“Let the games begin and may the odds be ever in your favor!”………..
Before the combatants enter the arena to fight to their last; the President of the dystopian world of the Hunger Games would wish them all this final sentiment. As the tenuous situation about the future of the Affordable Care Act (the ACA is the same thing as Obama Care) plays out, I wish for us all that the odds are in our favor because we will need it.
Neither the Trump Administration nor the Republican Controlled Congress are exactly sure how to “repeal and replace” the ACA, and live up to their campaign promises. It is a very difficult challenge to find a way to not lose coverage for 30 million Americans, reduce costs, eliminate mandates, and not allow insurance companies to impose pre-existing condition restrictions for coverage. Yet that is what has been promised. People around the country have come to realize just how important having healthcare coverage is in their lives, and how easy it is to lose it.
The majority of American’s get healthcare coverage through their employer so it is affordable, free of mandates, and without pre-existing condition prohibitions. But there are many millions more people who don’t get their coverage through an employer. The key to surviving your own healthcare, regardless of how you obtain coverage, is to understand the tricks of getting the most out of what you have.
- If you get coverage through your employer, make sure you take the time to understand what the options are that you have to choose from. It really is a matter of balancing the costs between monthly premiums, co-pays and deductibles relative to how much care and prescriptions you think you (and your family) will consume. If you don’t need a lot of care, then you should select the plan with lower premiums but higher deductibles and co-pays. If you require more care and prescriptions, then you want the plan that has a higher monthly premium but lower deductibles and co-pays.
- If you get coverage through Medicare, remember there is an open enrollment period every year from October 15 – December 7 allowing new enrollments, or current recipients to make changes to their plan. Medicare offers a large variety of choices that people can elect to put together the best combination of benefits for their needs and budget. People need to realize that enrolling in Medicare can be complicated, and if you don’t pay attention you can end up missing needed coverage or paying more out-of-pocket expenses in premiums, co-pays and deductibles than you realize-- or can afford.
- Medicaid is a “means based” program which means to qualify an applicant must meet both standards of medical necessity and live at asset and income levels below the poverty line. Applying for Medicaid can be a challenging process that requires the applicant to submit detailed medical and financial records. Medicaid will “look back” five years at financial records to make sure that assets have not been hidden or transferred to family members. If you are on Medicaid, that means you live below the poverty level and have become a ward of the state with very little choice or say about your long term care options.
- When it comes to long term care, it is important to understand the different forms of care and how it is all paid for. Qualifying for programs like Medicare and Medicaid to cover long term care is harder than people realize. If you do qualify, there are many restrictions to what is covered and for how long. Private pay such as savings, income, long term care insurance, and annuities is the preferred method of funding by long term care service providers. If you are private pay there are absolutely no restrictions to the forms of care you can access. In fact, some of the most desirable forms of senior care are private pay only. Most types of home care and assisted living communities will only accept private pay patients, and nursing homes give priority to private pay because Medicare and Medicaid pay for services at rates below private pay levels. Always remember, the worst time to start planning for Long Term Care is in the midst of a crisis because the options to pay for care can be complicated and take some time to access.
- The best way to survive the Healthcare Hunger Games is to stay healthy and need as little healthcare as possible. Investments you make today in your physical, mental and emotional health will pay you back with a better lifestyle and less need for doctors and prescriptions. This obviously equals increased longevity and a higher quality of life for you and your loved ones. In my book, A Survival Guide to Aging, the eight Quality of Life Factors are discussed in detail. How you handle attitude, adaptability, relationships, activities, exercise, nutrition, sleep, and mental health have a critical impact on your health and well-being at any age.
Surviving the Healthcare Hunger Games means understanding how the healthcare system works. If you want to win TrumpCare you will need to be a smart consumer of healthcare coverage options, and do all you can to make investments in yourself to minimize your need for healthcare and maximize your quality of life.
Chris Orestis is the CEO of Life Care Funding and a 20-year veteran of both the insurance and long-term care industries. A former Washington DC lobbyist, he is a nationally known senior care advocate and author of the Amazon best-selling books “Help on the Way” and “A Survival Guide to Aging,” a legislative expert, featured speaker, columnist and contributor to a number of insurance and long term care industry publications. His blog on senior living issues can be found at www.lifecarefunding.com. He can be reached at 888-670-7773 x 6623 or firstname.lastname@example.org.
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