Coping with Crisis: Getting the Right Help for an Aging Parent

When an older friend, parent or loved one begins to show signs of needing assistance, how do you step in without overstepping?

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It is a call nobody wants to receive: an energetic, independent parent in a distant state is suddenly behaving differently. When Jane first came to Grimaldi & Yeung her mother, Margaret, was in her early 80s and starting to have some health problems. Worse, she was showing signs of confusion. What could Jane do to take care of Margaret without uprooting either of their lives? Grimaldi & Yeung’s attorneys and social workers:

  • Performed a home inspection to determine what supports Margaret would need to remain at home.
  • Created a financial plan — including a trust — to protect Margaret’s assets and establish her eligibility for Medicaid to provide home care services.
  • Put Margaret’s legal documents — including a Durable Power of Attorney, Health Care Proxy and other Advanced Directives — in order so that Jane could direct her care and, if necessary, act as her agent.
  • Helped Jane identify and hire appropriate in-home health.
  • Consulted with Margaret’s physician to create a simplified routine that was easier for her to follow.
  • Held a “summit” with two care agencies to create a structure for Margaret and remove some of the uncertainty in her life.

Structure had become increasingly important for both Margaret and Jane. Additionally, Margaret’s assets needed to be consolidated and protected. Grimaldi & Yeung worked with the two women on a range of levels — legal, financial and human — to help take care of Margaret’s current and anticipated needs without disrupting either of their lives.

Medicare/Medicaid Planning: Medicare Options

One of the many issues a caregiver should be aware of is the new Medicare drug benefit. Your Grimaldi & Yeung attorney can help you understand the program, and identify Medicare plans which best meets their needs.

What is Part D?

Part D is a Medicare prescription drug benefit program which allows enrollees to add prescription drug coverage to their existing Medicare coverage. During the designated open enrollment period, people receiving Medicare, Medicaid or SSI (Supplementary Security Income) can choose the drug plan that best meets their needs. If you do not make a choice during this period, you will be automatically enrolled in a pre-selected private drug plan that may not be the best one for you.

Costs

Costs vary from year to year and from plan to plan. Essentially you will have to pay:

  • Your drug plan’s premium.
  • An annual deductible.
  • Co-payments of 25% of your annual drug costs between your deductible and the regular covered cost limit. If you use premium drugs the co-pays may be higher.
  • A substantial part of the costs is a payment which is required when an individual meets the program’s regular covered cost limit and the catastrophic cost floor. This is the “donut hole,” which will be phased out over the next decade.
  • Co-payments for any prescription drugs you receive over the catastrophic cost floor.

Extra Help

You may be eligible for extra help to pay for your premiums, deductibles and co-payments. If you are currently enrolled in Medicaid, Medicare Saving Program (MSP), or receive Supplemental Security Income (SSI), you automatically qualify for extra help and do not have to apply for it.

If you do not automatically qualify but think you will be unable to pay for this program, you should apply for this extra help. Our office is willing to assist anyone with this application. Otherwise you can apply online at www.ssa.gov or call or visit your local Social Security or local Medicaid office.

Factors to Consider

There are several key factors to consider when choosing one of the Medicare private drug plans:

  • Costs: While there is a basic plan that is outlined in the law, there is great flexibility for companies to design their own plan. Premiums can be higher or lower, depending on the coverage. Check each plan to see how they distribute the costs and fees.
  • Formulary: Each Medicare private drug plan will have its own formulary or list of covered drugs. You must compare plans to find one that covers your prescription drugs. There is a procedure to get coverage for medically necessary prescription drugs not covered by your plan.
  • Pharmacy Network: You must use pharmacies in your Medicare private drug plan’s network, so choose a plan with a convenient pharmacy location.
  • Rules: Since plans operate differently, it would be best to compare the rules and regulations of each plan and choose one that provides the flexibility you desire.
  • Special Needs: Lastly, when choosing a Medicare private drug plan, look for one that will fulfill any special needs or services that you require in order to obtain the most coverage for your prescription drug needs.

Caregivers and beneficiaries should take this opportunity to review their long-term care plans which include important strategies such as Powers of Attorney, Trusts, Wills Living Wills, Medicaid, and Health Care Proxies.