Aging Solutions Newsletter

September 2006

Caregiver Tip of the Month

— Medicare's Prescription Drug "Doughnut Hole" —

If your loved one's Medicare Part D Prescription Drug Plan is like most plans, it has what has been called a "doughnut hole" right in the middle of its benefits. That is, after the total cost of their prescription drugs reaches $2,250 during any one year, Medicare pays nothing more during that year until your loved one has spent a total of $3,600 out-of-pocket. The $3,600 includes the annual deductible and coinsurance payments.

Important Note: The $2,250 amount is the TOTAL cost of your loved one's prescription drugs. That includes what Medicare pays and your loved one's out-of-pocket expenses.

After your loved one has spent $3,600 during a year, Medicare's catastrophic protection will kick in for the rest of the year. During this time, your loved one's co-pay will be $5 per prescription, or 5% of their prescription's cost, whichever is higher.

How does this all work? Say, for example, that your loved one's prescription drug costs (Medicare's share plus their share) total $500 a month, their annual deductible is $250, and their coinsurance amount is 25%. Here how their out-of-pocket costs work out, month-by-month.

	Total Cost	Their Share	Their Total Out-of-Pocket
Month 1	$500.00	$312.50	$312.50
Month 2	$500.00	$125.00	$437.50
Month 3	$500.00	$125.00	$562.50
Month 4	$500.00	$125.00	$687.50
Month 5	$500.00	$312.50	$1,000.00
Month 6	$500.00	$500.00	$1,500.00
Month 7	$500.00	$500.00	$2,000.00
Month 8	$500.00	$500.00	$2,500.00
Month 9	$500.00	$500.00	$3,000.00
Month 10	$500.00	$500.00	$3,500.00
Month 11	$500.00	$120.00	$3,620.00
Month 12	$500.00	$25.00	$3,645.00

Important Note #2: The $3,600 out-of-pocket expense before Medicare's catastrophic coverage begins is a huge amount for most seniors. As a result, they may be tempted to use a discount prescription drug card or buy their prescriptions from Canadian pharmacies after Medicare temporarily stops paying because they have entered the doughnut hole.

This would be a huge mistake. The only prescription drug expenses that Medicare will use in filling the $3,600 doughnut hole are for prescriptions purchased through your loved one's Part D prescription drug plan. Anything that he or she purchases through a prescription discount card or from a Canadian pharmacy won't count.

Important Note #3: These amounts apply only to calendar year 2006. They will be increased for inflation on January 1st each year.

Our visitors ask ...

Q. My father lives on one side of our state and I live on the other. He has been living in a nice apartment there, but is reaching the point of not being able to safely cook and care for himself. His memory loss has reached the level where he is able to communicate only about 25% of his needs. He is still able to walk outside and use the bathroom without any issues. He is on no medications and, except for his mind, is in very good health at 79. His monthly payment from Social Security is very low (around $600) and his assets are next to nothing. My mother passed 5 years ago and I am the only relative within a thousand miles.

I would like to move my father into a facility near where I live, for the weekly drive with my work is very tiring. I do not know what type of help and facilities are in the city where I live so I would appreciate any information on whom to contact for help.

A. Unfortunately, your father's income is too low to pay for a room in an assisted living facility, probably the most appropriate type of residence for him at this point in time. And, neither Medicare nor Medicaid will pay any assisted living expenses. So, unless you can pay the portion of the assisted living expenses that your father cannot pay, assisted living will have to be ruled out.

Your father might qualify for some type of assistance that would allow him to remain in his apartment without using his stove. For example, Meals on Wheels could be delivered. Local agencies provide low cost, hot, nourishing meals to elderly and disabled persons, allowing them to remain in their own homes. To find a local Meals on Wheels program near your father, call the toll-free ElderCare Locator number at 1-800-677-1116, weekdays from 9am to 8pm, Eastern time.

Developed by the U.S. Administration on Aging, the Eldercare Locator is a free public service. It helps older people and their caregivers find a wide range of local support services to help them live independently and safely in their homes and communities for as long as possible.

Millions of older adults are eligible for federal and state benefits, but are not receiving them, including assistance to pay Part B and Part D premiums for Medicare benefits. This is unfortunate because these programs can help with housing, meals, transportation, health care, prescription drug costs, legal services and utility bills, just to name a few.

Benefits CheckUp is a service of the National Council on the Aging, a non-profit organization. It helps older adults quickly and easily find out which benefits they qualify for, and how to get them (many are available regardless of income). This is a free service and is completely confidential. It does not require their name, address, phone number, Social Security number, or any other information that could be used to identify them.

Simply complete the online questionnaire. In a few minutes, you'll have a list of programs for which your father most likely qualifies, including phone numbers and addresses. It also includes step-by-step instructions on how to apply for the benefits. To visit Benefits CheckUp, click on http://www.benefitscheckup.org/.

Daily Living Solutions

— products for seniors —

As we grow older, it often becomes difficult to use many everyday products because of arthritis and other conditions. If you or a loved one needs a little help – or a lot – we've selected a group of practical and affordable solutions from our affiliated merchants to help overcome those limitations.

Whether you are looking for yourself, or to help an elderly senior continue living in their own home, you'll find a wide variety of supplies and accessories – raised toilet seats, safety rails, incontinence supplies, large-handle eating utensils, pain relief, diabetic supplies, pill splitters and crushers, big-button telephones, canes, walkers, rollators, wheelchairs – and much more.

Everything is sorted into convenient categories in our Solutions for Seniors section.

Caregiving – Finding the money for care at home

A variety of resources can help pay for care at home. We discuss these resources in some detail in our article 12 tips to help you find money (and free resources) for care at home.

Caregiver Tip #2

— Social Security and Medicare —

Your Power of Attorney Means Nothing to Them

The Social Security/Medicare roadblock shows up out of the blue, usually at a time when we have our hands full trying to solve a multitude of other problems ... and we don't need one more source of frustration added to the stack we are already dealing with.

On the other hand, identity theft and other types of financial fraud against the elderly has become very prevalent. It is not as difficult as we would like to believe for a complete stranger to convince an elderly person to give them their Durable Power of Attorney. And, if Social Security's safeguards were not in place, it would be easy for a thief to change an elderly person's address and cash their monthly benefit checks, or to change the bank designated to receive their monthly automated deposits.

It is Social Security's and Medicare's primary responsibility to protect their benefits from any form of abuse. After all, these safety nets are the only benefits that many elderly people receive. As a result, both Social Security and Medicare have become extremely cautious in making any change to a elderly person's account. The fact that Social Security's and Medicare's safeguards make it inconvenient for adult children to handle their parents' financial affairs is of only secondary importance ... as it should be.

To overcome this problem, Social Security has instituted a Representative Payee Program. To quote their website,

"Social Security's Representative Payment Program provides financial management for the Social Security and SSI payments of our beneficiaries who are incapable of managing their Social Security or SSI payments. Generally, we look for family or friends to serve in this capacity."

(Because Medicare and Social Security are tied so closely together, Social Security maintains all addresses for both agencies.) For more information from Social Security, including how to apply to become a Representative Payee, click on Representative Payee Program.