SENIOR ARTICLE – Difference Between A Certified Nursing Assistant (CNA & a Caregiver)

Working with so many seniors & military veterans one of many questions asked is: What is the Difference Between a CNA & a Caregiver. Below is a brief explanation:

Basic Duties: Certified nursing assistants, called CNAs and Caregivers are often employed in home health care. Both are eligible to work as aides in hospitals, clinics, and assisted living facilities and Personal Care Homes.

CNAs: A certified nursing assistant is formally trained within a State-Approved educational facility and trained with at least 75 hours. Candidates must take an examination of competency to earn the title of CNA. CAN candidates also commonly have a criminal background check before certification. Graduates of CNA programs can work in the facilities (mentioned above) and can help a patient with the following: Help with bathing, dressing, transferring from bed to walker or wheelchair and oversee the patient take their medication (CNAs cannot administer or fill the medication box but watch the patient take their required medication only). CNAs can also help with cooking, cleaning, laundry, running errands and drive the patient (in the patient’s vehicle) to doctor appointments.

CNAs are usually working with a Caregiver Agency that employees them to be assigned to a patient, either in facilities or in the clients’ personal home. CNAs, if working in a hospital, may have a different job title, such as technician. Duties can include taking vital signs, caring for catheters, transporting patients, or help with discharging patients.

Caregiver: Caregivers provide assistance to the disabled or an elderly with day-to-day functions as helping with laundry, driving, paying bills, help the patient to eat or prepare meals. Many Caregivers are asked by the family to be a “companion” only….meaning, be at their bedside and read to them, or write letters for the patient or just be there to chat. Some Caregivers are employed as live-in companion, with room & board provided by the patient or patient’s family. A Caregiver that is NOT providing medical services needs no formal state-license as they are being more of a companion.

*Information provided by:
Brenda Dever-Armstrong, CEO/Owner/CSA
The Next Horizon Seniors & Military Advocate/Resources/Locator

SENIOR ARTICLE – January 2020

(You have rights and you have options. Be aware of them)

Medical expenses were a contributing factor for those that could not pay their medical bills or filed bankruptcy according to the American Journal of Public Health. The National Council on Aging surveyed social service professionals about their clients’ debt, more than half said medical debt was the biggest problem facing older Americans.

You may not be able to avoid medical debt, but you can navigate it better – Here are Five things to know:

  • Initially you have more leeway. Most medical debt is held by hospitals and doctors, whose practices are not structured that you are charged “interest.” Hospitals don’t charge “late fees.” This gives you time to figure out how to manage the debt. Also, when missed payments on a credit card can affect your credit score, the three major credit reporting agencies – don’t report medical debt that is less than six months overdue. They also remove from your record medical debts that are later paid by insurance.
  • Hospitals can reduce your burden. If you owe money to a hospital, ask if you can qualify for help paying it off. Under IRS rules, nonprofit hospitals must have charity care and financial assistance polices in place to help low-income folks. (Definitions of “low-income” can vary). Both profit and nonprofit hospitals offer financial assistance to people with income up to 300 or 400 percent of the federal poverty line (income up to $37,000 or $50,000 for one person, and $51,000 or $68,000 for a couple). If your hospital or doctor doesn’t have a program to help pay off your debt, talk your situation through with them. Many agree to a payment plan! Prevent the debt going into a collection agency. As long as you communicate and show good faith in managing the debt, they will help keep your debt in-house.
  • Replacing debt with debt could make things worse. Do Not Take Out a Home Equity Loan or Reverse Mortgage to pay off a medical debt – that puts your home at risk unnecessarily. Do not put your medical debt on a regular credit card or on a medical credit card because once the debt is on a credit card, you lose the ability to negotiate with your doctors or hospital on repayment. If your income is low enough, you might qualify for Medicaid and you may be able to get retroactive coverage from Medicaid for recent bills.
  • Collectors have to follow rules. Once a provider decides you cannot or not likely to pay what is due, they may have a Debt Collector take over. Under the Federal Fair Debt Collection Practices Act (FDCPA), collectors can’t “harass, oppress or abuse” you in connection with collecting a debt. But, Collectors can go to court to collect the debt. If they win, they can garnish part of your wages, but your Social Security and VA benefits are protected! State laws set a “time limit” three to six years, for them to file suit, but making a small good faith payment may extend that window.
  • You may not owe anything. If debt collectors call you regarding your medical debt, don’t assume their info. Is correct. Under the FDCPA, you have 30 days after a collector contacts you to ask for proof that actually owe the amount demanded. Medical debts can be bundled and sold multiple times to different collectors and mistakes are not uncommon.

Hopefully, these Five Steps will be helpful. After doing my research on this topic, the AARP Bulletin provided some of these guidelines.

Brenda Dever-Armstrong, CEO/Owner
The Next Horizon Seniors & Military Advocate/Resources

SENIOR ARTICLE – October 2019


There are many changes in Medicare 2020. These changes will impact all current & future Medicare beneficiaries. Below are the changes to keep your informed.

Medicare Changes in 2020: Starting in 2020, there will be no more first-dollar coverage plans available to those who are considered Medicare eligible after 2020. First-dollar coverage plans are Medicare Supplement Plans that leave you with zero out of pocket costs. The Medicare Part B premium will also increase.

The Three Medicare Supplement Plans considered first-dollar coverage plans are:
Plan C
Plan F
High Deductible Plan F

Why First-Dollar Coverage Plans are Being Discontinued: The reasons is some members of Congress believing Medicare beneficiaries are over-using healthcare services. With no out of pocket costs, playing it safe was priceless. By making everyone meet the Medicare Part B deductible, legislators hope to prevent beneficiaries from running to the doctor for every minor ailment. Lots of debate on this issue!

How Medicare Changes in 2020 Will Impact Beneficiaries: These changes will Only impact beneficiaries who are NOT considered “Medicare-eligible until after 2020. As long as you turned 65 prior to 1 January, 2020, you can continue to enroll in these First-Dollar coverage plans after they have been discontinued. These are being discontinued to those who are not considered Medicare Eligible until AFTER 2020. For those enrolled in a First-Dollar coverage plan, you are “GRANDFATHERED” in. You DO NOT need to make any changes to your coverage unless you are simple comparing benefits and/or rates to see if there is a better plan for you – such as: health needs have increased or less health care than previously needed. Again, as long as you are Medicare-eligible BEFORE 2020, you can still sign up for the First-Dollar coverage plan after they’re discontinued!

For Those “Medicare-Eligible” After 2020: For beneficiaries that are NOT eligible for Medicare until after 2020, you still have alternatives that will keep yours out of pocket costs LOW! The only different between the alternative plans listed below and First-Dollar coverage plans is the Part B Deductible, which is $185 as of 2019.

Alternatives to First-Dollar Coverage Plans: One alternative to Plan C is Plan N. Plan N is considered a cost-sharing plan. You pay a Co-pay of up to $20 for doctor visits and up to $50 in the emergency room. One good thing about Plan N is if you go to Urgent Care, vs your primary care physician or emergency room, there is NO Co-Pay!

Another Alternative to Plan C is Plan D. Plan D offers the same protection as Plan C, with the Exception of covering the Part B deductible. If you do not want the Co-Pays that come with Plan N, then Plan D is the way to go. Neither Plan D or Plan N covers excess charges. If you want coverage for Excess charges, you would go with Plan G. An Alternative to Plan F is Plan G. Aside from the Part B deductible, Plan G is the exact same plan like Plan F. Plan G is a good bet!! If you want the fullest possible coverage. Once you meet the annual Part B deductible, you should not have any further expenses for services covered by Medicare. Plan N is a good choice if you’re looking to same money on Premiums, pay a small Co-Pay, and are not concerned about excess charges. EXCESS CHARGES AREN’T ALLOWED in some states, and even where permitted, not all providers charge them. In fact, only 3% of providers charge excess charges.

Projected Medicare Premiums for 2020: As of now, it looks like the 2020 Medicare Part B premium will be $144.30. That’s an increase of $8.80 from 2019. The Part B deductible is projected to increase from $185 to $197 in 2020. The Part A deductible is projected to increase from $1,364 to $1,410 in 2020.

Veterans/Spouses: Tricare For Life is Medicare wraparound coverage for Tricare beneficiaries. You are eligible for Tricare For Life if you are entitled to Medicare Part A & Part B, regardless of your age…in other overseas locations, Tricare For Life is the primary payer. Remember: Tricare For Life pays AFTER Medicare and OHI for Tricare-covered health care services.

Speak to a Licensed Agent Today: Official today, 15 October is the Open Enrollment Period until 7 December 2019.

Still confused? I highly suggest going to and/or call your current agent or a Medicare Specialist. If anyone needs a Medicare Specialist, feel free to contact me and I will refer some Medicare Specialists for you to contact. No cost – and will help you with your current health care needs. Plan for 2020 – DO NOT WAIT… Also, contact Alamo Area Council of Governments (AACOG) as they have trained specialist who can assist.

*article from Medicare – General Information
Brenda Dever-Armstrong, CEO/CSA
The Next Horizon Seniors & Military Advocate/Resources
Bus. Ph: 210-275-3002

Medicaid Versus Medicare: Who Covers Nursing Home Costs?

When I meet with potential clients & my veterans, one of the questions asked often is: Who covers nursing home costs? Medicare or Medicaid (we help to qualify for Medicaid). Because staying in a nursing home may be covered by either Medicare or Medicaid, it can be confusing to determine which program will over your family member’s length of stay. There are some important differences.

The person must:
Have been hospitalized for medically necessary “inpatient” hospital care for at least three consecutive days, not counting the date of discharge.

Be admitted to the nursing home within 30 days after date of discharge from the hospital.

Require skilled nursing or rehab care on a daily basis for a condition for which the patient was hospitalized, and receiving a physician’s order that care us needed.

Skilled care is care that can only be administered by professional (physician or nurse) or technical personnel, and which will prevent further deterioration in the patient’s health. Examples include: intravenous feeding, injections, insertion of catheters, application of sterile dressings, treatment of skin ulcers, and therapeutic exercises of various kinds (physical therapy). Less medically-intensive and critical personal care services- even if performed by a nurse-are not considered skilled care.
If the care the patient requires is not considered “skilled care” as defined above, “it is called “custodial nursing home care.” This is a type of long-term care which is typically received in a nursing home. Only Medicaid – NOT Medicare-covers “custodial nursing home care.”

Medicare will only cover a patient for a maximum of 100 days (per separate spell of illness) – if it covers the patient at all! During days 1-20, Medicare will cover the “entire” cost of the nursing home stay. For days 21-100, the patient must pay a co-pay, which is currently set at $161 per day. If care is needed beyond the 100 day limit – or if the patient is no longer needing skilled or rehab care “before” 100 days have passed – then the patient either pay privately, be covered by some form of insurance or qualify for Medicaid.

Medicaid is a “need-based” program, meaning that the patient cannot have more than a certain minimal amount of assets and income in order to be covered. Medicare, on the other hand, is available regardless of the patient’s income or assets. If they meet the other assets, if they meet the other requirements listed above. Also, there is no mandate that a patient require skilled or rehab care in order to be covered by Medicaid, as there is for Medicare.

Finally, keep in mind that it is possible to be covered by Medicare and Medicaid, simultaneously. Such individuals are known as “dual Eligibility” which means Medicaid covers those expenses not covered by Medicare. Example: Such as paying medicare premiums and cost-sharing requirements and light custodial care.

If you have questions regarding if you can qualify for Medicaid (good program!), contact me any time. Ph: 210-275-3002……

Brenda Dever-Armstrong, CEO/CSA/Owner
The Next Horizon Seniors & Military Advocate/Resources/Placement