Category Archives: Medicare

New Data Shows Impact on Obamacare Cuts to Medicare Advantage

By: Attorney Nathan Simpson

Screen Shot 2014-05-27 at 3.09.26 PMNew data has been released showing the effects that the Affordable Care Act's cuts to the Medicare Advantage Program will have on American seniors. In Ohio, we are expecting to see a $55-$65 decrease in benefits or premium reduction each month for members of the Medicare Advantage program. This is just the first of many negative impacts that the Affordable Care Act could have on Ohio Seniors.

For a more detailed breakdown of how the Affordable Care Act will affect Ohio and other states, see the following link: http://www.ahipcoverage.com/2014/03/11/new-state-by-state-data-show-impact-on-seniors-of-proposed-cuts-to-medicare-advantage/.

If you would like to learn more about how the Affordable Care Act and the rising cost of long term care may affect your estate plan, please call an Ohio Elder Law Attorney today.

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DISCLAIMER – Every case is different because every case is different. This blog does not give legal advice. This blog does not create an attorney client relationship. You are not permitted to rely on anything in this blog for any reason. This blog is an entirely personal endeavor. Every person's situation is different and requires an attorney to review the situation personally with you.
No attorney-client relationship is created by this site.
The use of the Internet, this blog or email for communication with this firm or any individual member of this firm does not establish an attorney-client relationship. Before we represent any client, the client and the attorney will sign a written retainer agreement. If you do not have a written, signed retainer agreement with us, we are not representing you and will not be taking any action on your behalf.

Medicare cost increases will affect seniors negatively

By Kathy Cooper

Kaiser Family Foundation recently reported that increase in seniors' share of the cost burden for Medicare under Obamacare will negatively affect most seniors. The purpose of the Kaiser study was to determine how well seniors would be able to absorb rising Medicare premiums, co-pays, deductibles and related costs. The study concluded that most seniors are of modest means – low income, low savings and low home equity.

Screen Shot 2014-04-07 at 1.32.34 PMBaby boomers are just finding out how Medicare works and how much they will end up paying for normal healthcare expenses as they enter retirement. Medicare premiums, co-payments for doctor visits and some other services such as tests are deducted from their monthly Social Security checks and typically account for over 15% of those checks. Medigap insurance policies can help but often do not cover all of these out-of-pocket expenses. This picture does not include Part D which takes the cost to over 24% of their Social Security check this year. Unfortunately, the picture is only getting worse as you can see in this chart from the government estimating retiree medical costs.

Screen Shot 2014-04-07 at 1.32.50 PMFurther, Medicare does not pay for long term care and 50% of seniors have less savings that would be required to pay for just one year of care in a nursing home. According to Kaiser, half of Medicare beneficiaries have savings below $61,400.

If you are in the 94% of seniors below $1.1 million in savings, you need a plan and some good counseling to find benefits that may help you pay for healthcare in the future. Even if you have over a million dollars in savings, long term care can significantly reduce the amount you can leave your children or grandchildren – if you do not plan. An experienced elder law attorney can help.   

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DISCLAIMER – Every case is different because every case is different. This blog does not give legal advice. This blog does not create an attorney client relationship. You are not permitted to rely on anything in this blog for any reason. This blog is an entirely personal endeavor. Every person's situation is different and requires an attorney to review the situation personally with you.
No attorney-client relationship is created by this site.
The use of the Internet, this blog or email for communication with this firm or any individual member of this firm does not establish an attorney-client relationship. Before we represent any client, the client and the attorney will sign a written retainer agreement. If you do not have a written, signed retainer agreement with us, we are not representing you and will not be taking any action on your behalf.

When Should I Apply for Medicare?

By Chris Meyer

Screen Shot 2014-01-28 at 11.45.26 AMMany of our clients are unsure about when they should apply for Medicare. With the ever-changing rules and regulations of the healthcare world, it is difficult to keep up to date on the suggested age of applying for Medicare as well as the standard procedure as how to apply. It is important to know, assuming that you are not covered by an employer-sponsored program that you can and should apply three months before you turn age 65, including the month you turn 65. You can also apply three months after you turn age 65. If you do not sign up during this time period, you may have to pay a higher premium for late enrollment in Part B!

According to ssa.gov, “most people age 65 or older who are citizens or permanent residents of the United States are eligible for free Medicare hospital insurance.” You are eligible at the age of 65 if one you meet one of the following requirements:

  1. You receive or are eligible to receive Social Security benefits

  2. You receive or are eligible to receive railroad retirement benefits

  3. Your spouse receives or is eligible to receive Social Security or railroad retirement benefits

  4. You or your spouse (living or deceased, including divorced spouses) worked long enough in a government job where Medicare taxes were paid

  5. You are the dependent parent of a fully insured deceased child.
     

However, you are also eligible for Medicare before the age of 65 if one of the following requirements are met:

  1. You have been entitled to Social Security disability benefits for 24 months

  2. You receive a disability pension from the railroad retirement board and meet certain conditions

  3. You receive Social Security disability benefits because you have Lou Gehrig's disease (amyorophic lateral sclerosis)

  4. You worked long enough in a government job where Medicare taxes were paid and you have been entitled to Social Security disability benefits for 24 months

  5. You are the child or widow(er) age 50 or older, including a divorced widow(er), of someone who has worked long enough in a government job where Medicare taxes were paid and you meet the requirements of the Social Security disability program

  6. You have permanent kidney failure and you receive maintenance dialysis or a kidney transplant and:

    - You are eligible for or receive monthly benefits under Social Security or the railroad retirement system; or

    - You have worked long enough in a Medicare-covered government job; or

    -You are the child of spouse (including a divorced spouse) of a worker (living or deceased who has worked long enough under Social Security or in a Medicare-covered government job.

All of this information and more can be found on the website ssa.gov. You or a loved one may also apply for Medicare through this website as well.

Please feel free to contact us at 1-800-798-5297 with any questions you may have regarding Medicare. Also, be sure to Like us on Facebook for up-to-date topics in regards to Medicare and a wide variety of other Elder Law related topics.

(pic via Flickr)

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DISCLAIMER – Every case is different because every case is different. This blog does not give legal advice. This blog does not create an attorney client relationship. You are not permitted to rely on anything in this blog for any reason. This blog is an entirely personal endeavor. Every person's situation is different and requires an attorney to review the situation personally with you.
No attorney-client relationship is created by this site.
The use of the Internet, this blog or email for communication with this firm or any individual member of this firm does not establish an attorney-client relationship. Before we represent any client, the client and the attorney will sign a written retainer agreement. If you do not have a written, signed retainer agreement with us, we are not representing you and will not be taking any action on your behalf.

2014 Medicare Updates, Premiums and Co-Pays

By Roy Whited

Screen Shot 2014-01-28 at 9.13.15 AMMedicare Part A (hospital insurance) cost– Part A monthly premium

  • Most people don't pay a Part A premium because they paid Medicare taxes while working. For those who don't get premium free Part A, it can cost up to $426.00 each month.

 

Hospital stay- 2014 those on Medicare pay

  • $1,216.00 deductible per benefit period

  • $0 for the first 60 days of each benefit period

  • $304.00 per day for days 61-90 of each benefit period

  • $608.00 per “lifetime reserve days” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime)

 

Skilled nursing facility stay (skilled care only & requires a 3 day hospital stay) In 2014, you pay

  • $0 for the first 20 days of each benefit period

  • $152.00 per day for days 21-100 for each benefit period

  • All cost for each day after day 100 of the benefit period

 

Medicare Part B (medical insurance) cost– Part B monthly premium

  • You pay a Part B premium each month. Most people will pay the standard premium of $104.90. However, if your modified adjusted gross income as reported to the IRS is above certain amounts, you pay more. 
    Example, Individuals earning above $85,000.00 and under $107,000.00 and those filing jointly with income above $170,000.00 up to $214,000.00 pay $146.90 monthly. Top earners pay $335.70 monthly for their Part B coverage for 2014.

 

Medicare Advantage Plans (also called Plan C)

Medicare advantage plan costs can vary in different areas. We suggest you visit medicare.gov/find-a-plan to get plan premiums or call 1-800-Medicare (1-800-633-4227) TTY users should call 1-877-486-2068. You can also call your state insurance department.

 

Part D monthly premium

  • Medicare prescription drug plans monthly premium is based on your income. Your plan premium can be increased by $12.10 a month up to $69.30 a month for the top wage earners.

 

Summary-

All that being said, those on Medicare need to realize the greatest danger to losing their assets to a health care problem is usually related to long term nursing home stay. Remember Medicare only pays for skilled care in the nursing home and then only for a limited number of days and requires a 3 day hospital stay prior to going into the nursing home.

To learn about how you can protect your assets from being lost to these long term care cost, call Cooper, Adel & Associates and schedule a free 1 hour consultation.  

 

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DISCLAIMER – Every case is different because every case is different. This blog does not give legal advice. This blog does not create an attorney client relationship. You are not permitted to rely on anything in this blog for any reason. This blog is an entirely personal endeavor. Every person's situation is different and requires an attorney to review the situation personally with you.
No attorney-client relationship is created by this site.
The use of the Internet, this blog or email for communication with this firm or any individual member of this firm does not establish an attorney-client relationship. Before we represent any client, the client and the attorney will sign a written retainer agreement. If you do not have a written, signed retainer agreement with us, we are not representing you and will not be taking any action on your behalf.

The Sobering Reality of the Long-Term Care Situation Facing Baby Boomers

By Julian Guilfoyle

“Age is an issue of mind over matter. If you don’t mind, it doesn’t matter.”   ~Mark Twain

Screen Shot 2013-09-04 at 8.44.13 AMThe long-term care situation inherited by baby boomers presents a grim and worrisome reality. In addition to the emotional burdens faced by spouses and children, the financial burden is simply devastating for most Americans and their families. The U.S. Department of Health and Human Services conducted a study of long-term care in America and some of its’ findings are particularly noteworthy. They found that more than 70 percent of Americans over the age of 65 would require long-term services at some point in their lives. Forty percent of Americans who reach age 65 will require a nursing home stay with twenty percent of those requiring long-term care for longer than five years. When required, the average cost of a private room is $219 a day, or $79,935 a year.

Many boomers have already experienced, first-hand, the limits of Medicare when attempting to provide for their aging parents. Under the best-case scenario, if a loved-one requires “skilled” care or therapy, Medicare can cover up to 100 days of care in a facility. Of those, days 21-100 require a co-pay from the Medicare recipient. Further, this care is only provided if the person is transferred to the facility after three consecutive days in a hospital (which believe it or not, is harder than it seems).

The safety net providing long-term care services for seniors who can no longer afford it is Medicaid. The income and asset limits imposed on Medicaid recipients are closely scrutinized and verified. In addition, they require substantial “spend-downs” where seniors must pay privately for their care. This is financially ruinous for women because they have longer life expectancies and many live their golden years with a fraction of the savings they had accumulated.

There is a solution for this epidemic in the form of long-term care insurance. However, few Americans have purchased this insurance because of the negatives surrounding these policies. Many have seen their premiums increased as insurance companies compensate for the increased amount of people who actually require the benefits. As premiums became unsustainable, especially after the income loss associated at first death between spouses, many of these policies began lapsing or having their benefits reduced. In addition, under the best case scenario, meaning one never requires to use their long-term care insurance during their lifetime, they don’t receive any benefit from the substantial premiums they have paid.

Few will face any tax during their lifetime that can equate to the cost of long-term care burdened by the majority of seniors. There are ways to protect your family from this catastrophic financial load, but different circumstances require different solutions. To discuss these solutions please call our office at 800-798-5297.

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DISCLAIMER – Every case is different because every case is different. This blog does not give legal advice. This blog does not create an attorney client relationship. You are not permitted to rely on anything in this blog for any reason. This blog is an entirely personal endeavor. Every person’s situation is different and requires an attorney to review the situation personally with you.
No attorney-client relationship is created by this site.

The use of the Internet, this blog or email for communication with this firm or any individual member of this firm does not establish an attorney-client relationship. Before we represent any client, the client and the attorney will sign a written retainer agreement.
If you do not have a written, signed retainer agreement with us, we are not representing you and will not be taking any action on your behalf.

 

Medicare May be Reformed Again (But for the Good this time)

By Attorney Liz Durnell

Screen Shot 2013-05-22 at 8.36.12 AMDid you know that Medicare will not pay for any part of a nursing home stay if you or your loved one were not “admitted” to the hospital for three days? Sometimes the person was just in the hospital for “observation.” Under current Medicare laws, if you are in for “observation,” you were not considered “admitted” to the hospital and Medicare will not pay for your nursing home stay.

There are few ways to combat this issue: 1. Have proper planning in place so that you are not reliant on Medicare, and; 2. Write to Your Senators and Member of the House to Support Observation Status Reform.

Proper planning may include irrevocable trusts, certain qualified annuities, and legal documents such as a Power of Attorney, Health Care Power of Attorney, and Living Will. You should consult an Elder Law Attorney to ensure that your planning is proper.

You may also write your Senators and member of the House to ask them to become co-sponsors of the Improving Access to Medicare Coverage Act (H.R. 1179 and S.569). The legislation reforms observation status and would allow time spent in the hospital under observation status to count toward the requisite three-day hospital stay for Medicare coverage of skilled nursing care.FB

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DISCLAIMER – Every case is different because every case is different. This blog does not give legal advice. This blog does not create an attorney client relationship. You are not permitted to rely on anything in this blog for any reason. This blog is an entirely personal endeavor. Every person’s situation is different and requires an attorney to review the situation personally with you.
No attorney-client relationship is created by this site.

The use of the Internet, this blog or email for communication with this firm or any individual member of this firm does not establish an attorney-client relationship. Before we represent any client, the client and the attorney will sign a written retainer agreement.
If you do not have a written, signed retainer agreement with us, we are not representing you and will not be taking any action on your behalf.

 

Medicare and Nursing Homes: The End of the “Improvement” Standard

By Attorney Liz Durnell

Screen Shot 2013-04-25 at 10.32.21 AMIn all of my time working with the elderly, one of the most discussed issues is “how long will Medicare pay for my nursing home?” The maximum amount of time that Medicare will pay for skilled nursing care is 100 days. Medicare pays 100% for the first 20 days. For days 21-100, they will pay all but a co-pay that is usually covered by supplemental insurance.

In the past, the question of how long Medicare paid depended on when the nursing homes decided that the patient was no longer improving or had “plateaued”. Once plateaued, Medicare stopped paying.

A recent settlement between the Center for Medicare Advocacy, Vermont Legal Aid and the Obama Administration has changed this standard.

Following is an excerpt from the ElderLaw Answers article, “Medicare to End ‘Improve or You’re Out’ Standard for Coverage of Skilled Services.”

“In a major change in Medicare policy, the Obama administration has provisionally agreed to end Medicare’s longstanding practice of requiring that beneficiaries with chronic conditions and disabilities show a likelihood of improvement in order to receive coverage of skilled care and therapy services. The policy shift will affect beneficiaries with conditions like multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, ALS (Lou Gehrig’s disease), diabetes, hypertension, arthritis, heart disease, and stroke.”

As part of the proposed settlement, which the federal judge must still formally approve, Medicare will revise the manual that their contractors follow to clarify that Medicare coverage of skilled nursing and therapy services “does not turn on the presence or absence of an individual’s potential for improvement” but rather depends on whether or not the beneficiary needs skilled care, even if it would simply maintain the beneficiary’s current condition or slow further deterioration.

If you or a loved one are in a nursing home or assisted living facility or in the need of in home care, please contact the Elder Law Attorneys at Cooper, Adel & Associates to discuss your options.
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Contact us for a free consultation.

DISCLAIMER – Every case is different because every case is different. This blog does not give legal advice. This blog does not create an attorney client relationship. You are not permitted to rely on anything in this blog for any reason. This blog is an entirely personal endeavor. Every person’s situation is different and requires an attorney to review the situation personally with you.
No attorney-client relationship is created by this site.

The use of the Internet, this blog or email for communication with this firm or any individual member of this firm does not establish an attorney-client relationship. Before we represent any client, the client and the attorney will sign a written retainer agreement.
If you do not have a written, signed retainer agreement with us, we are not representing you and will not be taking any action on your behalf.

 

Attention Medicare Beneficiaries

By Roy Whited

Screen Shot 2013-04-23 at 10.12.53 AMThis information was taken in part from the Ohio Department of Insurance Website.

COLUMBUS – Lieutenant Governor and Ohio Department of Insurance Director Mary Taylor announced the Ohio Senior Health Insurance Information Program (OSHIIP), the state’s official source for free and unbiased Medicare information and counseling, will hold “Welcome to Medicare” events in 17 counties running April through May. The events will help new and soon-to-be beneficiaries understand the basics of Medicare.

At the events, people can learn about the important deadlines and benefits Medicare provides, Medicare Advantage plans, supplemental health insurance, and prescription drug coverage. There will also be information regarding financial assistance programs that help pay for Medicare’s Part B premium and out-of-pocket expense associated with prescription drug costs.

For a list of the upcoming events visit www.insurance.ohio.gov

Cooper, Adel & Associates law firm would like to encourage everyone to make sure they understand what and how much Medicare pays to cover the cost of a long-term nursing home stay. It is not much.

For more information on how to protect your assets from being lost to the cost of a long-term nursing home stay call 1-800-798-5297 to schedule a free one-hour consultation.

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DISCLAIMER – Every case is different because every case is different. This blog does not give legal advice. This blog does not create an attorney client relationship. You are not permitted to rely on anything in this blog for any reason. This blog is an entirely personal endeavor. Every person’s situation is different and requires an attorney to review the situation personally with you.
No attorney-client relationship is created by this site.

The use of the Internet, this blog or email for communication with this firm or any individual member of this firm does not establish an attorney-client relationship. Before we represent any client, the client and the attorney will sign a written retainer agreement.
If you do not have a written, signed retainer agreement with us, we are not representing you and will not be taking any action on your behalf.

Attention: Medicare Beneficiaries

 

Ohio Department of Insurance Program to Hold “Welcome to Medicare” Educational Events Statewide

COLUMBUS: The Ohio Senior Health Insurance Information Program (OSHIP), the state's official source for free and unbiased Medicare information and counseling, will hole “Welcome to Medicare” events in 15 counties from April 11th to July 25 to help new and soon-to-be beneficiaries understand the basics of Medicare, Lieutenant Governor and Department of Insurance Director Mary Taylor announced.

“Our staff is visiting every region of the state to personally help Ohioans new to Medicare understand how their new health insurance will work,” Taylor said of OSHIP, a program of the Ohio Department of Insurance. “Transitioning into Medicare can sometimes be a complicated change and we want to help put Ohioans at ease by addressing any questions or concerns they may have.”

At the “Welcome to Medicare” events, people can also learn the benefits Medicare provides and important deadlines they have to meet. Information will also be shared about Medicare Advantage plans, prescription drug coverage and supplemental health insurance coverage.

For those interested in a computer-generated Part-D comparison report, please bring your prescription drug information to include name, dosage, frequency and preferred pharmacy to the event. There will also be information about financial assistance programs which help pay for Medicare's Part B premium ($99.90 per month in 2012) and out-of-pocket expenses associate with prescription drug costs.

Here is a complete list of “Welcome to Medicare” events, which start at 6 p.m. Unless otherwise noted:

 

 

 

 

For more information about these events and Medicare, call OSHIIP at 1-800-686-1578. And be sure to visit www.insurance.ohio.gov or follow the Department on twitter @ OHInsurance and on Facebook www.facebook.com/OhioDepartmentofinsurance for more information.

Remember, while Medicare covers a lot of health care expenses it does not cover much of the cost related to long term nursing home stays. In fact it only covers skilled care for a limited number of days and pays nothing for custodial care. The average cost of a nursing home in Ohio is over $6,000 a month and can wipe out the life savings of many seniors. Why not contact the professionals at Cooper,Adel, and Associated, A Legal Profession to learn now planning today can protect your assets tomorrow. Call 1-800-798-5297 to schedule a free 1 hour consultation.

Beware of These Common Medicare Scams

 

By Roy Whited

This information was taken in part from an article posted on 12-18-2011 by MedicalBillingAndCoding.org/blog.

Whether you or someone you care about is a recipient of Medicare, it's essential to watch out for scammers in order to protect your benefits. Here we have listed some common scams that criminals use to try to get their hands on your Medicare number and the potential goldmine of benefits it can mean for them. Remember, never give out your information to anyone other than your health care provider. No one else should ever ask for it! Perhaps one exception to this would be your agent, or representative for your Medicare Supplement or Advantage Plan who may need the number to complete your application.

#1. The Poser Scam:

One of the more common ways criminals scam those with Medicare is by posing as Medicare employees, health care practitioners, or insurance representatives, something many may not suspect. These fraudsters call, email, or send a letter asking for personal information that usually includes bankaccount, Social Security, and Medicare numbers. While the interactions may seem legitimate, it's important to remember that federal employees, working for Medicare or otherwise, will never phone or email you to get bank or Medicare information. Why would they need to? Your insurance provider or doctor will not either. If you encounter any of these mailings or calls: hang up, ignore, and report them.

 

#2. The Healthcare Reform Scam

Healthcare reform is on the lips of just about everyone these days, and scammers are using it to cash in. Many adults don't know what the new healthcare legislation actually entails, and that's just the way criminals want it. It makes many Americans easy targets for scams, like those that claim to sell “healthcare reform insurance” that purportedly protects seniors from losses to their Medicare or fines they may incur from not meeting guidelines. The thing is, healthcare reform insurance doesn't exist. Identity thieves and scammers will use this tactic to try to get your Medicare numbers, SS numbers. They can create a whole heap of trouble for you.

 

#3. The Free Lunch Scam

Everyone loves free stuff, right? Well in this case, there truly is no such thing as a free lunch. Scammers in low income areas are taking advantage of some of the neediest Medicare recipients by drawing them in to fake health care clinics with the promise of free food or gifts. Once they have the victim right where they want them, they try to get Medicare numbers through coercion and then use them to commit Medicare fraud. No legitimate clinic or government program will ever exchange gifts for using their services. So, no matter how great it looks on paper, it's probably bogus.

 

#4. The Kickback Scam

While you'd be able to smell this scam from a mile away, some fraudsters can be pretty darn tricky. They might offer you a cut of the take in exchange for your Medicare number, but they won't put it like that. Criminals might veil it under a prize, reward, or other guise to mask the fact that they're doing something that is very clearly illegal. If anyone ever promises you a gift or monetary rewards for Medicare number, decline their offer immediately. You'll be drawn into the scam, and could face criminal charges for your role.

 

#5. The Refund Rip off Scam

As part of the Affordable Care Act, many senior Medicare recipients may be eligible to receive a refund from the government of $250 to help cover their prescription drug costs. Criminals have pounced on these checks as an opportunity to make some extra cash and scam some Medicare numbers at the same time. Many have called seniors and told them that they need to confirm Medicare numbers in order to send out the checks. The scams are varied and quite nefarious in that they prey on those that need benefits of Medicare the most. Keep in mind that Medicare numbers are like credit card numbers: they should never be given out to strangers over the phone.

 

#6. The Imposter Employee Scam

Anyone can claim to work for the government, and many who fall victim to fraudsters may not have thought to ask for identification (though that could easily be faked as well). The reality is that many criminals looking to scam those on Medicare will call or even come to the home of recipients asking for personal information like Medicare numbers and bank accounts. Medicare will not send people out to collect this information, nor do they cooperate with private insurers to collect this information. Never trust someone who calls or visits you out of the blue looking for information on this kind.

Should you be approached or exposed to any of the above scams make sure you contact the local police, the sheriff's office or the State Insurance Department to file an official complaint.

Should you have other questions about how to protect your life savings including your home, contract the law office of Cooper, Adel, and Associates to schedule a consultation at 1-800-798-5297.



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