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Planning for Health Care

Health Insurance Definitions

Rosemary K. Heins, Extension Educator — Family Resource Management

It is not fun to have an illness and some people feel ill just trying to make sense of the words used by the insurance industry. Consumers need to understand insurance terms to be smarter about their health insurance dollars. Let’s review four of the terms: premium, co-payment, co-insurance and deductible.

Premium is the amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.

Co-payment is a fixed amount, for example $15, you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service and some services, based on the plan, may not have a co-payment.

Co-insurance is your share of the costs of a covered health care service, calculated as a percent of the allowed amount for the service. For example, if your co-insurance rate is 30% and a procedure costs $1,000, the insurer will pay $700 and you will owe $300.

A final term, deductible, is the amount you owe for health care services before your health insurance plan starts to pay within a calendar year. Certain health care services are subject to a deductible and others may not be. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services. Each calendar year the deductible amount will need to be met before the insurance pays.

Insurance terms can be confusing. And I’ve only reviewed four of the many that would be in a good health insurance glossary. The message is if you don’t understand a term, ask questions, to be an informed consumer.

For answers to your health insurance questions, go to https://ask.extension.org/groups/1790

Considerations in Choosing a Health Insurance Plan

Rosemary K. Heins, Extension Educator — Family Resource Management

November 2013.

Comparison shopping can save you dollars; this is even more important in looking at the various health insurance plans to choose from. However, good comparison shopping for health insurance begins with truly taking a look at your households' health care needs.

Start by doing an inventory of how you use or may use health care services. Do you expect a lot of doctor visits? How many prescriptions do you need to fill regularly? Do you see any specialists? Is there a chronic disease you are managing? Do you anticipate in any health care changes in the coming year, like for having a child or a child turning 27?

You also need to determine costs that include the monthly premium and how much you have to pay out-of-pocket for services when you get care. Health care plans available through the health insurance marketplaces are put into categories based on the percentage of cost you are willing to take on. The lower the premium, the higher the out-of-pocket costs when you need care. The higher the premium, the lower the out-of-pocket costs when you need care.

Another factor to consider is the possibility that because your income is lower, you are eligible for tax credits. These are potentially available by selecting a health care plan made available through the health insurance marketplace. In Minnesota this is called MNsure. For more information you can go to the MNsure website or call 1-855-366-7873.

The bottom line is that you need to balance affordability with coverage. That begins by looking at the total picture of your households' health care needs.

Source

MNsure.org

HIPAA and Health Care Privacy

Rosemary K. Heins, Extension Educator — Family Resource Management

September 2013

HIPAA, commonly pronounced like the word for a large African animal — hippo — relates to medical information privacy. The acronym actually stands for Health Insurance Portability and Accountability Act of 1996. It guides health care providers in determining who they can share your information with.

A health care provider or health plan may share relevant information with family members or friends involved in your health care or payment for your health, if you tell the provider or plan that it can do so, or if you do not object to sharing of the information. An example would be, if you do not object, your doctor could talk with the friend who is with you at the hospital or the family member who pays your medical bill.

A provider or plan may also share relevant information with family or friends if, using professional judgment it believes you do not object. For example, if you send your friend to pick up a prescription for you, the pharmacist can assume you do not object to their being given the medication. Or when you are injured and cannot give your permission, a provider may share information with family or a friend with you since doing so would be in your best interest.

These are simple examples but recognize that HIPAA is a law that health care providers are required to follow. It is part of your privacy rights over health information, including getting a copy of your information, making sure it’s correct and knowing who has seen it.

Source

U.S. Department of Health and Human Services, A Patient’s Guide to the HIPAA Privacy Rule: When Health Care Providers May Communicate About You with Your Family, Friends, or Others Involved In Your Care, retrieved from http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/consumer_ffg.pdf

Caregiving Crisis Financial Management Basics

Rosemary K. Heins, Extension Educator — Family Resource Management

September 2013.

Often one of the tasks family caregivers suddenly face is managing a family elders’ finances, if there is an accident or illness. It adds additional anxiety to an already emotional time.

Pre-planning and have all financial and legal paperwork in one location is ideal but if this has not been done, it’s the place to start. Among these papers should be health care insurance information which needs to be reviewed. This includes Medicare and Medicaid, if they eligible.

If your ill parents are mentally competent, at a minimum, urge them to act immediately to:

  • Write or update their will
  • Legally designate a durable power of attorney for finances
  • Designate a health-care proxy or power of attorney for health care while stating their preferences in an advance directive for medical care. An advance directive states their preferences for medical treatment in the event they are unable to speak for themselves. Information on completing a Minnesota Health Care Directive is available from the Extension website within the Family section, under Planning for Health Care. http://www.extension.umn.edu/family/personal-finance/planning-for-health-care/mn-health-care-directive/

If you will be handling their financial affairs, get their written permission for you to access their medical information and records as well as their account information from financial institutions, credit card companies and investment companies.

Finally, respect your family elders’ rights to stay in control of their money and lives for as long as possible. Showing mutual respect helps keep the lines of communication open.

Sources

Stum, Marlene, The Minnesota Health Care Directive, University of Minnesota Extension, retrieve at http://www.extension.umn.edu/family/personal-finance/planning-for-health-care/mn-health-care-directive/

Swanson, P.C., Schindler, N. and Tran, T.T., (December 2009) Getting Organized: Bill Paying and Record Keeping, University of California Agriculture and Natural Resources Publication 8381, retrieve at http://anrcatalog.ucdavis.edu/pdf/8381.pdf

Financial Caregiving Goals

Rosemary K. Heins, Extension Educator — Family Resource Management

September 2013.

Adult children often do not know much about their parents’ financial situation. This can be a big problem if there is a sudden change in their health and they are no longer able to handle their own monetary affairs.

Advance planning helps a family avoid crisis decision-making, increases the parents’ future options, saves money, reduces sibling disagreements and lessens the possibility of needing to take court action in order to manage a parents’ financial affairs. It can also provide parents and children with peace of mind. The parental peace of mind comes from knowing their wishes are understood and will be carried out.
There are two goals important to caregivers that advance planning achieves. Through planning, caregivers are prepared for an emergency by knowing where to find the parent’s important financial and legal documents. The second goal is that through advance planning parents are encouraged to prepare financial and legal tools, such as durable power of attorney for financial decisions and for medical decisions.
If your parents are healthy and independent, children don’t need to know the specifics of their financial situation. The top priority is to share where parents keep their financial records and what do they want done in an emergency situation. As you learn more about their financial situation, you may not like or agree with their choices. However, remember it is their money and they have a right to make their own financial and estate-planning decisions. Encourage your family elder to seek advice from a qualified professional such as an attorney, accountant, or financial planner.

If your family hasn’t already had this conversation with parents, now could be the best time to start.

Source:

Swanson, P.C., Schindler, N., Tran,T. (December 2009), Introduction to Financial Caregiving and Glossary, University of California Agriculture and Natural Resources, retrieved from http://anrcatalog.ucdavis.edu/pdf/8379.pdf.

Minnesota Health Care Directive

Rosemary K. Heins, Extension Educator — Family Resource Management

Reviewed June 2013 by the author.

None of us can predict our future. One step for planning ahead though is to complete a health care directive, sometimes labeled a living will or durable power of attorney for health care.

Adults have the right to control their own medical care by consenting to or refusing medical treatment. Patients have the right to understand health problems, care options, and the effects of accepting or rejecting treatments.

Sometimes decisions must be made when a person isn’t able to decide or communicate preferences. Putting your wishes in writing helps make sure they’ll be known if family, friends, or health care providers need to make a care decision.

How do you put together a health care directive? First, obtain a copy of the Minnesota Health Care Directive form. This can be accessed from a medical clinic office or online.

On Part I, you can appoint someone, called an agent, to make health decisions for you if you become unable to make or communicate health care decisions.

On Part II, you can leave written instructions that can include your health care goals, fears and concerns. You include what you want as well as what you don’t want. You can also state limits of the powers you want your agent to have.

To make it legal, sign and date it. Then have the document witnessed by a notary public or two people, neither of whom is the person you are appointing to make your health care decisions.

Finally share a copy of the directive with the person you’re appointing and your health care providers. For more information and forms to complete, contact your health care provider or print them off the internet. A link to the form is available from the University of Minnesota Extension website at www.extension.umn.edu.

Source

Stum, M. S. (2011, January). The Minnesota health care directive. St. Paul, MN: University of Minnesota Extension.

Dollar Value of Caregivers

Rosemary K. Heins, Extension Educator — Family Resource Management

Reviewed June 2013 by the author.

Unpaid caregivers provide by far the majority of long-term services and supports received by persons with disabilities of all ages. The economic value of family caregiving was estimated at $450 billion in 2009 by the AARP Public Policy Institute.

When this estimate was made, caregivers provided an average of 18.4 hours of care per week, or over 950 hours per year. When one looks at these numbers, you realize that this is a half-time job without pay.

What does $450 billion mean? In a more meaningful context this means more than $1,500 for every person in the United States.

Unpaid caregiving is a part of the ‘informal economy’. This has financial consequences for caregivers. Among them may be a decision to cut work hours to part-time, declining promotions because of longer hours or passing up training opportunities requiring travel.

There are subtle financial consequences, too. Among them are lost opportunities for compound returns on 401(k) matching contributions, and a reduction in savings and investments.

The Women’s Institute for a Secure Retirement has an online publication, "Caregivers: Care for Yourself While Caring for Others." The website for access is www.wiserwomen.org. It’s a good resource for caregivers, women or men, to help work through some of the financial decisions of caregiving.

Source

The Women’s Institute for a Secure Retirement (WISER). (n.d.). Caregivers: Care for yourself while caring for others. Washington, D.C.: The Caregivers: Care for Yourself While Caring for Others (WISER).

Supporting Caregivers

Rosemary K. Heins, Extension Educator — Family Resource Management

Reviewed June 2013 by the author.

Family caregiving often starts with running errands and helping shop or manage legal and financial affairs. It sometimes escalates into more complex and intimate tasks if the health of the person needing care declines.

People needing caregiving are all ages. Nationwide, 53% or 6.4 million of all individuals who need long-term care are adults 65 and older, 44% or 5.3 million are 18 to 64, and 3 percent or 400,000 are children under age 18.

Caregivers need support. Fortunately resources are available from individuals, employers and communities. People may become overwhelmed when trying to obtain information and arrange for services. Here are some ideas of what individuals can do to help caregivers.

  • Volunteer to help family caregivers through organizations that reach out them, such as hospice, church or inter-faith respite care programs and other community groups.
  • One can also contact the Area Agency on Aging and inquire about other opportunities for supporting caregivers.
  • And we can offer companionship to family caregivers or help them network with others to find resources and support one another.

Caregiving is what families and friends do to help. Find more information on programs, such as Powerful Tools for Caregivers, at the Healthy Aging Minnesota website [no longer active]. These resources will provide education and support.

Affordable Health Care Act and COBRA

Rosemary K. Heins, Extension Educator — Family Resource Management

July 2013.

“Consolidated Omnibus Budget Reconciliation Act” sure doesn’t sound like it has anything to do with health care. But it’s commonly known as COBRA. It means employees have rights to continue health care coverage for 18 months after a job loss, reduced work hours, death, divorce and other life events.

If someone is using COBRA for health care coverage, how does the Affordable Health Care Act Marketplace option affect them once it goes into effect January 2014? In Minnesota, the Marketplace is called MNsure and will be open for residents to shop in October 2013.

According to information on the HealthCare.gov website, people with COBRA coverage can switch to a marketplace health insurance any time. Losing your COBRA coverage will qualify you to buy health insurance in the marketplace, even if it’s not during open enrollment. This is true whether the coverage runs out or you choose to end it. At any time during the year you will be able to visit the marketplace to find your options, compare plans, and enroll.

When you get health insurance through the marketplace, you may qualify for lower costs on the monthly premiums or out-of-pocket costs based on your income. This is not the case with COBRA coverage or insurance you buy outside of the marketplace.

For more information on the upcoming changes in health insurance coverage, seek out the HealthCare.gov website and/or the MNsure websites. At the MNsure site, health plans will be laid out in an "apples-to-apples" comparison style and will be rated by quality measures. You will be able to compare plans and select the one that's right for you.

Sources

United States Centers for Medicare & Medicaid Services. (n.d.) What if I currently have COBRA coverage? Washington, D.C.: United States Centers for Medicare & Medicaid Services.

Minnesota Management and Budget. (n.d.). MNsure. St. Paul, MN: Minnesota Management and Budget.

No one really plans to get sick or experience a health-related family crisis. Long term planning can help ensure that you and your family have the resources needed to cover costs and other needs related to health-related care. If you plan for financing long term care, you will also have more options about the type of care you and your loved ones receive. A good first step is to write down your wishes for your health-related care in a health care directive.

If you suddenly find yourself in a caretaker role for someone you love, you most likely will be faced with lots of questions and tasks that need to be accomplished. It helps to have access to additional resources, tools, and insight from other families going through the same situation.

The following resources will help you better manage medical debt through long term planning, create a health care directive, and more.

Health Insurance Definitions — Consumers need to understand insurance terms to be smarter about their health insurance dollars. Transcript and audio (2:06)

Considerations in Choosing a Health Insurance Plan — Comparison shopping can save you dollars; this is even more important in looking at the various health insurance plans to choose from. Transcript and audio (1:58)

Financing Long Term Care: A Resource Center for Families — Information, tools, and more to help you start planning for long term care.

Critical Conversations About Financing Long Term Care Online Course — Free online course to help you identify and communicate strategies to manage the risk of long term care.

Critical Conversations About Financing Long Term Care Workshop — Arrange for us to come and teach on this important topic. Excellent resource for employee groups, community organizations, and more.

Across Generations: The MN Health Care Directive — Who Needs One? — An introduction to health care directives, and an important tool to can help you plan ahead for health care decisions.

The Minnesota Health Care Directive — Planning tool to help you get the best end of life care.

Minnesota Health Care Directive — One step for planning ahead though is to complete a health care directive, sometimes labeled a living will or durable power of attorney for health care. Transcript and audio (1:57)

Health Care Directives Workshop — Arrange for us to come and teach on this important topic. Excellent resource for employee groups, community organizations, and more.

HIPAA and Health Care Privacy — The Health Insurance Portability and Accountability Act of 1996 guides health care providers in determining who they can share your information with. Transcript and audio (1:46)

Caregiving Crisis Financial Management Basics — Often one of the tasks family caregivers suddenly face is managing a family elders' finances, if there is an accident or illness. It adds additional anxiety to an already emotional time. Transcript and audio (1:47)

Affordable Health Care Act and COBRA — If you are on COBRA, find out how the Affordable Health Care Act will help you. Transcript and audio (1:57)

Dollar Value of Caregivers — Unpaid caregivers provide by far the majority of long-term services and supports received by persons with disabilities of all ages. Transcript and audio (1:59)

Supporting Caregivers — Family caregiving often starts with running errands managing legal and financial affairs, but it can escalate into more complex and intimate tasks if the health of the person needing care declines. Transcript and audio (1:54)

Dealing with Medical Debt — Helpful advice about dealing with medical debt. Transcript and audio (1:36)

Other Recommended Resources

Across Generations: Dealing with Life Transitions — Advice on how to evaluate, set goals, and share your plans with others.

Are Consumers Vulnerable to Low-Knowledge of Long Term Care? — Journal article that reviews consumers' knowledge of long-term care. Written by Amanda E. Matzek and UMN Extension Specialist, Marlene S. Stum; featured in Family & Consumer Sciences Research Journal.

National Institute on AgingNational Institute of Health —  This organization leads a broad scientific effort to understand the nature of aging and extend the healthy, active years of life.

End of Life: Helping with Comfort and CareNational Institute on Aging — Online guide that discusses key issues that occur at the end of life.

American Society on Aging — Develops leadership, knowledge, and skills to address the challenges and opportunities of adverse aging society.

Gerontological Society of America — Promotes and shares research on aging as well as supports aging education and training.

Use Your Home to Stay at HomeNational Council on Aging — This is the official reverse mortgage consumer booklet approved by the U.S. Department of Housing & Urban Development.

Consumer ResourcesThe National Center for Assisted Living — Get guides for selecting or moving into an assisted living residence.

Assisted Living StudiesThe National Center for Assisted Living — Find studies on assisted living and residential care facilities, including costs, Medicaid reimbursement, and more.

Caregiving Resource CenterAARP — Provides information, tips, and tools to caregivers.

Caregiver Information from MedicareUnited States Department of Health and Human Services — Get detailed information on Medicare, care options, support for caregivers, and more.

Financing Long Term Care: Insurance & It’s AlternativesUtah State University Cooperative Extension — Reviews long term care options, costs, insurance, and other resources.

Hiring and Working Successfully With In-Home Care ProvidersPacific Northwest Extension — Comprehensive guide to learn about in-home care services, how to develop a profile of care needs, how to screen and find the right person, and more.

National Association of Professional Geriatric Care Managers (NAPGCM) Helps connect families with an experienced and trained care manager.

LongTermCare.govUnited States Department of Health and Human Services — Online resource center reviews the basics, different plan options, how you decide, and more.

Administration on AgingUnited States Department of Health and Human Services — Find local programs, check for benefits, find online resources, and more.

Guide to Long Term Care InsuranceAmerica’s Health Insurance Plans — Online resources like a Guide to Long-Term Care Insurance, and articles on who buys long-term care insurance.

The IssuesAmerica's Health Insurance Plans — Offers background and resources on current health insurance-related issues, like the Affordable Care Act, rising health care costs, health care quality, and more.

State of the States Survey 2011: State Aging and Disability Agencies in Times of ChangeNational Association of States United for Aging and Disabilities — Comprehensive report updates the 2009 survey, and includes state-by-state information on programs offered, funding, staffing, and more.

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