Advice for Care Givers: Our Caregiver Blog
Traditional Medicare vs. Medicare Advantage

Traditional Medicare vs. Medicare Advantage

Traditional Medicare has parts A (hospital), B (outpatient) and D (pharmacy benefits). Medicare Advantage, which is run through a managed care ordganization and referred to as Part C, combines the benefits of parts A, B, D and sometimes additiaonl benefits (like vision and dental) that are not typically covered by Traditional Medicare.   Medicare part A is free, but the premiums for Traditional Medicare part B can run as high as $250/month and you have to pay 20% of the costs of outpatient services like Doctors visits.  Seniors enrolled in traditional Medicare ofter will purchase a "supplemental insurance plan" to help cover the additional 20% of non-paid services.
On the other hand,  The National Council on Aging reports that Monthly premiums for Medicare Advantage plans for 2024 average $18.50/month.  And since Medicare Advantage typically offers an expanded benefits plan (list of covered medical services) the choice between the two plans seems to be a simple choice:  Why pay 10x more for a Traditioanl Medicare plan when you can get more services through the much cheaper Medicare Advantage plan?  Well there are two major differences between the two plans that might have you second guessing the Medicare Advantage plans.  Perhaps the biggest disadvantage of Part C plans is that your provider network, Doctors and hospitals that you are allowed to to visit, is ALWAYS more restrictive than traditional Medicare Parts A & B.  If you happen to see a doctor or provider who is not in the Advantage network, you can be paying a sizable part of your billed services for going to see an out-of-network provider. In addition, Medicare Advantage can sometimes issue a denial of coverage for medically necessary care or care they feel is not necessary, and this can also be done retroactively thereby denying coverage for care you thought was being covered by your plan. However, if this ever happens to you there is still hope of getting coverage by appealing the denial for services:

    If a Medicare Advantage plan denies you coverage for services don't take it lying down.  File an appeal, and your odds are good that the plan will overturn its decision. That's the message for consumers in a government report examing service      and payment denials in Medicae Advantage plans. For help filing an appeal contact: Medicare Rights Center, and advocacy group for Medicare beneficiaries, to or call 800-333-411

So which plan is best for you?  That depends. In 2024 seniors were evenly split between plans with 50% enrolling in traditional Medicare and 50% choosing an Advantage plan.  You should probably look at your health status and if you've experienced extended hospital stays or specialists services traditioanl Medicare might work best for you.  Your financial situation obviously will play a big part in your decision as will the size of the networks for your Advantage plans or how many Medicare Advantage plans you have to choose from. City dwellers usually have a greater number of Medicare Advantage plans to select from vs. rural Americans and the competition may result in more competitive premiums.

And finally, fear not, even if you are enrolled in a plan you do not like, every Medicare benefitiary has the option to switch to another Advantage plan or even back to Traditional Medicare plan during the annual open enrollment period which runs from October 15 through December 7th.
When Are Adult Diapers Necessary?

When Are Adult Diapers Necessary?

We correspond with a  lot of caregivers and hear the same question from caregivers time and again.  This question is especially sensitive and there is no simple answer.  One of the questions that caregivers wrestle most with is "When is it time to introduce a senior to adult diapers?"  And we are convinced  more and more that caregivers who pose this question are already convinced it's past time to start using protective underwear. Their real question is, "How do you get a senior to swallow their dignity and start wearing incontinence products?"
We understand that being a full-time or part-time caregiver is no easy task and assuming janitorial tasks for a patient who refuses to take steps to lighten the caregiver's burden is a huge problem for caregivers who may or may not have accepted their role with some degree of consternation.
So we feel the easiest answer to the question of when an individual should be using incontinence products is when the senior is unable and/or unwilling to clean up after themselves and/or, you as caregiver, are faced with clean up duty on a weekly basis.  One major caveat should premise this difficult discussion: we fully realize that a great majority of caregivers are on the wayward side of 50 years young and you do no favors for yourself or your senior loved one when all the bending and kneeling results in your incapacitation with back, shoulder and knee as well as emotional and psychological issue associated with this unpleasant task.  Therefore, the underlying focus of this discussion should always be the physical and emotional health of the caregiver as well as that of the caree.
If everyone in our society was 100% agreeable to wearing diapers, this discussion would be elementary in nature, but like many stages in life, we quickly find that you can lead a horse to water (pardon the pun) but making him drink is a whole 'nother discussion . . . almost identical to this one!  As we're sure the poser of this delicate question has already learned, if you are willing to take on full-time janitorial and laundry duties you loved one will probably be just as willing to put off changing his/her style of undergarments; a situation which, of course, brings us right back to the original question, which we have already answered with a resounding, "NOW is the time!"
So as you broach the topic of upgrading to "absorbent undergarments" with your loved one, keep in mind a few things:
Incontinence is not a disease alone, but rather a symptom of some underlying ailment.  Incontinence is not necessarily a permanent issue either as both the cause and treatment should be discussed with your medical professional.  Nor is incontinence a natural result of dementia or the aging process.
Our very general guidelines for introducing the use of incontinence products:
Strike the phrase "adult diapers" from the discussion.  Terms such as "protective underwear," "absorbent undergarments" or "absorbent panties" are much more palatable.  Ask for input from your loved one, who may actually be sympathetic to your plight, but just too embarrassed to mention the obvious.  Construct your comments in a way that leaves their dignity intact, "I hear Lisa Rinna prefers the Depend pull-ons" (she does, have you seen her commercials?).  Above all else, don't draw a line in the sand on this topic by saying things like, "If you don't start wearing diapers I guess a nursing home is our next stop!"  Such tact will only result in the digging in of heals on each side of the discussion and prevent you from ever hearing the comment, "you know, these new underwear are really a godsend, and now I'm even sleeping all through the night!"
Last, you can find versions of this discussion all over the internet.