Saturday, December 17, 2011 There Go The Social Safety Nets (to help pay for catastrophic long-term care!!)
by Susan M. Graham, Attorney at Law, Senior Edge Legal, Boise, Idaho
We have no money in this country. We all know that. How does this impact on you if you need to pay for residential long-term care in a nursing home, assisted living or in your own home?
There are two government programs that are available to seniors to help pay for care - Medicare and Medicaid.
Medicare is a national health insurance program for people 65 and older. Medicare will help pay for a maximum of 100 days of care. To access this benefit a few requirements must be met. First, a person must be admitted to a hospital and stay there at least three days. Then, when they are discharged to a rehabilitative facility, such as the Boise Elks, if that person is improving, Medicare will pay 100% for the first 20 days of care. If the person continues to improve, Medicare will pay part and the individual or their supplemental insurance will pay part of the expense for the next 80 days.
What are the holes in this "safety net"? First, the Medicare recipient must be ADMITTED to the hospital and not there for OBSERVATION. The difference is huge. If a person is not admitted, Medicare will not pay a dime toward the rehabilitative care. If Medicare does not pay, then in most cases the supplemental health insurance coverage will not pay for the care as well. This problem is happening here in Idaho as well as nationwide. The bills for the first 20 days that I've seen range from $6,000 to $30,000. This is a huge bill for most individuals and families to absorb.
The next hole in the Medicare safety net requires that the person be "Improving" during their rehabilitative care. My cousin, Kathie, at age 98, went to the hospital for three days. She was admitted. They discharged her back to her nursing home and I was called two days later saying Medicare would not pay for her care because she was not "improving." She was old and could not follow instructions. I was not surprised that she failed this second test.
Another "safety net" is the federal and state Medicaid program. Part of this program helps to pay the long-term residential care expenses for people 65 and older who meet a list of criteria. The cost for privately paying these bills ranges from $20 per hour for a bath aide to $8,000 per month for skilled nursing care. To access this benefit, it is necessary to complete an application form and submit it to the Idaho Department of Health and Welfare. The last two application forms we submitted on behalf of a married couple were approximately 400 pages each.
There were at least six more inches of back-up information. It took hours and hours to sort out and complete the application and deal with the follow-up issues. All of our Medicaid applications have been approved in the past 5 years, but remember I have a law office. The process is onerous and next to impossible for regular families in crisis to complete on their own. That is not fair, but it is the real world.
We have no money in this country to continue to provide the safety nets that have been available.
What can you do to protect yourself and your loved ones?
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Make certain you have up-to-date legal documents that include your Living Will, Health Power of Attorney and Financial Power of Attorney.
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Let the people you plan to rely upon in a crisis know you have nominated them to help.
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If you need help, seek it out. Your failure to make informed decisions may cost you and your family thousands of dollars and unnecessary worry.
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Contact your government representatives and let them know you want honest safety nets that really work, not ones that exist on paper and are not really accessible to regular people.
Friday, November 05, 2010 Medicare Plan Review-Limited Time Only-Don't Wait!!!
Medicare open enrollment is between November 15 and December 31. This is your opportunity to switch Medicare drug or health care plans. It is the perfect time to review your coverage and is extra important this year because of the new federal health law.
AARP and the State of Idaho Senior Health Insurance Benefits Advisors (SHIBA) have scheduled statewide meetings to help people select the right prescription drug program. The meeting in the Boise Valley is scheduled for Monday November 15. There will be free on-site consultation with advisors, and no sales or marketing will occur. The location is at the AARP Idaho office, 3080 E. Gentry Way, Suite 100, Meridian, Idaho 83642 from 9:30 to 3:30 p.m. on a first-come, first- serve basis. No appointments are necessary. The publicity on the AARP website states “Confused by Medicare Rx? What you don’t know could cost you money! What is the best way to save money on prescription drugs? Do you know how to protect yourself against Medicare Fraud? Do you have the right prescription drug plan for your needs?”
Five reasons why you will want to review your plan.
1. You have a limited time period to change plans running from November 15 to December 31, 2010.
2. Your prescription drug plan can change their premiums, deductions and available list of drugs they cover, so your current plan may not be the best for you.
3. The cost of the prescription drug “donut hole” should decrease for most seniors in 2011 because Medicare participants will receive a 50% discount on brand-name drugs and a 7% discount on generic drugs. Unfortunately, it will take until the year 2020 before the donut hole is eliminated.
4. Under the new law, Medicare will now pay 100% of preventative care, such as annual wellness exams.
5. If you find you want to change plans, in 2011 you have between January 1 and February 15, which is 30 days shorter than in 2010.
Here are three steps you can take to help yourself:
1) Contact your Medicare supplemental insurance agent;
2) Attend the AARP meeting on November 15 to get more information that applies to you;
Insurance agents will be sending their clients a letter with an authorization for the agent to work with clients, which must be signed and returned to the agent. After November 15, the agent can then set an appointment to talk with the client about his or her Medicare and supplemental insurance needs.
Friday, August 13, 2010 HOW TO PAY FOR LONG-TERM CARE? - THE MEDICAID PROGRAM
Medicaid is a State of Idaho and Federal government program that helps people with long-term care costs. The laws and regulations in this area change often so this article will just cover the high points of what it takes to qualify for Medicaid to have the government program pay for long term nursing home care costs.
There are many tests that need to be passed before a person can qualify for Medicaid.
• The Medicaid applicant must be age 65 or older, or blind or deemed disabled according to the Social Security standards.
• the applicant usually must be a citizen.
• the applicant must have a medical need.
• the applicant must past the income test.
• the applicant (and their spouse, if any) must pass the asset test.
What are the benefits of receiving Medicaid?
Medicaid will pay 100% for residential nursing home care and all prescription drug costs in facilities that participate in the Medicaid program
Medicaid will pay 100% for residential care in assisted living, but will not pay for drugs. There are a few Assisted Living facilities that participate in Medicaid because the facilities are often reimbursed at below their break-even point.
Medicaid will pay $16/hour for a maximum of 8 hours per day for in home care by a certified caregiver.
Income Test
Single Person
If the applicant’s gross income is more than $2,022 per month, then the applicant fails the income test. If there income is less than $2,022 per month they will pass this test. Income is usually from social security and pensions, but there are other sources of income that can be considered.
Income for a Married Applicant’s Spouse.
If the income of the healthy spouse [called the “community spouse”] is less than $1,821.25, she can get additional funds from her husband’s social security and pension to bring her up to $1,821.25 and if she has excess shelter costs, she can have a maximum of $2,739 per month. If she needs even more monthly income, she can petition the court for a greater income. There is no limit on the income received by the healthy spouse, so she can have income from her social security, wages and pension of more than $1,821 and her husband may still qualify for Medicaid.
Solution to failing the income test.
If the Medicaid applicant fails the income test by having too much income, that person can set up an irrevocable “Income Qualifying Trust” which is often referred to as a “Miller Trust.”
How does this “Income Qualifying Trust” work? The Trust creator is the Medicaid applicant. The Trustee of the Trust is that person’s spouse, a child or some other trustworthy person. Often the entire amount of the Medicaid applicant’s social security and pension are automatically deposited in the old checking account. The Trustee then sets up a new checking account and every month transfers all the social security and pension to the new account. Then the Trustee makes monthly checks: one for $40 for personal needs, one for $25 for Trustee fees and the balance to the facility.
Next week we will address the Asset Test requirements to qualify for Medicaid.
Friday, June 25, 2010 The Conveyor Belt of Aging - As People Age They Usually Fall Apart
We all want to just die some day in the distant future. No one wants to be dependent and require caregivers for any extended period before we die. The reality is obvious - as we age we probably fall apart. Just like an older car, the tires get flat or bald, the fender rusts and falls off, the battery dies. What is the progression for people?
Hopefully you started on the conveyor belt of life for seniors as a healthy retired person. As the belt moves along have you found yourself;
• Taking medications
• Having health issues
• In the hospital for a crisis (pneumonia or a fall)
• Experiencing memory loss
• Less mobile
• Signing up for Medicare and supplemental insurance to help pay for all of this.
At this point care becomes an issue, care in the home is needed and a new concern becomes how to pay for that care. Is the care paid for “out of pocket," with long-term care insurance, Veterans Administration benefits, or Medicare? As the conveyor belt keeps moving, staying in the home may no longer be possible, so you move to an assisted living facility (where you can do a few things for yourself) or you become a fragile senior and need to be in a skilled nursing home. Again, the concern is what funds you will use to pay for that care – your own money, VA non-service connected pension benefits, Medicare, Medicaid or long-term care insurance.
What is the average length of care in facilities?
Assisted Living stays range from 2.5-3 years.1 To qualify to stay in an assisted living facility, the residents need some help with what are called “activities of daily living.” These six activities include: medications, bathing, dressing, toileting, transferring and eating.
Skilled Nursing Care (nursing home) stays average 2.4 years. Of course, the average is based on residents who stay for only a few days, and others who stay for a decade or more.
What does it cost for care in southwestern Idaho?
Assisted Living $2,000 to 5,000/month
Nursing Home $6,000 to $8,000/month
At Home $20/hr for a bath aide in the home to
$15,000/month for 24-hour care.
Once the conveyor belt has stopped, after death, are there care needs for the surviving spouse or dependent disabled children?
The issues become frightening when considering this progression. Start planning NOW.
1 Public Policy Institute, Assisted Living in the United States Fact Sheet, AARP, FS62R
Friday, March 19, 2010 What are Medicare's Future Financing Challenges?
A Reminder of How Medicare Works in Three Weekly Installments
The Kaiser Family Foundation has a recent report “Medicare a Primer 2010,” which explains the Medicare program in terms that lay people can understand. It highlights key elements of the Medicare program, which now provides health coverage to 47 million people (people age 65 and older and younger adults with permanent disabilities.) Medicare is an estimated 12 percent of the federal budget and 20 percent of total national health expenditures. It is often a significant part of discussions about how to moderate the growth of both federal spending and health care spending in the U.S. The Kaiser report looks at the characteristics of the Medicare population, what benefits are covered, how much people with Medicare pay for their benefits and the program’s overall costs and future financing challenges.
This short article highlights (1) What is Medicare?, (2) Who is Eligible? and (3) Medicare’s Future Financing Challenges.
MEDICARE'S FUTURE FINANCING CHALLENGES? Taken from pages 18 and 19 of the Kaiser Family Foundation “Medicare a Primer 2010.”.
Source: Kaiser Family Foundation (February 2010)
Read the primer: http://www.kff.org/medicare/7615.cfm
WHAT ARE MEDICARE’S FUTURE FINANCING CHALLENGES?
Looking to the future, Medicare is expected to face significant financing challenges due to increasing health care costs, the aging of the U.S. population, the declining ratio of workers to beneficiaries, and various economic factors.
In light of the recent economic downturn and pressures to reduce the federal budget deficit, policymakers are likely to turn their attention to ways to reduce federal spending on entitlement programs, including Medicare, Medicaid, and Social Security. Over the long term, several factors – including rising health care costs, an aging population, a decline in the number of workers per beneficiary, and increasing life expectancy – will present fiscal challenges for Medicare. From 2010 to 2030, the number of people on Medicare is projected to rise from 46 million to 79 million, while the ratio of workers per beneficiary is expected to decline from 3.7 to 2.4.
Sustained increases in health care costs are placing upward fiscal pressure on Medicare, as for other payers. Annual growth in Medicare spending is largely influenced by the same factors that affect health spending in general: increasing prices of health care services, increasing volume and utilization of services, and new technologies. Moving forward, system-wide efforts to curtail overall health care costs would help to improve Medicare’s financial outlook.
Ensuring Medicare’s financial stability over the long term is a pressing challenge for policymakers. Medicare provides essential coverage for 47 million beneficiaries, many of whom have multiple chronic conditions and significant health needs. Securing access to affordable health care for seniors and people with disabilities while addressing Medicare’s fiscal pressures is a high priority for the future.
Thank you for reading our three part reminder on how Medicare works. We hope you have enjoyed it .
Don't forget to come back and read next week's blog, you never know what it will be about.
Friday, March 12, 2010 Who Is Eligible For Medicare?
A Reminder of How Medicare Works in Three Weekly Installments
The Kaiser Family Foundation has a recent report “Medicare a Primer 2010,” which explains the Medicare program in terms that lay people can understand. It highlights key elements of the Medicare program, which now provides health coverage to 47 million people (people age 65 and older and younger adults with permanent disabilities.) Medicare is an estimated 12 percent of the federal budget and 20 percent of total national health expenditures. It is often a significant part of discussions about how to moderate the growth of both federal spending and health care spending in the U.S. The Kaiser report looks at the characteristics of the Medicare population, what benefits are covered, how much people with Medicare pay for their benefits and the program’s overall costs and future financing challenges.
This short article highlights (1) What is Medicare?, (2) Who is Eligible? and (3) Medicare’s Future Financing Challenges.
WHO IS ELIGIBLE? Taken from page 2 of the Kaiser Family Foundation “Medicare a Primer 2010.”.
Source: Kaiser Family Foundation (February 2010)
Read the primer: http://www.kff.org/medicare/7615.cfm
WHO IS ELIGIBLE FOR MEDICARE?
Most people age 65 and older are automatically entitled to Part A if they or their spouse are eligible for Social Security payments and have made payroll tax contributions for 10 or more years (40 quarters).
Individuals age 65 and over qualify for Medicare if they are U.S. citizens or permanent legal residents. Individuals do not need to meet an income or asset test to qualify for Medicare, and qualify without regard to their medical history or preexisting conditions. Adults under age 65 with permanent disabilities are eligible for Medicare after receiving Social Security Disability Income (SSDI) payments for 24 months, even if they have not made payroll tax contributions for 40 quarters. People with end-stage renal disease (ESRD) or Lou Gehrig’s disease are eligible for Medicare benefits as soon as they begin receiving SSDI payments, without having to wait 24 months. Individuals who are entitled to Part A do not pay premiums for covered services. Individuals age 65 and over who are not entitled to Part A, such as those who did not pay enough Medicare taxes during their working years, can pay a monthly premium to receive Part A benefits.
Individuals entitled to Part A and others age 65 and older may elect to enroll in Part B.
Part B is voluntary, but about 95 percent of beneficiaries with Part A are also enrolled in Part B. For most individuals who become entitled to Part A, enrollment in Part B is automatic unless the individual declines enrollment. Individuals age 65 and older who are not entitled to Part A may enroll in Part B. With the exception of the working aged (or their spouses) who may delay enrollment if they receive employment based coverage, those who do not sign up for Part B when they are first eligible typically pay a penalty for late enrollment, in addition to the regular monthly premium, for the duration of their enrollment in Part B.
Individuals are eligible for Part C, or Medicare Advantage, if they are entitled to Part A and enrolled in Part B.
Beneficiaries may generally elect to enroll in a Medicare Advantage (MA) plan on an annual basis between November 15 and March 31 of the following year.
Individuals are eligible for prescription drug coverage under a Part D plan if they are entitled to benefits under Part A and/or enrolled in Part B.
To get Part D benefits, beneficiaries must enroll in a stand-alone prescription drug plan (PDP) or Medicare Advantage prescription drug (MA-PD) plan. The enrollment period runs from November 15 to December 31 of each year for stand-alone prescription drug plans, and from November 15 through March 31 of the following year for Medicare Advantage drug plans. Similar to Part B, there is a permanent premium penalty for late enrollment for individuals who go for an extended period of time without drug coverage that is at least comparable to the Part D standard benefit (“creditable coverage”).
Stayed tuned for part 3 WHAT ARE MEDICARE'S FUTURE FINANCING CHALLENGES? Coming Friday March 19th.
Friday, March 05, 2010 WHAT IS MEDICARE?
A Reminder of How Medicare Works in Three Weekly Installments
The Kaiser Family Foundation has a recent report “Medicare a Primer 2010,” which explains the Medicare program in terms that lay people can understand. It highlights key elements of the Medicare program, which now provides health coverage to 47 million people (people age 65 and older and younger adults with permanent disabilities.) Medicare is an estimated 12 percent of the federal budget and 20 percent of total national health expenditures. It is often a significant part of discussions about how to moderate the growth of both federal spending and health care spending in the U.S. The Kaiser report looks at the characteristics of the Medicare population, what benefits are covered, how much people with Medicare pay for their benefits and the program’s overall costs and future financing challenges.
This short article highlights (1) What is Medicare?, (2) Who is Eligible? and (3) Medicare’s Future Financing Challenges.
WHAT IS MEDICARE? Taken from page 1 of the Kaiser Family Foundation “Medicare a Primer 2010.”
Source: Kaiser Family Foundation (February 2010)
Read the primer: http://www.kff.org/medicare/7615.cfm
WHAT IS MEDICARE?
Medicare is the nation’s health insurance program for Americans age 65 and older, and for younger adults with permanent disabilities.
Established in 1965 under Title XVIII of the Social Security Act, Medicare was initially established to provide health insurance to individuals age 65 and older, regardless of income or medical history. The program was expanded in 1972 to include individuals under age 65 with permanent disabilities receiving Social Security Disability Insurance payments and people suffering from end-stage renal disease (ESRD). In 2001, Medicare eligibility expanded further to cover people with amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease). As of 2010, 47 million people rely on Medicare for their health insurance coverage: 39 million people age 65 and over and 8 million people under age 65 with disabilities.
Medicare consists of four parts, each covering different benefits.
PART A, also known as the Hospital Insurance (HI) program, covers inpatient hospital services, skilled nursing facility, home health, and hospice care. Part A is funded by a tax of 2.9 percent of earnings paid by employers and workers (1.45 percent each). In 2009, Part A accounted for approximately 36 percent of total Medicare benefit spending. An estimated 45.6 million people were enrolled in Part A in 2009.
PART B, the Supplementary Medical Insurance (SMI) program, helps pay for physician, outpatient, home health, and preventive services. Part B is funded by general revenues and beneficiary premiums ($110.50 per month in 2010; $96.40 per month for beneficiaries held harmless from the premium increase. In 2009, Part B accounted for 27 percent of total benefit spending. Medicare beneficiaries who have higher annual incomes (over $85,000 per individual; $170,000 per couple in 2010) pay a higher, income-related monthly Part B premium, ranging from $154.70 to $353.60 in 2010 depending on income. Part B is voluntary; some people age 65 and older (such as those with employer sponsored health coverage) delay enrollment until they retire. An estimated 42.4 million people were enrolled in Part B in 2009.
PART C, also known as the Medicare Advantage program, allows beneficiaries to enroll in a private plan, such as a health maintenance organization (HMO), preferred provider organization (PPO), or private fee-for-service (PFFS) plan. These plans receive payments from Medicare to provide Medicare-covered benefits, including hospital and physician services, and in most cases, prescription drug benefits. Part C is not separately financed, and accounted for 23 percent of benefit spending in 2009. As of February 2010, 11.4 million beneficiaries are enrolled in Medicare Advantage plans.
PART D is the outpatient prescription drug benefit, delivered through private plans that contract with Medicare, either stand-alone prescription drug plans (PDPs) or Medicare Advantage prescription drug (MAPD) plans. Authorized by the Medicare Modernization Act of 2003 (MMA) and launched in 2006, Part D plans are required to provide a “standard” benefit (or one that is equivalent) and may provide enhanced benefits. Individuals with modest income and assets are eligible for additional assistance with premiums and cost-sharing amounts. Part D is funded by general revenues, beneficiary premiums, and state payments, and accounted for 10 percent of benefit spending in 2009. As of February 2010, 27.6 million beneficiaries are enrolled in a Part D plan, 17.7 million of whom are enrolled in stand-alone PDPs.
Stayed tuned for part 2 WHO IS ELIGIBLE?
Coming Friday March 12th.
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