Saving for your ageing parents: an easy guide to where to start

The needs of elderly parents can surprise even those who are prepared, but you don’t have to support your family alone

Adult children of older parents should prepare financially for the costs of care and travel. Photograph: Alamy

We all want to age like the late Pete Seeger, who celebrated his 90th birthday performing onstage in front of thousands of adoring fans of all ages at Madison Square Garden, and went on to entertain the Newport Jazz Festival audiences a few months later.

In our pragmatic moments, we know that the odds of living that long and in such good health aren’t in our favor. We know we need to plan not only to live longer but perhaps to spend more time in costly nursing homes or care facilities.

It's not just ourselves we have to worry about. Failing to develop a plan to help our parents in their final years could deliver a similar kind of blow to our emotional and financial wellbeing. In the last few months, I’ve watched three friends, ranging in age from their 40s to the early 60s, scramble to resolve non-medical problems for their parents. In all cases, that meant forking out on costly airfares to be there in person; in one case, it required money to hire a new accountant. “I’ve always been aware that at some point, there would be an emergency, but I had assumed it would be a stroke or something, not this,” one told me, ruefully.

A recent US Trust survey revealed that while about half of all Americans have planned for their own long-term care needs, only 18% of those with parents still living have factored in the possible need to help parents.

And yet, 26% of those under the age of 49 already were footing the bill for parents’ out-of-pocket medical expenses while 18% were contributing to long-term care costs.

I’m not suggesting that you double your savings rate to ensure that your nest egg is large enough to cover your needs as well as the needs of your parents and in-laws. That’s both illogical and – given that most of us are struggling to save for our own retirement – impractical. That doesn’t mean your hands are tied, however.

Start with the basics. Make a list of questions and fill out the answers. It's easiest to start with the most important documents you need to be prepared.

Do your parents have a health care proxy? A power of attorney prepared? Where are they located? In the midst of a crisis, you don’t want to go on a treasure hunt in quest of these crucial documents.

“Clients call me to say that hospitals won’t talk to them about treatment for their elderly father with dementia because no one has a healthcare proxy or knows where it is,” says Nan Giner, a partner at Boston-based Choate Investment Advisers.

Do your parents have long-term care insurance, or do they plan to “self-insure” and cover their costs from their savings?

“Knowing the answer to that question can help you understand how much risk there is that you’ll be called on to help” whether directly or by helping them to navigate the labyrinth of federal, state and local programs that exist to help fill gaps of this kind, says Dave Richmond, a financial adviser in Jackson, Michigan.

Beginning conversations on these topics might feel awkward – after all, it hasn’t been that long since your mom and dad were monitoring your behavior. But it’s important to be proactive. The more you’re able to communicate openly, the better the odds that you’ll spot something that otherwise might have developed into a crisis.

“Most of the parents I’ve worked with don’t want to be a burden to their children,” says Gideon Schein, founding partner of Eddy & Schein, a New York firm that manages personal finance and health insurance issues for senior citizens still living in their own homes. “The best way is to make parents aware that you’re asking for everyone’s benefit; that it’s a kindness to everyone in the family to be prepared – not for death, but for the rest of their lives.”

There are plenty of tips out there for ways to start tricky conversations like these. Bringing a third party into the discussion can also help, especially if your parents feel you’re overstepping your bounds, or you’re afraid of sounding greedy or self-interested. “Sometimes having a mediator takes the tension out of a situation,” says Schein.

A good place to start is an elder care attorney, who is intimately familiar with these issues, including specialized vehicles like pooled income trusts that can be invaluable to elderly individuals facing a financial shortfall in covering the cost of their care in their final years. They can refer their clients to other specialists, including people in Schein’s rapidly-growing industry, members of the American Association of Daily Money Managers.

None of this practical stuff will make it easier to deal with the emotional burden of octogenarian parents struggling with dementia or other major ailments. But part of everyone’s personal financial plan should include strategies for dealing with some of the most likely scenarios involving their parents. That leaves everyone in a less vulnerable position.

Study: More exercise, less sitting reduces heart failure risk for men

By American Heart Association 

DALLAS — sitting for long period’s increases heart failure risk in men, even for those who exercise regularly, according to new research published in the American Heart Association journal Circulation: Heart Failure.

Preventing heart failure, researchers found, requires a two-part behavioral approach: high levels of physical activity plus low levels of sedentary time. The study is the first to examine the link between heart failure risk and sedentary time, said Deborah Rohm Young, Ph.D., lead researcher and a senior scientist at Kaiser Permanente in Pasadena, Calif.

"Be more active and sit less. That's the message here," Young said.

Researchers followed a racially diverse group of 84,170 men ages 45 to 69 without heart failure. Exercise levels were calculated in METs, or metabolic equivalent of task, a measure of the body's energy use. Sedentary levels were measured in hours.  After an average of nearly eight years of follow-up, researchers found:

Men with low levels of physical activity were 52 percent more likely to develop heart failure than men with high physical activity levels, even after adjusting for differences in sedentary time.

Outside of work, men who spent five or more hours a day sitting were 34 percent more likely to develop heart failure than men who spent no more than two hours a day sitting, regardless of how much they exercised.

Heart failure risk more than doubled in men who sat for at least five hours a day and got little exercise compared to men who were very physically active and sat for two hours or less a day.

Study limitations included: Since no women were studied the results may not apply to them; results were self-reported, which could mean physical activity was over reported; results were based only on time outside of work and can't be applied to overall sedentary activity; and participants were members of comprehensive health plans, so results may not apply to men lacking health insurance.

The study supports the American Heart Association recommendation that people get at least 150 minutes a week of moderate-intensity aerobic activity to reduce their risk for heart failure and other cardiovascular diseases, Young said.

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By JENNIFER ROBISON

LAS VEGAS REVIEW-JOURNAL

If our email inbox is any indication, Las Vegans feel strongly about starting up a single-payer health insurance system.

After we wrote on Jan. 19 about a Vermont lawmaker’s federal proposal to mandate that states set up one-payer systems that would operate like Medicaid and guarantee coverage for all, the feedback rolled in.

We’ve selected two letters with opposing takes on the issue to keep the discussion going.

Once you’ve finished reading up on the debate, check out how a local consumer got a pleasant surprise when he recently signed up for new coverage.

■ Al Popp reached out with a novel idea. He writes: Let’s just expand Medicaid to everyone. How do we pay for this system? We pay for it by taxing all food and beverages at 10 percent. Just add it to the price of the product before the sale, like we do with gasoline excise taxes. If a person spends $200 a week for food and beverages, whether it be in a grocery store, convenience store, restaurant or catering business, one would be paying $20 a week for their health care, which equates to $1,040 a year. That, to me, is affordable health care. The more you spend on food and beverages, the more you will contribute to health care. I’m curious what your thoughts are on this plan.

Well, Al, I’m a reporter, so I’m completely flexible and I have no opinions.

In the interest of public debate, though, your plan is definitely worth sharing.

One common criticism of this kind of funding source is that poor Americans spend an above-average share of their income on groceries, so it becomes a regressive tax that penalizes lower-income earners more than wealthier households. This is why Nevada’s sales tax exempts food bought inside grocery stores.

So although you’re correct that people would pay less if they spent less, a plan to tax food and drink would disproportionately hurt discretionary income among working-class households.

Plus, low-income households already face higher food costs because their neighborhoods might have fewer supermarkets and pricier food as a result.

As you note, Al, your idea does have upsides. No one would be mandated to use Medicaid; they could still buy a private plan for more coverage, the way some affluent households pay both local property taxes and private-school tuition. International tourists who buy pricey meals on vacation also would feed into the system. And undocumented residents would pay as well, anytime they visit the grocery store. So would “panhandlers, the underground market and cash-paid workers,” as you said.

So, readers: Add what you’d like to Al’s suggestion.

■ On the other side, Las Vegas insurance broker Patrick Casale chimed in on single-payer with this: There are five reasons single-payer can never work for the United States: immigration; taxation; capping doctors’ and hospitals’ earnings; capping Big Pharma; and medical access.

Part of Patrick’s concern is that our country already is strapped financially, and a plan that opens free health care access to all (Medicaid doesn’t charge copays or premiums) would be unsustainable given current immigration rates. What’s more, he said, countries with one payer “have a tax rate that exceeds 50 percent, and numerous other taxes,” including sales taxes. Accounting firm KPMG backed that up with a 2012 study that pegged top marginal income-tax rates at 56.6 percent in Sweden, 55.4 percent in Denmark and 48 percent in Canada. The marginal U.S. rate is 39.6 percent.

Making a single-payer system work also might require limiting hospital charges and incomes, and that would in turn hurt access as providers perform fewer procedures to control costs, Patrick said. And tangling with the major pharmaceutical companies on what they charge would be a Herculean task in what he called “the most overdrugged nation worldwide.”

Patrick said he also would like to see the federal government eliminate fraud in Medicare and Medicaid before the programs expand to all Americans. Curbing malpractice lawsuits might make a difference in costs, too.

Anything else you can think of, readers?

■ Steve Selbrede wrote in with praise for a little-known provision of Obamacare: There have been many recent stories and letters about the absurdly high deductibles of Obamacare insurance plans. When I first began to investigate the Nevada Health Link website to choose my own plan, I was distressed to see very high deductibles. After about 30 hours of studying my options, I found that these deductibles are not always so high.

Steve discovered Cost Sharing Reduction, a little-known discount in the Affordable Care Act that lowers what you owe out of pocket for deductibles, coinsurance and copayments. It’s above and beyond the tax credit that helps cut premiums for lower-income earners.

You do need to meet a few guidelines to benefit. For starters, you have to buy your plan through Nevada Health Link, the state exchange’s website. Plus, the discount is good only on silver plans, the federal law’s benchmark coverage. And you have to make less than 250 percent of the federal poverty level. That’s $59,625 for a family of four, or $29,175 for a single.

Steve qualified, and after he chose Nevada Health CO-OP’s Southern Star Silver Plan, here’s what he found: His calendar-year deductible dropped from $4,250 to $750, while his out-of-pocket maximum fell from $6,350 to $1,500. His office visits went from $15 or $45, depending on network level, to $5 or $30. Specialist copays were reduced from $50 or $150 to $10 or $50.

You do need to complete the sign-up process at nevadahealthlink.com to determine whether you’ll get the break. So Steve offered some tips on how to make it through, if you have issues with the site.

First, forget about browsing for a plan without creating an account, because you won’t get a full reckoning of the cost unless you put in your details. Start an account at the site with a user name and a password, or you won’t be able to get back into your account. Do not provide your e-mail address, or you might not be able to return to your account. Make sure you know exactly what your adjusted gross income is before you get started. And check your insurer’s website for a provider list because the state exchange’s site doesn’t always match, he said.

“Don’t wait for a bill. Send a check in right away,” he added.

Information submitted

COLUMBUS — Complications with the federal health insurance exchanges have created challenges for some consumers who have not yet received proof of their insurance coverage. As a result, many consumers are unsure if their medical treatments are covered and are unable to provide their proof of coverage.

“Since open enrollment began on Oct. 1 the federal exchange has struggled to process applications and enroll consumers in coverage,” Ohio Lieutenant Governor and Department of Insurance Director Mary Taylor said. “These delays are making it more difficult and confusing for consumers to use the health insurance plans they have purchased through the federal exchange.”

If you recently purchased a plan, but still haven’t received proof of insurance from your insurance company, Taylor offers these tips.

Contact the Company

The first thing you should do is contact your insurance company to verify that you do have insurance coverage. Ask your insurance company for proof of coverage, such as an insurance card or identification numbers. Take detailed notes of conversations and include the representatives names, and date and time they took place. Keep copies of written communication you received from your insurance company such as emails or letters. You may need these materials later.

You should also verify that you have paid your first premium on time. Some insurers have permitted late payments for coverage that is retroactively effective to Jan. 1. Ask your insurer for their deadline and keep any records that can serve as proof of payment.

If you are about to buy coverage from the federal exchange, print any paperwork or confirmations that you receive during the enrollment process.

Payment Options

You may need to get a prescription filled or see your doctor before you receive your insurance card. Your provider (hospital, doctor, pharmacy) may be able to verify your coverage by contacting your insurer directly. If verification of coverage cannot be obtained, you still have options. One option is to pay for expenses out of pocket.

Once your insurance coverage is effective, your insurance company should reimburse you to the extent that the service or medication is covered under your policy. You may also be able to work with your doctor’s office, hospital or pharmacy to delay payment or set up a payment plan until they can verify that you’re insured.

Keep your receipts and any bank statements that show that you’ve paid for the services.

Contact the Ohio Department of Insurance

If you are still having difficulty obtaining proof of coverage from your insurance company, call the Ohio Department of Insurance consumer hotline at 1-800-686-1526 for assistance. Insurance information is available at www.insurance.ohio.gov. You can follow the Department on twitter @OHInsurance and on Facebook.

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Making the right insurance choices can have significant impact on the small business owner’s operation costs. With that in mind, New Jersey Department of Banking and Insurance Commissioner Ken Kobylowski offered some basic tips for small businesses for purchasing or updating their insurance coverage.

There are different types of policies available to small business owners that range from life insurance options to mandatory workers’ compensation.

Commissioner Kobylowski said small business and home-based business owners potentially have several different policies that can provide necessary protections.

“Small businesses should annually review their insurance policies to verify that their coverage meets their needs,” Commissioner Kobylowski said. “This could include workers’ compensation, commercial auto, business property and liability, group health and disability as well as group life and key-person life insurance.”

Commissioner Kobylowski offered the following tips:

What steps should a small business owner take?

• Shop around – Examine rates from several companies, being sure to compare plans providing identical coverage.

• Protect yourself – Stop. Call. Confirm. Verify with the Department that the companies quoting coverage are licensed by the State of New Jersey by calling 1-800-446-7467 or by checking online at www.dobi.nj.gov. Then use the National Association of Insurance Commissioners’ Consumer Information Resource (CIS) at https://eapps.naic.org/cis/ to compare a company offering coverage to other firms in the industry using their consumer complaint ratios.

• Review Annually – Small business insurance needs change as a company grows. Additional machinery purchased for a manufacturing plant or expansion to a larger facility could require an increase in property limits. Additions to an auto fleet could mean changes in a commercial auto policy or sales growth could result in the need for more business continuation coverage.

Commissioner Kobylowski reviewed the following policy options a small business owner might want to consider:

1. Workers’ Compensation. State law requires that all New Jersey employers, not covered by federal programs, have workers’ compensation coverage or be approved for self-insurance.

Typically, workers’ compensation covers the employee’s medical expenses, rehabilitation costs and lost wages if he or she is injured on the job. If an employer does not have workers’ compensation and an employee is injured on the job, the business may be liable for any medical expenses that individual incurs. The company might also face fines and penalties for noncompliance.

2. Property. Property insurance protects small business owners from losses due to damage to physical space or equipment and as a result of theft. For insurance purposes, a business’ property includes the physical building in which it resides, as well as its other assets.

All of the following, owned or leased, can be considered business property: the actual building; inventory; furniture, equipment and supplies; machinery; computers and other data processing equipment; valuable papers, books and documents; artwork and antiques; television sets, VCRs, DVD players, and satellite dishes; signs, fences and outdoor property not attached to a building; and non-tangible items, such as trademarks and copyrights.

3. Flood Insurance. Flood is not a covered peril in a standard business property insurance policy. Business owners can purchase flood coverage from the National Flood Insurance Program (NFIP), administered by FEMA. Flood insurance policies have a 30 day waiting period before going into effect. To find out more about the NFIP consumers can go to www.floodsmart.gov. If the flood insurance property limits from the NFIP are inadequate to cover a business, owners can check with an insurance agent or carrier representative about additional coverage options.

4. Ordinance or Law Coverage. This pays for rebuilding a destroyed property so that it will meet the current building codes. Older structures damaged may need upgraded electrical, heating, air conditioning and plumbing units based on current municipal codes. This covers the additional cost to upgrade due to new codes.

5. Business Interruption/Continuation. This type of insurance covers lost earnings due to a loss covered by one of the property insurance plans purchased, such as a fire or theft that shuts down a business for an extended period of time. Business interruption/continuation insurance covers expenses associated with running a business, such as payroll and utility bills, based on the company’s financial records.

Business interruption/continuation coverage can be added to a property insurance policy or purchased as part of a package insurance product.

6. Liability. This insurance product covers workplace risk, for example, if an individual falls while visiting a business premises, or a customer is hurt by a product a business sells, the business owner can be held responsible. Standard policies do not provide protection against sexual harassment, professional liability or commercial auto or truck claims.

7. Commercial auto. All motorized vehicles, whether used for personal or business purposes, need auto insurance. Automobile liability insurance – required by most states – covers medical expenses for injured persons and damages to the property of other individuals as a result of a motor vehicle accident caused by the insured’s negligence.

While the types of coverage provided by personal and commercial auto insurance policies are essentially the same, there are important distinctions. Typically, commercial auto insurance policies have higher liability limits, for example $1 million. They also may have provisions that cover rented and other non-owned vehicles, including employees’ cars driven for company business.

Several factors related to ownership and use of vehicles determine whether a personal or commercial policy is appropriate. These include: who owns or leases the vehicle –individually or the business as an entity; who drives the vehicle – owner or employees; and how the vehicle is principally used – for example, transporting people, delivering packages or carrying hazardous materials.

8. Umbrella Insurance. This coverage provides protection for an individual or business above the limits for a primary policy. It is recommended for a business with a value above its primary limits for various policies selected. It is also a smart purchase for high net worth individuals. A policy can cost relatively little for the protection it provides.

“Small business owners should discuss these insurance matters with a licensed insurance professional at an agency or carrier,” said Commissioner Kobylowski. “A life and health insurance professional should also be consulted to make sure every aspect of a small business is protected.”

Source: New Jersey Department of Banking and Insurance

According to her friends, Cynthia McGee Bryant was a religious woman who owned her own insurance agency, worked hard and didn't have enemies.

But on Monday, someone shot McGee Bryant, 53, to death inside her office at 400 W. 25th St., police said.

Few details were released by the investigators however they did not mention if the motive was robbery.

Officers received a 911 call about 12:15 p.m. and found Bryant's body a couple of minutes later at McGee Insurance and Financial Services, Police Department spokeswoman Shannon Cordingly said.

Detectives were hesitant in revealing where in the office Bryant's body was found or what part of the body she was shot in and whether anyone witnessed the crime.  They would not even say who was responsible in calling 911.

McGee Bryant's former husband, Reginald Bryant, said his ex-wife was focused on her job and on evangelical work.  She was a longtime member of Livingston Street Church of God in Orlando.

"She was a God-fearing woman," Bryant said.

McGee Bryant, who lived near Lake Mary, was from a small town in Georgia and also lived in upstate New York before moving to Central Florida to be near extended family, her ex-husband said.

She was named Allstate agent of the year in her territory in 2005 and started her own Allstate agency in Sanford in 2007, according to her website.

She started her current business in 2009.  Her business is selling personal and business insurance.  Her motto was "Integrity. Commitment.  Dedication.  Loyalty.  Respect.  Responsive."

Bishop Antonio Richardson, whom Bryant recruited a few months ago to be spiritual leader at Livingston Street Church of God, described McGee Bryant as "a very soft-spoken, giving person" who sometimes paid clients' premiums when they could not afford to, ministered to the homeless and handed out money on the street if she saw a needy person.

She as well was a licensed minister who was about to become outreach director for her congregation.

"It's a shock," Richardson said.

McGee Bryant's former mother-in-law, Edith Passmore Bryant, said she knew of no one who would want to harm her.

"I never heard her speak negatively about anyone," Passmore Bryant said. "She believed in helping people wherever she could."

Reginald Bryant said his ex-wife owned a Hummer and a Cadillac CTS and while Seminole County Sheriff's Office and Sanford police vehicles were outside the insurance office several hours after the killing, and a black Hummer H3 was towed.

The couple were married briefly in the mid-1990s and remained on good terms, he said. They had no children.

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Connecticut learns less is more with state health insurance website

Tuesday, November 12, statistics put out by Connecticut demonstrate that its website is the only one to sign up more folks for private insurance than for Medicaid.

Angel Medina, 21, went to talk to an Affordable Health Care act navigator in Hartford. Medina was dropped from his mother's health insurance two years ago.

"I have really bad eyes. I like to get them checked often, but since I don't have health insurance, no doctor's going to really want to take a look at me," he said.

He found out that he may qualify for Medicaid, which was long-drawn-out under Obamacare.

So far, 9,123 have enrolled over Connecticut's ultimate goal is to sign up 275,000 people.

Kevin Counihan, chief executive officer of Connecticut's health exchange, says he's not discouraged by the number of people signing up for private health insurance.

"Buying health insurance is expensive and it's expensive and it's confusing and it's complicated. So no, I am not disappointed by it. However, we clearly have a strong goal to meet by March," he said.

Counihan look forward to have 100,000 people enrolled by the end of March.  He credits the state's computer system with the smooth even out.

"Number one is, less is more. Do fewer things well than try to do more things inconsistently. Two is test the heck out of the system and make sure that before you go live, you are pretty darn confident that you know what is going to happen. And three is hire the best people that you can," he said.

Counihan was implicated with Massachusetts' health insurance rollout in 2006.  He says that taught him people don't buy insurance like they do a book or car.  They usually consider the options an average of 18n times before making up their minds.

He foresees a sprint of people signing up between Thanksgiving and Dec. 15, which in case is the deadline for coverage beginning on Jan. 1.

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