The Mystery of Medicare

I've been thinking a lot about Medicare lately, partly because Medicare and the possibility of cuts have been in the news. I am certainly no expert on health care; smarter people than I are stymied by how to reform health care, including Medicare.

So I'm not going to talk about that.

I'm going to talk about what I know.

Open enrollment begins on November 15. For those of you not on Medicare, this means that this is the time when people on Medicare can change their Medicare Part D plans or their Medicare Advantage plans.

This is important because with my own mother we have been able to save money every year by switching her Medicare D plan. Each year the insurance companies change their formularies (lists of covered medications) and they can raise premiums or deductibles.

The easiest way to compare plans is to go to the Medicare website. You will need a list of prescription medications in order to get the best information. Once you enter the medication information, you will get the lengthy list (over 50 providers in North Texas) of different plans available. It is possible to even choose your preferred pharmacy and compare prices at different pharmacies.

There are some things you need to watch for.

• If you have a Medicare Advantage plan that you like, DO NOT change your part D plan. If you choose a part D plan, you be dropped from your Advantage Plan. All Advantage plans have prescription drug benefits built into the plan.
• If you have Tricare for Life, you probably don't need a part D plan, because you already have coverage with Tricare.
• If you have coverage through a retirement plan, read your new options carefully. Some companies are only offering Advantage plans, and you might not want to sign up for one of those plans, because your doctors may not be providers.
• If you are just now eligible for Medicare A and/or B, be sure to sign up for a part D plan. If you wait too long you might be penalized.

All of this information is available in Medicare and You 2010 publication.

Guess Who I'm Letting in My Home

One of the most difficult decisions many older adults make is to allow caregivers into their home. But as hard as this decision is, I am beginning to think that choosing the right caregiver agency is even harder.

There are so many things to consider when choosing an agency. Cost is obviously a huge factor. Any way you look at it, paying for care is expensive. In the Fort Worth area, you can count on paying anywhere from $16-$24 an hour, and that is often with a four hour minimum. Some agencies will consider shorter minimums, but they might charge a higher hourly rate.

If round the clock care is needed, live-in care could be an option. Many agencies define live-in care based on whether the caregiver can sleep or not. If the caregiver can sleep, even getting up 3-4 times a night to provide assistance, this might qualify as live-in care. Of course, you then have to have a place for the caregiver to sleep, which in some situations might not be available. Live-in care is less expensive, usually in the $10-$12 dollar per hour range. Many times these caregivers are in the home for several days at a time, which can result in fewer caregivers.

If the caregiver is not able to get adequate sleep, the agency is probably going to insist on 24-hour care, which will usually be billed at the regular rate. You can expect however that the night time caregiver is awake all night long, and ready to provide assistance. Many agencies will try to have teams of 4-5 people on the care team in this situation, to minimize the number of people providing care.

In addition to having good, well-trained caregivers, it is also important to have a good relationship with the agency owner/administrator and other office staff. You are paying a lot of money for care, and it is reasonable to expect that when you call the office with a problem, you will get a quick response.

When choosing an agency, here are some questions you may want to consider asking:

• Are the caregivers certified?
• What kind of orientation and ongoing training do the caregivers receive?
• How are problems resolved?
• What kind of background checks are done?
• How many clients do you have?
• How many caregivers do you have?

Another source of information about caregiver agencies is the Department of Aging and Disability Services (DADS). They have a Long Term Care Quality Reporting System. At this website you can view information on recent complaints, not only for home care agencies but also for nursing homes and assisted living communities.

And finally, don't ignore your gut reaction. If you have a bad feeling after meeting with an agency owner or representative, pay attention. It might not be scientific, but these are people you will be dealing with on a regular basis, and if you don't like them, the relationship will probably not be a good one. There are enough other agencies out there that you should be able to find a good fit.