Mediconnect: Unbiased Healthcare Solutions

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MediConnect Insurance

For more information about the author, click to view their website: MediConnect Insurance

Posted on

Jul 17, 2020

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Pennsylvania - Greater Pittsburgh Area

Sally, a lifelong resident of the South Hills of Allegheny County, was a nervous wreck at a time in her life when things were spinning out of her control. Her husband, a retired state trooper, had recently passed away. He handled all the business aspects of their household. While grieving her loss, she was forced into managing her financial and planning affairs. Sally met with her advisor, Brian Breisinger, and asked an important question of him. Where, in southwestern Pennsylvania, do I turn to get advice regarding my health insurance?

From that conversation, the foundation of MediConnect Insurance was laid. Brian soon realized the health insurance industry was complicated and stressful for many people transitioning into retirement and beyond. The Medicare rules and health plan options are ever-changing. Sally needed education and sound advice to make the right decisions for her.

Today, MediConnect Insurance is the region's largest fully-independent healthcare advisory firm. Since Brian met Sally, the focus of MediConnect has always been providing unbiased expert advice in a simplistic manner while ensuring the most comprehensive options are available in budget-friendly packages. Further, there is never a fee or cost for these services.

MediConnect works with every insurance company in the region to provide access to comprehensive coverage for every individual. While reaching a large audience in their weekly radio show, every Saturday at 9 AM on KDKA AM 1020, they take the time to care about each person's needs.

Sally says, "Without Brian, I wouldn't have known what kind of coverage to select then. With MediConnect, I now have peace of mind that my insurance will be there if I need it and I don't have to do this alone every year."

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Pennsylvanias Personal Care Assistance (PCA) Program: A Guide to Paid Family Caregiving

Providing care for a loved one is a profound commitment, and in Pennsylvania, various programs exist to support family caregivers in this vital role. While Personal Care Assistance (PCA) broadly refers to services that help individuals with daily living activities, its important to understand that paid family caregiving in Pennsylvania primarily operates through specific Medicaid waivers. These initiatives aim to support the invaluable work of caregivers while allowing loved ones to remain in the comfort and familiarity of their own homes or the homes of family members.Understanding Personal Care Assistance (PCA) in PennsylvaniaIn Pennsylvania, Personal Care Assistance (PCA) refers to the services that help individuals with daily living activities and household tasks, enabling them to live independently. Its crucial to differentiate this from Personal Care Homes (PCH), which are residential facilities that provide housing, meals, supervision, and assistance, but typically do not offer third-party reimbursement for family caregivers providing care within them.Instead, paid family caregiving for PCA services in Pennsylvania primarily operates through various Medicaid waivers, also known as Home and Community-Based Services (HCBS) waivers. These waivers are designed to provide direct assistance with Activities of Daily Living (ADLs) and household services for older adults or individuals with disabilities who live in their own homes or the homes of loved ones. The services provided under these waivers are what constitute Personal Care Assistance in the context of paid family caregiving.Key Pennsylvania Medicaid Waivers for PCAPennsylvania offers several Medicaid waivers that facilitate paid family caregiving for Personal Care Assistance, each with specific eligibility criteria and rules regarding family members.1. Community HealthChoices (CHC) Waiver: Getting Paid to Care for Loved OnesThe Community HealthChoices (CHC) waiver is Pennsylvanias most common Medicaid managed care program that facilitates paid family caregiving for PCA. It is designed for individuals aged 21 or older who are eligible for both Medicaid and Medicare and require a nursing facility level of care. This program consolidates several former waivers into a single, comprehensive system and is administered by private healthcare insurance companies contracted by the state.Recipient Eligibility for CHC: To qualify for the CHC program, the individual needing care must meet several criteria: Age: The recipient must be 21 years of age or older. Dual Eligibility: They must be eligible for both Medicaid and Medicare. Functional Eligibility: A physician must certify that the individual has a condition requiring long-term services and supports, specifically an inability to perform essential Activities of Daily Living (ADLs) such as bathing, toileting, or transferring. A trained assessor will also conduct a functional eligibility determination to confirm the level of care needed. Financial Eligibility: The individual must meet specific income and/or asset requirements, determined by the local County Assistance Office (CAO). For example, in 2023, the income limit to qualify for the Pennsylvania Medicaid waiver program under CHC was $2,742 per month. Caregiver Eligibility (Who Can Be Paid, Spousal/Guardian Restrictions): Pennsylvanias Medicaid waivers generally permit family members, such as adult children, siblings, and even friends, to be compensated for providing care. However, under the CHC waiver, spouses (husband or wife) are typically not eligible to be paid caregivers. Similarly, individuals holding Power of Attorney (POA) for the care recipient or legally responsible guardians (such as parents caring for children under 18) are also generally excluded from paid caregiver roles under this program.Application Process: The process involves contacting the Pennsylvania Independent Enrollment Broker (IEB) at 1-877-550-4227, applying on the COMPASS website, and submitting necessary documentation, including physician certification and financial information. Once approved, the care recipient can select a state-licensed home care agency that employs family members, such as Avondale Care Group.Services Covered & How Agencies Facilitate Payments: The CHC waiver covers a range of personal care and home care services. This includes direct assistance with Activities of Daily Living (ADLs) like bathing, dressing, meal preparation, and medication management, as well as various household services. Family caregivers are hired as regular employees of the licensed home care agency, which handles all administrative tasks, including payroll and compliance.Payment Rates & Benefits for Family Caregivers: The compensation for family caregivers through Medicaid waiver programs in Pennsylvania typically ranges between $10 and $15 per hour. The number of hours approved depends on the care recipients health and needs, with a maximum of 35 hours of care per week often allowed. The maximum weekly pay rate for Pennsylvania is up to $700 per week, which aligns with or exceeds these hourly rates, potentially including overtime or other factors. Many agencies also offer additional benefits that significantly enhance the overall compensation package for family caregivers. These can include overtime pay, weekly pay, free Certified Nurse Aide (CNA) training for eligible caregivers, holiday pay (often 1.5 times the regular rate for specified holidays), 401k plans with company matching, company-sponsored healthcare insurance (with substantial premium coverage), flexible schedules, and paid time off.2. OBRA WaiverThe OBRA Waiver is designed to support individuals aged 18-59 who have a severe developmental physical disability and require an Intermediate Care Facility/Other Related Conditions (ICF/ORC) level of care. This program helps these individuals live as independently as possible within their communities by providing assistance with activities of daily living (PCA services).Family Member/Spouse Eligibility: Similar to the CHC waiver, the OBRA waiver excludes spouses or legal guardians from being paid caregivers.Payment Rates: Compensation for caregivers under the OBRA waiver varies by geographic area, typically ranging from $13 to $15 per hour. The maximum weekly pay rate for Pennsylvania is up to $700 per week.Application: The application process also begins by contacting the Independent Enrollment Broker (IEB) at 1-877-550-4227. 3. Consolidated WaiverThe Consolidated Waiver provides support and services to a broader population, including individuals of all ages with an intellectual disability (ID) or autism, as well as children under 22 with a developmental disability due to a medically complex condition. Recipients must be recommended for an intermediate care facility (ICF) level of care based on a medical evaluation.Family Member/Spouse Eligibility: A significant difference with the Consolidated Waiver is that it explicitly allows a friend or family member, including a spouse or legal guardian, to receive payment for care provided.Payment Rates: The average pay for Pennsylvania caregivers under the Consolidated Waiver typically falls between $11 and $14.50 per hour. The maximum weekly pay rate for Pennsylvania is up to $700 per week.Application: To apply for the Consolidated Waiver, individuals should contact the Office of Developmental Programs (ODP) customer line at 1-888-565-9435. Important Considerations: Medicaid Estate Recovery Program (MERP)While Pennsylvanias Medicaid programs offer crucial financial relief for family caregivers, it is essential for families to understand the long-term financial implications. The Medicaid Estate Recovery Program (MERP) is a federal requirement for all state Medicaid programs to seek repayment for long-term care costs after a recipient passes away. This recovery typically applies to individuals aged 55 and older who received Medicaid long-term care services, including those provided through Home and Community-Based Services (HCBS) waivers. Assets subject to recovery can include the deceased recipients primary home, even if it was exempt during their lifetime while receiving benefits. The states claim is generally delayed if there is a surviving spouse, a child under 21, or a child of any age who is blind or permanently disabled. Families may also be able to apply for undue hardship waivers in certain circumstances. Given these potential impacts on family inheritance and assets, it is highly advisable for families to consult with an elder law attorney or financial advisor for personalized guidance on MERP and comprehensive estate planning.  

Understanding ADLs and IADLs: Keys to Pennsylvanias Medicaid HCBS Programs

Pennsylvania offers Medicaid waiver programs under the Community HealthChoices (CHC) umbrella and the Pennsylvania Department of Aging (PDA) Waiver (often referred to as the PA Council on Aging Waiver). These programs help older adults and individuals with physical disabilities remain in their homes or community settings instead of entering nursing facilities. CHC and the PDA Waiver provide long-term services and supports (LTSS) based on assessed functional needs, emphasizing assistance with ADLs and IADLs. Covered services may include personal care assistance, adult day services, home-delivered meals, transportation, home modifications, assistive technology, and respite care for family caregivers. In addition, Pennsylvanias CHC Waiver offers Participant-Directed Services that allow participants to hire and manage their own caregivers, including family members. To qualify, applicants must be Medicaid-eligible, at least 60 years old (for PDA Waiver) or 21+ (for CHC), and require a nursing facility level of care as determined through a standardized functional assessment of ADLs/IADLs. In this article, we explain what Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) are and how needing help with these tasks is central to qualifying for Pennsylvanias Medicaid waivers like CHC and the PDA Waiver.What Are ADLs (Activities of Daily Living)?Activities of Daily Living (ADLs) are fundamental self-care tasks that a person must perform daily to maintain independence. Difficulty with ADLs often signals a need for supportive services. Core ADLs include: Mobility (Ambulating/Transferring): Safely walking, getting up from a chair, or transferring from a bed to a wheelchair. Dressing: Selecting and putting on appropriate clothing (including handling fasteners) without assistance. Eating: Feeding oneselfusing utensils to get food from a plate to the mouth and consuming it. Personal Hygiene: Bathing or showering and performing grooming activities like shaving, brushing teeth, and combing hair on ones own. Toileting (Continence): Independently using the toiletgetting to the toilet, transferring on and off, and cleaning oneself afterward. When someone can no longer perform several ADLs without help, it indicates that ongoing care or support is likely needed.What Are IADLs (Instrumental Activities of Daily Living)?Instrumental Activities of Daily Living (IADLs) are more complex tasks that allow a person to live independently in the community. While not necessarily performed daily, they are essential for managing ones household and life. Key IADLs include: Shopping for Essentials: The ability to shop for groceries, pick up prescriptions, or purchase clothing and other necessities. Meal Preparation: Planning and cooking mealsgathering ingredients and safely using kitchen appliances. Housekeeping: Keeping the home clean and livable tasks like cleaning, laundry, and taking out the trash. Money Management: Handling finances, such as paying bills on time, managing bank accounts, and budgeting. Transportation: Getting around or arranging transportationdriving oneself or using public transit or rides to run errands and attend appointments. Medication Management: Managing and taking medications properly remembering to take the correct medicines at scheduled times and refilling prescriptions. Communication: Using the phone or computer to communicatelooking up phone numbers, making calls, sending emails, and staying in touch with others. Trouble with IADLs is often one of the first signs that someone needs more support, even if basic ADLs are unaffected.Why ADLs and IADLs Matter for Medicaid Waiver EligibilityIn Pennsylvania, needing help with ADLs and IADLs is a central eligibility criterion for the CHC and PDA Waiver programs. These waivers serve individuals who would otherwise qualify for nursing facility care but prefer to remain in their own homes or community settings. Eligibility is determined through both financial and functional assessments. The functional assessment evaluates whether an individual requires hands-on assistance with ADLs and/or significant help with IADLs, thereby meeting a nursing facility level of care. Pennsylvania uses standardized toolsoften the Pennsylvania LongTerm Care Assessment System (PaLTAS) or the Minimum Data SetHome Care (MDSHC)to score independence in ADLs and IADLs.During the functional evaluation, an assessor reviews abilities such as transferring from bed to chair, walking safely, eating, toileting, meal preparation, housekeeping, medication management, and managing money. Cognitive issuessuch as memory problems due to dementiaare also considered since they impact daily functioning. If an individual cannot perform multiple ADLs without assistance or has significant deficits in IADLs, they are likely to meet the level-of-care requirement and become eligible for waiver services.Community HealthChoices (CHC) WaiverCommunity HealthChoices (CHC) is Pennsylvanias comprehensive HCBS waiver program for individuals aged 21 and older who require a nursing facility level of care. Administered by the Office of Long-Term Living (OLTL), CHC is a managed care program that combines physical health, long-term services and supports, and pharmacy benefits under a single plan (with behavioral health carved out). To qualify for CHC: Be age 21 or older. Meet Medicaid financial eligibility guidelines. Require a nursing facility level of care (confirmed through functional assessment). Live in a setting that meets HCBS requirements (e.g., home, apartment, assisted living). Be a Pennsylvania resident. Once enrolled, participants receive a comprehensive package of services tailored to their needs. Covered services may include personal assistance, home-delivered meals, adult day services, behavioral support, professional nursing, home modifications, assistive technology, transportation, and respite care. CHC also offers Participant-Directed Services, allowing participants to recruit, hire, train, and supervise their own caregiversoften family membersto assist with ADLs (bathing, dressing, toileting) and IADLs (meal preparation, medication reminders).PDA Waiver (Council on Aging Waiver)The Pennsylvania Department of Aging (PDA) Waiver, also called the Council on Aging Waiver, serves seniors aged 60 and over who require nursing facility level of care but choose to remain at home or in other community-based settings like domiciliary care homes. To qualify: Be age 60 or older. Meet Medicaid financial eligibility requirements. Be assessed as requiring nursing facility level of care (through the functional assessment). Live in a qualifying community setting. Covered services under the PDA Waiver may include personal care assistance, home-delivered meals, homemaker services, personal emergency response systems, respite care, adult day services, minor home modifications, and transportation. Like CHC, the PDA Waiver emphasizes managing ADL and IADL needs to keep participants safely in their homes.Participant-Directed ServicesBoth CHC and the PDA Waiver offer Participant-Directed Services, which empower participants to choose and manage their own caregivers, including family members, friends, or neighbors. Under this model, participants develop a service plan with guidance from a care coordinator, set schedules, and handle payroll tasks. This flexibility helps ensure that personal care and IADL support align with participants preferences and routines.Signs That Your Loved One May QualifyBelow are practical indicators that someone may be eligible for Pennsylvanias CHC or PDA Waiver due to difficulty with ADLs and IADLs: Trouble with Personal Care: Skipping showers, unkempt hair, or wearing dirty clothes may indicate difficulties with bathing and dressing (ADLs). Malnutrition or Weight Loss: An empty fridge or significant weight loss suggests issues with meal prep or feeding oneself (ADLs/IADLs). Mobility Decline and Falls: Struggling to walk without assistance, needing help to stand, or experiencing frequent falls signals reduced mobility (ADL: transferring/ambulating). Medication Errors and Memory Problems: Missing doses, mixing up pills, or forgetting appointments point to challenges with medication management and scheduling (IADLs). Household Neglect: Piles of mail, unpaid bills, or a cluttered home reflect trouble with housekeeping and money management (IADLs). A combination of needing help with several ADLslike bathing and toiletingand difficulties with IADLssuch as meal prep and housekeepingstrongly indicates a nursing facility level of care. Document these challenges for the functional assessment to demonstrate eligibility.Were Here to Help: Next Steps and Contact InformationNavigating Pennsylvanias Medicaid waiver programs can be complex, but you dont have to go it alone. At Passion to Care, we specialize in guiding Pennsylvania families through the CHC and PDA Waiver application processesfrom the initial functional assessment of ADLs and IADLs to completing paperwork and coordinating services once approved. If you notice your loved one struggling with daily tasks or if a professional has recommended nursing facility care, it may be time to explore CHC or the PDA Waiver. Our compassionate, family-first team ensures your loved ones needs are met with dignity and respect. Call us or contact us today to learn how to get started with Pennsylvanias Medicaid waivers for home and community-based services.

How Meal Preparation Can Help Seniors Live Healthier, Happier Lives

As we grow older, many daily activities that were once simple can become more difficult, including preparing healthy meals. For seniors, proper nutrition is essential to maintain energy, supporting the immune system, managing chronic conditions, and staying independent. Thats why meal preparation isnt just a convenience, its a lifeline.Key Benefits of Meal Preparation for Seniors1. Ensures Balanced, Nutritious MealsHaving meals prepared in advance ensures that seniors are eating regularly and get the essential nutrients their bodies need. It prevents reliance on unhealthy processed foods or skipping meals altogether.2. Supports Chronic Condition ManagementMany seniors live with conditions like diabetes, high blood pressure, or heart disease. Proper meal planning allows for dietary restrictions to be met, helping control symptoms and reduce complications.3. Reduces the Risk of MalnutritionMalnutrition is a silent threat among older adults, especially those living alone. Meal preparation helps safeguard against this by promoting consistent, nourishing eating habits.4. Promotes Independence and DignitySeniors who struggle with cooking may feel frustrated or dependent. Having meals planned and readywhether through caregiver support or meal delivery servicesallows them to eat well without feeling like a burden.5. Encourages Social EngagementWhen meal prep includes shared cooking or mealtimes, it creates opportunities for connection. Eating with a companion improves mood, reduces loneliness, and often encourages better eating habits.6. Saves Energy and Prevents AccidentsShopping, standing at the stove, lifting pots, or cutting ingredients can be physically taxing and even dangerous. Meal preparation helps minimize fatigue and reduces the risk of falls or burns in the kitchen. Meal Preparation OptionsThere are several ways to incorporate meal prep into a seniors routine: Family or caregiver assistance for shopping, cooking, and portioning meals Meal delivery services that offer senior-friendly, diet-conscious options Community programs such as Meals on Wheels Group cooking sessions at senior centers that combine nutrition with social interaction Freezer meal prepping once a week or month to ensure ready-made meals are always available Meal preparation is about more than just food, its about health, safety, and quality of life. For seniors, having access to nutritious, well-planned meals means more energy, better health, fewer hospital visits, and the ability to stay independent longer.

Local Services By This Author

MediConnect Insurance

Life Insurance 300 Bilmar Dr Ste 200, Pittsburgh, Pennsylvania, 15205

Discover MediConnect Insurance: Your Trusted Medicare PartnerAre you feeling overwhelmed by the choices and changes in Medicare? At MediConnect Insurance, were here to help! We specialize in making Medicare easy to understand, so you can focus on what really mattersyour health and happiness.Why Choose MediConnect?Personalized Guidance: Our friendly team of licensed agents takes the time to get to know you. We listen to your needs and help you find the best Medicare coverage tailored just for you.No-Cost Service: Our services are completely free for you! We get paid by insurance companies, which means our advice is always focused on whats best for youno strings attached.Comprehensive Options: Whether you're looking into Medicare Advantage plans, Medigap policies, or Dual Special Needs Programs, well explain all your options in simple terms. We help you understand how each plan works and what benefits they offer.Educational Resources: We believe that knowledge is power! Thats why we provide easy-to-read guides and host community presentations to help you learn about Medicare and related topics like Social Security and Medicaid.Ongoing Support: Once youre with us, we dont just say goodbye! We keep in touch to update you on any changes in Medicare that might affect your coverage. If you need to make changes to your plan, were here to assist you every step of the way.Community ConnectionsWere proud to be part of the community! MediConnect partners with local organizations to ensure that we can provide the best support possible. Whether its working with financial advisors or elder care specialists, were dedicated to helping you navigate your healthcare journey.Lets Get Started!If youre ready to take control of your Medicare experience, reach out to us today! At MediConnect Insurance, we make understanding Medicare simple and stress-free. Let us be your trusted partner in healthcare coveragebecause your peace of mind is our priority!Contact us now for a free consultation and discover how we can help you find the right Medicare plan for your needs!

MediConnect Insurance

Medicare Advantage Plans 300 Bilmar Dr Ste 200, Pittsburgh, Pennsylvania, 15205

MediConnect Insurance is your only TRUE Independent Medicare Plan Concierge Service.  We help to bridge the healthcare gap.  Our fully licensed agents represent all of the major carriers.  We provide FREE, unbiased Medicare coverage advice at no cost or obligation to you.   We are the premier health insurance advisory firm in Western PA focused on educating you on all of your Medicare and post-retirement options. We are partnered with known insurance providers in multiple states & there is NO COST to work with us.Established in 2016, MediConnect Insurance is an independent insurance organization based out of Pittsburgh, PA, we are your source for healthcare coverage. We partner with well-known insurance providers across nine states to bridge the healthcare gap by finding and securing the most optimal plans to fit your specific needs.Visit our website at www.mediconnectins.com for more information, or sign up to attend one of our upcoming live seminars which are listed on our website.  Our FREE in-person seminars are held on various dates and locations throughout the Greater Pittsburgh Area.  Our seminars will guide you through the following: Enrollment PeriodsWho Can Get Medicare?Parts A & B: Original MedicareOptions for More CoverageMedicare Supplement PlansWhats Next?Commons Questions? Affordable Care Act, (ACA or Obamacare)It is for individuals who are not Medicare and or Medicaid eligible or not covered under a group/employer plan. Insurance is provided by private companies specific to your state residence. There is an annual enrollment period as well as special enrollment periods (depending on circumstance) you may be eligible to enroll. Certain individuals may be eligible for federal subsidy based on income.To review what your options are, call and speak to one of our licensed representatives today! 

MediConnect Insurance

Retirement Planning 300 Bilmar Dr Ste 200, Pittsburgh, Pennsylvania, 15205

MediConnect Insurance is your only TRUE Independent Medicare Plan Concierge Service.  We help to bridge the healthcare gap.  Our fully licensed agents represent all of the major carriers.  We provide FREE, unbiased Medicare coverage advice at no cost or obligation to you.   We are the premier health insurance advisory firm in Western PA focused on educating you on all of your Medicare and post-retirement options. We are partnered with known insurance providers in multiple states & there is NO COST to work with us.Established in 2016, MediConnect Insurance is an independent insurance organization based out of Pittsburgh, PA, we are your source for healthcare coverage. We partner with well-known insurance providers across nine states to bridge the healthcare gap by finding and securing the most optimal plans to fit your specific needs.Visit our website at www.mediconnectins.com for more information, or sign up to attend one of our upcoming live seminars at https://www.mediconnectinsurance.com/live-events.Our FREE in-person seminars are held on various dates and locations throughout the Greater Pittsburgh Area.  Our seminars will guide you through the following: Enrollment PeriodsWho Can Get Medicare?Parts A & B: Original MedicareOptions for More CoverageMedicare Supplement PlansWhats Next?Commonly Asked Questions