How to Choose a Medicare Plan

Privately-run Medicare plans have become more popular in recent years. More than 10 million seniors have enrolled in the so-called Medicare Advantage plans, which are offered by insurers, up from 5.4 million in 2005. But they aren’t the right choice for everyone.

These plans wrap physician and hospital services into one, often with extra benefits, such as vision and dental coverage. Instead of paying doctors and hospitals directly, as it does under traditional Medicare, the federal government pays plans to manage care under the Advantage program. They can have some downsides, so you need to do careful research before you make a choice.

If you’re shopping for a Medicare plan, here are some tips to consider.

Start by figuring out your options. The federal government’s comparison site helps you find plans offered in your area. The Medicare Rights Center also has extensive background and resources available.

If there are no Medicare Advantage plans available in your region, you’ll be in traditional Medicare, the program administered by the federal government. With traditional Medicare, you can use any doctor who accepts Medicare. You’ll pay a set deductible, then a share of the cost of care after that. You may want to consider a Medigap policy to help with those expenses. Such policies can also help with things traditional Medicare doesn’t cover, like emergency care overseas.

If you are considering a Medicare Advantage plan, learn what the plan offers. The Medicare site offers quality ratings as well as general information, but you may also want to get advice from expert sources in your area. One option is your state’s health insurance assistance program, or SHIP. You can find a directory of these here. You can also go to a local agency on aging, which you can find through the government’s eldercare.gov site.

There are several types of Advantage plans. Most plans, such as health maintenance organizations and preferred provider organizations, manage care to control costs. Like other HMOs and PPOs, they rely on networks of doctors, so you want to make sure that your physicians and the hospital you prefer participate in that network. You may also want to ask about policies on referrals – can you see specialists without a referral from a primary-care doctor? In the case of a PPO, you might want to learn how much you will pay to see doctors who aren’t in the network. The private fee-for-service plans give you more choice because they aren’t required to have a network of doctors and hospitals. But that network exception will end starting in 2011.

Medicare Advantage plans sometimes have extra benefits, like eye exams, dental care and hearing aids. But you should make sure you understand the full coverage package, including whether it includes all Medicare benefits.

Know what the plan will cost. Advantage plans often offer lower premiums than traditional Medicare and supplemental insurance, and they can be good choices if a beneficiary is healthy. But you should weigh your decision carefully, because a private plan may be a worse deal than traditional Medicare if you need hospitalizations and other care for chronic illnesses. Besides the premium charges, you should understand the deductible, or the amount you will have to spend before the plan starts paying, and what you will owe for doctor visits, hospital stays and other care. Another thing to check is the out-of-pocket maximum, or the most you will pay for care in a year.

Check how the plan will work with your current benefits. If you have retiree benefits, you should ask your former employer if you would have to give them up if you leave traditional Medicare.

How to Keep Your Brain Fit

People generate new brain cells, and new connections between them, throughout life. And the more mental reserves people build up, experts believe, the better they can stave off age-related cognitive decline.

The more you challenge your brain, the more new nerve pathways you form. A mini-industry of brain teasers, puzzles and computer games has sprung up to help worried baby boomers do just that. But you can give your brain a good workout with just a few modifications in your daily life.

Some of the niftiest are “neurobics” — a term popularized by the late neurobiologist Lawrence Katz for engaging different parts of the brain to do familiar tasks. Try brushing your teeth or dialing the phone with your non-dominant hand. Theoretically, that can strengthen the pathways in the opposite side of your brain.

Since much of the brain is devoted to processing sensory input, Dr. Katz also suggested involving more of your senses in everyday activities — such as showering or eating dinner with your eyes closed.

Activities that challenge your brain on many levels, such as learning how to play a musical instrument or speak a new language, provide great stimulation. So do games like chess, bridge and Stratego that require you to strategize and interact socially at the same time.

Stress has the opposite effect. The stress hormone cortisol depresses the growth of nerve cells and the connections between them. Yoga, meditation, exercise and social interaction can all help alleviate it.

Getting sufficient sleep is also crucial. Untreated sleep apnea can be very detrimental to memory; age-related declines in testosterone and estrogen also interfere with sleep.

It is almost a given that what is good for your heart is good for your head, and vice versa. Heart disease, high blood pressure, diabetes, obesity — particularly abdominal fat — all raise the risk for age-related cognitive decline, as does smoking and heavy drinking. A heart-healthy diet with lots of vegetables, fruit, fish, whole grains and olive oil, and a minimum of saturated fat, is brain-healthy as well.

Exercise is emerging as an extremely valuable way to enhance brain health. Studies show that even 30 minutes of brisk walking daily can improve blood flow to the brain, boosting neural growth factors and brain connectivity, perhaps as much as mental cross-training does.

Keep in mind that some widely used medications may block the action of acetylcholine, a brain chemical that is crucial to memory circuits. These “anticholinergic” medications include some older antidepressants like Elavil, as well as some antihistamines, painkillers, muscle relaxants, antispasmotics and incontinence drugs. Your doctor may be able to prescribe a substitute medication that has less harmful memory effects.

The sad truth is, you can do everything right and still get Alzheimer’s. Like many diseases, brain aging appears to be a complex mix of genetic and environmental factors. Still, the strategies outlined above are good for your overall health, and they may shore up your defenses against all kinds of cognitive decline.

How to Choose a Nursing Home

As the U.S. population ages, more Americans are expected to need the services of nursing homes – around 2.7 million people by 2040, according to one projection. If you or a loved one are among them, there are some steps you can take to locate places that might work among the approximately 16,000 facilities located around the United States.

One good way to start your research is to check the growing number of resources available online. The Centers for Medicare and Medicaid Services, the federal agency that oversees Medicare, offers a helpful database that you can find on the Medicare Web site. Click on “Compare Nursing Homes in Your Area,” at the bottom of the page.

The database will let you search for homes by location, by name or according to other characteristics that matter to you. It offers a rating of the nursing home’s quality, ranging from one to five stars, with five being the best. The Medicare database includes a lot of other information that will matter to you: health inspection results, nursing home staffing numbers and fire safety findings, among other things. The database also highlights the nursing homes that are considered the most troubled, known as “special focus facilities.”

Among the key measures to look at in the federal site are information on pain management, pressure sores and the use of physical restraints. Other variables may simply reflect the population of a nursing home, as much as the quality of its care. An example is the percentage of residents whose need for help with daily activities has increased. Also, keep in mind that several of the measures in the Medicare site are self-reported by nursing homes, and the inspections, typically performed by state regulators, may vary in thoroughness and in how recent they are.

A number of other Web sites crunch the same data as the federal database, but boil down the information differently. One is MemberoftheFamily.net, maintained by a small company based in Severna Park, Md. The site, which is free, offers color-coded ratings based on the federal nursing-home data. HealthGrades.com, offered by Health Grades Inc., charges for its reports, though their quality findings too are based on the inspection data used in the federal site. Consumerreports.org has some nursing-home and assisted living information, but it may not be recent.

Internet research on nationally-focused sites is only a starting point. Many states have their own nursing-home information sites, which are often more in-depth than the broader Web tools. There are also a number of state and local resources you can tap in your research. You should ask for advice on what to look for, and information on good locations, as well as for help interpreting the data you’ve already turned up. States often have long-term care ombudsmen. To find the one for your state, you can go to the National Long-Term Care Resource Center, and click on your state to get a contact information for local ombudsmen.

Various federal government sites can guide you toward the best state and local groups. One good place to go is eldercare.gov, which helps you search for nonprofit and government entities in your area that specialize in helping older adults. Among these should be area agencies on aging.

The Medicare.gov site also has a helpful “Guide to Choosing a Nursing Home” that includes good advice, and it can point you toward various state and local agencies. The link to it is found under the Nursing Home Compare database form. Among the destinations listed in this guide are state health insurance assistance programs, which advise Medicare recipients on insurance and other issues, state medical assistance offices, which can explain about state programs that help pay nursing home costs for people with limited resources, and state survey agencies, which handle quality issues about nursing homes.

Finally – though most important of all – you want to make sure that you visit any nursing home you are considering as a destination for yourself or a family member. In fact, you want to visit repeatedly and without warning. You should ask to see the home’s most recent inspection form, which is supposed to be available to you during an in-person visit. Spend considerable time at the home, checking out how caregivers go about their work and how residents are treated.

The Medicare guide, as well as sites like aarp.org and nccnhr.org, include lists of things to ask and examine. AARP even has a printable form that you can literally use to check off various points. The detailed questions include everything from “Do the hallways have handrails?” to “Does the staff knock before entering a resident’s room?” and “Are background checks conducted on all the staff?”

How to Choose a Medicare Prescription Drug Plan

Medicare part D, the prescription-drug benefit begun in 2006, provides government-subsidized coverage of prescription drugs through private insurers. The benefit is available through drug-only plans or health plans that cover medical care as well as drugs. Like most private insurance, these plans usually charge premiums, deductibles and co-payments.

Each year, drug-benefit enrollees have the option of changing plans during a six-week open-enrollment period that begins mid-November. In previous years, most people have chosen to stay put. But seniors might benefit by shopping around because plans often change their premiums, deductibles and other cost-sharing.

Here are some tips on how to choose a drug plan that is best for you:

Don’t just look at premiums. Beneficiaries also should look at factors such as deductibles, co-payments and whether their favorite pharmacy is affiliated with the plan. In particular, seniors should look at the list of drugs a plan covers and what their cost-sharing will be under each plan. Where your medications fall on a plan’s drug list, for example, can make a big difference on your bottom line. Each plan has various “tiers” of drug types — such as generics, preferred brand-name drugs, nonpreferred brand-name drugs or specialty drugs — with the lower tiers requiring smaller co-payments.

Navigate the coverage gap. There is a gap in coverage in Medicare’s drug plans known as the “doughnut hole,” and in 2009 it begins after seniors and their drug plans have spent $2,700. Beneficiaries then must bear all costs until their out-of-pocket expenses reach $4,350. After that, the plan covers most drug costs for the rest of the year. Plans often charge higher premiums in return for covering drugs during the gap, but consumers should weigh whether the extra cost is worth the extra coverage. Seniors also can talk to doctors about cheaper alternatives to the drugs they are taking, such as generics, other brand-name drugs or older versions of drugs that may treat their conditions just as well.

Go online, get help. The online Plan Finder tool on the Medicare.gov Web site is indispensable for choosing a drug plan, and seniors who aren’t used to going online could turn to family, friends or advocates for help or call 1-800-Medicare. Helpful tutorials are also available from the Medicare Rights Center.

Once online, you can research what drugs treat your conditions at their local libraries, or tap into online tools such as Consumer Union’s Best Buy Drugs. You can seek free, one-on-one help from counselors at your state’s Health Insurance Assistance Program. You can also go to a local agency on aging, which you can find through the government’s eldercare.gov Web site.