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April Harris Jackson

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What Is A Death Doula?

Guest Author Ellen Abbott

As we approach Halloween and Día de los Muertos, it seemed appropriate to get a little more matter-of-fact about deathcare resources. One end-of-life resource that we want to highlight is the option of engaging a “death doula” for those who are facing the end of their lives. 

Our guest blogger this week is Ellen Abbott. We met Ellen in her role as Care Manager for Visionary Care Consultants but soon learned that we shared an interest in helping people through some of the most difficult transitions of life.  Ellen completed her certification as a death doula in 2019, so we asked her to tell us more about what a death doula is and how they serve those at the end of their lives. 

Contact Ellen at ellen.abbott615@gmail.com or check out her website if you’d like to learn more about death doulas.

The W’s of Death Doulas

You may have heard recently about a “death doula” or an “end of life doula” and wondered who they are and what do they do? As a death doula myself, I’m happy to tell you! 

What is a death doula?. We use midwives to educate and assist families to help bring babies into the world, why not have the same for those who are towards the end of their journey here? 

There is a growing movement among end-of-life professionals in the United States to bring back the role of a non-medical person who stands in the gap between doctors, hospice, and the family of a dying loved one. This person guides the family and the client around the maze of the healthcare system, educates on hospice, offers practical information about death and provides emotional support around the entire process. 

Who do death doulas serve?

A death doula serves the dying person as well as their loved ones. The goal of a death doula is to make sure that their client’s final wishes and needs are carried out before, during and after their death. This creates a healing and easier transition for the client and family. 

When should a death doula be called?

You don’t have to have a terminal diagnosis to hire a death doula. There are some doulas who focus on helping their clients plan so that they know what they want at the end of life, and instructions on what the family needs to know to carry out those wishes. This is extremely helpful to the family and client since the topic of death and final wishes are not popular conversations in today’s world. 

How do death doulas charge for their services?

Every death doula is different. Most offer free consultations and then an hourly rate of anywhere from $30-$100 an hour. Some offer packages for legacy planning along with being present for the client at the time of death. In middle Tennessee there is a Death Doula alliance, made up of local doulas that have been trained specifically for this role. They come from all backgrounds but usually from nursing, social work, counseling or clergy. 

Over the last century, death has been viewed as a medical failure even though we all know one day we will die. A death doula helps to normalize these conversations and talk about these topics that no one wants to bring up. The death doula starts with the end in mind, to ease client’s fears, knowing they have a plan and someone at their side when the time comes.

How can I plan long-term care with TennCare?

TennCare is Medicaid

What is TennCare? (A brief overview of Medicaid)

Quite simply, TennCare is Tennessee’s Medicaid program. While the name “TennCare” has the word “care” in it, it is NOT Medicare. In order to further clarify the difference between the terms “Medicaid” and “Medicare,” you need to remember that we use “Medicare” to “care” for our elders and “Medicaid” to “aid” those, of any age, in need. Essentially TennCare is Tennessee’s brand of Medicaid. Hopefully, that little trick will help you remember the differences between each program. 

Who qualifies for TennCare?

Now that you are familiar with the difference between Medicare and Medicaid, let’s discuss who qualifies for TennCare (Medicaid). 

There are three qualification criteria that you must meet in order to obtain Medicaid/TennCare. 

1. Medical qualification There is a special medical test that applicants must pass in order to qualify.  Usually, a care facility will handle this piece of the Medicaid application. 

2. Asset qualification – A TennCare applicant who is single can only have $2,000.00 in assets before they are eligible for TennCare.  Vehicles and real estate are usually exempt from the count of assets. A “Care and Savings Assessment” is a good place to start if the applicant needs help with figuring out what they have in assets and what options are available to make excess assets “non-countable” for TennCare purposes. 

3. Income qualification – A TennCare applicant can only receive $2,382.00 per month (as of 2021) in order to receive TennCare. If an applicant has more than this amount in income, an attorney can resolve it through what is called a Miller Trust or a Qualified Income Trust.

Long-term care is very expensive

Why should I be concerned about long-term care services?

Unless you are a millionaire or multi-millionaire, TennCare eligibility and designation could have a major impact on your finances and your family. While you may not need TennCare now, you will want to plan as if you will need it in the future. As you may have heard us say before “we hope for the best, and plan for the worst.” Having a plan is an effective way to ensure that you will have long-term care coverage when you need it. This isn’t to say that you won’t find yourself needing TennCare much sooner than expected. When this happens we call it “TennCare Crisis Planning”. 

Knowing your options makes all the difference

I don’t know where to start!

The biggest obstacle to TennCare planning is determining what to do with your assets and income; especially if there is excess in any category. There are a lot of rules and potential pitfalls that you need to look out for. Fortunately, we have some great financial planning and legal resources that can help our clients. If you have an immediate need for TennCare or want to plan for TennCare we can supply the client with what we call a “Care and Savings Assessment”. It’s a wonderful tool that helps people effectively navigate through their options.

How do we help our estate planning clients with TennCare planning?

For our estate planning clients, we like to take into consideration the possibility that you may need TennCare in the future. 

For example, it is our priority to set up our client estate plans to make sure that TennCare is accessible if it is ever needed.  As with many government organizations, Medicaid has lots of rules to follow and many people find that they did not know what rules they were supposed to be following until it was too late!   Fortunately for our clients, we know the rules and can help you plan in advance of ever needing to apply for TennCare to cover medical care.  Additionally, we create documents that make sure that someone can apply for Tenncare on your behalf. This is useful if you become incapacitated in the future. 

How do we help our Conservatorship clients with TennCare? 

Many of our conservatorship clients are caregivers for a loved one who requires skilled nursing to keep them safe. The average cost for this type of care is about $7,000.00 per month or more.  There is usually a large gap between monthly income and fees.  Our firm can navigate the TennCare application process and assure that the appropriate language is in the conservatorship order paperwork with the court so that the client may obtain the appropriate benefits for their loved one.  

How do we help clients with TennCare Crisis planning? 

For those who have never considered the cost of long-term care until they or a loved one need to enter a nursing facility, the cost of care is likely to come as a shock- and an unaffordable, but necessary, expense.  This is when we can step in with what we call “crisis planning,” meaning that you need a plan and you need a plan now

In these cases, we are able to look at the household financial situation of the person needing skilled care, as well as the family situation overall, and come up with a plan for how to best use existing resources and get them qualified for TennCare benefits to pay for the nursing home bills. This process called our “Care and Savings Assessment”,  is one of the most rewarding things that we do!  It allows us to help people get the care that they need while still providing a quality of life for themselves and their families. 

If you are concerned about accessing TennCare benefits for long-term care, contact our office for a complimentary initial call using our online calendar here

Read our article about Medicare planning.

Have you thought about qualifying for TennCare in the future?

You’re almost 65. Congrats on your Medicare Milestone!

We’ve been talking about Medicare for a few weeks now, but we haven’t gotten to the how-tos yet.  That’s about to change. Today we dig into how you actually enroll in Medicare. 

Your first Medicare enrollment period begins three months before you turn 65 and runs until three months after.  Even if you don’t sign up for any other coverage, we recommend that you sign up for Medicare Part A during this first enrollment period. 

To sign up for Part A, go to the Social Security Administration’s Medicare portal here.  It will be helpful to set up an account for when you come back to sign up for Part B or when you are ready to begin receiving retirement benefits. 

If you are signing up for Parts A and B, the process is the same. You’ll sign up through the Social Security Administration’s website. Remember that if you enroll for Part B, your premiums will either be deducted from your Social Security retirement payment or you will receive a bill. The 2021 Part B premium is $148.50 for most people.

If you are looking for a Medicare Advantage plan, Part D, or a Supplement (Medigap) plan, you will want to compare plan options using a plan comparison service.  There are insurance brokers like Kendall Chanley and Harry Perret here in town who can help you compare options and narrow things down. Once done, they will get you signed up. These services are free to you and it’s nice to have one agent who can help you each year. 

If you prefer to do things yourself or just want to do some exploring, Medicare.gov will allow you to find plans in your area and narrow them down based on what you are looking for and price ranges. I recommend filtering plans by the star ratings (four or above) and then whether you are looking for dental, vision, and prescription medicine access. 

Once you make it through your first enrollment period at age 65 (ideally), you’ll be eligible for open enrollment each year from October 15th through December 7th.  You may also have options to select coverage during a special enrollment period if you lose other coverage. 

Applying for Medicare isn’t nearly as scary as it sounds, but it does require advanced planning and research. You don’t want any deadlines sneaking up on you! Personally, I love using reminders on my calendar well in advance of any deadlines that I have. Maybe one to begin research, one to call an expert, one to compare plans, one to sign up….all before your birthday or November. 

What’s your plan for Medicare enrollment?  Head to our Facebook page to share your plans in the comments!

3 Common Mistakes People Make by Waiting to Sign Up for Medicare

I don’t know about you, but I don’t plan to retire at 65. I mean, that’s only 25 years away. And I like my job. Maybe that’s you.

Even still, don’t put off signing up for Medicare when you turn 65. Here’s Why.

Mistake #1: Waiting until after you retire to sign up for Part A. 

Why it’s a mistake: Medicare is basically free money. You paid for it with your taxes for the past forty-some years…but still.

Ultimately here’s the deal–you CAN wait. But since it’s no skin off your back, wouldn’t you rather set it and forget it?  Think about that time you set up automatic payments into your savings account or 401k. You may not have missed the money, but when you got your tax forms, you saw the benefit of making a small change. It’s the same here. Signing up for Part A is easy, and makes the process of signing up for Part B or a Medicare Advantage plan much easier. 

Mistake #2: Staying on private health insurance coverage instead of signing up for Part B, without doing further research.

Why it’s a mistake: The plan you are currently on may not provide enough coverage.

If you plan to stay on your current coverage instead of signing up for Part B as soon as you turn 65, you want to make sure that your health plan provides appropriate coverage. We’re talking about a qualified group health plan (as defined by the IRS). If you’ve ever had to provide proof of “creditable coverage” for plan enrollment, this is similar.  Otherwise, you will pay a penalty when you sign up for Part B coverage.  This penalty is paid with each premium payment and never goes away. The longer you are eligible for Part B without signing up, the more the penalty costs. Do your future self a favor and get HR to confirm (in writing) that your current coverage meets the requirements. 

Mistake #3: Assuming that your current insurance plan will continue to be available after you become eligible for Medicare

Why it’s a mistake:  Believe it or not, some insurance plans and employers will not cover you (or your spouse) if there is other coverage available elsewhere. That includes Medicare.  Medicare enrollment begins three months before you turn 65 and lasts three months after.  Start looking at your options early to make sure you don’t get left without insurance unexpectedly. 

Whatever you decide about retirement, make sure that you have the information you need to make good, informed decisions. 

Next week we’ll be getting into the nitty-gritty of how to actually sign up for Medicare. Make sure to follow us on Facebook or Instagram to see when the blog gets posted! 

My 3 Favorite (Free!) Medicare Resources

Healthcare in America is…..complicated. Medicare ensures that most people 65 and older have access to basic care for hospitalization and doctor’s care. 

But what else does it include?  That’s a great question….because it all depends on what you sign up for.  Some of it will depend on the specific plan you sign up for but all plans include core services. If we talk about Part A or Part B coverage, a Medicare Advantage plan (Part C) automatically includes these same services.  If you didn’t catch our Medicare 101 post last week, go catch up here

I had the good fortune to go through a training hosted by the State Health Insurance Program a few years ago that really opened my eyes to how Medicare coverage works. It was one of my first steps into the realm of elder law.

Since then, I’ve helped clients who are on Medicare and helped my parents navigate the process too when my Dad turned 65.  I wanted to share some of my favorite free resources to find out information about Medicare. Depending on whether you like to keep things old school, or want things as paperless as possible- there’s an option for everyone! 

  1. By mail- When you sign up for Medicare, you will get a Medicare and You handbook that is useful for helping you figure out what is included in Parts A and B. It is easy to read and understand exactly what your coverage includes. 
  2. By phone- As I mentioned above, the State Health Insurance Program (SHIP) is an awesome program that helps Tennesseans find the right health care plans for them. You can reach them at 1-877-801-0044 or, in the before times,  at local health fairs. Just remember that they are staffed by volunteers and might take some time to call you back.  If you’d like to become a volunteer, they would love to have you! 
  3. Online: Yes, I know that government websites don’t have the best reputation for having easily accessible information. But trust me….Medicare.gov is different. Whether you just want to learn about Medicare, compare plan options, or look for a new doctor, this website makes it simple to find what you’re looking for. 
  4. In your pocket- The Medicare “What’s Covered” App is available for Apple and Android user. You can open your phone to find out if a service or treatment your doctor recommends is covered and how much it is likely to cost out of your pocket. I’m pretty jealous that my insurance company doesn’t offer this. 

All of these options now have online availability (check out those lovely blue links). Regardless of how you prefer to absorb information, I hope you’ll find one resource that is your favorite. We will be polling our social media readers on Facebook and Instagram this month to see what their favorite Medicare resources are…..we hope we’ll see you there!