medicare at http://www.roadmapformedicare.com/sign-up.
Planning your Medicare Plan

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What is Medigap?
Medigap

What is Medigap?

by Jeff Dailey
written by Jeff Dailey

What is Medigap?

What is Medigap?As to most people didn’t know about, although they should be. Medigap is an insurance that covers the gaps by Medicare. And although Medigap is private coverage insurance, it is highly synchronized by both federal and state government, and for this reason, what is Medigap best value is that it is affordable for many seniors. What is Medigap?
The cost of health care is so expensive these days. Sometimes, when doctors or surgeons charge more than Medicare, you will have to pay the difference.
The best thing is to apply for it within 6 months of first being covered by Medicare, because at this season, insurers are obligatory to sell you the policy you want, even if you are considered high risk, or have a pre-existing condition. Plans must be guaranteed renewable as to what is Medigap rule that it cannot be canceled as long as you keep paying the premiums.
There are ten different standardized Medigap plans authorized by the federal government. However, individual states can decide which and how many are offered to sell to people. What is Medigap basic coverage of Plan A is that it is offered in every state, and every insurance company that sells Medigap must offer it. Basically, Plan A covers payments you would be accountable for if you were hospitalized for over 60 days, and Medicare no longer covered you. What is Medigap another concern is that it would also pay that part of payment of nonhospital care that Medicare Part B wouldn’t cover. Plan A would also cover the first 3 pints of blood you would need, in or out of the hospital. So plan A is a basic coverage.
Choosing among all the policies offered can be perplexing, so study the variety of plans well, what is Medigap benefit and what is Medigap best offer for you.
When choosing a plan, do as much evaluation shopping as possible, before you decide.
In conclusion, learn the plans and choose sensibly, making sure that your Medicare and Medigap policies together cover as many health catastrophe as possible.
 

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5 Programs that Lower Medicare Costs
Medicare Plans

5 Programs that Lower Medicare Costs

by Kimberly Johnson
written by Kimberly Johnson

5 Programs that Lower Medicare Costs

Even with Medicare, many people struggle to afford premiums, deductibles and other out-of-pockets health care costs. There are five federal programs that lower your costs for care even if you do not qualify for Medicaid: 5 Programs that Lower Medicare Costs
  1. Veterans’ Administration: If you are a vet, the Veterans’ Administration (VA) offers low-cost services and prescription drugs directly. And, you can have VA coverage as well as Medicare.
  2. Medicare Savings Programs: Depending on your income, these programs help pay for Medicare premiums and coinsurance, even if you don’t qualify for Medicaid. There are three programs, Qualified Medicare Beneficiary (QMB), Specified-Low Income Medicare Beneficiary (SLMB) and Qualified Individual (QI). Income and asset limits, and how they are counted, vary somewhat by state. You should apply through your local Medicaid office.
  3. Extra Help with Medicare Part D prescription drug coverage: You may qualify for Extra Help, which pays for some or all of the cost of your drug coverage, so long as your income is under $1471 (individual) or $1991 (couple) and your assets are below $13,070 (individual) or $26,120 (couple). You get this automatically if you have Medicaid or a Medicare Savings Program. Some states have State Pharmaceutical Assistance Programsthat provide even more assistance.
  4. Federally Qualified Health Centers (FQHCs) and other programs run by the Human Resources and Services Administration: FQHCs are located across the country and serve underserved populations and areas on a sliding-feed scale. They might waive the Medicare deductible and coinsurance, depending upon your income.
  5. Hill-Burton programs offer free or reduced care at Hill-Burton facilities in 38 states. Hill-Burton does not cover services fully covered by Medicare or Medicaid. Eligibility depends on your family size and income.

Keep in mind that you may be eligible for Medicaid based on your income after paying for some health care costs. For information on Medicaid, click here. To learn more about these programs, free local resources, and other programs that could help, contact your State Health Insurance Program. To contact your state Medicaid office, click here.

Written by Diane Archer
Huffington Post

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Discussing Your Aging Care and Death
Health

Discussing Your Aging Care and Death

by Jeff Dailey
written by Jeff Dailey

Discussing Your Aging Care and Death

Now that Medicare has begun to cover advanced care planning, chaotic life – and dying – decisions will hopefully diminish Discussing Your Care and Death

Discussing Your Aging Care and DeathThe “death panels” have arrived. Starting this month, your physician can charge Medicare for the time she spends speaking with you and your family about end-of-life care – a very good and important step. Lawyers bill for the time they spend counseling clients about estate planning. Until now, doctors have generally provided the analogous service – advanced care planning – for free.

Patients often postpone such discussions because they’re afraid to face their own mortality. And doctors have had an incentive to defer these discussions because they weren’t compensated for their efforts. When the time came, this job often fell to another doctor, usually in the hospital, who hadn’t known the patient as long or as well, and at a time when the patient was likely less able to participate meaningfully in the conversation. This isn’t any different outside the hospital; fewer than a third of people have end-of-life conversations with their loved ones.
While visiting my in-laws in July, I sampled how the new Medicare eligibility for advanced care planning will hopefully change how we doctors approach the conversation. My husband and I had a series of discussions with his parents (at his mother’s request), and I learned a lot from the experience. It’s not that I don’t have these discussions with my patients; I have them all the time. But with my in-laws, I’m not restricted to a one-time office visit or to the chaos of end-of-life decision-making in the hospital. The conversation could unfold slowly and thoughtfully over time.
On the first day, we spent an hour talking about what they enjoy, what makes life worth living and what they fear. On the second day, we spoke for over an hour about how to keep them healthy and safe in their home and what daily activities they find challenging. In other words, we focused a lot on the living, not the dying. It wasn’t until the third day that we spoke at length about end-of-life care. And we’ve spoken more about all these topics (and others) since.

These were not easy conversations. More than three hours of discussion over three days was not long enough to get to everything. It was hard for them to open up – even with us, their loved ones – to reveal their insecurities. And it was hard for my in-laws, as for many older or sick patients, to concentrate for a long period of time.
There’s so much we’ve touched on but haven’t resolved. My mother-in-law, who is seven years older than my father-in-law, is very worried about the increasing load of caregiving. “Thank heavens that we have the support groups, because they are so helpful,” she told us. “But you get a picture painted of what’s going to happen. I hear women in the support group talking about their husbands. They dress their husbands from top to bottom. They wash them. Right now we really have it good.”
As we’ve told her before, being a wife doesn’t mean she has to be the primary caregiver. But it isn’t cheap to hire outside help; 90% of long-term care of the old or disabled is provided by unpaid caregivers like spouses, and it takes a heavy toll on their health, well-being and finances.

My father-in-law is worried about the progression of his Parkinson’s disease. “I see people in the Parkinson’s support group who are in steady decline, and all of a sudden they’re in a care center. And then you read about them in the obituary column,” he told us. My father-in law doesn’t want to go to a memory care center alone. He wants my mother-in-law to go with him. But the reality is that – unless she develops dementia – she won’t. And we still haven’t dealt with this head-on.
It’s important to know if a patient wants CPR, electric shocks, to be put on a ventilator, to be given a feeding tube or antibiotics, or other life support. But it’s also important to understand how someone wants to live; isn’t what happens to us in life more important than the distribution of our assets when we’re gone? So why is it so controversial to talk about these issues: our challenges with falling, taking medications, getting out of bed or a chair, walking, bathing, dressing, preparing meals, eating, toileting, housekeeping, managing our finances, shopping or driving?
Starting this month, Medicare is also testing an approach that wouldn’t force us to choose between treatment that might cure and hospice care, which seeks to alleviate pain and other end-of-life symptoms. We can choose both, an approach that has been shown to improve quality of life while reducing costs.
That said, this is the United States of America: how we live often boils down to how much money we – or in the case of our health, our insurance company – have to spend. At least now, there will be money to help us talk about how we want to live until we die.

Author Celine Gounder at The Guardian

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