Understanding private insurance that covers the gap between what Medicare pays and what a provider charges.
Expert Elder Care Guidance
Expert Elder Care Guidance
An advance directive, also called a living will, is a document containing an individual's wishes about his/her future healthcare. An advance directive takes effect when the individual can no longer understand and appreciate treatment choices. It also specifies decisions about organ donations. People complete an advance directive to gain control over their future healthcare and to relieve family members from the burden of making difficult decisions.
Adult day services, also called adult day centers, are non-residential facilities that specialize in providing therapeutic, nursing and social activities for older adults with cognitive (thinking) and/or physical limitations. Many participants have Alzheimer's disease or another form of dementia. Adult day services are often used by primary caregivers who need a respite from caregiving responsibilities or by working family members who care for an older adult who cannot be left alone safely in the home.
Aging in place refers to an older adult's ability to remain living at whatever place they call home for as long as possible, with the help of universal design principles, home care, support services and assistive technologies.
Alternative medicine is a form of practice that is considered to be outside conventional treatment. It covers a broad range of healing therapies, including naturopathy, chiropractic, osteopathy, homeopathy and acupuncture. These therapies focus on getting the mind and body to effectively use their own natural healing processes. When an alternative therapy is used along with conventional treatments, it is called complementary.
Alzheimer's, the most common form of dementia, is a progressive, degenerative disorder that affects the brain's nerve cells. It results in loss of memory, thinking and language skills, and causes behavioral changes. Alzheimer's is most often diagnosed in people over 65 years of age, although early onset Alzheimer's can occur in younger people. Alzheimer's is named after Alois Alzheimer, the German psychiatrist and neuropathologist who first described the disease and its symptoms.
Assisted living facilities, also called catered living, personal care homes or boarding homes, provide residents help with the tasks of daily living (sometimes called ADLs or "activities of daily living") and monitor resident activities to ensure health, safety and well-being. Daily living tasks include bathing, grooming, taking pills on time, housekeeping, meals, managing bills and using transportation. Residents do well in assisted living if they are still performing some daily living tasks on their own and do not require 24-hour monitoring and care. Some assisted living facilities offer specialized round-the-clock supervision and therapeutic activities for residents who suffer from dementia.
Cardiac stress tests evaluate how the heart responds to the stress of physical activity for the purpose of determining if there is an abnormality. There are several different types of cardiac stress tests: An exercise electrocardiogram (ECG) monitors the heart by way of an electrocardiogram while the patient uses a treadmill or stationary bike; an exercise echocardiogram (echo) uses ultrasound images of the heart at rest and during peak exercise; a nuclear stress test measures blood flow; and a physiologic stress test, for people who are not physically able to use a treadmill or bike, uses drugs to stimulate the heart.
Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment and behavior. A leading cause of dementia in elderly adults is abnormal protein structures in certain areas of the brain. Dementia also occurs as the result of multiple small (mini) strokes known as vascular dementia. Most types of dementia are nonreversible. Alzheimer's disease is the most common form of dementia.
Devices include such items as limb, facial, breast and ocular prostheses; cochlear implants; and orthotics (custom-made footwear, diabetic shoes and insoles). When the use of devices is deemed medically necessary, Medicare Part B will cover a great deal of the costs under the category known as Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).
Diabetes is a chronic (lifelong) disease marked by high levels of sugar in the blood. Type 1 diabetes is usually diagnosed in childhood. Type 2 diabetes is far more common than type 1 and typically occurs in adulthood. One in four people in their mid-80s and older becomes diabetic. Three of the major symptoms of type 2 diabetes are extreme thirst or hunger, fatigue and itchy skin. Other common symptoms are weight loss, blurred vision, sores that don’t heal and increased urination, especially at night.
A durable healthcare power of attorney is a document in which an individual appoints a trusted person to make healthcare decisions on his/her behalf should the individual become unable to act independently.
DMEPOS is the federal program, paid through Medicare Part B, that covers some of the cost of medically necessary devices (limb, facial, breast and ocular prostheses; cochlear implants; and orthotics), one-time-use supplies (test strips and lancets used with blood-glucose monitors or supplies used with respirators and wound care) and equipment that can be reused (walkers, hospital beds and wheelchairs).
Electronic pill dispensers are devices that organize a person's weekly or monthly supply of medication. An alarm beeps when it’s time to take each medication and automatically dispenses the pills. Dispensers often include voice-recorded instructions and some can be phone-activated so that caregivers far away can monitor whether or not the medication has been taken.
The Family Caregiver Support Program, administered by each state, helps people who serve as unpaid caregivers for persons 60 years of age or older who have moderate incomes. The goal of the program is to relieve the emotional, physical and financial hardships of providing care and often means the difference between an older adult being able to stay at home or having to move to a nursing home.
FMLA is a federal law that requires larger employers (50 or more employees) to provide up to 12 weeks of job-protected unpaid leave to an employee who needs to care for a family member. To qualify, the employee must have worked for the company a minimum of 24 hours a week for at least one year.
A geriatric care manager is a health and human-services specialist who works with families and others who are caring for older adults. Geriatric care managers are experts in aging and eldercare and often come from such fields as nursing, gerontology, social work or psychology. They assess an older person's needs and make care and services recommendations for family caregivers. They can also make arrangements for the older person’s care, which is especially helpful for long-distance caregivers.
The Health Insurance Portability and Accountability Act is a federal law that sets standards for protecting the privacy of patients' health information. HIPAA is designed to protect a person's health records from getting into the wrong hands. It is also intended to allow individuals easier access to their own health records.
A home care agency, also known as non-medical senior care or in-home care, provides services that do not require a licensed professional or a physician’s prescription. A home care worker can provide companionship to an older adult who is aging in place, as well as help with activities such as medication reminding; preparing meals; transferring from chair, toilet or bed; bathing; getting dressed; light housekeeping or transportation to and from doctors’ appointments.
A home health care agency provides services that require a licensed professional - such as a registered nurse or physical, respiratory or occupational therapist - and a physician's prescription. These medical services are provided in the patient's home and can involve care for chronic health conditions or temporary care, as in the case of someone recovering from surgery or an injury.
Hospice care provides physical and emotional support to people who are in the final phase of a life-ending illness, as well as to their families, and focuses on comfort and quality of life rather than on curing the illness.
See Advance directive.
Long-term care insurance is private insurance that covers necessary medical or personal care services provided outside of a hospital setting, such as in a nursing home or in the insured person's home. Long-term care insurance can cover care generally not covered by Medicare or Medicaid.
See Nursing homes.
Medicaid is a federally supported, state-operated public assistance program that pays for the healthcare services of people with low incomes, including seniors and people with disabilities.
Medicare is a federal program that provides skilled medical care and medical insurance to people aged 65 and older. Medicare Part A covers hospital expenses, Part B covers physician and outpatient services, and Part D covers prescription drugs.
The coverage gap, also known as the "donut hole," refers to an aspect of the Medicare Part D prescription drug benefit that requires a beneficiary to pay 100 percent of his/her drug costs once the plan has paid out a set amount and until the beneficiary reaches a certain threshold when the coverage kicks back in. Starting 2011, those who reach the coverage gap receive a 50 percent discount on all of their brand medications, and by 2020 there will no longer be a coverage gap in Prescription Part D programs.
A Medicare scam refers to a situation in which an individual or company tries to collect healthcare reimbursement from Medicare under false pretenses. The most frequent kind of Medicare scam involves healthcare providers who invent ways to improperly bill Medicare for services or products. The second type of Medicare scam involves ruses designed to obtain a beneficiary’s Medicare number, as well as other personal and financial data.
Medigap is a generic name referring to private health insurance that covers the gap between what Medicare pays and what a provider charges.
Nursing homes, also called skilled nursing or long-term care facilities, provide residents with 24-hour nursing care and supervision because residents need continuous assistance due to serious medical conditions and/or advanced dementia. Residents typically require a protective environment, in addition to medical and healthcare services. Nursing homes offer skilled nursing care, rehab, medical services and protective supervision, as well as assistance with the activities of daily living.
Osteoporosis is a disease characterized by a decrease in bone mass and density, resulting in a predisposition to fractures and bone deformities. While osteoporosis is most common in postmenopausal women, the disease is found in men, as well.
Parkinson's disease is a neurodegenerative disease of the brain that affects the way a person's body moves. The disease is progressive, which means it gets worse over time, but usually this happens over a period of many years. The four main symptoms of Parkinson's are tremor (shaking or trembling), stiff muscles, slow movement and problems with balance or walking.
A PERS is an electronic monitoring system in which a person carries a device that he/she can use to signal a central dispatcher in the event of a fall or other emergency. A PERS gives older adults and other at-risk individuals round-the-clock access to assistance at the press of a button.
Respite care provides a temporary break for primary caregivers of older adults. Care can be delivered in the home to relieve the caregiver or outside of the home through services for the older adult such as attending an adult day center.
A reverse mortgage is designed for homeowners 62 years of age and older. It provides access to a home's equity, freeing up money that may be used to meet other expenses.
A stroke is a sudden loss of brain function, caused by the interruption of flow of blood to the brain (ischemic stroke) or the rupture of blood vessels in the brain (hemorrhagic stroke).
SNAP, formerly known as "Food Stamps," is a federal program that provides food and nutrition assistance to low-income individuals and families.
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