Monitoring Solutions for Loved Ones with Dementia

My husband, who lives at home, has dementia and I worry about him wandering off and not being able to get back. Can you recommend some monitoring technology devices or any other solutions that can help me keep tabs on him?

This is a concern for millions of Americans caring for a loved one with dementia at home. According to the Alzheimer's Association, about 60% of people who suffer from dementia wander at some point.

For caregivers, this can be frightening because many of those who wander end up confused and lost, even in their own neighborhood. Additionally, they are unable to communicate who they are or where they live. Here are some product and service solutions that may help.

Simple Solutions

For starters, there are a number of simple home modification solutions to keep your husband from wandering away. Some solutions include adding an extra lock on the top or bottom of the exterior doors out of the line of sight or installing door alarms on the exterior doors that let you know when they are opened. Also, you should keep your car keys in a secure location if you are concerned that he will try to drive. There are a variety of product solutions in this category.

You should alert your neighbors that your husband may wander so they can keep an eye out. Have a recent picture of him on hand to show around the neighborhood or to the police if he does get lost.

Monitoring Technology

For high-tech solutions, there are a variety of wearable GPS tracking devices that can help you keep tabs on him. Some popular options to consider include AngelSense, which can be attached to clothing or worn around the waist; wristwatches like the Theora Connect or NurtureWatch; and the GPS SmartSole, which is a shoe insole tracker.

All of these types of products come with smartphone apps that would alert you if your husband were to wander beyond a pre-established safe area and would let you know where to find him if he did. These products, with the exception of the GPS SmartSole, also provide two-way voice communication and auto pickup speakerphone so you can talk to him if he wanders.

Locating Services

If the previously listed options do not work for you, there are also locating services – like the MedicAlert + Safe Return program and Vitals Aware Services – that can help you in these situations.

The MedicAlert + Safe Return program comes with a personalized ID bracelet that would have your husband's medical information engraved on it, along with his membership number and the toll-free MedicAlert emergency phone number. If he goes missing, you would call 911 and report it to the local police department who would begin a search, and then report it to MedicAlert. If a Good Samaritan or police officer were to find him, they could call the MedicAlert number to get him back home.

The Vitals Aware Service works a bit differently. This is a free app-based network system that comes with a small beacon that your husband would wear. If he did go missing, anyone in the Vitals app network community that came within 80 feet of him would receive an alert and information about him so they could contact you.

Another option that could help, depending on where you live, is a radio frequency locater service like SafetyNet and Project Lifesaver, which are offered by some local law enforcement agencies. With these services, your husband would wear a wristband that contains a radio transmitter that emits tracking signals. If he goes missing, you would contact the local authorities who would send out rescue personnel who will use their tracking equipment to locate him. Visit and to see if these services are available in your community.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.


Published January 24, 2020

'Give It Twice' Trust

A very popular option for a parent with children is called the "Give It Twice" trust. This is a trust funded when the surviving parent passes away. Part of the estate is transferred outright to children. The balance is placed in a special "Give It Twice" trust.

The trust pays income to children for a term of years—usually 20 years. The income can be divided equally among the children for that period of time. Following the selected term of years, the trust principal is then transferred to charity.

In effect, the property has been used twice—once to benefit children with income and the second time to help charity at the end of the trust.

Cindy is a surviving spouse. Her spouse, Michael, passed away four years ago. She is doing fine and combined both IRAs into one. Cindy's estate is now approximately $800,000. Her home, CDs and other property are valued at $400,000, and the combination of IRAs is also about $400,000.

She was reading online about the "Give It Twice" trust. Because Cindy is debt free and has Social Security plus pension income, she thinks that her estate, when she passes away, is likely to be fairly close to its current value. Cindy sat down with her attorney David, to discuss the possibility of creating a trust.

Cindy: "David, I was reading an article online about this special 'Give It Twice' trust. It sounds like you can give an asset once to children through the income stream and then transfer the trust property to charity."

Attorney: "Yes, Cindy, that can be done."

Cindy: "Before Michael passed away, we talked about this. We agreed to treat each of our four children equally and also provide a benefit to our favorite charity."

Attorney: "With your estate of $800,000, you have the ability to do something pretty significant for both your family and favorite charity."

Cindy: "Yes, but there is one big problem. Our three older children—Bill, Sue and Pete—do fine. They are quite financially responsible. But our youngest son Ted is very creative. He spends money like water. If we gave him one-fourth of the estate or $200,000, I am afraid he would spend that very quickly. We need to figure out a way to protect at least part of his inheritance."

Attorney: "That 'Give It Twice' plan could be very helpful. You can benefit all four children equally with an initial amount. For example, you could transfer the $400,000 to them when you pass away. That would be $100,000 per child. The other $400,000 could go to the trust. They would each receive one-fourth of that income for 20 years. That would give Ted a chance to learn to save and invest. In addition, if you transfer the IRA into that trust, you can save all that income tax because the trust is tax exempt."

Cindy: "This sounds like a great plan. When I pass away, I could transfer my IRA into the 'Give It Twice' trust and benefit my four children and my favorite charity. But how do I do that?"

Attorney: "I can write a trust that you sign. It's called an unfunded trust because there are no assets at present. Then we will contact your IRA custodian and select this charitable remainder trust as the designated beneficiary for your IRA. When you pass away, the IRA balance will be transferred to the trustee of your 'Give It Twice' trust."

Cindy: "This is very exciting. It is going to be great for my family and we will also be able to help our favorite charity after the term of years. I especially like the way that this will help Ted to learn to save and invest. Let's move forward as quickly as possible."

Food Assistance Programs Can Help Seniors in Need

I would like to find out if my 73-year-old aunt is eligible for food stamps or any other type of food assistance program. It seems that she has a difficult time affording enough food each month, and I would like to help if I can. What can you tell me?

Sadly, millions of older Americans like your aunt struggle with food costs. According to a recent study by Feeding America, 5.5 million U.S. seniors age 60 and older are food insecure. Fortunately, there are several programs that may be able to help.

SNAP Benefits

While there are millions of seniors who are eligible for food stamps, less than 40% actually take advantage of this benefit. The federal food stamp program is formally titled the Supplemental Nutrition Assistance Program (SNAP). However, your state may use a different name for the program.

For seniors to get SNAP, their net income must be under the 100% federal poverty guidelines. So, in households with at least one-person age 60 and older or disabled, the net monthly income must be less than $1,041 per month for an individual or $1,410 for a family of two. Households receiving Temporary Assistance for Needy Families (TANF) or Supplemental Security Income (SSI) are also eligible.

Net income is figured by taking gross income minus allowable deductions, which includes a standard monthly deduction, medical expenses that exceed $35 per month out-of-pocket and shelter expenses (rent or mortgage payments, taxes and utility costs) that exceed half of the household’s income.

In addition to the net income requirement, a few states also require that a senior’s assets be below $3,500, not including their home, retirement or pension plans, income from SSI or TANF and vehicle (this varies by state). Most states, however, either have much higher asset limits or do not count assets at all when determining eligibility.

An eligible applicant or an authorized representative will need to fill out a state application form, which can be completed at the local SNAP office then mailed or faxed in. In many states it can be completed online.

If eligible, benefits will be provided on a plastic card that is used like a debit card and accepted at most grocery stores. The average SNAP benefit for 60-and-older households is around $125 per month.

To learn more or apply, contact your local SNAP office. Call 800-221-5689 for contact information or visit

Other Programs

In addition to SNAP, there are other federal programs that can help low-income seniors, age 60 and older, like the Commodity Supplemental Food Program (CSFP) and the Senior Farmers’ Market Nutrition Program (SFMNP).

The CSFP (see is a program that provides supplemental food packages to seniors with income limits at or below the 130% poverty line. The SFMNP ( provides seniors coupons that can be exchanged for fresh fruits and vegetables at farmers’ markets, roadside stands and community supported agriculture programs in select locations throughout the U.S. To be eligible, annual income must be below the 185% poverty level.

There are also many Feeding America network food banks that host “Senior Grocery Programs” that provide free groceries to older adults, no strings attached. Contact your local food bank (see to find out if a program is available nearby.

In addition to food assistance programs, there are also various financial assistance programs that may help pay for medications, health care, utilities and more. To locate these programs, and learn how to apply for them, go to


Published January 17, 2020

WCCF Offers Non-Profit Board Training

In 2018, the Foundation announced that all non-profit organizations that receive any type of grant from Washington County Community Foundation would have the opportunity to complete Board of Director training in order to receive grants in 2020.  Two sessions were offered in 2019 and one session will be available in 2020.  Nonprofits that have Board members that completed the training in 2019 are to be commended for their prompt action and response!  If a nonprofit is unsure as to whether they have any board members who have gone through this training, please reach out to the Washington County Community Foundation to find out.

Members of nonprofit Board of Directors are invited to this informative, fast-paced training on March 17, 2020, presented by David Bennett.  David served as the Executive Director of the Community Foundation of Greater Fort Wayne for 22 years.  At the last session, attendees gave very positive feedback on the presentation content and style.  Several local non-profits have sent multiple board members as a way of providing cost-effective training for their board.

David formed the Community Foundation Research and Training Institute (CFRTI) in 2017.  CFRTI provides a variety of training opportunities for community foundations and nonprofit organizations, along with strategic planning facilitation and the preparation of organizational risk assessments.

David is a life-long Hoosier.  He earned his bachelor’s degree in Economics from Williams College, and a Master’s in Public Affairs from Princeton University.   He currently resides in Grabill, Indiana.  David is President-Elect of the Rotary Club of Fort Wayne and has been recognized as a Paul Harris Fellow.

The 2020 session of Board of Directors training will be March 17th beginning at 8:30 AM at the Community Learning Center at 1707 N. Shelby Street in Salem.  The training will be an all-day event and should end by 4:30 PM.  Please plan to stay for the entire session so your organization gets credit for attending. 

Beginning this year, Washington County Community Foundation will require that nonprofits that receive funding from us have at least one current board member that has completed this valuable training.  Board members will sharpen their knowledge of the most critical elements of nonprofit management.  Nonprofits  that  already have board members that attended a previous training in 2019 are encouraged to send more to this highly informative training.  Non-profits that do NOT have a Board member that has completed the training will NOT be eligible for any type of grants until this requirement is completed.  If an organization had a former Board member that attended the training and is no longer on their Board of Directors, they will to need have another Board Member attend in order to receive grants. 

A refundable fee of $100.00 is due by March 10, 2020.  Upon successful completion of the program, Washington County Community Foundation will reimburse the organization or individual.

If you should have any questions or would like to reserve a spot(s), please contact Judy or Lindsey at 812-883-7334 or

Washington County Community Foundation is a nonprofit public charity established in 1993 to serve donors, award grants, and provide leadership to improve Washington County forever


Does Medicare Cover Counseling Services?

Does Medicare cover outpatient counseling services for its beneficiaries? Since the death of my sister last year, I have struggled with depression and anxiety and would like to get some help.

Yes, Medicare covers both outpatient and inpatient mental health services to help beneficiaries with depression, anxiety and many other needs. Here is what you should know.

Outpatient Coverage

If you have original Part B Medicare, your coverage will pay 80% (after you have met your $198 Part B deductible) for a variety of counseling and mental health care services that are provided outside a hospital, like individual or group therapy, family counseling and more. Medicare also covers services for treatment of beneficiaries who struggle with alcohol and drug abuse.

You, or your supplemental insurance, are responsible for the remaining 20% coinsurance due. Medicare gives you the option of getting treatment through a variety of mental health professionals such as psychiatrists, psychologists, clinical social workers and clinical nurse specialists.

To get this coverage, you will need to choose a "participating provider" that accepts Medicare assignment, which means they accept Medicare's approved amount as full payment for a service.

If you choose a "nonparticipating provider" who accepts Medicare but does not agree to Medicare's payment rate, you may have to pay more. If you choose an "opt-out provider" that does not accept Medicare payments at all, you will be responsible for the entire cost of treatment.

To locate a mental health care professional in your area that accepts Medicare assignment, use Medicare's online Physician Compare tool. Go to and type in your ZIP code, or city and state, then type in the type of professional you want to locate, like "psychiatry" or "clinical psychologist" in the search box. You can also get this information by calling Medicare at 800-633-4227.

Inpatient Coverage

If you need mental health services in either a general or psychiatric hospital, original Medicare Part A covers this too (after you have met your $1,408 Part A deductible). Your doctor should determine which hospital setting you need. If you receive care in a psychiatric hospital, Medicare covers up to 190 days of inpatient care for your lifetime. If you use all your lifetime days but need additional care, Medicare may cover additional inpatient care at a general hospital.

Additional Coverage

In addition to the outpatient and inpatient mental health services, Medicare also covers annual depression screenings that must be done in a primary care doctor's office or clinic. Annual depression screenings are 100% covered. If you have a Medicare prescription drug plan, most medications used to treat mental health conditions are covered too.

Medicare Advantage

If you happen to get your Medicare benefits through a private Medicare Advantage plan, they must provide the same coverage as original Medicare. However, they may impose different rules and will likely require you to see an in-network provider. You will need to contact your plan directly for details.

For more information, call Medicare at 800-633-4227 and request a copy of Publication 10184 "Medicare & Your Mental Health Benefits" or you can read it online at

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.


Published January 10, 2020

Free Basketball Tickets for Students of Salem Community Schools

Due to the generosity of Stanley Colglazier and his daughter, Sara Colglazier, to the Washington County Community Foundation, students of Salem Community Schools will receive free tickets to the January 17, 2020 JV and Varsity basketball games versus the Scottsburg Warriors.  Students may enter through any door accessible to the gymnasium and will need to sign-in for entrance to the game.   Salem students are strongly encouraged to wear Salem or black and gold attire.  The tickets are available for students attending Salem Community Schools in grades K-12; however, students in elementary school are required to be accompanied by an adult.  Be sure to take advantage of these free tickets as the Lions face off against Scottsburg.  For questions regarding tickets, please call the Washington County Community Foundation at 883-7334 or SHS athletic director, Hank Weedin at 883-3904. 

Washington County Community Foundation is a nonprofit public charity established in 1993 to serve donors, award grants, and provide leadership to improve Washington County forever


How to Choose the Right Hospital for You

I need a hip replacement and want to find a good, safe hospital to have it done. What resources can you recommend for evaluating hospitals? I do not currently have a doctor.

Most people spend more time shopping for a kitchen appliance or flat-screen TV than choosing a hospital. However, selecting the right hospital can be as important as the doctor you choose. Here are some tips and resources to help you research hospitals in your area.

Hospital Shopping

While you may not always have the opportunity to choose your hospital, especially in the case of an emergency, having a planned procedure can offer you a variety of choices.

When shopping for a hospital, one of the most important criteria to consider is the strength of the department that will be treating your area of need. A facility that excels in coronary bypass surgery, for example, may not be the best choice for a hip replacement. Research shows that patients tend to have better results when they are treated in hospitals that have extensive experience with their specific condition.

In order to choose a hospital that is best for you, it is important to discuss your concerns and consider alternatives with the doctor who is treating you. Some doctors may be affiliated with several hospitals from which you can choose. If you have yet to select a doctor, finding a top hospital that has expertise with your condition can help you determine which physician to actually choose.

Another important reason to do some research is the all too frequent occurrence of hospital infections, which kill around 75,000 people in the U.S. each year. Checking the hospital’s infection rates and cleanliness procedures is also a smart move.

Free Researching Tools

There are a number of free online resources that can help you evaluate and compare hospitals in your area, including:
  • Medicare’s Hospital Compare ( Operated by the Centers for Medicare and Medicaid Services, this tool has data on more than 4,000 U.S. hospitals.
  • Why Not The Best ( This tool was created by the Commonwealth Fund, a private foundation that provides performance data on all U.S. hospitals.
  • The Leapfrog Group ( This national, not-for-profit organization grades more than 2,000 U.S. hospitals on quality and safety.
These websites use publicly available data to rate hospitals on various measures of performance, like death rates from serious conditions such as heart failure and pneumonia, frequency of hospital-acquired infections, patient satisfaction and more.

On these websites, you plug in your location to find hospitals in your area. You can then check to see how each hospital manages patients in various conditions.

Two other websites that can help you choose a good facility include U.S. News & World Report ( and Healthgrades (

U.S News & World Report is an online publication that publishes a hospital ranking in 17 medical specialties like cancer, orthopedics and urology. It also provides ratings on common procedures and conditions, such as heart bypass surgery, hip and knee replacement and COPD. They also rank hospitals regionally within states and major metro areas.

Healthgrades, which is a private, for-profit organization, provides free hospital ratings on patient safety and medical procedures and scores hospitals using a 5-star scale. They also provide comprehensive information on most U.S. doctors including their education and training, hospital affiliations, board certification, awards and recognitions, professional misconduct, disciplinary action and malpractice records, office locations and insurance plans.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.


Published January 3, 2020

SECURE Act Creates Potential IRA Beneficiary Problems


The SECURE Act was passed by Congress and signed by the President in late December. It reduces future taxes for IRA owners by increasing the age for required minimum distributions from 70½ to 72. However, to pay for the cost of this tax reduction, the taxes paid by future IRA beneficiaries (typically children) will increase.

After the owner's death, IRAs, 401(k)s and other retirement accounts are generally transferred to designated beneficiaries. Custodians of IRAs and other retirement accounts offer a form, either printed or online, to select primary and secondary beneficiaries.

Most married IRA owners select their spouse as the primary beneficiary and children as the secondary beneficiary. When the first spouse passes away, the surviving spouse usually rolls over the IRA into his or her own IRA account. Under the SECURE Act, this is permitted and the surviving spouse must start required minimum distributions (RMDs) after reaching age 72.

When a surviving spouse passes away, children are typically the IRA designated beneficiaries. For individuals without children, the designated beneficiaries are often nephews and nieces. If the IRA owner designates children, nephews, nieces or other family as beneficiaries and also allocates part of the account to a charitable beneficiary, the portion for the nonprofit is normally distributed in a lump sum. However, distributions to children, nephews, nieces and other family members must now be made within 10 years.

For IRA owners who passed away in 2019, a child was able to "stretch" the IRA payout over his or her life expectancy. Assume mother Mary owned a traditional IRA and passed away in 2019. She designated daughter Susan (age 50) as her IRA beneficiary. While the IRA payouts are taxable income, Susan could reduce taxes by taking RMDs over her life expectancy. For a child age 50, the potential distribution period was approximately 34 years. By "stretching" the traditional IRA payout over 34 years, Susan reduced her income tax and benefitted from tax-free growth within the IRA.

If Mary passes away in 2020, the SECURE Act makes Susan take all distributions within ten years. She can wait and take the full payout in the tenth year, but that will greatly increase the tax rate paid on the IRA. Most children will choose to take partial payouts each year for the ten years. With a ten-year payout, the income taxes paid by Susan will be substantially higher than the prior "stretch" plan.

Some surviving spouses have three, four or more children. If one of the children is a "creative spender," a parent may choose to set up a trust. Without the protection of a trust, this creative spender may take the full IRA payout, send a huge tax payment to the IRS and quickly exhaust the balance in creative and unexpected ways. To protect these children, many parents have created "conduit" trusts to restrict the payout to only the RMDs due to the child.

Unfortunately, the SECURE Act eliminates RMDs for most children (there are exceptions for a disabled or chronically ill child). Under the SECURE Act there is no RMD and thus, with a conduit trust, no payout to the child until the tenth year. At that time, the full payout is made and the child will face a huge income tax bill.

Jamie Hopkins is a financial expert with the Carson Group in Omaha, Nebraska. She explains the conduit IRA trust problem and notes, "That is a complete disaster from a planning perspective," Hopkins said. "We just subjected most of that IRA money to the highest tax margin possible and locked up access to it."

Many concerned IRA owners want to update their estate plans to attempt to replace the "stretch" IRA distrubutuion schedule. Could a plan combine the tax-saving benefits of a stretch IRA with a term-of-years or life payout to children or other heirs? Could this plan also have the tax-free growth benefit of a stretch IRA?

While it sounds too good to be true, an IRA to a testamentary unitrust plan includes all of these benefits. An IRA owner may create a testamentary unitrust to create a replacement stretch distribution. When the IRA owner passes away, the unitrust is funded with the traditional IRA. Because the unitrust is tax-exempt, there is a bypass of the income tax on the traditional IRA and any future growth within the trust.

In the unitrust, the full IRA proceeds are invested and earn taxable income for the unitrust recipients. After all payments are completed, the remaining unitrust principal is transferred to qualified charities. The children or other heirs benefit from substantial income (with no reduction in trust corpus earning power due to taxes). After all payments are completed, there is a generous gift to the donor's favorite charities.

Why the Risk of Heart Attack Rises in Winter

I have read that people with heart problems need to be extra careful during the winter months because heart attacks are much more common. Why is this?

Everyone knows winter is cold and flu season, but many do not know that it is also the prime season for heart attacks too, especially if you already have heart disease or have suffered a previous heart attack. Here is what you should know, along with some tips to help you protect yourself.

In the U.S., the risk of having a heart attack during the winter months is twice as high as it is during the summertime. Why? There are a number of factors, and they are not all linked to cold weather. Even people who live in warm climates have an increased risk. Here are the areas you need to pay extra attention to this winter.

Cold temperatures: When a person gets cold, the body responds by constricting the blood vessels to help the body maintain heat. This causes blood pressure to go up and makes the heart work harder. Cold temperatures can also increase levels of certain proteins that can thicken the blood and increase the risk for blood clots. First and foremost, stay warm this winter. When you do have to go outside, make sure you bundle up in layers with gloves, a hat and place a scarf over your mouth and nose to warm up the air before you breathe it in.

Snow shoveling: Studies have shown that heart attack rates jump dramatically in the first few days after a major snowstorm, usually a result of snow shoveling. Shoveling snow is a very strenuous activity that raises blood pressure and stresses the heart. Combine those factors with the cold temperatures and the risks for heart attack surges. If your sidewalk or driveway needs shoveling this winter, hire a kid from the neighborhood to do it for you, or use a snow blower. If you must shovel, push–rather than lift–the snow as much as possible, stay warm, and take frequent breaks.

New Year's resolutions: Every Jan. 1, millions of people join gyms or start exercise programs as part of their New Year's resolution to get in shape, and many overexert themselves too soon. If you are starting a new exercise program this winter, take the time to talk to your doctor about what types and how much exercise may be appropriate for you.

Winter weight gain: People tend to eat and drink more, which results in more weight gain during the holiday season and winter months. These are all hard on the heart and risky for someone with heart disease. Keep a watchful eye on your diet this winter and avoid binging on fatty foods and alcohol.

Shorter days: Less daylight in the winter months can cause many people to develop "seasonal affective disorder" or SAD, a wintertime depression that can stress the heart. Studies have also looked at heart attack patients and found they usually have lower levels of vitamin D (which comes from sunlight) than people with healthy hearts. To boost your vitamin D this winter, consider taking a supplement that contains between 1,000 and 2,000 international units (IU) per day.

Flu season: Studies show that people who get flu shots have a lower heart attack risk. It is known that the inflammatory reaction set off by a flu infection can increase blood clotting which can lead to heart attacks in vulnerable people. If you have not already done so this year, get a flu shot for protection. And, if you have never been vaccinated for pneumococcal pneumonia, you should consider getting these two shots (given 12 months apart) too.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.

What to Do When Medicare Denies a Claim

How do I go about a filing an appeal with Medicare when they will not pay for something that they covered in the past?

If you disagree with a coverage or payment decision made by Medicare, you can appeal. Approximately half of all Medicare appeals are successful, so it is definitely worth your time.

Before appealing, talk with your doctor, hospital and Medicare to see if you can spot the problem and resubmit the claim. Some denials are caused by simple billing code errors by the doctor's office or hospital. If that does not fix the problem, here is how you appeal.

Original Medicare Appeals

If you have original Medicare, start with your quarterly Medicare Summary Notice (MSN). This statement will list all the services, supplies and equipment billed to Medicare for your medical treatment and will tell you why a claim was denied. You can also check your Medicare claims early online at or by calling Medicare at 800-633-4227.

There are five levels of appeals for original Medicare, although you can initiate a fast-track consideration for ongoing care, such as rehabilitation. Most people have to go through several levels to get a denial overturned.

You have 120 days after receiving the MSN to request a redetermination by a Medicare contractor, who will review the claim. Make a copy of your MSN, then circle the items you are disputing on the MSN. Provide an explanation of why you believe the denial should be reversed and include any supporting documents like a letter from the doctor or hospital explaining why the charge should be covered. Then send it to the address on the form.

You can also use the Medicare Redetermination Form. See to download it or call 800-633-4227 to request a copy by mail.

The contractor will usually decide within 60 days after receiving your request. If your request is denied, you can request reconsideration from a different claims reviewer and submit additional evidence.

A denial at this level ends the matter, unless the charges in dispute meet a minimum threshold (at least $160 in 2019). In that case, you can request a hearing with an administrative law judge. The hearing is usually held by videoconference or teleconference.

If you have to go to the next level, you can appeal to the Medicare Appeals Council. Then, for claims of at least $1,630 in 2019, the final level of appeal is judicial review in U.S. District Court.

Advantage and Part D Appeals

If you are enrolled in a Medicare Advantage health plan or Part D prescription drug plan the appeals process is slightly different. With these plans you have only 60 days to initiate an appeal. In both cases, you must start by appealing directly to the private insurance plan, rather than to Medicare.

If you think that your plan's refusal is jeopardizing your health, you can ask for a "fast decision," where a Part D insurer must respond within 24 hours, and Medicare Advantage health plan must provide an answer within 72 hours.

If you disagree with your plan's decision, you can file an appeal, which like original Medicare, has five levels. If you disagree with a decision made at any level, you can appeal to the next level.

For more information, along with step-by-step procedures on how to make an appeal, visit and click on the "Claims & Appeals" tab at the top of the page.

Get Help

If you need some help, contact your State Health Insurance Assistance Program (SHIP), which has counselors that can help you understand the billing process and even file your appeal for you for free. To locate your local SHIP, visit or call 877-839-2675. The Medicare Rights Center also offers free phone counseling at 800-333-4114.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.


Published December 13, 2019

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