General Information
Disclaimer
BlountSeniors.com makes every effort to keep all information current, however, business and service information may change from time to time without current updates being made in this site. If you should notice non-current information please email us so we can make updates. Additionally, while we do check references for our sponsors, we cannot guarantee service levels as they are independent from Blount Seniors. In addition, Blount Seniors reserves the right to decline sponsors for any reason deemed appropriate.
Questions about General Information Page
If you have any questions about the General Information page, please contact: [email protected]
Keep in mind
All information is subject to change. The directory is updated regularly, however; addresses, phone numbers, business names and hours of operation may change from time to time.
- All non-sponsor listings include name of business / resource and phone numbers.
- Sponsors are identified by a graphic display of the logo that have direct links to their websites if available for easy contact.
- All area codes are 865 unless indicated.
- Regardless of how you intend to pay, always ask a provider of health-related services what forms of payment they accept before you choose them.
- The sponsors are listed on the "Sponsors" page with links to their websites. Please support and thank them with your patronage!
Caregiving & Eldercare Assistance
If you are helping or caring for an older person, the first thing this directory can do for you is offer ideas about where you can find practical help. Research shows that caregivers can do a better job of caring for their relatives if they don’t try to do it all themselves but take advantage of community services and take some time off (often called respite).
Information and assistance for caregivers is available through Blount Seniors. If you cannot find what you need in this website please email or call us. Our staff can advise about available resources such as support groups, home modification, safety devices, adult day programs, and in-home services.
“Activities of Daily Living” and “Instrumental Activities of Daily Living” (ADLs and IADLs) are terms you may encounter when talking with social workers, healthcare professionals, and insurance representatives. ADLs are functions that healthy people can do for themselves but that sick or frail people can lose the ability to do without assistance. ADLs include eating, bathing, grooming, dressing, toileting, walking, and transferring (i.e., bed to chair, in and out of bath). IADLs include preparing meals, shopping, managing money, using the telephone, light or heavy housework, driving or using public transportation and remembering to take daily prescribed medications.
Caregivers are often at a loss to know what is causing a behavior change in the older person they care for, what to expect next, and what they can do about it (for example, the older person seems sad or depressed for long periods of time, is confused, or is irrational). Mental and behavioral changes can result from disease, poor nutrition, reactions to medicines, and the stress of major life changes such as a move from the family home or a death in the family.
Caregivers must deal with all of the tasks of everyday life, often including a job outside the home, in addition to providing care for an elderly person. Making a weekly schedule and spreading responsibilities among family and friends is the key to prevent caregiver fatigue and burn out. For information about Living Assistance please visit the "Living Assistance" page.
Information and assistance for caregivers is available through Blount Seniors. If you cannot find what you need in this website please email or call us. Our staff can advise about available resources such as support groups, home modification, safety devices, adult day programs, and in-home services.
“Activities of Daily Living” and “Instrumental Activities of Daily Living” (ADLs and IADLs) are terms you may encounter when talking with social workers, healthcare professionals, and insurance representatives. ADLs are functions that healthy people can do for themselves but that sick or frail people can lose the ability to do without assistance. ADLs include eating, bathing, grooming, dressing, toileting, walking, and transferring (i.e., bed to chair, in and out of bath). IADLs include preparing meals, shopping, managing money, using the telephone, light or heavy housework, driving or using public transportation and remembering to take daily prescribed medications.
Caregivers are often at a loss to know what is causing a behavior change in the older person they care for, what to expect next, and what they can do about it (for example, the older person seems sad or depressed for long periods of time, is confused, or is irrational). Mental and behavioral changes can result from disease, poor nutrition, reactions to medicines, and the stress of major life changes such as a move from the family home or a death in the family.
Caregivers must deal with all of the tasks of everyday life, often including a job outside the home, in addition to providing care for an elderly person. Making a weekly schedule and spreading responsibilities among family and friends is the key to prevent caregiver fatigue and burn out. For information about Living Assistance please visit the "Living Assistance" page.
Scams
Scams come in many forms and older people are often targets. Be wary of anyone wanting money from you in a call or visit that you did not initiate. Your bank, Social Security, or the Medicare office has all of your information and will NEVER call you for it. Don’t give your bank account, credit card, Medicare, or Social Security numbers to anyone over the phone. Never pay any amount of money for a “prize” that you have supposedly won. Remember: If it seems too good to be true, it probably is!
Be extremely wary of unsolicited offers to do home repair or improvement jobs, especially if someone drives up to your home uninvited and offers you a bargain. When looking for workers to do home repair, ask friends for referrals. Get an estimate from more than one business; ask if they offer a senior discount. Do not pay in advance and be sure to inspect the work before paying in full.
Consult with family, friends or Better Business Bureau before you spend or send a substantial amount of money. Ask for—and check—references before hiring a worker or signing a contract. Get the agreement in writing. Make an appointment to have someone from Legal Aid of East Tennessee look over a contract before you sign it.
Romance scams are becoming more common on dating websites. Wiring money to anyone that you have not met in person is not advisable. Check with relatives before wiring any money to get a grandchild out of jail in a foreign country. Be very careful before you give anyone access to your checking or bank account, including relatives.
Be extremely wary of unsolicited offers to do home repair or improvement jobs, especially if someone drives up to your home uninvited and offers you a bargain. When looking for workers to do home repair, ask friends for referrals. Get an estimate from more than one business; ask if they offer a senior discount. Do not pay in advance and be sure to inspect the work before paying in full.
Consult with family, friends or Better Business Bureau before you spend or send a substantial amount of money. Ask for—and check—references before hiring a worker or signing a contract. Get the agreement in writing. Make an appointment to have someone from Legal Aid of East Tennessee look over a contract before you sign it.
Romance scams are becoming more common on dating websites. Wiring money to anyone that you have not met in person is not advisable. Check with relatives before wiring any money to get a grandchild out of jail in a foreign country. Be very careful before you give anyone access to your checking or bank account, including relatives.
Hiring In-Home Services
When an individual or company is hired to come onto your property or into your home, you take on a certain amount of risk, as does the person you’re hiring. There are many issues, including liability for damage to your property, liability for injury to the person you hire, the potential for scams, and payment of the worker’s Social Security tax.
It is best to know the answers to the following questions before you hire someone to do work for you at home rather than regretting it later:
Questions to Ask When Hiring Someone to Come Onto Your Property or Into Your Home
NOTE: If you hire someone to work in your home, you may be responsible for paying Social Security and Medicare taxes. You will have to pay taxes if you are an “employer” who has the right to tell the worker when, where, and how to do the work.
It is best to know the answers to the following questions before you hire someone to do work for you at home rather than regretting it later:
Questions to Ask When Hiring Someone to Come Onto Your Property or Into Your Home
- Who is going to do the work? Does the company use employees or subcontractors?
- Who supervises the employees or subcontractors?
- Does the individual or company have experience? What type of experience? How long has the individual or company done this type of work?
- What kind of background checks are done by the company?
- What is the company’s policy on hiring employees or subcontractors with a criminal background? Some companies might do a police background check, but might not have a policy against hiring someone with a criminal background.
- Does the individual or company have a business license or other appropriate license? Is it current? Is their license held in Blount County, or somewhere else?
- Is the individual or company accredited by a governing agency? Does the individual or company have workers’ compensation insurance? Is it current?
- Has the individual or company paid an insurance bond?
- If the company uses subcontractors, does the subcontractor have a license? What about workers’ compensation insurance? Has the subcontractor paid an insurance bond?
- Have any complaints against the individual or company been filed with the Better Business Bureau, the Tennessee Consumer Affairs Division, or any applicable licensing board?
- Can the individual or company provide references and contact information for the references?
- What work or services will be provided?
- When will the work or services start and end?
- How much will the work or services cost and what is the payment schedule? Does the individual or company accept checks or money orders so you can prove that you paid for the work or services?
- Ask for a detailed contract that covers the work or services that will be done, any materials that will be used, the cost and payment schedule, and the start and end date.
NOTE: If you hire someone to work in your home, you may be responsible for paying Social Security and Medicare taxes. You will have to pay taxes if you are an “employer” who has the right to tell the worker when, where, and how to do the work.
Medicare
Medicare is a federal health insurance program that pays a large part of the medical expenses of most Americans over the age of 65 and some younger, disabled persons who have received federal disability benefits for at least 24 months. Individuals with end-stage renal disease or ALS (amyotrophic lateral sclerosis, often called “Lou Gehrig’s Disease”) may qualify for Medicare without the 24-month requirement. Anyone over age 65 may apply for Medicare. Most people get their Medicare coverage in one of two ways:
Original Medicare (Part A and Part B), Part D (prescription drug coverage) + Medigap/Supplement (which is optional).
Medicare Advantage Plan (Part C), which combines Parts A, B, and D. It may include some benefits not available through Original Medicare, i.e., some dental benefits.
Part A is premium-free to most people. Part B requires payment of a monthly premium. If you are not yet on Social Security, you will be billed quarterly for Medicare premiums.
Part D is insurance for reducing prescription drug costs. It may require payment of a monthly premium to a private company. There is a penalty imposed for not enrolling in a Part D plan when first enrolling in Medicare.
Help with Medicare Premiums
Help is available for low-income enrollees who cannot afford to pay their Medicare premiums, copayments, or deductibles. To find out more about Qualified Medicare Beneficiary (QMB), Special Low-Income Medicare Beneficiary (SLMB), Qualified Individuals 1 (QI1), and Extra Help programs, or to enroll, see page 124. The resource limits for the Medicare Savings (QMB, SLMB, and QI1) and Extra Help programs regularly change. If you were denied help in the past, you can call SHIP (State Health Insurance Assistance Program) at 691-2551 x4308 for information about the new resource limits.
When to Apply for Medicare
Applying for Medicare can be completed online at www.ssa.gov or by calling the local Social Security office. There is a 7-month enrollment window, beginning three months prior to your 65th birthday. If you do not enroll during this period, you may pay higher premiums later when you do sign up. If you are receiving Social Security or Railroad Retirement when you turn 65, you are automatically enrolled in Medicare and will receive your Medicare card in the mail. The only way individuals may delay taking Part B without a penalty is if they are enrolled in a health plan that is at least as good as Medicare, most often through employers.
If you continue to work after age 65 and are covered by your employer’s health insurance, Medicare will be the secondary payer for some hospital services under Part A. Contact Social Security promptly to enroll in Part B when you stop working or your employment-related health insurance terminates. You may have special rights to purchase a Medigap/Supplement policy if your employment-related coverage is ending.
The best way to learn about Medicare coverage is by visiting the website, www.medicare.gov. The Centers for Medicare and Medicaid Services (CMS), the federal agency that administers Medicare, sends a Medicare & You Handbook to beneficiaries yearly. It contains the latest information about your Medicare benefits, where to get help and additional information. A book can be requested through the website.
Original Medicare
Part A: Hospital Insurance. Part A pays 80% of Medicare-approved inpatient hospital care. In some instances, it helps pay for home health care, hospice care, and skilled nursing care in a nursing home. Per benefit period, copayments, coinsurance, and deductibles may apply. Visit www.medicare.gov or call 1-800-MEDICARE for specific costs. A benefit period begins when an individual is admitted as an inpatient to a hospital and ends when that person has been out of the hospital for 60 days. A new hospital deductible is charged only after that period. Some Medicap/Supplement plans cover that cost.
The amount Medicare will pay for a hospital stay is based on a patient’s diagnosis and whether care in a hospital is medically necessary. Once the doctor has decided that it is no longer medically necessary for a patient to remain in the hospital, the person will be discharged.
If the patient or the family disagrees with the doctor’s decision to discharge the patient, they can appeal the decision before having to leave the hospital. To appeal, contact KEPRO, Tennessee’s healthcare quality improvement organization, for information and assistance in starting the appeal process within the time allowed.
Part B: Medical Insurance. Medicare Part B pays 80% of Medicare-approved and medically necessary doctor care, out-patient care, home health services, durable medical equipment, and other medical services. Part B also covers many preventive services and general prescriptions. Enrollees pay a monthly premium and all costs until a yearly deductible is met. Then you typically will pay 20% of the Medicare-approved amount of the eligible service. Many preventive procedures do not require the 20-percent copayment. Doctors and durable medical equipment suppliers who accept as their full fee what Medicare allows are said to “accept Medicare assignment.”
Part D: Prescription Drug Insurance. Medicare Part D helps pay for medically necessary prescription drugs for beneficiaries. Part D is optional; however, there is a penalty for beneficiaries who do not enroll when they first become eligible but later decide to enroll. The annual open enrollment period is October 15 to December 7 each year and changes take effect on January 1. Enrollees must participate in Part A, B, or both and may pay a Part D monthly premium and yearly deductible. The limits of coverage are described in the annual Medicare & You handbook.
Enrollees eligible for both Medicare and Medicaid (dual eligible) receive prescription drug coverage through Medicare, not Medicaid.
Help with Medicare Premiums and Deductibles. Help is available for low-income Medicare beneficiaries who cannot afford to pay their Medicare premiums, copayments, or deductibles. To find out more about Qualified Medicare Beneficiary (QMB), Special Low-Income Medicare Beneficiary (SLMB), Qualified Individual (QI), or Extra Help programs, or to enroll, visit www.medicare.gov .
Medigap/Supplement Insurance. These policies are sold by private insurance companies to fill “gaps” in Original Medicare Part A and Part B coverage. The insurance helps pay your share (coinsurance, copayments, and deductibles) of the costs of Medicare-approved services. In Tennessee, you may choose from a variety of standardized policies, which are identified by letters (A, F, G, etc.). Be sure to shop around once you have determined the coverage that you are seeking. Even though policies are identical, the costs vary widely from one insurance company to another.
State and federal law guarantees your right to purchase the medicap/supplement insurance policy of your choice during the initial enrollment period that begins when you turn 65 and are enrolled in Parts A and B. You cannot be refused or charged more based on your health, medical history, or claims experience.
Guarantees of access to medigap/supplement (Guaranteed Issue Rights) policies are available outside the initial open enrollment period for people in the following situations:
Part C: Medicare Advantage Plans are approved by Medicare but run by private companies. When you join a Medicare Advantage plan you are still in Medicare, but you cannot have a Medicare Advantage plan and Original Medicare at the same time. When you have a Medicare Advantage plan, you do not need a Medigap (supplement) policy and it is illegal for anyone to sell you one.
Medicare Advantage plans provide your Part A and Part B coverage and must cover medically necessary services. They may offer extra benefits (such as dental care or routine eye exam), and many include Part D drug coverage. However, you must still pay your Medicare Part B premiums in addition to any premiums charged by the Medicare Advantage Plan. The kinds of Medicare Advantage Plans available in our area are:
Medicare Advantage Plans available in Tennessee are listed in the Medicare & You handbook or at www.medicare.gov.
Factors to Consider When Choosing Coverage
To decide whether to remain in Original Medicare or enroll in a Medicare Advantage plan (HMO, PPO, Special Needs) consider these factors:
Original Medicare with a Medigap/Supplement and Part D drug plan might make sense if you
A Medicare Advantage Plan could be your best choice if you
Compare all Medicare plan choices available in Blount County at www.medicare.gov.
Medicaid/TennCare
Medicaid, a national healthcare program for low-income persons, is cooperatively financed by the state and federal governments. Administered by the State of TN, the program provides medical services to eligible individuals. Benefits cover hospital, nursing home, and outpatient services.
In Tennessee, Medicaid is called TennCare. TennCare CHOICES is the program that pays for care in a nursing home, an assisted living facility, or for long-term care at home.
TennCare is for Tennesseans who fit into certain categories, including eligible uninsured women under age 65 who need treatment for breast and cervical cancer. Anyone receiving SSI is automatically eligible for TennCare. Even if you are not eligible for SSI now, you may be eligible for TennCare if you received both Social Security and SSI in at least one month after April 1977. Legal Aid of East TN has information about this eligibility. There are additional TennCare categories for some children and families with children. Children and pregnant women with high medical bills are also eligible for TennCare. This type of TennCare is called “Medicaid Spend Down.”
When you enroll in TennCare, you may choose a Managed Care Organization (MCO) or you will be assigned one. Before you choose your TennCare plan, think about which doctor, hospital, and pharmacy you want, as well as what other medical services you need. Check with each MCO to learn which services are provided under that plan (for example, eye and dental care, geriatric assessment). Check with all of your healthcare providers to learn which MCO plans they accept. Choose the MCO that offers the greatest number of services that you need and the doctor, hospital, and pharmacy you prefer.
TennCare MCOs must provide transportation for people signed up with their plan who do not have transportation to medical services. Call your MCO to get instructions about arranging transportation. Arrangements must always be made in advance, sometimes as much as five days ahead. Even in an emergency, call your MCO for instructions about obtaining transportation. TennCare provides pharmacy benefits to eligible enrollees; however, enrollees who also have Medicare receive their pharmacy benefits through Medicare Part D. If you or a family member has a problem with medical services under TennCare, begin by reporting the problem to the MCO; if in a nursing home, begin with the administrator. If you need further assistance, call the TennCare Advocacy Program. Whenever you write or mail anything to TennCare, keep a copy and get proof of mailing from the post office or send it by certified mail, return receipt requested. You then have proof that the document was mailed and received. If you are helping a family member and do not know whether s/he or is on TennCare or which plan s/he has, call the TennCare Information Line.
TennCare MCOs are responsible for providing mental health services, including substance abuse treatment, to their enrollees. The Mental Health Association of East TN will provide information about TennCare’s coverage of mental health services and will help to advocate or resolve problems.
TennCare CHOICES
TennCare CHOICES (or CHOICES for short) is TennCare’s program for adults age 21 and older with a physical disability, and seniors (age 65 and older). CHOICES assists with things like bathing, dressing, getting around your home, preparing meals, or doing household chores. CHOICES includes care in a nursing home as well as certain services to help a person remain at home or in the community, such as personal care visits, attendant care, home-delivered meals, personal emergency response system, adult day care, in-home/in-patient respite care, assistive technology, minor home modifications, pest control, assisted living, and Consumer directed care.
To qualify for and remain in CHOICES, you must:
Need the level of care provided in a nursing home; OR
CHOICES Group 1 is for people of all ages who receive nursing home care.
CHOICES Group 2 is for adults (age 21 and older) with a physical disability and seniors (age 65 and older) who qualify to receive nursing home care, but choose to receive care at home instead.
CHOICES Group 3 is for adults (age 21 and older) with a disability and seniors (age 65 and older) who don’t qualify for nursing home care, but need a more moderate package of services at home to delay or prevent the need for nursing home care.
To apply for CHOICES:
If you have TennCare, you can call your TennCare health plan (MCO). The number is on your TennCare card. If you are or represent an individual with intellectual disabilities, you can call the Department of Intellectual and Developmental Disabilities (DIDD) for free at 800-535-9725.
If you don't have TennCare, contact your local Area Agency on Aging at 865-724-1219. Even if you don't qualify for Medicaid, they can tell you about other programs that may help.
Medicare Fraud
Protecting Medicare’s Trust Funds to ensure the availability of future benefits continues to be a priority of our government. Detecting and deterring Medicare fraud requires the active help of every beneficiary. The Centers for Medicare and Medicaid Services (CMS) suggests:
Original Medicare (Part A and Part B), Part D (prescription drug coverage) + Medigap/Supplement (which is optional).
Medicare Advantage Plan (Part C), which combines Parts A, B, and D. It may include some benefits not available through Original Medicare, i.e., some dental benefits.
Part A is premium-free to most people. Part B requires payment of a monthly premium. If you are not yet on Social Security, you will be billed quarterly for Medicare premiums.
Part D is insurance for reducing prescription drug costs. It may require payment of a monthly premium to a private company. There is a penalty imposed for not enrolling in a Part D plan when first enrolling in Medicare.
Help with Medicare Premiums
Help is available for low-income enrollees who cannot afford to pay their Medicare premiums, copayments, or deductibles. To find out more about Qualified Medicare Beneficiary (QMB), Special Low-Income Medicare Beneficiary (SLMB), Qualified Individuals 1 (QI1), and Extra Help programs, or to enroll, see page 124. The resource limits for the Medicare Savings (QMB, SLMB, and QI1) and Extra Help programs regularly change. If you were denied help in the past, you can call SHIP (State Health Insurance Assistance Program) at 691-2551 x4308 for information about the new resource limits.
When to Apply for Medicare
Applying for Medicare can be completed online at www.ssa.gov or by calling the local Social Security office. There is a 7-month enrollment window, beginning three months prior to your 65th birthday. If you do not enroll during this period, you may pay higher premiums later when you do sign up. If you are receiving Social Security or Railroad Retirement when you turn 65, you are automatically enrolled in Medicare and will receive your Medicare card in the mail. The only way individuals may delay taking Part B without a penalty is if they are enrolled in a health plan that is at least as good as Medicare, most often through employers.
If you continue to work after age 65 and are covered by your employer’s health insurance, Medicare will be the secondary payer for some hospital services under Part A. Contact Social Security promptly to enroll in Part B when you stop working or your employment-related health insurance terminates. You may have special rights to purchase a Medigap/Supplement policy if your employment-related coverage is ending.
The best way to learn about Medicare coverage is by visiting the website, www.medicare.gov. The Centers for Medicare and Medicaid Services (CMS), the federal agency that administers Medicare, sends a Medicare & You Handbook to beneficiaries yearly. It contains the latest information about your Medicare benefits, where to get help and additional information. A book can be requested through the website.
Original Medicare
Part A: Hospital Insurance. Part A pays 80% of Medicare-approved inpatient hospital care. In some instances, it helps pay for home health care, hospice care, and skilled nursing care in a nursing home. Per benefit period, copayments, coinsurance, and deductibles may apply. Visit www.medicare.gov or call 1-800-MEDICARE for specific costs. A benefit period begins when an individual is admitted as an inpatient to a hospital and ends when that person has been out of the hospital for 60 days. A new hospital deductible is charged only after that period. Some Medicap/Supplement plans cover that cost.
The amount Medicare will pay for a hospital stay is based on a patient’s diagnosis and whether care in a hospital is medically necessary. Once the doctor has decided that it is no longer medically necessary for a patient to remain in the hospital, the person will be discharged.
If the patient or the family disagrees with the doctor’s decision to discharge the patient, they can appeal the decision before having to leave the hospital. To appeal, contact KEPRO, Tennessee’s healthcare quality improvement organization, for information and assistance in starting the appeal process within the time allowed.
Part B: Medical Insurance. Medicare Part B pays 80% of Medicare-approved and medically necessary doctor care, out-patient care, home health services, durable medical equipment, and other medical services. Part B also covers many preventive services and general prescriptions. Enrollees pay a monthly premium and all costs until a yearly deductible is met. Then you typically will pay 20% of the Medicare-approved amount of the eligible service. Many preventive procedures do not require the 20-percent copayment. Doctors and durable medical equipment suppliers who accept as their full fee what Medicare allows are said to “accept Medicare assignment.”
Part D: Prescription Drug Insurance. Medicare Part D helps pay for medically necessary prescription drugs for beneficiaries. Part D is optional; however, there is a penalty for beneficiaries who do not enroll when they first become eligible but later decide to enroll. The annual open enrollment period is October 15 to December 7 each year and changes take effect on January 1. Enrollees must participate in Part A, B, or both and may pay a Part D monthly premium and yearly deductible. The limits of coverage are described in the annual Medicare & You handbook.
Enrollees eligible for both Medicare and Medicaid (dual eligible) receive prescription drug coverage through Medicare, not Medicaid.
Help with Medicare Premiums and Deductibles. Help is available for low-income Medicare beneficiaries who cannot afford to pay their Medicare premiums, copayments, or deductibles. To find out more about Qualified Medicare Beneficiary (QMB), Special Low-Income Medicare Beneficiary (SLMB), Qualified Individual (QI), or Extra Help programs, or to enroll, visit www.medicare.gov .
Medigap/Supplement Insurance. These policies are sold by private insurance companies to fill “gaps” in Original Medicare Part A and Part B coverage. The insurance helps pay your share (coinsurance, copayments, and deductibles) of the costs of Medicare-approved services. In Tennessee, you may choose from a variety of standardized policies, which are identified by letters (A, F, G, etc.). Be sure to shop around once you have determined the coverage that you are seeking. Even though policies are identical, the costs vary widely from one insurance company to another.
State and federal law guarantees your right to purchase the medicap/supplement insurance policy of your choice during the initial enrollment period that begins when you turn 65 and are enrolled in Parts A and B. You cannot be refused or charged more based on your health, medical history, or claims experience.
Guarantees of access to medigap/supplement (Guaranteed Issue Rights) policies are available outside the initial open enrollment period for people in the following situations:
- Your employer-provided retiree group health insurance that supplemented Medicare is terminated
- You drop your supplement insurance when you enrolled in any Medicare Advantage plan for the first time and elect to leave the plan within 12 months of enrolling.
- You move out of the geographic area served by your Medicare Advantage plan
- Your Medicare Advantage plan’s contract with Medicare is not renewed
- You leave a Medicare Advantage plan or Medigap policy because the company hasn’t followed the rules or has misled you.
Part C: Medicare Advantage Plans are approved by Medicare but run by private companies. When you join a Medicare Advantage plan you are still in Medicare, but you cannot have a Medicare Advantage plan and Original Medicare at the same time. When you have a Medicare Advantage plan, you do not need a Medigap (supplement) policy and it is illegal for anyone to sell you one.
Medicare Advantage plans provide your Part A and Part B coverage and must cover medically necessary services. They may offer extra benefits (such as dental care or routine eye exam), and many include Part D drug coverage. However, you must still pay your Medicare Part B premiums in addition to any premiums charged by the Medicare Advantage Plan. The kinds of Medicare Advantage Plans available in our area are:
- Health Maintenance Organizations (HMO)
- Preferred Provider Organizations (PPO)
- PPOs with Point of Service (POS) options
- Special Needs Plans
Medicare Advantage Plans available in Tennessee are listed in the Medicare & You handbook or at www.medicare.gov.
Factors to Consider When Choosing Coverage
To decide whether to remain in Original Medicare or enroll in a Medicare Advantage plan (HMO, PPO, Special Needs) consider these factors:
Original Medicare with a Medigap/Supplement and Part D drug plan might make sense if you
- Want flexibility in choosing your doctors
- Visit doctors frequently
- Travel extensively
- Have a chronic medical condition
- Don’t mind higher premiums to get lower out-of-pocket costs (predictability)
A Medicare Advantage Plan could be your best choice if you
- Are willing to change doctors, if necessary
- Prefer all benefits from a single plan & premium
- Visit doctors infrequently & don’t mind paying per-visit copayments and coinsurance
- Don’t mind researching your options annually
- Want lower premiums than supplements offer
- Are informed about your choices and don’t mind comparison shopping for plans every year
- Want options beyond what Medicare provides
Compare all Medicare plan choices available in Blount County at www.medicare.gov.
Medicaid/TennCare
Medicaid, a national healthcare program for low-income persons, is cooperatively financed by the state and federal governments. Administered by the State of TN, the program provides medical services to eligible individuals. Benefits cover hospital, nursing home, and outpatient services.
In Tennessee, Medicaid is called TennCare. TennCare CHOICES is the program that pays for care in a nursing home, an assisted living facility, or for long-term care at home.
TennCare is for Tennesseans who fit into certain categories, including eligible uninsured women under age 65 who need treatment for breast and cervical cancer. Anyone receiving SSI is automatically eligible for TennCare. Even if you are not eligible for SSI now, you may be eligible for TennCare if you received both Social Security and SSI in at least one month after April 1977. Legal Aid of East TN has information about this eligibility. There are additional TennCare categories for some children and families with children. Children and pregnant women with high medical bills are also eligible for TennCare. This type of TennCare is called “Medicaid Spend Down.”
When you enroll in TennCare, you may choose a Managed Care Organization (MCO) or you will be assigned one. Before you choose your TennCare plan, think about which doctor, hospital, and pharmacy you want, as well as what other medical services you need. Check with each MCO to learn which services are provided under that plan (for example, eye and dental care, geriatric assessment). Check with all of your healthcare providers to learn which MCO plans they accept. Choose the MCO that offers the greatest number of services that you need and the doctor, hospital, and pharmacy you prefer.
TennCare MCOs must provide transportation for people signed up with their plan who do not have transportation to medical services. Call your MCO to get instructions about arranging transportation. Arrangements must always be made in advance, sometimes as much as five days ahead. Even in an emergency, call your MCO for instructions about obtaining transportation. TennCare provides pharmacy benefits to eligible enrollees; however, enrollees who also have Medicare receive their pharmacy benefits through Medicare Part D. If you or a family member has a problem with medical services under TennCare, begin by reporting the problem to the MCO; if in a nursing home, begin with the administrator. If you need further assistance, call the TennCare Advocacy Program. Whenever you write or mail anything to TennCare, keep a copy and get proof of mailing from the post office or send it by certified mail, return receipt requested. You then have proof that the document was mailed and received. If you are helping a family member and do not know whether s/he or is on TennCare or which plan s/he has, call the TennCare Information Line.
TennCare MCOs are responsible for providing mental health services, including substance abuse treatment, to their enrollees. The Mental Health Association of East TN will provide information about TennCare’s coverage of mental health services and will help to advocate or resolve problems.
TennCare CHOICES
TennCare CHOICES (or CHOICES for short) is TennCare’s program for adults age 21 and older with a physical disability, and seniors (age 65 and older). CHOICES assists with things like bathing, dressing, getting around your home, preparing meals, or doing household chores. CHOICES includes care in a nursing home as well as certain services to help a person remain at home or in the community, such as personal care visits, attendant care, home-delivered meals, personal emergency response system, adult day care, in-home/in-patient respite care, assistive technology, minor home modifications, pest control, assisted living, and Consumer directed care.
To qualify for and remain in CHOICES, you must:
Need the level of care provided in a nursing home; OR
- Be "at risk" of needing the level of care provided in a nursing home; AND
- Qualify for Medicaid long- term services and supports
CHOICES Group 1 is for people of all ages who receive nursing home care.
CHOICES Group 2 is for adults (age 21 and older) with a physical disability and seniors (age 65 and older) who qualify to receive nursing home care, but choose to receive care at home instead.
CHOICES Group 3 is for adults (age 21 and older) with a disability and seniors (age 65 and older) who don’t qualify for nursing home care, but need a more moderate package of services at home to delay or prevent the need for nursing home care.
To apply for CHOICES:
If you have TennCare, you can call your TennCare health plan (MCO). The number is on your TennCare card. If you are or represent an individual with intellectual disabilities, you can call the Department of Intellectual and Developmental Disabilities (DIDD) for free at 800-535-9725.
If you don't have TennCare, contact your local Area Agency on Aging at 865-724-1219. Even if you don't qualify for Medicaid, they can tell you about other programs that may help.
Medicare Fraud
Protecting Medicare’s Trust Funds to ensure the availability of future benefits continues to be a priority of our government. Detecting and deterring Medicare fraud requires the active help of every beneficiary. The Centers for Medicare and Medicaid Services (CMS) suggests:
- Never give your Medicare number to anyone over the phone or to someone you don’t know if you did not initiate the contact. Do not send it over the Internet, except to secure, encrypted sites such as Social Security’s and Medicare’s official sites. If in doubt, don’t do it, or get help.
- Check your Medicare Summary Notice (MSN) or report from your medigap or supplement company to be sure you received the medical services listed.
- Be suspicious of companies that offer “free” medical equipment or offer to waive your copayment.
- Beware of healthcare providers/suppliers who use door-to-door or phone offers to sell you goods and services.
- Beware of healthcare providers who say they represent Medicare or a federal agency or who use pressure tactics to get you to accept a service, product, or insurance.
- Beware of healthcare providers who offer “free” screening tests at senior gatherings and ask for your Medicare number. If the services are really free, they should not need your number.
Social Security
Nine out of ten Americans who have reached retirement age receive a monthly income check from Social Security. Reduced retirement benefits may start at age 62. Monthly benefits are available to workers upon retirement, to their dependents and/or survivors, and, in some cases, to persons with severe disabilities. Employed persons can begin receiving benefits at full retirement age, regardless of income.
Full-retirement age is now 66 years. That age will gradually increase until it reaches 67 for people born after 1959. A chart on the Social Security website (www.ssa.gov) shows the steps in which the retirement age will increase. To apply, contact the Social Security Administration for instructions on how to file a claim. When you are ready to file a claim go to the website or call the local Social Security field office. Spouses and widows or widowers may be eligible for special benefits, including death benefits. Individuals who are disabled before age 65 may apply for Social Security Disability benefits.
Supplemental Security Income (SSI)
Supplemental Security Income (SSI) provides a minimum monthly income to persons with limited income and resources who are age 65 or older, blind, or have other disabilities. Eligibility is based on income and assets. The Social Security office provides information about the program, takes applications, and helps file claims.
You may be eligible for TennCare (Medicaid) if you receive SSI now—or if you do not receive SSI now, but you received both Social Security and SSI in at least one month after April 1977. See medical information and financing for TennCare application information. Legal Aid of East TN has information about this eligibility.
Social Security Disability Insurance (SSDI)
The Social Security Disability Insurance program (also called SSDI) pays benefits to individuals and certain family members if they paid Social Security taxes and worked long enough to qualify. Adult children also may qualify for benefits through their parents' work records if the children have a disability that started before age 22. If an application for SSDI is denied, the appeal process should be used. It is not required, but it may be helpful to contact an attorney or Legal Aid of East Tennessee for advice on the appeal process.
Disabled individuals ages 18 to 64 years who have low incomes and limited assets may qualify for disability benefits through the Supplemental Security Income (SSI) program.
Full-retirement age is now 66 years. That age will gradually increase until it reaches 67 for people born after 1959. A chart on the Social Security website (www.ssa.gov) shows the steps in which the retirement age will increase. To apply, contact the Social Security Administration for instructions on how to file a claim. When you are ready to file a claim go to the website or call the local Social Security field office. Spouses and widows or widowers may be eligible for special benefits, including death benefits. Individuals who are disabled before age 65 may apply for Social Security Disability benefits.
Supplemental Security Income (SSI)
Supplemental Security Income (SSI) provides a minimum monthly income to persons with limited income and resources who are age 65 or older, blind, or have other disabilities. Eligibility is based on income and assets. The Social Security office provides information about the program, takes applications, and helps file claims.
You may be eligible for TennCare (Medicaid) if you receive SSI now—or if you do not receive SSI now, but you received both Social Security and SSI in at least one month after April 1977. See medical information and financing for TennCare application information. Legal Aid of East TN has information about this eligibility.
Social Security Disability Insurance (SSDI)
The Social Security Disability Insurance program (also called SSDI) pays benefits to individuals and certain family members if they paid Social Security taxes and worked long enough to qualify. Adult children also may qualify for benefits through their parents' work records if the children have a disability that started before age 22. If an application for SSDI is denied, the appeal process should be used. It is not required, but it may be helpful to contact an attorney or Legal Aid of East Tennessee for advice on the appeal process.
Disabled individuals ages 18 to 64 years who have low incomes and limited assets may qualify for disability benefits through the Supplemental Security Income (SSI) program.
ELDER ABUSE & EXPLOITATION
The abuse, neglect, or exploitation of a disabled or older adult is against the law. Elder abuse includes physical abuse, sexual abuse, mental abuse, and depriving a person of services by a caregiver. Elder exploitation includes taking government funds that have been paid to a disabled or older adult.
Tennessee law requires that any person who suspects abuse, neglect, or exploitation of a disabled or older adult to make a report to the Tennessee Department of Human Services, Department of Adult Protective Services. The toll-free number is 1-888-277-8366.
The majority of elder abuse & exploitation is inflicted by family members. Much of this relates to taking money, prescription drugs or property, obtaining a signature on documents not understood by the signer, or using a power of attorney to misappropriate funds or property.
The abuse, neglect, or exploitation of a disabled or older adult is against the law. Elder abuse includes physical abuse, sexual abuse, mental abuse, and depriving a person of services by a caregiver. Elder exploitation includes taking government funds that have been paid to a disabled or older adult.
Tennessee law requires that any person who suspects abuse, neglect, or exploitation of a disabled or older adult to make a report to the Tennessee Department of Human Services, Department of Adult Protective Services. The toll-free number is 1-888-277-8366.
The majority of elder abuse & exploitation is inflicted by family members. Much of this relates to taking money, prescription drugs or property, obtaining a signature on documents not understood by the signer, or using a power of attorney to misappropriate funds or property.
Legal
When dealing with issues related to your will, Power of Attorney, and protecting assets, it is recommended that you consult with a certified elder law attorney. This specialist has passed a rigorous national examination that covers public benefits and aging-related law, and met character and experience standards. Lawyers with the special certification in elder law are designated with "CELA" after their names. The Blount County Bar Association can provide names of local certified specialists.
Before you add someone else’s name to your bank account or other assets, consult an attorney about the possible negative consequences for both parties.Consider taking the practical legal steps outlined below to plan ahead for the possibility of mental or physical incapacity. If you are helping an older person who can no longer appropriately manage his or her own affairs, legal steps need to be taken as soon as possible. Even persons diagnosed with dementia may still have the capacity to execute legal documents. The purpose of legal action is to safeguard the rights and interests of the older person, to protect them and their property, and to obtain advice and counsel for them on financial and business concerns. Legal action can also protect and empower a caregiver to act on behalf of an older person.
Power of Attorney
Power of attorney is a legal step that permits one individual, known as the “principal,” to give to another person, called the “attorney-in-fact,” the authority to act on his or her behalf. The attorney-in-fact is authorized to handle banking and real estate, incur expenses, pay bills, and handle a wide variety of legal affairs for a specified period of time. The power of attorney can continue indefinitely during the lifetime of the principal as long as that person is competent and capable of granting or revoking a power of attorney. If the principal becomes comatose or mentally incompetent, the power of attorney automatically expires just as it would if the principal died. Therefore, this power of attorney may expire just when it is most needed.
Durable Power of Attorney
Because the power of attorney ceases to be effective when the principal becomes incompetent or incapable, many states, including Tennessee, have authorized a legal device called a durable power of attorney that takes effect when the principal becomes incompetent or unable to handle his or her own affairs. The durable power of attorney defines the circumstances under which it will take effect and lists what it authorizes the attorney-in-fact to do. This legal device, which must be executed while the principal is still mentally competent, can prevent the necessity of filing for a conservatorship in most cases. The attorney-in-fact must have agreed to serve. Once the principal is incompetent or incapable, the attorney-in-fact can be removed only by petitioning the court for a conservatorship. The principal can revoke (cancel) the durable power of attorney at any time as long as he or she is competent. The principal must inform the attorney-in-fact that the power is canceled; without that notice, the attorney-in-fact could legally continue to act for the principal.
Laws governing powers of attorney vary from state to state, and, since a durable power of attorney puts a considerable amount of power in the hands of the attorney-in-fact, the document should be drawn up by a lawyer licensed to practice in the state in which the principal resides. Financial powers of attorney should be tailored to the specific assets owned by the principal.
Representative Payee
The authority of a power of attorney does not extend to Social Security, SSI, or SSDI. These arrangements must be made with the Social Security Administration. If you are helping an older person who can no longer manage his or her own financial affairs, report this to Social Security. You can request an appointment as Representative Payee. If a person needs a “Rep Payee” and there is no obvious person to take on the role, the Social Security Administration will try to find the best person to do it or will assign them to an agency that will provide a Rep Payee.
The Rep Payee handles Social Security-related finances. After investigating, Social Security will send the beneficiary’s checks to the Rep Payee. The Rep Payee must spend the funds for the personal care or benefit of the beneficiary, saving any excess funds; make periodic accounting to Social Security about how the money has been spent; and inform the agency when the beneficiary moves or dies.
Conservatorship
Tennessee law uses the term “conservatorship” for adults and “guardianship” for minors. A conservatorship is a legal mechanism by which the court declares a person unable to handle his or her own affairs and, therefore, appoints a conservator. The court can transfer to the conservator the responsibility for making decisions about any or all of the following: financial affairs, living arrangements, and medical care. For someone who needs a conservator but no appropriate person is available to serve in that capacity, the Public Guardian can be appointed.
A conservator must make regular reports to the court on the ward’s affairs. Obtaining a conservatorship can be expensive, involve more than one attorney, and, if contested, take many months. Check to be sure your attorney has experience in filing for conservatorship.
Wills
A well-prepared will is an effective tool that provides explicit instructions for the distribution of a person’s property and, if appropriate, how that property is to be used after a person dies. A will designates a person to serve as the Personal Representative (formerly executor) responsible for carrying out the instructions in the will. A will makes it easier to settle affairs quickly and with fewer legal expenses. Since a will is seldom consulted until after the funeral, instructions about funeral arrangements should be given to whoever will be responsible for making those arrangements. These instructions, and any regarding body donation, should be included in a durable power of attorney.
Advance Care Plans/Living Wills
Public attention is increasingly focused on “right-to-die” issues as medical technology makes it possible to sustain some vestige of life in dying patients. Although older laws related to living wills and powers of attorney for health care are still valid, the Health Care Decisions Act, enacted in Tennessee in 2004, was intended to make it easier for individuals to express their wishes concerning end-of-life decisions. New advance care forms have been developed by the State of Tennessee and can be downloaded from the Internet (see Advance Directive). Documents prepared under the old laws are still valid; however, the new forms may be more appealing to some people.
An advance care plan must be signed, dated, and witnessed or notarized. You should discuss your advance care plan with your family and doctors. Give each of your doctors a signed copy to be added to your medical file, and confirm with the physician that he or she will honor such a document. Give a copy to the person who will make medical decisions for you in the event that you are unable to do so. Review your advance care plan yearly to make any needed changes. You may append a letter spelling out your specific wishes. Legal Aid of East Tennessee has advance care plan forms and notaries available.
When a person is in a nursing facility and is approaching the end of life, family members might want to consider filling out one or both of the following forms: DNR (Do Not Resuscitate) and POST (Physician’s Order for Scope of Treatment). The POST form allows a patient (or legal representative) to outline a plan for end-of-life treatment that is much more specific to the situation than an advance care plan. Both forms should be available at nursing facilities.
Appointment of Health Care Agent/Durable Health Care Power of Attorney
You can also obtain an Appointment of Health Care Agent (previously called a durable health care power of attorney) in Tennessee. Under it, you can give authority to another person(s), with his or her consent, to make healthcare decisions on your behalf. This includes consent, refusal to consent, and withdrawal of consent to maintain any care, treatment, service, or procedure, and to diagnose or treat a physical or mental condition. It must be signed, dated, and witnessed or notarized. You should discuss it with your family, primary physician, and, in detail, with your chosen attorney(s)-in-fact. Copies and notarization are available as above in the section on advance care plans. Revocation or discharge of an agent may be made either orally or in writing. These documents should be tailored to the individual to incorporate particular desires and preferences regarding religious ceremonies, burial, and so forth.
Other Legal Issues
Before you add someone else’s name to your bank account or other assets, consult an attorney about the possible negative consequences for both parties.Consider taking the practical legal steps outlined below to plan ahead for the possibility of mental or physical incapacity. If you are helping an older person who can no longer appropriately manage his or her own affairs, legal steps need to be taken as soon as possible. Even persons diagnosed with dementia may still have the capacity to execute legal documents. The purpose of legal action is to safeguard the rights and interests of the older person, to protect them and their property, and to obtain advice and counsel for them on financial and business concerns. Legal action can also protect and empower a caregiver to act on behalf of an older person.
Power of Attorney
Power of attorney is a legal step that permits one individual, known as the “principal,” to give to another person, called the “attorney-in-fact,” the authority to act on his or her behalf. The attorney-in-fact is authorized to handle banking and real estate, incur expenses, pay bills, and handle a wide variety of legal affairs for a specified period of time. The power of attorney can continue indefinitely during the lifetime of the principal as long as that person is competent and capable of granting or revoking a power of attorney. If the principal becomes comatose or mentally incompetent, the power of attorney automatically expires just as it would if the principal died. Therefore, this power of attorney may expire just when it is most needed.
Durable Power of Attorney
Because the power of attorney ceases to be effective when the principal becomes incompetent or incapable, many states, including Tennessee, have authorized a legal device called a durable power of attorney that takes effect when the principal becomes incompetent or unable to handle his or her own affairs. The durable power of attorney defines the circumstances under which it will take effect and lists what it authorizes the attorney-in-fact to do. This legal device, which must be executed while the principal is still mentally competent, can prevent the necessity of filing for a conservatorship in most cases. The attorney-in-fact must have agreed to serve. Once the principal is incompetent or incapable, the attorney-in-fact can be removed only by petitioning the court for a conservatorship. The principal can revoke (cancel) the durable power of attorney at any time as long as he or she is competent. The principal must inform the attorney-in-fact that the power is canceled; without that notice, the attorney-in-fact could legally continue to act for the principal.
Laws governing powers of attorney vary from state to state, and, since a durable power of attorney puts a considerable amount of power in the hands of the attorney-in-fact, the document should be drawn up by a lawyer licensed to practice in the state in which the principal resides. Financial powers of attorney should be tailored to the specific assets owned by the principal.
Representative Payee
The authority of a power of attorney does not extend to Social Security, SSI, or SSDI. These arrangements must be made with the Social Security Administration. If you are helping an older person who can no longer manage his or her own financial affairs, report this to Social Security. You can request an appointment as Representative Payee. If a person needs a “Rep Payee” and there is no obvious person to take on the role, the Social Security Administration will try to find the best person to do it or will assign them to an agency that will provide a Rep Payee.
The Rep Payee handles Social Security-related finances. After investigating, Social Security will send the beneficiary’s checks to the Rep Payee. The Rep Payee must spend the funds for the personal care or benefit of the beneficiary, saving any excess funds; make periodic accounting to Social Security about how the money has been spent; and inform the agency when the beneficiary moves or dies.
Conservatorship
Tennessee law uses the term “conservatorship” for adults and “guardianship” for minors. A conservatorship is a legal mechanism by which the court declares a person unable to handle his or her own affairs and, therefore, appoints a conservator. The court can transfer to the conservator the responsibility for making decisions about any or all of the following: financial affairs, living arrangements, and medical care. For someone who needs a conservator but no appropriate person is available to serve in that capacity, the Public Guardian can be appointed.
A conservator must make regular reports to the court on the ward’s affairs. Obtaining a conservatorship can be expensive, involve more than one attorney, and, if contested, take many months. Check to be sure your attorney has experience in filing for conservatorship.
Wills
A well-prepared will is an effective tool that provides explicit instructions for the distribution of a person’s property and, if appropriate, how that property is to be used after a person dies. A will designates a person to serve as the Personal Representative (formerly executor) responsible for carrying out the instructions in the will. A will makes it easier to settle affairs quickly and with fewer legal expenses. Since a will is seldom consulted until after the funeral, instructions about funeral arrangements should be given to whoever will be responsible for making those arrangements. These instructions, and any regarding body donation, should be included in a durable power of attorney.
Advance Care Plans/Living Wills
Public attention is increasingly focused on “right-to-die” issues as medical technology makes it possible to sustain some vestige of life in dying patients. Although older laws related to living wills and powers of attorney for health care are still valid, the Health Care Decisions Act, enacted in Tennessee in 2004, was intended to make it easier for individuals to express their wishes concerning end-of-life decisions. New advance care forms have been developed by the State of Tennessee and can be downloaded from the Internet (see Advance Directive). Documents prepared under the old laws are still valid; however, the new forms may be more appealing to some people.
An advance care plan must be signed, dated, and witnessed or notarized. You should discuss your advance care plan with your family and doctors. Give each of your doctors a signed copy to be added to your medical file, and confirm with the physician that he or she will honor such a document. Give a copy to the person who will make medical decisions for you in the event that you are unable to do so. Review your advance care plan yearly to make any needed changes. You may append a letter spelling out your specific wishes. Legal Aid of East Tennessee has advance care plan forms and notaries available.
When a person is in a nursing facility and is approaching the end of life, family members might want to consider filling out one or both of the following forms: DNR (Do Not Resuscitate) and POST (Physician’s Order for Scope of Treatment). The POST form allows a patient (or legal representative) to outline a plan for end-of-life treatment that is much more specific to the situation than an advance care plan. Both forms should be available at nursing facilities.
Appointment of Health Care Agent/Durable Health Care Power of Attorney
You can also obtain an Appointment of Health Care Agent (previously called a durable health care power of attorney) in Tennessee. Under it, you can give authority to another person(s), with his or her consent, to make healthcare decisions on your behalf. This includes consent, refusal to consent, and withdrawal of consent to maintain any care, treatment, service, or procedure, and to diagnose or treat a physical or mental condition. It must be signed, dated, and witnessed or notarized. You should discuss it with your family, primary physician, and, in detail, with your chosen attorney(s)-in-fact. Copies and notarization are available as above in the section on advance care plans. Revocation or discharge of an agent may be made either orally or in writing. These documents should be tailored to the individual to incorporate particular desires and preferences regarding religious ceremonies, burial, and so forth.
Other Legal Issues
- Issues concerning property, estates, and trusts are governed by state laws and, in some cases, local ordinances. If finances do not permit hiring a private attorney, Legal Aid of East Tennessee may provide, either directly or by referral to volunteer attorneys from the Blount County Bar Association, both legal advice and legal representation in court to low-income elderly persons.
- To get advice on tenant/landlord issues regarding leases, services, rental rights, and obligations, contact your attorney or Legal Aid of East Tennessee.
- Families often have questions about their responsibility for the cost of an older person’s health care and long-term care. They may need to seek legal advice about what their financial obligations are, if any. See your attorney, make an appointment with a Legal Aid of East Tennessee representative, or contact the Long-Term-Care Ombudsman for advice about responsibility for the costs of nursing home care and, specifically, about what to sign and not sign when arranging for a relative to enter a nursing home. You do not have to sign as a responsible party in order for the elder to be admitted.
Long-Term Care Insurance
Long-term-care insurance covers some or all of the costs of nursing home care. Some policies also cover care provided at home or services provided in the community, such as adult day programs and assisted living housing. The number of years of care and the payment per day varies with the policy. Cost-of-living increases on the daily benefit should be included if available and affordable. Some offer a care-management benefit—a trained professional who works with an individual or family to find the services needed.
Long-term-care insurance is not right for everyone. Some people have sufficient funds to cover the cost of nursing home care or in-home services; for others, the cost of the premium outweighs the potential benefit of the insurance. Discuss with a financial counselor whether long-term-care insurance is prudent for you. Under some conditions, long-term-care insurance premiums can be tax-deductible as a medical expense.
Long-Term-Care Partnership Program
The Tennessee Long Term Care Partnership (LTCP) Program, went into effect on October 1, 2008. The purpose of the program is to encourage individuals to buy long-term-care insurance, which will reduce the government's financial burden in paying for nursing home care. The incentive for the policy holders is that for every dollar that their long-term-care policies pay for their care, they are allowed to keep a dollar of countable assets and still qualify for Medicaid. The exempted assets will never be used when the person's Medicaid eligibility is determined, nor during estate recovery when the person dies. For more information, go to the Tennessee Department of Commerce and Insurance website.
Other Publicly Supported Programs
Other sources of public support that may supplement income for eligible older adults include SNAP (food stamps), housing assistance, property tax rebates, low-income home energy assistance programs and discounted or free telephone service. Older persons must apply in order to participate in any of the programs named above. Application information is included in the directory listing for each program.
Veterans, their widows or widowers, or their parents with limited income, may be eligible for benefits through the Veteran’s Administration. Contact VA office for details.
Long-term-care insurance is not right for everyone. Some people have sufficient funds to cover the cost of nursing home care or in-home services; for others, the cost of the premium outweighs the potential benefit of the insurance. Discuss with a financial counselor whether long-term-care insurance is prudent for you. Under some conditions, long-term-care insurance premiums can be tax-deductible as a medical expense.
Long-Term-Care Partnership Program
The Tennessee Long Term Care Partnership (LTCP) Program, went into effect on October 1, 2008. The purpose of the program is to encourage individuals to buy long-term-care insurance, which will reduce the government's financial burden in paying for nursing home care. The incentive for the policy holders is that for every dollar that their long-term-care policies pay for their care, they are allowed to keep a dollar of countable assets and still qualify for Medicaid. The exempted assets will never be used when the person's Medicaid eligibility is determined, nor during estate recovery when the person dies. For more information, go to the Tennessee Department of Commerce and Insurance website.
Other Publicly Supported Programs
Other sources of public support that may supplement income for eligible older adults include SNAP (food stamps), housing assistance, property tax rebates, low-income home energy assistance programs and discounted or free telephone service. Older persons must apply in order to participate in any of the programs named above. Application information is included in the directory listing for each program.
Veterans, their widows or widowers, or their parents with limited income, may be eligible for benefits through the Veteran’s Administration. Contact VA office for details.
Reverse Mortgages
A reverse mortgage, sometimes called “home equity conversion mortgage” (HECM), enables homeowners to use the equity in their home as security for a loan. They either receive monthly payments or a line of credit to be used as needed, up to the approved limit. The funds may be used for anything. The homeowner must occupy the property and is responsible for property taxes and insurance.
To be eligible, at least one of the homeowners must be 62 or older and must reside in their single-family home. A HUD-approved condominium is also eligible for the program. The person who applies for the reverse mortgage must own the property.
The reverse mortgage applicant must attend consumer education and counseling by an approved HECM counselor. The reverse mortgage has to be the only mortgage on the property, but if there is already one mortgage on the home, it can often be paid off with the reverse mortgage. The reverse mortgage can also be used to pay for some of the repairs that might be needed to make the home qualify for the reverse mortgage.
A reverse mortgage isn’t appropriate for everyone, but it can be a good decision for some. The application process for a reverse mortgage may take a few months and the closing costs are more than on a traditional loan.Reverse mortgages are quite different from any other loans, and the risks to borrowers are unique. Before considering one, you need to do your homework carefully and thoroughly. If you are considering a reverse mortgage, consult with a trusted legal or financial expert.
To be eligible, at least one of the homeowners must be 62 or older and must reside in their single-family home. A HUD-approved condominium is also eligible for the program. The person who applies for the reverse mortgage must own the property.
The reverse mortgage applicant must attend consumer education and counseling by an approved HECM counselor. The reverse mortgage has to be the only mortgage on the property, but if there is already one mortgage on the home, it can often be paid off with the reverse mortgage. The reverse mortgage can also be used to pay for some of the repairs that might be needed to make the home qualify for the reverse mortgage.
A reverse mortgage isn’t appropriate for everyone, but it can be a good decision for some. The application process for a reverse mortgage may take a few months and the closing costs are more than on a traditional loan.Reverse mortgages are quite different from any other loans, and the risks to borrowers are unique. Before considering one, you need to do your homework carefully and thoroughly. If you are considering a reverse mortgage, consult with a trusted legal or financial expert.
Funeral Planning
Planning ahead and comparison-shopping can help families avoid hasty and often expensive decisions when a loved one passes. Informed choices about funeral arrangements can be made ahead of time when no one is sick and when everyone who wants to participate in the planning is available. Think and talk about what arrangements you would like. Collect information on the cost of what you want. Prices differ greatly. Put the plans in writing. Keep them where they can be easily found. Tell someone you trust where they are kept. Do not put funeral plans in a will, which will not be read until after the funeral. Organ and body donation can also be preplanned.
The cost of a funeral depends on many factors. Funeral homes must provide current prices of all goods and services in writing. Funerals can be prepaid in a lump sum, in payments, through purchase of a special-purpose insurance policy, or through a burial trust fund, which can be purchased through the funeral home. Some funeral homes will “guarantee” your funeral; it will not cost more than you paid, even if prices have risen.
Money that is paid in advance, including the interest that has accumulated, can be transferred to another funeral home after your death and sometimes before. The new funeral home may charge you more.
Neither the irrevocable burial trust fund nor the irrevocable prepaid policy counts as an asset when determining eligibility for TennCare (Medicaid).
Social Security, the Veterans’ Administration, and life and casualty insurance pay death benefits, depending upon the circumstances at the time of death.
The cost of a funeral depends on many factors. Funeral homes must provide current prices of all goods and services in writing. Funerals can be prepaid in a lump sum, in payments, through purchase of a special-purpose insurance policy, or through a burial trust fund, which can be purchased through the funeral home. Some funeral homes will “guarantee” your funeral; it will not cost more than you paid, even if prices have risen.
Money that is paid in advance, including the interest that has accumulated, can be transferred to another funeral home after your death and sometimes before. The new funeral home may charge you more.
Neither the irrevocable burial trust fund nor the irrevocable prepaid policy counts as an asset when determining eligibility for TennCare (Medicaid).
Social Security, the Veterans’ Administration, and life and casualty insurance pay death benefits, depending upon the circumstances at the time of death.
Housing, Long-term Care & Healthcare Facilities
Changing living arrangements—whether short-term or long-term—is a major event in the life of an older person. Many times this change must be made on short notice in the midst of other difficult changes: decline in health, loss of a loved one, less energy, less money. There are a variety of housing and in-home care options. This makes it more likely that older consumers can find housing and/or services that fit their particular needs. Sometimes a move is necessary; other times, the senior’s current home can be modified and/ or in-home services can be provided that allow the senior to stay in place.
If a move to new housing is necessary, the first concerns are often cost and what an individual can afford. The other important questions are the kind and amount of services that are needed. When possible, it’s best to take enough time to think carefully and determine what services and issues are most important, balanced with the cost of each and the available funds. Sometimes a package of in-home services can be put together that allows an individual to stay at home, especially when combined with assistance from family and friends. Depending on the kinds of services needed, this can be less expensive than an assisted living facility or a nursing home. The Office on Aging or a private home care company can help an individual or caregiver consider available options.
LONG-TERM CARE & HEALTHCARE FACILITIES
Older people generally continue to live independently throughout all or most of their lives and are able to remain in their own homes. Families can often supply the practical and emotional support required most of the time. In some cases, when an older person has no family help available, requires more assistance than his or her family can provide, or wishes to downsize or wants the social environment and activities of a communal setting, s/he can move into a long-term-care facility such as an assisted living facility or a nursing home.
A healthcare facility is any place where healthcare professionals are involved in administering treatment or care to people with chronic or acute illnesses or injuries. This includes hospitals, nursing homes, assisted living facilities, residential homes for the aged, walk-in clinics, dialysis clinics, rehabilitation units and more.All healthcare facilities in Tennessee are licensed and regulated by the TN Department of Health, Division of Health Care Facilities, or sometimes by the Centers for Medicare and Medicaid Services, to make sure that the facilities comply with state and federal guidelines.
To find out whether a specific facility is licensed contact the facility itself or call the TN Department of Health. Information about all of the licensed facilities in the state, as well as useful information about all such facilities, is on the agency’s website, http://health.state.tn.us.
The Department of Health also has a hotline for reporting any complaint about how one of these licensed facilities is operating or to ask questions about a facility’s licensure status. The Complaint Hotline number is 877-287-0010. The Long Term Care Ombudsman. may be of assistance.
Choosing a Facility in Advance
Having some sense of control and choice can help the adjustment to a new place. Early planning allows time to look at many or all of the senior housing facilities in the area and improves the chances of making an appropriate decision. Whenever possible, an older person should participate in making the decision to move into a long-term-care facility.You can get information about how to choose a nursing home from Blount County Office on Aging, Long Term Care Ombudsman, medical and social work professionals, clergy, and friends who have relatives in long-term-care facilities. In addition, many publications and websites offer advice.
Six important factors influence the choice of a facility:
Type of care needed. The state licenses three levels of long-term care: Residential Homes for the Aged (RHAs), Assisted Care Living Facilities (ACLFs), and nursing homes. ACLFs and RHAs can offer services such as meals, laundry, and housekeeping, and some help with personal care, but usually cannot provide medical care unless they have 24-hour licensed nursing staff. If your loved one has dementia, you may need to consider only facilities that have secure units. Typically, no public dollars pay for staying in an ACLF or an RHA, and residents of these types of facilities pay the entire cost. However, some long-term-care insurance policies will pay for housing with assistance and in some cases, the Medicaid Waiver or Veteran’s Affairs Aid & Attendance might cover some of the cost.
Nursing homes offer medical care, often with more than one level of care. A physician will do an evaluation that determines whether skilled or intermediate care is needed before a person can be admitted to a nursing home. Some nursing homes also have secured units for the safe care of people with dementia. Note: In the following descriptions, “skilled” is a term for a particular type of care and does not refer to the expertise or ability of the person giving the care.
Skilled Care provides 24-hour-a-day nursing services for a person who has serious healthcare needs, up to and including high-level wound care, a respirator, tube feeding, intravenous therapy, and more. Rehabilitation services are also provided as needed. The specific services offered in each skilled-care facility may vary; ask about services when you are evaluating facilities. Skilled care is sometimes offered in transitional care units in hospitals.
Intermediate Care provides less extensive health care than skilled care. Nursing and rehabilitation services are provided for patients in intermediate care, but not around the clock. Intermediate care is for persons who need medical supervision and help with personal care, but not skilled nursing.
Certification. If ongoing long-term care will probably be necessary, choose a facility that is both Medicare- and Medicaid-certified. Some facilities do not accept Medicaid patients. In a dually-certified nursing home, a move would not be necessary if the resident’s funds run out.
Financial status. Make a complete inventory of available resources, including source and level of income, property owned, savings accounts, stocks and bonds, veteran’s benefits, pensions, insurance benefits, and any family assistance available. If there is not enough money to pay for nursing home care or it is probable that funds will quickly be expended, contact the East TN Area Agency on Aging & Disability and ask for CHOICES (page 132).
Medicare offers limited coverage for nursing home care. Visit www.medicare.gov or review the current Medicare & You handbook for details. If paying for nursing home care has used up your money and you need to apply for CHOICES, ask the nursing home staff for assistance. Apply before Medicare coverage or personal financial resources runs out. A Pre-Admission Evaluation (PAE) must be submitted for approval to the TennCare Bureau, even though you are already in the nursing home. Approval can be denied. Be prepared to appeal if you are turned down. Directions for doing so are included with the denial letter. If you are denied on medical grounds, you can request an onsite visit from the TennCare Bureau.
Location. Choosing a facility that is convenient to family and friends makes visiting and monitoring easier.
Availability of a bed. Nursing homes sometimes have long waiting lists. Finding a bed in a facility that accepts Medicaid patients can be difficult because some facilities have opted out of the Medicaid system.
Atmosphere. Nursing homes with a more homelike, less institutional setting can make a difference in quality of life.
Choosing a Facility in an Emergency
Many older persons and their families avoid discussions and decisions about nursing home placement until a medical crisis forces an immediate decision. If immediate help is needed in locating a nursing home refer to our Living Assistance, Professional and/or Medical sections of this website or contact us at Blount Seniors.
If an older person is required to transfer from the hospital to a nursing home on short notice because the doctor is ready to discharge him or her, emergency placement in a nursing home may be unavoidable. Even then, timing and arrangements for the transfer should be discussed with the physician and hospital personnel. You must still know what level of care is needed, whether the certification is by both Medicare and Medicaid, what funds are available to pay for care, consider the convenience of a facility’s location to family and friends of the patient, and find an available bed.
Long-Term-Care Ombudsman
The best way to ensure quality care for an elderly relative in a nursing home is for family members and friends to visit frequently and to establish and maintain good communication with the nursing home staff. To ask a question or resolve a problem regarding care of the nursing home resident, first talk to the nursing staff or the social worker. If the problem continues, talk to the nursing home administrator. If these steps do not resolve the issue, contact the district Long Term Care Ombudsman.
All states have an ombudsman program that is responsible for investigating, mediating, and trying to resolve complaints made by or on behalf of residents in long-term-care facilities (nursing homes, ACLFs, and RHAs). In Tennessee, the state, regional, or volunteer ombudsmen monitor and ensure the implementation of federal, state, and local laws governing resident rights and quality of care in long-term-care facilities. There is no charge for ombudsman services. You can find out about the ombudsman in another state by calling the Eldercare Locator (800-677-1116) or visiting www.eldercare.gov
In East Tennessee, the names and contact information of a facility’s ombudsmen are posted in a prominent place at each facility. When a loved one enters a nursing home, arrange to meet the ombudsman and acquaint him or her with your relative. The ombudsman can help resolve problems that may arise.
The Centers for Medicare and Medicaid Services (CMS) report information on the quality of care in nursing homes to help you choose high-quality health care. Visit www.medicare.gov or call 800-633-4227. Anonymous complaints about nursing homes can also be filed by calling the Complaint Hotline at 877-287-0010.
Patients’ Rights
Nursing homes that participate in the Medicaid and Medicare programs must have established patients’ rights policies. Ask the nursing home for a copy of its patients’ rights policy. Contact the district Long Term Care Ombudsman for more information.
Families’ Rights
Questions about family responsibility for the cost of an older person’s health care and long-term care frequently arise. Families may need to seek legal advice about their financial obligations, if any. Speak to your attorney or a Legal Aid of East Tennessee representative for advice about the responsibility for the costs of nursing home care and, specifically, about what to sign and not sign when arranging for a relative to enter a nursing home. You do not have to sign as a responsible party in order for the elder to be admitted. The spouse of a nursing home resident who is on Medicaid has the right to a certain minimum income and a maximum amount of assets.
If a move to new housing is necessary, the first concerns are often cost and what an individual can afford. The other important questions are the kind and amount of services that are needed. When possible, it’s best to take enough time to think carefully and determine what services and issues are most important, balanced with the cost of each and the available funds. Sometimes a package of in-home services can be put together that allows an individual to stay at home, especially when combined with assistance from family and friends. Depending on the kinds of services needed, this can be less expensive than an assisted living facility or a nursing home. The Office on Aging or a private home care company can help an individual or caregiver consider available options.
LONG-TERM CARE & HEALTHCARE FACILITIES
Older people generally continue to live independently throughout all or most of their lives and are able to remain in their own homes. Families can often supply the practical and emotional support required most of the time. In some cases, when an older person has no family help available, requires more assistance than his or her family can provide, or wishes to downsize or wants the social environment and activities of a communal setting, s/he can move into a long-term-care facility such as an assisted living facility or a nursing home.
A healthcare facility is any place where healthcare professionals are involved in administering treatment or care to people with chronic or acute illnesses or injuries. This includes hospitals, nursing homes, assisted living facilities, residential homes for the aged, walk-in clinics, dialysis clinics, rehabilitation units and more.All healthcare facilities in Tennessee are licensed and regulated by the TN Department of Health, Division of Health Care Facilities, or sometimes by the Centers for Medicare and Medicaid Services, to make sure that the facilities comply with state and federal guidelines.
To find out whether a specific facility is licensed contact the facility itself or call the TN Department of Health. Information about all of the licensed facilities in the state, as well as useful information about all such facilities, is on the agency’s website, http://health.state.tn.us.
The Department of Health also has a hotline for reporting any complaint about how one of these licensed facilities is operating or to ask questions about a facility’s licensure status. The Complaint Hotline number is 877-287-0010. The Long Term Care Ombudsman. may be of assistance.
Choosing a Facility in Advance
Having some sense of control and choice can help the adjustment to a new place. Early planning allows time to look at many or all of the senior housing facilities in the area and improves the chances of making an appropriate decision. Whenever possible, an older person should participate in making the decision to move into a long-term-care facility.You can get information about how to choose a nursing home from Blount County Office on Aging, Long Term Care Ombudsman, medical and social work professionals, clergy, and friends who have relatives in long-term-care facilities. In addition, many publications and websites offer advice.
Six important factors influence the choice of a facility:
Type of care needed. The state licenses three levels of long-term care: Residential Homes for the Aged (RHAs), Assisted Care Living Facilities (ACLFs), and nursing homes. ACLFs and RHAs can offer services such as meals, laundry, and housekeeping, and some help with personal care, but usually cannot provide medical care unless they have 24-hour licensed nursing staff. If your loved one has dementia, you may need to consider only facilities that have secure units. Typically, no public dollars pay for staying in an ACLF or an RHA, and residents of these types of facilities pay the entire cost. However, some long-term-care insurance policies will pay for housing with assistance and in some cases, the Medicaid Waiver or Veteran’s Affairs Aid & Attendance might cover some of the cost.
Nursing homes offer medical care, often with more than one level of care. A physician will do an evaluation that determines whether skilled or intermediate care is needed before a person can be admitted to a nursing home. Some nursing homes also have secured units for the safe care of people with dementia. Note: In the following descriptions, “skilled” is a term for a particular type of care and does not refer to the expertise or ability of the person giving the care.
Skilled Care provides 24-hour-a-day nursing services for a person who has serious healthcare needs, up to and including high-level wound care, a respirator, tube feeding, intravenous therapy, and more. Rehabilitation services are also provided as needed. The specific services offered in each skilled-care facility may vary; ask about services when you are evaluating facilities. Skilled care is sometimes offered in transitional care units in hospitals.
Intermediate Care provides less extensive health care than skilled care. Nursing and rehabilitation services are provided for patients in intermediate care, but not around the clock. Intermediate care is for persons who need medical supervision and help with personal care, but not skilled nursing.
Certification. If ongoing long-term care will probably be necessary, choose a facility that is both Medicare- and Medicaid-certified. Some facilities do not accept Medicaid patients. In a dually-certified nursing home, a move would not be necessary if the resident’s funds run out.
Financial status. Make a complete inventory of available resources, including source and level of income, property owned, savings accounts, stocks and bonds, veteran’s benefits, pensions, insurance benefits, and any family assistance available. If there is not enough money to pay for nursing home care or it is probable that funds will quickly be expended, contact the East TN Area Agency on Aging & Disability and ask for CHOICES (page 132).
Medicare offers limited coverage for nursing home care. Visit www.medicare.gov or review the current Medicare & You handbook for details. If paying for nursing home care has used up your money and you need to apply for CHOICES, ask the nursing home staff for assistance. Apply before Medicare coverage or personal financial resources runs out. A Pre-Admission Evaluation (PAE) must be submitted for approval to the TennCare Bureau, even though you are already in the nursing home. Approval can be denied. Be prepared to appeal if you are turned down. Directions for doing so are included with the denial letter. If you are denied on medical grounds, you can request an onsite visit from the TennCare Bureau.
Location. Choosing a facility that is convenient to family and friends makes visiting and monitoring easier.
Availability of a bed. Nursing homes sometimes have long waiting lists. Finding a bed in a facility that accepts Medicaid patients can be difficult because some facilities have opted out of the Medicaid system.
Atmosphere. Nursing homes with a more homelike, less institutional setting can make a difference in quality of life.
Choosing a Facility in an Emergency
Many older persons and their families avoid discussions and decisions about nursing home placement until a medical crisis forces an immediate decision. If immediate help is needed in locating a nursing home refer to our Living Assistance, Professional and/or Medical sections of this website or contact us at Blount Seniors.
If an older person is required to transfer from the hospital to a nursing home on short notice because the doctor is ready to discharge him or her, emergency placement in a nursing home may be unavoidable. Even then, timing and arrangements for the transfer should be discussed with the physician and hospital personnel. You must still know what level of care is needed, whether the certification is by both Medicare and Medicaid, what funds are available to pay for care, consider the convenience of a facility’s location to family and friends of the patient, and find an available bed.
Long-Term-Care Ombudsman
The best way to ensure quality care for an elderly relative in a nursing home is for family members and friends to visit frequently and to establish and maintain good communication with the nursing home staff. To ask a question or resolve a problem regarding care of the nursing home resident, first talk to the nursing staff or the social worker. If the problem continues, talk to the nursing home administrator. If these steps do not resolve the issue, contact the district Long Term Care Ombudsman.
All states have an ombudsman program that is responsible for investigating, mediating, and trying to resolve complaints made by or on behalf of residents in long-term-care facilities (nursing homes, ACLFs, and RHAs). In Tennessee, the state, regional, or volunteer ombudsmen monitor and ensure the implementation of federal, state, and local laws governing resident rights and quality of care in long-term-care facilities. There is no charge for ombudsman services. You can find out about the ombudsman in another state by calling the Eldercare Locator (800-677-1116) or visiting www.eldercare.gov
In East Tennessee, the names and contact information of a facility’s ombudsmen are posted in a prominent place at each facility. When a loved one enters a nursing home, arrange to meet the ombudsman and acquaint him or her with your relative. The ombudsman can help resolve problems that may arise.
The Centers for Medicare and Medicaid Services (CMS) report information on the quality of care in nursing homes to help you choose high-quality health care. Visit www.medicare.gov or call 800-633-4227. Anonymous complaints about nursing homes can also be filed by calling the Complaint Hotline at 877-287-0010.
Patients’ Rights
Nursing homes that participate in the Medicaid and Medicare programs must have established patients’ rights policies. Ask the nursing home for a copy of its patients’ rights policy. Contact the district Long Term Care Ombudsman for more information.
Families’ Rights
Questions about family responsibility for the cost of an older person’s health care and long-term care frequently arise. Families may need to seek legal advice about their financial obligations, if any. Speak to your attorney or a Legal Aid of East Tennessee representative for advice about the responsibility for the costs of nursing home care and, specifically, about what to sign and not sign when arranging for a relative to enter a nursing home. You do not have to sign as a responsible party in order for the elder to be admitted. The spouse of a nursing home resident who is on Medicaid has the right to a certain minimum income and a maximum amount of assets.