Q: Several years ago when my husband and I both retired we signed up for a Medicare plan several of our friends recommended. In the beginning neither of us took prescriptions on a regular basis or had any on-going health conditions so the plan met our needs. Last year my husband's health started to deteriorate and we encountered issues regarding one medication the plan would not cover. We also could not consult with a specialist because he was an out of network physician. What are our options?
A: The scenario you described is not all that unusual. It clearly points out the plan a person chooses when they first enroll in Medicare may not necessarily be the plan they should continue with as they go through the aging process. If an individual's needs are not being met they have the option of choosing another plan during the annual Medicare Open Enrollment period which runs Oct. 15 through Dec. 7.
During this time frame, a beneficiary may switch from Original Medicare to a Medicare Advantage plan or vice versa. They may also switch from one Medicare Advantage plan to another Medicare Advantage plan. There is also the option of choosing a different Part D plan.
It is extremely important to read all materials received from your current plan during this time period. Look for mailings related to "Evidence of Coverage" and "Annual Notice of Change." Do not ignore this information. Cost, coverage, providers and pharmacies within the network can change from year to year. What may work for someone one year may not work for them the following year.
If a person determines their current plan continues to be their best option they do not need to take any action. Otherwise time should be devoted to finding out what plans are available to them where they reside. There are several ways to obtain this information. Individuals or a responsible family member can meet with a certified and highly trained SHINE counselor. SHINE (Serving Health Insurance Needs of Everyone) is a program to provide community education and one-on-one consultations with individuals to help them evaluate, compare and enroll in a health plan that best meets their personal needs. Counselors are available at local Councils on Aging. Call 1-800-892-0890 to find a convenient location. A person also can call Medicare directly at 1-800-MEDICARE or go on-line to Medicare.gov and look for the Find a Plan link.
Q: My husband has been very ill for the last two years. His doctor recently explained to me there is nothing more that can be done and it is time for us to consider hospice care. I feel like it would be giving up on him if I agree to this. I know my husband has suffered for a long time but this is a difficult decision for me to make. My husband isn't coherent enough to have a discussion about this issue. How do I deal with this?
A: Your question is timely in the fact November is National Hospice and Palliative Care Month. The theme this year is "It's About How You Live." The focus is on living as "fully as possible despite a life-limiting illness." Annually over 1.5 million Americans diagnosed with terminal conditions receive services through hospice organizations. Hospice provides quality medical care in addition to emotional and spiritual support.
A comprehensive program of care is provided to patients and families dealing with end-of-life issues. The treatment team includes a physician, nurse, social worker, home health aides, counselors, clergy and volunteers who jointly address the overall impact of dealing with a life threatening illness. Patients must be referred by their physician who has every reason to believe the individual has six months or less to live. This is not a rule written in stone and there may be circumstances which extend the period of coverage. Hospice emphasizes providing comfort and dignity during the last days of a person's life.
Dismiss all potential feelings of guilt. Deciding to accept hospice care is not indicative of giving up. The emphasis is on caring when a cure is not possible. Your husband's physician has indicated in his professional opinion there is nothing medical science can do to cure or prevent further deterioration of your husband's condition. Hope and faith are invaluable when dealing with a loved one's illness but there are times reality must be faced no matter how difficult it is. If your husband is not cognitively capable of understanding his prognosis the decision will rest on your shoulders. It is never easy to let go even when it is clearly the right thing to do. Seek support of other family members and friends as you face the future.
Are you struggling caring for an older adult or having difficulty locating resources? Our experienced staff are available for no cost consultations in the home, office or community. For additional information or to schedule an appointment call 1-800-892-0890. Do you have a question? We encourage inquiries and comments from our readers. Direct correspondence to firstname.lastname@example.org or Elder Services of the Merrimack Valley, Inc., AgeInfo Department, 280 Merrimack Street, Suite 400, Lawrence, MA 01843. Joan Hatem-Roy is the CEO of Elder Services of the Merrimack Valley, Inc. and North Shore Elder Services.