Medicare/medigap

[cute fuzzy bunny]

We're looking at moving my dad into my wifes now soon to be empty house. This is an expansion on the "son with a spare room" approach to the enhanced "son with a spare house".

Problem is, he has a medicare HMO where he is, where for $65 a month all the medicare gaps are covered. Essentially with a small co-pay per visit and a small deductible for hospital stays, he's covered end to end.

Healthy as a horse so far, a little high blood pressure thats being treated with minor doses of one of the prescription drugs that would cost him about $30 a month if he wasnt covered.

Problem is, the wifes house is JUST outside the range of the HMO's coverage area. But they may be setting up a new hospital about 20 miles closer in a year or two. Whether they'll "cover" the zip then is still in question though, as its a "low income" area. Which is how insurance companies weed out having to cover less healthy poor people and minorities...they simply dont cover the areas such people tend to live in.

Other options look pretty lousy. I quickly checked some medigap and other stuff...looks like theres a bunch of things and they keep changing...medicare+choice, medicare advantage, medicare this medicare that. Like all health insurance the coverage and costs from one plan to the next change at least 5-6 items so you simply cant compare apples to apples and make a non-confused informed choice. But what I could find was medigap plans that appear to cover almost everything, but the costs shoot up to 200-300 a month!

My granddad got eaten alive by having no medigap policy and then getting quite ill in his late 80's. So while my dad is in good health, he's not going to make that leap.

So for those who have made it to medicare and probably researched the heck out of this already, whats the best and most cost effective support plan for medicare? Ideally almost everything is covered, the cost is decent, and the paperwork is minimal. Especially if the folks in northern cal can comment...he's going to be in yuba county in marysville, but kaiser and the other hmo's appear to not cover there.

The good news is he'd be able to go to my wifes hospital and get only the "good" doctors and taj mahal treatment if he ever did get sick. And he'd be <15 minutes away instead of 45.

 

[Roger_R]

I'm not the expert your looking for, but my elderly folks have gone through a few serious illnesses with nearly everything covered through medicare plus Blue Cross.  Dad's policy was running about $250/month with no presciption coverage and Mother's was over $300 with presciption coverage.  I'm not real familiar with the policy details, but the $65/mo sounds like a relative steal.

 

[John Galt]

My folks have not suffered any "serious" illnesses, but they have had some in-patient surgery, etc.
Whatever they had done was also covered pretty
much 100% by Medicare plus Blue Cross. However,
unlike the case of Roger_R, my folks pay around
$400 a month for their Blue Cross suppliment. Dad likes to say he bought the "best policy they had". I don't doubt it but did they really need that? I dare not
bring it up though. The other day I pointed out how much
money he was losing by keeping 30K in his checking account. He immediately got fiesty. Looks like there
is nothing I can do until he can no longer handle his own finances, or (God forbid) starts to wander into
Bizarroland...............

John Galt

 

[panhead]

Hmm, John Galt, I know I'm alot younger than you but it looks like we're in a similar position here. my father passed away a couple of years ago and I am trying to take care of my mother as well as I can with my job and travels. I know EXACTLY what you mean about the "loss of control" issue, it sure can be a big one for those who are used to calling the shots. For that matter, imagine someone trying to take control away from people like us, yuk !! LTC ? Not an issue, the time is already passed where it would likely be of any benefit. As for the finances, same issues, I'm dealing with a post depression era idealogy where the checking account is about as far as we can go (at least we got past the matress). How have you and others dealt with this ? It's a tough situation, and it sure causes some stress......

-pan-

 

[omni550]

panhead,

Dealing with the parents' loss of control is tough.

Both of my folks have since passed on. They were depression-era people -- and still had that mentality. Never had a checking account or a charge card.

Towards the end as they just became more passive about doing anything, we just had to be very firm about some things. For example, we had to insist that they draw up updated wills (the old ones still had my sibling apoointed as my guardian --- and I'm over 50!). We told them they could bequeath it all to 'anyone' --- even the maintenance man at their condo --- they just had to update their wills. We respected their privacy, but dragged them aound to the banks and law offices to help make (it almost seemed like force?) this to happen.

Similar things with their housing --- they bought a condo 2 miles from thier house, but never got around to selling the house or moving out of it. They'd go and sit in the condo during the day and go back to their house and sleep in their bed at night. This went on for 1-1/2 years. I finally decided that maybe they were overwhelmed by it all. We first gave them a choice --- you can pick your house or your condo -- but you can't have 2 homes within 2 miles of each other. They finally chose the condo. Then I gave them a date 2 months in the future --- told them that was the day their stuff was being moved to the condo --- they were free to leave their house in the morning --- but to show up at their condo after 5 PM, as that's where all their belongings would be. It felt odd giving them ultimatums and taking control. After they were all moved in, my Dad thanked me profusely several times --- so I knew we had done the right thing.

After that, us 2 kids, spent 3 months cleaning, painting, reflooring, and basically updating their old house. WHne listed with a realtor, it sold within a month for much more than they had expected.

After these expereinces, I began to realize that they were just getting overwhelmed by the choices they had to make, as well as just by the fact that they were getting older and 'losing control.'

My sibling and I started stepping it and gently helping the folks by 'forcing' (I don't like that word, but can't think of another) them to move forward/make choices on key items. Wherever possible, we let them make their own choices.

It's very difficult to see your folks get older and start needing you to step in and be the 'parent'. I looked at it from the perspective of role-reversal. Treating them kindly and wioth love, though sometimes it had to have a touch of firmness, just as they had done with me when I was a child.

I wish you the best with helping your Mom...


omni

 

[John Galt]

Interesting story omni, but a little depressing as I can
see all of that coming with my parents. My Dad
is prickly in the extreme and I have one brother.
We don't speak. Looks like it could be a real nightmare
scenario.

John Galt

 

[cute fuzzy bunny]

In a thread where I'm asking for advice, I'm going to find myself giving some!

For anyone looking at medigap policies, check with AARP for rates. What I've seen so far is that blue cross/blue shields rates are the highest for the same coverage policies.

I havent had any "control" problems yet, but I am seeing an odd change of behavior. My dad is also a depression era type. Used to dry out paper towels and wash tin foil. Last couple of years thats changed. Bought a golf cart he really, really didnt need. Wanted to spend almost 10k "screening in" his back patio, even though he couldnt explain why he wanted to do that (no bugs). Has a piece of grass about 10x8 and I bought him a nice lawn mower, but he just went out and bought a second one. When he moved here, he had a van. He spontaneously went out and traded the van for a car, no word mentioned. A year later, he again spontaneously traded the car for a small SUV like the one I bought my wife a few years ago.

So I'm a little concerned that mr "I dont need that!" is turning into a spontaneous big spender. I dont know if he's "losing it" or just deciding to spend his money like crazy now that he's over 70.

Roger - the $65 deal is a good one. Although you have to temper it with the co-pays. If he goes in for a doctor visit, has a blood test and an x-ray, thats 3 $25 co-pays he has to kick in for. And it being an HMO, he has to push a little to get seen, the docs only spend about 10 minutes with you, and everything has to be fully "justified" and pushed for. I'm with the same HMO until I get put on the wifes group plan, and I've had very good luck and no problems with them. Right now the "best" medigap policy through AARP is $223 a month for his age group. Was over $300 for the same medigap plan with bc/bs.

With about nine of the medigap plans, and doubtlessly countless other options though, especially for those who live in rural northern CA between the sacramento and oroville areas, I'm still looking for other choices. Maybe theres even a difference in medigap policies from one company to another that might explain why AARP's is cheaper than BC/BS.

 

[John Galt]

My Dad (86) is doing more weird stuff all the time.
What can I do? My folks want my help, but when it
gets into financial stuff..................
I feel stuck. Worse, it is causing us to delay or alter
our plans, and we are not getting any younger either.

John Galt

 

[Roger_R]

My take on it is that unless older parents are changing thier will to include the neighbors cat, or buying time shares in Costa Rica, if they like the control they have with their money let them have it. It's sort of like asking an 85 year old to cut back on carbs. There are some remaining things that may give them a little pleasure or the feeling of self sufficiency. My dad seemd to buy into every special offer CD every bank in town had. I think he had small accounts in about ten banks. Though he could still calculate out interest he would get on a certain savings amount, I think he forgot where all he had accounts and for how much. When he passed away it all worked out ok, though I can see how similar situations could start getting out of control.

The really important things are that they have the proper legal papers and you know where they are or have legally binding copies. Dad became suddenly ill and we needed to refer to his living will, but were unable to find it until he had passed on some time later. Fortunately I knew where he kept his safety deposit box key, but it was stashed away in a little hiding spot in the back of a closet.

Lord allow your elder relatives a long life and a gentle way out, but things can happen very suddenly and those few questions you might need answers for are good to know ahead of time.

 

[omni550]

The really important things are that they have the proper legal papers and you know where they are or have legally binding copies.

This is a very key point. We also made sure that our folks had designated a medical directive and a Power of Attorney.

These were some diffficult conversations we had(getting them to update their wills, as well as the medical directive and POA). We figured the worst time to try and do these is in a crisis moment, which is why we persisted.

It's difficult for anyone to sit down and think about these things, even when young and in the best of health. So, an older person who also might be suffering from health issues would understandably have even a tougher time of it. But these decisions and documents are critical to for the rest of the family to know and therefore be able to actually carry out the wishes of their parents.

Regarding their spendig habits, when both parents were alive, they didn't spend any money (as usual.) When Mom passed, it was the first time Dad had access to everything. He started going a bit overboard (in my opinion) on making charitable contributions. I was a bit concerned. My concerns were unfounded, as when he passed on about 18 months after Mom --- he still had plenty of assets.

omni

 

[Nords]

Gotta watch for dementia symptoms.

Elderly erratic behavior scares the hell outta me. If you even suspect that dementia could be an issue, call a family doctor to discuss it. Then persuade a visit for a "routine physical". Hopefully you already have the healthcare power of attorney!

My father visited my 84-year-old grandfather and noticed that he was repeating his same old stories within the hour and spending much of the day watching TV ads. Grandpa was living independently but alone in a retirement community that also offered assisted and full care. Grandpa was clean, alert, mobile & taking care of the apartment so Dad didn't worry about it.

Six months later the rental manager called my Dad to suggest that Dad should go check on Grandpa and remind him to start paying his rent again.

That began our five-year odyssey of legal & forensic hell. (Just for us, not for my grandfather.) As Dad visited with Grandpa, he realized that for at least the previous five years the daily mail had been collected & stuffed into a drawer... then a closet... then an unused room. It was literally over a thousand cubic feet of paper. No bills (other than the apartment rent) had been paid for at least three years. Utility companies would complain but none of them would cut off a senior citizen, so they just gave up and started adding 1.5% interest per month. For over THREE YEARS!! Same situation with federal & state taxes, although the IRS was threatening to take over Grandpa's checking account by then. The manager was getting paid monthly in cash so there was no motive to alert anyone until the cash stopped flowing.

Every day for over five years, if he wasn't with us, Grandpa had been eating EVERY meal at the local "Friendly's" restaurant. We ate there together several times (at his suggestion) and had no idea this had been his "habit". He was hugely popular with the staff for his 25% tips, so they didn't draw attention to the fact that he ate the exact same breakfast at the same table every day. And the same lunch. And the same dinner. For FIVE YEARS. (Clearly his genetics triumphed over his environment, which has given my father and me extensive "food for thought".)

In the early months of his dementia, Grandpa visited the local bank and emptied his safe deposit box into a briefcase. Bonds, stock certificates, several thousand in cash, deeds, a coin & stamp collection, investment diamonds from the '70s, family jewelry, you get the picture. During the months that Dad spent cleaning out the apartment (and the mail backlog) and tracking down the finances, the stuff never surfaced. He finally decided to give up on that research and shifted his attention to selling Grandpa's car. Luckily he decided to clean it first-- yup, the briefcase was still in the trunk. BTW, even deep in his dementia my Grandfather was a flawless driver. I guess that figures-- can you remember driving last week's errands?

Dealing with the IRS and the state was a real thrill. Although the first "missed" tax return had refunds large enough to cover subsequent returns, there were non-filing penalties followed by interest charges, more penalties, more charges, etc. The IRS & state settled only when enough lawyers were hired to make it too expensive & time-consuming to collect.

We were treated very well by the medical & long-term care staffs. My grandfather was blissfully ignorant of the whole thing and quite happily moved into his "new home" so that he didn't have to clean or to keep making the drive to Friendly's. I'm not even going to go into the saga of legal guardianship, long-term care, and powers of atty. Everything worked out all right in the end but it would have gone much better (and much cheaper) if it had been done years ago and updated annually. The emotional toll on my Dad during those first couple months was pretty severe. Needless to say he's set up an extensive legal system of safeguards and tripwires if his health should go down the same road. Heck, I'll probably get a call from MasterCard if Dad's bill is lost in the mail.

My grandfather lived in a full-care home for 14 years of the most blissful dementia you could imagine. He never made another decision and it was the happiest time of his life. He was in perfect health (despite the five years he spent on the "Friendly's Diet") and mobile to very nearly the end. Every morning was a thrill, every visitor was a surprise, daily walks were full of "discovery", and everything was new again just a few minutes later. We had more fun together at this stage of his life than I could ever remember. He finally succumbed to a respiratory virus that just overwhelmed his immune system, but otherwise he could have kept going for decades. Ironically he still had enough assets for another year or two of care before the Medicaid spend-down would have kicked in.

So for those of you planning to take your life expectancy into your own hands, beware of the day when you no longer remember that you aren't you (and you can't "beware" anymore either). Other legal & financial precautions should be taken so that your loved ones can make the same decisions that you used to be capable of making.

And if you're going through this now, my sympathies-- I know how you feel.

 

[John Galt]

Hello Nords. Thanks for your story. I have not gone through it yet but I sure see it coming. It's going to be a hell of a mess I'm afraid, unless someone just gets lucky and drops dead before things get complicated.
If I make it to my mid 80s, that's the way I'd like to go out.

John Galt

 

[lb]

I'm going through 'taking over' right now with my mother and if they show any signs of memory loss, or seem a little off, I think it is time to start making some decisions for them.

My mother is typical depression era and would save and scrimp and never spend money. She would be upset when she spent more than $20 for her weekly groceries. And the only planning she did was to have a will. She started having some memory problems about two years ago, but still fully competent, so there wasn't much I could do. It did mean I saw the house have no care and fixing up. No way would she think about an assisted living place and the monthly fee.

Looking back, I think you have to take over a bit, and not let the emotion of the role reversal make you hesitate. I tried to get her to agree to my helping out (writing checks, driving, laundry), but I think if you discuss it, there are two downsides - loss of control is right out in the open and it's a decision to be made. Instead, I think you just kind of do and let them complain, and consistently say you want to help out.

The good news, is that if things haven't gotten too bad (the bills were kept up), that when things come to a head, you can get through it. My mother fell down and was on the floor overnight, so when I arrived, I got her to the hospital, and now four weeks later, I have her settled in an assisted care facility, where she is settling in to her new routine.

One thing that did work out in my favor - I had visited a lawyer earlier in the year to discuss options about no power of atty, no health care proxy. So then when Mom was in the rehab center (between the hospital and the care facility), she came to the center and got the two items signed off. Did Mom really understand what she was signing - well, she trusted me that when I said she really needed to do this so I could help her.

Since she has been a saver all her life, she has a good chunk of money that will allow her to stay in a nice place. I guess the downside in lack of planning, is that it can all go to her care, but I figure it's her money and I don't mind spending it all on her. I rather hope that I am stil spending her money at the end and not relying on Medicare for nursing home cost (I do appreciate the Medicare medical coverage and luckily she is pretty healthy).

 

[Bob_Smith]

Nords! Wow - what a story!! How important it is to set up a system to help with those issues in advance.

I have a "letter of instruction" with all the details, and my kids know where it is and what to do if various things happen (death, disability, etc.). The letter is around 12 pages long and has all the details (even things like where to find the keys to the cars). It tells them where to find legal documents, a current list of assets, and many other things. It was a pain to write the first time, but now I just update it annually and that takes maybe a half hour.

lb, my parents are approaching that stage. You make some good points - maybe it's best to just plunge in and start doing things.

 

[John Galt]

Man, that's a great idea. I have some general idea
of what's what with my folks, but if I died it would take
a team of lawyers and accountants a year to unravel
my affairs (expensive too).

John Galt

 

[Brat]

As I read through these stories I see versions of my own.

My parents were independent and self sufficient and claimed to have all their affairs in order.  Then Dad got sick so I asked Mom to review their affairs.  A practical woman, she went to their safety deposit box and started sorting it out.  She couldn't assemble the pages of self-authored "revocable trust" they had written.  The "trust" hadn't been funded.  The will was over 30 years old.  There was pride of authorship there.  I suggested that she and Dad take it to a lawyer for "updating" and I gave them a couple names as I had just updated my will.

The choice of a lawyer is critical because the person needs to have LOTS of PATIENCE and the ability to identify the emotional needs of the couple.  The short of a long story is that my parents got it done.  One interesting document was a joint revocable living trust that could be amended if both agreed or with one grantor and a contingent trustee.  They had always made joint decisions but one never knows, so this insured that if things got goofy others got involved.  The lawyer saw that the trust was funded.  

Things did get goofy, I will spare all the details, but the net result is that both were able to have appropriate care and protection.  When Dad died Mom's life wasn't complicated further by legal matters.

What I have learned is that it isn't wise to take the path of least resistance and "butt out" of their lives.   It is difficult for them to let you help if you haven't been there all along, you have to play catch-up.  It's not easy.

For some retiring to a continuing care community is a great decision.  I wish my parents had gone that route because, as their world shrank, they could have the company of friends similarly situated.  I hope I can convince my husband to make that move someday.

Let's start a thread that focuses on frail parent care.  Some of us have been there, done that.