Mature Lifestyles • Thursday, October 17, 2013 Page 1
focus.mnsun.com
Ombudsmen: making sure seniors’ voices are heard BY EMILY HEDGES CONTRIBUTING WRITER The Swedish word “ombudsman” may not be familiar to everyone, but to seniors living in long-term care, it means friend, sounding board, advocate and hero. Ombudsmen like Sally Schoephoerster and James Dostal spend their days out in the community ensuring those receiving long-term care services have their voices heard. “Every state has a program. We work with people in nursing homes, assisted living, home care, anyone who receives long-term care services,” said Dostal, who covers the west metro area, Scott and McLeod counties for the Office of Ombudsman for Long-Term Care, a program of the Minnesota Board on Aging. “We serve as an advocate for the residents. We are impartial. We listen to both sides of an issue and try to find a resolution.” The 62-year-old went back to school late in life to earn a degree in gerontol-
ogy. He began with the department 13 years ago and feels it is a great fit for him. “It’s more than a job. It’s a part of who I am,” he said. “For me, it’s a job that has a purpose and a value for others. That makes it a great position to be in. People can feel lost and forgotten, powerless over what goes on – where they are at, their illness. To be able to make a difference in someone’s life is why I do it.” Dostal holds a paid position in the program, but adds that a number of volunteer positions are available to those who would like to advocate for others. “Volunteers can go to nursing homes on a weekly basis and get to know the residents, get them to open up, and help to find solutions,” said Dostal. “There are a number of volunteers out there who have done it for a long time. It becomes part of who you are.” Schoephoerster has also been an ombudsman for 13 years and covers north OMBUDSMEN - TO PAGE 3 Photo illustration
Page 2 Mature Lifestyles • Thursday, October 17, 2013
Part A
Late enrollment penalty
Hospital Insurance
focus.mnsun.com
How do I enroll in Part D?
Can I keep my doctor?
Premiums?
Brand name drugs
Part B Medical Insurance
Coinsurance and copays
Covered vs. non-covered services
Cost and coverage comparisons
Part C
Cost and coverage comparisons
? Service areas
?
?
Combines Part A, Part B and usually, but not always, Part D
Part D
Is original Medicare enough?
Do I need a referral to see a specialist?
Coverage gap
Benefit periods
Prescription Drug Coverage
H2462_72053 Accepted 10/07/2013. HealthPartners is a Cost plan with a Medicare contract. Enrollment in HealthPartners depends on contract renewal. Š2013 HealthPartners
Mature Lifestyles • Thursday, October 17, 2013 Page 3
focus.mnsun.com
Ombudsmen FROM PAGE 1 and northwest Hennepin County. “Growing up in a family with an elder living with us, I felt comfortable in that environment,” she said. “I have a background working in gerontology, so it seemed like a natural direction for me.” Empowering her clients through education is what Schoephoerster likes best about the job. “I like to educate consumers. They should be knowledgeable about the rules that govern service providers,” she said. To be an ombudsman also means that you’re always working to make the system better. “We are the ones in there fighting for consumers. Addressing systemic issues is part of our advocacy,” said Dostal. His advice to those entering into longterm care is simple: realize you are not powerless, take care in making decisions that will affect you legally down the road, read your contracts in assisted living and nursing homes, know what
you’re getting yourself into, and don’t be afraid to speak up. Although ombudsmen don’t get involved on the financial side of longterm care, they ensure all clients are treated equally. “Whether you’re paying for long-term care privately or through public programs, you should get the same quality of service. We’re about the quality of care rather than how to pay for it,” he said. Ombudsmen handle complaints and problems relating to: quality care and services; quality of life; rights violations; access to services; service termination; discharge or eviction; and public benefit programs. Ombudsmen serve residents of nursing homes, boarding care homes, assisted living facilities and those receiving home care services; those receiving Medicare benefits with hospital access or discharge concerns, and anyone seeking consultation about long-term care services. For more information on services and volunteer opportunities with the Office of Ombudsman for Long-Term Care, call 1-800-657-3591. All ombudsman services are free of charge to seniors. Photo illustration
So much is changing the way we think about work and age. People are thinking differently about retirement and many want to stay in the work force or transition into part-time work. Older workers are capable, experienced and mature. Your talents are appreciated and your contribution and skills are critical to Minnesota’s economy. Call the Senior LinkAge Line® A One Stop Shop for Minnesota Seniors at 1-800-333-2433 now for help to START your journey as a mature worker.
Page 4 Mature Lifestyles • Thursday, October 17, 2013
focus.mnsun.com
1-800-333-2433 Senior LinkAge Line is a free, statewide service for seniors, baby boomers, Medicare beneficiaries, caregivers and those trying to reduce prescription drug costs Julie Van Name is a nurse who never thought much about Medicare or prescription “donut holes.” The 55-year-old had health insurance through her work and no medical problems. All that changed suddenly when an autoimmune disease attacked her lungs, muscles and joints. She went from zero medications to 56 in the blink of an eye. “In a day I had this life-changing illness and needed all this help. I didn’t have time to prepare,” said Van Name. After going on disability, she received a notice that she was eligible for Medicare. Because she already had coverage, she declined Medicare, not realizing that she would soon be automatically dropped from her company’s policy. The result was a period of time that Van Name was uninsured. “I didn’t know what I was going to do. I couldn’t afford to pay for my oxygen,” she said. That’s when Van Name learned about the Senior LinkAge Line, Metropolitan Area Agency on Aging’s free statewide information and assistance service covering all 87 counties of Minnesota. Loudi Rivamonte, recreation supervisor for Eagan, sees firsthand how often Senior LinkAge Line helps people like Van Name deal with difficult situations. “It is a great program, and I know from touching base with many of the seniors who have participated in counseling appointments, a vital service. The counselors spend one hour of face to face time with the senior and many times their family members and caregivers to help them navigate the benefits of Medicare. Having a neutral party to offer guidance through a sometimes complicated journey through the healthcare world is quite a benefit,” she said. Michele Starkey, coordinator for the Burnsville Senior Center, agrees.
“With the variety of calls and inquiries we get on a daily basis, it’s nice to have a central contact where people can get the help they need.” For Van Name, that help came from a Senior LinkAge Line volunteer named Julie. “I learned that if you don’t sign up correctly with Medicare the first time, you can be subject to a penalty,” she said. “It can be costly. They helped me through it. That was the first step. She told me next, I’d need help with prescriptions and deductibles. She started talking about donut holes, catastrophic coverage. I was so overwhelmed.” Van Name considered herself an educated person, but felt ill-equipped to climb the mountain before her alone. Not only did Julie from Senior LinkAge Line walk her through each step of the process, she also followed up along the way even after Van Name was referred to a local Senior LinkAge Line volunteer named Sally. “Sally was an extension of Julie,” said Van Name. “She was so knowledgeable. That first day, she spent two hours with me.” Sally went over the basics of Medicare Parts A and B. She explained how supplemental plans worked, and what her options were based on the medications she needed. “They weren’t telling me what to do. They showed me the differences. It was so easy to make a mistake that might have cost me a few thousand (dollars) a year,” she said. One of the biggest problems for Van Name was a coverage gap on her prescriptions. In 2013, once a patient and their plan have spent $2,970 on covered drugs (the
LINKAGE - TO NEXT PAGE
Mature Lifestyles • Thursday, October 17, 2013 Page 5
focus.mnsun.com
BY RHONDA WHITENACK AND JIM CZECHOWICZ If you are disabled and you’re no longer able to work, you should learn how Social Security can help you. Disability is something most people do not like to think about. However, the unfortunate reality is this: the chances that you will become disabled are probably far greater than you realize. Studies show that a 20-year-old worker has a more than one in four chance of becoming disabled before reaching retirement age. Social Security pays benefits to people with disabilities through the Social Security disability insurance program, which is financed by Social Security taxes. If you qualify, you can receive a monthly disability benefit from Social Security for as long as your disability keeps you from working. The amount of your benefit is based on your average lifetime earnings. Potential Medicare coverage is dependent on several factors and usually starts after you receive disability cash benefits for 24 months. When you work and pay Social Security taxes, you earn credits. The number of credits you need to qualify for disability benefits depends on your age, and some of the work must be recent. For example, if you become disabled after age 31, you need to have worked at least a total of 10 years, including five of those having been worked within the past 10 years. But if you become disabled before age 24, you need only one and a half years of work in the past three years. If you have a disability that keeps you from working, the time to get started
with your application is now. That’s because it takes time to determine whether you qualify for benefits. It usually takes about three to five months for a medical decision from the state agency that evaluates your condition. If your application is approved, your first Social Security disability payment will be made for the sixth full months after the date we determine that your disability began. Given the time it can take, it’s in your best interest to do everything you can to speed up the process. The best first step is for you to read our online publication, Disability Benefits, at www.socialsecurity.gov/pubs. It will tell you all about the process, including the information you will need to apply for benefits. Then, take advantage of our online disability starter kits. You will find them on our disability website at www. socialsecurity. g ov / d i s ab i l ity. From that page, simply select the option to apply for benefits online, and on that page you will find the disability starter kits. There is one kit for children and one for adults. Each kit is available in both English and Spanish. The starter kits help you begin the process by providing information about the specific documents and the information that we will request from you. Take a look at the disability starter kit now at www.socialsecurity.gov/disability. Once you complete the online disability starter kit and you’re ready to apply, the most convenient way to do that is also online. Just go to the same disability website at www.socialsecurity.gov/disability. The writers are with Social Security public affairs in Bloomington and St. Paul.
Van Name ended up selecting one of the cheaper Medigap plans, something she wouldn’t have had the confidence to do without the information providFROM PREVIOUS PAGE ed by Senior LinkAge Line. combined amount plus your deduct“They helped make sure I was made ible), they end up in the coverage gap, aware of all of my choices so I could also called the “donut hole.” pick the best option,” she said. “We “For me, the donut hole was huge, a used all of the information to come couple of thousand dollars,” she said. up with the best possible plan so I can The Senior LinkAge Line counselors continue receiving care from the exact showed Van Name drug reimburse- same physicians.” ment plans and grants that were availVan Name is eager to pay back the able to debt she help her. feels she “By the owes Setime I left, I felt like this was something I want to nior LinkI felt like share. It was such a lifesaver. Age Line I knew by volun– Julie Van Name teering her all about all differtime to ent plans. become a I wasn’t counselor p a n i c ke d like Julie about what would happen when I hit and Sally. the donut hole. She prepared me for “I would love to make it easier for what to do when that happened,” said someone. They held my hand and Van Name. “She told me to call this made this process nice and smooth,” clinic for this medication and that clin- she said. “I felt like this is something I ic for that one. I was able to do that so want to share. It was such a lifesaver.” that the donut hole only cost me about The Senior LinkAge Line may be $200.” reached by calling 1-800-333-2433.
‘‘
‘‘
If you can’t work due to disability, Social Security may be able to help
LinkAge
You Choose How You Live! At Crest View, We Care Crest View Senior Communities offers all the services you’re ever likely to need. From senior housing to skilled care services, you’ll find that we offer choices and options to fit your needs.
Our Locations Crest View Lutheran Home
Crest View on 42nd 900 42nd Avenue NE Columbia Heights
4444 Reservoir Blvd NE* Columbia Heights
Columbia Village For more information call:
763-782-1601
The Boulevard Apartments 4444 Reservoir Blvd NE* Columbia Heights
Royce Place READERS’ CHOICE
Awards
1515 44th Avenue NE Columbia Heights
1675 44th Avenue NE Columbia Heights
Crest View Senior Community at Blaine 11860 Ulysses St NE Blaine (Under Development)
www.MinnLocal.com
CrestViewCares.org
Page 6 Mature Lifestyles • Thursday, October 17, 2013
focus.mnsun.com
Medicare annual enrollment period opens this month BY EMILY HEDGES CONTRIBUTING WRITER This October, Medicare’s annual open enrollment period coincides with the launch of the Affordable Care Act’s state-level, health insurance marketplace, leaving many seniors unsure about how the changes will impact them. “The question I get from those who are about to go on Medicare, or are on Medicare and considering changing plans, is ‘How does Obamacare affect Medicare?’” said Darwin Klockers, a Medicare counselor with Senior Community Services (SCS) who services the Brooklyn Park and Brooklyn Center areas. “It is a very simple answer. There is no impact other than some changes in the Part D Prescription Drug Program that make the coverage more affordable, primarily by giving them a discount on their prescriptions when they go into the donut hole.” Deb Taylor, chief operating officer of Senior Community Services, believes miscommunication has made some seniors fearful of changes from Obamacare, which is more officially known as the Affordable Care Act (ACA). “There is a lot of confusion about the Affordable Healthcare Act and Medicare,” Taylor said. “Basically, there will not be enrollment changes for Medicare beneficiaries as they will continue to have their annual review time to enroll in a Part D or Medicare Advantage Plan between Oct. 15 and Dec. 7. That coverage would be effective in January 2014.” As a result of the ACA, beginning Jan. 1, 2014, all U.S. citizens and legal residents will be required to have health insurance coverage. For those who are not on Medicare or hold health insurance through work, insurance may be purchased through their state’s health insurance marketplace. For Minnesotans, that one-stop shop is MNsure. Michele Kimball, director of AARP Minnesota, spends a good deal of time these days speaking to seniors about the ACA and MNsure. “The most common question I get from those over 65 is, ‘Do I need to worry about MNsure?’ The answer is no,” said Kimball. “Medicare beneficiaries are hearing so much about new health care exchange, and there’s a lot of misinformation.”
Photo illustration She stresses that MNsure is not replacing Medicare. MNsure will not sell Advantage plans (also called Medigap plans), and the ACA will not be cutting Medicare benefits to pay for coverage for the uninsured. What it will do is help seniors who have not reached Medicare age yet, or who have had trouble purchasing insurance because of preexisting conditions or cost-prohibitive premiums.
“Minnesotans’ buying power will go further on MNsure. The premiums of plans on MNsure are the lowest in the country, and individuals may be eligible for financial assistance to help pay their premiums,” said Jenni BowringMcDonough, media relations coordinator for MNsure. “Individuals can only get this financial help to pay premiums through MNsure. Some may even quali-
fy for a no-cost plan.” The ACA plans to strengthen and improve Medicare through free preventative care that no longer requires a copay, along with the gradual closing of the prescription drug donut hole, which will formally close in 2020. The ACA is also projected to save the Medicare program $500 billion over 10 years through greater efficiencies and resources to fight fraud, waste and abuse. “That savings will be used to extend the life of the Medicare trust fund an additional two years beyond its current solvency,” she said. Some comprehensive advantage plan holders may see a decrease in extras, such as dental and eye coverage, because of the ACA. Kimball explained that when Congress passed the Balanced Budget Act of 1997, which originated the Part C Advantage Plans, they decided to incentivize private companies to jump into the market by enhancing reimbursements up to 115 percent for services provided to beneficiaries. This stimulus was intended to last for two years. However, companies are still receiving this benefit 16 years later, something the ACA will end. “We’re going back to reimbursing 100 percent. Because of this, some advantage plans won’t be able to provide extras,” said Kimball. Kimball believes that much of the current health care confusion may be attributed to the slow implementation of the program. “Provisions of the ACA are gradual, not in full effect, so people are not realizing the benefits. I promise by 2016, the rhetoric will have died down,” said Kimball. On Oct. 25, Kimball will give the Keynote Address entitled “Health Care Law and You” at the Key Community Partner Awards hosted by Senior Community Services, which recognizes the effort and impact recipients have had on seniors in their communities. Tickets for the Key Community Partner Awards may be purchased by calling 952-767-7899. For more information about SCS, or if you have questions regarding Medicare, or the ACA , go to www.seniorcommunity.org. For more information about MNsure, go to www. mnsure.org.
Mature Lifestyles • Thursday, October 17, 2013 Page 7
focus.mnsun.com
HAVE YOU EXPERIENCED ANY OF THE FOLLOWING?
CONSUMER TECHNOLOGY STUDY
PARTICIPANTS
WANTED
• Difficulty hearing conversations in noisy situations, such as a restaurant? • Prolonged exposure to loud noise in the work environment? • Trouble understanding women and children’s voices? If you answered YES, or even suspect you may have hearing loss, you may qualify for an important digital hearing instrument study. Beltone, a global leader in hearing health care, is conducting a study of the Beltone Promise, a virtually-invisible system that utilizes advanced digital technology. This large-scale study allows Beltone to test the Beltone Promise in real-world situations, while participants experience the latest, state-of-the-art hearing instruments. All applicants will be given a FREE updated hearing evaluation to determine if they qualify. Eligible participants will be fitted for the appropriate system and oriented to its proper use. During the study, individuals will be asked to use the system daily, and will attend two brief follow-up appointments. If desired, participants may purchase the hearing instruments at a reduced rate, however there is no obligation to buy. This important study is a rare opportunity for those who are unsure if their hearing requires treatment. A reminder - the hearing evaluation is FREE even if you don’t qualify for the study.
This study is being conducted for a limited time only, so please call to request your appointment today. WHITE BEAR LAKE 1310 Hwy 96 Evenings, weekend, and in home appointments available.
1-800-647-1370
Page 8 Mature Lifestyles • Thursday, October 17, 2013
focus.mnsun.com
YOU
NEVER LOST THAT SENSE
OF ADVENTURE, DID YOU?
WE’VE
Stay as active as you want to be. At UCare, we’ve got you covered, with a range of Medicare options designed with Boomers in mind. UCare for SeniorsSM lets you choose from plans that cover prescription drugs, travel, eyewear, dental, fitness programs like SilverSneakers® and more. There are no co-pays for primary care visits with most plans. And you’ll get to talk to a real person 24/7 when you call customer service. It’s just what you’d expect from health care that starts with you. UCare Minnesota and UCare Health, Inc. are HMO-POS health plans with Medicare contracts. Enrollment in UCare Minnesota and UCare Health, Inc. depends on contract renewal. ©2013, UCare H2459 H4270_090512 CMS Accepted (09102012)
BEEN EXPECTING YOU.
Learn more about the benefits of UCare for Seniors in our new eGuide to Medicare at ucareplans.org/eguide. Or call (toll free) 1-877-523-1518 (TTY) 1-800-688-2534, 8 a.m. to 8 p.m. daily.