September 2018 Columns

Savvy Senior – September Columns

  1. Financial Aid for Family Caregivers
  2. Health Insurance Tips for Traveling Abroad
  3. Which Flu Shot Is Right for You?
  4. Choosing a Continuing-Care Retirement Community

Financial Aid for Family Caregivers

Dear Savvy Senior,
Do you know of any resources that help family caregivers monetarily? I have to miss a lot of work to take care of my elderly mother and it’s financially stressing me.
Stretched Thin

Dear Stretched,
Caring for an elder parent can be challenging in many ways, but it can be especially difficult financially if you have to miss work or quit your job to provide care. Fortunately, there are a number of government programs, tax breaks, and other tips that may be able to help you monetarily while you care for your mother. Here are some options to explore.

State assistance: Most states have programs that help low-income seniors pay for in-home care services, including paying family members for care. These programs – which go by various names like “cash and counseling” or “consumer-directed”– vary greatly depending on where you live and, in some states, on whether your mom is on Medicaid. To find out what’s available in your state, contact your local Medicaid office.

Veterans benefits: Veterans who need assistance with daily living activities can enroll in the Veteran-Directed Care program. This program, available through VA Medical Centers in 40 states, as well as in Washington, D.C., and Puerto Rico, provides as much as $2,000 a month, which can be used to pay family members for home care. Visit the “Home and Community Based Services” section at VA.gov/geriatrics for information.

Also available to wartime veterans and their surviving spouses is a benefit called Aid and Attendance, which helps pay for in-home care, as well as assisted living and nursing home care. This benefit can also be used to pay family caregivers. To be eligible your mother must need assistance with daily living activities like bathing, dressing or going to the bathroom. And, her annual income must be under $14,133 as a surviving spouse or $21,962 for a single veteran, after medical expenses. Her assets must also be less than $80,000 excluding her home and car. To learn more, go to Vets.gov/pension.

Tax breaks: If you pay at least half of your mom’s yearly expenses, and her gross income is below $4,050 (in 2017) not counting her Social Security or disability, you can claim her as a dependent on your taxes and get a $500 tax credit. For more information, go to IRS.gov/help/ita and click on “Whom May I Claim as a Dependent?”

If you can’t claim her as a dependent, you may still be able to get a tax break if you’re paying more than half her living expenses including medical and long-term care costs, and they exceed 7.5 percent of your adjusted gross income. You can include your own medical expenses in calculating the total. See IRS publication 502, Medical and Dental Expenses (IRS.gov/pub/irs-pdf/p502.pdf) for details.

Long-term care insurance: If your mother has long-term care insurance, check whether it covers in-home care. Some policies permit family members to be paid, although they may exclude people who live in the same household.

Paid caregiver leave: A small but growing number of companies offer paid caregiving leave as a way to recruit and retain their workforce. Additionally, some states provide caregiver benefits or paid leave to take care of ailing family members. Check with your employer to see what, if any, benefits are available to you.

Family funds: If your mother has some savings or other assets, discuss the possibility of her paying you for the care you provide. If she agrees, consult with an elder law attorney about drafting a short-written contract that details the terms of the work and payment arrangements, so everyone involved knows what to expect.

You should also check BenefitsCheckup.org, a free, confidential Web tool that can help you search for financial assistance programs that your mom or you may be eligible for.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book. ————————————————————————————————————————————————————————

Health Insurance Tips for Traveling Abroad

Dear Savvy Senior,
How does health insurance and Medicare cover health care outside the U.S.? My husband and I have a trip abroad planned this fall and would like to find out if we should buy extra insurance. What can you tell us?
Almost Retired

Dear Almost,
Great question! No one likes to think about health problems while on vacation, but medical emergencies happen, and your regular insurance may not cover your care when you’re traveling abroad. To avoid any expensive surprises, here are some tips to help make sure you’re covered.

Know What’s Covered
Your first step is to contact your health insurer to find out exactly what your plan covers when you’re traveling abroad.

If you have health coverage through an employer, the Health Insurance Marketplace or a private insurance company, the level of coverage can vary widely depending on your policy.

If your plan does provide coverage abroad ask about the specifics, such as whether the plan includes coverage for emergency evacuations to the U.S. and pre-existing medical conditions. You should also find out what your out-of-pocket costs will be if you need medical care while you’re away.

If, however, you or your husband has original Medicare, it does not provide coverage outside the U.S. except in certain circumstances – on a cruise ship within six hours of a U.S., for instance. Some coverage is built in if you have one of the Medigap supplemental plans (C, D, F, G, M, N) that pay 80 percent of bills for emergency care as long as it’s during the first 60 days of the trip abroad. There’s also a $250 annual deductible plus a lifetime limit of $50,000 for foreign travel emergency care.

If you happen to have a Medicare Advantage plan, your coverage outside the U.S. will depend on the plan. Some plans offer emergency care coverage while others don’t. You’ll need to check your plan for details.

Buy Extra Protection
If your policy doesn’t provide health coverage outside the U.S., or if the coverage is limited with high out-of-pocket costs, you can purchase a travel medical insurance policy to cover you, or supplement what your insurer won’t cover.

To shop and compare plans, visit sites like InsureMyTrip.com or SquareMouth.com. To give you a general idea of what travel medical insurance cost. A couple in their sixties planning a two-week trip to Europe, for example, could get a $50,000 medical coverage limit and $100,000 for a medical evacuation for around $100 or higher.

You also need to know that most travel medical plans do not cover costs related to a pre-existing health conditions. So if you or your husband has a pre-existing condition that might require medical care, choose a comprehensive travel policy, which typically covers medical care, medical evacuation, trip cancellation, trip interruption and baggage loss, and then tack on a pre-existing-condition waiver.

Finding Care
If you get sick or injured during your trip, call your travel insurer who can recommend local care options. For extra help, consider joining the International Association for Medical Assistance to Travelers (IAMAT.org), which provides its members access to a worldwide network of physicians who speak English and have agreed to affordable prearranged fees. Membership is free. Also visit Step.State.gov to enroll your trip with nearest U.S. Embassy or Consulate. They too can offer health care referrals.

Reimbursement
If you do have travel medical insurance, and you receive medical care while traveling abroad, you will probably be required to file a claim and show medical records outlining the care you received and receipts. So make sure you get copies of these so you can get reimbursed when you get home.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.
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Which Flu Shot Is Right for You?

Dear Savvy Senior,
I’ve been reading that there are a bunch of different flu vaccines for seniors this flu season. Which flu shot is right for me?
Flu-Conscious Carol

Dear Carol,
It wasn’t that long ago that if you wanted to get protected from the flu, you simply got a flu shot. But now days, there are so many flu vaccine options you might feel like you are ordering off a menu. To help you decide which flu shot is right for you, you need to consider your health, age and personal preferences. Here’s what you should know.

Flu Shot Options
Just as they do every year, the Centers for Disease Control and Prevention (CDC) recommends a seasonal flu shot to everyone 6 months of age and older, but it’s especially important for seniors who are at higher risk of developing serious flu-related complications. The flu puts more than 200,000 people in the hospital each year and kills an average of 24,000 – 80 to 90 percent of whom are seniors. Here’s the rundown of the different vaccine options (you only need to get one of these):

Standard flu vaccines: If you want to keep things basic, you can’t go wrong with a “standard (trivalent) flu shot,” which has been around for more than 40 years and protects against three different strains of flu viruses. This year’s version protects against two A strains (H1N1 and H3N2), and one influenza B virus.

Or, for additional protection, you should consider the “quadrivalent flu vaccine” that protects against four types of influenza – the same three strains as the standard trivalent flu shot, plus an additional B-strain virus.

Senior specific vaccines: If you’re age 65 or older and want some extra protection, you should consider the “Fluzone High-Dose” or “FLUAD.”

The Fluzone High-Dose has four times the amount of antigen as a regular flu shot does, while the FLUAD contains an added ingredient called adjuvant MF59. Both vaccines provide a stronger immune response for better protection.

Egg allergy vaccines: If you’re allergic to eggs, your flu shot options are “Flucelvax” or “FluBlok.” Neither of these vaccines uses chicken eggs in their manufacturing process.

Fear of needle vaccines: If you don’t like needles, and you’re between the ages of 18 and 64, your options are the “Fluzone Intradermal” or “AFLURIA” vaccine.

The Fluzone intradermal flu shot uses a tiny 1/16-inch long micro-needle to inject the vaccine just under the skin, rather than deeper in the muscle like standard flu shot. While the AFLURIA vaccine is administered by a jet injector, which is a medical device that uses a high-pressure, narrow stream of fluid to penetrate the skin instead of a needle.

You should also know that if you’re a Medicare beneficiary, Part B covers all flu vaccinations, but if you have private health insurance, you’ll need to check with your plan to see which vaccines they do or don’t cover.

Pneumonia Vaccines
Two other important vaccinations the CDC recommends to seniors, especially this time of year, are the pneumococcal vaccines for pneumonia. Around 1 million Americans are hospitalized with pneumonia each year, and about 50,000 people die from it.

The CDC recommends that all seniors, 65 or older, get two vaccinations –Prevnar 13 and Pneumovax 23. Both vaccines, which are administered just once at different times, work in different ways to provide maximum protection.

If you haven’t yet received any pneumococcal vaccine you should get the Prevnar 13 first, followed by Pneumovax 23 six to 12 months later. Medicare Part B covers both shots, if they are taken at least one year apart.

To locate a vaccination site that offers both flu and pneumonia shots, visit Vaccines.gov and type in your ZIP code.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

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Choosing a Continuing-Care Retirement Community

Dear Savvy Senior,
Can you give me some tips on picking an all-inclusive residential retirement community that offers independent housing along with assisted living and nursing care? My husband and I are looking to downsize and simplify, but we want our next move to be our last.

Approaching 80

Dear Approaching,
If you want your next move to be your final one, an all-inclusive retirement community – also known as a continuing-care retirement community (or CCRC) – is a great option to consider, but they aren’t cheap.

CCRCs are different from other types of senior housing because they provide all levels of housing, services and care in one convenient location.

While they vary greatly in appearance and services, most CCRCs offer apartments or sometimes single-family homes for active independent seniors. In addition, they also offer onsite assisted living for seniors who require help with basic living tasks like bathing, dressing or going to the bathroom, and nursing home care for residents when their health declines.

CCRCs also provide a bevy of resort-style amenities and services that include community dining halls, exercise facilities, housekeeping, and transportation, as well as many social and recreational activities.

But be aware that all these services come at a hefty price. Most communities have entry fees that range from the low to mid-six figures, plus ongoing monthly fees that can range from around $2,000 to over $4,000 depending on the facility, services and the contract option you choose.

With more than 2,000 CCRCs in operation throughout the U.S, finding a facility that fits your lifestyle, needs and budget will require some legwork. Here are some steps that can help you proceed.

Make a list: Start by calling the Area Agency on Aging (call 800-677-1116 for contact information) in the area you want to live for a list of CCRCs, or search websites like Caring.com.

Call the facilities: Once you’ve located a few, call them to find out if they have any vacancies, what they charge and if they provide the types of services you want or need. 

Take a tour: Many CCRCs encourage potential residents to stay overnight and have a few meals in their dining hall. During your visit, notice the upkeep of the facility and talk to the current residents to see how they like living there. Also, check out the assisted living and nursing facilities, and find out how decisions are made to move residents from one level of care to another.

To check-up on a facility, call the state long-term care ombudsman (see LTCombudsman.org) who can tell you if the assisted living and nursing care services within the CCRC have had any complaints or other problems. You can also use Medicare’s nursing home compare tool at Medicare.gov/nursinghomecompare.

Review contracts and fees: Most CCRCs offer three types of contracts: Life-care, or Type A contracts, which have the highest entry fee but covers all levels of long-term care as needed; Type B, or modified contracts that have lower entry fees but limits long-term care services in the initial fee; and Type C, or fee-for-service contracts, which offer the lowest entrance fees but requires you to pay extra for long-term care if you need it.

You also need to find out what yearly price increases you can expect? How much of your entry fee is refundable to you if you move or die? And what happens if you outlive your financial resources?

Research the CCRC: Find out who owns the facility and get a copy of their most recently audited financial statement and review it, along with the copy of the contract with your lawyer or financial advisor. Also get their occupancy rate. Unless it’s a newer community filling up, occupancy below 85 percent can be a red flag that the facility is having financial or management problems.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

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