Tag Archives: benefits

Medicaid: Long Term Care Security

As a gerontologist and a member of the Baby Boom generation, I think about what the state of long term care may be in seven years when I join the older-old, those above age 75.  Most of us would prefer to remain in our own homes as long as possible, but ultimately many of us will need more supervised care in a residential setting.  Most people don’t realize what various types of long term care cost, and many have not accumulated enough retirement savings to pay for all of the long term care they will need, especially given the extended lifespan that is now possible.  In addition, there are a lot of misperceptions about the scope of long term care benefits available through Medicare.

logo-genworth-desktopGenworth Financial Insurance Company conducts an annual survey of long term care costs in the United States.  In 2016, the national median annual cost of homemaker services in an individual’s private home came to $45,756.  The median annual cost of assisted living was $43, 536, and the median annual cost of a semi-private room in a nursing home was $82,128.  The median annual 2016 costs in Michigan were generally somewhat higher than the national median.  Genworth is predicting a 34% increase in costs in ten years, and an 80% increase in twenty years.

Americans are not great retirement savers compared with other nations, but there are reasons for that omission.  For the middle classes especially, wages have been stagnant since the 1970s, while the cost of living has increased.  The cost of a college education is more than eight times gregg-chicken-eggs-raw-eggs-eggshell-128885eater than it was in the 1970s, while the Consumer Price Index rose approximately four times  higher during the same period.  Pensions, which guaranteed retirement income for life, have virtually disappeared.  As a consequence, workers have lost one source of retirement income, since the pension replacements, the 401(k) or 403(b) plans, result primarily from employee savings, rather than employer contributions.  Finally, the economic downturn, which began earlier in Michigan than in much of the rest of the country, eroded the savings of many unemployed mature workers.

Our family story is no different; we experienced layoffs in the 2000s, which used up our retirement savings, up to then.  I paid off my student loans two years ago, and my husband just paid off his this year. We’re still paying on Parent PLUS loans for our son’s college education.  We expect to keep working as long as possible, and we’re also working hard to stay healthy so that we can do so.  But health is a result of past exposure and lifestyle, as well as present health practices, and we don’t know what lies ahead.

We do know that we can’t count on Medicare to cover our long term care expenses; it wasn’t designed for that.  Medicare will pay for skilled care, such as rehabilitation services, at home or in a nursing home,  for a limited period of time.  It will also pay for hospice care.  It does not pay for  assistance with managing personal care or housekeeping or ongoing nursing support in any setting, except for the brief period in which skilled care is also needed.  Each of us will have to manage those care expenses out of our retirement savings.  But when we live longer than expected, or health care expenses are greater than anticipated, or when both spouses require custodial care, then income and retirement assets often prove insufficient, and people rely on Medicaid to pay for their care.

Medicaid pays for the health care costs of qualifying poor people of all ages.  Low income older adults most often have Medicare coverage, and Medicaid helps them pay for the considerable out-of-pocket premiums, deductibles and coinsurance costs that Medicare does not cover, estimated to average between $1,700 to $3,000 per year.  Those costs can escalate quickly with surgery or expensive long term medications.  It also helps the low income elders receive care at home, rather than a nursing home, if they are lucky enough to qualify for a Medicaid waiver program.  The Medicaid waiver program allows for case management, in-home services, and community-based services for low income ill or disabled persons who would otherwise require nursing home placement.  In Michigan it’s called the MI Choice Waiver Program, and it’s about one third less costly than nursing home care.

But most areas have long waiting lists for Medicaid waiver services, and rural areas generally do not have sufficient supply of community-based services to keep people in their homes.  At a cost of more than $82,000 a year, most people needing custodial care in a nursing home will run out of personal savings and assets in a relatively brief period of time.  At that point more than half of nursing home residents apply for assistance from Medicaid.  Because of Medicaid older adults worry less at night about where they may end up when the money runs out.

A fixed cap on federal Medicaid payments to states could remove that sense of security.  With increasing health care costs, increasing numbers of older adults, lengthening lifespans, and a stagnant economy, states will have to reduce Medicaid spending considerably.  What will we do with ill, disabled, and poor older people who no longer receive payment for their nursing home bills?

It is these thoughts that keep me exercising most days of the week, meditating daily, and keeping up my license and professional credentials.   However, these are just stop gap measures, and I don’t feel nearly as secure.

Advertisements

2015 White House Conference on Aging

logo-WHCOA2015This is the year for the decennial White House Conference on Aging.  However, the Older Americans Act, which traditionally has outlined the Conference process, has not been reauthorized and the President’s budget has not been approved.  As a result, there are very little structure and no additional funds for the 2015 Conference.

nora-super-140Ms. Nora Super is the Executive Director of the Conference.  Her background includes more than twenty years experience in aging policy and community outreach.  The four themes that have emerged from community input, so far, are Retirement Security, Healthy Aging, Long-Term Services and Supports, and Elder Justice.  There is a blog for the Conference at  http://www.whitehouseconferenceonaging.gov/blog/   A number of regional forums are also scheduled.  The closest one to SE Michigan is the conference in Cleveland, OH on April 27th.

The Administration is using social and electronic media as much as possible to receive grass roots input and conduct informational meetings.  Everyone can participate by going to the web site and signing up to receive notices of events, such as webinars, and opportunities to participate.  You can also provide your thoughts and/or a story about your experience with aging or aging services, such as Medicare, Social Security, or in-home services, by submitting them through the following link:  http://www.whitehouseconferenceonaging.gov/submissions/register.aspx

Here’s the contact information if you have specific questions:

White House Conference on Aging
200 Independence Avenue SW, Suite 637D
Hubert H. Humphrey Building
Washington, DC  20201
(202) 619-3636
info@whaging.gov
www.whitehouseconferenceonaging.gov

Aging touches everyone.  I encourage you to participate in this opportunity for civic engagement at a time when our society includes the greatest proportion of older adults in history.

Sue Sweeney, Chair, Department of Aging Studies, Madonna University

National Council on Aging Funding for Outreach for SNAP

ncoa-logoIn the January 13th issue of the National Council on Aging‘s NCOA Week e-publication, they announced grant proposals for $25,000 or $50,000 to increase enrollment of older adults who are eligible for the federal  Supplemental Nutrition Assistance Program (SNAP).  The details of the RFP will be available next week.  As stated in the e-publication, “NCOA soon will be seeking proposals from community-based organizations for Senior SNAP Enrollment Initiative grants in two competitive categories ($25,000 and $50,000). The Request for Proposals will be released on or around Jan. 20. Optional Letters of Intent are due Feb. 13, and applications are due March 6.”

FoodNutrSvcesLogoA 2012 presentation by Lura Barber of the National Center for Benefits Outreach and Enrollment of NCOA is available online.  Called SNAP and Older Adults, the presentation points out that only one out of three eligible older adults are enrolled in SNAP, and provides basic information about SNAP organizational structure, eligibility, application process, and techniques to reach out to older adults who qualify.

Health Insurance Coverage

With Medicare open enrollment ending on December 7th this year and the health care marketplaces gaining enrollees, health insurance coverage is the topic of the day.  For those eligible for Medicare, the National Council on Aging (NCOA) has launched more of their Web tools.  MyMedicareMattersLogoTheir Medicare Web site, My Medicare Matters, has a Medicare Quick Check tool in which you enter some basic information about your current Medicare plans, and the tool returns suggestions for how to save money on your coverage and where to go for help.  One caveat: NCOA appears to be encouraging the use of one healthcare navigator, AON Hewitt Navigators, although other options for assistance are also listed.   It appears that AON Hewitt has agreed to meet NCOA standards of service in return for supporting an NCOA subsidiary firm, NCOA Services.

Another NCOA tool now available is a prescription drug savings estimator.  For this to work, you enter your zip code, the name of your Part D plan, and your prescription drugs.  When you enter the drugs, a window will open with dosage options for you to select.  The estimator will tell you whether you may be able to save on the drugs, and approximately how much, by choosing a different Part D plan.  However, not all drugs are included in the estimator’s database.  For example, I tried Advair, a commonly prescribed asthma medication, and it didn’t show up.

MichiganDrugPricesLogoFor those who are uninsured, don’t qualify for Medicare or Medicaid, and haven’t managed to complete enrollment through the Marketplace, the Michigan Department of Community Health has a useful Website called MichiganDrugPrices.com.  It has three parts: a search engine to compare drug prices among pharmacies, a list of retail discount drug programs, and a list of assistance programs for uninsured persons.  For the drug prices comparison, you enter your zip code and your drugs.  For each drug, a window will open with the drug name.  When you select it, in another window, there will be a list of the drug in each of its dosage strengths.  Unselect all but the dosage needed.  Then you’ll get a list of the pharmacies in the area with their price for the drug.  The drug database contains the 150 most prescribed medications in the Michigan Medicaid program, so a number of drugs are not included.

Even if you don’t live in Michigan, the site may be helpful, since the retail discount drug programs may be regional or national, such as Walmart or Kroger, and several of the assistance programs are national in scope.  There are also Helpful Links, which include some of the drug company assistance programs.  There are many more options than I had imagined.  Now people need to know how to find and apply for the assistance that’s available.  Sue Sweeney, Chair, Gerontology Department, Madonna University

Benefits for Older Adults

BenefitsCheckUpLogoThe National Council on Aging has an excellent resource for older adults in need of assistance.  BenefitsCheckUp is a Web site that screens the user for eligibility for a number of benefits at the federal or state level.  The site claims that the service has helped 3,678,107 people find over $13.5 billion worth of benefits.  The tool asks a number of questions about the user’s needs, interests, marital status, veteran status, income, assets, home ownership, expenses, and other questions that build from the answers that the user supplies to earlier questions.  You can use the tool for another person, as long as you answer as if you were that person.

At the end, a printable report is produced with a description of possible benefits, contact information for the user’s area, how to apply, and documentation that will be required when applying.  I submitted a fictitious test case of a middle-income 85 year old widow of a World War II veteran, who pays on a mortgage and property taxes, and who has two chronic illnesses.  The report I received included information on locating alternative housing, how to get a property tax exemption in the case of financial hardship, how to obtain advice on Medicare program selection, how to access the nutrition programs for older adults, information about chronic disease self-management programs, and how to get a senior discount for federal parks and national forests.  The programs recommended will, of course, depend on the information submitted.

It’s a resource that’s easy to use, provides detailed relevant information, and can be used by an advocate or representative to find the range of resources to assist with the hardship the elder is encountering.  That’s a huge advantage, because, as an example, the ability to save money on utilities or to use a reverse mortgage to access equity on a home may be the answer to the inability to pay the coinsurance on an expensive prescription.  We need to be holistic in our view of the person, their strengths, resources, and needs.  Sue Sweeney, Chair, Gerontology Department, Madonna University