ESTATE PLANNING

If anything positive could come out of the tragic situation involving Terri Schiavo, it is that many more Americans are pursuing various documents such as "living wills", health care proxies, trust, and wills. The following are frequently asked questions about obtaining a health care proxy in Massachusetts.

WHAT IS A HEALTH CARE PROXY?

A health care proxy document is a written instruction by a person, referred to as the Principal, who appoints a health care Agent, or Proxy Agent, to make medical or health decisions when the Principal is incapacitated and unable to make or communicate such decisions. Under a durable power of attorney, your Agent is authorized to make business and financial decisions for you in accordance with your wishes. This person cannot, however, make decisions about your health or health care. You must make a separate authorization in a health care proxy document. Your health care Agent could be the same person you have named as your Agent in your durable power of attorney document, or, you could name a different person, based on different factors that do not involve financial matters.

Health Care Proxy forms are available at the PCOA.

WHAT IS A LIVING WILL?
 

How is it different than a health care proxy?

In a "living will" document, a person spells out wishes for specific situations. However, "living will" is not legally binding in Massachusetts, and is not generally recommended because they may not cover specific situations that may occur.

WHO SHOULD HAVE A HEALTH CARE PROXY?

Anyone over the age of 18 should have a health care proxy as tragedy can strike at any age.

HOW DO I GET A HEALTH CARE PROXY?

A health care proxy document must be in writing and must be witnessed by two people. Once signed, it is important to give a copy to every doctor who treats you, your Proxy agent, keep a copy with your medical records, in your "yellow dot" package if you have a yellow dot, and keep a copy with you. You might also wish give a copy to all immediate family members, or other people medical staff might contact. You can obtain copies of a health care proxy document at the Council on Aging, or also at the following website from the Massachusetts Medical Society. www.healthcareproxy.org

WHAT HAPPENS IF I DON'T HAVE A HEALTH CARE PROXY?

If you become unable to communicate, it may be necessary for family members, caregivers, or friends to file a petition with the Probate Court in order to have a legal guardian appointed to make medical decisions.

WHAT HAPPENS IF I DECIDE TO CHANGE MY AGENT?

A health care proxy can be revoked at any time. You would simply fill out a new health care proxy document and redistribute the updated form.

Remember, if you appoint a health care proxy, the Agent will only be able to act on your behalf if and when you are unable to communicate your wishes. It is very important to discuss your wishes and beliefs with your Agent so that if needed, he or she can make medical decisions based on your wishes.

DIABETES SCREENING

Medicare will pay for diabetes screening tests for the purpose of early detection for persons at risk for diabetes. Since these are clinical laboratory tests, the beneficiary will not be responsible for a deductible or coinsurance.

The screening includes:

• Fasting glucose test; and
• Other tests that may be deemed appropriate after
  consulting with appropriate organizations

A person is at risk if they have any of the following risk factors:

• High blood pressure or high cholesterol
• Obesity
• Previously elevated impaired fasting glucose
  or previously impaired glucose tolerance

At least two of the following characteristics:

• Overweight
• Family history of diabetes
• History of gestational diabetes,
  or delivery of a baby over 9 pounds
• 65 years of age or older

MEDICARE INTERNET SITE

You may use My Medicare to:
    * View claim status (excluding Part D claims),
    * Order a duplicate Medicare Summary Notice (MSN) or replacement Medicare card,
    * View eligibility, entitlement and preventive services information,
    * View enrollment information including prescription drug plans,
    * View or modify your drug list and pharmacy information,
    * View address of record with Medicare and Part B deductible status, and
    * Access online forms, publications and messages sent to you by CMS.

    

In order to use this service, you must be a registered user.

MEDICARE PRESCRIPTION DRUG "EXTRA HELP"

 Are you struggling to afford costs related to your Medicare prescription drug plan? If you are a Medicare beneficiary with limited income and assets, you may be eligible to receive “Extra Help,” also known as the Low Income Subsidy (LIS). Social Security offers Extra Help to reduce costs related to Medicare prescription drug plans such as monthly premiums, annual deductibles, and prescription co-payments. Contact your SHINE counselor to see if you qualify for Extra Help!

ARE YOU A HOSPITAL INPATIENT OR OUTPATIENT?

If You Have Medicare—Ask !

Did you know that even if you stay in the hospital overnight, you might still be considered an “outpatient”? Your hospital status (whether the hospital considers you an “inpatient” or outpatient”) affects how much you pay for hospital status may also affect whether Medicare will cover care you get in a skilled nursing
Facility (SNF).

An inpatient admission begins the day you’re formally admitted to the hospital with a doctor’s order. The day before you’re discharged is your last inpatient day. You’re an outpatient if you’re getting emergency department services, observation services, lab tests, or X-rays, and the doctor hasn’t written an order to admit you as an impatient even if you spend the night at the hospital.

If you’re in the hospital more than a few hours,
always ask your doctor or the hospital staff if you’re an inpatient or an outpatient.

Medicare Part A (Hospital Insurance) covers inpatient hospital services. Generally, this means you pay a one-time deductible for all of your hospital services for the first 60 days you’re in the hospital.

Medicare Part B (Medical Insurance) covers most of your doctor services when you’re an inpatient. You pay 20% of the Medicare-approved amount for doctor services after paying the Part B deductible.

Medicare Part B covers outpatient hospital and doctor services. Generally, this means you pay a co-payment For each outpatient hospital service. This amount may vary by service.

For more detailed information on how Medicare covers hospital services, including premiums, deductibles and co-payments, call 1-800-MEDICARE (1-800-633-4227).

Medicare Update

Notes on Health Care Reform Act  Most of the cost-saving measures don’t affect basic Medicare benefits, but they may affect those enrolled in private Medicare Advantage plans.

• Health care reform requires the government to pay private insurers less, therefore it is likely some will choose not to continue their plans. Others will curtail extra benefits such as reimbursement for gym membership or free eyeglasses.
• The largest cuts will occur in 2015.
• Satisfactory plans will be eligible for bonuses.

Medicare reimbursements to nursing homes will be cut by approximately $15 billion over the next decade.

A combination of the additional revenue and savings are estimated to extend the life of Medicare an additional 7 to 10 years from its current insolvency date of 2017.

Medicare Rights

As a hospital inpatient, you have the right to:

• Receive Medicare covered services. This includes medically necessary hospital services and services you may need after you are discharged, of ordered by your doctor. You have a right to know about these services, who will pay for them and where you can get them.
• Be involved in any decisions about your hospital stay, and know who will pay for it.

Report any concerns you have about the quality of care you receive to the Quality Improvement Organization
(QIO) at Masspro at 1-800-252-5533 (TTY 1-800-439-2370.)

Your Medicare discharge rights: During your hospital stay, the hospital staff will be working with you to prepare you for safe discharge and arrange for services you may need after you leave the hospital. When you no longer need inpatient hospital care,
your doctor or the hospital staff will inform you of your planned discharge date.

If you think you are being discharged too soon:

• You can talk to the hospital staff, your doctor and your managed care plan about your concerns.
• You also have the right to an appeal, that is , a review of your case by a Quality Improvement Organization (QIO). The QIO is an outside reviewer hired by Medicare to look at your case to decide whether you are ready to leave the hospital. To appeal, you must contact the QIO no later than your planned discharge date and before you leave the hospital.
• If you do not appeal, but decide to stay in the hospital past your planned discharge date, you may have to pay for any services you receive after that date.

To file an appeal or report any concerns you have about the quality of care you receive
Masspro 1-800-252-5533 (TTY 1-800-439-2390)

between 8:30 AM—5:00 PM

(If you call this helpline outside of normal business hours, be sure to listen carefully to the after-hours helpline message and follow the instructions.)
(published by the Department of Health & Human Services Centers for Medicare & Medicaid Services)

Medicare Appeals

AN IMPORTANT RIGHT FOR MEDICARE BENEFICIARIES

Sometimes, Medicare beneficiaries feel they have been released from hospital, nursing home, home health agency or hospice care before they are ready to leave. All Medicare beneficiaries, whether covered under Original Medicare or a Medicare Advantage Plan, have appeal rights. This means that trained medical professionals will review the beneficiary’s medical record and decide whether the beneficiary has been released too soon or whether the timing of the release was correct.

Below are some steps to follow if you feel you are being released from a hospital, nursing home, home
health agency or hospice too soon:

• Talk to your doctor about continuing your care.
• Ask your case manager or social worker for an official (written) Medicare notice.
• Follow the instructions on the notice. Masspro‘s helpline telephone number will be on the notice.
• Masspro will ask you for your views and review your medical record.
• You’ll be informed of Masspro’s decision first by phone and then by mail. At that time, you will also receive information about other appeal rights.

Call Masspro’s helpline at 1-800-252-5533, or Medicare at 1-800-MEDICARE (1-800-633-4227). You can call or you can ask a friend or family member to call for you.

Home Modification Loans

For Adults and Children with Disabilities and Elders

The Commonwealth of Massachusetts provides loans so you can:

Improve home accessibility and live in your home longer.

0% interest and 3% interest loans from $1,000 to $30,000 for access-related projects. The 0% loan does not need to be repaid until the home is sold or transferred!

For more information or to apply, contact Steve Scarano at MRC at 617-204-3724 or contact him by email at Steven.Scarano@state.ma.us

$4.00 Medications

Wal-Mart, Target, Hannafords and Walgreen's all have a variety of generic medications offered for $4.00 each a month ! Also, for those with computers, you can go to www.needymeds.org to get free or no cost medications.

Mass MedLine

There has been a recent increase in the development of new discount cards initiatives providing discounts on both brand and generic medications at pharmacies across the state. Some plans indicate that they are a ‘statewide initiative’ which may be misinterpreted by the consumer that the program is a product of the Commonwealth of Massachusetts. There are multiple programs for patients to obtain their medications at an
affordable cost.

Please know that you can reach MassMedLine (toll free: 1-800-633-1617) as a trusted resource for all programs (federal, state and private) that provide assistance accessing medications and available plans.

MassMedLine is a result of a long-standing partnership between the Massachusetts College of Pharmacy and Health Sciences and the Massachusetts Executive Office of Elder Affairs. Please use the toll-free help line, or click on the “Ask The Pharmacist” link on their website at http://www.mcphs.edu/impact/community-service-programs/pharmacy-outreach-program to ensure you are utilizing the programs that are best for you.

Senior Service Links

American Association for Retired Persons
AARP is a nonprofit, nonpartisan membership organization for people age 50 and over.
Benefits Check-Up
BenefitsCheckUp helps thousands every day to find programs for people ages 55 and over that may pay for some of their costs of prescription drugs, health care, utilities, and other essential items or services. Please fill out our simple questionnaire to find programs that can assist you or your loved ones.
Mass Home Care
Are you looking for eldercare information, or services for a family member or friend? Is care in the community your first choice? Mass Home Care can help you find what you need.
North Shore Elder Services
North Shore Elder Services (NSES) is a team of specialists making life easier for elders and those who care for them. We offer information, support, and solutions.
Senior Corps
Senior Corps is a network of programs that tap the experience, skills, and talents of older citizens to meet community challenges with Foster Grandparents, Senior Companions, and RSVP (Retired and Senior Volunteer Program).
SeniorNet
SeniorNet is a 501(c)3 nonprofit organization of computer-using adults, age 50 and older. SeniorNet's mission is to provide older adults education for and access to computer technologies to enhance their lives and enable them to share their knowledge and wisdom.
The American Association of Homes and Services for the Aging
The American Association of Homes and Services for the Aging (AAHSA) is committed to advancing the vision of healthy, affordable, ethical long-term care for America. The association represents 5,600 mission-driven, not-for-profit nursing homes, continuing care retirement communities, assisted living and senior housing facilities, and community service organizations.

The National Senior Citizens Law Center
The National Senior Citizens Law Center advocates nationwide to promote the independence and well-being of low-income elderly individuals and persons with disabilities.

Dial 2-1-1 for Elderly Care

This is a statewide free confidential telephone service that connects callers to essential health and human services, such as a food pantry, or where to secure care for an aging parent.

This program is supported by the United Ways of Massachusetts. 2-1-1 is the dialing code for free access to health and human services Information and Referral. It provides an easy-to-remember and universally recognizable number that makes a critical connection between individuals and families seeking services or volunteer opportunities and the appropriate community based organizations and government agencies.

2-1-1 makes it possible for people to navigate the complex and every-growing maze of human service agencies and programs.

2-1-1 Services

211 is the national abbreviated dialing code for free access
to health and human services information.

Within the Commonwealth there are literally thousands of phone numbers for health and social service programs, government offices, community organizations, volunteer referral centers, donation clearinghouses, educational systems and neighborhood groups! This is a one-stopshopping program which also has access to updated disaster information, numerous post-disaster programs, interpreter services and also has the ability to act as the registration site for spontaneous volunteers and donations from the public during an emergency or crisis.

Extra Help from Social Security:

 

Extra Help is for Medicare recipients with limited income and resources. Some people qualify for full Extra Help, and some qualify for partial Extra Help, depending on income. Extra Help pays all or most of prescription drug plan monthly premiums and annual deductibles, and lowers the prescription drug copayments.
If you have Medicare, you can qualify for Extra Help if:

• you meet the Extra Help resource and income limits. See Extra Help Income and Resource Limits on the Social Security web site for current limits.
• you have MassHealth Standard (dual eligible), Medicare Buy-In (QMB, SLMB, or QI), or SSI. Medicare recipients in these categories automatically qualify for full Extra Help and do not have to file an application.

For more information about Extra Help:

• call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). Social Security can answer your questions, send you an application, or take your application over the phone.
• see Understanding The Extra Help With Your Medicare Prescription Drug Plan on the Social Security web site, for income and resource limits, how to apply, tips on completing the application, and additional information.
• go to Extra Help with Medicare Prescription Drug Plan Costs to apply online on the Social Security web site.

For more info see MassResources.org>>

Emergency Kit Checklist

Volunteers Wanted - Peabody Glen Health Care Center

SCAM ALERT!!!

Lynn Economic Opportunity HomeCorps Program Offered through the Attorney General's Office

For additional info see:

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Lahey Health Senior Care

North Shore - Cape Ann Emergency Preparedness Coalition

15 Local Boards of Health and Health Departments

www.nscalert.org