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I plan on retiring in a few months and need health insurance until I can enroll in Medicare. What are my options?

There are several places early retirees can find health insurance coverage before Medicare kicks in, but your options will depend on your income level, your health care needs and the length of time you need coverage.

Affordable Care Act: For most early retirees who are not yet eligible for Medicare, the Affordable Care Act (ACA) health insurance marketplace, also known as Obamacare, is the best option for getting comprehensive health coverage. Coverage will not be denied or cost more for preexisting health conditions.

If your income falls between 400% to 100% of the poverty level (or to 138% in states with expanded Medicaid coverage) after you retire, you will also be eligible for a subsidy that will reduce your monthly premiums. In 2024, 400% of poverty level is $60,240 for one individual or $81,760 for a married couple. Those with incomes below 100% of poverty level (or 138% in Medicaid expansion states), will qualify for Medicaid. For those with household incomes above 400% of poverty level, the ACA also provides subsidies to ensure premiums do not exceed more than 8.5% of their income for a benchmark policy.

To see how much subsidy you are eligible for, use the subsidy calculator at https://www.healthcare.gov/lower-costs/. To shop for ACA plans in your state, visit HealthCare.gov or call 800-318-2596. For extra help, contact a certified agent or broker at HealthCare.gov/find-assistance.

COBRA: Another temporary health insurance option you may be eligible for is the Consolidated Omnibus Budget Reconciliation Act (COBRA). Under this federal law, if you work for a company that has 20 or more employees, you can remain on your employer’s group health plan for at least 18 months – but could last up to 36 months. It is important to note that with COBRA, you will pay the full monthly premium yourself, plus a 2% administrative fee.

For more information, talk to your employer’s benefits administrator or contact the Employee Benefits Security Administration at Askebsa.dol.gov or call them at 866-444-3272.

If the company you work for has fewer than 20 employees, you may still be able to get continued coverage through your company if your state has “mini-COBRA.” Contact your state insurance department to see if this is available where you live.

Short-Term Health Insurance: If you cannot find an affordable ACA plan and COBRA is too expensive, another possible option is short-term health insurance. These plans, which are not available in every state, are more affordable, basic health plans that provide coverage for up to three months with a one-month extension available. Please note that short-term plans do not need to comply with the ACA so they can deny coverage, exclude preexisting conditions and may not cover prescription drugs.

Healthcare sharing ministries: If the previously listed options do not work for you, another temporary solution could be healthcare sharing ministries (HCSM). These are cost-sharing health plans in which members – who typically share a religious belief – make monthly payments to cover expenses of other members, including themselves.

HCSMs are less expensive than paying full out-of-pocket costs for traditional health insurance but be aware that HCSMs are not health insurance. They do not have to comply with the consumer protections of the ACA, and they can also reject or limit coverage for having pre-existing health issues and limit how much you will be reimbursed for your medical costs. Preventive care is also typically not covered either.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.

 

Published September 13, 2024

September is designated as National Preparedness Month. All individuals should use this time, before the natural disaster season, to protect important tax and financial information. The IRS offers several helpful tips to protect personal, financial and tax information. Additional information is also available on IRS.gov or FEMA.gov.

  1. Protect Important Documents —Original documents may include tax returns, Social Security cards, marriage certificates, birth certificates and deeds to property. These should be secured in a waterproof container in a safe location. You should also make copies of important documents and keep them in a safe deposit box or send them to a trusted person in a different location.
  2. Record of Valuables — With the ease of taking pictures on your cellphone, you should maintain photos of your high-value items. These photos or videos will be important if you lose the items in a natural disaster. These photos can help support your claims for tax benefits or insurance claims. The IRS also offers Publication 584, Casualty, Disaster, and Theft Loss Workbook. This will be very helpful to you if you have a loss due to a natural disaster.
  3. Rebuild Your Records — After any natural disaster, you may have a challenge in reconstructing or rebuilding your records. These records could be essential for receiving a federal grant or an insurance company payment. If you can accurately estimate your loss through records, the insurance adjuster will be able to justify the payments. The IRS has a Reconstructing Records webpage on IRS.gov that may be helpful.
  4. Employer Fiduciary Bond — If you are an employer, you may have difficulties if your payroll service provider experiences a natural disaster. Your payroll service provider is obligated to make timely federal tax payments. There should be a fiduciary bond that protects you as an employer if your payroll service provider is in a natural disaster and defaults.
  5. IRS Tax Relief — If FEMA declares your area a federal disaster zone, the IRS frequently postpones tax filing and payment deadlines. If you are within the disaster area, you will not need to contact the IRS. The IRS automatically identifies taxpayers with a business or personal address in the covered disaster area. If you reside outside the covered disaster area but have been impacted by the disaster, you may call 866-562-5227 to determine whether you qualify for relief.

Can you give me some tips on choosing an appropriate walker for my parent? My parent has some balance issues as well as arthritis and could use a little more help than what a cane provides.

When it comes to choosing a walker, there are several styles and options to consider, but finding the best fit for your parent will depend on their abilities and where they will be using it. Here are some tips that can help you choose.

Types of Walkers

There are three basic types of walkers on the market today. To help your parent choose, consider how much support they will need. You should also visit a medical equipment store or pharmacy that sells walkers to test the different types. To locate a nearby equipment supplier, search Medicare’s directory available at Medicare.gov/medical-equipment-suppliers.

Here are the different types of walkers to choose from:

Standard walker: Considered the most basic style, this walker has four legs with rubber-based feet (no wheels), is very lightweight, about 5 to 6 pounds, and typically costs between $30 and $100. This type of walker must be picked up and moved forward as you walk, so it is best suited for individuals who need significant weight-bearing support or who are walking very short distances.

Two-wheel walker: This type has the same four-leg style as the standard walker except it has wheels on the two front legs that allow you to easily push the walker forward without lifting, while the back legs glide across the floor providing support while you step forward. These are ideal for people with balance issues and are priced between $50 to $250.

Rollator: A rolling walker has wheels on all (three or four) legs. Four-wheel rollators typically come with a built-in seat, basket and hand-breaks. This style is best suited for people who need assistance with balance or endurance inside or outside the home. Some rollators even come with pushdown brakes that engage with downward pressure and lock if you sit on the seat. If your parent needs to navigate tight spaces at home, three-wheel rollators provide good maneuverability, but without a seat. Rollators typically run between $55 and $650.

Other Tips

After deciding on the type of walker, there are additional factors to consider to ensure that the walker meets your parent’s needs. The walker’s height must be adjusted appropriately. To find the correct height, your parent should stand with their arms relaxed at their sides and adjust the walker so that the handgrips line up with the crease on the inside of their wrist.

You should also verify that the walker’s weight capacity will support your parent, and if they choose a four-wheel rollator, that their body fits comfortably between the handgrips when sitting. Heavy duty (bariatric) rollators with higher weight capacities, bigger wheels and wider seats are also an option.

Your parent should also test the handgrips to make sure they are comfortable and that the walker folds up for easier storage and transport. Depending on where your parent plans to use the walker, there are accessories that can be added for convenience such as food tray attachments, tote bags for carrying personal items, oxygen tank holders and tennis ball walker glides that go over the feet of a standard walker to help it slide more easily across the floor.

Lastly, if a walker is medically necessary, consult with your parent’s doctor or a physical therapist. If a walker is prescribed, Medicare will cover 80% of the rental or purchase price.

As you approach end-of-life decisions, there are several steps that should be taken to make sure you receive the right type and level of care. To assist you in these decisions, most states now permit either an advance directive or a living will. Some seriously-ill persons also have a doctor sign a Physician Order for Life-Sustaining Treatment (POLST). These documents are designed to assist your family and doctors in making the decisions according to your preferences.

Senior Medical Planning

There are three important background areas that you should learn about before entering into senior medical care. These are the medical oath and principles of your care providers, the rules created by Congress to ensure your medical information is protected and the decisions by your state on the specific document that you use to convey your wishes.

Doctors will frequently follow a set of principles that were originally called the Hippocratic Oath. The first oath was written by Hippocrates, a Greek doctor who is considered the father of modern medicine.

A modern version of the Hippocratic Oath typically states, "To practice and prescribe to the best of my ability for the good of my patients." Following this principle, your doctor will attempt to restore you to good health.

Because of modern improvements in medicine, it is possible to prolong your life through the use of ventilators, intravenous feeding and other devices. While you certainly want your doctors and nurses to provide very good care, you may also need to offer some guidance on how extensively your family and doctors should use modern technology to prolong your life.

A second major area for you to understand is called HIPAA. The Health Insurance Portability and Accountability Act (HIPAA) was passed by Congress in 1996. It is designed to provide protection for you and to keep your health information private.

Under the HIPAA rules, you have the right to see your health records, but you must give written permission before your records are released to other individuals. The information provided by doctors or nurses about your care, medications or other personal information is protected. However, you will want to be certain that your designated healthcare proxy (the person who will assist in making healthcare decisions) has the right to review these records. You should sign a HIPAA release form in order to enable your advisors to give proper recommendations to your doctors and nurses.

Finally, you must understand the specific documents of your state. Some states use an advance directive in which you choose a combination of a durable power of attorney for healthcare and a living will. Other states have separate documents. It is very important that you use the appropriate document tailored for the laws of your state.

The Advance Directive

Your first key advisor is the person who will make your medical decisions if you are incapacitated. This individual is frequently called the healthcare proxy. He or she is your agent and holds your durable power of attorney for healthcare. Normally, you will select primary and secondary persons as your healthcare proxy agent.

You will want to list the persons, their addresses and phone numbers so they can be easily contacted. Your secondary healthcare proxy will assume the primary role if the first person is unable or unwilling to serve.

Part of your advance directive will also explain the level of authority that you have given. Your healthcare proxy usually does not have the authority to make decisions unless, in the view of your doctor, you are no longer able to make decisions yourself. However, many forms allow you to sign and empower that person immediately. The authority of your healthcare proxy may also extend after you pass away so that he or she can make appropriate decisions at that time.

Your healthcare proxy may be called upon to make significant decisions for your care. For example, it may be necessary to decide whether or not to use morphine or other types of pain medication. If the decision is to make use of morphine, then a second decision will be made on the use of a low dose or a high dose. With a lower dose of morphine or other types of pain medication, you may have greater clarity of mind but may be less comfortable. If you receive higher doses of medication, you may not be as clear-headed, even though you are at a higher comfort level. These decisions can only be made based on your condition at a given time, but they do directly impact the quality of your life in that circumstance.

A healthcare proxy may also be called upon to make very significant decisions about the hospital, nursing home or other care facility and the level of treatment. For example, some seniors have suffered broken hips or limbs at a time when their demise was near. A healthcare proxy will need to make decisions about the appropriate level of care or treatment under those circumstances.

A second section of an advance directive allows you to give counsel on the level of measures and technology that will be used to prolong your life. If you have an incurable or irreversible condition that will result in your death within a relatively short time, there are medical devices that can significantly prolong your life.

These are sometimes referred to as "heroic measures." If you desire all reasonable measures to be taken, you can generally request that care. If you do so, your life may be extended to the greatest extent possible under "generally accepted healthcare standards."

Your healthcare guidelines expressed in your advance directive will discuss your preferred level of nutrition and hydration. If you prefer to receive nutrition and hydration through intravenous methods, you may specifically request those options.

It is helpful for medical providers to have some level of direction for your pain management. If you prefer a higher level of pain management even though that gives you less clarity of thought, you may so indicate.

A third, fairly typical section of the advance directive covers donation of organs and designation of your primary doctor. If you would like to donate specific organs or designate specific purposes for the use of your body, you may identify the particular organs or discuss purposes. Common purposes include transplantation, therapy, research and education.

Advance directives and living wills may, under state law, be witnessed in a manner similar to the witnessing of your will. Some states require two witnesses or a notary to witness your advance directive. Check with your state law to make certain that you have complied with those requirements. A helpful website with state law requirements is www.caringinfo.org. It is maintained by the National Hospice and Palliative Care Organization and seeks to improve care at the end of life.

Physician Orders for Life-Sustaining Treatment (POLST)

A Physician Order for Life-Sustaining Treatment (POLST) is a medical order signed by your doctor or a medical staff person as authorized under your state law. While the name and provisions may be different in some states, the POLST option is generally available nationwide. If you have a serious illness or may pass away within one year, you may want to ask your doctor to sign this medical order.

The POLST typically covers cardiopulmonary resuscitation (CPR), medical interventions and nutrition. You may choose to have CPR or select “Do Not Resuscitate (DNR).” Your medical interventions may include full treatment to prolong your life, selective treatment that avoids burdensome procedures or comfort-focused treatment. Nutrition can be maintained long-term with feeding tubes, for a trial period or you may select no artificial means of nutrition.

All of these decisions should be made in consultation with your doctor. Both your doctor and you or your healthcare proxy must sign the POLST. Your POLST may reflect your values, religious beliefs and goals for care.

Even if you have a POLST signed by your healthcare provider, you still need an advance directive. The advance directive appoints your healthcare proxy (primary and secondary) and covers many medical circumstances not covered by the POLST. Everyone should sign an advance directive, while those who are seriously ill may benefit from a POLST.

Action Steps

After completing your living will or advance directive, you will sign and typically have witnesses for your original document. Prepare several copies of your advance directive. You will want to give a copy to your healthcare agent, your family, clergy, your doctors and other advisors who may be involved in assisting with your medical decisions.

At any time you may revoke the living will or advance directive. It generally is best to revoke the entire document and complete a new document. If you attempt to amend different parts of the advance directive, there is a risk that you may sign provisions that conflict or are inconsistent. If you are in need of urgent care or treatment, you do not want any conflicting provisions in your living will or advance directive.

Your living will or advance directive is a very important part of your personal planning. It is designed to help you receive the best possible care at the end of your life and still comply to the greatest extent with your personal healthcare preferences.

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