Savvy Senior August 2019 Columns

Savvy Senior – August Columns

  1. How Medicare Covers Ambulance Services
  2. How to Help an Aging Parent with a Hoarding Problem
  3. Is Pet Insurance a Good Idea for Seniors on a Budget?
  4. How to Find a Good Financial Planner

How Medicare Covers Ambulance Services

Dear Savvy Senior,
How does Medicare cover ambulance services? About three months ago, I took an ambulance to the hospital emergency room because I rarely drive anymore, and I just received a $1,100 bill from the ambulance company.
Surprised Senior

Dear Surprised,
This is a Medicare issue that confuses many seniors. Yes, Medicare does covers emergency ambulance services and, in limited cases, non-emergency ambulance services too, but only when they’re deemed medically necessary and reasonable. So, what does that means?

First, it means that your medical condition must be serious enough that you need an ambulance to transport you safely to a hospital or other facility where you receive care that Medicare covers.

If a car or taxi could transport you without endangering your health, Medicare won’t pay. For example, Medicare probably won’t pay for an ambulance to take someone with a simple arm fracture to a hospital. But if he or she goes into shock, or is prone to internal bleeding, ambulance transport may be medically necessary to ensure the patient’s safety on the way. The details make a difference.

Second, the ambulance must take you to the nearest appropriate facility, meaning the closest hospital, critical access hospital, skilled nursing facility or dialysis facility generally equipped to provide the services your illness or injury requires.

It also means that the facility must have a physician or physician specialist available to treat your condition. Thus, Medicare may pay for an ambulance to take you to a more distant hospital if, for example, you are seriously burned, and the nearest hospital doesn’t have burn unit.

Similarly, if you live in a rural area where the nearest hospital equipped to treat you is a two-hour drive away, Medicare will pay. But if you want an ambulance to take you to a more distant hospital because the doctor you prefer has staff privileges there, expect to pay a greater share of the bill. Medicare will cover the cost of ambulance transport to the nearest appropriate facility and no more.

Non-Emergency Situations
In limited cases, Medicare will also cover non-emergency ambulance services if such transportation is needed to treat or diagnose your health condition and the use of any other transportation method could endanger your health. Not having another means of transportation is not sufficient for Medicare to pay for services.

Some examples here are if you need transportation to get dialysis or if you are staying in a skilled nursing facility and require medical care. In these cases, a doctor’s order may be required to prove that use of an ambulance is medically necessary.

Ambulance Costs
The cost for ambulance services can vary from several hundred to several thousand dollars depending on where you live and how far you’re transported.

Under original Medicare, Part B pays 80 percent of the Medicare-approved amounts for ambulance rides. You, or your Medicare supplemental policy (if you have one), will need to pay the remaining 20 percent.

If you have a Medicare Advantage Plan, it must cover the same services as original Medicare, and may offer some additional transportation services. You’ll need to check with your plan for details.

How to Appeal
If an ambulance company bills you for services after Medicare denies payment, but you think the ride was medically necessary, you can appeal (see Medicare.gov/claims-appeals). Often, a lack of information about a person’s condition or need for services leads to denials.

If you need some help contact your State Health Insurance Assistance Program (SHIP), which has counselors that can help you file an appeal for free. To locate your local SHIP, visit ShiptaCenter.org or call 877-839-2675.

For more information on this topic, call Medicare at 800-633-4227 and ask them to mail you a copy of the “Medicare Coverage of Ambulance Services” booklet, or you can see it online at Medicare.gov/Pubs/pdf/11021-Medicare-Coverage-of-Ambulance-Services.pdf.

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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How to Help an Aging Parent with a Hoarding Problem

Dear Savvy Senior,
My 70-year-old mother has become somewhat of a hoarder. Since my father died a few years ago, her house is so disorganized and messy with stuff that it’s becoming a hazard. What should I do to help her?
Troubled Son

Dear Troubled,
Clutter addiction is a problem that effects up to five percent of Americans, many of whom are seniors. The problems can range anywhere from moderate messiness to hoarding so severe it may be related to a mental health disorder like obsessive-compulsive disorder. Here’s what you should know, along with some tips and resources that can help your mom.

Why People Hoard
The reasons most people hoard is because they have an extreme sentimental attachment to their possessions, or they believe they might need their items at a later date. Hoarding can also be a sign that an older person is depressed or showing early symptoms of dementia.

Common problems for seniors who live in excessive clutter are tripping, falling and breaking a bone; overlooking bills and missing medications that are hidden in the clutter; and suffering from the environmental effects of mold, mildew and dust, and even living among insects and rodents.

What to Do
To get a handle on your mom’s problem, the Institute for Challenging Disorganization offers a free “Clutter Hoarding Scale” that you can download off their website at ChallengingDisorganization.org.

If you find that your mom has a moderate cluttering problem, there are a number of things you can do to help.

Start by having a talk with her, respectfully expressing your concern for her health and safety, and offering your assistance to help her declutter.

If she takes you up on it, most professional organizers recommend decluttering in small steps. Take one room at a time or even a portion of a room at a time. This will help prevent your mom from getting overwhelmed.

Before you start, designate three piles or boxes for your mom’s stuff – one pile is for items she wants to keep-and-put-away, another is the donate pile and the last is the throwaway pile.

You and your mom will need to determine which pile her things belong in as you work. If your mom struggles with sentimental items that she doesn’t use, like her husband’s old tools or mother’s china for example, suggest she keep only one item for memory sake and donate the rest to family members who will use them.

You will also need to help her set up a system for organizing the kept items and new possessions.

Find Help
If you need some help with the decluttering and organizing, consider hiring a professional organizer who can come to your mom’s home to help you prioritize, organize and remove the clutter. The nonprofit group National Association of Productivity and Organizing Professionals has a directory on the website at NAPO.net to help you locate a professional in your area.

If your mom has a bigger, more serious hoarding problem (if her daily functioning is impaired, or if she is having financial difficulties, health problems, or other issues because of her hoarding) you’ll need to seek professional help. Antidepressants and/or talk therapy can help address control issues, anxiety, depression, and other feelings that may underline hoarding tendencies, and make it easier for her to confront her disorder.

To learn more and find professional help see the International OCD Foundation which provides a hoarding center on their website (Hoarding.iocdf.org) that offers information, resources, treatments, self-help groups, and more. Also see HoardingCleanup.com, a site that has a national database of qualified resources including cleaning companies and therapists that can help.

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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Is Pet Insurance a Good Idea for Seniors on a Budget?

Dear Savvy Senior,
I own two dogs and a cat that I would do almost anything for, but expensive veterinary bills put a strain on my budget. Is pet insurance a good idea?
Older Pet Owner

Dear Pet Owner,
If you’re the kind of pet owner who would do anything for their furry family, including spending thousands of dollars on medical care, pet insurance definitely is an option to consider. Here’s what you should know.

Rising Vet Costs
The cost of owning a pet has gone up in recent years. New technologies now make it possible for pets to undergo sophisticated medical treatments for many life-threatening diseases, just like humans. But these treatments don’t come cheap. That’s why pet insurance has gotten more popular in recent years. More than 2 million pets are currently insured in the U.S. and Canada, according to the North American Pet Health Insurance Association.

How Pet Plans Works
Pet insurance is actually very similar to human health insurance. Pet policies typically come with premiums, deductibles, co-payments and caps that limit how much will be paid out annually. But unlike people coverage, you usually have to pay the vet bills in full and wait for reimbursement from the insurer.

Pet policies vary greatly from basic plans that cover only accidents and illness, to comprehensive policies that provide complete nose-to-tail protection including annual checkups and vaccinations, spaying/neutering and death benefits. You should also be aware that pet policies typically don’t cover pre-existing conditions, and premiums are generally lower when your pet is young and healthy.

Costs for pet insurance will also vary by insurer and policy, but premiums typically depend on factors like the cost of veterinary care where you live and the age and breed of the pet. The average annual premium for basic accident and illness coverage was $516 per pet in 2017, while the average claim paid was $278, according to the pet health insurance association.

Shopping Tips
Major pet policy providers include the ASPCA, Embrace, Healthy Paws, Nationwide, PetFirst, Petplan and Trupanion. To help you shop and compare coverage and costs from pet insurers, go to PetInsuranceReview.com.

If you’re still working, one way to pay lower premiums, and possibly get broader coverage, is to buy pet insurance through your employer, if available. Eleven percent of employers in the U.S. offer pet health insurance benefits, according to the Society for Human Resource Management, and these plans are usually discounted.

An Alternative Option
Many animal advocates think most pet owners are better off forgoing pet insurance and instead putting the money you would have spent on premiums into a dedicated savings account to pay for vet care as needed. Depending on the policy, pet insurance can cost $1,500 to $6,000 over the life of an average pet, and most pet owners will never spend that much for treatment.

Ways to Save
If you can’t afford pet insurance or choose not to buy it, there are other ways you can save. For example, many local animal shelters offer free or low-cost spaying and neutering programs and vaccinations, and some shelters work with local vets who are willing to provide care at reduced prices for low-income and senior pet owners.

There are also a number of organizations that provide financial assistance to pet owners in need. To locate these programs, visitHumaneSociety.org/PetFinancialAid.

To save on pet medications, get a prescription from your vet (ask for generic is possible) so you can shop for the best price. Medicine purchased at the vet’s office is usually more expensive than you can get from a regular pharmacy or online.

Most pharmacies fill prescriptions for pets inexpensively, and many pharmacies offer pet discount savings programs too. You can also save by shopping online at a verified pharmacy like 1800PetMeds.com, DrsFosterSmith.com and PetCareRX.com.

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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How to Find a Good Financial Planner

Dear Savvy Senior,
Can you recommend some tips on finding and choosing a good financial planner? My wife and I are both in our late fifties and would like to get some professional advisement to help us better prepare for our retirement years.
Seeking Advice

Dear Seeking,
With all the different financial planners, advisers and services available today, finding and choosing a trusted professional that can help you meet your financial goals can be confusing. Here are a few suggestions to consider.

Where to Look
A good place to start your search is by asking friends or relatives for recommendations. If you don’t know anyone who can give you a referral, and you’re looking for broad-based financial advice, hire a Certified Financial Planner, or CFP, who are considered the “gold standard” in the industry. CFPs must act as fiduciaries, putting their client’ best interest above their own.

To get the CFP credential, they must have a college degree and be educated in a wide range of personal finance subjects, pass a rigorous certification exam, have three years professional experience, meet continuing-education requirements and abide by a code of ethics.

CFPs are taught to look at the big picture view of your finances, talking you through your goals, as well as advising you on the details of your financial life.

You’re also probably better off hiring a CFP that’s a fee-only planner, verses one who earns a commission by selling you financial products. Fee-only planners charge only for their services – for example you might pay $150 to $350 an hour for a financial tune-up, a flat fee per project or an asset-based fee.

To find a fee-only planner in your area, use the National Association of Personal Financial Advisors (NAPFA.org), which carefully vets all members and offers an online directory. Or see the Garrett Planning Network (GarrettPlanningNetwork.com), a network of fee-only advisers. Or the Alliance of Comprehensive Planners (ACplanners.org), a community of fee-only advisors that charge annual retainers.

If your needs are more specific, some other financial professionals to consider are a Registered Investment Adviser (RIA) who is registered with the Securities and Exchange Commission or a state securities regulator to manage investment portfolios; a Chartered Financial Consultant (ChFC), who specialize in insurance and estate planning; and a Certified Public Accountant (CPA), who can help with tax planning.

Be leery of many other financial advising titles, designations and certifications that are out there like the Certified Financial Consultant (CFC) or the Wealth Management Specialist (WMS). Many of these require no more than a few courses at a seminar or online, which means they’re not worth much. To research the different certifications or designations visit FINRA.org/investors – click on “Tools & Calculators,” then on “Professional Designations.”

How to Choose
After you find a few candidates in your area, call them up and schedule an appointment to meet and interview them. Find out about their experience, expertise and the types of services they provide; if they’re a fiduciary; how they charge and how much; what is their investment philosophy; and how will they handle your ongoing questions or financial needs. Look for someone whose clients are in situations similar to yours and who’s available as often as you need them.

It’s also wise to do a background check on your potential advisor. At LetsMakeaPlan.org, you can verify a planner’s certification as CFP (click on “Verify CFP Professional Status”). You’ll also see any information on the planner’s disciplinary history with CFP Board and on bankruptcy filings in the past 10 years.

To vet a registered investment adviser, go to Investor.gov where you can search an individual’s name and click on “Detailed Report” to see information on qualifications, employment history, disciplinary actions, criminal convictions and more.

To check out a broker, visit BrokerCheck.finra.org where you can search an individual or firm’s name to get details like years of experience, licensing, exams passed and regulatory actions.

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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