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)