The financial options and resources for health care come in a variety of forms. Much of this guide identifies for profit and non-profit organizations and resources that provide health care for financially compromised individuals and families. Being insured is the best defense against the medical emergencies and illnesses that might otherwise ruin your financial security. Please read this section carefully to see which resources you can contact to help you with your particular need.

If you have no medical insurance:
First, work with your primary health care provider. Ask for their help and recommendations. Hopefully, they will work out a financial arrangement acceptable to you. Inquire if they can direct you through “the system” so that your basic health care needs are met.
Check your eligibility for the government programs listed in this section, such as Social Security, Medicare and Medicaid.

Medicare is a national health insurance program for people age 65 and older, some people under age 65 with disabilities, and people with End-Stage Renal Disease. For more information about the program, contact the Centers for Medicare and Medicaid Services at 1-800-633-4227.

Medicaid is a medical assistance program for eligible low-income individuals. For more information, contact the Department of Public Health and Human Services of Montana at 1-800-332-2272.

AIMS (Advocates in Medicare Savings) - Missoula Aging Services - 337 Stephens Ave. - 728-7682 or 1-800-551-3191
AIM$ is a statewide project to help reduce Medicare and Medicaid waste, fraud and abuse. AIM$ teaches seniors to:

Understand Medicare summary notices
Protect themselves against healthcare waste fraud and abuse
Be an informed consumer
Keep a record of medical appointments and tests, and check bill to confirm all services listed were received.

AIM$ is a collaboration between Missoula Aging Services and Area Agencies on Aging and the Montana Senior Citizens Association. If you have any concerns about your Medicare statement, call 728-7682 or 1-800-551-3191. AIM$ is a free and confidential program.

Children’s Special Health Services - 1-800-762-9891 or 406-444-3622
Assists eligible families with medical costs that arise from treating children with special health care needs including, but not limited to: heart conditions, cleft lip, seizures, asthma, diabetes, and concerns with child’s development. Also sponsors specialty clinics throughout the state. Please call for info. Can be in addition to other insurance.

MHSP Mental Health Services Plan - 532-9700
Provides coverage for eligible adults diagnosed with severe and disabling mental illness who need medication. Must be in addition to other insurance (except Medicaid) 1-800-730-3903

Medicare Supplement Insurance - Since Medicare does not cover all doctor and hospital costs you should consider getting a medigap policy from a private insurer. Medigap policies, like Medicare, offer a window of opportunity for enrollment. Sign up for Medigap coverage within six months of the time you enroll for Medicare Part B coverage. Realize too that Medicare and Medigap supplements do not cover custodial and long-term care. Only skilled nursing care is covered for limited amounts of time. In fact, Medicare only pays for about 5% of all nursing home costs. See the action entitled Long Term Care insurance for more information.

Medicaid Home and Community Services
Department of Public Health and Human Services
2677 Palmer St., Suite 240 - 329-1312 or 329-1310
Serves residents of Mineral, Missoula, Sanders and Ravalli counties through case-management teams. Goal is to serve Medicaid clients in cost-effective home settings as an alternative to nursing-home placement. Services might include adult day services, environmental modifications, medical-alert monitors, nursing services, nutritional needs, personal care attendants and homemaker services, respite care, respiratory therapy and transportation, and possibly other services.

Missoula County Office of Public Assistance
2677 Palmer, Suite 100 - 329-1200
Hours are 7:30 a.m. to 5:30 p.m. Monday thru Thurs and Friday 7:30 a.m.-5:00 p.m. Provides Medicaid services for elderly, blind, disabled people for various hospital inpatient costs, outpatient services and waiver services such as physician, dentist, eye care and home services. Coverage also extended to certain infants, low-income pregnant women and families.

TANF (Temporary Assistance to Needy Families Program)
2677 Palmer, Ste. 100 - 329-1200
A time-limited cash assistance program designed to provide families with monthly cash grants and opportunities leading to self-support. A family’s TANF eligibility is limited to sixty (60) months in the adult’s lifetime. Participants must complete a Family Investment Agreement, a document listing activities, time frames, and mutual obligations of the State and the participant regarding the course of action to empower his/her family to become self-supporting.

Participants of the above programs may be eligible for Medicaid and Food Stamps.

Senior and Long Term Care Services
2677 Palmer, Ste. 240 - 329-1309
Serves residents of Mineral, Missoula, Ravalli and Sanders counties through Medicaid funded in home care programs. These programs include home health, home dialysis attendant, home and community based services and personal assistance (both agency based and self-directed personal assistance.) If you would like additional information about any of these programs feel free to call.

St. Patrick Hospital and Health Sciences Center Senior Service Program - 500 W. Broadway - 329-5741
Waiver of Medicare deductible available to low-income seniors. Financial counseling available to help explain and work through medical bills and insurance policies/payments. Also offers free workshops, health screenings and free prescription discount cards.

INSURANCE

Individual and Family Medical Insurance:
Medical insurance has the reputation of being very expensive, especially for comprehensive coverage with a low deductible. However, there are many different levels of coverage available. The size of your deductible (the amount you must pay before your insurance kicks in) greatly affects your level of coverage. This affects your cost, or premium, for insurance. Whether or not you choose dental, vision and prescriptions will also affect your premium. Policies are also available for short-term coverage if you are caught between jobs or if you are in the process of securing major medical coverage

Many people cannot afford coverage, yet many more who can, choose to go without! You may be surprised at the low cost of a large deductible, no-frills, major medical policy. While not ideal, it could save you from financial ruin.

If you are self-employed or an employer, research medical insurance for your business! As an employer you have options for medical coverage. Legislation and tax laws have improved your rights to both acquire and afford medical coverage for yourself, your family and your employees. Seek out a reputable provider to guide you through the process of acquiring “tax-wise” medical coverage.

Blue Care - Provides limited coverage for uninsured adults and children - 1800-447-7828, ext. 8295.

Caring Program for Children - Pays for minimal primary and preventive health care services for uninsured children - 1800-447-7828, ext. 3612.

Children’s Health Insurance Program (CHIP) This is a free or low-cost health insurance plan that provides coverage for uninsured children through age 18. Financial eligibility is based on family’s gross income and household size. Doesn’t count family’s assets or resources: savings, IRA’s, extra vehicles, etc. 523-4750 or 1-877-KIDS NOW

MCHA: Montana Comprehensive Health Association
administered by Blue Cross/Blue Shield
1-800-447-7828, ext. 8537
Makes comprehensive health insurance benefits available to high-risk individuals. Includes but is not limited to: coronary artery disease, leukemia, AIDS, malignant tumor, lupus. Also covers people who have been rejected by 2 insurers within the last 6 months. MCHA Portability Plan - is available to individuals losing group or cobra coverage. Also having 18 months of prior creditable coverage.

Medicaid - 2677 Palmer, Ste. 100 -329-1200
Provides medical coverage to children, based on family’s income. Takes into consideration family’s assets and resources. Family is not eligible for coverage if countable resources and assets exceed $3000 (excluding 1 house and 1 car). Apply: Office of Public Assistance 523-4950

Medicare - 700 S.W. Higgins, Ste 5 - 542-1580
Medicare is a federal health insurance program for individuals 65 and over or those with disabilities or permanent kidney failure.

Montana Youthcare - A private health insurance plan that provides a child with comprehensive coverage at affordable prices. Blue Cross Blue Shield 1-800-447-7828, ext. 896 #5

Northwester Scholastic Insurers - A private health insurance plan that provides a child who is in school with supplemental accidental bodily injury coverage. Provides coverage for families with or without insurance. If a family already has insurance, Northwestern will pay a percent of the family’s copay and/or the deductible owed to the other insurance company. 406-458-5902

INSURANCE FRAUD

Insurance fraud continues to be a problem across our country. You have the option to call the state auditors office in Helena at 1-800-332-6148 to verify a company or individual with which you are working. DO NOT HESITATE TO CALL WHENEVER IN DOUBT.

Senior Information Line - Missoula Aging Services
337 Stephens Avenue - 728-7682
www.missoulaagingservices.org
The Information and Assistance specialists at Missoula Aging Services are trained to assist seniors in defining and addressing all types of fraud including insurance fraud. If you have questions about a company or are concerned that you are being scammed, please don’t hesitate to call. We can verify an individuals licensing and business history and if necessary work as an advocate for you.

Another option for small employers:
If you are a small employer without the time or resources to manage your company medical coverage, retirement plans or workman’s compensation, there are businesses that provide these services to multiple businesses to gain the economy only a larger organization can have. Better Business Systems of Montana - 550 N. 31st St., Ste 302, Billings, MT 59104 1-800-454-2446.

Long Term Care Insurance
Why is it important for you and your family to learn about long-term care issues and to consider the suitability of long-term care insurance? Because the chances of needing long-term care are high, and the costs to you and your family could be substantial.

Statistically, chances are greater than 50% that we will require extended care at home or in a nursing home, according to the Health Insurance Association of America. Women tend to outlive men and are more likely to need long-term care services; the American Health Care Association indicates that women comprise 75% of the nursing home population for those over age 65.

In Montana, the state Office on Aging indicates nursing home care currently costs $100.00 per day. The expectation is that this cost will rise to $60,000.00 by the year 2015. The potential cost of long-term care has become an important financial planning issue because these expenses have the potential to rapidly drain a family’s resources.

Intelligently preparing for the potential cost of long-term care is clearly a personal responsibility. Many people have the misconception that Medicare will cover their nursing home bills, but Medicare only covers skilled care, and 95% of the persons in nursing homes are receiving custodial care. To qualify, an individual must meet the following requirements:

A hospital stay of 3 consecutive days - not including day of discharge - must precede entry into a skilled nursing facility. The nursing home admission must occur within 30 days of hospital discharge and be for the same condition that was treated in the hospital.
A physician must certify, on a daily basis, that the care needed is skilled nursing or skilled rehabilitation services.
The skilled nursing facility must be certified by Medicare.

If a person meets these requirements, Medicare will pay:

The first 20 days; up to 100% of the Medicare approved amount.
The next 80 days; approved expenses, with a contribution from the recipient of the daily coinsurance amount. In 1999, this amount is $96.00 per day.
Starting on the 101st day Medicare pays nothing and the patient is responsible for all charges.
Medicare also pays for some home health care costs. If eligibility requirements are met:
The patient must be under a physician’s care and the doctor must certify the need for home health care. The need must include intermittent skilled nursing care, physical therapy, speech therapy, or occupational therapy. Full time care is not covered and neither is homemaker services primarily needed to assist in meeting personal care or housekeeping needs.
The patient must be homebound, having a medical condition that restricts ability to leave
the house without assistance.
The home health care agency providing the services must be certified by Medicare.

In summary, the reason Medicare ultimately covers such a small percentage of the costs of long-term care is because the level of care needed is overwhelmingly custodial (“ personal assistance”) and Medicare covers care with a skilled element, to the extent that it covers long-term care at all. In nursing homes, approximately 95% of the care rendered is custodial.

The mission of MEDICAID, a joint federal-state assistance program, is to help those who could not otherwise afford long-term care. It is one of the largest sources of funding for long-term care and pays for 61% of all nursing home bills in Montana. Many persons begin paying for nursing care out of their own pockets and turn to Medicaid when their assets have been depleted. A person qualifying for and receiving Medicaid assistance may find that their options are limited as to where they receive care. In addition, states are required to pursue recovery of the cost of care after the death of the recipient: In Montana this is accomplished through the Medicaid Lien and Estate Recovery Law. Generally, reliance on Medicaid is only done as a last resort by those individuals who have few assets to protect.

Once a person understands the basic issues surrounding long-term care (the significant chances of someday requiring care; the potential financial drain; and who pays for these costs), it becomes clear that long-term care insurance may be a suitable option to offset the risk of a financial and emotional calamity. In fact, asset protection is secondary in many people’s minds. According to a Health Insurance Association of America survey, the most frequently cited reason for purchasing LTC insurance: to maintain independence and choice - and to avoid depending on others for care. “Peace of mind” is one of the basic reasons to buy long-term care insurance.

Is long-term care insurance appropriate for you or your parents? It depends on your age, your health and medical history, as well as your income and assets. Policies are “age-rated”: the earlier you purchase a policy, the lower the premiums. (Age 50 is not too early to be considering coverage). Persons with serious health problems will not be able to qualify for coverage - another good reason for purchasing a policy sooner rather than later. You should not buy long-term care insurance if you cannot afford the premiums. If your assets are limited, then you would likely qualify for Medicaid if you need long-term care; spending your limited resources on insurance premiums may not be in your best interest.

Other important considerations include your family health history, your marital status, the family support that would be available to you if you needed care, and the importance - to you - of maintaining independence and having a choice as to where you receive care. (Most persons would prefer to remain in their own homes as long as practical). A qualified long-term care insurance agent will be able to determine if insurance is suitable and available for your personal situation and will suggest a strategy to reduce your emotional and financial risks.

Comprehensive long-term care policies cover both nursing home and home health care in the same plan. Most policies also cover care provided in assisted living facilities, which provide assistance with activities of daily living, such as dressing, eating, and bathing. Community based care, such as adult day care, is also usually covered. “Nursing home only” policies are available and are less expensive. They are worth considering for persons whose living situations make it unlikely they would remain at home if they should require care. Other key elements of a long-term care policy:

Daily benefit: the maximum dollar amount a policy will pay: some pay the full daily benefit regardless of the charges you incur (“indemnity”), other policies pay only actual charges up to the covered amount (“reimbursement”).

Benefit period: the length of time for which benefits are payable

Elimination period: the number of days at the start of a claim for which no benefits are payable (also known as the “waiting period or the deductible”); typical options include 0, 30, 90 and 180 days.

Other optional benefits, or riders, that are available include:

Inflation protection: this optional policy feature increases the daily benefit each year to help keep pace with the increasing cost of long-term care; this is an important consideration for anyone younger than mid-70’s

Non-forfeiture benefit: an optional benefit that allows the insured to receive some type of benefit from the coverage if the policy is surrendered.

Some final advice...

Long-term care insurance provides an excellent alternative to personally financing the cost of long-term care, but it is a complex product with numerous substantial and subtle variations from company to company. Don’t buy this product in an educational vacuum. Work with an insurance agent who is knowledgeable about long-term care issues and familiar with a variety of long-term care insurance plans. The agent should take the time to learn about your personal situation, answer your questions, and should adequately explain the plan and features he or she is proposing. Know what you are buying - and why you are buying it. Review several different long-term care insurance policies.

And perhaps most importantly: involve your family in a discussion of long-term care issues and a decision to buy or not buy long-term care insurance - while you are healthy. They will almost certainly be impacted should the need for long-term care arise.

REVERSE MORTGAGES

Reverse mortgages are designed for homeowners age 62 and older and living in their homes as their primary residences. The reverse mortgage is a new tool for retirement planning. It is a way to turn your home into a source of cash. Before reverse mortgages, there were two ways to get cash out of your home: by selling it and moving, or by getting a home equity loan and making the required monthly payments. Now there is a way to turn the equity in your home into cash without making loan payments, and you continue to live there. This is why the term “reverse mortgage” is used. It is a type of mortgage that works exactly the opposite of the traditional mortgage we used when we bought our homes. Instead of paying the lender, the lender pays the homeowner, who retains ownership to the property, continues to live there, and makes no monthly repayments.

The reverse mortgage is a loan with a rising balance and must be repaid when the homeowner leaves the house, either by selling it and moving, or by passing away. The money from a reverse mortgage is not taxable and does not affect Social Security and Medicare.

The list is unlimited: travel bills, remodeling, redecorating, hobbies, medical and health care expenses, property taxes, emergency funds, college tuition for grandchildren, car purchase or repair, and the list goes on and on and on.....

The amount of money available for a reverse mortgage varies for everyone. No two homeowners are alike. Information can tailored to your specific circumstances.

There are three reverse mortgage programs for Montanas: the Federal Housing Administration Insured Reverse Mortgage (HECM), the Fannie Mae Homekeeper, and the State of Montana’s Reverse Annuity Mortgage (RAM). For free information and referral, call Justin Schedel, Montana Board of Housing - 1-800-761-6264.

Montana Board of Housing’s Reverse Annuity Mortgage Education Tool Program - Missoula Aging Services
337 Stephens Ave. - 728-7682 - 1-800-551-3191 www.missoulaagingservices.com
The Information and Assistance Staff at Missoula Aging Services is certified by the Montana Board of Housing to provide counseling on the MBH Reverse Annuity Mortgage. RAM counselors can meet with you to explain and define how a reverse annuity mortgage works and how it might benefit you. This is not a sales pitch, but an educational tool for people interested in the program.

ESTATE PLANNING

If you don’t plan the division of your estate, the government will do it for you. You may also suffer unnecessary estate taxes. Trusts, wills, charitable gifts, tax-exempt gifts and insurance trusts are all means for controlling your estate. By using effective estate planning techniques you can direct your estate to the people or organizations you would like to benefit. Find out how to protect your estate. Consult the yellow pages for a complete listing of financial planners, attorneys, accountants and insurance agents.