Understanding Medicare Options
Traditional Medicare Coverage
Traditional Medicare Coverage is comprised of three parts: Hospital Insurance (Part A), Medical Insurance (Part B), and Prescription Insurance (Part D). Part A is provided to people age 65 or older who are eligible for Social Security or Railroad Retirement benefits. Part B has a premium, which is deducted from your Social Security or Railroad Retirement monthly benefit before you receive it. Part D is purchased through insurance companies; these premiums may be paid directly to the insurance company or deducted from your Social Security or Railroad Retirement benefit. Because there are deductibles and co-pays with traditional Medicare, it is wise to purchase supplemental insurance.
These policies are known as Medigap policies. Medicare has required all companies offering Medigap policies to standardize their policies. The policies are categorized by capital letters, and insurance companies must provide identical coverage for each “letter” category. This enables you to easily compare prices. Go to Medicare’s website,www.medicare.gov, click on the “Health and Drug Plans” tab, then click on “Compare Medigap Policies,” and follow the directions to obtain a list of available insurance companies providing Medigap policies for your area. With a Medigap policy you will have two insurance cards (Medicare and your Medigap). It is important to show both cards to medical providers to be sure claims are filed with both insurances. If your Medigap policy does not include prescriptions coverage, you can also purchase a Part D policy from participating insurance companies; you would use that card for any prescriptions. If you follow the directions in the next section for “Health and Drug Plans,” you can obtain information on participating companies in your area.
Medicare Advantage Programs
In a Medicare Advantage Program, an insurance company contracted with Medicare combines the traditional Medicare coverage with supplemental coverage and issues a single policy under that insurance company. There are a variety of Medicare Advantage plans: Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Point of Service Organizations (POS), and Private Fee For Service (PFFS). With some Medicare Advantage Programs you may incur a financial penalty if you use an out-of-network provider or fail to obtain authorization from your primary care physician for certain treatments. Go to Medicare’s web site, www.medicare.gov, click on “Health and Drug Plans,” then click on “Compare Drug and Health Plans,” and follow the directions to find insurance companies offering: drug coverage, Medicare Advantage coverage, or both. With a Medicare Advantage Program you do not use your Medicare card. Since the policy issued by the insurance company combines your Medicare and supplemental coverage into a single policy, you will only use the card issued by the insurance company.
Enrollment Period
In most circumstances you are allowed to drop or switch a Medicare Advantage Plan only during the enrollment period. The “Medicare & You” handbook listed on Medicare’s website gives information on exceptions to this.
Sources of Help
If you go to Medicare’s website, www.medicare.gov, and click on “Medicare Basics,” there is a drop down box where you can select “Coverage Choices.” This gives a side by side comparison of traditional Medicare with Medicare Advantage Programs. The APPRISE program through PA Department of Aging (1-800-783-7076) also provides help with health insurance questions.
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REGISTER HERE for LONG-TERM CARE PLANNINGPower of Attorney
A Power of Attorney can be used to give another person the right to sell a car, home, or other property in the place of the maker of the Power of Attorney. A Power of Attorney might be used to allow another person to sign a contract for the maker of the Power of Attorney (the person who makes a power of attorney is called the “principal”). It can be used to give another person the authority to make health care decisions, do financial transactions, or sign legal documents that the principal cannot do for one reason or another. With few exceptions, Powers of Attorney can give others the right to do any legal acts that the makers of the Powers of Attorney could do them themselves. A General Power of Attorney gives the “power of attorney Agent” or simply “Agent” (the legal name of the person who is authorized to act for the principal) very broad powers to do almost every legal act that the principal can do. When Elder Law Attorneys draft general Powers of Attorney, they still list the types of things the Agent can do but these powers are very broad. People often do general Powers of Attorney to plan ahead for the day when they may not be able to take care of things themselves. By doing the General Power of Attorney, they designate someone who can do these things for them.
Normal Powers of Attorney terminate if and when the principal becomes incompetent. Yet many people do Powers of Attorney for the sole purpose of designating someone else to act for them if they cannot act for themselves. It is precisely when persons can no longer do for themselves that a Power of Attorney is most valuable. To remedy this inconsistency, the law created a Durable Power of Attorney that remains effective even if a person becomes incompetent. The only thing that distinguishes a Durable Power of Attorney from a regular Power of Attorney is special wording that states that the power survives the principal’s incapacity. Even a Durable Power of Attorney, however, may be terminated under certain circumstances if court proceedings are filed. Most Powers of Attorney done today are durable.
Yes. At the time the Power of Attorney is signed, the principal must be capable of understanding the document. Although a Power of Attorney is still valid if and when a person becomes incompetent, the principal must understand what he or she is signing at the moment of execution. That means a person can be suffering from dementia or Alzheimer’s Disease or be otherwise incompetent sometimes but as long as they have a lucid moment and are competent at the moment they sign the Power of Attorney, it is valid even if they do not remember signing it at a later date. At the time it is signed, the principal must know what the Power of Attorney does, whom they are giving the Power of Attorney to, and what property may be affected by the Power of Attorney.
Any competent person eighteen years of age and older can serve as an agent. Certain financial institutions can also serve. There is no course of education that agent must complete or any test that Agent must pass. Because a Power of Attorney is such a potentially powerful document, agents should be chosen for reliability and trustworthiness. In the wrong hands, a Power of Attorney can be a license to steal. It can be a big responsibility to serve as an agent.
For Medicaid
Medicare is health insurance and covers medical services such as physician appointments, therapy, blood tests, x rays, medical procedures and hospitalization. Medicare will sometime pay for rehabilitation in a long-term care facility for a period of 20 to 100 days, but not longer. In long-term care, Medicaid covers the cost of ongoing support services for daily functioning, such as room and board in a nursing home.
Medicaid is a federal program that is overseen by the Center for Medicare and Medicaid Services (CMS). In Pennsylvania, Medicaid is called Medical Assistance and is administered by the Department of Human Services (DHS).
In Pennsylvania, Medicaid funds are not available to pay for assisted living or personal care.
For Medicaid to pay for care in a nursing home, an individual recipient must be determined to need a nursing home level of care by a physician and the local Office of Aging. An individual whose income is not greater than three times the poverty level may keep up to $8,000 of total resources, but may otherwise keep only $2,400. The cash value of life insurance counts as a resource, but one car and a residential home does not count as a resource.
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Keystone Elder Law
At Keystone Elder Law, we believe that the physical, social, legal, and financial considerations of our clients all intertwine. We utilize an interdisciplinary approach to evaluate each area, which allows for the creation of a plan that addresses the concerns of the individual as a whole as well as the family. To this end, our model of practice includes a Care Coordinator (usually a nurse or social worker), whose expertise complements our team of attorneys.
When the road of life is smooth, decisions about legal and financial matters are easy to push aside for “a rainy day.” Planning ahead, however, will allow for more options as you view the map of where you’ve been and where you want to go. Don’t let a crisis limit your choices or derail your plans.
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