Health Insurance For Multiple Sclerosis

Insurance
 
BECAUSE GOVERNMENT CASH benefits are so unreliable and insubstantial, persons with disabilities are well advised to devise alternative methods for financing costs attributed to their own disabilities and illnesses. Given the potential enormity of liability, insurance is a logical alternative to direct financing of the potential liabilities.
 

Health Insurance For Multiple Sclerosis

Insurance takes the shape of a counter intuitive form of investment: you pay for something you hope you will never need to use. Because of the gloom inherent in these arrangements, some people hesitate to invest adequately in insurance coverage. This view, however, is risky wishful thinking unless you are very wealthy. 

Although you may never have enough dollars to pay for the potential devastating consequences of disability on your own, you can at least minimize the risks by insuring against them. Insurance is essentially a means of transferring financial risk to an outside party. Rather than risk all the consequences of disability, you instead pay a premium and transfer some of the risk to an insurance company.
 
As the probability increases of that risk coming to fruition, the cost to the insurance company increases correspondingly. Thus, the types of insurance that are most important to a disabled person are, unfortunately, precisely the types of insurance that become more difficult to obtain following the diagnosis of a significant medical condition (e.g., MS). The types of insurance that are directly affected by health conditions that the insurance industry considers serious enough to be "ratable" (i.e., to warrant a higher risk assessment) usually include:

• Life insurance.
• Health insurance.
• Disability insurance. 
• Long-term care insurance. 
• Disability-based insurance, such as: 
• Mortgage insurance. 
• Business overhead insurance. 
• Disability buy-sell insurance. 
• Key-person disability insurance. 

Of course, the limited availability of insurance does not decrease the need for it. For example, life insurance has traditionally been purchased to take care of needs such as maintenance of dependents following the death of a breadwinner, payment of liabilities, payment for college expenses, and payment for extraordinary needs. These needs remain just as important - if not more important - for a disabled individual.
 
Life insurance
 
Life insurance is essentially a pot of money available when we die. However, the life insurance contract itself has value even while the owner is still alive, because it represents guaranteed payment in the future of the proceeds of the policy. It is also possible, therefore, to view life insurance as a pot of money that is available during life for extraordinary needs, or as a substitute for some disability related insurance products (e.g., mortgage insurance). 

For example, a person who knows that he or she is going to die can convert existing life insurance into current money. Unfortunately, life insurance cannot normally be used in this manner by persons with MS because it is not considered a terminal disease. However, a well-spouse diagnosed with terminal cancer might want to make use of life insurance benefits in this way in order to generate needed funds more quickly. An attorney who specializes in elder law can provide information about the procedures involved and draw up the necessary contract with the viatical company offering this financial arrangement.

Another alternative is to use whole life insurance in place of term life, and then take out policy loans against the cash value of the whole life policy for extraordinary needs. Term life insurance (a form of life insurance that provides a fixed amount of money if the person dies within the stated term of the policy but has no additional investment value) is the insurance typically offered by employers. Whole life insurance (a form of investment that not only provides insurance but also accumulates cash value) is typically purchased privately by individuals. Assuming that you are able to obtain enough whole life insurance, you may be able to borrow enough against its value to defray the costs attributable to disability during your lifetime.
 

There are a number of ways that persons with a diagnosis of MS can obtain life insurance despite diagnosis. One way is to convert existing individual term life policies to whole life. Another way is to obtain as many group memberships as possible in associations that offer "guaranteed issue" life insurance (and then convert this to whole or universal life if offered). Also, a person with MS should accept as much employment-based life insurance as is available, and convert this insurance to whole life insurance if that option is available upon leaving employment. To find out more, you can check out Health Insurance For Multiple Sclerosis.
 

Government Assistance For Multiple Sclerosis

You should have a protection plan for every member of your family, tailored for that family member's situation. Those plans will differ, depending on whether the disabled family member is the primary breadwinner, the supporting spouse or caretaker, or a child or other dependent. This is because the risks that matter, and the degree to which those risks jeopardize the accumulation of wealth, vary greatly, depending on the life circumstances of each individual. The important thing to remember is that even the lack of a formal protection plan is a protection plan, albeit an inadequate one that provides no insurance and no strategies for avoiding risks.
 

Government Assistance For Multiple Sclerosis

Regardless of actual costs, a family would need to be quite wealthy to rely exclusively on family dollars to finance the long term expenses of the worst-case scenario. For this reason, it is absolutely essential for most families to create an estate plan that will ensure eligibility for government benefits. On the other hand, because government benefits are notoriously unreliable, a family should also make every effort to create an estate plan that relies on private dollars (including insurance dollars). 

Government benefits may only be awarded after a lengthy or costly legal battle; they are subject to legislative change (and so are difficult to plan for); and rules for eligibility may be narrowed or changed administratively as government policies or resources change. For example, a little-known provision of the Health Insurance Portability and Accountability Act of 1996 has made it a criminal offense (punishable by fines of up to $10,000 and jail sentences of up to 1 year) to apply for Medicaid during the disqualification period that follows any transfer of assets from one individual to another (for the purpose of achieving Medicaid eligibility). 

Thus, no application can be filed for Medicaid during the 36-month waiting period (60 months if a trust is involved) following the transfer of assets. This unfortunate provision, if allowed to remain, could seriously affect all elderly or seriously disabled individuals who look to Medicaid to cover the cost of nursing home services.

Government Benefits 

WITH THOSE LIMITATIONS in mind, many people who have disabilities are eligible for benefits under one or more of several government programs. The design of the programs is generally to protect persons with disabilities by making sure that they have sufficient resources to provide the basic necessities of life, including food, clothing, shelter, and healthcare. The programs can be grouped into two categories: those based on financial need (i.e., Supplemental Security Income [SSI] and Medicaid), and those classified as social insurance programs (i.e., Social Security [SSDI] and Medicare). 

The former are available to individuals with disabilities who satisfy certain financial restrictions. The latter are potentially available regardless of financial assets, and are based on the premiums that have been paid into the program during the person's years of employment.

Unfortunately, the rules relating to these programs are very complicated and constantly in flux. Generally, however, in order to qualify for benefits as a person with a disability, a person must be considered to have a "disability" within the meaning of the particular government program. Under the rules of the Social Security Administration (SSA), which are used by most government agencies, a person is considered to have a disability if he or she is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment that can be expected to result in death or that can be expected to last for a continuous period of at least 12 months.

To SSA, a job constitutes "substantial gainful activity" if the pay is $500 or more per month, after deducting the cost of impairment-related work expenses. The rules are less strict for people who have visual impairments. To find out more, you can check out Government Assistance For Multiple Sclerosis.

Financial Planning Multiple Sclerosis

Financial Planning
 
FINANCIAL PLANNING IS the methodical process of evaluating your total assets, liabilities, and future income potential, and then using that information to determine your best options for meeting future needs and wants. Plans should be made as soon as possible for the family members or friends who provide support, as well as the person who has MS. The plans should then be revised periodically or as new circumstances dictate. The planning process may include the assessment of a myriad of financial options, including insurance, annuities, pensions, home equity, and availability of government benefits. Certified financial planners and lawyers may be valuable in sorting through the options and identifying the possible legal and tax consequences of various choices and choice combinations.

Financial Planning Multiple Sclerosis

The normal process of financial planning requires a sequential series of steps, including:

1. Determining your financial situation.
2. Setting goals.
3. Developing a plan. 
4. Keeping simple records. 
5. Making an informal budget. 
6. Dealing with shortfalls, credit, and debt. 
7. Reviewing your progress. 

However, financial planning for families with members who have a disability is fundamentally different. Families with a member who has a disability that could become severe enough to require long-term services cannot normally be expected to earn enough to meet their own financial needs. Therefore, these families must develop alternative financial (and estate) plans that explicitly incorporate available government benefits. The resources required for long-term services are significantly lower if the person with a disability stays at home, has a disability that is less severe, and requires less assistance or supervision.
 
Safeguarding Your Family from Extraordinary Costs 

IT IS IMPERATIVE in constructing a financial plan that you not only develop your assets, but also safeguard yourself and your family from the potential extraordinary costs of the unpredictable illness. When you are planning for such risk, the sensible approach is to assume that the worst will happen, and assess your position should that occur. Unfortunately, when we become ill, the messages we receive from some of our most trusted loved ones and advisers cause us to do just the opposite. 

Encouraged to be optimistic and hope for the best, we often neglect necessary planning. One should never plan for the best. Such a strategy is doomed to fail in all but the most ideal and infrequent circumstances. From a strict planning perspective, planning for the worst should adequately prepare you for whatever awful surprises may come your way, and leave you pleasantly surprised about how prepared you were if something less than the worst occurs.
 
For example, if you are the primary breadwinner in your family and you become disabled, you may jeopardize the continuation of your family's entire health insurance package. And, while you are laid up, you somehow have to provide income replacement for the time you are not working, including finding income supplements for additional expenses attributable to any disability you may incur. You may find it difficult or impossible at that point to increase your life insurance to provide ample financial security for your loved ones. 

And, even upon returning to work (assuming that you are able to do so, and that you are able to obtain adequate health insurance coverage from your employer), you may find that you are less productive than you were previously, and therefore less able to garner the same income. All of these possibilities are daunting, to say the least. If you planned for all of them, you might be able to salvage whatever lifestyle you had before your disability occurred. If you adequately planned for none or only some of them, a significant, long-term disability would markedly reduce the quality of life for yourself and your family members.
 

So, the question in this circumstance becomes how can someone deal with the financial risks attributable to ill health while maintaining an adequate earnings and savings strategy? The answer lies mostly in devising a strategy of protection planning for the risk of ill health. The object of protection planning is to find ways to reduce those risks, to make yourself and your loved ones as "bullet-proof" as possible, given whatever unpleasant surprises your MS or other health conditions might bring your way. To find out more, you can check out Financial Planning Multiple Sclerosis.

Decision Making Multiple Sclerosis

Advance Directives 

ADVANCE DIRECTIVES ARE written documents in which competent persons state their anticipated medical decisions for the future. Directives can be communicated in one of two ways: (1) by making express written directives to healthcare providers, as in a living will, or (2) by designating another person who knows and would be sympathetic to your desires when the time for decision making arrived, if you were too incapacitated to make your wishes known. This second form of advance directive is known as a health care proxy or power of attorney for healthcare decision-making.
 

Decision Making Multiple Sclerosis

Although the living will and healthcare proxy are both advance directives, many standardized forms for directives only incorporate one of these two types (usually only a limited living will). No matter which standardized form you may be offered, a complete set of advance directives should include both a living will and a healthcare proxy.
 
The basic distinction between a living will and a healthcare proxy is the type of directive involved. A living will establishes certain treatment guidelines that are to be followed in the future. A healthcare proxy does not establish treatment guidelines directly. Rather, it appoints a trusted person to act as your agent (proxy) in making healthcare decisions for you if you have become too incapacitated to make them yourself. A healthcare proxy can incorporate provisions of a living will by requiring that the proxy follow any directives stated in a separate living will, or by incorporating the living will directly into the healthcare proxy (in which case, the authority of the chosen proxy would be limited by the living will conditions stated in the healthcare proxy). 

Because it is almost impossible to predict all circumstances that might arise during any future illness, it would be difficult to place all advance directives in a living will. A healthcare proxy in conjunction with a living will is necessary to safe-guard your right to self-determination. Consequently, a good set advance directives will include both a living will and a healthcare proxy.

If you become incapacitated without leaving any specific directives, your family members will generally be considered suitable substitute decision-makers. In theory, most courts agree that family members are the appropriate decision-makers, even in the absence of a proxy. In practice, however, family member decisions that are made without an enforceable healthcare proxy are not followed by healthcare providers if the providers question the good faith of the family members or strongly disagree with the medical decision. 

On the other hand, if an enforceable healthcare proxy specifically appoints the family member as proxy, healthcare providers must treat the decisions made by your proxy as if you had made them yourself. They would not be able to deviate from those decisions even if they happened to disagree with them. Advance directives that specifically appoint a proxy therefore provide protection against healthcare providers who would be hesitant to follow your values (as understood by your proxy) when you are incapacitated. Thus, healthcare proxies are critical devices for people who hold any values that differ substantially from those of the healthcare community.
 
Proxy vs. a Surrogate
 
IT IS ON this issue that an important legal distinction must be made between a proxy and a surrogate. A proxy implies that a person is designated in an advance directive, and is therefore someone appointed directly by the incapacitated patient. A surrogate is someone who is legally appointed outside of an advance directive. For example, if no valid healthcare proxy exists, a surrogate may be appointed to make decisions for the incapacitated patient.

A family member appointed without an enforceable advance directive is a surrogate. This surrogate may become empowered either by a legal relationship that automatically gives rise to right to make surrogate decisions (such as a family member) or by appointment as guardian by a court.

The extent to which a decision-maker can enforce decisions about the future care of a loved one will depend on whether the decision-maker was appointed by a healthcare proxy, in which case he or she is acting as proxy, or by some other process of law, in which case the person is legally understood to be a surrogate decision-maker. 

That these two types of decision-makers are regarded differently can be seen most clearly in quality- of-life determinations (e.g., the decision to remove life support because the patient's quality of life has diminished below an acceptable level). Decisions by proxies are almost invariably followed with respect to quality-of-life decisions, in keeping with an individual's right of self-determination. 

However, decisions regarding quality of life made by surrogates are examined with dose scrutiny to make sure that they conform to the incapacitated individual's desires or best interests. Again, the best way to ensure that your wishes are followed is to execute a complete set of advance directives. To find out more, you can check out Decision Making Multiple Sclerosis.

Planning For Advocates Multiple Sclerosis Patient

Life Circumstances Planning
 
TRADITIONALLY, LIFE CIRCUMSTANCES planning includes planning for housing, living arrangements, education, employment, transportation, long-term services, and other social objectives. Life circumstances planning is the most important early step because it will determine the overall setting in which the life plan will be implemented. For example, choosing to live in an isolated, rural area will certainly challenge efforts to obtain necessary personal services and transportation. Choosing any type of housing that has architectural barriers may itself impede independence and accentuate disability. On the other hand, accessible housing on reliable public transportation lines in a metropolitan area may be difficult to find as well as expensive.
 

Planning For Advocates Multiple Sclerosis Patient

Location and housing type will, in turn, dictate the price and availability of various forms of long-term services, as well as educational and employment opportunities. Moreover, the cost of almost every element of the life plan will be strongly influenced by the location and type of residence you select. The ideal housing location will allow you to take advantage of educational, community, and employment opportunities that meet your personal goals, and afford you access to all the long-term services you need (and can afford) in case of severe illness or disability.
 
Perhaps the best way to perform this life circumstances planning is to construct a letter of intent. This informal document is a way to communicate important information about yourself to individuals who might provide care for you or exercise judgment on your behalf in the future. A letter of intent encourages you to sit down and think about what you want for yourself. Although it is not legally binding, a letter of intent is a useful document. It should include information about you, your family members, other relationships, advocates, medical history and care, housing, religious values, other systems of values, final arrangements, education, daily living skills, work life, government or private benefits available, hobbies and interests, and anything else that comprises an important personal life factor.

The letter of intent serves as the core of the life circumstances planning process, and provides important information regarding necessary or available types and amounts of financial resources for both the financial and estate planning processes. Before a person with a disability begins working up a financial or estate plan, he or she is well advised to complete a thorough life circumstances plan and make decisions about housing, transportation, education, and other social circumstances.
 
Planning For Advocacy And Directives
 
BECAUSE THE PLANNING process requires preparation for the worst-case scenario, a person with a disability must squarely face the possibility of catastrophic long-term illness and disability. It is this possibility that requires consideration of the issue of legal incompetence.
 
Every competent adult has the legal right to make decisions about his or her own medical care, including the decision to accept or refuse that care. Sometimes illness interferes with a person's ability to exercise that legal right. This occurs, for example, when a person becomes too cognitively impaired to make competent decisions. As a result, the person who is judged legally incompetent can no longer carry out his or her personal wishes.
 
Unfortunately, this may occur at precisely the moment when those wishes would need to be followed because of the effects of illness. Under these circumstances, the person does not actually lose the right to make a decision; rather, the ability to carry out those wishes is lost due to legal incapacity to make the relevant decisions. To make matters even more difficult, healthcare providers need not abide by the decisions of an individual who has been judged legally incompetent if those decisions conflict with the healthcare provider's own judgment.
 

The way to enforce your wishes about medical care decisions, even in the event that you become legally incompetent to make those decisions, is to make them ahead of time and place them in a set of legally enforceable "advance directives." Doing so preserves your legal ability to carry out your wishes as stated in the advance directive, even after you are incapacitated. If you have a legally enforceable advance directive, healthcare providers must be directed by those wishes whether or not they agree with them. To find out more, you can check out Planning For Advocates Multiple Sclerosis Patient.