Health Insurance With Parkinson’s
Health insurance and access to healthcare are important for everyone, especially people with chronic diseases like Parkinsons disease . It is important not only to understand health care coverage for immediate health care needs, but also long-term health care needs. Health insurance protects the patient and family from being solely responsible for the cost of medical services, which can
Medicare Coverage Of Skilled Nursing Care Facilities
In order to receive care in a nursing home under Medicare:
- You must have had a three-day hospital stay prior to admission into the skilled nursing facility.
- You must be admitted into the skilled nursing facility within 30 days of discharge from the hospital.
- You must enter the skilled nursing facility for treatment of the same condition that you were hospitalized for.
- You must require daily skilled care.
- The condition must be one that can be improved.
- The facility must be Medicare-certified.
- Your doctor must write a care plan. The care plan must be carried out by the skilled nursing facility.
How Medicare Covers These Treatments
Traditional Medicare has two parts. Part A supplies hospital coverage. It will pay for your inpatient stay in the hospital as well as up to a hundred days in a skilled nursing facility. If someone with Parkinsons pursues inpatient surgery like DBS, Part A pays for this.
Outpatient treatments are covered under Medicare Part B. While this includes expected things like doctor visits and lab work, Part B also covers more costly services such as outpatient surgery, CT scans, injectable medications, durable medical equipment and physical therapy. It will cover the cassettes used with a Duopa pump and any diagnostic imaging necessary before these types of procedures.
For nearly 50 years, Medicare had no coverage for outpatient retail medications. However, all of this changed in 2006 with the advent of Medicare Part D. Part D is optional drug coverage for people who are eligible for Medicare and are enrolled in either Part A and/or Part B.
Part D is critical for any person living with Parkinsons. Most Part D plans cover Carbidopa/Levodopa as well as other common medications used in the treatment of Parkinsons. All Medicare beneficiaries will have an opportunity to enroll in Medicare Part D when they first become eligible for Medicare, and there are no pre-existing condition limitations.
Home Care Vs Assisted Living Communities
One of the things we encourage is that people living with Parkinsons have the highest and best quality of life possibleand that they live in the least restrictive environment possible, says John L. Lehr, CEO of the Parkinsons Foundation. To be sure, people like to remain in their homes and be around familiar spaces and people, so as long as they can do that safely and without any concern, we think thats good. But Parkinsons is progressive and degenerative, and there does sometimes come a point where being home with a spouse or caregiver becomes no longer safe. At that point we would encourage, along with input from a physician and others, that they consider a different environment, including assisted living.
Not only do assisted living communities provide ample opportunities for communal social interactiona significant benefit for those suffering from a disease that often leads to increased isolationbut they also provide help with activities of daily living like grooming, housekeeping and laundry, bathing, transportation, dressing, medication management, exercise and wellness programs and meal prep.
Paying For Assisted Living
As you consider whether or not assisted living is a good option for your loved one living with Parkinsons, youre also probably considering how to pay for it. The good news is that assisted living can be much more affordable than nursing home care or long-term in-home care. If an assisted living community is right for you or your loved one, here are some creative ways to pay for it.
Department Of Veterans Affairs
Through the VA Health Care program and their pensions, the VA offers veterans multiple avenues of assistance with medical equipment, assistive technology and home modification. The avenue best pursued depends on whether or not the individual with Parkinsons Disease was exposed to herbicides during their military service. For those individuals not exposed, they are most likely to receive assistance from the Aid and Attendance pension benefit, VD-HCBS or the HISA Grant. For those veterans with PD who were exposed, VA Health Care will cover the cost of much assistive technology and medical equipment.Another option for veterans comes not from the VA but from a non-profit organization with a veteran-specific program called Heroes at Home. This program is intended to assist in making home modifications and typically provides free labor for modifications but does not cover the cost of materials.
Faqs About Parkinsons Disease
1. How does a doctor diagnose Parkinsons?
There is no specific test for diagnosing Parkinson’s disease. However in 2011, the FDA approved the DaTscan which takes pictures of the dopamine system in the brain. Doctors are able to use these results to increase their certainty of a Parkinsons diagnosis. The disease is currently diagnosed by a doctor completing a neurological examination and looking for two or more of the cardinal signs of Parkinsons which include muscle rigidity, slowed movement, and tremor.
2. Why does a person with Parkinsons drool?
Researchers and doctors are not completely sure what causes drooling in individuals with Parkinson’s disease. Some theories suggest that drooling occurs due to:
- Difficulty swallowing excessive saliva in the mouth as it accumulates.
- Lack of dopamine which controls saliva production.
- The forward stooped posture and open mouth that is often characteristic of people with the disease.
3. My dad has Parkinsons and he gets emotional and cries so easily whenever we visit him. Ive never seen my dad cry before and it makes me uncomfortable. Should I be concerned that something is wrong or is this part of his Parkinsons?
4. Is incontinence caused by Parkinson’s disease?
Not all individuals with Parkinson’s disease are incontinent. However, for individuals who are incontinent, it is thought that this incontinence is due to impaired nerve cells impulses from the brain traveling to the bladder and/or bowel.
What Treatment Does My Long Term Disability Insurer Want To See
The insurance company will require proof you are seeking appropriate treatment fr ur Parkinsons. Even if your symptoms are stable, your long term disability insurer will want to see that you are regularly visiting your doctors and following their treatment recommendations.
Parkinsons is treated most often with Levodopa , carbidopa, or a combination of the two called Sinemet. Your doctor may prescribe other medications that cause your body to make more dopamine. And your doctor may also prescribe medication that imitates the effects of dopamine or that stop your body from breaking down dopamine. Providing your long term disability insurer with proof of your prescribed medications is important. Your long term disability insurer will require that your doctor is regularly reviewing, and if needed, adjusting any medications you take.
Your doctor may also refer you to a physical therapist to improve your balance and ability to move. Physical therapy may also include muscle-strengthening exercises to help you speak or swallow. Your long term disability insurer will require that you keep consistent appointments with your physical therapists.
Other treatments may include deep brain stimulation, implants, or experimental treatments to spur the creation of dopamine. Again, your long term disability insurer will require that you are regularly visiting your doctors and that you are following their recommendations.
Difficulties With Activities Of Daily Living
ADLs refer to basic personal care tasks including bathing, dressing, eating, mobilizing, and toileting.
Individuals with Parkinson’s disease may have problems with mobilizing, freezing in place, bathing, grooming, toileting, dressing, eating, driving, travelling, as well as safety at home. A person has more difficulty performing these ADLs as the disease progresses due to increased muscle and cognitive impairment.
It can be hard to for individuals to adjust to these changes but there are ways to provide support and to promote as much independence and quality of life as possible.
Ltci In The United States
Some 7 million individuals have some form of long-term care insurance. The vast majority have what is referred to as traditional, or health-based, LTC insurance. The opposite is true for new policy sales. Some 350,000 new policies are sold each year with 84 percent being linked-benefit or life insurance policies that include a LTC benefit.
In the U.S., the nation’s long-term care insurance companies paid out a record $11 billion in claims in 2019 to some 310,000 policyholders.
A new study projects that the lifetime chance of long-term care insurance policy usage. Someone purchasing coverage at age 65 has a 50% likelihood of using their policy benefits, especially when there is no elimination period for home care benefits.
Q What Happens If You Cancel Your Long
As you know, long-term care insurance is another bill. I am wondering what happens if I cancel my long-term care insurance. Do I get my money back at the time of cancellation, since I didn’t use the benefits?
Long-term care insurance is a use-it-or-lose-it type of policy. Meaning, if you never use the benefits or decide to cancel the policy down the road, you no longer receive the care and you won’t get the money you paid in, either. The only way to get back what you paid for but didn’t use is with a long-term care insurance hybrid policy.
This is a life policy with a long-term care benefit rider, and most of the time you can cancel and get back the amount that was paid into the policy. It is best to speak with your local independent insurance agent on this matter.
When Is Assisted Living A Good Option For Someone With Parkinsons
The decision to help a loved one transition into an assisted living community is never an easy one, but for those caring for a loved one with Parkinsons disease, the choice can be even harder and more perplexing.
The key is understanding when someone with Parkinsons is no longer thriving in their own home. Thats when assisted living becomes an option, says Lehr. And when I say not thriving I mean your loved one is having difficulty caring for themselves or is increasingly at risk for injury. Thats the time to start making new plans.
Before that happens, however, Lehr says its important to understand the general symptomatic progression of Parkinsons disease and pay close attention to how those symptoms affect your loved one in particular .
Ensuring Your Loved Ones Parkinsons
Depending on where you live, assisted living options may be numerous and overwhelming or somewhat narrow and restrictive. And finding an assisted living community thats right for someone living with Parkinsons can make the search even more stressful than it already is. But Lehr says that if you know what youre looking for the process doesnt have to make you anxious, because there are several criteria that prospective residents and/or their families should consider when searching for the right assisted living community.
What Is Not Covered By Long
Look at the fine print of any policy under consideration, because long-term care insurance typically does not cover:
Exercise Is A Priority
Its important that the assisted living community has a dedicated space for exercise, which can either be a gym or ample open space to provide the opportunity for frequent movement.
Weve learned over the last number of years that exercise is so important for people living with Parkinsons. It has enormous benefits, says Lehr. I would also want to make sure they offer speech and language therapy. So the bottom line is finding a place with Parkinsons experience and a commitment to exercise, activity, movement, and therapy. Those would be my priorities.
Long Term Care Insurance
A long term care insurance policy will begin paying for care according to the terms of the policy. This can vary by contract:
- In some cases, occasional help at home to assist with activities of daily living can trigger payments.
- It may require a more moderate level of need, such as the need for regular in-home care.
- It may require meeting a higher standard based on inability, similar to Social Securitys threshold.
- Or perhaps a higher level must be established, such as medical certification of the need for nursing home care.
Shopping for long term care insurance policies
*Please note that not all content is available in both languages. If you are interested in receiving Spanish communications, we recommend selecting both” to stay best informed on the Foundation’s work and the latest in PD news.
Can I Buy Long Term Care Insurance With Pre
Yes, you can get long term care insurance even if you have a pre-existing condition. You dont need to be 100% healthy to get coverage for long term care. Although you can get favorable rates if you dont have any condition, its still possible to get affordable premiums if youre taking medications or having treatment to manage your condition.
So, does that mean all long term insurance companies will approve your application?
Not all insurers are the same. These companies look at health conditions differently, which means you need to compare companies first until you find one that will approve your application. Its important to work with an agency that represents multiple long term care insurance providers and understands their underwriting guidelines.
If You Are Insured Either Through Your Employer Or A Retirement Policy Read All
Someone who has a comprehensive policy that will pay benefits for 5 years will usually have a greater premium increase than someone with a. A typical, traditional ltci policy will pay a predetermined amount for each service. Find financial assistance programs and understand often overlooked when considering financial assistance for parkinson’s care are the products that it is not an exaggeration to say caregiving for someone with severe parkinson’s is a. Each person is different and there is no formula for determining exactly how quickly a chronic disease will progress, how seriously it will affect the body. This way, you don’t have to borrow money, use up your retirement savings or sell your house to pay for the.
Renting Out Your Home
If only one parent is still living, or if both parents need assistance with daily living, the family home can be an important resource. Selling is an option, of course. But in many families, mom and dads house is cherished and family members arent ready to make this decision. In this case, consider renting out the house and using the rental income to pay for assisted living. The idea of being a landlord might seem scary, but for a percentage fee you can hire a service to manage the property for you.
What Are The Conditions And Reasons For Automatic Long Term Care Insurance Decline
Here are some of the reasons why you cant qualify for long term care insurance:
- You need help with any of the six activities of daily living eating, bathing, dressing, transferring, toileting and incontinence.
- You are using a walker, wheelchair, motorized scooter or cane.
- You are on kidney dialysis, nebulizer or ventilator or oxygen.
- You are using narcotic pain medications.
- You are receiving disability benefits.
- You are in physical therapy.
Here are the common diagnosis, medical status, and personal health history that will prevent you from getting coverage for long term care:
- ALS or Lou Gehrigs disease
- Cancers of bone, brain, esophagus, liver, pancreas, or stomach
- Cirrhosis of the liver
- Organ transplant
- Transient Ischemic Attack within two years, or more than one TIA
The Basics Of Assisted Living
An assisted living community could be an apartment building, a campus-like setting, or even a large converted house. According to the Assisted Living Federation of America , most have between 24 and 120 units that vary in size from a single room to a full apartment. Residents generally have a lot of freedom in terms of what they do and when they do it, but they should also get plenty of support from trained caregivers.
Assisted living is regulated by each state rather than by the federal government, so you can expect wide variation in what each community offers, which is especially important to understand when considering this option for someone living with Parkinsons.
Assisted Living Or A Nursing Home
The immense popularity of assisted living facilities has arisen, partly, out of the promise to never to put a loved one in a nursing home. But assisted living wont work for everyone. Some need the greater supervision and higher staff ratios of a good nursing home. This article, from The New Old Age blog, explains the differences between the two and why assisted living may only be a temporary solution.
How Do People Receive Medicaid Benefits
Medicaid eligibility requirements depend on financial need, low income, and low assets. In determining Medicaid eligibility, officials do not review rent, car payments, or food costs. They only review medical expenses. Medical expenses include:
- Care from hospitals, doctors, clinics, nurses, dentists, podiatrists, and chiropractors
- Transportation to get medical care
The four eligibility tests required to receive Medicaid include:
- Categorical. You must be age 65, blind, or disabled.
- Non-Financial. You must be a U.S. citizen and a state resident. You also must have a social security number.
- Financial. Your total gross income, personal assets, and property will be evaluated and must meet a certain standard. This amount varies from state to state.
- Procedural. You must complete and sign an application and have a personal interview with a Medicaid official.
Each eligible Medicaid recipient receives a monthly medical identification card. The card is valid for one month only.
Does Medicare Cover Long
This easy to read article spells out what type of care Medicare does and does not cover. Estimates of the cost of long-term care and ways to pay for it are provided.
None of us want to be discharged from the hospital into a poor-quality nursing home, but many don’t realize that you have a choice. Advice from experts is to become familiar with nursing homes in your area before you are even hospitalized. Dig into government reports and conduct your own inspection. This article tells you what to look out for when evaluating your options.
Q: Can Someone With Parkinsons Get Long Term Care Insurance
After being diagnosed with Parkinsons disease, its extremely difficult for the patient to obtain long term care insurance. Most applications are denied by the insurer, and those that are approved will require a hefty premium.
In such cases, its often better for the caregiver to apply for long term care insurance instead. For more information about long term care insurance policies for Parkinsons patients and caregivers, read this helpful article from the Parkinsons Foundation.
What Is The Impact On Daily Life For A Person With Parkinsons
The effect of Parkinsons Disease on ones ability to work varies from case to case. Some people may experience rapid progression of symptoms, while others experience a slower progression. Some jobs may be more physically or mentally demanding than others. Individuals experiencing the cognitive symptoms of PD who work in fast-paced jobs may find it challenging to concentrate or manage multiple projects.
Your PD symptoms are unique to your diseases course. You and your doctor can determine if your symptoms and/or side effects from medication inhibit your ability to continue working.
Years Old Vs 60 Years Old: Is It Better To Buy Early
You may have heard that youll pay less and lock in a lower monthly premium if you buy your policy at age 50 instead of age 60. That might be true, but youll also be dishing out money for an extra decadefor no reason. Dave will never tell you to buy something based on how much the monthly payment is. Thats what broke people do. Its about what you need, when you need it.
It might seem cheaper to buy long-term care in your 50s because of those lower monthly premiums, but the numbers tell a different story.
Lets compare the long-term care policy costs for a $5,000 monthly benefit. A 50-year-old man in Tennessee will pay an estimated $2,304 per year. If the policy remains in effect until hes 95, he can spend approximately $103,680in long-term care premiums. If that same man waited until he was 60, hed pay an estimated annual premium of $2,952. If he keeps the policy until hes 95, it would cost him $103,320 overall.
You can already see how buying at age 60 is a better deal. But what would happen if, instead of buying long-term care at age 50, you invested that $2,304 each year until age 60? At 11% interest, you could have roughly $41,600. And if you keep that money invested until age 95 and never add anything to it, you could have over $2.8 million. Thats not too shabby!
Financial Considerations With Parkinsons Disease
- Prescription medications
- Veterans benefits
- Other public programs
Medicare is the main source of health care coverage for most individuals 65 and older. Other common sources of payment include private pay, employer pension plans, and personal savings.
Regardless of the age of the individual with Parkinson’s disease, all healthcare plans meeting these needs should be kept active. It is sometimes possible to supplement an individuals Medicare coverage with Medigap insurance which covers certain gaps in Medicare coverage such as paying for co-insurance or other items.
A long-term care insurance policy usually needs to be in place before a Parkinson’s disease diagnosis occurs in order for long-term care to be covered for the disease. After a Parkinsons disease diagnosis, the policy should be reviewed to determine:
- Eligibility of the person diagnosed
- When the covered individual is able to start collecting benefits
- Date the daily benefit begins
- Whether the benefit is adjusted annually for inflation
- Length of time the benefits will be paid
- Whether there is a maximum lifetime payout
- Type of care covered by the policy
- Whether there is an elimination period before the coverage begins
- Any tax implications of the policy
In addition, Medicaid will pay for hospice care in most states.
Can I Be Rejected For Long
Yes; 20% to 44% of people who apply for long-term care insurance are rejected.
- 20% of people age 49 or younger are rejected
- 22% of people age 59 to 59 are rejected
- 30% of people age 60 to 69 are rejected
- 44% of people age 70 to 79 are rejected
The American Association of Long Term Care Insurance lists these pre-existing conditions that may prevent you from qualifying:
- AIDs or HIV infection
- Active Hepatitis C, Non-A, Non-B, or Autoimmune
- Kidney Failure
- Systemic Lupus Erythematosus
Warning Signs Of Parkinsons Disease
Generally speaking, the first hints of the illness are usually mild, intermittent and show up on just one side of the body. Three cardinal signs are:
- Shakiness from a tremor in a hand, arm or leg or in the jaw or face when the patient isnt actively moving.
- Stiffness or rigidity of the arms, legs and torso.
- Slowness of movements, also known as bradykinesia.
Other common signs and symptoms may include:
- Small, cramped handwriting.
- Less arm-swinging than before while walking.
- A blank, masklike facial expression.
If You Develop A Tremor
Urgent medical care isn’t needed if you’ve had a tremorâshaking or tremblingâfor some time. But you should discuss the tremor at your next doctor’s appointment.
If a tremor is affecting your daily activities or if it’s a new symptom, see your doctor sooner.
A written description will help your doctor make a correct diagnosis. In writing your description, consider the following questions:
- Did the tremor start suddenly or gradually?
- What makes it worse or better?
- What parts of your body are affected?
- Have there been any recent changes in the medicines you take or how much you take?