Medicare and Medicare Supplements can be a confusing issue to deal with.  Add to that the fact that there have been changes that the administration has proposed and tried to veto, and there are changes that Congress has over-ridden, with all sides trying to tell us that they are trying to fix the Medicare system before it goes from bad to worse.  Perhaps with the new administration taking office in the next few weeks there will be some clarity regarding the issues.

Though things can be perplexing and frustrating, there are some straight answers to some of the questions out there.  One such issue is whether Medicare Advantage will be phased out.  There has been quite a rumor going around stating that this is going to happen.  Actually, this is not going to happen. 

In light of the rumors, there are many questions about what people should do with their old prescription drug coverage, such as Medicare Part J.  Many people want to know if it is prudent to keep what they have or change to Medicare Advantage.

Most advisers suggest changing from their medigap/prescription drug plan (such as plan H, I, or J), since many companies are phasing these plans out and are not selling these plans to new clients any more.  They are allowing people who already have the old policies to keep them, but the premiums are higher than Medicare Advantage premiums and higher than Medicare Part D (for prescriptions), which is government subsidized. 

Medicare Advantage is sold by individual insurance companies, not Medicare.  You can switch to this plan and get your coverage for prescriptions that way, or you can get your coverage through Part D.  It is best to determine what is right for you, especially during open enrollment, which is going on right now and will last until December 31, 2008.   The most important thing to do is to research the correct information and then get the coverage that is best for your circumstances.

Don’t let the confusion draw you in.  The Centers for Medicare and Medicaid Services (CMS) has information on their website and people who will talk to you and answer questions by telephone.  You can also talk with a trusted insurance agent who can help you determine the coverage you need and help you make comparisons of the plans that are available. 

Take the time now – during open enrollment – to find out what you need and make sure to sign up so that your prescriptions and other medical bills will be taken care of.

No matter where you live in the United States, you are in the midst of the annual Medicare Open Enrollment Period.  There are things that you need to know, however.  You need to know whether you can go to your own doctor and specialists that you want to see.  You need to know what you are covered for, whether you need a referral for a specialist and how much any out of pocket costs will be for any healthcare.
In Florida, one couple found out some life or death information when his wife was ill and he was trying to help her get treatment from a specialist that had been treating her for years.  Here are excerpts from the news story about the issue they went through.

66-year-old Barbara Crawford suffered from serious heart problems for decades. When she turned 65 she qualified for Medicare so she and her husband spent hours trying to pick the best health care plan. They checked out WellCare Health Plans which is a Tampa based company. They say they were interested in the plan because their primary doctor and Barbara’s cardiologist were on the provider list. Barbara says “Well when you have your own doctors you really trust them.”

But her husband Bob says during a visit to their primary doctor the doctor refused to refer Barbara to the cardiologist even though he was listed in WellCare’s provider directory. “And he said well Bob I don’t use that doctor and I said he’s in the provider list and he said it doesn’t make any difference. We have our own group we use and we only use those on that group and I said well what good is a provider list?”

Bob says at that point he felt like he had a life or death decision to make. He wanted his wife to be able to go to a doctor that she already had an established relationship with. “When she couldn’t go to her cardiologist that she had been going to since she was 45 years old this is when I went out and got a private plan that we’re using and we have to pay for it every month.”

The Crawford’s are paying about $264 for the coverage and now they don’t have to worry about referrals Crawford’s situation because of privacy issues.  Your issues may not be as critical as the Crawford’s’ issues, however, it is still important to do some research before you buy.
Fortunately, here is a way to get free unbiased help with your Medicare health plan choices in Florida. There’s a statewide volunteer based program called SHINE. Serving Health Insurance Needs of Elders was formed in 1993 and the group says it’s helped more than 800,000 people. They provide counseling on Medicare eligibility, enrollment and coverage issues. Janet Mills is an area coordinator who’s been a volunteer with the organization for three years and says “We try to help educate people to advocate for themselves. Healthcare is a difficult maze in today’s world and so we try very hard to help people evaluate their different options.”

The Crawford’s acted as their own advocates and Barbara signed up for a different Medicare health plan to meet her needs. Mills says it’s something to keep in mind when you’re trying to figure out which Medicare drug plan to choose from too because asking questions now could prevent a lot of problems later. She says the public needs to know there’s help available whether you’re trying to enroll in a health plan or a prescription drug plan.  You can contact SHINE at 1-800-96-ELDER (5337).

With the open enrollment period coming up in a few days for Medicare, there are a lot of options available and a lot of information to sift through.  There are provisions in Medicare and Medicare Supplements for many healthcare procedures and supplies.  However, one area that Medicare and Medicaid only pay for a minimal part of is long term care.

Medicare and Medicaid pay for some long-term care Unfortunately, like any government program, there are very stringent guidelines and conditions that allow a person to receive payment.

Medicare, which people receive at age 65 or if they become permanently disabled before the age of 65,  only has 100 days of coverage for skilled nursing home care. Medicare pays first 20 days at 100%. For the next 80 days you are required to pay up to $128 a day (as of 2008). After 100 days, Medicare pays nothing and you are expected to pay the entire costs out of your pocket.

A difficult issue is that most people don’t need skilled care.  They need custodial care. This means that they can’t take care of themselves because of a physical problem, old age, or a brain impairment such as Alzheimer’s. These issues are not covered by Medicare or Medicare Supplements because they are not considered skilled care issues. In addition to paying only for skilled care, the criteria and guidelines state that you must have spent at least three days in the hospital before going to a nursing home facility for Medicare to pay for your stay.

Medicaid doesn’t do much more. It will pay for your nursing home stay, but only after you are practically destitute. You are expected to dissolve all stocks, bonds, retirement funds, or bank accounts in order to help pay the bill. If you live alone, they can take your house and other assets. Some people try to avoid this by putting all their assets into a living trust. The government has a “look-back” period designed to prevent people from transferring money into a trust and then going into a nursing home within 5 years after transferring funds into the trust.  It isn’t a bad idea to look into a living trust while you are healthy, as, not only will it help with the matter of nursing homes and long term care, but it will also – in most cases – avoid many taxes and probate for the beneficiaries.

Long-Term Care Insurance is called LTC for short. LTC policies pay for many types of care for a long term including nursing homes, assisted living facilities. It may also cover home care, custodial care, intermediate care and skilled care plus care needed for cognitive impairment like Alzheimer’s. They pay a certain amount per day as well after you have fulfilled a period of time (called an elimination period) before they start making the payments.  There is also a time limit on how long they will pay the benefit, although some policies will pay for life.

It is important to research LTC insurance policies before you need them.  For one thing, they will cost less if you buy them at the youngest age possible.  Though Medicare and Medicaid will help, it is not a bad idea to add some extra coverage so that you don’t get left with a hefty bill or losing your assets if you ever need Long Term Care.

It’s that time of year again – Open Enrollment from November15th until the end of December.  There is a lot of information to sift through and some of it – or maybe a lot of it – can be very confusing.

The good news is that there are organizations providing help to sift through it all and actually end up understanding what provisions you need, what is affordable and, as a result, which coverage and supplements are right for you.

If you are trying to find understandable information and straightforward facts there are places to go to get the information you need.  Look through your local newspaper in the Calendar Section for free events.  You will find various free seminars on topics such as How to Choose the Right Medicare Coverage; Choosing a Medicare Supplement; Determining What You Will Be Covered For; What is the Difference Between Plans?  and more information.

Usually you can find excellent seminars at your local senior citizens center, your local library, your local hospital, your local clinic and your local health department.  If a seminar is not listed in your newspaper Calendar Section, take the time to call the organizations just mentioned and find out what type of information or seminars they have planned.  You can also go online or call CMS – the Centers For Medicare and Medicaid Services – and they will be able to help sort out the basics for you and tell you if they will be having a seminar or presentation in your area.

Try to remember – especially when you attend a seminar or presentation – that many of these are presented by individual insurance companies that are trying to sell you their product.  As a result, it is important to attend a few seminars if possible so that you can compare what several companies have to offer.  Too often some companies charge a lot more for the same coverage that other companies charge far less for.  If you can go to a seminar presented by an unbiased individual, such as an individual from Medicare or an individual comparing several policies for you, this is the best way to get accurate information for making decisions.

Regardless of what you attend, try to at least attend one seminar or talk to someone you trust who understands Medicare and Medicare Supplements. Take the time to be sure that you choose the coverage that is right for you.

This time of year for the past 4 years has been the time for trick or treaters, gold and red leaves, brisk evenings and choosing Medicare supplements.  This particular year, your choice is extremely important.

With the economy sagging and prices for almost everything rising, there is little extra money for mistakes or unwise choices.  In addition most Medicare supplements are raising their premiums and tightening their coverage.

It is important to purchase a Medicare supplement because paying premiums is usually less costly than paying for your medication and other necessary medical procedures or equipment.  In addition, many people who do not have Medicare supplements and/or prescription drug coverage and, as a result, take less than the prescribed doses of medication could be risking their lives.

In order to determine which supplement is a good choice for you, there are a few things to think about.  First of all, list all your medications and the cost of each one per month.  If any of them are not on Wal Mart, Target or your local grocer’s $4 per month list, find out from your doctor or pharmacist if there is a generic or another comparable medicine that you can take instead that would keep you healthy and only cost you $4.  Secondly, determine how much the medications that you can’t get at a low price are costing you per month.  Talk to your doctor and pharmacist and see if there is a better price you can get – either through the pharmacist you already know or by checking with other pharmacies.  My granddaughter’s $179 per month prescription now costs me a much more affordable $49 per month because I found a small pharmacy with low overhead and a pharmacist who was willing to listen to me.  This could happen for you, too, if you compare prices and talk to the pharmacist.  Get to know the pharmacist so that you can work with them and they can work with you to try to keep bills low.

Thirdly, add up the monthly total of all the medications you take, after you have negotiated the new, lower prices with the pharmacist and through your doctor’s help.  If the total is low – especially because you are able to get the $4 per month prescriptions, you might want to get a supplement that is relatively inexpensive and will cover your overage.  If the total is high, you should look at a supplement that will cover as much of your medication bills for the year as possible.  The premiums will most likely cost less than paying out of pocket, and the supplement will cover other things as well.

Last, but not least, talk to a trusted friend who knows how the supplements work.  Go onto the Medicare website at www.medicare.gov and look at supplement plans.  Go onto the net and compare coverage and prices, and go to the local hospital or senior center and attend any of the seminars they have to help people understand Medicare supplements. 

Do the research you need to do now so that you won’t have a problem later.

As Medicare open-enrollment period nears, starting November 15th, it is time, once again, for seniors to look at their coverage and sift through the Medicare Supplement plans that are available.  In fact, as you are looking through all of the information to decide what you will be choosing for 2009, it will probably be somewhat, if not downright, confusing.

Since Medicare changed a few years ago and placed Medicare Supplemental policies in the hands of private insurers, there is a lot for people to consider.  First of all, you are probably getting calls from telemarketers representing a host of different insurance companies.  They are all competing for your hard earned dollars.  It is important that you know that these companies are not supposed to call you too early in the morning or too late in the evening, and if you want them to stop calling you, you can tell them to take you off of their list and they are required to do so.  If they continue calling after you have been asked to come off of their list, you can report them to the Insurance Commissioner in you state and they can be fined.

It is also important that you do not give them any personal information such as your Social Security number, date of birth or driver’s license number over the phone unless you definitely know who you are talking to.  In addition to the many annoying insurance telemarketers who call you, there are also scam artists who are phony and who will lie to you and say that they are with an insurance company so that they can get your information.  If you are unsure that the person calling is legitimate, give them no information and get a phone number to the insurance company so that you can call them with your questions.  If the telemarketer will not give you a phone number, don’t give them your information.

On top of all this, there are over 250 companies selling Medicare Supplement policies, though only 10 to 15 companies handle most of them.  It is important that you get information so that you can compare plans and determine what is best for you as far as coverage you need and premiums you can afford.  One way to do this if you have internet access is to go online to www.medicare.gov and click on medigap (which is the same as Medicare Supplements).  This can give you accurate information directly from Medicare.  You can also call an insurance agent or broker that you or someone you know trust, especially if they have worked with you in the past.

Regardless of your situation, you have several weeks to do research.  Take your time and check to see what will work for you.  Don’t let anyone push you into a policy that doesn’t seem right for you.  Choosing a Medicare Supplement is important.  Take the time to do it right.

Most people have Medicare. However, you need to face the fact that Medicare doesn’t actually cover everything that you need in order to take care of your health. There are still some things that you will need in order for you to be sure that you are fully insured.

If you want additional coverage, you may want to buy AARP Medicare Supplemental insurance policy or Medigap. With Medigap, you will see that it will be able to cover what Medicare can’t. With it, you will be able to further lessen the cost of health care.

AARP Medigap Insurance has a few health coverage options that you can choose from. It is just a matter of choosing the one that will best suit your needs. By choosing the right Medigap insurance policy, you will be able to save a lot of money on health care and on your premiums. Besides, you wouldn’t want to spend a lot of money on insurance premiums that you will not likely use, would you?

Medigap can offer you:

• Medicare Savings Programs
• Medicaid
• Prescription Drug Assistance
• Extra coverage for people with limited income
• Retiree health insurance

As you can see, there are health insurance policies available with AARP Medigap for almost every type of individual. If you have prescription medication that is way too expensive or one that you need in a long term, then getting the Prescription Drug Assistance Program is for you.

These are the things that you should know about AARP Medigap. By knowing what kind of insurance policy you should get, you will be able to save a lot of money and get what you really need.

Senior citizens are among the latest victims of the slowing economy because many don’t know they’re eligible for extra help with one of their biggest expenses — medicine.

Once Medicare has paid  out a certain amount for Part D prescription drug coverage, seniors hit the “gap” and have to pay full price.  They’re going back to splitting or sharing pills and doing without some medicines so they have money to eat, said Debbie Morrissey, who counsels seniors through the Southwest Missouri Office on Aging.. “I would say starting around July or August, we started

 getting calls and saw people coming in who were falling into the gap,” she said. “They’ll come in and say they can’t afford their medicines.”
Yet, some 1,730 seniors may be eligible for a program, “Extra Help,”  but don’t know it.  Extra Help is a program that will pay 75 percent to 100 percent of their prescription costs and monthly Part D premiums — whether they’re in and out of the gap. Seniors can apply for Extra Help through any Social Security office. The Social Security Administration estimates that Extra Help with Part D costs can save an individual up to $3,600 annually.

“For some, it pays everything,” said Matt Heger, with Primaris, Medicare’s quality improvement arm in Missouri. “Seventy-five percent is the low end … 95 percent is what it typically ends up paying, and it could reduce it to nothing.”  (Seniors receiving both Medicare and Medicaid benefits are automatically signed up for Part D Extra Help, Heger said.)

Eligibility for Extra Help is based on income and assets such as bank account and bonds. A person’s home or car are not considered assets under this program, according to Medicare guidelines.  Eligible individuals can earn up to $15,840 annually and have resources at or below $11,990. Married couples are eligible if they earn no more than $21,240 annually and their resources don’t exceed $23,970.

Medicare has identified the number of potential eligibles by ZIP code in each county. Now senior advocates are targeting those areas to get more people signed up, Heger said.  Various groups like Southwest Missouri Office on Aging, CLAIM, AIDS Project of the Ozarks and Social Security Administration can help people enroll.

Parts of this article were reprinted from NewsWire article.

XLHealth recently released the upgraded Care Improvement Plus 2009 for individuals covered by Medicare.  The plan is considered a special needs plan and was designed for chronically ill individuals on Medicare.  The benefits are available for Medicare recipients in Texas, and was designed to especially cover the 580,000 people in Texas who are dealing with continuous health issues including diabetes, heart problems, end state renal disease and chronic obstructive pulmonary disease.

“For 2009 we are continuing to focus on providing specialized benefits that go beyond what many Medicare plans offer, aimed at improving quality of care and controlling health care costs,” says Frederick C. Dunlap, board chairman and CEO of XLHealth, which owns and operates Care Improvement Plus.

“Beneficiaries with conditions such as diabetes and heart failure have significantly different health care needs, which is why Care Improvement Plus is such an important option for beneficiaries with chronic illnesses in Texas to consider,” he says.

These chronic illnesses have been extremely difficult for individuals to manage very well, especially due to limited Medicare and Medicare Supplements available.  To address these issues there are some exciting features of the plan including Medicare Part D prescription drug coverage that offers a $0 co-pay on many generic prescriptions; a provider network that allows beneficiaries to go to any doctor that will accept Care Improvement Plus for payment.  There is also coverage for vision care and preventative dental coverage as well as transportation to and from medical appointments.  The benefits are rounded out by covering podiatry – a very important area for seniors with diabetes – and last, but certainly not least, coverage for care-management services tailored to the needs of each participant.

For information on this coverage go to www.careimprovementplus.com.

As we know, there are many seniors on medications that are quite expensive – too expensive for individuals on a very limited income.  How do you choose between food and medication?  Often the choice is that the medication has to work.

There have been studies recently that have shown that lower co-pays can help seniors by encouraging them and making it easier for them to get their medication.  In response to these study results, United Healthcare’s Nevada’s Senior HMO has dramatically reduced the amount of co pays for medication for chronic conditions.

The new changes to the program will cost members up to $4.50 per month more for coverage, however it has already been shown to save individuals enrolled in it a sizeable amount of money on their medications, sometimes into the hundreds of dollars per month.

United Healthcare plans are available in many states and they have been trying to work on programs to help seniors on Medicare to be able to afford their medicine and to take it on a regular basis to keep their health stable.  United Healthcare has been working on this pilot program to see how well it is received and whether it achieves its objective.

Since United Healthcare is available in numerous states, it would be a good idea to keep your eye on their plans for seniors, whether or not you are a Medicare beneficiary.  If the pilot program in Nevada does well, it is probable that they will expand this type of program to other states where it would be cost effective and helpful to those covered by their senior plans.

If you have any questions about this program, you can find United Healthcare at www.unitedhealthcareonline.com.

It’s no surprise to anyone that medical treatment has gotten more and more expensive.  The good news is that there are newer, more effective treatments available for many conditions that were not even treatable one or two decades ago.  In fact, there are several conditions such as cancer and aids that were considered a death sentence if you were diagnosed with either one in the 1980’s and 1990’s. 

These days, there are ways to diagnose health issues early and there are even various tests that can be performed to determine if a person is at risk for various conditions.  DNA tests can predict some serious issues in advance.  Other tests can diagnose a condition before it becomes a serious problem.  Diabetes can now be predicted and at least treated with preventative medication, diet and other lifestyle changes especially in the pre-diabetes stage.

One of the positives and negatives of these advances is that many treatments involve IV medication.  It’s not the IV or the medication that’s the high part of the cost.  Medicare has a built-in problem in that is creating the cost.  Medicare does not cover IV treatment at home.  Instead of a visiting nurse or family member helping with the IV treatment, the individual has to go to the hospital to get treatment.  Needless to say, the hospital treatment is much more expensive than the cost of treatment at home. 

Receiving IV treatment at home costs about $150 to $200 per day, not to mention that it cuts down on the incidents of hospital acquired infections.  IV treatment at the hospital costs between $1,500 and $2,000 per day.  Some people without Medicare supplements can get outpatient treatment, but most need to be admitted into a hospital or nursing home.   Even if a patient tries to get the treatment at home, Medicare will cover the cost of the drugs but not the services, supplies and equipment needed to administer the treatment.

It is important for the future of Medicare that these glitches be fixed.  Medicare is tackling fraud and saving millions of dollars.  If they are able to tackle the built-in problems that are costing them money, they will be able to help more people get more services.

I don’t know about you, but if I am not feeling well and the doctor tells me I might need to have heart surgery of some sort, I am sure that I want any tests that are appropriate to be done before we get to the actual surgery part.  Unfortunately, if you are on Medicare, less than 44% of Medicare recipients are having those tests done because the doctors are not ordering them.

When a person is going to have angioplasty or have a stent implanted to open the arteries, there are risks involved.  The statistics show that 56% of individuals on Medicare who are going to have these procedures done are not getting heart stress tests and other valuable tests beforehand.  More than half of patients with stable heart disease are not getting exercise tests before doctors clear their coronary artery. These tests could determine the risks that patients face, and according to some doctors, these tests are essential and will not perform these procedures or surgeries without performing the tests first.

The stress test is so important because it determines how well a heart handles work, and that determines whether the patient even needs the angioplasty or not.  The joint guidelines from three United States heart groups say that it is necessary to perform the stress test to determine how badly the arteries are clogged and if there is a severe blockage to the flow of blood to the heart. 

It costs Medicare $15,000 for each angioplasty.  This has accounted for 10% in the Medicare expenses since 1990.  It has been suggested that Medicare reward doctors for practicing better medicine and having the stress tests done in advance.  Part of the reason for this is that in many cases the stress tests reveal that surgery is not necessary and that medication and other treatment which is less invasive and much less expensive will have the same results.

In fact, studies have shown that angioplasty without the proper tests in advance has contributed to $10,000 extra expense for those patients who did not have the tests, plus the death rate was higher for those who had angioplasty without the tests.  Those who had the tests had a 6% lower death rate and fared better overall, often without the angioplasty.

If you are in a situation where your doctor is considering angioplasty or other heart procedures, make sure to discuss having a stress test in advance.  If the doctor is non responsive, get a second opinion by a good cardiologist.  This is your heart and your life.  Especially with Medicare coverage, you should try to get the treatment that you actually need.

There have always been questions about what the rules are concerning Medicare and Medicaid.  Medicare seems to have been more straightforward than Medicaid – most people are more confused by Medicaid.

Some of the most common misconceptions about Medicaid involve what you are allowed to have or keep and what you are not allowed to have or keep in the way of money, property and other assets. 

One misconception is that if a person has Medicare they don’t need Medicaid. This is not exactly true.  The way this actually works is that Medicare covers a lot, but not long term care in nursing homes.  Medicaid covers long term care and some other issues involved with it.  Other people fear that if they go into a nursing home the government will take away their home.  This is not true.  They are allowed to keep their home, their car and various other things, including a burial policy if they go into a nursing home.  In addition, the state will not take assets.  They will not pay Medicaid benefits until your excess assets are valued at $2,000 or less (not including your house, car and other exempt items).  Their rules state that you cannot have over $2,000 in the bank or stocks, etc. and Medicaid pay for your medical expenses.  You are allowed to “spend down” your money to $2,000 so that Medicaid will start paying.

Many individuals find out that they can be eligible for Medicaid coverage, so they decide not to look into Long Term Care coverage.  Long Term Care coverage can help you in a number of ways, including allowing you to stay home for treatment if possible and also cover an adult foster care home or assisted living facility.  This gives you more choices, as Medicaid only covers specific nursing homes only; long term care coverage lets you choose where you will be treated to an extent, depending on the extent of care you need.

There are other misconceptions regarding Medicaid.  It is important that you know the truth of how Medicaid actually works so that you understand your coverage and the effect on your assets.  Talk to a financial planner, attorney or accountant who has experience in this area.

For further information go to www.cms.hhs.gov/ .

Nobody said it would be easy.  When you are suffering from various serious health issues all at the same time and doctors tell you that losing weight through bariatric surgery could help just about all of the issues, you start doing what needs to be done to get an OK for the surgery.

This is what happened to Clyde Brown, a former wrestler who had gone through many health problems including triple heart bypass surgery, gall bladder surgery, appendix surgery and back and knee surgery.  He also had sleep apnea and had to wear an oxygen tube at night so he would keep breathing while sleeping.

All of this left Clyde at a weight of 370 pounds.  His doctor suggested bariatric surgery, which reduces the stomach to the size of a small pouch to help an individual lose weight quickly.  Clyde and his doctor went to work trying to get Medicare to approve the procedure.

Getting approvals take time, and this approval took Clyde and his doctor four years.  This was not necessarily Medicare’s fault.  First, a doctor had to approve Clyde for the procedure, which took time.  He found a specialist and was eventually approved.  In addition, Clyde had to then get Medicare along with his other insurance, to approve the procedure. This also took time.  Then came the biggest hurdle – finding a hospital that was approved by Medicare to do this type of surgery. There were two hospitals not too far from Clyde’s home, and they were both willing to have the surgery performed, but they had to be approved, which is a lengthy process. 

Finally, in June of this year, everything came together, and on June 23rd Clyde underwent his bariatric surgery at St. Luke’s Hospital in Phoenix, Arizona.  The operation was a complete success and his recovery was much faster than expected, as well as free of any complications.  A week later Clyde and his wife Joanne celebrated their 31st wedding anniversary.

Clyde has now lost 73 pounds.  He hopes to end up weighing about 190 pounds when all is said and done.  He no longer has to use oxygen when he sleeps because the sleep apnea is gone.  He and Joanne take short walks together – something that was impossible for Clyde to do before the surgery.  He says that he can walk to the bathroom without getting out of breath, and he says that the overall health benefits were immediate.

Though Clyde has had to hang in there to win many matches in his career, this one is the most important of all.  He hung in long enough – four years – until all the pieces could be put together to give Clyde his life back and a path back to good health.

It is estimated that of the over 44 million Medicare beneficiaries in the United States, about 40% of them will need Long Term Care (LTC) in the future.  There are actually 76 million seniors in the country at present, however not all of them are participating in Medicare.  As the Baby Boomers continue to get older and retire, all the numbers will increase.

Though Medicare covers some LTC services, the coverage is somewhat limited.  For instance, studies show that quite a large amount of that 40% will need long term care for over 2 years. At an average of $75,000 to $100,000 per year, that is a lot of money. 

Medicare pays for nursing home rehabilitation after a person has been in the hospital.  Usually they leave the hospital and are taken to the nursing home, and Medicare allows for 100 days in the nursing home.   Though Medicare allows for 100 days in a nursing home, they usually only approve and pay for about 30 days.  They also only pay for 17 days of physical therapy per year.  Medicaid may help offset some of the other costs, but not a lot.

Most Medicare recipients are not aware of these limitations.  They think they are covered for a lot more time and a lot more services.  When the Medicaid Deficit Reduction Act was passed in 2005, it created substantial limits to what services were covered, and LTC coverage did not fare well.

There are a couple of options that seniors have in this situation.  One option is to look into a Long Term Care supplemental policy now – before you absolutely need it.  Make some comparisons to see what type of coverage you can get and what the premiums are, and get the best coverage you can.  This is important because often a senior in perfect health can accidentally trip, fall and break a leg or a hip, leading to the necessity of care and rehabilitation.  It is good to check the options available before anything like this happens.

The other option is to talk to your family.  What often happens if long term care is not available is that the family ends up taking care of their loved one.  One way to address the subject is to ask in advance what they think the plan should be if you get hurt or have a long term illness.  You can also ask if they will help you purchase a long term care policy which will relieve everyone of stress and ensure that you have the proper care if something should happen.

Be aware of your coverage.  Explore the various long term care policies available.  Don’t leave yourself vulnerable or surprised in the event that you need this type of care in the future.