Bruce was shocked, but he soon realized that his father had not been managing any of the couple’s finances. “We discovered that my dad hadn’t been paying my mother’s Medicare premiums since May 2010, and the medical bills were piling up,” Bruce said.

You’ve made your decision: although you’re eligible to collect Social Security payments, you’re going to keep working and delay receiving your retirement benefits.

But don’t forget about Medicare.

Even if you decide to wait until after you are age 65 to apply for retirement benefits, most people should apply for Medicare coverage at age 65. If you’d like to begin your Medicare coverage, you should apply within four months of reaching age 65.

There’s a fast, convenient, and simple way to apply online for Medicare in as little as 10 minutes — even if you’re not ready to receive retirement benefits. Just visit www.socialsecurity.gov/medicareonly.

At the website, you’ll find more than just the online Medicare application. You’ll also find information about Medicare, and have the opportunity to watch a short, fun video reuniting the cast of The Patty Duke Show to tell you about the ease and convenience of filing for Medicare online.

It’s important to note that people who already receive Social Security retirement or disability benefits do not need to apply for Medicare; they will be automatically enrolled.

There is no additional charge for Medicare hospital insurance (Part A) since you already paid for it by working and paying Medicare tax.  But there is a monthly premium for medical insurance (Part B). If you already have other health insurance when you become eligible for Medicare, you should consider whether you want to apply for the medical insurance. You may want to consult with an insurance specialist. To learn more about this and other Medicare considerations, read our online publication, Medicare, at www.socialsecurity.gov/pubs/10043.html.

Mr. McConnell is the Deputy Area Director for the Washington, D.C. Metropolitan Area which serves a complex of 16 offices in the District of Columbia, suburban Maryland, Northern Virginia, and the eastern panhandle of West Virginia.

Over the course of her career, Vera never emphasized private practice feeling it was too isolating in terms of her capacity to effect change.  Above all, she said she stressed the importance of distrusting simple answers and instead dealing with complexity in the area of human behavior.

After the passing of her husband, the nature of her work extended to a broader field as she did international consulting, establishing relationships in Europe.  “I had the great opportunity to meet some extraordinarily gifted people from whom I did learn much,” she said.

According to Vera, her profession was interrupted almost overnight when she lost the capacity to read over two years ago because of a physical change in the structure of her eye. As her eyesight continued to diminish, she found it impossible to operate independently with certain tasks such as money management.  Fortunately, she was connected to Kate Finan of Finan Financial Care, LLC, who has specialized in the daily money management needs of seniors in the area since 1993.

When Kate visits Vera, they consider the priority of items such as paying bills and making donations to charities; reconciling the checkbook; and reviewing and making decisions on how to respond to a fairly large volume of mail.  Vera has also appreciated the focus on her need for legal help as they have established a will and other important documents.  “She has been great in helping me organize the practical aspects of my life under the condition of diminished sight; she acts as an alter ego,” said Vera.

She also said she has found a connection with Kate as far as her capacity to see the complexity of what Vera has to deal with beyond simple solutions.

“In this relationship with Kate, what is paramount is the mutual recognition that the problem is not in a loss of mental capacity but rather in the capacity to deal with practical everyday problems,” said Vera.  “Without her help, I would have been stressed and unable to manage my current life.”

It can be difficult to choose the right medicare plan for you and your loved ones

By Ross Blair

The 43 million caregivers in the U.S. — people who provide unpaid care to family members or friends age 50 and older — are overworked and need help. Here’s why:

26 million of these caregivers hold down fulltime jobs and care of the older person in their spare time.
27 million of them also manage the older person’s finances, which includes helping them decipher their Medicare options.

With five parts to Medicare; 10 different Supplement plans: a multitude of Part C (Advantage) options, from drug coverage to networks to out-of-pocket limits; and increasing prescription drug costs, navigating the Medicare maze is a daunting task to an overburdened caregiver.

The Caregiver Medicare tips below offer help. They were developed by Ross Blair, CEO of Plan Prescriber, a provider of comparison tools and educational materials for Medicare-related insurance products. These tips answer common questions and help caregivers choose the Medicare plan that meets both the health and financial needs of their loved one.

1. Manage Timelines Effectively: Medicare eligibility begins for U.S. citizens and legal residents when they turn 65. A person has a seven-month initial enrollment period that begins three months before their birthday month and ends three months after. During this initial enrollment period, a person can enroll in Original Medicare (Parts A&B), a prescription drug plan (Medicare Part D) or a Medicare Advantage plan.

If you want to enroll in a medigap (Medicare supplement insurance) policy, the open-enrollment period starts the first month the person is both 65 and enrolled in Part B, and lasts for 6 months. During that 6-month medigap enrollment period, a person has a guaranteed right to buy any medigap policy sold in their state.

2. Avoid Late Enrollment: Those who enroll late in Original Medicare (Parts A & B) or a Medicare prescription drug plan (Part D) can incur permanent late penalties. Anyone who isn’t working, doesn’t have insurance from an employer or lives abroad should plan to enroll in Medicare at age 65.

People on Medicare who have a gap in their creditable prescription drug coverage for more than 63 continuous days will also have to pay a late-enrollment penalty for their prescription drug benefit (Medicare Part D).

3. Don’t Expect a Notification: If the person you’re caring for began receiving their Social Security benefits before age 65, they don’t have to apply for Original Medicare when they turn 65.  But, nobody else should expect to receive a notice from Medicare when they turn 65. Medicare puts the responsibility on the individual senior to begin the enrollment process.

4. Know Your Loved One’s Prescription Drugs: Compile a list of the future Medicare beneficiary’s current prescription drugs: names, dosages and required frequency of use. Then use the prescription drug plan comparison tool at PlanPrescriber.com to:

- Find out if the drugs on your list are generic or available in generic form. If a generic drug is available, ask the Medicare beneficiary’s primary doctor if it makes sense to switch from a to a lower-cost generic alternative.

5. Obtain Consent: If you are a caregiver for your parents and are meeting with their doctor to discuss their health and treatment plan without them, make sure your parents sign a consent form so their doctor will be able to legally discuss their medical and coverage needs with you.

6. Take Care of Yourself: Preserving your own health is just as important as caring for someone else’s. Take control of your own life by balancing caregiving with personal needs. Take time to nurture your interests and tend to your health. Know the Caregiver’s bill of rights.

7. Beware of Fraud: Identify and report any Medicare fraud, abuse or scams. To be on the lookout, carefully review the ‘Explanation of Benefits’ statements received for all regular Medicare and Part D services. Review bills from all providers to make sure you are paying for only the services or equipment the Medicare beneficiary received. Be careful about giving out any personal information (your own or your loved one’s) to individuals or organizations. There is a helpful section on fraud and specific tips to avoid fraud at www.Medicare.gov.

8. Don’t Overlook Legal Matters: At a certain point, it may be advisable for your loved one to grant you or another family member a Durable Power of Attorney that includes the ability to make decisions relating to your loved one’s healthcare. Discuss who will take on this important responsibility and if there are specific medical preferences or directives that your loved one has requested. You don’t want to make these types of decisions in the middle of a health crisis. Also, make sure your loved one has a Living Will or Advanced Healthcare Directive.

9. See if You Qualify for Financial Assistance: If you provide unpaid care for a family member or friend, it might be possible for you to get a small but regular payment for your work. If the person you’re caring for is eligible for Medicaid, a program called “Cash and Counseling” might be available in your state. Call Medicaid or visit http://www.cms.gov/home/medicaid.asp to find out.

The same holds true if the person you are caring for has long-term care insurance that includes home care coverage. Call the insurer to ask about this benefit and any possible restrictions.

Additional Resources
You may be able to get Extra Help to pay for your or your loved one’s prescription drug premiums and costs. For more information on Extra Help, you can contact:

- PlanPrescriber.com at 800-404-6968

- Medicare at 1-800-MEDICARE (1800-633-4227). TTY users should call 1-877-486-2048, 24-hours-a-day/ 7-days-a-week;

- Social Security at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778;

- Your Medicaid Office

In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances, and quantity limitations and restrictions may apply.

The Centers for Medicare and Medicaid Services (CMS) has neither reviewed nor endorsed the information provided in this press release.

With the help of an attorney and care management organization, Elizabeth Dusa found a homecare agency that has provided her with the support she needs.

Families are there for each other to celebrate the good times and help each other through the challenging times. Elizabeth Dusa had spent a lifetime caring for her son, but when her health began to turn, he became her loyal and compassionate caregiver in return. Unfortunately, he passed away suddenly, leaving Elizabeth alone with no remaining family or support.

Elizabeth grew up in Pennsylvania and is of Hungarian descent. When her son was diagnosed with juvenile diabetes, she was urged to institutionalize him. Although she was a single mother, she adamantly refused and took measures into her own hands. Elizabeth kept his health under control by monitoring his diet and keeping detailed journals of everything he ate. As a result, she was able to keep him healthy.

While maintaining this focus on her son, she led a frugal lifestyle in Annandale, Va. working as a secretary. In a true success story, her son eventually received a PhD in Physics, became an astronomer and had a celebrated career with the FBI.

With no one to care for her following her son’s death, Adult Protective Services (APS) was called in to help Elizabeth. They in turn contacted Elizabeth “Liz” Gray, an elder law attorney who now serves as the guardian for Ms. Dusa.

“I had to clean out the house, get her settled in Fairfax Nursing Center, and make sure she was well cared for,” said Ms. Gray. “She was losing weight, she wouldn’t let anyone touch her, she would scream and cry regularly, and at times was very combative.”

Ms. Gray then hired Elder Care Consultants, a geriatric care management firm to assist her in monitoring and coordinating Elizabeth’s care. Ms. Gray and Dia Loken, the RN and Care Manager assigned to Elizabeth’s case, observed that she was more comfortable around male caregivers, which they attributed to her strong relationship with her son.

They felt that finding a dedicated male caregiver that she could trust might enable them to reduce the medications Elizabeth was on to control her anxiety and combativeness. The search was more challenging than expected, so Dia connected with BestCare Home Care where she was introduced to Hugo Ruiz-Menandez, a trained physician in his native country of Bolivia.

“The care he provides to Elizabeth is extraordinary and the bond that the two of them have is exceptional. They are referred to as a little married couple at Fairfax Nursing Center because they are together always,” said Dia. “Her quality of life has been enhanced.”

Dia and the other professionals involved in Elizabeth’s case cannot emphasize enough the positive change they have seen in her.

“It was almost daily that she was getting into a physical altercation with another resident,” said Vanessa Bishop of ElderCare Consultants. “Now she is in love with her aide and has really calmed down.”

According to Dia, they have even been able to reduce Elizabeth’s medications as she has been consistently gaining weight and is rarely sick. Hugo also gives her fantastic skin care and the mere sound of his voice seems to calm Elizabeth down.

“I am very impressed with the responsiveness and work ethic of the caregivers and management at BestCare,” said Dia. “There are so many home care agencies to choose from, and it’s important not to tolerate substandard care. I don’t second guess their attention and care.”

She explained how important it is to have a team approach to care, especially in medically-complicated situations. The team is tuned into changes and is able to report to the physician in a timely and accurate manner.

Now Elizabeth, who once seemed alone, has quite the caring support network and essentially a different kind of family that will continually be there for her.

“I fell in love with her when I met her because she was so feisty,” said Dia. “In fact I have a picture of her on my refrigerator. My family refers to her affectionately as ‘The Duce.’”

You’ve probably heard that it’s the 75th anniversary of Social Security. However, there is another important birthday going on.

Social Security’s online Retirement Estimator is now celebrating its second anniversary.  The Retirement Estimator stands as the most popular online service in both the public and private sector “” a position it shares with another popular service, Social Security’s Benefit Application.  That’s according to the most recent annual American Customer Satisfaction Index (ACSI), which came out earlier this year. In an index ranking online services, Social Security’s Retirement Estimator and Benefit Application take the top spots, each with a score of 90. What’s the highest ranking service in the private sector? It’s Netflix, with a score of 87, tying with Social Security’s Help with Medicare Prescription Drug Plan Costs application.

The onlineRetirement Estimator is a convenient, secure, and quick financial planning tool that lets you calculate how much you might expect to receive in Social Security benefits when retirement rolls around. The tool uses your actual earnings information on file at Social Security, without displaying your personal information. So you get an instant estimate of your future retirement benefits.

TheRetirementEstimator even lets you run personalized scenarios and “what if” situations. For example, you can change the date you expect to retire or change expected future earnings to create and compare different retirement options. This can help you as you plan ahead.

And, it’s so easy to use.

To use theRetirement Estimator, you must have enough Social Security credits to qualify for benefits and you must not already be receiving monthly benefits.

We may take a few moments to celebrate this birthday, but we’re not resting on our laurels just yet. Later this year Social Security plans to introduce a Spanish-language version of the Retirement Estimator.

High customer service scores are a great birthday present for the two-year-old Retirement Estimator.  Come join the celebration and get an instant, personalized estimate of your future Social Security benefits. Visit www.socialsecurity.gov/estimator.

Mike Weakland is the Social Security Area Director in the Washington, D.C. Metropolitan Area.

“It came on like I am sure it does for other people, very subtly, and it was really hard to define what was happening,” she said.

Shocked and traumatized by the diagnosis, Betty also experienced feelings of frustration when trying to find the best resource to guide her through this challenging transition. Fortunately, she had a small support network that included her nearby sister Peg, her doctor and Mindy Felinton, an elder law attorney.

For years, Betty was able to care for Jim in their home, but she eventually needed to hire in-home caregivers in order to continue her career with Montgomery County Public Schools. Last summer, as she was getting ready to take her two-week vacation, she realized she was at a crossroad with his care. “His needs had gotten so great,” she said.

Since their townhouse was not a suitable arrangement, she reluctantly accepted that instead of hiring a full-time caregiver, the best option was a specialty care center for those with Alzheimer’s and Memory Care needs.

The financial burden of this choice, however, would be prohibitive based on the couple’s income and savings. Betty realized she would need to immediately apply for Medicaid and gather all of the supporting documentation. Her doctor then referred her to Mindy Felinton.

“Mindy gave me the best news I had received in eight years,” said Betty. “She assured me she would be the one to advocate for me and actually make this application come to fruition.”

With her knowledge and experience, Mindy was able to provide Betty with choices and a strategy to protect some of the couple’s assets and ensure they would still qualify for Medicaid. “For the average person, going through this application process alone is a very daunting task,” said Mindy.

The entire process from application to approval took approximately four months, and Betty got Jim into the Wilson Health Center at Asbury Methodist Village near her home and office, which has given her peace of mind.

Seeing her sister’s situation has actually prompted Peg and her husband to better organize their records and think about their future, but both women have learned there are experienced professionals that can lend a helping hand in unexpected and difficult times.

With the help of her team of elder law attorneys and geriatric care managers Mary Quigley was able to navigate a complicated care plan for her mother and brother.

“If I had to do it all over, I wouldn’t change a thing,” says Mary Quigley in reference to the unique journey she took caring for her mother and brother over the past several years. While her brother Charlie passed away almost two years ago, her journey of navigating a complex maze of legal and financial matters is not quite over.

A family of caregivers

Mary’s mom, Mary Giron, was a dedicated caregiver to Charlie. Charlie was disabled, and had always lived together with his mother in New Jersey. “No one could care for Charlie better than she could,” says Mary. “Mom rarely asked for help, but when she did, I knew that she really needed it.”

Although Mary had a flexible work schedule as a practice administrator for a dentist, she was also raising four children. Helping care for her mother and Charlie from a distance was tremendously difficult. With Mary’s only other sibling, Peter, living in France, the family decided that it was best for Mary’s mother and Charlie to relocate closer to Mary’s home in Northern Virginia. With the closer proximity and the help of a caregiver, Mary was able to develop a system in which she and her children could visit regularly and provide transportation and support as needed.

Changes in health, finding in home care

Mary and Peter were eventually forced to wrestle with the decision of placing their mother in a nursing home. “It was difficult to find a nursing home to accept her due to her complex needs,” says Mary.

At one point, she brought her mother home to receive care with the support of a home care nursing agency, which lasted only one day as her needs were too great. Her mother’s condition continued to deteriorate and, after several hospital admissions, her mother passed away in April 2007.

Getting help from Elder Law Attorneys

As their mother’s health had been declining, Mary and Peter realized that they would need to take a more active role in her care and in their brother Charlie’s care. However, neither their mom nor Charlie had any incapacity documents in place that would authorize another person to make health care or financial decisions for them.

They proceeded to enlist the help of Elder Law Attorney Margaret O’Reilly with the Fairfax Elder Law Firm of Cossa, Gray and O’Reilly, to determine whether incapacity documents could be executed for their mother or for Charlie. Unfortunately their mother’s health continued to slip so dramatically that she passed away before any documents could be executed.

Although her mother had a will, it had been drawn up in New Jersey in the 70s. After consulting with Elder Law Attorney Elizabeth Gray, also at the Fairfax Elder Law Firm of Cossa, Gray and O’Reilly, the family learned that, because of differing requirements between New Jersey and Virginia, the will could not be admitted to probate in Virginia since the witnesses could no longer be located.

“It is important to look at a will every three to five years or when there are life changes in the family such as births, deaths or divorce,” says Elizabeth. The mother’s estate would need to be handled through the Virginia laws of inheritance that apply when a person dies without executing a will.

The siblings also realized that they had no idea what or where their mom’s assets and financial accounts were. They sorted through their mother’s papers, and sat down with their elder law attorneys to determine how to proceed. Working together with an accountant and a financial planner, the attorneys at Fairfax Elder Law organized the accounts that needed to go through probate and managed the remaining accounts for distribution and tax reporting.

Mary and Peter also learned that their mother had never pursued any action to have Charlie found disabled, nor had she secured benefits for him or been appointed his guardian. Margaret says, “They simply lived together as mother and son. She took care of him and never had any difficulties doing that.”

It was clear to everyone that Mary and Peter were not going to have the same ease in talking to doctors and managing finances for Charlie. Since Charlie did not have sufficient capacity to sign incapacity documents, it was necessary to go to court for appointment of a guardian and conservator for him. With Margaret’s assistance, Mary and Peter were able to have themselves appointed as co-guardians and co-conservators for Charlie, with the authority to make decisions for his care and well-being.

Mary proceeded to make some modifications to her townhouse that would provide a safer and more accessible environment for Charlie. Elizabeth then helped the siblings arrange a consultation with a geriatric care manager to learn about the options for managing Charlie’s care and ultimately maximizing his quality of life. The care manager was able to suggest a plan of care as well as ways to help Charlie continue his interest in music.

Things seemed to settle down, and Mary recounts how happy she was to have everyone together for the holidays that year.

A few days after Christmas, Mary walked downstairs one morning to find Charlie laying half off the bed and she immediately called 911. At the hospital, it was determined that Charlie had a stroke and, in spite of efforts at rehabilitation, Charlie never regained his speech and mobility. Mary continued to visit him daily at the hospital. “It was tough, because I knew he wanted to talk to me but he couldn’t verbalize anything,” she says.

Attorney Elizabeth Gray again stepped in to help Mary hire a geriatric care manager who found a homecare provider and hospice service for Charlie so that he could go home with Mary after he was discharged from the hospital. “She was tremendous; she gave me guidance, and that’s what I needed,” says Mary. “I needed to know that when I couldn’t be there, someone could be, especially for Charlie because he couldn’t speak.”

Peter and his wife also flew in from France to assist in taking care of Charlie. “We were all there; we were singing his favorite songs and talking about the good days,” says Mary. Charlie died soon after returning home, surrounded by his family and his music. “Charlie was the strongest person I ever met in my entire life,” says Mary. “He needed me and I know if the tables were turned, he would have done the same thing.”

Mourning the loss of her mother and brother was complicated by the many details required to administer both estates. “I was overwhelmed. There was so much going on with the estate for my mom and no organization, I just couldn’t do it,” says Mary. “I just threw everything I could find in a box and passed it to Liz. Once I gave it all to her and they took over, I felt a huge weight lifted off my shoulders. Having Liz is great.”

With the support of her family and the expertise and guidance of the Fairfax Elder Law team, Mary is now able to say with a smile, “I see a light at the end of the tunnel.”

*Common Misconceptions*
Myth: “My assets are so small that a will is not necessary.”

Fact: Think again. You are generally worth more than you give yourself credit. Even if some possessions do not hold great monetary value, they could hold an enormous amount of sentimental value “” and that’s something you can’t put a price on. Failing to indicate who receives these treasures in your will can cause friction between family members that lasts for decades.

Myth: “When I die, my spouse will get all of my assets.”

Fact: If you and your spouse own assets jointly, at death

your share of the assets will automatically go to your surviving spouse. What happens when your surviving spouse dies? What will your children receive? Does your spouse have the financial skill to manage the family wealth?

Myth: “I can create a will on my own and save the legal costs.”

Fact: “Do-it-yourself” wills often do not contain all of the necessary components as required by law. Anyone who might benefit from an invalidation of your will can contest it, and if the courts decide in his or her favor, your estate may have to pay for all legal costs. Remember, the few dollars you save now can cost your loved ones thousands of dollars later.

Myth: “I don’t want my final wishes to be set in stone. I’ll create a will later in my life.”

Fact: The terms of a will can change as often as needed. Legal experts agree that you should reexamine your will periodically to make sure it is up-to-date. A will should receive a “checkup” whenever there is a substantial change in your life.

*How Do You Create a Will?*
Drafting a will is difficult and is not an endeavor you want to tackle single-handedly. It’s important that you call on the services of an estate-planning lawyer. A lawyer might help you:

Avoid the possible problems of “do-it-yourself” wills
Save on estate taxes
Take advantage of estate planning opportunities people often overlook
Change the terms of your existing will

*Life Insurance and Wills*
How does life insurance fit into the picture? Life insurance is a vehicle you can use to help make sure your estate is not depleted at death by potential estate taxes and other costs. In most instances, life insurance proceeds are paid income tax-free to your beneficiary (ies). Without life insurance proceeds, a portion of your estate may have to be sold to meet “final” expenses, like estate taxes, funeral costs, and outstanding debts.

*Don’t Wait Until It’s Too Late*
Despite the importance of an estate plan, which includes a will, 80% of Americans still do not have one.[1] Why? Creating a will forces each of us to come face to face with our own mortality “” and dealing with death is difficult. But, it will be much more difficult for your loved ones if you don’t have a will. Remember, you should seek the services of a qualified attorney to draft your will.

_Caroline Andresen is an Agent with New York Life Insurance Company in Berwyn, Pa._

Excerpt from Consumer Guide to Understanding Financial Performance and Reporting enhancing PEOPLE’S LIVES in Continuing Care Retirement Communities. The guide is available free of charge at www.carf.org.