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.

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.

But among her various interests, nothing compares to her passion for teaching. And through her personal determination and research along with the help of Greg Sieb, an aging-in-place specialist, she can now remain at home working as an academic tutor.

For several months, Inabelle’s family and friends were urging her to move into an assisted living home. Due to the difficulty she has with mobility, they were concerned that living in her home would be too challenging and potentially dangerous.

“I didn’t want to move,” said Inabelle, “If a professional advisor said I needed to, I would have considered it.”

She then sought the help of Stephanie Thomopoulos, a geriatric care manager, who in turn suggested getting a stair lift and recommended specialists who could help Inabelle remain at home. Additional recommendations came from other individuals who had stair lifts installed in their homes.

After speaking with three different specialists, she said it was an obvious choice.

“Whereas it seemed the others were trying to make a sale, Greg from Granting You Access was interested in being a service and had a lot of great ideas,” she said, “He reviewed with me how I would approach my new lift and we made some modifications for a safe procedure.”

As her guide, he chose the model stair lift that he knew would be best for Inabelle.

“The other vendors gave me a variety to choose from,” she said, “But he made it very clear why this specific model would be a superior choice to any other stair lift for my needs.”

With the help of her aging-in-place specialist, Inabelle also has grab bars in conjunction with the lift as well as a shower chair and adjusted walker. They also worked together to move her furniture into an appropriate arrangement.

And for Inabelle, these changes have made all of the difference.

“It is such a blessing to be able to get up and down the stairs easily and safely without pain,” she said, “Greg is very creative in his problem-solving in terms of how you can live more effectively and safely in your home.”

Giving credit to her specialist, Inabelle said she was granted the access to her home that she was promised.

“Installing the stair lift has enabled me to live independently and have the freedom to do what I want when I want to,” she said.

And of course, Inabelle has the freedom to remain an academic tutor in what has become an accessible and safer home.

When a person prefers to stay at home but needs ongoing care that cannot effectively be provided by family and friends, home care may be the best option. As the Home Health Care industry grows and advances, more seniors are able to age in place-receiving the care they need in the comfort of their homes. Regardless of age or health conditions, all seniors should consider home care as an option when making retirement living decisions.

In addition to care provided in an individual’s home, home care services are also available to supplement the care received in a hospital or facility; 25% of the care we classify as home care is actually performed in hospitals or facilities.

Home Care Options
An incredibly diverse field, home care can serve a variety of senior need levels. Home Care can include home support care, skilled nursing care, or hospice care. For information about hospice care, please see our hospice section on pg. 89.

Home Support Care is for seniors who are no longer able to perform all of the functions of daily living by themselves but who do not require skilled medical services. A home health aide can help with activities of daily living (ADLs), which include bathing, dressing, transferring, eating, and hygiene. Additional services generally include meal preparation, mobility exercises, light housekeeping, laundry services, medication reminders, and accompaniment to appointments.

Skilled Nursing Care is prescribed by a physician and is administered by a registered nurse. The services provided by skilled nurses include: administering injections, administering medications, wound care, IV monitoring, blood tests, catheter care, respiratory therapy, speech therapy, physical therapy, feeding tube administration, and more.

Home Care Providers
Home Care providers can be classified into three major categories: Medicare-certified Agencies, Private Duty Agencies, and Registries. All of these agencies deliver care to patients either in their homes or in a hospital, assisted living community, or nursing facility. Companies or hospitals may have both a Medicare-certified component as well as a private duty or registry component.

Medicare-certified Agencies deliver “brief and intermittent care” for a maximum of 60 days. Care must be ordered by a doctor. Physicians can renew orders for care whenever they deem it necessary. These agencies are qualified to deliver either skilled nursing care or home support care, which is completed by home health aides. Patients generally receive 1-3 hours of care per day several days a week. The amount and type of care provided will vary depending on the doctor’s specific orders. All Medicare-certified agencies are licensed by their home state and surveyed on a regular basis to ensure that federal quality and safety standards are followed.

When care has not been ordered by a physician, it can be obtained thorough Private Duty Agencies. The amount of care provided can range from round-the-clock or live-in care to companionship services, depending upon the needs and desires of the customer. Private Duty Agencies employ a variety of caregivers and can provide a wide array of services. Caregivers range from nurses to companion care workers, all employees of the agency. Agencies are regulated by their state governments, which enforce strict health and safety requirements.

Home Health Care Registries are much like Private Duty Agencies, except Registries do not employ the workers that are sent to customers’ homes. When you request Home Care Services through a Registry, they will refer an independent contractor to work in your home. As with Private Duty Agencies, the amount and type of care received is entirely up to the customer. Registries can provide services ranging from skilled nursing care to home support care and/or companion style services. Registries are monitored by their state governments to guarantee that they meet stringent health and safety requirements.

Costs of Home Care
Medicare-certified Agencies are reimbursed for their services by the federal Medicare or state Medicaid programs. Private Duty Agencies are generally compensated for their services through private payments. Long-term care insurance may cover some of the costs for Private Duty services; individuals can also use other financing options such as reverse mortgages to pay for care. Services by Registries are also covered by private payments, long-term care insurance, or other financing options.

Home Support Care can be provided by any of the agencies listed above, but must be paid for with private funds unless it is prescribed by a physician and provided by a Medicare-certified Agency. Prices for home support care range from $10-$20 per hour. Most long-term care insurance policies will cover home support care. If you qualify for Medicaid, a government program for low-income individuals, it may pay for some of your home support care needs. Since laws vary from state to state, you will need to contact your local Area Agency on Aging for more information concerning government benefits.

Skilled Nursing Care will be paid for by Medicare as long as it is determined to be “intermittent skilled care,” which includes occupational, respiratory, speech, and physical therapy, and is ordered by a doctor. Individuals who meet income requirements may be eligible to receive skilled nursing services covered by Medicaid. Major medical health insurance will also cover a limited number of skilled home visits. The number of visits covered will depend on your medical diagnosis and your health insurance plan. Costs for these services vary greatly depending upon coverage by Medicare, Medicaid, and private insurance and the degree of services required or purchases are options that should be considered. Assistance provided through the Older Americans Act and delivered by local Area Agencies on Aging includes the cost of some home care services. Individuals are generally asked to contribute to the costs in proportion to their income. Veterans who are at least 50% disabled due to a service-related condition are eligible for home health care provided by the Veterans Administration (VA). Services must be authorized by a physician and provided by one of the VA hospital home care units.

Contact you local Office on Aging or State Department of Health to find out if there are funds from social services block grants available to cover home care costs. Outside community organizations may also cover some or all of the costs of home care. Check with your hospital discharge planner, a social worker, the Area Agency on Aging, or the United Way for more information about resources in your community.

Sources for private payments other than major medical health insurance or long-term care insurance include Medigap insurance, managed care organizations, and CHAMPUS. Medigap is designed to cover the gaps in Medicare coverage. It will generally cover home support care to supplement the skilled nursing services already prescribed by a physician and provided by a Medicare-certified agency. Managed care organizations are group health plans that may cover some home care services; services must always be pre-approved. On a cost-shared basis, CHAMPUS provides skilled nursing services for military retirees, their dependents and survivors, and the dependents of active military personnel.

Finding a Home Care Provider
After determining the type and amount of services needed and the payment options that are available, consumers should begin interviewing potential providers. Choosing a Home Care provider is a highly important and personal decision. Finding a provider that is qualified, reliable, and compassionate is essential to the health and happiness of patients and their families.

While completing this search, keep in mind that home care workers frequently become very close to their patients. The bonds that patients and providers form are natural and beneficial to both parties; however, before allowing a provider to come into their homes, customers should complete thorough research to avoid the negative consequences of unscrupulous providers. Prior to obtaining services from any provider, find out more about how they run their company, their employee policies, and investigate their quality rankings published by the federal government (www.medicare.gov). The questions below are intended to help consumers investigate and interview potential providers.

Questions for Potential Providers:

Is the provider Medicare/Medicaid certified?
If yes, do they also operate a private pay division? (This allows patients that receive skilled care for a limited number of days to continue receiving private pay services from the same provider).

How many years has the provider been in business?

Is the provider associated with a larger health care group or hospital?

Is the provider accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHOP) or by the Community Health Accreditation Program (CHAP)?

Will the agency help you find the best homecare options for you?

Does the provider have a written policy describing the patient’s rights?

Are nurses or therapists required to evaluate the patient’s home care needs? If so, what does this entail? Do they consult the patient’s physicians and family members?

Will the provider give you written information describing how they commence and discontinue services to patients?

What backup does the patient have if their caregiver cannot show up at the scheduled time?

What are the internal complaint procedures?

Will the provider give a list of citations they have received from state surveyors over the past year?

Does the provider have a nursing supervisor on call and available 24 hours per day?

How does this provider select and train its employees? Does it protect its workers with written personnel policies, benefits packages, and malpractice insurance?

What types of reimbursements will the agency accept?

Will the provider give a list of references?

Article adapted and checklist borrowed from the Maryland-National Capital Homecare Association’s (MNCHA) and the National Association for Home Care’s (NAHC) websites. For more information, please visit their websites at www.mncha.org or www.nahc.org.

What is a PRS?
A PRS is a relatively simple tool to help keep the user in contact with friends, family, and, if needed, emergency services. Each system has three elements: a portable radio transmitter (help button), a console connected to the user’s telephone, and a response center to monitor the calls. In case of an emergency (a fall, chest pains, suspected intruder, etc.), the user simply calls for help by pressing the button on the radio transmitter.

The console picks up the signal (much like an automatic garage door opener) and automatically phones the response center (even if the phone is off the hook). The call is routed to the response center where the caller is identified through special coding. The monitoring center’s first response is to talk with the user and verify that an emergency exists. This can be done through two-way voice communication or by calling the user back on the phone. Next, monitors will call responders or emergency services to answer the call for help (even if they can’t reach the user by phone).

The features offered by many PRS providers are expanding at an astounding rate. Some systems now offer services such as companionship – the user just pushes the transmitter button and can talk with the response center for any reason. Other systems offer a speaker phone feature with their PRS that allows the user to answer the phone from wherever they are in the house, preventing accidents and aiding the disabled. Staff at the response centers often receive extensive training in such fields as gerontology and stress management, so they can better serve their clients.

As with any other purchase, seniors should seriously consider their specific needs and budget constraints before deciding on any one system. It is a good idea to get written quotes from several companies before making a final decision.

For more information about specific PRS vendors, check with the office of the state Attorney General, local consumer affairs office, or the Better Business Bureau to see if the company has had any complaints filed against them. Your local hospital may also be a good resource to look into; many hospitals offer PRS rentals, which are affordable and reliable.

For additional general information about personal response systems, consumers should consult the Federal Trade Commission’s report entitled “Personal Emergency Response Systems.” The report is free. Consumers can have a copy mailed to them or can review the information online. To request a copy of the publication, call 1-877-382-4357. The report is also available on the FTC’s website. Visit www.ftc.gov/bcp/conline/pubs/services/pers.htm to view a complete copy of the report