Alzheimer's Disease Financial Planning
Introduction
As you and your family evaluate your long-term
care needs for dealing with Alzheimer's disease, it is important to consider
financing options including health coverage, Medicare, and Medicaid.
Long-term
financial planning is important for everyone -- but is essential if you are
coping with the expense of a long-term illness, such as Alzheimer's disease.
Many people pay careful attention to their health after they are diagnosed with
Alzheimer's.
They research their treatment plan, take their medications on schedule,
and consult with their physician regularly.
However, it may take some time for
patients and caregivers to realize that a progressive illness like Alzheimer's
can have a tremendous effect on their financial well-being.
This article offers some basic information on
how to handle your finances while living with Alzheimer's disease.
Developing a Plan
Alzheimer's disease gets worse over time, and
dealing with a progressive illness is difficult.
There is no way to know how
you will feel or what you will be able to do days, months, or years from now.
But for your own security and that of your family, you need to plan ahead,
knowing that Alzheimer's disease will lead to increasing disability.
There are
professional financial managers and medical lawyers who deal with financial
planning for people with long-term or progressive illnesses.
Ask your doctor
for a referral,
or speak with a national association or support group to find a reputable
professional in this area.
Medical Coverage
·
If you are insured,
either through your employer or a retirement policy, read all of the policies
pertaining to long-term/progressive illnesses. If you are unsure about the
language or terminology, contact the personnel department or your financial
planner.
·
If you are unemployed
and you do not have coverage, you should look for the highest level of coverage
that you can afford. The Alzheimer's Association may be able to give you a list
of insurers with a high level of Alzheimer's coverage.
·
If you are 65 or over,
you qualify for Medicare. You can supplement this insurance with a "Medigap" policy
available through a private insurer. Note also that many states have
prescription assistance/reimbursement programs for low-income senior citizens.
·
If you are disabled
but too young to qualify for Social Security, you may be eligible to receive a
form of Medicare for the disabled.
·
If you cannot get
insurance and your income is low, you may qualify for Medicaid, a government
"safety net" program that pays for medical costs that exceed a
person's ability to pay.
Investigate Long- and Short-term Disability Insurance
Check to see if your employer has private
disability insurance, and contact your human resources department to
investigate your eligibility, the cost of enrolling, and how much of your
salary it will cover.
·
If you are unable to
continue working.
·
If you are too young
to qualify for Social Security, you should consider state-run disability
programs, unless you are enrolled in your employer's disability coverage.
·
If your total income
is below a certain level, you may qualify for federally subsidized Supplemental
Security Income (SSI). If you collect SSI, regardless of your age, you are a
candidate for Medicaid.
Medicare and Medicaid
What Is Medicare?
Medicare is a federal health insurance program
providing health care benefits to all Americans age 65 and over, as well as
some disabled individuals under age 65.
Eligibility for Medicare is linked to
Social Security and railroad retirement benefits.
Medicare has co-payments and deductibles. A
deductible is an initial amount you are responsible for paying before Medicare
coverage begins. A co-payment is a percentage of the amount of covered
expense you are required to pay.
What Are Medicare's Coverage Options?
Medicare has two parts:
1.
Part A (hospital
insurance)
2.
Part B (medical
insurance)
Part A Medicare coverage includes:
·
All normal hospital
services.
·
Skilled nursing
facility care.
·
Home health services,
including a visiting nurse or a physical, occupational, or speech therapist.
·
Medical supplies.
·
Hospice services.
Part B Medicare coverage includes:
·
Eighty percent of
reasonable charges from doctors and other health care professionals (after the
annual deductible is met).
·
Medically necessary
ambulance services.
·
Physical, speech, and
occupational therapy.
·
Home health care
services (physician certification is necessary).
·
Medical supplies and
equipment.
·
Transfusion of blood
and blood components provided on an outpatient basis.
·
Outpatient surgery.
Part B Medicare benefits require that you pay
a monthly premium. You must also be entitled to Part A benefits to receive Part
B benefits.
Medicare Coverage of Skilled Nursing Care Facilities
In order to receive care in a nursing home under Medicare:
·
You must have had a
three-day hospital stay prior to admission into the skilled nursing facility.
·
You must be admitted
into the skilled nursing facility within 30 days of discharge from the
hospital.
·
You must enter the
skilled nursing facility for treatment of the same condition for which you were
hospitalized.
·
You must require daily
skilled care.
·
The condition must be
one that can be improved by admission to the facility.
·
The facility must be
Medicare-certified.
·
Your physician must write
a care plan. The care plan must be carried out by the skilled nursing facility.
(Once the patient meets the level of functioning laid out in the care plan,
Medicare will no longer pay for services.)
Medicare Coverage of Home Care
In order to receive home care under Medicare:
·
The patient must be
homebound.
·
The physician must
certify a plan of care.
·
Care must be needed on
a non-continuous basis.
·
Care cannot exceed 35
hours per week or 8 hours per day.
·
Physical or speech therapy must be provided on a "necessary and
reasonable" basis. There are no restrictions on the number of days or
hours per week of these therapies.
·
If a person qualifies
for home health care, he or she is entitled to a home health aide to provide
some personal care.
What Is Medicaid?
Medicaid is a joint federal-state health insurance
program providing medical assistance primarily to low-income Americans. It also
is available to people under 65 if they are blind or disabled.
The purpose of Medicaid is to provide
preventive, therapeutic, and rehabilitative health services and supplies that
are essential to attain an optimum level of well-being.
How Do People Receive Medicaid Benefits?
There are two ways to receive Medicaid:
1.
Through Supplemental
Security Income (SSI) -- People who receive a cash grant under SSI and Aid to
Dependent Children are automatically eligible for Medicaid benefits.
2.
Medicaid spend down --
This is similar to a deductible or a co-payment that you must pay every month.
Once you meet your "spend down" amount, you are eligible for Medicaid
for the remainder of the month.
Who Is Eligible for Medicaid?
Medicaid eligibility requirements depend on
financial need, low income, and low assets. In determining Medicaid
eligibility, officials do not review rent, car payments, or food costs. They
only review medical expenses. Medical expenses include:
·
Care from hospitals,
doctors, clinics, nurses, dentists, podiatrists and chiropractors.
·
Medications.
·
Medical supplies and
equipment.
·
Health insurance
premiums.
·
Transportation to get
medical care.
Medicaid Coverage
Medicaid coverage varies from state to state.
For specific coverage guidelines, contact your state's Department of Human
Services. Generally, Medicaid benefits include:
Transportation
·
Ambulance services
when other means of transportation are detrimental to the patient's health.
·
Transportation to and
from the hospital at time of admission or discharge when required by the
patient's condition.
·
Transportation to and
from a hospital, outpatient clinic, doctor's office, or other facility when the
doctor certifies the need for this service.
Ambulatory Centers
·
Ambulatory health care
centers are often private corporations or public agencies that are not part of
a hospital. They provide preventive, diagnostic, therapeutic, and
rehabilitative services under the direction of a doctor. Ambulatory services
covered by Medicaid include dental, pharmaceutical, diagnostic, and vision
care.
Hospital Services
·
Inpatient hospital
care.
·
Private hospital rooms
only when the illness requires the patient to be isolated for his or her own
health or the health of others.
·
Outpatient preventive,
therapeutic, and rehabilitative services.
·
Professional and
technical laboratory and radiological services.
·
Medical Supplies and
Medications
·
General medical
supplies (when prescribed by a doctor).
·
Durable medical
equipment (such as hospital beds, wheelchairs, side rails, oxygen
administration apparatus, special safety aids, etc.).
·
Medications prescribed
by a doctor, dentist, or podiatrist.
Home Health Care
·
Visiting nurse
·
Home health aide
·
Physical therapist
Skilled Nursing Facilities
·
Skilled nursing
facilities and intermediate care facilities (providing short-term care for a patient
whose condition is stable or reversible) are covered through Medicaid with a
physician's authorization.
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