New York Elder Law Attorney Blog

New York City has seen a rapid increase in the number of individuals working as in home health aides as the city’s population continues to age. Unfortunately, many of these in home health service workers are older people themselves, earning low wages and relying on government services to survive as their own health continues to decline from performing hard work and aging.

Naturally, most seniors wish to preserve their independence and often turn to home health workers to perform cooking, cleaning, and other chores that may be more difficult at an advanced age. Home health workers are vital to the healthcare needs of seniors who do not need or wish to enter into a nursing home or other skilled care facility before it may be necessary or otherwise not cost feasible for any reason.

Experts studying the issue describe New York’s impoverished home health aides as a new underclass, often working long hours without prospects of  finding new and better paying work outside their current field. Sources calculate that some of these employees work for at little as $7 to $8 per hour, adding up to around $25,000 which does not even get close to a living wage in New York City.

Of the almost 60 million Medicare beneficiaries in the entire United States, nearly one-third of those individuals are covered by a Medicare Advantage Plan, an alternative to Medicare insurance offered by private companies contracting with the government and offering all Part A and Part B benefits. Federal officials estimate that number is expected to grow as high as 41 percent nationally over the next ten years but some states already see enrollment rates that high.

In states like California and Florida, Medicare Advantage plans are employing something known as global risk or full risk to help curb the skyrocketing costs of health care while creating financial incentive for providers to take the very best care they can of their patients. In those states, about half of Medicare Advantage plan members get care under the global risk model, compared to an estimated 10 percent nationally.

Under total risk arrangements, the insurance plan give health care companies the bulk of their Medicare funding when they take on the mantle of being financially responsible for all patient care. For the physicians groups, the arrangement means they get paid a large amount of money upfront for patient care and do not have to worry about billing issues or waiting for insurers to pre-approve medical procedures and treatments. Patients benefit by being able to spend more time with their doctors to get all the care they need and can usually get same day or next day appointments.

The White House recently issued new guidelines to states on acceptable alternative health care plans allowed under the Affordable Healthcare Act (ACA) that will allow states to apply for waivers and help shore up health care exchanges. Until now, such waivers were granted with so-called “guardrails” to ensure the waivers met at least the same coverage level as under the ACA.

By contrast, the new guidances issued by the White House allow states to loosen old guardrail requirements and allow healthcare plans that do not meet the coverage standards required under current federal law, including charging higher premiums for people with pre-existing conditions. The change in policy is a victory for states with conservative legislatures which were unable to gain such waivers under the previous administration because the suggested plans did not meet federal requirements.

“States know much better than the federal government how their markets work. With today’s announcement, we are making sure that they have the ability to adopt innovative strategies to reduce costs for Americans, while providing higher quality options,” Centers for Medicare and Medicaid Administrator Seema Verma said in a statement.

When open enrollment begins for Medicare, many seniors across the country will notice an expanded range of health care plan options, including those offered by private insurance companies through Medicare Advantage. With more Americans than ever considering and signing up for these Medicare alternatives, more insurance companies than usual are selling more Medicare Advantage plans for 2019, some offering lower or no premiums and improved benefits.

According to the Centers for Medicare and Medicaid Studies (CMS), an additional 14 new insurance companies will sell 3,700 plans for 2019, an estimated 600 more than offered to beneficiaries in 2018. CMS estimates that total enrollment for Medicare Advantage plans will grow to 23 million people in 2019, a 12 percent increase over the previous year and may grow to serve one-third of all Medicare enrollees in the next decade.

Medicare Advantage plans have been attractive to seniors due to the extra benefits these types of coverage options offer. Many of these private insurance plans can save seniors money because premiums, deductibles, and additional costs are lower than what beneficiaries pay with original Medicare offered by the federal government. One of the main downsides to Medicare Advantage Plans is that they require enrollees to seek care within a restricted network of health care providers.

Across the country, states are attempting to combat the tide of rising insurance premiums and overall increased healthcare costs burdening Americans by asking the federal government for permission to engage in so-called “reinsurance programs.” While these types of programs have only been in effect for a few years, the early data suggests they can be potent tools to help curb the cost of health care premiums for individuals with plans under the Affordable Healthcare Act.

A reinsurance program helps to protect insurers from very large claims by having the state step in to pay part of an insurance company’s claims once they pass a certain amount and can help stabilize an insurance market and make coverage more available and affordable but needs more than just a temporary pool set up to create real and lasting effects on the market.. Experts estimate that around three-dozen or so common medical conditions are responsible for high claims, with about half of ACA marketplace enrollees living with one or more of these conditions.

Although each state participating in reinsurance programs have their own models, some of the more common plans are for the state to cover insurance claims between $50,000 and $250,000 for those with ACA coverage. With the repeal of the ACA’s individual mandate, these reinsurance programs can serve as a temporary fix to help shore up individual marketplace plans and give lawmakers a few more years to come up with a long term solution to rising healthcare costs.

The Securities and Exchange Commission (SEC) recently issued a warning to consumers about the risk associated with adding cryptocurrencies to so-called self-directed individual retirement accounts. These types of unregistered IRAs allow individuals to invest their nest eggs outside of the stock market and bond market and often incorporate holdings in real estate, private mortgages, precious metals, and more recently cryptocurrencies like bitcoin.

In an investor alert issued by the SEC, regulators warned that the agency has the power to oversee traditional IRA investments like stocks, bonds and mutual funds but lacks oversight of self directed IRAs. Although spokespersons for the SEC did not mention a specific scheme or incident to prompt the alert, the agency nonetheless felt it was important to issue the statement to warn consumers about the risks associated with the accounts.

The SEC also recently joined the Association of International Certified Professional Accountants in pointing out that this type of fraud associated with self directed IRAs can pose a unique opportunities for criminals to perpetrate elder abuse. With questions about the solvency of Social Security, rising health care costs, and other economic uncertainty may lead seniors and adults planning for retirement to consider these type of risky, self directed IRA accounts over traditional investment methods.

A recent study by the University of California, San Diego School of Medicine suggests that women whose mothers lived healthy lives into their 90’s may be a key indicator for longevity and overall health. The study was published in the Journal of Age and Ageing and examined over 22,000 participants over a two-decade span and found that women whose mothers live to at least 90 years old with no health problems have a 25 percent chance of living past 90 years old.

In cases where both parents lived to be at least 90-years old, the study found that the likelihood of women living into their 90’s increased by 38 percent. However, researchers did not find any increased longevity in cases where only the subject’s father lived to be at least 90 years old. One key caveat to the study is that the subject’s parents not have suffered any chronic health conditions like heart disease, cancer, or diabetes.

The study is important because it helps to validate the view that genetic, environmental, and behavioral factors transmitted across generations may influence ageing outcomes among offspring. Although we cannot control the genes we are born with, we can however make healthy lifestyle choices, such as maintaining a good diet and getting exercise, that can create positive environmental factors to help us live longer, healthier lives and hopefully pass on those traits to our children.