Articles Posted in Elder Law

The odds are that most of us will end up caring for a relative or close friend at some point, helping to manage their health and wellness and even make important decisions to ensure that person lives a comfortable, dignified life. Whether these tasks include arranging transportation for doctor’s appointments, overseeing finances, performing chores, or helping hands on with hygiene, getting dressed, or meal preparation, caregivers come in all forms and play an important role in the lives of loved ones.

Statistically, long distance caregivers have an average age of 47 and nearly 70 percent are female. Almost all of them provide care to a close relative despite the challenges associated with long distance caregiving, more than half of them make visits at least once a week to the person they care for. Approximately 40-percent visit at least once a month.

Helping loved ones of friends who live close by can be challenging enough but when the person we are responsible for lives greater distances away, the challenges can included unique obstacles, including lengthy travel time, extra costs, an inability to attend medical appointments and questions about how to find help in a different state. Fortunately for these vital caregivers, there are a multitude of community-based resources to help make these tasks easier and help caregivers and their loved ones.

Authorities across the country are warning of new scams targeting elderly Social Security over the phone, where individuals claiming to be government representatives try to collect sensitive information under the guise of a computer glitch causing issues with benefits. The Social Security Administration has made it very clear that under no circumstances will it call or send emails to beneficiaries asking for personal information, such as Social Security numbers, dates of birth or other private information, and advises people to not respond to such messages.

Other scams include callers asserting that beneficiaries need to pay a fee to unlock their Social Security number because of criminal activity and will also need to confirm their Social Security number. The Federal Trade Commission recently confirmed an increase in this type of scam and beneficiaries should be on the lookout for this type of illicit activity.

The AARP Fraud Watch Network recently announced it has had more complaints to its helpline in the past few months from consumers targeted by Social Security impostors than the older IRS scams that harassed thousands, if not millions, of Americans since 2013. According to the office of the Treasury Inspector General for Tax Administration, those IRS scams stole more than $73.6 million from almost 15,000 victims over the past five years.

As of January 1, 2019, approximately 1.2 million seniors across will lose their SilverSneakers coverage on Medicare Advantage plans that give them access to gyms and health centers without any additional membership costs. The controversial business decision will affects plan holders in California, Connecticut, Illinois, Indiana, Iowa, Kansas, Missouri, Nebraska, Nevada, North Carolina, and Utah who have Medicare Advantage plans with UnitedHealthcare.

An additional 1.3 million seniors across nine states with Medicare Advantage plans with Medicare supplemental (Medigap) insurance will also lose their access to the SilverSneakers program. States affected by this move include Arizona, California, Connecticut, Illinois, Indiana, North Carolina, Ohio, Utah and Wisconsin. Although the benefits were optional with UnitedHealthcare, millions of seniors nonetheless took advantage of the option to visit gyms and fitness centers for exercise.

Beginning next year, UnitedHealthcare will instead offer seniors with Medicare Advantage supplemental policies will get 50 percent off memberships at thousands of gyms across the country, telephone access to wellness coaches and access to various online communities and health-related resources. Seniors with UnitedHealthcare Medicare Advantage plans can join Renew Active, the company’s health and fitness program which offers a network of over 7,000 locations members can visit for no additional cost and even qualify for evaluations from personal trainers and online brain-training programs.

The Trump Administration recently announced its intention to give private Medicare plans the power to negotiate drug prices with insurance companies in hopes of lower the the costs of vital medicines that seniors rely on to live healthier lives. Currently, private Medicare health plans under Medicare Part D must cover all or “substantially all” drugs in six “protected” classes, such as HIV treatments, antidepressants and cancer drugs, regardless of cost.

The Administration’s stance is that because insurance companies are required by their agreements with the Centers for Medicare and Medicaid Studies (CMS) to fully cover these medications, there is little incentive for the pharmaceutical companies that produce these drugs to lower prices for consumers. Part of the proposal would allow health insurance plans to exclude some of the protected drugs that see prices increases beyond the pace of inflation and new formulations not considered a “significant innovation” compared to the original.

“The lack of any ability for Part D plans to manage drugs in the protected classes has allowed the pharmaceutical industry to command high prices on protected class drugs in Part D, without patients getting a good deal,” Centers for Medicare and Medicaid Services Administrator Seema Verma said in a statement.

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.

Caring for a child with a disability creates challenges beyond our lifetime and often takes resources beyond what federal safety net programs can offer in order for our loved one to live the most comfortable and dignified life possible. While rules governing these federal programs place certain income restrictions on disabled persons to qualify, there are sanctioned trusts allowed specifically for special needs planning that allow for first party and third party benefits to supplement federal assistance.

In 2010, Congress passed the Achieving a Better Life Experience (ABLE) Act allowing beneficiaries to have up to $100,000 in a 529 special needs trust and retain Social Security Insurance benefits. Beneficiaries can also retain Medicaid coverage so long as the trust does not exceed the amount for a 529 college savings plan. The ABLE Act allows these trusts to be created so long as the beneficiary’s disability is established prior to the age of 26-years old.

Disabled persons can also create and fund their own first party special needs trusts through a (d)(4)(C). Funds for first party special needs trusts often come from sources such as a personal injury settlement, workers’ compensation award, or an inheritance left directly to the beneficiary. An amount equal to the annual federal gift tax exclusion (currently $15,000) can be deposited annually in the account while still maintaining the beneficiary’s eligibility for Medicaid and Supplemental Security Income

Figuring out the best time to claim Social Security benefits is an important part of retirement planning that can have long lasting impacts on the type of lifestyle individuals and their spouses can expect to enjoy in their Gold Years. Depending on when individuals decide to take their Social Security benefits, from the ages of 62 to 67, it can mean the difference of hundreds of dollars per month to thousands of dollars of the course of a lifetime.

While the conventional wisdom is to wait as long as possible to claim benefits, and hopefully reach maximum payouts, for many beneficiaries there comes a time known as the “break even point” when the amount of benefits claimed would be essentially the same regardless of the amount received per month. This happens because the program is designed to give individuals more or less the same payout over their projected lifetimes, known as “actuarial neutrality.”

Determining one’s break even point is a fairly straightforward process but should take into account certain other factors that may artificially inflate any projected payout, namely excluding cost of living adjustments. Including projected cost of living adjustments will only create artificially high numbers that may not end up being actual benefits received.

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