Health care costs later in life were significantly lower for adults who maintained moderate or high physical activity levels, according to a new analysis of claims data linked to the National Institutes of Health–American Association of Retired Persons (NIH-AARP) Diet and Health Study. The new study, published in BMJ Open Sport & Exercise Medicine, examined various levels of participation in physical activity throughout adulthood and how activity affected Medicare claims. Among the findings: Exercisers with a moderate level of activity had health care costs $1,200 a year lower after age 65 compared with adults who were consistently inactive from adolescence into middle age (moderate exercise involved walking or otherwise being in motion for a few hours most weeks). The health costs of those with a high level of activity were $1,350 lower per year. But even late starters benefited: Waiting until middle age to increase activity still led to cost reductions of $824 per year.

Adults who increased physical activity levels in their twenties experienced the most dramatic reductions in health costs: $1,874 lower per year. Even if some of those exercisers decreased activity during middle age, reducing how often they worked out in their forties and fifties, they still spent about $860 less on health care per year than people who were sedentary for most of their lives.

Participation in physical activity was associated with lower risk for several diseases, including cardio­vascular disease, type 2 diabetes, depression, dementia and several cancers, as well as lower risk of premature death. In the U.S., physical activity levels that don’t meet current guidelines are associated with annual health care expenditures of approximately $117 billion, according to a study published the journal Progress in Cardiovascular Diseases.

Women face unique challenges as they age. According to the Population Reference Bureau, a Washington based think tank, women live about seven years more than men. Living longer means planning for a longer retirement. That sounds good, but a longer retirement increases the odds of needing long-term care. A 2004 AARP study found more than 70% of nursing home residents were women.

Living longer also increases the odds of going it alone, as living longer may mean outliving a spouse. According to the Joint Center for Housing Studies of Harvard University, “In 2018 women comprised 74% of solo households age 80 and over.”

For these reasons, women should think about how to plan for long-term care.

Ability to pay

Long-term care is costly. The average private room at a long-term care facility is over $13K a month in my home state of Connecticut, according to Genworth’s Cost of Care Survey. Florida is a little cheaper. In the Naples area a private room is about $11K a month.

Of course, there are ways to keep the cost down, like paying for care at home. Home health care is about $5K a month in Naples, Fla. (Genworth 2020 figures). Multiply these numbers by 1.44 years – the average duration of care for women, according to the study – and these numbers can get big fast.

Medicare and Medicaid

Government programs such as Medicare and Medicaid are tricky. Medicare may cover some long-term care expenses, but only for the first 100 days. Medicare does not pay for custodial care – at home long-term care. Medicaid pays for long-term care, but you must qualify financially. Also, most long-term care facilities in my experience only have a set number of Medicaid beds available.

Spending down an estate to qualify for Medicaid is one way to pay for long-term care, but it’s not ideal in my opinion.

The risk the facility you want is not available for Medicaid recipients looms large. Also, to qualify for Medicaid may leave you financially destitute, not ideal after a lifetime of working. Finally, the rules for Medicaid can change. For some, Medicaid is the only option. For others, who have time on their side and the resources available, now is the time to start planning.

Run the Retirement Projections

The first step when mapping out a road trip on a GPS is to enter in your starting and destination point. It’s the same with retirement and long-term care planning. When I take on a new client, we always review the retirement projections. We start with an ideal scenario. This may mean both spouses live long happy lives. Or it could mean no long-term care is needed. Then I play a series of “what-if” scenarios. What-if the husband passes early? How does that impact their retirement? What if a female client lives to 100? Will she have enough to live on? What-if a single woman needs long-term care for dementia? Alzheimer’s and dementia can last for years, wreaking havoc on a retiree’s nest egg. I always stress test the ideal scenario.

Below is one example. In the base or ideal scenario, the client had a modest retirement success rate of 78% out of 100%. The higher the success rate, the better the chance the client does not run out of money. However, the odds drastically decrease when we plug in a long-term care expense for two years at her age 86.

Planning for long-term care

The outputs drive the recommendations. If a female client has a high retirement success rate – even with the long-term care expenses added into the analysis – then she may want to self-insure her future long-term care expenses. Self-insuring can mean setting up a designated long-term care investment account solely to be used for future long-term care expenses. This account can be a brokerage account or IRA or health savings account if available. Long-term care costs have increased by about 3%-5% over the years, a diversified portfolio is a smart way to keep pace with inflation.

If a female client has a modest degree of retirement success, like in the example above, the planning may be slightly different. The woman in this example may want to decrease current expenses to save more for the future. She may also want to review long-term care insurance. I may recommend in this scenario some combination of both – self-insuring and purchasing a small long-term care policy. The long-term care insurance is a backstop – preventing her from completely depleting her nest egg in the event of a long, protracted illness.

Some states also offer “partnership plans.” A partnership long-term care plan is a private insurance policy with a special perk. The plan allows an individual to keep some of the nest egg and still qualify for Medicaid. For example, if a partnership long-term care plan pays $300K in long-term care benefits, then $300K of personal investments or cash may be excluded from the Medicaid qualifying calculation. This is helpful if you do end up needing Medicaid to pay for long-term care.

Partnership plans have specific policy provisions like inflation protection. It’s best to seek help from a qualified agent familiar with partnership plans.

Other planning implications

Women can also consider delaying taking Social Security till age 70. If women live longer, the extra benefits accrued by waiting can help with long-term care. Women with a higher-earning husband may want to encourage the higher-earning spouse to delay until age 70 if appropriate. When the higher-earning spouse passes away, the widow can step into the higher benefit.

The average break-even age is generally around 77-83 for Social Security. If an individual can live longer than 83, the more dollars and sense it makes to delay collecting till age 70.

Finally, getting the right estate documents in order is a must. Women – and men – should have a power of attorney (POA). A POA gives a trusted individual the ability to write checks and send money to pay for long-term care. Women and men should also have a “trusted contact” on all their investment accounts. A trusted contact cannot transact money but is notified in the event of suspected elder abuse or fraud.

The moral of the story is to start planning! Women especially need to think about the impact a longer life can have on their retirement. Start with running the retirement projections. Play the “what-if” scenarios. The more a prospective client procrastinates, the fewer options are generally available. A change in health could prevent someone from qualifying for long-term care insurance. Delaying saving for a future long-term care expense can mean less growth on the investment.

When it comes to planning, patience is often not a virtue. Delaying or kicking the can down the road may prove costly.

For more information or to discuss your retirement and long-term care, please send me an email at maloi@sfr1.com.

Further reading: 3 Ways to Pay for Long-term Care

Investment advisory and financial planning services are offered through Summit Financial LLC, an SEC Registered Investment Adviser, 4 Campus Drive, Parsippany, NJ 07054. Tel. 973-285-3600 Fax. 973-285-3666. This material is for your information and guidance and is not intended as legal or tax advice. Clients should make all decisions regarding the tax and legal implications of their investments and plans after consulting with their independent tax or legal advisers. Individual investor portfolios must be constructed based on the individual’s financial resources, investment goals, risk tolerance, investment time horizon, tax situation and other relevant factors. Past performance is not a guarantee of future results. The views and opinions expressed in this article are solely those of the author and should not be attributed to Summit Financial LLC. Links to third-party websites are provided for your convenience and informational purposes only. Summit is not responsible for the information contained on third-party websites. The Summit financial planning design team admitted attorneys and/or CPAs, who act exclusively in a non-representative capacity with respect to Summit’s clients. Neither they nor Summit provide tax or legal advice to clients. Any tax statements contained herein were not intended or written to be used, and cannot be used, for the purpose of avoiding U.S. federal, state or local taxes.

This article was written by and presents the views of our contributing adviser, not the Kiplinger editorial staff. You can check adviser records with the SEC or with FINRA.

Supreme Court Justice Ruth Bader Ginsburg’s death heightened the stakes in a case scheduled to appear before the court Nov. 10 that could reverse improvements to Medicare and raise out-of-pocket costs for beneficiaries. The case, California v. Texas, which was filed by 20 Republican-leaning states, challenges whether the Affordable Care Act can exist without the individual mandate to buy health insurance. A Republican-controlled Congress removed the financial penalty for those without insurance in 2017.

“If the ACA was repealed or rescinded in full, it would be devastating for Medicare,” says David Lipschutz, associate director of the Center for Medicare Advocacy, which along with AARP and Justice in Aging filed an amicus brief supporting California and 16 other Democratic-leaning states defending the health care law. Many of the law’s provisions that strengthen the program’s fiscal solvency also strengthen consumer protections for beneficiaries, he says.

“The ACA’s changes are so ingrained in the program that people don’t remember what Medicare was like before the law,” adds Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center. Without the ACA, she says, the doughnut hole for prescription drug coverage, which closed in 2020, reopens, and “the expansion of preventive care services goes away.” The effects encompass both traditional Medicare and Medicare Advantage plans, eliminating ACA improvements that helped drive costs down for the program and beneficiaries. Here’s what happens to Medicare if the court invalidates the law.

Since 2011 the ACA has been steadily closing the prescription drug coverage gap, known as the doughnut hole, in Medicare Part D by requiring drug manufacturers and insurers to pick up more of the cost. The hole was finally closed this year with seniors paying 25% of the cost for both generic and brand-name medications and manufacturers picking up 70% of the tab; insurers kick in the remaining 5%. Before the ACA, seniors paid 100% of prescription drug expenses while in the doughnut hole.

Thanks to the ACA, there’s no copayment or deductible for potentially life-saving screenings for cancer, diabetes, heart disease and other illnesses. Flu shots and annual wellness visits are also free. Before the ACA, says the National Committee to Preserve Social Security and Medicare, beneficiaries had to pay 20% of the cost for most preventive care services.

The ACA requires Medicare Advantage plans to spend 85% of premium dollars on health care, not profits or overhead. The plans also can’t charge more than traditional Medicare for chemotherapy, renal dialysis, skilled nursing care and other specialized services. (Beginning in 2021, Advantage plans must accept enrollees with end stage renal disease.)

Those restrictions dramatically lowered costs for plan participants since the ACA became law in 2010 and enticed more Medicare enrollees to choose Advantage plans. Over the past decade, the average Medicare Advantage premium plummeted 43% while enrollment soared 117%, according to the NCPSSM.

A study cited in the amicus brief filed by the Center for Medicare Advocacy found that the ACA extended the solvency of the program’s trust fund by eight years to 2026, mostly by finding new sources of revenue and slowing the growth of payments to all providers. The Congressional Budget Office estimates that reversing those changes would cost the program $700 billion over 10 years. “Medicare would face almost immediate insolvency,” predicts the Senior Citizens League in a report.

Curbing provider payments also lowered costs for seniors, helping to keep Medicare Part A deductibles and copayments in check. Similarly, Part B premiums and deductibles are much lower than projected before the ACA became law. From 2011 to 2020, Part B premiums increased 23%, the Senior Citizens League found. From 2000 to 2009—the nine years before the law’s passage—Part B premiums rose almost five times faster, soaring 112% over that period.

The insurance industry has changed since I began my career. Long-term care insurance policies were the recommended option, and the company I started with even had their own stand-alone home health care policy.

A New York Times article “Aged, Frail, and Denied Care by Their Insurers” left me stunned on how insurance companies that sell traditional long-term care insurance policies deny claims when needed most and I had witnessed this on multiple occasions. It was difficult endorsing this product after all the backlash. According to AARP, 52% of people who turn 65 today will develop a severe disability that will require long-term care at some point in retirement. The U.S. Department of Health and Human Services reports that 70% of people over 65 will need long-term care at some point in their lives.

So, how do you approach such a delicate subject? Of course, you can always self-pay or apply for government benefits — such as Veterans Aid and Attendance or Medicaid — but the qualification rules are strict and continually changing. For instance, the Department of Veterans Affairs implemented new guidelines on net worth and asset transfers in September 2018.

Long-term care insurance is still an option, but even large companies, such as GE, intend to impose a $1.7 billion premium increase through 2029 on its roughly 274,000 long-term care insurance policyholders. The average policyholder age is 77. Can you visualize getting hit with a substantial premium increase on your long-term care insurance policy after paying on it for over 12 years? (Learn more by reading 6 Options to Fund Long-Term Care in Retirement.)

While there are other options to traditional long-term care insurance — including life insurance and annuity long-term care riders — not all are structured the same. In fact, there are two styles of riders that are often confused: 1.) long-term care riders; and 2.) chronic illness riders.

What is a long-term care rider?

A long-term care rider is an add-on or feature to a life insurance policy or an annuity under IRC §7702B (the Internal Revenue Code concerning the treatment of long-term care) designed to help pay for the costs of long-term care services. Claims paid on these can be either temporary or permanent (as opposed to chronic illness riders, which are only for permanent conditions). In order to qualify for services, they must be recommended by a licensed health practitioner — such as your doctor.

Long-term care benefits from a life insurance or annuity rider are paid in two ways:

Indemnity policy

With an indemnity policy, once the insured person qualifies for benefits, monthly payments are paid out according to the contract. The policy automatically pays the specified dollar amount directly to the policyholder each month, regardless of what the care actually costs.

Benefits paid in excess of the HIPAA “per diem” (or per day) limitation are subject to taxation. The HIPAA per diem rate for 2019 is $370 per day (up from $360 per day for both 2017 and 2018).

For example, say a 65-year-old woman purchases an annuity with a long-term care rider for $100,000 that provides an immediate benefit of about $300,000 (or $137 per day for up to six years). If she were to qualify for long-term care benefits in the following year (age 66), she’d receive about $141 per day, as the benefit grows over time based on the contractual guarantees. (It’s important to note that not all insurance companies operate the same way.) Since this amount is below the HIPAA per diem rate of $370 per day, all benefits paid would be tax-free!

Reimbursement policy

With a reimbursement policy, you’d only be “reimbursed” for your actual long-term care costs, instead of receiving a steady amount, like an indemnity policy.

Using the same example above, we’d have to find out how much the woman is spending in order to be reimbursed. Let’s say her costs were $120 per day and her daily maximum is $141, the $120 would be paid and the remaining $21 would be placed back into the pool.

It’s imperative to note that while some may prefer the reimbursement policy in order to extend their benefits, the indemnity policy is simpler in many instances, and the excess can be used for other significant non-medical purchases.

What is the difference between a chronic illness rider and a long-term care rider?

A chronic illness rider is under IRC § 101(g) to help pay for permanent qualifying events. It’s similar to a long-term care rider where two out of six Activities of Daily Living (ADLs) or severe cognitive impairment can trigger benefits, and a licensed health care provider — such as your doctor — will have to certify this. However, chronic illness policies only pay when it’s likely the illness will last the rest of your life — not temporarily.

For example, a 70-year-old who suffers a stroke would receive long-term care benefits under a long-term care rider but not necessarily a chronic illness rider. In many instances, a stroke would not be sufficient to receive benefits under a chronic illness rider. If that person is deemed to recover, the chronic illness policy will not pay any benefits (the chart below).

If the stroke is one from which they’ll never recover and is deemed “permanent,” the chronic illness policy will pay benefits according to the contract.

It’s extremely important to know that a chronic illness rider is not long-term care. I have witnessed many instances where both financial advisers and insurance agents have confused the two and misrepresent a chronic illness rider as a long-term care rider.

Let’s review the differences between a long-term care rider and chronic illness rider:

Pension Protection Act of 2006

The Pension Protection Act of 2006, which went into effect in 2010, opened up an immense tax-efficient opportunity. For those with life insurance or annuity policies with substantial taxable gains, they can do a tax-free 1035 exchange into a new life insurance or annuity with a long-term care rider.

Here are the types of the policies that are eligible to be transferred tax-free to a new policy:

While a life insurance policy can be exchanged to both another life insurance policy as well as an annuity, an annuity can only be transferred to another annuity.

For example, a 70-year-old has an existing annuity that was purchased for $100,000 and is now worth $200,000. He or she can do a 1035 exchange into a new annuity with a long-term care rider that guarantees $600,000 worth of benefits. The person would pay no taxes on the exchange … and could potentially receive all of those long-term care benefits tax-free.

As you’re looking into a lifelong investment for long-term health care benefits, remember to take all of these factors into consideration. And be sure to fully understand the differences between a chronic illness rider and a long-term care rider, because confusing the two could lead you to make a costly mistake.

This article was written by and presents the views of our contributing adviser, not the Kiplinger editorial staff. You can check adviser records with the SEC or with FINRA.

No matter how busy she is, and even when she's on vacation, Erin McLeod stops every night at 10 p.m. to make a phone call. On the other end is her 104-year-old friend, Henrietta Daytz, in her assisted-living facility in Sarasota, Fla. McLeod asks about Henrietta’s day and wishes her a good night. “She’s like family now,” says McLeod, president of the Senior Friendship Centers in Florida, which serve older adults. “It’s something we both look forward to.”

McLeod started calling when Daytz turned 99 and was still living independently. She says she figured that Daytz, a longtime volunteer at the senior center, could use someone checking in on her. McLeod’s family and friends sometimes join in on speakerphone.

A simple phone call is one strategy to help counter social isolation among the elderly, a condition increasingly recognized as a health threat on par with smoking, and even more harmful than obesity. About 17% of adults age 65 and older are identified as isolated, says AARP Foundation President Lisa Marsh Ryerson. Studies show that isolated older adults die at higher rates from high blood pressure, heart disease and other chronic diseases than more engaged seniors. British researchers found that social isolation may increase an older person’s risk of early death.

Older adults can become socially isolated when they live alone, have little contact with friends and family, and don’t get involved with community or civic groups. The death of a spouse, physical difficulties, caregiving and giving up driving contribute to it. Feeling lonely as you age isn’t a new affliction, but the link between isolation and poor health is becoming better understood. As more Americans age, researchers expect the problem to worsen.

“Social isolation kills,” says James Lubben, director of Boston College’s Institute on Aging. “We need to address it with all the seriousness we put into other health problems, like smoking. The message is finally getting out to pay more attention to this.”

McLeod calls it “death by sitting.” For example, consider a long-retired senior in his or her eighties who has lost a spouse or outlived friends and stays in a chair all day, watching TV news and getting agitated. Circulation suffers, brain function slows, and a lack of movement triggers or worsens a health condition, such as diabetes. Isolation affects people of all income levels; someone can be as alone in a lush gated community as in a modest income neighborhood.

Friends and family members sometimes feel powerless. But there are ways you can engage elderly relatives and neighbors, and connect them with opportunities to socialize or take care of their health. Reach out with a simple offer, such as taking out their trash. “Check in on people in your neighborhood, and in your family,” Ryerson says. “Begin conversations. If you’re headed out to run errands, offer to do their shopping. Or more important, make room in your car for them.”

You can avoid becoming isolated as you age by rethinking your retirement now, Lubben says. Include your social network in your retirement planning, so you’ll be near friends or family, or in a walkable community. Lubben, 72, and his wife loved living in Los Angeles years ago, but the couple plans to retire to New York, near their children. “Building the social capital you’ll need in retirement is just as important as saving for your nest egg,” he says. “One of the silliest mistakes older people make is to retire to a warmer climate where they don’t know anyone. They realize as they get older, they need some help, and no one’s around.”

Search for Social Outlets

To engage an older parent or neighbor, start by encouraging a second look at their local senior center. Some are remaking their outdated images, with gourmet cooking classes, wine tastings and meditation.

A friend took Elizabeth Kraft, 91, to the Senior Friendship Center in Venice, Fla., after her husband died in 2013. She expected old people playing bingo. She discovered greeters at the door, a bustling café and a live band playing music that she loves. “It felt very welcoming,” she says. “If you just sit on your porch all day and don’t do anything, you’ll lose your strength.”

There are more than 11,000 senior centers in the U.S., with varying services and fees (find one at NCOA.org). It might be difficult to persuade a parent to go. Suggest they use their skills to volunteer, McLeod says. “We’ll often see an adult kid dragging their mom or dad down here, and they’re complaining about being treated like a teenager,” she says. “Before you know it, they’re jumping right in.”

Seek out other socializing alternatives. In Chicago, three Mather’s More Than a Café locations cater to adults over 50 with coffee, lectures, writers’ groups and karaoke. Mather LifeWays, a nonprofit, launched the first café in 2000, aiming to keep older adults active in their communities.

Chuck Bermingham, 67, a retired computer specialist, was grieving and exhausted after his wife of 42 years died in 2015. A friend invited him to lunch at a Mather’s Café. Now he’s the chorus director and a regular at Saturday ukulele. “It’s been a great way for me to keep my mind off things,” he says. “I have a lot of new friends now.” More than 40 organizations in the U.S. have cafés or programs based on the Mather’s model. Those who are homebound can listen in by phone to live discussions on topics such as saving money and current events (search “Telephone Topics” at MathersLifeways.com).

If your parent needs to stop driving, be sure to plan ahead. In rural and suburban areas, older adults often end up stuck for rides, adding to isolation. Organize an informal volunteer network of friends and family members to provide transportation. Check with the local senior agency to see if there are any special services available, or go to Eldercare.gov.

Doctors and social workers are starting to screen patients for problems caused by isolation. Accompany a parent or relative to an appointment, and be sure to bring it up, if the doctor doesn’t ask, Lubben says.

If you’re older and alone, make an effort to build an old-fashioned social network in your neighborhood, advises AARP. Ask your neighbors about their grandchildren. Invite someone to go walking. Volunteer to read to a neighbor’s kids. (AARP offers more tips at Connect2Affect.org.)

“You have to be proactive,” says Jim Firman, president of the National Council on Aging. “Get into the mindset of, ‘If I don’t make new friends, especially with younger people, I’m just not going to have any.’ ” You might feel shy. But remember: Your health and happiness could hinge on that bold step.

It’s an act of love, a lesson in crisis management, a stress on finances and often a years-long slog. Over a recent 12-month period, more than 43 million adults provided care for a vulnerable family member or friend, according to the National Alliance for Caregiving and the AARP Public Policy Institute. The contribution to family and society is staggering. A Rand Corp. report puts the annual value of unpaid caregiving just for the elderly at $522 billion—-more than the amount it would take to retire the 2015 federal deficit.

Not only do caregivers provide mostly free care, but they also often sacrifice their own financial security in the process. The majority of care­givers are women, and for them, the total cost of caregiving amounts to an average of $324,040, according to a study of caregiving costs by MetLife. That figure reflects $142,690 in forgone wages, $131,350 in lost Social Security benefits and $50,000 in reduced pension benefits. It does not reflect forfeited career opportunities, nor does it include the expenses caregivers cover out of pocket, which can add up to several thousand dollars or more a year.

For all their efforts, most people don’t identify themselves as caregivers, says John Schall, CEO of the Caregiver Action Network, an advocacy group. “They think it’s just something you do as family, so they have no way of knowing there are resources for them.” But caregiving doesn’t have to be a solo enterprise. If you’re spending time, money and emotional capital providing care, here’s how to find help.

Enlist the family

You’d think that the more siblings you have, the more help you’d get when Mom or Dad needs assistance. But the job of caregiving often falls on the child who lives closest to the parent or on the child who is single. “One person always does more,” says Cindy Hounsell, president of the Women’s Institute for a Secure Retirement. Daughters are more likely to provide basic care, according to the MetLife study, whereas sons tend to contribute financial support. Either way, rather than carrying the load single-handedly, says Hounsell, discuss roles with your siblings as soon as you realize that your parent or elderly relative needs help.

One way to get everyone on the same page is to set up a family meeting—-by Skype, FaceTime or conference call, if necessary—-and have a social worker, mediator or care manager facilitate the discussion. A neutral party can identify assignments each of you can take on (say, regular visits by the sibling who lives nearby and bill paying by the one who lives in another state) and help the family navigate emotions that often arise when ailing parents are involved. “It’s really hard for some families to come to terms with the fact that they’re going to have to step up,” says Leah Eskenazi, director of operations and planning at the Family Caregiver Alliance.

At the meeting, discuss how caregiving and related expenses will be covered. Treat the matter as a business proposition, says Hounsell. “Say, ‘You want someone to take care of Mom. This is what it costs, and we’re all going to have to share in those costs.’ ” If you’re the primary caregiver, your family might agree to pay you as an independent contractor. In that case, it’s good to have a formal contract, known as a personal care agreement, to spell out the terms of the arrangement. (For information on how to draw up a contract, see “Financial Steps for Care­givers,” at www.wiserwomen.org.)

Or your parent might compensate you, either from income and savings or by adjusting his or her estate plan to give you a bigger share. Whatever the plan, “get buy-in from your siblings from the beginning,” says Melissa Rowley of Chicago, who managed the care for both of her parents and has been involved in a family dispute over how the finances were handled.

Meet with your parents while they are still healthy to discuss their ex­pectations for later care and how they plan to pay for it, says Randi Merel, a senior financial adviser at Merrill Lynch. After having that conversation, the children of one of her clients arranged to help pay for his long-term-care insurance. “If you do it before someone is ill, it’s a much easier dialogue,” says Merel. “You make better decisions.” As for Rowley, she says she’s angry with her parents for not spelling out the caregiving arrangements up front “because it gets ugly. There’s never a clear winner.”

Line up resources

Even with the help of siblings, you may need more boots on the ground—say, someone to drop by your parent’s place to fix meals or to provide transportation. To find help in your community, contact your local area agency on aging through the Eldercare Locator (800-677-1116). Such agencies provide direct support to caregivers, including respite care (usually on a limited basis), counseling and emergency assistance. They can also connect you with local providers for such services as home-delivered meals, transportation and help with chores.

Some of these services may be free. For instance, at Lotsa Helping Hands, you can post requests for help and get matched up with volunteers.

If a volunteer isn’t available, check out caregiving agencies, such as Home Instead Senior Care. Home Instead’s 611 U.S. franchises offer in-home care, including meal preparation, errand-running and housekeeping, generally for about $18 to $24 an hour. (You can also find nonmedical caregivers in your area by using the search tools at www.care.com and www.caring.com.) Homemaker services run a median $20 an hour, according to Genworth’s 2015 Cost of Care survey.

If you need a supervised setting for your relative while you’re at work or so you can take a break, investigate adult day care. Such facilities offer meals, supervised outings, social activities and sometimes health services. The median daily rate is $69.

Consider hiring a geriatric care manager if your parent has complicated needs or lives in another state. Such professionals, who often have a background in nursing or social work, can assess your parent’s situation, put together a care plan and help you execute it, and keep you and other family members in the loop. Fees range from $300 to $800 for an initial assessment and $100 to $200 an hour for care management, according to the Aging Life Care Association (formerly the National Association of Professional Geriatric Care Managers). You can find a geriatric care manager in your area by using the search tool at www.aginglifecare.org.

If you need help resolving family differences involving caregiving, find a mediator through www.mediation.org, a division of the American Arbitration Association. To find social workers who specialize in family and caregiving issues, use the HelpPro Social Worker Finder, at www.helppro.com.

Medicare does not pay for personal or homemaking care, but it does cover home health care for people who are homebound and intermittently need skilled nursing or physical or occupational therapy. The services must be part of a plan established and reviewed by a doctor, and they must be provided through a Medicare-certified home health agency. For details, see www.medicare.gov/coverage/home-health-services.html.

Medicaid, run by the states, will pay for personal and homemaker services, as well as adult day care, but only for care recipients whose income and assets fall under state limits (eligibility rules and covered services vary by state). Most states also have programs, including Medicaid, in which eligible care recipients are given a budget from which they can pay caregivers of their choice, including family members. See the National Resource Center for Participant-Directed Services, at www.bc.edu/schools/gssw/nrcpds.

Long-term-care insurance also pays for in-home care. You may have to wait up to 120 days, depending on the policy, before coverage kicks in. Be prepared to jump through hoops—such as providing documentation from a doctor that your family member needs the care—when you submit claims.

Talk to your boss

Your ability to juggle caregiving and your day job successfully could depend on your boss. A 2014 survey conducted for the Families and Work Institute shows that half of those who left their jobs to provide elder care did so because their employers weren’t flexible enough to accommodate their dual responsibilities—say, by letting them telecommute or work an earlier or later shift. For their part, employees are reluctant to raise an issue that might be perceived as affecting their work performance, says Ken Matos, senior director of research at the institute. “They don’t want to reveal their situation and don’t think there’s anything their employer can do about it.”

Recently, however, some employers have initiated programs that educate employees on elder-care resources and create a more receptive atmosphere for discussing work accommodations, such as job sharing. “Large businesses have realized it is more costly to them if they lose employees who are caregivers and have to hire and train new employees. It’s only a tiny crack in the wall, but it has begun,” says Schall, of the Caregiver Action Network. If your company has no such program and you need to ask for flexibility, frame it in a problem-solving way, says Matos: “Approach your employer not by saying ‘I’m not meeting goals’ but ‘I’m planning ahead to meet my goals.’ ”

Under the Family and Medical Leave Act, companies with 50 or more employees must allow up to 12 weeks a year of unpaid leave for workers who are caring for a newborn or an ailing family member. California is among a handful of states that go a step further by requiring employers to offer eligible employees up to six weeks of paid leave a year, at 55% of their wages, to care for a seriously ill family member.

Often, the stress of working a full-time job while caring for an elderly relative can feel overwhelming, even with a supportive employer. If you’re considering quitting your job, try to work at least long enough to vest in your pension or 401(k) plan (which may require vesting for employer contributions) or to accumulate enough credits to qualify for Social Security. And prepare a budget for paying expenses after you leave your job, says Schall. His advice: Rather than quit altogether, switch to part-time status. Be sure to find out how cutting your hours might affect your benefits, such as your pension or health insurance.

Q: My wife and I are both 65 and will be retiring later this year. Over the course of our careers we’ve worked hard at saving and will both have good pensions. Our plan had always been to wait until age 70 to start Social Security, but given our high annual retirement income (almost $200k), we are concerned that we may lose some of our Social Security if the government ever decides to introduce means testing. What are your thoughts on this? Should we wait until we are 70, or should we take the money now?

A: There are a couple of ways you should address Social Security. One is to simply crunch the numbers based upon current assumptions. The other, which speaks to your concern about means testing, is to consider the possibility that Social Security benefits may be reduced in the future for high-income retirees.

Because almost every article I read primarily deals with the financial calculations, without taking into account the very real possibility of changes to benefits, I’d like to primarily address the likelihood and repercussions of means testing.

One thing we know is that Social Security, in its current form, cannot continue forever. There simply aren’t going to be enough workers to pay for the benefits of all the projected retirees (according to AARP, some 75 million Americans will be over the age of 65 by 2030). Payroll taxes will either have to increase, or benefits will have to be reduced. (And, there could actually be a combination of both.)

Before you begin to think that I’m crazy for believing that future benefits will be cut, simply consider that Congress has already cut benefits a number of times. Sure, the reductions haven’t been exactly direct, as in everyone being forced to take a 10% cut, but they have happened indirectly through increased taxation.

Most people forget that for its first 45 years, or so, Social Security income was entirely tax-free. The money the government sent you each month was yours to do with as you pleased. But in 1983, Congress decided to tax the Social Security receipts of wealthier retirees. The Amendment to the Social Security Act began taxing up to 50% of the benefits for retirees with provisional incomes in excess of $25,000 for singles and $32,000 for married couples.

That taxation was clearly a reduction in benefits to wealthy retirees.

Taxation of Social Security got worse in 1993 with the passage of the Omnibus Budget Reconciliation Act. This law increased from 50% to 85% the portion of Social Security income that is subject to taxation. As a result, higher-income retirees had to give up a still-greater portion of their Social Security income.

As federal income taxes have increased this past decade, from a top rate of 28%, to a top rate of 39.6%, this too has had an impact on the benefits of wealthier retirees. For those in the top income tax bracket, the taxation has caused a 33% reduction in benefits. In other words, after taxes have been deducted, a Social Security income of $1,000 has been reduced to $667.

As the pressure to preserve Social Security for the masses mounts, due to the obvious strains on the system, it would seem to me that high-income retirees are again going to be the target. It would be hard for lawmakers to make the case that the Donald Trumps of the world should collect Social Security benefits while young working families are forced to pay a greater share of their income to payroll taxes.

So, if I were a betting man, and I had to place a wager on Social Security income for the top 10% of retirees, my bet would be that future benefits will be reduced, either via higher taxes or by outright means testing.

Given your situation, it would be foolish for both of you to wait until age 70 to collect benefits. At a minimum, one of you should “file and suspend” your benefits so that your spouse can begin collecting a spousal benefit. By doing this, you would both be deferring benefits until age 70, thus allowing your benefits to grow each year. However, one of you would be receiving a spousal benefit equal to 50% of the other’s full retirement amount. At age 70, the spouse can stop receiving the spousal benefit and apply for his or her own Social Security.

Now, if you are concerned that your future benefits may be reduced, either through means testing or through increased taxation, it may be best for at least one of you to start your benefits as soon as you retire. One could receive their normal, full retirement benefit, while the other collects a spousal benefit. As in the previous scenario, the spouse can switch to his or her own benefit at age 70.

Remember, almost anything is possible. If for any reason you have a sense that wealthy retirees will lose all of their Social Security income within the next few years, then you’d obviously both want to start receiving benefits right away. (Frankly, I can’t see that exact scenario happening, but the state of Social Security is worrisome, and it’s impossible to predict what Congress might do.)

As a general rule of thumb, for those who will be reliant upon Social Security for a large portion of their retirement income (the majority of Americans), if at all possible, I recommend they defer their benefits until age 70. This maximizes what they will receive. But for those people who have a high income and substantial net worth, the surest bet may be to begin taking benefits as soon as they can.

Scott Hanson, CFP, answers your questions on a variety of topics and also co-hosts a weekly call-in radio program. Visit MoneyMatters.com to ask a question or to hear his show. Follow him on Twitter at @scotthansoncfp.

This article was written by and presents the views of our contributing adviser, not the Kiplinger editorial staff. You can check adviser records with the SEC or with FINRA.

Discounts are a big selling point for an AARP membership. For just $16 a year, adults age 50 and older can join the 37-million member nonprofit organization and benefit from savings on travel, dining, shopping and entertainment. Certainly, many of the discounts are worthwhile. But in some cases money-savvy adults can find better deals through other avenues that don’t require a membership fee. Here are four AARP discounts, in particular, that can be beat by other rates and offers.

Restaurants. AARP members can get a 10% to 15% discount at several restaurants, including Denny’s, Landry’s Seafood House, McCormick & Schmick’s and Outback Steakhouse. However, you typically can find gift cards for these restaurants – as well as many other restaurants – selling at a discount of 20% to 25% at Web sites such as Cardpool, GiftCards.com and Raise. For example, we recently found a $50 Landry’s gift card selling for $37.50 (a 25% discount) at Raise. Anyone can buy gift cards that sell for less than face value from these sites. See How to Buy Discount Gift Cards for additional details. (Note: If you already have an AARP membership, you can use your restaurant discount in conjunction with a discounted gift card to amplify your savings.)

Hotels. AARP members get discounts of 5% to 20% at several hotel chains ranging from Best Western to Wyndham. The discounts apply to the best available rates offered by the hotels and can't be combined with other discounts. However, better discounts often can be found through travel sites and apps such as Last Minute Travel, which offers travelers access to wholesale prices for hotels in more than 150 countries. For example, we found a room with two double beds at the DoubleTree in Miami near the airport for $180 per night with the 5% AARP discount. But a similar room was available through the Last Minute Travel app for $150.

Airport parking. Park Ride Fly USA offers a 10% discount to AARP members who use the service to reserve a parking spot at an off-airport facility and take the company’s shuttle to the airport. However, if you fly out of one of the 12 major airports where FlightCar operates, you can park free and get paid if your car is rented to a pre-approved driver. Membership is free and members save an average of $100 in parking fees on a five-day trip and make $30 in rental earnings, according to FlightCar.

Entertainment. AARP currently is offering members savings of up to 30% on Cirque du Soleil shows. However, you can take advantage of Cirque du Soleil’s own special offers to get an even better deal. For example, we found a ticket for “The Beatles Love” show at Mirage Las Vegas marked down from $114 to $66 through a seasonal promotion. With an AARP discount, the $114 ticket only is marked down to about $92. For traveling shows, you can save more with Cirque’s discount for tickets bought in packs of four than you can with the AARP discount. For example, tickets for the “Varekai” touring show in Baltimore in July are $37.50 each when you buy in a pack of four. With the AARP discount, you’d pay $60.35 per ticket.

People who are enrolling in traditional Medicare should buy a supplemental insurance policy to cover the substantial gaps left by deductibles and co-payments, according to consumer advocates. But choosing a private Medigap plan can be daunting.

That's what Joyce Katen discovered when she turned 65 in May. "I got so confused," says Katen, a clothing manufacturing consultant in New York City. She turned to the Medicare Rights Center (www.medicarerights.org), a consumer group that helped her choose an insurance policy among numerous offerings.

Like others approaching 65, Katen first needed to decide how she would protect herself against Medicare's large coverage gaps. Most beneficiaries have two options. They can go with a private Advantage plan, which covers all Medicare benefits, provides drug coverage and limits out-of-pocket costs. Or they can opt for traditional Medicare and buy a separate Medigap policy as well as a Part D prescription-drug plan.

For Katen, that decision was easy. Advantage plans restrict your selection of providers, and Katen says she wants to be able to use any doctor she chooses, as traditional Medicare allows.

Then came the hard part for Katen: choosing a supplemental insurance policy. Medigap policies are sold by private insurers in ten standardized benefit designs, named A through N. With some exceptions, coverage and price generally increase as you move up the alphabet.

Plans C and F are held by a majority of the nine million Medigap beneficiaries. Both plans pay the deductible for Part A, which covers hospital costs, and for Part B, which covers outpatient costs. The deductible for Part A will be $1,260 for each benefit period in 2015, and the annual Part B deductible will be $147. (Plans E, H, I and J are no longer sold, but if you hold one, you can continue to keep it in most cases.)

To figure out which policy is best for you, consider your "health status, family medical history and risk tolerance," says Casey Schwarz, policy and client services counsel for the Medicare Rights Center. Healthier beneficiaries who rarely need medical care may be best suited for high-deductible plans.

Plans K and L are high-deductible policies that have lower premiums but impose higher out-of-pocket costs. Plan F also offers a high-deductible version.

But new beneficiaries should not choose a plan based solely on their health today. As long as you buy a Medigap policy within six months of enrolling in Part B, an insurer cannot reject you or charge you more because of medical issues. If you become ill and want to switch to a plan with better coverage, an insurer can boost the cost or turn you down.

Katen decided to go with the fully loaded Plan F. Katen, who is healthy, would rather pay more for comprehensive coverage and not worry about footing the bill if she gets sick. "I can't imagine not having the coverage," she says. She pays UnitedHealthcare, which sells policies under the AARP name, a monthly premium of $261, in addition to the monthly $104.90 Part B premium she pays to Medicare.

Find a Plan That Fits Your Needs

Depending on the plans offered in your area, Plan N could be a middle ground for many healthy beneficiaries. "Plan N provides very good coverage and is more affordable than Plan F," says Ross Blair, senior vice-president of eHealthMedicare.com, a division of online broker eHealth Inc. Plan N provides much of the same coverage as Plan F, but it doesn't cover the $147 Part B deductible. It also charges a $20 co-payment for doctor visits and a $50 co-payment for emergency room visits that don't result in hospital admissions.

In New York City, UnitedHealthcare offers a Part N plan for $178 a month, compared with Katen's $261 premium for Plan F. Katen could still come out ahead with Plan N if she had two emergency room visits and 40 visits to the doctor.

Once you choose your plan category, it usually makes sense to go with the cheapest plan. Under federal law, all plans offered under the same letter must offer the same benefits. Prices for the same policy can vary widely. For example, annual Plan F premiums range from $1,752 to $3,768 in Rockville, Md., and from $2,472 to $6,552 in Miami.

Besides checking the initial premium, ask the insurer which of the three pricing methods it uses for the plan you are considering. Attained-age pricing bases the premium on your age when you buy the policy, with rates rising as you grow older. Premiums can also increase because of inflation.

With issue-age pricing, the premium is based on the age at which you buy the policy (the younger you buy, the less expensive), and it will not change as you age, except for inflation. Community-rated policies charge the same price to everyone regardless of age, and your annual premium can only increase for inflation. "We would encourage going with a community-rated plan, with an issue-age plan being the next best thing," Blair says. He compares attained-age policies to variable-rate mortgages, which start off at a low price but can escalate considerably.

To understand how your costs may change over time, ask for a three- to five-year rate history for each policy you are considering. Also ask for quotes as if you were age 70, 75 and 80. Some insurers will offer discounts -- for nonsmokers, for women and for those who hold several policies with the company, such as homeowners and auto insurance.

While companies in most states can conduct medical underwriting if you apply for a plan after the initial six months are over, there are some exceptions. You can buy Medigap coverage without underwriting if you're in a Medicare Advantage plan and you move out of its service area, or if your insurer stops selling the Medigap plan you currently have. Another exception is if your retiree health coverage from a former employer ends. And some states, such as New York, prohibit underwriting after the six-month period.

To compare policies in your area, visit www.medicare.gov/find-a-plan/questions/medigap-home.aspx. To get additional help, get in touch with your local State Health Insurance Assistance Program at www.shiptalk.org. You'll find rules in your state by visiting the Web site of the National Association of Insurance Commissioners (www.naic.org). Note that Massachusetts, Minnesota and Wisconsin have their own standardized benefits.