Medicare transition questions….what happens now?

[Calm]

I know this goes in Social, but want lots of answers because I am really nervous. (And you all are my social network, everyone else I talk to are too young to worry about this, I figure there are quite a few seniors around here.

So after I have gotten your notice, I will ask the mods to move it over to Social unless there are others in the same state wondering what life after Medicare/retirement looks like and expects of them…

Insurance is apparently one of those things you don’t know what you got until it’s gone and with a calculation of around me spending $8000 on my drugs a year even with supplemental coverage, I am suddenly much less annoyed with Regence/Magellan.

So I am kind of terrified about what comes next.  Apparently to drop that $8000 a year out of pocket down I can go to generics (no problem) and go coupon shopping? Or have to compare pharmacies to see which is cheapest this month?  And do this each month?  With as many drugs as my family gets, this could be a full time job,

And then do I have to submit for reimbursements or does the pharmacist do the paper work?  

Help me, you’re my only hope!

 

Anyone have a good website for handholding info through transitioning as I am sooooo paranoid?  When Dad died, Mom turned her brain off and played baby, understandably because Dad was the non nonsense, I can do it faster without you type and it was a disaster in that they sent the premium payment info to the wrong address after dad died and even though I was talking to them twice monthly asking if she was covered for this and that, supposedly really stating on the ball, no one bothered to tell me premiums were past due until we we told they canceled her supplemental insurance…with no appeal as that date had past.

I thought it had been set up with auto payment and didn’t register we should still have gotten a notice or something.  Anyway, took 6 months and threatening them with a lawyer to get her back on even though it was their fault, so I am so paranoid and my Fibro brain isn’t absorbing much of how it actually works, though I am managing the different payments for different plans…I think.

Anyway….any advice on what type of coverage to get for high needs, expensive drugs and potentially longterm care at the end of life as my mother, her mother and her mother were all in fantasy land by the end of their life, though I am hoping science saves me some dignity at least?  

But mostly want to know how you do the routine stuff.  What is expected of you, etc.  my mom had one or two cheap drugs, nothing like the pharmacy that is our house, so I am familiar with how relatively easy the doctors visits are (though no specialists for her and I might want to go that route).
 

And what is the best routine for making sure we spend the least needed for the good stuff, not going for the luxury or maybe it will give you a 1% improvement for 50% of your income kind of thing…is there some app that tracks this stuff for you or just a good habit to establish?

Edited January 26, 2024 by Calm

[CV75]

6 minutes ago, Calm said:

I know this goes in Social, but want lots of answers because I am really nervous. (And you all are my social network, everyone else I talk to are too young to worry about this, I figure there are quite a few seniors around here.

So after I have gotten your notice, I will ask the mods to move it over to Social unless there are others in the same state wondering what life after Medicare/retirement looks like and expects of them…

Insurance is apparently one of those things you don’t know what you got until it’s gone and with a calculation of around me spending $8000 on my drugs a year even with supplemental coverage, I am suddenly much less annoyed with Regence/Magellan.

So I am kind of terrified about what comes next.  Apparently to drop that $8000 a year out of pocket down I can go to generics (no problem) and go coupon shopping? Or have to compare pharmacies to see which is cheapest this month?  And do this each month?  With as many drugs as my family gets, this could be a full time job,

And then do I have to submit for reimbursements or does the pharmacist do the paper work?  

Help me, you’re my only hope!

 

Anyone have a good website for handholding info through transitioning as I am sooooo paranoid?  When Dad died, Mom turned her brain off and played baby, understandably because Dad was the non nonsense, I can do it faster without you type and it was a disaster in that they sent the premium payment info to the wrong address after dad died and even though I was talking to them twice monthly asking if she was covered for this and that, supposedly really stating on the ball, no one bothered to tell me premiums were past due until we we told they canceled her supplemental insurance…with no appeal as that date had past.

I thought it had been set up with auto payment and didn’t register we should still have gotten a notice or something.  Anyway, took 6 months and threatening them with a lawyer to get her back on even though it was their fault, so I am so paranoid and my Fibro brain isn’t absorbing much of how it actually works, though I am managing the different payments for different plans…I think.

Anyway….any advice on what type of coverage to get for high needs, expensive drugs and potentially longterm care at the end of life as my mother, her mother and her mother were all in fantasy land by the end of their life, though I am hoping science saves me some dignity at least?  

But mostly want to know how you do the routine stuff.  What is expected of you, etc.  my mom had one or two cheap drugs, nothing like the pharmacy that is our house, so I am familiar with how relatively easy the doctors visits are (though no specialists for her and I might want to go that route).
 

And what is the best routine for making sure we spend the least needed for the good stuff, not going for the luxury or maybe it will give you a 1% improvement for 50% of your income kind of thing…is there some app that tracks this stuff for you or just a good habit to establish?

I would call your State's (Utah?) Medicare and Seniors' Health Insurance Information Program. A representative can help you decide on all sorts of Medicare-related options, including additional forms of coverage : https://insurance.utah.gov/consumer/seniors#:~:text=SHIP operates in every county,.daas.utah.gov.

 

[Calm]

51 minutes ago, CV75 said:

I would call your State's (Utah?) Medicare and Seniors' Health Insurance Information Program. A representative can help you decide on all sorts of Medicare-related options, including additional forms of coverage : https://insurance.utah.gov/consumer/seniors#:~:text=SHIP operates in every county,.daas.utah.gov.

 

I got a great person for the coverage plans.  We have everything except for a final decision on Part D I believe.

I want to know what comes after….the routine of how things are paid for, how prior authorizations are handled, how to keep the costs down for the expensive drugs, etc

My only experience with SSA and Medicare is for Mom and hers was relatively easy and yet I was one time 3 hours waiting on the phone to check to see if she was covered for something and several other times over an hour waiting….there has to be a better way,

I really messed up with Mom’s stuff because no one showed me the steps.  I thought premiums were automatic withdrawn and they weren’t.  And no one told me when asked over the phone because that was another department.

I have had too many experiences with government people giving us different directions for the same question.  I prefer to find out from people who are living it how it actually works.

Edited January 26, 2024 by Calm

[Teancum]

3 hours ago, Calm said:

I know this goes in Social, but want lots of answers because I am really nervous. (And you all are my social network, everyone else I talk to are too young to worry about this, I figure there are quite a few seniors around here.

So after I have gotten your notice, I will ask the mods to move it over to Social unless there are others in the same state wondering what life after Medicare/retirement looks like and expects of them…

Insurance is apparently one of those things you don’t know what you got until it’s gone and with a calculation of around me spending $8000 on my drugs a year even with supplemental coverage, I am suddenly much less annoyed with Regence/Magellan.

So I am kind of terrified about what comes next.  Apparently to drop that $8000 a year out of pocket down I can go to generics (no problem) and go coupon shopping? Or have to compare pharmacies to see which is cheapest this month?  And do this each month?  With as many drugs as my family gets, this could be a full time job,

And then do I have to submit for reimbursements or does the pharmacist do the paper work?  

Help me, you’re my only hope!

 

Anyone have a good website for handholding info through transitioning as I am sooooo paranoid?  When Dad died, Mom turned her brain off and played baby, understandably because Dad was the non nonsense, I can do it faster without you type and it was a disaster in that they sent the premium payment info to the wrong address after dad died and even though I was talking to them twice monthly asking if she was covered for this and that, supposedly really stating on the ball, no one bothered to tell me premiums were past due until we we told they canceled her supplemental insurance…with no appeal as that date had past.

I thought it had been set up with auto payment and didn’t register we should still have gotten a notice or something.  Anyway, took 6 months and threatening them with a lawyer to get her back on even though it was their fault, so I am so paranoid and my Fibro brain isn’t absorbing much of how it actually works, though I am managing the different payments for different plans…I think.

Anyway….any advice on what type of coverage to get for high needs, expensive drugs and potentially longterm care at the end of life as my mother, her mother and her mother were all in fantasy land by the end of their life, though I am hoping science saves me some dignity at least?  

But mostly want to know how you do the routine stuff.  What is expected of you, etc.  my mom had one or two cheap drugs, nothing like the pharmacy that is our house, so I am familiar with how relatively easy the doctors visits are (though no specialists for her and I might want to go that route).
 

And what is the best routine for making sure we spend the least needed for the good stuff, not going for the luxury or maybe it will give you a 1% improvement for 50% of your income kind of thing…is there some app that tracks this stuff for you or just a good habit to establish?

If you are moving on to Medicare I highly recommend you find a Medicare consultant/insurance broker. It is very confusing and there  are lots of options.  I am a year away from this but we did look at it for my wife this past year.  But because she is still on my insurance through my firm we don't need to change yet. But we di meet with a broker and expert on this and it was very helpful.

[pogi]

6 hours ago, Calm said:

how to keep the costs down for the expensive drugs, etc

I always recommend goodrx.com to all my patients who I prescribe Malarone to.  Most insurances won’t pay for it and it can be as costly as $13/pill at some pharmacies.  Goodrx.com compares prices at local pharmacies with and without coupon and you get discounted prices through the app.  With goodrx you can get Malarone for around $2/pill.  That is a BIG difference.  It is a nice one-stop shop for coupons and comparing drug store prices if you have to go that route.  I have heard some of my patients say they get a better deal using goodrx than by using their insurance.   

I don’t know much about insurance though.  In fact I despise its existence.

No, I am not being paid for this ad.

[rpn]

It can be really hard to figure this out.   Everybody has to pay for Medicare Part A (currently at $174 plus change (if you are also getting SS then you can have the payments taken out of your SS monthly check, otherwise directly to medicare.   Then you either go Medicare Advantage (make sure to identify what the various providers deductible and extras are for Parts B, C, and D (the drugs) and formulatries.  Or you go with regular medicare for Parts BC and D and also by a medigap policy which covers much of what isn't otherwise paid, with various deductibles (and since it is usually based on the day you bought it, you'd want to get it from the start so the premiums over the years will be as low as possible.

The Medicare sight has some help to walk you through it.  But I'd go to the AARP site or a real life expert (unfortunately, all the one's I've found are attached in some way to one of the plan options.

There are also deadlines: you can choose up to 3 months before you are eligible and two or three months after (depending on what day of the month your birthday is.   You will need to file for Medicare so you can get access to choose the plans, so you can sign up for it 3 months before your 65th birthday even without knowing what you are going to choose yet and you should so that you will be able to choose in time to meet your deadline. 

I wish it were easier and that people were not indundated by people saying they can help.   I really don't like that Medicare releases your information to so many people who will call you and you can't tell if they are independent or connected to a plan.

[Calm]

5 hours ago, Teancum said:

If you are moving on to Medicare I highly recommend you find a Medicare consultant/insurance broker. It is very confusing and there  are lots of options.  I am a year away from this but we did look at it for my wife this past year.  But because she is still on my insurance through my firm we don't need to change yet. But we di meet with a broker and expert on this and it was very helpful.

That is what we are doing.  Which is how I found out what my drugs would be after coverage, which then led to me feeling a bit ashamed about how I viewed our current insurance guys as it may have been a hassle from time to time, but they saved up money big time (I thank all you healthy people sincerely and deeply for subsidizing my druggy lifestyle).

[Calm]

2 hours ago, pogi said:

I always recommend goodrx.com to all my patients who I prescribe Malarone to.  Most insurances won’t pay for it and it can be as costly as $13/pill at some pharmacies.  Goodrx.com compares prices at local pharmacies with and without coupon and you get discounted prices through the app.  With goodrx you can get Malarone for around $2/pill.  That is a BIG difference.  It is a nice one-stop shop for coupons and comparing drug store prices if you have to go that route.  I have heard some of my patients say they get a better deal using goodrx than by using their insurance.   

I don’t know much about insurance though.  In fact I despise its existence.

No, I am not being paid for this ad.

So how does GoodRX work?  I look up my drug, print off a coupon and bring it with me or something else?

Edited January 27, 2024 by Calm

[Okrahomer]

1 hour ago, rpn said:

Everybody has to pay for Medicare Part A (currently at $174 plus change

Do you mean Part B?  Part A costs $0 for folks who have worked and paid into Medicare for at least 10-years. (See here)

[Calm]

For those filing for Medicare….learn from my mistake, don’t put off applying for a number right before you are going on Medicare.  It was one of my stupid so much anxiety surrounding it mistakes as I just put it off over and over again for the last 6 months (65 in Oct and my husband retires on the 31st of this month as he waited until I could get on Medicare).

They won’t give you your medicare number either when you apply or over the phone for security reasons, but you have to wait till you get it in the mail….and my memory says that is up to six weeks.  Rather than applying online, we popped down to the SSA building in Provo, waited 15 minutes and the rest was a breeze.  She did all the work.

There is one workaround not getting your number immediately and that is having them fax it to you.

I was on hold for over an hour (estimated wait time 39 minutes) to find this out.

I have made arrangements with a trusted friend to use their fax so come Monday it’s time for another solitaire marathon while I wait for them to pick up.

Edited January 27, 2024 by Calm

[MiserereNobis]

Wouldn't it be nice if all of this was just simply taken care of for everyone from birth to death without having to deal with insurance and paperwork and switching from this to that? You just know that if you are a citizen of the country, the country covers your medical necessities because you are a human being and advanced super wealthy countries (remember, the United States is the richest country in the history of the world) take care of their own?

Perhaps Elon Musk and Jeff Bezos and others could donate 75% of their wealth to this cause. It wouldn't change their lifestyle at all, but would radically change the living experiences of so so many. If they don't want to donate, tax them. It wouldn't change the way they live at all, so what do they care? If it's just because they want big numbers on a piece of paper, then that's pure greed.

Remember what Jesus had to say about riches and greed.

If the moderators want to ding me and ban me from the thread, I'll take it. The wife of one of the security guards at our school found out that her uterine cancer has metastasized and needs a second round of chemo treatment. He makes like $20k a year. It was the beginning of the year. She was told they couldn't start until she was able to pay the out-of-pocket deductible that is about 40% of their income. There was a go fund me set up for the public and a collection went around our school. They've raised enough money to start treatment.

Why is this happening in the wealthiest country the world has ever known? Why can't Cookie just get treated for cancer without having to ask other people to help her pay for it?

I'm sorry, I'm feeling raw from a few wealth inequality based situations recently.

Edited January 27, 2024 by MiserereNobis

[Derl Sanderson]

My mother took a pass on any prescription coverage when she retired at 63. At the time she was only taking a cheap thyroid medication. Now 93, she needs some pretty heavy-duty prescriptions. One of them is Eliquis, another is an inhaler called Stiolto Respimat. To get these domestically, she'd be paying about $1100 for 3 months of Eliquis, and over $600 for the other (thanks for NOTHING, Pfizer!). I can get the same, brand-name drugs off-shore for half that price or less. There are a number of companies that provide this service and you can shop them for the best price. You find them at pharmacychecker.com.

My medicare advisor gave me this website. I have been dealing with these off-shore pharmacies for over a year now. There are two downsides: (1) They are pretty slow. I have had to allow a month for delivery (coming from UK, New Zealand, Canada, Turkey). (2) None of them I have found will take VISA. They all want to draft your checking account. This really freaked me out at first, but I haven't ever been hit for more than the quoted amount. I have to enter my checking account information with each order as they do not keep it on file.

[Calm]

42 minutes ago, MiserereNobis said:

the moderators want to ding me and ban me from the thread, I'll take it.

I hope not.  This post is in line with my own thoughts.

I loved this aspect about Canada.  That was one thing we weren’t worrying about when Shannon was diagnosed with diabetes, how it would work money wise (though they had a strange restriction on her getting the pump, so it wasn’t perfect).

Edited January 27, 2024 by Calm

[Calm]

13 minutes ago, Derl Sanderson said:

My mother took a pass on any prescription coverage when she retired at 63. At the time she was only taking a cheap thyroid medication. Now 93, she needs some pretty heavy-duty prescriptions. One of them is Eliquis, another is an inhaler called Stiolto Respimat. To get these domestically, she'd be paying about $1100 for 3 months of Eliquis, and over $600 for the other (thanks for NOTHING, Pfizer!). I can get the same, brand-name drugs off-shore for half that price or less. There are a number of companies that provide this service and you can shop them for the best price. You find them at pharmacychecker.com.

My medicare advisor gave me this website. I have been dealing with these off-shore pharmacies for over a year now. There are two downsides: (1) They are pretty slow. I have had to allow a month for delivery (coming from UK, New Zealand, Canada, Turkey). (2) None of them I have found will take VISA. They all want to draft your checking account. This really freaked me out at first, but I haven't ever been hit for more than the quoted amount. I have to enter my checking account information with each order as they do not keep it on file.

What about counterfeit issues?  What guarantees do they have?

[Calm]

39 minutes ago, Derl Sanderson said:

My mother took a pass on any prescription coverage when she retired at 63. At the time she was only taking a cheap thyroid medication. Now 93, she needs some pretty heavy-duty prescriptions. One of them is Eliquis, another is an inhaler called Stiolto Respimat. To get these domestically, she'd be paying about $1100 for 3 months of Eliquis, and over $600 for the other (thanks for NOTHING, Pfizer!). I can get the same, brand-name drugs off-shore for half that price or less. There are a number of companies that provide this service and you can shop them for the best price. You find them at pharmacychecker.com.

My medicare advisor gave me this website. I have been dealing with these off-shore pharmacies for over a year now. There are two downsides: (1) They are pretty slow. I have had to allow a month for delivery (coming from UK, New Zealand, Canada, Turkey). (2) None of them I have found will take VISA. They all want to draft your checking account. This really freaked me out at first, but I haven't ever been hit for more than the quoted amount. I have to enter my checking account information with each order as they do not keep it on file.

Thank you, it’s been bookmarked

[Ginger Snaps]

2 hours ago, Calm said:

So how does GoodRX work?  I look up my drug, print off a coupon and bring it with me or something else?

You don’t necessarily need to print. My pharmacy just wants the numbers off the coupon and they’ll look at my phone. 

[Tacenda]

2 hours ago, MiserereNobis said:

Wouldn't it be nice if all of this was just simply taken care of for everyone from birth to death without having to deal with insurance and paperwork and switching from this to that? You just know that if you are a citizen of the country, the country covers your medical necessities because you are a human being and advanced super wealthy countries (remember, the United States is the richest country in the history of the world) take care of their own?

Perhaps Elon Musk and Jeff Bezos and others could donate 75% of their wealth to this cause. It wouldn't change their lifestyle at all, but would radically change the living experiences of so so many. If they don't want to donate, tax them. It wouldn't change the way they live at all, so what do they care? If it's just because they want big numbers on a piece of paper, then that's pure greed.

Remember what Jesus had to say about riches and greed.

If the moderators want to ding me and ban me from the thread, I'll take it. The wife of one of the security guards at our school found out that her uterine cancer has metastasized and needs a second round of chemo treatment. He makes like $20k a year. It was the beginning of the year. She was told they couldn't start until she was able to pay the out-of-pocket deductible that is about 40% of their income. There was a go fund me set up for the public and a collection went around our school. They've raised enough money to start treatment.

Why is this happening in the wealthiest country the world has ever known? Why can't Cookie just get treated for cancer without having to ask other people to help her pay for it?

I'm sorry, I'm feeling raw from a few wealth inequality based situations recently.

I hate to bring it up, but that's a problem with me and a couple of churches (LDS Catholic) that are billionaires. But I shouldn't go there. But hear you on those that can't get the health care they need. But then some would say that's socialism to help those like her. Yet the wealthy have tax loopholes that the rest of us can't get, how wrong is that?

I'm glad your friend will get the treatment, since I'm sure this is timely and she needs to get it going. While the rich, keep getting richer. And there's a whole host of stories with people out there that could use help from certain churches that are tax free. 

https://www.oxfamamerica.org/explore/stories/do-the-rich-pay-their-fair-share/

Edited January 27, 2024 by Tacenda

[The Nehor]

2 hours ago, MiserereNobis said:

Wouldn't it be nice if all of this was just simply taken care of for everyone from birth to death without having to deal with insurance and paperwork and switching from this to that? You just know that if you are a citizen of the country, the country covers your medical necessities because you are a human being and advanced super wealthy countries (remember, the United States is the richest country in the history of the world) take care of their own?

Perhaps Elon Musk and Jeff Bezos and others could donate 75% of their wealth to this cause. It wouldn't change their lifestyle at all, but would radically change the living experiences of so so many. If they don't want to donate, tax them. It wouldn't change the way they live at all, so what do they care? If it's just because they want big numbers on a piece of paper, then that's pure greed.

Remember what Jesus had to say about riches and greed.

If the moderators want to ding me and ban me from the thread, I'll take it. The wife of one of the security guards at our school found out that her uterine cancer has metastasized and needs a second round of chemo treatment. He makes like $20k a year. It was the beginning of the year. She was told they couldn't start until she was able to pay the out-of-pocket deductible that is about 40% of their income. There was a go fund me set up for the public and a collection went around our school. They've raised enough money to start treatment.

Why is this happening in the wealthiest country the world has ever known? Why can't Cookie just get treated for cancer without having to ask other people to help her pay for it?

I'm sorry, I'm feeling raw from a few wealth inequality based situations recently.

Same and also just start nationalizing pharmaceutical companies until the rest start behaving.

[Teancum]

16 hours ago, Calm said:

That is what we are doing.  Which is how I found out what my drugs would be after coverage, which then led to me feeling a bit ashamed about how I viewed our current insurance guys as it may have been a hassle from time to time, but they saved up money big time (I thank all you healthy people sincerely and deeply for subsidizing my druggy lifestyle).

I understand.  I have a bunch of meds as well.  For BP issues, stenosis in my neck, blood thinner for Afib and so on.  The blood thinner is incredibly expensive.  And this is all so complicated as you go to medicare and then look for supplemental insurance.

[Emily]

On 1/26/2024 at 10:32 AM, Calm said:

I know this goes in Social, but want lots of answers because I am really nervous. (And you all are my social network, everyone else I talk to are too young to worry about this, I figure there are quite a few seniors around here.

So after I have gotten your notice, I will ask the mods to move it over to Social unless there are others in the same state wondering what life after Medicare/retirement looks like and expects of them…

Insurance is apparently one of those things you don’t know what you got until it’s gone and with a calculation of around me spending $8000 on my drugs a year even with supplemental coverage, I am suddenly much less annoyed with Regence/Magellan.

So I am kind of terrified about what comes next.  Apparently to drop that $8000 a year out of pocket down I can go to generics (no problem) and go coupon shopping? Or have to compare pharmacies to see which is cheapest this month?  And do this each month?  With as many drugs as my family gets, this could be a full time job,

And then do I have to submit for reimbursements or does the pharmacist do the paper work?  

Help me, you’re my only hope!

 

Anyone have a good website for handholding info through transitioning as I am sooooo paranoid?  When Dad died, Mom turned her brain off and played baby, understandably because Dad was the non nonsense, I can do it faster without you type and it was a disaster in that they sent the premium payment info to the wrong address after dad died and even though I was talking to them twice monthly asking if she was covered for this and that, supposedly really stating on the ball, no one bothered to tell me premiums were past due until we we told they canceled her supplemental insurance…with no appeal as that date had past.

I thought it had been set up with auto payment and didn’t register we should still have gotten a notice or something.  Anyway, took 6 months and threatening them with a lawyer to get her back on even though it was their fault, so I am so paranoid and my Fibro brain isn’t absorbing much of how it actually works, though I am managing the different payments for different plans…I think.

Anyway….any advice on what type of coverage to get for high needs, expensive drugs and potentially longterm care at the end of life as my mother, her mother and her mother were all in fantasy land by the end of their life, though I am hoping science saves me some dignity at least?  

But mostly want to know how you do the routine stuff.  What is expected of you, etc.  my mom had one or two cheap drugs, nothing like the pharmacy that is our house, so I am familiar with how relatively easy the doctors visits are (though no specialists for her and I might want to go that route).
 

And what is the best routine for making sure we spend the least needed for the good stuff, not going for the luxury or maybe it will give you a 1% improvement for 50% of your income kind of thing…is there some app that tracks this stuff for you or just a good habit to establish?

You triggered a host of reactions with this one, none of them good. So I'll just say in advance, thank you for taking the time to take care of these things now instead of putting them off until they fall into someone else's lap. 👍

If you haven't already done it, look into appointing a social security representative payee. It would be nice to do it in advance rather than having your kids spend hours trying to explain to a paranoid dementia patient why she needs to sign the papers (...for every !#x@$! important financial need in her life that she said was taken care of and was not...)

Advance Designation Instructions:

https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.ssa.gov/payee/advance_designation.htm%23:~:text%3DAdvance%20Designation%20of%20Representative%20Payee,if%20the%20need%20ever%20arises.&ved=2ahUKEwiUw4q8h4CEAxVKJEQIHcCRBfgQFnoECAwQBQ&usg=AOvVaw3SOO3h2a1ed3b2_hqCM-N7

If you really think there's a high chance you'll end up with dementia, look into a "long term care supplement" policy -- but don't use the word "dementia" as one of your reasons for looking into them.

Medicare doesn't cover nursing home expenses other than for short-term recovery time after hospitalization, or a few weeks of "respite" when someone is approaching death. And medicaid only covers it if you are destitute and would likely die of neglect if left alone in your home. 

More Information on Long Term Care Policies and Why They are Needed

https://www.medicare.gov/what-medicare-covers/what-part-a-covers/how-can-i-pay-for-nursing-home-care

https://www.ncoa.org/article/does-long-term-care-insurance-cover-nursing-homes-a-comprehensive-guide

Long term care policies are expensive, but so is long term care. You are left with four choices for planning for that. Either save enough personal, out of pocket money to let you pay around $6000 a month until death (adjust for potential inflation) for a reasonably decent facility, buy a long term care policy, or plan on giving away all your possessions, including your house if you own one, to family members who will be in charge of your care so you'll qualify for medicaid to send you to some pretty grim facilities.

There's also the fourth option of moving in with your kids, but I don't personally recommend that option unless you've got a fantastic relationship with all your children and their spouses that guarantees they'll view your presence in their home as a blessing. I also don't recommend home care when severe dementia is involved. Physical frailties and a little bit batty, relatives can handle. The relentless needs of a paranoid, combative, fearful dementia patient can't be dealt with in a private home.

If you don't expect full blown dementia, just physical failing, and can reasonably expect your relatives to help with your care, then you'll still need enough money to pay for a maid and/or home help caregiver services. Also set aside money to pay for any modifications that need to be made in your home or children's home to accommodate your needs. 

Long term care policies can also cover home help (look for that provision.) So even if you go the route of moving in with kids, or staying in your own home, you might want to consider a policy that will pay for home help. A policy can also help alleviate the attitude that some parents (and their children) seem to get that estate assets need to be preserved for the children's "inheritance" instead of spent on expensive caregiver services. Raspberries to that idea. If you saved for retirement, the money is to take care of you in retirement -- even if that means spending every last penny on a nice caregiver to do your laundry, mop your floors and help you take a shower 

On a somewhat macabre "happy note". If you have life threatening health problems, your policy premiums will actually be cheaper than if you are otherwise healthy but likely to need extensive long term care because of ongoing physical or mental disabilities. This is the one time, when you are buying a medical policy, when you need to make every illness you put on the medical history sound as life threatening as possible. 🥴

Edited January 28, 2024 by Emily

[CV75]

On 1/26/2024 at 1:33 PM, Calm said:

I got a great person for the coverage plans.  We have everything except for a final decision on Part D I believe.

I want to know what comes after….the routine of how things are paid for, how prior authorizations are handled, how to keep the costs down for the expensive drugs, etc

My only experience with SSA and Medicare is for Mom and hers was relatively easy and yet I was one time 3 hours waiting on the phone to check to see if she was covered for something and several other times over an hour waiting….there has to be a better way,

I really messed up with Mom’s stuff because no one showed me the steps.  I thought premiums were automatic withdrawn and they weren’t.  And no one told me when asked over the phone because that was another department.

I have had too many experiences with government people giving us different directions for the same question.  I prefer to find out from people who are living it how it actually works.

I believe SHIPS would be able to address how the premium piece is paid, at least. Your providers (primary care physician, specialist, pharmacist, etc.) should be able to explain prior authorizations and cost options for the particular services and Rx you receive from them. How you are billed your share of the services/Rx received would have to some from those who have direct experience with it, but it will likely involve sharing the specifics of your particulate plan, set of plans, and services or Rx received.

[Calm]

2 hours ago, Emily said:

having your kids spend hours trying to explain to a paranoid dementia patient why she needs to sign the papers

I am going to try arrange it to get full time care.  Fun times planning for my own mental breakdown, yay!  My daughter and daughter in law both have fibromyalgia and additional issues and I don’t want to make them worse with added stress like what happened with me.  Here is hoping they solve the dementia issue before I get there, estimating probably have 15 years at minimum.  My mom and her mother were gentle, cheerful for the most part, hoping I will go that route….not quite accurate, I am actually hoping I will go Dad’s route, which is keep all my wits except for a bit of forgetfulness and then right before life gets too difficult, get a catastrophic illness so I am in a coma in 12 hours and then drift off quietly when the plug is pulled after everyone has a chance to say goodbye.  Dad always knew the most efficient way to get things done.  A little morbid here, but seriously looking at his medications it was obvious he had hit the max of what they could do for him, his doctor had chosen short term relief over long term endurance, I don’t think that doc knew what he was doing, rls wasn’t that well known back then nor was the side effects of the drugs. Since Dad detested being sick, I was very grateful for him he went as he did, though it was a disaster for Mom…and to be blunt, for me.

Thanks for the advice, Emily..  I need to hear this, need to be realistic even if hopeful.  Prepare for the worst, hope for not so bad.

Quote

On a somewhat macabre "happy note". If you have life threatening health problems, your policy premiums will actually be cheaper than if you are otherwise healthy but likely to need extensive long term care because of ongoing physical or mental disabilities. This is the one time, when you are buying a medical policy, when you need to make every illness you put on the medical history sound as life threatening as possible. 🥴

My husband is kind of pissed off his premiums are higher than mine.  I have never brought in income, so it’s all coming out of his pocket anyway, so I tell him just be glad I am saving money there because I make up for it elsewhere, lol.

We do need to save a good chunk of money because our daughter is unlikely to be able to ever work, it would take a miracle, but unless the economy collapses I think we have that covered.  Plus she has a very loving brother who has a very caring wife and he is doing quite well too, so we know she will be cared for no matter what, we don’t want her to feel like she is a burden and instead can contribute her share and more if she wants.

2 hours ago, Emily said:

Long term care policies can also cover home help (look for that provision.) So even if you go the route of moving in with kids, or staying in your own home, you might want to consider a policy that will pay for home help. A policy can also help alleviate the attitude that some parents (and their children) seem to get that estate assets need to be preserved for the children's "inheritance" instead of spent on expensive caregiver services. Raspberries to that idea. If you saved for retirement, the money is to take care of you in retirement -- even if that means spending every last penny on a nice caregiver to do your laundry, mop your floors and help you take a shower 

There is not an issue with going for a year to see what our income is really going to be after retirement and the costs of insurance, drugs etc before taking the next step of longterm care, right?  Iirc, long term care is part of the package we are getting, but just in case I start thinking I want more (once we see how the investment side is handled, what actual income comes from that plus SS….and how much we really need.  

We do need a master bath renovation out in as they ran out of money when they built the house and it never got a tub and I need a good size one big time these days plus it will improve resell value.  A couple of other things we will likely do to the house just to update it too.  And my husband wants to get chickens….???  I love me some eggs, but don’t need them fresh out of the ummm…..hen, yeah, that is what I was going to say all along.

I am not as nervous as I was.  As long as I don’t start worrying we have been scammed (we haven’t, they have a good reputation), but my paranoia strikes deep….Thanks everyone for joining the discussion.  I almost feel sane when discussing with mostly reasonable people like all of you.   

Edited January 28, 2024 by Calm

[Tacenda]

9 hours ago, Emily said:

You triggered a host of reactions with this one, none of them good. So I'll just say in advance, thank you for taking the time to take care of these things now instead of putting them off until they fall into someone else's lap. 👍

If you haven't already done it, look into appointing a social security representative payee. It would be nice to do it in advance rather than having your kids spend hours trying to explain to a paranoid dementia patient why she needs to sign the papers (...for every !#x@$! important financial need in her life that she said was taken care of and was not...)

Advance Designation Instructions:

https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.ssa.gov/payee/advance_designation.htm%23:~:text%3DAdvance%20Designation%20of%20Representative%20Payee,if%20the%20need%20ever%20arises.&ved=2ahUKEwiUw4q8h4CEAxVKJEQIHcCRBfgQFnoECAwQBQ&usg=AOvVaw3SOO3h2a1ed3b2_hqCM-N7

If you really think there's a high chance you'll end up with dementia, look into a "long term care supplement" policy -- but don't use the word "dementia" as one of your reasons for looking into them.

Medicare doesn't cover nursing home expenses other than for short-term recovery time after hospitalization, or a few weeks of "respite" when someone is approaching death. And medicaid only covers it if you are destitute and would likely die of neglect if left alone in your home. 

More Information on Long Term Care Policies and Why They are Needed

https://www.medicare.gov/what-medicare-covers/what-part-a-covers/how-can-i-pay-for-nursing-home-care

https://www.ncoa.org/article/does-long-term-care-insurance-cover-nursing-homes-a-comprehensive-guide

Long term care policies are expensive, but so is long term care. You are left with four choices for planning for that. Either save enough personal, out of pocket money to let you pay around $6000 a month until death (adjust for potential inflation) for a reasonably decent facility, buy a long term care policy, or plan on giving away all your possessions, including your house if you own one, to family members who will be in charge of your care so you'll qualify for medicaid to send you to some pretty grim facilities.

There's also the fourth option of moving in with your kids, but I don't personally recommend that option unless you've got a fantastic relationship with all your children and their spouses that guarantees they'll view your presence in their home as a blessing. I also don't recommend home care when severe dementia is involved. Physical frailties and a little bit batty, relatives can handle. The relentless needs of a paranoid, combative, fearful dementia patient can't be dealt with in a private home.

If you don't expect full blown dementia, just physical failing, and can reasonably expect your relatives to help with your care, then you'll still need enough money to pay for a maid and/or home help caregiver services. Also set aside money to pay for any modifications that need to be made in your home or children's home to accommodate your needs. 

Long term care policies can also cover home help (look for that provision.) So even if you go the route of moving in with kids, or staying in your own home, you might want to consider a policy that will pay for home help. A policy can also help alleviate the attitude that some parents (and their children) seem to get that estate assets need to be preserved for the children's "inheritance" instead of spent on expensive caregiver services. Raspberries to that idea. If you saved for retirement, the money is to take care of you in retirement -- even if that means spending every last penny on a nice caregiver to do your laundry, mop your floors and help you take a shower 

On a somewhat macabre "happy note". If you have life threatening health problems, your policy premiums will actually be cheaper than if you are otherwise healthy but likely to need extensive long term care because of ongoing physical or mental disabilities. This is the one time, when you are buying a medical policy, when you need to make every illness you put on the medical history sound as life threatening as possible. 🥴

Might I add to this, to never get a test to see if you might have Alzheimer's/dementia before applying for long term insurance. I made that mistake even after a family friend mentioned to not do it. I only did it because I'm using CBD/THC oil to prevent Alzheimer's along with treatment for hypothyroidism. Wanted a record of my getting tested in case I was in trouble for using THC. Now I need only get a medical card which I think I might be able to get. But by getting that testing done, I was denied a certain long term insurance plan. But second time looking into it the person I contacted was grateful I told her ahead of time that I had been denied in the past because of getting that done. I applied a second time because I wondered if there was something out there for me. And there is, it's different and probably not as good, but haven't decided yet and have lost contact. 

But thanks for these links you've shared, I don't want to burden my family with worrying about things as you've described.

[Tacenda]

I watched this video and believe it can be very helpful for children of aging parents, or even the parents that want to put into place provisions for themselves as well. This person has a 30 hour free course to watch as well (hopefully she's not trying to sell something, I haven't watched yet). But what she said on the video may come in handy for some. 

 

[pogi]

On 1/26/2024 at 7:40 PM, Calm said:

So how does GoodRX work?  I look up my drug, print off a coupon and bring it with me or something else?

Yep, that's how it works.   You can also show them the coupon on your phone instead of printing it off - save a little on paper and ink.