Medicaid Planning

Commonly Asked Questions about Over-the-Counter Tests and Medicare

Published on: March 10, 2022 | by Ettinger Law Firm

It’s almost an understatement to say that the Covid-19 pandemic has changed our lives and how we live in a range of ways. While Medicare did not pay for Covid-19 tests that were available over the counter, the Center for Medicaid Services is in the process of executing an effort in the spring of 2022 that will offer payment directly to qualifying pharmacies as well as other business entities that participate in this program to help Medicare recipients receive up to eight Covid-19 tests free each month.

Currently, Medicare Advantage Plans sometimes cover and pay for over-the-counter (OTC) Covid-19 tests as a supplement in combination with providing Medicare Part A and Part B coverage. If you’re enrolled in a Medicare Advantage Plan, you should review the terms of the plan to check whether the plan will cover and pay for Covid-19 tests.

All Medicare beneficiaries with Part B qualify to receive eight free OTC Covid-19 tests, despite whether a person is enrolled in a Medicare advantage plan.

How Medicare and Medicaid Are Addressing Long-Term Care Issues

Published on: March 10, 2022 | by Ettinger Law Firm

Deciding how to receive the medical care that a person needs is a critical part of the elder law process. Unfortunately, the unpredictable nature of aging and medical issues can make it challenging to determine what lies ahead. Various states have also begun to attempt to resolve financing challenges associated with elder care that a growing number of Americans will face in the next couple of decades as a growing portion of the baby boomer generation requires medical care.

The Growing Need for Assistance

Any person can end up needing assistance as they age. This is true regardless of whether a person ends up facing dementia, a significant drop in eyesight, or mobility issues. The degree of assistance and how long a person faces these issues can vary substantially. A person might end up needing assistance with meals, other daily living activities, or total care for the months or years before they pass away. Other times, people end up needing total care for years. The unpredictable nature of a person’s future makes it challenging to plan ahead.

Answers to Commonly Asked Medicare Home Health Questions

Published on: March 1, 2022 | by Ettinger Law Firm

The Center for Medicare Advocacy recently published a document answering various questions about Medicare’s home health benefits. In addition to a document answering frequently asked questions, the Center also published recordings of two webinars, “Medicare Coverage of Home Health Services”, which reviews the eligibility basics for Medicare coverage of home health services.

What Do Home Health Agencies Do?

Medicare’s home health benefits are known as the Mediacertified home health agencies. These benefits have been approved by Medicare to provide the home health services that Medicare covers. The agency has agreed to receive payment from Medicare. Additionally, Medicare only pays for home health services administered by home health agencies that are Medicare-certified.

Considering Medicare Advantage Plan Alternative

Published on: February 1, 2022 | by Ettinger Law Firm

Approximately, 26.9 million Americans are enrolled in Medicare Advantage Plans as of January 2022. While many people are content with their plans, not everyone is. Individuals have between January 1, 2022, to the end of March 2022 to make revisions to their Advantage Plan. During this period, a person can also drop a Medicare Advantage Plan and opt for a basic Medicare plan, which includes Part A and B.

Individuals should be aware of some important details before switching Medicare plans, though. For one, people can change plans early in the year. For example, a person might discover that their Medicare plan no longer covers important medication.

The Narrow Window to Change Plans

Protecting Assets With Caregiver Agreements

Published on: November 15, 2020 | by Ettinger Law Firm

Family members as caregivers overwhelmingly provide for elderly and disabled loved ones at home. Although a labor of love, taking care of ailing loved ones also has a market value, meaning that caretakers may be paid as a way to protect assets.

Through the use of a Caregiver Agreement, also known as a Personal Services Contract, the disabled or elderly person may transfer money to family members as compensation rather than as a gift. Gifts to family members made in the last five years before applying for Medicaid to pay for nursing home costs disqualify the applicant from receiving Medicaid for a certain period of time, known as a “penalty period.”

For example, mom depends on daughter Janice for her care. If mom gifts $100,000 to Janice, then goes into a nursing home in the next five years and applies for Medicaid, the gift to Janice will result in about a ten month penalty period. Janice will have to give the $100,000 back to mom to pay nursing home costs during the penalty period, or mom will have to use other resources to pay.

Preserving Income with Medicaid Pooled Trusts

Published on: November 8, 2017 | by Ettinger Law Firm

Medicaid is a safety net for millions of senior citizens across the country, providing funding to pay for home care, adult day care, or prescription drugs. However, the program is designed for low income individuals and can leave many on the fence financially over whether to choose to spend down assets or pay for these necessary services themselves.

Currently, the threshold to receive Medicaid services is only a few hundred dollars for individuals and just over $1,000 for married couples, which leaves these individuals with little income to pay rent, utilities, or buy groceries. Even financially secure seniors can find themselves needing vital Medicaid services like in-home or nursing home care in the event of a catastrophic health event, making planning for the future and keeping options open all the more vital.

One option that may be viable for certain individuals is joining a Pooled Supplemental Needs Trusts, also known as a Pooled Income Trust. Pooled income trusts work by the individual sending his or her income from Social Security, pensions, or annuities to non-profit organizations to pay bills and other expenses to stay below the Medicaid threshold. Any income left over after the individual passes away goes to the non-profit.

What Can I Do if I Have Been Denied Medicaid?

Published on: July 28, 2017 | by Ettinger Law Firm

As people age, many count on Social Security and Medicare to help them live happy, healthy, and comfortably in their golden years. However, some older Americans are unable to fully provide for themselves and must seek assistance before they become eligible for the landmark elder social services we have become accustomed to. Hard economic times, disability, and other unforeseen events are just some of the reasons elders may be eligible for Medicare.

One of the most important parts of the Medicare program is the nursing home care services members are eligible to receive, particularly seniors. However, not everyone may qualify for Medicare after applying, leaving many families to wonder how they will take care of their beloved elders. Fortunately, denied applicants are eligible to receive a Fair Hearing at their local Medicare office.

What is a Fair Hearing?

New York Medicaid Law – Pooled Trusts

Published on: August 23, 2016 | by Ettinger Law Firm

Pooled Trusts Eligibility

Pooled Trusts are a type of trust applicable to those individuals who are seeking public assistance benefits, such as Medicaid, to become eligible financially by setting aside funds in a trust for additional needs. The trust allows its beneficiaries to preserve a specified amount of money in a trust to pay for supplemental care not covered by public assistance programs. For the elderly, many need public benefits assistance as they continue to age but do not qualify based on higher income. In these situations, a pooled income trust will benefit an elderly person by allowing them to continue their lifestyle, which is usually seeking to stay in the home, while also obtaining homecare services and paying for what their budget requires.

New York Medicaid Rules

MEDICAID TRANSFER AFTER ADMISSION TO A RETIREMENT COMMUNITY

Published on: May 10, 2016 | by Ettinger Law Firm

THOROUGH PLANNING NEEDED IN ADVANCE

This blog has discussed the necessity of proper and thorough planning to ensure a smooth transition into a continuing care retirement community. This requires, among other things, that a person properly and legally transfer all of their assets, or a substantial portion of their assets that is, to people or entities that would enable them to be eligible for Medicaid. As many people know, there is a look back period where the state examines all transfers of assets or money over a certain period of time for purposes of Medicaid eligibility purposes.

If during that time a person transferred any aset for less than full market value or did not transfer the assets to a proper investment vehicle that is otherwise exempt from Medicaid assets, the Medicaid applicant will likely be denied for financial reasons. In other words Medicaid will claim that the applicant has too many assets or their income is too high to qualify. Some examples of a Medicaid exempt transfer is the purchase of a graveyard plot, prepayment for funeral services or the purchase of a short term Medicaid annuity. An interesting case from November, 2015 out of Broome County, entitled Good Shepherd Village at Endwell v. Peter Yezzi shows the many problems that can result when people start their Medicaid planning after admission to a continuing care retirement community.

MEDICARE’S OBSERVATIONAL STATUS

Published on: April 8, 2016 | by Ettinger Law Firm

SOME LIMITED RELIEF

Patients who rely on Medicare sometimes experience sticker shock after being released from the hospital only to find out that because some hospital administrator classified their stay as “observational” that they must pay a large portion of the final bill. Many times a doctor will seek to have a patient admitted for any number of reasons, only to have a bureaucrat reclassify the patient’s time at the hospital as observational. Such a designation will mean that Medicare will not pay for this time in the hospital. For Medicare to pay for a hospital stay, the patient has to be an admitted patient for at least three days (three midnights in the hospital).

Observational status does not equate to an admitted patient in Medicare’s own set of self defined definitions. That may be quite different to the patient who went to the hospital and received a number of drugs and tests during their time their and was consistent with the majority of their non-surgical stays in a hospital in life. In an effort to address these obvious problems that will only grow with time, President Obama signed a bill that required hospitals to warn patients that their stay will be considered observational in nature and that they are not being admitted under Medicare’s rules, which may result in a bill from the hospital that they will have to pay. The Notice of Observation Treatment and Implications for Care Eligibility Act would have to inform the patient that they are going to receive outpatient services under Medicare’s rules which requires cost sharing from the patient and that the observational status does not count towards the necessary three day inpatient in order to transition to a skilled nursing care facility.