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Health Care for Elders in Your Home

By Kelli Kirwan for LIFELines

Generations are beginning to shift positions in our society. Baby boomers are reaching retirement and Social Security age. The parents of the 1950's are researching in-home health care or senior living facilities. Many families are blending extended families as a way to stay connected, financially support one another, and physically care for their elders.

Many of our parents and grandparents live long, happy, healthy lives, but few escape the winter years of their life without some health problems such as illness and degenerative diseases. If you and your family are considering bringing a parent or grandparent to your home as a dependent, make sure you have all the facts so the transition and the future go as smoothly as possible. Be health-care savvy and know what your options are.

What Does TRICARE Cover?
The answer is "Nothing." Parents and grandparents are considered secondary dependents. This means they have all the benefits of being a military dependent except one — they are not eligible for enrollment in the TRICARE system. They may be seen at a military hospital or clinic if Space A (space available) care is offered, but even then the slots allotted for Space A are so few that its almost impossible to be seen for regular health care. In addition, Space A is not available at all military installations. Your alternatives are Medicare , Medicaid, and other supplemental health insurance.

Medicare Eligibility
There are simple guidelines to see if your family members are Medicare eligible and can receive Part A without having to pay premiums:

  • You are already receiving retirement benefits from Social Security or the railroad retirement board. That means you or your spouse must have worked for 10 years paying into Social Security and be age 65 or older. You do not have to be receiving the Social Security or railroad benefits; you just have to be eligible.

If you are under 65, you may still be eligible to receive Part A benefits of Medicare if you meet the following criteria:

  • You must be disabled and have been receiving disability for at least two years.
  • You must have end-stage renal disease (permanent kidney failure) and be on dialysis or be a kidney-transplant patient.

    What Does Medicare Cover?
    Medicare pays 80 percent after you have met your deductibles. Medicare is split into two parts. Part A covers in-patient services in hospitals and some nursing facilities and has an $812 deductible per benefit period. Part B covers doctors services and has a $100 deductible per calendar year.

    Part B also covers some occupational and physical therapies as well as nebulizers and external effusion pumps. There is some additional durable medical equipment that Medicare helps cover, such as canes, crutches, walkers, seat lifts, diabetic equipment, wheelchairs, and hospital beds. It also covers eyeglasses after each cataract surgery.

    What's Not Covered?
    Medicare does not cover prescription drugs. This can be a very costly part of health care, especially for older family members. Unfortunately, because secondary dependents are not eligible for TRICARE, they cannot have their prescriptions filled at military facilities.

    Because only 80 percent of your medical charges are covered, that leaves 20 percent to pay out of pocket in addition to any deductibles and co-payments.

    How Can You Cover the Financial Gaps in Medicare?
    Educate yourself on the various state and federal programs that supplement Medicare that your parent or grandparent may be eligible for. Follow legislation that can effect changes to Medicare benefits. With solid information on how the system works and what your family member is entitled to, you can make sound decisions on the different supplemental programs that are out there.

    Medicaid
    Medicaid is a joint federal and state program that helps individuals with limited resources. It can also help cover some nursing-home care. Eligibility varies from state to state, so with each move into another state you have to reapply.

    Supplemental Insurance
    Supplemental insurance is additional coverage you can purchase. Just as with any insurance, you need to shop around and educate yourself on the world of medical insurance, supplements, HMOs and PPOs so that you and your family member can make the best decision. You can purchase plans that typically cover everything that Medicare does not. Insurance companies such as Physicians Mutual can help cover prescription costs, co-pays, and deductibles. Out-of-pocket costs will depend on a number of variables such as location, age, and the type and extent of coverage.

    HMO vs. PPO
    An HMO is a health maintenance organization as opposed to a PPO, or preferred provider organization. Companies such as Secure Horizons offer both options. They suggest that individuals on a fixed income would benefit more from their HMO. HMOs use a selected network of doctors and facilities. To get specialist care, you must have referrals from the primary care manager. There are often low or no premiums. The PPO allows you to go to any doctor or hospital, but has a higher premium cost.

    Availability of Supplemental Insurance
    You must be sure to ask about the transferability of any additional insurance you purchase. Military life dictates frequent moves, and you need to be aware of any lapse in insurance coverage or the need to reapply. Secure Horizons, for instance, is only available in Arizona, California, Colorado, Nevada, Oklahoma, Oregon, Texas, and Washington. Physicians Mutual is typically available nationwide; however, if you're transferring overseas you may need to find other coverage.

    Healthy Lifestyle
    In addition to researching health insurance, take a few moments to discover senior programs that are offered in your area. Senior centers, the YMCA , YWCA , and fitness centers usually offer exercise programs for older people. Aquatic classes, yoga, and walking groups are all examples of safe exercise, and they have an added benefit — they help older people create a social network. Wellness of both mind and body can mean a big improvement in quality of life for families.

    The world of health insurance can be confusing and overwhelming, but with determination, good note taking, and family meetings, you can ensure that your loved ones are financially covered and have every opportunity to live a healthy life.


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