From October 15 to December 7 each year, Medicare enrollees have the option to change their insurance plans. For prescription drug coverage, which is only offered by private insurance companies, it pays to shop around. Even if you have been happy with your current plan, drug prices and premiums change from one year to the next. It's a good idea to compare. There could be hundreds of dollars at stake.

The federal government makes Medicare prescription plan rules, so some things are the same no matter the company. For instance, the point at which the initial coverage stops and the coverage gap begins—sometimes called the "donut hole"—is up to $4430 in 2022. But how soon you get to that number depends on drug pricing, which varies from one insurance company to the next.
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Here are some factors to consider:

• The price of your medicines. To compare plans, you must research the prices in each plan's "formulary" for each of your prescriptions. A plan that charges $200 for a month's worth of pills will land you in the coverage gap sooner than a plan that charges $100.
• The cost of the deductible. This is what you must pay before insurance kicks in. Some policies have a $0 deductible. Others go to the 2022 Medicare maximum: $480.
• The cost of copays. Typically, once the deductible is met, you need to pay a set fee per prescription or a percentage of the price of each drug. This is called the "copay." It varies widely from one company to another, as does the price or percentage that is required in the coverage gap.
• The price of the monthly premium. The lower the premium, the higher the copays.
• Customer service. Each plan has a Medicare star rating based on customer satisfaction and other performance factors. These are updated yearly. A rating of fewer than four stars probably indicates slow service, which could cost money or cause health problems.
• Other services tied to the drug plan. If you have a Medicare Advantage plan, prescriptions may be bundled with your coverage for doctors and hospitals. A plan that might be better for medicines may not include the doctors you have been seeing. You may need to choose which is more important.

Get help comparing plans. Go to Medicare.gov for an online comparison tool. Or use free telephone assistance at 1-800-MEDICARE. There, you can get help weighing the costs and benefits so you can select the best coverage for your money.

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If your adult child has cut off contact, you are not alone. An estimated 11% of parents are estranged from their adult kids. That's 1:8. But you wouldn't know it to hear others talk.

There is such a stigma around the issue that estranged parents rarely talk about it with others. Instead, they tend to cover things over.

That means carrying around feelings of shame, guilt, and deep sadness, often in isolation. Sound familiar?

Why do adult children sever the tie? There are myriad reasons. Two-thirds (67%) of estranged parents say they have never been told the reason why. On some level, perhaps the specific details of "why" are not material. In the end, it may be wise to simply conclude that everyone remembers family dynamics differently.

Should you try to reconcile? Reconciliation involves both parties, although parents usually initiate the effort. Be flexible about the outcome. Estrangement may be the best outcome. The important part is how you process it.

Begin with yourself. A child's rejection is not a measure of your worth as a person or a parent. Even fantastic parents go through periods when their children want nothing to do with them. Reach out to others so you have support. There are online and in-person groups for estranged parents. Talk with a counselor.

What adult children say they want. Surveys indicate that children who have split away want to "be heard" and to have their parent apologize for past actions. Expressions can be as simple as a sincere "I'm sorry. I wish I had been more ______." Some also ask their parent to accept boundaries, such as a limit to the type or frequency of contact.

Things to avoid. Don't issue repeated requests to meet. This can backfire: Your child may feel harassed. Try a light overture. If it is rebuffed, wait a significant time before trying again. If the door opens, prepare to just listen and empathize. "Correcting" them or stating your own feelings will likely bring everything to a halt. In fact, your child may never be open to hearing what it was like for you. And if those are the terms of reconciliation, you need to decide if that's okay with you. For some parents, it's simply not.

The goal is healing. Ideally, the healing involves getting back together. If it doesn't, use your support system to help you get to a healthy resolution inside yourself. No more isolation. No more shame.

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Did you know that we usually outlive our ability to drive safely by six to ten years? As we age, we naturally modify how we drive to address physical changes: Stiff joints, poor vision, slow reflexes. But a time will come when it's simply unwise to continue behind the wheel.

We do plenty of planning and preparation before retiring from work. Similarly, it's smart to take a moment and consider the probability that you may not be driving your last few years. How can you retire from driving without giving up an active life?

Most people find it works best to have more than one driving alternative. Check these out:

• Family and friends. This is by far the most common strategy.
• Ride-sharing apps. Services such as Lyft and Uber can be extremely helpful (and not that expensive when you factor in the costs of a vehicle, gas, insurance, etc., that you are being spared). Both services are exploring senior options with door-to-door assistance. No smartphone? Consider a phone service such as GoGoGrandparent.com.
• Local transportation programs. Many churches and senior centers have volunteer driver programs that are free or low cost. These are ideal for errands or doctor appointments. Think about "paying it forward" by serving as a volunteer driver now.
• Public transportation. Standard buses are an option. Some have a "buddy program or a "senior training day" to help you get oriented. Many public transit companies also provide "paratransit" services. This is a low-cost, door-to-door service available for those who meet disability criteria. Rides must be scheduled a day or two in advance.
• Special service vans. Senior centers often put together ride packages to cultural events. Leave the driving and the parking to someone else! Medical or cancer treatment centers may offer transportation. Take shuttle services to the airport.
• Self-driving cars. Wonderful to anticipate, but they are some time off as yet.
• Online services. Spare the trip! Order online and take advantage of delivery services. Arrange for appointments to be done by video chat when possible.

Considering a move or downsizing? Factor in driving retirement. Would your new abode allow for easy walking to where you want to go? To public transportation? For assisted living, is there van service to doctors or shopping?

Find out now what's available. Check out ridesinsight.org or call 855-607-4337 (toll-free, nationwide) to find local driving alternatives.

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When imagining an age-friendly house, many people think of ramps for wheelchairs and walkers. Indeed, ramps are essential--if and when they are needed. There are, however, modifications for the outside of a home that simply make daily life and basic maintenance easier. They help prevent falls by addressing the common conditions of arthritis, poor eyesight, or limited balance.

Some safety suggestions also deter thieves.

Lighting. To reduce shadows, point lights down rather than across. And use frosted glass fixtures or bulbs to reduce glare (a notable hindrance to seeing well as we age). Consider adding lights that come on automatically in low-light conditions or when motion is detected. Put them along all pathways and stairs, and at the corners of your house. Also install them at common destinations, such as all entry doors, the mailbox, a trash enclosure, and the garage door. Abundant light illuminates hazards while also discouraging burglars!

Stairs. Several modifications can make a stairway safer. Handrails, ideally on both sides, that are at least 1½ inches in diameter so they are easier to grip. And a textured or nonskid surface on the tread of each stair. Also take care to repair any broken steps so they are level and soundly anchored. Even out the rise of each step so they are all the same height. To make it easier on knees and hips, plan for the rise of each step to be no more than 7 inches and no less than 4 inches. The tread—space allotted for the length of your foot—should be no less than 11 inches. If you are reinstalling a staircase, plan for a landing for every 12 feet of vertical rise.

The entryway. Many activities occur at entryways: Opening a locked door, bringing in groceries, greeting visitors, retrieving delivered packages. In addition to good lighting and nonskid surfaces, consider elements that might facilitate these daily tasks. A lever doorknob is easier for arthritic hands. A keyless lock avoids the need to juggle groceries while finding the key. Perhaps a bench where you might set groceries down. A hinged chest/seat would enable delivery people to safely hide your packages. You might also consider a video doorbell to easily view who is there before opening the door. Video can also dissuade thieves—or at least get a recording if someone steals a package left on the doorstep.

Simplifying home maintenance. Add gutter covers to minimize the frequency of cleaning out leaves. (After a certain age, ladders are not your friend! Bones are too brittle if you fall.) Change to brick or vinyl siding to reduce the need for ladder-based maintenance of a wooden exterior. Similarly, resin-based decking will save hours of on-your-knees upkeep.

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If you have more than one child, deciding how to distribute your assets among them may prompt some angst: If and how should your will or trust reflect your understanding of their different needs? According to a Merrill Lynch study, two-thirds of parents over age 55 are open to the idea of unequal bequests.

"Fair" does not necessarily mean "equal." If one child has invested considerable time caring for you during health challenges—perhaps giving up valuable income-earning years—should that be reflected in their inheritance? Again, two-thirds of parents think it should. (Not all children agree.) If one child is in a lucrative profession and the others are not so well paid, should you bequeath equally or according to need? Should a health-challenged child get more? What if some of your kids have children and others do not? Should the nonparents get less?

Money does not equal love. This is a self-evident truth. But as a culture, we tend to view money as a proxy for affection. Differing amounts can bring up old resentments. "Dad loved you best …" These feelings may even play out in a court battle. (Sigh)

There are myriad ways to divide the pie. Here are three common scenarios:

• Equal parts in the will, but gifts as needed before you go. What you give to your children in the normal course of life need not be up for family discussion. It's between you and each individual child.
• Acknowledge prior financial help given as a "draw down" on the inheritance. Some children may have needed more help (a down payment for a house, rehab for substance abuse, assistance due to the pandemic). Deducting your past financial support from that child's "fair share" may quell resentment from other siblings.
• Unequal bequests with a description of your reasoning. Leave a note with your will or trust that affirms your equal love and explains your logic.
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Talk with your kids ahead of time. It's advisable to discuss your plans with your children individually. (You could learn that the prosperous child prefers that more be given to a less financially stable sibling because it reduces the chance of their being tapped for aid later.) You might then review your plans with everyone in a family meeting. If these conversations seem daunting, let's talk. We can serve as an objective sounding board to help clarify your thoughts, prepare for the discussions, and perhaps even facilitate your family conversation.

Work with an estate planning attorney. There may be options you hadn't thought of and details you need to include. You will need an attorney to draw up the final documents.

Are family dynamics a source of worry for you?
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Mild cognitive impairment (MCI) is the medical name for memory problems that exceed the "normal forgetfulness of aging" but are less than associated with an Alzheimer's diagnosis. If you have received a diagnosis of MCI, you are at risk for continued significant cognitive decline. Each year about 10–15% of persons with MCI receive an Alzheimer's diagnosis, as compared to 1–3% of all older adults.

That said, many people with MCI do not experience further decline. And some people even improve--if their memory loss was caused by something fixable like a medication reaction or untreated depression. For all these reasons, it is important to have symptoms reassessed every 6–12 months to monitor changes.

There are things you can do. While there is no medical treatment as yet for MCI, some everyday activities can help prevent or slow its progression. The goal is to increase blood flow and oxygen to your brain, and keep your mind active.

• Manage your blood pressure. Keeping blood pressure within the normal range has a profound effect on delaying memory problems.
• Practice healthy habits. Get regular aerobic exercise, such as brisk walking. Aim for eight hours of sleep. Eat a diet low in processed foods and high in fruits and vegetables. Limit alcohol. Quit smoking. Manage other conditions (e.g., diabetes, depression).
• Wear your hearing aids. A loss in hearing means a loss of stimulation to the brain. Studies now connect this loss with a decline in brain function. (Plus, some things you are "forgetting" may in fact be from conversations you didn't fully hear.)
• Participate in social activities. Even if you don't talk much, the stimulation of spending time with others is beneficial.
• Learn a new skill. Make your brain exercise! Try something you've never done. Brush your teeth with the "opposite" hand. Or have some fun: Ping-pong? Drumming?
• Engage your mind with puzzles. This is brain calisthenics. Keep your neurons firing with activities that make you think.

Memory aids. Accept that you are forgetful and support yourself for success. Make ample use of to-do lists, big calendars, and notes or alarms on your phone. Leverage the power of routines. Put your keys and glasses, purse/wallet in the same place every time. Set yourself up for environmental cueing, consciously putting things where you will see them when needed, such as leaving your morning pills by the coffee maker.

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Elder law focuses on the special rights, needs, and challenges that arise in the context of simply growing older and planning for possible care needs.

Attorneys specializing in elder law take a holistic perspective.

They acknowledge the interplay of health, family, disability, and housing, as well as emotional and financial issues. Consider a consultation for:
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• Estate planning. Within elder law, estate and trust attorneys advise on the best strategy for organizing and managing your assets now that also ensures ease of transfer upon your death. This may involve a will. Or a living trust. There are pros and cons to each. And, if you have a dependent adult in your life, an attorney can draw up a special needs trust to provide for care when you are no longer alive.
• Decision-making plans. With advancing age, many of us lose the ability to manage our finances or make complex healthcare decisions. Especially if you do not have relatives to step in, you will need legal assistance to locate and contract with trustworthy professionals to fill these roles.
• Paying for care. An elder law attorney knows about the many programs designed to assist with the cost of care. You may, for instance, be considering a reverse mortgage, but there are significant "gotchas" with this arrangement. If Medicaid is your fallback should you need a nursing home long term, you will want to work with an attorney to be sure your spouse is not left without resources when you die. Long-term care insurance is another payment option worthy of an attorney's review.
• Housing contracts. Before moving into an assisted living or continuing care retirement community (sometimes called a "life care" community) or a nursing home, have an elder law attorney review the paperwork. They can clarify tax implications and advise you regarding your rights and how or when you can cancel a housing contract.
• Claims and appeals. You may have disagreements with Social Security, Medicare, your pension fund, or other insurance or benefit programs. An elder law attorney can help you navigate the appeals process and increase your chance of a successful resolution.
• Grandparent visitation rights. Whether the schism is due to a divorce, the death of your child, or estrangement from your son or daughter, you do have rights to see your grandchildren. An elder law attorney can help you stay connected.
• Age discrimination in employment. Have you been turned down from a job, a promotion, or fired because of your age? An elder law attorney can help you rectify the situation.

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Activities that are easy now may become more difficult in the future: Going up and down stairs, standing up from sitting, getting in and out of the tub, catching your balance if you start to slip. . . . As you consider aging in place, it is wise to keep these issues in mind, particularly about the bathroom.

Structural considerations. To eliminate the need to climb stairs, the ideal is a full bathroom on the main level of the house. In addition, as we age, the likelihood of needing support increases. Whether a wheelchair or walker, or a spouse or paid caregiver is providing assistance, a spacious room is best.

Did you know the bathroom is the most dangerous room in the house? Eighty percent of falls occur in the bathroom on hard, sometimes slippery surfaces. Most falls occur in the process of sitting down on or getting up from the toilet, or getting in/out of the bath/shower.

Bathtub or shower? The most versatile design involves a water-friendly, nonslip floor with a drain, and no hard curb around the shower area. This allows for rolling a wheelchair into the shower and provides room for a helper. Even without such a radical makeover, it's easy to install a handheld showerhead and a built-in or portable bench in an existing bathroom to create a seated shower option.

If you need to soak—great for achy arthritic joints—consider a walk-in tub. These tubs have a watertight seal on a side door that allows you to walk in, sit on a bench, and then fill the tub to the desired height. Or have a dip cut into the side of an existing tub to lower the height for ease of stepping in and out.

Toilets and bidets. Purchasing a high toilet or adding an extender that raises the sitting surface greatly reduces the physical challenges of sitting down and getting up. Many people find a bidet adds to convenience and cleanliness. (Twisting to wipe our nether regions becomes more difficult with age.) Rather than ask for help, cleaning with water can improve hygiene while preserving dignity.

Other fall prevention strategies. You don't need a full remodel to improve safety. Installing grab bars beside the toilet and within and outside the bathing area is an easy and effective modification. Grab bars must be attached securely to the studs of the wall and be able to support 250–300 pounds. Installing nonslip flooring or applying antislip floor coatings for higher traction is also wise. Increased lighting will help visibility and reduce falls. In addition, lights installed on the wall instead of on the ceiling reduce the need to get on a ladder, and possibly fall, when changing a bulb.

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Life has a way of throwing us curveballs.

The unexpected death of a spouse—or a divorce—can certainly wreak havoc on your emotions. It can also throw a wrench in your finances.

If you are age 62 or older, here are some Social Security basics to bear in mind as you regain your financial footing or make contingency plans.

Survivor benefits. If you find yourself widowed after at least one year of marriage, then you are eligible to receive monthly survivor payments.

Did you also work outside the home? If so, you can choose the higher of the two benefits: yours personally; or as a surviving spouse.

Before deciding, confirm the amount for each one for three points in time: collecting now; waiting until age 70; or at your designated retirement age (as determined by Social Security). While you cannot receive both benefits at the same time, you can strategically claim the highest one now and then switch to the one that becomes higher later.

Spousal benefits. A divorce does not erase the contribution you made to the household. As a formerly married spouse, you are eligible for Social Security benefits based on the earnings of your breadwinning partner. As long as you were married for 10 years or more, you have earned spousal benefits.

Receiving spousal benefits does not affect what your ex will receive from Social Security. What's more, your ex does not need to know, give permission, or sign any papers. All you need to provide is the marriage certificate, divorce papers, and your ex's full name.

If you were also employed and are eligible for your own Social Security benefits, investigate which benefit will pay more: now; when you turn 70; or at your designated retirement age. Unlike survivor benefits, you cannot switch benefits at a later date. Decide when is the best time to apply, and choose the larger amount.

It's important to make a fact-based decision. The difference in monthly payments, added up over many years, could mean there are thousands of dollars at stake. There are many more details than we can cover here, including information about benefits in same-sex marriages. Consider working with a certified financial planner who can run the various calculations for you and suggest the wisest strategy. There's too much to lose to depend on Social Security staff for detailed guidance.

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Alzheimer's is different from the normal forgetfulness of aging. Alzheimer's is one of many conditions that cause the radical changes in memory, reasoning, and behavior known as "dementia." The normal forgetfulness of aging is just an inconvenience, a slowing down. The serious changes of dementia eventually result in the inability to live on your own.

Here are some helpful distinctions developed by the Alzheimer's Association:

• Memory failures that affect daily life. Trouble learning something new. Not recalling recent events. Asking the same question over and over. Normal aging: Not remembering something in the moment but recalling it later.
• Difficulty with problem solving and reasoning. Inability to think abstractly (e.g., use numbers) and create logical plans. Signs include difficulty figuring a tip or following a recipe. Normal aging: Occasional addition or subtraction errors.
• Trouble with familiar tasks. Drawing a blank while playing a beloved game or driving to a familiar location. Normal aging: Needing help with something recently learned.
• Losing the anchor of time. Forgetting the season or the year. Normal aging: Briefly losing track of the day of the week.
• Spatial problems. Trouble judging distance. Difficulty with balance. Normal aging: Needing glasses to read.
• Communication problems. Losing the thread of a conversation. Repeating a story or question. Normal aging: Occasional inability to find a word.
• "Losing" common objects. Putting belongings in odd places and not remembering. Inability to retrace steps. Accusing others of stealing. Normal aging: Forgetting why you went into a room and retracing your steps to remember.
• Poor judgment. Falling for scams, overspending, wearing odd outfits. Normal aging: Periodically making a bad decision or skipping a bill payment.
• Withdrawal from activities. Not socializing as much, especially as conversing becomes difficult. Normal aging: Consciously choosing to do something different.
• Moody or irritable. Significant personality changes: Depression, anxiety, fear, and paranoia. Normal aging: Getting grouchy if cherished routines are disrupted.
  
  

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