Despite the ongoing national and international health crisis, nature goes on and Spring has thankfully sprung in Caroline! It’s such a gift to see nature’s splendid colors, the leaves returning to the trees, and our fields looking good! At this point nothing smells better than fresh air and freshly cut grass!

Like so many workers, I have moved my office to my dining room and am working remotely. Please know we are still open for business and the MAP/ SHIP/SMP contact number is now 410-490-3078. We are still here to serve your needs and I’m still doing my “thing” daily so give me a call if you require information or assistance!

Since we are all surrounded by information overload about the pandemic, I’m going to briefly address the fact that Medicare covers the cost of physician ordered lab tests for Coronavirus (COVID-19) with no cost to the beneficiary. Also, if a beneficiary tests positive during an unrelated inpatient hospital stay and is required to stay in the hospital under quarantine, Medicare covers this as a medically necessary hospitalization. (https://www.medicare.gov/medicare-coronavirus)

Medicare.Gov states that E-visits can be used for treatment for COVID-19 and allow you to talk to your doctor without going to the doctor’s office. Virtual Check-ins are brief connections made by phone, video, or through online patient portals. The patient portals are simple to set up, can be used for more than a check-in in rural areas, and may be a good option for those who are homebound. These telehealth options provide communication between you and your practitioner without you physically going to the office. If you are experiencing possibly contagious symptoms this is an option to be considered so others are not exposed to your illness. To be covered by Medicare this check-in service must not be related to a medical visit one has had within seven prior days. It also cannot be used to make an appointment during the next 24 hours. Your doctor will record your verbal consent to this communication. Remember that you will pay the usual 20% co-insurance and deductibles for this type of check-in. Contact your doctor’s office to see if they are providing telemedicine options.

For those who are eligible for, or are currently participating in Medicare, here’s the refresher for 2020 premiums, coinsurances and deductibles for A&B. It’s a lot of information but this is information my readers need to have moving forward into 2020. The numbers reflect important increases in out of pocket costs that beneficiaries must be prepared for. There’s something for everyone, so jump in!

Medicare includes Part A, referred to as “Hospital” on your red, white and blue card, which covers Inpatient care, skilled nursing care, Hospice care, and some medical supplies. If one has worked 40 quarters (10 years) of Medicare covered employment, meaning you paid Medicare taxes from your pay check or self-employment, or are the non- working spouse or dependent child of someone who has met that criteria, part “A” is generally premium free. For those who worked 30-39 quarters of Medicare taxed employment there is a premium of $252 per month for “A”. For those who worked less than 30 quarters the premium cost for “A” is $458 per month.

Additionally, in 2020 there is a hospital deductible of $1,408 for each benefit period. A benefit period begins the day one is admitted as an impatient and ends when you haven’t received inpatient care for 60 days in a row. If a beneficiary enters a hospital or skilled nursing facility after a benefit period ends, a new benefit period begins, and the patient is liable for another deductible of $1408. There is no limit to the amount of benefit periods nor is there any kind of cap on the deductible paid per year. This is reason #1 to purchase supplemental insurance.

Patient Copays are a fixed amount depending on one’s length of stay and the facility you are in. If a patient is in a skilled nursing facility for more than 20 consecutive days, the copay is $176 per day for days 21-100. If the beneficiary is in a hospital for more than 60 days, the copay for day 61-90 is $352 per day. This is reason #2 to buy supplemental insurance.

Medicare Part “B”, referred to as “Medical” on your red, white, and blue card, covers 80% of outpatient care (all healthcare provided outside of an admitted hospital stay) including doctors’ visits, medically necessary blood work, x-rays, MRI’s, preventative services, and durable medical equipment. The premium for “B” in 2020 is $144.60 per month and is generally deducted automatically from your social security check. If you are not yet collecting SS you will be directly billed on a quarterly basis for $433.80. (NOTE: If you have not signed up for “B” due to employer coverage and that employment ends, you have 8 months to sign up for “B” without incurring a significant penalty. To sign up for “B” while you are employed, or during that 8 months after employment ends, you must fill out form 40-B.) Call Mary Moran for more information.

Moving right along, “B” has an annual deductible which has been going up each year. This year it is $199 out of your pocket before Medicare pays anything plus You are responsible for the 20% not covered by part “B”. That 20 % is reason #3 to buy supplemental insurance.

Since part “B” only covers 80% of one’s outpatient costs, and “A” has mind boggling deductibles and co-payments, SHIP strongly urges all Medicare recipients in Original Medicare to purchase supplemental insurance from a reputable insurance agent who specializes in Medicare Supplemental insurance. Take advantage of the Guaranteed Issue period of six months surrounding your 65th birthday to apply for this insurance without going through medical underwriting. (Technically it’s 7: that is three months before, the month of, and the three months following your 65th birthday) Do not wait until you have been hospitalized or develop health problems. Waiting past this period will, at best, increase your premium due to health issues and, at worst, allow the insurance companies the right to refuse you coverage.

Supplemental plans are also known as Medi-Gap plans. These supplemental plans are standardized by the federal government to ensure that the coverage of a given plan is the same no matter where you are in the USA. If a service is covered by Original Medicare, it is by law covered by the supplemental plan! Medi-Gap plans are not required but are essential. Beneficiaries purchase these plans to cover all the Medicare Part “A” deductibles, coinsurances, and hospital costs outlined above plus part “B” 20% co-pays. Please note that any supplemental insurance policy you buy will not pay any Part “B” penalties assessed for late enrollment since the penalty is considered part of your “B” premium and is not a medical expense.

It can be confusing when comparing supplemental plans simply because the powers that be decided to name the plans alphabetically…just like the three mandatory parts of Medicare (“A”, “B,” D”)! To give you an idea of how these plans function, let’s examine a G. The G supplemental insurance policy covers all hospital part “A” deductibles and copays, plus all the 20 % outpatient “B” costs, Except for the annual “B” deductible. Remember that, folks, the “G” supplemental policy does not pay the one time per year part “B” deductible, which in 2020 is $199. As long as you pay the premium monthly, your only out of pocket costs with the Medi-Gap G insurance is the annual deductible; everything else is covered! The right supplemental insurance policy can be the difference between bankruptcy and financial piece of mind when you have health issues.

To sum up- A= Hospital, B= Medical Outpatient plus Supplemental (GAP insurance) to cover A& B copays, coinsurances and that repeating A hospital deductible. These are the facets needed for complete medical coverage under Medicare. “D” Prescription Drug coverage will be addressed after an intro to “C”.

Medicare “C” is Advantage. This is not Federally funded Original Medicare. It is the form of Medicare which is sub-contracted out by the Federal Government to individual companies and Hospital systems who act as both Medicare Insurance and Health Care Providers. Therefore, since they are acting in the place of Medicare, they can refer to themselves as Medicare Advantage when advertising. These are the big TV advertisers during open enrollment who offer “expanded” Medicare services which are actually not covered by Original Medicare. Needless to say, this confuses a lot of folks who think the advertisers are offering products to all Medicare recipients.

Federally funded Medicare oversight is provided by CMS, (the Center for Medicaid and Medicare) and CMS requires Advantage plans to offer more coverage than Original Medicare … those required perks are what they are advertising! In 2020 some of the additional coverages supplied by Advantage are $800 annually toward dental services, up to $150 allowance per year toward routine vision services, and $1,350 every three years for hearing services. It would be nice if Original Medicare Beneficiaries were able to take advantage (pun intended!) of these necessities, huh?!? Talk to your elected officials about expanding Original Medicare coverage!

“C” plans only work within specific geographical territories, such as the territory of Queen Anne, Talbot, Caroline and Kent counties. Advantage “C” plans offer services strictly within their own network of doctors and hospitals. If one leaves that territory or network the beneficiary is not insured and does not have medical coverage at all, except for limited immediate emergencies. This means all costs for hospitalizations, non-emergency procedures, and doctors’ visits are the beneficiaries responsibility when out of network. Therefore, Advantage functions best in highly populated areas, such as Baltimore. The great thing about Original Medicare is that you are covered anywhere in the country, so once we break free of quarantine and are out an about again your travel area within the USA is covered!

Due to being for profit entities, Advantage plans can move in and out of an area or choose to only continue to serve a select group of beneficiaries. For instance, unless one has a gross income of less than $1,061 per month per individual, or $1,430 per couple, and is actively participating in the Medicaid QMB program, Advantage is not available for Caroline and mid shore residents.

Advantage normally bundles prescription drug coverage (with typical drug co-pays) together with Hospital and Medical in its’ plan. The 20% etc. normally billed separately in Original Medicare is paid by the beneficiary as co-pays for all services, with a large out of pocket limit on out of pocket payments due from the Beneficiary.

If you qualify for this program and feel it will meet your needs contact Mary Moran for assistance in applying for QMB, which pays all premiums, co-pays, coinsurances, and Medicare deductibles. QMB assistance works for both Original Medicare and Advantage so call 410-490-3078 for details!

Finally, let’s take a look at “D”. Medicare language regarding prescription drug coverage leads beneficiaries to believe that this important coverage is your choice when you sign up for Medicare. This “option” is true if you have comparable drug coverage from another source, such as employer coverage through you, your spouse, or other creditable private sources. Creditable means coverage that is expected to pay at least as much as Medicare’s standard prescription drug coverage. Please note that if you sign up for Medicare D you may lose your employer health coverage since it is an either/or situation. (www.medicare.gov)

The opportunity to stay with an employer plan is why the “choose to sign up” phrase is in the law. Without employer or former retirement drug coverage in place you must sign up for a prescription drug plan (part “D”) within 63 days of Medicare eligibility. Since the “choose to sign up” language is ambiguous some people who do not take prescription medications or who want to avoid paying the “D” monthly premium “opt out” of this coverage. Big mistake, folks! There is a lifetime penalty assessed for late enrollees in “D”. Medicare Law states that the 2020 base penalty is 33 cents for every month one does not have coverage. Therefore, if you have had Medicare since turning 65 but “opted out” of “D” until age 70, you will pay $19.14 per month penalty in addition to the prescription drug plans premium that you finally sign up for! The penalty math is 65 to age 70 = 60 months –two months grace period following 65th birthday. So, 58 months X 33 =$19.14 That penalty is assessed every month for the rest of your life…ouch!

The plan collects both premium and penalty from your Social Security check or bills you directly, then sends the penalty along to Medicare. For those that participate in the Maryland State Senior Prescription Drug Assistance program and have their monthly “D” premium paid, they will have to pay the penalty separately to the plan. That program only pays the premium and does not pay the penalty. No doubt about it …Medicare is complicated!

And that is why your Caroline County SHIP/ MAP is here for you! Call Mary Moran with Medicare questions or any other issues that require professional assistance at 410-490-3078.

Now that your head is spinning treat yourself to a sit on the porch or take a walk in this beautiful Caroline Spring weather! Let’s take a moment to be grateful for what we have and unplug for a moment!

May the Lord grant you good health and keep you safe!

Medical Adult Day Care

by Carole Friend LMSW

Staying Safe – Staying Connected.

Through these times of uncertainty, Caroline Medical Adult Day Care would like to express our gratitude to all frontline workers and support service staff members. Thank you to all for your effortful unwavering diligence as you demonstrate dedication and courage during these uncharted challenges. Thank you.

For those who have experienced suffering and loss, we only fall short of words to express the sadness. In these difficult times we can only offer our heartfelt condolences. One thing for certain, we have all been changed, things have certainly changed.

With that being said, we would like to offer an outlet; tell us about your losses. Understandingly, some have loss of family or friends, some loss of jobs, financial security or social supports or even time. I am asking you to write about your experiences during these times and mail it to me at Carole Friend c/o CMADC, 403 S. 7th St., Denton MD 21629. You may remain anonymous. I promise you I will read your stories.

In this time of safe distancing and self-isolation, staying home and even self-quarantine, it becomes difficult for many to stay connected. There are a number of ways to stay connected with others such as phone calls, internet, video chats, or social media. Even things like taking a walk or just bird watching keeps us connected with nature. We can practice safe physical distancing while remaining social. It is important to have connections with others. It holds true that staying connected to others will reduce feelings of isolation or loneliness.

Portions of our community are affected in special ways such as our elderly population which is more vulnerable to isolation and its effects. Isolation for seniors increases the risk of mortality while having less of a network to prompt medical attention. Feelings of isolation and loneliness can negatively affect both physical and mental health. Feelings of loneliness or perceived loneliness contribute to cognitive decline and risk dementia. Additionally, social isolation makes seniors more vulnerable to elder abuse. Many studies show a correlation between social isolation and high rates of elder abuse. Researchers aren’t certain whether isolated adults are more likely to fall victim to abuse or are a result of abusers attempting to isolate the elders from others. Nevertheless critical strategies for reducing elder abuse is speaking up and staying socially connected.

Furthermore, social isolation in seniors is linked to long-term illness. The Journal of Health and Social Behavior reports that prolonged isolation can be a bad for one’s health as smoking 15 cigarettes per day. Studies show illnesses and conditions such as chronic lung disease, arthritis, impaired mobility, and for were associated with social isolation. Unsurprisingly, ensuring adequate care for the elderly can help prevent this isolation. For the elderly living home alone, phone calls and visits are a critical part of social connecting. Also, seniors may find attending medical adult day care the answer for many issues such as the need for ongoing care and the desire for companionship and social connection.

A statement such as “Loneliness causes high blood pressure” may surprise you however a study in Psychology and Aging indicated a direct relationship between loneliness in older adults and increases in systolic blood pressure over the course of four years. Researchers suggest that the early interventions for loneliness may be key to prevent both the isolation and associated health risks.

Loneliness in seniors is a major risk factor for depression. Numerous studies have shown that feeling lonely is associated with more depressive symptoms in both middle-aged and older adults. It is important to recognize those feelings of loneliness, isolation or depression and seeking treatment. Stress, anxiety, loneliness, isolation and other depression like feelings are common reactions related to critical times. Asking for help is fundamental. Momentarily view the list of HELPLINES at the closing of this article for appropriate contacts you may find helpful. If you are unable to find what you need call the Maryland 211 information line.

Socially isolated seniors are more pessimistic about the future. According to the National Council on Aging, socially isolated seniors are more likely to predict their quality of life will get worse over the next five to 10 years, are more concerned about needing help from community programs as they get older, and are more likely to express concerns about aging in place. Community-based programs such as medical adult day care are critical in helping ward off potential problems and improving the quality of life for older people.

Physical and geographic isolation often leads to social isolation. One in six seniors living alone in the United States faces physical, cultural, and/or geographical barriers that isolate them from their peers and communities. This isolation can prevent them from receiving benefits and services that can improve their economic security and their ability to live healthy, independent lives.

In this time of uncharted challenges we may be asked to utilize our deeply profound personal resources such as courage, perseverance, and altruism. As we continue to practice our social roles, whether being frontliners, support service workers, or community supporters staying home and practicing safe physical distancing we recognize we are in this together. Our family at Caroline Medical Adult Day Care is looking forward to the resurgence of our community and a celebratory reunion. Stay connected.

If you have any questions regarding Caroline Medical Adult Day Care please contact the center at 410-479-8065.