Frequently Asked Questions From Seniors
Question: What is the difference between Medicare and Medicaid?
Answer: Medicare is a federal insurance program that primarily serves people over 65, whatever their income. Additionally, it serves younger disabled people and dialysis patients. Patients pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage. Medicare is basically the same everywhere in the United States and is run by the Centers for Medicare and Medicaid Services, an agency of the Federal Government.
Medicaid is an assistance program that is run by state and local governments within federal guidelines and varies from state to state. It primarily serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses although a small co-pay is sometimes required.
Question: What are the different parts of Medicare and what do they cover?
Answer: Generally, Medicare participants may choose between the Original Medicare Plan, a Medicare Advantage Plan (HMO, PPO, special needs and private fee-for-service plans) and, in some instances, other Medicare health plans that are only available in certain parts of the country. The participant pays the deductibles, co-payments and, in some cases, a monthly premium. Medicare then pays the rest of the tab for covered services.
Part A, often referred to as hospital insurance, covers inpatient hospital care, some skilled nursing, home health care and hospice care.
Part B, which has a monthly premium, helps pay for additional medical services. (It may cover physical and occupational therapy, for example, and some medically necessary home health care). This premium may change depending on the total income of the applicant.
Part D was launched in 2006 to provide prescription drug coverage. (If you have very little income or currently receive certain other government benefits, you may qualify for greater help with your prescription drug bills.) Under Part D, all Medicare beneficiaries now qualify for prescription drug coverage. As a beneficiary, you can choose from a variety of Medicare approved prescription drug plans. Keep in mind that these private insurance plans may have different premiums, deductibles, co-payments and lists of covered prescription drugs.
There is also the Medicare Advantage Plan (Part C), which is a private insurance option to replace Parts A & B. Covered services vary by plan but usually include physician and hospital care as well as some prescription drugs.
In addition, you may not need to enroll at all. You may already have a Medicare-approved prescription drug plan through Veteran Affairs, for example, or your employer, former employer, union or existing Medicare Advantage Plan. (If you are uncertain, contact your benefits advisor for guidance.) Before enrolling in any plan, make sure it meets your particular needs.
For more personalized assistance, visit Medicare on-line, contact a Medicare representative or seek assistance from CLAIM (Community Leaders Assisting the Insured of Missouri) at 1-800-390-3330 or at http://www.missouriclaim.org/.
Question: What is the different between all the different housing facilities like assisted living and skilled nursing?
Answer: This is very confusing and most individuals are not aware of all the little nuances that make up the different between an independent living environment, an assisted living community or a skilled nursing facility.
Independent Living Units (ILU): A housing facility type integrating shelter and services for an older adult who is willing and able to remain living independently, but who requires assistance in coordinating the support and services they need. ILU facilities coordinate environment, services, and community support in order to increase independence and offset social isolation. Services generally include housekeeping, maintenance, activities, personal care, nutrition, and transportation.
Assisted Living: A residential community with services that include meals, laundry, housekeeping, medication reminders, and assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The exact definition will vary from state to state, and a few states do not license assisted living facilities.
Skilled Nursing Facilities (SNF): A nursing facility providing medical and rehabilitation services to patients. Services are of lower acuity than those provided by a hospital. SNF beds provide patients with a high level of nursing, supervision, and health care
Question: My doctor told me he thinks I have dementia. What exactly is dementia and is it the same thing as Alzheimer’s?
Answer: Dementia is a "cluster" of symptoms, characterized by loss of cognitive skills (impaired memory, confusion and difficulty reasoning) that interferes with daily functioning. It is NOT a disease and is NOT normal, but rather accompanies certain diseases. The most common disease that produces dementia is Alzheimer's disease and other diseases include multi-infarct dementia and Parkinson's disease. The cause and severity of dementia will vary depending on the disease. It is VERY important that you under go a thorough diagnostic assessment to accurately diagnose the cause in order to provide optimal treatment.
Question: What is the MO Property Tax Credit Claim (Circuit Breaker) and how do I apply for it?
Answer: The Missouri Property Tax Credit Claim gives credit to certain senior citizens and 100 percent disabled individuals for a portion of the real estate taxes or rent they have paid for the year. The credit is for a maximum of $750 for renters and $1,100 for owners who owned and occupied their home. The actual credit is based on the amount of real estate taxes or rent paid and total household income (taxable and nontaxable). You have up to three years from the original due date to file your claim. Claims are due on April 15th.
Question: I am having trouble cleaning my house and running errands. How do I get help?
Answer: Being able to recognize you need help is a positive thing. Asking for help may be necessary to maintaining your life as safely and independently as possible in your home. The following are suggestions on how find help:
Asking your family members. Sometimes your loved ones are not aware that you need that little extra help to maintain your lifestyle. Give each person a responsibility, even if it is small, to help spread out the tasks.
If you don't have other family members to help out, consider involving friends, neighbors or members of your religious institution to assist you with activities.
Consult with St. Louis Area Agency on Aging and the St. Louis Information for Older Adults Resource Guide for a list of professional services that may be appropriate for you such as senior centers or in-home service agencies.
Please feel free to contact Senior Solutions at (314) 726-5766 and ask about services offered. We will have an initial consultation to assess your specific situation and make recommendations on services.
Question: Can you explain the “Donut Hole” and possible ways to reduce costs of my prescriptions?
Answer: The “donut hole” refers to a "coverage gap" within the defined standard benefit under the Medicare Part D prescription drug program. Under the defined standard benefit package there is a gap in coverage between the initial coverage limit and the catastrophic coverage threshold. Within this gap, the beneficiary pays 100% of the cost of prescription drugs before catastrophic coverage starts up to cover 95% of the cost.
Some suggestions for reducing costs are:
Look into the Missouri's State Pharmacy Assistance Program (Mo Rx). MoRx provides prescription drug assistance to Missourian's in need. It pays for 50% of your out of pocket costs on medications that are covered by your Medicare Part D plan. This means you will save 50% on your deductible, 50% on your co-pays and 50% during the coverage gap and beyond. You can learn more at http://morx.mo.gov/
Ask your doctor if there is a generic version of your medications. Brand names are usually more costly than their generic counterpart.
Discuss with your physician all the medications you are taking and any concerns you have about their costs. Your doctor may be able to find reduced or free samples of the medication to lower your costs.
Contact a geriatric Care Manager to look into other solutions to reduce your prescriptions costs.
Please feel free to contact Senior Solutions at (314) 726-5766 to speak with a geriatric care manager about lowering your medication costs.
Question: My son has durable power of attorney for healthcare for me. Do I still need a living will or an advance directive?
Answer: YES. The following answer is from the Probate Law Resource Guide from the Missouri Bar. "You accomplish a few things by giving advance directives, regardless of whether they direct all possible treatment, no treatment or only some treatment. First, you ensure that the treatment you receive is the treatment you desire, no more and no less. Second, you take the burden off of your family and friends to make those decisions for you at a time when they will most likely be emotionally upset by your critical condition. Finally, you may be avoiding litigation to determine what treatment you really desired or intended. In any event, it is time well spent."
Question: Nowadays, I am having trouble driving to the store. What are other sources of transportation I can use?
Answer: Driving safety is a major concern not only for the person who is driving but also for the general welfare of the public. Changes in physical abilities as a person ages can include poor vision, slower reaction, and decreased memory. Possible alternative sources of transportation could include asking family members, friends, members of your religious institution, and neighbors for rides when you have errands to run or a doctor’s appointment. Other alternative sources of transportation include public transportation, senior center services, Call-A-Ride, or a taxi. In addition, you can contact the St. Louis Area Agency on Aging at (314) 612-5918 or the Mid-East Area Agency on Aging at (636) 207-1323 to find out what other transportation options are available in your area. For further assistance in finding help with transportation or other tasks, please feel free to call Senior Solutions at (314) 726-5766.
Question: My husband and I are unable to keep up with the home repairs we need. We can not afford to hire a repairman. Where can we go to get help?
Answer: For many older adults, their homes are their most precious and greatest asset. There has been an increase in need for quality home repair for low-income older adults living in St. Louis City and County.
Contact Senior Solutions at (314) 726-5766 to inquire about assistance with minor home repairs.