What Do We Know about Early-Onset Dementia?

Rita Benezra Obeiter, 59, is a former pediatrician who was diagnosed several years ago with early-onset dementia, a rare form of the disease. When this occurs in people under age 65, the conditions cause additional and unique issues because they are so unexpected and because most of the potentially helpful programs and services are designed for and targeted to older people.

One issue is that doctors typically don’t look for the disease in younger patients. As a result, it can be months or even years before the right diagnosis is made and proper treatment can start.

WLNY’s recent article entitled “Some Health Care Facilities Say They’re Seeing More Cases Of Early-Onset Dementia Than Ever Before” reports that her husband Robert Obeiter left his job two years ago to care for her. She attends an adult day care, and aides help at home at night.

If Dementia is a generic term for diseases characterized by a decline in memory, language, and other thinking skills required to perform everyday activities, Alzheimer’s is the most common. The National Institute of Health reports that there’s approximately 200,000 Americans in their 40s, 50s, and early 60s with early onset Alzheimer’s.

One conference discussed a rise in early dementia because of the processed foods and fertilizers or the other environmental hazards, and there are definitely some genes more associated with Alzheimer’s—more so with early onset.”

There is no clear answer, and most of the treatments help to slow down the progression.

There is some research showing the Mediterranean diet can be protective, as well as doing cognitive exercises like crossword puzzles and Sudoku.

It’s true that no one can predict the future of their health, but there are ways financially that families can prepare. It can cost $150,000 a year or more. That’s why you should think about purchasing long term care insurance starting at the age of 40.

Long-term health insurance can pay for an aide to come into your home, and it can pay for the cost of assisted living, as well as off-set the cost of skilled care at a nursing home.  In Massachusetts, the average cost of memory care at an assisted living is $8,000 per month and $15,000 per month at a nursing home. Health insurance does not cover long-term care, nor does Medicare.     While everyone over the age of 18 needs a healthcare power of attorney and a financial POA, as we approach our 50s and 60s, considertion should be given to long term care planning.  An elder law attorney can assist you in outlining options and establishing a long term care plan that protects your assets from the devasting financial effects of long term care that enables you to create a legacy for your family and loved ones.

Reference: WLNY (Feb. 12, 2020) “Some Health Care Facilities Say They’re Seeing More Cases Of Early-Onset Dementia Than Ever Before”


What Do I Need to Know about Medicare in 2020?

CNBC’s recent article entitled “Here’s what you need to know about your 2020 Medicare costs” reports that Medicare will have some higher costs this year that you may want to factor into your health-care budget.

The Medicare program has about 61 million beneficiaries, most of whom are 65 or older. These people will see certain costs are adjusted by the federal government each year that can impact their premiums, deductibles and other cost-sharing aspects of the program. These changes don’t really involve big dollars. However, those affected should plan for how any increases will make a difference in their household spending.

For a person on a fixed income, all of the small changes can add up. Basic Medicare consists of Part A (hospital coverage) and Part B (outpatient care). Roughly a third of beneficiaries opt to get those benefits delivered through an Advantage Plan that’s offered by private insurers. These types of plans generally also include Part D (prescription drug coverage), and other extras like dental or vision. They also limit what you pay out of pocket for Parts A and B services.

Other beneficiaries go with the basic Medicare and buy a standalone Part D prescription drug plan. About a third purchase a supplement plan (“Medigap”) that covers some of the costs that come with basic Medicare, like coinsurance or copays.

Your coverage choices can play a part in the amount you pay in premiums, deductibles and copays or co-insurance. The frequency with which you use the health-care system can also add to your costs. Your income is another factor. Beneficiaries with limited income could be eligible for Medicaid or other programs that cover Medicare expenses. However, higher-income beneficiaries pay more for certain parts of coverage.

For those that fall in-between—a group who aren’t eligible for Medicaid or other types of assistance—every dollar is important.

Most Medicare beneficiaries pay no premium for Part A because they (or their spouse) have enough of a work history (10 years or more) of paying into the system through payroll taxes to qualify premium-free. If you don’t satisfy the minimum requirement, monthly premiums could be as high as $458 a month, based on whether you’ve paid any taxes into the Medicare system at all. That’s an increase from $437 in 2019. There are also cost-sharing aspects that go with Part A, despite whether you pay a premium.

As far as Part B, the standard premium in 2020 will be $144.60 monthly, an increase of $9.10 from $135.50 in 2019. Some recipients won’t pay the full standard premium due to a “hold harmless” clause that prevents their Part B premiums from increasing more than their Social Security cost-of-living adjustment (COLA). However, some people will pay more than the standard, due to income-adjusted surcharges.

The annual deductible for Part B will go up to $198 from $185 in 2019. Once you hit that deductible, you typically pay 20% of covered services. Note that beneficiaries in Advantage Plans may pay a different amount through copays, and Medigap policies either fully or partially cover that coinsurance. Even though Advantage Plan premiums differ among plans, the average for 2020 is $23. That’s a decrease of $27 from last year.

For Part D, the amount you pay for drug coverage depends partly on the plan you choose and your income. The average monthly premium for a standalone drug plan in 2020 will be $30— a few dollars less than the $32.50 in 2019. Higher earners will pay extra.

Those surcharges were set slightly downward.

Those charges are not included in your plan premium but instead come out of your Social Security check or through a bill. Although not everyone pays a deductible for Part D coverage (some plans don’t have one), the maximum it can be is $435 in 2020, up from $415 in 2019.

For those with high prescription costs, the amount that Part D enrollees pay out of pocket before qualifying for “catastrophic coverage” will go up to $6,350 in 2020 from $5,100 in 2019. In that phase of coverage, your share of prescription costs goes down.

Reference: CNBC (Dec. 30, 2019) “Here’s what you need to know about your 2020 Medicare costs”


Medicare Coverage for Long Term Care

Most people understand that by paying into Social Security throughout their careers, they can receive health care benefits through Medicare starting at age 65.  Individuals under age 65 who qualify to receive Social Security Disability benefits are also covered under Medicare, as well as anyone of any age who has Lou Gehrigs disease, known as Amyotrophic Lateral Sclerosis (ALS), or has been diagnosed with permanent kidney disease (end-stage renal disease) that requires dialysis or a kidney transplant.  But many people may not understand what is covered when long term care is needed.

In general, long term care is medical and non-medical care provided to a person who is unable to perform the basic actions needed on a daily basis to function independently.These basic actions are called activities of daily living and include bathing, dressing, eating, toileting, managing bowel and bladder function, and having enough physical mobility to be able to move safely to and from a bed or a chair, called transferring.  For people with chronic diseases, permanent injury such as from a stroke, or are suffering from the effects of aging, long term care is provided indefinitely without the expectation that the patient will recover.

Often patients receiving long term care services reside in a nursing home to be able to have their basic needs met.  For others who have become incapacitated due to an illness or injury, skilled nursing care may be needed with the goal of recovering to independent functional status.Medicare will pay for medically necessary acute care services and some long term care services that meet specific criteria.  Most long term care non-medical services are not covered by Medicare, such as nursing home expense or the services provided in the home for custodial-type care.

There are four specific types of long term care services, listed below, that Medicare will pay for, though certain conditions apply for most services to be covered:

  • Care in a skilled nursing facility for up to 100 days per benefit period
  • Services to treat medical conditions
  • Services to prevent further decline due to medical conditions
  • Hospice care

For a Medicare recipient to qualify for a skilled nursing home stay, the patient must have been provided acute care in a hospital for three consecutive days (often referred to as three midnights) prior to transferring to a skilled nursing facility or must be placed in a skilled nursing facility within 30 days of that qualifying acute care stay.  Being held on observation status for three consecutive days is not enough for Medicare to pay for additional care.

Once in a skilled nursing home, payment for services is based on length of stay with only a portion of the cost is covered after the first 20 days, and Medicare will not pay for the cost of the skilled nursing facility after the 100th day.These days of stay do not need to be consecutive.

When services to treat medical conditions are deemed medically necessary by a physician, Medicare will pay indefinitely on certain services as long as the physician writes an order for continued services every 60 days and these services remain medically necessary.   Services covered include intermittent or part-time skilled nursing care, therapy services provided by a Medicare-certified home health agency, medical social services, and medical supplies and durable medical equipment (of which 80% of the approved amount is covered).  For patients with conditions that may not improve, such as debility from a stroke, Parkinson’s disease, Alzheimer’s disease, Multiple sclerosis or ALS, Medicare will pay for services that could prevent further decline in their health status.   Hospice care for those with a terminal illness who have chosen to stop all active treatment and are not expected to survive longer than six months is also covered with Medicare.   This care includes medications for pain control or relief from the symptoms of the illness, as well as hospice care by a Medicare-approved hospice provider not only in the home but in a nursing home or a hospice care facility.  Lastly, some short-term hospital visits may be covered.

Understanding how to pay for long term care can be overwhelming. We help seniors and their loved ones plan for the possibility of needing long term care, including how to access and pay for it. If we can be of assistance, please don’t hesitate to reach out.