Nov 09

Prestige Care

Helping Seniors Manage Medical & Social Services

Posted by Prestige Care

If one or both of your parents are living with dementia, it’s quite possible that you’ve taken on the responsibility of helping them manage aspects of their finances and medical insurance. This is an important responsibility and understanding the internal workings of bureaucracies can be enormously frustrating. If you’re looking to gain a better understanding of what you’ll need in order to help your parents manage these systems, we’ve created a basic guide to help you navigate the most frequently asked questions.

Below, we breakdown the process for social security, Medicare and the VA.

Social Security

If you’re looking to manage a loved one’s social security benefits because they no longer have the ability to perform this function themselves, there are a few steps that you need to take. These steps also apply for those who qualify for Supplemental Security Income.

1. Make an appointment with your local Social Security office.

2. Request to be appointed as a representative payee.

3. Ensure you bring all the required documentation including proof of identity.

There are rules and regulations that you must adhere to once becoming a representative payee. It’s critical to maintain up-to-date financial documents so that you’ll have everything in order to file an annual report (which is often required). Below we’ve outlined a range or responsibilities that you’ll have as a representative payee.

1. Payees must use SSI payments to meet the essential needs of their loved one — food, shelter, household bills, medical care.

2. Payees can also opt to use funds for recreational activities and personal needs like toiletries and clothing.

3. All remaining funds must be deposited into an interest-bearing account of savings bonds.

4. Keep a meticulous record of how and when funds were received, spent or saved.

5. Payees must report any changes or events that could impact the beneficiary’s payments — marriage, divorce, death, move.

6. Payees must report any circumstances that may affect their ability to perform their role as a representative payee.

If you’re looking for a more in-depth guide for representative payees taking care of senior finances, the Social Security Administration has put together a useful PDF.

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Medicare

Similar to Social Security, navigating Medicare can be quite burdensome. If you’re caring for someone living in an assisted living community or memory care, we have a handful of tips that can help you navigate Medicare for a loved one.

Know Both Major Care Plans

a) Original Medicare - this plan includes hospitalization and medical insurance. Any healthcare provider or facility that accepts Medicare will accept Original Medicare.

b) Medicare Advantage Plan - this plan requires that healthcare providers and facilities are members of a specified network.

Choosing between these two plans requires that you assess the needs of your loved one. Some things to consider are finances, preferences, medical history, future healthcare needs and a full list of prescription medications.

Know Your A, B, C and Ds

A. Part A is hospital insurance. In general, Medicare Part A covers hospital care, skilled nursing facility care, nursing home care, hospice and home health services. Part A is free.

B. Part B is medical insurance. Part B includes premiums, copays and deductibles.

C. A Medical Advantage Plan is also known as Part C. It’s important to note that Part C covers Parts A and B.

D. Part D deals with prescription drugs.

Many people receiving Medicare benefits also apply and pay for Medigap. Medigap insurance covers what isn’t covered by Original Medicare. If you opt for a Medicare Advantage plan you will not qualify for Medigap as a Medicare Advantage plan offers its own gap coverage.

  1. Do Not Miss Deadlines

Missing deadlines can end up costing your loved one penalties and higher premiums. A general rule of thumb is that one should apply for Medicare three months before they turn 65 (this is the eligibility window). There is an initial enrollment period (IEP) that is your loved one’s primary chance to enroll in Medicare. It is from three months before an individual’s 65th birthday to three months after their 65th birthday.

This may seem like plenty of time to enroll but like anything in life this period of time can slip by quickly. You want to ensure your loved one is enrolled in Medicare during the IEP because if the deadline is missed you’ll have to wait for the next sign-up window which takes place between January 1 and March 31. Missing the IEP can result in delayed coverage, penalties and higher premiums.

  1. Visit Medicare.gov

The Medicare website offers a plethora of useful information and it’s also where you’ll go for open enrollment. On the website you can:

-Enroll in Medicare

-Locate upcoming health & drug plans

-Get Medicare costs

-Apply for a Medicare card

-Learn more about Medicare’s Special Enrollment Period

-Learn more about the parts of Medicare

-Learn more about Medigap policies 

  1. Make A Health Assessment Appointment

The first Medicare visit, often referred to as the “Welcome to Medicare” visit is free. This is a great opportunity to assess your loved one’s baseline needs with a physician.

VA Health Care Benefits

If your loved one served in the armed forces, you may need to help them navigate the ins and outs of the U.S. Department of Veterans Affairs. This process can be confusing and overwhelming which is why doing research can be a vital component of your role as a caregiver. There are three different paths that a veteran can take to obtain VA health care.

  1. Disability Status

If your loved one is living with a service-connected injury, illness or disability that was incurred during their military service or aggravated by their military service, this is a route you may want to explore.

If your loved one qualifies for disability status, gaining healthcare benefits is a much simple and more streamlined process. To qualify, your loved one must have served on active duty, active duty for training or inactive duty for training AND have received a VA disability rating. To receive a VA disability rating your loved one will need to undergo an examination often referred to as a compensation and pension exam. Reach out to your local VA medical center or a local physician who is partnered with the VA to set up an exam. If your loved one meets all of the parameters outlined above they must also have at least one of the following:

-A sickness or injury while serving in the military that can be linked to your current condition. The VA refers to this as an in-service disability claim.

-An illness or injury before joining the military that was made worse from military service. This is called a preservice disability claim.

-A disability related to active-duty service that didn't appear until after service ended. This is referred to as a post-service disability claim.

  1. Service History

If your loved one was a recipient of a Purple Heart, Medal of Honor or was a former Prisoner of War (POW), this is the route that you may want to explore.

Your loved one can qualify for healthcare benefits as part of their service history if they meet one of the following criteria:

-They are a former POW

-They received a Purple Heart

-They received a Medal of Honor.

-They served in Vietnam between 1962 and 1975.

-They served in the Southwest Asia/Gulf War between 1990 and 1998.

-They served at least 30 days at Camp Lejeune between 1953 and 1987.

  1. Income Needs

The VA offers health care for service members whose income is below a certain level (defined by the VA).

To learn more about income qualifications set forth by the VA, visit the U.S. Department of Veterans Affairs.

Navigating social services can be tricky. Most people find that if you start this process early, reach out to the proper channels and conduct sound research, it can be much more manageable. If you have a loved one living with Alzheimer’s or dementia, it’s important to help them navigate bureaucracies to ensure they are getting the care and coverage they deserve.