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Identify Sources of Financial Help

Are concerns about money making it hard for you and your loved one to focus on more important matters, such as managing pain and living the final chapter of life as fully as possible? If so, there's information on this Web site that can help. It is written specifically for people with end-of-life financial issues. Reviewing this material on your own or with your loved one may provide answers to some of biggest financial questions your loved one—and you as caregiver and as spouse, relative, or friend—may have. As you review this information, it may give you some ideas for steps to take in your own financial planning when you're ready for that.

The biggest sources of end-of-life financial help, particularly as sources of payment for hospice, are private health insurance and government programs like Medicare. But where can people in end-of-life situations turn for more help if they need it to take care of their family and pay bills and expenses? First, take a look at your loved one's financial assets, the ones listed on the Financial Inventory Worksheet [PDF].  He or she may be able to get help from:

Health Insurance

If your company’s health insurance plan offers hospice benefits, you will be able to use those benefits for the rest of your life—or until you reach the plan’s hospice benefit limit. If your plan does not offer hospice benefits, you still may want to keep coverage in that plan as long as possible, both for you and family members. First, check to see if your plan has a "disability extension of benefits." This means that, even though you are no longer covered by the plan generally, your illness may continue to be covered.

If there is no disability extension, take advantage of the Family and Medical Leave Act (FMLA) if you can. All companies with 50 or more employees are required to offer FMLA. This law gives you the right to take up to 12 weeks of unpaid leave and stay on your employer's healthcare plan during your leave. You will have to continue to pay your portion of the premium. After your leave is used up, you may be able to extend insurance coverage further through the Consolidated Omnibus Budget Reconciliation Act (COBRA).

COBRA lets you and covered family members keep health insurance for a period ranging from 18 to 36 months. Companies with 20 or more employees are required to offer COBRA. Your employer must tell you how to take advantage of COBRA if it’s available. Your cost will go up because you probably will have to pay the full premium, including the amount once paid by your employer, but your coverage will be the same as current workers. Family members covered by your plan can decide separately to take COBRA.

There is a program similar to COBRA for federal government workers called Temporary Continuation of Coverage (TCC). Ask your personnel office about this program and request a copy of Temporary Continuation of Coverage Under the Federal Employees Health Benefits Program, Pamphlet RI 79-27. What if your COBRA coverage runs out or you can’t get it because your company doesn’t have to offer COBRA benefits? Check out Health insurance through your state and If you don’t have health insurance.

Health Insurance Through Your State

Your state may have health insurance laws that give people better ways to continue health insurance coverage than private insurance. To find out about your state's programs, go to the Kaiser Family Foundation http://www.kff.org
web site and click your state on the map. You also can check with your state insurance department. For a state-by-state listing, visit the National Association of Insurance Commissioners (NAIC) web site http://www.naic.org or call the NAIC Help Desk at 816/783-8500.

If You Don’t Have Health Insurance

Here are some programs to check out if you don't have health insurance:

• Medicare can pay 100 percent of your hospice costs and a portion of other medical costs if you are disabled or age 65 or older.
• Medicaid can pay 100 percent of your hospice costs, plus your Medicare premiums, deductibles, coinsurance and some costs Medicare does not cover if you have low income and limited assets.
• Free health clinics in your community can provide some medical services.
• Many hospices provide care to people regardless of their ability to pay. Contact the HelpLine at 800/658-8898 for a list of hospices in your area.

Health Savings Accounts

If you have been contributing to a health savings account, you can withdraw money tax free to pay your "qualified medical expenses" or those of a spouse or dependent children. These expenses include medical care and services, dental and vision care and over-the-counter drugs. You may be able to pay medical insurance costs as well, such as COBRA premiums and Medicare premiums, deductibles, co-pays and coinsurance. The U.S. Treasury Department web site has information about health savings accounts, including answers to frequently asked questions.