In This Issue

	Managed Care in Medicare
	If you answer yes to any of these questions, Hurley Elder Care Law can help
	Life Care Planning Goals
	The Nuts and Bolts Guide to VA Benefits

Managed Care in Medicare

	When Medicare costs started skyrocketing along with the rest of the health care sector, Congress looked to managed care as a partial remedy. Managed care is a strategy used to reduce health care costs by discouraging providers from performing unneeded services and by promoting preventive medicine. A managed care health plan generally pays providers a flat monthly fee per patient regardless of whether care is actually provided. The financial arrangements among health plans, doctors, hospitals and other providers are all designed to manage risk and to lower health care costs by monitoring care more rigorously through rules as to benefit coverage, choice of doctors, referrals to specialists, defined drug formularies and other restrictions.
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If you answer yes to any of these questions, Hurley Elder Care Law can help.

		Has the elder been diagnosed with a mentally or physically debilitating disorder such as Alzheimer’s, Parkinson’s, ALS, stroke or a decline in functional capacity?
		Is the elder isolated due to the recent death of a spouse, or have family that either lives too far away or is too busy to provide adequate care?
		Is the elder soon to be discharged into a care facility or currently receiving in-home care?
		Does the elder have a variety of healthcare providers and need coordination and advocacy for quality care?
		Does the elder seem unusually concerned about costs of medication and services, indicating he or she may be having financial troubles?
		Does the elder have assets that fall between $50,000 and $400,000 – enough to finance a short stay in a care facility but not enough for an extended stay?
		Does the elder have a spouse whose financial needs must be considered in light of the elder’s medical condition?

Life Care Planning Goals

1. Meeting the elders’ immediate health care and long-term care needs.
2. Making sure the elder/family is making good health care and long-term care decisions.
3. Helping the elder/family sort through the maze of their long-term care options including residential options.
4. Identifying and accessing public benefits and resources to pay for care should the elder meet the qualifying criteria.
5. Help with asset management, including the burden of home ownership and personal property.
6. Providing the entire family the peace of mind that comes from knowing their loved one is monitored by a team that combines legal and financial expertise with specialized knowledge of the elders’ physical, mental and emotional health.
7. Ensuring the highest level of independence the elder can achieve, while ensuring safety.

Managed Care in Medicare

The Medicare Prescription Drug, Improvement and Modernization Act of 2003, while best known for adding Part D prescription drug coverage to Medicare, also expanded Medicare Advantage Plans. These plans are managed care programs that Medicare beneficiaries may choose instead of regular Medicare Parts A and B. The theory is that Medicare Advantage enrollees receive all the coverage they would receive under regular Medicare, but without the large deductibles and cost-sharing associated with regular Medicare. In addition, Medicare Advantage plans sometimes cover products and services that Medicare Parts A and B do not cover, such as prescription drugs or custodial care. The government pays these private health plans an amount per person enrolled, and in exchange, the private company administers the covered benefits. Does this sound too good to be true? In a way, it is. It is very important that anyone considering a Medicare Advantage Plan look carefully at the plan design…the approved providers, premiums, deductibles, benefits and services costs which are different for each Medicare Advantage Plan. For example, there are 69 Medicare Advantage Plans to choose from in Fulton County, Georgia, alone. Of those plans, 44 of them have also have prescription drug coverage. Comparison Shop A report by the Medicare Rights Center finds that Medicare Advantage plans have serious disadvantages over original Medicare. The report, based on thousands of beneficiary calls to the Medicare Rights Center, lists nine common problems with Medicare Advantage plans, including problems getting emergency or urgent care, problems getting care while away from home, and problems getting continuity of care. Consider your options carefully. On the website www.medicare.gov you can compare health insurers that offer Medicare Advantage plans according to plan features such as premium, prescription drug coverage, doctor and hospital choice, and outpatient surgery costs given your personal health situation. The site will soon include information on why Medicare beneficiaries have left a specific managed care plan. While there are many reputable agents who sell Medicare Advantage plans, there have been many cases of unethical marketing techniques and fraudulent sales practices. Some agents pose as Medicare representatives and sign up people without their knowledge. Some agents attempt to explain information quickly or in summary fashion, resulting in enrollees who do not actually understand the design or benefits of the plan they have agreed to join. There have been many reports of high pressure sales tactics, since commissions can be quite lucrative. GeorgiaCares, the State Health Insurance Assistance Program (SHIP) is the primary resource for Georgia’s Medicare beneficiaries to call for help. It is an objective, unbiased counseling organization and can be reached at 1-800-669-8387. GeorgiaCares can send you a booklet called “Medicare Advantage Plans – What You Need to Know” which will help you obtain the facts you need before enrolling in a plan. The chart below compares Medicare Advantage managed care plans to regular Medicare…