How Proposed Changes to Medicare Could Affect Your Wallet and Your Health Care: AARP Bulletin, January/February 2017 Issue

 

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En español | MEDICARE WORKS WONDERS for millions of American families, providing affordable access to today’s most advanced health care. Poll after poll invariably confirms its popularity. But will Medicare continue to work for us and for the next generations? That’s the question that Congress and the Trump administration will be asking in the coming months.

At AARP, we continue to believe passionately in this program, which has allowed our citizens to age with dignity. In this special report, we detail what the state of Medicare is today and provide what you need to know about the upcoming debate in Washington over the nation’s most important health care program.  — Robert Love, AARP Bulletin editor in chief

A Battle Looms

by Bill Walsh

As Donald Trump was mounting his insurgent candidacy for president, he repeatedly set himself apart from the Republican field by vowing to protect the Social Security and Medicare Americans have come to know.

He assured older voters, who proved to be a decisive voting bloc, that those programs would remain intact and the benefits delivered as promised.

“Every Republican wants to do a big number on Social Security. They want to do it on Medicare. They want to do it on Medicaid. And we can’t do that,” he said at a New Hampshire rally during the primaries. “It’s not fair to the people who have been paying in for years.”

Yet within days of Trump’s historic election, the guaranteed health coverage provided by Medicare was cast in doubt. House Speaker Paul Ryan (R-Wis.) revived his plan to replace it with a fixed-dollar subsidy that beneficiaries would use to buy private health insurance. Meanwhile, Congress is expected to move quickly to repeal the Affordable Care Act (ACA), which could have the effect of erasing the consumer-friendly Medicare benefits that the law created.

Stirring Fears and Uncertainty

As news of Ryan’s proposed Medicare overhaul spread, it stirred fears among the 57 million beneficiaries who rely on it to cover prescription drugs, doctor visits and hospitalizations. Democrats lined up to pledge their opposition. It also prompted an outcry from consumer groups, including AARP.

What remains to be seen in January, as Congress reconvenes and the president-elect takes office, is how Trump’s campaign assurances to protect Medicare will hold up against House lawmakers intent on revamping the popular health program.

Trump contributed to the uncertainty by announcing House Budget Committee Chairman Tom Price (R-Ga.) as his pick to run the Department of Health and Human Services. Price has been an advocate of Ryan’s Medicare approach, which supporters call “premium support” and critics decry as a “voucher system.” Trump’s website further raised questions about his plans for Medicare. It says he wants to “modernize Medicare,” which is often seen as Washington code for the type of changes Ryan wishes to make.

Since the election, Trump has not made any comments about Medicare. But in an interview with ABC News on Dec. 4, Vice President-elect Mike Pence said Trump “made it very clear in the course of the campaign that we’re going to keep our promises in Social Security and Medicare.”

The Ryan Approach

Ryan’s Medicare overhaul, a version of which passed the GOP-controlled House, would fundamentally change how Medicare works.

Since its creation in 1965, Medicare has been a “defined benefit” program, guaranteeing a certain level of health coverage. It now pays about 80 percent of costs associated with doctor and hospital visits. Beneficiaries are responsible for paying monthly premiums, copayments and annual deductibles.

57 million Americans rely on Medicare to afford health care

Ryan would convert Medicare from a “defined benefit” to a “defined contribution” program. Instead of a guaranteed level of coverage, a dollar amount would be set for Medicare beneficiaries to pay premiums on insurance they would buy from private-sector companies (this is why Ryan calls it “premium support”). Ryan’s plan would also increase the eligibility age from 65 to 67.

A former chairman of the House Budget Committee, Ryan wants to limit how much the government spends on Medicare. In 2015, Medicare accounted for 15 percent of the federal budget, a proportion expected to grow as the number of beneficiaries rises.

“The reforms we’re talking about do not affect the benefits for anyone in or near retirement,” Ryan said last month. “But for those of us in the younger generations, it won’t be there for us if we stay on the current path.”

The Mounting Opposition

Consumer advocates also want to address growing costs in the health care system, including Medicare. But they contend that Ryan’s approach would erode much-needed coverage and shift costs to many who live on fixed incomes and continue to struggle in the shadow of the Great Recession.

While Ryan says the annual subsidy would be greater for low-income people, critics say it is unlikely to keep pace with the rising costs of insurance. The result, they say, is that beneficiaries would shoulder more of the financial burden — or go without needed medical care. Although Ryan also says people would be allowed to stay in traditional Medicare, critics argue his approach is designed to gradually increase out-of-pocket costs in the program and nudge beneficiaries into private plans with no guaranteed level of coverage.

Opponents also say that there are better cost-saving options available. One of the most popular is giving Medicare the authority to negotiate prescription drug prices directly with drug companies. The change would help the federal government control a cost that accounts for $1 out of every $6 Medicare spends. That idea was supported by more than 80 percent of people in a Kaiser Family Foundation poll in 2015. As a candidate, Trump also embraced the idea, another potential point of friction with House Republicans, who generally oppose it, as does the pharmaceutical industry.

The Impact of Obamacare Repeal

What Trump and GOP leaders wholeheartedly agree on is that the first order of business will be repealing the Affordable Care Act, also known as Obamacare. Republican congressional leaders want a repeal vote in January so that a bill can be on the president’s desk right after he is sworn in.

77 percent of people say Medicare is a “very important” program

Although it has received little attention, a full repeal of Obamacare would eliminate Medicare benefits created by the law. Among other things, it improved Medicare’s financial outlook by slowing the growth of spending and clamped down on fraud, waste and excessive payments. It also enabled tens of millions of Medicare beneficiaries to get free preventive services such as flu shots and screenings for cancer and diabetes. And between 2010 and 2015, nearly 11 million Medicare beneficiaries saved $20.8 billion on prescription drugs—an average of $1,945 per person — because of the gradual closing of the coverage gap known as the doughnut hole.

While Obamacare remains controversial — in part because of its mandate to purchase health insurance and because premiums have increased for some plans—the Medicare provisions have proved popular with beneficiaries.

Medicare’s Enduring Popularity

Even in an era of hostility toward the federal government, support for some programs has remained strong. A Kaiser poll found that 77 percent of people say Medicare is a “very important” program, just below the level of support for Social Security at 83 percent.

Trump’s campaign assurances about protecting Medicare and Social Security undoubtedly played a role in his Election Day victory, especially among older voters. Those 65 and older supported him with 53 percent of the vote, compared with 45 percent for Democrat Hillary Clinton, according to the Pew Research Center. There will be a lot at stake for them when Congress reconvenes.

Also of Interest:

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The Cost of Family Caregiving: Out-of-Pocket Spending Surprisingly A Guest Post by Christina Ianzito

Out of Pocket Caregiving Report

Our country’s 40 million unpaid family caregivers devote a large portion of their own money toward the care of their loved ones.

They’re spending an average of $6,954 a year — nearly 20 percent of their income — on out-of-pocket (OOP) costs related to caregiving, according to a new AARP study, “Family Caregiving and Out-of-Pocket Costs: 2016 Report.”

Hispanic/Latino and low-income family caregivers spend even more: an average of 44 percent of their total annual income.

And that’s on top of other financial strains many caregivers face, such as needing to cut back on work hours or take unpaid leave, says Nancy LeaMond, Chief Advocacy and Engagement Officer at AARP. “The strain can be enormous and may put their own financial and retirement security at risk.” She adds that passing the bipartisan Credit for Caring Act, which provides a federal tax credit of up to $3,000, “would give some sorely needed financial relief to eligible family caregivers.”

Cost Infographic

AARP also supports the bipartisan Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act, which would require the development of a national strategy to support family caregivers.

Here are some striking findings from the new AARP report, which determined the amount of money that family caregivers spent over the last year:

  • Family caregivers of all ages spend $6,954 in OOP costs related to caregiving on average.
  • Family caregivers earning less than $32,500 are under significant financial strain, spending an average of 44 percent of their annual income on caregiving.
  • Family caregivers for adults with dementia reported nearly twice the OOP costs ($10,697) than those caring for adults without dementia ($5,758).
  • Hispanic/Latino family caregivers spend an average of $9,022, which represents 44 percent of their total income per year. By comparison, African American family caregivers spend $6,616, or 34 percent; white family caregivers spend $6,964, or 14 percent; and Asian Americans/Pacific Islanders spend $2,935, or 9 percent.
  • Long-distance family caregivers had the highest OOP costs at $11,923 compared with family caregivers living with or nearby their care recipients.

Family caregivers report dipping into savings, cutting back on personal spending, saving less for retirement or taking out loans to make ends meet. More than half of family caregivers reported a work-related strain, such as having to take unpaid time off.

Read the full report at www.aarp.org/caregivercosts.

Answers Your Top Medicare Coverage Questions A Guest by GoHealth

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Whether you’re a first-time Medicare buyer or a long-time enrollee, finding the right Medicare coverage can be confusing.

In an effort to help you find the right combination of plans, we’re answering the top consumer Medicare questions, including what your first step should be, your prescription drug coverage options, and much more.

Top 10 Medicare Coverage Questions

1. If I have Part A, how do I add Part B?

In order to complete your Original Medicare coverage and enroll in Part B, you must contact the Social Security office and actively enroll. Once you have both Parts A & B, you can complete your Medicare coverage with additional options.

2. What is a Medicare guaranteed issue right, and do I have it?

A Medicare guaranteed issue right is your right in certain situations to be granted a Medicare Supplement plan – or Medigap policy – regardless of certain other details concerning your health. In these specific situations, insurance companies must sell you a Medicare Supplement plan, cover all your pre-existing conditions, and not charge you more for a policy because of any health problems. Most commonly, you may have a guaranteed issue right if you lose coverage or your current health coverage changes.

3. If I only have Part A, what other types of Medicare can I get?

If you only have Part A, you are eligible to also get Part B. You cannot move forward with exploring other types of Medicare coverage until you have both Parts A & B.

4. Can I enroll in Part D without having Part B?

Unfortunately, you cannot. In order to move forward with additional Medicare options (including Part D), you must first have both Parts A & B.

5. What are my coverage options when it comes to prescription drugs?

If you need prescription drug coverage, you have a few different options. Once you get Parts A & B, you can choose to switch to Medicare Advantage, which sometimes offers prescription drug coverage. You can also choose to enroll in a Prescription Drug plan – or Part D – which offers different coverage options depending on which drugs you take.

6. How do I find my Medicare claim number?

You can call Social Security, and a representative there can help you locate your Medicare claim number.

7. How do I enroll in Medicaid?

You should call your state’s Medicaid department if you’re interested in Medicaid health insurance coverage.

8. What is the difference between Medicare Supplement and Medicare Advantage plans?

Medicare Supplement – or Medigap – plans help you complete your coverage. They can help you pay for health care costs that may not be covered by Original Medicare, such as copayments, coinsurance, and deductibles. Medicare Advantage is a private health insurance option that is required to cover all the same benefits as Parts A & B, plus additional benefits, such as prescription drug coverage. You cannot have a Medicare Supplement plan and Medicare Advantage at the same time.

9. Why would I enroll in Medicare Advantage instead of Original Medicare? Aren’t they the same thing?

While they are similar, there are also differences between Medicare Advantage and Original Medicare. By law, Medicare Advantage plans are required to cover all the same benefits as Original Medicare, or Parts A & B.

However, there may be some differences in how you pay your out-of-pocket costs with a Medicare Advantage plan, or you may have a smaller or larger deductible. There also may be some differences in the coverage itself. For example, while Original Medicare does not cover prescription drugs, some Medicare Advantage plans do offer that coverage.

10. How do I avoid gaps in my Medicare coverage?

There are many different types of Medicare coverage available to help you avoid any gaps in your coverage. It’s important to explore all of your options and coverage combinations with a licensed agent.

Call 1-877-568-1851 – TTY 711 to speak with one of our licensed sales agents. To enroll in Original Medicare, please contact your local Social Security office.

Medicare has neither reviewed nor endorsed this information.

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GoHealth Answers Your Top Medicare Coverage Questions posted by GoHealth

Guide to US Veterans Benefits An Article Originally Posted on A Place for Mom Blog

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ACCESS UP TO $2,000 PER MONTH IN VETERANS AID

The Veteran’s Aid and Attendance (VA&A) Pension provides benefits to veterans and their spouses to help pay for costs of care – both in-home care and senior housing. At A Place for Mom we work with many families who are not aware of the benefit and miss out on key financial support that help pay for senior living and home care expenses.

The benefit is anticipated to change next year and could impact the number of families eligible for this financial support. We encourage families to take action now to determine their eligibility.

LEARN MORE ABOUT THE VETERAN’S AID AND ATTENDANCE BENEFIT

LEARN MORE

VETERAN’S AID AND ATTENDANCE BENEFIT OVERVIEW

2016 BENEFITS

  • $1,788 per month for a veteran
  • $1,149 per month to a spouse
  • $2,120 per month to a couple
  • $1,406 per month to a veteran with a sick spouse

ANTICIPATED CHANGE 2017

We anticipate the payout to be consistent with current level, however, we believe the eligibility requirements will change.

2016 ELIGIBILITY REQUIREMENTS

  • Veteran served during an approved war period and honorably discharged.
  • Reviews current income and assets when applying. Veteran must meet following requirements:
  • – $80,000 or less in total assets with the exception of one home and one vehicle.

ANTICIPATED CHANGE 2017

The VA has provided guidance that the eligibility requirements will change in 2017.

It is to your advantage to apply today.

VETERANS BENEFITS 101

Veterans benefits provide those who have served their country, as well as their spouses, financial assistance during their retirement years. Veterans who are at least 65 years-old* and who served during war time (though not necessarily in actual combat) may be eligible for financial assistance through the Department of Veteran Affairs (VA) that can be used to help pay for care. Spouses and surviving spouses of wartime veterans are also often eligible. Veteran’s benefits can make all the difference for families who struggling to pay for care.

For further reading:

http://www.aplaceformom.com/senior-care-resources/articles/guide-to-us-veterans-benefits?mkt_tok=eyJpIjoiTnpRME1HVTJZVGhqTjJRMyIsInQiOiJlYmpaNmVGNlhcLzJqU2o2ZUJoS1dQWEpZZkorK0lXWU5qRkhvZDR5ZDk1bzh3ZSt5dVlsaU9EWEc3TFhNTGRvZVRhRCsyRTNoUzhJbkVKSmpiQ28rZEptVWJldDhxQTRma1NCODRzUzZiWGM9In0%3D

 

How to Escort Seniors to the Voting Polls A Guest Post By : A Place for Mom Staff

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Originally Posted in the Senior Living Blog: Posted On 24 Oct 2016

The United States has a proud democratic tradition dating back more than 200 years, and that tradition is based on the right to vote. Unfortunately, many older people who are receiving care at senior living communities aren’t always able exercise that right.

Seniors may be intimidated by the thought of getting to the polls and potentially waiting in long lines. Some might even wonder whether, as long term care residents, they’re still allowed to vote. Learn more about how to escort seniors to the polls during this election.

Escorting Senior Loved Ones to the Voting Polls

On Tuesday, November 8, 2016, U.S. citizens will vote and determine the direction of our country.

This year, senior advocacy organizations are making sure senior living residents’ voices are heard and votes are counted:

  • The Senior Citizens League put together a checklist to follow to ensure seniors are informed and ready to vote, which includes:
    • Knowing your district, registration and voting method, to researching candidates and issues, and finally, making your voice heard.
  • Worldwide Programs for the Elderly promotes escorting seniors to the voting polls through a program, which provides escort and transportation to ensure that age and mobility does not limit a senior’s right to vote.
  • Voting by absentee ballot is another way for seniors to make their voice heard if they are unable to go to their local polling place on Election Day. Be sure to research the set of rules regarding the specific requirements and qualifications for absentee voting in your state.

How Senior Living Providers Can Help Residents Vote

Senior living and other long-term care providers can help residents vote, by:

  1. Distributing sample ballots to familiarize residents with voting procedures.
  2. Helping residents get absentee ballots to vote.
  3. Helping residents register to vote.
  4. Hosting debate watching events.
  5. Hosting political discussions.
  6. Posting reminders about registration deadlines.
  7. Providing information on upcoming candidates and elections.
  8. Provide transportation to the polls.

We applaud these efforts and believe it’s vitally important that every citizen have the opportunity to make their voice heard.

If you are concerned that a senior loved one who lives in senior living may not be able to exercise their constitutional right to vote, contact your local Long-term Care Ombudsman for assistance.

For more information about polling locations and other election related matters where you live, visit the USA.gov Voting webpage.

Do you have experience escorting senior loved ones to the voting polls? Do you have any tips that you’d like to share? We’d love to hear your stories in the comments below.

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Highlights from the 2016 OR Today Magazine Convention’s Key Note Presentation: An Interview with Phyllis

Original Article Featured in OR Today Magazine, November 2016 Edition

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Do you believe that workplace bullying and incivility are the same?

No. Workplace incivility can best be defined as low-intensity unpleasant behavior that is rude, impolite, or inconsiderate. While the target can feel insulted or angry; an actual desire or intent to harm the other person is ambiguous. Anyone has the potential to behave inappropriately towards a coworker given the right circumstances coupled with a lack of self-management.

Workplace bullying however, is ongoing, offensive, abusive, intimidating or insulting behavior or actions directed at a person(s), causing the target to feel threatened, abused, humiliated or vulnerable. The person experiencing prolonged bullying can feel a range of psychological and physiological symptoms. The research supports that, those who bully, are very aware of their behavior and its effect on the others; even though they may deny that there is intent. Fortunately, there is only a very small percentage of the workforce that is capable of such sustained disregard for another individual.

So these behaviors are very different. Should the management be different as well?  

Yes, they should and I want to be clear as to why. The two keys here are insight and sustainability. The person who behaves in an uncivil manner has the ability to self-reflect on that indiscretion, feel remorse or regret and make the active choice to work on their self-management skills and achieve personal growth. A bully does not have this ability.

It is vital that we understand and accept that a nurse bully is a narcissist with a license. A narcissist lacks the capacity for empathy. The ability to reflect empathically on the consequence that one’s poor behavior has on another is vital for driving the desire to change. Bullies (narcissists) are incapable of this.

An uncivil staff member can gain insight though coaching and training. Positive, sustained changes in behavior can be noted within six to twelve weeks of working a clear emotional intelligence improvement action plan. A narcissist typically reacts in one of two ways to someone attempting to hold them accountable. They may escalate their behavior and retaliate or they will tell you what you want to hear and vow to reform. However, they cannot sustain any improvement because they lack a connection with the need to improve.

So why is managing bullying behavior in nursing so challenging?

This is a complex issue but one reason is that nurses are professional caregivers. Nursing leaders have a good deal of difficulty coming to terms with the fact that a bully/narcissist cannot be fixed. It is not a part of our caregiver DNA to “give-up” on someone. We talk ourselves into believing that if we just try a little harder that this individual will have an epiphany and the problem will be resolved.

The bully/narcissist is hoping that you will react exactly in this manner. They are experts at taking your wonderful qualities of empathy, patience and the need to heal and use them against you to achieve their goal of never being held accountable to sustained improvement. Essentially, we need to get out of our own way in order to take charge of this situation. Nurse leaders must try to accept that once someone shows you their true colors, you need to resist repainting them.

The only performance improvement plan for a bully/narcissist is a collaborative effort put forth by administration, human resources and the nurse leader that is time sensitive and rich with mandatory training. The documentation should discuss the need for improvement to be demonstrated within three to six months then sustained for six months as well.

Most bully/narcissists will not be able to withstand this type of scrutiny and may decide to move on. The others may stay but will find it very challenging to sustain the improvement. Should termination be the only option left, you can have the peace of mind that a sincere effort was made on your part; and twelve months’ worth of documentation to support your action.