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Beware of These Common Medicare Scams

Written on April 17, 2012 by Thom Cooper in Medicare

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.

Attention Medicare Beneficiaries

Written on February 13, 2012 by Thom Cooper in Medicare

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By Roy Whited

Medicare premiums, deductibles and co-pay amounts are lower than expected for 2012.

Part A (Hospital) Deductibles

Hospital Deductibles $1,156.00

(per benefit period day 1 to day 60)

Hospital co-pay $289.00/day

(inpatient days 61-90)

Lifetime Reserve Day co-pay $578.00/day

(inpatient days 91-150)

Skilled Nursing Facility co-pay $ 0

(day 1 to day 20)

*if after a 3 day hospital stay, skilled care only

Skilled Nursing Facility co-pay $144.50/day

(day 21-100) skill care only

Part B (Doctors & Outpatient)

Part B Premium $99.90/month

This standard premium applies to individuals with modified adjusted gross income (MAGI) of $85,000 or

less; married couples with MAGI of $170,000.00 or less.

Park B Annual Deductible $140.00

Co- Insurance Amount 20%

IMPORTANT: Remember, Medicare only pays for skilled nursing home care for 20 days, and also requires a 3 day hospital stay prior to the nursing home stay. The co-pay per day is $144.50 per day from day 21 to day 100 if you qualify and are receiving skilled care. After the 100 days the Medicare beneficiary is responsible for the cost of nursing home care. Medicare does NOT pay for custodial nursing home care or care you received in assisted living.

Contact Cooper, Adel, & Associates to learn more about protecting your asset.

Call 1-800-798-5297 for a free one-hour consultation.

Medicare Part D Open Enrollment Begins Earlier This Year

Written on October 24, 2011 by Thom Cooper in Medicare

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By: JM Megail Gaumer

More benefits, better choices and lower costs, the Centers for Medicare & Medicaid Services (CMS) is encouraging people with Medicare and their families to begin reviewing drug and health plan coverage options for 2012. The Medicare Open Enrollment Period – which began earlier this year on Saturday, October 15 – and has been expanded to last seven weeks and will end on December 7.

This longer period will give seniors and people with disabilities more time to compare and find the best plan.

The Affordable Care Act, allows people with Medicare to get certain preventive services for free and can get more affordable prescription drugs. Additional benefits to people with Medicare include lower prescription drug costs through a 50 percent discount on covered brand name drugs in the coverage gap (also referred to as the “donut hole”), wellness checkups, and access to certain preventive care with no copayments – a benefit that all Medicare Advantage plans will offer starting in 2012.

This year CMS is highlighting plans that have achieved an overall quality rating of 5 stars with a high performer or “gold star” icon so people with Medicare can easily find high quality plans. People with Medicare can switch to an available 5-star plan at any time during the year.

People can contact Medicare at 1-800-MEDICARE or visit Medicare’s Plan Finder – available at www.medicare.gov/find-a-plan – people will see the enhanced star ratings for 2012. In addition to the enhanced star ratings for 2012 and new “gold star” icon, Plan Finder users will see an icon showing which plans received a low overall quality rating for the past three years.

We at Cooper and Adel are happy to assist in any way we can if you or your family have questions.

Means Testing of Social Security and Medicare May be Closer Than You Think

Written on August 31, 2011 by Thom Cooper in Medicare

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Attorney Thom L. Cooper

I just read that the billionaire Warren Buffet said that he didn’t think he should get a Social Security check and that Social Security benefits should be means tested. Well spoken, I guess, by a person who gets millions of dollars of tax breaks every year and to whom that Social Security check would not make a bit of difference. Reflecting this recent attitude, I have come across several news articles (examples are below) suggesting that Social Security programs and Medicare Programs should be means tested as a way to solve the Federal budget problem.

“Means testing” is the idea that the amount of your assets and income will determine whether or not you get any Social Security or Medicare benefits. In other words you must spend all of your savings before getting these benefits. Most of my clients don’t believe that this is right. They believe that the Social Security withholding that was taken out of their paychecks for their entire lives was for their retirement. They also believe that Medicare is for everyone…rich or poor… just as President Lyndon Johnson said when the programs were enacted.

That idea is apparently changing among the policy makers in Washington as they face Federal budget problems. I believe the following articles reflect the changing mood among these policy makers. A particularly insidious idea is reflected in the third article which begins to equate Social Security benefits to “Welfare Benefits”. If you want a shock about this means testing idea get on the Internet and check it out yourself.

As an Ohio elder law attorney, I believe that seniors should act now to protect their assets from potential means testing!! The reason is that protecting assets from means testing normally requires waiting periods and “grandfather” provisions. Generally, the earlier you start to protect your assets, the better off you are. Our firm has been protecting assets from Nursing Home means testing for years and it now appears that the attorneys and staff at Cooper and Adel will have a big job ahead of us to make sure that our middle class clients are not impoverished as means testing of Social Security and Medicare moves forward.

Below is a sample of some of the articles:

In a recent Forbes Magazine Liz Davidson talks about the fact that the Social Security Disability Insurance Program is running out of money and is expected to be insolvent within six years (http://blogs.forbes.com/financialfinesse/). According to the author one of the things being suggested to solve the problem is:

“Another possibility is some sort of means testing, in which benefits are restricted to those with limited assets, forcing you to spend down your life savings just as you would have to do to qualify for long term care insurance under Medicaid.”

Another recent article in Cutting Edge History suggested:

“Keeping in mind the initial rationale for Social Security, means testing may make sense. A payment to an already wealthy retiree does little to increase their spending. The payment must be made to those who are forced to spend by the poverty of their alternatives.” (http://cuttingedgehistory.com/2011/08/08/a-case-for-means-testing-social-security/)

Yet a third recent article in National Affairs by Yuval Levin suggested (p. 35):

“Second, essentially all government benefits — including benefits for the elderly — should be means-tested so that those in greater need receive more help and those who are not needy do not become dependent on public support. Most retirees would still receive some public benefits (and the poorest could well get more than they do now), but the design of our welfare programs would avoid creating the misimpression that they are savings programs.” (http://www.nationalaffairs.com/publications/detail/beyond-the-welfare-state)

And to top it all off in a recent Article in ABC news President Obama suggested his support for the means testing of Medicare:

“President Obama indicated today that he would be open to means-testing Medicare – requiring wealthier seniors to pay more — as part of a compromise plan to reduce the deficit” http://blogs.abcnews.com/politicalpunch/2011/07/president-obama-publicly-supports-means-testing-medicare.html

Make no mistake, “wealthier senior” means you! If you want to look at the Governments definition of “wealthy” look at the current means testing requirements for nursing home spend downs.

How Do I Pay for Long Term Care?

Written on June 22, 2011 by Thom Cooper in Asset Protection, Medicaid, Medicare, Nursing Home Planning, Planning

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By Jordan Myers

Many senior citizens and adults reaching retirement age have a lot on their minds. “How should I manage my money when exiting the work force?” “How can I protect my assets?” and “How can I get high-quality healthcare without spending every dollar that I’ve worked my entire life to earn?” The answers to these questions can be difficult to answer, but answering them and planning ahead can make a world of difference!

In today’s blog I would like to talk about a common misconception concerning long term care for seniors and how planning is key in preventing a financial disaster. Some seniors believe that once they reach age 65 they will be entitled to Medicare benefits that will cover their medical expenses. While Medicare and Medicare supplemental insurance will pay out for doctor visits and prescription medication, it will NOT pay for long-term care in a nursing home or assisted living facility. Under certain specific circumstances, Medicare can pay for up to 100 days in a facility if discharged from a hospital into the facility, but after that you would be responsible to pay for the duration of the stay.

Did you know that, according to AARP.org, approximately 70% of Americans age 65 and older will spend at least some of their lifetime in a nursing home? One in ten of those seniors will spend at least 5 years in a facility. The current Average Private Pay Rate (APPR) for nursing homes in Ohio is $6,023 per month. That is over $360,000 over a five-year period, and I am asking you to consider that is using only the average. Many facilities have costs that are much higher.

Now let’s talk about the alternative resource that is used to pay for long term care, which is Medicaid. In an article from the website MoneyForVets.com, Medicaid is described as a government program that “pays for long term care expenses primarily for nursing home care. However, there are some exceptions where Medicaid will pay for home care or assisted living expenses.” The exceptions mentioned in the article refer to ‘Assisted Living Waiver” and a program called “Passport”.

Medicaid is a highly regulated program and can sometimes seem complicated. Many eligible seniors never receive the benefit because they simply never apply. While the program is invaluable to many seniors, applying on your own without understanding how the program works, or consulting an elder law professional, can have devastating consequences. That is why I am asking you to contact our office and schedule a free consultation to discuss your plans with an experienced elder law attorney.

Until next time! Remember, that it is better to look ahead with preparedness than to look back with regret.

What’s new with Medicare Benefits?

Written on May 19, 2011 by Thom Cooper in Medicare

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By Mary Roberts

May is Older Americans Month according to Lieutenant Governor Taylor. The State of Ohio Dept. of Insurance is attempting to help seniors understand their Medicare benefits. It is a way of celebrating the fact that we are now eligible for Medicare. We can call the Medicare experts at 1-800-686-1578 or go on OSHIP’s website www.insurand.ohio.gov OSHIP is making an effort to inform seniors about Medicare changes in 2011.

On an overview, one of the main changes is that there is a New Open Enrollment Period. In 2011 Open Enrollment Period begins on Oct. 15 and continues thru Dec. 7. The new dates are meant to remove stress from beneficiaries making critical decisions about their coverage during the busy holiday season. This time is set up to give seniors the opportunity to make changes they desire in their coverage.

There are also Free Preventive Services being offered without Medicare Part B deductibles or co-payments: Pap smear tests, pelvic exams, mammograms, pneumonia and hepatitis shots and more.

There is also help paying for Medicare Part B (medical coverage) premium for beneficiaries who meet certain income and resource requirements.

Additional information is available at www.medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227).

Were you admitted to the hospital as an inpatient or just for observation?

Written on April 27, 2011 by Thom Cooper in Medicare, Planning

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By Daneen Cline

My poor mother, not only is she plagued with numerous health issues, but to add insult to injury, her experiences as she travels through the health care system have repeatedly been chronicled and used as a teaching opportunity in this very blog by her opportunistic daughter (me). So what has happened to her recently that I am about to shamelessly exploit?

It was a hospital admission, no wait, that isn’t entirely accurate. Actually it was a Doctor-ordered “observation” in a hospital setting. What is the difference between admission and observation, you ask? Most of us are aware that if you have a 3 day hospital stay prior to a nursing home admission that Medicare will pay up to 100 days for the nursing home. However, a person can be in the hospital for 3 days under “observation” and will not qualify for the 100 days of nursing home benefits paid by Medicare.

My mother was in a regular hospital room, in a regular hospital bed, being tended by the same Doctors and nurses that were tending every other patient on the 6^th floor. She even had an IV in her arm and was receiving both physical and respiratory therapy. In short, she looked and was being treated like every other patient there. It wasn’t until 2 days after she entered the hospital , when her Doctor recommended we consider placing her in a nursing home for some rehabilitation that I discovered she was in the hospital for observation and therefore was going to be privately paying for that rehabilitation. When I questioned the Doctor as to why she was there under observation as opposed to being admitted as an inpatient he simply said that Medicare regulations didn’t allow him to admit her because her condition didn’t warrant it.

It has been 9 weeks since this happened to my mother, and since then we have had several clients in our office who have experienced the same thing with a loved one. The days of assuming a 3-day hospital stay will qualify you for Medicare paid nursing home benefits are long gone. If a loved one who has Medicare is admitted to the hospital, ask if they are an inpatient or if they are only under observation, it will save you from an unpleasant surprise if the subject of a nursing home placement comes up in the ensuing days. If you need help in a catastrophic healthcare emergency that may require a long-term nursing home stay, call our office to see if we can assist you.

What you need to know about Medicare if you are turning 65

Written on March 13, 2011 by Thom Cooper in Aging, Medicare

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By Attorney Thom Cooper

The following is an article taken from a colleague, Michael Ettinger, who is a New York Elder Law Attorney. It is one of the best reviews of Medicare I have come across and I thought I would like to share it with our clients.

The first of the 78 million baby boomers turned 65 on January 1, 2011, and some 10,000 boomers a day will reportedly be turning 65 between now and 2030. If you are among those about to turn 65, then it is time to think about Medicare. You become eligible for Medicare as soon as you turn 65, and delaying your enrollment can result in penalties, so it is important to act right away.

There are a number of different options to consider when signing up for Medicare. Medicare consists of four major programs: Part A covers hospital stays, Part B covers physician fees, Part C permits Medicare beneficiaries to receive their medical care from among a number of delivery options, and Part D covers prescription medications. In addition, Medigap policies offer additional coverage to individuals enrolled in Parts A and B.

Medicare enrollment begins three months before your 65th birthday and continues for 7 months. If you are currently receiving Social Security benefits, you don’t need to do anything. You will be automatically enrolled in Medicare Parts A and B effective the month you turn 65. If you do not receive Social Security benefits, then you will need to sign up for Medicare by calling the Social Security Administration at 800-772-1213 or online at http://www.socialsecurity.gov/medicareonly/. It is best to do it as early as possible so your coverage begins as soon as you turn 65.

If you are still working and have an employer or union group health insurance plan, it is possible you do not need to sign up for Medicare Part B right away. You will need to find out from your employer whether the employer’s plan is the primary insurer. If Medicare, rather than the employer’s plan, is the primary insurer, then you will still need to sign up for Part B. Even if you aren’t going to sign up for Part B, you should still enroll in Medicare Part A, which may help pay some of the costs not covered by your group health plan. For more information on Part A, click here.

If you don’t have an employer or union group health insurance plan, or that plan is secondary to Medicare, it is extremely important to sign up for Medicare Part B during your initial enrollment period. If you do not sign up for Part B right away, then you will be subject to a penalty. Your Medicare Part B premium may go up 10 percent for each 12-month period that you could have had Medicare Part B, but did not take it. In addition, you will have to wait for the general enrollment period to enroll. The general enrollment period usually runs between January 1 and March 31 of each year. For more information on Part B, click here.

With all the deductibles, copayments and coverage exclusions, Medicare pays for only about half of your medical costs. Much of the balance not covered by Medicare can be covered by purchasing a so-called “Medigap” insurance policy from a private insurer. You can search online for a Medigap policy in your area at http://www.medicare.gov/find-a-plan/questions/medigap-home.aspx. For more information on Medigap, click here.

Medicare also offers Medicare Part C (also called Medicare Advantage). You must be enrolled in Medicare Parts A and B to join a Medicare Advantage plan, the name for private health plans that operate under the Medicare program. If you join a Medicare Advantage Plan, the plan will provide all of your Part A and Part B coverage, and it may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most such plans include Medicare prescription drug coverage. For more information on Medicare Advantage, click here.

Finally, Medicare offers prescription drug coverage under Medicare Part D. If you are not going to sign up for a Medicare Advantage plan with prescription drug coverage, then you will want to enroll in a prescription drug plan at the same time you sign up for Parts A and B. For every month you delay enrollment past the initial enrollment period, your Medicare Part D premium will increase at least 1 percent. You are exempt from these penalties if you did not enroll because you had drug coverage from a private insurer, such as through a retirement plan, at least as good as Medicare’s. This is called “creditable coverage.” Your insurer should let you know if their coverage will be considered creditable. Visit the Medicare Web site at https://www.medicare.gov/find-a-plan/questions/home.aspx to find a drug plan in your area. For more information on Medicare’s prescription drug coverage, click here.

After you’ve signed up for Medicare Part B, you can schedule a free “Welcome to Medicare” exam with your doctor.

Medicare’s “Improvement Standard” may soon be history

Written on January 25, 2011 by Thom Cooper in Medicare, Nursing Home Planning, Planning

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By Attorney Steve Roush

For some time now, Medicare has been requiring patients to show consistent “improvement” before continuing to pay for short-term skilled nursing home therapy. That practice of cutting seniors off from therapy may soon be coming to an end. According to ElderLawAnswers, a class action lawsuit has now been filed by five national organizations to prevent Medicare from stopping payments in these types of situations. If successful, seniors may have more short-term options to help them get better after health setbacks.

Contact the Thom L. Cooper, Co. to find out more ways to help seniors pay for the costs of healthcare.

Extra Help with Medicare Prescription Drug Plan Cost

Written on January 6, 2011 by Thom Cooper in Medicare

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By Roy Whited

Those on Medicare, living in the 50 states or the District of Columbia can get Medicare prescription drug coverage. Some individuals with limited income and limited resources can be eligible for extra help to pay the costs, monthly premiums, annual deductibles, and prescription co-payments related to a Medicare prescription drug plan. The extra help is estimated to be worth an average of $3,900 per year. Many who qualify for these big savings don’t know they exist.

There are certain income and asset limits that apply to this program. For example, a married couple’s income must not exceed $21,855.00 or a single persons income needs to be below $16,245.00. Keep in mind that not all cash payments count as income for this program.

The resource limit is approximately $25,000.00 for a couple and about $12,500.00 for an individual. Again, keep in mind that not all assets count as a resource. Example, your primary residence does not count, as well as other personal possessions including your car, certain life insurance policies, etc.

You can obtain more information about this program by searching www.socialsecurity.gov or contact our office for general questions at 1-800-798-5297