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Understanding Advance Directives

Published: December 29, 2022

Advance Directives are legal documents that guide medical and health care decisions in the event that a person becomes incapacitated and is unable to make their own decisions.

Advance directives, sometimes called “living wills,” protect individuals if they are unable to make decisions regarding their health or end-of-life care.

There are many reasons why an adult may be unable to make their own medical and health care decisions. Disease processes such as Dementia or Alzheimer’s affect one’s ability to comprehend and make informed and independent decisions. Traumatic accidents or unexpected illnesses can lead to a comatose state or affect the brain’s ability to function. In both cases, you wouldn’t be able to be involved in decisions regarding your care. Even those who have lived a long and healthy life may find themselves unable to communicate effectively or comprehend during their final hours of life. In all of these instances, an advance directive is crucial to ensure that your wishes are respected and that you only receive the life-sustaining measures and the level of treatment you prefer. A life-threatening illness or accident can occur at any age, so everyone over the age of 18 should have an advance directive.

Parts of an Advance Directive

There are two main parts to an advanced directive. These either dictate specific health care instructions or appoint another individual to make the decisions on your behalf if needed. Both elements are equally important to have in place.

Living will

A living will is a legal document that states what medical care, treatments, or life-sustaining measures you would or would not want if in a vegetative state or terminal condition. A terminal condition is the advanced stage of an irreversible or incurable medical condition that will result in death despite continued medical treatment.

Resuscitation status is one of the most addressed instructions in a living will. This allows the individual to specify if they would like to be resuscitated or be a DNR (Do Not Resuscitate). They can also specify what means of resuscitation are okay. For example, someone may want CPR performed, but they do not wish to be mechanically ventilated. Other common instructions provided in a living will include measures such as blood transfusions, tube feedings, surgical interventions, and organ donation.

Health Care Power of Attorney or Health Surrogate Designation

A power of attorney, or health care proxy, is a legal document. This document allows you to designate a trusted individual, to make decisions on your behalf.

A power of attorney has more decision-making power than a living will. Typically, a living will only applies to the end of life or terminal conditions. A power of attorney can be used if an individual can no longer make informed decisions by themselves, regardless of their medical state. The individual you appoint as power of attorney can make decisions regarding medications, procedures, diagnostic exams, surgical interventions, long-term care management, end-of-life care matters, and more.

Most people appoint their spouse or child as a power of attorney. However, anyone, relative or not, can be appointed. The most important aspect of choosing this individual is trust. Choosing someone who respects your wishes and always keeps your best interest in mind when making decisions is imperative.

Creating (or updating) Advance Directives

There are many factors to consider, whether you need to create a new advanced directive or have an existing one. Something to keep in mind is that advance directives do not expire. Because of this, it is a good idea to review your advance directive every few years. This will help ensure that your wishes have not changed over time and that your health care proxy is still willing and capable of making decisions. Updates can be made to existing advance directives, or new ones can be implemented.

It’s also important to note that different legal factors can affect the validity of advance directives. For example, advance directives vary from state to state. This can be confusing because your state’s directive may not be valid in another state. When creating your advanced directive, it is extremely important to understand critical details. We highly recommend that you seek legal guidance from an estate planning or elder law attorney when doing so.

We hope you found this article helpful. If you have questions or would like to discuss your legal matters, please do not hesitate to contact our office at 215-364-1111 to schedule a consultation.

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It can be quite confusing to determine which Medicare plan is best for you. There are several types of plans, and each has its own advantages and disadvantages. Understanding some basic features will help you decide how to maximize your healthcare dollars and choices. You should review your choice periodically, especially as elements of the Inflation Reduction Act of 2022 change prescription medication and vaccine policies. Coverage can also change from year to year..

There are three basic types of plans:

  1. Original Medicare
  2. Medicare Advantage
  3. Medigap

Original Medicare

Medicare is a government health insurance plan for people 65 and older. Original Medicare, sometimes called traditional Medicare, comes in several parts. Each part covers different things and has various associated costs. 

Most people do not pay for Part A as it was deducted from their taxes paid while working. It is primarily for hospital visits and nursing care. However, there are many fees associated with being in a hospital that Medicare does not cover, which you still might have to pay out of pocket.

Part B requires monthly premiums, which can be deducted from your social security. You can elect to enroll in part B through Original Medicare. It covers a portion of doctors' visits, durable medical goods, and more. 

Part D covers the cost of many prescription medications. You can add it to Original Medicare or purchase it as part of a Medicare Advantage plan.

Medicare Advantage

Medicare Advantage is offered through private insurance companies that Medicare approves. Most plans include Parts A, B, and D of Original Medicare with some variations from the original. There are a wide variety of Medicare Advantage plans, including Preferred Provider Organizations (PPO) or Health Maintenance Organizations (HMO). PPOs tend to have higher premiums and offer more choices than HMOs. Medicare Advantage HMOs and PPOs often have higher premiums than traditional Medicare because they usually cover more expenses, including prescription drug costs, vision, hearing, and dental.

However, the overall costs, premiums, plus out-of-pocket expenses for Advantage plans can be lower than Original Medicare because the private insurers manage patient care and limit choices. They assemble networks of hospitals and physicians to control their costs and reduce their customer's premiums. They also restrict access to certain providers and increase the cost of care obtained out-of-network.

Traditional Medicare allows people to seek care from any provider participating in Medicare, which includes virtually all hospitals and physicians.

Medigap

Medigap is a co-insurance or supplement to Original Medicare. You can enroll when you first enroll in Part B. It is also available through Medicaid, a union, or a former employer when you qualify for both programs. You can’t have both Medicare Advantage and Medigap plans. Medigap helps cover expenses that Original Medicare does not cover, such as co-pays and deductibles. Due to the enrollment restrictions, you should strongly consider Medigap when you first become eligible.

The Right Choice for You

With all the different plans, parts, choices, and restrictions, it is crucial to consider your priorities for care. Limited access to doctors and hospitals may become important if you need specialized medical care, such as cancer treatment. Before enrolling, consider what specialty hospitals are included in Advantage plans. Likewise, Advantage plans can make it difficult to see a specialist for ongoing and chronic conditions due to limitations in long-term care services. An estate planning lawyer or elder law attorney can help address long-term care planning and the potential to qualify for Medicaid when necessary.

The Kaiser Family Foundation has put together a cost analysis to help you determine when Medicare Advantage would save you money. As you can see, the longer you stay in the hospital, the less advantageous an Advantage plan becomes.

Consumer Reports notes that the JAMA reported that seniors on Advantage plans often get more preventive care than those on traditional Medicare plans. JAMA published a comprehensive paper about how Medicare plan choice affects spending and discovered that Medicare Advantage enrollees usually spend less.

Consumer Reports notes that the JAMA reported that seniors on Advantage plans often get more preventive care than those on traditional Medicare plans. JAMA published a comprehensive paper about how Medicare plan choice affects spending and discovered that Medicare Advantage enrollees usually spend less.

A Guide in Choices after 65

Enrolling in the right Medicare coverage is one of many decisions that will affect your quality of life in your senior years. We are here to help you navigate a wide variety of choices.

If you have questions or would like to discuss your legal matters, please do not hesitate to contact our office at 215-364-1111 to schedule a consultation.

- Medigap, Medicare Advantage, and Traditional Medicare

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CLIENT Testimonial

Scott explained estate planning very thoroughly and in terms we could understand. He let us know our options and we feel that he is very knowledgeable, professional and also a compassionate person. We recommend Scott to our family and friends!
- Fred T., Willow Grove, Pennsylvania

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