28- Oct2016
Posted By: Tony Fischer
611 Views

Beware of Medicare Advantage Plans

As open enrollment for health insurance approaches, people all over the country are weighing the cost of their health care plans.  For seniors with Medicare coverage, there is pressure to convert straight Medicare insurance into an HMO or Advantage Plan. 

Late night infomercials and even entire TV channels are dedicated to promoting the advantages of Medicare HMOs with some insurers even promising lower monthly premiums if your join their network.  There are several positives to joining a Medicare HMO but can also be several disadvantages.

Before you join a Medicare based third party insurance plan there are several general concepts you should understand before sitting down with your insurance agent.

Medicare Advantage Plans vs. Medigap

The difference between Medicare based health plans and Medigap insurance are often misunderstood.  Medicare based heath insurance plans, often called Advantage plans, combine your Medicare and third party health insurer into one plan.  In most cases, members of Medicare based insurance plans pay one premium to their insurance company. The two insurance coverage’s become one and cannot be separated.

Medigap insurance plans are billed separately from your Medicare coverage and serve as a secondary insurance or co-payer to Medicare.  Medigap insurance can also be used to cover prescription medications.

How Medicare HMOs work.

Medicare based health plans get a monthly stipend from Medicare to manage your health insurance cost.  It helps the government control medical cost by allowing the insurer to determine coverage’s depending on the insured’s contract.

Medicare based plans still follow guidelines set forth be Medicare but they have their own rules regarding coverage amounts and the types of services covered.  In short the insurance company, not Medicare, is calling the shots.

Advantages of Medicare HMOs

Medicare HMOs offer a couple of unique advantages over having straight Medicare.  They can often lower monthly premiums and offer the ease of dealing with a single insurance company.  Depending on the company, Medicare based insurance plans also offer outreach and health maintenance programs as part of their coverage.

Medicare based plans coming from large employers as part of a pension benefit often have the most benefits. The ease of use, additional programs and lower premiums are the major reasons some seniors choose these types of insurance plans.

Disadvantages

It is important to note that most every healthcare provider is licensed by Medicare and accepts Medicare insurance coverage.    However, not all healthcare providers accept all Medicare HMOs. Providers have to negotiate contracts with health insurance companies in order to be a part of their network.  So even if your insurance is Medicare based, it may not be accepted by every provider.

Additionally, insurance coverage rules are standard for every provider billing Medicare.  Not so for Medicare HMOs as each company has there own rules and coverage based on the contracts they have with their members and providers.  Deductibles also vary based on the insurance company.

Not All Insurances Are Created Equal

We are getting closer to a universal single payer healthcare system but we have a long way to go. Even though an insurance is Medicare based, the types of services, networks, costs and deductibles vary greatly form company to company.  HMOs offer some nice advantages but they aren’t a fit for everyone.

Before You Enroll

Before you make any changes to your insurance coverage you should ask the following questions:

  • Will all the Doctors I use be covered with my new insurance?
  • How will my out of pocket expense change related to how I use my coverage now?
  • What is the process for appeals if I don’t agree with a coverage decision?
  • Are the services covered by the insurance network close to home and convenient to use?
  • How does the insurance company service their customers?

Insurance companies offering Medicare based plans boast extensive networks and coverage’s. But straight coverage is often more widely accepted and covers most costs.

Whatever choice you make understand how your insurance coverage fits into lifestyle and unique healthcare concerns. Developing a senior care plan is a great way to define you unique healthcare needs and coordinate care based on your human, insurance and financial resources.  We can help you develop this plan.  For more information of our senior care planning services CLICK HERE.

27- Oct2016
Posted By: Tony Fischer
144 Views

Warning Signs An Elder May Have Trouble Living Alone

As the Holidays approach it is the time many people start making trips to visit elderly relatives. Sometimes those visits are shocking if the elder is struggling to maintain their health and home.

But judging whether or not an elder needs help at home can be challenging.  Family members and friends are often hesitant to confront the elder about the subject for fear of offending or hurting their feelings.  Others become frustrated when they try to help only to meet resistance from the elder.

Our elder care coordinators deal with this scenario everyday. But if you don’t have training, how can you tell if a senior needs help at home?  We have listed warning signs that could indicate an elder you know is struggling to live alone.

Unexplained Bruising

As we age we start to lose our balance.  This is especially true if the elder in question leads a sedentary lifestyle. Lack of exercise and activity can also lead to issues with strength and endurance.  Disease.malnutrition and dehydration can also play a role poor balance.

These factors can lead to falls resulting in bruising on the arms, knees, lower legs and even the face.

Elder’s understand that repeated falling is a warning sign which often leads them to cover up the accident in fear of losing their independence. If your elder is trying to cover up or has difficulty explaining bruises then they may be having frequent falls and should see their doctor as soon as possible.

Expired Food

Another major red flag is expired food in the fridge or cupboard.  We have all been guilty of letting canned food expired in our cupboard but if an elderly person is letting large quantities of food go uneaten that could be a sign of other problems.

If the elder has a decreased appetite, is unable to go shopping or is having difficulty making meals they are at risk for malnutrition and should get help to make sure they are eating healthy meals.

Also Read>>>Signs A Senior May Be Hungry

Poor Housekeeping

We all have different definition of clean.  For a guy living at home alone chances are the house will be a little more messy than usual.  But if the mess goes beyond the normal resistance to house cleaning that could indicate other medical issues.

Garbage left in the house could indicate that the elder is having difficulty disposing of the garbage properly because of a physical deficit. Stacks of unopened mail could indicate that the elder is having trouble maintaining the business of the household.  Stacks of papers, books and boxes could indicate the elder is having trouble putting things away in their proper place.

Although dirty houses aren’t life threatening if the clutter goes beyond the norm the elder may need help maintaining a clean a safe environment.

Dirty Clothes

Laundry is a part of everybody’s regular routine.  For and elder that everyday task of throwing a load into the washing machine can be very difficult. Especially if the elder has a diagnosis that limits their mobility and strength.

Dirty clothes also have an odor and are uncomfortable.  If the elder can’t clean their clothes they may choose to isolate themselves for fear of embarrassment.

If you notice that the elder is wearing dirty clothes or that the bed sheets and towels are dirty it could indicate they are having trouble doing laundry related to physical weakness or memory.

Decline in Hygiene

Keeping ourselves clean is something most of us take for granted but for an elder with physical or mental deficits it can be very difficult.  Some elders even avoid bathing for fear of falling in the shower.

If you notice a significant decline in the hygiene of your elder it could indicate a larger problem.

Planning is the Key

The issues listed in this post are warning signs but it doesn’t mean your elder can’t live at home alone. They just may need a little help with some of these tasks to eliminate risk factors and create a safe and healthy home environment.

Our elder care coordinators can help you develop a plan for your elder that will address these issues and extend the time they have to live in their own home independently.  Click Here for more information on our Senior Care Planning Services. 

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