Real Life | Cutting our own health and long-term care costs

We’ve been phenomenon-izing our fast-growing golden-age longevity and its inevitable exploding health and long-term care costs that mercilessly usurp our “gold”, our assets and our children’s inheritances. So, it seems highly desirable to embellish some of the cost-control ideas mentioned in our recent columns. The more the better, right?

Entitlements

Entitlements, whether insurance or direct aid programs, federal, state, or corporate and regardless of our political opinions, are

just that: We’re entitled to them. We’ve paid for them, via taxes, labor, or premium payments. Let’s utilize our eligible benefits. Feelings of reluctance, pride, guilt, embarrassment, and “stigma” are as archaic as black and white television.

Obamacare and Medicaid are the rising stars in the galaxy. Robert Pear, in his July 29, 2015, New York Times column says that Obamacare-boosted Medicaid has sharply expanded both its numbers, now 66 million, its eligibility criteria now broadened to envelop many typical middle-class Americans.

He quotes George Washington University professor Sara Rosenbaum: “Medicaid plans, once the scourge of poor communities, taking money without providing much care, now provide invaluable services to people with severe physical and mental health problems. The care can be light-years better than what a Medicaid beneficiary would face if he/she had to go find an orthopedist, a rheumatologist, or a podiatrist, or get specialty drugs, on their own.” No longer are the “poor” its only clients, nor is the care limited to professional medical and institutional services.

As longevity and its accompanying alarmingly expensive long-term care costs (we recently quoted some of those shockers) drain our personal resources, how do we qualify for newly middle-class-friendly Medicaid? We well might need to someday. Follow your state’s criteria (they all have websites) about income, assets, and “look-back” rules covering how and when you use up or give away your wealth. Financial planners, CPA’s, and elder law attorneys devise strategies to make their clients eligible.

Long-term-care institutions’ intake and resident-affairs officers know the system well, and aggressively invoke it, both to recruit new customers and to retain residents who run out of money (most do). At least 60 percent of nursing home residents, even private ones, are on Medicaid.

Mr. Pear also emphasizes, and we’ve mentioned, the unforeseen and unexpected growing role of commercial insurers in both Medicare and Medicaid: “More than 30 percent of Medicare and half of Medicaid beneficiaries, are now in private health plans… as the government, in an effort to control costs and improve care, pays private insurers to provide and coordinate medical services …”. To us this means that shopping for alternatives might well pay off.

Fraud and improper payments

Hate being ripped off? When it’s big-time, such as the $ 17.5 billion in hits on Medicare and Medicaid that the Government Accountability Office says happened last year, it’s catastrophically costly for all of us, too. The Justice Department’s hard-charging investigators accused 243 persons involving over $ 700 million in June this year, alone.

Yes, we can help. We should. Www.medicare.gov tells us how to detect and to report (including 1-800-MEDICARE). Medicare sends us periodic detailed “Medicare Summary Notices” for exactly this purpose, and our commercial health insurers send us line-item-specific claim and benefits reports. In them we find the charges that don’t look right.

For example, items like: Six separate charges for Gershon’s four office same-visit surgical procedures. And the mysterious, unexplained “adjustment” billed to Marv eight months after Medicare and his secondary carrier paid 100 percent of the allowable negotiated charges. Or the CAT scan that Fran’s physician ordered, but never happened because the hospital discharged her.

But, some big “howevers”: Many charges or their amounts are innocent or incompetent (both human and software) data-entry errors, especially if the billing is out-sourced. Many actually are correct, but unexplained. Outrageous charges in the first statement column merely “list” prices, inflated to boost the much lower actual “negotiated” charges (I know, many of those seem outrageous, too).

But many suspicious items are wrong and disingenuous, and need to be challenged. Alternatively, sometimes a phone call to the provider’s billing supervisor, rather than to Medicare, Medicaid, or the insurance company, results in a surprisingly pleasant response and correction.

Long term care

As you know, this is the scary “big one”. That’s why we dialogue about it so much. As we live longer, needing help with the activities of daily living for more years, and as we and our families become increasingly detached from “the family home”, mobile, career-oriented, and demanding upgraded elder care, how will we cover the cost? Columnist Matthew Craft reports that the National Council of Aging estimates that most of us are tapped out after only a year.

Reinforcing our awareness of the problem’s seriousness and the urgent need to plan and start funding it early in life, we’ll benefit from citing Mr. Craft’s Associated Press article, which the Sun News carried on July 21 this year under the headline “Cost of elder care soaring”. I commend it to you.

Among his cost-cutting strategies: Provide adequate, compatible at-home facilities for Mom and Dad, even if it requires some remodeling (start early and plan ahead), or you and them moving in with each other or together in another house, as an alternative to even far costlier institutional care. When at-home aides are needed, organize the family to cover some of the shifts, and avoid the unneeded extra expense of overqualified help. But, as we often admonish, be oh-so-careful about physical arrangements, emotional impacts, and selection of aides.

If day care at the local center is feasible and cheaper than aides, go for it.

If institutional living is necessary, choose one suited in-house to Mom’s/Dad’s needs without having to incur additional costs for outsourced needed services. Reminding Mom/Dad that the entire building and grounds are their comfortable home, and willingness to share a bedroom with a compatible roommate saves a lot vs. a private bedroom.

Be financially smart: Strategize for Medicaid eligibility earlier, rather than waiting for the family’s resources to run dry. For our children, dramatize the need to nurture financial health care savings plans, tax-sheltered ones, and to acquire reliable tax-qualified long term care insurance, all beginning early in adult life. LTC insurance might even be feasible for you via your state’s long-term-care partnership (it has a website). If pre-arranging, pre-paying, or “buying in” to institutions is appropriate and cheaper and without opt-out penalties, embrace them. Arrange the commercial health and LTC insurance coverage to achieve the best benefit structure to suit your individual financial pattern, and cover both you and Beloved on one joint policy. Team it with dedicated regular savings funds to make up for premium-reducing higher deductibles and co-pays, longer waiting periods, and lower internal limits.

Prevention

Also worthy of re-visiting is the obvious good-sense truth that taking good care of ourselves and each other prevents, defers, diminishes, cost-incurring health issues, and hastens recovery from them. You know the picture: Diet, exercise, checkups, obeying doc’s orders, brain-stimulating problem-solving, meditation, de-stressing, and so on. Let’s watch each other, to detect appearance or behavior changes that we don’t notice in ourselves, or ones that we (often involuntarily) invoke defense mechanisms to fool ourselves about.

So, aggressively pursuing cost controls won’t solve the huge problem, but it surely will help. And we’ll deserve to give ourselves a feel-good “’waytago!”

This story was originally published October 28, 2015 at 10:54 AM with the headline "Real Life | Cutting our own health and long-term care costs."