Test for Training

/in /by
Read more
Senior Life Matters

Question; My doctor’s office keeps asking if I have a Health Care Proxy. I am healthy, I don’t think I need that. What do you think?

/in , /by

Question;

My doctor’s office keeps asking if I have a Health Care Proxy. I am healthy, I don’t think I need that. What do you think?

 

Answer;

I think a Health Care Proxy is very useful and you should definitely consider this an important part of your Health Care Plan! A Health Care Proxy is a wonderful protection for everyone, no matter how your health is!

A Health Care Proxy comes under the heading of Advanced Directives. Advanced Directives is a fancy term given to those tools that allow you to pre-determine or pre-decide your health care. There are a number of types of these documents, and I am going to briefly touch on each and why you might want them. The documents I will talk about are; Do Not Resuscitate Order (DNR), Health Care Proxy (HCP), Living Will, and Medical Orders for Life Sustaining Treatment (MOLST).

A Do Not Resuscitate Order (DNR) is an actual Medical Order given by your attending physician, which states that in a situation where your breathing has stopped and your heart has stopped, those that respond should NOT administer Cardio Pulmonary Resuscitation (CPR) for the purpose of restarting your breathing or heart. There are two types, a Hospital DNR (which is only valid while in the hospital) and a Non-Hospital DNR (which covers all other locations). As I noted, this is a Physician Order, so it is a document that is signed by your physician, NOT by you. You request it, but your physician enacts it.

If you have a Non- Hospital DNR, be sure to display it prominently in your home. If it is tucked away in a file cabinet, the emergency medical staff will attempt to resuscitate you. They must see the actual document. They cannot take your family or caregiver’s word that you have this on file somewhere.

You asked about a Health Care Proxy(HCP). The HCP is a document used to designate an individual or individuals, who will make Medical decisions in the event you are not able to communicate your decisions. There are a number of versions of this document available. Most hospitals, medical offices and attorneys have copies they can get to you. You can also get versions on-line, but be sure it is a version accepted in New York State. In New York State, a Health Care Proxy can be completed and signed by anyoneover 18thyears of age or older. When ready to sign this document, have two individuals who are NOT related to you, like a neighbor or classmate or people sitting at the next table in the restaurant, sign as a witness. This witnessing of your signature is simply to state that you did not sign the document under duress, and you were aware of what you were signing.

Once signed and witnessed by two adults, this is a legal document. The HCP does not give those you appoint the right to override your wishes for medical care. The HCP gives them the right to make decisions when you cannot communicate your wishes. It is assumed that you will inform the appointed individual(s) that they have been appointed as your HCP, and you should communicate your wishes clearly to them.

Most forms have instructions along with them, so that you can fill out specific directions if you choose to. There is information that must be explicitly indicated on the HCP form in order for your appointed proxies to be allowed to make decisions.

The HCP form is very easy to complete and it gives you control over your future. It means that in an emergency, someone you trust will be in charge of your medical care and decision making. ALL of us should have a HCP completed.

You do not need an attorney to complete a Health Care Proxy. A HCP can be completed by anyone over the age of 18. This document is considered legal and binding, once it is signed by you and witnessed by two individuals (also over the age of 18).

The next item is the Living Will. In many states the Living Will is a legally binding document. In New York State is it is considered a supportive document. It gives the physician and your family some indication about how you feel about particular medical procedures and treatments. Your appointed HCP can use the Living Will to help guide their decision making process on your behalf. Your physician can help guide your family and appointed proxy in making medical decisions, to follow your Living Will and the expressed wishes it contains.

The Living Will can be thought of as a narrative of your medical wishes and desires. It doesn’t need to follow a particular format or form, but there are templates available to help guide you through the process.

The last type of Advanced Directive I will cover is the Medical Orders for Life Sustaining Treatment (MOLST). In New York State, the MOLST is a legally binding document that applies across all health care settings. A MOLST form is advisable for people who are seriously ill, who might be in the last year of their life, or have particularly strong health care wishes. This is a four page, bright pink document, that includes Medical Orders from your physician, and the previously reviewed Advanced Directives. This is signed and renewed by your attending physician regularly. This MOLST form is a set of orders and directives that are transferable from facility to facility and setting to setting. This is ideal for an individual who is frequently hospitalized, or in a Skilled Nursing Facility (SNF). The MOLST may not be necessary for everyone.

In Chautauqua County we have a Health Care Proxy Registry. This is an actual on-line registry of your Health Care Proxy. This allows medical emergency responders, medical staff, and hospitals, access to these documents. This is a useful idea, as we don’t always have this information on our person when we are ill or in an accident. This Health Care Proxy Registry is now administered by NY Connects, which is a Chautauqua County program and can be reached at 716-753-4582.

Once these documents are completed, I would recommend giving a copy of all these completed forms to your family and medical practitioners. You can’t expect that individuals and physicians make good decisions on your behalf, if you don’t inform them of what you want done.

Advanced Directives do NOT include Power of Attorney (POA). A POA is a financial tool that you can use to give someone you trust the ability to pay bills, and handle ALL types of financial transactions on your behalf. POA has nothing to do with Health Care, unless it is writing a check to pay a medical bill.

You asked what I think, and I would say that everyone age of 18 or older should have at least a Health Care Proxy completed. This allows for medical decisions to be made if you cannot communicate. Say you are unconscious, in an accident, in a coma or having surgery; it allows for the person(s) you designate to make decisions guided by information you have communicated to them. It puts the decision making power of your health care in your hands and the hands of someone you trust.

We never know when an accident or medical emergency will take place. This small amount of pre-planning and communication allows you to be in charge, whether you can actually speak or not.

The Health Care Proxy document is pretty easy to complete. It asks for your name and the name of the individual you are appointing as your Health Care Agent, and that individual’s contact information (address and phone number). It asks for additional Health Care Agents (if you want to appoint a backup person or persons).

You have space to write special instructions. If you want the Proxy to have an end date there is an opportunity to add that date. Some individuals complete HCP documents for use during a serious illness or injury. If you wanted to appoint a Health Care Agent while you were having surgery, this form could be completed with an end date. Once your surgery is over you want the proxy to end. I can understand why an individual might want to do this. I would counter with this; “If you trust that individual for this specific period of time, why not leave the HCP document with no end date, and just trust them with this responsibility indefinitely?”

After this information is completed on the form, you simply sign it, with two witnesses, and add your address and phone number. Then it is finished. You then makes copies, to give your physicians, hospitals and family. You send it to NYConnects to put on the HCP Registry.

You have just taken a few giants steps to protecting yourself and your loved ones from difficulties later. Appointing a HCP allows for better outcomes for your health care. You need to remember to tell your Health Care Agent, that they are appointed. You also need to communicate your Health Care wishes. Your Health Care Agent can make the decisions you would want in a situation where you can’t.

To contact Janell Sluga, GCMC with questions or concerns, please call 716-720-9797 or e-mail her at janells@lutheran-jamestown.org.

Question; I don’t know if I need Medicare Part B. How do I find that out? I have Medicare Part A already.

/in /by

Question; I don’t know if I need Medicare Part B. How do I find that out? I have Medicare Part A already.

 

Answer; This question came at the perfect time. We are currently in the General Enrollment Period for Medicare Part B. Each year from January 1stto March 31st, the General Enrollment Period (GEP) allows those individuals who did not signed up for Medicare Part B when they should have, to sign up for their Part B benefit. This Medicare Part B benefit will then start on July 1stof this year.

More on this a little later, let’s first review Medicare Parts A & B.

Original Medicare is considered Medicare Part A and Medicare Part B. Most individuals are eligible for Medicare when they turn 65. Some individuals are eligible for Medicare earlier in life, usually due to a disability or illness.

Medicare Part A is the hospitalization coverage, and for most enrollees has no monthly premium. Medicare Part B is considered Medical coverage, which we commonly call outpatient services. Most enrollees this year pay a monthly premium of $135.50 for the Medicare Part B benefit. Some individuals pay more than that for two reasons 1) they are higher income or 2) they enrolled in Medicare Part B late.

You have Medicare Part A already, but do not have Part B. There is really just ONE good reason to not have Medicare Part B if you are eligible for it. The reason is that you have health insurance from a current employer or your spouse’s current employer.

If you are currently going to work AND have employer health coverage AND your employer group is larger than 20 employees, you do NOT need to sign up for Medicare Part B.

If you are NOT going to work or get your insurance from a spouse who is not going to work, you must have Medicare Part B. Also, if your employer group is less than 20 employees or your insurance from your spouse is through a group of less than 20 employees, you must have Medicare Part B.

If you have retiree coverage from ANYWHERE, you must have Medicare Part B.

If you have health insurance, but are not working at the employee group that the insurance is provided by, you must have Medicare Part B (This could be from a previous employer of yours that is still providing you with health insurance.)

If you have VA coverage and use that for your primary medical needs, I strongly recommend you have Medicare Part B.

If you are a federal retiree or retired postal worker, I strongly recommend you have Medicare Part B.

I think that covers everyone who could be eligible for Medicare, doesn’t it? Each year, I meet individuals who did not enroll into Medicare when they should have. This GEP is their opportunity to now sign up for Medicare Part B, between January 1stand March 31st. Once they use this GEP to sign up for Medicare Part B using the forms provided by Social Security Administration (SSA), they will receive their Medicare Part B benefit beginning July 1stof this year. That is a significant delay in getting the coverage I say you need. But if you don’t use this period this year, you will have to wait to the GEP next year and then wait until July 1 of that year!

Centers for Medicare & Medicaid Services (CMS) should be sending you a letter to remind you to sign up for Medicare Part B if you haven’t already. Those letters are issued to everyone who doesn’t have Medicare Part B and some of you are allowed to wait to sign up. As I already mentioned, you may have legitimate reasons to delay signing up for Medicare Part B.

Those individuals who are still working, or whose spouse is still working and provides them insurance do not need Medicare Part B. As long as your employer group is larger than 20 employees, you don’t have to sign up for Medicare part B at age 65.

If you have Medicare coverage due to a disability, that employee group must be 100 employees. The individuals who have Medicare due to a disability, are people who sometimes get missed by the system. Their spouse’s employer may not know they have a disability and are Medicare eligible, so they sometimes miss their Initial Enrollment Period to get Medicare Part B. This GEP is their opportunity to get the coverage they need.

I sometimes talk with individuals who use the VA for their health and medical needs. These individuals can get much of their medical care through the VA Health system, BUT when they need emergency care, that is not always possible through the VA Health system. I say “If you dial 911, a Medicare ambulance is coming to pick you up.” Ambulance Service is covered under Medicare Part B. If a veteran decided to NOT enroll in Part B, the Ambulance is his bill entirely to pay. When the ambulance brings you to an emergency room, that is also a Medicare Part B billable item. The veteran will pay for the Emergency Room entirely themselves. If that veteran is admitted to the hospital, the Medicare Part A will pay most of that hospital stay. This is why I strongly advise Veterans to enroll in Medicare Part B. I understand they mostly use the VA Health care system, but sometimes they may need the Medicare system.

I also talk with individuals who are retirees from the federal employee system, or the postal worker who is now retired. These individuals often get federal retiree benefits, and these plans do NOT require the individual to join Medicare Part B, but they will have a penalty if they decide to enroll later. The insurance will cover them even if they don’t enroll in Medicare. If they do choose to enroll in Medicare Parts B, they will have more comprehensive insurance coverage.

Those individuals who are not working and didn’t sign up for Medicare Part B when eligible, are accumulating an enrollment penalty that is paid once they enroll. If they never sign up for Medicare Part B, they never pay the premiums or the penalty. If they decide to enroll in Part B at some time in the future, they have a penalty for the period of time they did not have Part B. The Part B Penalty is 10% for each twelve (12) months you don’t have Medicare Part B. That means the current penalty is 10% of $135.50 for each of the twelve months without Medicare Part B. This year’s amount is $13.55 for each twelve months without insurance. That doesn’t sound like a lot, but it is paid every month for the rest of your life after you enroll. That is an extra $162.60 a year, for each year you did not have Medicare Part B.

I encourage individuals to enroll in Medicare Part B, even if they are veterans or Federal retirees because those penalties can add up fast, making Medicare more and more expensive every year.

The General Enrollment Period rolls around every year. Each year some individuals use this opportunity to get the Medicare Part B coverage they didn’t enroll in earlier. I am hoping I clarified for you whether you need Medicare Part B or not. If you still don’t understand, please reach out and ask us. We love talking about Medicare!

To contact Janell Sluga, GCMC with questions or concerns, please call 716-720-9797 or e-mail her at janells@lutheran-jamestown.org.